CHAPTER He-P 800  RESIDENTIAL CARE AND HEALTH FACILITY RULES

 

Statutory Authority:  RSA 151:9

 

PART He-P 801  GENERAL REQUIREMENTS FOR ALL FACILITIES

 

          He-P 801.01 - EXPIRED

 

Source.  #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; amd by #5933, eff 12-8-94; amd by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99, paragraph (r) EXPIRED: 12-8-00

 

          He-P 801.02 - 801.06 - EXPIRED

 

Source.  #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

 

          He-P 801.07 - EXPIRED

 

Source.  #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; amd by #5933, eff 12-8-94; amd by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99, paragraphs (b) through (e) EXPIRED: 12-8-00

 

          He-P 801.08 - 801.26 - EXPIRED

 

Source.  #1665, eff 11-30-80; ss by #2628, eff 2-21-84; ss by #2792, eff 8-2-84; ss by #3193, eff 1-28-86; amd by #4133, eff 9-23-86; amd by #4405, eff 4-21-88; ss by #5647, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

 

PART He-P 802  RULES FOR HOSPITALS AND SPECIAL HEALTH CARE SERVICES

 

          He-P 802.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all hospitals pursuant to RSA 151:2, I(a) and the special health care services offered by hospitals pursuant to RSA 151:2-e.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a hospital, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(h); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

 

Source.  #2044, eff 6-3-82; amd by #2793, eff 8-2-84; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New. #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of patients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving patients without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, pursuant to RSA 318-B and RSA 326-B.

 

          (e)  “Administrator” means the person responsible for the management of the licensed premises and who reports to and is accountable to the governing body.

 

          (f)  “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services. This term also includes “admitted”.

 

          (g)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills, durable powers of attorney for health care, or surrogate decision maker in accordance with RSA 137-J.

 

          (h)  “Adverse event” means a consequence of care that results in an undesired outcome which may or may not have been preventable, and which is listed in RSA 151:38.

 

          (i)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, and captive or affiliated insurance companies.

          (j)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA 137-J:34-37.

 

          (k)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a hospital pursuant to RSA 151:2, I(a) or provide a special health care service pursuant to RSA 151:2-e.

 

          (l) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 802, or other applicable federal or state requirements.

 

          (m)  “Cardiac catheterization laboratory services” mean those cardiac catheterization procedures that are performed in a cardiac catheterization laboratory, including diagnostic and interventional cardiac catheterization procedures.

 

          (n)  “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, and the patient’s guardian or agent, if any, as a result of the assessment process for the provision of care and services.

 

          (o)  “Change of ownership” means a change in the controlling interest of an established hospital or provider of special health care services to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

          (p)  “Chemical restraint” means a drug or medication that is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

 

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

 

          (r)  “Critical access hospital (CAH)” means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

 

          (s)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (t)  “Days” means calendar days unless otherwise specified in the rule.

 

          (u)  “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151 or He-P 802.

 

          (v)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post-test to the training provided.

 

          (w)  “Department” means the department of health and human services, at 129 Pleasant St, Concord, NH 03301.

 

          (x)  “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (y)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified deficiencies.

          (z)  “Dietitian” means a person who is licensed under RSA 326-H.

 

          (aa)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

 

          (ab)  “Elopement” means an event in which a patient who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away, escapes, or otherwise leaves the facility unsupervised, unnoticed, or prior to their scheduled discharge.

 

          (ac) “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

 

          (ad)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (ae)  “Emergency psychiatric services” means those services available on a 24-hour basis when a patient needs immediate treatment for psychiatric health concerns.

 

          (af)  “Emergency services” means those services rendered in accordance with RSA 151:2-g and includes emergency medical treatment of both physical and behavioral health concerns.   

 

          (ag)  “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

 

          (ah)  “Equipment” means  “any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures.

 

          (ai)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

 

          (aj)  “Facility” means “facility” as defined in RSA 151:19, II, including the part of the hospital where special health care services are rendered in accordance with RSA 151:2-e.

 

          (ak)  “Freestanding hospital emergency facility (FHEF)” means a hospital geographically separate from the parent hospital, which is owned or operated, directly or indirectly, by the parent hospital and which provides emergency acute care identical to those services provided by the parent hospital.

 

          (al)  “Governing body” means  a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

 

          (am)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

 

          (an)  “Hospital” means “hospital” as defined in RSA 151:2, I(a).

 

          (ao)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ap)  “Independent contractor” means an individual or business entity working under the supervision of the licensee but not employed by the licensee.

 

          (aq)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (ar)  “Informed consent” means the decision by a person, his or her guardian or agent, or surrogate decision-maker, to agree to a proposed course of treatment, after the person, his or her guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about the risks and benefits of the treatment and available alternatives, needed to make the decision competently.

 

          (as)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 802 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 802.

 

          (at)  “License” means the document issued by the department to an applicant, at the start of operation as a hospital or provider of special health care services which authorizes operation of a hospital or special health care services in accordance with RSA 151 and He-P 802, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

 

          (au)  “License certificate” means the document issued by the department to an applicant or licensee that contains the information on a license, and includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the hospital is licensed.

 

          (av)  “Licensed practitioner” means:

 

(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.

 

          (aw)  “Licensed premises” means the building, or portion thereof, that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (ax)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (ay)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (az)  “Locked unit” means a locked, secured, or alarmed hospital or units within a hospital, or anklets, bracelets or similar devices that cause a door to close automatically and lock when approached, thereby preventing a patient from freely exiting the hospital or unit within.

         

          (ba)  “Medical director” means a physician licensed in New Hampshire pursuant to RSA 329, who is responsible for the implementation of patient care policies and the coordination of medical care in the hospital.

 

          (bb)  “Medical staff” means those physicians and other licensed practitioners permitted by law and licensee policies to provide patient care services independently within their scope of practice.

 

          (bc)  “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

 

          (bd)  “Megavoltage radiation therapy equipment” means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues.  The term includes, but is not limited to, Cobalt-60 and linear accelerator machines.

 

          (be)  “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  This term does not include repair or replacement of interior finishes.

 

          (bf)  “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any patient. For the purposes of this definition, minimum means that the hospital provides stabilizing treatment to all patients until the patient has been physically transferred from the hospital.

 

          (bg)  “Nursing care” means the provision or oversight of a patient’s physical, mental, or emotional condition or diagnosis by a nurse, that if not monitored on a routine basis by a nurse, would or could result in physical or mental harm to a patient.

 

          (bh)  “Open heart surgery (OHS)” means open surgical procedures on the heart muscle, valves, coronary arteries, or other heart structures, including coronary artery bypass graft surgery.

 

          (bi)  “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, 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.

 

          (bj)  “Owner” means a person or organization who has controlling interest in the hospital.

 

          (bk)  “Parent hospital” means the hospital which owns and operates a freestanding hospital emergency facility.

 

          (bl)  “Patient” means any person admitted to or in any way receiving care, services, or both from a hospital licensed in accordance with RSA 151 and He-P 802.

 

          (bm)  “Patient record” means a separate file maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 802 and all documentation as required by other federal and state requirements.

 

          (bn)  “Patient rights” means the privileges and responsibilities possessed by each patient pursuant to RSA 151:21.

 

          (bo)  “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions.

 

          (bp)  “Personal care” means personal care services that are non-medical, hands-on services provided to a patient including, but not limited to, assistance with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the patient to take medications.          

 

          (bq)  “Personnel” means an individual who is employed by, a volunteer of, or an independent contractor of the hospital who provides services to patients. 

 

          (br)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit a patient’s freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques. This term does not include orthopedic appliances.

 

          (bs)  “Physician” means medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329.

 

          (bt)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified deficiencies with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bu)  “Primary interventional cardiac catheterization” means those catheter-based procedures that involve modification of the coronary arterial system under emergency conditions.

 

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

 

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

 

          (bx)  “Protective care” means the provision of patient monitoring services, including but not limited to:

 

(1)  Knowledge of patient whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (by)  “Psychiatric hospital” means a:

 

(1)  Hospital that has been verified by CMS as an inpatient psychiatric hospital; or

 

(2)  Hospital designated by CMS to provide psychiatric services in a distinct part unit.

 

          (bz)  “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (ca)  “Radiographic images” means x-rays or other images which are either on film, paper, or stored electronically.

 

          (cb)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (cc)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (cd)  “Rehabilitation hospital” means a:

 

(1)  Hospital that has been certified by CMS as an inpatient rehabilitation hospital; or

 

(2)  Hospital designated by CMS to provide comprehensive physical rehabilitation services in a distinct part unit.

 

          (ce)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (cf)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

 

          (cg)  “Special health care service” means cardiac catheterization laboratory services, open heart surgery, or treatment using megavoltage radiation therapy equipment.

 

          (ch)  “Swing beds” means beds within a hospital or critical access hospital participating in Medicare that are approved by the CMS for the provision of a skilled level of care.

 

          (ci)  “Volunteer” means an unpaid person who assists with the provision of services such as personal care services, food services, entertainment, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21; amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21

 

          He-P 802.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (March 2019), signed by the applicant or 2 of the corporate officers affirming to the following:

 

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any hospital or special health care service to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”;

 

c.  For any facility to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. section 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. section 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”; and

 

d.  For facilities to be licensed under the listed categories:

 

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed pursuant to He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42  C.F.R. 485.610(b) and (c), until the Commissioner makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”;

 

(2)  A floor plan of the prospective hospital;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  List of affiliated or related parties;

 

(5)  The applicable fee in accordance with RSA 151:5, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(6)  A resume identifying the name and qualifications of the administrator and medical director;

 

(7)  Copies of applicable licenses, certificates, or both, for the administrator and medical director;

 

(8)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the health care chapter of the Life Safety Code 101 and the Uniform Fire Code, NFPA 1, 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; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and their final inspection upon completion of the construction project;

 

(9)  If the hospital uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if public water supply is used, a copy of a water bill;

 

(10)  A written statement from the applicant, proposed licensee, administrator, and medical director stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient in this or any other state;

 

c. Does not have any permanent restraining or protective orders against the applicant, licensee, or administrator;

 

d.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person in this or any other state; and

 

(11)  If any of the items in (10) above have occurred, the individual shall include a detailed explanation of the circumstances surrounding the occurrences; and

 

(12)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and medical director.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

          (c)  If a hospital has not previously performed a special health care service but plans to do so, the hospital shall complete a new application including all of the above application requirements and any information required under He-P 802.38, He-P 802.39, and He-P 802.40.

 

          (d)  A previously operating special health care service, which means a special health care service as defined by RSA 151:2-e that was being offered by a hospital prior to July 1, 2016 and has continued to be offered since July 1, 2016, shall not require additional licensure separate from the hospital license but shall still comply with RSA 151 and all applicable He-P 802 provisions.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by RSA 151 and He-P 802.04(a) have been received.

 

          (b)  Following both a clinical and life safety code inspection, a license and license certificate shall be issued to the applicant if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 802.09.

 

          (c)  If an application does not contain all of the items required by He-P 802.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (d)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (e)  Licensing fees shall not be transferable to any other application(s).

 

          (f)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 802.13 if it determines that the applicant, proposed licensee, medical director, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable.

 

          (h)  A written notification of denial, pursuant to He-P 802.13(b), shall be sent to an applicant applying for an initial license, if it has been determined by the inspection in He-P 802.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 802.

 

          (i)  A written notification of denial, pursuant to He-P 802.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance for one full calendar year unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 802.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 802.04(a)(1) and (5);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 802.10(f), if applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 802.17(e)(2);

 

(5)  A copy of any new exceptions or variances granted by the state fire marshal, in accordance with Saf-C 6005;

 

(6)  A copy of any new variances granted by the local building inspector or state building code review board in accordance with He-P 802.07(g)(3); and

 

(7)  If a private water supply is used, documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  If the request in (c)(3) above is not received at the time of renewal, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license.

 

          (e)  Following an inspection as described in He-P 802.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151, He-P 802, and all federal requirements at the renewal inspection, or has submitted a POC that has been accepted by the department and implemented by the licensee if deficiencies were cited at the renewal inspection.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall not operate.

 

          (g)  If a licensee fails to submit an application for renewal prior to the expiration of the license and continues to operate:

 

(1)  The licensee shall be considered an initial licensee and shall follow all application requirements set forth for an initial license pursuant to He-P 802.04; and

 

(2)  The licensee shall be subject to a fine in accordance with He-P 802.13(e).

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.07  Hospital Construction, Modifications, or Structural Alterations.

 

          (a)  At least 60 days prior to construction, the licensee shall submit to the department accurate architectural plans, including sprinkler and fire alarm plans or drawings, that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, for the following:

 

(1)  A new building;

 

(2)  An addition or renovation to an existing building;

 

(3)  Structural alterations to any patient area;

 

(4)  Alterations that require approval from local or state authorities; and

 

(5)  Alterations that might affect compliance with the health and safety, fire, or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

 

          (b)  Sprinkler and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

          (c)  Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (d)  The department shall review and approve plans for construction, modification, or structural alterations of a facility for compliance with all applicable sections of RSA 151 and He-P 802 and notify the applicant of the approval prior to construction, modification, or structural alterations.

 

          (e)  A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

 

(1)  Saf-C 6000 and the state fire code, under RSA 153:1, VI-a , including, but not limited to, NFPA 1 and NFPA 101 and as amended in Saf- Fmo 300 by the fire marshal with the  board of fire control and ratified by the general court pursuant to RSA 153:5; 

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code Review Board pursuant to RSA 155-A:10, V; and

 

(3)  Federal, state, and local laws, regulations, and ordinances.

 

          (f)  Any newly constructed, modified, or structurally altered hospital or FHEF shall follow and comply with the Facility Guidelines Institutes (FGI)’s “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A, and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A.

 

          (g)  The authority for waivers shall be as follows:

 

(1)  The department shall be responsible for granting waivers pursuant to the FGI guidelines above and these rules;

 

(2)  The state fire marshal shall be responsible for granting exceptions or variances pertaining to the state fire code; and

 

(3)  The local building official or state building code review board shall be responsible for granting variances to the local or state building code, respectively.

 

          (h)  Waivers granted by the department for construction or modifications under the FGI guidelines above shall be permanent and not require annual renewal unless the underlying reason or circumstances for the waiver changes.

 

          (i)  Existing hospitals shall be deemed compliant with (f) above, unless and until modifications or changes are implemented in the facility.

 

          (j)  The completed building shall be subject to an inspection pursuant to He-P 802.09 prior to its use.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.08  Requirements for Organizational Changes.

 

          (a)  The licensee shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Capacity;

 

(6)  Administrator;

 

(7)  Medical director; or

 

(8)  Affiliated or related parties.

 

          (b)  When there is a change in the name, the licensee shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (c)  The licensee shall complete and submit a new application and obtain a new license and license certificate prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of beds beyond what was authorized under the initial license.

 

          (d)  When there is a change in address without a change in location, the licensee shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (e)  An inspection by the department shall be conducted prior to operation when there are changes in the following:

 

(1)  Ownership, unless the current licensee has no outstanding administrative actions in process and there will be no changes made by the new owner in the scope of services provided;

 

(2)  The physical location;

 

(3)  A change in the licensing classification;

 

(4)  A change that places the facility under a different life safety code occupancy chapter; or

 

(5)  An increase in the number of beds beyond what is authorized under the license.

 

          (f)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  An increase in the number of beds beyond what is authorized under the license;

 

(3)  A change in the scope of services provided;

 

(4)  A change in the address without a change in physical location; or

 

(5)  When a waiver has been granted.

 

          (g)  The licensee shall inform the department in writing no later than 30 days prior to a change in

administrator or medical director, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses for the new administrator or medical director;

 

(3)  The results of a criminal records check from the department of safety for the new administrator or medical director; and

 

(4)  A statement, which shall be signed at the time the initial offer of employment, contract, or engagement and then annually thereafter, stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient in this or any other state; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person in this or any other state.

 

          (h)  Upon review of the materials submitted in accordance with He-P 802.08(g), the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 802.16(b) and He-P 802.16(c) respectively.

 

          (i)  If the department determines that the new administrator or medical director does not meet the qualifications for the position as specified in (h) above, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (j)  The licensee shall inform the department in writing via e-mail, fax, or mail of any change in the licensee’s e-mail address as soon as practicable and in no case later than 10 days of the change.

 

          (k)  A restructuring of an established hospital that does not result in a transfer of the controlling interest of the licensee, but which might result in a change in the name of the licensee or corporation, shall not constitute a change in ownership.

 

          (l)  Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

 

          (m)  If a licensee chooses to cease the operation of the hospital or special health care service, the licensee shall submit written notification to the department at least 60 days in advance.

 

          (n)  The licensee shall return the previous license to the division within 10 days of the licensee ceasing operations.

 

          (o)  If the licensee is changing its ownership, physical location, address, or name, a new license shall not be issued if the licensee fails to return its previous license.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 802, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the licensee; and

 

(3)  Any records required by RSA 151 and He-P 802.

 

          (b)  The department shall conduct a clinical and life safety code inspection to determine full compliance with RSA 151 and He-P 802, to include a clinical and a life safety inspection, prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 802.08(e)(1);

 

(3)  A change in the licensee’s physical location;

 

(4)  An increase in the number of beds beyond what is authorized under the license;

 

(5)  Occupation of space after construction, modifications, or structural alterations; or

 

(6)  The renewal of a license, if not deemed under RSA 151:5-b.

 

          (c)  In addition to (b) above, the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A deficiency report or notice to correct shall be issued when, as a result of any inspection, the department determines that the licensee is in violation of any of the provisions of He-P 802, RSA 151, or any applicable state or federal law, administrative rule, or code.

 

          (e)  If deficiencies were cited, the licensee shall submit a POC, in accordance with He-P 802.12(c) within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (b) above that the prospective premises is not in full compliance with RSA 151, He-P 802, or any applicable federal, state, or local law, regulation, or code.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 802 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not have the potential to negatively impact the health or safety of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.11  Complaints.

 

          (a)  The department shall investigate a complaint against a licensed, non-CMS certified hospital when there is 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 RSA 151 or He-P 802.

 

          (b)  The bureau of licensing and certification shall refer for investigation to the department’s health facilities administration-certification unit or to the accrediting organization, as appropriate, any complaint against a CMS certified hospital that meets the following conditions:

 

(1) There is sufficient specific information to determine that if the allegation(s) were proven to be true, a violation would be determined to exist of the applicable requirements at 42 CFR 482, 42 CFR 485, 42 CFR 489, or the CMS, “Life Safety Code & Health Care Facilities Code Requirements" (2017 update)  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/LSC, as available and noted in Appendix A; and

 

(2) Investigations shall be conducted in accordance with CMS Publication #100-07, “State Operations Manual”, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984, including Chapter 5-Complaint Procedures, and applicable appendices, as available and noted in Appendix A.

 

          (c)  For complaints alleging violations of RSA 151 or He-P 802, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if deficiencies were found as a result of the investigation;

 

(2)  Notify any other federal, state or local agencies of alleged violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 802.12(c) if the inspection results in deficiencies being cited.

 

          (d)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value;

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value; and

 

(5)  Any other relevant investigative techniques.

 

          (e)  For complaints regarding an unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of inspection;

 

b.  The reasons for the inspection; and

 

c.  Whether or not the inspection resulted in a determination that the services being provided require licensing under RSA 151;

 

(2)  The owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (1) above to respond to a finding that they are operating without a license or submit a completed application for a license in accordance with RSA 151:7-a, II;

 

(3)  If the owner of an unlicensed hospital does not comply with (2) above, or if the department does not agree with the owner’s response, the department shall:

 

a.  Issue a written warning to immediately comply with RSA 151 and He-P 802; and

 

b.  Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III; and

 

(4)  Any person or entity who fails to comply after receiving a warning, as described in (3)a. above, shall be subject to an action by the department for injunctive relief under RSA 151:17.Whether or not the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 802, or other applicable laws.

 

          (f)  Complaint investigation files shall:

 

(1)  Be confidential in accordance with RSA 151:13;

 

(2)  Not be disclosed publicly; and

 

(3)  Be released by the department on written request only:

 

a.  To the department of justice when relevant to a specific investigation;

 

b.  To law enforcement when relevant to a specific criminal investigation;

 

c.  When a court of competent jurisdiction orders the department to release such information; or

 

d.  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 802, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions on a licensee; or

 

(4)  Monitoring of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each deficiency in which the licensee is not in compliance with RSA 151 or He-P 802; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a notice of deficiencies, the licensee shall submit a written POC detailing:

 

a.  How the licensee intends to correct each deficiency;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the deficiency does not recur, including how the measures are evaluated for effectiveness;

 

c.  The date by which each deficiency shall be corrected; and

 

d.  The position(s) of the employee(s) responsible for the corrective action;

 

(2)  The licensee shall submit the POC in (c) above to the department within 21 days of the date on the letter that transmitted the inspection report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline based on the following criteria:

 

a.  The licensee demonstrates that it has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

 

b.  The department determines that the health, safety, or well-being of the patients, personnel, or visitors will not be jeopardized as a result of granting the extension;

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 802;

 

b.  Addresses all deficiencies and deficient practices as cited in the inspection report;

 

c.  Prevents a new violation of RSA 151 or He-P 802 as a result of the implementation of the POC;

 

d.  Identifies the position(s) of the employee(s) responsible for the corrective action; and

 

e.  Specifies the date upon which the deficiencies will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either verbally or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that it made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted in accordance with this section, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 802.13(c)(12);

 

(6)  Following the date of completion specified by the licensee in the POC, the department shall verify the implementation of any POC by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection; and

 

(7)  If the POC or revised POC has not been implemented as verified by (6) above, the licensee shall be:

 

a.  Notified by the department in accordance with (b) above;

 

b.  Issued a directed POC in accordance with (d) below; and

 

c.  Subject to a fine in accordance with He-P 802(c)(13).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, deficiencies were identified that require immediate corrective action to protect the health and safety of the patients and personnel; and

 

(2) A POC or revised POC is not submitted or accepted in accordance with (c)(1) and (5) respectively.

 

          (e)  The department shall offer an opportunity for informal dispute resolution to any licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (f)  The informal dispute resolution shall be requested in writing by the licensee or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (g)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect.  The department shall provide a written notice to the licensee of the determination.

 

          (h)  The deadline to submit a POC in accordance with (c)(2) above shall not apply until the notice of the determination in (g) above has been provided to the licensee.

 

          (i)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (k)  The department shall impose state monitoring if it determines that repeated poor compliance or the conditions of the facility might negatively impact the health, safety, or well-bring of patients.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.13  Enforcement Actions and Hearings.

 

          (a)  As specified in this section, the department shall take the following enforcement actions for violation of RSA 151, He-P 802, or other applicable licensing rules:

 

(1)  Issue a warning;

 

(2)  Impose a fine in accordance with (e) below;

 

(3)  Deny the application for a renewal of a license in accordance with (c) and (d) below;

 

(4)  Immediately suspend a license; or

 

(5)  Revoke the license in accordance with (c) and (d) below.

 

          (b)  At the time of issuing a warning, imposing a fine, or denying, revoking, or suspending a license, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the deficiency has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (c)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 802, which poses a risk of to harm a patient’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay a fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information on an application, an applicant or licensee fails to submit an application that meets the requirements of He-P 802.04; or

 

(5)  An applicant, licensee or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 802.12(c) and (d);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 802 for the same violations within the last 5 inspections;

 

(8)  A licensee, its corporate officers, or its board members has had a license revoked and submits an application during the 5-year prohibition period specified in (l) below;

 

(9)  Upon inspection, the applicant’s premises are not in compliance with RSA 151 or He-P 802 and a waiver has not been granted;

 

(10)  The department makes a determination that the administrator, licensee, medical director, or applicant are guilty of one or more of the offenses listed in He-P 802.05(f) and a waiver has not been granted;

 

(11)  The applicant or licensee employs an administrator who does not meet all of the qualifications listed in He-P 802.16(b) and a waiver has not been granted; or

 

(12)  The applicant, administrator, licensee, or medical director has had a license revoked by any division of the department 5 years prior to the filing of the application.

 

          (d)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2 or RSA 151:2-e, the fine shall be $2,000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, RSA 151:2-e, and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed provider, or a licensee shall be $2,000.00;

 

(3)  For advertising services or otherwise representing that the facility has a license to provide services it is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

 

(4)  For a failure to transfer a patient whose needs exceeds the services or programs provided by the licensee in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For admission of a patient whose needs exceed the services or programs authorized by the license classification, in violation of RSA 151:5-a, II, and He-P 802.18, the fine for a licensee shall be $1,000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 802.11, He-P 802.13, or He-P 802.14, the fine shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 802.06(b), the fine shall be $500.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 802.08(a)(1), the fine shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 802.08(a)(2), the fine shall be $500.00;

 

(10)  For a failure to notify the department of a change in e-mail address as required by He-P 802.08(m), the fine for a licensee shall be $500.00;

 

(11)  For a failure to allow access by the department to the licensee’s premises, programs, services or records, in violation of He-P 802.09(a), the fine for an individual or licensee shall be $2,000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, in violation of He-P 802.12(c)(2) or (c)(5), the fine for a licensee shall be $500.00 unless an extension has been granted by the department;

 

(13)  For a failure to implement or maintain corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 802.12(c), the fine for a licensee shall be $1,000.00;

 

(14)  For a failure to establish, implement, or comply with all policies generated by the licensee as required under this rule, the fine for a licensee shall be $1,000.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 802.18, the fine for a licensee shall be $500.00;

 

(16)  For exceeding the maximum number of patients, in violation of He-P 802.14(m), the fine for a licensee shall be $500.00 per day;

 

(17)  For creating or providing false or misleading information contained on an application or on any records required to be maintained for licensing, in violation of He-P 802.14(h), the fine shall be $1,00.00 per offense;

 

(18)  For a failure to meet the needs of the patient, in violation of He-P 802.14(k)(1), the fine for a licensee shall be $1,000.00 per patient;

 

(19)  For employing, contracting with, or engaging an administrator, medical director, or other personnel who do not meet the qualifications for the position as set forth in this rule and a waiver was not received, the fine for a licensee shall be $500.00;

 

(20)  For placing a patient in a room that has not been approved or licensed by the department, in violation of He-P 802.27, the fine for a licensee shall be $500.00;

 

(21)  For failure to report an adverse event as required by He-P 802.15, the fine for a licensee shall be $2,000.00 per occurrence;

 

(22)  For failure to report infections and process measures as identified and required by He-P 802.22, the fine for a licensee shall be $1,000.00 per occurrence;

 

(23)  For failure to submit architectural plans or drawings prior to undertaking construction or renovation of the licensed facility in violation of He-P 802.07(a), the fine for a licensed facility shall be $500.00;

(24)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 802.09(b)(6), the fine shall be $500 per day; or

 

(25)  For failing to comply with any provision of He-P 802 where a patient’s health, safety, or well-being is placed in jeopardy, the fine shall be $1,000.

 

          (e)  When an inspection determines that a violation of RSA 151 or He-P 802 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

(1)  If the same deficiency is cited within 2 years of the original deficiency, the fine for a licensee shall be double the initial fine, but not to exceed $2,000.00; and

 

(2)  If the same deficiency is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the fine, but not to exceed $2,000.00.

 

          (f)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 802 shall constitute a separate violation and shall be fined in accordance with He-P 802.12(f). If the applicant or licensee is making good faith efforts to comply with He-P 802, the department shall not issue a daily fine.

 

          (g)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (h)  An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (j)  If a written request for a hearing is not made pursuant to (h) above, the action of the department shall become final.

 

          (j)  The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of patients when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (k)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 802 is achieved.

 

          (l)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (m)  When a license has been revoked for a reason listed in (c) or (d) above, the licensee shall not be eligible to reapply for a license for at least 5 years.

 

          (n)  If a license is revoked, the administrator or medical director:

 

(1)  Shall not be employed as an administrator or medical director for at least 5 years if the enforcement action pertained to their role in the hospital; and

 

(2)  Shall be reported to the appropriate licensing board.

 

          (o)  The 5-year period referenced in (m) and (n) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if no request for a hearing is requested pursuant to (h) above; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (p)  Notwithstanding (o) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 802.

 

          (q)  RSA 151:8 and RSA 541-A shall govern further appeals of department decisions under this section.

 

          (r)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 802.

 

Source.  #2044, eff 6-3-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, and:

 

(1)  For Medicare Certified Hospitals (Acute), CMS federal regulation at 42 CFR Part 482;

 

(2)  For Medicare Certified Critical Access Hospitals (CAH), CMS federal regulations at 42 CFR Part 485;

 

(3)  For Medicare Certified Psychiatric Hospitals, CMS federal regulations at 42 CFR Part 482;

 

(4)  For Medicare Certified Rehabilitation Hospitals, CMS federal regulations at 42 CFR Part 482;

 

(5)  For Medicare Certified Hospitals with Prospective Payment System Units for Psych or Rehab, CMS federal regulations at 42 CFR Part 412; and

 

(6)  For any newly licensed and certified hospital not specified as an acute, rehab, psych, or CAH hospital, all applicable CMS federal regulations for that hospital’s particular designation.

 

          (b)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the hospital, which shall include, at a minimum, the required services listed in He-P 802.18.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the licensee.

 

          (e)  By January 1, 2023, the licensee shall complete and implement an operational plan for the recognition and management of patients with dementia or delirium in accordance with RSA 151:2-I. The licensee shall keep the plan on file and make the plan available to the department of health and human services, bureau of licensing and certification upon request.

 

          (f)  All policies and procedures shall be reviewed per licensee policy.

 

          (g)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (h)  The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (i)  Except for the requirements of RSA 151:4, III(a)(5), the licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating a hospital or providing a special health care service, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (j)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (k)  Licensees shall:

 

(1)  Meet the needs of the patients during those hours that the patients are in the care of the licensee;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the hospital or special health care service;

 

(3)  Appoint an administrator;

 

(4)  Verify the qualifications of all personnel;

 

(5)  Provide sufficient numbers of qualified personnel to meet the needs of patients during all hours of operation;

 

(6)  Provide sufficient supplies, equipment, and lighting to meet the needs of the patients; and

 

(7)  Implement any POC that has been accepted by the department.

 

          (l)  The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney or surrogate for health care that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (m)  The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (n)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions, Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007 edition), available as noted in Appendix A.

 

          (o)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (p)  The licensee shall implement measures to ensure the safety and stabilizing treatment of patients who are assessed as an elopement risk or danger to self or others.

 

          (q)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 802.09(b), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted by calling 1-800-852-3345 x 9499 or in writing, to the:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street, Concord, NH 03301; and

 

(6)  The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

 

          (r)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 802 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (s)  Licensees shall, in accordance with He-P 802.15:

 

(1) Report all adverse events to the department;

 

(2)  Submit additional information if required by the department; and

 

(3)  Report the event to other agencies as required by law.

 

          (t)  The licensee shall immediately notify the local police department, the guardian and agent if any, when a patient, who has been assessed or is known as being a danger to self or others, has an unexplained absence after the licensee has searched the building and the grounds of the hospital.

 

          (u)  A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

 

          (v)  All records required by law or this rule shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (w)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to patients and personnel.

 

          (x)  The licensee shall develop policies and procedures regarding the release of information contained in patient records.

 

          (y)  The licensee shall provide cleaning and maintenance services, as needed to protect patients, personnel, and the public.

 

          (z)  The building housing the licensed facility shall comply with all state and local:

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

          (aa)  Smoking shall be prohibited in the licensed facility as required by RSA 155:66, I(b).

 

          (ab)  If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

 

          (ac)  If the licensee holds or manages a patient’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other patients, or other household members.

 

          (ad)  The licensee shall have written policies on the proper completion of an involuntary emergency admission certificate for those in need of mental health treatment that:

 

(1)  Are in compliance with RSA 135-C:27-33 and He-M 613; and

 

(2)  Detail the medical screening examination and stabilizing treatment provided to patients with mental health needs.

 

Source.  #2144, eff 9-28-82; ss by #3193, eff 1-28-86, EXPIRED: 1-28-92; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21; amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21

 

          He-P 802.15  Adverse Event Reporting.

 

          (a)  Pursuant to RSA 151:38, the administrator or designee shall report to the department the following adverse events:

 

(1)  Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573, as available as noted in Appendix A; and

(2)  The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker's intentional unsafe act. 

 

            (b)  An act by hospital or ambulatory surgery center staff resulting in an infection or disease shall be considered to be purposefully unsafe if it meets the following criteria:

 

 

(1)  There was an intentional act or reckless behavior;

 

(2)  No reasonable person with similar qualifications, training, and experience would have acted the same way under similar circumstances; and 

 

(3)  There were no extenuating circumstances that could justify the act. 

 

          (c)  If the licensee suspects an adverse event occurred, the administrator or designee shall send a report to the department in electronic or paper format, within 15working days after discovery of the event, including:

 

(1)  Licensee information;

 

(2)  Patient information;

 

(3)  Event information; and

 

(4)  Type of occurrence as listed in (a) above.

 

          (d)  For events reported in (a) above, the licensee shall, within 60 days after discovery of the event, provide the department:

 

(1)  An analysis that includes the type of harm and contributing factors; and

 

(2)  A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the licensee determines that one is not required.

 

          (e)  If the licensee suspects that it received a patient from a sending hospital that was subject to an adverse event, then the receiving administrator or designee shall notify the sending hospital’s administrator or designee and the department. The department shall inform the sending hospital that a report is required in accordance with (a) above.

 

          (f)  Upon receipt of a report of an adverse event, the department shall:

 

(1)  Acknowledge receipt of the event and review the information for completeness;

 

(2)  Review the corrective action plan for system changes that reduce the risk repeat of similar adverse events;

 

(3)  Communicate specific concerns to the licensee if the department does not find the corrective action plan credible;

 

(4)  Track and analyze adverse events for trends and underlying system problems; and

(5)  Provide information and make referrals to other state agencies as appropriate.

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.16  Organization and Administration.

 

          (a)  Each licensee shall have a governing body whose duties shall include:

 

(1)  Management and control of the operation of the hospital;

 

(2)  Assessment and improvement of the quality of care and services;

 

(3)  Appointment of the administrator;

 

(4)  Adoption of hospital by-laws defining responsibilities for the operation of the hospital, and establishment of a medical staff;

 

(5)  Approval of medical staff by-laws as described in (e)(2) below, defining the medical staff responsibilities;

 

(6)  Responsibility for management of the overall operation and fiscal viability of the hospital;

 

(7)  Responsibility for determination of the qualifications for appointment for all personnel; and

 

(8)  Ensuring compliance with all relevant health and safety requirements of federal, state, and local laws, rules, and regulations.

 

          (b)  Each hospital shall have a full-time administrator who:

 

(1)  Has a master’s degree from an accredited institution and at least 4 years of experience working in a health-related field or has a bachelor’s degree from an accredited institution and at least 8 years of experience working in a health-related field; and

 

(2)  Shall be responsible to the governing body for the daily management and operation of the hospital and any special health care services offered by the hospital including:

 

a.  Management and fiscal matters;

 

b.  Implementing the by-laws adopted by the governing body;

 

c.  The employment and termination of personnel necessary for the efficient operation of the hospital;

 

d.  The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the hospital and any special health care services offered by the hospital in the absence of the administrator;

 

e.  Attendance at meetings of the governing body, medical staff, and personnel, to serve as a liaison to the governing body;

 

f.  The planning, organizing, and directing of such other activities as may be delegated by the governing body;

 

g.  The delegation of responsibility to subordinates as appropriate; and

 

h.  Ensuring development and implementation of all policies and procedures on:

 

1.  Patient’s rights as required by RSA 151:19-21;

 

2.  Advanced directives as required by RSA 137-J;

 

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

 

4.  Organ and tissue donor identification and procurement;

 

5.  Withholding of resuscitative services from patients pursuant to RSA 137-J; and

 

6.  Adverse event reporting. 

 

          (c)  Each hospital shall have a full-time medical director who is qualified to practice medicine in the state and has at least 5-years’ experience as a physician in a hospital setting. This shall not apply to critical access hospitals.

 

          (d)  Each hospital shall have a medical staff in accordance with the by-laws adopted under (a)(4) above.

 

          (e)  The medical staff shall be responsible for:

 

(1)  Appointment of an executive committee made up of members of the medical staff which shall make recommendations directly to the governing body with regard to:

 

a.  The process by which physicians or other licensed practitioners shall be admitted to practice for the licensee;

 

b.  Evaluation of individuals seeking medical staff membership;

 

c.  Delineation of what clinical privilege includes;

 

d.  The organization of the quality assessment and improvement activities of the medical staff; and

 

e.  The appointment of a medical director who meets the qualifications of (c) above;

 

(2)  Development of medical staff by-laws and policies in conjunction with the governing body which shall establish a mechanism for self-governance by the medical staff and accountability to the governing body;

 

(3)  Monitoring and evaluation of the quality of patient care and patient care services in the hospital including:

 

a.  Monitoring of medication use and review of pharmacy activity in the hospital;

 

b.  Review of patient record quality;

 

c.  Review of blood use in the hospital; and

 

d.  Review of other functions such as risk management, infection control, disaster planning, hospital safety, and utilization review; and

(4)  Identifying and making available education programs designed to maintain the medical staff’s expertise in areas related to the services provided in the hospital.

 

          (f)  There shall be a full-time director of nursing services who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and:

 

(1)  Is an RN with a bachelor’s and a master’s degree from an accredited institution;

 

(2)  Is an RN with a bachelor’s degree and at least 4 years of relevant experience; or

 

(3)  Is an RN with a minimum of 8 years of relevant experience.

 

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

 

(1)  Establishment of standards of nursing practice used in the hospital;

 

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

 

(3)  Participating with the governing body, administrator, and medical staff to improve the quality of nursing care at the hospital;

 

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

 

(5)  Nutritional monitoring.

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.17  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified staff are present in the facility to meet the needs of patients at all times.

 

          (b)  For all applicants for employment, for all volunteers, or for all independent contractors who will  provide direct care or personal care services to patients, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except those exempted pursuant to RSA 151:2-d, VI;

 

(2)  Review the results of the criminal records check in accordance with (c) below;

 

(3)  Verify the qualifications of all applicants prior to employment; and

 

(4)  Verify that the applicant is not on the List of Excluded Individuals/Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General.

 

          (c)  Unless a waiver is granted in accordance with He-P 802.10 and (e) below, the licensee shall not employ, contract, or engage an individual if that individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of patients.

 

          (d) If the licensee discovers that an individual meets one of the criteria in (c) above and that individual is already employed, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the individual; or

 

(2)  Request a waiver of (c) above.

 

          (e)  If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if the department determines that the person poses a threat to the health, safety, or well-being of a patient; or

 

(2)  Grant a waiver pursuant to He-P 802.10 if the department determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

 

          (f)  The licensee shall check the names of the persons in (c) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, the NH board of nursing, nursing assistant registry, maintained pursuant to RSA 326-B:26 and 42 CFR 483.156, and the medical technician registry, maintained pursuant to RSA 328-I prior to employing, contracting with, or engaging them.

 

          (g)  The licensee shall:

 

(1) Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS;

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry; and

 

(3)  Only employ, contract with, or engage medical technicians who are listed on the medical technician registry.

 

          (h)  In lieu of (e) and (g) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (f) above and are allowable under (e) and (g) above.

 

            (i)  Prior to having contact with patients or food, all personnel shall:

 

(1)  Receive a tour of the employee’s work environment relative to their position;

 

(2)  Receive a copy of the job description for his or her position containing:

 

a.  Duties and responsibilities of the position;

 

b.  Physical requirements of the position; and

 

c.  Education and experience requirements of the position;

 

(3)  Meet the educational and physical qualifications of the position as listed in their job description;

 

(4)  Be licensed, registered, or certified as required by state statute and as applicable;

 

(5)  Receive an orientation within the first 3 days of work or prior to the assumption of duties that includes:

 

a.  The licensee’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The procedures for food safety for personnel involved in preparation, serving, and storing of food;

 

c.  The licensee’s infection control program;

 

d.  The licensee’s fire, evacuation and emergency plans which outline the responsibilities of personnel in an emergency;

 

e.  Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

 

f.  Beginning no later than January 1, 2023, the recognition and management of patients with dementia or delirium, in accordance with the licensee’s operational plan developed pursuant to He-P 802.14(e);

 

(6)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(7)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

 

(8)  Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(9)  Comply with all public health guidelines with requirements for infectious disease reporting and management.

 

          (j)  All personnel shall complete a mandatory annual in-service education, which includes a review of the licensee’s:

 

(1)  Policies and procedures required under He-P 802;

 

(2)  Infection control program;

 

(3)  Education program on fire and emergency procedures;

 

(4)  Mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29; and

 

(5)  Beginning no later than January 1, 2023, plan regarding the recognition and management of patients with dementia or delirium, in accordance with the licensee’s operational plan developed pursuant to He-P 802.14(e).

 

          (k)  Personnel who have direct contact with patients who have a history of TB or a positive laboratory and antigen testing shall have a symptomatology screen of a TB test.

 

          (l)  Current and complete personnel files shall be maintained and stored in a secure and confidential manner at the hospital.

 

          (m)  The licensee shall maintain a separate employee file which shall include, at a minimum, the following:

 

(1)  A completed application for employment or a resume;

 

 (2)  A signed statement acknowledging the receipt of the licensee’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A signed and dated job description;

 

(4)  A record of satisfactory completion of the orientation program required by (i)(5) above ;

 

(5)  A copy of each current New Hampshire license, registration, or certification in health care field and CPR certification, if applicable;

 

(6)  Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; 

 

(7)  A record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee as required by (j) above;

 

(8)  Documentation of any performance reviews conducted;

 

(9)  Information as to the general content and length of all continuing education or educational programs attended;

 

(10)  A statement, which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient in this or any other state; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person in this or any other state;

 

(11)  A copy of the results of a criminal records check;

 

(12)  Documentation that the individual or entity is not on the List of Excluded Individuals/Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

 

(13)  The results of the registry check in (f) above.

 

          (n)  The licensee shall maintain the records, but not necessarily a separate rile, for all volunteers and for all independent contractors who provide direct care or personal care services to patients, as follows:

 

(1)  For volunteers, the information in (m)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (m)(3), (4), (6), and (8)-(12), except that the letter in (h) above may be substituted for (m)(11) and (13).

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.18  Required Services.

 

          (a)  Each licensee shall provide the services that have been disclosed on its application and have been approved for by the department, or are required by state or federal law.

 

          (b)  If the licensee wishes to provide services other than the ones it is already licensed to provide, the licensee shall submit a letter of intent to provide the additional services, prior to providing the new service(s), to the department which includes:

 

(1)  A listing of the additional services to be provided;

 

(2)  The physical resources, personnel, and competency necessary to provide the additional services;

 

(3)  Floor plans describing change(s) or architectural plans if structural changes are involved;

 

(4)  The date the hospital wishes to start such services; and

 

(5)  Documentation of compliance with RSA 151 and He-P 802.

 

          (c)  If the licensee wishes to provide a special health care service, the licensee shall complete the requirements of He-P 802.04 above.

 

          (d)  Each licensee shall ensure the availability of competent and sufficient personnel, with the required skills and experience, to provide the services in (a) and (b) above, including personnel able to provide services for both physical and behavioral health concerns.

 

          (e)  The licensee shall have a policy governing CPR.

 

          (f)  The licensee shall establish health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the patient is at the hospital that includes: 

 

(1)  Monitoring the patient’s functioning, safety and whereabouts; and

 

(2)  Emergency response and crisis intervention.

 

          (g)  The licensee shall have social services available to the patient and patient’s family, which shall be provided by a social worker with at least a bachelor’s degree in social work or human services and includes:

 

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

 

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

 

(3)  Assistance with the patient’s adaptation to the hospital and involvement in the plan of care; and

 

(4)  Advocacy for the patient’s human and civil rights and responsibilities.

 

          (h)  The licensee shall complete discharge planning on all patients admitted to the hospital including the provision of written instructions to the patient, agent, or guardian.

 

          (i)  Discharge planning shall include, as applicable:

 

(1)  The patient’s medication needs upon discharge;

 

(2)  The need for medical equipment, special diets, or potential food-drug interactions;

 

(3)  The need for further placement in another health care setting;

 

(4)  The need for home health services upon discharge; and

 

(5)  Discharge instructions and education shall be provided to the patient in writing.

 

          (j)  All laboratories operated by the licensee shall be in compliance with He-P 808, He-P 817, and CMS 42 CFR Part 493 – Laboratory Requirements.

 

          (k)  Pharmacies shall be in compliance with RSA 318 and RSA 318-B and shall employ or contract with a pharmacist who is licensed to practice pharmacy in the state of New Hampshire.

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21; ss by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21

 

          He-P 802.19  Patient Management.

 

          (a)  Admission procedures shall include:

 

(1)  Completion of a health assessment and medical evaluation in accordance with the licensee’s policy which shall be documented for each patient accepted for care and treatment;

 

(2)  Provision of information concerning patient rights in a language the patient can understand, which might require a translator;

 

(3)  Provision of information in a clear concise manner to enable the patient to make appropriate treatment decisions;

 

(4)  Collection of specific patient medical and social history information as required by the licensee’s policy including information concerning advanced directives or alternative decision makers; and

 

(5)  Development of a treatment plan.

 

          (b)  Discharge documentation shall include:

 

(1)  The date and time of discharge;

 

(2)  The status of the patient at the time of discharge; and

 

(3)  Any discharge planning or referrals that have been conducted for the patient.

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.20  Patient Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each patient based on the services provided by the licensee.

 

          (b)  Patient records shall include, at a minimum:

 

(1)  Identification data including the patient’s:

 

a.  Name;

 

b.  Home address;

 

c.  Home telephone number;

 

d.  Name, address, and telephone number for an emergency contact person;

 

e.  Date of birth;

 

f.  Guardian or agent as applicable; and

 

g.  Admitting diagnosis;

 

(2)  A signed acknowledgment of receipt of patient bill of rights by the patient, guardian,  agent, or surrogate decision maker;

 

(3)  A written or electronic record of a health examination by a licensed practitioner;

 

(4)  Written, dated, and signed orders of all medications, treatments, and therapeutic diets;

 

(5)  Documentation of all services provided including signed progress notes by:

 

a.  Nursing personnel;

 

b.  Physicians; and

 

c.  Other health professionals authorized by licensee policy;

 

(6)  Orders and results of any laboratory, x-rays, consultations,  or other diagnostic tests;

 

(7)  The patient’s health insurance information;

 

(8)  The consent for release of information signed by the patient, guardian, or agent, if any;

 

(9)  The medication record;

 

(10)  Documentation of any accident or injuries occurring while in the care of the facility;

 

(11)  Documentation of a patient’s refusal of any care or services; and

(12)  Transfer or discharge documentation including planning, referrals, and notification to the patient and guardian or agent if any.

 

          (c)  Patient records shall be available to authorized personnel and any other person authorized by law or rule to review such records.

 

          (d)  Patient records shall be retained, accessible, and stored in an area inaccessible to those who do not have authorized access to such records.

 

          (e)  The licensee shall create a policy to determine the method by which release of information from patient records shall occur.

 

          (f)  Patient records shall be safeguarded against loss or unauthorized use by implementation of appropriate use, handling, and storage procedures.

 

          (g)  Patient records shall be retained 7 years after discharge of a patient, and in the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

 

          (h)  The licensee shall arrange for the storage of and access to medical records for 7 years in the event the hospital ceases operation.

 

          (i)  Electronic records shall be maintained according to current HIPAA regulations.

 

Source.  #5846, eff 6-22-94, EXPIRED: 6-22-00

 

New.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

          He-P 802.21  Medication Services.

 

          (a)  All medications shall be made available to the patient in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for use at the hospital;

 

(2)  Reorder medications for use at the hospital; and 

 

(3)  Receive and record new medication orders.

 

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

 

(1)  The patient’s name;

 

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

 

(3)  The frequency of administration;

 

(4)  For PRN doses, the indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that have 24-hour contra-indicated maximum doses; and

 

(5)  The dated and timed signature of the ordering practitioner.

 

          (d)  Each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient:

 

(1)  The patient’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 PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (e)  The dosage, frequency, and route of administration on the labels of all prescription medications for each patient shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (h) below.

 

          (f)  The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the licensee shall indicate in writing, in the medication record, the date the dose or the discontinuance occurred.

 

          (g)  Only a pharmacist shall make changes to prescription medication container labels except as allowed by (j) below.

 

          (h)  When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

 

          (i)  Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

 

          (j)  The transcribed order in (i) above shall be counter-signed by the authorized prescriber within 48 hours of receipt or as soon as possible but no longer than 30 days.

 

          (k)  No medications shall be given to or taken by a patient until a written order is received, except as allowed by (h) or (i) above.

 

          (l)  Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (k) above.

 

          (m)  All over-the-counter medications shall have a signed practitioner’s order specifying that the patient may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

 

          (n)  The medication storage area for medications shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each patient’s medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature and humidity.

 

          (o)  All medication at the hospital shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

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

 

          (q)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the hospital, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (r)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (s)  Except as required by (t) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

 

          (t)  Destruction of contaminated, expired, or discontinued controlled drugs shall:

 

(1)  Be in accordance with acceptable standards of practice identified by the manufacturer, as well as federal and state law, and rules;

 

(2)  Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

 

(3)  Be documented in the record of the patient for whom the drug was prescribed.

 

          (u)  The licensee shall maintain a written record for each medication taken by a patient at the facility that contains the following information:

 

(1)  Any allergies or adverse reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;

 

(5)  For PRN medications, the reason the patient required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (v)  The licensee shall report to the patient’s licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient’s record the reaction, the error, and date, time, and person notified.

 

          (w) The therapeutic use of cannabis by patients who are qualifying patients possessing a registry identification card may be permitted at a hospital as long as:

 

(1)  The licensee develops, maintains, and implements a general policy relative to patient use of cannabis at the licensed premises, including storage, security, and administration; and

 

(2)  The smoking of cannabis is not permitted on the licensed premises.

 

Source.  #9580, eff 10-24-09; amd by #9851, eff 1-14-11; amd by #10079, eff 1-26-12; ss by #12407, INTERIM, eff
10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.22  Infection Control.

 

          (a)  The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

(4)  The handling, transport and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

 

(5)  Reporting of infectious and communicable diseases as required by He-P 301;

 

(6)  Evaluating and revising the infection control program in accordance with current CDC recommended actions;

 

(7)  Maintenance of a sanitary physical environment; and

 

(8)  Infection control policies specific to each department.

 

          (c)  Education on the infection control program shall be completed by all personnel on an annual basis and  address the:

 

(1)  Cause of infections;

 

(2)  Effect of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (d)  Personnel infected with a disease or illness transmissible through food, saliva, or droplets, shall not work in food service or provide direct care in any capacity without personal protective equipment until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to patients or work in food services until such time as they are no longer infected.

 

          (f)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the personnel member receives tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable and durable bandage with secure edges.

 

          (h)  The licensee shall immunize all consenting patients for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (i)  The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

 

          (j)  The licensee shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

 

          (k)  The administrator shall appoint an infection control officer who shall:

 

(1)  Receive reports of communicable and infectious diseases; and

 

(2)  Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

 

          (l)  The licensee shall have a policy requiring personnel to make a report to the infection control officer if he or she suspects that a personnel member, including him or herself, or patient has a communicable disease.

 

          (m)  The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.21)

 

          He-P 802.23  Quality Assurance and Performance Improvement.

 

          (a)  The licensee shall develop and implement a quality assurance and performance improvement program (QAPI) that reviews policies and services and maximizes quality by preventing and correcting identified problems.

 

          (b)  As part of its QAPI, an interdisciplinary quality assurance and performance improvement committee shall be created and required to:

 

(1)  Meet at least quarterly to evaluate quality assurance and performance improvement activities;

 

(2)  Generate dated, written minutes for each meeting;

 

(3)  Maintain all QAPI activities, including minutes of meetings, for at least 2 years from the date the record was created; and

 

(4)  Make recommendations to the governing body to improve the quality of care.

 

          (c)  QAPI activities shall include:

 

(1)  Review of patterns and trends of activities which affect the quality of care;

 

(2)  Ensuring that quality control logs are maintained for any laboratory controls and proficiency testing required;

 

(3)  Ensuring that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer's recommendations or code requirements;

 

(4)  Ensuring that the medical staff monitoring and evaluation of patient care recommendations referenced in He-P 802.16(d), are considered by the full quality assessment and improvement committee; and

 

(5)  Reviewing and making recommendations for improvement in areas such as:

 

a.  Infection surveillance;

 

b.  Drug usage evaluation;

 

c.  Morbidity;

 

d.  Risk assessment;

 

e.  Mortality;

 

f.  Environmental safety;

 

g.  Monitoring of quality control practices in each service; and

 

h.  Adverse events in accordance with He-P 802.15.

 

          (d)  For each QAPI activity, the committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the licensee; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.22)

 

          He-P 802.24  Food Services.

 

          (a)  The licensee shall provide food services that:

 

(1)  Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as noted in Appendix A;

 

(2)  Provide for the nutritional needs of each patient;

 

(3)  Provide substitutions if a patient declines the items offered;

(4)  Provide patients’ diets that are supervised by a dietitian;

 

(5)  Provide diets that are in accordance with the orders of patients’ licensed practitioners;

 

(6)  Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

 

(7)  Provide food and drink to the patients that is:

 

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

 

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

 

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

 

d.  Labeled, dated, stored, and served in a manner appropriate to maintain proper food temperatures.

 

          (b)  Each patient shall be offered at least 3 meals in each 24-hour period unless contraindicated by the patient’s medical condition.

 

          (c)  Snacks shall be available between meals unless contraindicated by the patient’s medical condition. 

 

          (d)  The licensee shall provide therapeutic diets to patients only as directed by a licensed practitioner or other professional with prescriptive authority.  

 

          (e)  The use of outdated, unlabeled food, or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

 

          (f)  All work surfaces, food services equipment, dishes, utensils, and glassware shall be in good repair, cleaned and sanitized after each use, and properly stored.

 

          (g)  Soiled linen and trash shall not be transported through food preparation areas and shall be kept in an impervious container.

 

          (h)  All hospital personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

          (i)  Regularly scheduled training programs including sanitation and safety shall be made available to personnel. Information as to the content and length of this training shall be documented and kept in personnel records.

 

          (j)  A current therapeutic diet manual approved by the dietician and medical staff shall be readily available to all medical, nursing, and food service personnel.

 

          (k)  The licensee shall have written policies and procedures to address the following:

 

(1)  Availability of a diet manual and therapeutic diet menus to meet patients’ nutritional needs;

 

(2)  Frequency of meals served;

 

(3)  System for diet ordering and patient trays deliveries;

 

(4)  Accommodation of non-routine occurrences such as parenteral nutrition, total parenteral nutrition, peripheral parenteral nutrition, change in diet orders, early and late trays, and nutritional supplements;

 

(5)  Integration of the food and dietetic service into the licensee’s QAPI and infection control programs;

 

(6)  Guidelines for acceptable hygiene practices of food service personnel; and

 

(7)  Guidelines for kitchen sanitation.

 

            (l)  The licensee shall have a full-time employee who:

 

(1)  Serves as director of the food and dietetic services;

 

(2)  Is responsible for daily management of dietary services; and

 

(3)   Is qualified by experience or training.

 

            (m)  The licensee shall employ or contract with a qualified dietician to supervise the nutritional aspects of patient care.

 

            (n)  If the dietician does not work full-time, and when the dietician is not available, the licensee shall make adequate provisions for dietary consultation that meets the needs of the patients.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.25  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed premises.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the patients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A, and summarized as follows:

 

(1)  One hundred and five to 120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

 

(2)  One hundred and twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, and may be by separate booster, unless a chemical rinse is provided; and

 

(3)  One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

 

          (f)  All patient bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications and program supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals and hospital pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service area shall be covered at all times, except during food preparation and subsequent clean-up.

 

          (m)  The following requirements shall be met for laundry services:

 

(1)  The laundry room shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Clean supplies shall be stored in dust-free and moisture-free storage areas or containers.

 

          (p)  Any hospital that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.23)

 

          He-P 802.26  Physical Environment.

 

          (a)  The licensed premises shall be maintained so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

 

          (b)  The licensee shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Maintain the premises in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Keep the premises free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not limited to:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within a hospital including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit during the day if patient(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Any heating device other than a central plan shall be designed and installed so that:

 

(1)  Combustible material cannot be ignited by the device or its appurtenances;

 

(2)  If fuel-fired, such heating devices comply with the following:

 

a.  They shall be chimney or vent connected;

 

b.  They shall take air for combustion directly from outside; and

 

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

(3)  Any heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

 

          (g)  Unvented fuel-fired heaters shall not be used in any hospital.

 

          (h)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code pursuant to RSA 155-A.

 

          (i)  Screens shall be provided for doors and windows that are left open to the outside.

 

          (j)  Doors that are self-closing and remain closed when not in use are exempt from the requirement in (i) above.

 

          (k)  The licensee shall have a telephone to which the patients have access.

 

          (l)  Toilet and bathing facilities shall be provided to meet patient needs in relation to the number and acuity of the patients.

 

          (m)  Separate toilets with hand washing sinks shall be provided for personnel and visitors.

 

          (n)  All toilets shall be vented out-of-doors.

 

          (o)  Each bathroom shall be equipped with:

 

(1)  Soap dispensers;

 

(2)  Paper towels or a hand-drying device providing heated air; and

 

(3)  Hot and cold running water.

 

          (p)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (q)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (r)  All bathroom and closet doors must either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

 

          (s)  The licensee shall comply with all state and local codes and ordinances for:

 

(1)  Zoning;

 

(2)  Building;

 

(3)  Health;

 

(4)  Fire;

 

(5)  Waste disposal; and

 

(6)  Water.

 

          (t)  The hospital shall be accessible at all times of the year.

 

          (u)  The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel and the public.

 

          (v)  Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

 

          (w)  Doors shall be of such width as to permit removal of hospital beds and meet the state fire and building code.

 

          (x)  Corridors in patient occupied areas shall be wide enough to permit passage of 2 hospital beds, in addition to complying with NFPA 101 for means of egress.

 

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

 

          (z)  There shall be an emergency generator system to provide power pursuant to the following, as adopted by the commissioner of the department of safety in Saf-C 6000, pursuant to RSA 153, and as amended by the state fire marshal with the board of fire control:

 

(1)  The Electrical Systems chapter of NFPA 99, Health Care Facilities Code; and

 

(2)  The Standard for Emergency and Standby Power Systems, NFPA 110.

 

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

 

          (ab)  Facilities shall provide for prompt cleaning of bedpans, urinals and other utensils.

 

          (ac)  Any locked door providing egress from a patient room and/or means of egress within a hospital shall meet the requirements of the Health Care Occupancy chapter of NFPA 101, as adopted  pursuant to RSA 153:1, VI-a and amended in Saf-Fmo 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (ad)  Delayed egress doors on locked units shall be equipped with locking devices, which shall:

 

(1)  Unlock upon actuation of the automatic fire detection and sprinkler system; and

 

(2)  Unlock upon loss of power.

 

          (ae)  A system for sterilization of equipment and supplies shall be provided which shall be checked for effective sterilization in accordance with the manufacturer’s recommendation and the results of these quality control tests shall be documented.

 

          (af)  Sterile supplies and equipment shall be stored in a manner that protects from contamination and follows manufacturer’s recommendations.

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.24)

 

          He-P 802.27  Patient Care Units and Patient Rooms.

 

          (a)  There shall be a nurse’s station for each patient care unit.

 

          (b)  There shall be a utility room for every patient care unit with work and storage space and equipment for cleaning and sterilizing utensils as appropriate.

 

          (c)  Patient rooms in which patients shall be housed for more than 24 hours shall be outside rooms and shall not be located below grade unless they are dry, well ventilated, and have window space equivalent to or greater than 8% of the room’s square footage.

 

          (d)  There shall be a minimum of 3 feet of clear aisle space leading from the side of any patient bed to the room door.

          (e)  As stated in the FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A, patient rooms shall comply as follows:

 

(1)  For multiple bed rooms:

 

a.  Medical and surgical rooms shall have 120 square feet/patient;

 

b.  Critical care units shall have 200 square feet/patient; and

 

c.  Intermediate care units shall have 150 square feet/ patient;

 

(2)  For single rooms:

 

a.  Medical and surgical rooms shall have 100 square feet;

 

b.  Critical care units shall have 200 square feet; and

 

c.  Intermediate care units shall have 120 square feet;

 

(3)  For pediatric nursery, to minimize the possibility of cross infection, with the exception of pediatric critical care units, each nursery room serving pediatric patients shall contain no more than 8 bassinets. Each bassinet shall have a minimum clear floor area of 40 square feet;

 

(4)  For pediatric rooms, requirements shall be the same as for adult beds due to the size variation and the need to change from cribs to beds and beds to cribs; and

 

(5)  For newborn ICU, there shall be 120 square feet per bassinet excluding sinks and aisles.

 

          (f)  Each patient room, except for nursery beds, shall be served with a patient call station equipped for two-way voice communication.  For psychiatric units and psychiatric hospitals, this shall be optional.

 

          (g)  In addition to the FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available and noted in Appendix A, the call systems shall meet the requirements of UL 1069 Standard for Hospital Signaling and Nurse Call Equipment. Use of alternate technologies that meet the requirements of UL 1069, including radio frequency systems, shall be permitted for call systems.

 

          (h)  All medication in each nursing unit shall be clearly labeled and stored in a lighted area or cabinet which is either locked or under constant observation.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.25)

 

          He-P 802.28  Life Safety and Fire Safety Procedures.

 

          (a)  The administrator or designee shall appoint a safety committee which shall include representatives from administration, clinical services, and support services.

 

          (b)  The safety committee shall:

 

(1)  Appoint a safety officer who shall:

 

a.  Inspect the premises at least semi-annually to assure that all safety precautions are met; and

 

b.  Report to the safety committee any findings noted during the inspections;

 

(2)  Develop or approve written policies and procedures covering all matters of safety and fire protection and an emergency response plan, including:

 

a.  The emergency procedures required by the emergency response plan shall include, but not be limited to, evacuation routes, emergency notification numbers, and emergency instructions and shall be available in locations accessible to personnel and visitors;

 

b.  The fire safety plan shall provide for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarm to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation; and

 

9.  Extinguishment of the fire;

 

c.  Ensuring that the fire safety and evacuation plans are available to all supervisory personnel;

 

d. Ensuring that all employees receive in-service biennial training to clarify their responsibilities in carrying out the emergency plan; and

 

e.  The required plan shall be readily available at all times in the telephone operator’s location or at the security center; and

 

(3)  Conduct fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

 

a.  Infirm or bedridden patients shall not be required to be moved during drills to safety areas or to the exterior of the building;

 

b.  Drills shall be conducted quarterly on each shift to familiarize hospital personnel with the signals and emergency action required under varied conditions; and

 

c.  When drills are conducted between 9:00 p.m./2100 hours and 6:00 A.M./0600 hours, a coded or plain language announcement may be used instead of audible alarms.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.26)

 

          He-P 802.29  Emergency Preparedness.

 

          (a)  Each facility shall have an emergency management committee, of which the facility administrator shall be a member.

 

          (b)  The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (c)  An emergency management program shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

 

(1)  Elected state and local officials;

 

(2)  Police, fire, civil defense, and public health professionals;

 

(3)  Environment, transportation, and hospital officials;

 

(4) Facility representatives; and

 

(5)  Representatives from community groups and the media.

 

(d)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (e)  The emergency management committee shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency.

 

          (f)  The plan in (e) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site using an all hazards approach, in the event of fire, natural disaster, or severe weather and human-caused emergency to include missing patients and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the incident command system (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the licensee;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that might be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least annually;

 

(12)  Include the licensee’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Access to essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing critical incident stress management (CISM), if necessary;

 

(14)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

(15)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(16)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(17)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (g)  The licensee shall conduct and document with a detailed log, including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the licensee with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the licensee’s plan and who is not involved in the exercise;

 

(2)  Exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the licensee’s improvement plan.

 

            (h)  For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

 

(1)  Assumptions for calculation of food and water supplies, for maximum number of staff and patients, water source of supple, either tap or commercial, and expiration in months, tracking of supplies, rotation of products, and contracts and memorandums of understanding with food and water suppliers such as:

 

a.  Enough refrigerated, perishable foods for a 96-hour period;

 

b.  Enough non-perishable foods for a 96-hour period; and

 

c.  Portable water for a 96-hour period;

 

(2) Designated storage location(s); and

 

(3) Non-food and water, backup supplies including but not limited to medical, office, and other supplies necessary to continue operation of the facility and provide necessary care and oversight of patients during the emergency.

 

          (i)  The licensee shall notify the department and local fire department when a required sprinkler or fire alarm system is out of service for more than 4 hours in a 24-hour period.  The licensee shall be evacuated or an approved dedicated fire watch shall be provided for all parties left unprotected by the shutdown until the sprinkler or alarm system has been returned to service.

 

(1)  If a facility loses fire sprinkler coverage for more than 10 hours a fire watch must be instituted per NFPA; or

 

(2)  If a facility loses fire alarm coverage for more than 4 hours a fire watch shall be instituted per Centers for Medicare/Medicaid Services (CMS) or for non-certified facilities 8 hours per NFPA.

 

          (j)  The licensee shall notify the department when the emergency power has been utilized for 6 or more hours due to power outage.

 

          (k)  If there is an incident including, but not limited to, fire, toxic fumes including smoke that requires the evacuation of the hospital all or in part, the hospital shall notify the department immediately by phone and within 72 hours in writing.  A full follow-up written report on the incident shall be completed and submitted to the department when the investigation has been conducted and completed, including what the incident was, action taken, injuries and or deaths that occurred during incident including during evacuation, emergency procedures followed, notification of emergency services including local fire departments and the corrective actions taken.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21

 

          He-P 802.30  Psychiatric Units.  The following shall apply if the hospital has a distinct psychiatric unit:

 

          (a)  The psychiatric unit shall have a clinical director, service chief or equivalent that meets the training and experience requirements for examination by the American Board of Psychiatry and Neurology, or the American Osteopathic Board of Neurology and Psychiatry;

 

          (b)  The psychiatric unit shall have a director of nursing services who shall be:

 

(1)  A registered nurse (RN) currently licensed in New Hampshire who has a master’s degree or its equivalent in psychiatric and mental health nursing; or

 

(2)  An RN with a bachelor’s degree and a minimum of 3 years of experience in the care of the mentally ill and to include one year in a nursing management position;

 

(c)  Admission procedures shall include, in addition to those specified in He-P 802.19(a):

 

(1)  A psychiatric diagnosis;

 

(2)  An admitting diagnosis including any concurrent disease; and

 

(3)  Completion of a psychosocial assessment and family history as appropriate;

 

          (d)  The psychiatric unit shall provide emergency psychiatric services on a 24 hour per day basis, 7 days per week;

 

          (e)  The hospital shall perform a psychiatric evaluation as soon as practicable but no longer than 24 hours after admission on each patient admitted to the psychiatric unit including:

 

(1)  Medical history;

 

(2)  Present mental status;

 

(3)  Notation about the onset of symptoms and circumstances leading to admission and admitting diagnosis;

 

(4)  An estimate of the patients intellectual functioning, memory functioning and orientation;

 

(5)  An evaluation of the patient’s use or abuse of alcohol or drugs, as appropriate; and

 

(6)  When indicated a neurological examination;

 

          (f)  The hospital shall require that each patient have an individual treatment plan which includes:

 

(1)  The diagnosis;

 

(2)  An inventory of the patient’s strengths and weaknesses which would enable him to function in a normal situation;

 

(3)  Treatment goals;

 

(4)  The specific treatment modalities used based on the strengths and weaknesses demonstrated by the patient;

 

(5)  The responsibilities of each treatment team member; and

 

(6)  Documentation as to the specific therapeutic activities the patient shall participate in during his or her hospitalization;

 

          (g)  The psychiatric unit shall provide therapeutic activities which are:

 

(1)  Appropriate to the needs and interests of the patients;

 

(2)  Directed toward restoring the patient's physical and psychosocial functioning; and

 

(3)  In accordance with the treatment plan in (f) above;

 

          (h)  Progress notes shall be recorded in the patient’s medical record by all personnel involved in carrying out the individual treatment plan for each patient;

 

          (i)  In the psychiatric unit where patients might be a hazard to themselves or others, all glazing, both interior and exterior, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

 

          (j)  There shall be at least one seclusion room for each 24 beds or fraction thereof on each psychiatric unit;

 

          (k)  Seclusion rooms, if used as a treatment modality, shall:

 

(1)  Where restraining patients is provided,  have a maximum clear floor area of at least 60 square feet with a minimum wall length of 7 feet and a maximum wall length of 11 feet;

 

(2)  Be accessed by an anteroom or vestibule that also provides access to a toilet room.  The doors to the anteroom and the toilet room shall be a minimum of 3 feet 8 inches wide;

 

(3)  Be for only one patient;

 

(4)  Have doors that permit staff observation of patients through a view panel, while also maintaining provisions for patient privacy. The view panel shall be fixed glazing with polycarbonate or laminate on inside of glazing;

 

(5)  Be under constant observation, which may include video monitoring, when being used;

 

(6)  Be constructed to prevent patient hiding, escape, injury, or suicide;

 

(7)  Be constructed of materials that are of a type acceptable to the local authority having jurisdiction and the state regulatory agency when the interior of the seclusion treatment room is padded with combustible materials;

 

(8)  Not contain outside corners or edges;

 

(9)  Have the ability to be locked as applicable;

 

(10)  Not have electrical switches and receptacles within the rooms; and

 

(11)  Have doors that  swing out;

 

           (l)  The room(s) shall be appropriately located for direct nursing observation;

 

          (m)  Forensic units shall have security vestibules or sally ports at the unit entrance;

 

          (n)  Care and supervision of child psychiatric patients shall be separate and distinct from adult psychiatric patients;

 

          (o)  Patient room areas with beds or cribs shall be at least 100 square feet for single-bed rooms, 80 square feet per bed and 60 square feet per crib in multiple-bed rooms;

 

          (p)  Geriatric, Alzheimer’s and other dementia units patient room areas shall be at least 120 square feet in single bedrooms and 200 square feet in multiple-bed rooms;

 

          (q)  Maximum room capacity shall be 2 patients;

 

          (r)  A visitor room for patients to meet with friends or family with a minimum floor space of 100 square feet shall be provided;

 

          (s)  A quiet room shall be provided for a patient who needs to be alone for a short period of time but does not require a seclusion room. Such a room shall be a minimum of 80 square feet. A group therapy room may be combined with this space if the unit accommodates not more than 12 patients and when at least 225 square feet of enclosed private space is available for group therapy activities;

 

          (t)  When door closers are required, they shall be mounted on the public side of the door rather than the private patient side of the door and whenever possible they should be within view of a nurse workstation;

 

          (u)  Door hinges shall be designed to minimize points for hanging;

 

          (v)  Door lever handles shall point downward when in the latched positions. All hardware shall have tamper-resistant fasteners;

 

          (w)  All window glazing, borrow lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens;

 

          (x)  Clothing rods or hooks, if present, shall be designed to minimize the opportunity for patients to cause injury;

 

          (y)  Drawer pulls shall be of the recessed type to eliminate the possibility of use as a tie-off point;

 

          (z)  Special design considerations for injury and suicide prevention shall be given to shower, bath, toilet and sink hardware and accessories, including grab bars and toilet paper holders;

 

          (aa)  Grab bars are required in 10 percent of the private/semi-private patient toilet rooms. Where grab bars are provided, they shall be of a removable type and the space between the bar and the wall shall be filled to prevent a cord being tied around it for hanging;

 

          (ab)  The following shall not be permitted:

 

(1)  Towel bars;

 

(2)  Shower curtain rods; and

 

(3)  Lever handles;

 

          (ac)  In private patient bathrooms, the ceiling shall be of the tamper-resistive type or of sufficient height to prevent patient access; 

 

          (ad)  In patient bedrooms where acoustical ceilings are permitted, the ceiling shall be secured or of sufficient height to prevent patient access;

 

          (ae)  In private patient bathrooms, any plumbing, piping, ductwork, or other potentially hazardous elements shall be concealed above a ceiling;

 

          (af)  In patient bedrooms and bathrooms, ceiling access panels shall be secured or of sufficient height to prevent patient access;

 

          (ag)  In patient bedrooms and bathrooms, ventilation grilles shall be secured and have small perforations to eliminate their use as tie-off point or shall be of sufficient height to prevent patient access;

 

          (ah)  In unsupervised patient areas, sprinkler heads shall be recessed or of a design to minimize patient access;

 

          (ai)  In private patient bathrooms, air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type;

 

          (aj)  Electronic surveillance systems shall not be required in psychiatric nursing units, but if provided for the safety of the residents, any devices in resident areas shall be mounted in a tamper-resistance enclosure that is unobtrusive; and

 

          (ak)  A nurse-call system shall meet the requirements of UL 1069 Standard for Hospital Signaling and Nurse Call Equipment. Use of alternate technologies that meet the requirements of UL 1069, including radio frequency systems, shall be permitted for call systems and shall have tamper-resistant fasteners.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.33)

 

          He-P 802.31  Obstetrics.  If a hospital provides the services of obstetrics, then:

 

          (a)  The unit shall be exclusively designed for maternity patients and their newborn infants, except that gynecological patients, with no communicable diseases, may be admitted when the need exists only as determined by hospital policy;

 

          (b)  The department head shall be, at a minimum, a registered nurse with education, training, and experience in obstetric nursing;

 

          (c)  A pediatrician or family practitioner shall direct the medical care of newborn infants;

          (d)  Personnel assigned to the unit shall be free of infections and shall not be assigned to care for any other patients who might present a hazard of cross-infection;

 

          (e)  The unit shall employ or contract with nurses qualified by obstetrical education, training, and experience and in numbers adequate to meet the needs of each patient;

 

          (f)  The unit shall be physically separate and arranged to prevent traffic from other areas of the hospital to pass through the unit;

 

          (g)  The unit shall have facilities for the following functions:

 

(1)  Antepartum care for patient stabilization;

 

(2)  Fetal diagnostic testing such as amniocentesis, ultrasound, oxytocin stress tests and non-stress tests;

 

(3)  Labor observation and evaluation;

 

(4)  Labor;

 

(5)  Delivery;

 

(6)  Postpartum care; and

 

(7)  Neonatal care;

 

          (h)  The functions listed in (g) above may be combined in a single room or separated into separate service areas;

 

          (i)  If the functions listed in (g) above are in separate areas, the following shall apply:

 

(1)  Labor rooms shall include toilet and hand washing facilities in or immediately adjacent to the room;

 

(2)  Delivery rooms shall be in close proximity to the labor rooms;

 

(3)  Drugs and equipment necessary for emergency treatment of mother and infant shall be available in the delivery room;

 

(4)  Occupancy in rooms for postpartum care shall be limited to 2 patients; and

 

(5)  Lavatories shall be either in the room or available without accessing a general corridor;

 

          (j)  If the functions listed in (g) above are combined, the rooms shall include the following:

 

(1)  Each room shall be equipped for all types of deliveries except Cesarean section births or any delivery requiring general anesthesia;

 

(2)  Each combined function room shall have a toilet and shower room attached;

 

(3)  Lavatories shall contain facilities for hand washing, and infant bathing; and

 

(4)  Each combined function room shall have windows;

 

          (k)  Care of infants who have shown no complications shall be provided either in a newborn nursery area or in the mother’s room;

 

          (l)  If nursery care is provided:

 

(1)  Each newborn nursery room shall contain no more than 16 infant stations.  When a rooming in program is used, the total number of bassinets in these units may be reduced, but the newborn nursery shall not be omitted in its entirety from any hospital that includes delivery services;

 

(2)  The hospital shall maintain a continuing care nursery for hospitals that provide continuing care for infants requiring close observation, such as, low birth-weight babies who are not ill but require more hours of nursing than normal neonates, the minimum of 120 square feet per infant station;

 

(3)  Labor and delivery room(s) shall have a minimum clear floor area of 340 square foot with a minimum clear dimension of 13 feet. This shall include an infant stabilization and resuscitation space with a minimum clear floor area of at least 40 square feet. Each labor and delivery room shall be for single occupancy; and

 

(4)  Cesarean/delivery room(s) shall have minimum clear floor area of 440 square feet with a minimum dimension of 16 feet. This shall include an infant resuscitation space with a minimum clear floor area of at least 80 square feet;

 

          (m)  The number of bassinets shall exceed the number of obstetrical beds by 25% and, if intensive neonatal care is provided, the number of bassinets shall be increased by an additional 10%;

 

          (n)  Emergency equipment for resuscitation shall be readily available and in operable condition;

 

          (o)  Equipment for care of at risk infants shall be available;

 

          (p) The unit shall have the ability to provide isolation for infants with contagious diseases or infections; and

 

          (q)  Care of infants, either born in the unit or transported to the unit immediately after birth, shall include:

 

(1)  Use of a prophylactic in the infant’s eyes in accordance with RSA 132:6; and

 

(2)  Provision for accurate identification of infants.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.28)

 

          He-P 802.32  Radiology and Radiation Services.  If a hospital provides radiology, nuclear medicine, and therapeutic radiation services, then:

 

          (a)  The chief of radiology shall be a medical radiologist or a consulting medical radiologist;

 

          (b)  There shall be diagnostic x-ray facilities, providing a complete service, consisting of radiographic and fluoroscopic equipment;

 

          (c)  There shall be adequate toilet and dressing rooms for patients;

 

          (d)  Diagnostic x-ray and radiation therapy equipment shall be registered and radioactive material shall be licensed, in accordance with RSA 125-F, and shall meet all applicable requirements of He-P 4000;

 

          (e)  The technical staff employed by the radiology department shall perform the service as assigned by the medical radiologist for diagnostic uses of radiation, and by the radiation oncologist for the therapeutic uses of radiation, and in accordance with He-P 4000;

          (f)  The chief of radiology shall establish procedures necessary to assure the safe and proper use of all x-ray equipment and diagnostic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment;

 

          (g)  The medical director of radiation oncology shall establish procedures necessary to assure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment; and

 

          (h)  A radiation oncologist or therapeutic radiologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.29)

 

          He-P 802.33  Surgical Services.

 

          (a)  Hospitals which provide surgical services shall determine the scope of surgical services that shall be performed in the surgical suite.

 

          (b)  The hospital shall determine the types of anesthesia that shall be utilized for each type of surgical procedure and assure its availability in the surgical suite.

 

          (c)  The surgical suite shall be a separate unit, physically set apart from all other departments.

 

          (d)  The surgical suite shall contain the following:

 

(1)  At least one operating room equipped for general operating use within the scope of surgical services determined by the hospital in accordance with (a) above;

 

(2)  Facilities for sterilization, scrubbing and clean-up separate from the operating room;

 

(3)  Clean, sterile, and soiled or decontamination rooms which shall be separate and distinct;

 

(4)  Appropriate storage space for sterile supplies, instruments, anesthesia, and medications;

 

(5)  Emergency lighting;

 

(6)  Adequate ventilation, including air exchanges, humidity and temperature which shall meet the requirements of the ANSI/ASHRAE/ASHE Standard 170-2013: Ventilation of Health Care Facilities as referenced in the FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A, including but not limited to, operating rooms, sterile supply, clean, and decontamination rooms; and

 

(7)  Space routinely used for administering inhalation anesthesia and inhalation analgesia which shall be served by a scavenging system to vent waste gases with the air supply at or near the ceiling and return or exhaust air inlets near the floor level.

 

          (e)  The nursing director of the surgical suite shall be a registered nurse with education, training and experience in surgical nursing techniques.

 

          (f)  The anesthesiologist shall be qualified in anesthesiology in accordance with the medical staff bylaws of the hospital.

 

          (g)  The chief of surgical service shall be board certified in surgery.

 

          (h)  The surgical suite shall not be used for childbirth except for Caesarian section procedures.

 

          (i)  Except in emergencies, no operation shall be performed until:

 

(1)  The patient has had a physical examination and medical history completed;

 

(2)  Any indicated laboratory and x-ray examinations have been completed; and

 

(3)  The preoperative diagnosis has been recorded in the patient’s record.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.30)

 

          He-P 802.34  Emergency Services.

 

          (a)  Hospitals shall provide emergency services overseen by a medical director of emergency services who shall be certified by the American College of Emergency Physicians in emergency medicine or the equivalent osteopathic board, be eligible to sit for the examination in emergency medicine, or have equivalent training or experience in emergency medicine in the following skills in accordance with the American College of Emergency Physicians (ACEP) “Emergency Department Planning and Resource Guidelines,” (2014 edition), available as noted in Appendix A:

 

(1)  Bladder catheterization;

 

(2)  Cardiopulmonary resuscitation;

 

(3)  Cardiac electro conversion;

 

(4)  Cardiac pacer placement;

 

(5)  Cricothyrotomy;

 

(6)  CVP catheter placement;

 

(7)  EKG interpretation;

 

(8)  Endotracheal intubation;

 

(9)  Gastric lavage;

 

(10)  Initial fracture/dislocation management;

 

(11)  Nasal packing;

 

(12)  Pericadiocentesis;

 

(13)  Spinal immobilization; and

 

(14)  Thoracsotomy tube drainage.

 

          (b)  The medical director of emergency services shall hold current certification in advanced cardiac life support from the American Heart Association and in advanced trauma life support from the American College of Surgeons.

 

          (c)  An emergency department shall offer comprehensive emergency care to all individuals regardless of ability to pay 24 hours a day with at least one physician experienced in emergency care in the emergency care area or immediately available within the hospital.

 

          (d)  An emergency department shall employ or contract with licensed practitioners in the field of psychiatry, psychology, or other medical practitioners recognized by the board of medicine to have the knowledge and expertise to treat individuals in need of emergency mental health treatment to meet the mental health needs of individuals who present in the emergency department for mental health treatment.

 

          (e)  The nursing director of the emergency services shall be a registered nurse who is qualified by education, training, and experience to supervise the provision of emergency nursing services.

 

          (f)  The emergency department shall contain:

 

(1)  Appropriate access from ambulance unloading area to facilitate easy transfer of patients;

 

(2)  A waiting area for families of patients who are being treated or for patients waiting to be seen;

 

(3)  Treatment rooms for the care of emergency patients that are equipped to provide treatment of life-threatening conditions; and

 

(4)  Treatment areas which provide privacy for patient treatment without compromising patient care.

 

          (g)  Emergency service policies and procedures shall be developed regarding assessment and treatment by physicians and other personnel.

 

          (h)  The hospital shall develop a procedure for reporting suspected or alleged cases of child or adult abuse and neglect and emergency service personnel shall be trained in this procedure.

 

          (i)  Documentation of care provided in the emergency service department shall include the following information:

 

(1)  A record of the emergency care provided; and

 

(2)  A record of any emergency care provided prior to the patient’s arrival in the emergency room.

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.31); amd by #13206, EMERGENCY RULE, eff 5-14-21; ss by #13281, eff 10-23-21

 

          He-P 802.35  Critical Access Hospital.  A critical access hospital (CAH), as defined in He-P 802.03(r), shall meet the criteria set forth in He-P 802, except as follows:

 

          (a)  A CAH may also be granted swing-bed approval to provide post-hospital skilled nursing facility-level care in inpatient beds, which are not counted in the 96-hour calculation;

 

          (b)  A CAH may contract with a licensed hospice to provide hospice care;

 

          (c)  The CAH may dedicate beds to the hospice, but the beds shall be counted toward the 25-bed maximum;

 

          (d)  The hospice patient shall not be included in the calculation of the 96-hour annual average length of stay;

 

          (e)  The hospice patient may be admitted to the CAH for any care involved in their treatment plan or for respite care;

 

          (f)  In addition to the 25-inpatient CAH beds, a CAH may also operate a psychiatric or a rehabilitation distinct part unit of up to 10 beds each; 

 

          (g)  A CAH shall notify the department when it receives CAH status;

 

          (h)  The department shall issue a license to a CAH, which shall designate the number of staffed beds, up to the maximum allowed under critical access;

 

          (i)  The CAH shall be exempt from He-P 802.33(f) and instead may have a certified registered nurse anesthetist;

 

          (j)  If a CAH wishes to change its critical access status, the hospital shall notify the department; and

 

          (k)  The CAH shall be exempt from He-P 802.34(a) and (c).

 

Source.  #9580, eff 10-24-09; ss by #12407, INTERIM, eff 10-24-17, EXPIRED: 4-22-18

 

New.  #13166, eff 1-28-21 (formerly He-P 802.32)

 

          He-P 802.36  Psychiatric Hospital. 

 

          (a)  A psychiatric hospital, as defined in He-P 802.03(bw), shall meet the criteria set forth in He-P 802, including He-P 802.27.

 

          (b)  Each psychiatric hospital shall have a full time administrator who meets the qualifications for an administrator as defined in He-P 802.16(b) and shall be responsible to the governing body for the daily management and operation of the hospital which, in addition to those responsibilities defined in He-P 802.16(b), shall include ensuring development and implementation of hospital policies and procedures on:

 

(1)  Voluntary and involuntary emergency admission; and

 

(2)  Seclusion and restraints.

 

          (c)  Psychiatric hospitals shall be exempt from He-P 802.16(e) and (f) and He-P 802.31.

 

Source.  #13166, eff 1-28-21 (formerly He-P 802.33)

 

          He-P 802.37  Rehabilitation Hospital.

 

          (a)  A rehabilitation hospital, as defined in He-P 802.03(bz), shall meet the criteria set forth in He-P 802 and:

 

(1)  Each rehabilitation hospital shall have a full time administrator who meets the qualifications for an administrator as specified in He-P 802.16(b)(1)-(2) and is responsible to the governing body for the daily management and operation of the hospital including those responsibilities specified in He-P 802.16(b); and

(2)  Personnel requirements shall include:

 

a.  A director of nursing services who shall be exempt from He-P 802.16(e) and (f) and instead:

 

1. Be a registered nurse currently licensed in New Hampshire; and

 

2. Possess at least a bachelor’s degree with 3 years’ experience in the provision of comprehensive physical rehabilitation services; and

 

b.  A medical director of rehabilitation services who shall:

 

1.  Be a medical doctor or doctor of osteopathic medicine licensed in the state of New Hampshire;

 

2.  Provide services to the facility or unit and its inpatients for at least 20 hours per week; and

 

3.  Meet one of the following requirements:

 

(i)  Be board-certified by either the American Board of Physical Medicine and Rehabilitation or the American Society of Neurorehabilitation; or

 

(ii)  Have at least 2 years of training or experience in the medical management of inpatients requiring rehabilitative services.

 

          (b)  In addition to the requirements in He-P 802.17, rehabilitation hospitals shall have available the services of:

 

(1)  An occupational therapist licensed by the state of New Hampshire;

 

(2)  A physical therapist licensed by the state of New Hampshire;

 

(3)  A speech-language pathologist licensed by the state of New Hampshire;

 

(4)  A respiratory therapist licensed by the state of New Hampshire;

 

(5)  A psychologist licensed by the state of New Hampshire;

 

(6)  An orthotist/prosthetist;

 

(7)  A rehabilitation nurse with education, training, and experience in rehabilitation nursing and licensed by the state of New Hampshire; and

 

(8)  Other nursing personnel and aides educated and trained to provide services as instructed by the physician.

 

          (c)  Rehabilitation hospitals that accommodate inpatients shall comply with the following construction requirements:

 

(1)  The Health Care Occupancy chapter of NFPA 101, as adopted pursuant to RSA 153:1, VI-a and as amended in Saf-Fmo 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

(3)  The FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition) and FGI’s “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A.

 

          (d)  Minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules shall be 140 square feet in single-bed rooms and 125 square feet per bed in multiple-bed rooms.

 

          (e)  Maximum occupancy shall be 2 beds per room.

 

          (f)  A training unit shall be provided for teaching daily living activities, which includes:

 

(1)  A bedroom;

 

(2)  A full bathroom in addition to other toilet and bathing requirements;

 

(3)  A kitchen; and

 

(4)  Space for training stairs.

 

          (g)  Space requirements for the exercise area shall be designed to permit access to all equipment and be sized to accommodate equipment for physical therapy.

 

          (h)  In addition to He-P 802.23, quality assurance, a rehabilitation hospital shall establish and maintain a comprehensive, ongoing, facility-wide quality assurance program which involves assessment of all quality assurance activities conducted in the provision of its health care and rehabilitation program and services at all levels which includes no less than:

 

(1)  Assessment of rehabilitation outcomes using measures currently adopted by CMS for rehabilitation hospitals; and

 

(2)  A mechanism to assure the utilization of systematic data collection based on valid samples of the total patient population to measure performance and patient results, and to make recommendations to physicians and centers of needed changes.

 

          (i)  Rehabilitation hospitals shall be exempt from He-P 802.34.

 

Source.  #13166, eff 1-28-21 (formerly He-P 802.34)

 

          He-P 802.38  Freestanding Hospital Emergency Facility.

 

          (a)  A freestanding hospital emergency facility, as defined in He-P 802.03(aj), shall be governed by the same regulations as a general hospital with the following additions:

 

(1)  Each FHEF shall be owned and operated by a licensed parent general hospital, that participates in Medicare; and

 

(2)  Shall document how the needs of patients will be met during hours when the FHEF is not in operation.

 

          (b)  Each FHEF shall have a full-time administrator who may also be the administrator of the parent hospital and who:

 

(1)  Meets the requirements for an administrator as defined in He-P 802.16(b)(1)-(2); and

 

(2)  Shall be responsible to the parent hospital administrator or governing body for the daily management and operation of the hospital which shall act as liaison to the parent hospital for the patients and personnel of the FHEF, in addition to those responsibilities defined in He-P 802.16(b).

 

          (c)  The FHEF medical staff shall be members of the parent hospital in accordance with the parent hospital by-laws.

 

          (d)  The FHEF shall have a medical director of emergency services.

 

          (e)  The medical director of emergency services shall meet the requirements set forth in He-P 802.31(a) and (b).

 

          (f)  The director of nursing services shall, in lieu of the requirements in He-P 802.16(e) and (f):

 

(1)  Be part of the parent hospital’s single organized nursing services;

 

(2)  Be at least a registered nurse currently licensed in New Hampshire;

 

(3)  Have a bachelor’s degree in nursing or related field; and

 

(4)  Hold a current certificate in advanced cardiac life support from the American Heart Association and be an emergency nurse certified by the Board of Certification for Emergency Nursing.

 

          (g)  Each FHEF shall provide the services disclosed under He-P 802.18(a).

 

          (h)  An existing parent hospital shall be responsible for providing information required in He-P 802.18(b)(1)-(5) as applicable.

 

          (i)  The FHEF shall offer comprehensive emergency care 24 hours a day, 7 days a week.

 

          (j)  The FHEF shall have at least one physician experienced in emergency care present in the emergency care area or able to be present within 5 minutes during the entire hours of operation.

 

          (k)  Emergency service policies and procedures regarding assessment and treatment by physicians and other personnel shall be developed by the parent hospital and followed by the FHEF.

 

          (l)  The parent hospital’s procedure to handle suspected or alleged cases of child or adult abuse or neglect and emergency service shall be utilized by the FHEF and the personnel shall be trained in this procedure.

 

          (m)  Patients who require hospital admission shall be evaluated and stabilized prior to transfer to the parent hospital or hospital of the patient’s choice.

 

          (n)  Patients who are treated and released from the FHEF shall be discharged and treated in accordance with He-P 802.18(g).

 

          (o)  A medical record shall be maintained and kept active for each patient admitted to the freestanding hospital emergency facility and shall be subject to all rules under He-P 802.19, and in the event of transfer to a hospital, copies of the record of the medical assessment and notes about treatments given shall be transferred with the patient while the original record shall be maintained in the FHEF.

 

          (p)  An emergency laboratory shall be available to the FHEF during all hours of operation.

 

Source.  #13166, eff 1-28-21 (formerly He-P 802.35)

 

          He-P 802.39  Cardiac Catheterization Services.

 

          (a)  If cardiac catheterization services have not been provided by the hospital previously, no licensee shall offer cardiac catheterization services without a special health care service license.

 

          (b)  In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide cardiac catheterization services, regardless of whether the licensee holds a special health care license.

 

          (c)  Cardiac catheterization laboratory services shall only be provided on the campus of a licensed hospital.

 

          (d)  Licensed hospitals providing interventional cardiac catheterization laboratory services without on-site open-heart surgery shall secure and maintain a formal transfer agreement with a hospital performing open heart surgery.

 

          (e)  Licensed hospitals providing elective interventional cardiac catheterization laboratories shall also provide primary interventional cardiac catheterization laboratory services within 12 months of commencement of elective interventional cardiac catheterization laboratory services.

 

          (f)  Licensed hospitals providing primary interventional cardiac catheterization services shall meet the procedure volume requirements of 150 cardiac catheterization procedures of any kind at the licensed location on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any twelve-month period.

 

          (g)  Cardiac catheterization laboratories performing only diagnostic catheterization procedures and not interventional catheterization procedures shall not have any minimum volume requirements.

 

          (h)  Hospitals providing cardiac catheterization laboratory services shall include cardiac catheterization laboratory services in the hospital’s quality assurance plan to objectively and systematically monitor patient care.

 

          (i)  The quality assurance plan referenced in (h) above shall:

 

(1)  Contain patient selection criteria by procedures;

 

(2)  Contain formal transfer agreements and emergency protocols for transfer to another facility which:

 

a.  Specify the protocol for transfer to another facility; and

 

b.  Include the signature of both hospitals and be dated within the past 12 months of submission with the application;

 

(3)  Describe the mentoring program for licensed physicians, which shall include operator volume requirements; and

 

(4)  Describe the process of review and outcomes analysis for patients who have been transferred without compromising the statutory confidentiality protection of the hospital’s quality assurance program.

 

          (j)  All licensees performing cardiac catheterization laboratory services shall be accredited by a recognized accrediting agency for the provision of cardiac catheterization laboratory services.

          (k)  If the licensee is newly providing cardiac catheterization services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (j) above.

 

          (l)  Staffing for cardiac catheterization laboratory services shall be in accordance with the accrediting agency’s accepted staffing requirements.

 

          (m)  Cardiac catheterization laboratory services shall be directed and staffed by a board certified cardiologist with training and experience, which meets or exceeds the requirements of “ACCF/AHA/SCAI’s “2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures” (July 2013), available as noted in Appendix A.

 

Source.  #13166, eff 1-28-21

 

          He-P 802.40  Open Heart Surgery Services.

 

          (a)  If open heart surgery services have not been provided by the hospital previously, no licensee shall offer open heart surgery services without a special health care service license.

 

          (b)  In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide open heart surgery services, regardless of whether the licensee holds a special health care license.

 

          (c)  Open heart surgery services shall be available and accessible on-site 24 hours per day, 7 days per week, for emergency purposes.

 

          (d)  All licensees performing open heart surgery services shall be accredited by a recognized accrediting agency for the provision of open heart surgery services.

 

          (e)  If the licensee is newly providing open heart surgery services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (d) above.

 

          (f)  Staffing for open heart surgery services shall be in accordance with the accrediting agency’s accepted staffing requirements.

 

          (g)  Each open heart surgery program shall provide, at a minimum, the following:

 

(1)  A total of 4 segregated/private beds for cardiac care in an ICU;

 

(2)  A telemetry unit proximate to the ICU;

 

(3)  An acute renal dialysis service;

 

(4)  A cardiac rehabilitation service;

 

(5)  A minimum of 2 operating rooms equipped and available as needed for open heart surgery;

 

(6)  An in-house cardiac catheterization service; and

 

(7)  An available and accessible supply of blood and platelets, through an in-house supply or through affiliation with an established blood bank network.

 

          (h)  The licensee shall establish and maintain:

 

(1)  A quality assurance plan that includes:

 

a. An outline of utilization, or peer review and control programs, or both; and

 

b.  An annual review of the morbidity and mortality rates and other indicators of patient outcomes, compared with regional or national averages;

 

(2)  Protocols governing transfers, admissions, and discharges of open-heart surgery patients; and

 

(3)  Protocols to establish, maintain, and annually review including:

 

a.  A list of indications and contraindications to govern patient selection for open heart surgery;

 

b.  Guidelines governing the admission of open heart surgery patients to the intensive care, coronary care and progressive care units, and discharge from these units; and

 

c.  Mechanisms for follow-up surveillance of discharged patients.

 

          (i)  Licensee’s providing open heart surgery shall subscribe, for the purpose of external quality review, to a confidential data registry. 

 

          (j)  The licensee shall have the appropriate equipment to adequately perform open-heart surgery as required by the accrediting agency.

 

          (k)  Each licensee performing open heart surgery shall perform 150 open heart surgery cases on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any twelve-month period.

 

Source.  #13166, eff 1-28-21

 

          He-P 802.41  Megavoltage Radiation Therapy Services.

 

          (a)  If megavoltage radiation therapy services have not been provided by the hospital previously, no licensee shall offer megavoltage radiation therapy services without a special health care service license.

 

          (b)  In accordance with RSA 151:2-e, all licensees shall comply with this section if they provide megavoltage radiation therapy services, regardless of whether the licensee holds a special health care license.

 

          (c)  The licensee shall appoint a chief of radiation oncology who shall be certified in radiation oncology and responsible for:

 

(1)  Overseeing the services provided to ensure safe and quality care;

 

(2)  Ensuring personnel are qualified to perform megavoltage radiation therapy services in accordance with He-P 4000; and

 

(3)  Establishing procedures necessary to ensure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained commensurate to their duties in the operation and use of x-ray or radiation therapy equipment.

 

          (d)  A radiation oncologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000.

 

          (e)  A licensee providing treatment on megavoltage radiation therapy equipment shall ensure the provision of a comprehensive coordinated care plan which may include:

 

(1)  Clinical oncology services, including chemotherapy and surgical treatment of tumors and follow-up capabilities;

(2)  Services of a tumor registry;

 

(3)  Services of a simulation capability and dose computation equipment;

 

(4)  Services of a pathology laboratory;

 

(5)  Services of a physics laboratory;

 

(6)  Computerized tomography and/or magnetic resonance imaging capability;

 

(7)  Social work and counseling;

 

(8)  Brachytherapy or a referral arrangement for provision of the service;

 

(9)  Nutrition and dietary consultation; and

 

(10) In-house capabilities encompassing the full range of radiation therapy modalities, including megavoltage equipment and superficial treatment equipment and systemic therapy or referral arrangements for the provision of these services.

 

          (f)  All licensees performing megavoltage radiation services shall be accredited by a recognized accrediting agency for the provision of megavoltage radiation therapy services.

 

          (g)  If the licensee is newly providing megavoltage radiation therapy services, the licensee shall have 3 years, from the date of receiving a special health care license, to obtain accreditation required in (f) above.

 

          (h)  Staffing for megavoltage radiation therapy services shall be in accordance with the accrediting agency’s accepted staffing requirements.

 

          (i)  No licensee shall provide megavoltage radiation therapy services unless the program will treat a minimum of 200 patients on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any 12-month period for cognitive planning process codes.

 

          (j)  Any licensee holding a special health care service license to provide megavoltage radiation therapy services not on hospital premises shall adopt protocols for the transportation of patients for the provision of necessary support and emergency services, which shall include a written agreement for the acceptance and transfer of patients needing such emergency care, with the nearest acute care hospital or any acute care hospital within 30 minutes travel time.

 

Source.  #13166, eff 1-28-21

 

PART He-P 803  NEW HAMPSHIRE NURSING HOME RULES

 

          He-P 803.01  Purpose.  The purpose of this part is to set forth the classification of and licensing requirements for nursing home facilities pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(3).

 

Source.  #2191, eff 11-25-82; amd by #2640, eff 3-7-84; ss by #3193, eff 1-28-86; amd by #4232, eff 2-23-87; amd by #4349, eff 12-28-87; amd by #4517, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5644, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association or other legal entity operating a nursing home, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(h); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of residents;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to residents; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving residents without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrator” means the person responsible for the management of the licensed premises, who is licensed by the state of New Hampshire pursuant to RSA 151, and who reports to and is accountable to the governing body.

 

          (f)  “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (g)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions.  The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (h)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies, or other companies as the commissioner shall decide.

 

          (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA-J:34-37.

 

          (j)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a nursing home pursuant to RSA 151.

 

          (k)  “Area of non-compliance” means any action or failure to act that cause(s) a licensee to be out of compliance with RSA 151, He-P 803, or other applicable federal and state requirements.

 

          (l)  “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the resident to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

 

          (m) “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the resident, and the resident’s guardian, agent, or personal representative, if any, as a result of the assessment process, for the provision of care and services to a resident.

 

          (n)  “Certified nursing home” means a nursing home that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 803.

 

          (o)  “Change of ownership” means change in the controlling interest of an established nursing home to an individual or successor business entity.

 

          (p)  “Chemical restraint” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.

 

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

 

          (r)  “Core services” means those minimal services to be provided to any resident that must be included in the basic rate.

 

          (s)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological

helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (t)  “Days” means calendar days, unless otherwise specified.

 

          (u)  “Department” means the New Hampshire department of health and human services.

 

          (v)  “Direct care” means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (w)  “Direct care personnel” means any person providing direct care to a resident.

 

          (x)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (y)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs.  This term also includes “do not attempt resuscitation order (DNAR order).

 

          (z) “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

 

          (aa)  “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

 

          (ab)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (ac) “Equipment” means “any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services”, not to include portable refrigerators.  This term includes fixtures.

 

          (ad)  “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ae)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (af)  “Governing body” means a group of designated person(s) that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

 

          (ag)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the resident’s person and/or estate.

 

          (ah)  “Health care occupancy” means an occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical, or mental disability, or because of security measures not under the occupant’s control.

 

          (ai)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries.  ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (aj)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (ak)  “Informed consent” means the decision by a resident, his or her guardian or agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (al)  “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (am) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 803 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 803.

 

          (an)  “License” means the document issued by the department to an applicant at the start of operation as a nursing home which authorizes operation as a nursing home in accordance with RSA 151 and He-P 803, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date and the license number.

 

          (ao) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the nursing home is licensed for.

 

          (ap)  “Licensed practitioner” means:  

 

(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 New Hampshire licensing board.

 

          (aq)  “Licensed premises” means the building or buildings that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (ar) “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (as)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (at)  “Mechanical restraint” means a device designed to prohibit a resident’s free movement, including full bed rails, gates that prohibit a resident’s free movement throughout the living areas of a unit, half doors that prohibit a residents free movement throughout the living areas of a unit, geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will, wrist or ankle restraints, vests or pelvic restraints, or other similar devices that prevent a resident’s free movement.

 

          (au)  “Medical director” means a physician licensed in New Hampshire pursuant to RSA 329 or 326-B, who is responsible for the implementation of resident care policies and the coordination of medical care in the facility.

 

          (av) “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

 

          (aw) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  The term does not include repair or replacement of interior finishes.

 

          (ax)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health and safety of any resident.

 

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

 

          (az) “Nursing home(s)” means a place which provides for 2 or more persons basic domiciliary services, including board, room, and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.

 

          (ba) “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

 

          (bb) “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bc)  “Over-the-counter medications” means non-prescription medications.

 

          (bd)  “Owner” means a person or organization who has controlling interest in the nursing home.

 

          (be) “Patient or resident rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

 

          (bf)  “Personal representative” means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

 

          (bg)  “Personnel” means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a resident(s).

 

          (bh) “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the resident’s freedom of movement.

 

          (bi) “Physician” means a medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329, or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

 

          (bj)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

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

 

          (bm)  “Protective care” means the provision of resident monitoring services, including but not limited to:

 

(1)  Knowledge of resident whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (bn)  “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

 

          (bo) “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.        

 

          (bp)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (bq)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (br) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (bs)  “Resident” means any individual residing in and receiving care from a nursing home licensed in accordance with RSA 151 and all other federal and state requirements.

 

          (bt)  “Resident record” means documents maintained for each resident receiving care and services, which includes all documentation required by RSA 151, He-P 803, and all documentation compiled relative to the resident as required by other federal and state requirements.

 

          (bu)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

 

          (bv)  “Significant change” means a decline or improvement in a resident’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the resident’s health status; and

 

(3)  Requires interdisciplinary review and/or revision of the care plan.

 

          (bw)  “State monitoring” means the placement of individuals by the department at a nursing home to monitor the operation and conditions of the facility.

 

          (bx)  “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease or clinical conditions.

 

          (by)  “Unusual incident” means an occurrence of any of the following while the resident is either in the nursing home or in the care of nursing home personnel:

 

(1)  The unanticipated death of a resident that is not related to their diagnosis or underlying condition;

 

(2)  An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and that has resulted in an injury that requires treatment in an emergency room or by a licensed practitioner; or

 

(3)  An elopement from the nursing home or other circumstances that resulted in the notification and/or involvement of law enforcement or safety officials.

 

(bz) “Underwriters Laboratories (UL) listed” means that a product has been confirmed safe for use by a the global safety certification company UL.

 

          (ca)  “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (March 2019), signed by the applicant or 2 of the corporate officers, affirming to the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance.  I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

b.  For any nursing home to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any nursing home to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical assess hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  A floor plan of the prospective nursing home;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  List of affiliated or related parties;

 

(5)  The applicable fee in accordance with RSA 151:5, IV, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(6)  A resume identifying the qualifications of the nursing home administrator;

 

(7)  Copies of licenses for the nursing home administrator;

 

(8)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the health care chapter of the Life Safety Code 101 and the Uniform Fire Code, NFPA 1, 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; and

 

b.  For a building under construction, the written approvals required by a.  above shall be submitted at the end of construction based on the local official’s review of the building plans and their final onsite inspection of the construction project;

 

(9)  If the nursing home uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill;

 

(10)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, medical director, administrator, and any officer, director, shareholder, or general or limited partner thereof, as applicable;

 

(11) The previous 5 years of regulatory compliance history of the prospective licensee in providing long term care in New Hampshire, including by compliance with applicable statutes and regulations governing the operation of long term care facilities;

 

(12) The previous 5 years of regulatory compliance history of the prospective licensee in providing long term care in states other than New Hampshire, if any, including compliance with the applicable statutes and regulations governing the operation of long term care facilities in said states; and

 

(13)  Any waiver requests if applicable.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #9856-B, eff 1-26-11; ss by #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 803.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 803.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 803.

 

          (f)  Unless a waiver has been granted, the department shall deny a licensing request after reviewing the information in He-P 803.04(a)(9) above if it determines that the applicant, proposed licensee or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of residents.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 803.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 803.04(a)(1) and (5);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 803.10(f), if applicable; and

 

(4)  A statement identifying any variances applied for or granted by the state fire marshal.

 

          (d)  In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

 

          (e)  Following an inspection, as described in He-P 803.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) and (d) above as applicable, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 803 at the renewal inspection.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.07  Nursing Home Construction, Alterations or Renovations.

 

          (a)  At least 60 days prior to initiating construction, the nursing home shall provide to the department notice and stamped architectural, sprinkler, and fire alarm plans drawn to scale for any of the following including but not limited to:

 

(1)  A new building;

 

(2)  An addition or renovation to an existing building;

 

(3)  Structural alterations to any resident area;

 

(4)  Alterations that require approval from local or state authorities; and

 

(5)  Alterations that might affect compliance with the health and safety, fire or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

 

          (b)  The department shall review plans for construction, renovation or structural alterations of a nursing home for compliance with all applicable sections of RSA 151 and He-P 803 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

 

          (c)  Department approval shall not be required prior to initiating construction, renovations or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

          (d)  The nursing home shall comply with all applicable licensing rules when undertaking construction, renovations or structural alterations.

 

          (e)  A licensee or applicant constructing, renovating, or structurally altering a building shall comply with the following:

 

(1)  Saf-C 6000 and the state fire code under RSA 153:1, VI-a, including, but not limited to, NFPA 1 and NFPA 101 and as amended in Saf-FMO 300 by the fire marshal with the board of fire control and ratified by the general court pursuant to RSA 153:5;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3) The Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

 

          (f)  All nursing homes newly constructed or undergoing modification after the 2019 effective date of He-P 803 shall comply with the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

 

          (g)  Where renovation or structural alteration work is done within an existing facility, all such work shall comply, insofar as practical, with applicable sections of the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A.

 

 

          (h)  The department’s health facilities administration shall be the authority having jurisdiction for the application of the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A, and shall negotiate compliance and grant waivers in accordance with He-P 803.10 as appropriate.

 

          (i)  Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless otherwise specified.

 

          (j)  The completed building shall be subject to an inspection pursuant to He-P 803.09 prior to its use.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.08  Nursing Home Requirements for Organizational Changes.

 

          (a)  The nursing home shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Capacity; or

 

(6)  Affiliated parties or related parties.

 

          (b)  When there is a change in the name, the nursing home shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (c)  The nursing home shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of residents beyond what is authorized under the current license.

 

          (d)  When there is a change in address without a change in location the nursing home shall provide the department with a copy of the notification from the local, state or federal agency that requires the change.

 

          (e)  The nursing home shall inform the department in writing as soon as possible prior to a change in administrator and provide the department with the following:

 

(1)  The information specified in He-P 803.04(a)(9) if not currently employed by the licensee; and

 

(2)  Copies of applicable licenses for the new administrator.

 

          (f)  An inspection by the department shall be conducted prior to operation when there are changes in the following:

 

(1)  Ownership, unless the current licensee has no outstanding administrative actions in process and there will be no changes made by the new owner in the scope of services provided;

 

(2)  The physical location; or

 

(3)  An increase in the number of residents beyond what is authorized under the current license.

 

          (g)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

          (h)  A revised license and license certificate shall be issued for changes in the nursing home’s name.

 

          (i)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in the number of residents from what is authorized under the current license; or

 

(3)  When a waiver has been granted.

 

          (j)  Licenses issued under (f)(1) above shall expire on the date the license issued to the previous owner would have expired.

 

          (k)  The licensee shall return the previous license to the division within 10 days of the nursing home changing its ownership, physical location, address or name.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 803, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the nursing home; and

 

(3)  Any records required by RSA 151 and He-P 803.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 803, to include a clinical and a life safety inspection, prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 803.08(f)(1);

 

(3)  A change in the licensee’s physical location;

 

(4) A relocation within the facility or an increase in the number of beds beyond what is authorized under the current license;

 

(5)  Occupation of space after construction, renovations or structural alterations; or

 

(6)  The renewal of a license for non-certified nursing homes.

 

          (c)  In addition to (b) above, the department shall verify the implementation of any POC accepted or issued by the department.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 803 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought; and

 

(4)  The period of time for which the waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not have the potential to negatively impact the health or safety of the residents; and

 

(3)  Does not negatively affect the quality of resident services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.11  Complaints.

 

(a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  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 person who has first-hand knowledge regarding the allegation(s); and

 

(2)  There is 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 RSA 151 or He-P 803.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the nursing home, or the alleged unlicensed individual or entity;

 

(2)  The name, address and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 803.

 

          (c)  Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including:

 

(1)  Requests for additional information from the complainant or the licensee;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For the nursing home, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of alleged violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 803, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 803.12(c).

 

          (e)  For the unlicensed individual or entity the department shall provide written notification to the owner or person responsible that includes:

 

(1)  The date of inspection;

 

(2)  The reasons for the inspection; and

 

(3)  Whether or not the inspection resulted in a determination that the services being provided require licensing under RSA 151:2, I(e)(2).

 

          (f)  The owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (f) above to respond to a finding that they are operating without a license or submit a completed application for a license in accordance with RSA 151:7-a, II.

 

          (g)  If the owner of an unlicensed nursing home does not comply with (g) above, or if the department does not agree with the owner’s response, the department shall:

 

(1)  Issue a written warning to immediately comply with RSA 151 and He-P 803; and

 

(2)  Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III.

 

          (h)  Any person or entity who fails to comply after receiving a warning, as described in (h) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (i)  The fact that the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 803, or other applicable laws.

 

          (j)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 803, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC;

 

(2)  Imposing a directed POC upon a licensee;

 

(3)  Imposing fines upon an unlicensed individual, applicant or licensee;

 

(4)  Immediate suspension of a license; or

 

(5)  Revocation of a license.

 

          (b)  When fines are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance;

 

(2)  Identifies the specific remedy(s) that has been proposed; and

 

(3)  Provides the licensee with the following information:

 

a.  The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the fine becoming final; and

 

b.  The automatic reduction of a fine by 25% if the licensee waives the right to a hearing, the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a notice of areas of non-compliance, the licensee shall submit a POC detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur; and

 

c.  The date by which each area of non-compliance shall be corrected;

 

(2)  The licensee shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the inspection report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 803;

 

b.  Addresses all areas of non-compliance and deficient practices as cited in the inspection report;

 

c.  Prevents a new violation of RSA 151 or He-P 803 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 -day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 803.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with (f)(12) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and employees;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine;

 

(3)  Deny the application for a renewal of a license; or

 

(4)  Revoke or suspend the license in accordance with He-P 803.13.

 

          (f)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2 the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 803.11(g), the fine shall be $500.00;

 

(5)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 803.06(b), the fine shall be $100.00;

 

(6)  For a failure to notify the department prior to a change of ownership, in violation of He-P 803.08(a)(1), the fine shall be $500.00;

 

(7)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 803.08(a)(2), the fine shall be $500.00;

 

(8)  For a refusal to allow access by the department to the nursing home’s premises, programs, services or records, in violation of He-P 803.09(a), the fine for an applicant, individual, or licensee shall be $2000.00;

 

(9)  For refusal to cooperate with the inspection or investigation conducted by the department the fine shall be $ 2000.00;

 

(10)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 803.12(c)(2) or (5)(b), the fine for a licensee shall be $100.00 unless an extension has been granted by the department;

 

(11)  For a failure to implement any POC that has been accepted or issued by the department, in violation of He-P 803.12(c)(8), the fine for a licensee shall be $1000.00;

 

(12)  For a failure to establish, implement, or comply with licensee policies, after being notified in writing by the department of the need to establish, implement or comply with licensee policies, as required by He-P 803.14(c), the fine for a licensee shall be $500.00;

 

(13)  For a failure to provide services or programs required by the licensing classification and specified by He-P 803.14(b), the fine for a licensee shall be $500.00; 

 

(14)  For exceeding the maximum number of residents, in violation of He-P 803.14(k), the fine for a licensee shall be $500.00; 

 

(15)  For moving a current resident to an unlicensed space prior to approval from the department, the fine for a licensee shall be $500.00;

 

(16)  For falsification of information contained on an application or of any records required to be maintained for licensing, in violation of He-P 803.14(f), the fine shall be $500.00 per offense;

 

(17)  For a failure to meet the needs of the resident, in violation of He-P 803.14(i)(1), the fine for a licensee shall be $500.00;

 

(18)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 803.17(b)(1) and 803.18(d)(3), the fine for a licensee shall be $500.00;

 

(19)  For failure to report an unusual incident as required by He-P 803.14(t), the fine for a licensee shall be $500.00 per occurrence;

 

(20)  For failure to submit architectural sprinkler and fire alarm plans or drawings, when applicable, prior to undertaking construction or renovation of a proposed and or licensed facility in violation of He-P 803.07(a), the fine shall be $500.00;

 

(21)  When an inspection determines that a violation of RSA 151 or He-P 803 has the potential to jeopardize the health, safety or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the initial fine, but not to exceed $2000.00; and

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a.  above, the fine for a licensee shall be triple the fine, but not to exceed $2000.00;

 

(22)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 803 shall constitute a separate violation and shall be fined in accordance with He-P 803.12(f); and

 

(23)  If the applicant or licensee is making good faith efforts to comply with the violations of the provisions of RSA 151 or He-P 803, the department shall not issue a daily fine.

 

          (g)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

          He-P 803.13  Enforcement Actions and Hearings.

 

          (a)  At the time of imposing a fine, or denying, revoking or suspending a license, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department; and

 

(3)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 803, which violations have the potential to harm a resident’s health, safety or well-being;

 

(2)  An applicant or a licensee has failed to pay a fine imposed under administrative remedies;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 803.04;

 

(5)  An applicant, licensee or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 803.12(c), (d), and (e);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 803 for the same violations within the last 5 inspections;

 

(8)  A licensee, including corporation officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(9)  Upon inspection, the applicant’s premises is not in compliance with RSA 151 or He-P 803;

 

(10)  The department makes a determination that one or more of the factors in He-P 803.05(f) is true; or

 

(11)  The applicant or licensee fails to employ a qualified administrator.

 

          (c)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (d)  If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

 

          (e)  The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of residents when it finds that the health, safety or welfare of residents is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (f)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 803 is achieved.

 

          (g)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (h)  When a nursing home’s license has been denied or revoked, the applicant or licensee shall not be eligible to reapply for a license for 5 years, and the action shall be reported to the New Hampshire nursing home administrator licensing board for investigation and review of the administrator’s role if any.

 

          (i)  The 5 year period referenced in (h) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (j)  Notwithstanding (h) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 803.

 

          (k)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (l)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 803.

 

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

 

          (n)  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.

 

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

 

          (p)  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.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

 

          (b)  The licensee shall define, in writing, the scope and type of services to be provided by the nursing home, which shall include, at a minimum, the core services listed in He-P 803.15(d).

 

          (c)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the nursing home.

 

          (d)  All policies and procedures shall be reviewed per licensee policy.

 

          (e)  The licensee shall assess and monitor the quality of care and service provided to residents on an ongoing basis.

 

          (f)  The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The nursing home shall not:

 

(1)  Advertise or otherwise represent itself as operating a nursing home, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  Licensees shall:

 

(1)  Meet the needs of the residents during those hours that the residents are in the care of the nursing home;

 

(2)  Initiate action to maintain the nursing home in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the nursing home;

 

(4)  Appoint an administrator who shall meet the requirements of He-P 803.17(b)(1);

 

(5)  Appoint a medical director who shall meet the requirements of He-P 803.17(a);

 

(6)  Verify the qualifications of all personnel;

 

(7)  Provide sufficient numbers of personnel who are present in the nursing home and are qualified to meet the needs of residents during all hours of operation;

 

(8)  Provide the nursing home with sufficient supplies, equipment, and lighting to meet the needs of the residents;

 

(9)  Implement any POC that has been accepted by the department; and

 

(10)  Comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (j)  The licensee shall consider all residents to be competent and capable of making health care decisions unless the resident:

 

(1)  Has a guardian appointed by a court of competent jurisdiction;

 

(2)  Has a durable power of attorney for health care that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (k)  The licensee shall not exceed the number of occupants authorized by NFPA 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and identified on the licensing certificate.

 

          (l)  If the licensee accepts a resident who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the residents, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions:  Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

 

          (m)  The licensee shall report all positive tuberculosis test results for employees to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (n)  The licensee shall implement measures to ensure the safety of residents who are assessed as an elopement risk or danger to self or others.

 

          (o)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 803.09(b), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the nursing home website if available; and

 

(6)  The licensee’s floor plan for fire safety, evacuation and emergencies identifying the location of, and access to all fire exits.

 

          (p)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (q)  A licensee shall, upon request, provide a resident or the resident’s guardian or agent, if any, with a copy of his or her resident record pursuant to the provisions of RSA 151:21, X.

 

          (r)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and employees that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to residents and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to residents and personnel.

 

          (s)  Accidents, injuries, and unusual incidents shall be documented, including:

 

(1)  The date and time of the occurrence;

 

(2)  A description of the occurrence, including identification of injuries, if applicable;

 

(3)  The actions taken;

 

(4)  The signature of the person documenting the occurrence; and

 

(5)  If medical intervention was required, the date and time that the emergency contact person and guardian or agent, if any, and the licensed practitioner were notified.

 

          (t)  For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property the licensee shall :

 

(1)  Notify the department by faxing a notice to 603 271-5574 within 24 hours from the time the reportable incident, allegation of abuse, neglect, mistreatment, or misappropriation becomes known, that an investigation is in progress containing the following information:

 

a.  The nursing home name;

 

b.  A description of the incident including identification of injuries, if applicable;

 

c.  The name of resident;

 

d.  The date and time of the incident;

 

e.  If medical intervention was required, and if so, please provide:

 

1.  Who the medical intervention was provided by;

 

2.  The date the medical intervention was provided; and

 

3.  The time the medical intervention was provided; and

 

f.  When the practitioner and the resident representative was notified, if applicable; and

 

(2)  Within 5 days, submit a completed investigation report to the department containing the following information: 

 

a.  All items referenced in (1) above;

 

b.  The names and results of interview(s) with all personnel, resident(s), or other individuals involved in the unusual incident, including all applicable statement signatures; and

 

c.  The action taken by the licensee in direct response to the unusual incident(s), including any and all follow-up;

 

(3)  Immediately notify the local police department, the department, guardian, agent or personal representative, if any, when a resident, has eloped, after the licensee has searched the building and the grounds of the nursing home; and

 

(4)  Submit additional information, if required by the department, to support the incident report referenced in (t)(2) above.

 

          (u)  The licensee shall provide cleaning and maintenance services, as needed to protect residents, employees, and the public.

 

          (v)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

 

          (w)  Smoking shall be prohibited in the nursing home per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

 

          (x)  If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other residents.

 

          (y)  At the time of admission the licensee shall give a resident and the resident’s guardian, agent, or personal representative, a listing of all known applicable charges and identify what care and services are included in the charge.

 

          (z)  The licensee shall give a resident 30 days written notice for an increase in the cost or fees for any nursing home services.

 

          (aa)  Except as required to protect the health, safety, and well-being of the resident or other residents, prior to a resident room or bed location change, the licensee shall:

 

(1)  Provide written notice to the resident and/or the resident’s guardian or agent, as applicable, including:

 

a.  The reason for the change;

 

b.  The effective date of the change; and

 

c.  The location to which the resident is being moved;

 

(2)  Provide verbal notice to the resident and/or the resident’s guardian or agent, as applicable, including performing the following:

 

a.  Learning the resident’s preferences and taking them into account when discussing changes of rooms or roommates and the timing of such changes;

 

b.  Explaining to the resident the reason for the move; and

 

c.  Providing the opportunity to see the new location, meet the new roommate, and ask questions about the move;

 

(3)  For a resident who is receiving a new roommate, give that resident as much notice and information about the new person as possible, while maintaining confidentiality regarding medical information; and

 

(4)  Document all information contained in (1)-(3) above in the resident record.

 

          (ab)  The licensee shall develop and follow policies and procedures regarding resident room or bed location changes.

 

          (ac)  Following the death of a roommate, the licensee shall facilitate the provision of social services for the resident as needed.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.15  Required Services.

 

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

 

(1)  Is responsible for the day-to-day operations of the nursing home;

 

(2)  Meets the requirements of He-P 803.17(b)(1); and

 

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

 

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

 

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

 

(1)  An admissions packet including the following information:

 

a.  The basic daily, weekly, or monthly rate;

 

b.  A list of the core services required by He-P 803.14(b);

 

c.  Information regarding the timing and frequency of cost of care increases;

 

d.  The nursing home’s house rules;

 

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

 

f.  The nursing home’s policy for resident discharge planning;

 

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

 

1.  The availability of services;

 

2.  The nursing home’s responsibility for arranging services; and

 

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

 

h.  Information regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

4.  Monitoring third party services contracted directly by the resident and provided on the nursing home premises;

 

5.  Handling of resident funds pursuant to RSA 151:24 and He-P 803.14(y);

 

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

 

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

 

8.  Smoking;

 

9.  Roommates; and

 

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

 

(2)  A copy of the patients’ bill of rights under RSA 151:21 and the nursing home’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

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

 

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

 

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

 

(6)  Information on advanced directives.

 

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

 

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

 

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

 

(3)  Emergency response and crisis intervention;

 

(4)  Medication services in accordance with He-P 803.16;

 

(5)  Food services in accordance with He-P 803.20;

 

(6)  Housekeeping, laundry and maintenance services;

 

(7)  On-site activities and/or access to community activities designed to meet the individual interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents; and

 

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

 

          (e)  The licensee shall:

 

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

 

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

 

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

 

          (f)  At the time of a resident’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions, treatments, diet, c, and any other pertinent interventions to maintain the residents health and safety needs .

 

          (g)  The licensee shall have each resident seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.  During this visit a health examination shall be completed and documented.

 

          (h)  The health examination referenced in (g) above shall include in the medical record:

 

(1)  Diagnoses, if any;

 

(2)  Medical history;

 

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

 

(4)  Vital signs;

 

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

 

(6)  Allergies; and

 

(7)  Dietary needs.

 

          (i)  Assessments utilizing the 3.0 version of the Centers for Medicare and Medicaid Services Resident Assessment Instrument (RAI) including the minimum data set (MDS) with care area assessment (CAA) shall be completed on each resident as follows:

 

(1)  A comprehensive MDS shall be completed within 14 days after admission;

 

(2)  A comprehensive MDS shall be repeated annually or after any significant change, as defined in He-P 803.03(bw); and

 

(3)  A quarterly MDS shall be completed at least every 3 months.

 

          (j)  The care plan portion of the RAI shall be developed within 14 days of the MDS and revised based on needs identified by the MDS.

 

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

 

          (l)  The nursing care plan shall:

 

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

 

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

 

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

 

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

 

          (n)  Pursuant to RSA 151:21, IX, residents shall be free from chemical and physical restraints except when they are authorized in writing by a licensed practitioner for a specific and limited time necessary to protect the resident or others from injury, or as permitted by the CMS conditions of participation, or as allowed by (o) below and He-P 803.21(d).

 

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

 

          (p)  The nursing home shall have written policies and procedures for implementing physical, chemical, and mechanical restraints, including:

 

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

 

(2)  When restraints may be used;

 

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

 

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

 

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

 

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

 

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

 

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

 

          (q)  A resident may refuse all care and services.

 

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

 

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

 

(2)  Notify the licensed practitioner of the resident’s refusal of care;

 

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

 

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

 

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

 

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

 

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

 

(3)  Diagnosis, as applicable;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

(8)  Insurance information;

 

(9)  Advanced directives; and

 

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

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.16  Medication Services.

 

          (a)  All medications shall be administered in accordance with the orders of the licensed practitioner.

 

          (b)  Medications, treatments and diets ordered by the licensed practitioner shall be made available to the resident within 24 hours of the order, or in accordance with the licensed practitioner’s direction.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the nursing home;

 

(2)  Reorder medications for use at the nursing home; and

 

(3)  Receive and record new medication orders.

 

          (d)  For each prescription medication being taken by a resident, the licensee shall maintain one of the following:

 

(1)  The original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

 

(2)  A copy of the original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers.

 

          (e)  Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

 

(1)  The resident’s name:

 

(2)  The medication name, strength, and prescribed dose and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated original or electronic signature of the ordering practitioner.

 

          (f)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s order and labeled with the resident’s name.

 

          (g)  The label of all medication containers maintained in the nursing home shall match the current orders of the licensed practitioner and include the expiration date of the medication unless authorized by (aa) below.

 

          (h)  Except as allowed by (f) above and (i) below, only a pharmacist shall make changes to prescription medication container labels.

 

          (i)  When the licensed practitioner changes the dose of a medication and personnel of the nursing home are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the nursing home’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (j)  Any change or discontinuation of medications taken at the nursing home shall be pursuant to an order from a licensed practitioner or other professional with prescriptive powers.

 

          (k)  The licensee shall require that all telephone orders for medications, treatments, and diets are immediately transcribed and signed by the individual receiving the order.

 

          (l)  The transcribed order in (k) above shall be counter-signed by the authorized provider within 30 days of receipt or next visit but not to exceed 60 days.

 

          (m)  The licensee shall obtain an order from a licensed practitioner for all over-the-counter medications.

 

          (n)  The medication storage area shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature per manufacturer’s requirements.

 

          (o)  All medications at the nursing home shall be kept in the original containers or packaging and properly closed after each use.

 

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

 

          (q)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the nursing home, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (r)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (s)  All contaminated, expired or discontinued medication shall be destroyed within 90 days of the expiration date, the end date of a licensed practitioner’s orders or the date the medication becomes contaminated, whichever occurs first.

 

          (t)  Controlled drugs shall be destroyed only in accordance with state law.

 

          (u)  Medication(s) may be returned to pharmacies for credit only as allowed by the law.

 

          (v)  If a resident is going to be absent from the nursing home at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication shall be given to the person responsible for the resident while the resident is away from the nursing home.

 

          (w)  Upon discharge or transfer, the licensee may make the resident’s current medications available to the resident and the guardian or agent, if any.

 

          (x)  An order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (y)  The licensee shall maintain a written record for each resident for each medication taken by the resident at the nursing home that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials and job title of the person who administers, supervises, or assists the resident taking medication;

 

(5)  For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (z)  Stock medications shall only be accessed and administered by the licensed nurse or any other professional authorized by state or federal regulation pursuant to a licensed practitioner’s order.

 

          (aa)  A nursing home shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.02 under circumstances where the nursing home:

 

(1)  Has a director of nursing who is a registered nurse (RN) licensed in accordance with RSA 326-B; and

 

(2)  Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

 

          (ab)  The licensee shall develop and implement a system for reporting to the director of nursing or designee within 24 hours after any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications.

 

          (ac)  The written documentation of the report in (ab) above shall be maintained in the resident’s record.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.17  Organization and Administration.

 

          (a)  Each nursing home shall have a medical director who is a licensed physician in the state of New Hampshire.

 

          (b)  Each nursing home shall have a full time, onsite administrator who:

 

(1)  Is licensed pursuant to RSA 151-A:2; and

 

(2)  Shall be responsible for the daily management and operation of the nursing home including:

 

a.  Management and fiscal matters;

 

b.  The employment and termination of managers and personnel necessary for the efficient operation of the nursing home;

 

c.  The designation of an onsite alternate, in writing, who shall be responsible for the daily management and operation of the nursing home in the absence of the administrator;

 

d.  Ensuring development and implementation of nursing home policies and procedures on:

 

1.  Patient’s rights as required by RSA 151:20;

 

2.  Advanced directives and DNR orders as required by RSA 137-J;

 

3.  Discharge planning as required by RSA 151:26; and

 

4.  Unusual incident reporting;

 

e.  Monitoring and evaluating the quality of resident care and resident care services in the nursing home pursuant to He-P 803.24; and

 

f.  Identifying and making available education programs designed to maintain the personnel’s expertise in areas related to the services provided in the nursing home.

 

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

 

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

 

(1)  Establishment of standards of nursing practice used in the nursing home;

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

(e)  The director of nursing services shall enure compliance with all dementia training requirements pursuant to RSA 151:48-50 including continuing education.

 

(f)  Such continuing education shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1)  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

(2)  A minimum of 4 hours of ongoing training each calendar year.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.18  Personnel.

 

          (a)  The licensee shall develop a job description for each position at the nursing home containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Education and experience requirements of the position.

 

          (b)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  A student in a New Hampshire board of nursing approved nursing or nursing assistant program;

 

(2)  A nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(3)  Part of an established educational program working under the supervision of a nurse.

 

          (c)  For all new hires, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

 

(2)  Verify the qualifications and licenses, as applicable, of all applicants prior to employment; and

 

(3)  Verify that the applicant is not on the List of Excluded Individuals and Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General per 42 USC 1320-a7, or on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

 

          (d)  Unless a waiver is granted in accordance with He-P 803.10 and (f) below, the licensee shall not make a final offer of employment for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other known state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other known state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (e)  If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (d) above.

 

          (f)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

 

          (g)  The licensee shall not employ, contract with, or engage, any person in (c) above who is listed on the BEAS state registry unless a waiver is granted by BEAS.

 

          (h)  In lieu of (c) and (g) above, the licensee may accept from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) above.

 

          (i)  All employees shall:

 

(1)  Meet the educational and physical qualifications of the position as listed in their job description;

 

(2)  Not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department;

 

(3)  Be licensed, registered or certified as required by state statute and as applicable;

 

(4)  Receive an orientation within the first 3 days of work prior to the assumption of duties that includes:

 

a. The nursing home’s policies on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities, policies, procedures, and guidelines, of the position they were hired for;

 

c.  The nursing home’s infection control program;

 

d. The nursing home’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

 

e.  Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

 

(5)  Complete a mandatory annual in-service education, which includes a review of the nursing home’s:

 

a.  Policies and procedures on patient rights and responsibilities and abuse or neglect;

 

b.  Infection control;

 

c.  Education program on fire and emergency procedures; and

 

d.  Mandatory reporting requirements.

 

          (j)  Prior to having contact with residents, employees shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

 

(3)  Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(4)  Comply with all public health guidelines with regard to the requirements for communicable infectious disease reporting pursuant to He-P 301.

 

          (k)  All licensees using the services of independent contractors as direct care personnel shall ensure and document that the independent clinical contractors have:

 

(1)  Been oriented in accordance with (i)(4) above;

 

(2)  Documented results of all infectious disease testing shall comply as required by (j) (1)-(4) above;

 

(3)  Licenses that are current and valid; and

 

(4)  A written agreement that describes the services that will be provided.

 

          (l)  Current, separate and complete employee files shall be maintained and stored in a secure and confidential manner at the nursing home.

 

          (m)  The employee file shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the nursing home’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  A record of satisfactory completion of the orientation program required by (i)(4) above and any required annual continuing education, if any;

 

(5)  Verification of current New Hampshire license, registration or certification in health care field and CPR certification, if applicable;

 

(6)  Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; 

 

(7)  Documentation of annual in-service education as required by (i)(5) above;

 

(8)  A statement, which shall be signed at the time the initial offer of employment is made and then annually thereafter, stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety, or well-being of a resident; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person;

 

(9)  Documentation of the criminal records check, except for persons licensed by the NH board of nursing pursuant to RSA 326-B as allowed by RSA 151:2-d, VI; and

 

(10)  Documentation that the individual or entity is not on the List of Excluded Individuals and Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General per 42 USC 1320-a7, or on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

 

          (n)  An individual need not re-disclose any of the matters in (m)(8) and (m)(9) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.19  Resident Records.

 

          (a)  The licensee shall maintain a legible, current and accurate record for each resident based on services provided at the nursing home.

 

          (b)  At a minimum, resident records shall contain the following:

 

(1)  A copy of the resident’s admission agreement and all documents required by He-P 803.15(c);

 

(2)  Identification data, including:

 

a.  Vital information including the resident’s name, date of birth, and marital status;

 

b.  Resident’s religious preference, if known;

 

c.  Resident’s veteran status if known; and

 

d.  Name, address and telephone number of an emergency contact person;

 

(3)  The name and telephone number of the resident’s licensed practitioner(s);

 

(4)  Resident’s health insurance information;

 

(5)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(6)  A record of the health examination(s) in accordance with He-P 803.15(h);

 

(7)  Written, dated and signed orders for the following:

 

a.  All medications, treatments and special diets; and

 

b.  Laboratory services and consultations;

 

(8)  Results of any laboratory tests, or consultations;

 

(9)  All assessments and care plans, and documentation that the resident and the guardian or agent, if any, have been given the opportunity or has participated in the development of the care plan;

 

(10)  Documentation of informed consent;

 

(11)  All admission and progress notes;

 

(12)  Documentation of any alteration in the resident’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(13)  Documentation of any medical or specialized care;

 

(14)  Documentation of unusual incidents;

 

(15)  The consent for release of information signed by the resident, guardian or agent, if any;

 

(16)  Discharge planning and referrals as applicable;

 

(17)  Transfer or discharge documentation, including notification to the resident, guardian, or agent, if any, of transfer or discharge;

 

(18)  Room change documentation, including notification to the resident, guardian, or agent, if any, and if applicable;

 

(19)  The medication record as required by He-P 803.16(y) and (ac);

 

(20)  Documentation of a resident’s refusal of any care or services; and

 

(21)  Code status.

 

          (c)  Resident records and resident information shall be kept confidential and only provided in accordance with law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

 

          (e)  Resident records shall be available to health care workers and any other person authorized by law or rule to review such records.

 

          (f)  When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

 

          (g)  Records shall be retained for 7 years after discharge, except for records of Medicaid residents, which shall be retained for 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6-year period, whichever is longer.

 

          (h)  The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the nursing home ceases operation.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.20  Food Services.

 

          (a)  The licensee shall provide food services that:

 

(1)  Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as noted in Appendix A;

 

(2)  Provide the nutritional needs of each resident;

 

(3)  Meet the special dietary needs associated with health or medical conditions for each resident as identified by the health examination required by He-P 803.15(h);

 

(4)  Include provision of a food service manager who shall;

 

a.  Be responsible for the day to day operation of the kitchen;

 

b.  Have knowledge of the nutritional requirements for residents and of the planning and preparation of prescribed diets; and

 

c.  Have all the required competencies as per the licensee’s policy;

 

(5)  Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

 

(6)  Include dining facilities that have eating areas sufficient in size to provide seating for at least 50% of the licensed capacity.

 

          (b)  Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident’s care plan.

 

          (c)  Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident’s care plan.

 

          (d)  If a resident refuses the item(s) on the menu, a substitute shall be offered.

 

          (e)  Menus, including beverages for regular and therapeutic diets, shall be planned and written for at least 2 weeks in advance of serving.

 

          (f)  Each day’s menu shall be posted in a place accessible to food service personnel and residents.

 

          (g)  A listing of the diet orders and allowed foods for each resident shall be available to personnel.

 

          (h)  A dated record of menus as served shall be maintained for at least 3 months.

 

          (i)  The licensee shall provide therapeutic diets to residents only as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (j)  Residents requiring therapeutic diets shall have an assessment of nutritional status by a qualified dietitian or dietary technician at least quarterly and with any significant weight loss or weight gain.

 

          (k)  If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record along with education relating to non-compliance with prescribed diet, and notify the resident’s licensed practitioner.

 

          (l)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods maintained on the premises for the average daily census and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Enough drinking water for a 3-day period.

 

          (m)  All food and drink provided to the residents shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated and stored at proper temperatures; and

 

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

 

          (n)  The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

 

          (o)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (p)  All work surfaces shall be cleaned and sanitized after each use.

 

          (q)  All dishes, utensils and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

 

          (r)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (s)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

          (t)  Garbage or trash in the kitchen area shall be placed in lined containers with covers.

 

          (u)  All nursing home personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

          (v)  Regularly scheduled training programs including sanitation and safety shall be made available to personnel.  Information as to the content and length of this training shall be documented and kept in employee records.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.21  Restraints.

 

          (a)  For CMS certified nursing homes, the use of restraints shall be permitted as allowed by 42 CFR 483.12(a).

 

          (b)  For all other facilities, the requirements in (c) through (g) shall apply.

 

          (c)  When physical restraints are used, the following requirements shall be met:

 

(1)  Physical restraints shall be used only after less restrictive measures have been found to be ineffective to protect the resident or others from harm;

 

(2)  Except as allowed in (d) below, physical restraints shall be ordered for a specified and limited time by a licensed practitioner; and

 

(3)  The order for the physical restraints in (2) above may be verbal and shall:

 

a.  Be obtained by a licensed nurse before the physical restraint is administered; and

 

b.  Be followed with the licensed practitioner’s signature within 14 days.

 

          (d)  In an emergency situation, physical restraints may be authorized by a professional staff member designated by the licensee in accordance with established policy and procedure under He-P 803.15(p)(3) as follows:

 

(1)  The designated staff member shall promptly report the restraint use and the resident’s behavior to the resident’s licensed practitioner; and

 

(2)  The designated staff member shall document the use of restraints in the resident’s clinical record, in accordance with (g) below.

 

          (e)  When chemical restraints are used, the following requirements shall be met:

 

(1)  Chemical restraints shall be used only after less restrictive measures have been found to be ineffective to protect the resident or others from harm;

 

(2)  Chemical restraints shall be ordered for a specified and limited time by a licensed practitioner;

 

(3)  The order for the chemical restraints can be verbal and shall:

 

a.  Be obtained by a licensed nurse before the chemical restraint is administered; and

 

b.  Be followed with the licensed practitioner’s signature within 14 days;

 

(4)  Medication used as a chemical restraint may only be administered by a licensed nurse or licensed practitioner;

 

(5)  Standing orders for medications utilized as chemical restraints shall be prohibited; and

 

(6)  It shall be the responsibility of the licensed nurse or licensed practitioner administering the chemical restraint to document the administration of the medication and the effects as specified in He-P 803.16(y) and (ac).

 

          (f)  When mechanical restraints are used, the following requirements shall be met:

 

(1)  Mechanical restraints shall be used only when less restrictive measures have been found to be ineffective in protecting the resident or others from harm;

 

(2)  Mechanical restraints shall be ordered for a specific and limited time by a licensed practitioner and the order shall include:

 

a.  The type of restraint to be used;

 

b.  The reason for the restraint; and

 

c.  The time intervals at which the licensee’s personnel shall check the resident’s well-being and the placement and position of the restraint;

 

(3)  Standing orders for the use of mechanical restraints shall be prohibited;

 

(4)  Mechanical restraints shall not be applied in a manner that impedes circulation; and

 

(5)  Locked, secured or alarmed doors or elevators, or units within a nursing home, anklets, bracelets and similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the nursing home or unit within shall not be considered restraints provided they meet the requirements of the applicable building and fire safety codes and are documented in the care plan.

 

          (g)  The use of all restraints shall be documented in the resident’s clinical record according to the licensee’s policy, including:

 

(1)  The behavior and actions of the resident that necessitated the use of a restraint;

 

(2)  The authorization given to restrain the resident;

 

(3)  The type of restraint used;

 

(4)  The length of time the resident was restrained;

 

(5)  The effects of the restraint on the resident;

 

(6)  The report to the resident’s licensed practitioner and all actions taken; and

 

(7)  Any orders from the resident’s licensed practitioner.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.22  Resident Transfer or Discharge.  Transfers and discharges shall be done in accordance with RSA 151:26.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.23  Infection Control.

 

          (a)  The licensee shall appoint a person to be in charge of and develop and implement an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

 

          (b)  The infection control program shall include documented procedures for:

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions:  Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

 

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

 

(4)  The handling, transport and disposal of those items identified as infectious waste in Env-Sw 103.28;

 

(5)  Reporting of infectious and communicable diseases as required by He-P 301; and

 

(6)  Maintenance of a sanitary physical environment.

 

          (c)  The infection control education program shall:

 

(1)  Be completed by all new and current employees of the -licensee on an annual basis; and

 

(2)  Address the:

 

a.  Cause of infections;

 

b.  Effect of infections;

 

c.  Transmission of infections; and

 

d.  Prevention and containment of infections.

 

          (d)  Direct care personnel or employees infected with a disease or illness transmissible through food, saliva, fomites or droplets, shall not work in food service or provide direct care without personal protection equipment to prevent disease transmission until they are no longer contagious as determined by a licensed practitioner.

 

          (e)  Direct care personnel or employees infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected as determined by a licensed practitioner.

 

          (f)  Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Employees with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable bandage with secure edges.

 

          (h)  The licensee shall immunize all consenting residents for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.24  Quality Improvement.

 

          (a)  The nursing home shall establish an interdisciplinary quality improvement committee which:

 

(1)  Shall have a minimum of 3 members, including the medical director, an individual representing nursing and an individual representing administration;

 

(2)  Shall meet at least quarterly to evaluate quality improvement activities; and

 

(3)  Shall make recommendations to the administrator to improve the quality of care.

 

          (b)  The quality improvement committee shall be responsible for:

 

(1)  Determining the information to be monitored;

 

(2)  Determining the frequency with which information will be reviewed;

 

(3)  Determining the indicators that will apply to the information being monitored;

 

(4)  Evaluating the information that is gathered;

 

(5)  Determining the action that is necessary to correct identified problems;

 

(6)  Recommending corrective actions to the licensee; and

 

(7)  Evaluating the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.25  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed nursing home premises.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the residents.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, Table 2.5-1” (2018 edition), available as noted in Appendix A, , and summarized as follows:

 

(1)  Seventy-120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures, Where sinks are used primarily for hot water and are served by a single pipe supplying tempered water, it shall not exceed 80 degrees Fahrenheit;

 

(2)  One hundred forty degrees Fahrenheit for dietary areas, except that provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, which may be by separate booster, unless a chemical rinse is provided; and

 

(3)  One hundred sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a process which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures as specified by the manufacturer.

 

          (f)  All resident bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications and program supplies, and to prohibit access by residents.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and nursing home pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

          (l)  Trash receptacles in food service area shall have covers and shall remain closed except when in use.

 

          (m)  The following requirements shall be met for laundry services:

 

(1)  Dirty laundry shall not be permitted to contaminate kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing that are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Cleaning supplies shall be stored in dust-free and moisture-free storage areas.

 

          (p)  Any nursing home that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified as required by the department of environmental services shall notify the department upon receipt of notice of a failed water test.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19

 

          He-P 803.26  Physical Environment.

 

          (a)  The licensed premises shall be maintained so as to provide for the health, safety, well-being, and comfort of residents and personnel, including reasonable accommodations for residents and personnel with mobility limitations.

 

          (b)  Equipment providing heat within a nursing home including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit during the day if residents are present and 65 degrees Fahrenheit at night; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Any heating device other than a central plant shall be designed and installed so that:

 

(1)  Combustible material cannot be ignited by the device or its appurtenances;

 

(2)  If fuel-fired, such heating devices comply with the following:

 

a.  They shall be chimney or vent connected;

 

b.  They shall take air for combustion directly from outside; and

 

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

 

(3)  The heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

 

          (f)  Unvented fuel-fired heaters shall not be used in any nursing home.

 

          (g)  Plumbing shall be sized, installed, and maintained in accordance with the provisions of the International Plumbing Code, as specified in the State Building Code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

          (h)  Screens shall be provided for doors and windows that are left open to the outside.

 

          (i)  Doors that are self-closing and remain closed when not in use are exempt from the requirement in (h) above.

 

          (j)  The nursing home shall have a telephone to which the residents have access.

 

          (k)  The number of sinks and toilets shall be in a ratio of one for every 6 individuals, unless personnel have separate bathroom facilities not used by residents.

 

          (l)  Each bathroom shall be equipped with:

 

(1)  A soap dispenser;

 

(2)  Paper towels or a hand-drying device providing heated air;

 

(3)  Hot and cold running water; and

 

(4)  A door that either slides or swings, not a folding door or curtain.

 

          (m)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (n)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (o)  Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (p)  There shall be at least 100 square feet in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom, exclusive of space required for closets, wardrobes and toilet facilities.

 

          (q)  Each bedroom shall:

 

(1)  Contain no more than 2 beds if constructed after the 2011 adoption of these rules;

 

(2)  Have its own separate entry to permit the resident to reach his/her bedroom without passing through the room of another resident;

 

(3)  Have a side hinge door and not a folding or sliding door or a curtain unless it meets specific exceptions allowed by the codes referenced in He-P 803.07(e);

 

(4)  Not be used simultaneously for other purposes; and

 

(5)  Be separated from halls, corridors and other rooms by floor to ceiling walls.

 

          (r)  The licensee shall provide the following for the residents’ use, as needed:

 

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

 

(2)  A mattress that complies with the state fire code and codes adopted by reference pursuant to RSA 153:I, VI-a, and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5;

 

(3)  Clean linens, blankets and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  A light;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades, or curtains that provide privacy.

 

          (s)  A resident may refuse any of the items in (r) above with appropriate documentation.

 

          (t)  The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others.

 

          (u)  The licensee shall provide the following rooms to meet the needs of residents:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of seating at least 50% of the residents.

 

          (v)  Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

 

          (w)  Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

 

          (x)  If the nursing home admits residents under the age of 18, each age group shall have separate and distinct units.

 

          (y)  If the nursing home admits residents between the age of 10 and 17 years, each gender shall have separate and distinct units.

 

          (z)  The nursing home shall comply with all state and local codes and ordinances for:

 

(1)  Zoning;

 

(2)  Building;

 

(3)  Health;

 

(4)  Fire;

 

(5)  Waste disposal; and

 

(6)  Water.

 

          (aa)  The nursing home shall be accessible at all times of the year.

 

          (ab)  The nursing home shall provide housekeeping and maintenance adequate to protect residents, personnel and the public.

 

          (ac)  Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

 

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

 

          (ae)  There shall be a secondary power source to provide emergency power pursuant to the Electrical Systems chapter of NFPA 99, Health Care Facilities Code, and The Standard for Emergency and Standby Power Systems, NFPA 110, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

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

 

          (ag)  Facilities shall provide for prompt cleaning of bedpans, urinals, and other utensils.

 

          (ah)  Any locked door providing egress from a resident room and/or means of egress within a nursing home shall meet the requirements of the Health Care Occupancy chapter of NFPA 101, Life Safety Code, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (ai)  Special locking devices including delayed egress devices, shall meet the requirements of NFPA 101, the Life Safety Code, which shall:

 

(1)  Unlock upon actuation of the automatic fire detection and or suppression system; and

 

(2)  Unlock upon loss of power.

 

          (aj)  No more than one such device in (ai) above shall be located in any egress path of travel.

 

          (ak)  Sterile supplies and equipment shall not be mixed with unsterile supplies.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

          He-P 803.27  Emergency and Fire Safety.

 

          (a)  The administration of the licensed facility shall have, in effect and available to all supervisory personnel, written copies of a plan for the protection of all persons in the event of fire, including:

 

(1)  Evacuation to areas of refuge;

 

(2)  All personnel shall be periodically, at least annually if no changes are made to the plan, be instructed and kept informed with respect to their duties under this written plan.  Copies of this plan shall be readily available at all times in a central location, example, reception area, nurses station, or security center;

 

(3)  The emergency procedures required by the emergency response plan shall include, but are not limited to, evacuation routes, emergency notification numbers, and emergency instructions and shall be posted in locations accessible to personnel and visitors;

 

(4)  The nursing home fire safety plan shall provide for the following:

 

a.  Use of alarms;

 

b.  Transmission of alarm to fire department;

 

c.  Emergency phone call to fire department;

 

d.  Response to alarms;

 

e.  Isolation of fire;

 

f.  Evacuation of immediate area;

 

g.  Evacuation of smoke compartment;

 

h.  Preparation of floors and building for evacuation; and

 

i.  Extinguishment of the fire;

 

(5)  Ensuring that the fire safety and evacuation plans are available to all supervisory personnel;

 

(6)  Ensuring that all employees receive in-service annual training to clarify their responsibilities in carrying out the emergency plan;

 

(7)  The required plan shall be readily available at all times;

 

(8)  Conducting fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

 

a.  Infirm, bedridden, or cognitively impaired residents shall not be required to be moved during drills to safety areas or to the exterior of the building;

 

b.  Drills shall be conducted quarterly on each shift to familiarize nursing home personnel with the signals and emergency action required under varied conditions; and

 

c.  When drills are conducted between 9:00 p.m./2100 hours and 6:00 A.M./0600 hours, a coded announcement may be used instead of audible alarms;

 

(9)  Facilities shall complete a written record of fire drills and include the following:

 

a.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

b.  The location of exits used;

 

c.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

d.  The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

 

e.  The name and title of the person conducting the drill;

 

f.  A list of problems and issues encountered during the drill;

 

g.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

h.  The names of all staff members participating in the drill; and

 

(10)  Written records of the fire drills that shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (b)  All nursing homes shall have: 

 

(1)  At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10;

 

(2)  Be manually inspected when initially placed in service;

 

(3)  Be inspected either manually or by means of an electronic monitoring device/system at intervals not exceeding 31 days;

 

(4)  Be inspected at least once per calendar month; and

 

(5)  Documentation of  manual fire extinguisher inspections that shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation.  Documentation of electronically monitored fire extinguishers shall be provided to the department within 2 business days of the completion of the inspection or investigation.

 

          (c)  All nursing homes shall meet the health care chapter of NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (d)  Extension cords shall be prohibited except as allowed in accordance with NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (e)  Immediately following any fire or emergency, such as a gas incident, terrorism, or other threatening condition, the licensee shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

 

          (f)  The written notification in (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any employee or resident who was evacuated as a result of the incident, if applicable;

 

(5)  The name of any employee or resident who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (g)  Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code including but not limited to:

 

(1)  Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

 

a.  Minimum distance of 6.1 m or 20 ft;

 

b.  Minimum distance of 1.5 m or 5 ft if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

c.  A gas cabinet constructed per NFPA 30, Flammable and Combustible Liquids Code, or NFPA 55, Compressed Gases and Cryogenics Fluids Code, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

 

(2)  Cylinders shall be protected from damage by means of the following specific procedures:

 

a.  Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

 

b.  Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

 

c.  Cylinders shall be protected from tampering by unauthorized individuals;

 

d.  Cylinders or cylinder valves shall not be repaired, painted, or altered;

 

e.  Safety relief devices in valves or cylinders shall not be tampered with;

 

f.  Valve outlets clogged with ice shall be thawed with warm, not boiling water;

 

g.  A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

 

h.  Sparks and flame shall be kept away from cylinders;

 

i.  Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

 

j.  Large cylindersexceeding size E and containers larger than 45 kg or100 lb weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

 

k.  Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

 

l.  Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

 

(3)  Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

 

a.  Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

 

b.  Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

 

c.  Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

 

d.  The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

 

e.  Oxygen shall be referred to by its proper name, “oxygen”, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

 

f.  Oxygen shall not be used as a substitute for compressed air;

 

g.  The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

 

h.  Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels/tags used for indicating cylinder status such as full, in use, or empty;

 

i.  The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

 

j.  Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, heat ducts;

 

k.  Very cold cylinders or containers shall be handled with care to avoid injury;

 

l.  A precautionary sign, readable from a distance of 1.5 m or 5 ft, shall be displayed on each door or gate of the storage room or enclosure; and

 

m.  The sign shall include the following wording as a minimum:

 

CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING

 

          (h)  If the licensee has chosen to allow smoking under He-P 803.14(w), an outside location or a room used only for smoking shall be provided which:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non-combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act and He-P 1900.

 

Source.  #9856-A, eff 1-26-11, EXPIRED: 1-26-19

 

New.  #12721, INTERIM, eff 1-29-19, EXPIRED: 7-29-19

 

New.  #12860, eff 8-28-19; ss by #13246, eff 8-4-21

 

He-P 803.28  Emergency Preparedness.

 

          (a)  Each licensee shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

 

          (b)  The emergency management committee shall include the licensee’s administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the -licensee;

 

(11)  Conduct a facility-wide –walk-through and review, to include the property that the licensee is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least annually;

 

(12)  Include the licensee’s response to both short-term and long-term interruptions in the availability of utility service during the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations, to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation, to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Include the management of residents, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the licensee is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (f)  The licensee shall conduct and document with a detailed log, including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the -licensee’s plan and who is not involved in the exercise;

(2)  Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise.  The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement.  The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise.  Opportunities for improvement identified in critiques shall be incorporated in the licensee’s improvement plan.

 

          (g)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

          (h)  Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

 

(1)  Assumptions for calculations of food and water supplies including maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

 

(2)  Storage location(s); and

 

(3)  Back-up supplies.

 

Source.  #12860, eff 8-28-19

 

PART He-P 804  ASSISTED LIVING RESIDENCE–RESIDENTIAL CARE LICENSING

 

REVISION NOTE:

 

          Document #13368, effective 4-19-22, readopted with amendments the “Care Assessment for Residential Services Tool” form pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c.  The form is incorporated by reference in He-P 804.16(d) which requires the assisted living residence–residential care (ALR-RC) facility to assess each resident’s needs using the “Care Assessment for Residential Services Tool” form otherwise called the “CARES Tool”. Document #13368 contained only the amended form, giving it a new effective date, and updated the revision date on the form from the “January 2022 edition” to the “April 2022 edition.” 

 

          The prior filing affecting He-P 804.16 was Document #13339, effective 1-29-22, and the effective date of the rule remained unchanged by Document #13368.  Since Document #13368 updated the revision date on the form from “(January 2022 edition)” to the “(April 2022 edition)”, the revision date was subsequently updated editorially in He-P 804.16(d). 

 

He-P 804.01  Purpose.  The purpose of this part is to set forth the classification of and licensing requirements for assisted living residence–residential care (ALR-RC) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(1).

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an assisted living residence at the residential care level pursuant to RSA 151:9, VII(a)(1), except:

 

          (a)  All entities which are owned or operated by the state of New Hampshire;

 

          (b)  Residential care facilities authorized and inspected by the United States Department of Veterans Affairs which provide services to 3 or fewer individuals; and

 

          (c)  Any home where the total number of licensed or certified beds does not exceed 3 when all the residents receive services:

 

(1)  Under a current New Hampshire division for children, youth, and families license pursuant to RSA 170-E:27 and 31; or

 

(2)  In a certified community residence pursuant to RSA 126-A:20.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, ss by #9835, eff 12-18-10; ss by #12414, eff 11-3-17

 

          He-P 804.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a resident;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to a resident; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a resident without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Addition”  means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 804.

 

          (f)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

 

          (g)  “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (h)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

 

          (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA-J:34-37.

 

          (j)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ALR-RC pursuant to RSA 151:2, I(e).

 

          (k)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 804, or other federal or state requirements.

 

          (l)  “Assessment” means an evaluation of the resident to determine the care and services that are needed.

 

          (m)  “Assisted living residence–residential care (ALR-RC)” means a long term care residence providing personal care at the residential care level pursuant to RSA 151:9, VII(a)(1).

 

          (n)  “Care assessment for residential services (CARES) tool” means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I.

 

          (o)  “Care plan” means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

 

          (p)  “Change of ownership” means the transfer of the controlling interest of an established ALR-RC to any individual, agency, partnership, corporation, government entity, association or other legal entity. 

 

          (q)  “Chemical restraints” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.

 

          (r)  “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

 

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

 

          (t)  “Core services” means those minimal services to be provided to any resident by the licensee that are included in the basic rate.

 

          (u)  “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (v)  “Days” means calendar days unless otherwise specified in the rule.

 

          (w)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

 

          (x)  “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

 

          (y)  “Direct care” means hands-on care and services provided to a resident, including but not limited to medical, nursing, psychological, or rehabilitatitive treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

 

          (z)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

          (aa)  “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

 

          (ab)  “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

 

           (ac)  “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away or otherwise leaves a caregiving facility or environment unsupervised or unnoticed, without the knowledge of the licensee’s personnel.

 

          (ad)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (ae)  “Employee” means anyone employed by the ALR-RC and for whom the ALR-RC has direct supervisory authority.

 

          (af)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 804.

 

          (ag)  “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

 

          (ah)  “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ai) “Facility” means “facility” as defined in RSA 151:19, II.

 

          (aj)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident’s health care and other personal needs.

 

          (ak)  “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s or occupants control.

 

          (al)  “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents, who have resided at the licensed premises for more than 30 days.

 

          (am)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (an)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (ao)  “Informed consent” means the decision by a resident, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (ap)  “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (aq)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 804 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 804.

 

          (ar)  “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of disease.

 

          (as)  “License” means the document issued by the department or licensee of an ALR-RC which authorizes operation in accordance with RSA 151 and He-P 804, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number.

 

          (at)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the ALR-RC is licensed.

 

          (au)  “Licensed 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.

 

          (av)  “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (aw)  “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151.

 

          (ax)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ay)  “Life safety code” means the standards,  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.

 

          (az)  “Mechanical restraint” means locked or secured ALR-RCs or units within an ALR-RC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ALR-RC or unit within.

 

          (ba)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (bb)  “Mobile” means capable of moving from place to place, with or without assistive devices, without the assistance of others.

 

          (bc)  “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

 

          (bd)  “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.

 

          (be)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (bf)  “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a resident.

 

          (bg)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bh)  “Over-the-counter medications” means non-prescription medications.

 

          (bi)  “Patient rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

 

          (bj)  “Personal care” means personal care services that are non-medical, hands-on services provided to a resident including, but not limited to, assistance with ADL’s.

 

          (bk)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

 

          (bl)  “Personnel” means individual(s), either paid or volunteer, who provide direct or indirect care or services, or both, to a resident(s). 

 

          (bm)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (bn)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bo)  “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

 

(1)  A lancing or finger stick device to get a blood specimen;

 

(2)  A test strip or reagents to apply a specimen to for testing; or

 

(3)  A meter or monitor to calculate and show the results, including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

 

c.  A Cholesterol meter.

 

          (bp)  “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of patient care.

 

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

 

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

 

          (bs)  “Protective care” means the provision of resident monitoring services, including but not limited to:

 

(1)  Knowledge of resident whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (bt)  “Qualified personnel” means personnel that have been trained to and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bu)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained. 

 

          (bv)  “Renovation” means the replacement in type or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces. 

 

          (bw)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintain such materials, elements, equipment, or fixtures in good or sound condition.

 

          (bx)  “Reportable incident” means an occurrence of any of the following while the resident is either in the ALR-RC or in the care of ALR-RC personnel:

 

(1)  The unanticipated death of the resident;

 

(2)  An injury to a resident, that is potentially due to abuse or neglect; or

 

(3)  The elopement or unexplained absence of a resident from the ALR-RC.

 

          (by)  “Resident” means any person admitted to or in any way receiving care, services, or both from a facility licensed in accordance with RSA 151 and He-P 804.

 

          (bz)  “Residential board and care occupancy,” means “residential board and care occupancy” as defined in NFPA 101 of the state fire code, namely “ an occupancy used for lodging and boarding of 4 or more residents not related by blood or marriage to the owners or operators for the purpose of providing personal care services.”

 

          (ca)  “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 804, and as required by other federal or state laws.

 

          (cb)  “Respite care” means the admission of a person from his or her primary residence to an ALR-RC, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care.

 

          (cc)  “Self administration of medication with assistance” means the resident takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

 

          (cd)  “Self administration of medication without assistance” means the resident takes his or her own medication(s) without the assistance of personnel, including prompting.

 

          (ce)  “Self-directed medication administration” means a resident, who has a physical limitation that prohibits him or her from self administration of medication, with or without assistance, directs personnel to physically assist in the medication process which does not include assisting with injections or filling insulin syringes.

 

          (cf)  “Self evacuate” means the resident can initiate and complete movement from any location in the ALR-RC to an exit without assistance from personnel other than verbal or physical prompting.

 

          (cg)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

 

          (ch)  “Significant change”. means a decline or improvement in a resident’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the resident’s health status; and

 

(3)  Requires interdisciplinary review or revision of the care plan.

 

          (ci)  “State monitoring” means the placement of individuals by the department at an ALR-RC to monitor the operation and conditions of the facility.

 

          (cj)  “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

 

          (ck) “Underwriters laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

 

          (cl)  “Unexplained absence” means an incident involving a resident leaving the premises of the ALR-RC without the knowledge of the ALR-RC personnel in a manner that is contrary to their normal routine.

 

          (cm)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.04  License Application Submission.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License, or Special Health Care Services,” (January 2022), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

(2)  A floor plan of the prospective ALR-RC;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee, in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications of the ALR-RC administrator;

 

(6)  Copies of applicable licenses for the ALR-RC administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300 , including, at a minimum, the One and Two Family Dwelling chapter or the Residential Board and Care chapter of the life safety code, and local fire ordinances applicable for an assisted living residence–residential care; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(8)  If the ALR-RC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, or Env-DW 704.02, or if a public water supply, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and household members.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 804.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 804.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 804.13(b) if, it determines that the applicant, administrator, or a household member: 

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (f)  The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the following:

 

(1)  A copy of the ALR-RC’s admission agreement; and

 

(2)  A copy of the ALR-RC’s standard disclosure form.

 

          (g)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 804.

 

          (h)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (i)  A written notification of denial, pursuant to He-P 804.13(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (g) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 804.

 

          (j)  A written notification of denial, pursuant to He-P 804.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance unless a completed application for renewal has been received.

 

         (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 804.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 804.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 804.18(g)(2); and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with  Saf-C 6005, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (d)  In addition to to He-P 804.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (e)  Following an inspection as described in He-P 804.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by He-P 804.06(b) and (c), as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 804 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 804.04 and shall be subject to a fine in accordance with He-P 804.14(c)(7). 

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.07  ALR-RC New Construction and Existing Rehabilitation.

 

          (a)  For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 804 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Department approval shall not be required prior to initiating construction, renovations, or structural

alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own

risk.

 

          (g) The ALR-RC shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300, including but not limited to at a minimum:

 

a.  For 3 residents or fewer, the One and Two Family Dwelling chapter of the life safety code; and

 

b.  For 4 residents or more, the Residential Board and Care Occupancy chapter of the life safety code;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  The FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), available as noted in Appendix A; and

 

          (i)  All ALR-RCs newly constructed or rehabilitated after the 2022 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, (2018 edition), as applicable, available as noted in Appendix A.

 

          (j)  Where rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, (2018 edition) available as noted in Appendix A.

 

          (k)  The department’s bureau of health facilities administration shall be the authority having jurisdiction for the requirements in (h)-(j) above and shall negotiate compliance and grant waivers in accordance with He-P 804.10 as appropriate.

 

          (l)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

 

          (m)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (n)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

          (o)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 804.09 prior to its use.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.08    ALR-RC Requirements for Organizational or Service Changes.

 

          (a)  The ALR-RC shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds authorized under the current license; or

 

(6)  Services.

 

          (b)  The ALR-RC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3)  An increase in number of beds authorized under the current license; or

 

(4)  A change in services.

 

          (c)  When there is a change in the address without a change in location, the ALR-RC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the ALR-RC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of beds or residents authorized under the curerent license;

 

(4)  A change in licensing classification; or

 

(5)  A change that places the facility under a different life safety code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

 

          (g)  A revised license and license certificate shall be issued for a change in the ALR-RC name or a change in address without a change in physical location.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  An increase or decrease in the number of beds; 

 

(3)  A change in the scope of services provided; or

 

(4)  When a waiver has been granted in accordance with He-P 804.10.

 

          (i)  The ALR-RC shall inform the department in writing when there is a change in administrator no later than 5 days prior to a change  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  Copies of applicable licenses for the new administrator; and

 

(3) The results of a criminal background check from the NH department of safety for the new administrator;

 

(4)  The results of the criminal attestation as described in He-P 804.18(w); and

 

(5) The results of the bureau of elderly and adult services (BEAS) registry check per He-P 804.18(h). 

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 804.18(i) and (k).

 

          (k)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

           (l)  When there is to be a change in the services provided, the ALF-RC shall provide the department with a description of the service change and, where applicable, identify what additional personnel shall be hired and their qualifications, how the new services shall be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

          (m)  The department shall review the information submitted under (l) above and determine if the added services can be provided under the ALR-RC’s current license.

 

          (n)  The ALR-RC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (o)  A restructuring of an established ALR-RC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p) If a licensee chooses to cease operation of an ALR-RC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 804, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the ALR-RC; and

 

(3)  Any records required by RSA 151 and He-P 804.

 

          (b)  The department shall conduct a clinical and life safety code inspection, as necessary, to determine full compliance with RSA 151 and He-P 804 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 804.08(e)(1);

 

(3)  A change in the physical location of the ALR-RC;

 

(4)  A change in the licensing classification;

 

(5)  An increase in the number of beds;

 

(6)  Occupation of space after construction, renovations, or alterations; or

 

(7)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department as part of an annual inspection or as a follow-up inspection focused on confirming the implementation of a POC.

 

          (d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ALR-RC is in violation of any of the provisions of He-P 804, RSA 151, or other federal or state requirement.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 804.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 804 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

 

(4)  The period of time for which the waiver is sought if less than permanent.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the residents; and

 

(3)  Does not negatively affect the quality of resident services.

 

          (d) The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 804.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the ALR-RC, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 804.

 

          (c) Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed ALR-RC, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 804. 

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2) I n accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a written response to the findings prior to the department’s issuance of a warning;

 

(3)  In accordance with RSA 151:7-a, I, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, which results in a determination that the services being provided require licensing under RSA 151, the department shall issue a written warning, to the owner or person responsible, requiring compliance with RSA 151 and He-P 804;

 

(4)  The warning in (e)(3) above, shall include:

 

a.  The time frame within which the owner or person responsible shall comply with the directives of the warning;

 

b.  The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

 

c.  The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

 

(5)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 804.13(c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 804, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each finding;

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 804;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 804 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 804.12(d) and a fine in accordance with He-P 804.13(c)(13);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 804.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 804.13(c)(14) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and personnel;

 

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine in accordance with He-P 804.13(c);

 

(3)  Deny the application for a renewal of a license in accordance with He-P 804.13(b); or

 

(3)  Revoke the license in accordance with He-P 804.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of residents; or

 

(2)  The presence of conditions in the ALR-RC that negatively impact the health, safety, or well-being of residents.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 804 which poses a risk of harm to the health, safety, or well-being of a resident;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 804.04;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 804.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 804.12(c)(5) and has not submitted a revised POC in accordance with He-P 804.12(c)(6);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 804 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

 

(10) Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 804;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a resident whose needs exceed the services or programs provided by the ALR-RC, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(5)  For admission of a resident whose needs at the time of admission exceed the services or programs authorized by the ALR-RC licensing classification, in violation of RSA 151:5-a, II, and He-P 804.15(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 804.11(e)(5), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 804.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 804.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 804.08(a)(2), the fine for a licensee shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address as required by He-P 804.08(n), the fine for a licensee shall be $100.00;

 

(11)  For a failure to allow access by the department to the ALR-RC’s premises, programs, services, or records, in violation of He-P 804.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 804.08(i), the fine for a licensee shall be $100.00;

 

(13)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 804.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(14)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 804.12(c)(11) & (e) the fine for a licensee shall be $1000.00;

 

(15)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 804.14(b) and He-P 804.19(e), the fine for a licensee shall be $500.00;

 

(16)  For a failure to provide services or programs required by the licensing classification and specified by He-P 804.14(c), the fine for a licensee shall be $500.00;

 

(17)  For exceeding the licensed capacity, in violation of He-P 804.14(n), the fine for a licensee shall be $500.00 per day;

 

(18)  For providing false or misleading information or documentation, in violation of He-P 804.14(t), the fine for an applicant or licensee shall be $1000.00 per offense;

 

(19)  For a failure to meet the needs of a resident or residents, as described in He-P 804.15(a), the fine for a licensee shall be $500.00 per resident;

 

(20)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 804.18(e)-(f), under circumstances where the department has not granted a waiver in accordance with He-P 804.10, the fine for a licensee shall be $500.00;

 

(21) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 815.09(a), the fine shall be $2000.00;

 

(22)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 804.07(a), the fine for a licensed facility shall be $500.00;

 

(23)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 804.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(24)  When an inspection determines that a violation of RSA 151 or He-P 804 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; and

 

(25)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 804 shall constitute a separate violation and shall be subject to fines in accordance with He-P 804.13(c) provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 804, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated poor compliance on the part of the facility in areas that might impact the health, safety or well-being of residents; or

 

(2)  Concern that the conditions in the ALR-RC have the potential  to  worsen.

 

          (f)  An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (g)  If a written request for a hearing is not made pursuant to (f) above, the action of the department shall become final.

 

          (h)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a resident is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

 

          (i)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 804 is achieved.

 

          (j)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (k)  When an ALR-RC’s license has been denied or revoked, the applicant, family member, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

 

(l)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (m)  The 5-year period referenced in (k) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (n) Notwithstanding (m) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 804.

 

          (o)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or other individuals are circumventing rule (k) above by applying for a license through an agent or another person and will retain ownership, management authority, or both, the department shall deny the application.

 

          (p)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 804.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; rpld by #4516, eff 10-28-88; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5511, eff 11-25-92; amd by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.14  Duties and Responsibilities of the Licensee.

 

          (a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

 

          (b)  The licensee shall have written policies and procedures to include:

 

(1)  The rights and responsibilities of admitted residents in accordance with the paitents’ bill of rights under RSA 151:20, II;

 

(2)  The policies described in He-P 804.14(r), He-P 804.16(c)(11), and He-P 804.19(e); and

 

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

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

 

(1)  Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding:

 

a.  The residents’ functioning, safety, and whereabouts; and

 

b. The residents’ health status, including the provision of intervention as necessary or required;

 

(2)  Emergency response and crisis intervention;

 

(3)  Assistance with taking and ordering medications as needed;

 

(4)  The provision of 3 nutritious meals and snacks in accordance with He-P 804.21 unless the resident chooses other options according to their admission agreement;

 

(5)  Housekeeping, laundry, and maintenance services in accordance with the admission agreement;

 

(6)  The availability of activities, for which the facility shall make reasonable accommodation for residents with disabilities, to include, but not be limited to, television, radio, internet, games, newspapers, visitors, and music, designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the admission agreement;

 

(7)  Assistance in arranging medical and dental appointments, which shall include assistance in arranging transportation to and from such appointments and reminding the residents of the appointments; and

 

(8)  Supervision of residents when required to offset cognitive deficits that may pose a risk to self or others if the resident is not supervised.

 

          (d)  The licensee shall have a system to regularly identify the ALR-RC’s daily census, including times when a resident is absent from the ALR-RC.

 

          (e)  The licensee shall assist with arranging transportation to community activities, as available, designed to meet the individual interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents.

 

          (f)  The licensee shall:

 

(1)  Make available basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper. Such basic supplies shall be included in the basic rate except that there may be an additional charge for specific brands or items required to meet individual residents’ needs or requests;

 

(2)  Identify in the admission agreement the cost, if any, of basic supplies or other services for which there will be a charge;

 

(3)  Ensure that all personnel have received the training necessary to be qualified personnel to include demonstrated competency in the training given with documentation maintained in the employee file;

 

(4)  Comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education that shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

a.  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

b.  A minimum of 4 hours of ongoing training each calendar year.

 

(5)  Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known; and

 

(6)  Have a clearly identified policy for CPR that includes the following:

 

a.  If CPR is not performed, the policy shall include a statement that 911 shall be called in an emergency;

 

b.  If CPR is performed, there shall be either at least one person on duty per shift who is certified to perform CPR or an AED available for use; and

 

c. This policy shall be signed by each resident and their guardian, agent, or personal representative, if any, and be located in the resident’s file with their admission agreement.

 

          (g)  The licensee shall educate personnel about the needs and services required by the residents under their care and document such education to include demonstrated competancies.

 

          (h)  Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX.

 

          (i)  As soon as is practicable and in no case longer than 24 hours after the use of a physical or chemical restraint, the resident’s licensed practitioner, guardian, agent, or personal representative, if any, and the department shall be notified of the use of such restraints.

 

          (j)  The use of mechanical restraints, limited to locked or secured ALR-RCs, or units within an ALR-RC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ALR-RC or unit within as permitted by the state fire code, shall be allowed.

 

          (k)  Notwithstanding (j) above, the following methods of mechanical restraints shall be prohibited:

 

(1)  Full bed rails;

 

(2)  Gates, if they prohibit a resident’s free movement throughout the living areas of the ALR-RC;

 

(3)  Half doors, if they prohibit a resident’s free movement throughout the living areas of the ALR-RC;

 

(4)  Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will;

 

(5)  Wrist or ankle restraints;

 

(6)  Vests or pelvic restraints; and

 

(7)  Other similar devices that prevent a resident’s free movement.

 

          (l)  For reportable incidents, the licensee shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 271-4968 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

 

a.  The ALR-RC name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of resident(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  When the resident’s guardian, agent, or personal representative, if any, was notified;

 

i.  The signature of the person reporting the reportable incident;

 

j.  The date and time the resident’s licensed practitioner was notified, if applicable; and

 

k.  The date the facility performed the investigation required by (1) above;

 

(3)  As soon as practicable, notify the guardian, agent, or personal representative, if any;

 

(4)  As soon as practicable, notify the local police department, the department, and the guardian, agent, or personal representative, if any, when a resident has an elopement or unexplained absence and the licensee has searched the building and the grounds of the ALR-RC without finding the resident; and

 

(5)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (m)  The licensee shall comply with the requirements of RSA 151:19-30.

 

          (n)  The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (o)  The licensee shall give a resident and the resident’s guardian, agent, or personal representative, as applicable, written notice of the following:

 

(1)  For an increase in the cost or fees for any ALR-RC services, 30 days advance notice shall be required except for residents receiving Medicaid whose financial liability is determined by the state’s standard of need, or residents funded by the department’s choices for independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs; or

 

(2) For an involuntary change in room or bed location, the facility shall make reasonable accommodation of individual needs and preferences and give 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the resident or other residents, in such case the notice shall be as soon as practicable.

 

          (p)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a conspicuous area accessible to residents, employees, and visitors:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports for the last 12 months in accordance with He-P 804.09(d) and He-P 804.11(d);

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to The Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

 

(5)  The licensee’s evacuation floor plan identifying the location of, and access to, all fire exits.

 

          (q)  The licensee shall determine whether smoking will be allowed at the ALR-RC.

 

          (r)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68, and RSA 155:69 and He-P 804.26(f).

 

          (s)  If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.

 

          (t)  The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

 

          (u)  The licensee shall not advertise or otherwise represent themselves as having a license to provide services that they are not licensed to provide.

 

          (v)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (w)  The licensee shall develop quality assurance plans and policies that evaluate:

 

(1)  The quality of care and services provided to residents;

 

(2)  Compliance with RSA 151 and He-P 804;

 

(3)  The effectiveness of training provided to personnel; and

 

(4)  The effectiveness of corrective actions taken in response to statements of findings, notices to correct, and problems identified in (1)-(3) above

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.15  Resident Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria.

 

          (a)  The licensee shall only admit an individual or retain a resident:

 

(1)  Whose needs are compatible with the care, services, and programs offered by the ALR-RC and authorized by its license;

 

(2)  Who is and remains mobile;

 

(3)  Who can self evacuate or equivalency to safely evacuate;

 

(4)  Whose needs can be met by the facility personnel and which needs do not prevent the resident from being able to safely evacuate, except as allowed by (b) below; and

 

(5)  Who does not require special equipment for transfers to or from a bed or chair.

 

          (b)  Notwithstanding (a)(2)-(3) above, a resident who develops a condition that requires hospice care following admission to an ALR-RC may receive services from a New Hampshire home hospice care provider licensed under He-P 823, provided that the ALR-RC licensee can evacuate the resident without jeopardizing the other residents or personnel. In the event that the resident becomes immobile or unable to self evacuate, the licensee shall have a written plan to ensure that the resident can be evacuated 24/7 in the event of an emergency.

 

          (c)  A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

 

          (d)  The ALR-RC shall hold the resident’s bed open during a temporary absence, in accordance with RSA 151:25.

 

          (e)  The resident shall be transferred or discharged only as allowed under RSA 151:19, VII, RSA 151:21, V, or in accordance with the provisions of RSA 151:26.

 

          (f)  If a resident is to be transferred or discharged, the licensee shall develop a discharge plan that meets the resident’s needs with the input of the resident and the guardian, agent, or personal representative, if any.

 

          (g)  The most recent resident assessment tool, care plan, progress notes, and any current medication records shall accompany the resident upon transfer or discharge.

 

          (h)  If the transfer or discharge referenced in (f) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the resident as soon as possible.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.16  Required Services.

 

          (a)  The licensee shall provide administrative services that include the appointment of an administrator who:

 

(1)  Is responsible for the day-to-day operations of the ALR-RC;

 

(2)  Works no less than 35 hours per week at the ALR-RC, which may include day, evening, night, and weekend hours;

 

(3)  Meets the requirements of He-P 804.18(k);

 

(4)  Designates, in writing, a staff member who shall assume the responsibilities of the administrator in his or her absence; and

 

(5)  In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (3) above.

 

          (b)  At the time of application for admission, the licensee shall provide the resident and the guardian, agent, or personal representative, if any, a written copy of the residential service agreement pursuant to RSA 161-J, except that a copy of the residential service agreement shall not be required if the facility admission agreement includes all of the provisions of a residential service agreement.

 

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

 

(1)  The basic daily, weekly, and monthly fee;

 

(2)  A list of the core services required by He-P 804.14(c) that are covered by the basic rate;

 

(3)  Information regarding the timing and frequency of cost of care increases;

 

(4)  The time period covered by the admission agreement;

 

(5)  The criteria and acuity level that the resident must maintain in order to remain a resident  at an ALR-RC in accordance with He-P 804.15(a);

 

(6)  The ALR-RC’s house rules;

 

(7)  The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

 

(8)  The ALR-RC’s responsibility for resident discharge planning;

 

(9)  Information regarding care, services, or supplies not provided in the core services, to include:

 

a.  The availability of services;

 

b.  The ALR-RC’s responsibility for arranging services; and

 

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

 

(10)  The licensee’s policies and procedures regarding:

 

a.  Arranging for the provision of transportation;

 

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

 

c.  Monitoring third party services contracted directly by the resident and provided on the ALR-RC premises;

 

d.  Handling of resident funds pursuant to RSA 151:24 and He-P 804.14(s);

 

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

 

f.  Storage and loss of the resident’s personal property; and

 

g.  Smoking;

 

(11)  The licensee’s medication management services;

 

(12)  The list of grooming and personal hygiene supplies provided by the ALR-RC as part of the basic daily, weekly, or monthly rate;

 

(13)  A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the ALR-RC’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

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

 

(15)  The ALR-RC’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29;

 

(16)  Information on accessing the long-term care ombudsman;

 

(17)  Information on advanced directives;

 

(18)  Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both, or whether or not the facility has an AED on-site and available for use in an emergency;

 

(19)  Information that if the facility changes its current acceptance of payment sources, it shall provide 60 days’ notice of such change; and

 

(20)  A statement that a resident’s inability to cover the cost of care may result in discharge.

 

          (d)  The ALR-RC shall assess each resident’s needs using the “CARES Tool” (January 2022).

 

          (e)  All personnel who administer the CARES Tool shall be trained to complete the CARES Tool by the department or entities listed in RSA 151:5-a, III.

 

          (f)  The assessment described in (d) above shall:

 

(1)  Be completed no more than 30 days prior to or within 24 hours following admission to the ALR-RC;

 

(2)  Be completed in consultation with the resident and guardian, agent, or personal representative, if any;

 

(3)  Be repeated every 6 months or after any significant change as defined in He-P 804.03(ch);

 

(4)  Be signed and dated by the individual who completed the CARES Tool; and

 

(5)  Be signed by the resident and guardian, agent, or personal representative, acknowledging that the CARES Tool was completed as directed in (2) above.

 

          (g)  If  the guardian, agent, or personal representative if any is unable to sign the Cares Tool the facility shall have documented evidence that the guardian, agent, or personal representative has had an opportunity to take part in completing and reviewing the completed Cares Tool..

 

          (h)  If the CARES Tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES Tool.

 

          (i)  If the nursing assessment indicates that the resident cannot safely evacuate, the resident shall be ineligible for care and services at the ALR-RC.

 

          (j)  If the nursing assessment completed in accordance with (h) above is completed by a licensed practical nurse (LPN), the assessment shall be reviewed and co-signed by the registered nurse (RN) or physician that is supervising the LPN prior to implementation.

 

          (k)  If the Cares Tool indicates a need for a care plan, the care plan shall be:

 

(1)  Completed within 24 hours of the initial Cares Tool and within 24 hours of the completion of all subsequent Cares Toolsexcept where a nursing assessment is required in which case, the care plan shall be completed within 24 hours following the nursing assessment;

 

(2)  Made available to personnel who assist residents;

 

(3)  Completed in consultation with the resident and guardian, agent, or personal representative, if any; and

 

(4)  If the resident and guardian, agent, or personal representative, if any, are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

 

          (l)  The care plan identified in (k) above shall include on an ongoing basis:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The goal or objective of the plan;

 

(4)  The action or approach to be taken;

 

(5)  The responsible person(s) or position; and

 

(6)  The date of reevaluation, review, or resolution.

 

          (m)  Each care plan shall be reviewed at least every 6 months to determine if:

 

(1)  All items identified in the care plan are being met;

 

(2)  The care plan will be continued for another 6 months; and

 

(3)  The care plan will be revised to meet the current needs of the resident.

 

          (n)  Progress notes for each resident shall be written at least quarterly and include, at a minimum:

 

(1)  Changes in mobility, weight, memory, skin integrity, continence, medications, behavior, and personal care needs; and

 

(2)  A summary of visits to licensed practitioners and referrals.

 

          (o)  For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, the facility shall ensure that a discipline specific care plan:

 

(1)  Is completed within 24 hours of the discipline specific assessment;

 

(2)  Is completed in consultation with the resident and guardian, agent, or personal representative, if any;

 

(3)  Is updated following the completion of all future discipline specific assessments;

 

(4)  Is available to personnel who assist residents in the implementation of the discipline specific care plan;

 

(5)  Addresses the needs identified in the discipline specific assessment;

 

(6)  Includes the date the medical, nursing, or rehabilitative care or services, or hospice care need was identified;

 

(7) Identifies the resident goal or approach to be taken to address the medical, nursing, or rehabilitative care or services, or hospice care need;

 

(8)  Includes the date of reevaluation of the medical, nursing, or rehabilitative care or services, or hospice care need and the name of the responsible person; and

 

(9)  Is maintained in the resident’s record.

 

          (p)  For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, progress notes shall be written at every visit by the practitioner performing the service.

 

          (q)  At the time of a resident’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions, and therapeutic diets, as applicable.

 

          (r)  The licensee shall have each resident obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the ALR-RC.

 

          (s)  The health examination referenced in (r) above shall include:

 

(1)  Diagnoses, if any;

 

(2)  The medical history;

 

(3)  A list of current medications including over-the-counter medications, treatments, and therapeutic diets, if applicable; and

 

(4)  Allergies.

 

          (t)  Each resident shall have at least one health examination every 12 months by a licensed practitioner, unless the licensed practitioner determines that an annual health examination is not necessary and specifies in writing an alternative time frame, or unless the resident refuses in writing. Any such resident refusal shall be made annually.

 

          (u)  A resident may refuse all care and services.

 

          (v)  When a resident refuses care or services that could result in a threat to the resident’s health, safety, or well-being, or that of others, the licensee or personnel shall:

 

(1)  Inform the resident of the potential consequences of their refusal;

 

(2)  Notify the licensed practitioner and guardian, if any, of the resident’s refusal of care or services; and

 

(3)  Document in the resident’s record the items in (1) and (2) above, the refusal of care or services, and the resident’s reason for the refusal.

 

          (w)  The licensee shall maintain an emergency data sheet, updated as needed and at a minimum at the conclusion of each RAT assessment, in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

 

          (x)  The emergency data sheet referenced in (w) above shall include:

 

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

 

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

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations to include but not be limited to physical limitations, hearing loss, visual imparement, and cognitive challenges;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advanced directives; and

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

          (ac)  If a facility has independent living units within the same structure which are not separated by a firewall from the licensed facility, they shall be subject to the same requirements as licensed units with regard to fire and building codes, including inspections.

 

          (ad)  If ALR-RC services as defined by He-P 804.03(l) are provided by the staff of the facility to individuals in an independent living unit, the unit(s) shall be redesignated as licensed units in the ALR-RC and an application for a bed increase shall be completed as required by He-P 804.08(a)(5) and (b)(3).

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.17  Medication Services.

 

          (a)  All medications shall be made available to the resident in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis or when indicated by a change in the resident’s condition.

 

          (c)  Medications, treatments, and therapeutic diets ordered by a licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours, or when available in accordance with the licensed practitioner’s written direction.

 

          (d)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the ALR-RC;

 

(2)  Reorder medications for use at the ALR-RC; and

 

(3)  Receive and record new medication orders.

 

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

 

(1)  The resident’s name;

 

(2)  The medication name, strength, prescribed dose, and route, if different than by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that are used PRN; and

 

(5)  The dated signature of the ordering practitioner as allowed by He-P 804.03(ca).

 

          (f)  Except for pharmaceutical samples, each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient, unless it is an emergency medication as allowed by (ab) below:

 

(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 PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (g)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee, with the resident’s name, and shall be exempt from (f)(2)-(6) above.

 

          (h)  The dosage, frequency, and route of administration on the labels of all prescription medications for each resident shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (i) below.

 

          (i)  The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the ALR-RC shall indicate in writing, in the medication record, the date the dose or the discontinuance occurred.

 

          (j)  Only a pharmacist shall make changes to prescription medication container labels except as allowed by (k) below.

 

          (k)  When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

 

          (l)  Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

 

          (m)  The transcribed order in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

 

          (n)  No medications shall be given to or taken by a resident until a written order is received, except as allowed by (l) or (m) above.

 

          (o)  ALR-RCs that do not have a licensed nurse as described in (l) above on duty at the time an order for medications, treatments, or therapeutic diets are to be given shall receive said order in written form with the licensed practitioner’s signature and the date of the order.

 

          (p)  Faxes of signed orders or other electronic media with electronic signatures shall be acceptable to meet the requirements of (o) above.

 

          (q)  All over-the-counter medications as defined by He-P 804.03(av) shall have a signed practitioner’s order specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route.

 

          (r)  The medication storage area for medications not stored in the resident’s room shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (s)  All medication at the ALR-RC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (ad)(6) below.

 

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

 

          (u)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the ALR-RC, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (v)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (w)  Except as required by (x) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

 

          (x)  Destruction of contaminated, expired, or discontinued controlled drugs shall:

 

(1)  Be in accordance with acceptable standards of practice;

 

(2)  Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and

 

(3)  Be documented in the record of the resident for whom the drug was prescribed.

 

          (y)  When a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self administration of medication without assistance.

 

          (z)  If a resident is going to be absent from the ALR-RC at the time medication is scheduled to be taken and the resident is not capable of self administration of medication without assistance, the medication container shall be given to the person responsible for the resident while the resident is away from the ALR-RC.

 

          (aa)  Upon discharge or transfer, the licensee shall make the resident’s current medications available to the resident and the guardian, agent, or personal representative, if any, and upon death of a resident, the facility shall return or destroy all remaining medications, as appropriate, and document in resident record.

 

          (ab)  A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (ac)  Residents shall receive their medications by one of the following methods:

 

(1)  Self administration of medication without assistance as defined by He-P 804.03(br);

 

(2)  Self-directed medication administration as defined by He-P 804.03(bs);

 

(3)  Self administration of medication with assistance as defined by He-P 804.03(bq); or

 

(4)  Administered by individuals authorized by law, including via delegation.

 

          (ad)  If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

 

          (ae)  For residents who self administer medication without assistance, the licensee shall:

 

(1)  Obtain a written order from a licensed practitioner on an annual basis:

 

a.  Authorizing the resident to self administer medication without assistance; and

 

b.  Authorizing the resident to store the medications in their room;

 

(2)  Evaluate the resident on a 6 month basis or sooner, based on a significant change in the resident, to ensure they maintain the physical and mental ability to self administer medication without assistance;

 

(3)  Have the resident store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

 

(4)  If a resident requests, allow the resident’s medication to be placed in a central locked storage area provided by the ALR-RC;

 

(5)  Have a copy of the key to access the locked medication storage area in the resident’s room;

 

(6)  Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist; and

 

(7)  Except as provided for in (4) above, not be responsible, in any way, for management or control of the resident’s medications.

 

          (af)  The licensee shall allow the resident to self direct administration of medications if the resident:

 

(1)  Has a physical limitation due to a diagnosis that prevents the resident from self administration of medications with or without assistance;

 

(2)  Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self direct administration of medications;

 

(3)  Obtains an annual written verification of the resident’s physical limitation and self-directing capabilities from the resident’s licensed practitioner and requests the ALR-RC to file the verification in their resident record; and

 

(4)  Verbally directs personnel to:

 

a.  Assist the resident with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

 

b.  Assist the resident to apply, ingest, or instill the ordered dose of medication.

 

          (ag)  If a resident self administers medication with assistance, personnel shall be permitted to:

 

(1)  Remind the resident to take the correct dose of his or her medication at the correct time;

 

(2)  Place the medication container within reach of the resident;

 

(3)  Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner;

 

(4)  Record on the resident’s daily medication record that they have supervised the resident taking his or her medication; and

 

(5)  Document in the resident’s record any observed or reported side effects, adverse reactions, refusal to take medications, or medications not taken.

 

          (ah)  If a resident self administers medication with assistance, personnel shall not physically handle the medication in any manner.

 

          (ai)  Except for those residents who self administer medication without assistance, the licensee shall maintain a written record for each medication taken by a resident at the ALR-RC that contains the following information:

 

(1)  Any allergies or adverse reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises, or assists the resident taking medication;

 

(5)  For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (aj)  The facility shall have a written policy that incorporates the requirements listed in (ad)-(ai) for use in training and for reference by employees supervising medication administration.

 

          (ak)  Personnel who are not licensed practitioners or nurses but who assist a resident with self administration of medication with assistance or self-directed administration of medication shall, prior to providing such assistance, complete, at a minimum, a 4-hour medication assistance education program covering both prescription and non-prescription medication.

 

          (al)  A licensed nurse, licensed practitioner, or pharmacist shall teach the medication assistance education program, whether in-person or through other means such as electronic media provided it meets the requirements of (ak) above and (am) below.

 

          (am)  The medication supervision education program required by (ak) above shall include:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights relative to medication, which are:

 

a.  The right resident;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Medication administered at the right time; and

 

e.  Medication administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as antihypertensives or antibiotics;

 

(5)  Desired effects and potential side effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (an)  The administrator may accept documentation of training required by (ak) above if it was previously obtained by the applicant for employment at another licensed ALR-RC.

 

          (ao)  The licensee shall report to the resident’s licensed practitioner any adverse reactions and side effects to medications or medication errors, such as incorrect medications, immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the resident’s record the reaction, the error, and date, time, and person notified.

 

          (ap)  No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.

 

          (aq)  An ALR-RC shall have written orders from the licensed practitioner for all medications being taken by residents except for residents who have a licensed practitioner’s order to self administer medications without assistance and keep the medicine in their room.

 

          (ar)  An ALR-RC may keep non-prescription stock medications for a resident when accompanied by a licensed practicioner’s order and each resident has his or her own container for the medication.

 

          (as)  The therapeutic use of cannabis by residents who are qualifying residents possessing a registry identification card shall be permitted at an ALR-RC provided:

 

(1)  The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or

 

(2)  The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident.

 

          (at)  An ALR-RC that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration.

 

          (au)  An ALR-RC that designates itself as a facility caregiver according to (as)(1) above shall:

 

(1)  Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and

 

(2)  Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying residents with the therapeutic use of cannabis.

 

          (av)  An ALR-RC shall not permit the smoking of cannabis if smoking is not allowed on the ALR-RC premises.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.18  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the ALR-RC to meet the needs of residents at all times as determined by each Cares Tool.

 

          (b)  For those ALR-RCs licensed for 17 or more beds, at least one awake personnel shall be on duty at all times, including overnight, while residents are in the ALR-RC.

 

          (c)  For those ALR-RCs licensed for 16 or fewer beds, at least one awake personnel shall be on duty at all times, including overnight, while residents are in the ALR-RC, unless:

 

(1)  There is a UL listed communication system whereby residents can contact and awaken the sleeping personnel member via an intercom or other communication system in the personnel member’s room;

 

(2)  If the ALR-RC has residents with a history of exit seeking, the licensee has installed and maintains a functioning wander prevention system that will awaken the sleeping personnel; and

 

(3)  All residents:

 

a.  Require nothing more then occasional reminding or cueing;

 

b.  Require nothing more then verbal prompting for mobility and evacuation issues;

 

c.  Have no acute medical needs or ongoing nursing needs; and

 

d.  Have no history of being verbally or physically abusive.

 

          (d)  For all applicants for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, and for all household members, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing; and

 

(2)  Review the results of the criminal records check in (1) above in accordance with (e) below; and

 

(3)  Verify the qualifications of all applicants prior to employment.

 

          (e)  Unless a waiver is granted in accordance with (g)(2) below, the licensee shall not offer employment, contract with, or engage a person in (d) above, or allow a household member to continue to reside in the residence, if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (f)  If the information identified in (e) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

 

(2)  Request a waiver of (e) above.

 

          (g)  If a waiver of (e) above is requested, the department shall review the information and the underlying circumstances in (e) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a resident; or

 

(2)  Grant a waiver of (e) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

 

          (h)  The licensee shall check the names of the persons in (d) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, and against the NH board of nursing, nursing assistant registry, maintained pursuant RSA 326-B:26 and 42 CFR 483.156, prior to employing, contracting with, or engaging them, or prior to allowing or continuing to allow a household member to reside at the residence.

 

          (i)  The licensee shall not employ, contract with, engage, or allow to reside in the facility any person in (d) above who is listed on the BEAS state registry or the NH board of nursing, nursing assistant registry unless a waiver is granted by BEAS or the NH board of nursing, respectively.

 

          (j)  In lieu of (d) and (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (d) and (h) above and do not meet the criteria in (e) and (i) above.

 

          (k)  All administrators appointed after the 2022 effective date of these rules shall be at least 21 years of age and have one of the following combinations of education and experience:

 

(1)  A bachelor’s degree from an accredited institution and one year of experience working in a health care facility;

 

(2)  A New Hampshire license as an RN and at least 6 months of experience working in a health care facility;

 

(3)  An associate’s degree from an accredited institution and at least 2 years of experience working in a health care facility; or

 

(4)  A New Hampshire license as an LPN and at least one year of experience working in a health care facility.

 

          (l)  All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the ALR-RC each annual licensing period, in accordance with (t) and (u) below.

 

          (m)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of a nurse.

 

          (n)  The licensee shall inform personnel of the line of authority at the ALR-RC.

 

          (o)  The licensee shall educate personnel about the needs and services required by the residents under their care.

 

          (p)  Prior to having contact with residents or food, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (q)  In lieu of (p)(1) above, independent agencies contracted by the facility or by an individual resident to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (p)(1) and (3) above before working at the ALR-RC.

 

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

 

(1)  The residents’ rights in accordance with RSA 151:20;

 

(2)  The ALR-RC’s resident complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The emergency medical procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 804.22;

 

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

 

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

 

          (s)  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 resident’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan; and

 

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

 

          (t)  The facility administrator, licensed nurse, if available, or the administrator’s designee who has completed the 4-hour medication assistance supervision program required by He-P 804.17(ak) shall provide and document in writing, an annual review of its policies and procedures for self administration of medication without assistance, self administration of medication with assistance, and self-directed medication administration to all direct care personnel.

 

          (u)  The ALR-RC shall maintain a separate employee file for each employee, which shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the residents rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (d) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (r) above;

 

(7)  Information as to the general content and length of all in-service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

 

(9)  A copy of each current driver’s license, including proof of insurance, if the employee transports residents using their own vehicle;

 

(10)  Documentation that the required physical examinations or health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; 

 

(11)  The statement required by (w) below; and

 

(12)  The results of the registry checks in (h) above. 

 

          (v)  The ALR-RC shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (u)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (u)(3), (4), (6), and (8)-(12) above, except that the letter in (j) and (q) above may be substituted for (u)(4), (10), and (12) above, if applicable.

 

          (w)  All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a resident; and

 

(3)  Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

 

          (x)  An individual shall not have to re-disclose any of the matters in (w) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

 

          (y)  The licensee shall protect and store in a secure and confidential manner all records described in (u) and (v) above.

 

          (z)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

 

          (aa)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (ab)  The ALR-RC shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

 

          (ac)  The policy in (ab) above shall include:

 

(1)  Education;

 

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

 

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

 

(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 abuse, misuse, and diversion prevention policy.

 

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.19  Resident Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the ALR-RC.

 

          (b)  At a minimum, resident records shall contain the following:

 

(1)  A copy of the resident’s residential service agreement, admission agreement, or both, as applicable, and all documents required by He-P 804.16(b) and (c);

 

(2)  Notwithstanding (1) above, financial records may be kept in a separate file;

 

(3)  Identification data, including:

 

a.  The resident’s name, date of birth, and marital status;

 

b.  If the resident is receiving respite care as described in He-P 804.20, the resident’s home address and phone number;

 

c.  Resident’s religious preference, if known;

 

d.  Resident’s veteran status, if known; and

 

e.  Name, address, and telephone number of an emergency contact person;

 

(4)  The name and telephone number of the resident’s licensed practitioner(s);

 

(5)  If services are provided at the ALR-RC by individuals not employed by the licensee, documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, and the business address and telephone number;

 

(6)  Resident’s health insurance information;

 

(7)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(8)  A record of the health examination(s) in accordance with He-P 804.16 (r) - (t);

 

(9)  Written, dated, and signed orders for the all medications, treatments, and therapeutic diets;

 

(10)  Results of any laboratory tests, X-rays, or consultations performed at the ALR-RC;

 

(11)  All assessments and care plans, and documentation that the resident and the guardian or agent, if any, has participated in the development of the care plan;

 

(12)  All admission and progress notes;

 

(13)  Documentation of any alteration in the resident’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken, including licensed practitioner notification;

 

(14)  Documentation of medical, nursing, or other specialized care, as applicable;

 

(15)  Documentation of reportable incidents;

 

(16)  The consent for release of information signed by the resident, guardian, or agent, if any;

 

(17)  Discharge planning and referrals;

 

(18)  Transfer or discharge documentation, including notification to the resident and guardian, agent, or personal representative, if any, of involuntary room change, if applicable;

 

(19)  The medication record as required by He-P 804.17(ai);

 

(20)  Emergency data sheet, which contains the information required by He-P 804.16(x);

 

(21)  Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner; and

 

(22)  Documentation of a resident’s refusal of any care or services.

 

          (c)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting residents, to include:

 

(1)  That immunizations shall be provided and reported to the department’s division of public health services immunization program in accordance with RSA 151:9-b, I-V, He-P 309.02, and He-P 309.08; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, all residents that have received or declined to receive immunizations, to be included in the resident record in (b) above.

 

          (d)  Resident records and resident information shall be kept confidential and only provided in accordance with law.

 

          (e)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

 

          (f)  When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

 

          (g)  Records shall be retained for 4 years after discharge, except that when the resident is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

 

          (h)  The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the ALR-RC ceases operation.

 

          (i)  If the facility uses an electronic record storage system, it shall provide computer access to all resident records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 804 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

 

          (j)  All resident electronic records shall have security provisions to ensure confidentiality.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.20  Respite Care in ALR-RC.

 

          (a)  The licensee shall only admit an individual for respite care services when the needs of the individual are compatible with the services and programs offered by the facility as allowed by its license and the facility can meet the needs of the individual in accordance with He-P 804.15(a)-(d).

 

          (b)  When a temporary admission to an ALR-RC occurs and the individual is scheduled for a stay of no more than 30 consecutive days as agreed upon by the individual and the licensee as part of a discharge plan, the licensee shall: 

 

(1)  Obtain written verification signed by the resident, guardian or agent, if any, or personal representative, indicating they have been given a copy of the patient rights and responsibilities as required by RSA 151:20, I;

 

(2)  Obtain a signed admission agreement listing the services that shall be provided;

 

(3)  Be permitted to use the prescription label on the medication container as the licensed practitioner’s order provided that:

 

a.  The medication is in the original bottle as dispensed by the pharmacy;

 

b.  The pharmacy label has not been altered in any manner;

 

c.  The prescription label indicates that the medication is still current; and

 

d.  The medication container contains all the same medication or has been labeled by the pharmacy verifying that the bottle contains all the same prescription medication;

 

(4)  Complete the CARES Tool prior to or immediately on admission to determine that the potential residents’ needs can be met by the facility;

 

(5)  Note in the resident’s record, the resident’s allergies, if any, diagnoses, and history of wandering or unexplained absences; and

 

(6)  Obtain copies of current advanced directives information, if available.

 

          (c)  For planned recurrent respite care the resident shall be discharged but may be readmitted using the same admission documents completed within the previous 6 months, as long as there are no identified changes in the resident’s condition or care needs except that the medication requirement in (b)(3) above shall be re-verified.

 

          (d)  If the resident exceeds the 30-day time period, the resident shall no longer be considered to be receiving respite care and:

 

(1)  A complete admission shall occur within 72 hours; or

 

(2)  The resident shall be discharged from the facility. 

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17; ss by #13339, eff 1-29-22

 

          He-P 804.21  Food Services.

 

          (a)  The licensee shall provide food services that meet:

 

(1)  The US Department of Agriculture’s recommended dietary allowance as specified in the “2015-2020 Dietary Guidelines for Americans,” available as noted in Appendix A;

 

(2)  The nutritional needs of each resident; and

 

(3)  The special dietary needs, including any therapeutic diets, associated with health or medical conditions for each resident as identified on the RAT.

 

          (b)  Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises, unless contraindicated by the resident’s care plan.

 

          (c)  There shall be no more than 14 hours between the evening meal and breakfast except if:

 

(1)  The licensee offers snacks at bedtime;

 

(2)  The resident agrees, in writing, to allow more than 14 hours between the evening meal and breakfast; or

 

(3)  The resident refuses to eat a specific meal.

 

          (d)  Snacks shall be offered and made available between meals and at bedtime if not contraindicated by the resident’s care plan.

 

          (e)  If a resident refuses the item(s) on the menu, a substitute shall be offered.

 

          (f)  Each day’s menu shall be posted in a place accessible to food service personnel and residents.

 

          (g)  A dated record of menus as served shall be maintained for at least the previous 4 weeks.

 

          (h)  The licensee shall provide therapeutic diets to residents only as ordered by a licensed practitioner or other professional with prescriptive authority.

 

          (i)  If a resident has a pattern of refusing to follow a prescribed therapeutic diet, personnel shall document the reason for the refusal in the resident’s medical record and notify the resident’s licensed practitioner.

 

          (j)  All food and drink provided to residents shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

(2)  Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and chapter 3 of the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administration, Food Code, 2013 edition, available as noted in Appendix A;

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated, and stored at proper temperatures; and

 

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

 

          (k)  The use of expired or unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded. The dates associated with such terms as “sell by”, “use by”, or “best if used by” shall not constitute the expiration date.

 

          (l)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (m)  All work surfaces shall be non-porous and cleaned and sanitized after each use.

 

          (n)  All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

 

          (o)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (p)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

 

          (q)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (r)  Garbage or trash in the kitchen area shall be placed in lined containers with covers which shall remain closed except when in use.

 

          (s)  All ALR-RC personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.22  Infection Control.

 

          (a)  The ALR-RC shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

          (b)  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 communicable diseases or illnesses;

 

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

 

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

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, formites, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected.

 

          (f)  Personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ALR-RC until a diagnosis of tuberculosis is excluded, or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, fitted bandage.

 

          (h)  If the ALR-RC has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.23  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times, and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the residents.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and resident supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service areas shall be covered at all times, except during food preparation and subsequent clean-up.

 

          (m)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and be separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas or containers.

 

          (p)  Any ALR-RC that has its own water supply and whose water has been tested and failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17

 

          He-P 804.24  Quality Improvement.

 

          (a)  The ALR-RC shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The ALR-RC shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored:

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the ALR-RC; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

          (e)  The quality improvement committee shall meet at least quarterly.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

 

Source.  #12414, eff 11-3-17

 

          He-P 804.25  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, comfort, and privacy of resident(s) and personnel, including reasonable accommodations for residents and personnel with mobility limitations.

 

          (b) The ALR-RC shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within an ALR-RC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following conditions are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Unvented fuel-fired heaters shall not be used in any ALR-RC.

 

          (g)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (h)  Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (i)  The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

 

          (j)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (k)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (l)  Bedrooms shall have at least 100 square feet for each resident in each private bedroom and at least 80 square feet for each resident in a semi-private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities.

 

          (m)  Bedrooms in an ALR-RC licensed prior to 4/3/2008 shall:

 

(1)  Be exempt from (l) above;

 

(2)  Provide at least 80 square feet per resident in a private room; and

 

(3)  Provide at least 70 square feet per resident in a semi-private room.

 

          (n)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the resident to reach his or her bedroom without passing through the room of another resident;

 

(3)  Have a side hinge door and not a folding or sliding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors, and other rooms by floor to ceiling walls;

 

(6)  Be located on the same level as the bathroom facilities if the resident has impaired mobility as identified by the RAT; and

 

(7)  If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom within 24 hours and without requiring additional construction or renovation.

 

          (o)  The licensee shall provide the following for the residents’ use, as needed:

 

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

 

(2)  A firm mattress that complies with the state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau, mirror, and bedside table;

 

(5)  A lamp;

 

(6)  A chair;

 

(7)  A closet or storage space for personal belongings; and

 

(8)  Window blinds, shades, or curtains that provide privacy.

 

          (p)  The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others and may waive any of the items in (o) above with a note signed by the resident or guardian and which note shall be placed in the resident’s file.

 

          (q)  The licensee shall provide the following rooms to meet the needs of residents:

 

(1)  One or more living rooms or multipurpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all residents.

 

          (r)  Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

 

          (s)  Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

 

          (t)  All bathroom, bedroom, and closet doors shall either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

 

          (u)  Screens shall be provided for doors, windows, or other openings to the outside.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17 (from He-P 804.24); ss by #13339, eff 1-29-22

 

          He-P 804.26  Fire Safety.

 

          (a)  All ALR-RCs shall meet at a minimum the following:

 

(1)  For facilities with 3 residents or fewer, the One and Two Family Dwelling chapter of the life safety code; and

 

(2)  For facilities with 4 residents or more, the Residential Board and Care Occupancy chapter of the life safety code.

 

          (b)  All ALR-RCs shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the ALR-RC’s electrical service, or wireless, as approved by the state fire marshal for the ALR-RC;

 

(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, and which meets the following requirements:

 

a.  Maximum travel distance to each extinguisher shall not exceed 50 feet;

 

b.  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;

 

c.  Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

 

d.  Documentation of  manual fire extinguisher inspections must be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation;

 

e.  Documentation of electronically monitored fire extinguishers must be provided to the department within 2 business days of the completion of the inspection or investigation;

 

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

 

g.  The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

 

(3)  An approved carbon monoxide monitor on every level.

 

          (c)  A fire safety program shall be developed and implemented to provide for the safety of residents and personnel.

 

          (d)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  Emergency EMS transport related to pre-existing conditions.

 

          (e)  The written notification required by (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (f)  If the licensee has chosen to allow smoking within the ALR-RC, a designated smoking area shall be provided which:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non-combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64–77, the Indoor Smoking Act.

 

          (g)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, or the resident’s guardian, a person with durable power of attorney (DPOA), agent, or personal representative, as appropriate at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident. Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (h)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (i)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the One and Two Family Dwelling chapter or the Residential Board and Care Occupancy chapter of the life safety code, the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Willing residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All ALR-RC facilities identified in (1) above shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the dark of night when a majority of residents are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the fire safety plan, and approved by the department and the local fire authority based on construction of the building, and shall provide residents with experience in egressing through all exits and means of escape;

 

e.  Facilities shall complete a written record of fire drills that includes the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At least annually, and whenever a resident experiences a significant change, as defined in He-P 804.03(ch), the facility shall conduct a resident Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the resident’s needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, and residents’ ability to evacuate on their own and choose an alternate exit;

 

h.  At least annually, the facility shall review all residents’ FSES in totality to ensure that the facility can meet not only the needs of each individual resident but the resident population as a whole during a time of emergency;

 

i.  Based on the review in h. above, if the facility is unable to meet the needs of any resident based on the FSES, the facility shall address the safety concerns through a variety of interventions such as resident discharge, additional staff, and modification to the current building; and

 

j.  The fire drills for facilities built to the Residential Board and Care Occupancy chapter of the life safety code shall be permitted to be announced, in advance, to the residents just prior to the drill;

 

(2)  For buildings constructed to the Health Care Occupancy chapter of the life safety code and to the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the Health Care Occupancy chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7. Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy chapter of the life safety code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, residents, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that residents are given the experience of evacuating to the appropriate location or exiting through all emergency exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

h.  Written records of the fire drills shall be maintained on site and available to the department  during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

i.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(3)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

Source.  #9121, eff 4-3-08, EXPIRED: 4-3-16

 

New.  #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12414, eff 11-3-17 (from He-P 804.25); ss by #13339, eff 1-29-22

 

          He-P 804.27  Emergency Preparedness.

 

          He-P 804.27  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

 

          (b)  The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

 

(12)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Include the management of residents, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (f)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not involved in the exercise;

 

(2)  Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

 

          (g)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

          (h)  Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

 

(1)  Assumptions for calculations of food and water supplies including maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

 

(2)  Storage location(s); and

 

(3)  Back-up supplies.

 

Source.  #12414, eff 11-3-17

 

 

PART He-P 805  SUPPORTED RESIDENTIAL HEALTH CARE FACILITY LICENSING RULES

 

REVISION NOTE:

 

          Document #13368, effective 4-19-22, readopted with amendments the “Care Assessment for Residential Services Tool” form pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c.  The form is incorporated by reference in He-P 805.16(d) which requires the supported residential health care facility (SRHCF) to assess each resident’s needs using the “Care Assessment for Residential Services Tool” form.  Document #13368 contained only the amended form, giving it a new effective date, and updated the revision date on the form from the “January 2022 edition” to the “April 2022 edition.” 

 

          The prior filing affecting He-P 805.16 was Document #13333, effective 1-25-22, and the effective date of the rule remained unchanged by Document #13368.  Since Document #13368 updated the revision date on the form from “(January 2022 edition)” to the “(April 2022 edition)”, the revision date was subsequently updated editorially in He-P 805.16(d). 

 

          He-P 805.01  Purpose.  The purpose of this part is to set forth the classification of and licensing requirements for supported residential health care facilities (SRHCF) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(2).

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93, EXPIRED: 7-14-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.02 Scope. This part shall apply to any individual, agency, partnership, corporation, government entity, association or other legal entity operating a SRHCF pursuant to RSA 151:9, VII(a)(2).

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of residents;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to residents; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving residents without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 805.

 

          (f)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.

 

          (g)  “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (h)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker identified under RSA 137-J:34-37.

 

          (j)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an SRHCF pursuant to RSA 151.

 

          (k) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 805, or other federal or state requirements.

 

          (l)  “Assessment” means an evaluation of the resident to determine the care and services that are needed.

 

          (m)  “Care assessment for residential services (CARES) tool” means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I.

 

          (n)  “Care plan” means a written guide developed by the licensee, in consultation with the resident or guardian, agent, or personal representative, if applicable, as a result of the assessment process for the provision of care and services as required by He-P 805.16(d) - (j).

 

          (o)  “Change of ownership” means the transfer of the controlling interest of an established SRHCF to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

          (p)  “Chemical restraints” means any medication that is used for discipline or staff convenience, in order to alter a resident’s behavior such that the resident requires a lesser amount of effort or care, and is not in the resident’s best interest, and not required to treat medical symptoms.

 

          (q)  “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

 

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

 

          (s)  “Core services” means those services provided by the licensee that are included in the basic rate.

 

          (t)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

          

          (u)  “Days” means calendar days unless otherwise specified in the rule.

 

          (v)  “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

 

          (w)  “Direct care” means the provision of hands-on care and services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (x)  “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

 

          (y)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified deficiencies.

 

          (z)  “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

 

          (aa)  “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

 

          (ab)  “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away or otherwise leaves a caregiving facility or environment unsupervised or unnoticed, without the knowledge of the licensee’s personnel.

 

          (ac)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (ad)  “Employee” means anyone employed by the SRHCF and for whom the SRHCF has direct supervisory authority.

 

          (ae)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 805.

 

          (af) “Equipment” means  any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

 

          (ag)  “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ah) “Facility” means “facility” as defined in RSA 151:19, II.

 

          (ai)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident’s health care and other personal needs.

 

          (aj)  “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s control.

 

          (ak)  “Household member” means the caregiver, all family members and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days.

 

          (al) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (am)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (an)  “Informed consent” means the decision by a resident, his or her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (ao)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (ap)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee's compliance with RSA 151 and He-P 805 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 805.

 

          (aq)  “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of disease.

 

          (ar)  “License” means the document issued to an applicant or licensee of an SRHCF which authorizes operation in accordance with RSA 151 and He-P 805, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date and license number.

 

          (as)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the SRHCF is licensed for.

 

          (at)  “Licensed practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician's assistant;

 

(3)  Advanced practice registered nurse;

 

(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.

 

          (au)  “Licensed premises” means the building that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (av)  “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151.

 

          (aw)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ax) “Life safety code” means the standards, 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.

 

          (ay)  “Mechanical restraint” means locked, secured, or alarmed SRHCFs or units within an SRHCF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within.

 

          (az)  “Medical director” means a medical doctor, advanced practice registered nurse, doctor of osteopathy or doctor of naturopathic medicine licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in an SRHCF.

 

          (ba)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (bb)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include “repair” or “replacement” of interior finishes. 

 

          (bc)  “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional or physical health and safety of a resident.

 

          (bd)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (be)  “Nursing care plan” means a written guide developed by a nurse in consultation with the resident and/or guardian, agent, or personal representative, that lists the interventions necessary to meet the resident’s nursing needs.

 

          (bf)  “One and 2 family dwelling unit” means one- and 2-family dwellings, which shall include those buildings containing not more than 2 dwelling units in which each dwelling unit is occupied by members of a single family with not more than 3 outsiders, if any, accommodated in rented rooms.

 

          (bg)  “Orders” means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, 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.

 

          (bh)  “Over-the-counter medications” means non-prescription medications.

 

          (bi)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

 

          (bj)  “Patient rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21. This term includes “resident rights”.

 

          (bk)  “Performance based design” means an engineering approach to fire protection design and construction based on:

 

(1)  Established fire safety goals and objectives;

 

(2)  Deterministic and probabilistic analysis of fire scenarios; and

 

(3)  Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria.

 

          (bl)  “Personal assistance” means providing or assisting a resident in carrying out activities of daily living.

 

          (bm)  “Personal representative” means a person designated in accordance with RSA 151:19, V to assist the resident for a specific, limited purpose or for the general purpose of assisting the resident in the exercise of any rights.

 

          (bn)  “Personnel” means individual(s), either paid or volunteer, who provide direct or indirect care or services, or both, to a resident(s).

 

          (bo)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints or other containment techniques.

 

          (bp)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bq)  “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

 

(1)  A lancing or finger stick device to get blood specimen;

 

(2)  A test strip or reagents to apply a specimen to for testing; or

 

(3)  A meter or monitor to calculate and show the results, including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

 

c.  A Cholesterol meter.

 

          (br)  “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of patient care.

 

          (bs)  “Pro re nata (PRN) medication” means medication taken as circumstances may require.

 

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

 

          (bu)  “Protective care” means the provision of resident monitoring services, including but not limited to:

 

(1)  Knowledge of resident whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (bv)  “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bw)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (bx)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (by)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

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

 

(1)  The unanticipated death of the resident;

 

(2)  An injury to a resident, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the resident; or

 

(3)  The elopement or unexplained absence of a resident from the SRHCF.

 

          (ca)  “Resident” means any person admitted to or in any way receiving care, services or both who resides in a SRHCF.

 

          (cb)  “Residential board and care”, as defined in NFPA 101 of the fire code, means a facility where residents are provided with personal care and activities that foster continued independence and residents are trained and required to respond to fire drills to the extent they are able.  These facilities are further grouped as “small”, 4-16 beds or “large”, over 16 beds.

 

          (cc)  “Residential care facility”, as defined in NFPA 101 of the fire code, means a long term care residence providing personal assistance at the residential care level pursuant to RSA 151:9, VII(a)(1).

 

          (cd)  “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 805 and as required by other federal and state law.

 

          (ce)  “Respite care” means the admission of a person from his or her primary residence to an SRHCF, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care.

 

          (cf)  “Self administration with assistance” means the resident takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

 

          (cg)  “Self administration without assistance” means an act whereby the resident takes his or her own medication(s) without the assistance of another person.

 

          (ch)  “Self directed medication administration” means an act whereby a resident, who has a physical limitation that prohibits him or her from self-administering, directs personnel to physically assist in the medication process.

 

          (ci)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

 

          (cj)  “Severe mobility impairment” means the ability to move to stairs but without the ability to use them.

 

          (ck) “Significant change” means a decline or improvement in a resident’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the resident’s health status; and

 

(3)  Requires interdisciplinary review and/or revision of the care plan.

 

          (cl)  “State monitoring” means the placement of individuals by the department at an SRHCF to monitor the operation and conditions of the facility.

 

          (cm) “Stock medication” means over-the-counter medication available for use by more than one resident.

 

          (cn)  “Supported residential health care facility (SRHCF)” means a long-term care residence providing personal assistance at the supported residential care level pursuant to RSA 151:9, VII(a)(2).

 

          (co)  “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

 

          (cp)  “Underwriters Laboratories (UL) Listed” means that the global safety certification company UL has confirmed that the product is safe for use.

 

          (cq)  “Unexplained absence” means an incident involving a resident leaving the premises of the SRHCF without the knowledge of the SRHCF personnel in a manner that is contrary to their normal routine.

 

          (cr) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.04  Initial License Application Submission.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (February 2023), signed by the applicant or 2 of the corporate officers, affirming to the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

(2)  A floor plan of the prospective SRHCF;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications of the SRHCF administrator;

 

(6)  Copies of applicable licenses for the SRHCF administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300 including the health care chapter of the Life Safety Code, and local fire ordinances applicable for a health care facility; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(8)  If the SRHCF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant, licensee if different than the applicant, and administrator.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 805.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 805.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 805.13(b) if it determines that the applicant, licensee, administrator, or medical director:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any other administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  Following both a clinical and life safety inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 805.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)  A written notification of denial, pursuant to He-P 805.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 805.05(f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 805.

 

          (i) A written notification of denial, pursuant to He-P 805.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 805.04(a)(1) at least 120 days prior to the expiration of the current license and include:

 

(1)  The current license number;

 

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 805.10(f), if applicable;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 805.18(c); and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I, by the state fire marshal, with the board of fire control.

 

          (c)  In addition to He-P 805.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw702 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection as described in He-P 805.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by He-P 805.06(b) and (c) as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 805, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 805.04(a) and shall be subject to a fine in accordance with He-P 805.13(c)(7). 

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.07  SRHCF Construction, Modifications or Structural Alterations.

 

          (a)  For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

 

(b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural sprinkler and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b,V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 805 and notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f) Department approval shall not be required prior to initiating construction, renovations, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

          (g) The SRHCF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  Saf-C 6000 and the state fire code under RSA 153:1, VI-a, including but not limited to, NFPA 1 and  NFPA 101, and as amended in Saf-FMO 300 , by the state fire marshal with the board of fire control and ratified by the general court pursuant to RSA 153:5;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  The Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities”, (2018 edition), available as noted in Appendix A.          

 

          (i)  All SRHCFs newly constructed or rehabilitated after the 2022 effective date of these rules shall comply with the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 edition), as applicable, as available as noted in Appendix A.

 

          (j)  Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Health, Care, and Support Facilities” (2018 edition), as available as noted in Appendix A.

 

          (k)  The department shall be the authority having jurisdiction for the requirements in (h) and (i) above and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 805.10 as appropriate.

 

         (l)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

 

          (m)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (n)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

          (o)  The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 805.09 prior to its use.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.08  SRHCF Requirements for Organizational or Service Changes.

 

          (a)  The SRHCF shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds authorized under the current license; or

 

(6)  Services.

 

          (b)  The SRHCF shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3)  An increase in the number of beds authorized under the current license; or

 

(4) A change in services.

 

          (c)  When there is a change in address without a change in location the SRHCF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the SRHCF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department:

 

(2)  The physical location;

 

(3)  An increase in the number of beds or residents authorized under the current license;

 

(4)  A change in license classification; or

 

(5)  A change that places the facility under a different life safety code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the SRHCF name or a change in address without a change in physical location.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  An increase or decrease in the number of beds;

 

(3)  A change in the scope of services provided; or

 

(4)  When a waiver has been granted in accordance with He-P 805.10.

 

          (i)  The SRHCF shall inform the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change,  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following: 

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses for the new administrator;

 

(3)  The results of a NH criminal background check from the NH department of safety for the new administrator or medical director;

 

(4)  The results of the criminal attestation as described in He-P 805.18(t); and

 

(5)  The results of the BEAS registry check per He-P 805.18(e).

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 805.18(g) and (h).

 

          (k)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

           (l)  When there is to be a change in the services provided, the SRHCF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

          (m)  The department shall review the information submitted under (l) above and determine if the added services can be provided under the SRHCF’s current license.

 

          (n)  The SRHCF shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

          (o)  A restructuring of an established SRHCF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)   If a licensee chooses to cease operation of a SRHCF, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 805, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the SRHCF; and

 

(3)  Any records required by RSA 151 and He-P 805.

 

          (b)  The department shall conduct a clinical and life safety code inspection, as necessary, to determine full compliance with RSA 151 and He-P 805 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 805.08(e)(1);

 

(3)  A change in the physical location of the SRHCF;

 

(4)  A change in the licensing classification;

 

(5)  A change in the life safety code occupancy chapter the facility is licensed under;

 

(6)  An increase in the number of beds;

 

(7)  Occupation of space after construction, renovations or alterations; or

 

(8)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the SRHCF is in violation of any of the provisions of He-P 805, RSA 151, or other federal or state requirement(s).

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 805, within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 805 shall submit a written request for a waiver to the department that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

 

(4)  The period of time for which the waiver is sought if less than permanent.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the residents; and

 

(3)  Does not affect the quality of resident services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g) If a waiver renewal request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license.

 

          (h)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); or

 

(3)  There is 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 RSA 151 or He-P 805.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the SRHCF, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 805.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed SRHCF, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4) Require the licensee to submit a POC in accordance with He-P 805.

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

 

(3)  In accordance with RSA 151:7-a, I, the department may issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 805;

 

(4)  The warning in (e)(3) above, shall include:

 

a.  The time frame within which the owner or person responsible shall comply with the directives of the warning;

 

b.  The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

 

c.  The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

 

(5)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 805.13 (c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

                    He-P 805.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 805, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a license; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151, He-P 805, or other applicable licensing rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings, or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate space on the state notice detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 805;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 805 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

b.  The department determines that the health, safety, or well-being of a resident shall not be jeopardized as a result of granting the extension;

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 805.12(d) and a fine in accordance with He-P 805.13(c)(13);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 805.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 805.13(c)(14) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine in accordance with He-P 805.13(c);

 

(3)  Deny the application for a renewal of a license in accordance with He-P 805.13(b); or

 

(4)  Revoke the license in accordance with He-P 805.13(b).

 

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

 

          (g)  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.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

 

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

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the SRHCF that negatively impact the health, safety, or well-being of patients.

 

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 805 which poses a risk of harm to a resident’s health, safety, or well-being;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, the applicant or licensee fails to submit an application that meets the requirements of He-P 805.04;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes or fails to cooperate with any inspection or inspection conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 805.12(c),(d), and (e);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 805 for the same violation within the last 5 inspections;

 

(8)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

 

(9)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 805;

 

(10)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(11)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(12) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

 

(4)  For a failure to transfer a resident whose needs exceed the services or programs provided by the SRHCF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(5)  For admission of a resident whose needs exceed the services or programs authorized by the SRHCF licensing classification, in violation of RSA 151:5-a, II, and He-P 805.15(a) and (b), the fine for a licensee shall be $1,000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 805.11(e)(5), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 805.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 805.08(a), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 805.08(b)(2), the fine for a licensee shall be $500.00;

 

(10)  For a failure to notify the department of a change in e-mail address as required by He-P 805.08(n), the fine for a licensee shall be $100.00;

 

(11)  For a failure to allow access by the department to the SRHCF’s premises, programs, services, or records, in violation of He-P 805.09(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

 

(12)  For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 805.08(i), the fine for a licensee shall be $100.00;

 

(13)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 805.12(c)(2) and (6), the fine for a licensee shall be $100.00;

 

(14)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 805.12(c)(11) and (e), the fine for a licensee shall be $1000.00;

 

(15)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 805.16(i) and He-P 805.19(d), the fine for a licensee shall be $500.00;

 

(16)  For a failure to provide services or programs required by the licensing classification and specified by He-P 805.14(b), the fine for a licensee shall be $500.00;

 

(17)  For exceeding capacity, in violation of He-P 805.14(l), the fine for a licensee shall be $500.00, per day;

 

(18)  For providing false or misleading information or documentation, in violation of He-P 805.14(r) the fine for shall be of $1000.00 per offense;

 

(19)  For a failure to meet the needs of the resident, in violation of He-P 805.15(a), the fine for a licensee shall be $500.00, per resident;

 

(20)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 805.18(g)-(h), under circumstances where the department has not granted a waiver in accordance with He-P 805.10, the fine for a licensee shall be $500.00;

 

(21) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 815.09(a), the fine shall be $2000.00;

 

(22)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 805.07(a), the fine for a licensed facility shall be $500.00;

 

(23)  For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities; as required by He-P 805.09(b)(7), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(24)  When an inspection determines that a violation of RSA 151 or He-P 805 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original deficiency the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00;

 

(25)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 805 shall constitute a separate violation warranting additional fines in accordance with He-P 805.13(c), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 805, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  The department shall impose state monitoring under the following conditions:

 

 

(1)  Repeated poor compliance on the part of the facility in areas that may impact the health, safety or well-being of residents; or

 

(2)  Concern that the conditions in the SRHCF have the potential to worsen.

 

         (f)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to appeal.

 

          (g)  If a written request is not made pursuant to (f) above, the action of the department shall become final.

 

          (h)  The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or well-being of a resident is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III. 

 

          (i)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 805 is achieved.

 

          (j)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (k)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (l)  When a SRHCF’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director, for at least 5 years, if the enforcement action pertained to their role in the SRHCF.

 

          (m)  The 5-year period referenced in (l) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for an administrative hearing is made and a hearing is held.

 

          (n)  Notwithstanding (l) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 805.

 

          (o)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (l) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

 

          (p)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 805.

 

Source.  #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.14  Duties and Responsibilities of the Licensee.

 

          (a)  The licensee shall comply with all relevant federal, state and local laws, rules, codes and ordinances as applicable.

 

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

 

(1)  The presence of staff whenever a resident is in the facility;

 

(2)  Health and safety services to all residents to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding:

 

a.  The residents’ functioning, safety and whereabouts; and

 

b. The residents’ health status, including the provision of intervention as necessary or required;

 

(3)  Emergency response and crisis intervention;

 

(4)  Assistance with taking and ordering medications as determined by a resident’s ability or inability to safely manage medications as determined by the Resident Assessment Tool (RAT);

 

(5)  The provision of 3 nutritious meals and snacks unless the resident chooses other options according to their residential service agreement;

 

(6)  Housekeeping, laundry and maintenance services in accordance with the residential service agreement;

 

(7) The availability of on-site activities, for which the facility shall make reasonable accommodation for residents with disabilities, to include, but not be limited to television, radio, internet, games, newspapers, visitors and music, designed to sustain and promote physical, intellectual, social and spiritual well-being of all residents in accordance with the residential service agreement;

 

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

 

(9)  Personal supervision of residents when necessary to offset cognitive deficits that might pose a risk to the safety of self or others if the resident is not supervised.

 

          (c)  The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(2):

 

(1)  Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

 

(2)  Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

 

(3)  Behavioral health care services.

 

          (d)  The licensee shall assist with arranging transportation to community programs, such as religious services and cultural, social, educational and recreational activities according to the availability of such services in the surrounding communities.

 

          (e)  The licensee shall:

 

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

 

(2)  Not be responsible for the cost of purchasing a specific brand of product at a resident’s request;

 

(3)  Ensure that sufficient numbers of qualified personnel are present in the SRHCF to meet the needs of residents at all times;

 

(4)  Ensure that demonstrated competencies required by the “qualified personnel” referenced in (3) above are documented in the employee personnel file; and

 

(5)  Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known.

 

          (f)  The use of chemical or physical restraints as defined under He-P 805.03(m) and (ax), respectively, shall only be permitted as allowed by RSA 151:21.

 

          (g)  After the use of a physical of chemical restraint, the facility shall make the following notifications:

 

(1)  To the resident’s guardian or agent, if any, as soon as is practicable and in no case longer than 24 hours; and

 

(2)  To the health facilities licensing unit within 48 hours by fax, at (603) 271-5574, or by electronic means.

 

          (h)  The use of mechanical restraints, limited to locked, secured and/or alarmed SRHCFs or units within an SRHCF, or anklets, bracelets or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within as permitted by the fire code, shall be allowed.

 

          (i)  The following methods of mechanical restraints shall be prohibited:

 

(1)  Full bed rails;

 

(2)  Gates, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;

 

(3)  Half doors, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;

 

(4)  Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will;

 

(5)  Wrist or ankle restraints;

 

(6)  Vests or pelvic restraints; or

 

(7)  Other similar devices that prevent a resident’s free movement.

 

          (j)  For reportable incidents, the licensees shall have responsibility for:

 

(1)  Faxing to 271-5574 or, if a fax machine is not available, conveying by electronic or regular mail, the following information to the department within 48 hours of a reportable incident as defined in He-P 805.03(bf):

 

a.  The SRHCF name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the unusual incident;

 

d.  The name of resident(s) involved in the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  When the resident’s guardian or agent, if any, or personal representative, or emergency contact person was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the residents licensed practitioner was notified, if applicable;

 

(2)  As soon as practicable, notifying the local police department, the department and the guardian, agent, or personal representative, if any, when a resident has an elopement or unexplained absence and the licensee has searched the building and the grounds of the SRHCF without finding the resident; and

 

(3)  Notifying the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (k)  The licensee shall comply with the patient’s bill of rights as set forth in RSA 151.

 

          (l)  The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (m)  The licensee shall give a resident a written notice as follows:

 

(1)  Thirty days advance notice for an increase in the cost or fees for SRHCF services unless the increase of cost or fees is due to a change in the resident’s condition and service needs; or

 

(2)  Fourteen days advance notice for an involuntary change in room or bed location, unless the change is required to protect the health, safety and well-being of the resident or other residents, in such case the notice shall be as soon as practicable.

 

          (n)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public and conspicuous area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  The most recent inspection report as specified in RSA 151:6-a;

 

(3)  A copy of the patient’s bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to The Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, N.H. 03301 or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

 

(5)  The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

 

          (o)  The licensee shall determine the smoking status of the SRHCF.

 

          (p)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68 and RSA 155:69 and He-P 805.25(f).

          (q)  The licensee may hold or manage a resident’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents or other household members.

 

          (r)  The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.15  Resident Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria.

 

          (a)  The licensee shall only admit an individual or retain a resident whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the SRHCF.

 

          (b)  If the SRHCF admits or retains an individual who:

 

(1)  Requires lift equipment for transfers, all direct care personnel shall document in their personnel file that they have been trained in the correct operation of such equipment;

 

(2)  Has a stage 2, 3, or 4 pressure sore, the licensee shall obtain the services of a nurse or other licensed health care professional, who may be a consultant, who has obtained the skills, training and experience for the prevention of pressure sores in accordance with standards set forth by the National Pressure Ulcer Advisory Panel;

 

(3)  Requires continuing nursing care or monitoring including but not limited to residents who are convalescing from an illness or injury and require short-term medical care, the SRHCF shall employ or contract for nursing personnel 24 hours per day; or

 

(4)  Requires hospice care and the resident is no longer capable of taking medications supervised by unlicensed staff or unable to self direct the taking of medications, the licensee shall have a nurse available to meet the needs of the resident but with delays no longer than 30 minutes, during all shifts, to administer medications or shall administer medications by nurse delegation in accordance with Nur 404.

 

          (c)  A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care established in accordance with RSA 137-H or RSA 137-J.

 

          (d)  During a temporary absence the SRHCF shall hold the resident’s bed open in accordance with RSA 151:25.

 

          (e)  The resident shall be transferred or discharged, in accordance with RSA 151:5-a, RSA 151:19, RSA 151:21 V, and RSA 151:26.

 

          (f)  The licensee shall develop a discharge plan with the input of the resident and the guardian or agent, if any.

 

          (g)  The following documents shall accompany the resident upon transfer or discharge:

 

(1)  The most recent resident assessment tool, care plan and quarterly progress notes if the resident is being transferred to another residential care facility or another SRHCF;

 

(2)  The most recent nursing assessment, if applicable;

 

(3)  A copy of the most recent medication administration/assistance record; and

 

(4)  A licensed practitioner’s order for transfer, if applicable.

 

          (h)  If the transfer or discharge referenced in (e) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the resident as soon as possible.

 

          (i)  If the transfer or discharge referenced in (e) above is required for life safety reasons, the facility shall make a review of the residents needs and options for meeting these needs prior to discharge.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.16  Required Services.

 

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

 

(1)  Is responsible for the day-to-day operations of the SRHCF;

 

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

 

(3)  Meets the requirements of He-P 805.18(g) and (h); and

 

(4)  Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence.

 

          (b)  At the time of application for admission, the licensee shall provide the resident and legal agent, if any or personal representative, a written copy of the residential service agreement pursuant to RSA 161-J, except that a copy of the residential service agreement shall not be required if the facility admission contract includes all of the provisions of a residential service agreement.

 

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

 

(1)  An admissions contract including the following information:

 

a.  The basic daily, weekly, and monthly fee;

 

b.  A list of the core services required by He-P 805.14(b) that are covered by the basic fee;

 

c.  Information regarding the timing and frequency of cost of care increases;

 

d.  The time period covered by the admissions contract;

 

e.  The SRHCF’s house rules;

 

f.  The reasons a resident may be transferred or discharged in accordance with RSA 151:5-a, II, or RSA 151:21, V;

 

g.  The SRHCF’s responsibility for resident discharge planning;

 

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

 

1. The availability of services;

 

2.  The SRHCF’s responsibility for arranging services; and

 

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

 

i.  The licensee’s policy regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

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

 

5.  Handling of resident funds pursuant to RSA 151:24 and He-P 805.14(q);

 

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

 

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

 

8.  Smoking;

 

j.  If the facility is not constructed to meet the health care occupancy chapter of NFPA 101, the admission agreement shall note that the resident may need to be discharged or transferred when the facility can no longer meet the resident’s evacuation needs as required by the approved fire safety and emergency plan approved by the local fire department;

 

k.  The licensee’s medication management services and associated costs; and

 

l.  The list of grooming and personal hygiene supplies provided by the SRHCF as part of the basic daily, weekly, or monthly rate;

 

(2)  A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the SRHCF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

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

 

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

 

(5)  Information on accessing the long-term care ombudsman;

 

(6) Information on advanced directives;

 

(7)  Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both; and

 

(8)  Whether or not the facility has an automatic electronic defibrillator (AED) onsite and available for use in an emergency.

 

          (d)  The SRHCF shall assess each resident’s needs using the “Care Assessment for Residential Services  Tool” (April 2022).

 

          (e)  All personnel who administer the CARES tool shall be trained to complete the CARES tool by the department or entities listed in RSA 151:5-a, III.

 

          (f)  The assessment described in (d) above shall:

 

(1)  Be completed no more than 30 days prior to admission to the SRHCF;

 

(2)  Be completed in consultation with the resident and guardian or agent, if any;

 

(3)  Be repeated every 6 months or after any significant change as defined in He-P 805.03(cj);

 

(4)  Be signed and dated by the individual who completed the CARES tool; and

 

(5)  Be signed by the resident and guardian, agent, or personal representative, acknowledging that the CARES tool was completed as directed in (2) above.

 

          (g)  If the guardian, agent, or personal representative, if any, is unable to sign the CARES tool, the facility shall have documented evidence that the guardian, agent, or personal representative has had an opportunity to take part in completing and reviewing the completed CARES tool.

 

          (h)  If the CARES tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES tool.

 

          (i)  If the CARES tool identifies a need for a care plan, the care plan shall be:

 

(1)  Completed within 24 hours of the resident’s admission for the initial CARES tool and within 24 hours of the completion of all subsequent CARES tools;

 

(2)  Made available to personnel who assist residents;

 

(3)  Be completed in consultation with the resident and guardian or agent, if any; and

 

(4)  If the resident and guardian or agent are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

 

          (j)  The care plan identified in (i) above shall include on an ongoing basis:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The goal or objective of the plan;

 

(4)  The action or approach to be taken;

 

(5)  The responsible person(s) or position; and

 

(6)  The date of reevaluation, review, or resolution.

 

          (k)  All care plans shall be reviewed at least every 6 months to determine if:

 

(1)  The care plan will be continued for another 6 months;

 

(2)  The care plan will be revised to meet the needs of the resident; or

 

(3)  The care plan will be discontinued because the plan is no longer needed.

 

          (l)  Progress notes shall be written at least every 90 days and include, at a minimum:

 

(1)  Care plan outcomes if a care plan was developed as identified by the CARE tool;

 

(2)   The resident’s physical, functional, and mental abilities; and

 

(3)  Changes in behavior, such as eating habits, sleeping pattern, and relationships.

 

          (m)  At the time of a resident’s admission, the licensee shall obtain written and signed orders from a licensed practitioner for medications, treatment, and special diet.

 

          (n)  The licensee shall have each resident obtain a health assessment by a licensed practitioner within one year prior to admission or within 72 hours following admission to the SRHCF.

 

          (o)  The health assessment referenced in (n) above shall include:

 

(1)  Diagnoses, if any;

 

(2)  The medical history;

 

(3)  A list of current medications including over-the-counter medications, treatments, and special diets, if applicable; and

 

(4)  Allergies.

 

          (p)  Each resident shall have at least one health assessment every 12 months, unless the primary care licensed practitioner determines annually that a health assessment is not necessary and specifies in writing an alternative time frame, or the resident annually refuses in writing.

 

          (q)  A resident may refuse all care and services.

 

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

 

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

 

(2)  Notify the licensed practitioner and guardian, if any, of the resident’s refusal of care; and

 

(3)  Document in the resident’s record the refusal of care and the resident’s reason for the refusal.

 

          (s)  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 another medical facility.

 

          (t)  The information data sheet referenced in (s) above shall include:

 

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

 

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

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advanced directives; and

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.17  Medication Services.

 

          (a)  All medications shall be administered in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  All medications and treatments shall be reviewed, re-ordered, and signed by a practitioner on an annual basis.

 

          (c)  All personnel shall follow the written and signed orders of the licensed practitioner for each resident.

 

          (d)  Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours or when available as in accordance with the licensed practitioner’s written direction.

 

          (e)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the SRHCF;

 

(2)  Reorder medications for use at the SRHCF; and

 

(3)  Receive and record new medication orders.

 

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

 

(1)  The resident’s name:

 

(2)  The medication name, strength, prescribed dose and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated signature of the ordering practitioner.

 

          (g)  For PRN medications the ordering practitioner shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (h)  Each prescription medication shall legibly display the following information unless it is an emergency medication as allowed by (ap) below:

 

(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 pro re nata (PRN) medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (i)  Pharmaceutical samples shall be used in accordance with the licensed practitioners written order and labeled by the licensed practitioner, the administrator, licensee or their designee with the resident’s name and are exempt from (h)(2)-(6) above.

 

          (j)  The dosage, frequency and route on the labels of all prescription medications for each resident shall be identical to the dosage, frequency and route on the facility medication record except as allowed by (k) below.

 

          (k)  The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the medication record for a change or discontinuance shall indicate in writing the date the dose or the discontinuance occurred.

 

          (l)  Only a pharmacist shall make changes to prescription medication container labels except as allowed by (m) below.

 

          (m)  When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

 

          (n)  Only a licensed nurse shall accept telephone orders for medications, treatments, and diets, and the licensed nurse shall immediately transcribe and sign the order.

 

          (o)  The transcribed order referenced in (n) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

 

          (p)  No medications shall be given to or taken by a resident until a written order is received, except as allowed by (o) above.

 

          (q)  All over-the-counter medications as defined by He-P 805.03(as) shall have a signed practitioner’s order specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency and route.

 

          (r)  The medication storage area for medications not stored in the resident’s room shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each resident's medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (s)  All medications, including over the counter medications, shall remain in the original containers except as authorized by (ae)(5) and (af)(4)c. below.

 

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

 

          (u)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the ALR-SRHC, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (v)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (w)  Except as required by (y) below, any contaminated, expired or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first.

 

          (x)  Controlled drugs shall be destroyed only in accordance with state law.

 

          (y)  Destruction of controlled drugs under (x) above shall:

 

(1)  Be accomplished in the presence of at least 2 people who must sign, date and record the amount destroyed; and

 

(2)  Be documented in the record of the resident for whom the drug was prescribed.

 

          (z)  When a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self-administering without assistance, as described in (ae) below.

 

          (aa)  If a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication container shall be given to the person responsible for the resident while the resident is away from the SRHCF.

 

          (ab)  Upon discharge or transfer, the licensee shall make the resident’s current medications available to the resident and the guardian or agent, if any, and upon death of a resident, the facility shall return or destroy all remaining medications, as appropriate.

 

          (ac)  A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (ad)  Residents shall receive their medications by one of the following methods:

 

(1)  Self-administered without assistance as allowed by (ae) below;

 

(2)  Self-directed administration of medication as allowed by (af) below;

 

(3)  Self-administered with assistance as allowed by (ag) and (ah) below; or

 

(4)  Administered by individuals authorized by law.

 

          (ae)  For residents who self-administer without assistance as defined in 805.03(bn) the licensee shall:

 

(1)  Obtain a written order from a licensed practitioner on an annual basis:

 

a.  Authorizing the resident to self-administer medications without assistance; and

 

b.  Authorizing the resident to store the medications in their room;

 

(2)  Evaluate the resident initially and then on a 6month basis or sooner if the resident experiences a significant change, to ensure they maintain the physical and mental ability to self-administer without assistance;

 

(3)  Have the resident store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

 

(4)  Have a copy of the key to access the locked medication storage area in the resident’s room; and

 

(5)  Allow only the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

 

          (af)  The licensee shall allow the resident to self-direct administration of medications as defined in He-P 805.03(bj) if the resident:

 

(1)  Has a physical limitation due to a diagnosis that prevents them from self-administration;

 

(2)  Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self-direct administration of medications;

 

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the SRHCF to file the verification in their resident record; and

 

(4)  Verbally directs personnel to:

 

a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing or cutting;

 

b.  Assist the resident to apply, ingest or instill the ordered dose of medication; and

 

c.  Fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

 

          (ag)  If a resident self-administers medication with assistance, as defined in He-P 805.03(bm), personnel shall only:

 

(1)  Remind the resident to take the correct dose of his or her medication at the correct time;

 

(2) Place the medication container within reach of the resident and open the container, if requested by the resident;

 

(3)  Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner;

 

(4)  Record on the resident's daily medication record that they have observed the resident taking his or her medication;

 

(5)  Document in the resident’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken; and

 

(6) Not touch the medications or remove them from the container.

 

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

 

          (ai)  If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall only do so as allowed by RSA 326-B and Nur 404.

 

          (aj)  Except for those residents who self-administer medication without assistance, the licensee shall maintain a daily medication record for each medication taken by the resident at the SRHCF that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials and job title of the person who administers, supervises or assists the resident taking medication;

 

(5)  For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (ak)  Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a resident with self administration with assistance, self directed administration  or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication assistance education program covering both prescription and non-prescription medication. 

 

          (al)  A licensed nurse, licensed practitioner or pharmacist shall teach the medication assistance education program, whether in-person or through other means such as electronic media provided it meets the requirements of the (ak) above.

 

          (am)  The medication assistance education program required by (ak) above shall include:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights which are:

 

a.  The right resident;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as antihypertensives or antibiotics;

 

(5)  Desired effects and potential side effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (an)  The administrator may accept documentation of training required by (ak) above if it was previously obtained by the applicant for employment at another licensed SRHCF.

 

          (ao)  An SRHCF shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.03 under circumstances where the SRHCF:

 

(1)  Has a director of nursing who is an RN licensed in accordance with RSA 326-B; and

 

(2)  Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

 

          (ap)  The licensee shall document in the resident record and report any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, to the licensed practitioner, and to the agent or guardian if applicable, immediately upon the adverse reaction or medication error.

 

          (aq)  The written documentation of the report in (aq) above shall be maintained in the resident’s record.

 

          (ar)  No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident.

 

          (as)  Stock medication shall not be used in the SRHCF.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.18  Personnel.

 

          (a)  For all applicants for employment, except those licensed by the New Hampshire board of nursing, and for all household members 17 years of age or older, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety;

 

(2)  Review the results of the criminal records check in accordance with (b) below; and

 

(3)  Verify the qualifications of all applicants prior to employment.

 

          (b)  Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment for any position or allow a household member to continue to reside in the residence if the individual:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

 

(3)  Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the residents.

 

          (c)  The department shall grant a waiver of (b) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of residents.

 

          (d)  No employee shall be permitted to maintain their employment, and no household member shall be permitted to remain residing in the facility, if he or she has been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or has had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department.

 

          (e)  The licensee shall check, prior to hiring, the names of all prospective employees against the bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-E 720, and the NH board of nursing, nursing assistant registry maintained pursuant RSA 326-B:26 and 42 C.F.R. section 483.156.

 

          (f)  The licensee shall not make a final offer of employment to any prospective employee listed on the BEAS state registry or the NH board of nursing, nursing assistant registry unless a waiver is granted by the bureau of elderly and adult services or the NH board of nursing, respectively.

 

          (g)  For an SRHCF licensed for 17 or more beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience:

 

(1)  A bachelor’s degree from an accredited institution and 2 years of relevant experience working in a health care setting;

 

(2)  A New Hampshire license as an RN, with at least 2 years of relevant experience working in a health care setting;

 

(3)  An associate’s degree from an accredited institution plus 4 years of relevant experience working in a health care setting; or

 

(4)  A New Hampshire license as an LPN, with at least 4 years of relevant experience working in a health care setting.

 

          (h)  For an SRHCF licensed for 16 or fewer beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience:

 

(1) A bachelor’s degree from an accredited institution and one year of relevant experience working ina health care setting;

 

(2)  A New Hampshire license as an RN, with at least one year of relevant experience working in a health care setting;

 

(3)  An associate’s degree from an accredited institution plus 2 years of relevant experience working in a health care setting;

 

(4)  New Hampshire license as an LPN, with at least 2 years of relevant experience working in a health care setting; or

 

(5)  Be a high school graduate or have a GED with 6 years of relevant experience working in a health care setting with at least 2 of those years as direct care personnel in a long-term care setting within the last 5 years.

 

          (i)  All administrators shall obtain and document in accordance with (s)(7) and (8) below, 12 hours of continuing education related to the operation and services of the SRHCF each annual licensing period.

 

          (j)  All personnel shall be at least 18 years of age if working as direct care personnel unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of a nurse.

 

          (k)  The licensee shall inform personnel of the line of authority at the SRHCF.

 

          (l)  The licensee shall educate personnel about the needs and services required by the residents under their care.

 

          (m)  Prior to having direct care contact with residents, personnel, including volunteers and independent contractors shall:

 

(1)  Submit to the licensee the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment and for personnel other than volunteers and independent contractors, submit the results of a physical examination or a health screening;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(4)  In lieu of (1) above, independent contractors hired by the facility may provide the facility with a signed statement that they have complied with (1) and (3) above for their employees working at the SRHCF.

 

          (n)  Within the first 7 days of employment, all personnel who have direct or indirect contact with residents, to include volunteers who have direct care contact or who prepare and serve food shall receive a tour of the SRHCF and an orientation that includes the following:

 

(1)  The residents’ rights in accordance with RSA 151:21;

 

(2)  The SRHCF’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 805.22;

 

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

 

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

 

          (o)  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 resident’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan; and

 

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

 

          (p)  The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education.

 

          (q)  Such continuing education shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1)  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct  service staff members; and

 

(2)  A minimum of 4 hours of ongoing training each calendar year.

 

          (r)  The licensee shall provide an annual review of its policies and procedures for self-administration of medication without assistance, self-administration of medication with assistance, and self-directed medication administration to all direct care personnel.

 

          (s)  The personnel file for each individual shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the residents rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (a) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (n) above;

 

(7)  Information as to the general content and length of all in-service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs and demonstrated competencies that is signed and dated by the employee;

 

(9)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and

 

(10)  The statement required by (t) below.

 

          (t)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety ,or well-being of a resident; or

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (u)  The licensee shall maintain separate personnel records that:

 

(1)  Contain the information required by (s) above; and

 

(2)  Are protected and stored in a secure and confidential manner.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.19  Resident Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the SRHCF.

 

          (b)  At a minimum, resident records shall contain the following:

 

(1)  A copy of the resident’s residential service agreement and/or admission contract  and all documents required by He-P 805.16(c);

 

(2) Notwithstanding (1) above, financial records may be kept in a separate file;

 

(3)  Identification data, including:

 

a.  Vital information including the resident’s name, date of birth, and marital status;

 

b.  If the individual is receiving respite care as described in He-P 805.20, the resident’s home address and phone number;

 

c.  Resident’s religious preference, if known;

 

d.  Residents veteran status, if known; and

 

e.  Name, address and telephone number of an emergency contact person;

 

(4)  The name and telephone number of the resident’s licensed practitioner(s);

 

(5)  For individuals contracted by the SRHCF or the resident to provide services at the SRHCF, their name, employer, business address and telephone number;

 

(6)  Resident’s health insurance information;

 

(7)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(8)  A record of the health assessment in accordance with He-P 805.16(m) and (n);

 

(9)  Written, dated and signed orders for the following:

 

a.  All medications, treatments and special diets; and

 

b.  Laboratory services and consultations performed at the SRHCF;

 

(10)  Results of any laboratory tests, X-rays or consultations performed at the SRHCF;

 

(11)  All admission and progress notes;

 

(12)  For services that are provided at the SRHCF by individuals who are not employed by the licensee, documentation shall include the name of the agency providing the services, the date services were provided, the name of the person providing services and a brief summary of the services provided;

 

(13)  Documentation of any alteration in the resident’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(14)  Documentation of medical or specialized care;

 

(15)  Documentation of reportable incidents;

 

(16)  The consent for release of information signed by the resident, guardian or agent, if any;

 

(17)  Discharge planning and referrals;

 

(18)  Transfer or discharge documentation, including notification to the resident, guardian or agent, if any, of involuntary room change, transfer or discharge, if applicable;

(19)  The medication record as required by He-P 805.17(af)(4), (aj) and (ar);

 

(20)  Information data sheet, which contains the information required by He-P 805.16(t);

 

(21)  Documentation of nurse delegation as required by He-P 805.17(ai);

 

(22)  Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner; and

 

(23)  Documentation of a resident’s refusal of any care or services.

 

          (c)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting residents and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, all residents and employees that have received or declined to receive immunizations.

 

          (d)  Resident records and resident information shall be kept confidential and only provided in accordance with law.

 

          (e)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

 

          (f)  When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

 

          (g)  Records shall be retained for 4 years after discharge, except that when the resident is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

 

          (h)  The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the SRHCF ceases operation.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

He-P 805.20  Respite Care in SRHCF.

 

          (a)  The licensee shall only admit an individual for respite care services when the needs of the individual are compatible with the services and programs offered by the facility and the facility can meet the needs of the individual in accordance with He-P 805.15.

 

          (b)  When a temporary admission to an SRHCF occurs and the individual is scheduled for a stay of no more than 30 consecutive days as agreed upon by the individual and the licensee as part of a discharge plan, the licensee shall:

 

(1)  Obtain written verification signed by the resident, guardian or agent, if any, or personal representative, indicating they have been given a copy of the resident rights and responsibilities as required by RSA 151:20, I;

 

(2)  Obtain a signed admissions contract listing the services that shall be provided;

 

(3)  Obtain information regarding allergies, diagnoses, if any, and written and signed orders for medications, treatments, and special diets within 72 hours from the licensed practitioner;

 

(4)  Be permitted to use the prescription label on the medication container supplied by the individual as the licensed practitioner’s order provided that:

 

a.  The medication is in the original bottle as dispensed by the pharmacy;

 

b.  The pharmacy label has not been altered in any manner; and

 

c.  The prescription label indicates that the medication is still current;

 

(5)  Complete the CARES tool prior to or immediately on admission;

 

(6)  Identify the resident’s history of wandering or unexplained absences; and

 

(7)  Obtain advanced directives information, if available.

 

          (c)  For planned recurrent respite care the resident shall be discharged but may be readmitted using the same admission documents completed within the previous 6 months, as long as there are no identified changes in the resident’s condition or care needs.

 

          (d)  If the resident exceeds the 30-day time period, they shall no longer be considered respite care and a complete admission shall occur within 72 hours.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.21  Food Services.

 

          (a)  The licensee shall provide food services that meet:

 

(1)  The US Department of Agriculture recommended dietary allowance as specified in the “Dietary Guidelines for Americans, 2005” available as noted in Appendix A;

 

(2)  The nutritional needs of each resident; and

 

(3)  The special dietary needs associated with health or medical conditions for each resident as identified on the RAT.

 

          (b)  Each resident shall be offered at least 3 nutritious meals and snacks unless the resident chooses other options according to their admission contract.

 

          (c)  Snacks shall be available between meals and at bedtime if not contraindicated by the resident’s care plan.

 

          (d)  If a resident refuses the item(s) on the menu, a substitute shall be offered.

 

          (e)  Each day’s menu shall be posted in a place accessible to food service personnel and residents.

 

          (f)  A dated record of menus as served shall be maintained for at least the previous 4 weeks.

 

          (g)  The licensee shall provide therapeutic diets to residents only as ordered by a licensed practitioner or other professional with prescriptive authority.

 

          (h)  If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record and notify the resident’s licensed practitioner.

 

          (i)  All food and drink provided to the residents shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated and stored at proper temperatures; and

 

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

 

          (j)  The use of expired, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

 

          (k)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (l)  All work surfaces shall be cleaned and sanitized after each use.

 

          (m)  All dishes, utensils and glassware shall be in good repair, cleaned and sanitized after each use and properly stored.

 

          (n)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (o)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

 

          (p)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (q)  Trash receptacles in food service areas shall have covers and shall remain closed except when in use.

 

          (r)  All SRHCF personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.22  Infection Control.

 

          (a)  The SRHCF shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

          (b)  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-Wm 2604; and

 

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

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected.

 

          (f)  Personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SRHCF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

          (h)  If the SRHCF has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.23  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation, pursuant to Env-Ws 315 and 316.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the residents.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and resident supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation or dining areas.

 

          (j)  Solid waste, garbage and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(3)  Soiled materials, linens and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

 

(4)  Soiled linens and clothing, which are considered contaminated with infectious waste under Env-Wm 2604 shall be handled as infectious waste.

 

          (m)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (n)  Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

 

          (o)  Any SRHCF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15

 

          He-P 805.24  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being and comfort of resident(s) and personnel, including reasonable accommodations for residents and personnel with disabilities.

 

          (b)  Equipment providing heat within an SRHCF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any SRHCF.

 

          (f)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 155-A.

 

          (g)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (h)  Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (i)  The number of sinks, toilets, tubs or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

 

          (j)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (k)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (l)  In an SRHCF licensed for 16 or fewer residents, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

 

          (m)  In an SRHCF licensed for 17 or more residents, there shall be at least 100 square feet for each resident in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities;

 

          (n)  The space requirements in (l), (m), and (n) above shall be exclusive of space required for closets, wardrobes, and bathroom.

 

          (o)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the resident to reach his or her bedroom without passing through the room of another resident;

 

(3)  Have a side hinge door and not a folding or sliding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors, and other rooms by floor to ceiling walls;

 

(6)  Be located on the same level as the bathroom facilities, if the resident has impaired mobility as identified by the CARES tool; and

 

(7)  If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom without requiring additional construction or renovation.

 

          (p)  The licensee shall provide the following for the residents’ use, as needed, except as requested by the resident or guardian and documented in their resident record:

 

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

 

(2)  A firm mattress that complies with the state fire code and codes as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  A lamp;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades, or curtains that provide privacy.

 

          (q)  The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others.

 

          (r)  The licensee shall provide the following rooms to meet the needs of residents:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all residents.

 

          (s)  Each licensee shall have an Underwriters Laboratories (UL) Listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

 

          (t)  Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

 

          (u)  All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (v)  During seasons when insects are active, screens shall be provided for:

 

(1)  Doors;

 

(2)  Windows; and

 

(3)  Other openings to the outside.

 

          (w)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (w) above.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

                    He-P 805.25  Fire Safety.

 

          (a)  SRHCFs shall meet one of the following requirements:

 

(1) All SRHCFs established after October 25, 2006, shall meet the Health Care Occupancy Chapter of NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300; or

 

(2)  All SRHCFs established prior to October 25, 2006, shall meet at a minimum the Residential Board and Care Chapter of NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300.

 

          (b)  All SRHCFs shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the SRHCF’s electrical service, or wireless, as approved by the state fire marshal for the SRHCF;

 

(2)  At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 and:

 

a.  Be manually inspected when initially placed in service;

 

b.  Be inspected either manually or by means of an electronic   monitoring device or system at intervals not exceeding 31 days; and

 

c. Be inspected at least once per calendar month and documentation of manual fire extinguisher inspections shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation.  Documentation of electronically monitored fire extinguishers shall be provided to the department within 2 business days of the completion of the inspection or investigation; and

 

(3)  An approved carbon monoxide monitor on every level.

 

          (c)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  Emergency EMS transport related to pre-existing conditions.

 

          (d)  The written notification required by (c) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (e)  If the licensee has chosen to allow smoking, a designated smoking area shall be provided which has, at a minimum:

 

(1)  A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Walls and furnishings constructed of non-combustible materials; and

 

(3)  Metal waste receptacles and safe ashtrays.

 

          (f)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, or the resident’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident. Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (g)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (h)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the Residential Board and Care or One and Two Family Dwelling Chapters of the Life Safety Code (NFPA 101), the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All SRHCF facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when residents are sleeping.  Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide residents with experience in egressing through all exits and means of escape;

 

e.  Facilities shall complete a written record of fire drills that includes the following:

 

1.  The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At least annually, the facility shall conduct a resident Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the residents needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, residents ability to evacuate on their own and choose an alternate exit; and

 

h.  The fire drills for facilities built to the Residential Board and Care chapter of the Life Safety Code (NFPA 101), shall be permitted to be announced, in advance, to the residents just prior to the drill;

 

(2)  For all SRHCFs that were originally constructed to meet the Health Care Occupancy Chapter of Life Safety Code, NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300, and the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office and the department to meet the Health Care Occupancy Chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy Chapter of the Life Safety Code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, residents, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that residents shall be given the experience of evacuating to the appropriate location or exiting through all exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill;

 

8.  The names of all staff members participating in the drill; and

 

9.  Written records of the fire drills shall be maintained on site and available to the department  during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

h.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(3)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

Source.  #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22

 

          He-P 805.26  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (b) The emergency management committee shall develop and institute a written Emergency Preparedness Plan (plan) to respond to a disaster or an emergency.

 

          (c)  The plan in (b) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(8)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(9)  Include the management of residents, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(10)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(11)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(12)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(13)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

 

          (d)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations or both.

 

          (e)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

Source.  #10813, eff 4-21-15

 

PART He-P 806  NON-EMERGENCY WALK-IN CARE CENTERS

 

          He-P 806.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all non-emergency walk-in care centers (NEWCC), whether stationary or mobile, pursuant to RSA 151:2, I(d).

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (c), (d), (m) and (s) EXPIRED: 1-13-03

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.02  Scope.  This part shall apply to any organization, business entity, partnership, corporation, government entity, association or other legal entity operating a NEWCC, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i);

 

          (b)  Entities that provide health screening services for the purpose of risk assessment only and not for diagnosis and/or treatment; and

 

          (c)  Immunization clinics that are registered with the department’s division of public health services.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (c) and (d) EXPIRED 1-13-03

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of patients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

 

(3)   “Sexual abuse” means contact or interaction of a sexual nature involving a vulnerable adult as defined in RSA 161-F:43, II(c), or, in the case of sexual abuse of a minor, as defined in RSA 169-C:3, XXVVII-b.

 

          (b)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (c)  “Administer” means an act whereby one or more doses of a medication are instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (d)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises

 

          (e)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

 

          (f)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (g)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a NEWCC pursuant to RSA 151:2.

 

          (h)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.

 

          (i)  “Assessment” means an evaluation of the patient to determine the care and services that are needed.

 

          (j)  “Change of ownership” means a change in the  controlling interest of an established NEWCC to an individual or successor business entity.

 

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

 

          (l) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (m)  “Days” means calendar days unless otherwise specified in the rule.

 

          (o)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

 

          (n)  “Department” means the New Hampshire department of health and human services.

 

          (o)  “Direct care” means hands-on care and services provided to a patient including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (p)  “Discharge instructions” means instructions developed as a result of the assessment process in the provision of services.

 

          (q)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions required of the licensee to correct areas of non-compliance.

 

          (r)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (s) “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license in response to non-compliance with RSA 151 or He-P 806.

 

          (t) “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

 

          (u)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

 

          (v)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (w)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

 

          (x)  “Health screening services” means assessment or testing performed for the purpose of assessing a patient’s risk of having a disease condition and where the patient with an elevated risk is not diagnosed or treated but encouraged to contact a licensed provider for diagnosis and treatment as needed.  This term does not include any on-site services provided by a licensed NEWCC.

 

          (y)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (z)  “Infectious waste” means those items specified by Env- Sw 904.

 

          (aa)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (ab)  “Informed consent” means the decision by a person or his/her guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (ac)  “Inspection” means the process followed by the department to determine an applicant or a licensee’s compliance with RSA 151 and He-P 806 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151, and He-P 806.

 

          (ad)  “License” means the document issued to an applicant at the start of operation as a NEWCC  which authorizes operation of a NEWCC in accordance with RSA 151 and He-P 806, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date and license number.

 

          (ae)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized that the NEWCC is licensed for.

 

          (af)  “Licensed practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician’s assistant;

 

(3)  Advance practice registered nurse (APRN);

 

(4)  Doctor of osteopathy;

 

(5)  Doctor of naturopathic medicine; or

 

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

 

          (ag)  “Licensed premises” means a physical location where care and services pursuant to He-P 806 are provided, including:

 

(1)  The building or buildings at a site specific address; and/or

 

(2)  A mobile vehicle that is registered to a site specific address.

 

          (ah)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (ai)  “Licensing classification” means the specific category of services authorized by a license.

 

          (aj)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

          (ak)  “Medical director” means a  licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B, who is responsible for overseeing the quality of medical care and services at the NEWCC.

 

          (al)  “Medical staff” means those physicians and other licensed practitioners permitted by law and NEWCC policies to provide patient care services independently within the scope of his or her practice act.

 

          (am)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

(an)  “Mobile  NEWCC vehicle ” means a vehicle capable of traveling under its own power or being towed from site to site and fully equipped to meet all the requirements specific in section He-P 806.21.

 

          (ao)  “Modification” means the reconfiguration of any space; the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  The term does not include repair or replacement of interior finishes.

          (ap)  “Neglect” means an act or omission, that results or could result in the deprivation of essential services or supports necessary to maintain the mental, emotional or physical health and safety of a patient.

 

          (aq)  “Non-emergency walk-in care center (NEWCC)” means a medical facility where a patient can receive medical care which is not of an emergency life-threatening nature, without making an appointment and without the intention of developing an ongoing care relationship with the licensed practitioner.  This term includes such facilities that are self-described as urgent care centers, retail health clinics, and convenient care clinics.  A NEWCC can be a stand-alone entity, an entity located within a retail store or pharmacy or a mobile vehicle, which can be owned and operated by the retail store or pharmacy, or be owned and operated by a third party.

 

          (ar)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (as)  “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, 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

 

          (at)  “Over-the-counter medications” means non-prescription medications.

 

          (au)  “Patient” means any person  registered to or in any way receiving care, services or both from a NEWCC licensed in accordance with RSA 151 and He-P 806.

 

          (av) “Patient record” means a separate file maintained  for each person receiving  care and services by the licensee, which includes all documentation required by RSA 151 and He-P 806 and all documentation as required by other applicable federal and state requirements.

 

          (aw)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

 

          (ax)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.

 

          (ay)  “Personnel” means an individual who is employed by the facility, a volunteer, or an independent contractor who provides direct care to a patient.

 

          (az)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (ba)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

 

          (bb)  “Point of care devices” means testing involving a system of devices, typically including:

 

(1)  A lancing or finger stick device to get the blood sample;

 

(2)  A test strip to apply the blood sample; or

 

(3)  A meter or monitor to calculate and show the results, including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or

 

c.  A Cholesterol meter.

 

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

 

          (bd)  “Professional staff” means staff who are licensed, registered, or certified by the state to provide health care services.

 

(be) “Qualified personnel” means personnel that have been trained to adequately perform the tasks which they perform, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bf)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (bg) “Register” means the point in time when a patient has been accepted by a licensee for the provision of services.

 

          (bh)  “Rehabilitation” means any of the following undertaken in an existing building or mobile vehicle, as defined in this section:

 

(1)  Addition;

 

(2)  Modification;

 

(3)  Reconstruction;

 

(4)  Renovation: and

 

(5)  Repair.

 

          (bi)  “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures that do not result in a reconfiguration of the building spaces within.

          (bj)  “Repair” means the patching, restoration, or painting of materials, elements, equipment or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (bk) “Reportable incident” means an occurrence of any of the following while the patient is either in the NEWCC or in the care of NEWCC personnel:

 

(1)  The unanticipated death of the patient;

 

(2) An injury to a patient, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the patient; or

 

(3)  The unexplained absence of a patient from the NEWCC who is determined to be a danger to themselves or others.

 

          (bl)  “Security provisions” means locked when not in use.

 

          (bm)  “Stabilize” means to provide medical care to allow the patient or patient to be moved or transferred to another facility.

 

          (bn)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (a), (i), (j) and (m) EXPIRED: 1-13-03

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a, and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services,” (March 2019) signed by the applicant or 2 of the corporate officers affirming the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any NEWCC to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”;

 

c.  For any NEWCC to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”; and

 

d.  For facilities to be licensed under the listed categories:

 

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed pursuant to He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42  C.F.R. 485.610(b) and (c), until the Commissioner makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”;

 

(2)  A floor plan of the prospective NEWCC;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability company; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee, in accordance with RSA 151:5 , XIII payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications of and copies of applicable licenses for the NEWCC administrator and medical director;

 

(6)  Copies of applicable licenses and/or certificates for the NEWCC administrator and Medical Director;

 

(7)  Written local approvals as follows:

 

a.  The following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements;

 

2.  The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including the applicable chapter of NFPA 101 and local fire ordinances and including but not limited to business or ambulatory health care; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

 

(8)  If the NEWCC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02 or, if a public water supply is used, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, the administrator and medical director for which the application is submitted.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; amd by #6427, eff 1-13-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99, paragraphs (b) and (m) EXPIRED: 1-13-03

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 806.04(a) or 806.26 have been received.

 

          (b)  If an application does not contain all of the items required by He-P 806.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 806.13(b) if, it determines that the applicant, or administrator:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse,

neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 806.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location including licenses issued for mobile NEWCC vehicles.

 

          (h)  A written notification of denial, pursuant to He-P 806.13(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f)  and a maximum of 2follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 806.

 

          (i)  A written notification of denial, pursuant to He-P 806.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall Complete and submit to the department an application form pursuant the He-P 806.04(a)(1) and (4) at least 120 days prior to the expiration of the current license to include:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 806.10(f), if applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 806.16(g)(2); and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03 - 6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

(c)  In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection as described in He-P 806.09 a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) above, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 806 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 806.04 and shall be subject to a fine in accordance with He-P 806.14.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New. #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.07  NEWCC Construction, Modifications or Renovations.

 

          (a)  For new construction and/or rehabilitation of an existing building, including, but not limited to renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work. For a NEWCC mobile vehicle general layout plans, including but not limited to the all fire protection systems, wall locations, separations, exiting drawings must also be submitted 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 806 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Construction and rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

 

          (g)  The NEWCC shall comply with all applicable state laws, rules, and local ordinances when

undertaking construction or rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, as follows

 

a.  NFPA 101, Life Safety Code Business Use Chapter; or

 

b.  NFPA 101, Life Safety Code Ambulatory Health Care Chapter; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

            (i)  All NEWCCs newly constructed or rehabilitated after the 2018 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition), as applicable, available as noted in Appendix A.

 

          (j)  Where rehabilitation is done within an existing facility, all such work shall comply, insofar as

practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition) available as noted in Appendix A.

 

          (k)  Per the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition) available as noted in Appendix A, and notwithstanding He-P 806.07(j), where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

 

          (l)  The department shall be the authority having jurisdiction for the requirements in He-P 806.07 (i)-(k) and shall negotiate compliance and grant waivers in accordance with He-P 806.10 as appropriate.

 

          (m)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

 

          (n)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (o)  Exceptions or variances pertaining to the state fire code referenced in He-P 806.07(h)(1) shall be granted only by the state fire marshal.

 

          (p)  The building and/or mobile vehicle, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 806.09 prior to its use.

 

          (q)  He-P 806.07 shall not apply to mobile NEWCC vehicles.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly He-P 806.08)

 

          He-P 806.08  NEWCC Requirements for Organizational or Service Changes.

 

          (a)  The NEWCC shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  Services.

 

          (b)  The NEWCC shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  A change in services.

 

          (c)  When there is a change in address without a change in location, the NEWCC shall provide the department with a copy of the notification from the local, state or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the NEWCC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance then an inspection will be conducted as soon as practical by department;

 

(2)  The physical location except for mobile NEWCC vehicle;

 

(3)  A change in licensing classification; or

 

(4)  A change that places the facility under a different life safety code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification or physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the NEWCC’s name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator or medical director;

 

(2)  A change in address without a change in physical location; or

 

(3)  When a waiver has been granted.

 

          (i)  The NEWCC shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change and provide the department with the following:

 

(1) A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  The results of a criminal records check conducted under He-P 806.16;

 

(3)  Copies of applicable licenses for the new administrator or medical director; and

 

(4)  A copy of the criminal attestation as described in He-P 806.16.

 

          (j)  Upon review of the materials submitted in accordance with He-P 806.08(i), the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the positions as specified in He-P 806.15(c) or (d).

 

          (k)  If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the NEWCC in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (l)  The NEWCC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (m)  A restructuring of an established NEWCC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.        

 

(n)  When there is to be a change in the services provided, the NEWCC shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

          (o)  The department shall review the information submitted under He-P 806.08(n) and determine if the added services can be provided under the NEWCC current license including physical plant restrictions.

 

          (p)  If a licensee chooses to cease operation of an NEWCC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New. #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly He-P 806.07)

 

          He-P 806.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 806, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The proposed or licensed premises;

 

(2)  All programs and services provided by the NEWCC; and

 

(3)  Any records required by RSA 151 and He-P 806.

 

          (b)  The department shall conduct a clinical and  life safety code inspection, as necessary to determine full compliance with RSA 151 and He-P 806 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 806.07(e)(1);

 

(3)  A change in the physical location of the NEWCC except for mobile NEWCC vehicle;

 

(4)  A Change in the licensing classification;

 

(5)  Occupation of space after construction, renovations or structural alterations;

 

(6)  The renewal of a non-certified NEWCC license; or

 

(7)  The issuance of a mobile NEWCC vehicle.

 

          (c)  In addition to He-P 806.09 (b) the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the NEWCC is in violation of any of the provisions of He-P 806, RSA 151, or other federal or state requirement.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 806.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 806.09(b), that the prospective premises is not in full compliance with RSA 151 and He-P 806.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 806 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety or well-being of the patients; and

 

(3)  Does not affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required in He-P 806.10 (a).

 

          (g)  The request to renew a waiver shall be subject to He-P 806.10(b) through (f).

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.11  Complaints.

 

(a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 806.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the NEWCC, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 806.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed NEWCC, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 806.11(a), or does not violate and statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 806.12(c).

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by He-P 806.11(e)(1) to submit a completed application for a license;

 

(3) If the owner of an unlicensed NEWCC does not comply with He-P 806.11(e)(2), the department shall issue a written warning to immediately comply with RSA 151 and He-P 806; and;

 

(4)  Any person or entity who fails to comply after receiving a warning, as described in He-P 806.11(e)(3), shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 806.13(c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any administrative or adjudicative proceedings relative to the licensee.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 806, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with  He-P 806.12(c);

(2)  Imposing a directed POC upon a licensee in accordance with He-P 806.12(d);

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of noncompliance with RSA151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area on non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 806;

 

b.  Addresses all areas of non-compliances as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 806 as a result of the  implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless within the 14-day period, the licensee requests an extension either via telephone or in writing and the department grants the extension based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with He-P 806.12 (c)(1) and be reviewed in accordance with He-P 806.12 (c)(3); and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14-days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 806.12(d)  and a fine in accordance with He-P 806.13(c)(12);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee; 

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 806.12(b); and

 

b.  Issued a directed POC in accordance with He-P 806.12 (d) and a fine in accordance with He-P 806.13(c)(3) .

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas on non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

 

(2) A revised POC is not submitted within 14-days of the written notification from the department; or such other date as applicable if an extension was granted by the department; and

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in He-P 806.12(d)  has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine according to He-P 806.12(f)(10);

 

(2)  Deny the application for a renewal of a license in accordance with He-P 806.13(b); or

 

(3)  Revoke the license in accordance with He-P 806.13(b).

 

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

 

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

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with He-P 806.12(c) shall not apply until the notice of the determination in He-P 806.12(h) has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of clients; or

 

(2)  The presence of conditions in the NEWCC that negatively impact the health, safety, or well-being of patients.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated a provision of RSA 151 or He-P 806, which poses a risk of  harm to a patient’s health, safety, or well-being.

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, or schedule an initial inspection an applicant or licensee fails to submit an application that meets the requirements of He-P 806.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents or interferes, or fails to cooperate, with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 806.12(c), (d) and (e);

 

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 806.12(c)(5) and has not submitted a revised POC as required by He-P 806.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 806 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in He-P 806.13(h);

 

(10)  Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 806;

 

(11)  Unless a waiver has been granted the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state.

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2 the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license after receipt of an order to cease and desist in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 806.14(g), the fine for an applicant, licensee or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a client whose needs exceeds the services or programs provided by the NEWCC in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For  registration of a client whose needs at the time of  registration exceed the services or programs authorized by the NEWCC, in violation of RSA 151:5-a, II, and He-P 806.14(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 806.11(e)(4), the fine for an unlicensed provider or licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 806.06(e), the fine shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 806.08(a)(1), the fine shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 806.08(a)(2), the fine shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address, in violation of He-P 806.08(l), the fine shall be $100.00;

 

(11)  For a refusal to allow access by the department to the NEWCC’s premises, programs, services or records, in violation of He-P 806.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14-days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 806.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 806.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement or comply with licensee policies, as required by He-P 14(a), (d) & (e), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 806.14(c), the fine for a licensee shall be $500.00; 

(16)  For providing false or misleading information or documentation, in violation of He-P 806.14(i), the fine shall be $1000.00 per offense;

 

(17)  For failure to meet the needs of a client or clients, as described in He-P 806.14(k), the fine for a licensee shall be $1000 per client;

 

(18)  For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 806.09(b)(5), the fine for a licensee shall be $500;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 806.10, in violation of He-P 806.15(c), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 806.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 806.09(b)(5), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that there is a violation of RSA 151 or He-P 806 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; 

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 806 shall constitute a separate violation and shall be fined in accordance with He-P 806.13(c); and

 

(24)  If the applicant or licensee is making good faith efforts to comply with (4),(6) and (15) above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to He-P 806.13 (e), the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the secession of operations when it finds that the health, safety or well-being of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 806 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When an NEWCC’s license has been denied or revoked, the applicant, licensee or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years, if the enforcement action pertained to their role in the NEWCC 

 

          (k)  The 5-year period referenced in (j) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license became effective, if appeal is filed; or

 

(2) The date a final decision upholding the action of the department, if a request for an administrative hearing was made and a hearing was held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 806.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A or He-P 806.

 

          (o)  Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, as applicable.

 

          (b)  The licenses shall register  only those patients whose needs can be met by the NEWCC.

 

          (c)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19–21.

 

          (d)  The licensee shall define, in writing, the scope and type of services to be provided by the NEWCC including the mobile NEWCC vehicle and shall post the same in the facility and in all facility advertising including on the facility’s website.

 

          (e)  The licensee shall have a written policies and procedures to include:

 

(1)  The rights and responsibilities of  registered patients in accordance with the “ Patients’ Bill of Rights” under RSA 151:21;

 

(2)  The policies described in He-P 806; and

 

(3) A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (f)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the facility and for:

 

(1)  Reviewing the policies and procedures every 3 years; and

 

(2)  Revising them as needed.

 

          (g)  All policies and procedures shall be reviewed and approved by the medical director.

 

          (h)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (i)  The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

 

          (j)  The licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating a NEWCC, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (k)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (l)  Licensees shall:

 

(1)  Meet the needs of the patients during those hours that the patients are in the care of the NEWCC;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the NEWCC;

 

(3)  Appoint an administrator;

 

(4)  Verify the qualifications of all personnel;

 

(5)  Provide sufficient numbers of qualified personnel to meet the needs of patients during all hours of operation;

 

(6)  Provide sufficient supplies, equipment, and lighting to meet the needs of the patients;

 

(7)  Require all personnel to follow the orders of the licensed practitioner for every patient that has such orders and encourage the patient to follow the licensed practitioner’s orders;

 

(8)  Initiate action to maintain the NEWCC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances; and

 

(9)  Implement any POC that has been accepted by the department.

 

          (m)  The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney for health care or surrogate decision making that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (n)  In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

 

(1)  Telephone at 603-271-4496;

 

(2)  Telephone at 603-271-5300 after business hours; or

 

(3)  Fax to 603-271-0545.

 

          (o)  If the licensee registers and/or treats a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patients, as specified by the  Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (p)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The license and current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with, He-P 806.09 (d)for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  The licensee’s evacuation floor plan identifying the location of, and access to all fire exits, except that mobile NEWCC vehicles shall be exempt from this requirement; and

 

(6)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345;

 

          (q)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 806 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (r)  A licensee shall, upon request, provide a patient or the patient’s guardian, agent, or surrogate decision-maker if any, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

 

          (s)  All records required for licensing shall be legible, current, accurate and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (t)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to patients and staff.

 

          (u)  The licensee shall develop policies and procedures regarding the release of information contained in patient records.

 

          (v)  The building or mobile vehicle that houses the NEWCC shall comply with all state and local: 

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

          (w)  Smoking shall be prohibited in the facility as required by RSA 155:66, I(b).

 

          (x) For reportable incidents, licensees shall have responsibility for:

 

(1)  Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Faxing to 271-4968 or, if a fax machine is not available,  submit via regular mail, postmarked within 48 hours of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 48 hours of a reportable incident:

 

a.  The NEWCC name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of client(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom, and the date and time;

 

h.  When the client’s guardian, agent, surrogate decision-maker or personal representative, if any, was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the client’s licensed practitioner was notified, if applicable; and

 

k.  The date the facility performed the investigation required by (1) above;

 

(3)  As soon as practicable, notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client has an unexplained absence and the licensee has searched the building and the grounds of the NEWCC without finding the client and it has been determined by the facility that the client is a danger to themselves or others; and

 

(4)  If abuse or neglect is suspected, notifying  the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

            (y)  The licensee shall maintain a log in each mobile vehicle to document that all on-board water is from a verifiable potable Source.

 

Source.  #2349, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5512, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19; amd by #12928, eff 11-26-19

 

          He-P 806.15  Required Services.

 

          (a)  Each facility shall have a governing body or owner whose responsibilities include:

 

(1)  Management and control of the operation;

 

(2)  Assurance of the quality of care and services;

 

(3)  Appointment of the medical director and clinic administrator;

 

(4)  Determination of the qualifications and appointment of physicians, administrator, and other professional staff;

 

(5)  Management of overall operation and fiscal viability of the clinic; and

 

(6)  Ensuring compliance with all relevant health and safety requirements of federal, state and local laws and regulatory requirements.

 

          (b)  The licensee shall provide administrative services that include the appointment of an administrator who:

 

(1)  Is responsible for the day-to-day operations of the NEWCC;

 

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

 

(3)  Meets the requirements of He-P 806.15 (c);

 

(4)  Designates, in writing, a qualified administrator staff member who shall assume the responsibilities of the administrator in his or her absence; and

 

(5)  In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of He-P 806.15(c).

 

          (c)  Any administrator appointed after the 2019 effective date of these rules shall:

 

(1)  Possess at a minimum, a bachelor’s degree in business or a health-related field;

 

(2)  Be an RN; or

 

(3)  Have at least 4 years equivalent experience in a health-related field.

 

          (d)  Each facility shall have a medical director who shall be a physician or APRN licensed in the state of New Hampshire and who shall have training and experience commensurate with the services offered by the clinic as determined by the governing body described in He-P 806.15 (a). 

 

          (e)  The medical director shall be responsible for:

 

(1)  The development and approval of clinic procedures and policies;

 

(2)  The development of facility protocols for assisting patients whose medical needs are outside the NEWCC’s scope of practice;

 

(3)  Monitoring and evaluation of the quality of patient care; and

 

(4)  Providing medical direction, consultation and supervision to the professional staff.

 

          (f)  The administrator and medical director may hold more than one position in the NEWCC and may serve in these capacities for multiple NEWCCs.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.16  Personnel.

 

          (a)  Each NEWCC shall be staffed with at least one licensed practitioner on site during the full hours of operation.

 

          (b)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the facility to meet the needs of the patients at all times.

 

(c)  The licensee shall develop a job description for each position in the NEWCC containing:

 

(1)  Position title;

 

(2)  Duties of the position;

(3)  Physical requirements of the position; and

 

(4)  Qualifications and educational requirements of the position.

 

          (d)  For all applicants for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

 

(2)  Review the results of the criminal records check in He-P 806.16 (1) in accordance with He-P 806.16 (e);

 

(3)  Verify the qualifications of all applicants prior to employment; and

 

(4) Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

 

          (e)  Unless a waiver is granted in accordance with He-P 806.10 and He-P 806.16 (f), the licensee shall not offer employment, contract with, or engage a person in He-P 806.16 (d) if the person:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation in this or any other state

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  If the information identified in He-P 806.16(e) regarding any person in He-P 806.16(d) is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1) Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of He-P 806.16(d).

 

          (g)  If a waiver of He-P 806.16 (d) above is requested, the department shall review the information and the underlying circumstances in He-P 806.16 (d) and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a patient; or

 

(2)  Grant a waiver of He-P 806.16(d) if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a  patient(s).

 

          (h)  The licensee shall check the names of the persons in He-P 806.16(d) against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-W 720, the NH board of nursing, nursing assistant registry, maintained pursuant RSA 326-B:26 and 42 CFR 483.156, and the medical technician registry, maintained pursuant to RSA 328-I prior to employing, contracting with, or engaging them.

 

          (i)  The licensee shall:

(1)  Not employ, contract with, or engage any person in He-P 806.16 (d) who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

 

          (j)  In lieu of He-P 806.16 (d) and (h), the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with He-P 806.16 (d) and (h) and do not meet the criteria in He-P 806.16 (ed) and (h).

 

          (k)  Prior to having contact with patients or food, personnel shall:

 

(1)  Receive a tour of the NEWCC;

 

(2)  Receive a copy of the job description for his or her position at the NEWCC containing:

 

a.  Position title;

 

b.  Duties of the position;

 

c.  Physical requirements of the position; and

 

d.  Education and experience requirements of the position;

 

(3)  Meet the educational qualifications of the position as listed on their job description;

 

(4)  Be licensed, registered, or certified as required by state statute;

 

(5)  Receive an orientation within the first 3 days of work or prior to the assumption of duties that includes:

 

a.  The NEWCC’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The NEWCC’s policies, procedures and guidelines;

 

d.  The NEWCC’s infection control program policies and procedures;

 

e.  The NEWCC’s fire, evacuation, and emergency plans which outline the responsibilities and educational requirements of personnel in an emergency; and

 

f.  The mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

 

(6)  Complete mandatory annual in-service education, which includes a review of the NEWCC’s:

 

a.  Polices and procedures on patient rights and responsibilities, and complaints;

 

b.  Infection control program;

 

c.  Education program on fire and emergency procedures; and

 

d.  Mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

33

(7)  Be at least 18 years of age unless they are:

 

a.  A licensed nursing assistant working under the supervision of a registered nurse in accordance with Nur 700; or

 

b.  Part of an established educational program working under the supervision of a registered nurse;

 

(8)  Prior to contact with patients, submit to the NEWCC the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(9)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

 

(10) Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (l)  Personnel who have direct contact with patients who have a history of TB or a positive laboratory and antigen testing shall have a symptomatology screen of a TB test.

 

          (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 patient’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan; and

 

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

 

          (n)  Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner in one location, for example, hospital human resources department or on site of NEWCC;

 

          (o)  The licensee shall maintain a separate employee file for each employee, which shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  A signed statement acknowledging the receipt of the licensee’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  A record of satisfactory completion of the orientation program required by He-P 806.16;

 

(5)  A copy of each current New Hampshire license, registration, or certification in health care field and CPR certification, if applicable;

 

(6)  Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; 

 

(7)  Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

 

(8)  Documentation of an annual performance review;

 

(9)  Information as to the general content and length of all continuing education or educational programs attended;

 

(10)  A statement, which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient in this or any other state; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state;

 

(11)  Documentation of the criminal records check; and

 

(12)  The results of the registry checks in He-P 806.16(g).

 

          (p)  The licensee shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in He-P 806.16(n)(1), (2), (4), (6), (7), (10), (11), and(12); and

 

(2)  For independent contractors, the information in He-P 806.16(n)(2), (4), (6), (7), (10), (11), and (12), except that the letter in He-P 806.16 (i) and (j)(7) may be substituted for (n)(6), (11), and (12), if applicable.

 

          (q)  An individual need not re-disclose any of the matters in He-P 806.16(e) if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

 

          (r)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.17  Patient Records.

 

          (a)  A patient record shall be maintained for each patient accepted for treatment by the facility.

 

          (b)  The licensee shall maintain a legible, current, and accurate record for each patient based on the services provided at the NEWCC:

 

          (c)  At a minimum patient records shall contain the following:

 

(1)  Identification data, including the patient’s:

 

a.  Name;

 

b.  Home address;

 

c.  Home telephone number;

 

d.  Name, address, and telephone number for an emergency contact;

 

e.  Date of birth; and

 

f.  Guardian, agent, or surrogate decision-maker when applicable.

 

(2)  A signed acknowledgment of receipt of the patient bill of rights and the facility’s complaint procedures, signed by the patient, guardian, agent, or surrogate decision-maker;

 

(3)  Patient's health insurance information;

 

(4)  A written or electronic record of a health assessment by a licensed practitioner or registered nurse;

 

(5)  Dated and signed orders for medications, treatments, special diets, laboratory service, and referrals to other practitioners, as applicable;

 

(6)  The consent for release of information signed by the patient, guardian, agent or surrogate decision-maker, if any;

 

(7)  The medication record;

 

(8)  Documentation of any accident or injuries occurring while in the care of the facility;

 

(9)  Documentation of all services provided including signed progress notes by:

 

a.  Nursing personnel;

 

b.  Physicians; and

 

c.  Other health professionals authorized by facility policy;

 

(10)  Documentation of a patient’s refusal of any care or services;

 

(11)  Transfer or discharge documentation including planning, referrals, and notification to the patient and guardian, agent, or surrogate decision-maker, if any, of involuntary room change, if applicable; and

 

(12)  Orders and results of any laboratory, x-ray or results of other diagnostic tests.

 

          (d)  Patient records shall be available to the professional staff and health care workers and any other person authorized by law or rule to review such records.

 

          (e)  Patient records shall be retained in the facility and stored in an area inaccessible to those who do not have authorized access to such records.

 

          (f)  The licensee's policy shall determine the method by which release of information from patient or patient records shall occur.

 

          (g)  When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use by implementation of use, handling and storage procedures.

 

          (h)  Patient records shall be retained 7 years after discharge of a patient or patient.  In the case of minors, patient records shall be retained until at least 3 years after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

 

          (i)  The licensee shall arrange for storage of and access to patient records for 7 years in the event the clinic ceases operation.

 

          (j)  The facility shall notify the department where the storage required in He-P 806.17(i)  is located.

 

          (k)  Referrals to other health care providers shall occur if medically indicated and the facility does not provide the services required.

 

          (l)  Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

 

          (m)  If the facility uses an electronic record storage system, it shall provide computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 806 for the onsite inspection.  Access shall include assistance navigating the database and printing portions of the record, if needed.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.18  Quality Improvement.

 

          (a)  The licensee shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing and correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The NEWCC shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored:

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the NEWCC; and

 

(7) Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable;

 

(8)  Ensure that quality control logs are maintained for any laboratory quality control testing; and

 

(9)  Ensure that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer’s recommendations.

 

          (e)  The quality improvement committee shall meet at least quarterly.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.19  Infection Control.

 

          (a)  The NEWCC shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases and appoint an individual who will oversee the development and implementation of an infection control program that educates and provides policies and procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

(4)  The handling, storage, transportation and disposal of those items specified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

 

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

 

          (c)  The NEWCC shall appoint an individual who will oversee the development and implementation of the infection control program.

 

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

 

(1)  Causes of infection;

 

(2)  Effects of infections;

 

(3)  Transmission of infections;

 

(4)  Prevention and containment of infections; and

 

(5)  Use of universal precautions.

 

          (e)  Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious as determined by a licensed practitioner.

 

          (f)  Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients until such time as they are no longer infected as determined by a licensed practitioner.

 

          (g)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (h)  Personnel and staff with an open wound who provide direct care in any capacity shall cover such wound at all times by an impermeable and durable bandage with secure edges.

 

          (i)  The licensee shall immunize all consenting patients for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (j)  If the NEWCC has an incident of an infectious disease reported in He-P 806.19(b)(5), the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (k)  The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

 

          (l)  The licensee shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

 

          (m)  The administrator shall appoint an infection control officer who shall:

 

(1)  Receive reports of communicable and infectious diseases; and

 

(2)  Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

 

          (n)  The licensee shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee, or patient has a communicable disease.

 

          (o)  The NEWCC shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

          (p)  If equipment needs to be cleaned in order to prevent contamination, the  NEWCC shall develop and maintain written procedures for safe and effective cleaning of the equipment.

          (q)  The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19

 

          He-P 806.20  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment both inside and outside the facility.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times, and precautions such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Hospitals and Outpatient Facilities,” 2018 edition, as available as noted in Appendix A., and summarized as follows:

 

(1)  One hundred and five degrees through120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

 

(2)  One hundred and twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the ware washer, and may be by separate booster, unless a chemical rinse is provided; and

 

(3)  One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

 

          (f)  All patient bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and program supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, outdoor animals, and pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service area shall be covered at all times, except during food preparation and subsequent clean-up.

 

          (m)  Laundry and laundry rooms, if present, shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 905.04 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Clean supplies shall be stored in dust-free and moisture-free storage areas or containers.

 

          (p)  Any NEWCC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

 

          (q)  Sterile supplies and equipment shall:

 

(1)  Be stored in dust-proof, moisture-free storage areas; and

 

(2)  Not be mixed with un-sterile supplies.

 

          (r)  All soiled items at the NEWCC shall be disposed of according to the facility’s infection control policies.

 

          (s)  There shall be a designated, enclosed storage area for soiled, dirty, and bio-hazardous materials.

 

          (t)  If equipment or supplies need to be sterilized in order to prevent contamination, the NEWCC shall develop and maintain written procedures for cleaning, packaging and sterilization that includes:

 

(1)  Testing and documenting sterilization processes used;

 

(2) Testing and documenting the effectiveness of sterilization equipment for adequate sterilization in accordance with the manufacturer’s recommendations or using industry acceptable quality control standards;

 

(3)  Documentation when supplies are outdated; and

 

(4)  Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly provisions of He-P 806.19)

 

          He-P 806.21  Physical Environment.

 

          (a)  The licensed premises, including mobile NEWCC vehicles, shall be maintained, inside and outside, so as to provide for the health, safety, well-being and comfort of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

 

          (b)  The licensee shall:

 

(1)  Have all emergency entrances and exits accessible at all times and be free from obstructions;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and patients,

including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not be limited to:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c) Notwithstanding general access requirements from the Facility Guidelines Institute (FGI) “Guidelines for the Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A, a NEWCC located on the premises of another entity shall not be required to provide separate exterior entrances or designated parking, or to provide a patient waiting area or reception area that is separated from the public area of the host entity.

 

          (d)  Equipment providing heat within an NEWCC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove or pellet stove shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit if patient(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (e)  Electric heating systems shall be exempt from He-P 806.21 (d)(2).

 

          (f)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employees areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (g)  Unvented fuel-fired heaters shall not be used in any NEWCC.

 

          (h) Plumbing shall be sized, installed, and maintained in accordance with the provisions of the International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

          (i)  Ventilation shall be provided throughout the entire building by means of a mechanical ventilation system or with one or more screened windows that can be opened.

 

          (j)  Screens shall be provided for doors, windows or other openings to the outside.

 

          (k)  Doors that are self-closing and remain closed when not in use are exempt from the requirement in (i) above.

 

          (l)  In accordance with RSA 155:66, I(b), smoking shall be prohibited in the NEWCC.

 

          (m)  All NEWCCs shall have access within the NEWCC to a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels or a hand-drying device providing heated air, and hot and cold running water.

 

          (n)  All bathroom doors shall have a side hinge door and not a folding or sliding door or a curtain.

 

          (o)  Notwithstanding (l) above, if the NEWCC is located within a retail store that has a public bathroom with a toilet and the bathroom complies with all applicable sanitation and construction regulations, the NEWCC shall not be required to have its own bathroom but shall:

 

(1)  Have its own hand washing sink with hot and cold running water, soap dispenser, and paper towels or a hand-drying device providing heated air, and

 

(2)  Not permit biological samples collected in the retail store’s public bathroom to be transported through the retail store except in properly enclosed biohazard containers and bags.

 

          (p)  There shall be sufficient space and equipment for the services provided at the NEWCC.

 

          (q)  All exam tables shall be changed with clean linens or common paper between use by different patients.

 

          (r)  The licensee shall provide patients with continuous access to a device or means that will signal NEWCC personnel when they are in need of assistance.

 

          (s)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (t)  If available, all showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (u)  All mattresses and new upholstered furniture or draperies shall comply with the applicable portions of Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (v)  A privacy partition, curtain, or screen shall be required between beds in semiprivate rooms.

 

          (w)  The NEWCC shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (x)  The NEWCC shall be clean, sanitary, maintained in a safe manner and good repair, and kept free of hazards.

 

          (y)  The NEWCC shall provide the following:

 

(1)  Reception and waiting areas that include a reception desk or counter, chairs, tables and lighting adequate to read materials and complete forms as required;

 

(2)  Public access to toilet facilities with non-porous floors;

 

(3)  A number of examination and treatment rooms adequate to provide services to the average number of patients seen daily; and

 

(4)  Hot water available at all times from taps available to patients and not less than 105 degrees Fahrenheit or more than 120 degrees Fahrenheit.

 

          (z)  Medical waste shall be disposed of in accordance with the requirements of Env-Sw 904.

 

          (aa)  Except as described in He-P 806.21 (b) , the NEWCC shall comply with all federal, state and local health, building, fire and zoning laws, rules and ordinances.

 

          (ab)  The water used in the NEWCC shall be suitable for human consumption, pursuant to Env-Ws 315 and Env-Ws 316.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly He-P 806.20)

 

          He-P 806.22  Fire Safety.

 

          (a)  All NEWCCs shall meet the appropriate chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

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

 

          (c)  The NEWCC shall immediately notify the department by phone, fax or electronic mail within 24 hours, and in writing within 72 hours, of any fire or situation, excluding a false alarm, that requires either an emergency response to the NEWCC or the evacuation of the licensed premises.

 

          (d)  The written notification required by He-P 806.22(c) shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injuries to patients or personnel or damage sustained by the NEWCC;

 

(3)  A description of events preceding and following the incident;

 

(4) The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

 

(5) The name of any personnel or patient who required medical treatment as a result of the incident, if applicable; and

 

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (e)  For the use and storage of oxygen and other related gases, NEWCCs shall comply with NFPA 99 as adopted by the commissioner of the department of safety under Saf-C 6000 including, but not limited to, the following:

 

(1)  All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

 

(2)  Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

 

(3)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

a.  Not be stored with any flammable gas, liquid, or vapor;

 

b.  Be separated from combustibles or incompatible materials by:

 

1.  A minimum distance of 20 ft or 6.1 m;

 

2.  A minimum distance of 5 ft or 1.5 m if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour; and

 

c.  Shall be secured in an upright position, such as with racks or chains;

 

(4)  A precautionary sign, readable from a distance of 5 ft or 1.5 m, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”;

 

(5)  Precautionary signs, readable from a distance of 5 ft or 1.5 m, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means; and

 

(6) Must comply with NH department of transportation requirements with regard to oxygen transport, storage, and use.

 

          (f)  Each licensee shall develop a written emergency plan that covers:

 

(1)  Loss of electricity, water and or heat;

 

(2)  Bomb threat;

 

(3)  Severe weather;

(4)  Fire;

 

(5)  Gas leaks; and

 

(6)  Any situation that requires evacuation or closure of the NEWCC.

 

          (g)  Each licensee shall annually review and revise, as needed, its emergency plan.

 

          (h)  Evacuation drills shall include the transmission of a fire alarm signal if a fire alarm system is installed, and simulation of emergency fire condition.

 

          (i)  Evacuation drills shall be quarterly and vary in time, as needed, to include all staff.

 

          (j)  All staff shall participate in at least one drill quarterly.

 

          (k)  For NEWCCs located within a retail store or pharmacy, the fire drill shall consist of a required review of all fire safety procedures and exit protocols for the retail store or pharmacy.  All personnel on duty shall participate fully in each drill held by the retail store or pharmacy in which the NEWCC may be located.

 

          (l)  For personnel who are unable to participate in the scheduled drill as required in He-P 806.22(j) on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

 

          (m)  Personnel who are unable to participate in a drill in accordance with He-P 806.22(j) shall participate in a drill within the next quarter. 

 

          (n)  Regular staff, including per-diem or temporary personnel shall not be the only person(s) on duty unless they have:

 

(1)  Participated in at least one actual fire drill in the facility in the past year; and

 

(2)  Participated in the facility’s orientation program pursuant to He-P 806.16.

 

          (o)  All emergency and evacuation drills shall be documented and include the following information:

 

(1)  The names of the personnel involved in the evacuation;

 

(2)  The number of patients involved in the evacuation;

 

(3)  The time, including AM or PM, date, month, and year the drill was conducted;

 

(4)  The exits utilized;

 

(5)  The total time necessary to evacuate the NEWCC;

 

(6)  The time needed to complete the drill; and

 

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

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly provisions of He-P 806.21)

 

          He-P 806.23  Emergency Preparedness.

 

          (a)  Each facility shall have a group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (b)  The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in He-P 818.23(d) and (e);

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in He-P 806.23(d) shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4) Be based on realistic conceptual events;

 

(5)  Be modeled on the ICS in coordination with local emergency response agencies;

 

(6) Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable;

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(7)  Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

(8)  Include the management of participants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

 

(9)  Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

 

(10)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (f)  Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

 

          (g)  The facility shall review and update its emergency plan, as needed, as a result of drills and

exercises, real event(s), and/or annual plan review. Any substantial changes to the plan as a result of drills and exercises, real events, shall be submitted to the local Emergency Management Director for review

 

          (h)  Notwithstanding He-P 806.23(a)-(f), when an NEWCC is a part of a larger institution which has a comprehensive emergency preparedness plan, the NEWCC may use the institution’s plan, and if so, it shall:

 

(1)  Identify the portions of the plan that pertain to the NEWCC in a separate document for use by NEWCC personnel;

 

(2)  Provide annual training to prepare personnel in its application as required by He-P 806.23(f); and

 

(3)  Review and update the plan as required by He-P 818.23(g) above.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly provisions of He-P 806.21)

 

          He-P 806.24  Pharmacy and Medications.

 

          (a)  Medications shall be administered only by a person licensed to do so by the State of NH.

 

          (b)  If an emergency drug cart is maintained, it shall be under the control of a  professional staff and shall be inventoried and maintained according to the written policy of the medical director.

 

          (c)  All medications shall be stored in a clean well-organized cabinet or closet which shall be locked when not in use.

 

          (d)  Appropriate security provisions shall be made for medications requiring refrigeration.

 

          (e)  Security provisions such as locked drawers shall be made for individual physician samples if no central storage location is established.

 

          (f)  Schedule I and II drugs scheduled in accordance with RSA 318-B:1-a shall be stored in a locked compartment within the locked medicine cabinet or closet.

 

          (g)  Disposal of outdated medications and controlled drugs shall be in accordance with state and local ordinances and the provisions of RSA 318-B and Ph 707.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly He-P 806.22)

 

          He-P 806.25  Laboratory.  Any NEWCC which obtains or performs tests on human samples for diagnostic or treatment purposes shall meet the following:

 

          (a)  Only tests designated as “CLIA waived” by the FDA shall be performed unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808;

 

          (b)  The NEWCC shall hold a CLIA “certificate of waiver” if only CLIA waived testing is performed, the NEWCC shall have the appropriate CLIA certificate under 42 CFR 493, and have a laboratory license under He-P 808;

 

          (c)  A procedure manual shall:

 

(1)  Be readily accessible at all times to testing personnel; and

 

(2)  Contain:

 

a.  The written procedure for each test performed in the laboratory;

 

b.  A copy of the package insert for each test performed;

 

c.  The laboratory’s procedure for test requisition and specimen collection;

 

d.  The specimen handling and follow-up procedure for all patient samples that are referred to another laboratory for testing;

 

e.  The phlebotomy procedure;

 

f.  Job descriptions for the testing personnel and specimen collection personnel; and

 

g.  Documentation that the medical director has approved all procedures;

 

          (d)  Unless the facility holds a separate He-P 808 license for the laboratory, the medical director required by He-P 806.15 (d) shall be the director for all laboratory testing;

 

          (e)  All patient test requisitions, reports and records shall be completed and maintained in accordance with 42 CFR 493;

 

          (f)  All patient test requisitions, reports and records shall be safeguarded against loss, damage, tampering, and unauthorized access and maintained for a minimum of 4 years;

 

(g)  Refrigerator and freezer temperatures shall be recorded each day specimens, reagents and/or test kits are stored and must fall within the following ranges:

 

(1)  Refrigerator temperatures shall be between 2 and 8 degrees centigrade; and

 

(2)  Freezer temperatures shall be colder than minus 10 degrees centigrade;

 

          (h)  Centrifuge speed shall fall between 2800 and 3500 revolutions per minute or as specified by the manufacturer and be verified by tachometer on an annual basis;

 

          (i)  No expired specimen collection equipment and reagents, such as vacutainer tubes and glucola, shall be retained in the station or used for specimen collection;

 

          (j)  Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the NEWCC;

 

          (k)  The medical director shall assure that all testing and phlebotomy personnel have a documented annual competency review that shall include a visual inspection of the performance of a phlebotomy and each test method performed; and

 

          (l)  If the NEWCC performs phlebotomies to collect blood specimens for testing, the facility shall have:

 

(1)  A blood collection chair with a device to prevent patient falls or a reclining chair;

 

(2)  A cot or an alternative method that allows a patient to lie down in the event of dizziness or illness;

 

(3)  A specimen collection area that:

 

a.  Is separate from the reception area;

 

b.  Contains a work counter and hand washing facilities;

 

c.  Measures, at a minimum, 36 square feet; and

 

d.  Maintains patient confidentiality and privacy; and

 

(4)  A processing area that, at a minimum, has 6 linear feet of counter space.

 

Source.  #9655, eff 2-13-10, EXPIRED: 2-13-18

 

New.  #12674, INTERIM, eff 11-19-18, EXPIRED: 5-20-19

 

New.  #12795, eff 5-30-19 (formerly provisions of He-P 806.21)

 

          He-P 806.26  Mobile NEWCC Vehicles.

 

          (a)  Mobile NEWCC vehicles shall be eligible for licensure only if they are:

 

(1)  Operated by a NEWCC that is located in a building or other permanent structure and has a valid NH facility license issued by the department in accordance with He-P 806; or

 

(2)  Operated by another NH licensed facility that is located in a building or other permanent structure.

 

          (b)  Each applicant shall comply with He-P 806, except that:

 

(1)  He-P 806.07 shall not apply to mobile NEWCC vehicles;

 

(2)  In lieu of He-P 806.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

 

a.  A copy of the applicant’s current NEWCC license;

 

b.  A valid New Hampshire motor vehicle registration for the mobile NEWCC vehicle;

 

c.  The VIN of the mobile NEWCC vehicle; and

 

d.  A space utilization diagram for the mobile NEWCC vehicle; and

 

(3)  Client and facility records that are stored off site shall be available for inspection upon request of licensing staff within 30 minutes of being requested.

 

          (c)  The NEWCC portions of the mobile NEWCC vehicle shall have a non-porous floor.

 

          (d)  Detailed written documentation of travel dates, times and locations, including periods of non-use, shall be maintained for the mobile NEWCC vehicle.

 

          (e)  The NEWCC mobile vehicle shall have mounted smoke and carbon monoxide detection devices which are installed and maintained.

 

          (f)  The NEWCC mobile vehicle shall contain appropriately rated fire extinguishers mounted within;

 

          (g)  The NEWCC mobile vehicle shall have marked exits.

 

          (h)  The NEWCC mobile vehicle shall have at a minimum battery-operated emergency lighting for exiting.

 

Source.  #12795, eff 5-30-19

 

PART He-P 807  RULES FOR RESIDENTIAL TREATMENT AND REHABILITATION FACILITIES

 

Statutory Authority: RSA 151:9, I.

 

          He-P 807.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all residential treatment and rehabilitation facilities (RTRF) pursuant to RSA 151:2, I(d).

 

Source.  #1779 eff 7-19-81; ss by #2347, eff 4-28-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff
1-29-92, EXPIRED: 5-28-92

 

New.  #5751, eff 12-2-93, EXPIRED: 12-2-99

 

New.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff
2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a RTRF, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i); and

 

          (b)  All facilities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.03  Definitions. In this part, the following words have the following meanings, unless context clearly indicates otherwise:

 

         (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients without his or her informed consent;

 

         (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management;

 

         (c) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure;

 

         (d) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B;

 

         (e)  “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise;

 

         (f)  “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility;

 

         (g)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” shall include living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35;

 

         (h)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies;

 

         (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35;

 

         (j)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a RTRF pursuant to RSA 151;

 

         (k)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 807, or other federal or state requirements;

 

         (l)  “Assessment” means an evaluation of the client to determine the care and services that are needed;

 

         (m)  “Care plan” means a documented guide developed by the licensee, in consultation with the licensed practitioner, personnel, the client, and/or the client’s guardian, agent or personal representative, if any, as a result of the assessment process for the provision of care and services. This term also includes “treatment plan”;

         (n)  “Change of ownership” means a change in the controlling interest of an established RTRF to a successor business entity;

 

         (o)  “Chemical restraint” means any medication prescribed to control a client’s behavior or emotional state without a supporting diagnosis or for the convenience of program personnel;

 

         (p)  “Client” means any person admitted to or in any way receiving care, services or both from a RTRF licensed in accordance with RSA 151 and He-P 807;

 

         (q)  “Client record” means documents maintained for each client, which includes all documentation required by RSA 151 and He-P 807, and all documentation compiled relative to the client as required by other federal or state laws;

 

         (r)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee;

 

         (s) “Comprehensive evaluation” means a multi-disciplinary assessment of level of function by healthcare professionals licensed or certified in the field of rehabilitation;

 

         (t)  “Contracted employee” means a temporary employee working under the direct supervision of the RTRF but employed by an outside agency;

 

         (u)  “Core services” means those minimal services to be provided to any client by the licensee that shall be included in the basic rate;

 

         (v) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others;

 

         (w)  “Days” means calendar days unless otherwise specified in the rule;

 

         (x) “Department” means the New Hampshire department of health and human services;

 

         (y)  “Direct care” means hands-on care and services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments;

 

         (z)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance;

 

         (aa)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the client will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”;

 

         (ab)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency;

 

         (ac) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 807;

 

         (ad) “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures;

 

         (ae)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception or fraud;

 

         (af)  “Facility” means “facility” as defined in RSA 151:19, II;

 

         (ag)  “Guardian” means a person appointed in accordance RSA 464-A to make informed decisions relative to the client’s health care and other personal needs;

 

         (ah)  “Impaired” means when a physician or health care worker whose ability to function in his or her usual role has been reduced or otherwise compromised by  any substances including but not limited to legally prescribed medications or alcohol;

 

         (ai) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries.  ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents;

 

         (aj)  “Infectious waste” means those items specified by Env-Sw 103.28;

 

         (ak)  “Informed consent” means the decision by a person or his or her guardian, agent, or surrogate decision maker to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently;

 

         (al) “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel;

 

         (am)  “Inspection” means the process followed by the department to determine an applicant or a  licensee’s compliance with RSA 151 and He-P 807 or to respond to allegations, pursuant to RSA 151:6,  of non-compliance with RSA 151 and He-P 807;

 

         (an)  “License” means the document issued by the department to an applicant at the start of operation as an RTRF, which authorizes operation of a RTRF in accordance with RSA 151 and He-P 807, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number;

 

         (ao)  “License certificate” means the document issued by the department to an applicant or licensee that, contains the information on a license and includes the name of the administrator, the type(s) of services authorized and the number of beds that the RTRF is licensed for;

 

         (ap)  “Licensed practitioner” means: 

 

(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;

 

         (aq)  “Licensed premises” means the building, or buildings, that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license;

 

         (ar)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151;

 

         (as) “Licensing classification” means the specific category of services authorized by a license;

 

         (at)  “Life safety code” means the national Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

         (au)  “Mechanical restraint” means  locked or secured RTRFs or units within a RTRF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the RTRF or unit within;

 

         (av)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance;

 

         (aw)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  The term does not include repair or replacement of interior finishes;

 

         (ax)  “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional or physical health and safety of any client;

 

         (ay) “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable  life safety rules or codes;

 

         (az) “Nursing care” means the provision of care or oversight of a physical, mental, or emotional condition or diagnosis by a nurse;

 

         (ba)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, recommendations, or 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;

 

         (bb)  “Owner” means a person or organization who has controlling interest in the RTRF;

 

         (bc)  “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21. This term includes “resident rights”;

 

         (bd)  “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions;

 

         (be)  “Personal representative” means a person, other than the licensee of an employee of or a person having a direct or indirect ownership interest in, a facility, who is designated in writing by a client or client’s legal guardian for a specific, limited purpose or for the general purpose of assisting the client in the exercise of any rights as defined in RSA 151:19, V; 

 

         (bf)  “Personnel” means individual(s) employed by the facility, volunteer(s), or independent contractor(s), who provide direct care or services to a client; 

 

         (bg)  “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the client’s freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques;

 

         (bh)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6;

 

         (bi) “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of client care;

 

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

 

         (bk)  “Pro re nata (PRN) medication” means medication taken as circumstances may require in accordance with a licensed practitioner’s orders;

 

         (bl)  “Protective care” means the provision of client monitoring services, including but not limited to:

 

(1)  Knowledge of client whereabouts;

 

(2)  Minimizing the likelihood of accident or injury; and

 

(3) Other means of ensuring client safety;

 

         (bm)  “Qualifications” means education, experience and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee;

 

         (bn)  “Qualified personnel” means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control or kitchen staff trained in food safety protocols;

 

         (bo)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained; 

 

         (bp) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces;

 

         (bq)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition;

 

         (br)  “Reportable incident” means an occurrence of any of the following while the client is either in the RTRF or in the care of the RTRF personnel:

 

(1)  The unanticipated death of the client;

 

(2)  An injury to a client, that is indicative of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or

 

(3)  The unexplained absence of a client from the RTRF who is determined to be a danger to themselves or others;

 

         (bs)  “Residential treatment and rehabilitation facility”(RTRF) means a place, excluding hospitals as defined in RSA 151-C:2, which provides residential care, treatment and comprehensive specialized services relating to the individual’s medical, physical, psychosocial, vocational, or educational needs;

 

         (bt)  “Self administration of medication without assistance” means an act whereby the client takes his or her own medication(s) without the assistance of another person;

 

         (bu)  “Self administration with supervision” means an act whereby the client takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others;

 

         (bv)  “Self- directed medication administration” means an act whereby a client, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions, injections, or filling insulin syringes;

 

         (bw)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client;

 

         (bx)  “Significant change” means a change in cognitive or physical capabilities that decreases a client’s ability to care for himself beyond an episodic event;

 

         (by) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease or clinical conditions, or to increase or decrease specific nutrients in the food consumed by the client;

 

         (bz)  “Unexplained absence” means an incident involving a client leaving the premises of the RTRF without the knowledge of the RTRF personnel; and           

 

(ca) “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License, or Special Health Care Services” (March 2019) signed by the applicant or 2 of the corporate officers affirming the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any new RTRF to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a

description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any RTRF to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

 

(2)  A floor plan of the prospective RTRF;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, VI, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name, qualifications, and copies of applicable licenses for the RTRF administrator;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000 under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, including the applicable chapter National Fire Protection Association (NFPA) 101 , and local fire ordinances applicable for an RTRF; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

 

(7)  If the RTRF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if public water supply, a copy of a water bill; and

 

(8)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant and the administrator for which the application is submitted.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #9873-B, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 807.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 807.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e) Unless a waiver has been granted pursuant to He-P 807.10, the department shall deny a licensing request in accordance with He-P 807.13(b) if, it determines that the applicant, administrator, or a household member:

 

(1) Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse,

neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (f)  Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 807.

 

          (g) All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)  A written notification of denial, pursuant to He-P 807.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) above  and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 807.

 

          (i)  A written notification of denial, pursuant to He-P 807.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 807.04(a)(1) at least 120 days prior to the expiration of the current license to include:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 807.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of current employees who have a permanent waiver granted in accordance with He-P 807.18(f); and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire

marshall, in accordance with Saf-C 6005.03 - 6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (c)  In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

 

          (d)  Following an inspection as described in He-P 807.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) and (c) above prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151, He-P 807, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 807.04 and shall be subject to a fine in accordance with He-P 807.14.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.07  RTRF Construction, Modifications or Renovations.

 

          (a)  For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 807 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  The RTRF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (g)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, as follows:

 

a.  NFPA 101, Life Safety Code Residential Board and Care Occupancy Chapter; or

 

b.  NFPA 101, Life Safety Code Health Care Occupancy Chapter; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  The FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities”, (2018 edition), available as noted in Appendix A; and

 

          (h)  All RTRFs newly constructed or rehabilitated after the 2019 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of  Residential Health, Care, and Support Facilities” (2018 edition), as applicable, available as noted in Appendix A.

 

          (i)  Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” ( 2018 edition), available as noted in Appendix A.

 

          (j) The department shall be the authority having jurisdiction for the requirements in He-P 807.07(i)-(k) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 807.10 as appropriate.

 

          (k)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

 

          (l)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (m)  Exceptions or variances pertaining to the state fire code referenced in He-P 807.07(h)(1)  shall be granted only by the state fire marshal.

 

          (n)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 807.09 prior to its use.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.08  RTRF Requirements for Organizational Changes.

 

          (a)  The RTRF shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  Services.

 

          (b)  The RTRF shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  A change in service.

 

          (c)  When there is a change in address without a change in location the RTRF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the RTRF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

 

(2)  The physical location;

 

(3)  A change in licensing classification; or

 

                  (4)  A change that places the facility under a different life safety code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or a change in physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the RTRF’s name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)       A change of administrator;

 

(2)  A change in address without a change in physical location; or

 

(3)  When a waiver has been granted in accordance with He-P 807.10.

 

          (i)  The RTRF shall inform the department in writing when there is a change in administrator  no later than 5 days prior to a change  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  The results of a NH criminal background check conducted pursuant to He-P 807(e);

 

(3)  Copies of applicable licenses for the new administrator; and

 

(4)  A copy of the criminal attestation as described in He-P 807.18(s).

 

          (j)  Upon review of the materials submitted in accordance with (e) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 807.16(a) and He-P 807.18(k).

 

          (k)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the RTRF in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

          (l)  The RTRF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

          (m)  A restructuring of an established RTRF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (n)  When there is to be a change in the services provided, the RTRF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

 

          (o)  The department shall review the information submitted under (n) above and determine if the added services can be provided under the RTRF’s current license including physical plan restrictions.

 

          (p)  If a licensee chooses to cease operation of an RTRF, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting that is consistent with the clinical needs of the resident based on assessment including but not limited to another RTRF, a higher level of care facility, a lower level of care facility, or a home.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 807, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The proposed or licensed premises;

 

(2)  All programs and services provided by the RTRF; and

 

(3)  Any records required by RSA 151 and He-P 807.

 

          (b)  The department shall conduct a clinical and life safety code inspection, as necessary to determine full compliance with RSA 151 and He-P 807 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 807.08(e)(1);

 

(3)  A change in the licensee’s physical location;

 

(4)  A change in licensing classification;

 

(5)  An increase in the number of clients beyond what was authorized under the initial license;

 

(6)  Occupation of space after construction, renovations or structural alterations; or

 

(7)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department.

 

(d)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the RTRF is in violation of any of the provisions of He-P 807, RSA 151, or other federal or state requirement.

 

(e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 807.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

(f)  A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 807.09(b) that the prospective premises are not in full compliance with RSA 151 and He-P 807.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 807 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety or well-being of the clients; and

 

(3)  Does not negatively affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) of RSA 151 or He-P 807 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3) There is sufficient specific information for the department to determine that the allegations(s), if proven true, would constitute a violation of any of the provisions of RSA 151 or He-P 807.

 

          (b)  When practicable the complaint shall be in writing and shall contain the following information:

 

(1)  The name and address, if known, of the RTRF, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 807.

 

          (c)  Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, which include:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4) Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed RTRF, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

 

(3)  If the department determines the complaint is unfounded, and does not violate their statutes, rules, or regulations the licensee will be notified in writing of such determination and the department will take no further action; and

 

(4)  If areas of non-compliance are found, require the licensee to submit a POC in accordance with He-P 807.12(c).

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV.

 

(2)  In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by He-P 807.11 (e)(1) to submit a completed application for a license;

 

(3)  If the owner of an unlicensed RTRF does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 807; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 807.13(c)(6).     

 

(f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.12  Administrative Remedies.

 

          (a)  The department shall, after notice and opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 807, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee;

 

(4)  Monitoring of a license;

 

(5)  Immediate suspension of a license; or

 

(6)  Revocation of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action.

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a. Achieves compliance with RSA 151 and He-P 807;

 

b. Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 807 as a result of the implementation of the POC; and

 

d. Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14-days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 807.13(c)(12);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with (b) above; and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with (f)(12) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14-days of the written notification from the department; and

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

 

(1)  Impose a fine according to He-P 807.13(c)(6);

 

(2)  Deny the application for a renewal of a license in accordance with He-P 807.13(b)(6); or

 

(3)  Revoke or suspend the license in accordance with He-P 807.13(g).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings if the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department and shall include any evidence that has not yet been reviewed by the department.

 

          (h)  Upon receipt of the requested informal dispute resolution made by the applicant, licensee, or administrator, the department shall review the evidence presented and if requested, within the informal dispute resolution request, meet with, in person or via telephone, the applicant, licensee, or administrator.

 

          (i)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. 

 

          (j)  The statement of findings or notice to correct shall not be changed, if based on the evidence presented, the statement of findings is determined to be correct.

 

          (k)  The department shall provide a written notice to the applicant or licensee notifying the applicant, licensee, or administrator of such determination.

 

          (l)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (m)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (o)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of clients; or

 

(2)  The presence of conditions in the RTRF that negatively impact the health, safety, or well-being of clients.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 807, which poses a risk  of harm a client’s or employee’s health, safety or well-being;

 

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4) After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 807.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 807.12(d) and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 806.12(c)(5) and has not submitted a revised POC as required by He-P 806.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 807 for the same violations within the last 5 inspections;

 

(9)  A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(10)  Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 807;

 

(11)  Unless a waiver has been granted the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license and after receipt of an order to cease and desist, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a client whose needs exceeds the services or programs provided by the RTRF, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For  admission of a client whose needs at the time of  registration exceed the services or programs authorized by the RTRF, in violation of RSA 151:5-a, II and He-P 807.15(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 807.11(e)(4), the fine for an unlicensed provider or licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 807.06(e), the fine shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 807.08(a)(1), the fine shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 807.08(a)(2), the fine shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address, in violation of He-P 807.08(l), the fine shall be $100.00;

 

(11)  For a refusal to allow access by the department to the RTRF’s premises, programs, services or records, in violation of He-P 807.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14-days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 807.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 807.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement or comply with licensee policies, as required by He-P 807.14(a), (d), and (e), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 807.14(c), the fine for a licensee shall be $500.00; 

 

(16)  For providing false or misleading information or documentation, in violation of He-P 807.14(i), the fine shall be $1000.00 per offense;

 

(17)  For failure to meet the needs of a client or clients, as described in He-P 807.18(a) and He-P 807.24(j), the fine for a licensee shall be $1000 per client;

 

(18)  For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 807.09(b)(5), the fine for a licensee shall be $500;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 807.10, in violation of He-P 807.16(a), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 807.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-p 807.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that there is a violation of RSA 151 or He-P 807 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;  and

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 807 shall constitute a separate violation and shall be fined in accordance with He-P 807.13(c), provided that if the applicant or licensee is making good faith efforts to comply with the violations of the provisions of RSA 151 or He-P 807, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of clients when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 807 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a RTRF’s license has been denied or revoked, the applicant, licensee or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years, if the enforcement action pertained to their role in the RTRF. 

 

          (k)  The 5-year period referenced in (j) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if appeal is filed; or

 

(2)  The date a final decision upholding the action of the department, if a request for a hearing was made and a hearing was held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 807.

 

          (m) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 807.

 

          (o) Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.14  Duties and Responsibilities of the Licensee.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, regulations, codes, and ordinances as applicable.

 

(b) The licensee shall admit only those clients whose needs can be met by the RTRF.

 

          (c)  The licensee shall have a system to regularly identify the daily census, including times any client is absent from the RTRF.

 

          (d)  The licensee shall define, in writing, the scope and type of services to be provided by the RTRF.

 

          (e) The licensee shall comply with the Patients’ Bill of Rights as set forth in RSA 151:19-30.

 

(f)  The licensee shall have a written policies and procedures to include:

 

(1)  The rights and responsibilities of all clients in accordance with the Patients’ Bill of Rights under RSA 151:21;

 

(2)  The policies described in He-P 807.14, He-P 807.16, He-P 807.19, and He-P 807.26; and

 

(3)  A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (g)  The licensee shall develop and implement written policies and procedures governing the operation of the RTRF and all services provided by the facility and for:

 

(1)  Reviewing the policies and procedures every 3 years; and

 

(2)  Revising them as needed.

 

          (h)  The licensee shall assess and monitor the quality of care and service provided to clients on an ongoing basis.

 

          (i)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (j)  The licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating a RTRF, unless it is licensed; or

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (k)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (l)  Licensees shall:

 

(1)  Meet the needs of the clients during those hours that the clients are in the care of the RTRF;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the RTRF;

 

(3)  Appoint an administrator;

 

(4)  Verify the qualifications of all personnel;

 

(5)  Provide sufficient numbers of qualified personnel to meet the needs of clients during all hours of operation;

 

(6)  Provide sufficient supplies, equipment, and lighting to meet the needs of the clients;

 

(7)  Require all personnel to follow the orders of the licensed practitioner for every client that has such orders and encourage the client to follow the licensed practitioner’s orders;

 

(8)  Initiate action to maintain the RTRF in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances; and

 

(9)  Implement any POC that has been accepted by the department.

 

          (m)  The licensee shall consider all clients competent and capable of making health care decisions unless the client:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney for health care or surrogate decision making that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (n)  In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

 

(1)  Telephone at 603-271-4496;

 

(2)  Telephone at 603-271-5300 after business hours; or

 

(3)  Fax to 603-271-0545.

 

          (o)  If the licensee registers and treats a client who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (p)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The license and current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with, He-P 807.09 (d)for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  The licensee’s evacuation floor plan identifying the location of and access to all fire exits; and

 

(6)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345;

 

          (q)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 807 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (r)  A licensee shall, upon request, provide a client or the client’s guardian, agent, or surrogate decision-maker if any, with a copy of his or her client record pursuant to the provisions of RSA 151:21, X.

 

          (s)  All records required for licensing shall be legible, current, accurate and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (t)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (u)  The licensee shall develop policies and procedures regarding the release of information contained in client records.

 

          (v)  The licensed premises shall comply with all state and local: 

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

            (w)  Smoking shall be prohibited in the RTRF per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

 

            (x)  For reportable incidents, allegations of abuse, neglect, mistreatment or misappropriation of property, the licensee shall have responsibility for:

 

(1)  Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident; and

 

(2)  Faxing to 603 271-4968, or if a fax machine is not available, submitting via regular mail, postmarked within 24 hours of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 24 hours of the reportable incident:

 

a.  The RTRF name;

 

b.   A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of client(s) involved in or witnessing the incident;

 

e.  The date and time of the incident;

 

f.  The action taken in direct response to the incident, including any follow-up;

 

g. If medical intervention was required, who provided the medical intervention and the date and time that the medical intervention was provided;

 

h.  When the client’s guardian, agent, surrogate decision-maker, or personal representative, if any, was notified;

 

i.  The signature of the person reporting the incident; and

 

j.  The date and time the client’s licensed practitioner was notified, if applicable; and

 

(3)  Within 5 days, submit a completed investigation report to the department containing the following information: 

 

a.  All items referenced in (1) above;

 

b.  The names and results of interview(s) with all personnel, resident(s) or other individuals involved in the reportable incident, including all applicable  statement signatures; and

 

c.  The action taken by the licensee in direct response to the incident(s), including any and all follow-up.

 

(4)  Immediately notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client who has been assessed or is known as being a danger to self or others, has eloped after the licensee has searched the building and the grounds of the RTRF; and

(5) Submit additional information, if required to the department, to support the incident report referenced in (x)(3) above.

 

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

 

(1)  Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided regarding:

 

a.  The clients’ functioning, safety and whereabouts;

 

b.  The clients’ health status, including the provision of intervention as necessary or required; and

 

c.  Personnel safety.

 

(2)  Emergency response and crisis intervention;

 

(3)  Medication services in accordance with He-P 807.17;

 

(4)  Food services in accordance with He-P 807.20;

 

(5)  Housekeeping, laundry and maintenance services;

 

(6)  On-site activities designed to sustain and promote physical, intellectual, social and spiritual well-being of all clients;

 

(7)  Assistance in arranging medical and dental appointments, including arranging transportation to and from such appointments and reminding the clients of the appointments; and

 

(8)  Personal supervision of clients when required to offset deficits that may pose a risk to self or others if the client is not supervised.

 

          (z)  The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(4):

 

(1)  Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

 

(2)  Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

 

(3)  Behavioral health care services.

 

          (aa)  The licensee shall:

 

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

 

(2)  Not be responsible for the cost of purchasing a specific brand of product at a client’s request.

 

          (ab)  The licensee shall educate personnel about the needs and services required by the clients under their care.

 

          (ac)  Physical or chemical restraints shall only be used as allowed by RSA 151:21, IX.

 

          (ad)  Immediately after the use of a physical or chemical restraint, the client’s guardian or agent, if any, and the department shall be notified of the use of restraints.

 

          (ae)  The RTRF shall:

 

(1)  Have policies and procedures on:

 

a.  What type of emergency restraints may be used;

 

b.  When restraints may be used; and

 

c.  Who may authorize the use of restraints; and

 

(2)  Provide personnel with education and training on the limitations and the correct use of restraints.

 

          (af)  The use of physical restraints shall be allowed only as defined under He-P 807.03(bf).

 

          (ag)  The RTRF shall document accidents, injuries, and reportable incidents  and include:

 

(1)  The date and time of the occurrence;

 

(2)  A description of the occurrence, including identification of injuries, if applicable;

 

(3)  The actions taken;

 

(4)  The signature of the person documenting the unusual incident; and

 

(5)  If medical intervention was required, the date and time that the emergency contact person and guardian or agent, if any, and the licensed practitioner were notified.

 

          (ah)  The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (ai)  The licensee shall give a client a written notice as follows:

 

(1)  For an increase in the cost or fees for any RTRF services 30 days advanced notice; or

 

(2)  For an involuntary change in room or bed location, 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

 

          (aj)  The licensee shall determine the smoking status of the RTRF.

 

          (ak)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P 807.24(f).

 

          (al)  The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other clients or other household members.

 

          (am)  The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

 

          (an)  The licensee shall respond to a notice of areas of non-compliance by providing a POC in accordance with He-P 807.12(c).

 

          (ao)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.15  Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria.

 

          (a)  The licensee shall only admit an individual or retain a client whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the RTRF.

 

          (b)  A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

 

          (c)  The client shall be transferred or discharged, as defined in RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

 

(1)  The client’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

 

(2)  The client cannot be safely evacuated in accordance with Saf-C 6000;

 

(3)  The client or the client’s guardian, if any, determines that the client shall leave the facility;

 

(4)  The client is a danger to himself/herself or others;

 

(5)  The client completed the program or was transferred based on changes in the client’s functioning; or

 

(6)  The client was terminated from the program based on one of the following:

 

a.  The client was administratively discharge;

 

b.  The client was  in non-compliance with the program;

 

c.  The client left the program before completion against advise of treatment staff; or

 

d.  The client is inaccessible.

 

          (d)  The licensee shall develop a discharge plan with the input of the client and the guardian or agent, if any.

 

          (e)  The following documents shall accompany the client upon transfer:

 

(1)  The most recent client assessment tool, care plan, and quarterly progress notes;

 

(2)  The most recent nursing assessment, if applicable;

 

(3)  The most recent multi-disciplinary care plan, if applicable;

 

(4)  Current medication records; and

 

(5)  A licensed practitioner’s order for transfer, if applicable.

 

          (f)  If the transfer or discharge referenced in (c) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

 

          (g)  Notwithstanding (a) and (c) above, a client receiving hospice care from a licensed home health hospice caregiver, may remain in the RTRF upon written agreement with the client or his/her legal guardian and the RTRF.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.16  Required Services.

 

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

 

(1)  Is responsible for the day-to-day operations of the RTRF;

 

(2)  Meets the requirements of He-P 807.18(k) and (l);

 

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

 

(4)  In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (2) above.

 

          (b)  At the time of application for admission, the licensee shall provide the client a written copy of the clientele service agreement pursuant to RSA 161-J:4.

 

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

 

(1)  An admissions contract including the following information:

 

a.  The basic daily, weekly, or monthly fee;

 

b.  A list of the core services required by He-P 807.14 that are covered by the basic fee;

 

c.  Information regarding the timing and frequency of cost of care increases;

 

d.  The time period covered by the admissions contract;

 

e.  The RTRF’s house rules;

 

f.  The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

 

g.  The RTRF’s responsibility for client discharge planning;

 

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

 

1.  The availability of services;

 

2.  The RTRF’s responsibility for arranging services; and

 

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

 

i.  The licensee’s policies and procedures regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

4.  Monitoring third party services contracted directly by the client and provided on the RTRF premises;

 

5.  Handling of client funds pursuant to RSA 151:24 and He-P 807.14(t);

 

6.  Storage and loss of the client’s personal property; and

 

7.  Smoking;

 

j.  The licensee’s medication management services; and

 

k.  The list of grooming and personal hygiene supplies provided by the RTRF as part of the basic daily, weekly or monthly rate;

 

(2)  A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the RTRF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

(3)  The RTRF’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29; and

 

(4)  Information on advanced directives.

 

          (d)  The RTRF shall perform a preliminary assessment of each client’s needs and develop a preliminary care plan upon admission or within 24 hours following admission.

 

          (e)  A comprehensive evaluation shall be completed within 30 days for neuro-rehabilitation facilities.

 

          (f)  The evaluation required by (e) above shall:

 

(1)  Be completed in consultation with the client’s licensed practitioner, as applicable, and guardian or agent, if any;

 

(2)  Be reviewed every 6 months or after any significant change as defined in He-P 807.03(bl);

 

(3)  Include a medication review;

 

(4)  Include a review of the client’s clinical and treatment record; and

 

(5)  Include an assessment for pain, vital signs, physical, cognitive, mental, and behavioral status, as well as an assessment as to how the client is psychologically adapting to his or her social environment.

 

          (g)  A care plan or treatment plan shall be written and shall include the date the problem or need was identified, the client goal or treatment to be taken, the date of re-evaluation, and responsible person(s), as applicable.

 

          (h)  The care plan or treatment plan shall:

 

(1)  Be completed within 24 hours of the comprehensive evaluation;

 

(2)  Be updated following the completion of each future assessment;

 

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

 

(4)  Address the needs identified by the comprehensive evaluation in (e) above.

 

          (i)  The care plan or treatment plan as defined in He-P 807.03(k) and required by (g) above, shall include:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The goal or objective of the plan;

 

(4)  The action or approach to be taken;

 

(5)  The responsible person(s) or position; and

 

(6)  The date of reevaluation, review, or resolution.

 

          (j)  Progress notes shall be written at least monthly and include at a minimum:

 

(1)  Treatment care plan outcomes;

 

(2)  Changes in the client’s physical, functional, and mental abilities;

 

(3)  Changes in behavior, such as eating habits, sleeping pattern, and relationships; and

 

(4)  Summary of protective care that has been provided.

 

          (k)  At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

 

          (l)  All personnel shall follow the orders of the licensed practitioner for each client and encourage clients to follow the practitioner’s orders.

 

          (m)  The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the RTRF.

 

          (n)  The health examination in (m) above shall include:

 

(1)  Diagnoses, if any;

 

(2)  The medical history;

 

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

 

(4)  Vital signs;

 

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

 

(6)  Allergies;

 

(7)  Dietary needs; and

 

(8)  Pain assessment for neuro-rehabilitation clients.

 

          (o)  Each client shall have at least one health examination every 12 months, unless the licensed practitioner determines that an annual physical examination is not necessary and specifies in writing an alternative time frame, or the client refuses in writing. 

 

          (p)  A client may refuse all care and services. 

 

          (q)  When a client refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

 

(1)  Inform the client and guardian of the potential results of their refusal;

 

(2)  Notify the licensed practitioner of the client’s refusal of care; and

 

(3)  Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

 

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

 

          (s)  The information data sheet in (r) above shall include:

 

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

 

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

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advanced directives; and

 

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

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.17  Medication Services.

 

          (a)  All medications and treatments shall be administered in accordance with the orders of the licensed practitioner, except as allowed in (b) below.

 

          (b)  Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24 hours or in accordance with the licensed practitioner’s direction.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the RTRF;

 

(2)  Reorder medications for use at the RTRF; and

 

(3)  Receive and record new medication orders.

 

          (d)  For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

 

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

 

(1)  The client’s name:

 

(2)  The medication name, strength, and prescribed dose and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated signature of the licensed practitioner.

 

          (f)  For PRN medications the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (g) All prescription medications brought by a client shall be in their original containers and comply with (e) above.

 

          (h)  Each prescription medication shall legibly display the following information:

 

(1)  The client’s name;

 

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

 

(3)  The frequency of administration;

 

(4)  The indications for usage of all PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing licensed practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (i)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee with the client’s name and shall be exempt from (h)(2)-(6) above.

 

          (j)  The label of all medication containers maintained in the RTRF shall match the current written orders of the licensed practitioner unless authorized by (m) below.

 

          (k)  Only a pharmacist shall make changes to prescription medication container labels.

 

          (l)  Any change or discontinuation of medications taken at the RTRF shall be pursuant to a written order from a licensed practitioner.

 

          (m)  When the licensed practitioner changes the dose of a medication and personnel of the RTRF are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the RTRF’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (n)  Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

 

(o)  All prescription medications, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be kept on the client’s person or stored in the client’s room, shall be stored as follows:

 

(1)  Over-the-counter medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner;

 

(2)  Medications shall be kept in a storage area that is:

 

a.  Locked and accessible only to authorized personnel;

 

b.  Organized to allow correct identification of each client'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;

 

(3) 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 accessible only to authorized personnel; and

 

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

 

         (p)  Over-the-counter (OTC) medications shall be handled in the following manner:

 

(1)  Only original, unopened containers of OTC medications shall be allowed to be brought into the program;

 

(2)  OTC medication shall be stored in accordance with (p)(1) above; and

 

(3)  OTC medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (q)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (r)  Except as allowed by (x) below, any contaminated, expired or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first.

 

          (s)  Controlled drugs shall be destroyed only in accordance with state law and;

 

(1)  Be accomplished in the presence of at least 2 people; and

 

(2)  Be documented in the record of the client for whom the drug was prescribed. 

 

          (t)  Medication(s) may be returned to pharmacies for credit only as allowed by the law.

 

          (u)  When a client is going to be absent from the RTRF at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering, as described in (ac) and (ad) below.

 

          (v)  If a client is going to be absent from the RTRF at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the RTRF.

 

          (w)  Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian or agent, if any.

 

          (x)  A written order from a licensed practitioner shall be required annually for any client who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (y)  Clients shall receive their medications by one of the following methods:

 

(1)  Self-administered medication as allowed by (z) below;

 

(2)  Self-directed administration of medication as allowed by (aa) below; 

 

(3)  Self-administered with supervision as allowed by (ab) and (ac) below; or

 

(4)  Administered by individuals authorized by law.

 

          (z)  For clients who self-administer medication as defined in He-P 807.03(br) the licensee shall:

 

(1)  Obtain a written order from a licensed practitioner on an annual basis:

 

a.  Authorizing the client to self-administer medications without supervision;

 

b.  Authorizing the client to store the medications in their room; and

 

c.  Identifying the medications that may be kept in the client’s room;

 

(2)  Evaluate the client on a 6 month basis or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-administer;

 

(3)  Have the client store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

 

(4)  Have a copy of the key to access the locked medication storage area in the client’s room; and

 

(5)  Allow the client to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

 

          (aa)  The licensee shall allow the client to self-direct administration of medications as defined in He-P 807.03(bt) if the client:

 

(1)  Has a physical limitation due to a diagnosis that prevents them from self-administration;

 

(2)  Receives evaluations every 6 months or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-direct administration of medications;

 

(3) Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the RTRF to file the verification in their client record; and

 

(4)  Verbally directs personnel to:

 

a.  Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing or cutting; and

 

b.  Assist the client to apply, ingest or instill the ordered dose of medication.

 

          (ab)  If a client self-administers medication with supervision, as defined in He-P 807.03(bs), personnel shall:

 

(1)  Remind the client to take the correct dose of his or her medication at the correct time;

 

(2)  Place the medication container within reach of the client;

 

(3)  Remain with the client to observe the client taking the appropriate amount and type of medication as ordered by the licensed practitioner;

 

(4)  Record on the client's daily medication record that they have supervised the client taking his or her medication; and

 

(5)  Document in the client’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken.

 

          (ac)  If a client self-administers medication with supervision, personnel shall not physically handle the medication in any manner.

 

          (ad)  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.

 

          (ae)  Personnel shall remain with the client until the client has taken the medication.

 

          (af)  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.

 

          (ag)  A licensed nursing assistant (LNA) who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the RTRF:

 

(1)  Medicinal shampoos and baths;

 

(2)  Glycerin suppositories and enemas; and

 

(3)  Medicinal topical products to intact skin as ordered by the licensed practitioner.

 

          (ah)  Except for those clients who self-administer medication, the licensee shall maintain a written record for each medication taken by the client at the RTRF that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises or assists the client taking medication;

 

(5)  For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (ai)  Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a client with self-administration with supervision, self-directed administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

 

          (aj) The medication supervision education program shall be taught by a licensed nurse, licensed practitioner or pharmacist, whether in-person or through other means such as electronic media.

 

          (ak)  The medication supervision education program required by (ai) above shall include:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights which are as follows:

 

a.  The right client;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as antihypertensives or antibiotics;

 

(5)  Desired effects and potential side effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (al)  The administrator may accept documentation of training required by (ai) above if it was previously obtained by the applicant for employment at another licensed facility.

 

          (am)  The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

 

          (an)  The written documentation of the report in (am) above shall be maintained in the client’s record.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.18  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the RTRF to meet the needs of clients at all times.

 

          (b)  There shall be at least one awake personnel member on duty at all times while clients are in the facility.

 

(c)  The licensee shall develop a job description for each position in the RTRF containing:

 

(1)  Position title;

 

(2)  Duties of the position;

 

(3)  Physical requirements of the position; and

 

(4)  Qualifications and educational requirements of the position.

 

          (d)  For all applicants for employment, volunteers, and independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d;

 

(2)  Review the results of the criminal records check in accordance with (e) below;

 

(3)  Verify the qualifications of all applicants prior to employment; 

 

(4) Verify that the applicant is not listed on the BEAS state registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49; and

 

(5) Verify the applicant is licensed, registered, or certified if required by state statute.

 

          (e)  Unless a waiver is granted in accordance with (g) below, the licensee shall not offer employment, contract with, or otherwise engage a person in (d) above if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the clients.

 

          (f)  If the information identified in (e) above regarding any person subject to (d) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (d) above.

 

          (g)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, or the person shall not or no longer shall reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

 

          (h) The licensee shall:

 

(1)  Not employ, contract with, or engage any person in (d) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

 

          (i)  In lieu of (d) and (g), the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (d) and (g) and do not meet the criteria in (e) and (g).

 

(j)  The waiver in (g)(2) above shall be permanent for as long as the individual remains in the same job unless additional convictions or findings under (e) above occur.

 

          (k)  Administrators shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

 

(1) A bachelor’s degree from an accredited institution and one year of relevant experience working in a health related field;

 

(2)  A New Hampshire license as an RN, with at least one year relevant experience working in a health related field; or

 

(3)  An associate’s degree from an accredited institution plus 3 years relevant experience in a health related field.

 

          (l)  All administrators shall obtain and document in accordance with (s)(7) and (s)(8) below, 12 hours of continuing education related to the operation and services of the RTRF each annual licensing period.

 

          (m)  All personnel shall be at least 18 years of age if working as direct care personnel unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of licensed staff.

 

          (n)  The licensee shall inform personnel of the line of authority at the RTRF.

 

          (o)  Prior to having contact with clients or food, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (p)  In lieu of (o)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (o)(1) and (3) above before working at the RTRF.

 

          (q)  Prior to having contact with clients or food, personnel shall receive a tour of the RTRF and an orientation that explains the following:

 

(1)  The clients’ rights in accordance with RSA 151:20;

 

(2)  The RTRF’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 807.21;

 

(7)  The facility confidentiality requirements;

 

(8)  Grievance procedures for both staff and clients;

 

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

 

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

 

          (q) 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 client’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan;

 

(4)  The licensee’s policies and procedures; and

 

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

 

          (r)  The licensee shall provide an annual review of its policies and procedures for self-administration of medication, self-administration of medication with supervision, and self-directed medication administration to all direct care personnel, as applicable.

 

          (s)  The RTRF shall maintain a separate employee file for each employee,  which shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (d) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (q) above;

 

(7)  Information as to the general content and length of all in‑service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs required above;

 

(9)  A copy of a current, valid driver’s license, including proof of insurance, if the employee transports clients;

 

(10)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(11)  The statement required by (u) below; and

 

(12) The results of the registry checks in (h) above

 

          (t)  The RTRF shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (s)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (s)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (o) above may be substituted for (s)(4), (10), and (12) above, if applicable.

 

          (u)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a client; or

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

 

          (v)  An individual shall not have to re-disclose any of the matters in (u) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

 

          (w)  An individual shall disclose any new convictions, as soon as practicable, to the facility administrator. Any such convictions shall be reported to the department for review.

 

          (x)  The licensee shall protect and store in a secure and confidential manner all records described in (s) and (t) above.

 

          (y)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

 

          (z)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (aa)  The RTRF shall have a written policy, as described in RSA 151:41, 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.

 

          (ab)  The policy in (aa) above shall include provisions relating to the following:

 

(1)  Education;

 

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

 

(3)  Procedures for 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 of misuse or diversion by personnel exists;

 

(6)  Employee assistance procedures;

 

(7)  Confidentiality of investigations, reports, and resolutions of controlled drug misuse or diversion;

 

(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.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.19  Client Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the RTRF.

 

          (b)  Client records shall contain the following:

 

(1)  A copy of the client’s service agreement and all documents required by He-P 807.16(c);

 

(2)  Identification data, including:

 

a.  Vital information including the client’s name;

 

b. Home address;

 

c.  Home telephone number;

 

d.  Name, address and telephone number for emergency contact;

 

e.  Date of birth, and

 

f.  Guardian, agent, or surrogate decision-maker where applicable.

 

(3)  The name and telephone number of the client’s licensed practitioner(s);

 

(4)  The client’s health insurance information;

 

(5)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(6)  A record of the health examination(s) in accordance with He-P 807.16(m) and (o);

 

(7)  Written, dated and signed orders for the following:

 

a.  All medications, treatments, and special diets, as applicable; and

 

b.  Laboratory services and consultations performed at the RTRF;

 

(8)  Results of any laboratory tests, X-rays, or consultations performed at the RTRF;

 

(9)  All evaluations, assessments, and treatment plans, including documentation that the client and the guardian or agent, if any, has participated in the development of the care and treatment plans;

 

(10)  All admission and progress notes;

 

(11) If services are provided at the RTRF by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

 

(12)  Documentation of any alteration in the client’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(13)  Documentation of any medical or specialized care;

 

(14)  Documentation of reportable incidents;

 

(15)  The consent for release of information signed by the client, guardian, or agent, if any;

 

(16)  Discharge summary, planning, and referrals;

 

(17)  Transfer or discharge documentation, including notification to the client, guardian, agent,  or surrogate decision-maker, if any, of involuntary room change, transfer or discharge, if applicable;

 

(18)  The information required by He-P 807.17(ai) as applicable;

 

(19)  Information data sheet, which contains the information required by He-P 807.16(s);

 

(20)  Documentation of nurse delegation of medications as required by the nurse practice act, as applicable; and

 

(21)  Documentation of a client’s refusal of any care or services.

 

          (c)  Client records and client information shall be kept confidential and only provided in accordance with HIPAA, or any other applicable provision of law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur.

 

          (e)  When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

 

          (f)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to residents and staff; and

 

(3)  Systems to prevent tampering with information pertaining to residents and staff.

 

          (g)  Records shall be retained for at least 7 years after discharge, except that when the client is a minor, records shall be retained for at least 7 years after the minor reaches the age of majority.

 

          (h)  The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the RTRF ceases operation.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.20  Food Services.

 

          (a)  The licensee shall provide food services that:

 

(1)  Meet the US Department of Agriculture recommended dietary allowance as specified in the  United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as listed in Appendix A;

 

(2)  Meet the special dietary needs associated with health or medical conditions for each client as identified in their client record; and

 

(3)  Offer at least 3 meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

 

          (b)  Snacks shall be available between meals and at bedtime if not contraindicated by the client’s care plan.

 

          (c)  If a client refuses the item(s) on the menu, a substitute shall be offered.

 

          (d)  Each day’s menu shall be posted in a place accessible to food service personnel and clients.

 

          (e)  A dated record of menus as served shall be maintained for at least the previous 4 weeks.

 

          (f)  The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (g)  If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

 

          (h)  All food and drink provided to the clients shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated, and stored at proper temperatures; and

 

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

 

          (i)  The use of outdated or unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

 

          (j)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (k)  All work surfaces shall be cleaned and sanitized after each use.

 

          (l)  All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

 

          (m)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (n)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms. 

 

          (o)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (p)  Garbage or trash in the kitchen area shall be placed in lined containers with covers.

 

          (q)  All RTRF persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.21  Infection Control.

 

          (a)  The RTRF shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases to include:

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

 

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

 

(4)  The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

 

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

 

(6)  Maintenance of a sanitary physical environment.

 

          (b)  The infection control education program shall address:

 

(1)  Causes of infection;

 

(2)  Effects of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (c)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

 

          (d)  Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

 

          (e)  Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the RTRF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (f)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

          (g)  Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A.

 

          (h)  The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting personnel and clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (i) The RTRF shall develop and implement a POCT policy, if it provides POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.22  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the Facility Guidelines Institute “Guidelines for the Design and Construction of Residential Health, Care, and Support Facilities, Table 2.5-1” (2018 edition), available as noted in Appendix A, and summarized as follows:

 

(1)  70-120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures;

 

(2)  140 degrees Fahrenheit for dietary areas, except that provisions shall be made to provide 180 degrees Fahrenheit rinse water at the ware washer, which may be by separate booster, unless a chemical rinse is provided; and

 

(3)  160 degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven processes which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures specified by the manufacturer.

 

          (f)  All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and client supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service areas shall be covered.

 

          (m)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(3)  Soiled materials, linens and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

 

          (p)  Any RTRF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services ,shall notify the department.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.23  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

 

          (b)  Equipment providing heat within an RTRF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood or pellet stove, or wood or pellet furnace shall:

 

(1)  Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if the client(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any RTRF.

 

          (f)  Plumbing shall be sized, installed, and maintained in accordance with the  International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155:A:10,V.

 

          (g)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (h)  Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

 

          (i)  The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by clients.

 

          (j)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (k)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (l)  In an RTRF licensed for 16 or fewer clients, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

 

          (m)  In an RTRF licensed for 17 or more clients, there shall be at least 100 square feet for each client in each private bedroom and at least 80 square feet for each client in a semi-private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities.

 

          (n)  Existing bedrooms in an RTRF licensed prior to the 2019 effective date of these rules shall be exempt from (l) and (m) above.

 

          (o)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the client to reach his/her bedroom without passing through the room of another client;

 

(3)  Have a side hinge or pocket door that meets applicable codes, and not a folding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors, and other rooms by floor to ceiling walls; and

 

(6)  Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the assessment.

 

          (p)  The licensee shall provide the following for the clients’ use, as needed:

 

(1)  A bed appropriate to the needs of the client;

 

(2)  A firm mattress that complies with Saf-C 6000 under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  Adequate lighting;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades or curtains that provide privacy.

 

          (r)  The client may use his or her own personal possessions provided they do not pose a risk to the client or others.

 

          (s)  The resident or guardian may indicate and the home shall document that the resident does not wish or need to have one of more of the items in (p) above and the reason for the removal.

 

          (t)  The licensee shall provide the following rooms to meet the needs of clients:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all clients.

 

          (u)  Each licensee shall have a communication system in place so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

 

          (v)  Lighting shall be available to allow clients to participate in activities such as reading, needlework or handicrafts.

 

          (w)  All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

(x)  Screens shall be provided for:

 

(1)  Doors;

 

(2)  Windows; or

 

(3)  Other openings to the outside.

 

          (y)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (x) above.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.24  Fire Safety.

 

          (a) All RTRFs shall meet at a minimum the residential board and care chapter of NFPA 101 as adopted by the department of safety in Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (b)  All RTRFs, including those with 3 or fewer clients, shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the RTRF’s electrical service, or wireless, as approved by the state fire marshal for the RTRF;

 

(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)  An approved carbon monoxide monitor on every level.

 

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

 

          (e)  Immediately following any fire or emergency, including but not limited to, gas leak or evacuation of the facility due to flooding or an explosion, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

 

          (f)  The written notification required by (e) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4) The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

 

(5) The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

 

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (g)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian or a person with durable power of attorney (DPOA) over the client, at the time of admission and a summary of the client’s responsibilities shall be provided to the client. Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (h)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available annually, and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, prior to the change.

 

          (i)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the residential board and care or one and two family dwelling chapters of the life safety code (NFPA 101), the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All RTRF facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape, except as noted in c. above; 

 

e.   shall complete a written record of fire drills that include the following:

 

1.  The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At admission, the facility shall conduct a client Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the clients’ needs during a fire drill including mobility, assistance to evacuate, staff needed, risk of resistance, clients ability to evacuate on his or her own, and choosing an alternate exit; and

 

h.  The fire drills for facilities built to the residential board and care chapter of the life safety code (NFPA 101), shall be permitted to be announced, in advance, to the clients just prior to the drill; and

 

(2)  For RTRFs originally constructed to the health care occupancy chapter of the life safety code and to the codes,  rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed engineer qualified in fire protection, the state fire marshal’s office, and the department pursuant to He-P 807.07, to meet the health care occupancy chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire, and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff with the signals and emergency action required under varied conditions;

 

c. Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter-in-place plan, also known as defend-in-place plan, shall have this plan approved by the department per the state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f. I f the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point, and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4 . The amount of time taken to completely evacuate the facility to an approved area of refuge or through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill, if any;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

h. At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility.

 

          (j)  Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code including but not limited to:

 

(1) Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

 

a.  Minimum distance of 6.1 m (20 ft);

 

b. Minimum distance of 1.5 m (5 ft) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

c.  A gas cabinet constructed per NFPA 30, Flammable and Combustible Liquids Code, or NFPA 55, Compressed Gases and Cryogenics Fluids Code, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

 

(2)  Cylinders shall be protected from damage by means of the following specific procedures:

 

a. Oxygen cylinders shall be protected from abnormal mechanical shock which is liable to damage the cylinder, valve, or safety device;

 

b. Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

 

c. Cylinders shall be protected from tampering by unauthorized individuals;

 

d. Cylinders or cylinder valves shall not be repaired, painted, or altered;

 

e. Safety relief devices in valves or cylinders shall not be tampered with;

 

f. Valve outlets clogged with ice shall be thawed with warm, not boiling, water;

 

g. A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

 

h. Sparks and flame shall be kept away from cylinders;

 

i. Even if they are considered to be empty, cylinders shall not be used as rollers or supports or for any purpose other than that for which the supplier intended them;

 

j. Cylinders exceeding size E and containers larger than 45 kg (100 lb) weight shall be transported on a proper hand truck or cart complying with NFPA 99, section  11.4.3.1;

 

k. Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

 

l. Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

 

(3)  Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

 

a.  Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

 

b.  Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

 

c.  Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

 

d. The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

 

e. Oxygen shall be referred to as “oxygen”, not air, and liquid oxygen shall be referred to as “liquid oxygen”, not liquid air;

 

f.  Oxygen shall not be used as a substitute for compressed air;

 

g.  The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

 

h. Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels/tags used for indicating cylinder status, for example, full, in use, and empty;

 

i.  The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

 

j.  Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, heat ducts;

 

k.  Very cold cylinders or containers shall be handled with care to avoid injury; and

 

l.  A precautionary sign, readable from a distance of 1.5 m (5 ft), shall be displayed on each door or gate of the storage room or enclosure, and shall include the following wording at a minimum:

 

CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING

 

          (k)  If the licensee has chosen to allow smoking under He-P 807.14(w), an outside location or a room used only for smoking shall be provided which:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non-combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act and He-P 1900.

 

          (l)  Each licensee shall develop a written emergency plan that covers:

 

(1)  Loss of electricity;

 

(2)  Loss of water;

 

(3)  Loss of heat;

 

(4)  Bomb threat;

 

(5)  Severe weather;

 

(6)  Fire;

 

(7)  Gas leaks;

 

(8)  Unexplained client absences; and

 

(9)  Any situation that requires evacuation of the RTRF.

 

          (m)  Each licensee shall:

 

(1)  Annually review and revise, as needed, its emergency plan;

 

(2) Submit its emergency plan to the local emergency management director for review and approval when initially written and whenever the plan is revised; and

 

(3)  Maintain documentation on‑site which establishes that the emergency plan has been approved as required under (2) above.

 

          (n)  Each RTRF that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of the  RTRF’s their local community provided that:

 

(1)  It has a generator capable of supplying the entire facility;

 

(2)  It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

 

(3) It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.       

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

          He-P 807.25  Emergency Preparedness.

 

          (a)  Each facility shall have an emergency management committee, of which the facility administrator must be a member. 

 

          (b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (c)  The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

 

(1)  Elected state and local officials;

 

(2)  Police, fire, civil defense, and public health professionals;

 

(3)  Environment, transportation, and hospital officials;

 

(4)  Facility representatives; and

 

(5)  Representatives from community groups and the media.

 

(d)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan as described in (e) and (f) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  A description of how the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (e) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (f)  The plan in (e) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather or human-caused emergency such as missing residents and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as

appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the ICS in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment including the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention,protection, and mitigation strategies, and to determine the outcome of prior strategies at least annually;

 

(12)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  Heating, ventilation, and air conditioning (HVAC);

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure

that creates a hazardous incident;

 

g. Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that

creates a hazardous incident;

 

h. Medical gas and vacuum systems, if applicable;

 

i. Communications systems; and

 

j. Essential services, such as kitchen and laundry services;

 

(13) Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

 

(14) Include the management of residents, particularly with respect to physical and clinical issues, to include:

 

a. Relocation of residents, with their medical record, including the medicine administration records, if time permits;

 

b. Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c. How to provide security during the disaster;

 

(15) Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17) Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18) If the facility is located within 10 miles of a nuclear power plant and is part of the NewHampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

(g)  The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1) Drills  shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not otherwise involved in the drill;

 

(2) Drills shall evaluate program plans, procedures, training, and capabilities toidentify opportunities for improvement;

 

(3) The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill. The debriefing shall include all key individuals, including observers,

administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

 

(h)  For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

 

(1)  Assumptions for calculations of food and water supplies, for maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, rotation of products, and contracts and memorandums of understanding with food and water suppliers such as;

 

(a)  Enough refrigerated, perishable foods for a 3-day period;

 

(b)  Enough non-perishable foods for a 7-day period; and

 

(c)  Potable water for a 3-day period.

 

(2)  Designated storage location(s); and

 

(3)  Non-food and water, back-up supplies including but not limited to medical, office, and other supplies necessary to continue operation of the facility and provide necessary care and oversight of residents during the emergency.

 

Source.  #9873-A, eff 2-24-11; ss by #12727, INTERIM, eff 2-20-19, EXPIRED: 8-19-19

 

New.  #12962, eff 12-31-19

 

PART He-P 808  LABORATORIES AND LABORATORY SERVICES RULES

 

          He-P 808.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all laboratories, whether stationary or mobile, and laboratory services pursuant to RSA 151:2, I(c).

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a laboratory, except:

 

          (a)  The facilities listed in RSA 151:2, II (a)-(i);

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i);

 

          (c)  All laboratories which conduct testing solely for forensic purposes, pursuant to RSA 151:2, II(i);

 

          (d)  All entities that are licensed in accordance with RSA 153-A by the department of safety as providers of transporting or non-transporting emergency medical care;

 

          (e)  All entities that perform waived testing for the sole purpose of risk assessment and which test results are not used for the diagnosis or treatment of disease;

 

          (f)  Laboratories that are duly licensed by the state of New Hampshire under this rule shall not be required to be licensed as a collection station under He-P 817, to perform the functions of a collection station; and

 

          (g)  Laboratories that are owned, operated, and located on the licensed premises of a hospital licensed in accordance with RSA 151:2, I(a) and He-P 802.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.03  Definitions.

 

          (a)  “Administrator” means the licensee or an individual appointed by the licensee who has responsibility for all aspects of the daily operations of the laboratory.

 

          (b)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license for a laboratory pursuant to RSA 151:2, I(c).

 

          (c)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 808, or other federal or state requirements.

 

          (d)  “Change of ownership” means the transfer in the controlling interest of an established laboratory to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

          (e)  “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories need to meet to be certified to perform testing on human specimens.

 

          (f)  “Patient” means any person receiving services from a laboratory licensed in accordance with RSA 151 and He-P 808.

 

          (g) “Patient record” means a separate file maintained for each patient, which includes all documentation required by RSA 151 and He-P 808, and as required by federal and state law.

 

          (h)  “Commissioner” means the commissioner of the department of health and human services or the commissioner’s designee.

 

          (i)  “Days” means calendar days unless otherwise specified in the rule.

 

          (j)  “Department” means the New Hampshire department of health and human services.

 

          (k)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified deficiencies.

 

          (l)  “Emergency” means an unexpected occurrence or set of circumstances, which requires immediate, remedial attention.

 

          (m)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (n)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 808.

 

          (o)  “Facility” means ”facility” as defined in RSA 151:19, II.

 

          (p)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (q)  “Independent contractor” means an individual or business entity working under the supervision of the licensee but not employed by the licensee.

 

          (r)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (s)  “Inspection” means the process followed by the department to determine an applicant or a licensee's compliance with RSA 151 and He-P 808 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 808.

 

          (t) “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease.

 

          (u) “Laboratory director” means the person who shall provide overall management and direction for all laboratory testing procedures.

 

          (v)  “License” means the document issued to an applicant or licensee of a laboratory which authorizes operation, in accordance with RSA 151 and He-P 808, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

 

          (w)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized that the laboratory is licensed for.

 

          (x)  “Licensed premises” means the building(s), other structure(s), or mobile laboratory vans, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.  It does not include the private residence of a patient receiving services from an agency licensed under the authority of RSA 151.

 

          (y)  “Licensee” means any individual, agency, partnership, corporation, federal, state, county or local government entity, association, or other legal entity to which a license has been issued pursuant to RSA 151.

 

          (z)  “Licensing classification” means the specific category of services authorized by a license.

 

          (aa)  “Life safety code” means the adoption by reference of the life safety code, 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.

 

          (ab)  “Mobile laboratory van” means a vehicle capable of traveling under its own power or being towed from site to site and fully equipped to meet all the requirements specified in section He-P 808.21.

 

          (ac)  “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include “repair” or “replacement” of interior finishes.

 

          (ad)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (ae)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

 

          (af)  “Personnel” means an individual who is employed by the licensee, a volunteer, or an independent contractor.

 

          (ag)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of the clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of complaint investigation conducted pursuant to RSA 151:6.

 

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

 

          (ai)  “Qualification” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

 

          (aj) “State building code” means “state building code” as defined in RSA 155-A:1, IV.

 

          (ak) “State fire code” means “state fire code” as defined in RSA 153:1.

 

          (al) “State monitoring” means the placement of individuals by the department at a laboratory to monitor the operation and conditions of the facility.

 

          (am)  “Specimen” means a portion of tissue, body fluid, or material from a human body.

 

          (an)  “Technical consultant” means an individual qualified as a technical consultant by 42 CFR § 493.1411.

 

          (ao) “Volunteer” means an unpaid person who assists with the provision of laboratory services, and who does not provide direct care or services to patients.

 

          (ap)  “Waived testing” means all laboratory tests categorized as waived by 42 CFR § 493.

 

          (aq)  “Waiver”  means a  request for an alternative means of satisfying a rule requirement in He-P 808.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.04  License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department, except that subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile laboratory vans:

 

(1)  A completed application form entitled “Application for Residential and or Health Care License (Laboratories and Collecting Stations),” (July 2023 edition) signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government department if a government unit, affirming to the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

 

(2)  A floor plan of the prospective laboratory;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability company; or

 

c.  “Certificate of Trade Name,” if a sole proprietorship;

 

(4)  The applicable fee in accordance with RSA 151:5, XXIII, payable in cash, or if paid by check or money order, in the exact amount of the fee and made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications, and copies of applicable licenses, for the administrator and laboratory director;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code and any local ordinances; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(7)  If the laboratory uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02,  Env-Dw 704.02, or, if a public water supply is used, a copy of a water bill;

 

(8)  The results of a criminal records check for the applicant, the licensee, if different than the applicant, the laboratory director, and the administrator, as applicable. The results must include criminal history from the state of New Hampshire; and

 

(9) List of all tests performed and a copy of the CLIA certificate.

 

          (b)  The applicant shall mail or hand deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 808.04(a), or He-P 808.21 for mobile laboratory vans, have been received.

 

          (b)  If an application does not contain all of the items required by He-P 808.04(a) or He-P 808.21, the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted under He-P 808.17(f), the department shall deny a license request if it determined that the applicant, licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, theft, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  Following an inspection, a license shall be issued if the department determines that an applicant requesting such initial license is in full compliance with RSA 151 and He-P 808.

          

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable, including licenses issued for mobile laboratory vans.

 

          (h) A written notification of denial, pursuant to He-P 808.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 808.05(f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 808.

 

          (i) A written notification of denial, pursuant to He-P 808.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.06  License Expirations and Procedures for Renewal.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an “Application for Residential and or Health Care License (Laboratories and Collection Stations)” (July 2023 edition) pursuant to He-P 808.04(a)(1) at least 120 days prior to the expiration of the current license and include with the application:

 

(1)  The current license number;

 

(2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 808.10(f).  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3) A list of any current employees who have a permanent waiver granted in accordance with He-P 808.17(f):

 

(4)  A copy of any temporary, new, or existing variances or waivers applied for or granted by the state fire marshal; and

 

(5) A list of all tests performed and a copy of the CLIA certificate.

 

          (c)  In addition to He-P 808.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all of the items required by He-P 808.06(b) and (c), as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 808, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if the area of non-compliance were cited.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.07  Laboratory Construction, Modifications, or Structural Alterations.

 

          (a)  For new construction and for rehabilitation of an existing building including, but not limited to, renovations, modifications, reconstructions, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed including, but not limited to, window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 808 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  The licensee or applicant shall comply with all applicable state laws, rules, and local ordinances when undertaking any construction or rehabilitation.

 

          (g)  A licensee or applicant undertaking construction, repairs, renovations, rehabilitation, or modifications of a building shall comply with the appropriate chapters and sections of the State Fire Code and State Building Code.

 

          (h)  Department approval shall not be required prior to initiating construction, repairs, renovations, rehabilitation, or modifications of a building, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

          (i)  All laboratories newly constructed or rehabilitated shall comply with the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2022 edition), available as noted in Appendix A.

 

          (j)  Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2022 edition), available as noted in Appendix A.

 

          (k)  The department shall be the authority having jurisdiction for the requirements in He-P 808.07(i)-(j) above and shall negotiate compliance with the licensee or applicant or their representatives and grant waivers in accordance with He-P 808.10 as appropriate.

 

          (l)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, or ceilings that allow for the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

 

          (m)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (n)  Variances pertaining to the State Fire Code referenced in He-P 808.07(g) above shall be granted only by the state fire marshal.

 

          (o)  Variances pertaining to the state building code shall be granted by the local building official or the state fire marshal if in a state owned building.

 

          (p)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 808.09 prior to its use.

 

          (q)  He-P 808.07 shall not apply to mobile laboratory vans.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.08  Laboratory Requirements for Organizational Changes.

 

          (a)  The licensee shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of categories authorized under the current license or revisions to the current list of tests performed; or

 

(6)  Services.

 

          (b)  The laboratory shall complete and submit a new application form, required by He-P 808.04(a)(1), and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3)  An increase in the number of categories authorized under the current license; or

 

(4)  A change in services.

 

          (c)  When there is to be a change of address without a change in location, the laboratory shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the laboratory shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practicable by department;

 

(2)  The physical location;

 

(3)  A change in the number of categories authorized under the current license;

 

(4) A change in licensing classification; or

 

(5) A change that places the facility under a different life safe code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the laboratory name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in categories authorized to test;

 

(3)  A change in address without a change in physical location;

 

(4)  A change in the scope of services provided; or

 

(5)  When a waiver has been granted in accordance with He-P 808.10.

 

          (i)  The laboratory shall inform the department, in writing, when there is a change in administrator or laboratory director no later than 5 days prior to a change,  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or laboratory director change, and  provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or laboratory director;

 

(2)  Copies of applicable licenses for the new administrator or laboratory director;

 

(3)  The results of a criminal records check to include results for the state of New Hampshire for the new administrator or laboratory director; and

 

(4)  A copy of the signed criminal attestation, as described in He-P 808.17(j), for the new administrator or laboratory director.

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the administrator or laboratory director meets the qualifications for the position as specified in He-P 808.14(e)(6) and He-P 808.14(e)(6).

 

          (k)  If the department determines that the new administrator or laboratory director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (l)  When there is to be a change in the testing provided, the licensee shall provide the department with:

 

(1)  A description of the testing change(s);

 

(2)  Identification of what additional personnel shall be hired and their qualifications, if applicable;

 

(3)  How the new services shall be incorporated into the infection control and quality improvement programs; and

 

(4)  A description of what changes, if any, shall be made to the physical environment.

 

          (m)  The department shall review the information submitted under (l) above and determine if the added services shall be provided under the licensee’s current license.

 

          (n)  The laboratory shall inform the department, in writing via email, fax, or mail, of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

          (o)  A restructuring of an established laboratory that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  If a licensee chooses to cease operation of a laboratory, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 808, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the laboratory; and

 

(3)  Any records required by RSA 151 and He-P 808.

 

          (b)  The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 808 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 808.08(e)(1);

 

(3)  A change in the licensee’s physical location, except for mobile laboratory vans;

 

(4)  Occupation of space after construction, renovations, or structural alterations;

 

(5)  A change in the licensing classification;

 

(6)  The renewal of a license; or

 

(7)  The issuance of a mobile laboratory van license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

 

          (d)  A statement of findings for clinical inspections or a notice to correct for life safety inspections shall be issued when, as a result of any inspection, the department determines that the licensee is in violation of any of the provisions of He-P 808, RSA 151, or any other federal or state requirement(s).

 

          (e) If areas of non-compliance were cited, in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 808, within 21 days of the date on the letter.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 808 shall submit a written request for waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers granted shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the reasonable explanation or the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver when submitting a completed renewal application form pursuant to He-P 808.04(a)(1) or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92; ss by #13710, eff 8-2-23

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.11  Complaints.

 

          (a)  The department shall accept and investigate written complaints that meet the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); or

 

(3)  There is 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 RSA 151, He-P 808, or any other applicable state or federal laws.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the laboratory or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 808.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the licensee;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4) Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For the licensed laboratory, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee,                                                                                                                               along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation as appropriate;

 

(3)  Require the licensee to submit a POC in accordance with He-P 808.12(c), if applicable; and

 

(4)  Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules.

 

          (e)  The following shall apply for the unlicensed laboratory:

 

(1)  In accordance with RSA 151-7-a, II, the department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reason(s) for, and the results of, the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(c);

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice, required by (e)(1) above, to respond if the determination is that the services require licensing;

 

(3)  If the owner of an unlicensed laboratory does not respond in accordance with (e)(2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 808; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 808.

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 808, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of He-P 808; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a notice of the areas of non-compliance the licensee shall submit a POC detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur;

 

c.  The date by which each area of non-compliance  shall be corrected; and

 

d. The position of the employee responsible for the corrective action.

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 808;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings;

 

c.  Prevents a new violation of RSA 151 or He-P 808 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance shall be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable, the department shall notify the licensee, in writing, within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless within the 14 day period the licensee requests an extension, either via telephone or in writing, and the department grants the extension based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 808.12(d) and a fine in accordance with He-P 808.13(c)(9);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC has not been implemented by the completion, at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 808.12(b); and

 

b.  Issued a directed POC in accordance with He-P 808.12(d). 

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health, safety, and well-being of patients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as  applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine;

 

(3)  Deny the application of a license in accordance with He-P 808.13(b); or

 

(4)  Revoke the license in accordance with He-P 808.13(b).

 

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

 

          (g)  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.

 

         (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC, in accordance with (c) above, shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j) Any violations cited for the State Fire Code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

 

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

 

         (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the laboratory that negatively impact the health, safety, or well-being of patients.

 

(3)  Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules; or

 

(4)  Conditions exist for implementation of temporary management as described in (n) below but no temporary manager can be found.

 

          (m)  The department shall appoint a temporary manager to assume operation of a laboratory when, following an inspection, the department determines that:

 

(1)  The licensee has repeatedly failed to manage and operate the laboratory in compliance with RSA 151 and He-P 808 and such laboratory practices have adversely impacted the health, safety, or well-being of patients;

 

(2)  The licensee has failed to develop or implement policies and procedures for infection control, sanitation, or life safety codes, which results in imposing harm or the potential for harm to the patients; or

 

(3)  The health, safety, and well-being of the patients are at risk and emergency action is required.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

         He-P 808.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;  

 

(3)  If a fine is imposed,  the automatic reduction by 25% if the fine is paid within 10 days of the date on the written notice from the department, and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, II as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 808, which violations have the potential to harm a patient’s or employee’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay a fine imposed under an enforcement action;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 808.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6) The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 808.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 808.12(c)(6) and has not submitted a revised POC in accordance with He-P 808.12(c)(6)b.;

 

(8)  The licensee is cited a third time under RSA 151 or He-P 808 for the same violation(s) within the last 5 inspections;

 

(9)  A licensee, including corporation or its corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premises is not in compliance with RSA 151 or He-P 808;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee, has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12) Unless a waiver has been granted, the applicant or licensee fails to employ a qualified administrator or laboratory director; or

 

(13) The applicant has had a license revoked by the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000 for an applicant or unlicensed provider;

 

(2)  For failure to cease operations after a denial of a license or after receipt of an order to cease and desist, in violation of RSA 151 and RSA 541-A:30 the fine for an unlicensed individual, applicant, unlicensed provider, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed individual or a licensee shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 808.11(e), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(5)  For a failure to submit a renewal application prior to the expiration date, in violation of He-P 808.06(b), the fine for a licensee shall be $100.00;

 

(6)  For failure to notify the department prior to a change of ownership, in violation of He-P 808.08(a)(1), the fine for a licensee shall be $500.00;

 

(7)  For failure to notify the department, prior to a change of location, in violation of He-P 808.08(a)(2), the fine for a licensee shall be $500.00;

 

 (8)  For a failure to allow access by the department to the laboratory’s premises, programs, services, patients, or records, in violation of He-P 808.09(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

 

(9)  For failure to submit a POC or revised POC within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 808.12(c)(2) and (6), the fine for a licensee shall be $100.00;

 

(10)  For failure to implement or maintain  the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 808.12(c)(9), the fine for a licensee shall be $1000.00; 

 

(11)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 808.14(e), the fine for a licensee shall be $500.00;

 

(12)  For a failure to provide services or programs required by the licensing classification and specified by He-P 808.14(d), the fine for a licensee shall be $500.00;

 

(13)  For false or misleading information or misleading information or documentation, in violation of  He-P 808.13(b)(5), the fine for an applicant shall be $500.00 per offense;

 

(14)  For employing an administrator or a laboratory director who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 808.10 in violation of He-P 818.18(h)-(j), the fine for a licensee shall be $500.00;

 

(15)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 808.07(a), the fine for a licensed facility shall be $500.00;

 

(16)  For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, as required by He-P 808.09(b)(5), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(17)  When an inspection determines that a violation of RSA 151 or He-P 808 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same deficiency is cited within 2 years of the original deficiency, the fine for a licensee shall be double the original fine, but not to exceed $2000.00; or

 

b.  If the same deficiency is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

 

(18)  Each day that the licensee continues to be in violation of the provisions of RSA 151 or He-P 808 shall constitute a separate violation and shall be fined in accordance with He-P 808.12; and

 

(19)  If the licensee is making good faith efforts, as verified by documentation or other means, to obtain a license in (1) above or comply with warnings in (4) above, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of cash, check, or money order for the exact amount due;

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds; and

 

(3)  When payment is made in a form other than cash, it shall be made payable to the “Treasurer - State of New Hampshire.”

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 808 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j) When a laboratory’s license has been denied or revoked, the applicant, licensee, administrator, or laboratory director shall not be eligible to reapply for a license or be employed as a laboratory director for 5 years, if the enforcement action pertained to their role in the laboratory. 

 

          (k)  The 5-year period referenced in (i) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause, as verified by documentation or other means, to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 808.

 

          (m)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 808.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.14  Duties and Responsibilities of all Licensees.

 

          (a)  The licensee shall comply with all applicable federal, state, and local laws, rules, codes, and ordinances.

 

          (b)  The licensee shall have a written policy and procedure setting forth the rights of patients in accordance with RSA 151:21.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided at the laboratory, including mobile laboratory vans.

 

          (d)  The licensee shall not falsify or omit any information contained in:

 

(1)  The application in He-P 808.04(a)(1) or any other documents required for the licensing of a laboratory; or

 

(2)  The records maintained for the patients and personnel of the laboratory.

 

          (e)  The licensees shall have responsibility and authority for:

 

(1)  Managing, controlling, and operating the laboratory;

 

(2)  Developing and implementing written policies and procedures governing all of the operations and services provided, and for reviewing said policies and procedures annually and revising as needed;

 

(3)  Initiating action to maintain the laboratory in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(4)  Establishing, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the laboratory;

 

(5)  Appointing a laboratory director who shall meet the qualification requirements as stated in:

 

a.  42 CFR § 493.1405 for laboratories performing moderate complexity testing;

 

b.  42 CFR § 493.1443 for laboratories performing high complexity testing; or

 

c. For labs performing only waived testing the director shall meet the following qualifications:

 

1.  A bachelor's degree in health sciences with a minimum of 3 years’ experience in a laboratory; or

 

2.  An associate’s degree in health sciences with a minimum of 5 years’ experience in a laboratory;

 

(6) Appointing an administrator who shall meet the following qualifications:

 

a.  A bachelor's degree in health sciences with a minimum of 3 years’ experience in a laboratory; or

 

b.  An associate’s degree in health sciences with a minimum of 5 years’ experience in a laboratory;

 

(7)  Employing a clinical consultant in accordance with 42 CFR § 493.1417 or 42 CFR § 493.1455 as appropriate;

 

(8)  Employing a technical consultant if the laboratory is performing moderately complex tests as defined in 42 CFR § 493.1411;

 

(9)  Employing a general supervisor and a technical supervisor if the laboratory is performing highly complex tests as defined in 42 CFR § 493.1449, 1461, and 1469 if the laboratory is performing cytology;

 

(10)  Providing sufficient numbers of personnel who are present in the laboratory and are qualified as testing personnel according to 42 CFR § 493 to perform the laboratory tests stated in the laboratory’s scope of services;

 

(11)  Providing sufficient supplies, equipment, and lighting to ensure all services are provided in a safe and timely manner; and

 

(12)  Implementing any POC that has been accepted or issued by the department. 

 

          (f)  The licensee shall post the following documents in an area of the licensed premises that is conspicuous and open to patients and the general public:

 

(1)  The current license issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued for the previous 12 months;

 

(3)  Any notice of a pending hearing or order as required by RSA 151:29, II, pertaining to the licensee issued by the department or a court during the previous 24 months;

 

(4)  A notice as required by RSA 151:29 stating complaints may be submitted to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

(5)  A copy of the licensee’s complaint procedure as required by RSA 151:29, I; and

 

(6) A copy of the patients’ bill of rights, in accordance with RSA 151:21.

 

          (g)  The licensee shall admit and allow any department representative to inspect the licensed premises and laboratory services for the purpose of determining compliance with RSA 151 and He-P 808 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (h)  All records required for licensing shall be:

 

(1)  Available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

(2)  Legible, current, and accurate.

 

          (i)  Any licensee maintaining electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent deletion;

 

(2)  Safeguards to ensure the confidentiality of the information on patients and personnel; and

 

(3)  Systems to prevent the tampering of information on patients and personnel.

 

          (j)  The licensee shall provide a patient or their legal representative with a copy of his or her patient record, pursuant to the provisions of RSA 151:21, X, upon request.

 

          (k)  The licensee shall develop a facility system with written policies and procedures that will ensure that only the patient and the ordering licensed practitioner are allowed to receive a copy of the laboratory tests results unless the laboratory has written consent from the patient to release the test results to others.

 

          (l)  The building or structure or mobile laboratory van that houses the laboratory shall comply with the following:

 

(1)  All applicable local health requirements;

 

(2)  All applicable state and local building ordinances;

 

(3)  All applicable local zoning ordinances; and

 

(4)  All applicable state and local fire ordinances.

 

          (m)  The licensee shall maintain a log in each mobile laboratory van to document that all on-board water is from a verifiable potable Source.

 

          (n)  Licensees that perform the functions of a collection station under this rule shall also be in compliance with He-P 817 rules for collection stations.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss 8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.15  Laboratory Standards.

 

          (a)  All laboratories shall comply with all regulations contained in 42 CFR § 493.

 

          (b) All laboratories shall require the individual functioning as technical consultant or general supervisor to have 2 years of laboratory experience in the specialties being supervised.

 

          (c)  All laboratory equipment shall be maintained as recommended by the manufacturer to include, but not limited to, annual tachometer checks of centrifuges, annual cleaning and maintenance of microscopes, and calibration of thermometers and pipettes.

 

          (d)  All laboratories shall disinfect point of care devices used for multiple patients after each use.

 

          (e)  All laboratories shall perform quality controls on waived meter devices each day they are used, unless the device performs internal electronic controls with each test performed.

 

          (f)  Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the collection station.

 

          (g)  All clinical equipment shall be:

 

(1)  In good working order; and

 

(2)  Serviced in accordance with manufacturers’ instructions and a written record of the service performed shall be kept at the collection station.

 

          (h)  Sharps containers shall be secured so as to prevent unauthorized access and tampering.

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.16  Patient Records, Test Requisitions, and Test Reports.

 

          (a)  All patient records, test requisitions, and test reports shall be completed and maintained in accordance with 42 CFR § 493.

 

          (b)  All records, requisitions, and reports shall be safeguarded against loss, damage, tampering, and unauthorized access and retained for a minimum of 4 years.

 

          (c)  Prior to ceasing operation, the licensee shall arrange for the storage of and access to records, requisitions, and reports for a minimum period of 4 years.

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.17  Personnel.

 

          (a)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position and in accordance with the requirements of 42 CFR § 493;

 

(2)  Be licensed, registered, or certified if required by state statute;

 

(3)  Receive an orientation within the first 7 days of work that includes:

 

a.  The duties and responsibilities of the position;

 

b.  The laboratory’s infection control program; and

 

c.  The laboratory’s fire, evacuation, and emergency plans, which outline the responsibilities of personnel in an emergency; and

 

(4)  Prior to testing patient samples, the employee shall have an orientation in the applicable policies, procedures, of the laboratory.

 

          (b)  All personnel shall complete annual in-service education in the laboratory:

 

(1)  Policies and procedures on patients’ rights;

 

(2)  Infection control program; and

 

(3)  Fire and emergency procedures.

 

          (c)  All licensees using the service of independent clinical contractors shall:

 

(1)  Provide the clinical contractors with an orientation as specified in (a)(3) above;

 

(2)  Maintain a copy of the clinical contractors’ licenses as required by (a)(2) above, if applicable;

 

(3)  Have a written agreement with each clinical contractor that describes the services that will be provided and agrees to comply with the requirements of (a)(1) through (3) above; and

 

(4)  Have documentation of the criminal record check or employee waiver, as applicable.

 

          (d)  For all new hires, including  volunteers  and  independent contractors whose scope of employment will involve direct contact with a patient, patient records, or patient tissue, body fluids, or other biological material, the licensee shall:

 

(1)  Obtain and review a criminal records check, which shall include results of criminal history from the state of New Hampshire;

 

(2)  Review the results of the criminal records check in accordance with (e) below and verify the qualifications of all applicants prior to employment;

 

(3)  Require the employee to submit the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(4)  Allow the employee to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB;

 

(5)  Comply with the requirements of the United States Centers for Disease Control and Prevention, “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(6)  Report all positive tuberculosis (TB) test results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02, and 301.03.

 

          (e)  Unless a waiver is granted in accordance with (f) below, the licensee shall not offer employment for any position if the individual:

 

(1)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

 

(2)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(3)  Otherwise poses a threat to the health, safety, or well-being of the patients.

 

          (f)  The department shall grant a waiver of (e) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of patients.

 

          (g)  The waiver in (f) above shall be permanent for as long as the individual remains in the same job unless additional convictions or findings under (e) above occur.

 

          (h)  If the information identified in (e) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department.

 

          (i)  An employee shall not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department.

 

          (j)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

 

          (k)  For individuals with the waiver described in (f) above, the statement required by (j) above shall cover the period of time since the waiver was granted.

 

          (l)  An individual shall not be required to re-disclose any of the matters in (f) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (m)  Current and complete personnel files shall be maintained at the licensed premises, except as allowed by (p) below.

 

          (n)  Personnel files shall include:

 

(1)  Identification data;

 

(2)  Qualifications and work experience;

 

(3)  Record of satisfactory completion of the orientation program required by (a)(3) above;

 

(4)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(5)  Documentation of annual in-service education as required by (b) above; and

 

(6)  The statement required by (j) above.

 

          (o)  Personnel files shall be:

 

(1)  Maintained on an individual basis, separate and distinct from other employees, and contain only information relating to the specific personnel member;

 

(2)  Stored in locked containers or cabinets or in a locked room on the premises; and

 

(3)  Maintained for at least 5 years following termination of employment.

 

          (p)  Personnel files may be stored in a central location provided that:

 

(1)  The personnel file is available to the department at the licensed premises within 30 minutes of being requested; and

 

(2)  The files are in accordance with (n) and (o) above.

 

          (q)  All testing personnel shall have a competency review for each test procedure performed prior to testing patient samples, as well as twice in the first year and annually thereafter.

 

          (r)  The competency review shall include:

 

(1)  Monitoring the pre-analytic, analytic, and post analytic phases of the testing procedure;

 

(2)  Direct observation of the testing personnel in the performance of the test procedure; and

 

(3)  Documentation of test results and awareness of test parameters and limitations as described in the package insert.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.18  Quality Assessment.  Licensed laboratories, including mobile laboratory vans, shall develop and implement a quality assessment program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

            He-P 808.19  Infection Control.

 

            (a)  All laboratories shall develop and implement an infection control program.

 

            (b)  The laboratory’s infection control program shall:

 

(1)  Comply with all regulations contained in 29 CFR § 1910.1030;

 

(2)  Include education and instruction on:

 

a.  Proper hand washing techniques; and

 

b.  The utilization of universal precautions;

 

(3)  Include written procedures for the handling, storage, transportation, or disposal of those items identified as infectious waste in Env-Sw 904;

 

(4)  Include written procedures for the management of patients or staff with infectious or contagious diseases or illnesses; and

 

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

 

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

 

(1)  Causes of infections;

 

(2)  Effects of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

(d)  Personnel infected with a disease or illness transmissible through contact, fomites, or droplets shall not have any contact with patients until they are no longer contagious.

 

(e)  Only sterile equipment and containers such as needles, syringes, test tubes, and urine containers used for cultures shall be used when collecting specimens.

 

(f)  The handling, storing, transporting, or disposing of items specified as infectious waste in Env-Sw 904.01 shall be done in accordance with Env-Sw 904.

 

(g)  There shall be no use of tobacco products, smoking, eating, drinking, or applying of cosmetics in the areas where specimen collection takes place or where specimens are processed in accordance with 29 CFR § 1910.1030.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

            He-P 808.20  Physical Environment.

 

            (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

 

(1)  Buildings or mobile laboratory vans, as applicable;

 

(2)  Health;

 

(3)  Fire; and

 

(4)  Waste disposal.

 

            (b)  The laboratory shall have all entrances and exits to the licensed premises accessible at all times.

 

            (c)  The laboratory shall be clean and maintained in a safe manner and good repair and kept free of hazards.

 

            (d)  All supplies shall be stored in enclosed storage spaces.

 

          (e)  All corridors shall be free from obstruction.

 

          (f)  The licensee shall ensure that the laboratory has:

 

(1)  Working space for the analysis and reporting of tests performed by the laboratory;

 

(2) Refrigeration and freezers, as required, to preserve specimens and reagents at optimal temperatures as recommended by a given procedure or manufacturer;

 

(3) Cooling, heating, and ventilation systems that are maintained in accordance with manufacturers’ specification;

 

(4) Temperature and humidity control in the laboratory work area that is maintained and monitored in accordance with manufacturer’s instructions for the testing being performed to ensure quality results; and

 

(5)  Access to bathrooms that contain at least one toilet and one hand-washing sink with:

 

a.  A supply of hot and cold running water;

 

b.  Soap dispensers;

 

c.  Paper towels or a hand drying device providing heated air; and

 

d.  Non-porous floors.

 

          (g)  If equipment or supplies need to be sterilized in order to prevent contamination, a system for sterilization shall be provided.

 

          (h)  The sterilization system required in (g) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented.

 

          (i)  Sterile supplies and equipment shall not be mixed with unsterile supplies and shall be stored in dust-proof, moisture-free storage areas.

 

          (j)  Cleaning solutions, compounds, and substances, which might be considered hazardous waste as defined in RSA 147-A:2, VII, also known as hazardous and toxic materials in these rules, shall be:

 

(1)  Distinctly labeled and legibly marked so as to identify the contents;

 

(2)  Stored in a place separate from food and supplies; and

 

(3)  Kept in an enclosed section separated from other cleaning materials.

 

          (k)  Toxic materials shall not be used in a way that contaminates equipment or in any way that constitutes a hazard to personnel or other persons, or in any way other than in full compliance with the manufacturer's labeling.

 

(l) Equipment, work surfaces, and flooring within areas used for collection and processing patient specimens shall include only non-porous material suitable for disinfection and shall be free of tape and adhesives.

 

Source.  #2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92

 

New.  #5758, eff 12-20-93, EXPIRED: 12-20-99

 

New.  #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

          He-P 808.21  Mobile Laboratory Vans.

 

          (a)  Mobile laboratory vans shall be eligible for licensure only if they are:

 

(1)  Operated by a laboratory that is located in a building or other permanent structure; and

 

(2)  The laboratory in (1) above has a valid license issued by the department in accordance with He-P 808.

 

          (b)  Each applicant shall comply with He-P 808, except that:

 

(1)  He-P 808.07 shall not apply to mobile laboratory vans;

 

(2)  In lieu of He-P 808.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

 

a.  A copy of the applicant’s current laboratory and laboratory services license;

 

b.  A valid New Hampshire motor vehicle registration for the mobile laboratory van;

 

c.  The VIN of the mobile laboratory van; and

 

d.  A space utilization diagram for the mobile laboratory van; and

 

(3)  Patient and facility records that are stored off site shall be available for inspection upon request of licensing personnel within 30 minutes of being requested.

 

          (c)  The laboratory portions of the mobile laboratory van used to collect, process, store, or transport specimens, reagents, or supplies shall have a non-porous floors and work surfaces.

 

          (d)  Only such tests that are identified as waived in 42 CFR § 493 shall be performed in a mobile laboratory van.

 

          (e)  Detailed written documentation of travel dates, times, and locations, including periods of non-use, shall be maintained for the mobile laboratory van.

 

          (f)  Mobile laboratory vans shall record temperatures each day of laboratory use and whenever testing reagents are stored in the van to ensure compliance with manufacturers’ instructions for the test system used by the laboratory.

 

Source.  #8852, eff 3-24-07; ss by #10267, eff 2-2-13; ss by #13710, eff 8-2-23

 

He-P 808.22  Emergency and Fire Safety.

 

          (a) Laboratories shall meet the requirement in the applicable chapters and sections of the state fire code and state building code.

 

          (b)  An emergency and fire safety program shall be developed and implemented based upon the hazards present in the lab.

 

(c)  Smoke detectors shall be hardwired, powered by the electrical service, and located on every level of the facility.

 

(d) At least one fire extinguisher shall be located on every level of the facility or every 75 feet of corridor, type based on the hazards present in the lab, and be:

 

(1) Manually inspected when initially placed in service; and

 

(2) Inspected either manually or by means of an electronic monitoring device or system at intervals not exceeding 31 days.

 

(e)  A carbon monoxide monitor shall be located on every level.

 

(f)  Immediately following any fire or emergency situation, excluding a false alarm, licensees shall notify the department by phone and follow up with written notification within 72 hours.

 

(g)  The written notification under (f) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any damage;

 

(3) A description of events preceding and following the incident;

 

(4) The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

 

(5) The name of the individual the licensee authorizes the department to contact if additional information is required.

 

(h)  Storage of flammable gases or liquids shall be within an enclosed interior space constructed of noncombustible or limited-combustible construction. If stored outdoors, storage shall be in an enclosure with doors or gates, that can be secured against unauthorized entry.

 

(i)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

(1) Not be stored with any flammable gas, liquid, or vapor;

 

(2) Be separated from combustibles or incompatible materials by:

 

a. A minimum distance of 20 ft or 6.1 meters;

 

b. A minimum distance of 5 ft or 1.5 meters if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

c. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

 

(3) Be secured in an upright position, such as with racks or chains.

 

          (j)  All freestanding tanks of compressed gases shall be firmly secured to the adjacent wall, or secured in a stand or rack, except for in mobile laboratory vans, where they shall be secured during transport as required by the state fire code.

 

          (k)  Flammable gases and liquids shall be stored in metal fire retardant cabinets, except when located in a mobile laboratory van, where they shall be secured during transport as required by the state fire code.

 

          (l)  Quantities of flammable gases and liquids under 500 milliliters may be retained at the bench work area when directly in use.

 

          (m)  A precautionary sign, readable from a distance of 5 ft or 1.5 meters, shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”.

 

          (n)  Precautionary signs, readable from a distance of 5 ft or 1.5 meters, and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

 

          (o)  The laboratory shall develop a fire safety plan, which includes the following:

 

(1)   Use of alarms;

 

(2)  Transmission of alarms to fire department;

 

(3)  Emergency phone call to fire department;

 

(4)  Response to alarms;

 

(5)  Isolation of fire;

 

(6)  Evacuation of immediate area;

 

(7)  Evacuation of smoke compartment;

 

(8)  Preparation of floors and building(s) for evacuation;

 

(9)  Extinguishment of fire; and

 

(10)  List of written emergency telephone numbers for key personnel, fire and police departments, poison control center, 911, and ambulance service(s).

 

          (p)  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative personnel, with the signals and emergency action required under varied conditions.

 

          (q)  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions.

 

          (r)  Facilities shall complete written records of fire drills and include the following:

 

(1) The date and time, including AM or PM, the fire drill was conducted and if the actual fire alarm system was used;

 

(2) The location of exits used;

 

(3) The number of people participating at the time of the fire drill;

 

(4) The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

 

(5) The name and title of the person conducting the fire drill;

 

(6) A list of all problems and issues encountered during the fire drill;

 

(7) A list of improvements and resolutions to the issues encountered during the fire drill; and

 

(8) The names of all personnel participating in the fire drill.

 

          (s) Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (t)  At no time shall a personnel member who has not participated in a fire drill be the only personnel member on duty within the facility.

 

          (u)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

          (v)  A written plan for fire safety, evacuation, and emergencies shall be adopted and posted in multiple locations throughout the laboratory.

 Source.  #13710, eff 8-2-23

 

          He-P 808.23  Emergency Preparedness.

 

          (a)  Each facility shall have an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

 

          (b)  The committee shall include:

 

(1)  The facility administrator;

 

(2)  Others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility; and

 

(3)  An applicable external representation, if the licensee is a high complexity lab, including but not limited to:

 

a.  Elected state and local officials;

 

b.  Police, fire, civil defense, and public health professionals;

 

c.  Environment, transportation, and hospital officials;

 

d.  Facility representatives; and

 

e.  Representatives from community groups and the media.

 

          (c)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

(d) The plan in (c) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of a fire, natural disaster, severe weather, chemical emergency, or human-caused emergency;

 

(2)  Be reviewed and approved by the local emergency management director;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Federal Emergency Management Agency’s Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the facility’s plan shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Include the facility's response to both short-term and long-term interruptions in the availability of utility services in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems; and

 

g.  Communications systems;

 

(8)  Include a process for alerting and managing personnel in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(9)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(10)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(11)  Include an educational, competency-based program for the personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

 

(12)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this process in the plan in the event of a radiological disaster or emergency.

 

          (e)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both.

 

Source.  #13710, eff 8-2-23

 

PART He-P 809  HOME HEALTH CARE PROVIDERS

 

          He-P 809.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all home health care providers (HHCPs) pursuant to RSA 151:2, I(b).

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; amd by #6240, HB 32, eff 5-3-96, EXPIRED 12-31-98; ss and amd by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.02  Scope.  This part shall apply to any organization, business entity, partnership, corporation, government entity, association or other legal entity operating a HHCP, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g);

 

          (b)  Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H;

 

          (c)  Entities that are licensed under another home health care license and are providing only the services permitted under that license;

 

          (d)  A person furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment and educate the user on its proper use; and

 

          (e)  For a period ending on September 25, 2024, emergency medical services units and emergency medical care providers operating under the jurisdiction and regulatory oversight of the New Hampshire department of safety, bureau of emergency medical services, in compliance with the “mobile integrated healthcare protocol” contained in the New Hampshire patient care protocols, incorporated by reference in Sac-C 5902.01.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #10939, eff 9-25-15; ss by #12640, eff 10-3-18; amd by #12893, eff 10-1-19

 

          He-P 809.03  Definitions.

 

          (a)  “Abuse” means  any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a patient;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to a patient; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a patient with or without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

 

          (c)  “Administer” means “administer” as defined by RSA 318:1, I, namely “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 person for immediate consumption or use.”

 

          (d)  “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HHCP.

 

          (e)  “Admission” means accepted by a licensee for the provision of services to a patient.

 

          (f)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (g)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a HHCP pursuant to RSA 151.

 

(h)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 809, or other federal or state requirements.

 

          (i)  “Assessment” means an evaluation of the patient to determine the care and services that are needed.

 

          (j)  “Branch office” means a location physically separate from the primary location of the HHCP and that:

 

(1)  Provides oversight for employees who provide direct care services to patients in their residential setting; and

 

(2)  Is under the administration and supervision of the primary location of the HHCP.

 

          (k)  “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services as required by He-P 809.15(o)-(q).

 

          (l)  “Change of ownership” means a change in the controlling interest of an established HHCP to a successor business entity.

 

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

 

          (n)  "Community health services" means services that are provided in  community settings, including but not limited to foot clinics, flu shot clinics, educational programs and nutrition services.

 

          (o) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (p)  “Days” means calendar days unless otherwise specified in the rule.

 

          (q)  “Department” means the New Hampshire department of health and human services.

 

          (r)  “Direct care” means hands-on care and services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (s)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

 

          (t)  “Do not resuscitate order (DNR order)” means an order that, in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term includes "do not attempt resuscitation order (DNAR order)”.

 

          (u)  “Drop site” means a location, which does not meet the definition of a branch office, where materials, equipment, and supplies used in the provision of services may be temporarily stored.

 

          (v)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (w)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, or fraud.

 

          (x)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and other personal needs.

 

          (y)  “Home health care provider (HHCP)” means any organization or business entity, whether public or private, whether operated for profit or not, which is engaged in arranging or providing, directly or through contract arrangement, one or more of the following services:

 

(1)  Nursing services;

 

(2)  Home health aide services; or

 

(3)  Other therapeutic and related services, which can include, but are not limited to;

 

a.  Physical and occupational therapy;

 

b.  Speech pathology;

 

c.  Nutritional services;

 

d.  Medical social services;

 

e.  Personal care services; and

 

f.  Homemaker services which may be of a preventative, therapeutic, rehabilitative, health guidance, or supportive nature to persons in their places of residence.

 

          (z)  “Homemaker services” means services that are of a supportive nature that do not routinely require hands-on contact with a patient other than to maintain the patient’s safety.  Such services may include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, companion services, and medication reminders.

 

          (aa) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ab)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (ac)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (ad) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 809 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 809.

 

          (ag) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 809.

 

          (ae)  “License” means the document issued by the department to an applicant at the start of operation as an HHCP which authorizes operation in accordance with RSA 151 and He-P 809, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

 

          (af) “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which the HHCP is licensed.

 

          (ag)  “Licensed 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.

 

          (ah)  “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices. This term does not include drop sites or the private residence of a patient receiving services from a HHCP.

 

          (ai)  “Licensing classification” means the specific category of services authorized by a license.

 

          (aj) “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (ak)  “Neglect” means an act or omission that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a patient.

 

          (al) “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, 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.

 

          (am)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (an)  “Patient” means any person admitted to or in any way receiving care, services, or both from a HHCP licensed in accordance with RSA 151 and He-P 809. Patient includes patient as used in RSA 151:20 and RSA 151:21.

 

          (ao) “Patient record” means the documentation of all care and services, which includes all documentation required by RSA 151 and He-P 809 and any other applicable federal or state requirements.

 

          (ap)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21-b.

 

          (aq)  “Personal care service provider” means a person who provides non-medical hands-on assistance to a patient, to help with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, assisting with topical medications, or reminding a patient to take medications.

 

          (ar)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.

 

          (as)  “Personnel” means an individual who is employed by the facility, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to patients.

 

          (at)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (au)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

 

          (av)  “Point of care devices”  means testing involving a system of devices, typically including:

 

(1)  A lancing or finger stick device to get the blood sample;

 

(2)  A test strip to apply the blood sample; or

 

(3)  A meter or monitor to calculate and show the results including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin time (PT) and iternational normalized ratio (INR) anticoagulation meters; or

 

c.  Cholesterol meter.

 

          (aw) “Primary location” means the principal site for the HHCP where the business office and administrative staff are located.

 

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

 

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

 

          (az)  “Professional staff” means:

 

(1)  Physicians;

 

(2)  Physician assistants;

 

(3)  Advanced practice registered nurses;

 

(4)  Registered nurses;

 

(5)  Registered physical therapists;

 

(6)  Speech therapists;

 

(7)  Licensed practical nurses;

 

(8)  Licensed respiratory therapists;

 

(9)  Occupational therapists;

 

(10)  Medical social workers; and

 

(11)  Dietitians.

 

          (ba)  “Reportable incident” means an occurrence of any of the following while the patient is in the care of HHCP personnel:

 

(1)  The unanticipated death of the patient; or

 

(2)  An injury to a patient that is potentially due to abuse or neglect.

 

          (bb)  “Self-administration of medication with assistance” means an act whereby the patient takes his or her own medication after being prompted by personnel but without requiring physical assistance from others beyond placing the container within reach, opening the medication container, reading the medication label to the patient, and utilizing hand over hand technique pursuant to Nurs 404.03(b).

 

          (bc)  “Self-administration of medication without assistance” means the participant is able to take his or her own medication(s) without the assistance of personnel, including prompting.

 

          (bd)  “Self-directed medication administration” means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions,  injections or filling insulin syringes.

 

          (be)  “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability of the patient.

 

          (bf)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; amd by #6240, HB 32, eff 5-3-96, EXPIRED 12-31-98; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License,” (September 2018 edition) signed by the applicant or 2 of the corporate officers affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any HHCP to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any HHCP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  If applicable, proof of authorization from the secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability company; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(3)  The applicable $250 fee, in accordance with RSA 151:5, XI(b), payable in cash in the exact amount of the fee, or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(4)  A resume identifying the qualifications of and copies of applicable licenses for the HHCP administrator;

 

(5)  Written local approvals as follows:

 

a.  For the proposed licensed premises the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements;

 

2.  The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control and local fire ordinances applicable for a business; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project; and

 

(6)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant, licensee,  and administrator.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 809.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 809.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted in accordance with He-P 809.10, the department shall deny a licensing request in accordance with He-P 809.13(b) if it determines that the applicant, licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  An inspection shall be completed in accordance with He-P 809.09 prior to the issuance of a license.

 

          (g)  The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

 

          (h)  Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 809.

 

          (i)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (j)  A written notification of denial, pursuant to He-P 809.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 809.

 

          (k)  A written notification of denial, pursuant to He-P 809.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall:

 

(1)  Complete and submit to the department an application form pursuant to He-P 809.04(a)(1) at least 120 days prior to the expiration of the current license;

 

(2)  The current license number;

 

(3) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 809.10(f), as applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 809.17(d); and

 

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal.

 

          (c)  Following an inspection, as described in He-P 809.09, a license shall be renewed if the department determines that the licensee:

 

(1) Submitted an application containing all the items required by (c) above, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 809 at the renewal inspection.

 

          (d)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 809.04 and shall be subject to a fine in accordance with He-P 809.13(c)(5).

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.07  Branch Offices and Drop Sites.

 

          (a)  The HHCP may establish branch offices and drop sites provided that no direct care is provided to a patient at a drop site.

 

          (b)  The HHCP shall notify the department in writing prior to establishing or operating branch offices with the following information:

 

(1)  The branch office address;

 

(2)  The branch office phone number; and

 

(3)  The license number of the HHCP.

 

          (c)  The HHCP shall submit to the department the information required by He-P 809.04(a)(5) for branch offices.

 

          (d)  Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 809.

 

          (e)  All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.08  HHCP Requirements for Organizational or Service Changes.

 

          (a)  The HHCP shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location of the licensed premises;

 

(3)  Address; or

 

(4)  Name.

 

          (b) The HHCP shall complete and submit a new application and obtain a new license and license certificate prior to :

 

(1)  A change in ownership; or

 

(2)  A change in licensing classification.

 

          (c)  When there is a change in address without a change in location, the HHCP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in address due to a physical location change , the HHCP shall provide the department with:

 

(1)  A letter which contains the license number, new address, and date of the move; and

 

(2)  Local approval form as specified in He-P 809.04(a)(5).

 

          (e)  When there is a change in the name, the HHCP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (f)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance then an inspection shall be conducted as soon as practical by department; or

 

(2)  A change in licensing classification.

 

(g)  A new license shall be issued for a change in ownership.

 

          (h)  A revised license and license certificate shall be issued for a change in address.

 

          (i)  A revised license and license certificate shall be issued for a change in name.

 

          (j)  A license and license certificate shall be issued at the time of initial licensure.

 

          (k)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator;

 

(2)  When a waiver has been granted;

 

(3)  When there is a change in services; or

 

(4)  When a branch office has been added.

 

          (l)  The HHCP shall inform the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change  and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  Copies of applicable licenses for the new administrator;

 

(3) The results of a criminal records check from the NH department of safety for the new administrator; and

 

(4)  Results of bureau and elderly adult registry check.

 

          (m)  Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 809.15(d).

 

          (n)  If the department determines that the new administrator does not meet the qualifications for his or her position as specified in (m) above, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

(o)  A restructuring of an established HHCP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  The HHCP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (q)  If a licensee chooses to cease operation of an HHCP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 809, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the HHCP; and

 

(3)  Any records required by RSA 151 and He-P 809.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151, He-P 809, and other federal or state requirements prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 809.08(f)(1);

 

(3)  A change in licensing classification; or

 

(4)  The renewal of a license.

 

          (c)  In addition to (b) above the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings shall be issued when, as a result of an inspection, the department determines that the HHCP is in violation of any of the provisions of He-P 809, RSA 151, or other federal or state requirements.

 

          (e)  If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 809.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #5630, eff 5-26-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 809 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3) A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (c) through (f) above.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #6240, HB 32, eff 5-3-96, EXPIRED: 12-31-98

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

          He-P 809.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 809.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the HHCP, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 809.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  Physical inspection of the licensed premises;

 

(3)  Review of relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed HHCP, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 809.12(c) if the inspection results in areas of non-compliance being cited.

 

(e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 809; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine in accordance with He-P 809.13(c)(1).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any administrative or judicial proceedings relative to the licensee.

 

Source.  #4073, eff 6-26-86, EXPIRED: 6-26-92

 

New.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 809, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules ; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings, the licensee shall submit a written POC for each item, written in the appropriate place on the statement and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action.

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 809;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings;

 

c.  Prevents a new violation of RSA 151 or He-P 809 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing within 14 days, of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

2.  The department determines that the health, safety or wellbeing of a patient will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 809.13(c)(11);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an on-site follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 809.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and a fine in accordance with He-P 809.13(c)(11).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients or personnel;

 

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 809.13(b); or

 

(3)  Revoke the license in accordance with He-P 809.13(b).

 

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

 

          (g)  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.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with He-P 809.12(c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

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

 

          (k)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the HHCP that negatively impact the health, safety, or well-being of patients.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 809 in a manner which posed a risk of harm to a patient’s health, safety, or well-being of a patient;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, or schedule an initial inspection an applicant or licensee fails to submit an application that meets the requirements of He-P 809.04;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 809.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 809.12(c)(5) and has not submitted a revised POC as required by He-P 809.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 809 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 809;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine  for an applicant, unlicensed entity or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 809.14(g), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 809.11(e)(4), the fine for an unlicensed entity or a licensee shall be $500.00;

 

(5)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 809.06(e), the fine for a licensee shall be $100.00;

 

(6)  For a failure to notify the department prior to a change of ownership, in violation of He-P 809.08(a)(1), the fine for a licensee shall be $500.00;

 

(7)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 809.08(a)(2), the fine for a licensee shall be $1000.00;

 

(8)  For a failure to notify the department of a change in e-mail address, in violation of He-P 809.08(n), the fine shall be $100.00;

 

(9)  For a failure to allow access by the department to the HHCP’s premises, programs, services, patients, or records, in violation of He-P 809.09(a)(1)-(2), the fine for an applicant, unlicensed entity or licensee shall be $2000.00;

 

(10)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 809.12(c)(2) or (5), the fine for a licensee shall be $500.00;

 

(11)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 809.12(c)(8), the fine for a licensee shall be $1000.00;

 

(12)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 809.14(b), (d), and (s) the fine for a licensee shall be $500.00;

 

(13)  For a failure to provide services or programs required by the licensing classification and specified by He-P 809.14(c), the fine for a licensee shall be $500.00;

 

(14)  For a failure to transfer a patient whose needs exceeds the services or programs provided by the HHCP, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(15)  For providing false or misleading information or documentation to the department, in violation of He-P 809.14(f), the fine shall be $1000.00 per offense;

 

(16)  For a failure to meet the needs of the patient, as described in  He-P 809.14(i)(2), the fine for a licensee shall be $1000.00 per patient;

 

(17)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department  in accordance with He-P 809.14, the fine for a licensee shall be $500.00;

 

(18)  When an inspection determines that a violation of RSA 151 or He-P 809 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

 

(19)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 809 shall constitute a separate violation and shall be fined in accordance with He-P 809.13(c); and

 

(20)  If the applicant or  licensee is making good faith efforts to comply with above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer”; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license, the cessation of services, patient when it finds that the health, safety, or well-being of patients is in jeopardy and requires emergency action in accordance with RSA 541:A-30.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 809 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a HHCP’s license has been denied or revoked, , the applicant, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for at least 5 years if the denial or revocation specifically pertained to their role in the program.

 

          (k)  The 5 year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for an administrative hearing is made and a hearing is held.

 

          (l)  Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 809.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 809.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49, and rules promulgated thereunder, as applicable.

 

          (b)  The licensee shall have written policies and procedures to include:

 

(1)  The rights and responsibilities of admitted patients in accordance with the “Home Care  Clients’’ Bill of Rights” under RSA 151:21-b;

 

(2)  The policies described in He-P 809; and

 

(3)  A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the HHCP, which shall include at a minimum, the core services listed in He-P 809.15.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HHCP and for:

 

(1)  Reviewing the policies and procedures every 2 years; and

 

(2)  Revising them as needed.

 

          (e)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (f)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The licensee shall not advertise or otherwise represent the HHCP as providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  Licensees shall:

 

(1)  Manage and operate the HHCP;

 

(2)  Meet the needs, as determined by the care plan, of the patient during those hours that the HHCP personnel is in the patient’s home;

 

(3)  Initiate action to maintain the HHCP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(4)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HHCP;

 

(5)  Appoint an administrator;

 

(6)  Verify the qualifications of all personnel;

 

(7)  Accept new patients based upon the availability of personnel to meet the patients’ requested service needs;

 

(8)  Require all personnel to follow the orders of the licensed practitioner for every patient that has such orders and encourage the patient to follow the licensed practitioner’s orders; and

 

(9)  Implement any POC that has been accepted or issued by the department.

 

          (j)  The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (k)  The licensee shall only accept a patient whose needs can be met through the program and services offered under the current license.

 

          (l)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (m)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (n)  The licensee shall post the following documents in a public area:

 

(1)  The license and current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports for the last 12 months issued in accordance with He-P 809.09(d);

 

(3)  A copy of the Home Care Patient'’ Bill of Rights specified by RSA 151:21-b;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

 

          (o)  For reportable incidents the licensees shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2  business days of a reportable incident:

 

a.  The HHCP name;

 

b. A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d. The name of the patient involved and the name of any witnesses to the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.   The action taken in direct response to the reportable incident, including any follow-up;

 

g.   If medical intervention was required, by whom and the date and time;

 

h.  Whether the patient’s guardian, agent, or personal representative, if any, was notified;

 

i.   The signature of the person reporting the reportable incident; and

 

j.  The date and time the patient’s licensed practitioner was notified;

 

(3)  If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(4)  Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any patient who dies within 10 days of a reportable incident;

 

(5)  Provide the information required by (3) above in writing within 3 business days of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

 

(6)  Submit any further information requested by the department.

 

          (p)  The licensee shall admit and allow any department representative to inspect the HHCP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 809 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (q)  The licensee shall, upon request, provide a patient or their guardian agent, or surrogate decision-maker  if applicable, with a copy of his or her patient record, pursuant to the provisions of RSA 151:21, X.

 

          (r)  All records required for licensing shall be legible, current, accurate, and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (s)  Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining  the confidentiality of information pertaining to patients and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to patients and personnel.

 

          (t)  At the time of admission the licensee shall give a patient and their guardian, agent, or surrogate decision-maker  if applicable, a listing of all applicable HHCP charges and identify what care and services are included in the charge.

 

          (u)  The licensee shall give a patient a written notice at least 30 days before any increase is imposed in the cost or fees, for any HHCP services, except for patients receiving Medicaid whose financial liability is determined by the state’s standard of need, or patients funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18; amd by #12893, eff 10-1-19

 

          He-P 809.15  Required Services.

 

          (a)  The licensee shall have a written contractual agreement for all services provided by arrangement.

 

          (b)  Any contractual agreement to provide care and services shall:

 

(1)  Identify the care and services to be provided;

 

(2)  Specify the qualifications of the personnel that will be providing the care and services;

 

(3)  Require that the HHCP must authorize the services; and

 

(4)  Stipulate the HHCP retains professional responsibility for all care and services provided.

 

          (c)  The licensee shall provide staff for the following positions:

 

(1)  An administrator to oversee the HHCP, except as allowed by (e)(1) below; and

 

(2)  A director of patient services.

 

          (d)  Any new administrator shall possess at least a bachelor’s degree in business or a health related field, or be a registered nurse (RN).

 

          (e)  The administrator shall:

 

(1)  Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

 

(2)  Be permitted to hold more than one position at the HHCP if:

 

a.  The individual meets the qualifications of all positions; and

 

b.  The duties and responsibilities of the positions can be accomplished by one individual.

 

          (f)  Any new director of patient services shall have at least 2 years’ experience supervising personnel or providing direct home health care services and:

 

(1)  Be a New Hampshire–licensed  or compact registered nurse; or

 

(2)  Have a bachelor’s degree in a health related field.

 

          (g)  The director of patient services shall be responsible for the overall delivery of patient care and services.

 

          (h)  At the time of admission, personnel of the HHCP shall:

 

(1)  Provide, both orally and in writing, to the patient, or the patient’s guardian or agent, if applicable, the HHCP’s:

 

a.  Policy on patient rights and responsibilities, including a copy of the home care Clients’ Bill of Rights, pursuant to RSA 151:21-b;

 

b.  Complaint procedure;

 

c.  List of services that are to be provided by the HHCP; and

 

d.  List of the care and services that are provided by an independent contractor;

 

(2)  Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, or the patient’s guardian or agent, if applicable;

 

(3)  Collect and record the following information:

 

a.  Patient’s name, home address, home telephone number, and date of birth;

 

b. Name and telephone number of an emergency contact and guardian or agent, if applicable;

 

c.  Name of patient’s primary care provider and the provider’s address and telephone number, as applicable;

 

d.  Written and signed consent for the provision of care and services; and

 

e.  Copies of  all legal directives such as durable power of attorney, guardianship, or living will, as applicable;

 

f.  Copy of order activating durable power of attorney, if applicable; and

 

g.  Copy of DNR order, if applicable; and

 

(4)  Obtain documentation of informed consent and consent for release of information.

 

          (i)  Each patient shall have a health assessment conducted by professional personnel in the specific discipline providing care, as authorized by their provider, to determine the level of care and services required by the patient, except as allowed by (k) and (l) below:

 

(1)  Prior to initiating care for the specified discipline;

 

(2)  At least every 90 days thereafter; and

 

(3)  Whenever there is a significant change in the patient’s condition.

 

          (j)  The assessment required by (i) above shall contain at a minimum the following:

 

(1)  Pertinent diagnoses including mental status;

 

(2)  Goals and objectives of the services that shall be provided by the HHCP;

 

(3)  Estimated duration and frequency of care and services;

 

(4)  Any equipment required;

 

(5)  Prognosis;

 

(6)  Functional limitations;

 

(7)  Rehabilitation potential;

 

(8)  Activities that are limited;

 

(9)  Nutritional requirements;

 

(10)  Medications and treatments administered or assisted by personnel of HHCP;

 

(11)  Any safety precautions; and

 

(12)  Discharge planning or referral information as applicable.

 

          (k)  Patients receiving only homemaker services shall not require an assessment or a care plan.

 

          (l)  For patients receiving only personal care services, the assessment in (i) above  shall:

 

(1) Be performed initially and every 6 months thereafter by a registered nurse, licensed practical nurse (LPN), or the director of patient services to determine the services required; and

 

(2)  At a minimum include (j)(1), (4), (6), (8), (9), (10), and (11) above.

 

          (m)  If the assessment required by (i) or (l)(1)  and (2) above is completed by an LPN or the director of patient services who is not a registered nurse, the assessment shall be reviewed and co-signed by the registered nurse or physician  prior to the development of the patient’s care plan.

 

          (n)  For those patients receiving direct care or personal care services, the licensee shall develop a care plan within 3 business days of admission or prior to the initiation of services, if later, that is based on the results of the assessment required by (i) and (l) above.

 

          (o)  The care plan required by (n) above shall include:

 

(1)  The date of the assessment;

 

(2)  A description of the problem or need;

 

(3)  The goals for the patient, if applicable, and identifying which services require medical, nursing, or other therapeutic professional care and which of these services can be provided by personal care service providers as defined by He-P 809.03(aq);

 

(4)  The action or approach to be taken by HHCP personnel;

 

(5)  The responsible person(s) or position;

 

(6)  The date of re-evaluation, reassessment, and resolution; and

 

(7)  Documentation that the patient and their legal representative, if applicable, were involved in the development of the care plan and any revisions made to the plan.

 

          (p)  The care plan shall be prepared by an interdisciplinary team that includes:

 

(1)  The personnel performing the assessment;

 

(2)  Other personnel in disciplines as determined by the patient’s needs; and

 

(3)  The patient or the patient’s legal representative.

 

          (q)  The care plan shall be reviewed and revised at least every 90 days by the interdisciplinary team, or every 6 months if only personal care services are provided, and shall be made available to all personnel that assist the patient in the implementation of the plan.

 

          (r)  The licensee shall have an order for any service for which such order is required by the licensing statute of the licensed practitioner. Such orders shall be renewed at least annually.

 

          (s)  All personnel of the HHCP shall follow the orders of the licensed practitioner and carry out the goals stated in the care plan, as applicable.

 

          (t)  The licensee shall develop a discharge plan with the input of the patient or the patient’s legal representative, if any, including:

 

(1)  Date and reason for discharge;

 

(2)  Discharge instructions and referrals, if applicable;

 

(3)  Discharge or transfer summary; and

 

(4)  Written and signed order for discharge, if applicable.

 

          (u)  Written notes shall be documented in the patient’s record at the time of each visit for:

 

(1)  All care and services provided by the HHCP including the:

 

a.  Date and time of the care or service;

 

b.  Description of the care or service;

 

c.  Progress notes, including, as applicable:

 

1.  Changes in the patient’s physical, functional, and mental abilities;

 

2.  Changes in the patient’s behaviors such as eating or sleeping patterns; and

 

3.  The patient’s pain management, if applicable; and

 

d.  Signature and title of the person providing the care or service; and

 

(2)  Any reportable incident involving the patient when HHCP personnel are in the patient’s home.

 

          (v)  For each patient accepted for care and services by the HHCP, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  The written confirmation required by (h)(2) above;

 

(2)  The identification data required by (h)(3) above;

 

(3)  Consent and medical release forms, as applicable;

 

(4)  Consent for release of information, as applicable;

 

(5)  The record of the assessments required by (i) or (l) above;

 

(6)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by (r) above;

 

(7)  All care plans required by (n) above including documentation that the patient or their legal representative participated in the development of the care plan;

 

(8)  All written notes required by (u) above;

 

(9)  All daily medication records required by He-P 809.16(g)(7)d.  and f.;

 

(10)  A discharge plan or transfer summary as required by (t) above;

 

(11)  Documentation of service authorization, if required, for a patient receiving third party payment including but not limited to Medicaid waiver services; and

 

(12)  Documentation of any patient refusal to follow their licensed practitioner’s written and signed orders.

 

          (w)  Patient records shall be available to:

 

(1)  The patient, the patient’s guardian, the patient’s agent, and the patient's surrogate decision-maker;

 

(2)  HHCP personnel as required by their job responsibilities and subject to the licensee’s policy on confidentiality;

 

(3)  Any individual given written authorization by the patient, the patient’s guardian, the patient’s agent, or the patient's surrogate decision-maker;

 

(4)  Any individual authorized by a court of competent jurisdiction; and

 

(5)  The department or any individual authorized by law.

 

          (x)  The licensee shall develop and implement a method for the written release of information in patient records that is consistent with federal and state law.

 

          (y)  The HHCP shall store all paper and electronic backup files of patient records in the primary or branch office except when they are being utilized by authorized personnel.

 

          (z)  Paper records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by authorized personnel.

 

          (aa)  Electronic records shall be maintained as required by He-P 809.14(s).

 

          (ab)  Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

 

          (ac)  The HHCP shall arrange for storage of, and access to, patient records as required by (ab) above in the event that the HHCP ceases operation.

 

          (ad)  If the HHCP is providing home hospice care, it shall be licensed in accordance with He-P 823.

 

          (ae)  Only personnel with documented phlebotomy training may collect human blood specimens from patients for laboratory testing.

 

          (af)  If CLIA-waived laboratory testing is performed by personnel of the HHCP, the licensee shall obtain a CLIA Certificate of Waiver and follow all CLIA requirements in the performance of the laboratory testing including the documentation of training and competency review of all testing personnel.

 

          (ag)  If the licensee collects human specimens for laboratory testing, it shall follow the manufacturer's instructions and/or the reference laboratory's instructions for collection and storage of human specimens.

 

          (ah)  If the licensee tests human specimens, it shall be licensed as a laboratory in accordance with He-P 808, except the licensee may perform  CLIA-waived point of care tests without obtaining a laboratory license in accordance with He-P 809.15(af) and (aj).

 

(ai)  The HHCP shall follow all manufacturer’s instructions to include:

 

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

 

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

 

(3)  All recommended and required quality control procedures for POC meters and devices.  If the manufacturer does not require or recommend procedures for external quality control performance, the licensee shall perform control testing using at least 2 levels of liquid quality control material for each test immediately before the first patient test each calendar day.

 

          (aj)  Licensee collecting human specimens for laboratory testing shall require a collecting station license in accordance with He-P 817 except when collected by a trained registered nurse or licensed nursing assistant.

 

          (ak)  Training consists of collection, storage, and transport of the specimens.

 

          (al)  Training will be done by a registered nurse trained in the collection, storage and transport of human specimens.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM,
eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18; amd by #12893, eff 10-1-19

 

          He-P 809.16  Medication Services.

 

          (a)  All medications and treatments shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  HHCP personnel who are not authorized by law to administer medications may remind and prompt patients to take their medications at the proper time, place medication container(s), including pill planners, within patient reach, opening the medication container when patient is present, reading the medication label to the patient, and utilizing hand over hand technique, as defined in 809.03 (bb), as per the care plan without requiring documentation of specific medications taken.

 

          (c)  If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

 

          (d)  A licensed nursing assistant (LNA) may perform hand over hand assistance by following the care plan, as delegated by a licensed nurse, to a competent and stable patient pursuant to RSA 326-B.

 

          (e)  The licensee shall allow the patient to self-direct medication administration, as defined in He-P 809.03(bb), if the patient:

 

(1)  Has a physical limitation due to a diagnosis that prevents the patient from self-administration of medication with or without assistance;

 

(2)  Obtains an annual written verification of the patient’s physical limitation and self-directing capabilities from the patient’s licensed practitioner or the assessment performed by an RN according to He-P 809.15(i) and such documentation is included in the patient record; and

 

(3)  Verbally directs personnel to:

 

a.  Assist the patient with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

 

b.  Assist the patient to apply, ingest, or instill the ordered dose of medication.

 

          (f) If personnel, who are authorized by law, administer medication(s), delegate medication administration, or prepare medication in advance for administration in accordance with RSA 318:42, XIII and XIV, the HHCP shall:

 

(1)  Maintain a list of medications currently being taken by the patient;

 

(2)  Administer all medications in accordance with the orders of the licensed practitioner;

 

(3)  Maintain an order, or a copy thereof, in the patient’s record that includes:

 

a.  The patient’s name;

 

b.  The medication name, strength, prescribed dose, and route of administration;

 

c.  The frequency of administration;

 

d.  The indications for usage of all PRN medications; and

 

e.  The date ordered;

 

(4)  Only use medications that have been be kept in the original containers, as dispensed by the pharmacy, licensed practioner’s samples, or over the counter medications;

 

(5)  Require that any change or discontinuation of medications shall be pursuant to an order from a licensed practitioner or other individual authorized by law;

 

(6)  Require that all telephone orders for medications or treatments are:

 

a.  Taken only by a licensed health care professional if such action is within the scope of their practice act;

 

b.  Immediately transcribed and signed by the individual taking the order; and

 

c.  Counter-signed by the ordering practioner as soon as possible and with a documented reason if signed more than  30 days after the telephone order being taken;

 

(7)  Require that the medication to be administered by HHCP personnel be:

 

a.  Prepared immediately prior to administration; and

 

b.  Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B;

 

(8)  Require that when personnel are assisting or administering medication, they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

 

(9)  Maintain documentation for all medications either assisted by or administered by HHCP personnel that includes:

 

a.  The name of the patient;

 

b.  A list of any allergies or allergic reactions to medications;

 

c.  The name, strength, dose, frequency, and route of administration of the medications;

 

d.  The date and time medication was taken;

 

e.  The signature and identifiable initials and job title of:

 

1.  The person assisting or administering the medication; or

 

2.  The person administering or assisting the patient taking his or her medication;

 

f.  Documented reason for any medication refusal or omission; and

 

g.  For PRN medications, the reason the patient required the medication and the effect of the PRN medication at the time of the next patient contact; and

 

(10)  Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any.

 

a.  Observed adverse reactions to or side effects of medication; and

 

b.  Medication errors such as incorrect medications.

 

          (g)  If the HHCP provides “self-administration of medication with assistance” medication services to a patient as defined by He-P 809.03(bb), the HHCP shall:

 

(1)  Maintain, in the home, a list of medications currently being taken by the patient;

 

(2)  Assist with self-administration of medications in accordance with the orders of the licensed practitioner;

 

(3)  Maintain either the original order, or a copy thereof, in the patient’s record that includes:

 

a.  The patient’s name;

 

b.  The medication name, strength, prescribed dose and route of administration;

 

c.  The frequency of administration;

 

d.  The indications for usage of all PRN medications; and

 

e.  The date ordered;

 

(4)  Not allow personnel to assist with self-administration of medications if anyone other than a pharmacist has changed prescription medication container labels except as allowed by (7)f. below;

 

(5)  Require that any change or discontinuation of medications shall be pursuant to an  order;

 

(6)  Require that all telephone orders for medications or treatments are:

 

a.  Taken only by a licensed health care professional if such action is within the scope of their practice act;

 

b.  Immediately transcribed and signed by the individual taking the order; and

 

c.  Counter-signed by the ordering practioner within 30 days or with a documented reason if more than 30 days;

 

(7)  Allow a patient to self-administer medication with assistance by personnel, as directed by the care plan, and which personnel shall be required to:

 

a.  Remind the patient to take the correct dose of his or her medication at the correct time from the original medication bottle;

 

b.  Place the medication container within reach of the patient;

 

c.  Remain with the patient to observe them taking the appropriate number and type of medication as ordered by the licensed practitioner;

 

d.  Record that they have supervised the patient taking their medication on the patient’s daily medication record;

 

e.  Document in the patient’s record any observed or reported side effects, adverse reactions, refusal to take medications, and medications not taken; and

 

f.  Require that if the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HHCP are unable to obtain a new prescription label:

 

1.  The RN shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HHCP’s written procedure, indicating that there has been a change in the medication order;

 

2.  The RN shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

3.  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first;

 

(8)  Maintain documentation for all medications assisted by HHCP personnel that includes:

 

a.  The name of the patient;

 

b.  A list of any allergies or allergic reactions to medications;

 

c.  The name, strength, dose, frequency, and route of administration of the medications;

 

d.  The date and time medication, including PRN medications, was taken;

 

e.  The signature, identifiable initials, and job title of the person assisting the patient taking his or her medication; and

 

f.  Documented reason for any medication refusal or omission;

 

(9)  Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

 

a.  Observed adverse reactions to or side effects of medication; or

 

b.  Medication errors such as incorrect medications; and

 

(10)  Require LNAs who assist patients with self-administration of medications  to comply with the board of nursing requirements according to RSA 326-B

 

          (h)  A home health personal care service provider shall successfully complete a medication assistance education program taught by a licensed nurse, licensed practitioner, or pharmacist, whether in person or through other means such as electronic media, prior to assisting a patient with self-administration of medication with assistance, self-directed medication administration, or administration via nurse delegation.

 

          (i)  The medication assistance education program required by (h) above shall, at a minimum, include training on the following subjects:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights, including:

 

a.  The right patient;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as antihypertensive medications or antibiotics;

 

(5)  Desired effects and potential side effects versus adverse effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (j)  For patients who qualify for the use of therapeutic cannabis, the licensee shall keep a copy of the registry identification card in the patient’s record.

 

          (k)  The licensee shall develop, maintain, and implement a patient specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be handled and  administered to the patient.

 

          (l)  If allowed by the policy in (k) above, cannabis shall be treated  in a manner similar to controlled medications with respect to assisting qualifying patients with the therapeutic use of cannabis.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM,
eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

          He-P 809.17  Personnel.

 

          (a)  The licensee shall develop a job description for each position in the HHCP containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Qualifications and educational requirements of the position.

 

          (b)  For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care or personal care services to patients the licensee shall:

 

(1)  Obtain a criminal record check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check in (1) above in accordance with (c)(1)-(2) below; and

 

(3)  Verify the qualifications of all applicants prior to employment.

 

          (c)  Unless a waiver is granted in accordance with He-P 809.10 and (e) below, the licensee shall not offer employment, contract with, or engage a person in (b) above,for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (d)  If the information identified in (c) above regarding any person identified in (b) above,  is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (c) above.

 

          (e)  If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a patient; or

 

(2)  Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

 

          (f)  The licensee shall:

 

(1)  Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS;

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the  nursing assistant registry or licensing site with the NH board of nursing.

 

          (g)  In lieu of (b) and (f) above, the licensee may accept from independent agencies contracted by the licensee to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) and (f) above and do not meet the criteria in (c) and (f) above.

 

          (h)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position as listed on their job description;

 

(2)  Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(3)  Be licensed, registered, or certified as required by state statute;

 

(4)  Receive an orientation prior to contact with a patient that includes:

 

a.  The HHCP’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The HHCP’s policies, procedures, and guidelines;

 

d.  The HHCP’s infection control program;

 

e.  The HHCP’s fire evacuation  and emergency plans which outline the responsibilities of personnel in an emergency;

 

f.  The mandatory reporting requirements such as RSA 161:F:46-48 and RSA 169-C:29-31; and

 

g.  Body mechanics training;

 

(5)  Complete mandatory annual in-service education, which includes a review of the HCCP’s:

 

a.  Policies and procedures on patient rights and responsibilities;

 

b.  Infection control program; and

 

c.  Fire and emergency procedures;

 

(6)  Be at least 18 years of age if working as direct care personnel unless they are:

 

a.  An LNA working under the supervision of an RN in accordance with Nur 700; or

 

b.  Part of an established educational program working under the supervision of an RN;

 

(7)  Prior to contact with patients or food, submit to the HHCP the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2-step tuberculosis (TB) testing, mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(8)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

 

(9)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (i)  In lieu of (h)(8) above, independent agencies contracted by the facility to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (h)(7) and (9) above before working at the HHCP.

 

          (j)  The scope of services provided by a personal care service provider shall be as follows:

 

(1)  Basic personal care and grooming to include:

 

a.  Sponge bathing;

 

b.  Gathering and handing the patient materials related to bathing;

 

c.  Regulating the bath or shower water temperature and running the water;

 

d.  Hair care including shampooing;

 

e.  Skin care to include application of preventive skin care products;

 

f.  Filing of nails;

 

g.  Assisting with oral hygiene;

 

h.  Shaving of patient using an electric razor; and

 

i.  Dressing to include putting on or removing clothing, shoes, and stockings;

 

(2)  Transfer assistance as follows:

 

a.  Weight bearing assistance such as steadying the patient and arranging items to assist the transfer of the patient; and

 

b.  Non-weight bearing assistance on a case-by-case basis as specified by the HHCP;

 

(3)  Mobility assistance as follows:

 

a.  Accompanying the patient as he or she moves from one location to another, removing obstacles from his or her path, opening doors, and handing the patient his or her cane or walker;

 

b.  Pushing a wheelchair which has been fitted to the patient; and

 

c.  On a case-by-case basis steadying the patient as he or she ambulates;

 

(4)  Assistance with toileting and toileting hygiene measures as follows:

 

a.  Assistance with the use of the toilet, commode, bedpan, and urinal;

 

b. Assistance with the use of products related to hygiene care such as disposable incontinent briefs or pads;

 

c.  Assistance with cleaning after elimination;

 

d.  Assisting with cleaning the patient after instances of vomiting, diarrhea, and incontinence;

 

e.  Assistance with ostomy care in a long term, well healed, trouble free ostomy, such as assisting in application of the stoma bag on a case-by-case basis as individually trained by the appropriate professional staff; and

 

f.  Assistance with catheter care only by emptying the urinary drainage bag on a case-by-case basis as individually trained by the appropriate professional staff;

 

(5)  Assistance with personal appliances as follows:

 

a.  Insertion and cleaning dentures;

 

b.  Insertion and cleaning hearing aids;

 

c.  Cleaning and putting on eye glasses; and

 

d.  Assisting with application of some types of braces, splints, slings, and prostheses on a case-by-case basis as determined by the HHCP and individually trained by the appropriate professional staff; and

 

(6)  Assistance with nutrition, hydration, and meal preparation as follows:

 

a.  Preparation of the meal;

 

b.  Arranging food including cutting up or mashing the food;

 

c.  Filling the patient’s fork or spoon;

 

d.  Encouraging the patient to eat or drink; and

 

e.  Feeding the patient by mouth on a case-by-case basis as determined by the agency.

 

          (k)  The HHCP shall determine the patient-related training required by the personal care service provider, in addition to the basic training described in (m) below, in order to provide the personal care services which are on a case-by-case basis as described in (j) above.

 

          (l)  Prior to assisting patients with transfers, bathing, feeding, or dressing, personal care service providers, whose duties include the aforementioned tasks, shall attend a minimum 8-hour training in the performance of these duties, the clinical portion of which shall be conducted by a licensed professional such as an LPN or RN.

 

          (m)  The training in (j) above shall include at a minimum:

 

(1)  Orientation to home care including the role of the personal care service provider and the general orientation required by (h)(4) above;

 

(2)  Communication with patients, and understanding patient needs;

 

(3)  Personal and home safety including environmental safety and emergency response;

 

(4)  Personal care skills including:

 

a.  Supervision and verbal prompting;

 

b.  Assisting in bathing, dressing, grooming, mouth care, hair care, and skin care;

 

c.  Assisting in elimination including cleaning the patient after elimination and use of products related to hygiene care;

 

d.  Moving and transferring patients;

 

e.  Nutrition, the mechanics of eating, hydration, and how to prepare, serve, and encourage the patient to eat and drink;

 

f.  Use of assistance devices;

 

g.  Fall prevention; and

 

h.  Medication reminder training; and

 

(5)  Responsibility, accountability, and record keeping.

 

          (n)  LNAs who are working as personal care service providers shall be deemed as already having received the training required in (m) above but shall be required to receive the training required by (h)(4) above.

 

          (o)  The HHCP shall maintain a record for training of each personal care service provider.

 

          (p)  The HHCP shall provide supervision of the personal care service provider every 6 months.

 

          (q)  The director of patient services shall:

 

(1)  Coordinate the individual training required for personal care services provided on a case-by-case basis; and

 

(2)  Assure that the care plan is being carried out.

 

          (r)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud,theft, abuse, neglect, or exploitation of any person.

 

          (s)  Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients or food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

 

          (t)  All personnel shall follow the  orders of the licensed practitioner for each patient and encourage patients to follow the practitioner’s order.

 

          (u)  Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HHCP licensed premises.

 

          (v)  The employee records required by (u) above shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data, including date of birth; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the HHCP’s policy setting forth the patient rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (h)(4) above and any required continuing education program;

 

(5)  A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

 

(6)  Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Documentation of annual in-service education as required by (h)(5) above;

 

(8)  Documentation of training as required by (m) above;

 

(9)  The statement signed at the time of the initial offer of employment and renewed annually thereafter by all personnel as required by (r) above;

 

(10)  Documentation of the criminal records check; and

 

(11)  The results of the registry checks in (f) above.

 

          (w)  The HHCP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (v)(2) and (6)-(10) above; and

 

(2)  For independent contractors, the information in (v)(2), and (4)-(12) above, except that the letter in (h) and (j) above may be substituted for (v)(6), (9), and (10) above, if applicable.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.18  Quality Improvement.

 

          (a)  The HHCP shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of the HHCP quality improvement program, a quality improvement committee shall be established.

 

          (c)  The HHCP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the licensee; and

 

(7)  Evaluate the effectiveness of the corrective actions.

 

          (e)  The quality improvement committee shall meet at least quarterly.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.19  Infection Control and Sanitation.

 

          (a)  The HHCP shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand-washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of patients 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)  Reporting of infectious and communicable diseases as required by He-P 301.

 

          (c)  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.

 

          (e)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious unless they utilize appropriate infection control equipment as required by the facility’s policy and procedures on infection control.

 

          (f)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight-fitting bandage.

 

          (h)  Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

 

          (i)  If the HHCP has an incident of an infectious disease reported in (b)(5) above, the HHCP shall contact the public health nurse in the county in which the patient resides and follow the instructions and guidance of the nurse.

 

          (j)  Sterile supplies and equipment shall:

 

(1)  Be stored in dust-proof, moisture-free storage areas; and

 

(2)  Not be mixed with dirty supplies.

 

          (k)  If the HHCP has soiled items at itslicensed premises, they shall be disposed of according to the facility’s infection control policies.

 

          (l)  If equipment needs to be cleaned in order to prevent contamination, the HHCP shall develop and maintain written procedures for safe and effective cleaning of the equipment.

 

          (m)  The HHCP shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

 

          (n)  The HHCP shall not re-use any equipment or supplies that require sterilization.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.20  Physical Environment and Emergency Preparedness.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

 

(1)  Building;

 

(2)  Health, including waste disposal and water;

 

(3)  Fire; and

 

(4)  Zoning.

 

          (b)  The HHCP shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (c)  The HHCP shall be clean, maintained in a safe manner and in good repair, and kept free of hazards.

 

          (d)  Each licensee shall develop a written emergency plan that covers any situation that prevents the HHCP from providing patient services and which:

 

(1)  Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

 

(2)  Is approved by the local emergency management director or fire department, as appropriate;

 

(3)  Is available to all personnel;

 

(4)  Is based on realistic conceptual events;

 

(5)  Is modeled on the incident command system (ICS) in coordination with local emergency response agencies;

 

(6)  Provides that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Includes the HHCP's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources; and

 

f.  Communications systems;

 

(8)  Includes a plan for alerting and managing personnel in a disaster, and accessing critical incident stress management (CISM), if necessary;

 

(9)  Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a patient;

 

(10)  Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

 

(11)  If the HHCP is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

 

          (e)  Each licensee shall annually review and revise, as needed, its emergency plan.

 

Source.  #9466, eff 5-2-09; ss by #12167, INTERIM, eff
4-29-17, EXPIRED: 10-26-17

 

New.  #12640, eff 10-3-18

 

          He-P 809.21  Community Health Services.

 

          (a)  The following rules shall not apply to the HHCP when providing community health services:

 

(1)  He-P 809.14 (b), The Home Care Patients Bill of Rights; and

 

(2)  He-P 809.15:

 

a.  Paragraphs (a) and (b) on contractual agreement with patients;

 

b.  Subparagraph (h)(1)a. on  provision of the home care client Bill of Rights, procedures, and policies;

 

c.  Subparagraph (h)(3)e. on obtaining copies of advance directives;

 

d.  Paragraphs (i) and (j) on conducting health assessments;

 

e.  Paragraphs (n), (o), (p), and (q) on plan of care;

 

f.  Paragraph (t) on discharge plans; and

 

g.  Paragraphs (u), (v), and (w) on record-keeping requirements.

 

Source.  #12640, eff 10-3-18

 

PART He-P 810  BIRTHING CENTER RULES

 

He-P 810.01  Purpose.  The purpose of this part is to set forth the licensing and operating requirements for birthing centers pursuant to RSA 151:2, I(d).

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a birthing center except:

 

(a)  The facilities listed in RSA 151:2, II;

 

(b)  All entities which are owned or operated in their entirety by the state of New Hampshire, pursuant to RSA 151:2, II(h); and

 

(c)  All health promotion, disease prevention, or screening clinics operated by a New Hampshire licensed birthing center.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.03  Definitions.

 

(a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients with or without his or her informed consent.

 

(b)  “Administer” means “administer” as defined in RSA 318:1, I.

 

(c)  “Administrative remedy” means an action imposed upon a licensee in response to non-compliance with RSA 151, He-P 810, or other licensing rules.

 

(d)  “Administrator” means the licensee or individual appointed by the birthing center to be responsible for all aspects of the daily operation of the licensed premises.

 

(e)  “Admission” means the point in time when a client has been accepted by a licensee for the provision of services and is physically present in the licensed facility.

 

(f)  “Advanced practice registered nurse-certified nurse midwife (APRN-CNM)” means an individual licensed by the New Hampshire board of nursing in accordance with RSA 326-B:11 and certified by the American Certified Nurse Midwife Certification Council.

 

(g)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a birthing center pursuant to RSA 151.

 

(h)  “Area of noncompliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 810, or other federal and state requirements.

 

(i)  “Assessment” means an evaluation of the client to determine the care and services that are needed.

 

(j)  “Birthing center” means a facility that is not located in a licensed acute care hospital, and which provides prenatal care through postnatal care, and which instructs and assists women in natural childbirth.

 

(k)  “Care plan” means a written guide developed by a licensed or certified practitioner, in consultation with the client, as a result of the assessment process for the provision of care and services as required by He-P 810.16(g) and (h).

 

(l)  “Certified midwife” means a “certified midwife” as defined in Mid 301.01(b).

 

(m)  “Certified nurse-midwife” means a “certified nurse-midwife” as defined in Mid 301.01(c).

 

(n)  “Change of ownership” means a change in the controlling interest in an established birthing center to a successor business entity.

 

(o)  “Client” means any person admitted to or in any way receiving care, services, or both from a birthing center licensed in accordance with RSA 151 and all other applicable federal and state requirements.

 

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

 

(q)  “Department” means the New Hampshire department of health and human services.

 

(r)  “Direct care personnel” means any person providing hands-on care or services to a client.

 

(s)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified areas of non-compliance.

 

(t)  “Emergency” means an unexpected occurrence or set of circumstances that require immediate, remedial attention.

 

(u)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

(v)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

 

(w)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

(x)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 810, or to respond to allegations of non-compliance with RSA 151 or He-P 810.

 

(y)  “License” means the document issued by the department to an applicant at the start of operation as a birthing center, which authorizes operation in accordance with RSA 151 and He-P 810, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

 

(z)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the birthing center is licensed.

 

(aa)  “Licensed or certified practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Licensed advanced practice registered nurse-certified nurse midwife (APRN-CNM);

 

(3)  Doctor of osteopathy;

 

(4)  Doctor of naturopathic medicine with certification in natural childbirth; or

 

(5)  Certified midwife.

 

(ab)  “Licensed premises” means the facility that comprises the physical location that the department has approved for the birthing center to conduct operations in accordance with its license.  It can include the private home of the licensed or certified practitioner, but it does not include the private residence of a client receiving services from the birthing center licensed under the authority of RSA 151.

 

(ac)  “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151and He-P 810.

 

(ad)  “Licensing classification” means the specific category of services authorized by a license.

 

(ae)  “Medical director” means a New Hampshire licensed physician, doctor of naturopathic medicine with certification in natural childbirth, or an APRN-CNM who is responsible for overseeing the quality of medical care and services at the birthing center.

 

(af)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

(ag)  “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a client.

 

(ah)  “Owner” means a person or organization who has controlling interest in the birthing center.

 

(ai)  “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct care or services to a client.

 

(aj)  “Physician” means an individual licensed in the state of New Hampshire pursuant to RSA 329.

 

(ak)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

(al)  “Pro re nata (PRN) medication” means medication taken as circumstances may require.

 

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

 

(an)  “Reportable incident” means an occurrence of an error, a negative outcome, or an accident, which occurs while the client is in the care of the licensee, and has resulted in injury that requires examination or treatment by a licensed practitioner.

 

(ao)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.04  License Application Requirements.

 

(a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (8/4/2016 edition), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

 

b.  For any birthing center to be newly licensed on or after July 1, 2016:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any birthing center to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. section 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. section 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

 

(2)  A floor plan of the prospective birthing center including the location of all beds;

 

(3)  Proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable $150.00 fee, in accordance with RSA 151:5, XXI, payable in cash or, if paid by check or money order, in the exact amount of the fee, made payable to the “Treasurer, State of New Hampshire;”

 

(5)  A resume identifying the name and qualifications of the birthing center administrator and medical director;

 

(6)  Copies of applicable licenses, certificates, or both, for the birthing center administrator and medical director;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or, if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all local applicable zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, including the ambulatory health care chapter of National Fire Protection Association (NFPA) 101 as adopted by the department of safety, and local fire ordinances applicable for a birthing center; or

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(8)  If the birthing center uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and 704.02, or if a public water supply, a copy of a water bill; and

 

(9)  For a birthing center to be newly licensed on or after July 1, 2016, and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. section 485.610 (b) and (c), a letter from the chief executive officer of the hospital stating that the proposed new birthing center will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital.

 

(b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.05  Processing of Applications and Issuance of Licenses.

 

(a)  An application for an initial license shall be deemed to be complete when the department determines that all items required by He-P 810.04(a) have been received.

 

(b)  If an application does not contain all of the items required by He-P 810.04(a), the department shall notify the applicant in writing of the items required to be submitted before the application can be processed.

 

(c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

(d)  Licensing fees shall not be transferable to any other application(s).

 

(e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 810.13(b) if, after reviewing the information in He-P 810.18(a)-(b), it determines that the applicant, administrator, or a household member:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of clients.

 

(f)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

(g)  Following an inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 810.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.06  License Expirations and Procedures for Renewals.

 

(a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued, unless a completed application for renewal has been received.

 

(b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 810.04(a)(1) at least 120 days prior to the expiration of the current license.

 

(c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 810.04(a)(1) and (4);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 810.10(f), if applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 810.18(c); and

 

(5)  A statement identifying any variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03–6005.04, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (d)  In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (e)  Following an inspection as described in He-P 810.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) and (d) above, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of noncompliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 810 at the renewal inspection.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 810.04.

 

          (g)  If a licensee chooses to cease the operation of the birthing center, the licensee shall submit written notification to the department at least 45 days in advance.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.07  Birthing Center Construction, Modifications, or Structural Alterations.

 

          (a)  Notice and accurate architectural plans or drawings that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

 

(1)  A new building;

 

(2)  Additions to a building;

 

(3)  Alterations that require approval from local or state authorities; and

 

(4)  Modifications that might affect compliance with the health and safety, fire or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

 

          (b)  Architectural sprinkler and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

(c)  Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

(d)  The department shall review plans for construction, modifications, or structural alterations of a birthing center for compliance with all applicable sections of RSA 151 and He-P 810 and notify the applicant or licensee as to whether the proposed plans comply with these requirements. 

 

(e)  Department approval shall not be required prior to initiating construction, modifications, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

(f)  The birthing center shall comply with the applicable licensing rules when doing construction, modifications, or structural alterations.

 

(g)  Any licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

 

(1)  The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

(2)  The state building code, as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  Local rules, regulations, and ordinances.

 

(h)  Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

(i)  Exceptions or variances pertaining to the state fire code referenced in (g)(1) above shall be granted only by the state fire marshal.

 

(j)  The building or renovated space shall be subject to an inspection pursuant to He-P 810.09 prior to its use.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.08  Birthing Center Requirements for Organizational or Service Changes.

 

(a)  The birthing center shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds; or

 

(6)  Services.

 

(b)  The birthing center shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in number of beds.

 

(c)  When there is a change in address without a change in location, the birthing center shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

(d)  When there is a change in the name, the birthing center shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

(e)  When there is to be a change in the services provided, the birthing center shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

(f)  The department shall review the information submitted under (e) above and determine if the added services can be provided under the birthing center’s current license.

 

(g)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of noncompliance was submitted and accepted by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of beds; or

 

(4)  A change in licensing classification.

 

(h)  A new license shall be issued for a change in ownership or physical location.

 

(i)  A revised license and license certificate shall be issued for a change in name.

 

(j)  A license certificate shall be issued at the time of initial licensure.

 

(k)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator or medical director;

 

(2)  An increase or decrease in the number of beds;

 

(3)  A change in the scope of services provided;

 

(4)  A change in address without a change in physical location; or

 

(5)  When a waiver has been granted.

 

(l)  The birthing center shall notify the department in writing as soon as possible prior to a change in administrator or medical director and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical

director; and

 

(2)  Copies of applicable licenses, certificates, or both, for the new administrator or medical director.

 

(m)  Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 810.15(a) for an administrator and He-P 810.15(d) for a medical director.

 

(n)  If the department determines that the new administrator or medical director does not meet the qualifications for their position as specified in (m) above, it shall so notify the birthing center in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

(o)  A restructuring of an established birthing center that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

(p)  Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

 

(q)  Licensees shall inform the department in writing via e-mail, fax, or mail of any change in the facility’s e-mail address as soon as practicable and in no case later than 10 days of the change, as this is the primary method used for all emergency notifications to the facility.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.09  Inspections.

 

(a)  For the purpose of determining compliance with RSA 151 and He-P 810, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services being provided by the birthing center; and

 

(3)  Any records required by RSA 151 or He-P 810.

 

(b)  The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 810 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as provided for in He-P 810.08(g)(1);

 

(3)  A change in the physical location of the birthing center; 

 

(4)  A change in the licensing classification, as defined in He-P 810.03(ad);

 

(5)  An increase in the number of beds;

 

(6)  Occupation of space after construction, modifications, or structural alterations; or

 

(7)  The renewal of a license.

 

(c)  In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department.

 

(d)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (a) above, that the prospective premises is not in full compliance with RSA 151 and He-P 810.

 

(e)  A statement of findings for clinical inspections or a notice to correct for life safety inspections shall be issued when, as a result of any inspection, the department determines that the birthing center is in violation of any of the provisions of He-P 810, RSA 151, or any applicable code.

 

(f)  If areas of noncompliance were cited in either a statement of findings or a notice to correct, the licensee shall submit a written POC, in accordance with He-P 810.12(c), within 21 days of the date on the letter that transmits the statement or notice.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.10  Waivers.

 

(a)  Applicants or licensees seeking waivers of specific rules in He-P 810 shall submit a written request for a waiver to the commissioner, that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule for which a waiver is sought.

 

(b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

(c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety or well-being of the clients; and

 

(3)  Does not affect the quality of client services.

 

(d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

(e)  Waivers shall not be transferable.

 

(f)  When a licensee wishes to renew the waiver beyond the approved period of time, the licensee shall apply for a new waiver at least 60 days prior to the expiration of the existing waiver by submitting the information required by (a) above.

 

(g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #5635, eff 6-7-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.11  Complaints and Investigations.

 

(a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 810.

 

(b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the birthing center, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 810.

 

(c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

(d)  The following shall apply for a licensed birthing center:

 

(1)  The department shall provide written notification of the results of the investigation to the licensee along with a statement of findings or notice to correct if areas of noncompliance were found as a result of the investigation;

 

(2)  The department shall notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  If the department determines that the complaint is unfounded or does not violate any statutes or rules, the department shall notify the licensee in writing and take no further action; and

 

(4)  If the investigation results in areas of noncompliance being cited, the licensee shall be required to submit a POC in accordance with He-P 810.12(c).

 

(e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above the department shall issue a written warning to immediately comply with RSA 151 and He-P 817; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (i) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

(f)  Complaint investigations shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; and

 

(4)  In connection with an adjudicative proceeding relative to licensure.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.12  Administrative Remedies.

 

(a)  The department shall impose administrative remedies for violations of RSA 151, He-P 810, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a license;

 

(4)  Imposing fines upon an unlicensed individual, applicant, or licensee in accordance with (f) below; or

 

(5)  Monitoring of a licensee.

 

(b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules;

 

(2)  Identifies the specific remedy(s) that has been imposed; and

 

(3)  Provides the following information:

 

a.  The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the imposition of a fine; and

 

b.  The automatic reduction of a fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of noncompliance has been corrected, or a POC has been accepted and approved by the department.

 

(c)  A POC shall be developed and complied with in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of noncompliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the noncompliance does not recur; and

 

c.  The date by which each area of noncompliance shall be corrected;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 810;

 

b.  Addresses all areas of noncompliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 810 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of noncompliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, or as extended under (5)b. above, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 810.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with (f)(12) below.

 

(d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection or investigation, areas of noncompliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

(e)  If, at the time of the next inspection, the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny an application for a renewal of a license in accordance with He-P 810.13; or

 

(3)  Revoke the license in accordance with He-P 810.13.

 

(f)  The department shall impose fines as follows:

 

(1)  For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine for an applicant or unlicensed provider shall be $2000.00;

 

(2)  For failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for the applicant, unlicensed provider, or licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

 

(4)  For failure to transfer a client whose needs change such that the needs exceed the services or programs authorized by the license, in violation of RSA 151:5-a and He-P 810.14(k), the fine for a licensee shall be $500.00;

 

(5)  For acceptance or admission of a client whose needs exceed the services or programs authorized by the licensee’s licensing classification, in violation of RSA 151:5-a and He-P 810.14(j), the fine for a licensee shall be $1000.00;

 

(6)  For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 810.11(j), the fine for an unlicensed provider or licensee shall be $500.00;

 

(7)  For submitting a renewal application for a license less than 120 days prior to the expiration date, in violation of He-P 810.06(b), the fine for the licensee shall be $100.00;

 

(8)  For failure to notify the department prior to a change of ownership, in violation of He-P 810.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For failure to notify the department prior to a change in the physical location, in violation of He-P 810.08(a)(2), the fine for a licensee shall be $500.00;

 

(10)  For failure to allow access by the department to a birthing center’s programs, services or records, in violation of He-P 810.14(n), the fine for an applicant, unlicensed provider, or licensee shall be $2000.00;

 

(11)  For failure to submit a POC or a revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the statement of findings or notice to correct, in violation of He-P 810.12(c)(2) or He-P 810.12(c)(5)b., the fine for a licensee shall be $100.00;

 

(12)  For failure to implement any POC that has been accepted or issued by the department, in violation of He-P 810.12(c)(8), the fine for a licensee shall be $1000.00; 

 

(13)  For failure to establish, implement, or comply with licensee policies, as required by He-P 810.14(b) and He-P 810.14(h)(2), the fine for a licensee shall be $500.00;

 

(14)  For failure to provide medical services required by the license and specified by He-P 810.15(d), the fine for a licensee shall be $500.00;

 

(15)  For exceeding the licensed capacity of the birthing center, in violation of He-P 810.14(l), the fine for a licensee shall be $500.00 per day, multiplied by the number of unauthorized clients present;

 

(16)  For furnishing or making false or misleading statements or reports to the department, or for falsification of information contained on an application or of any records required to be maintained for licensing, in violation of He-P 810.14(e), the fine for an applicant or licensee shall be $500.00 per offense;

 

(17)  For failure to meet the needs of the client, in violation of He-P 810.14(h)(3), the fine for a licensee shall be $500.00;

 

(18)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 810.15(a) and He -P 810.18(d), respectively, or under circumstances where the department has not granted a waiver in accordance with He-P 810.10, the fine for a licensee shall be $500.00;

 

(19)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 810.07(a), the fine for a licensed facility shall be $500.00;

 

(20)  When an inspection determines that a violation of RSA 151 or He-P 810 has the potential to jeopardize the health, safety, or well-being of a client, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of noncompliance is cited within 2 years of the original area of noncompliance the fine for a licensee shall be $1000.00; and

 

b.  If the same area of noncompliance is cited for a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00 per area of noncompliance;

 

(21)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 810 shall constitute a separate violation and shall be fined in accordance with He-P 810.12; and

 

(22)  If the applicant or licensee is making good faith efforts to comply with (4), (6) and (15) above, the department shall not issue a daily fine.

 

(g)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.13  Enforcement Actions and Hearings.

 

(a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department; and

 

(3)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

(b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 810 which poses a threat to the health, safety, or well-being of a client;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 810.04;

 

(5)  An applicant, licensee or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  A licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department, in accordance with He-P 810.12(c), (d), and (e);

 

(7)  A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 810.12(c)(5) and has not submitted a revised POC as required by He-P 810.12(c)(5)b;

 

(8)  A licensee is cited a third time under RSA 151 or He-P 810 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(10)  For an initial license, upon inspection, the applicant’s premises are not in full compliance with RSA 151 or He-P 810;

 

(11)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(12)  The owner(s), licensee, or administrator has been found guilty of or plead guilty to a felony assault, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state.

 

(c)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

(d)  If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

 

(e)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of clients is in jeopardy and emergency action is required, in accordance with RSA 541-A:30, III.

 

(f)  If the immediate suspension of a license is ordered:

 

(1)  The licensee shall immediately cease to operate; and

 

(2)  The department shall hold a hearing within 10 working days of the date the order was issued.

 

(g)  If an immediate suspension is upheld at the hearing described in (f)(2) above, the licensee shall not operate until the department determines through inspection that compliance with RSA 151 and He-P 810 is achieved.

 

(h)  Hearings and appeals of department decisions under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

(i)  When a birthing center’s license has been denied or revoked, the the applicant, licensee, administrator, or medical director shall not be eligible to apply for a license, or be employed as an administrator or medical director for at least 5 years, if the enforcement action specifically pertained to their role in the program.

 

(j)  The 5-year period referenced in (i) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

(k)  Notwithstanding (i) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 810.

 

(l)  RSA 541 shall govern further appeals of department decisions under this section.

 

(m)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 810.

 

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

 

(o)  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.

 

(p)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement or notice is determined to be incorrect. The department shall provide notice to the applicant or licensee of the determination.

 

(q)  The deadline to submit a POC in accordance with He-P 810.12(c)(2) shall not apply until the notice of the determination to not make a change to the statement of findings or notice to correct in (o) above has been provided to the applicant or licensee.

 

(r)  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.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

He-P 810.14  Duties and Responsibilities of All Licensees.

 

(a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

 

(b)  The licensee shall have a written policy and procedures setting forth the rights and responsibilities of clients admitted to the birthing center in accordance with RSA 151:20.

 

(c)  The licensee shall define, in writing, the scope and type of services to be provided at the birthing center, including the client services required in He-P 810.16.

 

(d)  The licensee shall assess and monitor the quality of care and services.

 

(e)  The licensee shall not falsify any information contained in:

 

(1)  The “Application for Residential or Health Care License,” or any other documents required for the licensing of a birthing center; or

 

(2)  The records required to be maintained for the clients and personnel of the birthing center.

 

          (f)  The licensee shall not advertise or otherwise represent the birthing center as having residential care or health care programs or services for which they are not licensed to provide.

 

          (g)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (h)  Licensees shall have responsibility and authority for:

 

(1)  Managing, controlling, and operating the birthing center;

 

(2)  Developing and implementing written policies and procedures governing all of the operations and services provided, and for:

 

a.  Reviewing the policies and procedures annually; and

 

b.  Revising as needed;

 

(3)  Meeting the needs of a client when the client is in the care of the birthing center;

 

(4)  Establishing, in writing, a chain of command that sets forth the line of authority for the operation of the birthing center;

 

(5)  Appointing an administrator;

 

(6)  Appointing a medical director;

 

(7)  Verifying the qualifications of all personnel;

 

(8)  Providing sufficient numbers of personnel who are present in the birthing center and are qualified to meet the needs of clients during all hours of operation, in accordance with He-P 810.15(f)(1);

 

(9)  Reporting all positive tuberculosis test (TB) results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03;

 

(10)  Providing the birthing center with sufficient supplies, equipment, and lighting to ensure that the needs of clients are met; and

 

(11)  Implementing any POC that has been accepted or issued by the department.

 

          (i)  The licensee shall consider all clients to be competent and capable of making health care decisions unless the client:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction;

 

(2)  Has a durable power of attorney for health care that has been activated; or

 

(3)  Is a minor.

 

          (j)  The licensee shall only admit a client whose needs can be met through the programs and services offered under the current license.

 

          (k)  If the licensee has a client whose needs cannot be met by the programs and services offered at the birthing center, the licensee shall transfer the client to a licensed facility whose current license classification will allow it to meet the needs of the client.

 

          (l)  The birthing center shall not exceed the number of licensed beds authorized by the department.

 

          (m)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in an area of the birthing center that is conspicuous and open to clients and the general public:

 

(1)  The current license issued in accordance with RSA 151:2;

 

(2)  All statements of findings and notices to correct issued in accordance with He-P 810.09(d) and He-P 810.11(f) for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, N.H. 03301 or by calling 1-800-852-3345; and

 

(5)  The licensee’s evacuation floor plan identifying the location of and access to all fire exits.

 

          (n)  The licensee shall admit and allow any department representative to inspect the birthing center and all programs and services they are providing at any time for the purpose of determining compliance with RSA 151 and He-P 810 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (o)  For reportable incidents, the licensee shall:

 

(1)  Fax to 271-5574 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident as defined in He-P 810.03(an):

 

a.  The birthing center’s name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of client(s) involved in the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  When the client’s guardian or agent, if any, or personal representative, or emergency contact person was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the clients licensed practitioner was notified, if applicable; and

 

(2)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (p)  A licensee shall provide a client or their guardian, agent acting pursuant to an activated durable power of attorney (DPOA), or anyone else authorized in writing by the client with a copy of the client’s record pursuant to the provisions of RSA 151:21, X, upon request.

 

          (q)  All records required for licensing shall:

 

(1)  Be available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a;

 

(2)  Be legible, current and accurate; and

 

(3)  Be maintained in a secure manner that safeguards confidentiality and prevents tampering with data.

 

          (r)  Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of clients and staff that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent deletion;

 

(2)  Safeguards to ensure the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (s)  The licensee shall comply with the patient’s bill of rights as set forth in RSA 151:21.

 

          (t)  The licensee shall provide housekeeping and maintenance service, as needed to protect clients, personnel, and the public.

 

          (u)  Applicants, licensees, and staff shall cooperate with the department during all departmental visits authorized under RSA 151 and He-P 810, including allowing representatives of the department to:

 

(1)  Enter and complete an inspection of the premises;

 

(2)  Review and reproduce any forms or reports which are required to be maintained or made available to the department; and

 

(3)  Interview staff and clients of the birthing center.

 

          (v)  The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.15  Required Services.

 

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

 

(1)  Has a bachelor’s degree in business administration or health and human services;

 

(2)  Is a licensed physician in the State of New Hampshire;

 

(3)  Is a certified midwife or certified nurse midwife (CNM) in the State of New Hampshire; or

 

(4)  Is an APRN-CNM in the State of New Hampshire.

 

          (b)  The licensee shall establish a process for verifying the credentials of personnel involved in the direct care of the client which includes written documentation that:

 

(1)  The individual is licensed or certified to practice health care in New Hampshire, if required; and

 

(2)  The individual has the requisite education and experience to meet the requirements of the position, and required by this section.

 

          (c)  In addition to (b) above, the licensee shall:

 

(1)  Document that each employee involved in the direct care of clients has been advised of the duties that they may perform;

 

(2)  Establish in writing the process for updating the scope of practice of personnel as necessary; and

 

(3)  Conduct an annual review of all credentialed personnel and document the review in their file.

 

          (d)  The licensee shall provide medical services that include the appointment of a medical director who:

 

(1)  Is a physician licensed in the State of New Hampshire;

 

(2)  Is an APRN-CNM licensed in the State of New Hampshire; or

 

(3)  Is a doctor of naturopathic medicine with certification in natural childbirth.

 

          (e)  The medical director shall:

 

(1)  Participate in the development of policies and procedures for the birthing center;

 

(2)  Participate in the birthing center’s quality improvement program; and

 

(3)  Provide consultation to the birthing center’s personnel.

 

          (f)  In addition to (d) above, the licensee shall:

 

(1)  Provide qualified personnel sufficient to meet the needs of clients that, at a minimum, shall include:

 

a.  A primary caregiver to attend each birth that is:

 

1.  An obstetrician;

 

2.  A family practice physician;

 

3.  A licensed APRN;

 

4.  A certified midwife; or

 

5.  A naturopathic doctor with certification in natural childbirth; and

 

b.  A second person to attend each birth that has been verified by the birthing center as being appropriately credentialed as specified in (b) above;

 

(2)  Have at least 2 persons on call when births are anticipated, one of whom is a person listed under (f)(1)a. above; and

 

(3)  Provide the following services in the birthing center or at the home of the client:

 

a.  Orientation to the birthing center, the fees, and the services of the birthing center;

 

b.  Education for pregnancy, labor, breastfeeding, infant care, early discharge, parenting, and sibling preparation;

 

c.  Prenatal care;

 

d.  Intrapartum care;

 

e.  Postpartum care; and

 

f.  Follow up care for the mother and newborn.

 

          (g)  The following services shall be prohibited in the birthing center or at the home of the client:

 

(1)  Regional or general anesthesia including awake sedation;

 

(2)  Vacuum extraction; and

 

(3)  Chemical induction and augmentation.

 

          (h)  The licensee shall provide dietary services that include light nourishment during labor and postpartum.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, eff 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.16  Client Services.

 

          (a)  At the time of admission, personnel of the birthing center shall:

 

(1)  Provide, both verbally and in writing, to the client or the client’s legal representative, the birthing center’s policy on client rights and responsibilities, complaint procedure, and rules and obtain written confirmation acknowledging receipt of the policies;

 

(2)  Collect and record the following information:

 

a.  Client’s name, home address, and home telephone number;

 

b.  Client’s date of birth;

 

c.  Name, address, and telephone number of an emergency contact;

 

d.  Name of client’s primary care provider with the address and telephone number; and

 

e  Client’s insurance information, if applicable;

 

(3)  Provide an orientation to the scope of services provided at the birthing center;

 

(4)  Provide instruction and education relevant to the following:

 

a.  Conception;

 

b.  Health and nutrition;

 

c.  Pregnancy;

 

d.  Lactation and lactation assistance;

 

e.  Family planning

 

f.  The postpartum period;

 

g.  Holistic care;

 

h.  Early recognition and prevention of potential health problems;

 

i.  Detection of any abnormal conditions in the mother, fetus, and newborn;

 

j.  Procurement of medical assistance, if necessary; and

 

k.  Execution of emergency measures in the absence of medical help, if necessary;

 

(5)  Complete a health examination and a social, family, medical, reproductive, nutritional, and behavioral history;

 

(6)  Obtain from the client documentation of informed consent; and

 

(7)  Obtain from the client a written consent for release of information, if the client so

authorizes.

 

          (b)  Only clients who meet the eligibility criteria and have registered at least 4 weeks prior to the anticipated date of birth shall be admitted to the birthing center.

 

          (c)  In order to be eligible:

 

(1)  The client’s licensed or certified practitioner shall determine that the client was medically, psychologically, surgically, and obstetrically uncomplicated during her prenatal care;

 

(2)  A client shall not present any of the following contraindications:

 

a.  Placenta previa;

 

b.  Multiple fetuses;

 

c.  Insulin dependent diabetes;

 

d.  Previous cesarean section, unless authorized in accordance with Mid 503; or

 

e.  Rh factor sensitivity with positive antibody titre;

 

(3)  A client shall have written approval from a medical doctor (MD), doctor of osteopathic medicine (DO) with certification in natural childbirth, or APRN-CNM to deliver in the birthing center if she presents with any of the following potential medical risk factors:

 

a.  Maintenance on anti-epileptic medications without convulsive activity within the last year;

 

b.  Blood dyscrasias;

 

c.  Current hepatitis;

 

d.  A positive HIV test result or AIDS;

 

e.  Current alcoholism;

 

f.  Current drug addiction, including use of hallucinogens;

 

g.  Chronic pulmonary disease that interferes with oxygen saturation;

 

h.  Chronic hypertension;

 

i.  Past history of significant heart disease; or

 

j.  Maintenance on psychotropic medication which, as a result of a consultation with the client’s physician, has been determined to have a sedating effect on the newborn.

 

          (d)  All clients who present with, or develop during prenatal care, any one or more of the following shall be evaluated by a physician or a certified nurse midwife to determine appropriateness for delivery in a birthing center:

 

(1)  Younger than 16 or older than 45 years of age;

 

(2)  High blood pressure, which is defined as 140/90 or elevation of 30 systolic or 15 diastolic on at least 2 occasions, at least 6 hours apart;

 

(3)  Anemia, which is defined as hemoglobin of less than 10 grams, unresolved at term;

 

(4)  History of genetic problems or previous intrauterine death at greater than 20 weeks or unexplained stillbirth;

 

(5)  Possibility of multiple fetuses, malpresentation, or fetus too small or large for gestational age;

 

(6)  Past history of significant hemorrhaging during delivery, which is defined as the loss of 500 cubic centimeters (cc) of blood or greater;

 

(7)  Abnormal Pap smear;

 

(8)  Active primary herpes at term;

 

(9)  Positive cervical herpes cultures;

 

(10)  Indications that the fetus has died in utero;

 

(11)  Suspected postmaturity greater than 42 weeks;

 

(12)  Heart murmur or arrhythmia other than functional;

 

(13)  Prior obstetrical problems, including, but not limited to:

 

a.  Past prematurity;

 

b.  Uterine abnormalities;

 

c.  Placental abruption; and

 

d.  Incompetent cervix;

 

(14)  Development of other conditions potentially detrimental to the pregnancy, such as recurrent urinary tract or kidney infection or active gonorrhea;

 

(15)  Polyhydramnios or oligohydramnios;

 

(16)  Suspected intrauterine growth retardation;

 

(17)  Condyloma acuminata, significant or intravaginal;

 

(18)  Suspected premature labor less than 37 weeks;

 

(19)  Present with or develop a significant overweight or underweight state; or

 

(20)  Non-insulin dependent gestational diabetes or abnormal glucose challenge test.

 

          (e)  If the client’s risk factors, as outlined in (d) above, have been evaluated by an MD, DO with certification in natural childbirth, or APRN-CNM and deemed appropriate for delivery in the birthing center, the MD, DO with certification in natural childbirth, or APRN-CNM shall:

 

(1)  Provide written documentation of their approval; and

 

(2)  Include this documentation as part of the client’s record.

 

          (f)  Any client who develops the following conditions during prenatal care shall be prohibited from delivery at the birthing center and transferred to the care of a physician or a certified nurse midwife for a hospital delivery:

 

(1)  Multiple fetuses;

 

(2)  Malpresentation, including breech position, that is not resolved before the onset of labor;

 

(3)  Confirmation that the fetus is small for gestational age;

 

(4)  Placenta previa or abruptio placenta;

 

(5)  Onset of labor prior to the 37th week of pregnancy; or

 

(6)  Insulin dependent diabetes.

 

          (g)  A care plan shall be developed and revised based on needs identified by the client’s licensed or certified practitioner.

 

          (h)  If a certified midwife is the primary practitioner, the midwife shall consult with a physician or licensed APRN who is certified as a midwife and develop a plan of care for all clients who present with the following conditions:

 

(1)  Maternal distress as indicated by:

 

a.  Hypertension; which is a systolic reading of 30 mm of mercury and a diastolic reading of 15 mm of mercury over baseline;

 

b.  Blood loss greater than 500 cc; or

 

c.  Temperature greater than 100 degrees Fahrenheit or less than 97 degrees Fahrenheit;

 

(2)  Prolonged rupture of the membranes prior to the onset of labor for more than 18 hours;

 

(3)  Fetal distress as indicated by:

 

a.  Persistent bradycardia;

 

b.  Persistent tachycardia; or

 

c.  Particulate meconium;

 

(4)  Failure to progress in spite of active labor that is defined as:

 

a.  A lack of steady dilation and descent after 24 hours for primigravida or 18 hours for multigravida during the first stage of labor;

 

b.  A lack of fetal descent after 2 hours during the second stage of labor; or

 

c.  Failure to deliver the placenta after one hour during the third stage of labor;

 

(5)  Neonatal distress as indicated by:

 

a.  Obvious congenital anomalies;

 

b.  Apical pulse rate greater than 160 per minute;

 

c.  Respiratory rate greater than 80 per minute;

 

d.  Temperature outside the parameters of 97.7 to 99.4 degrees Fahrenheit or 36.5 to 37.5 degrees Celsius;

 

e.  Persistent signs of respiratory difficulty without signs of improvement within one hour after birth;

 

f.  Persistent central cyanosis or pallor;

 

g.  Signs of hypoglycemia, such as jitteriness, lethargy or hypothermia;

 

h.  Jaundice appearing before 24 hours after birth;

 

i.  Small for gestational age; or

 

j.  A 5 minute Apgar score that is 6 or 7.

 

          (i)  All clients who present the following conditions during labor or delivery shall be immediately transferred to a hospital:

 

(1)  Malpresentation;

 

(2)  Multiple fetuses;

 

(3)  Prolapsed cord;

 

(4)  Neonatal distress as indicated by:

 

a.  Apnea with persistent central cyanosis or pallor;

 

b.  Persistent grunting and retractions;

 

c.  A 5 minute Apgar score of 5 or less, or failure to achieve an Apgar score of 7 within 30 minutes; or

 

d.  Jaundice before 24 hours; or

 

(5)  Uncontrolled maternal bleeding.

 

          (j)  Prenatal care shall be provided at the home of the client, at the office of the licensed practitioner, or at the birthing center.

 

          (k)  Prenatal care shall include, but is not limited to:

 

(1)  A health examination including pelvic and speculum exam, as applicable;

 

(2)  A social, family, medical, reproductive, nutritional, and behavioral history;

 

(3)  Assessing vital signs including blood pressure;

 

(4)  Arranging for the following blood tests if not previously completed during the present pregnancy:

 

a.  Complete blood count (CBC);

 

b.  Blood type and Rh antibody screen;

 

c.  Rubella titre;

 

d.  Syphilis serology;

 

e.  Hepatitis B surface antigen; and

 

f.  HIV testing, if requested by the client;

 

(5)  An initial nutritional assessment and counseling;

 

(6)  Pap smear, if not done in the last 2 years;

 

(7)  Chlamydia and gonorrhea screening tests, as applicable;

 

(8)  Establishment of gestational age; and

 

(9)  Advising of available prenatal testing.

 

          (l)  Following the initial visit, the licensed or certified practitioner shall see the client:

 

(1)  Once a month through the 28th week of pregnancy;

 

(2)  Once every 2 weeks from the 28th week until the 36th week of pregnancy; and

 

(3)  Once a week from the 36th week of pregnancy until the onset of labor.

 

          (m)  Each prenatal visit shall include, but is not limited to, the following care:

 

(1)  Determining weight;

 

(2)  Assessing blood pressure;

 

(3)  Urine dip for protein and glucose, which may be performed by the client;

 

(4)  Assessment of general health;

 

(5)  Monitoring of uterine measurements, fetal heart rate, and fetal activity; and

 

(6)  Arranging for birthing center tests or procedures as indicated.

 

          (n)  Intrapartum care shall include, but is not limited to:

 

(1)  Monitoring the condition of mother and fetus;

 

(2)  Providing emotional and physical support;

 

(3)  Assisting with the delivery;

 

(4)  Repairing minor tears or episiotomies as necessary;

 

(5)  Examination and assessment of the newborn;

 

(6)  Inspection of the placenta, membranes, and cord vessels; and

 

(7)  Management of any maternal or neonatal complications.

 

          (o)  Postpartum care shall include, but is not limited to:

 

(1)  Remaining with the client and newborn for a minimum of 2 hours after birth or until:

 

a.  The infant:

 

1.  Is alert;

 

2.  Has good color;

 

3.  Has a good sucking reflex;

 

4.  Is breathing normally; and

 

5.  Has a stable temperature within the range of 97 to 100 degrees F; and

 

b.  The mother:

 

1.  Has a firm fundus;

 

2.  Does not have excessive vaginal bleeding;

 

3.  Is afebrile;

 

4.  Has voided; and

 

5.  Has established successful breastfeeding, if applicable;

 

(2)  Obtaining or arranging for a blood sample from the newborn for metabolic disorders as required by RSA 132:10-a;

 

(3)  Providing the client with information on routine postpartum and newborn care, including follow up care with a pediatrician or family practitioner for the newborn;

 

(4)  Providing the client’s obstetrician, primary care physician, pediatrician, or certified nurse midwife with a written summary of labor and delivery and an assessment of the newborn;

 

(5)  Contacting the client by telephone within 24 hours of discharge to establish well-being and health of mother and newborn;

 

(6)  Providing 2 postpartum visits within 6 weeks of delivery; and

 

(7)  Managing any complications that may arise and, based on the complication:

 

a.  Consulting with a physician under the arrangements required by Mid 502.06 or a certified nurse midwife; or

 

b.  Transferring the client with notification to the consulting physician or certified nurse midwife.

 

          (p)  The certified nurse midwife or certified midwife, or other person authorized by law, shall administer the following medications as clinically indicated:

 

(1)  Rhogam (immune globulin) for Rh blood incompatibility;

 

(2)  Eye prophylaxis for prevention of gonococcal infection in the newborn;

 

(3)  Oxygen for fetal distress and infant resuscitation;

 

(4)  Lidocaine hydrochloride by infiltration only for the purpose of postpartum repair of tears, lacerations, or episiotomies;

 

(5)  Vitamin K, orally or intramuscular, for prevention of hemorrhagic disease in the newborn;

 

(6)  Oxytocins, orally or intramuscular, for control of postpartum maternal hemorrhage; and

 

(7)  Intravenous fluids as an emergency measure for maternal complications.

 

          (q)  Birthing center personnel shall follow the orders of the licensed or certified practitioner.

 

          (r)  The client’s record shall contain written notes for:

 

(1)  All care and services provided at the birthing center, including:

 

a.  Date and time that the care or services were provided;

 

b.  Description of the care or services provided;

 

c.  Client’s response to the care or services provided; and

 

d.  Signature and title of the person providing the care or service; and

 

(2)  Any reportable incidents involving the client, which shall include, but not be limited to:

 

a.  Date and time of the reportable incident;

 

b.  Description of the reportable incident, including identification of injuries, if applicable;

 

c.  Actions taken by personnel, including follow-up;

 

d.  Date and time the emergency contact person, guardian, or agent acting pursuant to a DPOA and the licensed or certified practitioner were notified if medical intervention was required;

 

e.  Signature and title of the person reporting the unusual incident; and

 

f.  Signature and title of the person completing the report.

 

          (s)  The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX.

 

          (t)  In addition to (s) above, the use of mechanical restraints shall be prohibited.

 

          (u)  Clients shall be transferred or discharged from the birthing center:

 

(1)  In accordance with:

 

a.  RSA 151:21,V and RSA 151:26; and

 

b.  The birthing center’s policies; and

 

(2)  When there is:

 

a.  A written order from a licensed practitioner;

 

b.  A medical emergency and the client is in need of care and services not available at the birthing center; or

 

c.  The client has developed one of the conditions listed in (f) above.

 

          (v)  A summary shall be written for any client discharged or transferred from the birthing center which includes:

 

(1)  The date and time the client left the birthing center;

 

(2)  The place to which the client was transferred or discharged;

 

(3)  The condition of the client at the time of discharge or transfer; and

 

(4)  The discharge plan and instructions for home and follow up care.

 

          (w)  After receiving permission from the client or legal representative, copies of the clinical progress notes and medication records shall accompany the transferred client.

 

          (x)  For each client accepted for care and services at the birthing center, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  The written confirmation required by (a)(1) above;

 

(2)  The identification data required by (a)(2) above;

 

(3)  The record of the health examination required by (a)(5) above;

 

(4)  Consent forms and release forms required by (a)(7) above;

 

(5)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

 

(6)  Results of any birthing center tests or ultrasounds;

 

(7)  All consultation reports;

 

(8)  All assessments;

 

(9)  All written notes required by (r) above; and

 

(10)  A discharge or transfer summary as required by (v) above.

 

          (y)  Client records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the birthing center’s personnel.

 

          (z)  Client records shall be retained for a minimum of 4 years after discharge or, in the case of a minor, until one year after reaching age 18, but no less than 4 years after discharge.

 

          (aa)  Prior to the birthing center ceasing operation, it shall arrange for the storage of and access to client records for 4 years after the date of closure, which shall be made available to the department and past clients upon request.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.17  Medications.

 

          (a)  If the licensee maintains a pharmacy on the licensed premises it shall comply with RSA 318.

 

          (b)  All prescription medications listed under He-P 810.16(p) may be maintained as stock medications at the birthing center.

 

          (c)  The licensed practitioner shall approve all over-the-counter medications taken by clients at the birthing center.

 

          (d)  All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

 

          (e)  Licensees shall maintain either the original, or a copy of the original written order in the client’s record, signed by a licensed practitioner or other individual authorized by law, for each prescription medication being taken at the birthing center.

 

          (f)  Each prescription medication shall legibly display the following information:

 

(1)  The client’s name, unless it is a stock medication as allowed in (b) above;

 

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

 

(3)  The frequency of administration;

 

(4)  The indications for usage of all PRN medications;

 

(5)  The date ordered; and

 

(6)  The name of the prescribing practitioner.

 

          (g)  Except for stock medications identified in He-P 810.16(p), the label of all medication containers maintained in the birthing center shall match the current written orders of the licensed practitioner.

 

          (h)  Only a pharmacist shall make changes to prescription medication container labels.

 

          (i)  Any change or discontinuation of medications taken at the birthing center shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

 

          (j)  All prescription medication not ordered, approved, or labeled for a specific client, including but not limited to pharmaceutical samples, which is stored at the birthing center, shall be the responsibility of the medical director.

 

          (k)  All verbal orders from an authorized prescriber, including but not limited to telephone orders, shall be taken by a licensed person such as a nurse or other licensed health care professional, if such action is within the scope of their practice act, and immediately transcribed and signed by the individual taking the order, and shall be counter-signed by the authorized prescriber within 48 hours.

 

          (l)  The medication storage area shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean, organized in a fashion to ensure correct identification of each client’s medication(s), and have lighting adequate to read all medication labels; and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (m)  Medication kept at the birthing center shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

          (n)  Topical liquids, ointments, creams, or powder forms of products shall be stored separately from oral, optic, ophthalmic, and parenteral products.

 

          (o)  Controlled drugs, as defined by RSA 318-B: 1, VI, stored in a central storage area of the birthing center shall be:

 

(1)  Kept in a separately locked compartment within the locked medication storage area; and

 

(2)  Accessible only to authorized personnel.

 

          (p)  Except as allowed by (r) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days.

 

          (q)  The destruction of contaminated, expired, or discontinued medication under (p) above shall:

 

(1)  Be accomplished in the presence of at least 2 people; and

 

(2)  Be documented in the record of the client.

 

          (r)  Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 704.07.

 

          (s)  Upon discharge or transfer, the licensee shall make the client’s current medications available to take with them.

 

          (t)  The department shall order a birthing center to obtain the routine services of a consultant pharmacist for 12 months if areas of noncompliance regarding medications, which the department determines present a potential risk to clients’ health, are found during any inspection or investigation.

 

          (u)  Only individuals authorized by law shall administer medications to clients.

 

          (v)  Medication shall be prepared immediately prior to administration and shall be prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B.

 

          (w)  When administering medication, personnel shall remain with the client until the client has taken all of the medication.

 

          (x)  The licensee shall maintain a written record for each medication taken by the client at the birthing center, containing the following information:

 

(1)  Any allergies or allergic reaction to medication;

 

(2)  The name and strength of the medication;

 

(3)  The dose taken by the client;

 

(4)  The route of administration, if other than by mouth;

 

(5)  The signature and identifiable initials and job title of:

 

a.  The person administering the medication; and

 

b.  The person supervising or assisting the client taking his or her medication;

 

(6)  Documented reason for any medication refused or omitted; and

 

(7)  For PRN medications, the reason the client required the medication and the effect of the PRN medication.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.18  Personnel.

 

          (a)  For all applicants for employment, except, pursuant to RSA 151:2-d, VI, those licensed by the New Hampshire board of nursing, and for all household members 17 years of age or older, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety; and

 

(2)  Review the results of the criminal records check in accordance with (b) below and verify the qualifications of all applicants prior to employment.

 

          (b)  The licensee shall not offer employment for any position or allow a household member to continue to reside in the residence if the individual:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the clients.

 

          (c)  The department shall grant a waiver of (b) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

 

          (d)  No employee shall be permitted to maintain their employment, and no household member shall be permitted to remain residing in the facility, if he or she has been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or has had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state unless a waiver has been granted by the department.

 

          (e)  The licensee shall check, prior to hiring, the names of all prospective employees against the bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-E 720, and the NH board of nursing’s nursing assistant registry maintained pursuant RSA 326-B:26 and 42 C.F.R. section 483.156.

 

          (f)  If the information identified in (b) above regarding any employee is learned after the person begins employment, the licensee or administrator shall submit the information to the department immediately upon discovery.

 

          (g)  All personnel shall:

 

(1)  Be at least 18 years of age if working as direct care personnel;

(2)  Meet the educational and physical qualifications for their position, as listed in the job description in (n)(5) below;

 

(3)  Be licensed, registered, or certified if required by state statute;

 

(4)  Receive an orientation within the first 3 days of work, including:

 

a.  The birthing center’s policy on client rights and responsibilities and complaints in accordance with RSA 151:20;

 

b.  The duties and responsibilities of the position;

 

c.  The birthing center’s policies, procedures, and guidelines;

 

d.  The birthing center’s infection control program;

 

e.  The birthing center’s fire, evacuation, and emergency plans outlining the responsibilities of personnel in an emergency; and

 

f.  Mandatory reporting requirements such as those found in RSA 161-F:46 or RSA 169-C: 29;

 

          (h)  Prior to having contact with clients or food, personnel shall:

 

(1)  Submit to the birthing center the results of a physical examination or health screening and results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control (CDC), conducted not more than 12 months prior to employment;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition, available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (i)  All personnel shall complete annual in-service education, including a review of the birthing center’s:

 

(1)  Policies and procedures relative to patient’s rights;

 

(2)  Infection control program;

 

(3)  Education program on fire, evacuation, and emergency procedures; and

 

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

 

          (j)  All professional direct care personnel shall have current certificates in:

 

(1)  Adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association; and

 

(2)  Neonatal CPR equivalent to the American Heart Association and American Academy of Pediatrics’ “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines,” available as noted in Appendix A.

 

          (k)  All direct care personnel shall be familiar with the location, operation, and use of all equipment in the birthing center.

 

          (l)  All birthing centers using the service of independent clinical contractors who have direct contact with clients shall:

 

(1)  Provide each clinical contractor with an orientation as specified in (g)(4) above;

 

(2)  Maintain copies on file of a physical examination or health screening and 2-step tuberculosis testing, Mantoux method, that were conducted not more than 12 months prior to employment for each clinical contractor;

 

(3)  Maintain a copy of the clinical contractors’ licenses as required by (g)(3) above, if applicable; and

 

(4)  Have a written agreement with each clinical contractor that describes the services that will be provided.

 

          (m)  Current and complete personnel files shall be maintained at the birthing center for all personnel.

 

          (n)  The personnel file required by (m) above shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of the birthing center’s policy setting forth the client’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(4)  A copy of the results of the criminal record check as described in (a) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  A record of satisfactory completion of the orientation program required by (g)(4) above;

 

(7)  Information as to the general content and length of all in-service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs required by (g), (i) and (j) above;

 

(9)  A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

 

(10)  Documentation that the required physical examination or health screenings, TB test results and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(11)  If applicable, copies of current certificates in:

 

a.  Adult CPR equivalent to basic life support from either the American Red Cross or the American Heart Association; and

 

b.  Neonatal CPR equivalent to the American Heart Association and American Academy of Pediatrics “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines,” available as noted in Appendix A; and

 

(12)  The statement required by (o) below.

 

          (o)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of clients.

 

          (p)  An individual need not re-disclose any of the matters in (o) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (q)  The licensee shall maintain separate personnel records that:

 

(1)  Contain the information required by (n) above; and

 

(2)  Are protected and stored in a secure and confidential manner.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.19  Quality Improvement.

 

          (a)  The birthing center shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c) The birthing center shall determine the size and composition of the quality improvement committee based on the size of the birthing center and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the birthing center; and

 

(7)  Evaluate the effectiveness of the corrective actions.

 

          (e)  If the birthing center utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review:

 

(1)  The client census;

 

(2)  The number of unlicensed personnel administering medications via nurse delegation;

 

(3)  Categories of medications administered;

 

(4)  Route of administration; and

 

(5)  Any incidents or medication errors and actions taken.

 

          (f)  The quality improvement committee shall meet at least quarterly.

 

          (g)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (h)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.20  Infection Control.

 

          (a) The birthing center shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of clients 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.

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, formites or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by an authorized medical professional.

 

          (f)  Personnel with an open wound who participate in food preparation or service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

          (g)  Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

 

          (h)  If the licensee accepts a client who is known to have a disease reportable under He-P 301 or an “infectious disease,” which means any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall provide the required procedures and personnel training for the care of the clients, as specified by United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.21  Sanitation.

 

          (a)  The birthing center shall have and maintain a source of potable water available for human consumption.

 

          (b)  All furniture, floors, ceilings, walls, and fixtures shall be kept clean, sanitary, and in good repair at all times.

 

          (c)  All client bathrooms shall have non-porous floors.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the client.

 

          (e)  Birthing center personnel shall clean and disinfect bedpans, commodes, basins, fixtures, toilets, and showers or tubs after each use.

 

          (f)  If equipment or supplies need to be sterilized in order to prevent contamination, the birthing center shall develop and maintain written procedures for cleaning, packaging, and sterilizing, including:

 

(1)  Testing and documenting the sterilization processes used; and

 

(2)  Documentation when supplies are outdated.

 

          (g)  The sterilization system required in (f) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented and available on site for review by the department.

 

          (h)  Sterile supplies and equipment shall:

 

(1)  Be stored in dust-proof, moisture-free storage areas; and

 

(2)  Not be mixed with non-sterile supplies.

 

          (i)  Cleaning solutions, compounds, and substances that might be considered toxic or defined as hazardous waste, in accordance with RSA 147-A:2 VII, shall be kept in an enclosed area and be:

 

(1)  Distinctly labeled and legibly marked so as to identify the contents; and

 

(2)  Stored in a place separate from food, medications and client supplies.

 

          (j)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils, or in any way other than in full compliance with the manufacturer’s labeling.

 

          (k)  In-house trash and garbage receptacles shall be insect and rodent proof, water tight, lined or cleaned, and disinfected after emptying and kept covered except when in use.

 

          (l)  Trash receptacles for paper waste may be kept uncovered in all areas except food service areas.

 

          (m)  There shall be a designated work area for soiled materials and linens that contains a work counter of at least 6 linear feet, a sink, and a storage area.

 

          (n)  A supply of clean linens shall be stored in a clean area separated from soiled linens and available in sufficient amounts to meet the needs of the clients.

 

          (o)  Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack, or a covered container.

 

          (p)  Soiled linens and clothing, which would be considered contaminated with infectious waste shall be handled as infectious waste.

 

          (q)  Laundry rooms shall have non-porous floors and be kept separate from the kitchen and eating areas.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.22  Physical Environment.

 

          (a)  The birthing center shall comply with all state and local laws, rules, codes, and ordinances for:

 

(1)  Building;

 

(2)  Health;

 

(3)  Fire;

 

(4)  Waste disposal; and

 

(5)  Water.

 

          (b)  The birthing center shall:

 

(1)  Have all entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and clients, including but not limited to hazards from falls, burns, or electrical shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take measures to prevent the presence of rodents, insects, and vermin, including but not limited to:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self closing and remains closed unless in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within a birthing center, including but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if there are clients present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Unvented fuel-fired heaters shall not be used in any birthing center.

 

          (g)  Plumbing shall be sized, installed, and maintained in accordance with the provisions of the International Plumbing Code 2009, as specified in the State Building Code under RSA 155-A:1, IV.

 

          (h)  Delivery rooms shall have general lighting in addition to examination lighting at each birthing bed. Portable examination lights shall be permitted, but must be immediately accessible.

 

          (i)  Ventilation shall be provided throughout the entire building whenever necessary, including but not limited to, fans to remove excessive heat, moisture, smoke, objectionable odors, dust, and explosive or toxic gases.

 

          (j)  There shall be a reception and waiting area that includes chairs, tables, and lighting sufficient to allow for needlepoint or reading.

 

          (k)  Pursuant to RSA 155:66, I, smoking shall be prohibited in the birthing center.

 

          (l)  There shall be public access to a telephone and toilet facilities for the client and the client’s visitors.

 

          (m)  The licensee shall ensure the birthing center has properly maintained equipment including, but not limited to:

 

(1)  A heat source for the newborn;

 

(2)  Portable lighting;

 

(3)  Sterilizer or demonstration of sterilizing capability;

 

(4)  Blood pressure equipment, thermometers, fetoscope, or doptone;

 

(5)  Oxygen;

 

(6)  Neonatal resuscitation bag; and

 

(7)  Intravenous equipment.

 

          (n)  The birthing center shall provide clients with continuous access to a device or means that will signal personnel when the client(s) are in need of assistance.

 

          (o)  The number of sinks and toilets in the birthing center shall be as follows:

 

(1)  Sinks and toilets in a ratio of one to every 6 clients; and

 

(2)  Personnel and visitors shall either have:

 

a.  Separate sinks and toilets; or

 

b.  Be counted along with clients in the ratios in (1) above.

 

          (p)  All clients shall have access to a bathroom with a toilet, tub or shower, a hand washing sink, soap dispensers, and paper towels or a hand-drying device providing hot air.

 

          (q)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (r)  All bathroom and closet door locks or latches shall be designed so that the door can be easily unlocked and opened from the outside.

 

          (s)  Each client bedroom shall have natural lighting directly from outside windows of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (t)  Each client bedroom shall provide at least 100 square feet per room, exclusive of space required for closets, wardrooms, and bathrooms and contain the following:

 

(1)  A bed with mattress, pillow, linens, and blankets;

 

(2)  A lamp for the bed; and

 

(3)  Window blinds or curtains that provide privacy.

 

          (u)  Only one client shall be admitted to each bedroom in the birthing center.

 

          (v)  Each bedroom shall have a door that shall be of the side hinge type and not a folding door or a curtain.

 

          (w)  Each bedroom shall have its own separate entry to permit the client to reach their room without passing through the room of another person.

 

          (x)  All mattresses and new upholstered furniture or draperies shall either comply with Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, or be treated annually with a fire retardant spray.

 

          (y)  Each birthing center may be licensed for more than one licensing classification, but if the licensee has overnight beds for more than one licensing classification, physically separate and distinct units shall be required for each classification.

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.23  Fire Safety.

 

          (a)  An emergency and fire safety program shall be developed and implemented to provide for the safety of clients and personnel in accordance with the following:

 

(1)  The birthing center shall have a telephone and extensions accessible at all times in each client bedroom in case of emergency;

 

(2)  The birthing center shall have at least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10, as adopted by the department of safety;

 

(3)  The birthing center shall immediately notify the department by phone, fax, or electronic mail within 24 hours and in writing within 72 hours of any fire or situation, excluding a false alarm, that requires either an emergency response to the birthing center or the evacuation of the licensed premises; and

 

(4)  The written notification under (3) above shall include:

 

a.  The date and time of the incident;

 

b.  A description of the location and extent of the incident, including any damage;

 

c.  A description of events preceding and following the incident;

 

d.  The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

 

e.  The name of the individual the birthing center wishes the department to contact if additional information is required.

 

          (b)  All freestanding tanks of compressed gases shall be firmly secured to the adjacent wall or secured in a stand or rack.

 

          (c)  Flammable gases and liquids shall be stored in metal fire retardant cabinets.

 

          (d)  A written plan for fire safety, evacuation, and emergencies shall be adopted and posted in multiple locations throughout the facility.

 

          (e)  Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions.

 

          (f)  Evacuation drills shall be conducted twice a year, and each employee shall participate in at least 2 drills a year.

 

          (g)  The licensee shall maintain a report for each evacuation drill, which includes:

 

(1)  The names of the personnel and clients involved;

 

(2)  The time, date, month, and year the drill was conducted;

 

(3)  The exits utilized;

 

(4)  The total time required to evacuate the building and the time needed to complete the emergency drill or both; and

 

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

 

Source.  #8957, eff 7-27-07, EXPIRED: 7-27-15

 

New.  #11039, INTERIM, 2-24-16, EXPIRES: 8-22-16; ss by #11161, eff 8-20-16

 

          He-P 810.24  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (b)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (c)  The plan in (b) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, missing clients and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(7)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(8)  Include the management of clients, particularly with respect to physical and clinical issues to include relocation of clients with their medical record including the medication administration records, if time permits, as detailed in the emergency plan;

 

(9)  Include an educational program for the staff, to provide an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

 

(10)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

 

(d)  The facility shall contact the local emergency management director annually to determine if any revisions are needed based upon current trends in emergency management, local policy changes, and hazard changes. Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

 

Source.  #11161, eff 8-20-16

 

PART He-P 811  END STAGE RENAL DISEASE DIALYSIS CENTERS

 

          He-P 811.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all end stage renal disease (ESRD) dialysis centers pursuant to RSA 151:2, I(d).

 

Source.  #5600, eff 3-24-93, EXPIRED: 3-24-99

 

New.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association or other legal entity operating an end stage renal disease dialysis centers, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #5600, eff 3-24-93, EXPIRED: 3-24-99

 

New.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a vulnerable adult as defined in RSA 161-F:43, II(c), or, in the case of sexual abuse of a minor, as defined in RSA 169-C:3, XXVVII-b.

 

          (b) “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (d)  “Administrator” means the person responsible for the management of the licensed premises who is licensed by the state of New Hampshire pursuant to RSA 151 and who reports to and is accountable to the governing body.

 

          (e)  “Admitted” means accepted by a licensee for the provision of services to a client.

 

          (f)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (g)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

 

          (h)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA-J:34-37.

 

          (i)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license pursuant to RSA 151.

 

          (j) “Area of non-compliance” means any action or failure to act that cause(s) a licensee to be out of compliance with RSA 151, He-P 803, or other applicable federal and state requirements.

 

          (k)  “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the client to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

 

          (l)  “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the client, and the client’s guardian, agent, or personal representative, if any,  as a result of the assessment process, for the provision of care and services to a client.

 

          (m)  “Change of ownership” means the transfer of a controlling interest of the licensed entity to an individual or successor business entity.

 

          (n)  “Chemical restraint” means any medication that is used for discipline or staff convenience, in order to alter a client’s behavior such that the client requires a lesser amount of effort or care, and is not in the client’s best interest, and not required to treat medical symptoms. 

 

          (o)  “Client” means any person admitted to or receiving care, services, or both from a health care facility licensed in accordance with RSA 151 and He-P 811.

 

          (p)  “Client record” means documents maintained for each person receiving care and services, which includes all documentation required by RSA 151, He-P 811, and all documentation compiled relative to the client as required by other federal and state requirements.

 

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

 

          (r) “Critical incident stress management (CISM)” means an adaptive, short-term psychological

helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

 

          (s)  “Days” means calendar days, unless otherwise specified.

 

          (t)  “Department” means the New Hampshire department of health and human services.

 

          (u)  “Dialysis” means the passage of a solute through a membrane.

 

          (v)  “Direct care” means hands on care or services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (w)  “Direct care personnel” means any person providing hands-on care or services to a client.

 

          (x)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (y)  “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the client will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

 

          (z) “Elopement” means when a client who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility  unsupervised or unnoticed without knowledge of the licensee’s personnel.

 

          (aa)  “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.

 

          (ab)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (ac)  “End stage renal disease dialysis center (ESRDDC)” means a facility which provides hemodialysis or peritoneal dialysis on an outpatient basis and any other acute or chronic dialysis related procedures as approved by their governing body.

 

          (ad) “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 811.

 

          (ae) “Equipment” means  any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

 

          (af)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ag)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (ah)  “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

 

          (ai)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions over the client’s person and/or estate.

 

          (aj)  “Hemodialysis” means removal of toxic substances from the blood of persons for whom one or both kidneys are defective or absent by passing it through tubes made of semi permeable membranes which are continually bathed by solution which selectively remove unwanted material.

 

          (ak) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (al)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (am)  “Informed consent” means the decision by a client, his or her guardian, agent, or surrogate decision-maker   to agree to a proposed course of treatment, after the client, guardian, agent, or surrogate decision-maker  has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (an)  “Inspection” means the process used by the department to determine an applicant or a licensee’s compliance with RSA 151, He-P 811, and all other federal and state requirements or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 811.

 

          (ao)  “License” means the document issued by the department to an applicant at the start of operation as an ESRDDC which authorizes operation as an ESRDDC in accordance with RSA 151 and He-P 811, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and the license number.

 

          (ap)  “License certificate” means the document issues by the department to an applicant or licensee that contains the information on a license and includes the name of the administrator and the type(s) of services authorized.

 

          (aq)  “Licensed practitioner” means:

 

(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 New Hampshire licensing board.

 

          (ar)  “Licensed premises” means the building(s)  that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (as)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (at)  “Licensing classification” means the specific category of services authorized by a license.

 

          (au) “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (av)  “Medical director” means a physician board certified in internal medicine or pediatrics with a board approved training program in nephrology and licensed in New Hampshire pursuant to RSA 329 who is responsible for the implementation of client care policies and the coordination of medical care in the facility.

 

          (aw)  “Medication” means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

 

          (ax) “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

 

          (ay)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a client.

 

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

 

          (ba)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bb)  “Owner” means any person, corporation, association, or any other legal entity who has controlling interest in the facility.

 

          (bc)  “Parenteral” means any non-oral means of administration, but is generally interpreted as relating to injecting directly into the body, bypassing the skin and mucous membranes. The common parenteral routes are intramuscular (IM), subcutaneous (SC) and intravenous (IV).

 

          (bd)  “Patient or client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21.

 

          (be)  “Performance-based design”  means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions.

 

            (bf)  “Peritoneal dialysis” is a type of dialysis which uses the lining of the abdomen (peritoneum) as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure.

          (bg)  “Personal representative” means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in accordance with RSA 151:19, V, to assist the client for a specific, limited purpose or for the general purpose of assisting the client in the exercise of any rights.

 

          (bh)  “Personnel” means an individual(s), who is employed by the licensed facility, a volunteer, or an independent contractor, who provide direct care or services to a client(s).

 

          (bi)  “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the client’s freedom of movement. 

 

          (bj)  “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

 

          (bk)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

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

 

          (bn)  “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bo) “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (bp) “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (bq) “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (br)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

 

          (bs)  “Significant change” means a decline or improvement in a client’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the client’s health status; and

 

(3)  Requires interdisciplinary review and/or revision of the care plan.

 

          (bt) “State monitoring” means the placement of individuals by the department at an ESRDDC to monitor the operation and conditions of the facility.

 

          (bu)  “Reportable incident” means an occurrence of any of the following while the client is either in the ESRDDC or in the care of ESRDDC personnel:

 

(1)  The unanticipated death of a client that is not related to their diagnosis or underlying condition;

 

(2)  An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and has resulted in an injury that requires treatment in an emergency room by a licensed practitioner; or

 

(3)  An elopement from the ESRDDC or other circumstances that resulted in the notification and/or involvement of law enforcement or safety officials.

 

          (bv) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a and submit to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (March 2019), signed by the applicant or 2 of the corporate officers, affirming to the following:

 

a. “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

b.  For any ESRDDC to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”;

 

c.  For any ESRDDC to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical assess hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”; and

 

d.  For facilities to be licensed under the listed categories:

 

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed pursuant to  He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R 485.610(b) and (c), until the Commissioner makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”

 

(2)  A floor plan of the prospective ESRDDC;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  List of affiliated or related parties;

 

(5)  The applicable fee in accordance with RSA 151:5, XIV, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(6)  A resume identifying the qualifications of the ESRDDC administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf C 6000, as amended pursuant to RSA 153:5, by the state fire marshal with the board of fire control as adopted by the commissioner of the department of safety, and local fire ordinances applicable for a health care occupancy; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final onsite inspection of the construction project;

 

(8)  If the ESRDDC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, and Env-Dw 704.02, or, if a public water supply is used, a copy of a water bill;

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant and the administrator, as applicable; and

 

(10) Any waiver requests, if applicable.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH  03301

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 811.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 811.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 811.

 

          (f)  Unless a waiver has been granted, the department shall deny a licensing request after reviewing the information required by He-P 811.04(a)(9) above if it determines that the applicant, proposed licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

            (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

            (h)  A written notification of denial, pursuant to He-P 811.13(a) shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 811.05(e) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 811.

 

            (i)  A written notification of denial, pursuant to RSA 811.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their applicant is complete and an inspection needs to be scheduled.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance,  unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 811.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 811.04(a)(1) and (5);

                                                                                                             

(2)  The current license number;

 

(3)  A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 811.10(f), if applicable; and

 

(4)  A statement identifying any variances applied for or granted by the state fire marshal.

 

          (d)  In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

 

          (e)  Following an inspection as described in He-P 811.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) and (d) above as applicable, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 811 at the renewal inspection.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.07  ESRDDC Construction, Renovations, Modifications, or Structural Alterations.

 

          (a)  For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 811 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  The ESRDDC shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (g)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C-6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, as follows:

 

a.  NFPA 101, Life Safety Code Ambulatory Health Care Occupancy Chapter; or

 

b.  NFPA 101, Life Safety Code Business Occupancy Chapter; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  The FGI “Guidelines for Design and Construction of Outpatient Facilities, Renal Dialysis Center Chapter”, (2018 edition), available as noted in Appendix A.

 

          (h)  All ESRDDCs newly constructed or rehabilitated after the 2019 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of  Outpatient Facilities, Renal Dialysis Center Chapter” (2018 edition), available as noted in Appendix A.

 

          (i)  Where rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities, Renal Dialysis Center Chapter” ( 2018 edition), available as noted in Appendix A.

 

          (j) The department shall be the authority having jurisdiction for the requirements in He-P 811.07(i)-(j) and shall negotiate compliance and grant waivers in accordance with He-P 811.10, as appropriate.

 

          (k)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

 

          (l)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (m)  Exceptions or variances pertaining to the state fire code referenced in He-P 811.07(h)(1) shall be granted only by the state fire marshal.

 

          (n)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 811.09 prior to its use.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.08  ESRDDC Requirements for Organizational Changes.

 

          (a)  The ESRDDC shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Dialysis stations; or

 

(6)  Affiliated parties or related parties.

 

          (b)  When there is a change in the name, the ESRDDC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (c)  The ESRDDC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of dialysis stations beyond what is authorized under the current license.

 

          (d)  When there is a change in address without a change in location, the ESRDDC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (e)  The ESRDDC shall inform the department in writing as soon as possible prior to a change in administrator and provide the department with the following:

 

(1)  The information specified in He-P 811.04(a)(9) if not currently employed by the licensee;

 

(2)  A resume identifying the name and qualifications of the new administrator; and

 

(3)  Copies of applicable licenses for the new administrator.

 

          (f)  Upon review of the materials submitted in accordance with (e) above, the department shall make a determination as to whether the new administrator:

 

(1)  Does not have a history of any of the criteria identified in He-P 811.05(f); and

 

(2)  Meets the qualifications for the position as specified in He-P 811.15(a).

 

          (g)  If the department determines that the new administrator does not meet the qualifications as specified in He-P 811.15(a), it shall so notify the ESRDDC in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

          (h)  When there is to be a change in the services provided, the ESRDDC shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

          (i)  The department shall review the information submitted under (h) above and determine if the added services can be provided under the ESRDDC’s current license.

 

          (j)  An inspection by the department shall be conducted prior to operation when there are changes in the following:

 

(1)  Ownership, unless the current licensee has no outstanding administrative actions in process and there will be no changes made by the new owner in the scope of services provided;

 

(2)  The physical location; or

 

(3)  An increase in the number of dialysis stations beyond what is authorized under the current license.

 

          (k)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

          (l)  A revised license and license certificate shall be issued for changes in the ESRDDC’s name.

 

          (m)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in the number of dialysis stations from what is authorized under the current license; or

 

(3)  When a waiver has been granted under He-P 811.10.

 

          (n)  Licenses issued under (j)(1) above shall expire on the date the license issued to the previous owner would have expired.

 

          (o)  The licensee shall return the previous license to the division within 10 days of the ESRDDC changing its ownership, physical location, address, or name.

 

(p)  If a licensee chooses to cease operation of an ESRDDC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting including but not limited to another ESRDDC.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 811, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the ESRDDC; and

 

(3)  Any records required by RSA 151 and He-P 811.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 811, to include a clinical and a life safety inspection, prior to: 

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 811.08(j)(1);

 

(3)  A change in the licensee’s physical location;

 

(4)  A relocation within the facility or an increase in the number of beds beyond what is authorized under the current license;

 

(5)  Occupation of space after construction, renovations, or structural alterations;

 

(6)  The renewal of a license for non-certified ESRDDCs; or

 

(7)  Verification of the implementation of any POC accepted or issued by the department as part of an annual or follow-up inspection.

 

            (c)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determined that the RTRF is in violation of any of the provisions of He-P 811, RSA 151, or other federal or state requirement.

 

            (d)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 811.12(c), within 21 days of the sate on the letter that transmits the inspection report.

 

            (e)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 811.09(b), that the prospective premises is not in full compliance with RSA 151 and He-P 811.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 811, except for waivers referenced in He-P 811.07(m), shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought; and

 

(4)  The period of time for which the waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not have the potential to negatively impact the health or safety of the clients; and

 

(3)  Does not negatively affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.11  Complaints.

 

(a)  The department shall investigate any complaint that meets the following conditions:

 

(1) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(2)  There is 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 RSA 151 or He-P 811.

 

          (b)  When practicable, the complaint shall be in writing and shall contain the following information:

 

(1)  The name and address of the ESRDDC, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 811.

 

          (c)  Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including:

 

(1)  Requests for additional information from the complainant or the licensee;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For the licensed ESRDDC, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of alleged violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 803, or does not violate and statutes, rules, or regulations; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 811.12(c).

 

          (e)  If the department determines that the complaint is unfounded or that the alleged act does not violate any statutes, rules, or regulations, the department shall so notify the unlicensed individual or licensee and take no further action.

 

          (f)  If the investigation results in areas of non-compliance being cited, the licensee shall be required to submit a POC in accordance with He-P 811.12(c).

 

          (g)  For the unlicensed individual or entity, the department shall provide written notification to the owner or person responsible that includes:

 

(1)  The date of inspection;

 

(2)  The reasons for the inspection; and

 

(3)  Whether or not the inspection resulted in a determination that the services being provided require licensing under RSA 151:2, I(d).

 

          (h)  The owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (f) above to respond to a finding that they are operating without a license or submit a completed application for a license in accordance with RSA 151:7-a, II.

 

          (i)  If the owner of an unlicensed ESRDDC does not comply with (h) above, or if the department does not agree with the owner’s response, the department shall:

 

(1)  Issue a written warning to immediately comply with RSA 151 and He-P 811; and

 

(2)  Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III.

 

          (j)  Any person or entity who fails to comply after receiving a warning, as described in (h) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (k)  The fact that the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 811, or other applicable laws.

 

          (l)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.12  Administrative Remedies.

 

          (a)  The department shall, after notice and opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 811, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC;

 

(2)  Imposing a directed POC upon a licensee;

 

(3)  Imposing fines upon an unlicensed individual, applicant, or licensee;

 

(4)  Suspension of a license; or

 

(5)  Revocation of a license.

 

          (b)  When fines are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance;

 

(2)  Identifies the specific remedy(s) that has been proposed; and

 

(3)  Provides the licensee with the following information:

 

a. The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the fine becoming final; and

 

b.  The automatic reduction of a fine by 25% if the licensee waives the right to a hearing, the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a notice of the areas of non-compliance, the licensee shall submit a POC detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur; and

 

c.  The date by which each area of non-compliance shall be corrected;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the inspection report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 811;

 

b.  Addresses all area of non-compliance and deficient practices as cited in the inspection report;

 

c.  Prevents a new violation of RSA 151 or He-P 811 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 811.12(b); and

 

b. Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with (f)(12) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine;

 

(3)  Deny the application for a renewal of a license; or

 

(4)  Revoke or suspend the license in accordance with He-P 811.13.

 

          (f)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 811.11(h), the fine shall be $500.00;

 

(5)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 811.06(b), the fine shall be $100.00;

 

(6)  For a failure to notify the department prior to a change of ownership, in violation of He-P 811.08(a)(1), the fine shall be $500.00;

 

(7)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 811.08(a)(2), the fine shall be $500.00;

 

(8)  For a refusal to allow access by the department to the ESRDDC’s premises, programs, services, or records, in violation of He-P 811.09(a), the fine for an applicant, individual, or licensee shall be $2000.00;

 

(9)  For refusal to cooperate with the inspection or investigation conducted by the department, the fine shall be $ 2000.00;

 

(10)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 811.12(c)(2) or (5)(b), the fine for a licensee shall be $100.00 unless an extension has been granted by the department;

 

(11)  For a failure to implement any POC that has been accepted or issued by the department, in violation of He-P 811.12(c)(8), the fine for a licensee shall be $1000.00;

 

(12)  For a failure to establish, implement, or comply with licensee policies, after being notified in writing by the department of the need to establish, implement, or comply with licensee policies, as required by He-P 811.14(c), the fine for a licensee shall be $500.00;

 

(13)  For a failure to provide services or programs required by the licensing classification and specified by He-P 811.14(b), the fine for a licensee shall be $500.00; 

 

(14)  For exceeding the maximum number of dialysis stations, in violation of He-P 811.14(j), the fine for a licensee shall be $500.00; 

 

(15)  For falsification of information contained on an application or of any records required to be maintained for licensing, in violation of He-P 811.14(g), the fine shall be $500.00 per offense;

 

(16)  For a failure to meet the needs of the client, in violation of He-P 811.14(l)(1), the fine for a licensee shall be $500.00;

 

(17)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 811.15(a) and 811.18(a)(4)-(5), the fine for a licensee shall be $500.00;

 

(18)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 807.07(a), the fine for a licensed facility shall be $500.00;

 

(19)  When an inspection determines that a violation of RSA 151 or He-P 811 has the potential to jeopardize the health, safety, or well-being of a client, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the initial fine, but not to exceed $2000.00; and

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the initial fine, but not to exceed $2000.00;

 

(20)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 811 shall constitute a separate violation and shall be fined in accordance with He-P 811.12(f), provided that the applicant or licensee is making good faith efforts to comply with the violations of the provisions of RSA 151 or He-P 811, as verified by documentation or other means, the department shall not issue a daily fine.

 

 

          (g)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.13  Enforcement Actions and Hearings.

 

          (a)  At the time of imposing a fine, or denying, revoking, or suspending a license, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department; and

 

(3)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 811, which violations have the potential to harm a client’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay a fine imposed under administrative remedies;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 811.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 811.12(c), (d) and (e);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 811 for the same violations within the last 5 inspections;

 

(8)  A licensee, including corporation officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(9)  Upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 811;

 

(10)  The department makes a determination that one or more of the factors in He-P 811.05(f) is true; or

 

(11)  The applicant or licensee fails to employ a qualified administrator or received a waiver allowing the employment of an administrator who does not meet requirements of He-P 811.15(a).

 

          (c)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (d)  If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

 

          (e)  The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of clients when it finds that the health, safety or welfare of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (f)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 811 is achieved.

 

          (g)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (h)  When a ESRDDC’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years, if the enforcement action pertained to their role in the ESRDDC. 

 

          (i)  The 5 year period in (h) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (j)  Notwithstanding (i) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 811.

 

          (k)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (l)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 811.

 

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

 

          (n)  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 and shall include any evidence that has not yet been reviewed by the department.

 

          (o)  Upon receipt of the requested informal dispute resolution made by the applicant, licensee, or administrator, the department shall review the evidence presented and if requested, within the informal dispute resolution request, meet with, in person or via telephone, the applicant, licensee, or program director.

 

          (p)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. 

 

          (q)  The statement of findings or notice to correct shall not be changed, if based on the evidence presented, the statement of findings is determined to be correct.

 

          (r)  The department shall provide a written notice to the applicant or licensee notifying the applicant, licensee, or administrator of such determination.

 

          (s)  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.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.14  Duties and Responsibilities of All Licensees.

 

          (a) The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

 

          (b)  The licensee shall define, in writing, the scope and type of services to be provided by the ESRDDC, which shall include, at a minimum, the core services listed in He-P 811.15.

 

          (c)  The licensee shall develop and implement written polices and procedures governing the operation and all services provided by the ESRDDC.

 

          (d)  All policies and procedures shall be reviewed per licensee policy and revised as needed.

 

          (e)  The licensee shall educate personnel about the needs and services required by the clients under their care.

 

          (f)  The licensee shall assess and monitor the quality of care and service provided to clients on an ongoing basis.

 

          (g)  The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

 

          (h)  The licensee shall not advertise or otherwise represent the program as having health care programs or services that they are not licensed to provide.

 

          (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (j)  The licensee shall not exceed the maximum number of stations authorized by the department.

 

          (k)  The licensee shall establish and maintain by-laws that:

 

(1)  Define the operation and performance of the ESRDDC;

 

(2)  Establish a credentialing process; and

 

(3)  Maintain documentation of all medical staff privileges.

 

          (l)  Licensees shall:

 

(1)  Ensure that the dialysis needs of the clients are met during those hours that the client is in the care of the ESRDDC;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the ESRDDC;

 

(3)  Appoint an administrator who shall meet the requirements of He-P 811.15(a);

 

(4)  Appoint a medical director, who shall meet the requirements of He-P 811.15(e);

 

(5)  Initiate action to maintain the ESRDDC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(6)  Provide sufficient numbers of personnel who are present in the ESRDDC and are qualified to meet the needs of clients during all hours of operation;

 

(7)  Provide the ESRDDC with sufficient supplies, equipment, and lighting to meet the needs of clients;

 

(8)  Implement any POC that has been accepted or issued by the department;

 

(9)  Initiate, implement, and continue action to correct any issue identified by the quality improvement committee; and

 

(10) Comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (m)  The licensee shall provide housekeeping and maintenance adequate to protect clients, personnel, and the public.

 

          (n)  The licensee shall consider all clients to be competent and capable of making health care decisions unless the client:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction;

 

(2)  Has durable power of attorney for health care that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (o)  The licensee shall only accept a client whose needs can be met under the current licensing classification and through the programs and services offered.

 

          (p)  The licensee shall have a written affiliation agreement with at least one acute care hospital for the provision of inpatient care and other acute care hospital services.

 

          (q)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  The most recent inspection report as specified in RSA 151:6-a;

 

(3)  A copy of the patient’s bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of client’s rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the ESRDDC website if available; and

 

(6)  The licensee’s floor plan for fire safety, evacuation, and emergencies identifying the location of, and access to all fire exits.

 

          (r)  The licensee shall develop policies and procedures regarding the release of information contained in client records.

 

          (s)  The licensee shall ensure that all personnel required to be licensed in the state of New Hampshire practice in accordance with the appropriate practice act and the rules adopted there under.

 

          (t)  The licensee shall not exceed the number of occupants authorized by NFPA 101, as adopted by the commissioner of the department of safety under Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, and identified on the licensing certificate.

 

          (u)  If the licensee accepts a client who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the client as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

 

 

          (v)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (w)  The licensee shall ensure that all records required for licensing:

 

(1)  Shall be available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

(2)  Shall be legible, current, and accurate.

 

          (x)  Smoking shall be prohibited in an ESRDDC per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a client’s bedroom.

 

          (y)  The water used in the ESRDDC shall be suitable for human consumption pursuant to Env-Dw 702.02 and Env-Dw 704.02.

 

          (z)  For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property the licensee shall:

 

(1)  Notify the department by fax to 603 271-5574, or if a fax machine is not available, submit via regular mail, postmarked within 24 hours of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information:

 

a.  The ESRDDC name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the incident;

 

d.  The name of client(s) involved in or witnessing the incident;

 

e.  The date and time of the incident;

 

f.  The action taken in direct response to the incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  Whether the client’s guardian or agent, if any, or personal representative was notified;

 

i.  The signature of the person reporting the incident; and

 

j.  The date and time the client’s licensed practitioner was notified;

 

(2)  Within 5 days a completed investigation report shall be submitted to the department and contain the following information:

a.  All items referenced in (1) above;

b.  The names and results of interview(s) with all personnel, client(s), or other individuals involved in the reportable incident, including all applicable  statement signatures; and

c.  The action taken by the licensee in direct response to the incident(s), including any and all follow-up;

(3)  Immediately notify the local police department, the department, guardian, agent, or personal representative,  if any, when a client, who has been assessed or is known as being a danger to self or others, has eloped after the licensee has searched the building and the grounds of the ESRDDC; and

 

(4) Submit additional information if required by the department.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.15  Required Services.

 

          (a)  The licensee shall provide administrative services that include the appointment of a full time administrator who:

 

(1)  Meets one of the following requirements:

 

a.  Has a bachelor’s degree in business administration or a health related field; or

 

b.  Is a registered nurse currently licensed in the state of New Hampshire with at least 12 months experience in clinical nursing with 6 months of the experience being in the care of clients with nephrology disorders;

 

(2)  Is responsible for the day-to-day operations of the ESRDDC;

 

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

 

(4)  May hold more than one position within the facility if qualified.

 

          (b)  The licensee shall credential licensed practitioners involved in the direct care of clients as follows:

 

(1)  The licensee shall establish a credentialing committee composed of, at a minimum, the medical director, the administrator, and the director of nursing; and

 

(2)  The credentialing committee shall be responsible for:

 

a.  Establishing the education and experience requirements of each direct-care position;

 

b.  Establishing a system for determining that the person being credentialed is:

 

1.  Licensed or certified to practice health care in New Hampshire; and

 

2.  Qualified by education and experience to meet the requirements of the position in a. above;

 

c.  Approving, and documenting the approval of, the duties that may be performed by the person being credentialed;

 

d.  Establishing a procedure for updating the approvals in b. above as necessary; and

 

e.  The annual review of all credentialed personnel. 

 

          (c)  The licensee shall provide medical services that meet the guidelines in the Association for the Advancement of Medical Instrumentation (AAMI)’s “American National Standard for Dialysate for Hemodialysis” (RD 52:2009 edition), available as noted in Appendix A for:

 

(1)  Water quality requirements and testing; and

 

(2)  The reuse of hemodialyzers and other dialysis supplies.

 

          (d)  The licensee shall provide instructions and education to clients, including but not limited to medical needs, nutrition, hygiene, medical emergencies, community support and resources.

 

          (e)  The licensee shall appoint a medical director who:

 

(1)  Is a physician licensed in the state of New Hampshire;

 

(2)  Is board certified in internal medicine or pediatrics;

 

(3)  Has completed a board-approved training program in nephrology;

 

(4)  Has at least 12 months experience providing care to patients receiving dialysis; and

 

(5)  Shall perform the following duties:

 

a.  Participate in the ESRDDC’s quality assurance program;

 

b.  Participate in the implementation of corrective action plans in affected problem areas;

 

c.  Participate in the credentialing process for all licensed health care practitioners;

 

d.  Act as a liaison between the licensed practitioners and the client;

 

e.  Be available to consult with the client’s licensed practitioner, as needed;

 

f.  Participate in the development of medical emergency procedures and all standing orders;

 

g.  Be available to respond to the center by phone or in person in the case of an emergency or shall ensure that a physician meeting the qualifications of the medical director is available; and

 

h. Review and approve all patient care policies including infection control for the ESRDDC.

 

          (f)  The licensee shall provide nursing services that include:

 

(1)  A department of nursing that is under the supervision of a director of nursing;

 

(2)  The appointment of a full time director of nursing who:

 

a.  Is a registered nurse currently licensed in the state of New Hampshire;

 

b.  Has at least one year of experience as a registered nurse caring for clients with nephrology disorders; and

 

c.  Shall perform the following duties:

 

1. Provide nursing direction, supervision, and staff evaluations to promote quality nursing care;

 

2.  Be a member of the ESRDDC’s quality improvement committee; and

 

3.  Participate in the development nursing protocols and procedures; and

 

(3)  Sufficient staff to meet the dialysis needs of clients at all times while in the care of the facility.

 

          (g)  The licensee shall provide dialysis technician services that include the employment of dialysis technicians who are qualified through education and technical training as required by the center’s policies and procedures.

 

          (h)  The licensee shall not be required to have a separate collection station license, pursuant to He-P 817 to collect patient samples for laboratory testing from clients of its dialysis services.

 

          (i)  The ESRDDC must obtain a lab license in accordance with He-P 808 if it performs laboratory testing unless the ESRDDC limits the testing preformed to point of care waived glucose testing.

 

          (j)  The licensee shall not be required to have a separate home health license, pursuant to He-P 809, to provide staff-assisted home dialysis in a client’s place of residence.

 

          (k)  The licensee shall provide social work services, including the employment of a sufficient number of social workers to meet the needs of their clients and who:

 

(1)  Have at least a master’s degree in social work; or

 

(2)  Have a bachelor’s degree in a health or human services field, plus:

 

a.  Two years experience as a social worker; and

 

b.  Have established a consultative relationship with a person holding a master’s degree in social work.

 

          (l)  The licensee shall provide dietary services, including the employment of a sufficient number of dietitians to meet the needs of clients and who:

 

(1)  Are registered by the American Dietetic Association and have one year of experience in clinical nutrition; or

 

(2)  Have a baccalaureate or advanced degree with major studies in food and nutrition or dietitian and one year of experience in clinical nutrition.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.16  Client Management.

 

          (a)  At the time of admission, personnel of the ESRDDC shall:

 

(1)  Have a written order from a licensed practitioner for the client’s treatment at the ESRDDC;

 

(2)  Provide, both orally and in writing, to the client or the client’s legal representative and obtain written confirmation acknowledging receipt and understanding of the following policies:

 

a.  The facility’s policy on client rights and responsibilities which, at a minimum, shall contain the patient’s bill of rights under RSA 151:21;

 

b.  The facility’s policies and procedures on the reuse of dialysis supplies, including hemodialyzers, if applicable;

 

c.  The facility’s complaint procedure; and

 

d.  Information about advanced directives such as:

 

1.  Living wills, pursuant to RSA 137-H; 

 

2.  Durable powers of attorney for healthcare, pursuant to RSA 137-J; and

 

3. DNR order;

 

(3)  Collect and record identification data that includes:

 

a.  Client’s name, home address, and home telephone number;

 

b.  Client’s date of birth;

 

c.  Name, address, and telephone number of an emergency contact;

 

d.  Name, address, and telephone number of the client’s primary care provider;

 

e.  Client’s insurance information; and

 

f.  Copies of all executed legal directives such as durable power of attorney, legal guardian, or living will;

 

(4)  Obtain documentation of informed consent for:

 

a.  All treatments prescribed by the licensed practitioner; and

 

b.  The reuse of dialysis supplies, including hemodialyzers, if applicable;

 

(5)  Obtain consent for release of information as applicable;

 

(6)  Obtain a medical history and physical examination that has been completed by a licensed practitioner; and

 

(7)  Conduct a nursing assessment completed by:

 

a.  A registered nurse; or

 

b. An LPN, but a review and signature by a registered nurse shall be required in accordance with the nurse practice act RSA 326-B.

 

          (b)  The licensee shall ensure that medical care and services are provided as follows:

 

(1)  Each client shall be under the care of a licensed practitioner at all times;

 

(2)  Each ESRDDC shall have a least one dialysis station in which a person with an infectious disease may be dialyzed;

 

(3)  The reuse of dialysis supplies, including hemodialyzers, shall be permitted only when the client or guardian  has:

 

a.  Been informed of the center’s policies and procedures regarding the reuse of dialysis supplies; and

 

b.  Provided written consent for the staff use of reused dialysis supplies;

 

(4)  An individualized care plan shall be developed by an interdisciplinary team, composed of the client, the licensed practitioner, a registered nurse, a social worker, and a dietician, and based on the results of:

 

a.  The client’s medical history and physical examination; and

 

b.  The interdisciplinary assessment as determined by the client’s needs;

 

(5)  The individualized care plan shall:

 

a.  Identify the treatment, including modality and dialysis settings, for the client;

 

b.  Be reviewed and updated as indicated by the client’s response to treatment; and

 

c.  Contain documentation that the client or their guardian participated in the development of the care plan;

 

(6)  The client shall be provided education in the following areas:

 

a.  Purpose and procedures for the different types of dialysis treatments;

 

b.  Outcomes associated with end stage renal disease, or chronic kidney disease; and

 

c.  The center’s emergency procedures, including both medical and non-medical procedures;

 

(7)  Each client shall receive a rehabilitative assessment, as applicable;

 

(8)  The center’s staff shall notify the department within one business day of any reportable incidents or a significant change of status and document such notification;

 

(9)  The personnel of the ESRDDC shall follow the orders of the licensed practitioner;

 

(10)  Written notes shall be documented in the client’s record for:

 

a.  All care and services provided at the ESRDDC that shall include the:

 

1.  Date and time of the care or service;

 

2.  Description of the care or service;

 

3.  Progress notes; and

 

4.  Signature and title of the person providing the care or service;

 

b.  Notification of the licensed practitioner of:

 

1.  Any significant change in the status of the client; or

 

2. Any side effects, adverse reactions, or ineffective results of any medications prescribed for the client; and

 

c.  Any significant changes or reportable incidents involving the client, which shall include the:

 

1.  Date and time of the incident or occurrence;

 

2.  Description of the incident or occurrence, including identification of injuries, if applicable;

 

3  If medical intervention was required:

 

(i)  Date and time the emergency contact person or guardian was notified; and

 

(ii)  Date and time the licensed practitioner was notified;

 

4.  Action taken including follow-up; and

 

5.  Signature and title of the person reporting the incident or occurrence;

 

(11)  The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX;

 

(12)  If the ESRDDC offers a home dialysis program, it shall:

 

a.  Have written policies and procedures for training clients and their caregivers;

 

b.  Provide oversight and monitoring of the home dialysis procedure;

 

c.  Provide consultations with a social worker, registered dietitian, or other professionals, as necessary;

 

d.  Ensure either directly or indirectly that adequate supplies and equipment are available;

 

e.  Provide annual testing of home water supplies for dialysis use as required by the AAMI’s “American National Standard for Dialysate for Hemodialysis” (RD 52:2009 edition), available as noted in Appendix A;

 

f.  Maintain written documentation of all care and services provided by the staff of the ESRDDC; and

 

g.  Not be required to have a separate home health care provider license, pursuant to He-P 809; and

 

(13)  ESRDDC trained caregivers operating under the direction of the ESRDDC who assist with home dialysis shall not be required to hold a separate home health care provider license, pursuant to He-P 809.

 

          (c)  The licensee shall transfer a client whose needs exceed those authorized by the current licensing classification or cannot be met by the programs and services offered at or arranged by the ESRDDC.

 

          (d)  If unforeseen complications arise that cannot be stabilized at the ESRDDC, the facility shall:

 

(1)  Transfer the client to an acute care hospital;

 

(2)  Call 911 for transport; and

 

(3)  Have copies of medical information regarding the treatment received at the center transferred with the client.

 

          (e)  Documentation for any client discharged or transferred from the facility shall include:

 

(1)  The date and time of discharge or transfer;

 

(2)  The physical, mental, and medical condition of the client;

 

(3)  Destination of client;

 

(4)  Name of responsible person accompanying the client;

 

(5)  Discharge planning and referrals;

 

(6)  Discharge summary;

 

(7)  Physician signed order for discharge or transfer; and

 

(8)  In the event of death, the funeral director’s receipt.

 

          (f)  Transfers and discharges shall be done in accordance with RSA 151:21 and RSA 151:26.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.17  Medication.

 

          (a)  All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

 

          (b)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the ESRDDC;

 

(2)  Reorder medications for use at the ESRDDC; and

 

(3)  Receive and record new medication orders.

 

          (c) For each prescription medication being taken by a client at the ESRDDC, the licensee shall maintain in the client’s record, the original or a copy of, the written or electronic order, signed by a licensed practitioner or other professional with prescriptive powers.

 

          (d)  Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

 

(1)  The client’s name;

 

(2)  The medication name, strength, prescribed dose, and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN;

 

(5)  The dated signature of the licensed practitioner; and

 

(6)  For pro re nata (PRN) medications the licensed practitioner shall indicate, in writing, the indications for use and any special precautions or limitations for use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (e)  Medications shall be kept in locked storage.

 

          (f)  Except as allowed by (d)(6) above, each prescription medication shall legibly display the following information:

 

(1)  The client’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 PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing licensed practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (g)  Any change or discontinuation of medications taken at the ESRDDC shall be pursuant to a written order from a licensed practitioner.

 

          (h)  Telephone orders for medications shall only be taken by a licensed person such as a nurse and shall be counter-signed by the authorized prescriber within 30 days.

 

          (i)  There shall be a medication storage area for all medications kept at the ESRDDC, which shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean, organized in a fashion to ensure correct identification of each client’s medication(s), and have lighting adequate to read all medication labels; and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (j)  Except as allowed by (q) below, all medication at the ESRDDC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

          (k)  Controlled drugs, as defined by RSA 318-B:1, are stored in a central storage area in the ESRDDC, they shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel.

 

          (l)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

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

 

          (n)  Except as allowed by (o) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders, or the medication becoming contaminated, whichever occurs first.

 

          (o)  Controlled drugs shall be destroyed only in accordance with state law.

 

          (p)  If medication(s) are to be returned to pharmacies, the medication(s) shall be returned to pharmacies for credit only as allowed by the law.

 

          (q)  Medication administered by individuals authorized by law to administer medications shall be prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

 

          (r)  Personnel shall remain with the client until the client has taken the medication.

 

          (s)  If a nurse delegates the task of medication administration to a patient care technician, the nurse shall follow the requirements of the nurse practice act.

 

          (t)  The licensee shall maintain a written record for each medication taken by the client at the ESRDDC which contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises or assists the client taking medication;

 

(5)  For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (u)  Each ESRDDC which permits patient care technicians to administer heparin or its derivatives shall:

 

(1)  Require patient care technicians to be under the direction of a registered nurse as required by the nurse practice act for nurse delegation of medications;

 

(2)  Require the delegating licensed nurse to document that patient care technicians have received the required initial competency verification and annual competency evaluations as required by the nurse practice act; and

 

(3)  Have a copy of the client assessment documented in the client record, verifying the client is stable and is an acceptable candidate to receive heparin via nurse delegation, as required by the nurse practice act.

 

          (v)  The licensee shall develop and implement a system for reporting  within 24 hours any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications.

 

          (w)  The written documentation of any reports in (v) above shall be maintained in the client’s record.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.18  Personnel.

 

          (a)  The licensee shall develop a job description for each position at the ESRDDC containing:

 

(1)  Position title;

 

(2)  Duties of the position;

 

(3)  Physical requirements of the position; and

 

(4)  Qualifications and education requirements of the position.

 

          (b)  For all applicants considered for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the ESRDDC, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

 

(2)  Review the results of the criminal records check in accordance with (c) below;

 

(3) Verify that the person is not listed on the BEAS state registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49;

 

(4)  Verify that the applicant meets the educational and physical qualifications of the position; and

 

(5)  Verify that the applicant is licensed, registered, or certified if required by state statute.

 

          (c)  Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment, contract with, or engage a person in (d) above if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2) Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the clients.

 

          (d)  If the information identified in (c) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (d) above.

 

          (e) If a waiver of (b) above is requested, the department shall review the information and the underlying circumstances in (b) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

 

(2)  Grant a waiver of (b) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

 

(f)  The waiver in (e)(2) above shall be permanent for as long as the individual remains in the same job unless additional convictions or findings under (c) above occur.

 

          (g)  All personnel shall be at least 18 years of age if working as direct care personnel unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of a licensed clinical supervisor.

 

          (h)  The licensee shall inform personnel of the line of authority at the ESRDDC.

 

          (i)  Prior to having contact with clients, all personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contracting or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (j)  In lieu of (o)(1) below, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services shall provide the licensee with a signed statement that its employees have complied with (o)(1) and (3) below before working at the ESRDDC.

 

          (k)  Prior to having contact with clients, all personnel shall receive a tour of the ESRDDC and have an orientation that explains the following:

 

(1)  The clients’ rights in accordance with RSA 151:20;

 

(2)  The ESRDDC’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 811.21;

 

(7) The licensee’s confidentiality requirements;

 

(8) The grievance procedures for staff and clients; and

 

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

 

          (l)  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 client rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan;

 

(4)  The licensee’s policies and procedures; and

 

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

 

          (m)  All licensees using the service of independent clinical contractors who have direct contact with clients shall ensure that these personnel have:

 

(1)  Been oriented in accordance with (k) above;

 

(2)  Submitted results of a physical examination or health screening and 2 step tuberculosis testing, mantoux method, conducted not more than 12 months prior to employment;

 

(3)  Provided a copy of any license, registration, or certification as required by (a)(5) above; and

 

(4)  Have a written agreement with the licensee that describes the services that will be provided and agrees to comply with (1) through (3) above.

 

          (n)  Current and complete personnel files shall be maintained and available to the department for inspection.

 

          (o)  The personnel file required by (n) above shall include the following:

 

(1)  A completed application for employment or a resume;

 

 (2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy and received training on the implementation of the of the licensee’s policy setting forth the client rights and responsibilities as required by RSA 151:20;

 

(4)  A copy of the results of the criminal record check required by (b)(1) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (k) above;

 

(7)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(8)  Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(9)  Documentation of annual in-service education as required by (l) above;

 

(10)  For patient care technicians that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine the personnel member is competent to administer medications;

 

(11) Results of the registry checks required in (b) above;

 

(12)  A signed statement from the employee required by (o) below; and

 

(13)  Documentation to verify compliance with (r), (s) and (t) below, as applicable.

 

          (o)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a client; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (p)  For individuals with the waiver described in (e) above, the statement required by (o) above shall cover the period of time since the waiver was granted.

 

          (q)  An individual shall not be required to re-disclose any of the matters in (o) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (r)  The license shall ensure that all direct care personnel have current certification in:

 

(1)  Basic life support (BLS);

 

(2)  Cardio pulmonary resuscitation (CPR); and

 

(3)  Automatic electronic defibrillator (AED).

 

          (s)  The licensee shall ensure that all personnel are familiar with the location of the equipment required by He-P 811.22(k).

 

          (t)  The licensee shall ensure that all personnel, in accordance with their practice act, are familiar with the operation and use of the equipment required by He-P 811.22(k).

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.19  Client Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the ESRDDC which includes, at a minimum:

 

(1)  The written confirmation required by He-P 811.16(a)(2);

 

(2)  The identification data required by He-P 811.16(a)(3);

 

(3)  Consent forms as required by He-P 811.16(a)(4);

 

(4)  Consent for release of information as applicable required by He-P 811.16(a)(5);

 

(5)  The record of the medical history and health examination required by He-P 811.16(a)(6);

 

(6)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

 

(7)  Results of any laboratory tests;

 

(8)  All consultation reports;

 

(9)  All assessments for the last 12 months;

 

(10)  All care plans for the last 12 months;

 

(11)  All written notes required by He-P 811.16(b)(10);

 

(12)  The medication record required by He-P 811.17(t) and (v);

 

(13)  Discharge or transfer documentation as required by He-P 811.16(e); and

 

(14)  Documentation of nurse delegation of medications as required by the nurse practice act, as applicable.

 

          (b)  Client records shall be:

 

(1)  Safeguarded against loss, damage, or unauthorized use; and

 

(2)  Retained for 7 years from the date of the patient’s last contact with the licensee, unless, before that date, the patient has requested that the file be transferred to another health care provider, except that when the client is a minor, records shall be retained for 7 years or until the person reaches the age of 19, whichever is longer.

 

          (c)  The licensee shall arrange for storage of and access to client records as required by (b)(2) above in the event the ESRDDC ceases operation.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur. 

 

          (e)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.20  Quality Improvement.

 

          (a)  The licensee shall develop and maintain a quality improvement program whose objectives shall be to reveal patterns and initiate action to provide an optimum quality of care for all clients.

 

          (b)  The quality improvement program shall include a quality improvement committee, which shall consist of:

 

(1)  The medical director;

 

(2)  The director of nursing;

 

(3)  A social worker;

 

(4)  A dietitian; and

 

(5)  At least one other direct care staff provider.

 

          (c)  The quality improvement committee shall:

 

(1)  Review within 24 hours:

 

a.  All client cases where a medical emergency occurs; and

 

b.  Client cases which require unexpected transfer to an acute care facility;

 

(2)  Establish and implement a system for the monthly surveillance of dialysate water and reuse;

 

(3)  Review all reports of unexpected occurrences involving clients, personnel, or visitors;

 

(4)  Ensure that outside services such as laboratory services or water analysis are provided in accordance with federal and state laws and administrative rules;

 

(5)  Ensure that individuals with appropriate qualifications maintain medical equipment;

 

(6)  Establish an ongoing program to determine performance improvement projects, to carry out interventions to mitigate quality issues and to audit corrective actions; and

 

(7)  Meet at least quarterly.

 

          (d)  Documentation of all quality improvement meetings shall be maintained on-site for at least 2 years.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.21  Infection Control and Sanitation.

 

          (a)  The ESRDDC shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases. 

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as noted in Appendix A;

 

(3)  The care of clients with infectious or contagious diseases or illnesses;

 

(4)  The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28;

 

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

 

(6)  The prevention of cross contamination between patients, for the post treatment disinfection of machines and stations to provide a sanitary patient care environment.

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

 

          (e)  Personnel infected with scabies, lice, or any communicable disease shall not provide direct care to clients until such time as they are no longer infected.

 

          (f)  Pursuant to RSA 141-C, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ESRDDC until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, and tight-fitting bandage.

 

          (h)  Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as noted in Appendix A.

 

          (i)  The licensee shall identify, track, and report infections and process measures, as required by RSA 151:33 and He-P 309.

 

          (j)  The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside the facility.

 

          (k)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (l)  A supply of potable water shall be available for human consumption pursuant to He-P 811.24(h).

 

          (m)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

 

          (n)  All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination. 

 

          (o)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and client supplies.

 

          (p)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (q)  Only individuals authorized under RSA 430:33 shall apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

 

          (r)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (s)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (t)  Laundry shall meet the following requirements:

 

(1)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(2)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste; and

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations;

 

          (u)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (v)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

 

          (w) Sterile supplies and equipment shall not be mixed with unsterile supplies.

 

          (x)  Any ESRDDC with a non-municipal water supply and whose water has been tested and has failed to meet acceptable levels as required by the department of environmental services shall notify the department.

 

          (y)  Trash receptacles in food service area shall have covers and shall remain closed except when in use.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.22  Physical Environment.

 

          (a)  The licensed premises shall be maintained so as to provide for the health, safety, well-being, and comfort of clients and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

 

          (b)  Equipment providing heat within an ESRDDC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature that is a minimum of 70 degrees Fahrenheit when client(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any ESRDDC.

 

          (f)  The ESRDDC shall have:

 

(1)  An emergency call system; and

 

(2)  A generator, in working condition at all times.

 

          (g)  The generator in (f)(2) above shall be tested regularly in accordance with manufacturer’s recommendations.

 

          (h)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (i)  Ventilation shall be provided in all client areas by means of a mechanical ventilation system or one or more screened windows that can be opened, per the state building code and the FGI “Guidelines for the Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A.

 

          (j)  The ESRDDC shall contain an underwriter’s laboratory (UL) listed nursing or monitoring station from which clients receiving dialysis services can be monitored.

 

          (k)  Each ESRDDC shall provide the following supplies and equipment, which shall be maintained in an operable condition in accordance with the manufacturer’s recommendations:

 

(1)  Oxygen delivery system;

 

(2)  Emergency ventilating supplies including airways;

 

(3)  Automatic External Defibrillator (AED);

 

(4)  Intravenous fluids and administration devices;

 

(5)  Suction machine capable of battery operation or a secondary power source;

 

(6)  Emergency supplies, under the supervision of a registered nurse or physician, which shall be inventoried and maintained according to ESRDDC policy; and

 

(7)  A stretcher, gurney, or transfer device capable of adjusting to the trendelenberg position.

 

          (l)  Restocking of the emergency supplies described in (j) above shall occur immediately after each use.

 

          (m)  There shall be at least one toilet and one hand-washing sink for client use, which shall have:

 

(1)  Soap dispensers;

 

(2)  Paper towels or a hand-drying device providing heated air;

 

(3)  Hot and cold running water; and

 

(4)  A door that either slides or swings, not a folding door or curtain.

 

          (n)  If the ESRDDC has showers and tubs, they shall have:

 

(1)  Slip resistant floors; and

 

(2)  Surfaces which are intact, easily cleanable, and impervious to water.

 

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

 

          (p)  The ESRDDC shall have a telephone to which the clients have access.

 

          (g)  The ESRDDC shall have sufficient space and equipment for the services authorized to be provided at the ESRDDC.

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.23  Emergency and Fire Safety.

 

          (a)  All ESRDDCs shall, at a minimum, meet the Business or Ambulatory Health Care Occupancy chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (b)  The licensee shall provide and maintain a complete fire alarm system installed and maintained in accordance with Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, regardless of the size of the facility.

 

          (c)  The licensee shall comply with all state and local codes and ordinances for:

 

(1)  Building, including the International Building Code as adopted by RSA 155-A:2;

 

(2)  Health;

 

(3)  Fire, including but not limited to NFPA 101 and Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

 

(4)  Waste disposal; and

 

(5)  Water, including the requirements of He-P 811.06(d).

 

          (d)  The ESRDDC shall:

 

(1)  Have all entrances and exits to the licensed premises accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and clients, including but not limited to hazards from falls, burns, or electrical shocks;

 

(3)  Be free from environmental nuisances, including noise and odors; and

 

(4)  Take measures to prevent the presence of rodents, insects, and vermin including, but not limited to:

 

a.  Having tightly fitting screens to all doors, windows, or other openings to the outside unless the door is self-closing and remains closed unless in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

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

 

          (i)  Each licensee shall develop a written emergency response plan that covers:

 

(1)  Loss of electricity;

 

(2)  Loss of water;

 

(3)  Loss of heat;

 

(4)  Bomb threat;

 

(5)  Severe weather;

 

(6)  Fire;

 

(7)  Gas leaks;

 

(8)  Unexplained client disappearances; and

 

(9)  Any situation that requires evacuation of the ESRDDC.

 

          (j)  Each licensee shall:

 

(1)  Annually review and revise, as needed, its emergency plan;

 

(2)  Submit its emergency plan to the local emergency management director for review and approval when initially written and whenever the plan is revised; and

 

(3)  Maintain documentation on‑site which establishes that the emergency plan has been approved as required under (2) above.

 

          (k)  Fire and/or evacuation drills shall be conducted quarterly as follows:

 

(1)  Each employee shall participate in at least one drill every calendar quarter; and

 

(2)  Each drill shall include the transmission of a fire alarm signal and simulation of emergency fire conditions.

 

          (l)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  Emergency EMS transport related to pre-existing conditions.

 

          (m)  The written notification required by (l) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (n)  For personnel who are unable to participate in the scheduled drill described in (k) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility fire and emergency plan and document such instruction in their personnel file.

 

          (o)  Personnel who are unable to participate in a drill in accordance with (k) and (n) above shall participate in a drill within the next quarter.

 

          (p)  The timing of quarterly drills shall be at varying times to include all shifts and all clients and individuals in the ESRDDC at the time of the drill.

 

          (q)  All emergency and evacuation drills shall be documented and include the following information:

 

(1)  The names of the participating personnel and clients;

 

(2)  The time, date, month, and year the drill was conducted;

 

(3)  The exits utilized if the ESRDDC does not comply with the health care chapter of the state fire code;

 

(4)  The total time necessary to evacuate the ESRDDC, when evacuation of the facility is required by the drill;

 

(5)  The time needed to complete the drill; and

 

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

 

          (r)  Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code including but not limited to:

 

(1) Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

a.  Minimum distance of 6.1 m (20 ft);

 

b.  Minimum distance of 1.5 m (5 ft) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

c.  A gas cabinet constructed per NFPA 30, Flammable and Combustible Liquids Code, or NFPA 55, Compressed Gases and Cryogenics Fluids Code, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

 

(2)  Cylinders shall be protected from damage by means of the following specific procedures:

 

a.  Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

 

b.  Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

 

c.  Cylinders shall be protected from tampering by unauthorized individuals;

 

d.  Cylinders or cylinder valves shall not be repaired, painted, or altered;

 

e.  Safety relief devices in valves or cylinders shall not be tampered with;

 

f.  Valve outlets clogged with ice shall be thawed with warm, not boiling water;

 

g.  A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

 

h.  Sparks and flame shall be kept away from cylinders;

 

i.  Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

j.  Large cylinders (exceeding size E) and containers larger than 45 kg (100 lb) weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

 

k.  Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

l.  Cylinders shall not be supported by radiators, steam pipes, or heat ducts;

 

(3)  Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

 

a.  Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

 

b.  Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

 

c.  Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

d.  The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

 

e.  Oxygen shall be referred to by its proper name, oxygen, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

 

f.  Oxygen shall not be used as a substitute for compressed air;

 

g.  The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

h.  Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels/tags used for indicating cylinder status (e.g., full, in use, empty);

 

i.  The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

 

j.  Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, heat ducts;

 

k.  Very cold cylinders or containers shall be handled with care to avoid injury;

 

l.  A precautionary sign, readable from a distance of 1.5 m (5 ft), shall be displayed on each door or gate of the storage room or enclosure; and

 

m.  The sign shall include the following wording as a minimum:

 

     CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

                                               NO SMOKING

 

Source.  #9963, eff 7-28-11; ss by #12827, INTERIM, eff 7-20-19, EXPIRED: 1-16-20

 

New.  #12985, eff 1-29-20

 

          He-P 811.24  Emergency Preparednes.

 

          (a)  Each facility shall have an emergency management committee, of which the facility administrator shall be a member. 

 

          (b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (c)  The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

 

(1)  Elected state and local officials;

 

(2)  Police, fire, civil defense, and public health professionals;

 

(3)  Environment, transportation, and hospital officials;

 

(4)  Facility representatives; and

 

(5)  Representatives from community groups and the media.

 

          (d)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  A description of how the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (e)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (f)  The plan in (e) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, or human-caused emergency such as missing clients and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the -licensee;

 

(11)  Conduct a facility-wide –walk-through and review, to include the property that the licensee is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

 

(12) Include the licensee’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  Heating, ventilation, and air conditioning (HVAC);

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Essential services, such as kitchen and laundry services, if applicable;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Include the management of clients, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of clients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the -licensee is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (g)  The licensee shall conduct and document with a detailed log, including personnel signatures, 2 drills a year.  A drill could be to test the facilities communication systems and contact lists this would include local authorities, the State and any other call trees the facility may utilize.  One drill may be to rehearse mass casualty, if available, that will test the facilities response with emergency services, disaster receiving stations, or both.  If a mass casualty drill is utilized it must comply with the following:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the -licensee’s plan and who is not involved in the exercise;

 

(2)  Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The –licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify areas of non-compliance and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the -licensee’s improvement plan.

 

          (h)  For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

 

(1)  Assumptions for calculations of food and water supplies including maximum number of staff and clients, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

 

a. Enough non-perishable foods for a 2-day period; and

 

b.  Potable water for a 2-day period.

 

(2)  Storage location(s); and

 

(3)  Back-up supplies.

 

Source.  #12985, eff 1-29-20

 

PART He-P 812  RULES FOR AMBULATORY SURGICAL CENTERS

 

         He-P 812.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all ambulatory surgical centers (ASC) pursuant to RSA 151:2, I(d).

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRED: 12-24-18

 

New.  #12926, eff 11-26-19

 

         He-P 812.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association or other legal entity operating an ASC, except:

 

         (a)  All facilities listed in RSA 151:2, II(a)-(g); and

 

         (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

         He-P 812.03  Definitions. In this part, the following words have the following meanings, unless context clearly indicates otherwise:

 

         (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of patients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

 

(3)   “Sexual abuse” means contact or interaction of a sexual nature involving a vulnerable adult as defined in RSA 161-F:43, II(c), or, in the case of sexual abuse of a minor, as defined in RSA 169-C:3, XXVVII-b;

 

         (b)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure;

 

         (c) “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use, by an individual authorized by law, pursuant to RSA 318-B and RSA-326-B;

 

         (d)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises;

 

         (e)  “Admission” means the point in time when a patient has been accepted by a licensee for the provision of services;

 

         (f)  “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J or a surrogate decision maker in accordance with RSA 137-J:35;

 

         (g)  “Adverse event” means a negative consequence of care, including any misadministration as defined in He-P 4000, which results in unintended injury which might have been preventable, and which is listed in RSA 151:38;

 

         (h)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies;

 

         (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision maker in accordance with RSA 137-J:35;

 

         (j)  “Ambulatory surgical center (ASC)” means any building, place, or a portion thereof, exclusive of physician or dentist’s offices that maintains and operates services for the performance of outpatient surgical procedures;

 

         (k)  “Anesthesiologist” means a physician who is licensed to practice medicine in the state of New Hampshire and who is accredited by the American Board of Anesthesiology, the American College of Anesthesiology, or the American Osteopathic Board of Anesthesiology;

 

         (l) “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a ASC pursuant to RSA 151:2, I(d);

 

         (m)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 812, or other federal or state requirements;

 

         (n)  “Assessment” means an evaluation of the patient to determine the care and services that are needed;

 

         (o)  “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, and/or the patient’s guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services;

 

         (p)  “Certified ASC” means an ASC certified by the Centers for Medicare and Medicaid Services (CMS) to provide Medicare or Medicaid funded care or services;

 

         (q) “Certified Registered Nurse Anesthetist (CRNA)” means an advanced practice nurse who administers anesthesia for surgery or other medical procedures under the direction of an anesthesiologist;

 

         (r)  “Change of ownership” means a change in the controlling interest of an established ASC to an individual or successor business entity;

 

         (s)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee;

 

         (t)  “Contracted employee” means a temporary employee working under the direct supervision of the ASC but employed by an outside agency;

 

         (u) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others;

 

         (v)  “Days” means calendar days unless otherwise specified in the rule;

 

         (w)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post-test to the training provided;

 

         (x)  “Department” means the New Hampshire department of health and human services;

 

         (y)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance;

 

         (z)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, in the event of an actual or imminent cardiac or respiratory arrest, that chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs.  This term includes “do not attempt resuscitation order (DNAR order)”;

 

         (aa)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency;

 

         (ab)  “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license or suspension of a license in response to non-compliance RSA 151 or He-P 812;

 

         (ac)  “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures;

 

         (ad)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud;

 

         (ae)  “Facility” means “facility” as defined in RSA 151:19, II;

 

         (af)  “Governing body” means a group of individuals who are responsible for policy direction of the ASC;

 

         (ag)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A, or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs;

 

         (ah)  “Health care occupancy” means occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupants control;

 

         (ai)  “Incident Command System (ICS)” means a standardized, on-scene, emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries.  ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents;

 

         (aj)  “Infectious waste” means those items specified by Env-Sw 904;

 

         (ak)  “Informed consent” means the decision by a person or his/her guardian, agent, or surrogate decision maker, to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently;

 

          (al)  “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel;

 

         (am)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 812 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 812;

 

         (an)  “License” means the document issued by the department to an applicant at the start of operation of an ASC which authorizes operation in accordance with RSA 151 and He-P 812, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number;

 

         (ao)  “License certificate” means the document issued by the department to an applicant or licensee that contains the information on a license and includes the name of the administrator and the type(s) of services authorized;

 

         (ap)  “Licensed 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 New Hampshire state licensing board;

 

         (aq)  “Licensed premises” means the building(s) that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license;

 

         (ar)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151;

 

         (as)  “Licensing classification” means the specific category of services authorized by a license;

 

         (at)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

         (au)  “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329 and certified by the American Board of Medical Specialties or certified by the American Osteopathic Association in the field of surgery or anesthesia, who is responsible for overseeing the quality of medical care and services at the ASC;

 

         (av)  “Medical staff” means those physicians and other licensed practitioners permitted by law and ASC policies to provide patient care services independently within the scope of his or her practice act;

 

         (aw)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance;

 

         (ax)  “Modification” means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  The term does not include repair or replacement of interior finishes.

 

         (ay)  “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any patient;

 

         (az)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes;

 

         (ba)  “Nursing care” means the provision or oversight by a nurse of a patient’s physical, mental, or emotional condition by diagnosis as confirmed by a licensed practitioner; 

 

         (bb) “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for any or all medications, treatments, recommendations, or 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;

 

         (bc)  “Over-the-counter medications” means non-prescription medications;

 

         (bd)  “Patient” means any person admitted to or in any way receiving care, services, or both from an ASC or provider of any special health care service licensed in accordance with RSA 151 and He-P 812;

 

         (be)  “Patient record” means documents maintained for each person receiving care, services, or both, which includes all documentation required by RSA 151 and He-P 812 and all documentation compiled relative to the patient as required by other federal and state requirements;

 

         (bf)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21;

 

         (bg)  “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions;

 

         (bh)  “Personal representative” means a person designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose or for the general purpose of assisting a patient in the exercise of any rights;

 

         (bi)  “Personnel” means individual who is employed by the facility, a volunteer, or an independent contractor, who provides direct or personal care or services to a patient;

 

         (bj)  “Physician” means a medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329;

 

         (bk)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6;

 

         (bl)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care;

 

         (bm)  “Point of care devices” means testing involving a system of devices, typically including:

 

(1)  A lancing or finger stick device to get the blood sample;

 

(2)  A test strip to apply the blood sample; or

 

(3)  A meter or monitor to calculate and show the results; including but not limited to:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin Time (PT) and International Normalized Ration (INR) anticoagulation meters; or

 

c.  Cholesterol meter;

 

         (bn)  “Procedure” means a licensee’s written standardized method of performing duties and providing services;

 

         (bo)  “Professional staff” means:

 

(1)  Physicians;

 

(2)  Physician assistants;

 

(3)  Advanced practice registered nurses;

 

(4)  Licensed nurses;

 

(5)  Physical therapists;

 

(6)  Speech therapists;

 

(7)  Respiratory therapists;

 

(8)  Occupational therapists;

 

(9)  Social workers; and

 

(10)  Dieticians;

 

         (bp)  “Qualified personnel” means any personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, including but not limited to nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols;

 

         (bq)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained;

 

         (br)  “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures, that does not result in reconfiguration of the building spaces within;

 

         (bs)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purposes of maintaining such materials, elements, equipment, or fixtures in good or sound condition;

 

         (bt)  “Stabilize” means to provide medical care to allow the patient to be moved or transferred to another ASC or general hospital without negative effects;

 

         (bu)  “Surgery” means a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedures; and

 

         (bv)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or persons who provide religious services or entertainment.

 

Source.  #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraphs (g), (p) and (q) EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

         He-P 812.04  Initial License Application Requirements.

 

         (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III, and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (March 2019), signed by the applicant or 2 of the corporate officers affirming the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any ACS to be newly licensed:

 

“I certify that I have notified the public of intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than ten (10) business days prior to the filing of this application”;

 

c.   For any ASC to be newly licensed and to be located within a radius of fifteen (15) miles of a hospital as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of fifteen (15) miles of a hospital as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than ten (10) business days prior to the filing of this application.”; and

 

d.  For facilities to be licensed under the listed categories:

 

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed pursuant to  He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R 485.610(b) and (c), until the Commissioner makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”

 

(2)  A floor plan of the prospective ASC;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority” if a corporation;

 

b.  “Certificate of Formation” if a limited liability corporation; or

 

c.  “Certificate of Trade Name” if a sole proprietorship or if otherwise applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name and qualifications of the ASC administrator and medical director;

 

(6)  Copies of applicable licenses and/or certificates for the ASC administrator and medical director;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, including but not limited to the ambulatory health care occupancy chapter of NFPA 101 as adopted by the commissioner of the department of safety, and local fire ordinances applicable for an ASC; and

 

b.  For a building under construction, the written approvals required by He-P 812.04(a)  shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(8)  If the ASC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, or, if a public water supply is used, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, the administrator, and the medical director, as applicable.

 

         (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (e) EXPIRED: 6-27-05

 

New. #9727-B, eff 6-18-10; ss by #12557, INTERIM,
eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.05  Processing of Applications and Issuance of Licenses.

 

         (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 812.04(a) have been received.

 

         (b)  If an application does not contain all of the items required by He-P 812.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

         (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

         (d)  Licensing fees shall not be transferable to any other application(s).

 

         (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 812.13(b) if it determines that the applicant(s), administrator, or medical director:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of a patient.

 

         (f)  Following both a clinical and life safety inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 812.

 

         (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

         (h)  A written notification of denial, pursuant to He-P 812.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 812.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 812.

 

         (i)  A written notification of denial, pursuant to He-P 812.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraphs (c) and (d) EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.06  License Expirations and Procedures for Renewals.

 

         (a)  A license shall be valid on the date of issuance and expire one year from date of issuance, unless a completed application for renewal has been received.

 

         (b)  Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 812.04(a)(1) at least 120 days prior to the expiration of the current license and include with the application:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 812.10(f), if applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 812.17(e)(2);

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03- 6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control; and

 

(5)  A list of specialties that are performed at the center.

 

         (c)  In addition to He-P 812.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

 

         (d)  Following an inspection as described in He-P 812.09, a license shall be renewed if the department determines that the licensee:

 

(1) Submitted an application containing all the items required by He-P 812.06(b) and (c) as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151, He-P 812, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.07  ASC Construction, Modifications or Renovations.

 

         (a)  For new construction and for rehabilitation of an existing building, including, but not limited to certain repairs, renovations, modifications, reconstruction, and additions, construction documents, and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

         (b) The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

         (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office, as required by RSA 153:10-b, V.

 

         (d)  Any licensee or applicant who wants to use performance-based designs to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

         (e)  The department shall review construction documents, drawings, and plans of a newly   proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 812 and shall notify the applicant or licensee whether the proposal complies with these requirements.

 

         (f) The ASC shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

         (g)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control, including but not limited to at a minimum:

 

a.  If certified either directly or through accreditation with CMS, shall meet with Ambulatory Health Care Occupancy Chapter; or

 

b.  If not certified either directly or through accreditation with CMS, meet the appropriate chapter of the life safety code occupancy, including but not limited to business, ambulatory health care occupancy; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

         (h)  All ASCs, newly constructed or rehabilitated, after the 2019 effective date of He-P 812 shall comply with the Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition)  available as listed in Appendix A.

 

         (i)  Where rehabilitation is done with an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition) , available as listed in Appendix A.

 

         (j)  Per the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2018 edition) available as noted in Appendix A.

 

         (k) The department’s bureau of health facilities administration shall be the authority having jurisdiction for the requirements in (h) – (j) above and shall negotiate compliance and grant waivers in accordance with He-P 812.10 as appropriate.

 

         (l)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

 

         (m)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require renewal unless the underlying reason or circumstances for the waivers change.

 

         (n)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

         (o)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 812.09 prior to its use.

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.08  ASC Requirements for Organizational Changes.

 

         (a)  The ASC shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  Services.

 

         (b)  The ASC shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership; or

 

(2)  A change in the physical location.

 

          (c)  When there is a change in address without a change in location, the ASC shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the ASC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

         (e)   When there is to be a change in the services provided, including the type of sedation used, the ASC shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made.

 

         (f)  The department shall review the information submitted under (e) above and determine if the added services can be provided under the ASC current license.

 

         (g)  An inspection by the department shall be conducted prior to operation when there are changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department;

 

(2)  The physical location;

 

(3)  A change in licensing classification; or

 

(4)  A change that places the facility under a different life safety code occupancy chapter.

 

         (h)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

         (i)  A revised license and license certificate shall be issued for changes in the ASC’s name.

 

         (j)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator or medical director;

 

(2)  A change in address without a change in physical location; or

 

(3)  When a waiver has been granted under He-P 812.10.

 

         (k) The ASC shall inform the department in writing no later than 5 days prior to a change in administrator or medical director in the event of death or other extenuating circumstances requiring an administrator or medical director change and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2) Copies of applicable licenses for the new administrator;

 

(3)  The results of a criminal records check from the NH department of safety for the new administrator or medical director; and

 

(4)  A copy of the criminal attestation as described in He-P 812.17(m)(9).

 

         (l)   Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the administrator or medical director meets the qualifications for the position as specified in He-P 812.16(c) and He-P 812.03(au).

 

         (m)  If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the ASC in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

         (n)  The ASC shall inform the department in writing via email, fax, or mail of any change in the e-mail address no  later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

         (o)  A restructuring of an established ASC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

         (p)  If a licensee chooses to cease operation of an ASC, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.09  Inspections.

 

         (a)  For the purpose of determining compliance with RSA 151 and He-P 812, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the ASC; and

 

(3)  Any records required by RSA 151 and He-P 812.

 

         (b)  The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 812, prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 812.08(g)(1);

 

(3)  A change in the physical location of the ASC;

 

(4)  A change in the licensing classification;

 

(5)  Occupation of space after construction, renovations or structural alterations; or

 

(6)  The renewal of a non-certified ASC license.

 

         (c)  In addition to (b) above, the department shall conduct an inspection as necessary to verify the implementation of any POC accepted or issued by the department.

 

         (d) A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ASC is in violation of any of the provisions of He-P 812, RSA 151, or other federal or state requirement(s).

 

         (e) If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 812, within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #5514, eff 11-25-92; amd by #6530, eff 6-27-97; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (b)(7) EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 812 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived. 

 

         (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver. 

 

         (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety or well-being of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

         (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

         (e)  Waivers shall not be transferable.

 

         (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

         (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #5514, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.11  Complaints.

 

         (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 complainants’ first-hand knowledge regarding the allegations or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

 

(3)  There is 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 RSA 151 or He-P 812.

 

         (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the ASC, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 812.

 

         (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

                  (4)  Interviews with individuals who might have information that is relevant to the investigation.

 

         (d)  For the licensed ASC, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 812.

 

         (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed ASC does not comply with (e)(2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 812; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 812.

 

         (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13 and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #5514, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.12  Administrative Remedies.

 

         (a)  The department shall, after notice and an opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 812, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

         (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

         (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct the licensee shall submit its written POC for each item, written in the appropriate place on the state notice detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action.

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 812;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 812 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable the department shall notify the licensee in writing, within 14 days, of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

b.  The department determines that the health, safety, or well-being of a patient will not be jeopardized as a result of granting the waiver;

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P812.13(c)(12);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 812.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 812.13(c)(13) below.

 

         (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

 

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

         (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine;

 

(3)  Deny the application for a renewal of a license in accordance with He-P 812.13(b); or

 

(4)  Revoke the license in accordance with He-P 812.13(b).

 

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

 

         (g)  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.

 

         (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

         (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

         (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

 

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

 

         (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the ASC that negatively impact the health, safety, or well-being of patients.

 

Source.  #5514, eff 11-25-92; ss by #6530, eff 6-27-97, EXPIRED: 6-27-05

 

New.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.13  Enforcement Actions and Hearings.

 

         (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

         (b)  The department shall deny an application or revoke a license if:

 

(1) An applicant or a licensee has violated a provision of RSA 151 or He-P 812, which violations have the potential to harm a patient’s health, safety, or well-being;

 

(2) An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee or fine in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, or schedule an initial inspection, an applicant, or licensee fails to submit an application that meets the requirements of He-P 812.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents or interferes with, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 812.12(c), (d), and (e);

 

(7) The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 812.12(c)(5) and has not submitted a revised POC in accordance with He-P 812.12(c)(5)(b);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 812 for the same violations within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 812;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13) The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

         (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

 

(4)  For a failure to transfer a patient whose needs exceed the services or programs provided by the ASC, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For admission of a patient whose needs exceed the services or programs authorized by the ASC, in violation of RSA 151:5-a, II and He-P 812.15(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 812.11(e), the fine for an unlicensed provider or licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 812.06(b), the fine shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 812.08(a)(1), the fine shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 812.08(a)(2), the fine shall be $500.00;

 

(10)  For a failure to notify the department of a change in e-mail address, in violation of He-P 812.08(n), the fine shall be $100.00;

 

(11)  For a refusal to allow access by the department to the ASC’s premises, programs, services or records, in violation of He-P 812.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 812.12(c)(2) or (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 812.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement or comply with licensee policies, as required by He-P 812.18(b) and (f), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 812.18, the fine for a licensee shall be $500.00; 

 

(16)  For providing false or misleading information or documentation, in violation of He-P 812.14(g), the fine shall be $1,000.00 per offense;

 

(17)  For a failure to meet the needs of a patient or patients, as described in He-P 812.14(j), the fine for a licensee shall be $1,000.00 per patient;

 

(18)  For placing a patient in a room that has not been approved or licensed by the department, in violation of He-P 812.09(b)(5), the fine for a licensee shall be $500.00;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 812.10, in violation of He-P 812.16(b), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings; when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 812.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities; as required by He-P 812.09(b)(5), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that a violation of RSA 151 or He-P 812 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine shall be $1,000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in (a) above, the fine for a licensee shall be $2000.00; and

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 812 shall constitute a separate violation and shall be fined in accordance with He-P 812.12(c), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 807, as verified by documentation or other means, the department shall not issue a daily fine.

 

         (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire”, or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

         (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

         (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

         (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of patients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

         (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 812 is achieved.

 

         (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

         (j)  When an ASC’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years, if the enforcement action pertained to their role in the ASC. 

 

         (k)  The 5-year period referenced in (j) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if not filed; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

         (l)  Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 812.

 

         (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (l) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

         (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 812.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.14  Duties and Responsibilities of All Licensees.

 

         (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, regulations, codes, and ordinances, including RSA 161-F:40 and rules promulgated thereunder.

 

         (b)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

 

         (c)  The licensee shall define, in writing, the scope and type of services to be provided by the ASC, which shall include at a minimum, the required services listed in He-P 812.18.

 

         (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the ASC.

 

         (e)  All policies and procedures shall be reviewed annually.

 

         (f)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

         (g)  The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

 

         (h)  The licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating a ASC, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

         (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

         (j)  Licensees shall:

 

(1)  Meet the needs of the patients during those hours that the patients are in the care of the ASC;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ASC;

 

(3)  Appoint an administrator and medical director;

 

(4)  Verify the qualifications of all personnel;

 

(5)  Provide sufficient numbers of qualified personnel to meet the needs of patients during all hours of operation;

 

(6)  Provide sufficient supplies, equipment, and lighting to meet the needs of the patients; and

 

(7)  Implement any POC that has been accepted by the department.

 

         (k)  The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney for health care or surrogate that has been activated; or

 

(3)  Is an un-emancipated minor.

 

         (l)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures for the care of the patients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

 

         (m)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

         (n)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license and license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 812.09(b), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  The licensee’s floor plan, identifying the location of, and access to all fire exits;

 

(6)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted by calling 1-800-852-3345 or in writing to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

 

(7)  A list of physicians who have an ownership or financial interest in the ASC.

 

         (o)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 812 as authorized by RSA 151:6 and RSA 151:6-a.

 

         (p)  Licensees shall, in accordance with He-P 812.15:

 

(1)  Report all adverse events to the department as required by He-P 812.15(a)-(c);

 

(2)  Submit additional information if required by the department; and

 

(3)  Report the event to other agencies as required by law.

 

         (q)  A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

 

         (r)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

         (s)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to patients and personnel.

 

         (t)  The licensee shall develop policies and procedures regarding the release of information contained in patient records.

 

         (u)  The licensee shall provide cleaning and maintenance services, as needed, to protect patients, personnel, and the public.

 

         (v)  The licensed premises shall comply with all state and local:

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

         (w)  Smoking shall be prohibited in the ASC per RSA 155:66, I(b), except as permitted by RSA 155:67. If allowed, smoking shall be restricted to designated smoking areas as per the licensee’s official smoking policy, but in no case shall smoking be permitted in any room containing an oxygen cylinder or oxygen delivery system or in a resident’s bedroom.

 

         (x)  If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

 

         (y)  Upon request, the licensee shall give a patient and the patient’s guardian, agent, or personal representative, or surrogate decision-maker as applicable, a listing of all known applicable charges and identify what care and services are included in the charge.

 

         (z) The licensee may perform the following Clinical Laboratory Improvement Amendments (CLIA) waived tests, as per 42 CFR Part 493.15, without obtaining a NH state laboratory license:

 

(1)  Urine drug screening;

 

(2)  Alcohol screening;

 

(3)  Urine pregnancy; and

 

(4)  Glucose testing.

 

         (aa) If the licensee collects urine specimens for laboratory testing, the licensee shall follow the manufacturer’s instructions and the reference laboratory’s instructions for collection, transporting, and storage of urine specimens.

 

         (ab)  If the licensee collects other human specimens it shall be licensed as a collection station in accordance with He-P 817.

 

         (ac)  If the ASC performs any laboratory test other than those exempted by (z) above, the licensee shall be licensed as a laboratory in accordance with He-P 808.

 

         (ad)  The ASC shall hold the appropriate CLIA certificate to perform any laboratory tests.

 

         (ae) The licensee shall maintain the manufacturer’s test system instructions including package inserts and operator’s manuals.

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.15  Adverse Event Reporting.

 

         (a)  Pursuant to RSA 151:37-38, the ASC administrator or designee shall report to the department the following adverse events:

 

(1)  Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573, available as noted in Appendix A;

 

(2)  The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker’s intentional unsafe act; and 

 

                  (3)  An act by a hospital or ambulatory surgery center staff with the potential to result or resulting in an infection or disease.

 

         (b)  If the licensee suspects an adverse event occurred, the ASC administrator or designee shall send a report to the department in electronic or paper format, within 15 business days after discovery of event including:

 

(1)  ASC information;

 

(2)  Patient information;

 

(3)  Event information; and

 

(4)  Type of occurrence as listed in (a) above.

 

         (c)  For events reported in (b) above the ASC shall, within 60 days, provide the department:

 

(1)  An analysis that includes the type of harm and contributing factors; and

 

(2)  A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the ASC determines that one is not required.

 

         (d)  If the ASC suspects that it received a patient from a sending ASC or hospital that was subject to an adverse event, then the receiving ASC administrator or designee shall notify the sending ASC or hospital’s administrator or designee and the department. The department shall inform the sending ASC or hospital that a report is required in accordance with (b) above.

 

         (e)  Upon receipt of a report of an adverse event, the department shall:

 

(1)  Acknowledge receipt of event and review information for completeness;

 

(2)  Review corrective action plan for system changes that reduce the risk repeat of similar adverse events;

 

(3)  Communicate specific concerns to the ASC if the department does not find the corrective action plan credible;

 

(4)  Track and analyze adverse events for trends, underlying system problems; and

 

(5)  Provide information and make referrals to other state agencies as appropriate.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.16  Organization and Administration.

 

         (a)  Each ASC shall have a governing body whose duties include:

 

(1)  Management and control of the operation of the ASC;

 

(2)  Assessment and improvement of the quality of care and services;

 

(3)  Appointment of the ASC administrator;

 

(4)  Adoption of policies and procedures defining responsibilities for the operation of the ASC and the establishment of a medical staff;

 

(5) Approval of medical staff policies and procedures establishing the medical staff responsibilities;

 

(6)  Responsibility for management of the overall operation and fiscal viability of the ASC;

 

(7)  Responsibility for determination of the qualifications for appointment for all managers, medical staff and personnel; and

 

(8)  Ensuring compliance with all relevant health and safety requirements of federal, state and local laws rules and regulations.

 

          (b)  If the ASC is a sole proprietorship, the duties in (1) above shall pertain to the individual in ownership status.

 

         (c)  Each ASC shall have a full-time administrator who:

 

(1)  Meets one of the following qualifications:

 

a.  The administrator shall have a master’s degree from an accredited institution in business administration or a health-related field;

 

b.  The administrator shall have a bachelor’s degree from an accredited institution and at least 2 years of experience working in a health-related field; or

 

c.  The administrator shall be a registered nurse and have at least 3 years of experience working in a health-related field; and

 

(2)  Shall be responsible to the governing body for the daily management and operation of the ASC including:

 

a.  Management and fiscal matters;

 

b.  Implementing the policies and procedures adopted by the governing body;

 

c.  The employment and termination of personnel necessary for the efficient operation of the ASC;

 

d.  The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the ASC in the absence of the administrator;

 

e.  Attendance at meetings of the governing body, medical staff, and personnel, to serve as a liaison to the governing body;

 

f.  The planning, organizing, and directing of such other activities as may be delegated by the governing body;

 

g.  The delegation of responsibility to subordinates as appropriate;

 

h.  Ensuring development and implementation of ASC policies and procedures on:

 

1.  Patient’s rights as required by RSA 151:20-21;

 

2.  Advanced directives as required by RSA 137-J;

 

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

 

4.  Organ and tissue donor identification and procurement, as applicable;

 

5.  Withholding of resuscitative services from patients pursuant to RSA 137-J; and

 

6.  Adverse event reporting; and

 

i.  Notifying the department, directly or through delegation, as specified in He-P 812.15, of any adverse event involving a patient; and

 

(3)  May hold more than one position within the ASC provided the individual meets the qualifications of each position.

 

         (c)  Each ASC shall have a medical staff in accordance with the policies and procedures established under (a)(4) above.

 

         (d)  There shall be a full-time director of nursing services who:

 

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

 

(2)  Has a minimum of 4 years’ relevant experience;

 

(3)  Is responsible for:

 

a.  Establishment of standards of nursing practice used in the ASC;

 

b.  Ensuring that the admission process and patient assessment process coordinates patient requirements for nursing care with available nursing resources;

 

c.  Participating with the governing body, administrator and medical staff to improve the quality of nursing care at the ASC; and

 

d.  Nursing care as authorized by their nurse practice act and according to RSA 326-B; and

 

(4)  May hold more than one position within the ASC provided the director of nursing meets the qualifications of each position.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

New.  #12926, eff 11-26-19

 

          He-P 812.17  Personnel.

 

         (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the ASC to meet the needs of the patients at all times.

 

         (b) For all applicants for employment, volunteers, or independent contractors who provide direct personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal services within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

 

(2)  Review the results of the criminal records check in accordance with (d) below;

 

(3)  Verify the qualifications of all applicants prior to employment;

 

(4)  Verify that the applicant is not on the List of Excluded Individuals/Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

 

(5)  Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

 

         (c)  Unless a waiver is granted in accordance with (e)(2) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, if the person:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

(d)  If the information identified in (c) above regarding any person subject to (b) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging with the person; or

 

(2)  Request a waiver of (c) above.

 

(e)  If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

 

(1)  Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a patient(s); or

 

(2)  Grant a waiver of (c) above, if after the investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

 

(f)  The licensee shall:

 

(1)  Not employ, contract with, or engage with any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage with board of nursing licensees who are listed on the licensing site with the NH board of nursing registry or compact site.

 

         (g)  In lieu of (c) and (f) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (f) above and do not meet the criteria in (c) and (g) above.

 

         (h)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position as listed in their job description;

 

(2)  Be licensed, registered, or certified as required by state statute and as applicable;

 

(3)  Receive an orientation within the first 3 days of work or prior to the assumption of duties that includes:

 

a.  The ASC’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities, policies, procedures, and guidelines, of the position they were hired for;

 

c.  The ASC’s infection prevention program;

 

d.  The ASC’s fire, evacuation, and emergency plans which outline the responsibilities and educational requirements of personnel in an emergency; and

 

e.  Mandatory reporting requirements for abuse or neglect such as those found in RSA 161–F and RSA 169-C:29;

 

(4)  Complete a mandatory annual in-service education, which includes a review of the ASC’s:

 

a.  Policies and procedures on patient rights and responsibilities and abuse or neglect;

 

b.  Infection prevention; and

 

c.  Education program on fire and emergency procedures.

 

         (i)  Prior to having contact with patients, personnel shall:

 

(1)  Submit to the licensee proof of a physical examination or a health screening conducted not more than 12 months prior to employment which shall include at a minimum the following:

 

a.  The name of the examinee;

 

b.  The date of the examination;

 

c.  Whether or not the examinee has a contagious illness or any other illness that would affect the examinee’s ability to perform their job duties;

 

d.  Results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control (CDC); and

 

e.  The dated signature of the licensed health practitioner;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the United States Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

         (j)  Personnel who have direct contact with patients who have a history of TB or a positive laboratory and antigen testing shall have a symptomology screen of a TB test.

 

         (k)  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 patient’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s written emergency plan; and

 

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

 

(l)  Current, separate and complete personnel files shall be maintained and stored in a secure and confidential manner.

 

         (m)  The licensee shall maintain a separate employee file for each employee, which includes the following:

 

(1)  A completed application for employment or a resume;

 

(2)  A signed statement acknowledging the receipt of the ASC’s policy setting forth the patient’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (h)(3) above;

 

(5)  A copy of each current New Hampshire license, registration, or certification in health care field and basic life support certification, if applicable;

 

(6)  Documentation that the required physical examination or health screening and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by employee;

 

(8)  Documentation of annual performance review;

 

(9)  A statement which shall be signed at the time the initial offer of employment, contract, or engagement is made and then annually thereafter, that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient(s) in this or any other state; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect or exploitation of any person in this or any other state;

 

(10)  Documentation of the criminal records check;

 

(11)  Documentation that the individual is not on the List of Excluded Individuals/Entities, maintained by the U.S. Department of Health and Human Services Office of Inspector General; and

 

(12)  The results of the registry checks in (11) above.

 

(n)  The licensee shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (m)(1), (3), (4), (6) and (8) through (12) above; and

 

(2)  For independent contractors, the information in (m) (3), (4), (6) and (8) through (12) above.

 

          (o)  An individual need not re-disclose any of the matters in (9) and (10) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.18  Required Services.

 

          (a)  The licensee shall determine the scope of surgical services that shall be performed in the surgical suite.

 

          (b)  The licensee shall determine the types of anesthesia to be utilized and shall meet NFPA 99, Health Care Facilities Code for supply and storage.  Once determined, the ASC shall assure its availability in the surgical suite.  Flammable anesthetics shall not be used in an ASC.

 

          (c)  Each licensee shall ensure the availability of sufficient personnel, with the required skills and experience, to provide the services in (a) above.

 

          (d)  The licensee shall have a policy governing basic life support training and use.

 

          (e)  The licensee shall have a surgical suite, which shall be a separate unit, physically set apart from all other departments.

 

          (f)  The surgical suite shall contain the following:

 

(1)  At least one operating room equipped for general operating use within the scope of surgical services determined by the ASC in accordance with (a) above;

 

(2)  Facilities for sterilization, scrubbing, and clean-up, separate from the operating room;

 

(3)  Clean, sterile, soiled, or decontamination rooms which shall be separate and distinct from each other;

 

(4)  Appropriate storage space for sterile supplies, instruments, anesthesia and medications;

 

(5)  Emergency lighting;

 

(6)  Heating ventilation and air conditioning (HVAC) systems shall comply with the FGI “Guidelines for Design and Construction of Outpatient Facilities” (2018 Edition), available as noted in Appendix A, including the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE/ANSI/ASHE) Standard 170-2017 and the State of NH 2009 International Mechanical Code; and

 

(7)  Space routinely used for administering inhalation anesthesia and inhalation analgesia, which shall be served by a scavenging system to vent waste gases.

 

          (h) The ASC shall have appropriately certified or licensed supervisory personnel present during the procedures being performed.

 

          (i)  No operation shall be performed until:

 

(1)  The patient has had a physical examination and medical history completed, within the past 30 days;

 

(2)  Any indicated laboratory and x-ray examinations have been completed;

 

(3)  The preoperative diagnosis has been recorded in the patient’s record; and

 

(4) The patient has signed a consent for anesthesia.

 

          (j)  The ASC shall complete discharge planning on all patients admitted to the ASC including the provision of verbal and written instructions to the patient, and/or personal representative, agent, surrogate decision-maker, or guardian as applicable.

 

          (k)  Discharge planning shall include, as applicable:

 

(1)  The patient’s medication needs upon discharge;

 

(2)  The need for medical equipment, special diets, or potential food-drug interactions; and

 

(3)  The need for home health services upon discharge.

 

          (l)  The ASC shall have a procedure for the immediate transfer to a hospital, of patients requiring emergency medical care beyond the capabilities of the ASC.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.19  Patient Records.

 

          (a)  A patient record shall be maintained for each patient accepted for treatment by the facility.

 

          (b)  The license shall maintain a legible, current, and accurate record for each patient based on the services provided at the ASC.

 

          (c)  At a minimum, patient records shall contain the following:

 

(1)  Identification data including the patient’s:

 

a.  Name;

 

b.  Home address;

 

c.  Telephone number;

 

d.  Name, address, and telephone number for an emergency contact;

 

e.  Date of birth; and

 

f.  Guardian, agent, or surrogate decision-maker, as applicable;

 

(2)  A signed acknowledgment of receipt of the patients’ bill of rights by the patient, guardian, agent, or surrogate decision-maker;

 

(3)  Patient’s health insurance information;

 

(4)  Written or electronic record of a health examination by a licensed practitioner;

 

(5)  Written, dated, and signed orders for medications, treatments, special diets, laboratory services, and referrals to other practitioners, as applicable;

 

(6)  The consent for release of information signed by the patient, guardian, agent, or surrogate decision-maker, if any;

 

(7)  The medication record;

 

(8)  Documentation of any accident or injuries occurring while in the care of the facility;

 

(9)  Documentation of all services provided including signed notes by:

 

a.  Nursing personnel;

 

b.  Physicians; and

 

c.  Other health professionals authorized by ASC policy;

 

(10)  Documentation of a patient’s refusal of any care or services;

 

(11)  Transfer or discharge documentation including planning, referrals, and notifications to the patient and guardian, agent, or surrogate decision-maker, if any, of involuntary room change, if applicable;

 

(12)  Laboratory, x-rays, or results of other diagnostic tests; and

 

(13)  The consent for treatment signed by the patient, guardian, agent or surrogate decision-maker, if any.

 

          (d)  Patient records shall be available to the professional staff and health care workers and any other person authorized by law or rule to review such records.

 

          (e)  Patient records shall be retained in the facility and stored in an area inaccessible to those who do not have authorized access to such records.

 

          (f)  The licensee’s policy shall determine the method by which release of information from patient records shall occur.

 

          (g)  When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use by implementation of appropriate use, handling, and storage procedures.

 

          (h)  Patient records shall be retained 7 years after the discharge of a patient. In the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

 

          (i)  The ASC shall arrange for the storage of and access to patient records for 7 years in the event the ASC ceases operation.

 

          (j)  The licensee shall arrange for storage of and access to patient records for 7 years in the event the clinic ceases operation.

 

          (k)  The facility shall notify the department where the storage required in (i) above is located.

 

          (l)  Referrals to other health care providers shall occur if medically indicated and the facility does not provide the services required.

 

          (m)  Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

 

          (n)  If the facility uses an electronic record storage system, it shall provide computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 812 for the onsite inspection.  Access shall include assistance navigating the database and printing portions of the record, if needed.

 

          (o)  Radiologic services shall only be provided when integral to procedures offered by the ASC.

 

          (p)  The ASC shall adopt and implement policy and procedures that provide safety for patient and personnel and are based on nationally recognized standards.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.20  Infection Control.

 

          (a)  The licensee shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.     

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

 

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

 

(4)  The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

 

(5)  Reporting of infectious and communicable diseases as required by He-P 301;

 

(6)  Evaluating and revising the infection control program in accordance with current CDC recommended actions;

 

(7)  Maintenance of a sanitary physical environment; and

 

(8)  Infection control policies specific to each department.

 

          (c)  The infection control education program shall:

 

(1)  Be completed by all personnel on an annual basis; and

 

(2)  Address the:

 

a.  Cause of infections;

 

b.  Effect of infections;

 

c.  Transmission of infections; and

 

d.  Prevention and containment of infections.

 

          (d)  Personnel infected with a disease or illness transmissible through food, saliva, or droplets, shall not provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to patients until such time as they are no longer infected.

 

          (f)  Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel and staff with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, secure-fitting bandage.

 

          (h)   If the ASC has an incident of an infectious disease reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (i)  The ASC shall have available space, supplies and equipment for proper handling of suspected or actual infectious conditions.

 

          (j)  The ASC shall require that licensed practitioners evaluate all patients at risk for an infection or communicable disease to ensure the detection or presence of same.

 

          (k)  The ASC administrator shall appoint an infection control officer who shall:

 

(1)  Receive reports of communicable and infectious diseases; and

 

(2)  Report to the director of the division of public health services all diseases for which reporting is required under RSA 141-C.

 

          (l) The ASC shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee or patient has a communicable disease.

 

          (m)  The ASC shall identify, track, and report infections, as required by RSA 151:33 and He-P 309.

 

          (n)  The infection control program shall report to quality assurance and performance improvement (QAPI) on at least a quarterly basis.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.21  Quality Assessment and Performance Improvement.

 

          (a)  The licensee shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing and correcting identified problems.

 

          (b)  As part of its quality improvement program, an interdisciplinary quality assurance and performance improvement committee shall be created and required to:

 

(1)  Meet at least quarterly to evaluate quality assurance and performance improvement activities;

 

(2)  Generate dated, written minutes for each meeting;

 

(3)  Maintain all quality improvement activities, including minutes of meetings, for at least 2 years from the date the record was created; and

 

(4)  Make recommendations to the governing body to improve the quality of care.

 

          (c)  Quality assurance and performance improvement activities shall include:

 

(1)  Review of patterns and trends of activities which affect the quality of care;

 

(2)  Ensuring that quality control logs for preventive maintenance and safety checks are maintained for all equipment according to manufacturer’s recommendations or code requirements;

 

(3)  Monitoring and evaluation of the quality of patient care and patient care services in the ASC which shall include:

 

a.  Monitoring of medication use and review of pharmacy activity in the ASC;

 

b.  Review of patient record quality;

 

c.  Review of blood use in the ASC, as applicable; and

 

d.  Review of other functions such as risk management, infection control, disaster planning, ASC safety, and utilization review; and

 

(4)  Reviewing and making recommendations for improvement in areas such as:

 

a.  Infection surveillance;

 

b.  Morbidity;

 

c.  Mortality;

 

d.  Monitoring of personnel quality control practices in each service; and

 

e.  Adverse events in accordance with He-P 812.15.

 

          (d)  For each quality assurance and performance improvement activity, the committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the ASC; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.22  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment both inside and outside the facility.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the patients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation when used for laundry, as required in the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2018 edition), available as noted in Appendix A, and summarized as follows:

 

(1)  One hundred and five to 120 degrees Fahrenheit for clinical areas, representing the minimum and maximum allowable temperatures; and

 

(2)  One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used which meets the designed water temperatures specified by the manufacturer.

 

          (f)  All patient bathing and toileting facilities shall be cleaned and disinfected to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications and program supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, and outdoor animals.

 

          (j)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

 

          (k)  Laundry and laundry rooms, if present, shall meet the following requirements:

 

(1)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(2)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(3)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

 

          (l)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (m)  Clean supplies shall be stored in dust-free and moisture-free storage areas.

 

          (n)  Any ASC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department upon receipt of notice of a failed water test.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.23  Pharmacy and Medications.

 

          (a)  Medications shall be administered only by a person licensed to do so by the state of NH.

 

          (b)  An emergency drug cart shall be maintained, it shall be under the control of a licensed nurse or physician, and shall be inventoried, in accordance with the written policy of the ASC. 

 

          (c)  All medications shall be stored in a clean, well-organized cabinet or closet which shall be locked when not in use.

 

          (d)  Appropriate security provisions shall be made for medications requiring refrigeration.

 

          (e)  Security provisions such as locked drawers shall be made for individual physician samples if no central storage location is established.

 

          (f)  Schedule I and II drugs scheduled in accordance with RSA 318-B:1-a shall be stored in a locked compartment within the locked medicine cabinet or closet.

 

          (g)  Disposal of outdated medications and controlled drugs shall be in accordance with state and local ordinances and the provisions of RSA 318-B and Ph 707.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.24  Physical Environment.

 

   (a)  The licensed premises shall be maintained so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

 

(b)  The  licensed premises shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not be limited to:

 

a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b. Repairing holes and caulking of pipe channels; and

 

c. Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within an ASC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall:

 

(1)  Maintain a temperature of at least 55 degrees Fahrenheit during the day if patient(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Any heating device other than a central plan shall be designed and installed so that:

 

(1)  Combustible material cannot be ignited by the device or its appurtenances;

 

(2)  If fuel-fired, such heating devices comply with the following:

 

a.  They shall be chimney or vent connected;

 

b.  They shall take air for combustion directly from outside; and

 

c. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and

 

(3)  Any heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

 

          (g)  Unvented fuel-fired heaters shall not be used in any ASC.

 

          (h)  Plumbing shall be sized, installed, and maintained in accordance with the state building code under RSA 155-A.     

 

          (i)  Screens shall be provided for doors and windows that are left open to the outside.

 

          (j)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (i) above.

 

          (k)  The ASC shall have a telephone to which the patients have access.

 

          (l)  Toilet and bathing facilities shall be provided to meet patient needs in relation to the number, acuity, and gender of the patients, but no less than one toilet per 8 patient care stations.

 

          (m)  Separate toilet facilities with hand washing sinks shall be provided for personnel and visitors.

 

          (n)  All toilets shall be vented out-of-doors.

 

          (o)  Each bathroom shall be equipped with:

 

(1)  Soap dispensers;

 

(2)  Paper towels or a hand-drying device providing heated air; and

 

(3)  Hot and cold running water.

 

          (p)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (q)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (r)  All bathroom and closet doors must either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.

 

          (s)  The licensee shall comply with all state and local codes and ordinances for:

 

(1)  Zoning;

 

(2)  Building;

 

(3)  Health;

 

(4)  Fire;

 

(5)  Waste disposal; and

 

(6)  Water.

 

          (t)  The facility shall be accessible at all times of the year.

 

          (u)  The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel and the public.

 

          (v)  Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.

 

          (w)  Doors shall be of such width as to permit removal of a patient in a bed and meet the state fire and building codes.

 

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

 

          (y)  There shall be an emergency generator system to provide emergency power pursuant to the following, as adopted by the commissioner of the department of safety in Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control:

 

(1)  The Electrical Systems chapter of NFPA 99, Health Care Facilities Code; and

 

(2)  The Standard for Emergency and Standby Power Systems, NFPA 110.

 

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

 

          (aa)  Facilities shall provide for prompt cleaning of bedpans, urinals and other utensils.

 

          (ab)  Any locking mechanism utilized by the facility on egress doors shall comply with the Ambulatory Health Care Occupancy Chapter of NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control.

 

          (ac)  The ASC shall maintain a system for sterilization of equipment and supplies as follows:

 

(1) The sterilization system shall be checked for effective sterilization in accordance with the manufacturer’s recommendation; and

 

(2)  The results of these quality control tests shall be documented.

 

          (ad)  The ASC shall have a storage room for clean/sterile supplies, including packs, which meets the following requirements:

 

(1)  There shall be provisions for ventilation, humidity, and temperature control;

 

(2)  Sterile supplies and equipment shall not be mixed with unsterile supplies; and

 

(3) Sterile supplies shall be stored in dustproof and moisture free, labeled containers or cupboards.

 

          (ae)  Signs shall be provided at all entrances to restricted areas and shall clearly indicate that surgical attire is required.

 

          (af)  The ASC shall be divided into 3 designated areas, unrestricted, semi-restricted, and restricted, which are defined by the physical activities performed in each area and by the FGI’s “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.7 Requirements for Outpatient Surgery Facilities” (2018 edition), available as noted in Appendix A.

 

          (ag)  Operating room sizes shall be based on procedures to be performed, including the number of staff required and the amount and size of equipment that will be used.  At a minimum operating room sizes shall meet the requirements of the FGI’s “Guidelines for the Design and Construction of Outpatient Facilities, Chapter 2.1 Common Elements for Outpatient Facilities and Chapter 2.7 Requirement for Outpatient Surgery Facilities” (2018 edition), available as noted in Appendix A.  In addition, at a minimum, the square footage requirements, shall take into account circulation pathways, sterile fields, movable equipment, and anesthesia work area.

 

          (ah)  Operating rooms shall be located within the restricted corridors of the surgical suite.

 

          (ai)  Semi-restricted areas shall have ceilings that are smooth and without crevices, scrubbable, non-absorptive, Non-perforated and capable of withstanding cleaning with chemicals.

 

          (aj) Restricted areas shall have ceilings that are monolithic. Cracks or perforations in these ceilings shall not be permitted and the central diffusers shall not be considered part of a monolithic ceiling.  All access openings in these ceilings shall be gasketed.

         

          (ak) If utilizing lay-in ceilings, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot.

 

          (al) A nurse call system shall be required per the FGI’s “Guidelines for the Design and Construction of Outpatient Facilities” (2018 edition), available as noted in Appendix A.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.25  Life Safety and Fire Safety Procedures.

 

          (a)  The administrator or designee shall appoint a safety committee to include representatives from administration, clinical services and support services.

 

          (b)  The safety committee shall:

 

(1)  Appoint a safety officer who shall:

 

a.  Inspect the ASC at least semi-annually to assure that all safety precautions are met; and

 

b.  Report to the safety committee any findings noted during the inspections;

 

(2)  Develop or approve written policies and procedures covering all matters of safety and fire protection and an emergency response plan, including:

 

a.  The emergency procedures required by the emergency response plan shall include, but are not limited to, evacuation routes, emergency notification numbers and emergency instructions and shall be posted in locations accessible to personnel and visitors;

 

b.  The ASC fire safety plan shall provide for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarm to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation; and

 

9.  Extinguishment of the fire;

 

c.  Ensuring that the fire safety and evacuation plans are available to all supervisory personnel;

 

d. Ensuring that all employees receive in-service annual training to clarify their responsibilities in carrying out the emergency plan; and

 

e.  Ensuring that the required plan shall be readily available at all times in the telephone operator’s location or at the security center; and

 

(3)  Conduct fire drills, including the transmission of a fire alarm signal and simulation of emergency fire situation, as follows:

 

a.  Recovery and operating room patients shall not be required to be moved during drills to safety areas or to the exterior of the building; and

 

b.  Drills shall be conducted quarterly on each shift to familiarize ASC personnel with the signals and emergency action required under varied conditions.

 

          (c)  The emergency plan required by (b)(2) above shall be approved and signed by the local fire chief.

 

          (d)  The ASC shall notify the department and local fire department when a required sprinkler or fire alarm system is out of service for more than 4 hours in a 24-hour period.  The ASC shall be evacuated or an approved dedicated fire watch shall be provided for all parties left unprotected by the shutdown until the sprinkler or alarm system has been returned to service.

 

          (e)  The ASC shall notify the department when the emergency power has been utilized for 6 or more hours due to power outage.

 

          (f)  Provisions shall be made for the medical gas(es) used in the facility.  Adequate space for supply and storage, including space for serve cylinders, shall be provided.  Protection of this area shall meet NFPA 101 and NFPA 99 Health Care Facilities Code, as adopted in Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control.

 

          (g)  If piped medical gas is used, the installation, testing, and certification of nonflammable medical gas and air systems shall comply with the requirements of NFPA 99, as adopted in Saf-C 6000 by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control.

 

          (h)  Where the functional program requires, central clinical vacuum system installations shall be in accordance with NFPA 99, as adopted in Saf-C 6000  as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control.

 

          (i)  If there is an incident including, but not limited to, fire, toxic fumes including smoke, flooding, and power outage, which requires the evacuation of the ASC all or in part, the ASC shall immediately notify the department by phone, once the incident has been stabilized.  Within 72 hours of the incident, the ASC shall submit a written report which gives further details of the incident and the action taken.

 

Source.  #9727-A, eff 6-18-10, EXPIRED: 6-18-18

 

New.  #12557, INTERIM, eff 6-26-18, EXPIRES: 12-24-18

 

New.  #12926, eff 11-26-19

 

          He-P 812.26  Emergency Preparedness.

 

          (a)  Each facility shall have an emergency management committee, of which the facility administrator must be a member. 

 

          (b) The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (c)  The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (d)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (e) and (f) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (e)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (f)  The plan in (e) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(7)  Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

 

(8)  Include the management of participants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

 

(9)  Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

 

(10) If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

            (g)  Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

 

            (h)  The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

 

            (i) Notwithstanding (a)-(g) above, when an ASC is a part of a larger institution which has a comprehensive emergency preparedness plan, the ASC may use the institution’s plan, and if so, it shall:

 

(1)  Identify the portions of the plan that pertain to the ASC in a separate document for use by ASC personnel;

 

(2)  Provide annual training to prepare personnel in its application as required by (g) above; and

 

(3)  Review and update the plan as required by (h) above.

 

Source.  #12926, eff 11-26-19

 

PART He-P 813  ADULT FAMILY CARE RESIDENCE

 

Statutory Authority: RSA 151:2, IV; and RSA 151:9:VIII

 

          He-P 813.01  Purpose.  The purpose of these rules is to establish the minimum standards and procedures for the certification of an adult family care residence.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.02  Scope.  These rules shall apply to any individual, agency, partnership, association, or other legal entity offering adult family care services to one or 2 residents in a home-like environment and receiving reimbursement from the New Hampshire Medicaid choices for independence (CFI) waiver program for those services.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.03  Definitions.

 

          (a)  “Abuse” means “abuse” as defined in RSA 161-F:43, II.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks common to the average individual, such as personal hygiene, transfers and walking.

 

          (c)  “Admission” means the act of a resident’s initial physical move into an AFCR.

 

          (d)  “Adult family care (AFC)” means a housing option for eligible participants under the  CFI waiver program, which includes a combination of personal care, homemaking, and other services that are provided to a participant who is a resident in a certified residence of an unrelated individual or the CFI waiver participant’s relative in accordance with a person-centered plan.

 

          (e) “Adult family care provider” means an individual 21 years or older who has been certified by the department in conjunction with the oversight agency to provide care and assistance in his or her home residence to 1 or 2 individuals.

 

          (f)  “Adult family care residence (AFCR)” means the dwelling in which AFC is provided for one or 2 residents.

 

          (g)  “Applicant” means an individual, agency, partnership, corporation, federal, state, county or local government entity, association, or other legal entity seeking a certificate to operate an AFCR pursuant to RSA 151:2, IV.

 

          (h)  “Assessment” means an evaluation of the resident to determine what care and services are needed.

 

(i)  “Case manager” means a person providing services in accordance with He-E 805, who has the primary responsibility for assessing the participant’s needs, developing a comprehensive care plan, and coordinating and monitoring the services described in the comprehensive care plan.

 

          (j)  “Certification” means the written approval by the manager of the office of program support for the operation of an AFCR in accordance with He-P 813.

 

          (k)  “Certificate holder” means the person or agency whose name is on the AFCR certification issued.

 

          (l)  “Choices for Independence (CFI) waiver program” means a system of long-term services and supports (LTSS) provided under Section 1915(c) of the Social Security Act to participants who meet the eligibility requirements in He-E 801.03 and He-E 801.04.  This term is also known as home and community-based care for the elderly and chronically ill (HCBC-ECI) and as home and community-based services- choices for independence (HCBS-CFI).

 

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

 

          (n)  “Deficiency” means any action, failure to act or other set of circumstances that cause a certificate holder or oversight agency to be out of compliance with RSA 151 or He‑P 813.

 

          (o)  “Department” means the New Hampshire department of health and human services.

 

          (p)  “Emergency plan” means a document outlining the responsibilities of certificate holders and the oversight agency in an emergency.

 

          (q)  “Exploitation” means “exploitation” as defined in RSA 161-F:43, IV.

 

          (r)  “Fire safety assessment” means a documented evaluation completed by a certificate holder based on a drill, completed in accordance with He-P 813.20.

 

          (s)  “Household member” means the adult family care provider and all adult household members age 17 or older that reside at the AFCR.

 

          (t)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of caregivers.

 

          (u)  “Investigation" means the process used by the department to respond to allegations of non‑compliance with RSA 151 and He-P 813.

 

          (v)  “Licensed practitioner” means any of the following disciplines acting within their relevant scope of practice:

 

(1)  Medical doctor;

 

(2)  Physician's assistant;

 

(3)  Advanced registered nurse practitioner (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.

 

          (w)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (x)  “Neglect” means “neglect” as defined in RSA 161-F:43, III.

 

          (y)  “Orders” means prescriptions, instructions for treatments, special diets or therapies, signed by a licensed practitioner, or other individual authorized by law.

 

          (z)  “Oversight agency” means an agency, entity or organization enrolled as a New Hampshire Medicaid provider that is designated by the department to provide oversight functions of AFCRs.

 

          (aa)  “Over-the‑counter medications” means non‑prescription medications for use by a resident at the certified premises.

 

          (ab)  “Person-centered” means that the CFI waiver participant receiving services or his or her authorized representative are the center of the system of care, and participant’s needs and preferences drive the care and services provided.

 

          (ac)  “Plan of correction (POC)” means a plan developed and written by the adult family care provider or oversight agency, which specifies the actions that will be taken to correct deficiencies identified by the department.

 

          (ad)  “Procedure” means a written, standardized method of performing duties and providing services.

 

          (ae)  “Representative” means an individual granted authority by law to represent another individual, including a legal representative as defined in RSA 161-F:11, VII, and a resident’s personal representative as defined in RSA 151:19, V.

 

          (af)  “Resident” means any person who has been determined eligible for nursing home level of care under the CFI waiver program in accordance with He-E 801, and who is admitted to an AFCR certified in accordance with RSA 151 and He-P 813.

 

          (ag)  “Resident record” means a secure file, located in the AFCR, that contains the resident’s person-centered plan, service agreement, emergency data sheet, medication record and progress notes.

 

          (ah)  “Self administered with supervision” means an act whereby the resident is prompted by an adult family care provider to take his or her own medication(s) without requiring physical assistance from others.

 

          (ai)  “Self administration of medication” means an act whereby the resident is able to take his or her own medication(s) without the verbal or physical assistance of another person.

 

          (aj)  “Self directed” means an act whereby a resident, who has a physical limitation that prohibits him or her from self-administering, directs the adult family care provider to physically assist in the medication process.

 

          (ak)  “Service” means a specific activity performed by the adult family care provider or oversight agency, either directly or indirectly, to benefit or assist a resident.

 

Source.  #8595, eff 4-1-06; #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.04  Adult Family Care Provider Qualifications, Duties and Responsibilities.

 

          (a)  An adult family care provider shall:

 

(1)  Be at least 21 years of age;

 

(2)  Possess a high school or general equivalency diploma;

 

(3)  Possess and maintain a NH driver’s license;

 

(4)  Possess the results of a physical examination or health screening completed no more than 12 months prior to filing the initial application;

 

(5)  Possess the results of a 2-step tuberculosis (TB) test, Mantoux method, completed no more than 12 months prior to filing the initial application;

 

(6)  Be equipped to provide care to an elderly and/or disabled adult in accordance with a respective resident’s person-centered plan;

 

(7)  Have a written agreement with an oversight agency; and

 

(8)  Prior to accepting a resident within an AFCR, participate in 6 hours of orientation, offered by or through the oversight agency, which includes, at a minimum, the following:

 

a.  The aging process and associated changes;

 

b.  The philosophy and provision of person-centered services and supports;

 

c.  The role of the oversight agency and case management services;

 

d.  The resident’s rights in accordance with RSA 151:21;

 

e.  AFCR complaint procedures;

 

f.  The services provided by the AFCR in accordance with these rules;

 

g.  Based on the adult family care provider’s resident(s), information on the specific diseases and conditions, including:

 

1.  All medical conditions, medical history, routine and emergency protocols, and any special nutrition, dietary, hydration, elimination, and ambulation needs;

 

2.  Any communication needs;

 

3.  Any behavioral supports required of residents served;

 

4.  Any assistance that residents need to evacuate the AFCR in case of an emergency;

 

5.  The procedures for food safety regarding preparation, serving, and storing of food; and

 

6.  The mandatory reporting requirements in accordance with RSA 161-F:46-50.

 

          (b)  Annually, the  adult family care provider shall participate in a minimum of 6 hours of continuing education or training, as conducted by or coordinated by the oversight agency, which presents the information contained in (a)(8) above.

 

          (c)  Adult family care providers shall follow the orders of the licensed practitioner or other licensed professional with prescriptive authority for each resident and encourage residents to follow the practitioner’s orders.

 

          (d)  The adult family care provider shall provide care in accordance with the resident’s person-centered plan, fire safety plan and personal safety plan.

 

          (e)  The adult family care provider shall provide services in accordance with He-P 813.16.

 

          (f)  During a planned absence or in the event of an emergency, the adult family care provider in collaboration with the oversight agency and case manager shall arrange for a substitute adult family care provider to provide care for the residents in accordance with the resident’s person-centered plan and these rules.

 

          (g)  The adult family care provider shall provide access to the home for licensed professionals for the delivery of other services to the resident if the resident requires additional specific services not provided by the adult family care provider as outlined in the resident’s person-centered plan.

 

          (h)  The adult family care provider shall provide or arrange for the resident with access to community activities, including:

 

(1)  Religious services;

 

(2)  Social and cultural events;

 

(3)  Educational activities;

 

(4)  Recreational activities; and

 

(5)  Opportunities for the resident to visit with his or her family and friends.

 

          (i)  The adult family care provider shall provide or arrange for sufficient supplies, including but not limited to toiletries, clean linens, and towels, to ensure that the needs of the resident are met.

 

          (j)  An adult family care provider file shall be available at the AFCR for review by the department and contain the following:

 

(1)  A completed application by the adult family care provider to provide adult family care services;

 

(2)  Proof that the applicant meets the minimum age requirements;

 

(3)  A statement signed by the adult family care provider that he or she has received a copy of and received training by or through the oversight agency, in the implementation of the policy and procedures setting forth the resident’s rights and responsibilities as required by RSA 151:20;

 

(4)  A copy of the results of the criminal records, motor vehicle, and bureau of elderly and adult services (BEAS) Adult Registry checks for all adults living or working in the AFCR;

 

(5)  Documentation of satisfactory completion of the required orientation program;

 

(6)  Documentation regarding the content, length, and dates of all subsequent annual training or educational programs attended;

 

(7)  A copy of a current driver’s license; and

 

(8)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x‑rays, if required, have been completed by the appropriate health professionals.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.05  Oversight Agency Responsibility.  Oversight agencies through a signed written agreement between the oversight agency’s executive director and the adult family care provider shall:

 

          (a)  Comply with these rules, which include:

 

(1)  Providing the services described in these rules;

 

(2)  Requesting a waiver for an adult family care provider or AFCR in accordance with He-P 813.25; and

 

(3)  Reporting based on the department’s quality assurance measures developed in accordance with RSA 126-A:4, IV;

 

          (b)  Monitor the AFCRs compliance with these rules which includes:

 

(1)  Identifying possible deficiencies pursuant to these rules to assist adult family care providers with necessary corrective action and to maintain compliance;

 

(2)  Conducting periodic announced or unannounced quality assurance visits, at least annually;

 

(3)  Complete criminal, motor vehicle, and BEAS registry checks for all adult household members prior to submission of the initial application; and

 

(4)  Notify the department within 7 days of a resident moving into an AFCR; and

 

          (c)  Provide the following supports:

 

(1)  Coordinate with adult family care providers to provide coverage for absences, both planned and in the event of an emergency;

 

(2)  Provide education and training as described in He-P 813.18(aa)-(ac), and as follows:

 

a.  Initial orientation training;

 

b.  Continuing education and training; and

 

c.  Medication supervision training in accordance with He-P 813.18;

 

(3)  Facilitate the transfer of residents due to revocations of certification, voluntary closure of AFCR, or immediate suspension of operation;

 

(4)  Develop a person-centered plan with the adult family care provider;

 

(5)  Approve personal safety plans prior to a resident being left unsupervised;

 

(6)  Conduct quarterly evaluations of physical and cognitive functioning of residents;

 

(7)  Quarterly discuss the progress notes of each resident with the adult family care provider; and

 

(8)  Assist with orders for medications from a licensed practitioner as needed.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.06  Resident Eligibility.  The AFCR shall only admit residents who:

 

          (a)  Meet financial and clinical eligibility requirements for the CFI waiver  program;

 

          (b)  Have needs for supports and services that are able to be met directly by the AFCR or through arrangement with other providers;

 

          (c)  Are able to evacuate the residence in compliance with Saf-C 6008.04 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control; and

 

          (d)  Do not place the health or safety of any other resident or household member in jeopardy.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.07  Administrative Requirements.

 

(a)  An AFCR shall:

 

(1)  Be located in areas where other family housing is located;

 

(2)  Not display any sign that labels the individuals or functions of the residence; and

 

(3)  Have no more than 2 persons receiving paid services in the residence without regard to payment.

 

          (b)  The adult family care provider shall hold the certificate to operate the residence in conjunction with an enrolled medicaid adult family care provider agency that is authorized by the department as an oversight agency to administer adult family care.

 

          (c)  The adult family care provider shall provide a list of the names of all persons living in the residence to the oversight agency, changes to the list shall be reported to the oversight agency within 30 days of the change.

 

          (d)  The adult family care provider shall have personal injury liability insurance for the residence. Certificates of insurance shall be on file at the premises.

 

          (e)  All AFCR household members and staff that transport a resident, shall have a valid driver’s license and current automobile liability insurance, which shall be in at least the following amounts and coverage:

 

(1)  $100,000 coverage for any single person injured; and

 

(2)  $300,000 coverage for personal injuries per accident.

 

          (f)  No adult family care provider or other person living or working in an adult family care residence shall serve as the legal guardian or legally liable representative of an individual living in the residence.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.08  Certification Process.

 

(a) The certification process shall only apply to those homes where the resident is living with an adult family care provider who is not a family member.

 

          (b)  An applicant shall apply to be certified via an application form obtained from the department’s health facilities administration entitled “Request for Certification of Adult Family Care Residence” (November 2019). 

 

          (c)  An applicant shall request certification for any of the following reasons:

 

(1)  Certification of a new AFCR; or

 

(2)  For an existing AFCR:

 

a.  A change in the oversight agency;

 

b.  A change in physical location; or

 

c.  A request for an increase from one to 2 certified beds or a decrease from 2 to one certified bed.

 

          (d)  The applicant shall provide the following with the application:

 

(1)  Directions to the home;

 

(2)  Copies of all approved waivers, pending waiver requests, or both;

 

(3)  Verification from the department or local fire official that the applicant complies with all applicable state and local fire ordinances for a single or 2 family dwelling, including verification that the AFCR:

 

a.  Has smoke detectors that are:

 

1.  Placed on every level of the AFCR;

 

2.  Placed in every bedroom;

 

3. Interconnected and hardwired or a wireless system approved by the New Hampshire state fire marshal’s office; and

 

4.  Powered by the AFCR’s electrical service;

 

b.  Has at least one ABC type fire extinguisher on every level of the AFCR;

 

c.  Is free from fire hazards; and

 

d.  Has at least one functioning carbon monoxide detector on every inhabited level of the home and in the basement;

 

(4)  An approval from the local fire official signed and dated with the following information:

 

a.  Date indicates that approval was obtained more than 90 days prior to the submission of the application;

 

b.  Verifies the street address of the proposed or existing AFCR;

 

c.  Verifies that the home complies with all state and local fire codes;

 

d.  Includes the date of the life safety inspection; and

 

e.  States the specific the number of beds for safe occupancy by AFC residents living in the proposed of existing AFCR; and

 

(5)  For AFCRs not served by a public water system, an analysis report completed within the previous 12 months by a certified laboratory that verifies the water supplied to or used in the prospective home is suitable for human consumption and in compliance with Env-Dw702.02 and Env-Dw 704.02.

 

          (e)  The applicant shall provide to the department a written agreement, signed by the oversight agency’s executive director, or his or her designee, that indicates that the oversight agency agrees to monitor the residence.

 

          (f)  The applicant and all household members living within the home shall authorize the oversight agency, pursuant to He-P 813.05, to complete a registry check in the BEAS adult registry to verify that the applicant and other adult household members do not have a non-criminal finding of abuse, neglect, or exploitation of an incapacitated adult.

 

          (g)  Information disclosed regarding adjudication of juvenile delinquency, as required by (c)(10)b. above, shall be confidential and shall not be released except in a proceeding involving the question of certification or revocation of a license, or pursuant to court order.

 

          (h)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

          (i)  The department shall process applications in accordance with RSA 541-A:29.

 

          (j)  An application for an initial certification shall be deemed to be complete when the department determines that all items required in (b ), and (d)-(g) above have been received.

 

          (k)  If an application does not contain all of the items required by (b), and (d)-(g) above the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (l)  All certifications issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (m)  A temporary certification shall be granted for 90 days, or until the certification has been approved or denied, from the date that the department receives all information required on the application form incorporated by reference in He-P 813.08(b).

 

          (n)  Within 90 days of the receipt of the application, the department’s health facilities administration shall complete an inspection for the purposes of determining whether the AFCR is in compliance with these rules.

 

(o)  At the time of inspection, the department shall be provided with the results of criminal record checks, motor vehicle records, and BEAS adult registry checks for the applicant, adult family care provider, and all household members age 17 years or older as completed by the oversight agency, pursuant to He-P 813.05.

 

(p)  If the applicant, adult family care provider, or any household member age 17 years or older has been convicted on a felony or misdemeanor, or has a substantiated complaint by a state agency, he or she shall provide to the department a written disclosure containing a list of any:

 

(1)  Misdemeanor or felony convictions, in this or any other state;

 

(2)  Adjudications of juvenile delinquency;

 

(3)  Permanent restraining or protective orders;

 

(4)  Evidence of any conduct that could endanger the well-being of the individual receiving care;

 

(5)  Findings by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation;

 

(6)  Current investigations by any law enforcement agency;

 

(7)  Current investigations by the department for abuse, neglect or exploitation; or

 

(8)  An explanation of the circumstances surrounding disclosure of matters described in a. through g. above.

 

          (q) After the inspection, if the department deems the AFCR not in compliance with these rules, the AFCR shall submit a plan of correction in accordance with He-P 813.09.

 

          (r) After the inspection, if the department deems the AFCR in compliance with these rules, the department shall issue a certification to the AFCR.

 

Source.  #8595, eff 4-1-06; amd by #9899-A, eff 3-29-11, (paras (b)-(p)); amd by #9899-B, eff 3-29-11 (para (a)); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.09  Inspections and Plans of Correction.

 

          (a)  The department shall conduct inspections to determine compliance with all applicable rules prior to:

 

(1)  Issuing an initial certification; and

 

(2)  Renewal of a certificate except as allowed by He-P 813.10.

 

          (b)  Following an inspection and determination pursuant to (a) above, the department shall issue a written inspection report that includes:

 

(1)  The name and address of the physical location of the AFCR;

 

(2)  The name of the responsible oversight agency;

 

(3)  The date of the inspection;

 

(4)  The name of the person(s) conducting the inspection; and

 

(5)  A listing of all rules with which the AFCR failed to comply.

 

          (c)  If deficiencies were cited in the inspection report, within 21 days of the date of issuance of the report, the AFCR shall submit a written plan of correction or submit information as to why the deficiency(ies) did not exist.

 

          (d)  The department shall evaluate any submitted information on its merits and render a written decision on whether a written plan of correction is necessary.

 

          (e)  The plan of correction submitted in accordance with (c) above shall describe:

 

(1)  How the AFCR corrected or intends to correct the deficiency(ies);

 

(2)  How the AFCR intends to prevent reoccurrence of each deficiency; and

 

(3)  The date by which each deficiency shall be corrected.

 

          (f)  The department shall issue a certificate if it determines that the plan of correction: 

 

(1)  Addresses the deficiency in a manner which achieves full compliance with rules cited in the inspection report;

 

(2)  Addresses all deficiencies cited in the inspection report;

 

(3)  Does not create a new violation of statute or rule as a result of its implementation; and

 

(4)  States a completion date.

 

          (g)  The department shall reject a plan of correction that fails to comply with (e) and (f) above.

 

          (h)  If the proposed plan of correction is rejected, the department shall notify the AFCR in writing of the reason(s) for rejection. 

 

          (i)  Within 21 days of the date of the written notice under (h) above, the AFCR shall submit a revised plan of correction that:

 

(1)  Includes proposed alternatives that address the reason(s) for rejection; and

 

(2)  Is reviewed in accordance with (e) and (f) above.

 

          (j)  If the revised plan of correction is rejected, the department shall deny the certification request.

 

          (k)  The department shall verify that a plan of correction, as submitted and accepted, has been implemented by:

 

(1)  Reviewing materials submitted by the AFCR;

 

(2)  Conducting a follow-up inspection; or

 

(3)  Reviewing compliance during the next certification inspection required by He-P 813.

 

          (l)  AFCR’s shall receive announced or unannounced quality assurance visits.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.10  Renewal of Certifications.

 

          (a)  Each adult family care provider shall complete and submit an application form entitled  “Request For Certification of Adult Family Care Residence” (November 2019).

 

          (b)  Applications for renewal of certification shall be received by the department at least 60 days prior to the expiration of the current certification.

 

          (c)  The adult family care provider shall submit with the renewal application:

 

(1)  The information required by He-P 813.08(d)-(g);

 

(2)  A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 813.25, if applicable; and

 

(3)  A statement identifying any variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03 - Saf-C 6005.04 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

 

(4)  If renovations were completed since the last certification was granted, a new signed approval from the local fire official, which includes a statement that:

 

a.  Required building permits pursuant to local building codes were obtained; or

 

b.  Indicates whether or not the adult family care provider altered any means of egress.

 

          (d)  An application for certification renewal shall be approved if:

 

(1)  The application contains all the information required by (a) and (c) above;

 

(2)  The application is received prior to the expiration of the current certificate; and

 

(3)  The AFCR is found to be in compliance with He-P 813 as a result of an inspection performed pursuant to He-P 813.09.

 

          (e)  An AFCR shall be granted certification for a period of one year, from the date of expiration, if:

 

(1)  At its previous annual inspection, an AFCR had no deficiencies cited; and

 

(2)  The adult family care provider submitted 60 days prior to the expiration of the current certificate the following in lieu of an onsite inspection:

 

a.  A completed and signed application for certification;

 

b. Documentation, signed by the oversight agency’s executive director, or his or her designee, that the adult family care provider agency has monitored and will continue to monitor the residence and that the residence remains in full compliance with all applicable rules; and

 

c.  Copies of quality assurance reviews in accordance with He-E 801.

 

          (f)  If at the time of the annual inspection is due, the AFCR does not have any residents, the adult family care provider may:

 

(1)  Submit a letter notifying health facilities administration of its intent to close; or

 

(2) Submit a written request to the health facilities administration for certification renewal without an annual inspection which contains the following information:

 

a.  The name and location of the residence;

 

b.  The certificate number; and

 

c.  The expiration date of the certificate.

 

          (g)  A certification issued pursuant to (e) and (f) above shall be granted only once in any 2-year period.

 

          (h)  If a certification has been approved in accordance with (f) above, the certificate shall indicate “renewed without inspection.”

 

          (i)  An oversight agency shall notify health facilities administration, in writing within 7 days of an individual moving into a residence certified in (e) and (f) above.

 

          (j)  An on-site inspection shall be conducted within 90 days of receipt any notification in (i) above.

 

          (k)  Any adult family care provider who does not submit a complete application for renewal prior to the expiration of an existing certification shall be required to apply for a new certification in accordance with He-P 813.08.

 

          (l)  If the adult family care provider chooses to cease operation of the AFCR, the adult family care provider shall submit written notification to the oversight agency and the department at least 45 days in advance of closure.

 

Source.  #8595, eff 4-1-06; amd by #9899-A, eff 3-29-11, (paras (b)-(l)); amd by #9899-B, eff 3-29-11, (para (a)); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.11  Denial of Certification.

 

          (a)  The department shall deny an application for certification if:

 

(1)  The applicant, certificate holder, or any person living in the AFCR has:

 

a.  Been found guilty of abuse, neglect, or exploitation of any person, or assault, fraud or a felony against a person in this or any other state by a court of law; or

 

b.  Had a complaint investigation for abuse, neglect, or exploitation substantiated by the department or an administrative agency of any other state and has not received a waiver in accordance with He-P 813;

 

(2)  Any adult family care provider or person living in the AFCR has a felony conviction;

 

(3)  Any individual living in the AFCR has a misdemeanor conviction;

 

(4)  An applicant or family member has an illness or behavior that, as evidenced by the documentation obtained and the observations made by the department, would endanger the well-being of the individuals or impair the ability of the AFCR to comply with department rules;

 

(5)  The applicant or any representative of the applicant:

 

a.  Knowingly provides false or misleading information to the department;

 

b.  Prevents or interferes with any inspection or investigation by the department; and

 

c.  Fails to provide required documents to the department;

 

(6)  An inspection of an applicant for a new certificate finds the applicant to be out of compliance with RSA 151 or He-P 813 or other applicable certification rules;

 

(7)  At an inspection the applicant or certificate holder is not in compliance with RSA 151 or He-P 813 or other applicable certification rules;

 

(8)  The applicant has demonstrated a history or pattern of multiple, or repeat violations of RSA 151 or its implementing administrative rules that pose or have posed a health or safety risk to individuals receiving care in the AFCR;

 

(9)  The applicant has submitted a plan of correction that has been rejected by the department in accordance with He-P 813; or

 

(10)  The applicant failed to fully implement and continue to comply with a plan of correction that has been accepted by the department in accordance with He-P 813.

 

          (b)  If the department determines that the AFCR meets any of the criteria for denial listed in He-P 813 the department shall deny the certification of the residence.

 

          (c)  Certification shall be denied upon the written notice by the department to the AFCR stating the specific rule(s) with which the residence does not comply.

 

          (d)  Any applicant aggrieved by the denial of an application may request an adjudicative proceeding in accordance with He-P 813.

 

          (e)  An AFCR shall not admit additional residents if a notice of denial of certificate has been issued.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.12  Certification.

 

          (a)  Certification shall be valid on the date of issuance and expire the following year on the last day of the same month it was issued.

 

          (b) To be eligible for reimbursement by the department, a non-relative adult family care residence shall be certified in accordance with He-P 813.

 

          (c)  All certificates shall be non-transferable from one adult family care provider or oversight agency to another or from one physical location to another.

 

          (d)  A certificate issued to an applicant shall indicate:

 

(1)  The effective date of the certificate;

 

(2)  The expiration date of the certificate;

 

(3)  The certificate number;

 

(4)  The type of certificate, which shall be listed as:

 

a.  Temporary; or

 

b.  Annual, which shall encompass both initial and renewal certifications;

 

(5)  The maximum number of certified beds allowed;

 

(6)  The name of the oversight agency; and

 

(7)  Information regarding any waivers issued in accordance with He-P 813.

 

          (e)  Temporary certificates shall be valid for 90 days from the date of issuance.

 

          (f)  Renewal certificates shall be issued for one year from the expiration date of the previous certificate.

 

          (g)  Upon written request, the department shall issue a revised certificate when the local, state or federal government modifies the street address of an AFCR without any change in the physical location of the AFCR.

 

          (h)  The request submitted in accordance with (g) above shall contain the following:

 

(1)  The name and address of the adult family care residence as it appears on the current certificate;

 

(2)  The name and address of the adult family care residence as it will appear on the new certificate; and

 

(3)  A copy of the notification of the required change in street address.

 

          (i)  When a certificate is revised in accordance with (g) above, the certificate number and expiration date shall not change.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.13  Revocation of Certification.

 

          (a)  The department shall issue a notice of intent to revoke an AFCR’s certification if the certificate holder or any household member:

 

(1)  Fails to comply with the provisions of He-P 813 above; and

 

(2)  Meets the criteria for denial in He-P 813.11, or for the following:

 

a.  An inspection finds the certificate holder to be out of compliance with RSA 151 or any of the applicable certification rules;

 

b.  The certificate holder has demonstrated a history of multiple, or repeat violations of RSA 151, He-P 813, or other applicable rules that pose or have posed a health or safety risk to residents;

 

c.  The certificate holder has submitted a plan of correction that has been rejected by the department in accordance with He-P 813;

 

d.  The certificate holder has failed to fully implement or continue to comply with a plan of correction that has been accepted by the department in accordance with He-P 813; or

 

e.  Prior denial or revocation of certification or denial of application for certification has taken place.

 

          (b)  The notice of intent to revoke the certification of the AFCR shall state the specific rule(s) with which the residence does not comply.

 

          (c)  Any certificate holder aggrieved by the revocation of the AFCR’s certificate may request an adjudicative proceeding in accordance with He-P 813.24 and the revocation shall not become final until the period for requesting an adjudicative proceeding has expired or, if the certificate holder requests an adjudicative proceeding, until such time as the administrative appeals unit issues a decision upholding the department’s action.

 

          (d)  An AFCR shall not accept additional individuals if a notice of intent to revoke the certification of the AFCR has been issued.

 

          (e)  If certificate has been revoked, the certificate holder, in conjunction with the oversight agency, shall transfer all individuals to another appropriately certified AFCR within 10 days of certificate revocation becoming final in accordance with He-P 813.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.14  Immediate Suspension of Certification.  Notwithstanding the provision of He-P 813, if the department orders suspension of a certificate in accordance with RSA 541-A:30, III, and the AFCR shall immediately cease operating.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.15  Resident Admission and Person-Centered Plan Development.

 

          (a)  Prior to admission, adult family care provider shall provide the resident and, if applicable, his or her authorized representative with a written copy of the resident admissions contract pursuant to RSA 161- J:4, which includes the following information:

 

(1)  The basic daily, weekly, and monthly rate paid to the adult family care provider;

 

(2)  A list of the services required by He-P 813 that are covered by the basic rate;

 

(3)  The time period covered by the admissions contract;

 

(4)  The AFCR’s house rules;

 

(5)  The grounds for immediate termination of the agreement, pursuant to RSA 151:26, II(b);

 

(6)  The AFCR’s responsibility for resident discharge planning;

 

(7)  Information regarding services not provided by the AFCR, to include:

 

a.  Contact and other information regarding nursing and other health care services;

 

b.  The AFCR’s responsibility for arranging services;

 

c.  The rate and payment for services;

 

(8)  The AFCR’s policies and procedures regarding:

 

a.  Providing transportation;

 

b.  Arranging for the provision of third party services, such as cable television;

 

c. Third party services contracted directly by the resident and provided on the AFCR premises;

 

d.  Storage and loss of the resident’s personal property;

 

e.  Filing complaints; and

 

f.  When a residents temporarily leaves the AFCR, the policy for holding a bed open, in compliance with RSA 151:25;

 

(9)  The AFCR’s medication management services;

 

(10)  A copy of the current version of the patients’ bill of rights under RSA 151: 21 and the AFCR’s policies and procedures for implementation of the patient’s bill of rights pursuant to RSA 151:20, II;

 

(11)  A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(5), and the AFCR ’s policy and procedure for assisting with the appeals process; and

 

(12)  The AFCR’s policy and procedure for handling reports of abuse, neglect, or exploitation.

 

          (b)  The adult family care provider and the oversight agency shall develop a person-centered plan, reviewed every 6 months, and revised based on the resident’s needs.

 

          (c)  The person-centered plan shall include the following:

 

(1)  A description of the resident’s needs;

 

(2)  The date the need was identified;

 

(3)  The goals or objectives of the plan;

 

(4)  The actions or approaches to be taken;

 

(5)  A statement about whether or not the resident may safely be left alone in the home or community and, if so, the time frame and duration that he or she may be left alone;

 

(6)  The name of the individual responsible for carrying out the plan; and

 

(7)  The date(s) of re-evaluation, review, or resolution for any identified issues.

 

          (d)  The person-centered plan shall be a written guide:

 

(1)  Developed by the case manager, the resident and/or his or her representative, the adult family care provider and the oversight agency that outlines the resident’s needs and process for the provision of services which shall address the resident’s:

 

a.  Ability to manage his or her ADL’s;

 

b.  Physical health, including impairments of mobility, sight, hearing and speech;

 

c.  Intellectual functioning and mental health;

 

d.  Need for supervision;

 

e.  Need for medication assistance;

 

f.  Need for family and community involvement; and

 

g.  Need for community and social health services; and

 

(2)  Reviewed and updated whenever there is a change in the resident’s condition and at the time of annual eligibility redetermination.

 

          (e)  Monthly progress notes for every resident shall be recorded by the adult family care provider including, at a minimum:

 

(1)  A brief description of the care, including assistance with ADLs, that has been provided;

 

(2)  Observations regarding changes in the resident’s physical, functional and cognitive abilities;

 

(3)  Observations regarding changes in behavior, such as eating habits, sleeping patterns, and relationships; and


(4)  The current status of the individual’s goals noted in the current person-centered plan.

 

          (f)  The adult family care provider, case manager and oversight agency shall meet or confer quarterly to review the progress notes required in (e) above.

 

          (g)  At the time of admission the adult family care provider, with the assistance of the oversight agency, if necessary, shall obtain orders from a licensed practitioner for medications if applicable.

 

          (h)  Each resident shall have a health examination not more than 6 months prior to admission and at least one health examination every 12 months. 

 

          (i)  If a resident refuses care or services, the adult family care provider shall notify the case manager and oversight agency.

 

          (j)  The adult family care provider shall maintain an emergency data sheet in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility, which includes:

 

(1)  The resident’s full name and the name the resident prefers to be called by, if different;

 

(2)  The name, address and telephone number of the resident’s next of kin or representative;

 

(3)  The resident’s diagnoses;

 

(4)  The resident’s allergies, if any;

 

(5)  The resident’s functional limitations, if any;

 

(6)  The resident’s date of birth;

 

(7)  The resident’s advanced directives; and

 

(8)  Any other pertinent information not specified in (1)-(7) above.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.16  AFCR Services and Supports.

 

          (a)  The adult family care provider shall maintain the health and safety of all household members to minimize the possibility of accident or injury when providing the following services and supports:

 

(1)  Food services, as described in He-P 813.17;

 

(2)  Medication services, as described in He-P 813.18;

 

(3)  Housekeeping, laundry, and maintenance services, as described in He-P 813.19;

 

(4)  Sanitation services; pursuant to He-P 813.04(i);

 

(5)  Activities designed to engage the resident to sustain and provider physical, intellectual, and social and spiritual well- being including those described in He-P 813.04(h);

 

(6)  Assistance in arranging appointments, including:

 

a.  Reminding the resident of appointments; and

 

b.  Providing transportation to and from appointments; and

 

(7)  Supervision of residents with cognitive deficits that might pose a risk to themselves or others if the resident is not supervised.

 

          (b)  For adult family care providers that provide transportation, the adult family care provider shall maintain current registration and inspection on all vehicles used for the transportation of a resident.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.17  Food Services.

 

          (a)  The adult family care provider shall:

 

(1)  Meet the nutritional needs of each resident, including special dietary needs associated with any health or medical conditions or religious requirements as specified in the person-centered plan or medical orders;

 

(2)  Offer at least 3 meals in each 24-hour period, with no more than 14 hours between the evening meal and breakfast, excepting snacks that are offered at bedtime, unless contraindicated by the resident’s person-centered plan or medical orders;

 

(3)  Make snacks available between meals and at bedtime if not contraindicated by the resident’s person-centered plan; and

 

(4)  If a resident has a pattern of refusing to follow a prescribed diet:

 

a.  Document the reason for the refusal in the resident’s record; and

 

b.  Notify the resident’s licensed practitioner, case manager and oversight agency.

 

          (b)  For the purposes of emergency preparedness, each AFCR shall have a supply of food and water sufficient for all household members and residents, including:

 

(1)  Refrigerated, perishable foods for a 3-day period;

 

(2)  Non-perishable foods for a 7-day period; and

 

(3)  Drinking water for a 3-day period.

 

          (c)  The adult family care provider shall maintain:

 

(1) All food and drinks safe for human consumption and free of spoilage, filth or other contamination including the immediate disposal of outdated food, or canned goods that have damage to their hermetic seals; and

 

(2)  All food preparation and food service areas safe, clean and in sanitary condition including:

 

a.  Ensuring all work surfaces, dishes, utensils and glassware shall be in good repair and cleaned after each use; and

 

b.  When preparing and serving food, adult family care providers shall wash their hands and exposed portions of their arms with liquid soap and running water before preparing or serving food.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.18); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.18  Medication Services.

 

          (a)  All medications shall be administered in accordance with the orders of the resident’s prescribing licensed practitioner or other licensed professional with prescriptive authority.

 

          (b)  Medications and treatments ordered by the licensed practitioner or other licensed professional with prescriptive authority shall be available to give to the resident within 24 hours of being ordered.

 

          (c)  The adult family care provider shall have a system in place to:

 

(1)  Obtain any medication ordered for immediate use by the resident; 

 

(2)  Re-order medications for use by the resident; and

 

(3)  Receive new medication orders.

 

          (d)  For each prescription medication being taken by a resident, the adult family care provider shall have a copy of the signed order in the resident’s record.

 

          (e)  All medication orders shall not be older than one year.

 

          (f)  Adult family care providers shall not make changes to the label of any residents’ prescription container.

 

          (g)  Any licensed practitioner’s order for a change or discontinuation of medications taken by the resident in the AFCR shall be noted by the home adult family care provider, who shall:

 

(1)  Notify the oversight agency and case manager of the change or discontinuation; and

 

(2)  Follow up with the licensed practitioner or other individual authorized by law to ensure the receipt of written documentation of same.

 

          (h)  The change in dosage, without a pharmacist changing the prescription label as described in (h) above, shall be allowed for a maximum of 30 days from the date of the new medication order, or 90 days for mail order medications.

 

          (i)  At the time of admission and on an annual basis, the adult family care provider shall obtain from a licensed practitioner written approval for the specific over-the counter medications requested by, or on behalf of, the resident.

 

          (j)  Adult family care providers shall store all over-the-counter medications in a secure area to restrict access by other residents, household members and children residing in the home.

 

          (k)  All over-the-counter medication containers shall be:

 

(1)  Marked by the adult family care provider with the name of the resident using the medication; and

 

(2) Taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (l)  The medication storage area for medications not stored in the resident’s room shall be:

 

(1)  Locked and accessible only to the adult family care provider;

 

(2)  Clean, organized and lit in a fashion to ensure correct identification of each resident's medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (m)  Except as allowed by RSA 318:42, all medication at the AFCR shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

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

 

          (o)  When a resident is going to be absent from the AFCR at the time medication is scheduled to be taken, the medication container shall be given to the resident or to the person responsible for the resident’s care during the absence.

 

          (p)  Upon discharge or transfer, a resident shall be provided with his or her current medication(s).

 

          (q)  A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry and self-administer without supervision emergency medications such as nitroglycerine, inhalers or EpiPens.

 

          (r)  Residents shall receive their medications in the following manner:

 

(1)  Self-administer medication as allowed by (w) below;

 

(2)  Self-administer with supervision as allowed by (x) below; or

 

(3) Administered by an individual that a nurse has delegated the task of medication administration to.

 

          (s)  For residents who self-administer medication, the adult family care provider shall:

 

(1) Obtain on a bi-annual basis a written order from a licensed practitioner authorizing him or her to self-administer medications without supervision;

 

(2)  Ensure that the resident receives quarterly evaluations by the oversight agency to ensure that he or she maintains the physical and cognitive ability to self-administer;

 

(3)  Assist the resident in storing the medications in their room by locking them up to safeguard against unauthorized access and to maintain them at proper temperatures; and

 

(4)  Maintain a key to access the locked medication storage area in the resident’s room with a copy of the key being given to the home adult family care provider.

 

          (t)  If a resident self-administers medication with supervision, adult family care providers shall be permitted to:

 

(1)  Remind the resident to take the correct dose of his or her medication at the correct time;

 

(2)  Place the medication container within reach of the resident;

 

(3) Remain with the resident to observe him or her taking the appropriate dose and type of medication as ordered by the licensed practitioner;

 

(4)  Record on a resident’s daily medication record that he or she has supervised the resident taking his or her medication; and

 

(5)  Document in the resident’s record any observed or reported side effects, adverse reactions, and refusal to take medications or medications not taken.

 

          (u)  If a resident self-administers medication with supervision, home adult family care providers shall not physically handle the medication in any manner.

 

          (v)  The licensed practitioner shall allow the resident to self-direct medications if the resident has a physical limitation and wishes to self-direct.

 

          (w)  If a resident self-directs the administration of medication, the adult family care provider may, upon the request of the resident, physically assist the resident with his or her medication, including opening the medication container, handing the resident the medication, and closing the container.

 

          (x)  If individuals authorized by law administer medications, the medication shall be:

 

(1)  Prepared immediately prior to administration; and

 

(2)  Prepared, identified, and administered by the same person pursuant to RSA 318 and RSA 326-B.

 

          (y)  When administering medication, the adult family care provider or other individual authorized by law shall remain with the resident until the resident has taken all of the medication.

 

          (z)  If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall comply with RSA 326-B concerning nurse delegation.

 

          (aa)  Except for those residents who self-administer prescription and over the counter medications, adult family care providers shall maintain a written record for each medication taken by the resident at the AFCR, containing the following:

 

(1)  The name and strength of the medication;

 

(2)  The dose taken by the resident;

 

(3)  The date and the time the medication was taken;

 

(4)  The signatures, identifiable initials and job titles of the home adult family care providers or adult family care providers who supervise, assist with, or administer the medications;

 

(5)  The reason for any medication refused or omitted;

 

(6)  For medication taken as needed, the reason the resident required the medication and the effect of the medication; and

(7)  Any allergies or allergic reactions to medications.

 

(ab)  Adult family care providers shall administer as needed medications in accordance with a PRN protocol that shall contain specific written parameters for medication administration and shall be written and approved by a licensed nurse or prescribing practitioner. 

 

(ac)  When a controlled drug is prescribed for a resident, the adult family care provider shall maintain an inventory that includes documentation of a daily count.

 

          (ad)  The licensed nurse from the oversight agency shall provide, at a minimum, an initial 4-hour medication supervision education program to adult family care providers who assist residents with self-administration with supervision, self-directed administration, or who administer medication, via nurse delegation which shall cover the administration of both prescription and non-prescription medication.

 

          (ae)  On an annual basis, adult family care providers who administer medication via nurse delegation shall complete a minimum of 2 hours of training to review the medication supervision education program referenced in (ad) above.

 

          (af)  The medication supervision education program and annual in-service training required by (ad) and (ae) above shall include:

 

(1)  A review of the medications that the resident is currently taking;

 

(2)  Infection control and proper hand washing techniques;

 

(3)  The 6 rights which are:

 

a.  The right resident;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time;

 

e.  Administered via the right route; and

 

f.  The right documentation.

 

(4)  Documentation requirements;

 

(5)  General categories of medications, such as anti-hypertensives and antibiotics;

 

(6)  Desired effects and potential side effects of medications; and

 

(7)  Medication precautions and interactions.

 

          (ag)  The adult family care provider shall develop and implement a system for immediately notifying the resident’s prescribing, licensed practitioner and the oversight agency RN within 24 hours of the occurrence of any:

 

(1)  Observed adverse reactions to medication; or

 

(2)  Medication errors such as incorrect medications or omissions.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 803.17); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.19  Physical Environment.

 

          (a)  Living space and outdoor space shall be arranged and maintained as to provide for the health and safety of all household members. 

 

          (b)  The adult family care provider shall protect the resident’s right to privacy.

 

          (c)  An AFCR shall:

 

(1)  Be maintained in good repair and free of hazard to all household members;

 

(2)  Be free from environmental nuisances, including loud noise and foul odors;

 

(3)  Replace all smoke detector batteries twice per year;

 

(4)  Ensure that all doors, hallways, and stairs are clear and unobstructed;

 

(5)  Ensure that all flammable or combustible materials are stored at least 3 feet from electric heaters, wood, coal, kerosene or pellet stoves, furnaces, boilers, or water heaters;

 

(6)  Ensure that oil furnaces are serviced annually, and that all of furnaces are serviced annually or as recommended or required by the service provider or manufacturer; and

 

(7)  Ensure that, if oxygen is stored in the residence, that all doors entering the home are labeled accordingly.  Any oxygen in the AFCR shall be firmly secured to the wall or secured in a stand or rack.

 

          (d)  Each resident bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the resident to reach his or her bedroom without passing through the room of another resident;

 

(3)  Not be used as an access way to a common area or another bedroom or for any other purposes;

 

(4)  Be separated from halls, corridors and other rooms by floor to ceiling walls; and

 

(5)  Have at least one operable window with a tightly fitting screen to the outside.

 

          (e)  A resident having impaired mobility as determined by his or her licensed practitioner or person-centered plan shall:

 

(1)  Have a bedroom located on the same level as the bathroom facilities; and

 

(2)  Not be assigned a bedroom above or below the ground level of the AFCR;

 

          (f)  The certified home adult family care provider shall provide the following for the resident’s use:

 

(1)  A bed appropriate to the needs of the resident, including a mattress, pillow, linens, and blankets;

 

(2)  Clean linens for personal care;

 

(3)  Furniture including, a bureau, mirror, and lamp;

 

(4)  Easily accessible closet or storage space for clothing and personal belongings;

 

(5)  Window blinds or curtains that provide privacy; and

 

(6)  A lockable container for the storage of medications.

 

          (g)  The adult family care provider shall permit the use of a resident’s personal possessions, provided they do not pose a risk to the resident or others.

 

          (h)  The adult family care provider shall provide at least one living room or a multi-purpose room and a designated dining area.

 

          (i)  The resident shall be able to access adult family care providers whenever they assistance is needed.

 

          (j)  Ample and adequate lighting shall be available throughout the AFCR to enable residents to navigate safely throughout the AFCR and to participate in activities such as reading, writing, crafts, or using a computer.

 

          (k)  At least one operating telephone shall be accessible to the residents at all times for incoming and outgoing calls.

 

          (l)  An AFCR shall have:

 

(1)  At least one indoor bathroom, which includes a sink, toilet, and a bathtub or shower for every 6 persons in the household including the resident and all adults living in the AFCR;

 

(2)  A functioning septic or other sewage disposal system; and

 

(3)  A supply of hot and cold running potable water shall be available for human consumption and food preparation at all times, as follows:

 

a.  If drinking water is supplied by a non-public water system, the water shall be tested and found to be in accordance with Env-Dw  702.02 and Env-Dw  704.02 initially and every 6 years thereafter; and

 

b.  If the water is not approved for drinking, an alternative method for providing safe drinking water shall be implemented.

 

          (m)  The provider shall maintain the furniture, floors, ceilings, walls, and fixtures shall be clean and in good repair.

 

          (n)  The adult family care provider shall maintain:

 

(1)  Linens, clothing and other laundry shall be clean and sanitary;

 

(2)  A supply of clean linens shall be provided as needed to each resident; and

 

(3)  Bathing and toileting facilities for all residents, clean and disinfected as often as necessary to prevent illness or contamination.

 

          (o)  The adult family care provider shall distinctly label and legibly mark poisonous compounds, such as cleaning products and solutions and insecticides, to identify the contents and store in a place separate from food, medications and resident supplies.

 

          (p)  The adult family care provider shall not use toxic materials in a way that contaminates food, equipment or utensils, or in any way other than in full compliance with the manufacturer’s labeling.

 

          (q)  Except where residents have control of the thermostat in their own rooms, equipment providing heat to each the AFCR shall:

 

(1)  Be capable of maintaining temperatures of:

 

a.  At least 65 degrees Fahrenheit at night; and

 

b.  At least 70 degrees Fahrenheit during the day if the resident(s) are present; and

 

(2)  Be maintained in good repair.

 

          (r)  When new plumbing is installed, it shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15.

 

          (s)  The AFCR shall provide ventilation in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (t) All bathroom, bedroom and closet door latches shall be designed for easy opening from the inside and easy opening of the locked door from the outside in the event of an emergency.

 

          (u)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (v) Any firearms or ammunition kept at the AFCR shall be stored in a locked cabinet when not in use.

 

          (w)  Prior to beginning construction or renovations, or modifications to an AFCR, the certificate holder shall notify the health facilities administration of the plans.

 

          (x)  A adult family care provider or applicant undergoing construction, renovations, or modifications to an AFCR shall comply with:

 

(1)  The state fire code Saf-C 6000 as adopted by the commissioner of the department of safety under RSA 153 and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control;

 

(2)  The state building code as adopted under RSA 155-A:2; and

 

(3)  Local building, zoning and ordinance codes.

 

          (y)  At all times, including during any construction at the AFCR, the adult family care provider shall maintain the environment free of hazardous conditions, including but not limited to:

 

(1)  Electrical hazards;

 

(2)  Plumbing hazards;

 

(3)  Exposed insulation;

 

(4)  Tripping hazards, such as throw rugs, cords and construction debris;

 

(5)  Chemical fumes; and

 

(6)  Sawdust or sheetrock dust.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.20); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.20  Safety and Emergency Protocol.

 

          (a)  If the resident is provided unsupervised time, the adult family care provider shall complete a personal safety assessment to identify a resident's knowledge of and ability to respond to each of the following:

 

(1)  Fire;

 

(2)  Medical emergency;

 

(3)  Unsafe conditions in the home and community;

 

(4)  Abuse and exploitation;

 

(5)  Being lost in one’s community;

 

(6)  Severe weather and other natural disasters; and

 

(7)  Building maintenance problems, such as power outages.

 

          (b) If the personal safety assessment determines that the resident needs assistance to respond appropriately to situations outlined in (a) above, a personal safety plan shall be developed and implemented by the resident, the adult family care provider or caregiver. 

 

          (c)  A personal safety plan shall:

 

(1)  Identify the supports necessary for a resident to respond to each of the contingencies listed in (a) above;

 

(2)  Indicate who will provide the needed supports;

 

(3)  Describe how the supports will be activated in an emergency;

 

(4)  Indicate approval of the resident, guardian, or representative, the adult family care provider and the oversight agency prior to the resident being left alone; and

 

(5)  Be reviewed every 6 months and revised whenever there is a change in the resident’s ability to respond to the contingencies listed in the plan or the resident moves to a new AFCR.

 

          (d)  An emergency and fire safety plan shall be developed and implemented to provide for the safety of residents, adult family care providers and household members. 

 

          (e)  The plan in (d) above shall:

 

(1)  Address any situation that requires evacuation of the AFCR;

 

(2)  Identify the location of all evacuation routes and exits; and

 

(3)  Provide for and assures the safe evacuation of all persons from the premises.

 

          (f)  Each adult family care provider shall comply with all laws and rules designed to protect life and safety in the event of a fire or other emergency.

 

          (g)  Prior to providing services, the adult family care provider and oversight agency shall develop a written emergency and fire safety plan that contains the following information:

 

(1)  The name and address of the AFCR;

 

(2)  The responsible oversight agency;

 

(3)  The name of the resident(s) living in the AFCR;

 

(4)  Whether 24-hour supervision is provided;

 

(5)  In the event of an emergency, the name and phone number of agency back-up;

 

(6)  The AFCR’s evacuation plan;

 

(7)  The signature of the adult family care provider; and

 

(8)  A fire safety assessment for each resident in accordance with (k) below.

 

          (h)  Each adult family care provider shall annually review and revise, as needed, its emergency and fire safety plan.

 

          (i)  Evacuation drills shall be held at varied times of day, and include all residents and all individuals in the home at the time of the drill.

 

          (j)  Fire drills shall be conducted at least once per month for the first 4 months after the admission of a new resident, and then every other month thereafter.

 

          (k)  At least 2 of the fire drills conducted annually shall be conducted during the night, the first of which shall occur within the first 4 months after the admission of a new resident.  Night time fire drills shall be conducted between the hours of 10 p.m. and 6 a.m. EST.

 

          (l)  When a new resident moves into the AFCR, the AFCR shall:

 

(1)  Conduct monthly drills until all residents have evacuated the premises in 3 minutes or less for 4 consecutive monthly drills; and

 

(2)  Thereafter conduct drills every other month.

 

          (m)  The adult family care provider shall maintain a report of each fire drill conducted, which includes:

 

(1)  The names of the residents, household members, and other individuals involved;

 

(2)  The time, day, month, and year the drill was conducted;

 

(3)  The exits utilized;

 

(4)  The total time required to evacuate the AFCR; and

 

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

 

          (n)  A fire safety assessment to review a resident’s ability to evacuate the building with or without assistance within 3 minutes shall be completed by the adult family care provider within 5 days of the resident’s move into an AFCR.

 

          (o)  The fire safety assessment shall:

 

(1)  Be based on an actual evacuation drill conducted at the residence; and

 

(2)  Include the following individual risk factors:

 

a.  Response to alarm;

 

b.  Response to instruction;

 

c.  Vision and hearing;

 

d.  Impaired consciousness;

 

e.  Mobility;

 

f.  Resistance to evacuation;

 

g.  The resident’s ability to independently exit and complete the evacuation from the house;

 

h.  Whether the resident is capable of choosing a backup strategy; and

 

i.  Whether the resident would be able to stay at a designated meeting point.

 

          (p) The fire safety assessment shall indicate the date completed and signature of the person documenting the resident’s risk factors.

 

          (q)  For each resident unable to evacuate within 3 minutes, a fire safety plan shall be developed and approved by the resident or representative, case manager, adult family care provider and the oversight agency that identifies:

 

(1)  The cause(s) for such inability;

 

(2)  The specific assistance needed by the resident from the adult family care provider; and

 

(3)  Specific actions that the resident shall take to reduce the evacuation time to 3 minutes or less.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.21); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.21  Resident Records.

 

          (a)  The adult family care provider shall maintain on site a legible, current, and accurate record for each resident based on services provided at the AFCR.

 

          (b)  At a minimum, resident records shall contain the following:

 

(1)  A copy of the admissions contract and all documents required by He-P 813.15;

 

(2)  Identification data, which shall include:

 

a.  Vital information including the resident’s name, date of birth, and marital status;

 

b.  If a resident is present only for respite care as described in He-P 813.24, the resident’s home address and phone number;

 

c.  The resident’s religious preference, if known;

 

d.  The name, address, and telephone number of an emergency contact person;

 

(3)  The names and telephone numbers of the resident’s licensed practitioners;

 

(4)  The names, employers, business addresses, and telephone numbers of individuals contracted by the resident to provide services at the AFCR;

 

(5)  Copies of all executed legal directives, such as durable power of attorney and living will;

 

(6)  A record of the health examination(s) conducted by a licensed practitioner, which includes the information required by He-P 813.18(p) unless the licensed practitioner or resident documents refusal;

 

(7)  Written, dated and signed orders for the following:

 

a.  All medications;

 

b.  Treatments; and

 

c.  Special diets;

 

(8)  All assessments and plans;

 

(9)  Documentation that the resident or representative has participated in the development of the person-centered plan;

 

(10)  All admission and progress notes;

 

(11) If services are provided at the AFCR by individuals not employed by the AFCR, documentation, which shall include:

 

a.  The name of the agency providing the services;

 

b.  The date services were provided; and

 

c.  The name of the person providing the services;

 

(12)  Documentation of any alteration in the resident’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken, including practitioner notification;

 

(13)  Documentation of specialized care;

 

(14)  Documentation of unusual incidents;

 

(15)  The resident’s or representative’s consent for release of information;

 

(16)  Transfer or discharge planning and referrals;

 

(17)  Notification to the resident or representative of involuntary room change, transfer or discharge;

 

(18)  The medication record, including:

 

a.  The medication name, strength, dose, frequency and route of administration;

 

b.  The date and time the medication was taken;

 

c.  Effects of over the counter medications;

 

d.  Documentation of medication errors or resident refusal to take the medication; and

 

e.  Notice to the resident’s licensed practitioner of any undesirable effects;

 

(19)  Emergency data sheet, which contains the information required by He-P 813;

 

(20)  Documentation of any resident refusal of care or services; and

 

(21)  Documentation of nurse delegation as required by He-P 813.18(y), if applicable.

 

          (c)  Resident records shall be available to:

 

(1)  The resident;

 

(2)  The AFCR and oversight agency staff as required by their job responsibilities;

 

(3)  Any individual(s) given written authorization by the resident or representative; and

 

(4)  The department and its agents.

 

          (d)  The adult family care provider shall arrange for retention of and access to resident records for 6 years from the date the resident leaves the AFCR or for 4 years from the date the AFCR ceases operation.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.22); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.22  Voluntary Closure of AFCR.  When an AFCR no longer intends to operate, an oversight agency shall notify the department in writing of the following:

 

          (a)  The name of the AFCR;

 

          (b)  The certificate number of the AFCR;

 

          (c)  The address of the AFCR;

 

          (d)  The date the AFCR closed or will close; and

 

          (e)  The location that the resident(s) have moved to, including the name of the home and certificate number of the home, if available.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.23  Complaints and Investigations.

 

          (a)  The department shall accept and investigate complaints that allege:

 

(1)  A violation of RSA 151 or He-P 813;

 

(2)  That an individual or entity is operating as an AFCR without being certified; or

 

(3)  That an individual or entity is advertising or otherwise representing the AFCR as having or performing services for which it is not certified to provide, pursuant to RSA 151.

 

          (b)  When practicable, the complaint shall be in writing containing the following information:

 

(1)  The name and address of the alleged uncertified AFCR;

 

(2)  The name, address and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 813.

 

          (c)  The department shall not investigate a complaint unless the commissioner determines that, if the allegations are proven to be true, would constitute a violation of the provisions of RSA 151 or He-P 813.

 

          (d)  For a certified AFCR, the department shall:

 

(1)  Provide written notification of the results of the investigation to the adult family care provider along with an inspection report if deficiencies were found as a result of the investigation; and

 

(2)  Notify any other state or local agencies of suspected violations of their statutes or rules based on the results of the investigation.

 

          (e)  If the department determines that the complaint is unfounded or does not violate any statutes or rules, the department shall take no further action.

 

          (f)  If the investigation results in deficiencies being cited, the adult family care provider shall be required to submit a plan of correction in accordance with He-P 813.09.

 

          (g)  The department shall provide written notification to the adult family care provider or the oversight agency that includes:

 

(1)  The date of investigation;

 

(2)  The reasons for the investigation; and

 

(3) Whether or not the investigation revealed that the services being provided require certification under RSA 151.

 

          (h)  In accordance with RSA 151 the adult family care provider or the oversight agency shall be allowed 7 days from the date of the notice required by (g) above to respond to any findings cited by the department.

 

          (i)  The department shall accept the response in (f) and (h) above if it includes:

 

(1)  For certified programs, a POC to achieve compliance with RSA 151 and He-P 813 within 30 days; or

 

(2)  For uncertified programs, a complete application for certification.

 

          (j)  If the owner of an uncertified home does not provide a response as described in (h) above, the department shall:

 

(1)  Issue a written warning to immediately comply with RSA 151 and He-P 813; and

 

(2)  Provide information stating that the resident has the right to appeal the warning in accordance with RSA 151:7-a, III.

 

          (k)  Any person or entity who fails to comply after receiving a warning as described in (j) above shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (l)  Except for any deficiency reports issued or POC’s received, the name of the complainant and the information contained in the investigation file shall be kept confidential as required by RSA 151:13, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To a law enforcement agency(ies) when relevant to a specific criminal investigation;

 

(3) To appropriate professional licensing boards, as authorized by RSA 151:13, if the information contained in the complaint file appears contrary to professional practices;

 

(4)  During any adjudicative proceeding that concerns:

 

a.  The issuance of a warning in accordance with RSA 151:7-a;

 

b.  The imposition of an administrative fine in accordance with RSA 151:16-a; or

 

c.  The suspension, denial or revocation of a license under RSA 151:8 and RSA 151:9, I(f);

 

(5)  After the department suspends, denies or revokes a license under RSA 151:7, II; or

 

(6) When a court of competent jurisdiction orders the department to release such information.

 

Source.  #8595, eff 4-1-06; ss by #9899-A, eff 3-29-11 (from He-P 813.11); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.24  Appeals.

 

          (a)  An applicant for certification, adult family care provider, AFCR, or oversight agency may request a hearing regarding a denial or revocation of certification;

 

          (b)  Within 10 days of the date of the notification of denial or revocation of certification, a request for appeal shall be submitted in writing to the department's administrative appeals unit at:

 

Administrative Appeals Unit

Department of Health and Human Services

109 Pleasant Street- Main Building

Concord NH 03301

 

          (c)  Appeals shall be conducted in accordance with He-C 200.

 

Source.  #9899-A, eff 3-29-11; ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

          He-P 813.25  Waivers.

 

          (a)  An oversight agency may request a waiver of specific procedures outlined in this rule, in writing, from the department.

 

          (b)  A request for waiver shall include:

 

(1)  A specific reference to the section of the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternative provisions or procedures being proposed;

 

(4)  If the residence is certified, the date of certification;

 

(5) If it applies to a specific resident, the signature of the resident(s) or legal guardian(s) indicating knowledge of the request; and

 

(6)  Signature of the oversight agency’s executive director or designee approving that a waiver be requested.

 

          (c)  A request for waiver shall be submitted to:

 

Health Facilities Administration

Department of Health and Human Services

129 Pleasant Street- Brown Building

Concord NH 03301

 

          (d)  No provision or procedure prescribed by statute shall be waived.

 

          (e)  A request for waiver shall be granted after the commissioner or his or her designee within 30 days if the alternative proposed by the AFCR meets the objective or intent of the rule and:

 

(1)  Does not negatively impact the health or safety of the resident(s); or

 

(2)  Is administrative in nature, and does not affect the quality of resident care.

 

          (f)  The determination on the request for waiver shall be made within 30 days of the receipt of the request.

 

          (g)  Upon receipt of approval of a waiver request, the oversight agency’s or AFCR’s subsequent compliance with the alternative provisions or procedures approved in the waiver shall be considered compliance with the rule for which the waiver was sought.

 

          (h)  With the exception of waivers granted pursuant to (i) below, and unless otherwise specified, waivers granted by the department shall have no expiration date.

 

          (i)  Those waivers which relate to the following shall be effective for the current certification period only:

 

(1)  Fire safety; or

 

(2)  Other issues relative to resident health, safety, or welfare that require periodic reassessment. 

 

          (j)  All waivers shall end with the closure of an AFCR.

 

          (k)  An AFCR applicant, adult family care provider or oversight agency may request a renewal of a waiver from the department.  Such request shall be made at least 90 days prior to the expiration of a current waiver.

 

Source.  #9899-A, eff 3-29-11 (from He-P 813.10); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19

 

New.  #12934, eff 12-6-19

 

PART He-P 814  COMMUNITY RESIDENCES AT THE RESIDENTIAL CARE AND SUPPORTED RESIDENTIAL CARE LEVEL

 

          He-P 814.01  Purpose.  The purpose of these rules is to set forth the licensing requirements for all community residences (CR) at the residential care and supported residential care level licensed pursuant to RSA 151:2, I(e), and thereby ensure, through basic standards, the health and safety of individuals in a community residence receiving shelter, food, training, and protective oversight services.

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.02  Scope.  This part shall apply to any person, agency, partnership, corporation, government entity, association, or other legal entity operating a community residence except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of an individual;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to an individual; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving an individual without his or her informed consent.

 

          (b)  “Acquired brain disorder” means a disruption in brain functioning that:

 

(1)  Is not congenital or caused by birth trauma;

 

(2)  Presents a severe and life-long disabling condition, which significantly impairs a person’s ability to function in society;

 

(3)  Occurs prior to age 60;

 

(4)  Is attributable to one or more of the following reasons:

 

a.  External trauma to the brain as a result of:

 

1.  A motor vehicle incident;

 

2.  A fall;

 

3.  An assault; or

 

4.  Another related traumatic incident or occurrence;

 

b.  Anoxic or hypoxic injury to the brain such as from:

 

1.  Cardiopulmonary arrest;

 

2.  Carbon monoxide poisoning;

 

3.  Airway obstruction;

 

4.  Hemorrhage; or

 

5.  Near drowning;

 

c.  Infectious diseases such as encephalitis and meningitis;

 

d.  Brain tumor;

 

e.  Intracranial surgery;

 

f.  Cerebrovascular disruption such as a stroke;

 

g.  Toxic exposure; and

 

h.  Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system; and

 

(5)  Is manifested by:

 

a.  Significant decline in cognitive functioning and ability;

 

b.  Deterioration in:

 

1.  Personality;

 

2.  Impulse control;

 

3.  Judgment;

 

4.  Modulation of mood; or

 

5.  Awareness of deficits; or

 

c.  Both a. and b. above.

 

          (c)  “Activities of daily living (ADL)” means basic daily routine tasks such as:

 

(1)  Walking;

 

(2)  Bathing;

 

(3)  Shaving;

 

(4)  Brushing teeth;

 

(5)  Combing hair;

 

(6)  Dressing;

 

(7)  Food preparation and eating;

 

(8)  Getting into or out of bed;

 

(9)  Laundry;

 

(10)  Cleaning room;

 

(11)  Managing money;

 

(12)  Shopping;

 

(13)  Using public transportation;

 

(14)  Writing letters;

 

(15)  Making telephone calls;

 

(16)  Obtaining and keeping appointments;

 

(17)  Monitoring and supervision of medication;

 

(18)  Recreational and leisure activities; and

 

(19)  Management of incontinence.

 

          (d)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (e)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to an individual for immediate consumption or use by a person authorized by law, including RSA 318-B and RSA 326-B.

 

          (f)  “Administrator” means the licensee or person appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

 

          (g)  “Admission” means accepted by a licensee for the provision of services to an individual.

 

          (h)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for heath care executed in accordance with RSA 137-J.

 

          (i)  “Applicant” means an person, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a CR pursuant to RSA 151:2, I(e).

 

          (j)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 814, or other federal and state requirements.

 

          (k)  “Building rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

 

(1)  Addition;

 

(2)  Modification;

 

(3)  Reconstruction;

 

(4)  Renovation; and

 

(5)  Repair.

 

          (l)  “Change of ownership” means a change in the controlling interest of an established CR to a successor business entity.

 

          (m)  “Chemical restraint” means any medication prescribed to control an individual’s behavior or emotional state without a supporting diagnosis or for the convenience of personnel.

 

          (n)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

 

          (o)  “Community residence (CR)” means a facility of 4 or more individuals that is both certified by the department under RSA 126-A and licensed by the department under RSA 151, and that is operating in accordance with He-M 1001 or He-M 1002. The term includes “home”.

 

          (p)  “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (q)  “Days” means calendar days unless otherwise specified in the rule.

 

          (r)  “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

 

          (s)  “Designated Receiving Facility (DRF)” means a facility which receives persons for involuntary admissions under RSA 171-B, designated by the commissioner for one or more purposes, including, but not limited to:

 

(1)  Receiving persons for involuntary admission directly pursuant to a court order; and

 

(2)  Receiving involuntarily admitted persons by transfer with the approval of the commissioner or designee.

 

          (t) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, “a disability:

 

(1)  Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

 

(2)  Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.

 

          (u)  “Direct care” means hands-on care or services provided to an individual, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (v)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (w)  “Elopement” means when an individual who is cognitively, physically, mentally, emotionally, or chemically impaired, or any combination thereof, wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or contrary to the hours of supervision specified in his or her service agreement, as described in He-M 401 or He-M 503.

 

          (x)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (y)  “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

 

          (z)  “Exploitation” means the illegal use of an individual’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from an individual through the use of undue influence, harassment, duress, deception, or fraud.

 

          (aa)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the individual’s health care and other personal needs.

 

          (ab)  “Household member” means the caregiver, all family members, and any other persons age 17 or older, who is not an individual, as defined in (ad) below, who resides at the licensed premises for more than 30 days.

 

          (ac)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ad)  “Individual” means the person who is admitted to the CR for care, services, and training regardless of the length of stay and who is eligible for services due to acquired brain disorder, developmental disability, or mental illness.

 

          (ae)  “Individual record” means a separate file maintained for each individual receiving care and services, which includes all documentation required by RSA 151 and He-P 814, and all documentation received relative to the individual as required by other federal and state requirements.

 

          (af)  “Infectious waste” means those items specified by Env-Wm 2604.

 

          (ag)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 814 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 814.

 

          (ah)  “License” means the document issued to an applicant or licensee which authorizes operation of a CR in accordance with RSA 151 and He-P 814, and includes the name of the licensee, the name of the business, the physical address, the licensing classification, the effective date, and license number.

 

          (ai)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the CR is licensed.

 

          (aj)  “Licensed 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.

 

          (ak) “Licensed premises” means the building(s), or portion thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

 

          (al)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (am)  “Licensing classification” means the specific category of services authorized by a license.

 

          (an)  “Load-bearing element” means any column, girder, beam, joist, truss, rafter, wall, floor, or roof sheathing that supports any vertical load in addition to its own weight, or any lateral load.

 

          (ao)  “Mechanical restraint” means locked, secured, or alarmed CRs or units within an CR, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing an individual from freely exiting the CR or unit within.

 

          (ap)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (aq)  “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “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)  Mental retardation;

 

(3)  Continuous or noncontinuous 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.”

 

          (ar)  “Modification” means:

 

(1)  The reconfiguration of any space;

 

(2)  The addition, relocation, or elimination of any door or window;

 

(3)  The addition or elimination of load-bearing elements;

 

(4)  The reconfiguration or extension of any system;

 

(5)  The installation of any additional equipment; and

 

(6)  The term does not include repair or replacement of interior finishes.

 

          (as)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of an individual.

 

          (at)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (au)  “Patient rights” means the privileges and responsibilities possessed by each individual provided by RSA 151:21.

 

          (av)  “Personal assistance” means providing or assisting an individual in obtaining one or more of the following services:

 

(1)  Assistance with ADL, such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, or monitoring, supervision, or administration of medication;

 

(2)  Assistance with instrumental activities of daily living such as doing laundry, food preparation, obtaining appointments, or engaging in recreational or leisure activities;

 

(3)  Supportive services such as recreational and leisure activities, transportation, social services, medical, dental, and other health care services, habilitation or rehabilitative services, day care, or other services required to meet an individual’s needs; or

 

(4)  Monitoring an individual’s activities to provide for the individual’s and others’ safety and well-being including, general supervision or oversight of the physical and mental well-being of an individual who needs assistance to maintain his or her participation in the facility or who needs assistance to manage his or her personal or financial affairs, regardless of whether a guardian has been appointed for the individual.

 

          (aw)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the individual for a specific, limited purpose or for the general purpose of assisting an individual in the exercise of any rights.

 

          (ax)  “Personnel” means a person who is employed by the facility, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to individuals.

 

          (ay)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the individual’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (az)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

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

 

          (bc)  “Protective care” means the provision of individual monitoring services, including but not limited to:

 

(1)  Knowledge of individual whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (bd)  “Reconstruction” means the reconfiguration of a space:

 

(1)  That affects an exit or a corridor shared by more than one occupant space; or

 

(2)  Such that the building rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (be)  “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

 

          (bf)  “Repair” means the patching, restoration, or painting of materials, elements, equipment or fixtures for the purpose of maintaining such materials, elements, equipment or fixtures in good or sound condition.

 

          (bg)  “Reportable incident” means an occurrence of any of the following while the individual is either in the CR or in the care of CR personnel:

 

(1)  The unanticipated death of the individual;

 

(2)  An injury to an individual that is potentially due to abuse or neglect; or

 

(3)  The elopement or unexplained absence of an individual from the CR.

 

          (bh)  “Residential board and care occupancy”, as defined in National Fire Protection Association (NFPA) 101 of the fire code, means an occupancy used for lodging and boarding of 4 or more individuals not related by blood or marriage to the owners or operators for the purpose of providing personal care services.

 

          (bi)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist an individual.

 

          (bj)  “Supervision” means the process by which the individual is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

 

          (bk)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

          (bl)  “Written and signed orders” means a document, produced electronically or via paper, by a licensed practitioner for medications, 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.

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.04  Certification Required.  In order to be licensed under He-P 814, a community residence shall also be certified under He-M 1001 or He-M 1002.

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.05  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”

 

b.  For any CR to be newly licensed on or after July 1, 2016:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any CR to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  A floor plan of the prospective CR;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” if a sole proprietorship or if otherwise applicable;

 

(4)  A resume identifying the name and qualifications of the CR administrator;

 

(5)  Copies of applicable licenses, certificates, or both for the CR administrator;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with Saf-C 6000, the state fire code, including, at a minimum, the residential board and care chapter of National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(7)  If the CR uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

 

(8)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and all household members.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.06  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 814.05(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 814.05(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 814.14(b) if it determines that the applicant, licensee, administrator, or household member:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of individuals.

 

          (d)  Following a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 814.

 

          (e)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (f)  If the applicant does not provide the items required by the written notice in (b) above within 90 days, the application will be closed and a new application will be required.

 

Source.  #5515, eff 11-25-92, EXPIRED: 11-25-98

 

New.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.07  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 814.05(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 814.05(a)(1);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing non-permanent waiver(s) previously granted by the department, in accordance with He-P 814.11(f), if applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 814.18(e), He-M 506, He-M 1001, or He-M 1002; and

 

(5)  A statement identifying any variances applied for or granted by the state fire marshal.

 

          (d)  In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (e)  Following an inspection as described in He-P 814.10, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) and (d) above as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 814 at the renewal inspection.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 814.05 and shall be subject to a fine in accordance with He-P 814.14(c)(6).

 

          (g)  Prior to issuing a renewal license the department shall review any of the information submitted in accordance with He-P 814.05(b) above and shall deny a license renewal in accordance with He-P 814.06(c).

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.08  CR New Construction and Existing Building Rehabilitation.

 

          (a)  For new construction and for building rehabilitation of an existing building, including, but not limited to, certain repairs, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 814 shall and notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

 

          (g)  The CR shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or building rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or building rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C-6000, including, but not limited to, at a minimum, for 4 residents or more, the residential board and care occupancy chapter of NFPA 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

          (i)  All CRs newly constructed or rehabilitated after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as applicable, as available as noted in Appendix A.

 

          (j)  Where building rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as available as noted in Appendix A.

 

          (k)  Per the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition, as available as noted in Appendix A, and notwithstanding (j) above, where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

 

          (l)  The department’s bureau of health facilities administration shall be the authority having jurisdiction for the requirements in (i)-(k) above and shall negotiate compliance and grant waivers in accordance with He-P 814.11 as appropriate.

 

          (m)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

 

          (n)  Waivers granted by the department for construction or building rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (o)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

          (p)  The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 814.10 prior to its use.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.09  CR Requirements for Organizational Changes.

 

          (a)  The CR shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  Capacity.

 

          (b)  The CR shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of individuals beyond what is authorized under the current license.

 

          (c)  When there is a change in address without a change in location, the CR shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the CR shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of beds;

 

(4)  A change in licensing classification; or

 

(5)  A change in the life safety code occupancy chapter.

 

          (f)  A new license shall be issued for a change in ownership or a change in physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the CR name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in the number of individuals from what is authorized under the current license;

 

(3)  A change in address without a change in physical location; or

 

(4)  When a waiver has been granted.

 

          (i) The CR shall notify the department in writing no later than 5 days prior to a change in administrator as soon as practicable in the event of a death or other extenuating circumstances and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  Copies of applicable licenses, certificates, or both, for the new administrator; and

 

(3) The results of a criminal records check from the NH department of safety for the new administrator.

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 814.18(l) and either He-M 1001 or He-M 1002.

 

          (k)  If the department determines that the new administrator does not meet the qualifications as specified in (j) above, it shall so notify the CR in writing so that a waiver can be sought or the CR can search for a qualified candidate.

 

          (l)  The CR shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (m)  A restructuring of an established CR that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (n)  Licenses issuedfor a change in ownership shall expire on the date the license issued to the previous owner would have expired.

 

          (o)  If a licensee chooses to cease the operation of the CR, the licensee shall submit written notification to the department at least 30 days in advance, which shall include a written closure plan that ensures adequate care of individuals until they are transferred or discharged to an appropriate alternate setting.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.10  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 814, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the CR; and

 

(3)  Any records required by RSA 151 and He-P 814.

 

          (b)  The department shall conduct a life safety inspection, and a clinical inspection, as appropriate, to determine full compliance with RSA 151 and He-P 814 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed under He-P 814.09(e)(1);

 

(3)  A change in the physical location of the CR;

 

(4)  An increase in the number of beds beyond what is currently authorized;

 

(5)  Occupation of space after construction, modifications, or structural alterations; or

 

(6)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety inspections shall be issued when, as a result of an inspection, the department determines that the CR is in violation of any of the provisions of He-P 814, RSA 151, or any applicable state law, administrative rule, or code.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a written POC, in accordance with He-P 814.13(c), within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 814.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.11  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 814 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary and how a waiver is justified; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and individuals as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

 

(1)  Meet the objective or intent of the rule;

 

(2)  Do not negatively impact public health or the health or safety of the individuals; and

 

(3)  Do not affect the quality of individual services.

 

          (d)  The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.12  Complaints.

 

          (a)  The department shall investigate complaints that allege:

 

(1)  A violation of RSA 151, He-P 814, or rules adopted under RSA 126-A:20;

 

(2)  That a person or entity is operating as a CR without being licensed; or

 

(3)  That an person or entity is advertising or otherwise representing the CR as having or performing services for which it is not licensed to provide, pursuant to RSA 151:2, III.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the CR, or the alleged unlicensed person or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151, He-P 814, or rules adopted under RSA 126-A:20.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  For the licensed CR, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 814.13(c) if the inspection results in areas of non-compliance being cited.

 

          (e)  For the unlicensed person or entity, the department shall:

 

(1)  Provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

 

(2)  Require the owner or person responsible to submit a completed application for a license in accordance with RSA 151:7-a, II, within 7 days from the date of the notice required by (1) above; and

 

(3)  Issue a written warning to immediately comply with RSA 151 and He-P 814 if the owner of an unlicensed facility does not comply with (2) above.

 

          (f)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine as described in He-P 814.14(c)(1).

 

          (g)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any administrative or judicial proceedings relative to the licensee.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.13  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 814, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a license; or

 

(4)  Monitoring of a licensee in accordance with (l) below.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate place on the notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position/job title of the personnel responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 814;

 

b.  Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 814 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

2.  The department determines that the health, safety or well being of an individual will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(11) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with (b) above; and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 814.14(c)(12) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the individuals and employees;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such later date as is applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has been found not to have been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 814.14(b); or

 

(3)  Revoke the license in accordance with He-P 814.14(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  Any violations cited for fire code may be appealed to the New Hampshire state fire marshal, pursuant to RSA 151:6-a, II.

 

          (i)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (j)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (i) above has been provided to the applicant or licensee.

 

          (k)  An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, initiated action to suspend or revoke a license, or denied an application for a license.

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of individuals; or

 

(2)  The presence of conditions in the facility that negatively impact the health, safety, or well-being of individuals.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.14  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated RSA 151 or He-P 814 in a manner which poses a risk of harm to an individual’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 814.05;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents. interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 814.13(c), (d), and (e);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 814 for the same violations within the last 5 inspections;

 

(8)  A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

 

(9)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 814;

 

(10)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been convicted of or adjudicated for a sexual assault or other violent crime, theft or fraud, or a finding of abuse, neglect or exploitation in this or any other state, or poses a threat to the health, safety, or well-being of an individual;

 

(11)  The applicant or licensee fails to employ a qualified administrator; or

 

(12)  The applicant has had a license revoked by another division or unit of the department within a 5 year period of the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed person or entity;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed person or entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 814.15(g), the fine for an applicant, licensee, or unlicensed person or entity shall be $500.00;

 

(4)  For a failure to transfer an individual whose needs exceed the services or programs provided by the CR after being directed by the department to transfer the individual, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 814.12(f), the fine shall be $500.00;

 

(6)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 814.07(b), the fine shall be $100.00;

 

(7)  For a failure to notify the department prior to a change of ownership, in violation of He-P 814.09(a)(1), the fine shall be $500.00;

 

(8)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 814.09(a)(2), the fine shall be $1000.00;

 

(9)  For a failure to notify the department of a change in e-mail address, in violation of He-P 814.09(m), the fine shall be $100.00;

 

(10)  For a refusal to allow access by the department to the CR’s premises, programs, services, or records, in violation of He-P 814.10(a), the fine for an applicant, person, or licensee shall be $2000.00;

 

(11)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 814.13(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(12)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 814.13(c)(8), the fine for a licensee shall be $1000.00;

 

(13)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 814.15(d), the fine for a licensee shall be $500.00;

 

(14)  For a failure to provide services or programs required by the licensing classification and specified by He-P 814.15(c), the fine for a licensee shall be $500.00; 

 

(15)  For exceeding the maximum number of occupants, in violation of He-P 814.15(k), the fine for a licensee shall be $500.00;

 

(16)  For providing false or misleading information or documentation, in violation of He-P 814.15(f), the fine shall be $1000.00 per offense;

 

(17)  For a failure to meet the needs of an individual, in violation of He-P 814.15(i)(1), the fine for a licensee shall be $1000.00 per individual;

 

(18)  For placing an individual in a room that, based on the floor plan required by He-P 814.05(a)(2), has not been approved or licensed by the department, the fine for a licensee shall be $500.00;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 814.11, in violation of He-P 814.15(i)(4) and (5), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 814.08(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, the fine shall be $500.00, which shall be assessed daily;

 

(22)  When an inspection determines that a violation of RSA 151 or He-P 814 has the potential to jeopardize the health, safety, or well-being of an individual, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

 

(23)  Each day that the person or licensee continues to be in violation of the provisions of RSA 151 or He-P 814 shall constitute a separate violation and shall be fined in accordance with He-P 814.14(c); and

 

(24)  If the applicant or licensee is making good faith efforts to comply with (4), (5) or (19) above, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of individuals is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 814 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a CR’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the CR, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years.

 

          (k)  The 5 year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 814.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  RSA 541-A shall govern further appeals of department decisions under this section.

 

          (o)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 814.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRES: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.15  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and rules promulgated thereunder.

 

          (b)  In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of individuals receiving services at the CR, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21, “Patients’ Bill of Rights” are upheld.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the CR, which shall include at a minimum, the required services listed in He-P 814.16.

 

          (d)  The licensee shall develop and implement written polices and procedures governing the operation and all services provided by the CR and for:

 

(1)  Reviewing the policies and procedures annually;

 

(2)  Revising them as needed; and

 

(3)  Implementing a written policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (e)  The licensee shall assess and monitor the quality of care and service provided to individuals on an ongoing basis.

 

          (f)  The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The licensee shall not:

 

(1)  Advertise or otherwise represent the program as operating a CR, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  Licensees shall:

 

(1)  Meet the needs of the individuals during those hours that the individuals are in the care of the CR;

 

(2)  Initiate action to maintain the CR in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the CR;

 

(4)  Appoint a qualified administrator;

 

(5)  Verify the qualifications of all personnel, in accordance with He-M 1001 or 1002;

 

(6)  Provide sufficient numbers of personnel who are present in the CR and are qualified to meet the needs of individuals during all hours of operation;

 

(7)  Provide the CR with sufficient supplies, equipment, and lighting to meet the needs of the individuals; and

 

(8)  Implement any POC that has been accepted or issued by the department.

 

          (j)  The licensee shall consider all individuals to be competent and capable of making health care decisions unless the individual:

 

(1)  Has a guardian appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated.

 

          (k)  The licensee shall not exceed the number of occupants as authorized by NFPA 101 as adopted by the commissioner of the department of safety under RSA 153 as Saf-C 6000, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the license certificate issued by the department.

 

          (l)  The licensee shall not admit an individual whose needs exceed the program and services offered by the CR.

 

          (m)  If the licensee accepts an individual who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the individuals, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (n)  The licensee shall report all positive tuberculosis test results for employees to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (o)  Any licensee who admits or who has an individual with a diagnosis of dementia, Alzheimer’s disease, or a primary or secondary diagnosis of mental illness shall:

 

(1)  Require all direct care personnel caring for the individual to be trained in the special care needs of individuals with dementia, Alzheimer's disease, or mental illness; and

 

(2)  Provide a physical environment that has a safety and security system that prevents an individual from leaving the premises without the knowledge of personnel, if the individual:

 

a.  Has eloped from the CR in the last 60 days; or

 

b.  Is a danger to self or to others.

 

          (p)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 814.12(d), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to “Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301” or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

 

          (q)  For reportable incidents, the licensee shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 271-4968 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

 

a.  The CR name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or employees involved in, witnessing, or responding to the reportable incident;

 

d.  The name of individual(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  When the individual’s guardian or agent, if any, or personal representative was notified;

 

i.  The signature of the person reporting the reportable incident;

 

j.  The date and time the individual’s licensed practitioner was notified, if applicable; and

 

k.  The date the facility performed the investigation required by (1) above;

 

(3)  As soon as practicable, notify the guardian, agent, or personal representative, if any;

 

(4)  As soon as practicable, notify the local police department, the department, and the guardian, agent, or personal representative, if any, when an individual has an elopement or unexplained absence and the licensee has searched the building and the grounds of the CR without finding the individual; and

 

(5)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (r)  The licensee shall admit and allow any department representative to inspect the CR and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 814 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (s)  Applicants, licensees, and employees shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 814, including allowing representatives of the department to:

 

(1)  Enter and complete an inspection of the premises;

 

(2)  Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

 

(3)  Interview employees and individuals of the CR. 

 

          (t)  A licensee shall, upon request, provide an individual or the individual’s guardian or agent, if any, with a copy of his or her individual record pursuant to the provisions of RSA 151:21, X.

 

          (u)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (v)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of individuals and employees that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to individuals and employees; and

 

(3)  Systems to prevent tampering with information pertaining to individuals and employees.

 

          (w)  The licensee shall develop policies and procedures regarding the release of information contained in individual records.

 

          (x)  The licensee shall provide cleaning and maintenance services, as needed, to protect individuals, employees, and the public.

 

          (y)  The CR shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

 

          (z)  If the CR is not on a municipal water system, the water used in the CR shall be potable and suitable for human consumption.

 

          (aa)  The licensee shall determine whether smoking will be allowed at the CR.

 

          (ab)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking-permitted areas in accordance with RSA 155:68 and RSA 155:69 and He-P 1900, as applicable.

 

          (ac)  If the licensee holds or manages an individual’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other individuals, or other household members.

 

          (ad)  At the time of admission the licensee shall give an individual and the individual’s guardian, agent, or personal representative, if applicable, a listing of all CR charges and identify what care and services are included in the charge.

 

          (ae)  The licensee shall give an individual a 30-day written notice before any increase is imposed in the cost or fees for any CR services.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.16  Required Facility and Individual Services.  Each CR shall provide, at a minimum, services and programs for the individuals they provide services to in accordance with He-M 1001 or He-M 1002.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.17  Medication Services. 

 

          (a)  Each CR shall provide medication services in accordance with He-M 1201 or He-M 1202.

 

          (b)  The therapeutic use of cannabis by individuals who are qualifying patients possessing a registry identification card shall be permitted at a CR provided:

 

(1)  The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or

 

(2)  The facility permits an individual to possess and use cannabis at the licensed premises, the individual is able to self-administer medication without assistance, and the cannabis remains in the possession of the individual.

 

          (c)  A CR that permits the therapeutic use of cannabis in accordance with (b) above shall develop, maintain, and implement a general policy relative to individual use of cannabis at the licensed premises, including storage, security, and administration.

 

          (d)  A CR that designates itself as a facility caregiver according to (b)(1) above shall:

 

(1)  Have an individual-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the individual; and

 

(2)  Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying patients with the therapeutic use of cannabis.

 

          (e)  A CR shall not permit the smoking of cannabis if smoking is not allowed on the CR premises.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.18  Personnel.

 

          (a)  CRs operating under He-M 1001 shall provide personnel in accordance with He-M 506 staff qualifications and staff development requirements for developmental services agencies.

 

          (b)  Prior to delivering services to an individual, personnel in all CRs shall have received training in the following areas:

 

(1)  Rights as set forth in He-M 309 or He-M 310;

 

(2)  The specific health-related requirements of each individual, including:

 

a.  All current medical conditions, medical history, and routine and emergency protocols; and

 

b.  Any special nutrition, dietary, hydration, elimination, or ambulation needs;

 

(3)  Any specific communication needs of individuals served;

 

(4)  Any behavioral supports required of individuals served; and

 

(5)  Any assistance individuals need to evacuate the residence in the case of emergency.

 

          (c)  Documentation of the training in (b) above shall be maintained in personnel records.

 

          (d)  Unless a waiver is granted in accordance with (e) below, the licensee shall not offer employment, allow to be a volunteer, contract with an independent contractor who will provide direct care or personal care services to individuals or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, or allow a household member to continue to reside in the residence if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of individuals.

 

          (e)  The department shall grant a waiver of (d) above if, after reviewing the underlying circumstances, it determines that the person does not pose a current threat to the health, safety, or well-being of individuals.

 

          (f)  If the information identified in (d) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

 

(2)  Request a wiaver of (d) above.

 

          (g)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the residence if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of an individual; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of an individual.

 

          (h)  The licensee shall check the names of the persons in (d) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-E 720, and, if appropriate, the NH board of nursing registry maintained pursuant RSA 326-B:26 and 42 CFR 483.156, prior to employing, contracting with, or engaging them, or prior to allowing or continuting to allow a household member to reside at the residence.

 

          (i)  The licensee shall not employ, contract with, engage, or allow to reside in the residence any person in (d) above who is listed on the BEAS state registry or the NH board of nursing, nursing assistant registry, unless a waiver is granted by BEAS or the NH board of nursing, respectively.

 

          (j)  In lieu of (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual to provide direct care or personal care services a signed statement that the agency’s employees have complied with (h) above and do not meet the criteria in (d) and (i) above.

 

          (k)  All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made, and then annually thereafter, stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a resident; and

 

(3)  Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

 

          (l)  All administrators appointed after the 2017 effective date of these rules shall be at least 21 years of age and have one of the following combinations of education and experience:

 

(1)  A bachelor’s degree from an accredited institution and one year of experience working in a health care facility;

 

(2)  A New Hampshire license as an RN and at least 6 months of experience working in a health care facility;

 

(3)  An associate’s degree from an accredited institution and at least 2 years of experience working in a health care facility; or

 

(4)  A New Hampshire license as an LPN and at least one year of experience working in a health care facility.

 

          (m)  All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the CR each annual licensing period.

 

          (n)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V and as required by He-P 309.02 and He-P 309.08; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, all individuals and employees that have received or declined to receive immunizations.

 

          (o)  Employees shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (p)  The CR shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

 

          (q)  The policy in (p) above shall include:

 

(1)  Education;

 

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

 

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

 

(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 abuse, misuse, and diversion prevention policy.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.19  Quality Improvement.  Each CR shall provide quality improvement in accordance with He-M 1001 or He-M 1002.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRES: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.20  Infection Control.

 

          (a)  The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of individuals with infectious or contagious diseases or illnesses who can safely participate in the program;

 

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

 

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

 

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

 

(1)  Cause of infection;

 

(2)  Effect of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (d)  If the CR has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (e)  Personnel infected with a disease or illness transmissible through food, saliva, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (f)  Personnel infected with scabies or lice shall not provide direct care to individuals or work in food services until such time as they are no longer infected.

 

          (g)  Pursuant to RSA 141-C:1, employees with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the employee is receiving tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (h)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight-fitting bandage.

 

          (i)  In accordance with RSA 151:9-b, the licensee shall:

 

(1) Arrange for or provide all consenting individuals an immunization for influenza and pneumococcal disease;

 

(2)  Arrange for or provide all consenting employees an immunization for influenza; and

 

(3)  Report immunization data to the department’s immunization program as required by He-P 309.02 and He-P 309.08.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.21  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment throughout the CR licensed premises.

 

          (b)  All furniture, floor, ceiling, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the individuals.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All individuals’ bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, program supplies, and other cleaning materials.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only professionals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make in inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

 

          (l)  Trash receptacles in food service area shall be covered at all time.

 

          (m)  If the CR provides laundry services, the following requirements shall be met:

 

(1)  The laundry room shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas and shall not be mixed with soiled supplies.

 

          (p)  Any CR that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services, shall notify the NH department of health and human services upon receipt of notice of a failed water test.

 

          (q)  Waste water shall be disposed of through a system that meets the requirements of the NH department of environmental services.  Sink drains not connected to the sanitary sewer or septic system and similar methods of disposal above ground shall be strictly prohibited.

 

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

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.22  Physical Environment.

 

          (a)  The licensed premises shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of individuals and employees, including reasonable accommodations for individuals and employees with mobility limitations.

 

          (b)  The CR shall comply with all state and local codes and ordinances for:

 

(1)  Zoning;

 

(2)  Building;

 

(3)  Health;

 

(4)  Fire;

 

(5)  Waste disposal; and

 

(6)  Water.

 

          (c)  The CR shall be accessible at all times of the year.

 

          (d)  The CR shall have a telephone accessible at all times in case of emergency.

 

          (e)  Doors and windows opening to the outside air shall be tight fitting.

 

          (f)  The CR shall be free from environmental nuisances such as noise and odors.

 

          (g)  Equipment providing heat within a CR including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit during the day if individual(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (h)  Electric heating systems shall be exempt from (g)(2) above.

 

          (i)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in personnel areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (j)  Unvented fuel-fired heaters shall not be used in any CR.

 

          (k)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (l)  Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (m)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in He-P 814.21(r).

 

          (n)  Lighting shall be available to allow individuals to partake in activities such as reading, needlework, or handicrafts.

 

          (o)  The CR shall have dining facilities to accommodate each individual.

 

          (p)  All CRs shall have at least one toilet and one hand sink and as many additional toilets and sinks as are necessary to meet the needs of the individuals in the home, as follows:

 

(1)  At a minimum there shall be one sink, toilet, and tub or shower for every 6 individuals, and there shall be as many additional showers or bathing facilities as are necessary to meet the needs of the individuals in the home; and

 

(2)  Separate bathroom facilities for family members and employees shall not be counted in the 1:6 ratio as set forth in (1) above.

 

          (q)  Each bathroom shall be equipped with:

 

(1)  Soap dispensers;

 

(2)  Paper towels or a hand-drying device providing heated air; and

 

(3)  Hot and cold running water.

 

          (r)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (s)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (t)  There shall be sufficient space and equipment for the services provided at the CR, as follows:

 

(1)  Furniture to allow for each individual to sit comfortably as necessary throughout the day;

 

(2)  Tables and chairs to assure that each individual has a seat at a table for each meal or snack and for doing activities such as crafts or puzzles; and

 

(3)  Supplies such as plates, cups, glasses, silverware, liquid soap for hand washing, toilet tissue, and paper towels in a supply to accommodate the number of individuals authorized by the license.

 

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

 

          (v)  No individual’s room shall accommodate more than 2 individuals.

 

          (w)  Each individual shall have:

 

(1)  A bed appropriate to the needs of the individual;

 

(2)  A firm mattress with cover;

 

(3)  A pillow, linens, and blankets;

 

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

 

(5)  A bureau with mirror;

 

(6)  A bedside table;

 

(7)  A lamp; and

 

(8)  An upholstered chair.

 

          (x)  The individual or guardian may indicate and the home shall document that the individual does not wish or need to have one or more of the items in (w) above and the reason for the removal.

 

          (w)  The individual may provide items listed in (w) from his or her own personal possessions provided that they are clean and in good repair.

 

          (z)  Each individual room door shall be of the side hinge type.  Folding doors or curtains shall be prohibited.

 

          (aa)  Each individual room shall contain a closet or storage space for the individual’s personal belongings.

 

          (ab)  Each individual room shall have its own separate entry to permit the individual to reach his or her room without passing through the room of another person.

 

          (ac)  Individuals shall have a living or multi-purpose room for their use which has a capacity of meeting the needs of the individuals.  Such rooms shall be provided with reading lamps, chairs, tables, and couches, which shall be comfortable and in good repair.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.23  Fire Safety.

 

          (a)  All CRs shall meet the requirements of the appropriate chapter of NFPA 101 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and any pertinent chapter and related codes regarding the installation, testing, and maintenance of the fire alarm system.

 

          (b)  All CRs shall have, at a minimum:

 

(1)  One of the following:

 

a.  Approved smoke alarms installed inside every sleeping room, outside every sleeping area in the immediate vicinity of the bedrooms, and on all levels, including basements, that are interconnected and powered by the CR’s electrical service; or

 

b.  A wireless fire alarm system approved by the NH fire marshal;

 

(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 for the most recent 12-month period;

 

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.

 

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

 

          (d)  Immediately following any fire or emergency situation, licensees shall notify the department by phone and in writing within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  EMS transport related to known pre-existing conditions.

 

          (e)  The written notification required by (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injuries to individuals or employees or damage sustained by the CR;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any employees or individuals who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any employees or individuals who required medical treatment as a result of the incident, if applicable; and

 

(6) The name of the person the licensee wishes the department to contact if additional information is required.

 

          (f)  For the use and storage of oxygen and other related gases, CRs shall comply with NFPA 99 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

 

(1)  All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

 

(2)  Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

 

(3)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

a.  Not be stored with any flammable gas, liquid, or vapor;

 

b.  Be separated from combustibles or incompatible materials by:

 

1.  A minimum distance of 20 ft (6.1 m);

 

2.  A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

3.  An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

 

c.  Be secured in an upright position, such as with racks or chains;

 

(4)  A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

 

(5)  Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

 

          (g)  Flammable gases and liquids shall be stored in metal fire retardant cabinets.

 

          (h)  Pursuant to RSA 155:68 and 69, if the licensee has chosen to allow smoking, a designated smoking-permitted area shall be provided which has, at a minimum:

 

(1)  A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Walls and furnishings constructed of non-combustible materials; and

 

(3)  Metal waste receptacles and safe ashtrays.

 

          (i)  Each licensee shall develop a written fire safety plan.

 

          (j)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the individual, or the individual’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the individual’s responsibilities shall be provided to the individual. Each individual shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (k)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (l)  For buildings constructed to the Residential Board and Care Chapter of the NFPA 101, the following shall be required:

 

(1)  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

(2)  Individuals shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

(3)  All CR facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when individuals are sleeping.  Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

(4)  The drills shall involve the actual evacuation of all individuals to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide individuals with experience in egressing through all exits and means of escape;

 

(5)  Facilities shall complete a written record of fire drills that includes the following:

 

a.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

b.  The location of exits used;

 

c.  The number of people, including individuals, personnel, and visitors, participating at the time of the drill;

 

d.  The amount of time taken to completely evacuate the facility;

 

e.  The name and title of the person conducting the drill;

 

f.  A list of problems and issues encountered during the drill;

 

g.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

h.  The names of all staff members participating in the drill;

 

(6)  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

(7)  At least annually, the facility shall conduct a resident Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the individuals needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, individuals ability to evacuate on their own and choose an alternate exit; and

 

(8)  The fire drills for facilities built to the Residential Board and Care chapter of the NFPA 101, shall be permitted to be announced, in advance, to the individuals just prior to the drill.

 

          (m)  Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

 

          (n)  All personnel shall participate in at least one drill quarterly.

 

          (o)  For personnel who are unable to participate in the scheduled drill described in (n) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

 

          (p)  Personnel who are unable to participate in a drill in accordance with (n) and (o) above shall participate in a drill within the next quarter.

 

          (q)  Per-diem or temporary personnel shall not be the only person on duty unless they have:

 

(1)  Participated in at least 2 actual fire drills in the facility in the past year; and

 

(2)  Participated in the facility’s orientation program pursuant to He-M 1001 or He-M 1002.

 

Source.  #9288, eff 10-3-08, EXPIRED: 10-3-16

 

New.  #12048, INTERIM, eff 11-19-16, EXPIRED: 5-18-17

 

New.  #12374, eff 9-1-17

 

          He-P 814.24  Emergency Preparedness.

 

          (a)  Each facility shall have group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (b)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (c)  The plan in (b) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, missing individuals and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

 

(12)  Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j. Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Include the management of individuals, particularly with respect to physical and clinical issues to include:

 

a. Relocation of individuals with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (d)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not involved in the exercise;

 

(2)  Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

 

          (e)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of individuals and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

          (f)  Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (e) above. The plan shall include the following:

 

(1)  Assumptions for calculations of food and water supplies including maximum number of staff and individuals, water source of supply (tap or commercial) and expiration (months), tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

 

(2)  Storage location(s); and

 

(3) Back-up supplies.

 

Source.  #12374, eff 9-1-17

 

PART He-P 815  INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID) 

 

          He-P 815.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all intermediate care facilities for individuals with intellectual disabilities(ICF/IID) licensed pursuant to RSA 151:2, I(e), and thereby ensure, through basic standards, the health and safety of residents in an ICF/IID that provides comprehensive and individualized health care and rehabilitation services to residents to promote their functional status and independence including shelter, food, training, and protective oversight services.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.02  Scope.  This part shall apply to any person, agency, partnership, corporation, government entity, association, or other legal entity operating an ICF/IID except:

 

          (a)  All facilities listed in RSA 151:2, II (a)-(h); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

 

Source.  #13568, eff 2-25-23

 

          He-P 815.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a resident;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to an resident; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a resident without his or her consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a resident for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

 

          (f)  “Admission” means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (g)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive”  includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (h)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies.

 

          (i)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA-J:35-37.

 

          (j)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ICF/IID pursuant to RSA 151:2, I(e).

 

          (k)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 815, or other federal or state requirements.

 

          (l) “Assessment” means an evaluation of the resident to determine the care and services that are needed.

 

          (m) “Care plan” means a written guide developed by the licensee, in consultation with the resident, guardian, agent, or personal representative, if applicable, as a result of the assessment process for the provision of care and services to a resident.

 

          (n)  “Certified intermediate care facility” means an intermediate care facility that is certified by the Centers of Medicare and Medicaid Services (CMS) and deemed compliant with He-P 815.

 

          (o)  “Change of ownership” means the transfer of the controlling interest of an established ICF/IID to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

          (p)  “Chemical restraint” means a drug or medication that is used as a restriction to manage the residents behavior or restrict the resident’s freedom of movement and is not a standard treatment or dosage for the resident’s condition.

 

          (q)  “Clinical Laboratory Improvement Amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

 

          (r)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or the commissioner’s designee.

 

          (s)  “Contracted employee” means a temporary employee working under the direct supervision of the ICF/IID but employed by an outside agency.

 

          (t)  “Core services” means those minimal services to be provided to any resident that must be included in the basic rate.

 

          (u)  “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

 

          (v)  “Days” means calendar days unless otherwise specified in the rule.

 

          (w)  “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

 

          (x)  “Direct care” means hands on care or services to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (y)  “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

 

          (z)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (aa)  “Discharge” means moving a resident from a licensed facility or entity to a non-licensed facility or entity.

 

          (ab)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).

 

          (ac)  “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

 

          (ad)  “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

 

          (ae)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (af) “Employee” means anyone employed by the ICF/IID and for whom the ICF/IID has direct supervisory authority.

 

          (ag)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to the non-compliance of RSA 151 or He-P 815.

 

          (ah)  “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

 

          (ai)  “Exploitation” means the illegal use of a resident’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from an resident through the use of undue influence, harassment, duress, deception, or fraud.

 

          (aj)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (ak)  “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

 

          (al)  “Guardian” means a parent of a minor or a person appointed in accordance with RSA 464-A or RSA 463 to make informed decisions relative to the resident’s health care and other personal needs. 

 

          (am)  “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical, or mental disability, or because of security measures not under the occupant’s control.

 

          (an)  “Household member” means the caregiver, all family members, and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days.

 

          (ao)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ap)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (aq)  “Informed consent” means the decision by a parent, a resident, guardian, agent, or surrogate decision-maker to agree to a proposed course of treatment, after the parent, resident, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (ar)  “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (as)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 815 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 815.

 

          (at)  “Laboratory” means any building, place, or mobile laboratory van, for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease.

 

          (au)  “License” means the document issued by the department to an applicant or licensee of an ICF/IID which authorizes operations in accordance with RSA 151 and He-P 815, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

 

          (av)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds that the ICF/IID is licensed for.

 

          (aw)  “Licensed practitioner” means:

 

(1)  Medical doctor;

 

(2)  Physician’s assistant;

 

(3)  Advanced practice registered nurse;

 

(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.

 

          (ax)  “Licensed premises” means the building(s), or portion thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

 

          (ay)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (az)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ba)  “Life safety code” means the adoption by reference of the life safety code, 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.

 

          (bb)  “Mechanical restraint” means locked, secured, or alarmed ICF/IIDs or units within an ICF/IID, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the ICF/IID or unit within.  These do not include postural supports for residents with inadequate tone or motor control to balance independently.

 

          (bc)  “Medical director” means a medical doctor, advanced practice registered nurse, doctor of osteopathy or doctor of naturopathic medicine licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in an ICF/IID.

 

          (bd)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (be)  “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “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.”

 

          (bf)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes. 

 

          (bg)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident.

 

          (bh)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

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

 

          (bj)  “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

 

          (bk)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bl)  “Over-the-counter medications” means non-prescription medications.

 

          (bm)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (bn)  “Personal assistance” means providing or assisting a resident in carrying out activities of daily living. 

 

          (bo)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the resident for a specific, limited purpose or for the general purpose of assisting a resident in the exercise of any rights.

 

          (bp)  “Personnel” means an individual who is employed by the facility, a volunteer, or an independent contractor, and provides direct care or personal care services to residents.

 

          (bq)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the resident’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques. Physical restraints does not include postural supports for residents with inadequate tone or motor control to balance independently.

 

          (br)  “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

 

          (bs)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bt)  “Point of care testing (POCT)” means medical diagnostic testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of resident care.

 

          (bu)  “Point of care devices” means a system of devices used to obtain medical, diagnostic results. Examples include, but are not limited to:

 

(1)  A lancing or finger stick device to obtain blood specimen;

 

(2)  A test strip or reagents to apply a specimen to for testing; or;

 

(3)  A meter or monitor to calculate and show the results, including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin Time and International Normalized Ratio anticoagulation meters; or

 

c.  A Cholesterol meter.

 

          (bv)  “Pro re nata (PRN) medication” means medication taken as circumstances might require in accordance with licensed practitioner’s orders.

 

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

 

          (bx)  “Protective care” means the provision of resident monitoring services, including but not limited to:

 

(1)  Knowledge of resident whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (by)  “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bz)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained. 

 

          (ca)  “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

 

          (cb)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (cc)  “Reportable incident” means an occurrence of any of the following while the resident is either in the ICF/IID or in the care of ICF/IID personnel:

 

(1)  The unanticipated death of the resident;

 

(2)  An injury to a resident, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the resident; or

 

(3)  The elopement or unexplained absence of a resident from the ICF/IID.

 

          (cd)  “Resident” means any person admitted to or in any way receiving care, services, or both who resides in an ICF/IID.

 

          (ce)  “Resident record” means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 815 and as required by other federal and state law.

 

          (cf)  “Resident rights” means the privileges and responsibilities possessed by each resident provided by RSA 151:21.

 

          (cg) “Seclusion” means an intervention defined as solitary containment in a fully protective environment with close surveillance by qualified personnel for purposes of safety or behavior management.

 

          (ch)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident.

 

          (ci)  “Significant change” means a decline or improvement in a resident’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the resident’s health status; and

 

(3)  Requires interdisciplinary review or revision of the care plan.

 

          (cj)  “State monitoring” means the placement of individuals by the department at an ICF/IID to monitor the operation and conditions of the facility.

 

          (ck)  “Supervision” means the process by which the resident is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

 

          (cl)  “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident.

 

          (cm)   “Underwriters Laboratories (UL) listed” means that the global safety certification company UL has confirmed that the product is safe for use.

 

          (cn)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (February 2023), signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit affirming and certifying the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

(2)  A floor plan of the prospective ICF/IID;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” if a sole proprietorship or if otherwise applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, VI, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name and qualifications of the ICF/IID administrator;

 

(6)  Copies of applicable licenses, certificates, or both for the ICF/IID administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the appropriate occupancy chapter of the life safety code 101 and the uniform fire code, NFPA 1, as published by the National Fire Protection Association (NFPA) and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5, and local fire ordinances applicable for a health care facility; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(8)  If the ICF/IID uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill;

 

(9)  The results of a criminal records check for the applicant(s), licensee if different than the applicant, medical director, and the administrator, as applicable;

 

(10)  A copy of the criminal attestation as described in He-P 815.17(m)(8) for the  administrator and medical director;

 

(11)  If residents are adults, the results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director; and

 

(12)  If residents are minors, the results of the DCYF central registry check of founded report of abuse and neglect for the administrator and medical director.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #13568, eff 2-25-23

 

          He-P 815.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 815.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 815.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 815.13(b) if it determines that the applicant, licensee, administrator, or medical director:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (f)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 815.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)  A written notification of denial, pursuant to He-P 815.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 815.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 815.

 

          (i)  A written notification of denial, pursuant to He-P 815.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 815.04(a)(1) at least 120 days prior to the expiration of the current license to include:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 815.10(f), if applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 815.10; and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03-6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (c)  In addition to He-P 815.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection as described in He-P 815.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by He-P 815.06(b) and (d) as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 815, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation, shall be required to submit an application for an initial license pursuant to He-P 815.04.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.07 ICF/IID  New Construction and Existing Building Rehabilitation.

 

          (a)  For new construction and for building rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 815 and notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

 

          (g)  The ICF/IID shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or building rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or building rehabilitation of a building shall comply with the following:

 

(1)  The state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300, including but not limited to the health care chapter of NFPA 101, and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5 including the;

 

a.  NFPA 101, “Life Safety Code Residential Board and Care Occupancy Chapter”; or

 

b.  NFPA 101, “Life Safety Code Health Care Occupancy Chapter”;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  The Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities”, (2022 edition), available as noted in Appendix A. 

 

          (i)  All ICF/IID’s newly constructed or rehabilitated after the 2023 effective date of these rules shall comply with the FGI “Guidelines for Design and Construction of  Residential Health, Care, and Support Facilities” (2022 edition), as applicable, available as noted in Appendix A.

 

          (j)  Where building rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,”(2022 edition), as available as noted in Appendix A.

 

          (k)  The department shall be the authority having jurisdiction for the requirements in He-P 815.07(h)-(i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 815.10 as appropriate.

 

          (l)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using an UL listed or approved sealant that provides an equivalent rating as provided by the original surface.

 

          (m)  Waivers granted by the department for construction or building rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (n)  Exceptions or variances pertaining to the state fire code referenced in He-P 815.07(h)(1) shall be granted only by the state fire marshal.

 

          (o)  The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 815.09 prior to its use.

 

Source.  #13568, eff 2-25-23

 

            He-P 815.08  ICF/IID Requirements for Organizational Changes.

 

          (a)  The ICF/IID shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds authorized under the current license; or

 

(6)  Services.

 

          (b)  The ICF/IID shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3)  An increase in the number of beds authorized under the current license; or

 

(4)  A change in services.

 

          (c)  When there is a change in address without a change in location, the ICF/IID shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the ICF/IID shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department:

 

(2)  The physical location;

 

(3)  An increase in the number of beds or residents authorized under the current license;

 

(4)  A change in licensing classification; or

 

(5)  A change that places the facility under a different life safety code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

          (g)  A new license and license certificate shall be issued for change of ownership, classification, or physical location.

 

          (h)  A revised license and license certificate shall be issued for changes in the ICF/IID name or a change in address without a change in physical location.

 

          (i)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  An increase or decrease in the number of beds;

 

(3)  A change in the scope of services provided; or

 

(4)  When a waiver has been granted in accordance with He-P 815.10.

 

          (j)  The ICF/IID shall notify the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses, certificates, or both, for the new administrator or medical director;

 

(3) The results of a criminal records check to include results for the state of New Hampshire for the new administrator or medical director; and

 

(4)  The results of the criminal attestation as described in He-P 815.17(m)(8).

 

          (k)  Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position.

 

          (l)  If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the ICF/IID in writing so that a waiver can be sought or the ICF/IID can search for a qualified candidate.

 

          (m)  The ICF/IID shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. 

 

          (n)  The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

          (o)  A restructuring of an established ICF/IID that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  If a licensee chooses to cease the operation of the ICF/IID, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 815, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the ICF/IID; and

 

(3)  Any records required by RSA 151 and He-P 815.

 

          (b)  The department shall conduct a clinical and life safety inspection as necessary, to determine full compliance with RSA 151 and He-P 815 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed under He-P 815.08(e)(1);

 

(3)  A change in the physical location of the ICF/IID;

 

(4)   A relocation within the facility;

 

(5)  A change in the life safety code occupancy chapter the facility is licensed under;

 

(6)  An increase in the number of beds;

 

(7)  Occupation of space after construction, modifications, or structural alterations; or

 

(8)  The renewal of a non-certified license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of an inspection, the department determines that the ICF/IID is in violation of any of the provisions of He-P 815, RSA 151, or other federal or state requirement.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a written POC, in accordance with He-P 815.12, within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 815 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary and how a waiver is justified;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and

 

(4)  The period of time for which the waiver is sought if less than permanent.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

 

(1)  Meet the objective or intent of the rule;

 

(2)  Do not negatively impact public health or the health, safety, or well-being of the residents; and

 

(3)  Do not affect the quality of resident services.

 

          (d)  The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); 

 

(3)  There is 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 RSA 151 or He-P 815; 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 or abuse;

 

b.  Verbal or emotional abuse; or

 

c.  The danger of physical injury to one or more residents.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the ICF/IID, or the alleged unlicensed person or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 and He-P 815.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4)  Interviews with residents who might have information that is relevant to the investigation.

 

          (d)  For the licensed ICF/IID, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Require the licensee to submit a POC in accordance with He-P 815.12, unless the department determined the complaint is unfounded or does not violate any statutes or rule; and

 

(4)  If it is determined the complaint is unfounded or does not violate any statutes or rules, notify the licensee in writing and take no further action.

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e);

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

 

(3)  If the response described in (e)(2) is not received within 7 days from the date of receipt of the notice described in (e)(1) and in accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 815;

 

(4)  The warning in (e)(3) above, shall include:

 

a.  The time frame within which the owner or person responsible shall comply with the directives of the warning;

 

b.  The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

 

c.  The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

 

(5)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 815.13(c)(5).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any administrative or judicial proceedings relative to the licensee.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 815, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a license; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate space on the state notice detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means,   to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 815;

 

b.  Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 815 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 815.12(d) and a fine in accordance with He-P 815.13(c)(11);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 815.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 815.13(c)(12) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and employees;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such later date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has been found not to have been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 815.13(b)(6); or

 

(3)  Revoke the license in accordance with He-P 815.13(b)(6).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

 

          (k)  An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine, initiated action to suspend or revoke a license, or denied an application for a license.

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of residents; or

 

(2)  The presence of conditions in the facility that negatively impact the health, safety, or well-being of residents.

 

          (m)  The department shall appoint a temporary manager to assume operation of an ICF/IID when, following an inspection, the department determines that:

 

(1)  The licensee has repeatedly failed to manage and operate the ICF/IID in compliance with RSA 151 and He-P 815 and such ICF/IID practices have failed to meet the needs of the residents;

 

(2)  The licensee has failed to develop or implement policies and procedures for infection control, sanitation, or life safety codes, imposing harm or the potential for harm to the residents; or

 

(3)  The health, safety, and well-being of the residents are at risk and emergency action is required.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated RSA 151 or He-P 815 in a manner which poses a risk of harm to a resident’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 815.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 815.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 815.12 (c)(5) and has not submitted a revised POC as required by He-P 815.12 (c)(6);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 815 for the same violations within the last 5 inspections;

 

(9)  A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 815;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been convicted of or adjudicated for a sexual assault or other violent crime, theft or fraud, or a finding of abuse, neglect or exploitation in this or any other state, or poses a threat to the health, safety, or well-being of a resident;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by another division or unit of the department within a 5 year period of the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed person or entity;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed person or entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 815.14(g), the fine for an applicant, licensee, or unlicensed person or entity shall be $500.00;

 

(4)  For a failure to transfer an resident whose needs exceed the services or programs provided by the ICF/IID after being directed by the department to transfer the resident, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 815.11(e), the fine shall be $500.00;

 

(6)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 815.06(b), the fine shall be $100.00;

 

(7)  For a failure to notify the department prior to a change of ownership, in violation of He-P 815.08(a)(1), the fine shall be $500.00;

 

(8)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 815.08(a)(2), the fine shall be $500.00;

 

(9)  For a failure to notify the department of a change in e-mail address, in violation of He-P 815.08(m), the fine shall be $100.00;

 

(10)  For a refusal to allow access by the department to the ICF/IID’s premises, programs, services, or records, in violation of He-P 815.09(a), the fine for an applicant, person, or licensee shall be $2000.00;

 

(11)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 815.12(c)(2) and (6), the fine for a licensee shall be $500.00;

 

(12)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 815.12(c)(11), the fine for a licensee shall be $1000.00;

 

(13)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 815.14(b) and (d), the fine for a licensee shall be $500.00;

 

(14)  For a failure to provide services or programs required by the licensing classification and specified by He-P 815.14(c), the fine for a licensee shall be $500.00; 

 

(15)  For exceeding the licensed capacity in violation of He-P 815.14(k), the fine for a licensee shall be $500.00 per day;

 

(16)  For providing false or misleading information or documentation, in violation of He-P 815.14(f), the fine shall be $1000.00 per offense;

 

(17)  For a failure to meet the needs of an resident, in violation of He-P 815.14(i)(1), the fine for a licensee shall be $1000.00 per resident;

 

(18)  For placing a resident in a room that, based on the floor plan required by He-P 815.04(a)(2), has not been approved or licensed by the department, the fine for a licensee shall be $500.00;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 815.10, in violation of He-P 815.14(i)(4) and (5), the fine for a licensee shall be $500.00;

 

(20) For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 815.09(a), the fine shall be $2000.00;

 

(21)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 815.07(a), the fine for a licensed facility shall be $500.00;

 

(22)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, in violation of He-P 815.09(b)(7), the fine shall be $500.00, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(23)  When an inspection determines that a violation of RSA 151 or He-P 815 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

 

(24)  Each day that the person or licensee continues to be in violation of the provisions of RSA 151 or He-P 815 shall constitute a separate violation and shall be subject to fines in accordance with He-P 815.13(c); and

 

(25)  If the applicant or licensee is making good faith efforts to comply with (4), (5), or (19) above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of residents is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 815 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When an ICF/IID’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the ICF/IID, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years.

 

          (k)  The 5 year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has reasonable information or evidence that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 815.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  RSA 541-A and He-C 200 shall govern further appeals of department decisions under this section.

 

          (o)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 815.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and rules promulgated thereunder.

 

          (b)  In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of residents receiving services at the ICF/IID, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21, “Patients’ Bill of Rights” are upheld.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the ICF/IID, which shall include at a minimum, the required services listed in He-P 815.15.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation of all services provided by the ICF/IID and for:

 

(1)  Reviewing the policies and procedures annually;

 

(2)  Revising them as needed;

 

(3)  Implementing a written policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

 

(4)  Managing the behavior of residents under the age of 18, including how and under what circumstances seclusion or restraint is used, pursuant to RSA 126-U:2. 

 

          (e)  The licensee shall assess and monitor the quality of care and service provided to residents on an ongoing basis.

 

          (f)  The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The licensee shall not:

 

(1)  Advertise or otherwise represent the program as operating an ICF/IID, without a valid license; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  Licensees shall:

 

(1)  Meet the needs of the resident;

 

(2)  Initiate action to maintain the ICF/IID in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ICF/IID;

 

(4)  Appoint a qualified administrator and medical director;

 

(5)  Verify the qualifications of all personnel;

 

(6)  Provide sufficient numbers of personnel who are present in the ICF/IID and are qualified to meet the needs of residents during all hours of operation;

 

(7)  Provide the ICF/IID with sufficient supplies, equipment, and lighting to meet the needs of the residents;

 

(8)  Implement any POC that has been accepted or issued by the department; and

 

(9)  Require that all personnel follow the orders of the licensed practitioner for each resident and encourage the residents to follow the licensed practitioner’s orders.

 

          (j)  The licensee shall consider all residents to be competent and capable of making health care decisions unless the resident:

 

(1)   Has a guardian appointed by a court of competent jurisdiction;

 

(2)  Has a durable power of attorney for health care that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (k)  The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (l)  The licensee shall not admit a resident whose needs exceed the program and services offered by the ICF/IID.

 

          (m)  If the licensee accepts a resident who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the residents, as specified by the United States Centers for Disease Control and Prevention (CDC) “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (n)  The licensee shall report all positive tuberculosis test results for employees to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (o)  The licensee shall implement measures to ensure the safety of residents who are assessed as an elopement risk or danger to self or others.

 

          (p)   If serving an adult population, the licensee shall ensure compliance with all dementia training requirements pursuant to RSA 151:47-49 including continuing education to include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1)  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

(2)  A minimum of 4 hours of ongoing training each calendar year.

 

          (q)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 815.09, for the previous 12 months;

 

(3)  A copy of the residents’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of resident rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to “Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301” or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman; and

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

 

          (r)  For reportable incidents, the licensee shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 603-271-4968 or, if a fax machine is not available, convey by electronic mail to hfa-licensing@dhhs.nh.gov or regular mail to 129 Pleasant Street, Concord, NH 03301, the following information to the department within 48 hours of a reportable incident:

 

a.  The ICF/IID name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or employees involved in, witnessing, or responding to the reportable incident;

 

d.  The name of resident(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  When the resident’s guardian or agent, if any, or personal representative was notified;

 

i.  The signature of the person reporting the reportable incident;

 

j.  The date and time the resident’s licensed practitioner was notified, if applicable; and

 

k.  The date the facility performed the investigation required by (1) above;

 

(3)  As soon as practicable, notify the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a resident has an elopement or unexplained absence and the licensee has searched the building and the grounds of the ICF/IID without finding the resident; and

 

(4)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (s)  For uses of restraint with a resident under the age of 18, the license shall notify the resident’s parents or guardians in accordance with RSA 126-U:7 including verbal and written documentation.

 

          (t)  The licensee shall admit and allow any department representative to inspect the ICF/IID and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 815 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (u)  Applicants, licensees, and employees shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 815, including allowing representatives of the department to:

 

(1)  Enter and complete an inspection of the premises;

 

(2)  Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

 

(3)  Interview employees and residents of the ICF/IID. 

 

          (v)  A licensee shall, upon request, provide a resident or the resident’s guardian or agent, if any, with a copy of his or her resident record pursuant to the provisions of RSA 151:21, X.

 

          (w)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (x)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of residents and employees that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to residents and employees; and

 

(3)  Systems to prevent tampering with information pertaining to residents and employees.

 

          (y)  The licensee shall develop policies and procedures regarding the release of information contained in resident records.

 

          (z)  The licensee shall provide cleaning and maintenance services, as needed, to protect residents, employees, and the public.

 

          (aa)  The ICF/IID shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

 

          (ab)  If the ICF/IID is not on a municipal water system, the water used in the ICF/IID shall be potable and suitable for human consumption.

 

          (ac)  If the licensee holds or manages a resident’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.

 

          (ad)  The licensee shall develop and follow policies and procedures regarding resident room or bed location changes.

 

          (ae)  Following the death of a roommate, the licensee shall facilitate the provision of social services for the resident as needed.

 

          (af)  If the residents are minors, any licensee, employee, personnel, or other person associated with the facility who suspects that a child is being abused or neglected is a mandated reporter in accordance with RSA 169-C:29 and shall report the suspected abuse to the division for children, youth, and families at 1-800-894-5533. 

 

Source.  #13568, eff 2-25-23

 

          He-P 815.15  Required Services.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

f.  Reportable incident reporting;

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

(1)  An admissions packet including the following information:

 

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

 

b.  The ICF/IID’s facility rules;

 

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

 

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

 

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

 

1.  The availability of services;

 

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

 

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

 

f.  Information regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

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

 

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

 

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

 

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

 

8.  Smoking;

 

9.  Roommates; and

 

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

 

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

 

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

 

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

 

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

 

(6)  Information on advance directives and DNR status.

 

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

 

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

 

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

 

(3)  Emergency response and crisis intervention;

 

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

 

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

 

(6)  Housekeeping, laundry, and maintenance services;

 

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

 

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

 

          (h)  The licensee shall:

 

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

 

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

 

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

 

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

 

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

 

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

 

(1)  Diagnoses, if any;

 

(2)  Medical history;

 

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

 

(4)  Vital signs;

 

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

 

(6)  Allergies;

 

(7)  Dietary needs;

 

(8)  Evaluation of vision and hearing; and

 

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

 

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

 

          (m)  The nursing care plan shall:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

(2)  When restraints may be used;

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

(3)  Diagnosis, as applicable;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advance directives and DNR status; and

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Source.  #13568, eff 2-25-23

 

          He-P 815.16  Medication Services. 

 

          (a)  All medications shall be administered in accordance with the orders of the licensed practitioner.

 

          (b)  Medications, treatments and diets ordered by the licensed practitioner shall be made available to the resident within 24 hours of the order, or in accordance with the licensed practitioner’s direction.

 

(c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the ICF/IID;

 

(2)  Reorder medications for use at the ICF/IID; and

 

(3)  Receive and record new medication orders.

 

          (d)  For each prescription medication being taken by a resident, the licensee shall maintain one of the following:

 

(1)  The original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

 

(2)  A copy of the original written or electronic order in the resident’s record, signed by a licensed practitioner or other professional with prescriptive powers.

 

          (e)  Each medication order shall legibly display the following information unless it is an emergency medication as allowed by (aa) below:

 

(1)  The resident’s name:

 

(2)  The medication name, strength, and prescribed dose and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated original or electronic signature of the ordering practitioner.

 

          (f)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s order and labeled with the resident’s name.

 

          (g)  The label of all medication containers maintained in the ICF/IID shall match the current orders of the licensed practitioner and include the expiration date of the medication unless authorized by (aa) below.

 

          (h)  Except as allowed by (f) above and (i) below, only a pharmacist shall make changes to prescription medication container labels.

 

          (i)  When the licensed practitioner changes the dose of a medication and personnel of the ICF/IID are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the ICF/IID’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (j)  Any change or discontinuation of medications taken at the ICF/IID shall be pursuant to an order from a licensed practitioner or other professional with prescriptive powers.

 

          (k)  The licensee shall require that all telephone orders for medications, treatments, and diets are immediately transcribed and signed by the resident receiving the order.

 

          (l)  The transcribed order in (k) above shall be counter-signed by the authorized provider within 30 days of receipt or next visit but not to exceed 60 days.

 

          (m)  The licensee shall obtain an order from a licensed practitioner for all over-the-counter medications.

 

          (n)  The medication storage area shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2) Clean and organized with adequate lighting to ensure correct identification of each resident’s medication(s); and

 

(3) Equipped to maintain medication at the proper temperature per manufacturer’s requirements.

 

          (o)  All medications at the ICF/IID shall be kept in the original containers or packaging and properly closed after each use.

 

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

 

          (q)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the ICF/IID, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (r)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (s)  All contaminated, expired, or discontinued medication shall be destroyed within 90 days of the expiration date, the end date of a licensed practitioner’s orders, or the date the medication becomes contaminated, whichever occurs first.

 

          (t)  Controlled drugs shall be destroyed only in accordance with state law.

 

          (u)  Medication(s) may be returned to pharmacies for credit only as allowed by the law.

 

          (v)  If a resident is going to be absent from the ICF/IID at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication shall be given to the person responsible for the resident while the resident is away from the ICF/IID.

 

          (w)  Upon discharge or transfer, the licensee may make the resident’s current medications available to the resident and the guardian or agent, if any.

 

          (x)  An order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (y)  The licensee shall maintain a written record for each resident for each medication taken by the resident at the ICF/IID that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials and job title of the person who administers, supervises, or assists the resident taking medication;

 

(5)  For PRN medications, the reason the resident required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (z)  Stock medications shall only be accessed and administered by the licensed nurse or any other professional authorized by state or federal regulation pursuant to a licensed practitioner’s order.

 

          (aa)  An ICF/IID shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.02 under circumstances where the ICF/IID:

 

(1)  Has a director of nursing who is a registered nurse (RN) licensed in accordance with RSA 326-B; and

 

(2)  Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

 

          (ab)  The licensee shall develop and implement a system for reporting to the director of nursing or designee within 24 hours after any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications.

 

          (ac)  The written documentation of the report in (ab) above shall be maintained in the resident’s record.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.17  Personnel.

 

          (a)  The licensee shall develop a job description for each position at the ICF/IID containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Education and experience requirements of the position.

 

          (b)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  A student in a New Hampshire board of nursing approved nursing or nursing assistant program;

 

(2)  A nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(3)  Part of an established educational program working under the supervision of a nurse.

 

          (c)  For all applicants for employment, for all volunteers, or for all independent contractors who will provide direct care or personal care services to residents, the licensee shall:

 

(1)  Obtain and review a criminal records check in accordance with RSA 151:2-d;

 

(2)  Verify the qualifications and licenses, as applicable, of all applicants prior to employment;

 

(3)  If residents are adults the licensee shall check the names of the persons in (c) above against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49; and

 

(4) If residents are minors, the licensee shall check the names of the persons in (c) above against the DCYF central registry check of founded reports of abuse and neglect.

 

          (d)  Unless a waiver is granted in accordance with He-P 815.10 and (f) below, the licensee shall not make a final offer of employment for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other known state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other known state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (e)  If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (d) above.

 

          (f)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s).

 

          (g)  If residents are adults, the licensee shall not employ, contract with, or engage, any person who is listed on the BEAS state registry unless a waiver is granted by BEAS.

 

          (h) If residents are minors, the licensee shall not employ, contract with, or engage, any person who is listed on the DCYF central registry of founded reports of abuse and neglect.

 

          (i)  In lieu of (c), (g), and (h), if applicable, above, the licensee may accept from independent agencies contracted by the licensee or by a resident to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c), (g),  and (h), if applicable, above and do not meet the criteria in (d) above.

 

          (j)  All employees shall:

 

(1)  Meet the educational and physical qualifications of the position as listed in their job description;

 

(2)  Not be permitted to maintain their employment if they have been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department;

 

(3)  Be licensed, registered, or certified as required by state statute and as applicable;

 

(4)  Receive an orientation within the first 3 days of work prior to the assumption of duties that includes:

 

a.  The ICF/IID’s policies on resident rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities, policies, procedures, and guidelines of the position they were hired for;

 

c.  The ICF/IID’s infection control program;

 

d.  The ICF/IID’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

 

e.  Mandatory reporting requirements for abuse or neglect such as those found in RSA 161-F and RSA 169-C:29; and

 

(5)  Complete a mandatory annual in-service education, which includes a review of the ICF/IID’s:

 

a.  Policies and procedures on resident rights and responsibilities and abuse or neglect;

 

b.  Infection control;

 

c.  Education program on fire and emergency procedures; and

 

d.  Mandatory reporting requirements.

 

          (k)  Prior to having contact with residents, employees shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the CDC, conducted not more than 12 months prior to employment;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

 

(3)  Comply with the requirements of the CDC “Guidelines for Preventing the Transmission of M tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to Mycobacterium tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(4)  Comply with all public health guidelines with regard to the requirements for communicable infectious disease reporting pursuant to He-P 301.

 

          (l)  All licensees using the services of independent contractors as direct care personnel shall ensure and document that the independent clinical contractors have:

 

(1)  Been oriented in accordance with (i)(4) above;

 

(2)  Documented results of all infectious disease testing shall comply as required by (k) (1)-(4) above;

 

(3)  Licenses that are current and valid; and

 

(4)  A written agreement that describes the services that will be provided.

 

          (m)  Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the ICF/IID.

 

          (n)  The employee file shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the ICF/IID’s policy setting forth the resident’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the employee that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  A record of satisfactory completion of the orientation program required by (i)(4) above and any required annual continuing education, if any;

 

(5)  Verification of current New Hampshire license, registration or certification in health care field, and CPR certification, if applicable;

 

(6)  Documentation that the required physical examination, or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Documentation of annual in-service education as required by (i)(5) above;

 

(8)  A statement, which shall be signed at the time the initial offer of employment is made and then annually thereafter, stating that he or she:

 

a.  Does not have a felony conviction in this or any other state;

 

b.  Has not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety, or well-being of a resident; and

 

c.  Has not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person;

 

(9)  Documentation of the criminal records check;

 

(10)  Documentation that the employee is not on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49 if serving residents who are adult; and

 

(11) Documentation that the employee is not on the DCYF central registry of founded reports of abuse and neglect if serving residents who are minors.

 

          (o)  An employee shall not be required to re-disclose any of the matters in (n)(8) and (n)(9) above if the documentation is available and the department has previously reviewed the material and granted a waiver so that the individual can continue employment.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.18  Quality Improvement.  

 

          (a)  The ICF/IID shall establish an interdisciplinary quality improvement committee which:

 

(1)  Shall have a minimum of 3 members, including the medical director, an individual representing nursing, and an individual representing administration;

 

(2)  Shall meet at least quarterly to evaluate quality improvement activities; and

 

(3)  Shall make recommendations to the administrator to improve the quality of care.

 

          (b)  The quality improvement committee shall be responsible for:

 

(1)  Determining the information to be monitored;

 

(2)  Determining the frequency with which information will be reviewed;

 

(3)  Determining the indicators that will apply to the information being monitored;

 

(4)  Evaluating the information that is gathered;

 

(5)  Determining the action that is necessary to correct identified problems;

 

(6)  Recommending corrective actions to the licensee; and

 

(7)  Evaluating the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.19  Infection Control.

 

          (a)  The ICF/IID shall appoint a person to be in charge of developing and implementing an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

          (b)  The infection control program shall include documented procedures for:

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the CDC “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

 

(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 103.28; and

 

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

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to residents or work in food services until such time as they are no longer infected.

 

          (f)  Personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the ICF/IID until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable bandage with secure edges.

 

          (h)  If the ICF/IID has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (i)  The licensee shall immunize all consenting residents for influenza and pneumococcal disease and all consenting personnel for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.20  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment both inside and outside.

 

          (b)  The furniture, floor, ceiling, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation, pursuant to Env-Dw 700.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the residents.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and resident supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only professionals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make in inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

 

          (l)  Trash receptacles in food service area shall be covered at all time.

 

          (m)  The following requirements shall be met for laundry services:

 

(1)  Dirty laundry shall not be permitted to contaminate kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing that are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste. 

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

 

          (p)  Any ICF/IID that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify department.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.21  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of residents and personnel, including reasonable accommodations for residents and personnel with disabilities.

 

          (b)  Equipment providing heat within an ICF/IID including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where residents have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in personnel areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any ICF/IID.

 

          (f)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 155-A.

 

          (g)  Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (h)  Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (i)  The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents.

 

          (j)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

            (k)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (l)  There shall be at least 100 square feet in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom.

 

          (m)  The space requirements in above shall be exclusive of space required for closets, wardrobes, and bathroom.

 

          (n)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the resident to reach his/her bedroom without passing through the room of another resident;

 

(3)  Have a side hinge door and not a folding or sliding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors and other rooms by floor to ceiling walls;

 

(6)  Be located on the same level as the bathroom facilities, if the resident has impaired mobility; and

 

(7)  If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom without requiring additional construction or renovation.

 

          (o)  The licensee shall provide the following for the residents’ use, as needed, except as requested by the resident or guardian and documented in their resident record:

 

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

 

(2)  A firm mattress that complies with the state fire code and codes adopted by referenced as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  A lamp;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades, or curtains that provide privacy.

 

          (p)  The resident may use his or her own personal possessions provided they do not pose a risk to the resident or others.

 

          (q)  The licensee shall provide the following rooms to meet the needs of residents:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all residents.

 

          (r)  Each licensee shall have a UL listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency.

 

          (s)  Lighting shall be available to allow residents to participate in activities such as reading, needlework, or handicrafts.

 

          (t)  All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (u)  During seasons when insects are active, screens shall be provided for:

 

(1)  Doors;

 

(2)  Windows; and

 

(3)  Other openings to the outside.

 

          (v)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (u) above.

 

          (w)  If the ICF/IID admits residents under the age of 18, each age group shall have separate and distinct units.

 

          (x)  If the ICF/IID admits residents between the age of 10 and 17 years, residents shall be provided privacy for bathing, toileting, and sleeping.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.22  Fire Safety.

 

          (a)  All ICF/IID s shall meet the requirements of the appropriate chapter of NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5 and any pertinent chapter and related codes regarding the installation, testing, and maintenance of the fire alarm system.

 

          (b)  All ICF/IID’s shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the ICF/IID’s electrical service, or wireless, as approved by the state fire marshal for the ICF/IID;

 

(2)  At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10; and

 

(3)  An approved carbon monoxide monitor on every level.

 

          (c)  Immediately following any fire or emergency situation, licensees shall notify the department by phone and in writing within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  EMS transport related to known pre-existing conditions.

 

          (d)  The written notification required by (c) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injuries to residents or employees;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or residents who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (e)  Storage and use of oxygen cylinders or systems shall comply with NFPA 99, “Health Care Facilities Code” including but not limited to:

 

(1)  Oxidizing gases such as oxygen and nitrous oxide shall be separated from combustibles or flammable materials by one of the following:

 

a.  Minimum distance of 6.1 m or 20 ft;

 

b.  Minimum distance of 1.5 m or 5 ft if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, “Standard for the Installation of Sprinkler Systems”; or

 

c.  A gas cabinet constructed per NFPA 30, “Flammable and Combustible Liquids Code”, or NFPA 55, “Compressed Gases and Cryogenics Fluids Code”, if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13;

 

(2)  Cylinders shall be protected from damage by means of the following specific procedures:

 

a.  Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device;

 

b.  Oxygen cylinders shall not be stored near elevators or gangways or in locations where heavy moving objects will strike them or fall on them;

 

c.  Cylinders shall be protected from tampering by unauthorized individuals;

 

d.  Cylinders or cylinder valves shall not be repaired, painted, or altered;

 

e.  Safety relief devices in valves or cylinders shall not be tampered with;

 

f.  Valve outlets clogged with ice shall be thawed with warm, not boiling water;

 

g.  A torch flame shall not be permitted, under any circumstances, to come in contact with a cylinder, cylinder valve, or safety device;

 

h.  Sparks and flame shall be kept away from cylinders;

 

i.  Even if they are considered to be empty, cylinders shall not be used as rollers, supports, or for any purpose other than that for which the supplier intended them;

 

j.  Large cylinders exceeding size E and containers larger than 45 kg or100 lb weight shall be transported on a proper hand truck or cart complying with NFPA 99, section 11.4.3.1;

 

k.  Freestanding cylinders shall be properly chained or supported in a proper cylinder stand or cart; and

 

l.  Cylinders shall not be supported by radiators, steam pipes, or heat ducts; and

 

(3)  Cylinders and their contents shall be handled with care, which shall include the following specific procedures:

 

a.  Oxygen fittings, valves, pressure reducing regulators, or gauges shall not be used for any service other than that of oxygen;

 

b.  Gases of any type shall not be mixed in an oxygen cylinder or any other cylinder;

 

c.  Oxygen shall always be dispensed from a cylinder through a pressure reducing regulator;

 

d.  The cylinder valve shall be opened slowly, with the face of the indicator on the pressure reducing regulator pointed away from all persons;

 

e.  Oxygen shall be referred to by its proper name, “oxygen”, not air, and liquid oxygen shall be referred to by its proper name, not liquid air;

 

f.  Oxygen shall not be used as a substitute for compressed air;

 

g.  The markings stamped on cylinders shall not be tampered with, because it is against federal statutes to change these markings;

 

h.  Markings used for the identification of contents of cylinders shall not be defaced or removed, including decals, tags, and stenciled marks, except those labels or tags used for indicating cylinder status such as full, in use, or empty;

 

i.  The owner of the cylinder shall be notified if any condition has occurred that might allow any foreign substance to enter a cylinder or valve, giving details and the cylinder number;

 

j.  Neither cylinders nor containers shall be placed in the proximity of radiators, steam pipes, or heat ducts;

 

k.  Very cold cylinders or containers shall be handled with care to avoid injury;

 

l.  A precautionary sign, readable from a distance of 1.5 m or 5 ft, shall be displayed on each door or gate of the storage room or enclosure; and

 

m.  The sign shall include the following wording as a minimum:

 

“CAUTION:

OXIDIZING GAS(ES) STORED WITHIN

NO SMOKING”

 

          (f)  If the licensee has chosen to allow smoking, an outside location or a room used only for smoking shall be provided which:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non-combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64-77, the Indoor Smoking Act, and He-P 1900. 

 

          (g)  Each licensee shall develop a written fire safety plan.

 

          (h)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, or the resident’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the resident’s responsibilities shall be provided to the resident.

 

          (i)  Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (j)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (k)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the “Residential Board and Care or One and Two Family Dwelling Chapters” of the “Life Safety Code”, NFPA 101, the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All ICF/IID facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when residents are sleeping.  Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide residents with experience in egressing through all exits and means of escape;

 

e.  Facilities shall complete a written record of fire drills that includes the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At n time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At least annually, the facility shall conduct a resident “Fire Safety Evacuation Scoring System” (FSES) as listed in NFPA 101A, “Alternatives to Life Safety”, to determine the resident’s needs during a fire drill including, but not limited to, mobility, assistance to evacuate, staff needed, risk of resistance, and residents ability to evacuate on their own and choose an alternate exit; and

 

h.  The fire drills for facilities built to the “Residential Board and Care chapter of the Life Safety Code”, NFPA 101, shall be permitted to be announced, in advance, to the residents just prior to the drill;

 

(2)  For all ICF/IID’s that were originally constructed to meet the “Health Care Occupancy Chapter of Life Safety Code”, NFPA 101 as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and the rules and regulations adopted and enforced by the state fire marshal’s office or the municipality or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office and the department to meet the “Health Care Occupancy Chapter”, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7. Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the “Health Care Occupancy Chapter of the Life Safety Code”;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, residents, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that residents shall be given the experience of evacuating to the appropriate location or exiting through all exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including residents, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

h.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(3)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.23  Emergency Preparedness.

 

          (a)  Each licensee shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. 

 

          (b)  The emergency management committee shall include the licensee’s administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  A description of how the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, missing residents and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

 

(12)  Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j. Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

 

(14)  Include the management of residents, particularly with respect to physical and clinical issues, including:

 

a.  Relocation of residents with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

          (f)  The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills and exercises shall be monitored by at least one designated evaluator who has

knowledge of the licensee’s plan and who is not involved in the exercise;

 

(2)  The designated evaluator shall evaluate, through the drills and exercises, the program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The licensee shall conduct a debriefing session not more than 72 hours after the conclusion of the drill or exercise with all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued by the designated evaluator to identify areas for improvement, deficiencies, and opportunities for improvement, and be incorporated in the licensee’s improvement plan.

 

          (g)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of residents and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

          (h)  Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (g) above, which includes:

 

(1)  Assumptions for calculations of food and water supplies to include:

 

a.  The maximum number of staff  and residents;

 

b. Source of water supply, either tap or commercial;

 

c. Expiration in months, tracking of supplies, and rotation of products; and

 

d.  Contracts and memorandums of understanding with food and water suppliers;

 

(2)  Storage location(s); and

 

(3)  Back-up supplies.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.24  Resident Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the ICF/IID.

 

          (b)  At a minimum, resident records shall contain the following:

 

(1)  A copy of the resident’s admission agreement and all documents required by He-P 815.15(f);

 

(2)  Identification data, including:

 

a.  Vital information including the resident’s name, date of birth,  and  parent or guardian contact information;

 

b.  Resident or resident’s family’s religious preference, if known;

 

c.  If an adult, the resident’s veteran status, if known, and marital status; and

 

d.  Name, address, and telephone number of an emergency contact person;

 

(3)  The name and telephone number of the resident’s licensed practitioner(s);

 

(4)  Resident’s health insurance information;

 

(5)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A or RSA 463, a durable power of attorney for healthcare, or a living will;

 

(6)  A record of the health examination(s) in accordance with He-P 815.15(k);

 

(7)  Written, dated, and signed orders for the following:

 

a.  All medications, treatments, and special diets; and

 

b.  Laboratory services and consultations;

 

(8)  Results of any laboratory tests, or consultations;

 

(9)  All assessments and care plans, and documentation that the resident and the guardian or agent, if any, have been given the opportunity or has participated in the development of the care plan;

 

(10)  Documentation of informed consent;

 

(11)  All admission and progress notes;

 

(12)  Documentation of any alteration in the resident’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(13)  Documentation of any medical or specialized care;

 

(14)  Documentation of unusual incidents;

 

(15)  The consent for release of information signed by the resident, guardian, or agent, if any;

 

(16)  Discharge planning and referrals as applicable;

 

(17)  Transfer or discharge documentation, including notification to the resident, guardian, or agent, if any, of transfer or discharge;

 

(18)  Room change documentation, including notification to the resident, guardian, or agent, if any, and if applicable;

 

(19)  The medication record as required by He-P 815.16(y) and (ac);

 

(20)  Documentation of a resident’s refusal of any care or services; and

 

(21)  Code status.

 

          (c)  Resident records and resident information shall be kept confidential and only provided in accordance with law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident’s record shall occur.

 

          (e)  Resident records shall be available to health care workers and any other person authorized by law or rule to review such records.

 

          (f)  When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access.

 

          (g)  Records shall be retained for 7 years after discharge, except for records of Medicaid residents, which shall be retained for 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6-year period, whichever is longer.

 

          (h)  The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the ICF/IID ceases operation.

 

Source.  #13568, eff 2-25-23

 

          He-P 815.25  Food Services.

 

          (a)  The licensee shall provide food services that:

 

(1)  Meet the U.S. Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2020-2025” (Ninth Edition), available as noted in Appendix A;

 

(2)  Provide the nutritional needs of each resident;

 

(3)  Meet the special dietary needs associated with health or medical conditions for each resident as identified by the health examination required by He-P 815.15(j);

 

(4)  Employ a food service manager who shall;

 

a.  Be responsible for the day to day operation of the kitchen;

 

b.  Have knowledge of the nutritional requirements for residents and of the planning and preparation of prescribed diets; and

 

c.  Have all the required competencies as per the licensee’s policy;

 

(5)  Include facilities and equipment for meal delivery and assisted feeding, as applicable; and

 

(6)  Include dining facilities that have eating areas sufficient in size to provide seating for at least 50% of the licensed capacity.

 

          (b)  Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident’s care plan.

 

          (c)  Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident’s care plan.

 

          (d)  If a resident refuses the item(s) on the menu, a substitute shall be offered.

 

          (e)  Menus, including beverages for regular and therapeutic diets, shall be planned and written for at least 2 weeks in advance of serving.

 

          (f)  Each day’s menu shall be posted in a place accessible to food service personnel and residents.

 

          (g)  A listing of the diet orders and allowed foods for each resident shall be available to personnel.

 

          (h)  A dated record of menus as served shall be maintained for at least 3 months.

 

          (i)  The licensee shall provide therapeutic diets to residents only as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (j)  Residents requiring therapeutic diets shall have an assessment of nutritional status by a qualified dietitian or dietary technician at least quarterly and with any significant weight loss or weight gain.

 

          (k)  If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident’s medical record along with education relating to non-compliance with prescribed diet, and notify the resident’s licensed practitioner.

 

          (l)  All food and drink provided to the residents shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated, and stored at proper temperatures; and

 

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

 

          (m)  The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded or distinctly segregated from the usable food.

 

          (n)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (o)  All work surfaces shall be cleaned and sanitized after each use.

 

          (p)  All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

 

          (q)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (r)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (s)  Garbage or trash in the kitchen area shall be placed in lined containers with covers.

 

          (t)  All personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

          (u)  Regularly scheduled training programs including sanitation and safety shall be made available to personnel. Information as to the content and length of this training shall be documented and kept in employee records.

 

Source.  #13568, eff 2-25-23

 

PARTS He-W 816 through He-W 819 - RESERVED

 

PART He-P 816  EDUCATIONAL HEALTH CENTERS

 

          He-P 816.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all educational health centers (EHC) licensed pursuant to RSA 151:2, I(a).

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, association, or legal entity other than a governmental unit operating an educational health center, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g);

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h); and

 

          (c)  All clinics whose sole source of funding for services is from a contract with the department of health and human services.

 

Source.  #5516, eff 11-25-92; amd by #5984, eff 2-4-95; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (d)(2) EXPIRED: 2-4-03

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a student;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to a student; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a student with or without his or her informed consent.

 

          (b)  “Academic program” means a course of study, offered by the licensee, in subjects such as English, social studies, the arts, mathematics, language, and science.

 

          (c)  “Administer” means “administer” as defined by RSA 318:1.

 

          (d)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

 

          (e)  “Admission” means accepted by a licensee for the provision of services to a student.

 

          (f)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an EHC pursuant to RSA 151:2, I(a).

 

(g)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 816, or other federal or state requirements.

 

          (h)  “Chemical restraint” means any medication prescribed to control a student’s behavior or emotional state without a supporting diagnosis or for the convenience of personnel.

 

          (i)  “Change of ownership” means a change in the controlling interest in an EHC to a successor business entity.

 

          (j) “Continuing education” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

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

 

          (l)  “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (m)  “Days” means calendar days unless otherwise specified in the rule.

 

          (n)  “Department” means the New Hampshire department of health and human services.

 

          (o)  “Direct care personnel” means any person providing hands-on care or services to a student.

 

          (p)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct areas of non-compliance.

 

          (q)  “Educational health center (EHC)” means a facility that provides health care services to students of a residential educational institution, including but not limited to, private schools and colleges.

 

          (r)  “Educational institution” means an established institution, other than an institution operated by a government entity, whose purpose is to impart knowledge or skills.

 

          (s)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (t) “Exploitation” means the illegal use of a person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a person through the use of undue influence, harassment, duress, deception, or fraud.

 

          (u)  “Guardian” means the parent of a student under the age of 18 or a person appointed under RSA 463.

 

          (v)  “Guideline” means a written statement that specifies the assessment and treatment to be provided to a student of the EHC for a specific medical condition.

 

          (w)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (x)  “Infectious waste” means those items specified by Env-Wm 2604.

 

          (y)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 816 or to respond to allegations of non-compliance with RSA 151 or He-P 816.

 

          (z)  “License” means the document issued by the department to an applicant at the start of operation as an EHC which authorizes operation in accordance with RSA 151 and He-P 816, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

 

          (aa)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the EHC is licensed.

 

          (ab)  “Licensed practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician’s assistant;

 

(3)  Licensed 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.

 

          (ac)  “Licensed premises” means the facility that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

 

          (ad)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151 and He-P 816.

 

          (ae)  “Licensing classification” means the specific category of services authorized by a license.

 

          (af)  “Mechanical restraint” means locked, secured, or alarmed EHCs or units within an EHC, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a student from freely exiting the EHC or unit within.

 

          (ag)  “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, or an APRN licensed in accordance with RSA 326-B, who is responsible for overseeing the quality of medical care and services at the EHC.

 

          (ah)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (ai)  “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a student.

 

          (aj)  “Nurse” means a person licensed in accordance with RSA 326-B as either an APRN, registered nurse (RN), or a licensed practical nurse (LPN).

 

          (ak)  “Orders” means written prescriptions, instructions for treatments, special diets, or therapies given by a licensed practitioner.

 

          (al)  “Patient rights” means the privileges and responsibilities possessed by each student provided by RSA 151:21.

 

          (am)  “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct or indirect care or services, or both, to a student(s).

 

          (an)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the student’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (ao)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

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

 

          (ar)  “Reportable incident” means an occurrence of any of the following while the student is either in the EHC or in the care of EHC personnel:

 

(1)  The unanticipated death of the student; or

 

(2)  An injury to a student that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the student.

 

          (as)  “Student” means any person enrolled at the educational institution, or any faculty, staff, or visitor of the educational institution, who is admitted to or is in any way receiving care, services, or both from an EHC licensed in accordance with RSA 151 and He-P 816.

 

          (at)  “Student record” means the documentation of all care and services, which includes all documentation required by RSA 151, He-P 816, and any other federal and state requirements.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential Care or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any EHC to be newly licensed on or after July 1, 2016:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any EHC to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”; and

 

“I understand that, in accordance with RSA 151:4, III(a)(7), this facility cannot be licensed under He-P 802, 806, 810, 811, 812, 816, 823, or 824 if it is within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), until the Commissioner of the Department of Health and Human Services makes a determination that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital. I also understand that if the Commissioner is not able to make such a determination, the license will not be issued.”

 

(2)  A floor plan of the prospective EHC;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable $500 fee in accordance with RSA 151:5, XVI, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name and qualifications of the EHC administrator;

 

(6)  Copies of applicable licenses for the EHC administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the appropriate occupancy chapter of National Fire Protection Association (NFPA 101), as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; or

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(8)  If the EHC uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, and administrator.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5516, eff 11-25-92; amd by #5984, eff 2-4-95; amd by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99; paragraph (a)(3) EXPIRED: 2-4-03

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 816.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 816.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 816.13(b) if, after reviewing the information in He-P 816.18(b)-(d), it determines that the applicant, licensee, administrator, or medical director, as applicable:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of students.

 

(f)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (g)  The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

 

          (h)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 816.

 

          (i)  If an applicant is found not to be in compliance with RSA 151 and He-P 816 after a second onsite inspection, the application shall be denied and a new application with the applicable fee shall be required.

 

          (j)  If the applicant does not provide the items required by the written notice in (b) above within 90 days of the notice, the application shall be closed and a new application with applicable fees shall be required.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 816.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 816.04(a)(1) and (4);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 816.10(f), as applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 816.18(d); and

 

(5)  A statement identifying any variances applied for or granted by the state fire marshal.

 

          (d)  In addition to (c) above, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates, or documentation that the EHC is on a municipal water system.

 

          (e)  Following an inspection, as described in He-P 816.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) and (d)  above, prior to the expiration of the current license;

 

(2) Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 816 at the renewal inspection.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 816.04.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.07  EHC Construction, Modifications or Renovations.

 

          (a)  Notice and accurate architectural plans or drawings that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

 

(1)  A new building;

 

(2)  Additions to a building;

 

(3)  Alterations that require approval from local or state authorities; and

 

(4)  Modifications that affect compliance with the health and safety, fire or building codes, including but not limited to, fire suppression, detection systems and means of egress.

 

(b)  Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

(c)  Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department documentation of fire marshal approval for such methods.

 

          (d)  The department shall review plans for construction, modifications, or structural alterations of an EHC for compliance with all applicable sections of RSA 151 and He-P 816 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

 

          (e) Department approval shall not be required prior to initiating construction, modifications, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at his or her own risk.

 

          (f) The EHC shall comply with all applicable licensing regulations when doing construction, modifications, or alterations.

 

          (g)  A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

 

(1)  The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  Local rules, regulations, and ordinances.

 

          (h)  All EHCs newly constructed after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Common Elements for Non-Residential Support Facilities chapter, 2014 edition, as available as noted in Appendix A.

 

          (i)  Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reasons or circumstances for the waivers change.

 

          (j)  Exceptions or variances pertaining to the state fire code referenced in (g)(1) above shall be granted only by the state fire marshal.

 

          (k)  The completed building shall be subject to an inspection pursuant to He-P 816.09 prior to its use.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.08  EHC Requirements for Organizational Changes.

 

          (a)  The EHC shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  The number of beds authorized under the current license.

 

          (b)  The EHC shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of beds authorized under the current license.

 

          (c)  When there is a change in address without a change in location, the EHC shall provide the department with a copy of the notification from the local, state or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the EHC shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

(e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of participants; or

 

(4)  A change in licensing classification.

 

(f)  A new license shall be issued for a change in ownership or physical location.

 

(g)  A revised license and license certificate shall be issued for a change in name.

 

(h)  A license certificate shall be issued at the time of initial licensure.

 

(i)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator;

 

(2)  An increase or decrease in the number of students;

 

(3)  A change in the scope of services provided;

 

(4)  A change in address without a change in physical location; or

 

(5)  When a waiver has been granted.

 

(j)  The EHC shall notify the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator; and

 

(2)  Copies of applicable licenses, certificates, or both, for the new administrator.

 

(k)  Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 816.15(a)(1).

 

(l)  If the department determines that the new administrator does not meet the qualifications for their position as specified in (k) above, it shall so notify the EHC in writing so that a waiver can be sought or the EHC can search for a qualified candidate.

 

(m)  A restructuring of an established EHC that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

(n)  Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

 

          (o)  The EHC shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

(p)  If a licensee chooses to cease the operation of the EHC, the licensee shall submit written notification to the department at least 30 days in advance.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 816, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the EHC; and

 

(3)  Any records required by RSA 151 and He-P 816.

 

          (b)  The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151, He-P 816, and other federal or state requirements prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed under He-P 816.08(g)(1);

 

(3)  A change in the physical location of the EHC;

 

(4)  A change in the licensing classification;

 

(5)  A change in the number of beds;

 

(6)  Occupation of space after construction, modifications, or structural alterations; or

 

(7)  The renewal of a license.

 

          (c)  In addition to (b) above the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the EHC is in violation of any of the provisions of He-P 816, RSA 151, or other federal or state requirements.

 

          (e)  If deficiencies were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 816.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (b) above that the prospective premises is not in full compliance with RSA 151 and He-P 816.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 816 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and students as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the terms of the waiver proposed by the applicant or licensee:

 

(1)  Meet the objective or intent of the rule;

 

(2)  Do not negatively impact public health or the health or safety of the students; and

 

(3)  Do not negatively affect the quality of student services.

 

          (d)  The licensee’s subsequent compliance with the terms of the waiver as approved shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (c) through (e) above.

 

Source.  #5516, eff 11-25-92; ss by #5984, eff 2-4-95; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99

 

New.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.11  Complaints.

 

          (a)  The department shall investigate any complaint that meet the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 816.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the EHC or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 816.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  For the licensed EHC, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 816.12(c) if the inspection results in areas of non-compliance being cited.

 

(e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 816; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any administrative or judicial proceedings relative to the licensee.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 816, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below; or

 

(3)  Imposing conditions upon a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur;

 

c.  The date by which each area of non-complianceshall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 816;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 816 as a result of the implementation of the POC;

 

d.  Identifies the position of the employee responsible for the corrective action; and

 

e.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

2.  The department determines that the health, safety or wellbeing of a resident will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 816.13(c)(11);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 816.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 816.13(c)(12).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection or investigation, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the students and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such later date as is applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 816.13(b); or

 

(3)  Revoke the license in accordance with He-P 816.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

 

          (g)  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 or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or the notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

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

 

Source.  #9193, eff 6-26-08, ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

 

          He-P 816.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 816 in a manner which poses a risk of harm to a student’s health, safety, or well being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 816.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  A licensee failed to fully implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 816.12(c), (d), and (e);

 

(7)  A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 816.12(c)(5) and has not submitted a revised POC as required by He-P 816.12(c)(5);

 

(8)  A licensee is cited a third time under RSA 151 or He-P 816 for the same violations within the last 5 inspections;

 

(9)  A licensee or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Upon inspection, the applicant’s premise is not in full compliance with RSA 151 or He-P 816;

 

(11)  The department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 816.14(h), the fine for an applicant, licensee, or unlicensed provider shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 816.11(e), the fine shall be $500.00;

 

(5)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 816.06(b), the fine for a license shall be $100.00;

 

(6)  For a failure to notify the department prior to a change of ownership, in violation of He-P 816.08(a)(1), the fine shall be $500.00;

 

(7)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 816.08(a)(2), the fine for a licensee shall be $1000.00;

 

(8)  For a failure to notify the department of a change in e-mail address, in violation of He-P 816.08(q), the fine shall be $100.00;

 

(9)  For a failure to allow access by the department to the EHC’s premises in violation of He-P 816.09(a)(1) and (2), the fine for an applicant, individual or licensee shall be $2000.00;

 

(10)  For a failure to provide to the department any records maintained by the licensee and required by He-P 816.09(a)(3), the fine for a licenses shall be $2000.00;

 

(11)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits statment of findings or notice to correct, or by the date of an extension as granted, in violation of He-P 816.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(12)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 816.12(c)(8), the fine for a licensee shall be $1000.00;

 

(13)  For a failure to establish, implement, or comply with licensee policies, in violation of He-P 816.14(b), (d), (w), and (x), the fine for a licensee shall be $500.00;

 

(14)  For a failure to provide services or programs required by the licensing classification and specified by He-P 816.15(f) - (j), the fine for a licensee shall be $500.00; 

 

(15)  For exceeding the licensed capacity, if applicable, in violation of He-P 816.14(n), the fine for a licensee shall be $500.00 per day multiplied by the number of unauthorized students present;

 

(16)  For providing false or misleading information or documentation to the department, in violation of He-P 816.14(g), the fine shall be $1000.00 per offense;

 

(17)  For a failure to meet the needs of the student, in violation of He-P 816.14(j)(2), the fine for a licensee shall be $1000.00;

 

(18)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 816.15(a), (c), and (e) and He-P 816.18(h) and (i), the fine for a licensee shall be $500.00;

 

(19)  For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 816.09(a), the fine shall be $2000.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility, in violation of He-P 816.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities as required by He-P 816.09(b)(6), the fine shall be $500, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that there is a violation of RSA 151 or He-P 816 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliancey is cited within 2 years of the original area of non-compliance, the fine shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00;

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 816 shall constitute a separate violation and shall be fined in accordance with He-P 816.13(c); and

 

(24)  If the applicant or licensee is making good faith efforts to comply with (4) or (18) above, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well being of students is in jeopardy and emergency action is required in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 816 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When an EHC’s license has been denied or revoked, if the enforcement action specifically pertained to his or her role in the program, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years from:

 

(1)  The date the department’s decision to revoke or deny the license became effective, if no request for an administrative hearing is requested; or

 

(2)  The date an order is issued upholding the action of the department, if a request for an administrative hearing was made and a hearing was held.

 

          (k)  Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 816.

 

          (l)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 816.

 

          (m)  Any violations cited for the fire code may be appealed to the state fire marshal, pursuant to RSA 151:6-a, II.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

 

          (b)  In accordance with RSA 151:20, the licensee shall have a written policy setting forth the rights and responsibilities of students receiving services at the EHC, as well as written procedures to implement its policy to ensure that the rights set forth in RSA 151:21 “Patients’ Bill of Rights” are upheld.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided at the EHC.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided at the EHC.

 

          (e)  All policies and procedures shall be reviewed annually and revised as needed.

 

          (f)  The licensee shall assess and monitor the quality of care and services it provides to students on an ongoing basis.

 

          (g)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (h)  The licensee shall not advertise or otherwise represent the EHC as having residential care or health care programs or services for which it is not licensed to provide.

 

          (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (j)  Licensees shall:

 

(1)  Manage and operate the EHC;

 

(2)  Meet the needs of the students during the hours that the students are in the care of the EHC;

 

(3)  Initiate action to maintain the EHC in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(4)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the EHC;

 

(5)  Appoint an onsite administrator;

 

(6)  Appoint a director of nursing;

 

(7)  Appoint a medical director;

 

(8)  Verify the qualifications of all personnel;

 

(9)  Provide sufficient numbers of personnel who are present in the EHC and are qualified to meet the needs of students during all hours of operation;

 

(10)  Provide the EHC with sufficient supplies, equipment, and lighting to ensure that the needs of students are met;

 

(11)  Implement any POC that has been accepted or issued by the department; and

 

(12)  Require that all personnel follow the orders of the licensed practitioner for each student and encourage the students to follow the licensed practitioner’s orders.

 

          (k)  The licensee shall consider all students to be competent and capable of making health care decisions unless the student is under 18 years of age.

 

          (l)  The licensee shall only admit or treat a student whose needs can be met by the EHC.

 

          (m)  If the licensee has a student whose needs cannot be met by the programs and services offered at the EHC, the licensee shall transfer the student to a hospital or other appropriately licensed facility.

 

          (n)  The licensee shall not occupy more beds or exceed the maximum number of students to be cared for each day as authorized by NFPA 101 as adopted by the commissioner of the department of safety as Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the license certificate issued by the department.

 

          (o)  If the licensee accepts a student who is known to have a disease reportable under He-P 301, or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the students, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (p)  The licensee shall report all positive tuberculosis (TB) test results for personnel to the department’s bureau of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (q)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license issued in accordance with RSA 151:2;

 

(2)  All clinical inspection reports for the last 12 months in accordance with He-P 816.09(d) and He-P 816.11(d)(1);

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of students’ rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Office of Legal and Regulatory Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345;

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits; and

 

(7)  The EHC’s hours of operation.

 

          (r)  Licensees shall:

 

(1)  Fax to 271-5574 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

 

a.  The EHC name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of the student(s) or person(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  Whether the emergency contact or guardian, if any, was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the student’s primary care licensed practitioner was notified, if applicable;

 

(2)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(3)  Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above to report the death of any student or the death of any student who dies within 10 days of a reportable incident;

 

(4)  Provide the information required by (3) above in writing within 72 hours of the death of any student or the death of any student who dies within 10 days of an reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

 

(5)  Submit any further information requested by the department.

 

          (s)  The licensee shall admit and allow any department representative to inspect the EHC and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 816, as authorized by RSA 151:6 and RSA 151:6-a.

 

          (t)  Applicants, licensees, and personnel shall cooperate with the department during all departmental inspections and investigations authorized under RSA 151 and He-P 816, including allowing representatives of the department to:

 

(1)  Enter and complete an inspection of the premises;

 

(2)  Review and reproduce any records, forms, or reports which are required to be maintained or made available to the department; and

 

(3)  Interview personnel and students of the EHC. 

 

          (u)  The licensee shall, upon request, provide a student or their guardian, if applicable, with a copy of his or her student record pursuant to the provisions of RSA 151:21, X.

 

          (v)  All records required for licensing shall be legible, current, and accurate and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (w)  Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of students and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to students and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to students and personnel.

 

          (x)  The licensee shall develop policies and procedures regarding the release of information contained in student records.

 

          (y)  The licensee shall provide housekeeping and maintenance services, as needed to protect students, personnel, and the public.

 

          (z)  The EHC shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

 

          (aa)  If the EHC is not on a public water supply, the water used in the EHC shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.15  Required Health Care Services.

 

          (a)  The licensee shall appoint an administrator who:

 

(1)  Has a bachelor’s degree in a health-related field, or is a registered nurse;

 

(2)  Is responsible for the day to day operations of the EHC;

 

(3)  Shall, directly or through delegation, notify the student’s contact person or guardian, if any, and primary care licensed practitioner in the event of any reportable incident involving the student;

 

(4)  Shall make available and assure delivery of the following required services:

 

a.  Counseling, including psychological services;

 

b.  Education on communicable diseases, chemical dependency, and promotion of good health;

 

c.  Medical follow up; and

 

d.  Nursing assessment and intervention; and

 

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

 

          (b)  The administrator described in (a) above shall be permitted to hold more than one position at the EHC if the individual meets the qualifications of the positions.

 

          (c)  The licensee shall appoint a medical director who meets one of the following qualifications:

 

(1)  Is a physician currently licensed in the state of New Hampshire; or

 

(2)  Is an APRN currently licensed in the state of New Hampshire.

 

          (d)  The medical director in (c) above shall:

 

(1)  Participate in the development of and approve all policies and procedures, standing orders, and guidelines for student care;

 

(2)  Participate as a member of the quality improvement committee;

 

(3)  Provide medical direction and consultation to the professional staff; and

 

(4)  Stock medications and physician’s samples as authorized by his or her practice act.

 

          (e)  The licensee shall appoint a director of nursing who:

 

(1)  Is an RN or an APRN licensed to practice in the state of New Hampshire in accordance with RSA 326-B;

 

(2)  Is employed full time when the academic program is in session;

 

(3)  Shall be permitted to hold more than one position at the EHC if the individual meets the qualifications of the positions; and

 

(4)  Shall:

 

a.  Make available and assure delivery of nursing care and services;

 

b.  Provide nursing direction and supervision to the direct care staff;

 

c.  Provide coverage by a licensed nurse, except that if it is an LPN, an RN shall be available for consultation and supervision via telephone;

 

d.  Notify the administrator in the event that there is insufficient nursing staff to meet the needs of the ECH’s students;

 

e.  Participate in the development of the EHC’s nursing policies and guidelines; and

 

f.  Establish a system for referrals for any services needed by the student but are not available at the EHC.

 

          (f)  The licensee shall provide nursing and direct care personnel to meet the needs of students.

 

          (g)  The licensee shall provide counseling services to meet the needs of the students, which may be provided directly by the licensee or by contract.

 

          (h)  The licensee shall provide the following:

 

(1)  Nursing care, in accordance with (e)(4)a. above and as authorized by RSA 326, including, but not limited to:

 

a.  Medication administration;

 

b.  Wound care;

 

c.  Initial and ongoing assessments of the client’s pain level, vital signs, and physical, cognitive, and behavioral status; and

 

d.  Assessment as to how the student is adapting psychologically to their social environment if a student presents with this type of problem;

 

(2)  Nutritional monitoring;

 

(3)  Case management; and

 

(4)  Referrals to community service agencies when necessary.

 

          (i)  If the EHC has licensed beds, the licensee shall have:

 

(1)  A kitchen within the EHC if meals are prepared in the EHC; or

 

(2)  A refrigerator and microwave oven if meals are prepared off site.

 

          (j)  In addition to (i) above, the licensee shall provide dietary services appropriate to meet the needs of students.

 

Source.  #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

 

          He-P 816.16  Student Services.

 

          (a)  Prior to providing services at the EHC, the EHC shall:

 

(1)  Provide, in writing, to the student, or guardian if applicable, the EHC’s policies on student rights and responsibilities and its complaint procedure and rules;

 

(2) Obtain written confirmation acknowledging receipt and understanding of the policies in (a)(1) above;

 

(3)  Collect and record, in the student’s record, the following information:

 

a.  Student’s name, home address, home telephone number, and date of birth;

 

b.  Name, address, and telephone number of an emergency contact; and

 

c.  Student’s insurance information, if applicable for billing purposes; and

 

(4)  For students in grades K-12, confirm, by reviewing received documentation, that the student has had a physical examination prior to or within 90 days following the start of classes that includes:

 

a.  Diagnosis, if applicable;

 

b.  Medical history;

 

c  Medical findings, including the presence or absence of communicable diseases;

 

d.  Identification of all current medications;

 

e.  Allergies;

 

f.  Dietary needs, if applicable; and

 

g.  A completed immunization record, as required by He-P 301.

 

          (b)  The EHC shall develop a policy, in coordination with the educational institution of which it is a part, with regard to TB testing of students from areas designated as a high risk area by the United States Centers for Disease Control and Infection (CDC), including, at a minimum, the following:

 

(1)  The EHC shall require that any student from an area designated as a high risk area by the CDC shall have a TB test, Mantoux method, or other method approved by the CDC, prior to the start of classes; and

 

(2)  The frequency and timeframe of required TB testing of students who travel to and return from a high risk area.

 

          (c)  Any student with a positive TB test shall be tracked as directed by the department’s bureau of disease control.

 

          (d)  If the EHC is an integrated service provider such as providing education, counseling, or dietary services in addition to nursing, and an RN is not available by telephone, radio, or pager to respond within 15 minutes, the EHC may continue to provide the integrated services if it has a written plan in place to refer students for emergency care and the integrated service providers have documented annual training to exercise the plan.

 

          (e)  Notwithstanding (d) above, an EHC may offer counseling and education services during off-hours or when it is closed due to the unavailability of an RN.

 

          (f)  When an RN has assessed a student and determined that the student needs periodic medical care, nursing observation, or monitoring, the RN shall:

 

(1)  Document the findings of a nursing assessment, including, but not limited to, the following, as applicable:

 

a.  Obtaining a history regarding what brought the student to the EHC;

 

b.  An assessment of the student’s pain level;

 

c.  The student’s vital signs;

 

d.  The student’s physical, cognitive, and behavioral status; and

 

e.  How the student is adapting psychologically to their social environment; and

 

(2)  Determine if the student should remain in his or her dormitory room, be monitored at the EHC, or be admitted to the EHC if the EHC has licensed beds.

 

          (g)  When an RN has assessed a student and determined that the student requires continuous nursing observation, monitoring, and/or medical care, the RN shall:

 

(1)  Admit the student to the EHC if the EHC has licensed beds, and maintain awake nursing personnel for as long as the student requires continuous nursing observation, monitoring, and/or medical care; or

 

(2)  Transfer the student to a facility licensed to provide the necessary student services.

 

          (h)  For any student that is admitted to a bed in the EHC, the RN shall complete the following written documents:

 

(1)  A nursing assessment, as specified in (f)(1) above;

 

(2)  Daily progress notes, if applicable; and

 

(3)  A discharge summary and discharge instructions, if applicable.

 

          (i)  In the event of a medical emergency concerning a student, the nurse in charge shall promptly notify the administrator, or his or her designee, and the medical director of the event and document all information involving the emergency and notifications in the student record.

 

          (j)  Physical or chemical restraints shall be prohibited except as allowed by RSA 151:21, IX.

 

          (k)  Immediately after the use of physical or chemical restraints, the EHC shall make the following notifications:

 

(1)  To the student’s guardian, if any, as soon as is practicable and in no case longer than 24 hours; and

 

(2)  To the department’s health facilities licensing unit within 48 hours by fax, at (603) 271-5574, or by electronic means.

 

          (l)  The EHC shall:

 

(1)  Have policies and procedures on:

 

a.  What type of physical or chemical restraint can be used;

 

b.  When physical or chemical restraint can be used; and

 

c.  What professional personnel may authorize the use of restraints; and

 

(2)  Provide personnel authorized by (1)c. above with education and training on the limitations and the correct use of restraints.

 

          (m)  The use of mechanical restraints shall be prohibited.

 

          (n)  For each student accepted for care and services at the EHC, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

 

(2)  Results of any laboratory tests, X-rays or consultations performed at the EHC;

 

(3)  All admission notes;

 

(4)  All assessments;

 

(5)  All care and services provided at the EHC including the:

 

a.  Date and time of the care or service;

 

b.  Description of the care or service;

 

c.  Daily progress notes, if applicable;

 

d.  Student’s response to the care and services provided; and

 

e.  Signature and title of the person providing the care or service;

 

(6)  All medication records required by He-P 816.17(ah);

 

(7)  Documentation of nurse delegation, if applicable;

 

(8)  If services are provided at the EHC by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

 

(9)  Documentation of reportable incidents involving the student, including the information required by He-P 816.14(r); and

 

(10)  Documentation of the refusal of a student to follow the prescribed orders of the licensed practitioner, including the date and time the licensed practitioner was notified of the refusal.

 

          (o)  Student records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets, except when being used by the EHC’s personnel.

 

          (p)  Student records and information shall be kept confidential and only provided in accordance with law.

 

          (q)  The licensee shall develop and implement written policy and procedures that specify the method by which release of information from a student’s record shall occur.

 

          (r)  Records shall be retained for a minimum of 4 years.

 

          (s)  The licensee shall arrange for storage of, and access to, student records as required by (r) above in the event the EHC ceases operation.

 

          (t)  If anyone other than a licensed provider, RN, or LPN trained in phlebotomy collects human specimens from students for laboratory testing, the EHC shall also be licensed as a collection station in accordance with He-P 817.

 

          (u)  If the EHC tests human specimens it shall be licensed as a laboratory in accordance with He-P 808, and, if in possession of a laboratory license under He-P 808, it shall not be required to have the collection station license referenced in (t) above.

 

          (v)  Not withstanding (u) above, the EHC may perform the following Clinical Laboratory Improvement Amendments (CLIA) waived tests, as per 42 CFR Part 493.15, without having a NH state laboratory or collecting station license, required by He-P 808 and He-P 817, respectively:

 

(1)  Rapid strep testing;

 

(2)  Urine dip-stick testing;

 

(3)  Finger stick glucose testing;

 

(4)  Rapid flu testing;

 

(5)  Rapid HIV testing; and

 

(6)  Urine pregnancy testing.

 

          (w) The performance of CLIA moderate or high complexity testing including microscopic testing such as potassium hydroxide or wet prep analysis requires that the EHC also be licensed as a laboratory under He-P 808.

 

          (x)  The EHC shall hold the appropriate CLIA certificate to perform any laboratory tests.

 

Source.  #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

 

          He-P 816.17  Medication Services.

 

          (a)  If the licensee maintains a pharmacy on the licensed premises, it shall comply with RSA 318.

 

          (b)  All procedures for managing and distributing medication(s) shall comply with all applicable federal and state laws and rules.

 

          (c)  The licensee shall develop and implement written policies and procedures governing the management and distribution of student medications provided by the EHC.

 

          (d)  The written policies and procedures shall include, but not be limited to, the following:

 

(1)  How medication is provided to students;

 

(2)  What type of medications students are allowed to keep on their person, including number of doses;

 

(3)  What personnel of the educational institution, such as teachers and residential staff, are allowed to assist students with medications when not given at the EHC;

 

(4)  What training such personnel of the educational institution who can assist students with medication will receive from EHC personnel; and

 

(5)  How EHC personnel shall:

 

a.  Administer medication; and

 

b.  Facilitate medication delivery if a student self-administers off the premises of the EHC or is assisted by or has his or her medication administered by educational facility personnel, in compliance with RSA 326-B.

 

          (e)  All medications shall be administered in accordance with the orders of the licensed practitioner or other individual authorized by law.

 

          (f)  EHC nursing staff shall follow their nurse practice act when administering medications or filling pill planners for students.

 

          (g)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the EHC;

 

(2)  Obtain any routine medications required within 24 hours for use at the EHC;

 

(3)  Reorder medications for use at the EHC;

 

(4)  Receive new medication orders; and

 

(5)  Report any observed adverse reactions to medication, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error to the student’s licensed provider and guardian, if applicable.

 

          (h)  For each prescription medication being taken by a student in grades K-12 and all other students while under the care of the EHC, the licensee shall maintain in the student’s record, one of the following:

 

(1)  The original written order, signed by a licensed practitioner or other individual authorized by law; or

 

(2)  A copy of the original written order, signed by a licensed practitioner or other individual authorized by law.

 

          (i)  Each prescription medication shall legibly display the following information:

 

(1)  The student’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 PRN medications; and

 

(5)  The dated signature of the ordering practitioner.

 

          (j)  The label of all medication containers maintained in the EHC shall match the current written orders of the licensed practitioner.

 

          (k)  Pharmaceutical samples shall be:

 

(1)  Used in accordance with the licensed practitioner’s written order;

 

(2)  Labeled with the participant’s name by the licensed practitioner, the licensee, or their designee; and

 

(3)  Exempt from (i)(2)-(5) above.

 

          (l)  Only a pharmacist or other licensed practitioner shall make changes to the labels on prescription medication container labels.

 

          (m)  Any change or discontinuation of prescription medications taken at the EHC shall be pursuant to a written order from a licensed practitioner or other individual authorized by law.

 

          (n)  When the licensed practitioner or other individual authorized by law changes the dose of a medication and the personnel of the EHC are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the EHC’s written procedure indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed:

 

a.  For a maximum of 90 days from the date of the new medication order;

 

b.  Until the medications in the marked container are exhausted; or

 

c.  In the case of PRN medication, until the expiration date on the container, whichever occurs first.

 

          (o)  Prescription medication that is not ordered, approved or labeled for a specific student, including but not limited to pharmaceutical samples, may be kept at the EHC provided that these medications are dispensed to the student only upon the order of an authorized licensed practitioner. A signed copy of the order shall be filed in the student’s medical record within 3 business days following the order.

 

          (p)  The medication in (o) above shall be the responsibility of the medical director.

 

          (q)  Only a licensed nurse or other licensed health care professional shall take telephone orders for medications, treatments, and diets, if such action is within the scope of their practice act.

 

          (r)  Telephone orders specified in (q) above shall be:

 

(1)  Immediately transcribed and signed by the individual receiving the order; and

 

(2)  Counter-signed by the authorized prescriber within 30 days.

 

          (s)  All medications taken by a student at the EHC shall require written approval for its use by a licensed practitioner.

 

          (t)  The medication storage area or units shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each student's medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (u)  All medication at the EHC shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use, except as allowed by (o) above.

 

          (v)  Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner as to prevent cross contamination.

 

          (w)  If controlled substances, as defined by RSA 318-B:1, VI, are stored in the EHC they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (x)  Except as required below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, at the end date of a licensed practitioner’s orders, or if the medication becomes contaminated, whichever occurs first.

 

          (y)  If the licensee employs or contracts with a pharmacist who has been designated an agent of the NH pharmacy board, then controlled medications shall be destroyed in accordance with the pharmacy board rules Ph 707.

 

          (z)  Destruction of controlled drugs shall:

 

(1)  Be destroyed only in accordance with state law;

 

(2)  Be accomplished in the presence of at least 2 EHC personnel; and

 

(3)  Be documented in the record of the student for whom the drug was prescribed. 

 

          (aa)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (ab)  The department shall order a licensee to obtain the routine services of a consultant pharmacist for 12 months if medication deficiencies which present a risk to the student’s health and safety are identified during any inspection.

 

          (ac)  When a student leaves the educational institution, the student or their guardian may take any current medication(s) with them.

 

          (ad)  Medication(s) may be returned to pharmacies for credit only under the provisions of Ph 704.07.

 

          (ae)  Medications left at the EHC upon the student leaving the educational institution, either permanently or for an extended absence, shall be destroyed and documented in the student’s record.

 

          (af)  Students shall receive their medications in accordance with the policies of the EHC developed in accordance with (c) above

 

          (ag) If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse and delegatee shall comply with the rules of medication delegation in accordance with Nur 404, as applicable, and RSA 326-B.

 

          (ah)  The licensee shall maintain a written record for each medication taken by the student at the EHC that contains the following information:

 

(1)  Any allergies or adverse reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature and identifiable initials and job title of the person administering the medication or supervising the student taking his or her medication;

 

(5)  For PRN medications, the reason the student required the medication and the effect of the PRN medication, if known;

 

(6)  Documented reason for any medication refused or omitted; and

 

(7)  Observed side effects and adverse reactions.

 

          (ai)  Personnel who are not otherwise licensed practitioners, and nurses who assist with observing a student self-administer medication, shall complete an orientation class taught by the EHC nurse which shall include the review of the policies and procedures set forth by the EHC for medication observation.

 

          (aj)  Non-prescription stock medications may be kept at the EHC.

 

          (ak)  An EHC shall use emergency drug kits only in accordance with NH pharmacy board rule, Ph 705.03, under circumstances where the EHC:

 

(1)  Has a director of nursing who is an RN licensed in accordance with RSA 326-B;

 

(2)  Has contractual agreements with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318; and

 

(3)  Has the contents approved, in writing, by the licensee’s medical director.

 

          (al)  The emergency drug kit in (ak) above shall be accessed only by the licensed nurse or licensed practitioner on duty.

 

          (am)  The licensee shall develop and implement a system for reporting to the student’s primary care licensed practitioner any adverse reactions to medications, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

 

          (an)  The written documentation of the report in (am) above shall be maintained in the student’s record.

 

          (ao)  The licensee shall conduct an annual review of its policies and procedures relative to medications.

 

Source.  #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

 

          He-P 816.18  Personnel.

 

          (a)  The licensee shall develop a job description for each position at the EHC containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Education and experience requirements of the position.

 

          (b)  For all applicants for employment, and for all volunteers and independent contractors who will have direct contact with participants, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check in (1) above in accordance with (c) below; and

 

(3)  Verify the qualifications of all applicants prior to employment.

 

          (c)  Unless a waiver is granted in accordance with He-P 816.10 and (d) below, the licensee shall not offer employment for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

 

(3)  Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of students.

 

          (d)  The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of students.

 

          (e)  If the information identified in (c) above regarding any employee is learned after the person is hired, the licensee shall immediately notify the department.

 

          (f)  The department shall review the information in (c) above and notify the licensee that the individual can no longer be employed if, after investigation, it determines that the individual poses a threat to the health, safety, or well-being of a student.

 

          (g)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position as listed in their job description;

 

(2)  Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department;

 

(3)  Be licensed, registered, or certified as required by state statute;

 

(4)  Receive an orientation within the first 3 days of work that includes:

 

a.  The EHC’s policies on rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The EHC’s policies, procedures, and guidelines;

 

d.  The EHC’s infection control program;

 

e.  The EHC’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

 

f.  Mandatory reporting requirements such as those found in RSA 169-C:29; and

 

(5)  Complete mandatory annual in-service education, which includes a review of the EHC’s:

 

a.  Polices and procedures on student rights and responsibilities;

 

b.  Infection control program;

 

c.  Education program on fire and emergency procedures; and

 

d.  Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

 

          (h)  All direct care staff shall have current certifications in adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association.

 

          (i)  Prior to having contact with students, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the United States Centers for Disease Control and Prevention, conducted not more than 12 months prior to employment;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (j)  Personnel, volunteers. or independent contractors hired by the licensee who will have direct contact with students who have a history of TB or a positive skin test shall have a symptomatology screen of a TB test.

 

          (k)  All licensees using the services of independent clinical contractors at the EHC, such as psychologists, shall ensure that these personnel have:

 

(1)  Been oriented in accordance with (g)(4) above;

 

(2)  Submitted results of tuberculosis testing, either Mantoux method or blood assay, conducted not more than 12 months prior to employment;

 

(3)  Provided a copy of any license required by law; and

 

(4)  A written agreement that describes the services that will be provided.

 

          (l)  All personnel shall follow the orders of the licensed practitioner for each student and shall encourage students to follow the practitioner’s orders.

 

          (m)  Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the EHC or the administrative office for all EHC personnel and independent clinical contractors.

 

          (n)  The personnel file required by (m) above shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data, including date of birth; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the EHC’s policy setting forth the student’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (g)(4) above and any required annual continuing education, if any;

 

(5)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(6)  Documentation that the required physical examination, or health screening and, TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Copies of current CPR certifications;

 

(8)  Documentation of annual in-service education as required by (g)(5) above;

 

(9)  Information as to the general content and length of all continuing education or educational programs attended;

 

(10)  For unlicensed personnel that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine the personnel member is competent to administer medications;

 

(11)  A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

 

a.  Do not have a felony conviction in this or any other state;

 

b.  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a student; and

 

c.  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; and

 

(12)  Documentation of the criminal records check.

 

          (o)  An individual need not re-disclose any of the matters in (n)(11) and (12) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (p)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

Source.  #9193, eff 6-26-08; ss by #9565, eff 10-16-09; ss by #12197, eff 6-2-17

 

          He-P 816.19  Quality Improvement.

 

          (a)  The EHC shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The licensee shall determine the size and composition of the quality improvement committee based on the size of the EHC and the care and services offered.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored, which at a minimum shall include;

 

a.  Reportable incidents;

 

b.  Complaints, to include student, family, guardian, and staff concerns;

 

c.  Health care needs, trends, and infection rates of students;

 

d.  Student and staff conflicts; and

 

e.  Medication delivery;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the licensee; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

          (e)  The quality improvement committee shall meet at least twice per year, once during the fall and once during the spring.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.20  Infection Control.

 

          (a)  The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of students with infectious or communicable diseases or illnesses;

 

(4)  The handling, transport and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

 

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

 

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

 

(1)  Cause of infection;

 

(2)  Effect of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in the EHC until they are no longer contagious.

 

          (e)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (f)  Personnel with an open wound who work in the EHC shall cover such wound at all times by an impermeable, durable, tight fitting bandage.

 

          (g)  Personnel infected with scabies or lice/pediculosis shall not provide direct care to students until such time as they are no longer infected.

 

          (h)  If the EHC has an incident of an infectious disease reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (i)  Any EHCs caring for students with infectious or communicable diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified in the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.21  Sanitation.

 

          (a)  The EHC shall maintain a clean, safe, and sanitary environment throughout the EHC licensed premises.

 

          (b)  All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  The EHC shall maintain a supply of potable water available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times, and precautions such as temperature regulation shall be taken to prevent a scalding injury to the students.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, program supplies, and other cleaning materials.

 

          (g)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (h)  Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (i)  Bathrooms and laundry rooms, if present, shall have non-porous floors.

 

          (j)  There shall be a designated soiled workroom that contains a sink and storage area for soiled materials and linens.

 

          (k)  If equipment or supplies need to be sterilized in order to prevent contamination, the EHC shall develop and maintain written procedures for cleaning, packaging, and sterilization that includes:

 

(1)  Testing and documenting sterilization processes used;

 

(2)  Documentation when supplies are outdated; and

 

(3)  Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

 

          (l)  The sterilization system required in (k) above shall be checked for effective sterilization in accordance with the manufacturer’s recommendation, and the results of these quality control tests shall be documented.

 

          (m)  Sterile and clean supplies and equipment shall:

 

(1)  Be stored in dust-proof, moisture-free storage areas; and

 

(2)  Not be mixed with soiled supplies.

 

          (n)  All student bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination, but at least:

 

(1)  For bedpans, urinals, commodes, and other student equipment as follows:

 

a.  After each use if used by more than one student; or

 

b.  Daily if used by only one student;

 

(2)  For showers or tubs after each use by a different person; and

 

(3)  For basin, fixtures, and toilets at least once a day, and more often when soiled regardless of the number of people.

 

          (o)  Any EHC that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services shall notify the department of health and human services upon receipt of notice of a failed water test.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.22  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of students and personnel, including reasonable accommodations for students and personnel with mobility limitations.

 

          (b)  Equipment providing heat within an EHC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit if student(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in personnel areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any EHC.

 

          (f)  Plumbing shall be sized, installed, and maintained in accordance with the provisions of the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (g)  Ventilation shall be provided throughout the entire building by means of a mechanical ventilation system or with one or more screened windows that can be opened.

 

          (h)  Screens shall be provided for doors, windows, or other openings to the outside.

 

          (i)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (h) above.

 

          (j)  The EHC shall have a telephone to which the students have access.

 

          (k)  There shall be a reception and waiting area that includes chairs, tables, and sufficient lighting.

 

          (l)  In accordance with RSA 155:66, I, smoking shall be prohibited in the EHC.

 

          (m)  All EHCs shall have access within the EHC to a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels or a hand-drying device providing heated air, and hot and cold running water.

 

          (n)  All bathrooms doors shall have a side hinge door and not a folding or sliding door or a curtain.

 

          (o)  There shall be sufficient space and equipment for the services provided at the EHC.

 

          (p)  If the EHC does not have licensed beds it shall provide standard twin size, or larger, bed(s) in a room designated specifically for rest or sleep to accommodate each student who may require rest or sleep during the time they are present during the day.

 

          (q)  All beds shall be changed with clean linens between use by different students.

 

          (r)  The licensee shall provide students with continuous access to a device or means that will signal EHC personnel when they are in need of assistance.

 

          (s)  In addition to (m) above, EHC’s with licensed beds shall have a bathroom equipped with tub or shower facilities sufficient to meet the needs of students.

 

          (t)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (u)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (v)  Each room containing a licensed bed(s) shall:

 

(1)  Provide at least 100 square feet per room with one bed and at least 160 square feet per room with 2 beds exclusive of space required for closets, wardrobes, and toilet room, except those licensed rooms existing on the date that this section takes effect shall provide at least 80 square feet for rooms with one bed and 140 square feet for rooms with 2 beds;

 

(2)  Have a door that shall be of the side hinge type and not a folding door or a curtain;

 

(3)  Have its own separate entry, which permits a student to reach the room without passing through another patient room;

 

(4)  Have at least 3 feet of clear aisle space leading from one side of any bed to the door;

 

(5)  Contain the following:

 

a.  A minimum of one, but no more than 2, beds with mattresses;

 

b.  A pillow, linens, and blankets for each bed; and

 

c.  One bedside table and a lamp or light for each bed;

 

(6)  Have at least one over the bed table per room;

 

(7)  Have window blinds or curtains that provide privacy;

 

(8)  A privacy partition, curtain, or screen between beds in semiprivate rooms; and

 

(9)  Have natural lighting directly from outside windows of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (w)  All mattresses and new upholstered furniture or draperies shall comply with Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (x)  The licensee shall be permitted to be licensed for more than one classification, but if the licensee has overnight beds for more than one licensing classification, physically separate and distinct units shall be required for each such classification and a different fire code chapter shall be enforced for each classification, as applicable.

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.23  Fire Safety.

 

          (a)  All EHCs shall meet the requirements of the appropriate chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (b)  All EHCs that have overnight beds shall have:

 

(1)  Smoke detectors on every level and in every sleeping room that are interconnected to the building’s fire alarm system and either hardwired, powered by the EHC’s electrical service, or AC 120 volt wireless, as approved by the state fire marshal;

 

(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, and which meets the following requirements:

 

a.  Maximum travel distance to each extinguisher shall not exceed 50 feet;

 

b.  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;

 

c.  Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

 

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

 

e.  The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

 

(3)  An approved carbon monoxide monitor on every level.

 

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

 

          (d)  The EHC shall immediately notify the department by phone, fax, or electronic mail within 24 hours and in writing within 72 hours of any fire or situation, excluding a false alarm, that requires either an emergency response to the EHC or the evacuation of the licensed premises.

 

          (e)  The written notification required by (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injuries to students or personnel or damage sustained by the EHC;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or students who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or students who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (f)  For the use and storage of oxygen and other related gases, EHCs shall comply with NFPA 99 as adopted by the commissioner of the department of safety as Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

 

(1)  All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

 

(2)  Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

 

(3)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

a.  Not be stored with any flammable gas, liquid, or vapor;

 

b.  Be separated from combustibles or incompatible materials by:

 

1.  A minimum distance of 20 ft (6.1 m);

 

2.  A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

 

c.  Shall be secured in an upright position, such as with racks or chains;

 

(4)  A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

 

(5)  Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

 

          (g)  Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

 

          (h)  Evacuation drills shall be conducted monthly if the EHC has licensed beds or quarterly if it does not have beds and vary in time to include all personnel.

 

          (i)  All personnel shall participate in at least one drill quarterly.

 

          (j)  For personnel who are unable to participate in the scheduled drill described in (i) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

 

          (k)  Personnel who are unable to participate in a drill in accordance with (i) above shall participate in a drill within the next quarter.

 

          (l)  Per-diem or temporary personnel shall not be the only person on duty unless they have:

 

(1)  Participated in at least one actual fire drill in the facility in the past year; and

 

(2)  Participated in the facility’s orientation program pursuant to He-P 816.18(g)(5).

 

          (m)  All emergency and evacuation drills shall be documented and include the following information:

 

(1)  The names of the personnel and students involved in the evacuation;

 

(2)  The time, including AM or PM, date, month, and year the drill was conducted;

 

(3)  The exits utilized;

 

(4)  The total time necessary to evacuate the EHC;

 

(5)  The time needed to complete the drill; and

 

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

 

Source.  #9193, eff 6-26-08, EXPIRED: 6-26-16

 

New.  #11199, INTERIM, eff 10-14-16, EXPIRED: 4-12-17

 

New.  #12197, eff 6-2-17

 

          He-P 816.24  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (b)  The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(7)  Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

 

(8)  Include the management of particpants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

 

(9)  Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

 

(10)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

(f)  The facility shall contact the local emergency management director annually to determine if any revisions are needed based upon current trends in emergency management, local policy changes, and hazard changes.

 

(g)  Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

 

(h)  The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

 

(i)  Notwithstanding (a)-(f) above, when an EHC is a part of a larger educational institution which has a comprehensive emergency preparedness plan, the EHC may use the institution’s plan, and if so, it shall:

 

(1)  Identify the portions of the plan that pertain to the EHC in a separate document for use by EHC personnel;

 

(2)  Provide annual training to prepare personnel in its application as required by (g) above; and

 

(3)  Review and update the plan as required by (h) above.

 

Source.  #12197, eff 6-2-17

 

PART He-P 817  COLLECTION STATION RULES

 

          He-P 817.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all collection stations pursuant to RSA 151:2, I(c).

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a collection station, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g);

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h);

 

          (c)  All collection stations that collect specimens from humans solely for forensic purposes, pursuant to RSA 151:2, II(h);

 

          (d)  All entities which are licensed in accordance with RSA 153-A by the New Hampshire department of safety as providers of transporting or non-transporting emergency medical care;

 

          (e)  Entities which are currently licensed under He-P 808 Laboratories and Laboratory Services Rules; and

 

          (f)  Entities which are currently licensed under He-P 806 Non-Emergency Walk-In Care Centers.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients with or without his or her informed consent.

 

          (b)  “Administrator” means the licensee or an individual appointed by the licensee who has responsibility for all aspects of the daily operations of the collection station.

 

          (c)  “Applicant” means an individual, agency, partnership, corporation, federal, state, county, or local government entity, association, or other legal entity seeking a license for the operation of a collection station pursuant to RSA 151:2, I(c).

 

          (d)  “Change of ownership” means a change in the controlling interest of an established collection station to a successor business entity.

 

          (e)  “Client” means any person admitted to or in any way receiving care, services, or both from a collection station licensed in accordance with RSA 151 and He-P 817.

 

          (f)  “Client record” means the documentation of all care and services, which includes all documentation required by RSA 151 and He-P 817 and any other applicable federal and state requirements.

 

          (g)  “Collection station” means any building, place, or mobile collection station van used for the purpose of receiving or obtaining specimens from the human body for laboratory examination.

 

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

 

          (i)  “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 817, or other federal and state requirements.

 

          (j)  “Department” means the New Hampshire department of health and human services.

 

          (k)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified deficiencies.

 

          (l)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (m)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception or fraud.

 

          (n)  “Inspection” means the process used by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 817 or to respond to allegations of non-compliance with RSA 151 and He-P 817.

 

          (o)  “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He- P 817.

 

          (p)  “Licensed premises” means the facility that comprises the physical location, including mobile collection station vans, that the department has approved for the licensee to conduct operations in accordance with its license.  It does not include the private residence of a client receiving services from an agency licensed under the authority of RSA 151.

 

          (q)  “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151 and He-P 817.

 

          (r)  “Licensing classification” means the specific category of services authorized by a license.

 

          (s)  “Mobile collection station van” means a vehicle capable of traveling under its own power or being towed from site to site and which is fully equipped to meet all the requirements specified in section He-P 817.21.

 

          (t)  “Neglect” means an act or omission, which results, or could result, in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a client.

 

          (u)  “Owner” means a person or organization who has controlling interest in the collection station.

 

          (v)  “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct care or services to a client.

 

          (w)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

          (y)  “Qualification” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

 

          (z)  “Reportable incident” means an occurrence of an error, a negative outcome, or an accident, which occurs while the client is in the care of the licensee, and has resulted in injury that requires examination or treatment by a licensed practitioner.

 

          (aa)  “Specimen” means a portion of tissue, body fluid, or material from a human body.

 

(ab)  “Statement of findings” means a document issued by the department following an inspection or investigation identifying areas in which the licensee is not in compliance with He-P 817 or RSA 151 and which sets forth the evidence that supports the findings of noncompliance.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.04  License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III-a, and submit the following to the department, except that subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile collection station vans:

 

(1)  A completed application form entitled “Application for Residential or Health Care License (Laboratories and Collecting Stations)” (10/25/2011), signed by the applicant or 2 of the corporate officers, affirming the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”

 

(2)  A floor plan of the prospective collection station;

 

(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability company; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee, in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee, made payable to the “Treasurer of the State of New Hampshire”;

 

(5)  A resume identifying the qualifications and copies of applicable licenses for the collection station administrator;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, including the business chapter of NFPA 101 as adopted by the department of safety, and local fire ordinances applicable for a collection station; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(7)  If the collection station uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 313.01 and 314.01, or if a public water supply, a copy of a water bill; and

 

(8)  The results of a criminal records check from the NH department of safety for the applicant, including the licensee and administrator, as applicable.

 

          (b)  The applicant shall mail or hand deliver the documents in (a) above to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be deemed to be complete when the department determines that all items required by He-P 817.04(a), or He-P 817.21 for mobile collection station vans, have been received.

 

          (b)  If an application does not contain all of the items required by He-P 817.04(a) or He-P 817.21, the department shall notify the applicant in writing of the items required to be submitted before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e) The department shall deny a licensing request if, after reviewing the information in He-P 817.04(a)(8), it determines that the applicant, licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (f)  Following an inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 817.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable, including licenses issued for mobile collection station vans.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month in which it was issued.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 817.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The information required by He-P 817.04(a)(1) including current license number;

 

(2)  The licensing fee, prescribed by RSA 151:5, IX;

 

(3)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 817.10(f), if applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 817.17(c); and

 

(5)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005.03 - 6005.04.

 

          (d)  In addition to (c) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Ws 313.01 for bacteria and Env-Ws 314.01 for nitrates.

 

          (e)  Following an inspection as described in He-P 817.09, a license renewal shall be issued if the department determines that the licensee:

 

(1)  Has submitted an application containing all the items required by (c) and (d) above, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if deficiencies were cited at the last licensing inspection or investigation; and

 

(3) The licensee is found to be in compliance with RSA 151 and He-P 817 at the renewal inspection.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 817.04.

 

          (g)  If a licensee chooses to cease the operation of the collection station, the licensee shall submit written notification to the department at least 45 days in advance.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.07  Collection Station Construction, Modifications, or Structural Alterations.

 

          (a)  Architectural plans or drawings shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

 

(1)  A new building;

 

(2)  Additions to a building;

 

(3)  Alterations that require approval from local or state authorities; and

 

(4)  Modifications that might affect compliance with the health and safety, fire, or building codes, including but not limited to, fire suppression, detection systems and means of egress.

 

          (b)  Architectural sprinkler and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10, (b)IV.

 

          (c)  Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (d)  The department shall review plans for construction, modifications, or structural alterations for compliance with all applicable sections of RSA 151 and He-P 817 and notify the applicant or licensee as to whether the proposed plans comply with these requirements.

 

          (e)  Department approval shall not be required prior to initiating construction, renovations, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

          (f)  A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

 

(1)  The state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  Local rules, regulations, and ordinances.

 

          (g)  Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (h)  Exceptions or variances pertaining to the state fire code referenced in (f)(1) above shall be granted only by the state fire marshal.

 

          (i)  The completed building shall be subject to an inspection pursuant to He-P 817.09 prior to the use of the newly constructed or modified facility.

 

          (j)  He-P 817.07 shall not apply to mobile collection station vans.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.08  Collection Station Requirements for Organizational Changes.

 

          (a)  The collection station shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address; or

 

(4)  Name.

 

          (b)  When there is a change in the name, the collection station shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (c)  The collection station shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership; or

 

(2)  A change in the physical location.

 

          (d)  When there is a change in address without a change in location the collection station shall provide the department with a copy of the notification from the local, state or federal agency that requires the change.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of noncompliance was submitted and accepted by the department; or

 

(2)  The physical location.

 

          (f)  A new license shall be issued for a change in ownership or a change in physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the collection station name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator; or

 

(2)  When a waiver has been granted.

 

          (i)  The collection station shall inform the department in writing as soon as practicable when there is a change in administrator and provide the department with the following:

 

(1)  The information specified in He-P 817.04(e); and

 

(2)  A resume identifying the name and qualifications of the new administrator.

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator:

 

(1)  Is disqualified by the information submitted in response to (i)(1) above; or

 

(2)  Meets the qualifications for the position as specified in He-P 817.17 (h).

 

          (k)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

          (l)  A restructuring of an established collection station that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (m)  Licenses issued for a change in ownership shall expire on the date the license issued to the previous owner would have expired.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New. #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  INTERIM, #10830, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.09  Inspections.

 

(a)  For the purpose of determining compliance with RSA 151 and He-P 817, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the collection station; and

 

(3)  Any records required by RSA 151 and He-P 817.

 

          (b)  The department shall conduct a clinical inspection and life safety inspection, as appropriate, to determine full compliance with RSA 151 and He-P 817 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed in He-P 817.08(a)(3);

 

(3)  A change in the licensee’s physical location, except for mobile collection station vans;

 

(4)  The renewal of a license;

 

(5)  The issuance of a mobile collection station van license; or

 

(6)  Occupation of space after construction, modifications, or structural alterations.

 

          (c)  The department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

 

          (d)  Following the inspections described in (b) and (c) above, the department shall provide the licensee with a written inspection report.

 

          (e)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 817.

 

          (f)  If deficiencies were cited in the inspection report described in (d) above, the licensee shall submit a written POC, in accordance with He-P 817.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 817 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3) A full explanation of alternatives proposed by the applicant or licensee, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health or safety of the clients; and

 

(3)  Does not affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew the waiver beyond the approved period of time, the licensee shall apply for a new waiver at least 60 days prior to the expiration of the existing waiver by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.11  Complaints and Investigations.

 

          (a)  The department shall respond to any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 817.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the collection station, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 817.

 

(c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  The following shall apply for a licensed collection station:

 

(1)  The department shall provide written notification of the results of the investigation to the licensee along with an inspection report if deficiencies were found as a result of the investigation;

 

(2)  The department shall notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  If the department determines that the complaint is unfounded or does not violate any statutes or rules, the department shall notify the licensee in writing and take no further action; and

 

(4)  If the investigation results in deficiencies being cited, the licensee shall be required to submit a POC in accordance with He-P 817.12(c).

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above the department shall issue a written warning to immediately comply with RSA 151 and He-P 817; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (i) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

(f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New. #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 817, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below; or

 

(4)  Imposing fines upon an unlicensed individual, applicant, or licensee in accordance with (e) below.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules;

 

(2)  Identifies the specific remedy(s) that has been proposed; and

 

(3)  Provides the following information:

 

a.  The right to a hearing in accordance with RSA 541-A and He-C 200 prior to the imposition of fines; and

 

b.  The automatic reduction of a fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the deficiency has been corrected, or a POC has been accepted and approved by the department.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings, or a notice to correct, the licensee shall submit its POC for each item, written in the appropriate space on the notice and containing:

 

a.  How the licensee intends to correct each deficiency;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the deficiency does not recur; and

 

c.  The date by which each deficiency shall be corrected;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the inspection or investigation report unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 817;

 

b.  Addresses all deficiencies and deficient practices as cited in the inspection or investigation report;

 

c.  Prevents a new violation of RSA 151 or He-P 817 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the deficiencies will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

2.  The department determines that the health, safety, or well being of a client will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with (f)(9) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date , at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 817.12(b) above; and

 

b.  Issue a directed POC in accordance with He-P 817.12(d) and a fine in accordance with He-P 817.12(f)(10).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of noncompliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2) A revised POC is not submitted within 14 days of the written notification from the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

(e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 817.13; or

 

(3)  Revoke the license in accordance with He-P 817.13.

 

(f)  The department shall impose fines as follows:

 

(1)  For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine for an unlicensed individual or a licensee shall be $2000.00;

 

(2)  For failure to cease operation after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that the licensee is not licensed to provide, in violation of RSA 151:2, III, the fine for an unlicensed individual or a licensee shall be $500.00;

 

(4)  For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a, the fine for an unlicensed provider or a licensee shall be $500.00;

 

(5)  For submitting a renewal application for a license less than 120 days prior to the expiration date, in violation of He-P 817.06(b), the fine for a licensee shall be $100.00;

 

(6)  For failure to notify the department prior to a change of ownership, in violation of He-P 817.08(a), the fine for a licensee shall be $500.00;

 

(7)  For failure to notify the department, prior to a change of physical location, in violation of He-P 817.08(c), the fine for a licensee shall be $500.00;

 

(8)  For a failure to allow access by the department to the collection station’s premises, programs, services, or records, in violation of He-P 817.14(g)-(h), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00;

 

(9)  For failure to submit a POC or a revised POC, within 21 days or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 817.12(c)(2) and (5) the fine for a licensee shall be $100.00;

 

(10)  For a failure to implement any POC that has been accepted or issued by the department, in violation of He-P 817.12(c)(8), the fine for a licensee shall be $1000.00;

 

(11)  For falsification of information contained on the application or of any records required to be maintained for licensing in violation of He-P 817.14(d), the fine for an applicant or licensee shall be $500.00 per offense;

 

(12)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 817.07(a), the fine for a licensed facility shall be $500.00;

 

(13)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He -P 817.17(b)(1), the fine for a licensee shall be $500.00;

 

(14)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 817 shall constitute a separate violation warranting additional fines in accordance with He-P 817.12;

 

(15)  When an inspection or investigation determines that a violation of RSA 151 or He-P 817 that is subject to a fine has occurred, repeat violations or failure to correct a previously cited violation, which occurs within 2 years of the date of the original violation, the fine for a licensee shall be $2000.00; and

 

(16)  If the applicant or licensee is making good faith efforts to comply with (4) or (13) above, the department shall not issue a daily fine.

 

(g)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department; and

 

(3)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant for an initial license is in violation of RSA 151 or He-P 817;

 

(2)  A licensee is in violation of RSA 151 or He-P 817 which poses a risk of harm to a client’s health, safety, or well-being;

 

(3)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(4)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(5)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 817.04;

 

(6)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false information to the department;

 

b.  Prevents or interferes with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(7)  A licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 817.12(c) or (d);

 

(8)  A licensee has submitted a POC that has been rejected by the department in accordance with He-P 817.12(c)(5) and has not submitted a revised POC as required by He-P 817.12(c)(5);

 

(9)  The licensee is cited a third time under RSA 151 or He-P 817 for the same violation within the last 5 inspections;

 

(10)  A licensee, including corporate officers or board members, has had a license revoked and submits an application during the 5 year prohibition period;

 

(11)  An inspection of the applicant’s premises does not find full compliance with RSA 151 or He-P 817; or

 

(12)  The owner(s), licensee, or administrator has been found guilty of or plead guilty to a felony assault, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department.

 

          (c)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (d)  If a written request for a hearing is not made pursuant to (c) above, the action of the department shall become final.

 

          (e)  The department shall order the immediate suspension of a license, and the cessation of operations, when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

 

          (f)  If the immediate suspension of a license is ordered:

 

(1)  The licensee shall immediately cease to operate; and

 

(2)  The department shall hold a hearing within 10 working days of the date the order was issued.

 

          (g)  If an immediate suspension is upheld at the hearing described in (f)(2) above, the licensee shall not operate until the department determines through inspection that compliance with RSA 151 and He-P 817 is achieved.

 

          (h)  Hearings and appeals of department decisions under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (i)  When a collection station’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the denial or revocation pertained to their role in the collection station.

 

          (j)  The 5 year period referenced in (i) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (k)  Notwithstanding (i) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 817.

 

          (l)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 817.

 

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

 

          (n)  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.

 

          (o)  The department will change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide notice to the applicant or licensee of the determination.

 

          (p)  The deadline to submit a POC in accordance with He-P 817.12(c)(2) shall not apply until the notice of the determination to not make a change to the statement of findings in (o) above has been provided to the applicant or licensee.

 

          (q)  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.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853 eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

 

          (b)  The licensee shall have a written policy and procedure setting forth the rights and responsibilities of clients receiving services at the facility in accordance with RSA 151:20.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided at the collection station or mobile collection station van.

 

          (d)  The licensee shall not falsify or omit any information contained in:

 

(1)  The “Application for Residential or Health Care License,” or any other documents required for the licensing of a collection station; or

 

(2)  The records maintained for the clients and personnel of the collection station.

 

          (e)  The licensee shall have responsibility and authority for:

 

(1)  Managing, controlling and operating the collection station;

 

(2)  Developing and implementing written policies and procedures governing all of the operations and services provided, and for reviewing said policies and procedures annually and revising them as needed;

 

(3)  Initiating action to maintain the collection station in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(4)  Establishing, in writing, a chain of command that sets forth the line of authority for the operational responsibilities of the collection station;

 

(5)  Appointing an administrator who shall be responsible for the day-to day operations of the collection station;

 

(6)  Providing sufficient numbers of personnel who are present in the collection station and are qualified to perform the services stated in the collection station’s scope of services;

 

(7)  Providing sufficient supplies, equipment, and lighting to ensure all services are provided in a safe and timely manner;

 

(8)  Reporting all positive tuberculosis test (TB) results for personnel to the department’s TB program in accordance with RSA 141-C:7, He-P 301.02 and 301.03; and

 

(9)  Implementing any POC that has been accepted or issued by the department.

 

          (f)  The licensee shall ensure that all specimen collection and storage requirements are met and only provide phlebotomy collection services:

 

(1)  At their licensed premises, including in a licensed mobile collection station van under the oversight of the collection station;

 

(2)  At a client’s place of residence; and

 

(3)  At a senior center, adult day care center, or an outpatient mental health facility provided that collection occurs no more than one day per week at this location.

 

          (g)  The licensee shall post the following documents in an area of the licensed premises that is conspicuous and open to clients and the general public:

 

(1)  The current license issued in accordance with RSA 151:2;

 

(2)  All inspection and investigation reports issued in accordance with He-P 817.09(c) and He-P 817.11(d)(2)a. for the previous 12 months;

 

(3)  Any notice of pending hearing or order as required by RSA 151:29, II, pertaining to the licensee issued by the department, or a court during the previous 24 months;

 

(4)  A copy of the patients’ bill of rights specified by RSA 151:21 or RSA 151:21-b;

 

(5)  A notice as required by RSA 151:29 stating complaints may be submitted to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

(6)  The licensee’s evacuation floor plan identifying the location of, and access to, all fire exits, except that mobile collection station vans shall be exempt from this requirement.

 

(h)  The licensee shall ensure that all personnel read and comply with the patients’ bill of rights as set forth in RSA 151:21.

 

          (i)  The licensee shall admit and allow any department representative to inspect the licensed premises and all programs and services of any licensee that is providing collection station services at any time for the purpose of determining compliance with RSA 151 and He-P 817 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (j)  All records required for licensing shall be:

 

(1)  Available to the department during any inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

(2)  Legible, current, and accurate.

 

          (k)  For reportable incidents, the licensee shall:

 

(1)  Convey by electronic or regular mail the following information to the department within 48 hours of a reportable incident as defined in He-P 817.03(z):

 

a.  The collection station name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of client(s) involved in the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident; and

 

g.  If medical intervention was required, by whom and the date and time; and

 

(2)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if these were not submitted in the initial report.

 

          (l)  Any licensee maintaining electronic records shall develop a system with written policies and procedures to protect the privacy of clients and staff that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent deletion;

 

(2)  Safeguards to ensure the confidentiality of the information on clients and staff; and

 

(3)  Systems to prevent the tampering of information on clients and staff.

 

          (m)  The licensee shall provide a client or their legal representative with a copy of his or her client record, pursuant to the provisions of RSA 151:21, X, upon request.

 

          (n)  The licensee shall develop written policies and procedures that will ensure that only the client and the ordering licensed practitioner are allowed to receive a copy of the laboratory tests results unless the collection station has written consent from the client to release the test results to others.

 

          (o)  Mobile collection station vans shall maintain a log on-site documenting that all on-board water used for drinking and washing was obtained from a verifiable potable Source.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.15  Collection Station Standards.

 

          (a)  Except as allowed by (b) below, the collection station shall collect or receive specimens only at the written or electronic request of a physician, dentist, chiropractor, court of law, or any other person authorized by state statute to order and receive laboratory tests.

 

          (b)  The collection station shall follow up with all telephone requests for the collection or receipt of specimens with a written confirmation within 30 days.

 

          (c)  At a minimum, the written or electronic test request required by (a) above, shall include:

 

(1)  The client’s identifier;

 

(2)  The client’s sex and age or date of birth;

 

(3)  The specific test(s) to be performed;

 

(4)  The name or unique identification such as an account number of the authorized person requesting the tests;

 

(5)  The date of specimen collection;

 

(6)  The name or other identifier such as test code number of the test requested;

 

(7)  The time of specimen collection when required by the collection procedure; and

 

(8)  The body source of the specimen when required by the collection procedure.

 

          (d)  At a minimum, written documentation for the collection or receipt of a specimen shall be maintained and include the following information:

 

(1)  The unique identifier assigned to the specimen;

 

(2)  The date of specimen receipt;

 

(3)  The time of specimen receipt when required by the collection procedure; and

 

(4)  Information contained on the test request as described in (c) above.

 

          (e)  At a minimum, the specimen label shall include the patient name and birth date, date and time of collection, and the initials of the person collecting the sample.

 

          (f) The collection station shall have documentation of the specimen collection, handling, and processing requirements, from the laboratory performing the test, for all analytes collected, to include requirements pertaining to storage, temperature, transport, collection media, preservatives, centrifuge speed, light protection, and any other special collection or handling requirements of the laboratories test system.

 

          (g)  Recordings of refrigerator and freezer temperatures shall be done each day the collection station operates and shall fall within the following ranges:

 

(1)  Refrigerator temperatures shall be between 2 and 8 degrees centigrade; and

 

(2)  Freezer temperatures shall be colder than minus 10 degrees centigrade.

 

          (h)  Centrifuge speed, for spinning blood samples, shall:

 

(1)  Fall between 2800 and 3500 revolutions per minute or as specified by the manufacturer and be verified by tachometer on an annual basis; and

 

(2)  For mobile collection station vans, be verified whenever the van is moved.

 

          (i)  No expired specimen collection equipment and reagents, such as vacutainer tubes and glucola, shall be retained in the station or used for specimen collection.

 

          (j)  Corrective measures such as repair or replacement shall be made in the event of an equipment failure and a written record of the corrective measures shall be kept at the collection station.

 

          (k)  All clinical equipment shall be:

 

(1)  In good working order; and

 

(2)  Serviced in accordance with manufacturers’ instructions and a written record of the service maintained by the collection station.

 

          (l)  Sharps containers shall be secured so as to prevent unauthorized access, tampering, or both.

 

          (m)  Collection stations performing waived glucose screening by glucometer tests shall:

 

(1)  Acquire and maintain a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver, pursuant to 42 CFR 493.15;

 

(2)  Perform quality controls each day of testing;

 

(3) Have a written procedure for the collection station response to a high patient glucometer reading that clearly identifies the response required, who to notify, and any other actions required by collection station personnel; and

 

(4)  Clean the glucometer between patients with an appropriate cleaner.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.16  Client Records, Test Requisitions, and Test Reports.

 

          (a)  All test requisitions and test reports shall be completed and maintained in accordance with 42 CFR § 493.

 

          (b)  Each collection station shall keep a client record which shall contain, at a minimum, the information required by He-P 817.15(c).

 

          (c)  All records, requisitions, and reports shall be safeguarded against loss, damage, tampering, and unauthorized access and retained for a minimum of 4 years.

 

          (d)  Prior to ceasing operation, the licensee shall arrange for the storage of and access to records, requisitions and reports for a minimum of 4 years.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.17  Personnel.

 

          (a)  For all applicants for employment, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety; and

 

(2)  Review the results of the criminal records check in accordance with (b) below and verify the qualifications of all applicants prior to employment.

 

          (b)  Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment for any position if the individual:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation;

 

(3)  Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (c)  The department shall grant a waiver of (b) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

 

          (d)  No employee shall be permitted to maintain their employment if he or she has been convicted of a felony, sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this or any other state by a court of law or has had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department unless a waiver has been granted by the department.

 

          (e)  The licensee shall check, prior to hiring, the names of all prospective employees against the department’s bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-W 720.

 

          (f)  The licensee shall not make a final offer of employment to any prospective employee listed on the BEAS state registry unless a waiver is granted by the bureau of elderly and adult services.

 

          (g)  The licensee shall develop a job description for each position in the collection station containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Education requirements of the position.

 

          (h)  The licensee shall hire an administrator who has a minimum of 2 years administrative experience in a health care facility, who has phlebotomy experience, and meets one of the following criteria:

 

(1)  Is a licensed New Hampshire:

 

a.  Physician;

 

b.  Physician’s assistant;

 

c.  Advanced practice registered nurse;

 

d.  Dentist;

 

e.  Optometrist;

 

f.  Naturopath;

 

g.  Respiratory therapist; or

 

h.  Registered nurse;

 

(2)  Is a medical technologist certified by a nationally recognized certification board, such as the American Society of Clinical Pathology;

 

(3)  Is an emergency medical technician (EMT) registered by the National Registry of Emergency Medical Technicians; or

 

(4)  Has a minimum of an associate’s degree in a life science.

 

(i)  All personnel shall:

 

(1)  Meet the requirements of the position as listed in the job description described in (g) above;

 

(2)  Be licensed, registered, or certified if required by state statute;

 

(3)  Receive an orientation within the first 7 days of work that includes:

 

a.  The collection station’s policies on patient’s rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position;

 

c.  The collection station’s policies, procedures, and guidelines;

 

d.  The collection station’s infection control program;

 

e.  The collection station’s fire and emergency plans; and

 

f.  The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29;

 

(4)  Submit results of a physical examination or health screening conducted not more than 12 months prior to employment, including at a minimum the following:

 

a.  The name of the examinee;

 

b.  The date of the examination;

 

c.  Whether or not the examinee has a contagious illness or any other illness which would affect the examinee’s ability to perform their job duties;

 

d.  Results of a 2-step tuberculosis (TB) test, Mantoux method or other method approved by the Centers for Disease Control (CDC);

 

e.  Medications currently prescribed for the examinee which might affect the examinee’s ability to perform their job duties;

 

f.  Evidence of current alcohol or drug abuse by the examinee, which might affect the examinee’s ability to perform their job duties;

 

g.  Impairment of vision or hearing which might affect the examinee’s ability to perform their job duties;

 

h.  Evidence of current mental illness or emotional disorder which affect the examinee’s ability to perform their job duties; and

 

i.  The dated signature of the licensed health practitioner; and

 

(5)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious TB or has a positive TB test.

 

          (j)  All personnel shall complete annual in-service education in the collection station’s:

 

(1)  Policies and procedures on patient’s rights and responsibilities;

 

(2)  Infection control program;

 

(3)  Fire and emergency procedures; and

 

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

 

          (k)  The personnel of the collection station shall consist of phlebotomists or other personnel who are instructed in the collection of specimens from the human body.

 

          (l)  The instruction required in (k) above, shall be accomplished by:

 

(1)  A formal education program; or

 

(2)  On the job training.

 

          (m)  All licensees using the service of independent clinical contractors shall:

 

(1)  Provide the clinical contractors with an orientation as specified in (i)(3) above;

 

(2)  Maintain a copy of a physical examination or health screen and TB testing, mantoux method, that was conducted no more than 12 months prior to employment for each clinical contractor;

 

(3)  Maintain a copy of the clinical contractors’ licenses as required by (i)(2) above, if applicable; and

 

(4)  Have a written agreement with each clinical contractor that describes the services that will be provided and agreement to comply with (1) through (3) above.

 

          (n)  Current and complete personnel files shall be maintained at the licensed premises for all personnel except as allowed by (r) below.

 

          (o)  The personnel file required by (n) above, shall include:

 

(1)  A completed application for employment or a resume;

 

(2)  Qualifications and work experience;

 

(3)  A signed statement acknowledging the receipt of the licensee’s policy setting forth the clients rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(4)  A copy of the results of the criminal record check as described in (a) above;

 

(5)  A signed statement acknowledging compliance with (p) below;

 

(6)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(7)  Record of satisfactory completion of the orientation program required by (i)(3) above;

 

(8)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(9)  Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(10)  Documentation of annual in-service education as required by (j) above; and

 

(11)  The statement(s) required by (p) below.

 

(p)  Unless a waiver has been granted in accordance with (c) above, all personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a client; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

 

          (q)  Personnel records shall be:

 

(1)  Maintained on an individual basis, separate and distinct from other employees and contain only information relating to the specific personnel member; and

 

(2)  Stored in locked containers or cabinets or in a locked room on the premises.

 

          (r)  Personnel records may be stored in a central location provided that:

 

(1)  The personnel record is available to the department at the licensed premises within 30 minutes of being requested; and

 

(2)  The records are maintained in accordance with (o) above.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.   #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.18  Quality Assessment. The collection station or mobile collection station van shall develop and implement a quality assessment program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.19  Infection Control.

 

          (a)  The collection station shall develop and implement an infection control program.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

(4)  The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Wm 2604; and

 

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

 

          (c)  The infection control 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.

 

          (d)  Personnel infected with a disease or illness transmissible through contact, fomites, or droplets shall not have contact with clients until they are no longer contagious.

 

          (e)  Only sterile equipment and containers such as needles, syringes, test tubes, and urine containers used for cultures shall be used when collecting specimens.

 

          (f)  The handling, storing, transporting, or disposing of those items specified as infectious waste in Env-Wm 2604.01 shall be done in accordance with Env-Wm 2604.

 

          (g)  There shall be no use of tobacco products, smoking, eating, drinking, or applying of cosmetics in the areas where specimen collection takes place or where specimens are processed in accordance with 29 CFR § 1910.1030.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

          He-P 817.20  Physical Environment, Emergency and Fire Safety.

 

          (a)  The collection station shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

 

(1)  Building or mobile collection station vans, as applicable;

 

(2)  Health;

 

(3)  Fire; and

 

(4)  Waste disposal.

 

          (b)  The collection station, including mobile collection station vans, shall have all entrances and exits to the licensed premises accessible at all times.

 

          (c)  The collection station shall be clean and maintained in a safe manner and good repair and kept free of hazards.

 

          (d)  All supplies shall be stored in an enclosed storage space.

 

          (e)  All corridors shall be free from obstruction.

 

          (f)  The collection station shall have:

 

(1)  If performing venipuncture, a blood collection chair with a device to prevent client falls or a reclining chair;

 

(2)  If performing venipuncture, a cot or an alternative method that allows a client to lie down in the event of dizziness or illness;

 

(3)  A specimen collection area that:

 

a.  Is separate from the reception area, except for mobile collection station vans that admit only one client at a time;

 

b.  Contains a work counter and hand washing facilities;

 

c.  Measures, at a minimum, 36 square feet (ft.); and

 

d.  Maintains client confidentiality and privacy;

 

(4)  A processing area that, at a minimum, has 6 linear ft. of counter space;

 

(5)  A reception area that includes a desk or counter, chairs, and lighting; and

 

(6)  Access to bathrooms that contain at least one toilet and one hand-washing sink with:

 

a.  A supply of hot and cold running water;

 

b.  Soap dispensers;

 

c.  Paper towels or a hand drying device providing heated air; and

 

d.  Non-porous floors.

 

          (g)  Sterile supplies and equipment shall not be mixed with unsterile supplies and shall be stored in dust-proof, moisture-free storage areas.

 

          (h)  All cleaning supplies shall be stored separately from client supplies.

 

          (i)  Cleaning solutions, compounds, and substances which might be considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be:

 

(1)  Distinctly labeled and legibly marked so as to identify the contents;

 

(2)  Stored in a place separate from food and supplies; and

 

(3)  Kept in an enclosed section separated from other cleaning materials.

 

          (j)  Toxic materials shall not be used in a way that contaminates equipment or in any way that constitutes a hazard to personnel or other persons, or in any way other than in full compliance with the manufacturer’s labeling.

 

          (k)  The collection station shall notify the department by phone, fax, or e-mail within 24 hours and in writing within 72 hours, of any fire or situation, excluding a false alarm, which requires the evacuation of the licensed premises.

 

          (l)  The written notification under (k) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any person evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (m)  A written emergency plan for fire safety and evacuation shall be adopted and posted in multiple locations throughout the collection station.

 

          (n)  The collection station shall have a fire extinguisher inspected annually by the local fire authority or a certified fire extinguisher maintenance company.

 

          (o)  If the collection station is located in a building where fire evacuation drills are required under Saf-C 6000 or any other state or local ordinance, then the collection station shall participate in those drills.

 

          (p)  If the collection station chooses to remain open during an emergency or disaster, it shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency which shall at a minimum:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to a bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources; and

 

g.  Communications systems;

 

(8)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(9)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(10)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

 

Source.  #5775, eff 1-24-94, EXPIRED: 1-24-00

 

New.  #8410 eff 8-19-05; ss by #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

He-P 817.21  Mobile Collection Station Vans.

 

          (a)  Mobile collection station vans shall be eligible for licensure only if they are:

 

(1)  Operated by a collection station or laboratory that is located in a building or other permanent structure; and

 

(2)  The collection station or laboratory has a valid license issued by the department.

 

          (b)  Each applicant shall comply with He-P 817, except for He-P 817.07(a)-(e) and:

 

(1)  In lieu of He-P 817.04(a)(1)-(3) and (5)-(7), each applicant shall submit:

 

a.  A copy of the applicant’s current collection station or laboratory license;

 

b.  A valid New Hampshire motor vehicle registration for the mobile collection station van;

 

c.  The VIN of the mobile collection station van; and

 

d.  A space utilization diagram for the mobile collection station van; and

 

(2)  Personnel, client, and facility records that are stored off site shall be available for inspection at the licensed premises upon request of licensing staff within 30 minutes of being requested.

 

          (c)  The collection station portions of the mobile collection station van shall have a non-porous floor.

 

          (d)  Detailed written documentation of travel dates, times and locations, including periods of non-use, shall be maintained for the mobile collection station van.

 

Source.  #8853, eff 3-24-07, EXPIRED: 3-24-15

 

New.  #10830, INTERIM, eff 5-25-15, EXPIRES: 11-21-15; ss by #10979, eff 11-20-15

 

PART He-P 818  ADULT DAY PROGRAMS

 

          He-P 818.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all adult day programs (ADPs) pursuant to RSA 151:2, I(f).

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating an ADP, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.03  Definitions.

 

(a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a participant;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to a participant; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a participant with or without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and self-management of medications.

 

          (c)  “Administer” means “administer” as defined by RSA 318:1.

 

          (d)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises.

 

          (e)  “Admission” means accepted by a licensee for the provision of services to a participant.

 

          (f)  “Adult Day Program (ADP)” means a program that provides one or more of the following services, for fewer than 12 hours a day, to participants 18 years of age and older:

 

(1)  Supervision;

 

(2)  Assistance with ADL;

 

(3)  Nursing care;

 

(4)  Rehabilitation;

 

(5)  Recreational, social, cognitive, and physical stimulation; and

 

(6)  Nutrition.

 

          (g)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J.

 

          (h)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an ADP pursuant to RSA 151:2, I(f).

 

(i)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 818, or other federal or state requirements.

 

(j)  “Assessment” means an evaluation of the participant to determine the care and services that are needed.

 

          (k)  “Care plan” means a written guide developed by the licensee, in consultation with personnel, the participant, and the participant’s guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

 

          (l)  “Change of ownership” means a change in the controlling interest in an ADP to a successor business entity.

 

          (m)  “Chemical restraint” means any medication prescribed to control a participant’s behavior or emotional state without a supporting diagnosis or when used for the convenience of personnel.

 

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

 

          (o)  “Core services” means those minimal services to be provided by the licensee that are included in the basic rate.

 

          (p)  “Critical Incident Stress Management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (q)  “Days” means calendar days unless otherwise specified in the rule.

 

          (r)  “Department” means the New Hampshire department of health and human services.

 

          (s)  “Direct care personnel” means any person providing hands-on care or services to a participant.

 

          (t)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (u)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (v)  “Exploitation” means the illegal use of a participant’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a participant through the use of undue influence, harassment, duress, deception, or fraud.

 

          (w)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the participant’s health care and other personal needs.

 

          (x)  “Household member” means the caregiver, all family members, and any other individuals age 17 or older, who is not a participant, who have resided at the licensed premises for more than 30 days.

 

          (y)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (z)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (aa) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 818, or to respond to allegations of non-compliance with RSA 151 or He-P 818.

 

          (ab)  “License” means the document issued by the department to an applicant at the start of operation as an ADP which authorizes operation in accordance with RSA 151 and He-P 818, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and the license number.

 

          (ac)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the ADP is licensed.

 

          (ad)  “Licensed practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician's assistant;

 

(3)  Licensed 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.

 

          (ae)  “Licensed premises,” means the building, or portion(s) thereof, that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.

 

          (af)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151 and He-P 818.

 

          (ag)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ah)  “Mechanical restraint” means locked, secured, or alarmed ADPs or units within an ADP, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a participant from freely exiting the ADP or unit within.

 

          (ai)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (aj)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a participant.

 

          (ak)  “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a participant.

 

          (al)  “Orders” means written prescriptions, instructions for treatments, special diets, or therapies given by a licensed practitioner, or other professional with prescriptive powers.

 

          (am)  “Over-the-counter medications” means non-prescription medications.

 

          (an)  “Participant” means any person, over the age of 18, admitted to or in any way receiving care, services, or both, from an ADP licensed in accordance with RSA 151 and He-P 818.

 

          (ao)  “Participant record” means a separate file maintained for each person receiving care and services, which includes all documentation required by RSA 151 and He-P 818, and all documentation received relative to the participant as required by other federal and state requirements.

 

          (ap)  “Patient rights” means the privileges and responsibilities possessed by each participant provided by RSA 151:21. This term includes “participant rights.”

 

          (aq)  “Personal assistance” means providing or assisting a participant in carrying out activities of daily living.

 

          (ar)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the participant for a specific, limited purpose, or for the general purpose of assisting a participant in the exercise of any rights.

 

          (as)  “Personnel” means individual(s), either paid or volunteer, including independent contractors, who provide direct or indirect care or services or both to a participant.

 

          (at)  “Physical restraint” means the use of a hands-on or other physically applied technique to physically limit the participant’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (au)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

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

 

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

 

          (ax)  “Protective care” means the provision of participant monitoring services, including but not limited to:

 

(1)  Knowledge of participant whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (ay)  “Reportable incident” means an occurrence of any of the following while the participant is either in the ADP or in the care of ADP personnel:

 

(1)  The unanticipated death of the participant;

 

(2)  An injury to a participant, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the particpant; or

 

(3)  The elopement or unexplained absence of a participant from the ADP.

 

          (az)  “Self administration of medication with assistance” means the participant takes his or her own medication(s) after being prompted by personnel but without requiring physical assistance from others.

 

          (ba)  “Self administration of medication without assistance” means the participant is able to take his or her own medication(s) without the assistance of personnel, including prompting.

 

          (bb)  “Self-directed medication administration” means a participant, who has a physical limitation that prohibits him or her from self administration of medication, with or without assistance, directs personnel to physically assist in the medication process which shall not include assisting with injections or filling insulin syringes.

 

          (bc)  “Senior center” means a community based entity that provides meals, recreational activities, wellness programs, transportation, or other services for seniors but provides no services that require licensure under RSA 151.

 

          (bd)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a participant.

 

          (be)  “Significant change” means a change in a participant’s cognitive or physical capabilities that decreases his or her ability to care for himself or herself beyond an episodic event.

 

          (bf)  “Unexplained absence” means an incident involving a participant leaving the premises of the ADP without the knowledge of the ADP personnel.

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (May 2017 edition), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.”;

 

b.  For any ADP to be newly licensed on or after July 1, 2016:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any ADP to be newly licensed on or after July 1, 2016 and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

 

(2)  A floor plan of the prospective ADP;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, XX, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name and qualifications of the ADP administrator;

 

(6)  Copies of applicable licenses, certificates, or both, for the ADP administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the day-care occupancies chapter of National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a health care facility; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project;

 

(8)  If the ADP uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, administrator, and household members.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 818.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 818.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 818.13(b) if, after reviewing the information in He-P 818.19(b)-(d), it determines that the applicant, administrator, or any household member:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety or well-being of participants.

 

(f)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (g)  Following both a clinical and life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 818.

 

          (h)  If an applicant is still found not to be in compliance with RSA 151 and He-P 818 after a second onsite inspection, the application shall be denied and a new application with the applicable fee shall be required.

 

          (i)  If the applicant does not provide the items required by the written notice in (b) above within 90 days of the notice, the application shall be closed and a new application with applicable fees shall be required.

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 818.04(a)(1) at least 120 days prior to the expiration of the current license.

 

          (c)  The licensee shall submit with the renewal application:

 

(1)  The materials required by He-P 818.04(a)(1) and (4);

 

(2)  The current license number;

 

(3)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 818.10(f), as applicable;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 818.19(e); and

 

(5)  A statement identifying any variances applied for or granted by the state fire marshal.

 

          (d)  In addition to (c) above, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (e)  Following an inspection as described in He-P 818.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (c) above, and (d) above as applicable, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 818 at the renewal inspection.

 

(f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license shall be required to submit an application for initial license pursuant to He-P 818.04.

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

 

          He-P 818.07  ADP Construction, Modifications, or Structural Alterations.

 

          (a)  Notice and accurate architectural plans or drawings that show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use, shall be submitted to the department at least 60 days prior to the start of construction or initiating any structural modifications to a building, for the following:

 

(1)  A new building;

 

(2)  Additions to a building;

 

(3)  Alterations that require approval from local or state authorities; and

 

(4)  Modifications that might affect compliance with the health and safety, fire, or building codes, including but not limited to, fire suppression, detection systems, and means of egress.

 

(b)  Architectural, sprinkler, and fire alarm plans shall be submitted to the NH state fire marshal’s office as required by RSA 153:10-b, V.

 

(c)  Any licensee or applicant who wants to use performance-based standards to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (d)  The department shall review plans for construction, modifications, or structural alterations of an ADP for compliance with all applicable sections of RSA 151 and He-P 818 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

 

          (e)  Department approval shall not be required prior to initiating construction, modifications, or structural alterations, however an applicant or licensee who proceeds prior to receiving approval shall do so at their own risk.

 

          (f)  The ADP shall comply with all applicable licensing regulations when doing construction, modifications, or alterations.

 

          (g)  A licensee or applicant constructing, modifying, or structurally altering a building shall comply with the following:

 

(1)  The state fire code, Saf-C 6000, including but not limited to the day care chapter of NFPA 101, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V; and

 

(3)  Local rules, regulations, and ordinances.

 

          (h)  All ADPs newly constructed after the 2017 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Adult Day Care chapter, 2014 edition, as available as noted in Appendix A.

 

(i)  Waivers granted by the department for construction or renovation purposes shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

(j)  Exceptions or variances pertaining to the state fire code referenced in (g)(1) above shall be granted only by the state fire marshal.

 

          (k)  The completed building shall be subject to an inspection pursuant to He-P 818.09 prior to its use.

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.08  ADP Requirements for Organizational Changes.

 

          (a)  The ADP shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name; or

 

(5)  Capacity.

 

          (b)  The ADP shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in the number of participants beyond what was authorized under the initial license.

 

          (c)  When there is a change in address without a change in location, the ADP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the ADP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

(e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless an inspection was conducted within 90 days of the date of the change in ownership and a plan of correction designed to address any areas of non-compliance was submitted and accepted by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of participants; or

 

(4)  A change in licensing classification.

 

(f)  A new license shall be issued for a change in ownership or physical location.

 

(g)  A revised license and license certificate shall be issued for a change in name.

 

(h)  A license certificate shall be issued at the time of initial licensure.

 

(i)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator;

 

(2)  An increase or decrease in the number of participants;

 

(3)  A change in the scope of services provided;

 

(4)  A change in address without a change in physical location; or

 

(5)  When a waiver has been granted.

 

(j)  The ADP shall notify the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator; and

 

(2)  Copies of applicable licenses, certificates, or both, for the new administrator.

 

(k)  Upon review of the materials submitted in accordance with (l) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as specified in He-P 818.15(a)(1).

 

(l)  If the department determines that the new administrator does not meet the qualifications for their position as specified in (k) above, it shall so notify the ADP in writing so that a waiver can be sought or the ADP can search for a qualified candidate.

 

(m)  A restructuring of an established ADP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

(n)  Licenses issued for a change of ownership shall expire on the date the license issued to the previous owner would have expired.

 

          (o)  The ADP shall inform the department in writing via e-mail, fax or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (p)  If a licensee chooses to cease the operation of the ADP, the licensee shall submit written notification to the department at least 30 days in advance.

 

Source.  #5517, eff 11-25-92; ss by #6895, INTERIM, eff
11-26-98, EXPIRED: 3-26-99

 

New.  #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

 

          He-P 818.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 818, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the ADP; and

 

(3)  Any records required by RSA 151 and He-P 818.

 

          (b)  The department shall conduct a clinical and life safety code inspection as necessary to determine full compliance with RSA 151, He-P 818, and other federal or state requirements prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 818.08(g)(1);

 

(3)  A change in the licensee’s physical location;

 

(4)  An increase in the number of participants beyond what was authorized under the current license;

 

(5)  Occupation of space after construction, modifications, or structural alterations; or

 

(6)  The renewal of a license.

 

          (c)  In addition to (b) above the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the ADP is in violation of any of the provisions of He-P 818, RSA 151, or other federal or state requirements.

 

          (e)  If deficiencies were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 818.12(c) within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection in (b) above that the prospective premises is not in full compliance with RSA 151 and He-P 818.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 818 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and participants as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health or safety of the participants; and

 

(3)  Does not affect the quality of participant services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (c) through (e) above.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 818.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the ADP, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 818.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any records that might be relevant and have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  For the licensed ADP, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 818.12(c) if the inspection results in areas of non-compliance being cited.

 

(e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above the department shall issue a written warning to immediately comply with RSA 151 and He-P 818; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 818, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a licensee in accordance with (k) below.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 818;

 

b.  Addresses all areas of non-compliance cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 818 as a result of the implementation of the POC;

 

d.  Identifies the position of the employee responsible for the corrective action; and

 

e.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14 day period but has been unable to do so; and

 

2.  The department determines that the health, safety or wellbeing of a resident will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 818.13(c)(12);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 818.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 818.13(c)(13).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the participants and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 818.13(b); or

 

(3)  Revoke the license in accordance with He-P 818.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution.

 

          (g)  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 or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or the notice to correct if, based on the evidence presented, the statement of findings or notice to correct is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

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

 

          (k)  The department shall impose state monitoring under the following conditions:

 

(1)  The department determines that repeated poor compliance on the part of the facility in areas that may impact the health, safety, or well-being of participants; or

 

(2)  Concern that the conditions in the ADP have the potential to worsen.

 

Source.  #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

 

          He-P 818.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 818 which poses a risk of harm to a participant’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 818.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 818.12(c), (d), and (e);

 

(7)  The licensee is cited a third time under RSA 151 or He-P 818 for the same violation(s) within the last 5 inspections;

 

(8)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (k) below;

 

(9)  Upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 818;

 

(10)  The department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(11)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(12)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 818.14(h), the fine for an applicant, licensee or unlicensed provider shall be $500.00;

 

(4)  For a failure to transfer a participant whose needs exceeds the services or programs provided by the ADP, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 818.11(f), the fine shall be $500.00;

 

(6)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 818.06(b), the fine shall be $100.00;

 

(7)  For a failure to notify the department prior to a change of ownership, in violation of He-P 818.08(a)(1), the fine shall be $500.00;

 

(8)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 818.08(a)(2), the fine shall be $1000.00;

 

(9)  For a failure to notify the department of a change in e-mail address, in violation of He-P 818.08(q), the fine shall be $100.00;

 

(10)  For a failure to allow access by the department to the ADP’s premises, programs, services or records, in violation of He-P 818.09(a), the fine for an applicant, individual, or licensee shall be $2000.00;

 

(11)  For a failure to provide to the department any records maintained by the licensee and required by He-P 818.14(u), the fine for a licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the statment of findings or notice to correct, or by the date of an extension as granted, in violation of He-P 818.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 818.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement or comply with licensee policies, in violation of He-P 818.14(d), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 818.14(c), the fine for a licensee shall be $500.00;

 

(16)  For exceeding the maximum number of occupants, in violation of He-P 818.14(l), the fine for a licensee shall be $500.00; 

 

(17)  For providing false or misleading information or documentation in violation of He-P 818.14(g), the fine shall be $1000.00 per offense;

 

(18)  For a failure to meet the needs of a participant or participants, in violation of He-P 818.14(j)(1), the fine for a licensee shall be $1000.00 per participant;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 818.15(a)(1), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 818.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities as required by He-P 818.09(b)(5), the fine shall be $500, which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that a violation of RSA 151 or He-P 818 has the potential to jeopardize the health, safety or well-being of a participant, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00 per area of non-compliance;

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 818 shall constitute a separate violation and shall be fined in accordance with He-P 818.13(c); and

 

(24)  If the applicant or licensee is making good faith efforts to comply with (4), (5) or (19) above the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following  requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of participants is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 818 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When an ADP’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for at least 5 years, if the enforcement action pertained to their role in the ADP.

 

          (k)  The 5 year period referenced in (j) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if no request for an administrative hearing is requested; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 818.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  RSA 541 shall goern further appeals of department decisions under this section.

 

          (o)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 818.

 

            (p)  Any violations cited for the fire code may be appealed to the state fire marshal, pursuant to RSA 151:6-a, II.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

            He-P 818.14  Duties and Responsibilities of All Licensees.

 

            (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable, including RSA 161-F:49 and He-E 720.

 

            (b)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:20, II.

 

            (c)  The licensee shall define, in writing, the scope and type of services to be provided by the ADP, which shall include, at a minimum, the core services listed in He-P 818.15.

 

            (d)  The licensee shall develop and implement written polices and procedures governing the operation and all services provided by the ADP.

 

            (e)  All policies and procedures shall be reviewed annually and revised as needed.

 

            (f)  The licensee shall assess and monitor the quality of care and service provided to participants on an ongoing basis.

 

            (g)  The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

 

            (h)  The licensee shall not:

 

(1)  Advertise or otherwise represent the program as operating an ADP, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

            (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

            (j)  Licensees shall:

 

(1)  Meet the needs of the participants during those hours that the participants are in the care of the ADP;

 

(2)  Initiate action to maintain the ADP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the ADP;

 

(4)  Appoint an administrator;

 

(5)  Verify the qualifications of all personnel;

 

(6)  Provide sufficient numbers of personnel who are present in the ADP and are qualified to meet the needs of participants during all hours of operation;

 

(7)  Provide the ADP with sufficient supplies, equipment, and lighting to meet the needs of the participants; and

 

(8)  Implement any POC that has been accepted or issued by the department.

 

            (k)  The licensee shall consider all participants to be competent and capable of making health care decisions unless the participant:

 

(1)  Has a guardian appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated.

 

          (l)  The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the licensing certificate.

 

          (m)  The licensee shall not admit a participant whose needs exceed the program and services offered by the ADP.

 

          (n)  If the licensee accepts a participant who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the participants, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (o)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (p)  Any licensee who admits or who has a participant with a diagnosis of dementia, Alzheimer’s disease, or a primary or secondary diagnosis of mental illness shall:

 

(1)  Require all direct care personnel caring for the participant to be trained in the special care needs of participants with dementia, Alzheimer's disease, or mental illness; and

 

(2)  Provide a physical environment that has a safety and security system that prevents a participant from leaving the premises without the knowledge of staff, if the participant:

 

a.  Has wandered from the ADP in the last 60 days;

 

b.  Has had a change in their wandering behavior as determined by the nursing assessment completed in accordance with He-P 818.16(a)(4); or

 

c.  Is a danger to self or to others.

 

          (q)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2) All clinical inspection reports issued in accordance with He-P 818.09(d) and He-P 818.11(d)(1), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345; and

 

(5)  The licensee’s evacuation floor plan identifying the location of and access to all fire exits.

 

          (r)  The licensee shall admit and allow any department representative to inspect the ADP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 818 as authorized by RSA 151:6 and RSA 151:6-a.

 

            (s)  Licensees shall:

 

(1)  Fax to 271-5574 or, if a fax machine is not available, convey by electronic or regular mail, the following information to the department within 48 hours of a reportable incident:

 

a.  The ADP name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of participant(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  Whether the participant’s guardian or agent, if any, or personal representative was notified; and

 

i.  The signature of the person reporting the reportable incident;

 

(2)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(3)  Contact the department immediately by telephone, fax, or e-mail to report the death of any participant or the death of any participant who dies within 10 days of a reportable incident;

 

(4)  Provide the information required by (3) above in writing within 72 hours of the death of any participant if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made;

 

(5)  Immediately notify the local police department, the department, guardian, agent, or personal representative if any, when a participant has an unexplained absence after the licensee has searched the building and the grounds of the ADP; and

 

(6)  Submit additional information if required by the department.

 

          (t)  A licensee shall, upon request, provide a participant or the participant’s guardian or agent, if any, with a copy of his or her participant record pursuant to the provisions of RSA 151:21, X.

 

          (u)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (v)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of participants and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to participants and staff; and

 

(3)  Systems to prevent tampering with information pertaining to participants and staff.

 

          (w)  The licensee shall develop policies and procedures regarding the release of information contained in participant records.

 

          (x)  The licensee shall provide cleaning and maintenance services, as needed to protect participants, personnel, and the public.

 

          (y)  The building housing the ADP shall comply with all state and local:

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

          (z)  If the ADP is not on a public water supply, the water used in the ADP shall be suitable for human consumption, pursuant to Env-Dw 702.02 and Env-Dw 704.02.

 

          (aa)  The licensee shall determine whether smoking will be allowed at the ADP.

 

          (ab)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:68 and RSA 155:69.

 

          (ac)  If the licensee holds or manages a participant’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other participants, or other household members.

 

          (ad)  At the time of admission the licensee shall give a participant and the participant’s guardian, agent, or personal representative, if applicable, a listing of all ADP’s charges and identify what care and services are included in the charge.

 

          (ae)  The charge for core services described in He-P 818.15 shall be included in the basic rate and shall not be charged separately.

 

          (af) The licensee shall give a participant and the participant’s guardian, agent, or personal representative, if applicable, a 30-day written notice before any increase is imposed in the cost or fees for any ADP services.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.15  Required Services.  Each ADP shall provide, at a minimum, the following core services and programs:

 

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

 

(1)  Is at least 21 years of age;

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

          (b)  Nursing services that:

 

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

 

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

 

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

 

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

 

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

 

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

 

(3)  Provide the following:

 

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

 

b.  Nutritional monitoring;

 

c.  Care management or referral to a case manager;

 

d.  Referrals to community service agencies when necessary; and

 

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

 

          (c)  Recreational activity services that include:

 

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

 

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

 

          (d)  Personal care services that include:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

(3)  Emergency response and crisis intervention;

 

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

 

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

 

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

 

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

 

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

 

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

 

          (g)  Dietary services that include:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Source.  #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

 

          He-P 818.16  Care Requirements.

 

          (a)  At the time of admission, personnel of the ADP shall:

 

(1)  Provide, both verbally and in writing, to the participant, guardian, agent, and personal representative, as applicable:

 

a.  The ADP’s policies on participant rights and responsibilities;

 

b.  The scope and type of services to be provided by the ADP;

 

c.  The ADP’s complaint procedure and rules; and

 

d.  Obtain written confirmation acknowledging receipt of these policies and rules;

 

(2)  Collect and record in the participant record the following information:

 

a.  Participant’s name, home address, home telephone number, and date of birth;

 

b.  Name, address, and telephone number of an emergency contact;

 

c.  Participant’s primary licensed practitioner’s name, address, and phone number;

 

d.  Copies of any executed legal directives such as guardianship orders for health care issues under RSA 464-A, durable power of attorney, or a living will; and

 

e.  The name of the participant’s guardian, agent, or personal representative, if any;

 

(3)  Require the participant to have a physical examination by a licensed practitioner that has been completed no more than one year prior to admission or within 72 hours after admission and includes:

 

a.  Diagnoses, if any;

 

b.  The medical history;

 

c.  Medical findings, including the presence of communicable disease;

 

d.  Vital signs;

 

e.  Prescribed and over-the-counter medications;

 

f.  Allergies, if any;

 

g.  Dietary needs, if any; and

 

h.  Functional abilities and limitations;

 

(4)  Have the RN, or LPN who is directly or indirectly supervised by an RN, complete a nursing assessment within 7 days of attendance to determine the level of services required by the participant;

 

(5)  Have the administrator, licensed nurse, or activities coordinator complete a recreational assessment;

 

(6)  Have the administrator, licensed nurse, or social worker complete a social history;

 

(7)  Complete an emergency data sheet that, at a minimum, lists the following information:

 

a.  The participant's full name, address, telephone number, and date of birth;

 

b. The name, address, and telephone number of the participant's family or the person legally responsible for the participant;

 

c.  The participant’s diagnosis;

 

d.  Medications administered to or by the participant at the ADP, including the last dose taken and when;

 

e.  Any known allergies;

 

f.  The participant's functional level and needs requirements as assessed by the ADP staff;

 

g.  Copies of any advanced directives, guardianship, or durable powers of attorney, if applicable;

 

h.  The participant’s health insurance information; and

 

i.  Any other pertinent information not specified in a.-h. above; and

 

(8)  Obtain orders from a licensed practitioner for medications, prescriptions, and diets.

 

          (b)  A written daily medication record shall be utilized for all medication taken by participants at the ADP.

 

          (c)  A care plan shall be completed within the first 30 days of attendance based upon the results of all of the participant’s assessments listed above and shall include:

 

(1)  The date any specific problem or need was identified;

 

(2)  A description of services to let caregivers and personnel know what problem(s) or need(s) was identified as a result of the assessments;

 

(3)  The goals for the participant;

 

(4)  The action or approach to be taken by the ADP to meet needs identified by the assessment(s);

 

(5)  The party responsible for implementing the action or approach to be taken;

 

(6)  The date the next re-evaluation is to occur; and

 

(7)  Written documentation to verify that the participant, family, or caregiver was offered the opportunity to be involved in the development of the care plan and any revisions made thereafter.

 

          (d)  The licensed nurse and other personnel as deemed necessary by the licensed nurse shall review the care plan at least every 6 months and revise it whenever necessary.

 

          (e)  The care plan referenced in (c) above shall be:

 

(1)  Reviewed and updated within 5 business days following the completion of each future assessment; and

 

(2)  Made available to personnel who assist participants in the implementation of the plan.

 

          (f)  If the nursing assessment, developed in accordance with (a)(4) above, or the care plan, developed in accordance with (c) above, is completed by an LPN, the assessment and care plan shall be reviewed and co-signed by an RN or physician that is supervising the LPN prior to the implementation of the participant’s care plan.

 

          (g)  The direct care personnel of the ADP shall implement the care plan.

 

          (h)  The participant record shall contain written notes as follows:

 

(1)  Notes on all medical, nursing, rehabilitative, or therapeutic care and services provided at the ADP shall include the:

 

a.  Date and time that the care or services were provided;

 

b.  Description of the care or services provided;

 

c.  Participant’s response to the care or services provided; and

 

d.  Signature and title of the person providing the care or service;

 

(2)  Progress notes shall include at a minimum:

 

a.  Care plan outcomes;

 

b.  Changes in the participant’s physical, functional, and mental abilities;

 

c.  Changes in behavior;

 

d.  Summary of protective care that has been provided; and

 

e.  Summary of assistance provided with ADLs; and

 

(3)  Progress notes in (2) above shall be written at least every 30 days for the first 90 days and then quarterly thereafter.

 

          (i)  The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX.

 

          (j)  Immediately after the use of a physical or chemical restraint, the participant’s guardian or agent, if any, and the department shall be notified of the use of such restraints.

 

          (k)  The ADP shall:

 

(1)  Have policies and procedures on the use of restraints in an emergency:

 

a.  What type of restraints may be used;

 

b.  When restraints may be used; and

 

c.  What personnel may authorize the use of restraints, which shall be limited to the administrator, medical director, director of nursing, and other licensed personnel; and

 

(2)  Provide personnel with education and training on the limitations and the correct use of restraints.

 

          (l)  The use of mechanical restraints shall be allowed.

 

          (m)  The participant shall be discharged, as defined under RSA 151:19, I-a, in accordance with RSA 151:26 and RSA 151:21, V.

 

          (n)  The licensee shall develop a discharge plan for each participant with the input of the participant and the guardian or agent, if any.

 

          (o)  Transfers to a medical facility for emergency medical treatment may occur without prior notification to the guardian, agent pursuant to an activated POA, or the licensed practitioner, when the participant is in need of immediate emergency care.

 

          (p)  For each participant accepted for care and services at the ADP, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  The written confirmation required by He-P 818.16(a)(1);

 

(2)  The identification data required by He-P 818.16(a)(2);

 

(3)  Consent and medical release forms, as applicable;

 

(4)  The record of a physical examination as required by He-P 818.16(a)(3);

 

(5)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

 

(6)  All assessments;

 

(7)  All care plans, including documentation that the participant or person legally responsible participated in the development of the care plan if they chose to;

 

(8)  All written notes required by He-P 818.16(h);

 

(9)  All daily medication records;

 

(10)  A discharge plan as required by He-P 818.16(n);

 

(11)  The emergency data sheet required by He-P 818.16(a)(7);

 

(12)  Documentation of reportable incidents involving the participant, including the information required by He-P 818.14(s); and

 

(13)  Documentation of the refusal of a participant to follow the prescribed orders of the licensed practitioner including the date and time the licensed practitioner was notified of the refusal.

 

          (q)  Participant records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the ADP’s personnel.

 

          (r)  Participant records shall be retained for a minimum of 4 years after discharge.

 

          (s)  Prior to the ADP cessation of operations, it shall arrange for the storage of and access to participant records for 4 years after the date of closure, which shall be made available to the department and past participants, their designees, or both upon request.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.17  ADP Located in Senior Centers, Nursing Homes, Assisted Living Residence –Residential Care (ALR-RC), or Supported Residential Health Care Facilities (SRHCF).

 

          (a)  In addition to complying with all other rules in He-P 818, an ADP that is physically located in a senior center, nursing home, ALR-RC, or SRHCF shall meet the following physical environment requirements:

 

(1)  At least one room in the senior center, nursing home, ALR-RC, or SRHCF physical environment shall be designated as the licensed ADP; and

 

(2)  The room(s) in the senior center, nursing home, ALR-RC, or SRHCF that has been designated as the licensed ADP shall:

 

a.  Be of a size no less than 200 square feet;

 

b.  Be used exclusively by the participants and staff of the ADP;

 

c.  Have a designated medication storage area;

 

d.  Have a designated storage area for medical supplies and equipment; and

 

e.  Have a bathroom that:

 

1.  Is handicapped accessible;

 

2.  Contains a toilet, hand-washing sink, paper towels or hand drying blower, soap dispenser, and a shower; and

 

3.  Is located on the same floor as the ADP.

 

          (b)  In addition to the requirements in (a) above, all ADPs located in a senior center, nursing home, ALR-SRHC, or SRHCF shall provide a recliner or a regular or twin sized bed that is designated specifically for rest or sleep and available in an area that is used exclusively for ADP participants to accommodate each participant who requires rest or sleep during the time they are present throughout the day.

 

          (c)  All beds shall be changed with clean linens between uses when used by different participants or, if using recliners, sanitized and disinfected as needed if soiled.

 

          (d)  Required services provided by an ADP that is physically located in a senior center, nursing home, ALR-SRHC, or SRHCF shall be provided by ADP personnel in the room(s) designated as the licensed ADP.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.18  Medication Services.

 

          (a)  All medications shall be administered in accordance with the orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the participant within 24 hours or in accordance with the licensed practitioner’s direction.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the ADP;

 

(2)  Reorder medications for use at the ADP;

 

(3)  Receive and record new medication orders; and

 

(4)  Report any observed adverse reactions to medication, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error to the paticipant’s licensed provider and guardian, if applicable.

 

          (d)  For each prescription medication being taken by a participant, the licensee shall maintain one of the following:

 

(1)  The original written order in the participant’s record, signed by a licensed practitioner or other professional with prescriptive powers; or

 

(2)  A copy of the original written order in the participant’s record, signed by a licensed practitioner or other professional with prescriptive powers.

 

          (e)  Each medication order shall display the following information:

 

(1)  The participant’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 PRN medications; and

 

(5)  The dated signature of the ordering practitioner.

 

(f)  The label of all medication containers maintained in the ADP shall match the current written orders of the licensed practitioner.

 

          (g)  Pharmaceutical samples shall be:

 

(1)  Used in accordance with the licensed practitioner’s written order;

 

(2)  Labeled with the participant’s name by the licensed practitioner, the licensee, or their designee; and

 

(3)  Exempt from (e)(2)-(5) above.

 

          (h)  Only a pharmacist shall make changes to the labels on prescription medication container labels.

 

          (i)  Any change or discontinuation of medications taken at the ADP shall be pursuant to a written order from a licensed practitioner or other professional with prescriptive powers.

 

          (j)  When the licensed practitioner or other professional with prescriptive powers changes the dose of a medication and the personnel of the ADP are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker, that does not cover the pharmacy label, in a manner consistent with the ADP’s written procedure indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1)-(2) above shall be allowed:

 

a.  For a maximum of 90 days from the date of the new medication order;

 

b.  Until the medications in the marked container are exhausted; or

 

c.  In the case of PRN medication, until the expiration date on the container, whichever occurs first.

 

          (k)  If the ADP has a medical director, either on staff or otherwise contracted, prescription medication that is not ordered, approved, or labeled for a specific participant, including but not limited to pharmaceutical samples, may be kept at the ADP.

 

          (l)  The medication in (k) above shall be the responsibility of the medical director.

 

          (m)  Only a licensed nurse or other licensed health care professional shall take telephone orders for medications, treatments, and diets, if such action is within the scope of their practice act.

 

          (n)  Telephone orders specified in (m) above shall be:

 

(1)  Immediately transcribed and signed by the individual receiving the order; and

 

(2)  Counter-signed by the authorized prescriber within 30 days.

 

          (o)  OTC medications shall be handled in the following manner:

 

(1)  The licensee shall obtain written approval from the participant’s licensed practitioner annually; and

 

(2)  OTC medication containers shall be marked, with the name of the participant using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (p)  The medication storage area for medications shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each participant's medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (q)  All medication taken by participants at the ADP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

          (r)  A licensed nurse may organize participant medications for use in the participant’s home as allowed by RSA 318:42, XIV.

 

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

 

          (t)  If controlled drugs, as defined by RSA 318-B:1, VI, are stored in a central storage area in the ADP, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (u)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (v)  Except as required by (x) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, at the end date of a licensed practitioner’s orders, or when the medication becomes contaminated, whichever occurs first.

 

          (w)  Controlled drugs shall be destroyed only in accordance with state law.

 

          (x)  Destruction of controlled drugs under (w) above shall:

 

(1)  Be accomplished in the presence of at least 2 people; and

 

(2)  Be documented in the participant’s medication record for whom the drug was prescribed.

 

          (y)  Upon discharge, a participant, or the participant’s guardian or agent, may take the participant’s current medication(s) with them.

 

          (z)  Neither the licensee nor any other personnel working for the ADP shall accept money, goods, or services for free or below cost as compensation or inducement for supplying the participant’s medications.

 

          (aa)  A written order from a licensed practitioner shall be required annually for any participant who is authorized to carry and self-administer without assistance emergency medications such as nitroglycerine or inhalers.

 

          (ab)  Participants shall receive their medications in one of the following manners:

 

(1)  Self administration of medication without assistance;

 

(2)  Self-directed medication administration;

 

(3)  Self administration of medication with assistance; or

 

(4)  Administered by individuals authorized by law.

 

          (ac)  For participants who self administer medication without assistance, as defined in He-P 818.03(ba), the licensee shall:

 

(1)  Obtain a written order from a licensed practitioner on an annual basis:

 

a.  Authorizing the participant to self administer medications without assistance;

 

b.  Authorizing the participant to store the medications in their possession; and

 

c.  Identifying the medications that may be kept by the participant;

 

(2)  Evaluate the participant every 6 months or sooner, based on a significant change in the participant, to ensure they maintain the physical and mental ability to self-administer medication without assistance;

 

(3)  Have the participant store the medication(s) in a manner that prohibits other people from accessing the medications and in a manner that will maintain the medications at proper temperatures; and

 

(4)  Allow the participant to fill and utilize a medication system that does not require medication to remain in the container as dispensed by the pharmacist.

 

          (ad)  The licensee shall allow the participant to self-direct medication administration, as defined in He-P 818.03(bb), if the participant:

 

(1)  Has a physical limitation due to a diagnosis that prevents the participant from self administration of medication, with or without assistance;

 

(2)  Receives evaluations every 6 months or sooner based on a significant change in the participant, to ensure the participant maintains the physical and mental ability to self-direct medication administration;

 

(3)  Obtains an annual written verification of their physical limitation and self-directing capabilities from the participant’s licensed practitioner and requests the ADP to file the verification in their participant record; and

 

(4)  Verbally directs personnel to:

 

a.  Assist the participant with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

 

b.  Assist the participant to apply, ingest, or instill the ordered dose of medication.

 

          (ae)  Personnel assisting with self-directed medication administration, other than those permitted by their licensing board to administer medications, shall not be permitted to assist with injections or filling insulin syringes.

 

          (af)  If a participant self-administers medication with assistance, as defined by He-P 818.03(az), personnel shall be permitted to:

 

(1)  Remind the participant to take the correct dose of his or her medication at the correct time;

 

(2) Open the medication container and place the medication container within reach of the participant;

 

(3) Remain with the participant to observe them taking the prescribed dose and type of medication as ordered by the licensed practitioner;

 

(4)  Record on the participant’s medication record that they have supervised the participant taking their medication; and

 

(5)  Document in the participant record any observed or reported side effects or adverse reactions, any refusal to take medications, and any medications not taken.

 

          (ag)  If a participant self-administers medication with assistance, personnel shall not be permitted to physically handle the medication in any manner.

 

          (ah)  Medication administered by individuals authorized by law to administer medication shall be:

 

(1)  Prepared immediately prior to administration; and

 

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

 

          (ai)  Personnel shall remain with the participant until the participant has taken all of the medication.

 

          (aj)  If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall:

 

(1)  Only delegate medications that are administered by mouth;

 

(2)  Document in the individual’s personnel file the evaluation method and tools used to determine that the individual receiving the delegation of medication administration has the necessary skills to administer medication;

 

(3)  Document in the individual’s personnel file that the individual continues to be delegated the task of administering medication, based on the nurse’s ongoing evaluation;

 

(4)  Document in the individual’s personnel file any notice that the delegation of medication administration has been rescinded, if applicable; and

 

(5)  Document in the participant record the:

 

a.  Specific medication to be administered;

 

b.  Dosage, route, and specific time that the medication is to be administered;

 

c.  The names of personnel to whom the nurse has delegated responsibility for the administration of medications; and

 

d.  The results of the nurse’s assessment, completed no more than 30 days prior to the delegation occurring, that determined that the participant’s condition is stable and that the participant is appropriate for receipt of medication administration via nurse delegation.

 

          (ak)  A licensed nursing assistant (LNA) may administer the following when under the direction of the licensed nurse employed by the ADP:

 

(1)  Medicinal shampoos and baths;

 

(2)  Glycerin suppositories and enemas; and

 

(3)  Medicated topical products to intact skin as ordered by the licensed practitioner.

 

          (al)  Except for those participants who self-administer medication without assistance, the licensee shall maintain a written record for each medication taken by the participant at the ADP that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers or assists the participant taking medication;

 

(5)  For PRN medications, the reason the participant required the medication and the effect of the PRN medications; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (am)  Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a participant with self administration of medication with assistance, self-directed medication administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

 

          (an)  The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, or other person who has undergone training by a licensed nurse, licensed practitioner, or pharmacist.

 

          (ao)  The medication supervision education program required by (am) above shall include:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The “5 rights” of medication administration which are:

 

a.  The right participant;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as anti-hypertensives or antibiotics;

 

(5)  Desired effects and potential side effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (ap)  The administrator may accept documentation of training required by (am) above if it was previously obtained by the applicant for employment at another facility licensed under RSA 151.

 

          (aq)  Non-prescription stock medication may be kept at the ADP, but it shall be accessed and administered only by the licensed nurse or medication nurse assistant on duty.

 

          (ar)  An ADP shall use emergency drug kits only in accordance with NH pharmacy board rules, Ph 705.03, under circumstances where the ADP:

 

(1)  Has a director of nursing who is a registered nurse licensed in accordance with RSA 326-B;

 

(2)  Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318; and

 

(3)  Has the contents approved in writing by the licensed medical director.

 

          (as)  The licensee shall conduct an annual review of its policies and procedures for self administration of medication without assistance, self administration of medication with assistance, and self-directed medication administration.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.19  Personnel.

 

          (a)  The licensee shall develop a job description for each position in the ADP containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Education and experience requirements of the position.

 

          (b)  All applicants for a license shall obtain a criminal record check from the New Hampshire department of safety in accordance with RSA 151:2-d.

 

          (c)  For all applicants for employment, except, pursuant to RSA 151:2-d, VI, those licensed by the New Hampshire board of nursing, for all volunteers and independent contractors who will have direct contact with participants, and for all household members, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety;

 

(2)  Review the results of the criminal records check in accordance with (d) below; and

 

(3)  Verify the qualifications of all applicants prior to employment.

 

          (d)  Unless a waiver is granted in accordance with (e) below, the licensee shall not offer employment for any position or allow a household member to continue to reside in the ADP if the individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

 

(3)  Has been found by the department or any administrative agency in this or any other state to have committed assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of participants.

 

          (e)  The department shall grant a waiver of (d) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of participants.

 

          (f)  If the information identified in (d) above is learned after the person is hired or after an individual becomes a household member, the licensee shall immediately notify the department.

 

          (g)  The department shall review the information in (d) above and notify the licensee that the individual can no longer be employed or, if a household member, can no longer reside at the premises if, after investigation, it determines that the individual poses a threat to the health, safety, or well-being of a participant.

 

          (h)  The licensee shall check the names of the following people against the bureau of elderly and adult services (BEAS) state registry, maintained pursuant to RSA 161-F:49 and He-W 720, and against the NH board of nursing, nursing assistant registry, maintained pursuant RSA 326-B:26 and 42 CFR 483.156:

 

(1)  All household members;

 

(2) All volunteers and independent contractors prior to having any direct contact with participants; and

 

(3)  All prospective employees, prior to hiring.

 

          (i)  The licensee shall not permit any volunteer or independent contractor to have direct contact with participants or make a final offer of employment to any prospective employee listed on the BEAS state registry or the NH board of nursing, nursing assistant registry unless a waiver is granted by BEAS or the NH board of nursing, respectively.

 

          (j)  All personnel including volunteers and independent contractors shall:

 

(1)  Meet the requirements of the position as listed in the job description described in (a) above, as applicable;

 

(2)  Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department;

 

(3)  Be licensed, registered, or certified as required by state statute;

 

(4)  Be at least 18 years of age if working as direct care personnel unless they are:

 

a.  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

b.  Involved in an established educational program working under the supervision of a nurse; and

 

(5)  Receive an orientation within the first 3 days of work including:

 

a.  The ADP’s policies on participant rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The ADP’s policies, procedures, and guidelines;

 

d.  The ADP’s infection control program;

 

e.  The ADP’s fire and emergency plans; and

 

f.  Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

 

          (k)  All personnel shall complete annual continuing education, including a review of the ADP’s:

 

(1)  Policies and procedures relative to participant rights and complaint procedures as required by RSA 151:20;

 

(2)  Infection control program;

 

(3)  Education program on fire and emergency procedures; and

 

(4)  Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

 

          (l)  There shall be at least one personnel member on duty who has current certification in adult cardio pulmonary resuscitation (CPR) equivalent to basic life support from either the American Red Cross or the American Heart Association whenever the ADP is in operation.

 

          (m)  Prior to having contact with participants or food, personnel, including volunteers and independent contractors, shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (n)  In lieu of (m)(1) above, independent contractors hired by the ADP may provide the ADP with a signed statement that they have complied with (m)(1) and (3) above for their employees working at the ADP.

 

          (o)  All licensees using the services of independent clinical contractors, such as a podiatrist, shall:

 

(1)  Have a written agreement with each clinical contractor that describes the services that will be provided; and

 

(2)  Maintain a copy of the clinical contractors’ licenses as required by (j)(3) above if applicable.

 

          (p)  All personnel shall follow the orders of the licensed practitioner for each participant and encourage participants to follow the practitioner’s orders.

 

          (q)  Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the licensed ADP premises for all personnel of the ADP.

 

          (r)  The personnel file required by (q) above shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data, including date of birth; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the ADP’s policy setting forth the participant rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (j)(5) above;

 

(5)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(6)  Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Copies of current CPR certifications;

 

(8)  Information as to the general content and length of all continuing education or educational programs attended;

 

(9)  Documentation of annual continuing education as required by (k) above;

 

(10)  A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

 

a.  Do not have a felony conviction in this or any other state;

 

b.  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect or exploitation;

 

c.  Have not been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect or exploitation of any person; and

 

d.  Do not otherwise pose a threat to the health, safety or well-being of participants; and

 

(11)  Documentation of the criminal records check.

 

          (s)  An individual need not re-disclose any of the matters in (r)(10) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (t)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

Source.  #9106, eff 3-18-08; ss by #9565, eff 10-16-09; ss by #12198, eff 6-2-17

 

          He-P 818.20  Quality Improvement.

 

          (a)  The ADP shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The licensee shall determine the size and composition of the quality improvement committee based on the size of the ADP and the care and services offered.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored, which at a minimum shall include;

 

a.  Reportable incidents;

 

b.  Complaints, to include resident, family, guardian, and staff concerns;

 

c.  Falls;

 

d.  Participant and staff conflicts; and

 

e.  Medication delivery;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the ADP; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

          (e)  If the ADP utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review, including:

 

(1)  The participant average daily census;

 

(2)  The number of unlicensed personnel administering medications via nurse delegation;

 

(3)  Categories of medications administered;

 

(4)  Route of administration; and

 

(5)  Any incidents or medication errors and actions taken.

 

          (f)  The quality improvement committee shall meet at least quarterly.

 

          (g)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (h)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.21  Infection Control.

 

          (a)  The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of participants with infectious or contagious diseases or illnesses who can safely participate in the program;

 

(4)  The handling, transport, and disposal of those items identified as infectious waste in Env-Sw 103.28; and 

 

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

 

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

 

(1)  Cause of infection;

 

(2)  Effect of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (d)  Personnel infected with a disease or illness transmissible through food, saliva, or droplets shall not work in food service or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to participants or work in food services until such time as they are no longer infected.

 

          (f)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the individual is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

(h)  In accordance with RSA 151:9-b, the licensee shall:

 

(1) Arrange for or provide all consenting participants an immunization for influenza and pneumococcal disease;

 

(2)  Arrange for or provide all consenting personnel an immunization for influenza; and

 

(3)  Report immunization data to the department’s division of public health services, bureau of infectious disease control as required by RSA 151:9-b, III.

 

          (i)  If the ADP has an incident of an infectious diseases reported in (b)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.22  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment throughout the licensed ADP premises.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions such as temperature regulation shall be taken to prevent a scalding injury to the participants.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All participant bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place separate from food, medications, and program supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides as defined by RSA 430:29, XXVI, for rodent or cockroach control in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying.

 

          (l)  Trash receptacles in food service area shall be covered at all time.

 

          (m)  If the ADP provides laundry services, the following requirements shall be met:

 

(1)  The laundry room shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

 

(n)  Laundry rooms and bathrooms shall have non-porous floors.

 

(o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

 

(p)  Any ADP that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the NH department of environmental services, shall notify the department upon receipt of notice of a failed water test.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.23  Physical Environment.

 

          (a)  The licensed premises shall be maintained so as to provide for the health, safety, well-being, and comfort of participants and personnel, including reasonable accommodations for participants and personnel with mobility limitations.

 

          (b)  Equipment providing heat within an ADP including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature of at least 70 degrees Fahrenheit during the day if participant(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (c)  Electric heating systems shall be exempt from (b)(2) above.

 

          (d)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (e)  Unvented fuel-fired heaters shall not be used in any ADP.

 

          (f)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (g)  Ventilation shall be provided by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (h)  Screens shall be provided for doors, windows, or other openings to the outside.

 

          (i)  Doors that are self-closing and remain closed when not in use are exempt from the requirement in (h) above.

 

          (j)  Lighting shall be available to allow participants to partake in activities such as reading, needlework, or handicrafts.

 

          (k)  The ADP shall have dining facilities to accommodate each participant.

 

          (l)  The ADP shall have a telephone to which the participants have access.

 

          (m)  All ADPs shall have at least one toilet and one hand sink and as many additional toilets and sinks as are necessary to meet the needs of the participants in the program.

 

          (n)  Each bathroom shall be equipped with:

 

(1)  Soap dispensers;

 

(2)  Paper towels or a hand-drying device providing heated air;

 

(3)  Hot and cold running water; and

 

(4)  Grab bars next to toilets.

 

          (o)  All showers and tubs shall have grab bars and slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (p)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (q)  All ADPs newly licensed after 3/18/2008 shall have at least one shower or bathing facility and as many additional showers or bathing facilities as are necessary to meet the needs of the participants in the program.

 

          (r)  There shall be sufficient space and equipment for the services provided at the ADP, as follows:

 

(1)  Furniture to allow for each participant to sit comfortably as necessary throughout the day;

 

(2)  Tables and chairs to assure that each participant has a seat at a table for each meal or snack and for doing activities such as crafts or puzzles; and

 

(3)  Supplies such as plates, cups, glasses, silverware, liquid soap for hand washing, toilet tissue, and paper towels in a supply to accommodate the number of participants authorized by the license.

 

          (s)  In addition to the requirements in (r) above, all ADPs shall provide a recliner, cot, or bed available in an area designated specifically for rest or sleep to accommodate each participant who requires rest or sleep during the time they are present throughout the day.

 

          (t)  All cots or beds shall be changed with clean linens between uses when used by different participants or, if using recliners, sanitized and disinfected as needed if soiled.

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.24  Fire Safety.

 

          (a)  All ADPs shall meet the requirements of the day care chapter of NFPA 101 as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (b)  All ADPs shall have:

 

(1)  Smoke detectors on every level that are interconnected and either hardwired, powered by the ADP’s electrical service, or wireless, as approved by the state fire marshal;

 

(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, and which meets the following requirements:

 

a.  Maximum travel distance to each extinguisher shall not exceed 50 feet;

 

b. 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;

 

c.  Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

 

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

 

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

 

(3)  A carbon monoxide monitor on every level. 

 

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

 

          (d)  Immediately following any fire or emergency situation, licensees shall notify the department by phone and follow-up with written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  EMS transport related to known pre-existing conditions.

 

          (e)  The written notification required by (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injuries to participants or personnel or damage sustained by the ADP;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or participants who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or participants who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (f)  All freestanding tanks of compressed gases shall be firmly secured to the adjacent wall or secured in a stand or rack.

 

          (g)  Flammable gases and liquids shall be stored in metal fire retardant cabinets.

 

          (h)  Pursuant to RSA 155:68 and 69, if the licensee has chosen to allow smoking, a designated smoking area shall be provided which, at a minimum:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non-combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64–77, the Indoor Smoking Act.

 

          (i)  Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire condition.

 

          (j)  Evacuation drills shall be conducted monthly and vary in time to include all personnel.

 

          (k)  All personnel shall participate in at least one drill quarterly.

 

          (l)  For personnel who are unable to participate in the scheduled drill described in (k) above, on the day they return to work the administrator or designee shall, if applicable, instruct them as to any changes in the facility’s fire and emergency plan and document such instruction in their personnel file.

 

          (m)  Personnel who are unable to participate in a drill in accordance with (j) and (k) above shall participate in a drill within the next quarter. 

 

          (n)  Per-diem or temporary personnel shall not be the only person on duty unless they have:

 

(1)  Participated in at least 2 actual fire drills in the facility in the past year; and

 

(2)  Participated in the facility’s orientation program pursuant to He-P 818.19(j)(4).

 

          (o)  All emergency and evacuation drills shall be documented and include the following information:

 

(1)  The names of the personnel and participants involved in the evacuation;

 

(2)  The time, date, month, and year the drill was conducted;

 

(3)  The exits utilized if the ADP does not comply with the health care chapter of the state fire code;

 

(4)  The total time necessary to evacuate the ADP, if required;

 

(5)  The time needed to complete the drill; and

 

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

 

Source.  #9106, eff 3-18-08, EXPIRED: 3-18-16

 

New.  #12006, INTERIM, eff 10-15-16, EXPIRED: 4-13-17

 

New.  #12198, eff 6-2-17

 

          He-P 818.25  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

          (b)  The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  How the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

          (d)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, missing participants and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(7)  Include a plan for alerting and managing staff in a disaster, and for accessing Critical Incident Stress Management (CISM), if necessary;

 

(8)  Include the management of particpants, particularly with respect to physical and clinical issues to include relocation of participants with their participant record including the medication administration records, if time permits, as detailed in the emergency plan;

 

(9)  Include an educational program for the staff, which provides an overview of the components of the emergency management program, concepts of the ICS, and the staff’s specific duties and responsibilities; and

 

(10)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

(f)  The facility shall contact the local emergency management director annually to determine if any revisions are needed based upon current trends in emergency management, local policy changes, and hazard changes.

 

(g)  Annually, the facility shall participate in a community-based disaster drill which may be a table top discussion drill with outside agencies.

 

(h)  The facility shall review and update its emergency plan, as needed, as a result of drills and exercises, real event(s), and annual plan review.

 

(i)  Notwithstanding (a)-(f) above, when an ADP is a part of a larger institution which has a comprehensive emergency preparedness plan, the ADP may use the institution’s plan, and if so, it shall:

 

(1)  Identify the portions of the plan that pertain to the ADP in a separate document for use by ADP personnel;

 

(2)  Provide annual training to prepare personnel in its application as required by (g) above; and

 

(3)  Review and update the plan as required by (h) above.

 

Source.  #12198, eff 6-2-17

 

PART He-P 819  CASE MANAGEMENT AGENCIES

 

          He-P 819.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all case management agencies (CMA) pursuant to RSA 151:2, I(b).

 

Source.  #5633, eff 5-27-93; ss by #7006, INTERIM, eff
5-26-99, EXPIRED: 9-23-99

 

New.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.02  Scope.  This part shall apply to any agency, partnership, corporation, government entity, association, or other legal entity providing case management services in a client’s place of residence and operating as a case management agency, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i);

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i);

 

          (c)  All licensed healthcare entities, whether residential or non-residential, where case management is a component of the services provided, to include but not limited to hospitals, nursing homes, home health agencies, assisted living facilities, residential rehabilitation, residential psychiatric treatment, substance use disorder residential facilities, non-emergency walk-in care centers, ambulatory surgical centers, end stage renal dialysis centers, community residences, adult day care centers, and hospice care;

 

          (d) Community mental health programs approved in accordance with He-M 403, where case management is a component of the services provided; and

 

          (e)  Area agencies designated in accordance with He-M 505, where case management is a component of the services provided.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients without their informed consent.

 

          (b)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the CMA.

 

          (c)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker as identified under RSA 137-J:35.

 

          (d)  “Applicant” means an, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a CMA pursuant to RSA 151.

 

          (e) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 819, or any other federal or state requirements.

 

          (f)  “Assessment” means an evaluation of the client to determine the care and services that are needed.

 

          (g)  “Branch office” means a location physically separate from the primary location that provides client services under the administration and supervision of the primary location of the CMA.

 

          (h)  “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the client, and the client’s guardian, agent, or personal representative, as a result of the assessment process for the provision of care and services as required by He-P 819.15(b)(2).

 

          (i)  “Case management agency (CMA)” means an organization in consultation with the client in the client’s place of residence, arranges for and coordinates the delivery of care and services to meet the physical, emotional, medical, nursing, financial, legal, and social services needs of the client.

 

          (j)  “Case manager” means a person who provides case management services for an eligible individual and who is responsible for the ongoing assessment, coordination and monitoring of services to a client and is employed by a case management agency.

 

          (k)  “Case management supervision” means the provision of professional oversight and guidance of case manager performance by:

 

(1)  Monitoring and oversight of case manager interactions and courses of action with the individuals for whom the case manager provides case management services;

 

(2)  Monitoring and oversight of a case manager’s service implementation activities including a review of all complex clients at least once per quarter;

 

(3)  Written evaluation of a case manager’s performance at least annually;

 

(4)  Identifying corrective action to improve a case manager’s performance; and

 

(5)  Teaching and training case managers to enhance quality of case management service delivery as well as providing current choices for independence (CFI) program information.

 

          (l)  “Change of ownership” means the transfer in the controlling interest of an established CMA to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

          (m)  “Client” means any person admitted to or in any way receiving services from a CMA licensed in accordance with RSA 151 and He-P 819.

 

          (n)  “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

 

          (o)  “Client record” means a separate file maintained for each client, which includes all documentation required by RSA 151, He-P 819, and any other federal and state law.

 

(p)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or their designee.

 

          (q)  “Community residence” means a facility of 4 or more individuals that is both certified by the department under RSA 126-A and licensed by the department under RSA 151, and that is operating in accordance with He-M 1001 or He-M 1002.

 

          (r)  “Days” means calendar days unless otherwise specified in the rule.

 

          (s)  “Department” means the New Hampshire department of health and human services.

 

          (t)  “Direct care” means the provision of hands-on care or services to a client.

 

          (u)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee shall take to correct identified deficiencies.

 

          (v)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (w)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 819.

 

          (x)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, or fraud.

 

          (y) “Facility” means “facility” as defined in RSA 151:19, II.

 

          (z)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and other personal needs.

 

          (aa)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 819 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 819.

 

          (ab)  “License” means the document issued to an applicant or licensee of an CMA which authorizes operation in accordance with RSA 151 and He-P 819, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

 

          (ac)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized that the CMA is licensed for.

 

          (ad)  “Licensed 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.

 

          (ae)  “Licensed premises” means the building that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license.  This term includes branch offices but does not include the private residences of a client receiving services from a CMA.

 

          (af)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ag)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services or supports necessary to maintain the mental, emotional or physical health and safety of a client.

 

          (ah)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (ai)  “Personal representative” means a person designated in accordance with RSA 151:19 to assist the client for a specific, limited purpose or for the general purpose of assisting a client in the exercise of any rights.

 

          (aj)  “Personnel” means individual(s) who provide case management services to a client.

 

          (ak)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (al) “Primary location” means the principle site for the CMA where the business office and administrative staff are located.

 

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

 

          (an)  “Psychosocial history” means information about an individual’s past and present functioning in the areas of:

 

(1)  Physical health and capabilities;

 

(2)  Psychological health including emotional and coping abilities;

 

(3)  Social environment, including interactive skills, activities, and supports;

 

(4)  Decision making abilities;

 

(5)  Social and family interactions;

 

(6)  Employment and financial management;

 

(7)  Financial considerations;

 

(8) Vocational interests and activities, including spiritual preferences; and

 

(9)  Other areas of significance, including, but not limited to, substance abuse or misuse, and involvement with the behavioral health care system, the developmental disability system, or the legal system.  

 

          (ao) “Reportable incident” means an occurrence of any of the following while the client is either in the CMA or in the care of CMA personnel:

 

(1) The unanticipated death of the client; or

 

(2) An injury to a client that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client.

 

          (ap) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

 

          (aq) “State Fire Code” means “New Hampshire Fire Code” or “state fire code” as defined in RSA 153:1, VI-a, namely, “the adoption by reference of the Life Safety Code NFPA 101 and the Uniform Fire Code NFPA 1, 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. The provisions of any other national code, model code, or standard referred to within a code listed in this definition shall be included in the state fire code unless amended in accordance with RSA 153:5.”

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III (a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Services” (February 2023), signed by the applicant or 2 of the corporate officers affirming the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

(2)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability company; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(3)  The applicable fee, in accordance with RSA 151:5, XXII payable in cash or,  if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(4)  A resume identifying the qualifications of the CMA administrator;

 

(5)  Copies of applicable licenses for the CMA administrator;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2. The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4. The fire chief verifying that the applicant complies with the state fire code and local fire ordinances; and

 

b. For a building under construction, the written approvals required by a. above shall be submitted at the time of application based on the local official’s review of the building plans and again upon completion of the construction project; and

 

(7) For the applicant(s), licensee, and administrator, the results of a criminal records check. Results shall include criminal history from the state of New Hampshire.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Bureau of Licensing and Certification

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 819.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 819.04, the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 819.13(b) if it determines that the applicant, licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (f)  Following an inspection, as described in He-P 819.09, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 819.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)   written notification of denial, pursuant to He-P 819.13(a), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 819.05(f) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 819, or any applicable federal, state, or local law, regulation, or code.

 

          (i)  A written notification of denial, pursuant to He-P 819.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 819.04(a)(1) at least 120 days prior to the expiration of the current license and shall include the following:

 

(1)  The materials required by He-P 819.04(a)(1), and (3);

 

(2)  The current license number;

 

(3) A request for renewal of any existing waiver previously granted by the department, in accordance with He-P 819.10(f), if applicable;

 

(4)  A list of any current employees for which a waiver was previously granted according to He-P 819.17(c); and

 

(5) A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with the state fire code.

 

          (c)  Following an inspection, as described in He-P 819.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

 

(2)  Submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 819 at the renewal inspection.

 

          (d)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 819.04 be subject to a fine in accordance with He-P 819.13(c)(5).

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.07  Branch Offices.

 

          (a)  CMAs may establish branch offices.

 

          (b)  The CMA shall notify the department in writing prior to operating at an additional location(s).

 

          (c)  The CMA shall submit to the department the information required by He-P 819.04(a)(5) for branch offices.

 

          (d)  Upon receipt of the information required by (b) and (c) above, the department shall issue a revised annual license certificate to reflect the addition of the branch offices provided the additions do not violate RSA 151 or He-P 819.

 

          (e)  All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.08  CMA Requirements for Organizational Changes.

 

          (a)  The CMA shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Primary physical location of the licensed premises;

 

(3)  Address;

 

(4)  Branch locations;

 

(5)  Name; or

 

(6)  Services.

 

(b)  If there is a name change, the CMA shall submit to the department, a copy of the certificate or amendment from the New Hampshire secretary of state, if applicable.

 

(c)  The CMA shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating, for:

 

(1)  A change in ownership; or

 

(2)  A change in the physical location.

 

(d)  When there is a change in address without a change in location, the CMA shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

(e)  When there is a change in address due to a physical location change, the CMA shall provide the department with:

 

(1)  A letter which contains the license number, new address, and date of the move; and

 

(2)  Local approval form as specified in He-P 819.04(a)(6).

 

(f)  An inspection by the department shall be conducted prior to operation when there is a change in the following:

 

(1)  The ownership, unless the current licensee is in full compliance, then an inspection shall be conducted as soon as practical by the department; or

 

(2)  A change in services.

 

          (g)  A new license shall be issued for a change in ownership or a change in physical location.

 

          (h)  A revised license and license certificate shall be issued for a change in name.

 

          (i)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  When a waiver has been granted;

 

(3)  A change in the scope of services; or

 

(4)  When a branch office has been added.

 

          (j)  The CMA shall inform the department in writing no later than 5 days prior  to a change of administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring a change of administrator, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  Copies of applicable licenses for the new administrator;

 

(3)  The results of a criminal records check for the new administrator. Results shall include criminal history from the state of New Hampshire;

 

(4)  The results of a bureau and elderly adult services registry check; and

 

(5)  A signed attestation per He-P 819.17(j)(8)a-d.

 

          (k)  Upon review of the materials submitted in accordance with (j) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position, as outlined in He-P 819.15(a).

 

          (l)  If the department determines that the new administrator does not meet the qualifications of the position, as specified in He-P 819.15(a) it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (m)  A restructuring of an established CMA that does not result in a transfer of the controlling interest of the CMA, but which might result in a change in the name of the CMA, shall not constitute a change in ownership and a new license shall not be required.

 

          (n)  The CMA shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable but in no case later than 10 days after the change. The CMA’s email address shall be the primary method of correspondence used for all emergency notifications to the CMA.

 

          (o)  If a licensee chooses to cease the operation of a CMA, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 819, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the CMA; and

 

(3)  Any records required by RSA 151 and He-P 819.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 819 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 819.08(g)(1);

 

(3) The renewal of a license; or

 

(4)  The verification of the implementation of any POC accepted or issued by the department as part of an annual or follow-up inspection.

 

          (c)  A statement of findings for inspections shall be issued when, as a result of any inspection, the department determines that the CMA is in violation of any of the provisions in He-P 819, RSA 151, or any other federal or state requirement.

 

          (d)  If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 819.12(c), within 21 days of the date of the letter that transmitted the inspection report.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 819 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought; and

 

(4)  The period of time for which the waiver is sought if less than permanent.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health or safety of the clients; and

 

(3)  Does not affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.11  Complaints.

 

          (a)  The department shall investigate complaints that meet the following conditions:

 

(1) The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 819.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the CMA, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 819.

 

          (c)  Investigations shall include all techniques and methods for gathering information, which are appropriate to the circumstances of the complaint, including:

 

(1)  Requests for additional information from the complainant or the licensee;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For the licensed CMA, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation; and

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate; and

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under He-P 819, or does not violate any statutes, rules, or regulations; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 819.12(c).

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e); 

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

 

(3) If the response described in (e)(2) is not received within 7 days from the date of receipt of

the notice described in (e)(1) and in accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 819;

 

(4)  The warning in (e)(3) above, shall include:

 

a. The time frame within which the owner or person responsible shall comply with the directives of the warning;

 

b. The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the CMA; and

 

c. The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

 

(5)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 819.13.

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 819 or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings, the licensee shall submit a written POC which shall contain the following:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area(s) of non-compliance does not recur; to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 819;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings;

 

c.  Prevents a new violation of RSA 151 or He-P 819 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the deficiencies shall be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, either verbally or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

(8)  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 819.13;

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an on-site follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 819.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 819.13.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 819.13; or

 

(3)  Revoke the license in accordance with He-P 819.13(b)(6).

 

          (f) The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department in a statement of findings, provided that the applicant or licensee submits a written request for informal dispute resolution.

 

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

 

          (h) The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i) The deadline to submit a POC in accordance with He-P 819.12(c)(2) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j) Informal dispute resolution shall not be available to any applicant or licensee against whom the department has imposed an administrative fine or initiated an action to revoke, deny, or refuse to issue or renew a license.

 

          (k)  The department shall impose state monitoring if repeated non-compliance on the part of the agency occurs in areas that negatively impact the health, safety, or well-being of clients.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of a fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area(s) of non-compliance has been corrected, or a  POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated RSA 151 or He-P 819, in a manner that posed a risk of  harm to a client’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of, and given an opportunity to supply missing information, or schedule an initial inspection an applicant or licensee fails to submit an application that meets the requirements of He-P 819.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 819.12(c), (d) and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 819.12(c)(5) and has not submitted a revised POC as required by He-P 819.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 819 for the same violation(s) within the last 5 inspections;

 

(9)  A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (i) and (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 819;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of, or plead guilty to, felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or has had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant or licensee has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines on unlicensed individuals, applicants, or licensees as follows:

 

(1)  For failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

 

(2)  For failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, licensee, or unlicensed entity shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 819.11(e)(4), the fine for an unlicensed entity or licensee shall be $500.00;

 

(5)  For failure to submit a renewal application for a license prior to its expiration date, in violation of He-P 819.06(d), the fine shall be $100.00;

 

(6)  For failure to notify the department prior to a change of ownership, in violation of He-P 819.08(a)(1), the fine shall be $500.00;

 

(7)  For failure to notify the department prior to a change in the physical location, in violation of He-P 819.08(a)(2), the fine shall be $1000.00;

 

(8) For failure to notify the department of a change in e-mail address, in violation of He-P 819.08(o), the fine shall be $100.00;

 

(9)  For failure to allow the department access to the CMA’s premises, programs, services, or records, in violation of He-P 819.09(a), the fine for an applicant, licensee , or unlicensed entity shall be $2000.00;

 

(10)  For failure to submit a POC within 21 days of the date on the letter that transmits the inspection report or a revised POC within 14 days of the date of a granted extension, in violation of He-P 819.12(c)(2) or He-P 819.12(c)(5), the fine for a licensee shall be $500;

 

(11)  For failure to implement or maintain the corrective action set forth in any POC or revised POC that has been accepted or issued by the department, in violation of He-P 819.12(c)(8), the fine for a licensee shall be $1000.00;

 

(12)  For failure to establish, implement, or comply with licensee policies, as required by He-P 819.14 (e), the fine for a licensee shall be $500.00;

 

(13)  For providing false or misleading information or documentation to the department, in violation of He-P 819.14(g), the fine shall be $1000.00 per offense;

 

(14)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver, in violation of He-P 819.15(a) or He-P 819.17(g), the fine for a licensee shall be $500.00;

 

(15)  When an inspection determines that a violation of RSA 151 or He-P 819  for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a. If the same areas of non-compliance is cited within 2 years of the original areas of non-compliance the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

 

(16)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 819 shall constitute a separate violation and shall be fined in accordance with He-P 819.13(f); and

 

(17)  If the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 819 as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment to the department of any imposed fine(s) shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order, made payable to the “Treasurer, State of New Hampshire”, or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 819 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (k)  When a CMA’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the enforcement action pertained to their role in the CMA. 

 

          (l)  The 5 year period referenced in (k) above shall begin on:

 

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

 

(2) The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (m)  Notwithstanding (l) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and

He-P 819.

 

          (n) If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (o)  No ongoing enforcement action shall preclude the imposition of any other remedy available to the department under RSA 151, RSA 541-A, or He-P 819.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.14  Duties and Responsibilities of All Licensees.

 

          (a)  The CMA shall not provide direct care to any client unless it is also:

 

(1)  Certified by the department as an other qualified agency in accordance with RSA 161-H and He-E 601; or

 

(2)  Licensed by the department as a home care service provider or a home health care provider in accordance with RSA 151 and He-P 822 or He-P 809, respectively.

 

          (b)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, as applicable.

 

          (c)  The licensee shall comply with the home care clients’ bill of rights as set forth in RSA 151:21-b.

 

          (d)  The licensee shall define, in writing, the scope and type of services to be provided by the CMA.

 

          (e)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the CMA to include but not limited to:

 

(1)  Complaint policy;

 

(2)  Documentation and records management;

 

(3)  Release of information;

 

(4)  Case management supervision protocol;

 

(5)  Evaluation, training, and competency of personnel;

 

(6)  Case management practice and services; and

 

(7)  Quality improvement program, as required by He-P 819.18.

 

          (f)  All policies and procedures shall be reviewed annually and revised as needed.

 

          (g)  The licensee or any personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (h)  The licensee shall not:

 

(1)  Advertise or otherwise represent the program as operating a CMA, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (j)  Licensees shall:

 

(1)  Initiate action to maintain the CMA in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(2)  Appoint an administrator; and

 

(3)  Implement any POC that has been accepted or issued by the department.

 

          (k)  The licensee shall consider all clients competent and capable of making health care decisions unless the client:

 

(1)  Has a guardian appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated.

 

          (l)  A licensee shall provide a client or their guardian, agent, or personal representative with a copy of their client record pursuant to the provisions of RSA 151:21-b, II(i), upon request.

 

          (m)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (n)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (o) Client records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the CMA’s personnel.

 

          (p)  Client records shall be retained for a minimum of 4 years after discharge.

 

          (q)  Prior to the CMA ceasing operation, it shall arrange for the storage of and access to client records for 4 years after the date of closure, which shall be made available to the department and past clients upon request.

 

          (r)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 819.09(b) and He-P 819.11(c), for the previous 12 months;

 

(3)  A copy of the home care clients’ bill of rights specified by RSA 151:21-b;

 

(4)  A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints may also be made, which shall also be posted on the CMA’s website if available;

 

(5) A copy of the licensee’s policies and procedures relative to the implementation of client rights and responsibilities;

 

(6) A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to:

 

Department of Health and Human Services

Bureau of Licensing and Certification

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 603-271-9039; and

 

(7) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to, all fire exits.

 

          (s)  The licensee shall admit and allow any department representative to inspect the CMA and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 819 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (t)  At the time of admission, the licensee shall give a client and their guardian, agent, or personal representative, if applicable, a listing of all CMA’s charges and identify what services are included in the charge.

 

          (u)  The licensee shall give a client a written notice before any increase is imposed in the cost or fees for any CMA services.

 

          (v)  In the event of an emergency, the CMA shall inform local emergency officials of clients in need of evacuation.

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.15  Required Services.

 

          (a)  The licensee shall provide an administrator who:

 

(1)  Is at least 21 years of age;

 

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

 

a.  A bachelor’s degree from an accredited institution in business or a health care field such as nursing or social work and at least 2 years of related experience; or

 

b.  Is a registered nurse (RN), licensed in New Hampshire, with at least 2 years of related experience;

 

(3)  Is responsible for the day to day operation of the CMA services; and

 

(4)  Hires staff necessary to assist in maintaining regulatory compliance.

 

          (b)  Case managers shall be responsible:

 

(1)  For the completion of an assessment that includes a psychosocial history;

 

(2)  For the development of a care plan in conjunction with the client and their agent, if applicable;

 

(3)  For the coordination of services identified in the care plan and ensuring that providers hold all required licenses or registrations, as applicable;

 

(4)  For the monitoring of services to determine that services identified in the care plan are provided according to the timeframes and frequencies identified in the care plan and are meeting the client’s needs;

 

(5)  To document changes in a client’s needs and to develop recommendations for changes in the care plan as appropriate;

 

(6) For conducting a risk assessment for any client whose condition, behavior or other circumstances represent a risk to the individual, person(s) providing services or others; and

 

(7)  For documenting all case management services provided and their outcomes.

 

          (c)  For reportable incidents, the licensee shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 603-271-4968 or, if a fax machine is not available, convey by electronic mail to hfa-licensing@dhhs.nh.gov, or regular mail, the following information to the bureau of licensing and certification within 48 hours of a reportable incident:

 

a.  The CMA name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the

reportable incident;

 

d.  The name of the client(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom, and the date and time;

 

h.  When the clients’ guardian, agent, or personal representative, was notified;

 

i.  The signature of the person reporting the reportable incident;

 

j.  The date and time the client’s licensed practitioner was notified, if applicable; and

 

k.  The date the CMA performed the investigation required by (1) above;

 

(3)  As soon as practicable, notify the guardian, agent, or personal representative; and

 

(4)  Notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.16  Client Services.

 

          (a)  At the time of admission, personnel of the CMA shall:

 

(1)  Provide, both orally and in writing, to the client, guardian, agent, and personal representative, as applicable:

 

a.  A copy of the home care clients’ bill of rights;

 

b.  The CMA’s complaint procedure and rules; and

 

c.  Documentation to verify receipt of these policies and rules; and

 

(2)  Collect and record the following information:

 

a.  Client’s name, home address, and home telephone number;

 

b.  Client’s date of birth;

 

c.  Name, address, and telephone number of an emergency contact;

 

d.  Name of client’s primary care provider with the address and telephone number;

 

e.  Copies of all legal directives such as durable power of attorney, legal guardian, living will, or documentation of the request; and

 

f.  Written and signed consent for the delivery of services and the release of information.

 

          (b)  Each client shall have an initial assessment prior to the development of the care plan.

 

          (c)  Each client shall have a review of needs whenever the case manager, client, or guardian, agent or personal representative determine that the services provided are no longer required or not meeting the client’s needs.

 

          (d)  The care plan shall be developed by the case manager and the client or client’s guardian, agent or personal representative.

 

          (e)  For each client accepted for care and services by the CMA, a current and accurate record shall be maintained that includes, at a minimum:

 

(1)  The written confirmation required by (a)(1) above;

 

(2)  The identification data required by (a)(2) above;

 

(3)  Consent and medical release forms, as required by (a)(2)f. above;

 

(4)  The record of assessments and reviews as required by (b) and (c) above;

 

(5) All care plans, including documentation that the client, guardian, agent or personal representative participated in the development of the care plan if they choose to;

 

(6)  A copy, initialed by the client and/or the client’s guardian, agent or personal representative, of all charges and services to be provided as required by He-P 819.14(r); and

 

(7)  Documentation of all contacts with the client and/or the client’s guardian, agent or personal representative, with service providers identified in the client’s care plan, and with anyone else involved with the client’s care plan.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.17  Personnel.

 

          (a)  The licensee shall develop a job description for each position in the CMA containing:

 

(1)  Duties of the position; and

 

(2)  Education and experience requirements of the position.

 

          (b)  For all applicants for employment, the licensee shall:

 

(1)  Obtain and review a criminal records check in accordance with RSA 151:2-d. Results shall include criminal history from the state of New Hampshire ;

 

(2) Verify that the potential employee is not listed on the State Registry maintained by the department’s bureau of elderly and adult services (BEAS) per RSA 161-F:49. The licensee shall not employ any person who is listed on the BEAS state registry unless a waiver is granted by BEAS;

 

(3)  Require the employee to submit the results of a physical examination or pre-employment health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(4)  Allow the employee to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

 

(5)  Comply with the requirements of the United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition) available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (c)  Unless a waiver is granted in accordance with (d) below, the licensee shall not offer employment for any position if the individual:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation or any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (d)  The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

 

          (e)  Waivers granted under (d) above shall be permanent as long as the individual is employed by the CMA.

 

          (f)  All personnel shall:

 

(1)  Meet the requirements of the position as listed in the job description required by (a) above;

 

(2)  Be licensed, registered, or certified as required by state statute; and

 

(3)  Receive an orientation within the first 3 business days of work that includes:

 

a.  The CMA’s policies on client rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The CMA’s policies, procedures, and guidelines;

 

d.  The CMA’s emergency plans; and

 

e.  Mandatory reporting requirements such as those found in RSA 161-F:42-57 and RSA 169-C:29.

 

          (g)  Comply with all dementia training requirements pursuant to RSA 151:47-49, including continuing education, as applicable.

 

          (h)  Such continuing education in (g) above shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1) A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

(2) A minimum of 4 hours of ongoing training each calendar year.

 

          (i) All personnel shall complete annual continuing education, which shall include a review of the CMA’s policies and procedures relative to client rights and complaint procedures.

 

          (j)  Current, separate, and complete personnel files shall be maintained and stored in a secure and confidential manner at the licensed premises for all personnel of the CMA.

 

          (k)  The personnel file required by (j) above shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  A signed statement acknowledging the receipt of the CMA’s policy setting forth the client’s rights and responsibilities, and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  Record of satisfactory completion of the orientation program required by (f)(3) above;

 

(4)  A copy of each current New Hampshire license, registration, or certification in health care field, if applicable;

 

(5)  Documentation that the required TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(6)  Documentation of annual continuing education as required by (j) above;

 

(7)  Documentation of the BEAS state registry check and the criminal record check; and

 

(8)  A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel stating that they:

 

a.  Do not have a felony conviction in this or any other state;

 

b.  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft abuse, neglect, or exploitation;

 

c.  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; and

 

d.  Do not pose a threat to the health, safety, or well-being of a client.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He-P 819.18  Quality Improvement.

 

          (a)  The CMA shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established containing a minimum of the administrator and one employee.

 

          (c)  The quality improvement committee shall:

 

(1)  Determine the indicators to be monitored and ensure that indicators reflect the clinical requirements of He-P 819;

 

(2)  Determine the frequency with which information shall be reviewed;

 

(3)  Evaluate the information that is gathered;

 

(4)  Develop and implement the action necessary to correct identified problems; and

 

(5)  Evaluate the effectiveness of the corrective actions.

 

          (d)  The quality improvement committee shall meet at least annually and record the minutes of each meeting.

 

          (e)  Documentation of all quality improvement activities, including minutes of meetings, shall be confidential in accordance with RSA 151:13-b.

 

Source.  #10260, eff 1-25-13; ss by #13709, eff 8-1-23

 

          He‑P 819.19  Physical Environment and Fire Safety.

 

          (a)  The licensee shall comply with all applicable federal, state, and local laws, rules, codes, and ordinances for:

 

(1)  Building;

 

(2)  Health, including waste disposal and water;

 

(3)  Fire; and

 

(4)  Zoning.

 

          (b)  The CMA shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (c)  The CMA shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

 

          (d)  Each licensee shall develop a written emergency plan that covers any situation that prevents the CMA from safely providing client services and which:

 

(1)  Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergencies to include, but not be limited to, a bomb threat;

 

(2)  Is available to all personnel;

 

(3)  Is based on realistic conceptual events;

 

(4)  Includes the CMA's response to both short-term and long-term interruptions in the availability of utility service for the licensed premises during the disaster or emergency, including establishing contingency plans for continuum of care:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources; and

 

f.  Communications systems;

 

(5)  Includes a plan for alerting and managing personnel in a disaster;

 

(6)  Includes a policy detailing the responsibilities of personnel for responding to an emergency during provision of case management services;

 

(7)  Includes an educational, competency-based program for personnel to provide an overview of the components of the emergency management program and the personnel’s specific duties and responsibilities; and

 

(8)  If the CMA is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

 

          (e)  Each licensee shall annually review and revise, as needed, its emergency plan.

 

Source.  #13709, eff 8-1-23

 

PART He-P 820  INDIVIDUAL HOME CARE SERVICE PROVIDERS

 

          He-P 820.01  Purpose.  The purpose of this part is to set forth the mandatory registration requirements for all individuals who solicit and provide health support services, personal care services, or homemaker services for compensation pursuant to RSA 151:2-b, V.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.02  Scope.

 

          (a)  This part shall apply to any individual who solicits and provides health support services, personal care services, or homemaker services except:

 

(1)  Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H and He-P 601;

 

(2)  Home care service provider agencies that are licensed under He-P 822;

 

(3)  Agencies or entities that are licensed under He-P 809;

 

(4)  Persons providing only meal services in an individual’s permanent or temporary residence;

 

(5)  Persons furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment and educate the user on its proper use;

 

(6)  Persons who provide health support services, personal care services, or homemaker services without compensation;

 

(7)  Persons who provide health support services,  personal care services, or homemaker services for compensation, but who do not solicit those services;

 

(8)  Persons who provide health support services, personal care services, or homemaker services only to a family member(s); and

 

(9)  Persons under the age of 18 who provide health support services, personal care services, or homemaker services.

 

          (b)  Employees of an agency in (a)(1)-(3) above who solicit and provide health support services, personal care services, or homemaker services for compensation outside the scope of their employment shall not be exempt from registration as an individual home care service provider.

 

          (c)  Because RSA 151:2, V, requires registration for an individual home care service provider to operate, and RSA 541-A:1, VIII, defines a “license” as a “form of permission required by law”, even if called “registration”, then requirements in RSA 151 which refer specifically to “license” or “licensing” shall also apply to the registration of individual home care service providers.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1) “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of a client;

 

(2) “Physical abuse” means the misuse of physical force which results or could result in physical injury to a client; or

 

(3) “Sexual abuse” means contact or interaction of a sexual nature involving a client with or without his or her informed consent.

 

          (b) “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Administrative remedy” means a corrective action imposed upon a registrant in response to non-compliance with RSA 151 or He-P 820.

 

          (d)  “Applicant” means an individual who is seeking a “registration certificate” in order to operate as a registered individual home care service provider under RSA 151:2-b, V.

 

          (e) “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a registrant to be out of compliance with RSA 151, He-P 820, or other federal or state requirements.

 

          (f)  “Client” means any person receiving services from an individual who is registered in accordance with RSA 151 and He-P 820.

 

          (g)  “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

 

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

 

          (i)  “Days” means calendar days unless otherwise specified in the rule.

 

          (j)  “Department” means the New Hampshire department of health and human services at 129 Pleasant Street, Concord, NH 03301.

 

          (k)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation, or suspension of a license in response to non-compliance with RSA 151 or He-P 820.

 

          (l)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

 

          (m) “Health support services” means non-medical supportive services that can be taught to the IHCSP by a client or caregiver, and do not require the skills of a licensed individual.

 

          (n)  “Homemaker” means an individual whose scope of services is limited to providing homemaker services as reflected on the registration certificate.

 

          (o)  “Homemaker services” means non-medical services that are of a supportive nature that do not require hands-on contact with a client other than to maintain the client’s safety.  Such services include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, and companion services.

 

          (p)  “Individual home care service provider (IHCSP)” means “individual homecare service provider” as defined in RSA 151:2-b, V, namely “any individual not employed by a home health care provider licensed under RSA 151:2, I(b) who solicits and provides health support services, personal care services, or homemaker services for compensation to clients in their places of residence; provided that the client is not a family member.”  This term includes a registered individual home care service provider under RSA 151:2, V.

 

          (q)  “Investigation” means the process followed by the department to respond to allegations pursuant to RSA 151:6 of non-compliance with RSA 151 and He-P 820.

 

          (r)  “Neglect” means an act or omission which results, or could result, in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a client.

 

          (s)  “Personal care services” means non-medical, hands-on services provided to a client, including, but not limited to, helping with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the client to take medications.

 

          (t)  “Registration” means the mandatory requirement established by RSA 151:9-a, XII, that an individual shall give notice to the department that he or she plans to solicit and provide personal care services or homemaker services for compensation.  The “registration” is certified on a document called a “registration certificate” that authorizes the individual to provide these services for compensation.

 

          (u)  “Registration certificate” means the document issued by the department to an applicant or registrant that includes the name of the registrant and his or her physical address, the effective date and the registration number, any waivers granted to the registrant, upon renewal of a registration the new effective date of the registration, and at the registrant’s option, the registrant’s business name.

 

          (v)  “Solicit” or “solicits” means to advertise through any channel of communication, including, but not limited to audio, video, print, or electronic media, or by word of mouth as an individual home care service provider as defined in RSA 151:2-b, V, and He-P 820, or to actively seek or request compensation for providing individual home care services to a client as defined in RSA 151:2-b, V, and He-P 820.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.04  Initial Registration Application Requirements.

 

          (a)  Each applicant for registration shall comply with the requirements of RSA 151:9-a, XII, and submit the following to the department:

 

(1)  A completed application form entitled “Application for Individual Home Care Service Provider Registration” (January 2023) that is signed by the applicant and which states:

 

“I affirm that I am familiar with and in full compliance with the provisions of RSA 151:2, V, and He-P 820.  I also affirm that I have not been convicted of a felony in this or any other state, have not been convicted for sexual assault, other violent crime, assault, fraud, abuse, neglect, exploitation or any other criminal offense that suggests that they may pose a threat to the health, safety or well-being of a client, and have not been found to have committed assault, fraud, abuse, neglect or exploitation by the department or any other administrative agency in this or any other state.  I understand that providing false information shall be grounds for denial or revocation of my registration and the imposition of a fine.”;

 

(2)  The applicable fee, in accordance with RSA 151:5, XI, payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire.”;

 

(3)  The results of a criminal records check, for the applicant. Results shall include the criminal history from the state of New Hampshire;

 

(4)  The results of the state registry check, which is maintained by the department’s bureau of elderly and adult services pursuant to RSA 161-F:49;

 

(5)  Qualifications, including education, experience and copies of all applicable licenses for the administrator; and

 

(6) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable.

 

          (b)  The application in He-P 820.04(a)(1) shall include the following advisory:

 

“Advisory:  The New Hampshire Department of Health and Human Services is authorized to require all licensed home care providers to read and understand the Home Care Clients’ Bill of Rights set forth in RSA 151:21-b, and to distribute the law to all of their clients.  The Department recommends that all individual homecare service providers read and understand the Home Care Clients’ Bill of Rights and share the information with their clients.”

 

            (c)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.05  Processing of Applications and Issuance of Registrations.

 

          (a)  An application for an initial registration shall be complete when the department determines that all items required by He-P 820.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 820.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any registration fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (d)  Registration fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted in accordance with He-P 820.08, the department shall deny a registration request if it determines that the applicant or registrant:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (f)  Following receipt and review of the application, the registration certificate signed by the commissioner shall be issued to the applicant if the department determines that the application meets all of the requirements in He-P 820.04(a) above.

 

          (g)  Upon receipt of the registration certificate, the individual:

 

(1)  May use the title “registered individual home care service provider”; and

 

(2)  Shall not use the title “licensed individual home care service provider”.

 

          (h)  All registrations issued in accordance with RSA 151 shall be non-transferable by person.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.06  Registration Expirations and Procedures for Renewals.

 

          (a)   A registration shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each registrant shall complete and submit to the department an application form for renewal pursuant to He-P 820.04(a)(1) at least 120 days prior to the expiration date of the current registration.

 

          (c)  Following receipt and review of the renewal application, a registrant shall be renewed if the department determines that the application meets all of the requirements in (b) above.

 

          (d)  Any registrant who does not submit a complete application for renewal prior to the expiration of an existing registration shall be required to submit an application for initial registration pursuant to He-P 820.04.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.07  Requirements for Organizational or Service Changes.

 

          (a)  The registrant shall provide the department with written notice that includes his or her current registration number no later than 30 days after any of the following changes:

 

(1)  Physical address of the registered individual;

 

(2)  Mailing address of the business if different than the physical address in (1) above; and

 

(3)  Name of the individual.

 

          (b)  Upon receipt of the notice set forth in (a) above, the department shall issue a revised registration certificate to the registrant that includes the relevant changes.

 

          (c)  A revised registration certificate shall also be issued when a new waiver has been granted.

 

          (d)  Registration certificates issued under (c) above shall be valid for one year from the date of issuance.

 

          (e)  The IHCSP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the IHCSP.

 

          (f)  If a registrant chooses to cease operation of a IHCSP, the registrant shall submit written notification to the department at least 45 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.  

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.08  Waivers.

 

          (a)  Applicants or registrants seeking waivers of specific rules in He-P 820 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or registrant, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the granting of the waiver will not negatively impact the health, safety, or well-being of clients, or that the waiver is not being granted to one applicant or registrant who is in the same situation as another applicant or registrant whose waiver has been denied.

 

          (d)  Waivers shall not be transferable.

 

          (e) When a registrant wishes to renew a non-permanent waiver beyond the approved period of time, the registrant shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (f)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.09  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 820.     

 

          (b)  When practical, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the IHCSP, or the alleged unregistered individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 820.

 

          (c)  Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the IHCSP;

 

(2)  Physical inspection of the premises;

 

(3)  Review of relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

     (d)  For a registered individual, the department shall:

 

(1)  Provide written notification of the results of the investigation to the registrant;

 

(2)  Provide written notification to the registrant of the corrective action that must be taken to resolve the issues underlying the complaint; and

 

(3)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, if appropriate.

 

            (e)  For an unregistered individual, the department shall provide written notification of the results of the investigation that includes:

 

(1)  The date of investigation;

 

(2)  The reasons for the investigation; and

 

(3)  Whether or not the investigation resulted in a determination that the services being provided require registration under RSA 151:2, V.

 

          (f)  If an individual does not respond to a written notice within 30 days of the date it was sent, or if the department does not agree with the individual’s response, the department shall:

 

(1)  Issue a written warning to immediately comply with RSA 151 and He-P 820; and

 

(2)  Provide notice stating that the individual has the right to appeal the warning in accordance with RSA 151:7-a, III.

 

          (g)  Any individual who fails to comply after receiving a warning as described in (f) above shall be subject to an action by the department for injunctive relief under RSA 151:17.

 

          (h)  The fact that the department takes action for injunctive relief under RSA 151:17 shall not preclude the department from taking other action under RSA 151, He-P 820, or other applicable laws.

 

          (i)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the registrant solely for the purposes of the adjudicative action.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

          He-P 820.10  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 820, or other applicable rules, including:

 

(1)  Requiring a registrant to submit a plan of correction (POC) in accordance with (c) below;

 

(2)  Imposing a directed POC upon a registrant in accordance with (d) below;

 

(3)  Imposing a fine upon an unregistered individual, applicant, or a registrant;

 

(4)  Monitoring of a registrant; or

 

(5)  Revocation of a registration.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the registrant is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that have been proposed.

 

            (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings, the registrant shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the registrant intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The registrant shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the statement of findings or notice to correct unless the registrant requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The registrant demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 820;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 820 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the deficiencies will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a registration certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable, the department shall notify the registrant in writing within 14 days of the reason for rejecting the POC;

 

(6)  The registrant shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the registrant requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The registrant demonstrates that the registrant has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

b.  The department determines that the health, safety, or well-being of a client will not be jeopardized as a result of granting the waiver;

 

(7) The revised POC shall comply with (1) above and be reviewed in accordance with (3) above;

 

(8)  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the registrant shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 820.11(c)(7);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the registrant;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the registrant in the plan; and

 

(11)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the registrant shall be:

 

a.  Notified by the department in accordance with (b) above; and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 820.11(c)(7).

 

            (d)  The department shall develop and impose a directed POC that specifies corrective actions for the registrant to implement when:

 

(1) As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department; or

 

(3)  A revised POC submitted by the registrant or administrator has not been accepted.

 

            (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine according to He-P 820.11(c)(7);

 

(3)  Deny the application for a renewal of a registration in accordance with He-P 820.11(b)(6); or

 

(4)  Revoke or suspend the registration in accordance with He-P 820.11(b).

 

            (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or registrant who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or registrant submits a written request for an informal dispute resolution to the department.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, registrant, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or registrant of the determination.

 

          (i)  An informal dispute resolution shall not be available for any applicant or registrant against who the department has imposed an administrative fine, or initiated action to suspend, revoke, deny, or refuse to issue or renew a registration.

 

          (j)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the IHCSP in areas that impact the health, safety, or well-being of clients; or

 

(2)  The presence of conditions in the IHCSP that negatively impact the health, safety, or well-being of clients.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23; ss by #13531, eff 1-25-23

 

          He-P 820.11  Enforcement Actions and Hearings.

 

          (a)  Prior to imposing a fine, or denying or revoking a registration, the department shall send to the applicant or registrant a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or registrant to a hearing shall be conducted in the same manner as a registrant in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable.

 

          (b)  The department shall deny an application or revoke a registration if:

 

(1)  An applicant or a registrant violated any of the provisions of RSA 151 or He-P 820 in a manner which poses a risk of harm to a client’s health, safety, or well-being;

 

(2)  An applicant or a registrant has failed to pay a fine imposed under administrative remedies;

 

(3)  An applicant or a registrant has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or registrant fails to submit an application that meets the requirements of He-P 820.04;

 

(5)  An applicant, registrant, or any representative of the applicant or registrant:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  A registrant has had a registration revoked and submits an application during the 5-year prohibition period specified in (g) below;

 

(7)  The registrant failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 820.10(d) and (e);

 

(8)  The registrant has submitted a POC that has not been accepted by the department in accordance with He-P 820.10(c)(5) and has not submitted a revised POC as required by He-P 820.10(c)(5);

 

(9)  A registrant, has had a registration revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(10)  Unless a waiver has been granted the department makes a determination that the registrant has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state; or

 

(11) The applicant has had a registration revoked by any division or unit of the department within 5 years prior to the application.

 

            (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unregistered services after being notified by the department of the need for a registration, in violation of RSA 151:2, the fine shall be $200.00 for an applicant or unregistered provider;

 

(2)  For a failure to cease operations after a denial of a registration or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant or unregistered provider or a registrant shall be $200.00;

 

(3)  For advertising services or otherwise representing themselves as having a registration to provide services that they are not registered to provide, in violation of RSA 151:2, III, the fine for an applicant or unregistered provider shall be $50.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 820.09(f), the fine for an unregistered provider or a registrant shall be $50.00;

 

(5)  For a failure to submit a renewal application for a registration prior to the expiration date, in violation of He-P 820.06(b), the fine for a registrant shall be $10.00;

 

(6)  For a failure to allow access by the department to the IHCSP programs, services, patients or records, in violation of He-P 820.09(a)(1)-(3), the fine for an applicant, unregistered individual, or registrant shall be $2000.00;

 

(7)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 820.10(c)(2) and (6), the fine for a registrant shall be $100.00;

 

(8)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 820.10(c)(11), the fine for a registrant shall be $1000.00;

 

(9)  For falsification of information contained on an application, the fine for an applicant or registrant shall be $50.00 per offense;

 

(10)  When an inspection determines that a violation of RSA 151 or He-P 820 has the potential to jeopardize the health, safety, or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a registrant shall be double the original fine, but not to exceed $1000.00; and

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a registrant shall be triple the original fine, but not to exceed $2000.00; and

 

(11)  Each day that the registrant continues to be in violation of the provisions of RSA 151 or HeP 820 shall constitute a separate violation and shall be fined in accordance with He-P 820.10.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or registrant has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or registrant shall have 30 days after issuance of the notice of enforcement action to request a hearing to contest the action.

 

         (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

         (g)  The department shall order the immediate revocation of a registration, the cessation of services, and the transfer of care of clients when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (i)  When an individual’s registration has been denied or revoked, the applicant or registrant shall not be eligible to reapply for a registration for 5 years from:

 

(1)  The date of the department’s decision to revoke or deny the registration became effective, if no request for an administrative hearing is requested; or

 

(2)  The date an order is issued upholding the action of the department, if a request for an administrative hearing was made and a hearing was held.

 

            (j)  The 5-year period referenced in (i) above shall begin on:

 

(1)  The date the department’s decision to revoke or deny the registration, if not filed; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for an administrative hearing was made and a hearing was held.

 

          (k)  Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant should be awarded a waiver under He-P 820.08.

 

          (l)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 820.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

            He-P 820.12  Duties and Responsibilities of All Registrants.

 

          (a) The registrant shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

 

          (b)  The registrant shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (c)  The registrant shall consider all clients to be competent and capable of making all decisions relative to their own service needs unless the client:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J.

 

          (d)  Registrants may remind clients to take their medications, place medication container(s), including pill planners, within client reach, and open the medication container(s).

 

          (e)  The registrant shall comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education that shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1)  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

(2)  A minimum of 4 hours of ongoing training each calendar year.

 

          (f)  The registrant shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The registrant shall not advertise or otherwise represent themselves as providing services not registered to provide, pursuant to RSA 151:2, III.

 

Source.  #10013, eff 10-22-11; ss by #10206, eff 10-20-12; ss by #13531, eff 1-25-23

 

PART He-P 821  EQUIPMENT MANAGEMENT ORGANIZATION PROVIDER REGULATIONS - EXPIRED

 

Source.  #5645, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

PART He-P 822  HOME CARE SERVICE PROVIDER AGENCIES (HCSPA)

 

          He-P 822.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all home care service provider agencies (HCSPA) pursuant to RSA 151:9-a, XI.

 

Source.  #5629, eff 5-26-93; ss by #7006, INTERIM,
eff 5-26-99, EXPIRED: 9-23-99

 

New.  #9522, eff 7-25-09, EXPIRED 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.02  Scope.  This part shall apply to any organization, business entity, partnership, corporation, government entity, association, or other legal entity providing personal care services or homemaker services through personal care service providers or homemakers employed by an agency, except:

 

          (a)  All facilities listed in RSA 151:2, II (a)-(i);

 

          (b)  Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H;

 

          (c)  Entities that are licensed under He-P 809;

 

          (d)  Persons providing only meal services in an individual’s permanent or temporary residence;

 

          (e)  Persons, who are not employers of personal care or homemaker service workers, who are personally providing personal care or homemaker services through a direct agreement with the recipient of services in the recipient’s permanent or temporary residence, and who are registered under He-P 820; and

 

          (f)  Persons furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment, and educate the user on its proper use.

 

Source.  #9522, eff 7-25-09; ss by #10013, eff 10-22-11, EXPIRED: 10-22-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” which means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a client;

 

(2)  “Physical abuse” which means the misuse of physical force which results or could result in physical injury to a client; or

 

(3)  “Sexual abuse” which means contact or interaction of a sexual nature involving a client with or without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as grooming, eating, transferring, toileting, bathing, dressing, and self-management of medications.

 

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

 

          (d)  “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HCSPA.

 

          (e)  “Admission” means accepted by a licensee for the provision of services to a client.

 

          (f)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J  or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (g)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a HCSPA pursuant to RSA 151.

 

(h)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 822, or other federal or state requirements.

 

          (i)  “Assessment” means an in-person evaluation to determine the services that are needed.

 

          (j)  “Branch office” means a location physically separate from the primary location of the HCSPA and that:

 

(1)  Provides oversight for employees who provide direct care services to clients in their residential setting; and

 

(2)  Is under the administration and supervision of the primary location of the HCSPA.

 

          (k)  “Change of ownership” means a change in the controlling interest of an established HCSPA to a successor business entity.

 

          (l)  “Client” means any person admitted to or in any way receiving services from a HCSPA licensed in accordance with RSA 151 and He-P 822.  “Client” includes “patient” as used in RSA 151:20 and RSA 151:21.

 

          (m)  “Client record” means the documentation of all services, which includes all documentation required by RSA 151 and He-P 822 and any other applicable federal and state requirements.

 

          (n)  “Client rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21-b.

 

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

 

          (p)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (q)  “Days” means calendar days unless otherwise specified in the rule.

 

          (r)  “Deficiency” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151 or He-P 822.

 

          (s)  “Department” means the New Hampshire department of health and human services.

 

          (t)  “Direct care” means hands-on care and services provided to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (u)  “Direct care personnel” means any person providing hands-on services to a client.

 

          (v)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

 

          (w)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (x)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, or fraud.

 

          (y)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and other personal needs.

 

          (z)  “Home care service provider agency (HCSPA)” means any organization or business entity, except as identified in He-P 822.02(e), whether public or private, whether operated for profit or not, which is engaged in providing, through its employees, personal care services or homemaker services which may be of a supportive nature to persons in their places of residence.

 

          (aa)  “Homemaker” means an employee of a home care service provider agency whose scope of services is limited to providing homemaker services as reflected on the license certificate.

 

          (ab)  “Homemaker services” means non-medical services that are of a supportive nature that do not require hands-on contact with a client other than to maintain the client’s safety.  Such services can include, but are not limited to, laundry, housecleaning, cooking, transporting to and from medical or other appointments, shopping, and companion services.

 

          (ac)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries, and is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ad)  “Infectious disease” means any disease caused by the growth of microorganisms in the body which might or might not be contagious.

 

          (ae)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (af)  “In‑service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (ag)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 822 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 822.

 

          (ah)  “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 822.

 

          (ai)  “License” means the document issued by the department to an applicant at the start of operation as a HCSPA which authorizes operation in accordance with RSA 151 and He-P 822, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and the license number.

 

          (aj)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which  the HCSPA is licensed for.

 

          (ak)  “Licensed 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.

 

          (al)  “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices.  This term does not include the private residence of a client receiving services from a HCSPA.

 

          (am)  “Licensing classification” means the specific category of services authorized by a license.

 

          (an)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (ao)  “Neglect” means an act or omission, that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional, or physical health and safety of a client.

 

          (ap)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (aq)  “Personal care” means personal care services that are non-medical, hands-on services provided to a client to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the client to take medications.

 

          (ar)  “Personal care service provider” means a person who provides non-medical hands-on assistance to a client, to help with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding a client to take medications.

 

          (as)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the client for a specific, limited purpose or for the general purpose of assisting the client in the exercise of any rights.

 

          (at)  “Personnel” means an individual who is employed by the HCSPA, who is a volunteer, or who is an independent contractor and provides direct care, personal care services,  homemaker services, or all to a client(s).

 

          (au)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (av)  “Primary location” means the principle site for the HCSPA where the business office and administrative staff are located.

 

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

 

          (ax) “Professional staff” means:

 

(1)  Physicians;

 

(2)  Physician assistants;

 

(3)  Advanced practice registered nurses (APRN);

 

(4)  Registered nurses;

 

(5)  Registered physical therapists;

 

(6)  Speech therapists;

 

(7)  Licensed practical nurses;

 

(8)  Licensed respiratory therapists;

 

(9)  Occupational therapists;

 

(10)  Medical social workers; and

 

(11)  Dietitians.

 

          (ay)  “Reportable incident” means an occurrence of any of the following while the client is in the care of HCSPA personnel:

 

(1)  The unanticipated death of the client; or

 

(2)  An injury to a client that is potentially due to abuse or neglect.

 

          (az)  “Service plan” means a written guide developed by the licensee, or its personnel, in consultation with the client, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services as required by He-P 822.15(l)-(n).

 

          (ba)  “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability of the client.

 

          (bb)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #9522, eff 7-25-09; amd by #10013, eff 10-22-11; paras. (a)-(y), (ab)-(am), (ao)-(ap), (ar)-(ay) EXPIRED:
7-25-17; amd by #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III-a, and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (December 2018 edition) which is signed by the applicant or 2 of the corporate officers affirming the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license, and the imposition of a fine.”;

 

b.  For any HCSPA to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any HCSPA to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in New Hampshire in the form of one of the following:

 

a.  A certificate of authority, if a corporation;

 

b.  A certificate of formation, if a limited liability company; or

 

c.  A certificate of trade name, where applicable;

 

(3)  The applicable fee in accordance with RSA 151:5 if HCSPA serves less than 10 clients or $250 fee  if HCSPA serves more than 10 clients, in accordance with RSA 151:5 payable in cash in the exact amount of the fee or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(4)  A resume identifying the qualifications for the HCSPA administrator;

 

(5)  Written local approvals as follows:

 

a.  For the proposed licensed premises, the following written local approvals, shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements;

 

2.  The building official verifying that the applicant complies with all applicable state and local building codes and ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control and local fire ordinances applicable for a business; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project; and

 

(6)  If the HCSPA uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill; and

 

(7)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee, and administrator.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 822.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 822.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted in accordance with He-P 822.10, the department shall deny a licensing request in accordance with He-P 822.13(b), if it determines that the applicant, licensee, or administrator:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (f)  An inspection shall be completed in accordance with He-P 822.09 prior to the issuance of a license.

 

          (g)  The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the NH department of safety for all current personnel.

 

          (h)  Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 822.

 

          (i)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (j)  A license issued in accordance with RSA 151 and He-P 822 shall be for one of the following licensing classifications:

 

(1)  Personal care services; or

 

(2)  Homemaker services.

 

          (k)  A written notification of denial, pursuant to He-P 822.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 822.

 

          (l)  A written notification of denial, pursuant to He-P 822.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall:

 

(1)  Complete and submit to the department an application form pursuant to He-P 822.04(a)(1) at least 120 days prior to the expiration of the current license; and submit:

 

a.  The materials required by He-P 822.04(a);

 

b.  The current license number;

 

c.  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 822.10(f), as applicable.  If such a request is not received the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

d.  A list of any current employees who have a permanent waiver granted in accordance with He-P 822.17(c); and

 

e.  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (c)  Following an inspection as described in He-P 822.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 822 at the renewal inspection.

 

          (d)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for initial license pursuant to He-P 822.04 and shall be subject to a fine in accordance with He-P 822.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.07  Branch Offices.

 

          (a)  The HCSPA may establish branch offices.

 

          (b)  The HCSPA shall notify the department in writing prior to establishing or operating branch offices with the following information:

 

(1)  The branch office address;

 

(2)  The branch office phone number; and

 

(3)  The license number of the HCSPA.

 

          (c)  The HCSPA shall submit to the department the information required by He-P 822.04(a) (5) for branch offices.

 

          (d)  Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 822.

 

          (e)  All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.08  HCSPA Requirements for Organizational or Service Changes.

 

          (a)  The HCSPA shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location of the licensed premises;

 

(3)  Address; or

 

(4)  Name.

 

          (b)  The HCSPA shall complete and submit a new application and obtain a new license and license certificate prior to:

 

(1)  A change in ownership; or

 

(2)  A change in licensing classification.

 

          (c)  When there is a change in address without a change in location, the HCSPA shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in address due to a physical location change, the HCSPA shall provide the department with:

 

(1)  A letter which contains the license number, new address, and date of the move; and

 

(2)  Local approval form as specified in He-P 822.04(a) (5).

 

          (e)  When there is a change in the name, the HCSPA shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

(f)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance then an inspection will be conducted as soon as practical by department; or

 

(2)  A change in licensing classification.

 

          (g)  A new license and license certificate shall be issued for a change in ownership.

 

          (h)  A revised license and license certificate shall be issued for a change in address.

 

          (i)  A revised license and license certificate shall be issued for a change in name.

 

          (j)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator;

 

(2)  When a waiver has been granted;

 

(3)  When there is a change in services; or

 

(4)  When a branch office has been added.

 

          (k)  The HCSPA shall inform the department in writing no later than 5 business days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator; 

 

(2)  Copies of applicable licenses for the new administrator;

 

(3)  The results of a criminal records check from the NH department of safety for the new administrator; and

 

(4)  Results of a bureau and elderly adult (BEAS) registry check.

 

          (l)  Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 822.15(d).

 

          (m)  If the department determines that the new administrator does not meet the qualifications, for his or her position, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (n)  A restructuring of an established HCSPA that does not result in a transfer of the controlling interest of the HCSPA, but which might result in a change in the name of the HCSPA or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (o)  The HCSPA shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the HCSPA.

 

          (p)  If a licensee chooses to cease operation of a HCSPA, the licensee shall submit written notification to the department at least 45 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 822, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The  licensed premises;

 

(2)  All programs and services provided by the HCSPA; and

 

(3)  Any records required by RSA 151 and He-P 822.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 822 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership except as allowed by He-P 822.08(f) (1);

 

(3)  A change in licensing classification; or

 

(4)  The renewal of a license.

 

          (c)  In addition to (b) above the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings shall be issued when, as a result of an inspection, the department determines that the HCSPA is in violation of any of the provisions of He-P 822, RSA 151, or other federal or state requirements.

 

          (e)  If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 822.12(c), within 21 days of the date of the letter that transmits the inspection report.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 822 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  Waivers shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the clients; and

 

(3)  Does not negatively affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 822.

 

          (b)  When practical, the complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known, of the HCSPA, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 822.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the HCSPA;

 

(2)  Physical inspection of the premises;

 

(3)  Review of relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed HCSPA, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 822.

 

          (e)  The following shall apply for an unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed HCSPA does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 822; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P822.13(c).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 822, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC; in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing;

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 822;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 822 as a result of this implementation; and

 

d.  Specifies the date upon which the deficiencies will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable;

 

a.  The department shall notify the licensee in writing within 14days of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period,the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (c) (1) above and be reviewed in accordance with (c) (3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14days of the date of the written notification from the department that states the original POC was rejected,, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 822.13(c) (12) below unless the department has granted an extension;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 822.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 822.13(c) (13) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 822.13(b); or

 

(3)  Revoke the license in accordance with He-P 822.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with He-P 822.12(c) shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

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

 

          (k)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the  HCSPA in areas that impact the health, safety, or well-being of clients; or

 

(2)  The presence of conditions in the HCSPA that negatively impact the health, safety, or well-being of clients.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 822 in a manner which poses a risk of harm to a client’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, or schedule an initial inspection, an applicant or licensee fails to submit an application that meets the requirements of He-P 822.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 822.12(c),(d), and (e);

 

(7) The licensee has submitted  a POC that has not been accepted by the department in accordance with He-P 822.12(c)(5) and has not submitted a revised POC as required by He-P 822.12(c)(5)d.;

 

(8)  The licensee is cited a third time under RSA 151 or He-P 822 for the same violations within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premises are not in compliance with RSA 151 or He-P 822;

 

(11)  Unless a waiver has been granted,  the department makes a determination that the applicant, administrator, licensee, or a household member  of a licensee has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and 822.14(g), the fine for an applicant, licensee, or unlicensed entity  shall be $500.00;

 

(4)  For a failure to transfer a client whose needs exceed the services or programs provided by the HCSPA, in violation of RSA 151:5-a,II the fine for a licensee shall be $500.00;

 

(5)  For admission of a client whose needs at the time of admission  exceed the services or programs authorized by the HCSPA, in violation of RSA 151:5-a,II, the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 822.11(d) and (e), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 822.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 822.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 822.08(a)(2), the fine for a licensee shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address, in violation of He-P 822.08(o), the fine shall be $100.00;

 

(11)  For a failure to allow access by the department to the HCSPA’s premises, programs, services, or records, in violation of He-P 822.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, , in violation of He-P 822.12(c), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 822.12(c), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 822.14(d), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified as required by He-P 822.14(c), the fine for a licensee shall be $500.00;

 

(16)  For providing false or misleading information or documentation in violation of He-P 822.14, the fine for a licensee shall be $1000.00 per offense;

 

(17)  For a failure to meet the needs of the client, as described in He-P 822.15, the fine for a licensee shall be $1000.00 per client;

 

(18)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department, in accordance with He-P 822.14, the fine for a licensee shall be $500.00;

 

(19)  When an inspection determines that there is a violation of RSA 151 or He-P 822 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines shall be assessed as follows:

 

a. If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be $2000.00; 

 

(20)  Each day that the individual or  licensee continues to be in violation of the provisions of RSA 151 or He-P 822 shall constitute a separate violation and shall be fined in accordance with He-P 822.13(c); and

 

(21)  If the applicant or licensee is making good faith efforts to comply with He-P 822.13 (c)(1)-(19), as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license, and the cessation of services, when it finds that the health, safety, or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30.

 

          (h)  If an immediate suspension is upheld the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 822 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a HCSPA’s license has been denied or revoked, the applicant, licensee, or administrator, shall not be eligible to apply for a license or be employed as an administrator for at least 5 years if the denial or revocation specifically pertained to their role in the program. 

 

          (k)  The 5 year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (j) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 822.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 822.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances, including RSA 161-F:49, and rules promulgated thereunder, as applicable.

 

          (b)  The licensee shall have written policies and procedures to include:

 

(1)  The rights and responsibilities of admitted clients in accordance with the “Home Care Clients’ Bill of Rights” under RSA 151:21-b;

 

(2)  The policies described in He-P 822; and

 

(3)  A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the HCSPA.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HCSPA and for:

 

(1)  Reviewing the policies and procedures every 2 years; and

 

(2)  Revising them as needed.

 

          (e)  The licensee shall assess and monitor the quality of service provided to clients on an ongoing basis.

 

          (f)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (g)  The licensee shall not advertise or otherwise represent the HCSPA as providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  Licensees shall:

 

(1)  Manage and operate the HCSPA;

 

(2)  Meet the needs, as determined by the care plan, of the client during those hours that the HCSPA personnel is in the client’s home;

 

(3)  Initiate action to maintain the HCSPA in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances; 

 

(4)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HCSPA;

 

(5)  Appoint an administrator;

 

(6)  Verify the qualifications of all personnel;

 

(7)  Accept new clients based upon the availability of personnel to meet the clients requested service needs; and

 

(8)  Implement any POC that has been accepted or issued by the department.

 

          (j)  The licensee shall consider all clients to be competent and capable of making all decisions relative to their own service needs unless the client:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (k)  The licensee shall only accept a client whose needs can be met through the program and services offered under the current license.

 

          (l)  If the licensee accepts a client who is known to have a disease reportable under He-P 301 or an infectious disease, , the licensee shall follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (m)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (n)  The licensee shall post the following documents in a public area:

 

(1)  The license and current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports for the last 12 months issued in accordance with He-P 822.09(d) and He-P 822.11(d)(1);

 

(3)  A copy of the “Home Care Clients’ Bill of Rights” specified by RSA 151:21-b;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of client rights and responsibilities;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the;

 

Department of Health and Human Services,

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street,

Concord, NH 03301 or by calling 1-800-852-3345; and

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

 

          (o) For reportable incidents, the licensees shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 271-4968 or, if a fax machine is not available, electronically via webmail at https://www.dhhs.nh.gov/oos/bhfa/contact.htm and click on the e-mail link, convey by electronic or regular mail, the following information to the department within 48 business hours of a reportable incident:

 

a.  The HCSPA name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of the client involved and the name of any witnesses to the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.   The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  Whether the client’s guardian, agent, or personal representative, if any, was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the client’s licensed practitioner was notified;

 

(3)  Notify the department with a written report within 5 business days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(4)  Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any client who dies within 10 days of a reportable incident;

 

(5)  Provide the information required by (3) above in writing within 72 hours of the unexpected death of any client or the death of any client who dies within 10 business days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

 

(6)  Submit any further information requested by the department.

 

          (p)  The licensee shall admit and allow any department representative to inspect the HCSPA and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 822 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (q)  The licensee shall, upon request, provide a client or their guardian or agent or surrogate decision-maker, if applicable, with a copy of his or her client record, pursuant to the provisions of RSA 151:21, X.

 

          (r)  All records required for licensing shall be legible, current, accurate, and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (s)  Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2) Safeguards for maintaining the confidentiality of information pertaining to clients and personnel; and

 

(3)  Systems to prevent tampering with information pertaining to clients and personnel.

 

          (t)  At the time of admission the licensee shall give a client and their guardian, agent, or surrogate decision-maker, if applicable, a listing of all applicable HCSPA charges and identify what care and services are included in the charge.

 

          (u)  The licensee shall give the client a written notice at least 30 days before any increase is imposed in the cost or fees, for any HCSPA services, except for clients receiving Medicaid whose financial liability is determined by the state’s standard of need, or clients funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.15  Required Services.

 

          (a)  The licensee shall have a written contractual agreement for all services provided by arrangement.

 

          (b)  Any contractual agreement to provide services shall:

 

(1)  Identify the  services to be provided;

 

(2)  Specify the qualifications of the personnel that will be providing the services;

 

(3)  Require that the HCSPA must authorize the services;

 

(4)  Stipulate the HCSPA retains professional responsibility for all services provided; and

 

(5)  Be limited to the types of services allowed under the HCSPA level of services.

 

          (c)  The licensee shall provide staff for the following positions:

 

(1)  An administrator to oversee the HCSPA, except as allowed by (e)(1) below; and

 

(2)  A director of client services.

 

          (d)  Any new administrator shall possess:

 

(1)  An associate degree from an accredited school and at least 2 years of relevant HCSPA experience;

 

(2)  A bachelor’s degree from an accredited school and one year of relevant experience; or

 

(3)  A high school diploma or equivalent and a minimum of 5 years relevant HCSPA experience.

 

          (e)  The administrator shall:

 

(1)  Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

 

(2)  Be permitted to hold more than one position at the HCSPA if:

 

a.  The individual meets the qualifications of all positions; and

 

b.  The duties and responsibilities of the positions can be accomplished by one individual.

 

          (f)  Any new director of client services shall have at least a high school diploma and 2 years’ experience supervising personnel or providing personal care services.

 

          (g)  The director of client services or designee shall:

 

(1)  Be responsible for the overall delivery of client services;

 

(2)  Provide sufficient qualified personnel to meet the needs of the clients; and

 

(3)  Supervise the overall delivery of client services.

 

          (h)  At the time of admission, personnel of the HCSPA shall:

 

(1)  Provide, both orally and in writing, to the client, or the client’s guardian or agent, if applicable, the HCSPA’s:

 

a.  Policy on client rights and responsibilities, including a copy of the Home Care Clients’ Bill of Rights, pursuant to RSA 151:21-b;

 

b.  Complaint procedure;

 

c.  List of services that are to be provided by the HCSPA; and

 

d.  List of care and services to be provided by an independent contractor, if appropriate;

 

(2)  Obtain written confirmation acknowledging receipt of the items in (1) above from the client, or the client’s guardian or agent, or surrogate decision-maker, if applicable;

 

(3)  Collect and record the following information:

 

a.  Client’s name, home address, home telephone number, and date of birth;

 

b. Name and telephone number of an emergency contact and guardian or agent, if applicable;

 

c.  Name of client’s primary care provider and the provider’s address and telephone number as applicable;

 

d.  Written and signed consent for the provision of care and services; and

 

e.  Copies of all legal directives such as durable power of attorney, guardianship, or living will, as applicable; and

 

(4)  Obtain documentation of informed consent and consent for release of information.

 

          (i)  Each client shall have an assessment conducted by an HCSPA nurse, the director of client services or designee to determine the services required by the client, except as allowed in (j) below:

 

(1)  Prior to initiating services;

 

(2)  At least every 6 months thereafter; and

 

(3)  Whenever there is a significant change in the client’s condition.

 

          (j)  The assessment required by (i) above shall contain at a minimum the following:

 

(1)  Pertinent diagnoses including mental status, as related by the client or the client’s agent, as appropriate;

 

(2)  Any equipment required;

 

(3)  Functional limitations;

 

(4)  Activities that are limited;

 

(5)  Dietary requirements; and

 

(6)  Any safety precautions.

 

          (k)  Clients receiving only homemaker services shall not require an assessment or a service plan.

 

          (l)  For clients receiving only personal care services, the assessment in (i) above shall be performed initially and every 6 months thereafter by a registered nurse, licensed practical nurse (LPN), the director of client services or designee to determine the services required.

 

          (m)  The licensee shall develop a service plan within 3 business days of admission or prior to the initiation of services, if later, that is based on the results of the assessments required by (i) above.

 

          (n)  The service plan required by (l) above shall include:

 

(1)  The date of the assessment;

 

(2)  A description of the client’s needs;

 

(3)  The services to be provided by HCSPA personnel;

 

(4)  The responsible person(s) or position;

 

(5)  The date of changes to the service plan; and

 

(6)  Documentation that the client and their legal representative, if applicable, were involved in the development of the service plan and any revisions made to the plan.

 

          (o)  The licensee shall develop a discharge plan, pursuant to RSA 151:26, with the input of the client or the client’s legal representative, if any, including:

 

(1)  Date and reason for discharge;

 

(2)  Discharge instructions and referrals, if applicable;

 

(3)  Discharge or transfer summary; and

 

(4)  An order for discharge, if applicable.

 

          (p)  Written notes shall be documented in the client’s record at the time of each visit for:

 

(1)  All services provided by the HCSPA and shall include the:

 

a.  Date and time of the service;

 

b.  Description of the service;

 

c.  Progress notes including, as applicable:

 

1.  Observable changes in the client’s functional, cognitive, or daily activity abilities; and

 

2.  Changes in the client’s behaviors such as eating or sleeping patterns; and

 

d.  Signature and title of the person providing the service;

 

(2)  Any reportable incident involving the client when HCSPA personnel are in the client’s home; and

 

(3)  Discharge or transfer documentation, if applicable, that shall include the date and reason for discharge or transfer.

 

          (q)  For each client accepted for care and services by the HCSPA, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  The written confirmation required by (h)(2) above;

 

(2)  The identification data required by (h)(3) above;

 

(3)  Consent forms, as applicable;

 

(4)  Consent for release of information, as applicable;

 

(5)  The record of the assessment required by (i) above;

 

(6)  All service plans required by (l) above including documentation that the client or their legal representative participated in the development of the service plan;

 

(7)  All written notes required by (p) above; and

 

(8)  Discharge documentation as required by (p)(3) above.

 

          (r)  Client records shall be available to:

 

(1)  The client, the client’s guardian, or the client’s agent;

 

(2)  HCSPA personnel as required by their job responsibilities and subject to the licensee’s policy on confidentiality;

 

(3)  Any individual given written authorization by the client, the client’s guardian, client’s agent, or the patient's surrogate decision-maker;

 

(4)  Any individual authorized by a court of competent jurisdiction; and

 

(5)  The department or any individual authorized by law.

 

          (s)  The licensee shall develop and implement a method for the written release of information in client records that is consistent with federal and state laws.

 

          (t)  The HCSPA shall store all paper and electronic backup files of client records in the primary or branch office except when they are being utilized by authorized personnel.

 

          (u)  Paper records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by authorized personnel.

 

          (v)  Electronic records shall be maintained as required by He-P 822.14(t).

 

          (w)  Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

 

          (x)  The HCSPA shall arrange for storage of, and access to, client records as required by (u) and (v) above in the event that the HCSPA ceases operation.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.16  Medication Services.

 

          (a)  The HCSPA personnel, who are not authorized by law to administer medications, may remind and prompt clients to take their medications at the proper time, place medication container or pill planners within client’s reach, and open the medication container or pill planner(s) when the client is present, as per the service plan without requiring documentation of specific medications taken.

 

          (b)  If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.17  Personnel.

 

          (a)  The licensee shall develop a job description for each position in the HCSPA containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Qualifications and educational requirements of the position.

 

          (b)  For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care or personal care services to clients the licensee shall:

 

(1) Obtain a criminal record check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check (1) above in accordance with (c)(1)-(3) below;

 

(3)  Verify the qualifications of all applicants prior to employment; and

 

(4)  Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

 

          (c)  Unless a waiver is granted in accordance with He-P 822.10 and (d) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (d)  The department shall grant a waiver of (c) above if, after reviewing the underlying circumstances, it determines that the person does not pose a threat to the health, safety, or well-being of clients.

 

          (e)  If the information identified in (c) above regarding any person identified in (b) above, is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (c) above.

 

          (f)  If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

 

(2)  Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

 

          (g)  The licensee shall:

 

(1)  Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the licensing site with the New Hampshire board of nursing or with a compact state.

 

          (h)  In lieu of (b) and (g) above, the licensee may accept from independent agencies contracted by the licensee to provide direct care or personal care services a signed statement that the agency’s employees have complied with (b) and (g) above and do not meet the criteria in (c) and (g) above.

 

          (i)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position as listed on their job description;

 

(2)  Not have been convicted of a felony, sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state by a court of law or had a complaint investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(3)  Be licensed, registered, or certified if required by state statute;

 

(4)  Receive an orientation prior to contact with a client that includes:

 

a.  The HCSPA’s policy on client rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The HCSPA’s policies, procedures, and guidelines;

 

d.  The HCSPA’s infection control program;

 

e.  The HCSPA’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency;

 

f.  The mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31; and

 

g.  Body mechanics training;

 

(5)  Complete mandatory annual in-service education, which includes a review of the HCSPA’s:

 

a.  Policies and procedures on client rights and responsibilities;

 

b.  Infection control program;

 

c.  Fire and emergency procedures; and

 

d.  Mandatory reporting requirements such as RSA 161-F:46-48 and RSA 169-C:29-31;

 

(6)  Be at least 18 years of age if working as direct care personnel unless they are:

 

a. A licensed nursing assistant (LNA) working under the supervision of an RN in accordance with Nur 700; or

 

b.  Part of an established educational program working under the supervision of an RN;

 

(7)  Prior to contact with clients or food, submit to the HCSPA the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2 step tuberculosis (TB) testing, mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(8)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

 

(9)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (j)  In lieu of (i)(8) above, independent agencies contracted by the HCSPA to provide direct care or personal care services shall provide the licensee with a signed statement that the agency’s employees have complied with (i)(8) and (10) above before working at the HCSPA.

 

          (k)  The scope of services provided by a homemaker shall be limited to those services as defined in He-P 822.03(ab) and shall not include those services described in (l)(1)-(5) below.

 

          (l)  The scope of services provided by a personal care service provider shall be as follows:

 

(1)  Basic personal care and grooming to include:

 

a.  Sponge bathing;

 

b.  Gathering and handing the client materials related to bathing;

 

c.  Regulating the bath or shower water temperature and running the water;

 

d.  Hair care including shampooing;

 

e.  Skin care to include application of preventive skin care products;

 

f.  Filing of nails;

 

g.  Assisting with oral hygiene;

 

h.  Shaving of client using an electric razor; and

 

i.  Dressing to include putting on or removing clothing, shoes, and stockings;

 

(2)  Transfer assistance as follows:

 

a.  Weight bearing assistance such as steadying the client and arranging items to assist the transfer of the client; and

 

b.  Non-weight bearing assistance on a case-by-case basis as specified by the HCSPA;

 

(3)  Assistance with toileting and toileting hygiene measures as follows:

 

a.  Assistance with the use of the toilet, commode, bedpan, and urinal;

 

b.  Assistance with the use of products related to hygiene care such as disposable incontinent briefs or pads;

 

c.  Assistance with cleaning after elimination;

 

d. Assisting with cleaning the client after instances of vomiting, diarrhea, and incontinence;

 

e.  Assistance with ostomy care in a long term, well healed, trouble free ostomy, limited to assisting in application of the stoma bag on a case-by-case basis as individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate professional staff; and

 

f.  Assistance with catheter care to include emptying the urinary drainage bag or switching from a leg bag or a night bag or vice versa on a case-by-case basis as individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate professional staff ;

 

(4)  Assistance with personal appliances as follows:

 

a.  Insertion and cleaning dentures;

 

b.  Insertion and cleaning hearing aids;

 

c.  Cleaning and putting on eye glasses; and

 

d.  Assisting with application of some types of braces, splints, slings, and prostheses on a case-by-case basis as determined by the HCSPA and individually trained by the HCSPA’s director of client services or designee who has been trained by the appropriate staff; 

 

(5)  Assistance with nutrition, hydration, and meal preparation as follows:

 

a.  Preparation of the meal;

 

b.  Arranging food including cutting up or mashing the food;

 

c.  Filling the client’s fork or spoon;

 

d.  Encouraging the client to eat or drink; and

 

e.  Feeding the client by mouth on a case-by-case basis as determined by the agency; and

 

(6)  Homemaker services.

 

          (m)  The HCSPA shall determine the client-related training required by the personal care services provider in addition to the basic training described in (o) below, in order to provide the personal care services which are on a case-by-case basis as described in (l) above.

 

          (n)  Prior to assisting clients with transfers, feeding, bathing, or dressing, personal care service providers, whose duties include the aforementioned tasks, shall attend a minimum 8-hour training in the performance of these duties, director of client services or designee who has been trained by the appropriate professional staff.

 

          (o)  The training in (n) above shall include at a minimum:

 

(1)  Orientation to home care including the role of the personal care services provider and the general orientation required by (i) above;

 

(2)  Training in communication with clients, and understanding client needs;

 

(3) Training in personal and home safety including environmental safety and emergency response;

 

(4)  Training in personal care skills including:

 

a.  Supervision and verbal prompting;

 

b.  Assisting in bathing, dressing, grooming, mouth care, hair care, and skin care;

 

c. Assisting in elimination including cleaning the client after elimination and use of products related to hygiene care;

 

d.  Moving and transferring clients;

 

e.  Nutrition, the mechanics of eating, hydration, and how to prepare, serve, and encourage the client to eat and drink;

 

f.  Use of assistance devices;

 

g.  Fall prevention; and

 

h.  Medication reminder training; and

 

(5)  Training in responsibility, accountability, and recordkeeping.

 

          (p)  LNAs who are working as personal care service providers shall be deemed as already having received the training required in (o) above but shall be required to receive the training required by (i)(4) above.

 

          (q)  The HCSPA shall maintain a record for training of each personal care service provider.

 

          (r)  The HCSPA shall provide supervision of the personal care service provider every  6 months.

 

          (s)  The director of client services or designee shall:

 

(1)  Coordinate the individual training required for personal care services provided on a case-by-case basis;

 

(2)  Observe the performance of the personal care services provider on a quarterly basis;

 

(3)  Assure that the plan of care is being carried out; and

 

(4)  Perform an annual evaluation.

 

          (t)  All personnel shall sign a statement at the time the initial offer of employment is accepted and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a client; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

 

          (u)  Personnel, volunteers, or independent contractors, hired by the licensee, who have a history of TB or a positive skin test and who will have direct care contact with clients or food shall have a symptomatology screen in lieu of a TB test. 

 

          (v)  Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HCSPA licensed premises.

 

          (w)  The personnel records required by (v) above shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data, including date of birth; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the HCSPA’s policy setting forth the clients’ rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (i)(4) above and any required continuing education program;

 

(5)  A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

 

(6)  Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Documentation of annual in-service education as required by (i)(4) above;

 

(8)  The statement signed at the time the initial offer of employment is accepted and renewed annually thereafter by all personnel as required by (t) above;

 

(9)  Documentation of the criminal records check; and

 

(10)  Documentation that the elder abuse registry checks required by (g) above.

 

          (x)  The HCSPA shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services for clients within the facility, as follows:

 

(1)  For volunteers, the information in (w)(2) and (6)-(10) above; and

 

(2)  For independent contractors, the information in (w)(2), and (4)-(10) above, except that the letter in (j) above may be substituted for (w)(5), (8), and (9) above, if applicable.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.18  Quality Improvement.

 

          (a)  The HCSPA shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of the HCSPA’s quality improvement program, a quality improvement committee shall be established.

 

          (c)  The HCSPA shall determine the size and composition of the quality improvement committee based on the services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the indicators to be monitored;

 

(2)  Evaluate the information that is gathered;

 

(3)  Determine the action that is necessary to correct identified problems;

 

(4)  Recommend corrective actions to the licensee; and

 

(5)  Evaluate the effectiveness of the corrective actions.

 

          (e)  The quality improvement committee shall meet at least every 6 months.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.19  Infection Control and Sanitation.

 

          (a)  The HCSPA shall develop and implement an infection control program that educates and provides procedures for the prevention and control and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

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

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious as determined by a licensed practitioner unless they utilize appropriate infection control equipment as required by the HCSPA policy and procedures on infection control.

 

          (e)  Pursuant to RSA 141-C:1, personnel with a newly positive mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (f)  Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable and durable, bandage with secure edges.

 

          (g)  Personnel infected with scabies or lice pediculosis shall not provide direct care to clients or prepare food until such time as they are no longer infected as determined by a licensed practitioner.

 

          (h)  If equipment needs to be cleaned in order to prevent contamination, the HCSPA shall develop and maintain written procedures for safe and effective cleaning of the equipment.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

          He-P 822.20  Physical Environment and Emergency Preparedness.

 

          (a)  The licensee shall comply with all federal, state, and local laws, rules, codes, and ordinances for:

 

(1)  Building;

 

(2)  Health, including waste disposal and water;

 

(3)  Fire; and

 

(4)  Zoning.

 

          (b)  The HCSPA shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (c)  The HCSPA shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

 

          (d)  Each licensee shall develop a written emergency plan that covers any situation that prevents the HCSPA from providing client services and which:

 

(1)  Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

 

(2)  Is approved by the local emergency management director or fire department, as appropriate;

 

(3)  Is available to all personnel;

 

(4)  Is based on realistic conceptual events;

 

(5)  Is modeled on the ICS in coordination with local emergency response agencies;

 

(6)  Provides that all personnel designated or involved in the emergency preparedness plan of the HCSPA shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Includes the HCSPA's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources; and

 

f.  Communications systems;

 

(8)  Includes a plan for alerting and managing personnel in a disaster, and accessing CISM, if necessary;

 

(9)  Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a client;

 

(10)  Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

 

(11)  If the HCSPA is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

 

          (e)  Each licensee shall annually review and revise, as needed, its emergency plan.

 

Source.  #9522, eff 7-25-09, EXPIRED: 7-25-17

 

New.  #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18

 

New.  #12702, eff 1-3-19

 

PART He-P 823  HOME HOSPICE CARE PROVIDER

 

          He-P 823.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all home hospice care providers (HHCPs), pursuant to RSA 151:2, I(b).

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a HHCP, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(g);

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h);

 

          (c)  Agencies that are certified by the department as other qualified agencies delivering personal care services in accordance with RSA 161-H; and

 

          (d)  All homemaker services that provide only the following services:

 

(1)  Housekeeping or housecleaning;

 

(2)  Companionship;

 

(3)  Shopping; or

 

(4)  Preparation of meals that are not therapeutic diets ordered by a licensed practitioner.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of a patient;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to a patient; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving a patient with or without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, self-management, and monitoring or supervision of medications.

 

          (c)  “Administer” means “administer” as defined by RSA 318:1, I, namely “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 person for immediate consumption or use.”

 

          (d)  “Administrator” means the licensee, or an individual appointed by the licensee, who is responsible for all aspects of the daily operations of the HHCP.

 

          (e)  “Admission” means accepted by a licensee for the provision of services to a patient.

 

          (f)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (g)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an HHCP pursuant to RSA 151.

 

(h)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that causes a licensee to be out of compliance with RSA 151, He-P 823, or other federal or state requirements.

 

          (i)  “Assessment” means an evaluation of the patient to determine the care and services that are needed.

 

          (j)  “Branch office” means a location physically separate from the primary location of the HHCP and that:

 

(1)  Provides oversight for employees who provide direct care services to patients in their cliental setting; and

 

(2)  Is under the administration and supervision of the primary location of the HHCP.

 

          (k)  “Care plan” means a written guide developed by the licensee, or its personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

 

          (l)  “Change of ownership” means a change in the controlling interest of an established HHCP to a successor business entity.

 

          (m)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

 

          (n)  “Coordinator” means a person from the HHCP who coordinates the care and services necessary to provide optimum health care management for the patient.

 

          (o)  “Core services” means those services provided by the licensee that are included in the basic rate.

 

          (p) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (q)  “Days” means calendar days unless otherwise specified in the rule.

 

          (r)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post test to the training provided.

 

          (s)  “Department” means the New Hampshire department of health and human services.

 

          (t)  “Direct care” means hands-on care and services provided to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (u)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified areas of non-compliance.

 

          (v)  “Do not resuscitate order (DNR order)”  means an order that, in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. The term includes “do not attempt resuscitation order (DNAR order)”.

 

          (w) “Drop site” means a location, which does not meet the definition of a branch office, where materials, equipment, and supplies used in the provision of hospice services may be temporarily stored.

 

          (x)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (y)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including but not limited to, situations where a person obtains money, property or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

 

          (z)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to thepatient ’s health care and other personal needs.

 

          (aa)  “Home hospice care provider (HHCP)” means an agency which provides hospice services to patients and their families in the patient’s residence.

 

          (ab)  “Hospice” means a specialized program of care and supportive services, which provides a combination of medical, social and spiritual services to terminally ill patients  and their families.

 

          (ac)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ad)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (ae)  “In‑service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (af) “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 823 or to respond to allegations, pursuant to RSA 151:6,  of non-compliance with RSA 151 and He-P 823.

 

          (ag) “Investigation” means the process used by the department to respond to allegations of non-compliance with RSA 151 and He-P 823.

 

          (ah)  “License” means the document issued by the department to an applicant at the start of operation as an HHCP which authorizes operation in accordance with RSA 151 and He-P 823, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

 

          (ai)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator and the type(s) of services authorized for which the HHCP is licensed.

 

          (aj)  “Licensed 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.

 

          (ak)  “Licensed premises” means the building(s) that comprises the physical location the department has approved for the licensee to conduct operations in accordance with its license. This term includes branch offices.  This term does not include the private residence of a patient  receiving services from a HHCP. 

 

          (al)  “Licensing classification” means the specific category of services authorized by a license.

 

          (am)  “Medical director” means a New Hampshire licensed practitioner, licensed in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the HHCP.

 

          (an)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (ao)  “Neglect” means an act or omission that results, or could result, in the deprivation of essential services or supports necessary to maintain the mental, emotional or physical health and safety of a patient .

 

          (ap)  “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse that, if not monitored on a routine basis by a nurse, would or could result in a physical or mental harm to a patient.

 

          (aq)  “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, 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.

 

          (ar)  “Over-the-counter medications” means non-prescription medications.

 

          (as)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (at)  “Patient” means any person admitted to or in any way receiving care, services, or both from a HHCP licensed in accordance with RSA 151 and He-P 823.

 

          (au) “Patient record” means the documentation of all care and services, which includes all documentation required by RSA 151,  He-P 823, and any other applicable federal and state requirements.

 

          (av)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21-b.

 

          (aw)  “Personal care” means personal care services that are non-medical, hands-on services provided to a patient including, but not limited to, assistance with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the patient to take medications.

 

          (ax)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights.

 

          (ay)  “Personnel” means an individual who is employed by the HHCP, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to clients.

 

          (az)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the patient’s freedom of movement, which includes but is not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (ba)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bb)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

 

          (bc)  “Point of care devices”  means testing involving a system of devices, typically including:

 

(1)  A lancing or finger stick device to get the blood sample;

 

(2)  A test strip to apply the blood sample; or

 

(3)  A meter or monitor to calculate and show the results including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or

 

c.  Cholesterol meter.

 

          (bd) “Primary location” means the principle site for the HHCP where the business office and administrative staff are located.

 

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

 

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

 

          (bg)  “Professional management responsibility” means that the professional staff of the HHCP provider continues to provide guidance and services to the  patient regardless of the location of the patient.

 

          (bh)  “Professional staff” means:

 

(1)  Physicians;

 

(2)  Physician assistants;

 

(3)  Advanced practice registered nurses;

 

(4)  Registered nurses;

 

(5)  Registered physical therapists;

 

(6)  Speech therapists;

 

(7)  Licensed practical nurse;

 

(8)  Licensed respiratory therapists;

 

(9)  Occupational therapists;

 

(10)  Medical social workers;

 

(11)  Dietitians;

 

(12)  Spiritual care coordinator;

 

(13)  Bereavement counselors; and

 

(14)  Volunteer coordinators.

 

          (bi)  “Reportable incident” means an occurrence of any of the following while the patient is in the care of HHCP personnel:

 

(1)  The unanticipated death of the patient; or

 

(2)  An injury to a patient that is potentially due to abuse or neglect.

 

          (bj)  Self-administration of medication with assistance” means an act whereby the patient takes his or her own medication after being prompted by personnel but without requiring physical assistance from others beyond placing the container within reach, opening the medication container, reading the medication label to the patient, and utilizing hand over hand technique pursuant to Nur 404.03(b).

 

          (bk)  “Self-administration of medication without assistance” means the patient takes his or her own medication(s) without the assistance of personnel, including prompting.

 

          (bl)  “Self-directed medication administration” means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication, with or without assistance, directs personnel to physically assist in the medication process which shall not include assisting with injections or filling insulin syringes.

 

          (bm)  “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability or limitations of the patient.

 

          (bn)  “Volunteer” means an unpaid person, screened and trained by agency, who provides assistance to patients and families with companionship, household chores, shopping, transportation, et cetera,  who does not provide direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a) and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License,” (September 2018 edition) signed by the applicant or 2 of the corporate officers, affirming and certifying  to the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

b.  For any HHCP to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any HHCP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  If applicable, proof of authorization from the secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(3)  The applicable fee of $250 in accordance with RSA 151:5, X(b), payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(4)  A resume identifying the qualifications of and copies of applicable licenses for the HHCP administrator and medical director;

 

(5)  Written local approvals as follows:

 

a.  For an existing administrative building, not including a patient’s home where care is being provided, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health,drinking water, and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, including the health care chapter of NFPA 101 as adopted by the commissioner of the department of safety, under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control, and local fire ordinances applicable for a business; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project; and

 

(6)  The results of a criminal records check from the New Hampshire department of safety for the applicant(s), licensee, if different than the applicant, licensee, administrator, and medical director.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 823.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 823.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 823.13(b) if it determines that the applicant, licensee, administrator, or medical director:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  An inspection shall be completed in accordance with He-P 823.09 prior to the issuance of a license.

 

          (g)  The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the results of a criminal records check from the New Hampshire department of safety for all current personnel.

 

          (h)  Following a clinical inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 823.

 

          (i)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (j)  A written notification of denial, pursuant to He-P 823.13(b)(1), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (h) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 823.

 

          (k)  A written notification of denial, pursuant to He-P 823.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 90 days of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall:

 

(1)  Complete and submit to the department an application form pursuant to He-P 823.04(a)(1) at least 120 days prior to the expiration of the current license;

 

(2)  The current license number;

 

(3) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 823.10(f), if applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(4)  A list of any current employees who have a permanent waiver granted in accordance with He-P 823.18(d); and

 

(5)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal.

 

          (c)  Following an inspection, as described in He-P 823.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) above, prior to the expiration of the current license;

 

(2)  Has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited at the last licensing inspection or investigation; and

 

(3)  Is found to be in compliance with RSA 151 and He-P 823 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

 

          (d)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license, and does not intend to cease operation, shall be required to submit an application for initial license pursuant to He-P 823.04 and shall be subject to a fine in accordance with He-P 823.13(c)(5).

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIREd: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.07  Branch Offices and Drop Sites.

 

          (a)  The HHCP may establish branch offices and drop sites provided that no direct  patient care is provided to a patient at the drop site.

 

          (b)  The HHCP shall notify the department in writing prior to establishing or operating branch offices with the following information:

 

(1)  The branch office address;

 

(2)  The branch office phone number; and

 

(3)  The license number of the HHCP.

 

          (c)  The HHCP shall submit to the department the information required by He-P 823.04(a)(5) for branch offices.

 

          (d)  Upon receipt of the information required by (b) and (c) above, the department shall issue a revised license certificate to reflect the addition of the branch offices, provided the additions do not violate RSA 151 or He-P 823.

 

          (e) All records, including those maintained at any branch office, shall be made available to the inspector at the primary location of the licensed premises at the time of inspection.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.08  HHCP Requirements for Organizational or Service Changes.

 

          (a)  The HHCP shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location of the licensed premises;

 

(3)  Address; or

 

(4)  Name.

 

         (b)  The HHCP shall complete and submit a new application and obtain a new license and license certificate prior to:

 

(1)  A change in ownership; or

 

(2)  A change in licensing classification.

 

          (c)  When there is a change in address without a change in location, the HHCP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in address due to a physical location change , the HHCP shall provide the department with:

 

(1)  A letter which contains the license number, new address, and date of the move; and

 

(2)  Local approval form as specified in He-P 823.04(a)(5).

 

          (e)  When there is a change in the name, the HHCP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

(f)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance then an inspection shall be conducted as soon as practical by department; or

 

(2)  A change in licensing classification.

 

(g)  A new license and license certificate shall be issued for a change in ownership.

 

(h)  A revised license and license certificate shall be issued for a change in name.

 

(i)  A license and license certificate shall be issued at the time of initial licensure.

 

(j)  A revised license certificate shall be issued for any of the following:

 

(1)  A change in administrator;

 

(2)  When a waiver has been granted;

 

(3)  When there is a change in services; or

 

(4)  When a branch office has been added.

 

          (k)  The HHCP shall inform the department in writing no later than 5 days prior to a change in administrator, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change  and provide the department with the following:

 

(1) A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses for the new administrator or medical director;

 

(3) The results of a criminal records check from the NH department of safety for the new administrator; and

 

(4)  Results of bureau and elderly adult registry Check.

 

          (l)  Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position, as specified in He-P 823.15(g).

 

          (m)  If the department determines that the new administrator or medical director does not meet the qualifications for his or her position as specified in (l) above, it shall so notify the licensee in writing, within 14 days, so that a waiver can be sought or the licensee can search for a qualified candidate.

 

(n)  A restructuring of an established HHCP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (o)  The HHCP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (p)  If a licensee chooses to cease operation of an HHCP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

New.  #12642, eff 10-9-18

 

          He-P 823.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 823, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the HHCP; and

 

(3)  Any records required by RSA 151 and He-P 823.

 

          (b)  The department shall conduct an inspection to determine full compliance with RSA 151 and He-P 823, and other federal or state requirements prior to: 

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 823.08(f)(1);

 

(3)  A change in the licensing classification; or

 

(4)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings shall be issued when, as a result of an inspection, the department determines that the HHCP is in violation of any of the provisions of He-P 823, RSA 151, or other federal or state requirements.

 

          (e)  If areas of non-compliance were cited in a statement of findings, the licensee shall submit a POC, in accordance with He-P 823.12(c) , within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #5646, eff 6-23-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 823 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and  patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above:

 

          (g)  The request to renew a waiver shall be subject to (c) through (f) above.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 823.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the HHCP, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 823.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint as follows:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the licensed premises;

 

(3)  Review of  relevantrecords; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed HHCP, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 823.12(c) if the inspection results in areas of non-compliance being cited.

 

(e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2) In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 823; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine in accordance with He-P 823.13(c)(1).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an administrative or judicial proceeding relative to the licensee.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 823, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

          (b) When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings , the licensee shall submit a written POC for each item, written in the appropriate place on the statement and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 823;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings;

 

c.  Prevents a new violation of RSA 151 or He-P 823 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever applies;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14  days of the date of the written notification from the department that states the original POC was rejected unless, within the 14 day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

2.  The department determines that the health, safety, or wellbeing of a patient will not be jeopardized as a result of granting the waiver;

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 823.13(c)(11);

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an on-site follow-up inspection; or

 

c.  Reviewing compliance during the next inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 823.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and a fine in accordance with He-P 823.13(c)(12).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients  or personnel;

 

(2) A revised POC is not submitted within 14 days of the written notification from the department or such other date as  applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 823.13(b); or

 

(3)  Revoke the license in accordance with He-P 823.13(b).

 

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

 

          (g)  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.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with He-P823.12(c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

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

 

          (k)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the facility that negatively impact the health, safety, or well-being of patients.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 823 in a manner which poses a risk of harm to a patient’s health, safety, or well-being;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, or schedule an initial inspection the applicant or licensee fails to submit an application that meets the requirements of He-P 823.04;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  A licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 823.12(c),(d), and (e);

 

(7)  A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 823.12(c)(5) and has not submitted a revised POC as required by He-P 823.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 823 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant or licensee is not in compliance with RSA 151 or He-P 823;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator or medical director who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00  for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, for an applicant, unlicensed entity, or a licensee the fine shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III and He-P 823.14(g) the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 823.11(e)(4), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(5)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 823.06(e), the fine for a licensee shall be $100.00;

 

(6)  For a failure to notify the department prior to a change of ownership, in violation of He-P 823.08(a)(1), the fine for a licensee shall be $500.00;

 

(7)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 823.08(a)(2), the fine for a licensee shall be $1000.00;

(8)  For a failure to notify the department of a change in e-mail address, in violation of He-P 823.08(o), the fine shall be $100.00;

 

(9)  For a failure to allow access by the department to the HHCP’s premises, programs, services, patients, or records, in violation of He-P 823.09(a)(1)-(3), the fine for an applicant, unlicensed individual or licensee shall be $2000.00;

 

(10)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 823.12(c)(2) and (5), the fine for a licensee shall be $100.00;

 

(11)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 823.12(c)(8), the fine for a licensee shall be $1000.00;

 

(12)  For a failure to establish, implement or comply with licensee policies, as required by He-P 823.14(b), (d), and (s), the fine for a licensee shall be $500.00;

 

(13)  For a failure to provide services or programs required by the licensing classification and specified by He-P 823.14(c), the fine for a licensee shall be $500.00;

 

(14)  For a failure to transfer a  patient whose needs exceeds the services or programs provided by the HHCP, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(15) For providing false or misleading information or documentation to the department, in violation of He-P 823.14(f), the fine shall be $1000.00 per offense;

 

(16)  For a failure to meet the needs of the patient, in violation of He-P 823.15(e), the fine for a licensee shall be $1000.00 per patient;

 

(17)  For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 823.14(i)(5)-(6), the fine for a licensee shall be $500.00;

 

 

(18)  When an inspection determines that a violation of RSA 151 or He-P 823 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the original fine, but not to exceed $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above, the fine for a licensee shall be triple the original fine, but not to exceed $2000.00;

 

(19)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 823 shall constitute a separate violation and shall be fined in accordance with He-P 823.13(c); and

 

(20)  If the applicant or licensee is making good faith efforts to comply with (14) or (16) above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or well-being of a patient is in jeopardy and emergency action is required in accordance with RSA 541:A-30.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 823 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When an HHCP’s license has been denied or revoked, the applicant, family member, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

 

          (k)  The 5-year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 823.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 823.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all federal, state and local laws, rules, codes, and ordinances, including RSA 161-F:49 and rules promulgated thereunder, as applicable.

 

          (b)  The licensee shall have a written policies and procedures to include:

 

(1)  The rights and responsibilities of admitted patients in accordance with the “Home Care Clients’ Bill of Rights” under RSA 151:21-b;

 

(2)  The policies described in He-P 823; and

 

(3)  A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the HHCP, which shall include at a minimum, the core services listed in He-P 823.15.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the HHCP and for:

 

(1)  Reviewing the policies and procedures every 2 years; and

 

(2)  Revising them as needed.

 

          (e)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (f)  The licensee or HHCP personnel shall not falsify documentation or provide false or misleading information to the department.

 

          (g)  The licensee shall not advertise or otherwise represent the program as operating an HHCP, or providing services that it is not licensed to provide, pursuant to RSA 151:2, III.

 

          (h)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (i)  The licensee shall:

 

(1)  Manage and operate the HHCP;

 

(2)  Meet the needs of the patients during those hours that the patient is in the care of the HHCP;

 

(3)  Initiate action to maintain the HHCP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(4)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the HHCP;

 

(5)  Appoint an administrator and a medical director;

 

(6)  Verify the qualifications of all personnel;

 

(7) Provide sufficient numbers of qualified personnel who are available to meet the needs of patients during all hours that the HHCP has contracted with patients to provide service;

 

(8)  Provide personnel with sufficient supplies and equipment to meet the needs of the patients;

 

(9)  Require all personnel to follow the orders of the licensed practitioner for every patient and encourage the patient to follow the licensed practitioner’s orders; and

 

(10)  Implement any POC that has been accepted or issued by the department.

          (j)  The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction; or

 

(2)  Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (k)  The licensee shall only accept a patient whose needs can be met through the program and services offered under the current license.

 

          (l)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall follow the required procedures and personnel training for the care of the patient, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A.

 

          (m)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03.

 

          (n)  The licensee shall post the following documents in a public area:

 

(1)  The license and current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports for the last 12 months issued in accordance with He-P 823.09(d) and He-P 823.11(d)(4);

 

(3)  A copy of the “Home Care Clients’ Bill of Rights” specified by RSA 151:21-b;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration,

129 Pleasant Street

Concord, NH 03301 or by calling 1-800-852-3345; and

 

(6)  The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits.

 

          (o)  For reportable incidents, the licensees shall:

 

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2 business days of a reportable incident:

 

a.  The HHCP name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of patientinvolved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom and the date and time;

 

h.  Whether the patient’s guardian, agent, or personal representative,  if any, was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the patient’s licensed practitioner was notified;

 

(3)  Immediately notify the guardian, agent, or personal representative, if any;

 

(4)  If abuse or neglect is suspected, the licensee shall  notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(5)  Contact the department immediately by telephone, fax, or e-mail to report the information required by (2) above in the case of the death of any patient who dies within 10 days of a reportable incident;

 

(6)  Provide the information required by (4) above in writing within 72 hours of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

 

(7)  Submit any further information requested by the department.

 

          (p)  The licensee shall admit and allow any department representative to inspect the HHCP and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 823 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (q)  A licensee shall, upon request, provide a patientor their legal guardian or agent, or surrogate decision-maker if applicable, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

 

          (r)  All records required for licensing shall be legible, current, accurate and be made available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (s)  Any licensee that maintains electronic records shall develop a system with written policies and procedures to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and personnel; and

(3)  Systems to prevent tampering with information pertaining to patients and personnel.

 

          (t)  At the time of admission the licensee shall give a patient and their legal guardian agent, or surrogate decision-maker if applicable, a listing of all HHCP’s charges and identify what care and services are included in the charge.

 

          (u)  At the time of admission the licensee shall give a patient and their guardian, agent, or surrogate decision-maker  if applicable, a listing of all applicable HHCP charges and identify what care and services are included in the charge.

 

          (v)  The licensee shall provide all personnel with education in hospice philosophy and hospice care.

 

          (w)  No patient shall receive any direct patient care at the HHCP primary location, branch office, or drop site(s).

 

          (x)  The HHCP shall comply with all federal, state, and local health, building, fire, and zoning laws, rules, and ordinances.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18; amd by #12928, eff 11-26-19

 

          He-P 823.15  Required Services.

 

          (a)  The licensee shall provide the following core hospice care services:

 

(1)  Nursing services sufficient to meet the nursing needs of the patient, which are:

 

a.  Determined by the patient’s care plan;

 

b.  Available, as needed, 24 hours a day; and

 

c.  Supervised by a registered nurse.

 

(2)  Home health aide and personal care services that are provided either directly or by contract as the needs of the patient dictate and as determined by the patient’s care plan;

 

(3)  Assisting patients to acquire pharmaceutical services such as equipment, appliances, medical supplies, and other pharmaceutical services as the needs of the patient dictate and as determined by the patient’s  care plan;

 

(4)  Hospice care social services such as assessment of the social environment and financial issues supervised by a social worker;

 

(5)  Hospice volunteer services;

 

(6)  Nutritional counseling, physical or occupational therapy, and speech therapy that are provided or arranged for as needed in accordance with patient’s care plan;

 

(7)  Spiritual services which are offered in accordance with the patient’s and family's beliefs and values; and

 

(8)  Bereavement services that are available to the family for up to one year following the death of the patient.

          (b)  If, on a temporary basis, not to exceed 90 days, the HHCP cannot provide any of the core care and services in (a) above, the HHCP shall have a written agreement with another agency to provide the required services.

 

          (c)  Any contractual agreement to provide care and services shall:

 

(1)  Identify the care and services to be provided;

 

(2)  Specify the qualifications of the personnel that will be providing the care and services;

 

(3)  Require that the HHCP must authorize the services; and

 

(4)  Stipulate the HHCP retains professional responsibility for all care and services provided.

 

          (d)  The HHCP shall provide or arrange for the provision of short-term in-patient stays in a hospital, nursing home, or hospice house during those times when the patient’s pain or symptoms are unable to be managed in the home.

 

          (e)  The HHCP shall retain professional management responsibility for all services that are provided including contracted services when a hospice patient is in another licensed facility.  These responsibilities shall be defined in a written contractual agreement.

 

          (f)  The licensee shall provide staff for the following positions:

 

(1)  An administrator to oversee the HHCP, except as allowed by 823.15(g)(1) below;

 

(2)  A full time director of patient services;

 

(3)  A medical director;

 

(4)  A volunteer coordinator;

 

(5)  A social services coordinator; and

 

(6)  Spiritual and or bereavement coordinator.

 

          (g)  Any administrator shall have at least a bachelor's degree in business or a health-related field with a minimum of one year’s experience in hospice care or be a registered nurse and:

 

(1)  Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

 

(2)  Be permitted to hold more than one position at the HHCP if:

 

a.  The individual meets the qualifications of all positions; and

 

b.  The duties and responsibilities of the positions can be accomplished by one individual; and

 

(3)  Be responsible for maintaining the HHCP in full compliance with all federal, state, and local laws, rules, codes, and ordinances at all times.

 

          (h)  Any director of patient services shall:

 

(1)  Be a New Hampshire-licensed or compact-registered nurse;

 

(2)  Be a New Hampshire-licensed advanced practice registered nurse; or

(3)  Have a bachelor's degree in a health field related to hospice care.

 

          (i)  The director of patient services shall:

 

(1)  Be responsible for the overall delivery of patient care and services;

 

(2)  Provide sufficient nursing personnel to meet the need of the patients;

 

(3)  Supervise the overall delivery of patient care and services; and

 

(4)  Coordinate the supervision of licensed nurse aides (LNA) at least every 2 weeks by a registered nurse at the patient’s home to determine if the LNA is providing care and services in accordance with the patient’s care plan.  The LNA shall not have to be present during this visit.

 

          (j)  The medical director shall be a licensed provider and shall be responsible for:

 

(1)  The overall medical component of the hospice plan of care;

 

(2)  Participating on the interdisciplinary patient care team;

 

(3)  Determining, in consultation with the interdisciplinary team, that an individual is appropriate for hospice care services; and

 

(4) Consultative physician visits for hospice and palliative care patients as requested by physicians.

 

          (k)  Volunteer services shall be provided under the direction of a coordinator of volunteer services who:

 

(1)  Implements a direct service volunteer program;

 

(2)  Coordinates the orientation, education, support, and supervision of direct service volunteers; and

 

(3)  Coordinates the utilization of direct service volunteers with other hospice staff.

 

          (l)  All volunteers shall be oriented and educated relative to their prescribed function according to the hospice care provider’s policies and procedures.

 

          (m)  The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

 

(1)  Recruitment and retention;

 

(2)  Screening;

 

(3)  Orientation;

 

(4)  Scope of function;

 

(5)  Supervision;

 

(6)  Ongoing training and support;

 

(7)  Records of volunteer activities; and

 

(8)  Criminal record checks.

 

          (n)  The social services coordinator shall have:

 

(1)  At least a master’s degree from a graduate school of social work; or

 

(2) A bachelor’s degree in a related health or human services field, have at least 2 years experience as a social worker and have established a consultative relationship with a person who qualifies in (1) above.

 

          (o)  The social services coordinator shall:

 

(1)  Participate in the development of the care plan; and

 

(2) Work in conjunction with the director of patient services to coordinate all social services required by the care plan and ensure their delivery.

 

          (p)  The spiritual and or bereavement coordinator shall be a person who has at least a bachelor's degree in an applicable field such as theology of education, psychology, or counseling and who has completed at least 8 additional hours in death and dying, grief, and bereavement.

 

          (q)  Persons providing bereavement services shall have education in death and dying, grief, and bereavement.

 

          (r)  The spiritual and or bereavement coordinator shall be responsible for providing an organized program of bereavement services for up to 12 months after the death of the patient including:

 

(1)  Counseling to families after the patient’s death;

 

(2)  Developing a care plan that reflects the needs of the patient’s family; and

 

(3)  Others services necessary to aid in the bereavement process.

 

          (s)  If the licensee collects human specimens for laboratory testing, it shall follow the manufacturer's instructions and/or the reference laboratory's instructions for collection and storage of human specimens.

 

          (t)  If the licensee test human specimens, it shall be licensed as a laboratory in accordance with He-P 808, except the licensee may perform the following CLIA-waiverd point of care test without obtaining a laboratory license in accordance with He-P 808:

 

(1)  Glucose;

 

(2) PT/INR;

 

(3)  Dipstick urinalysis; and

 

(4)  Occult blood.

 

          (u)  The licensee shall hold the appropriate CLIA certificate to perform any laboratory tests.

 

          (v)  Licensee collecting human specimens for laboratory testing shall require a collecting station license in accordance with He-P 817 except when collected by a trained registered nurse or licensed nursing assistant.

 

          (w)  Training shall consist of collection, storage, and transport of the specimens.

 

          (x)  Training shall be done by a registered nurse trained in the collection, storage and transport of human specimens.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.16  Patient Services.

 

          (a)  The licensee shall only admit those patients whose needs can be met by the HHCP.

 

          (b)  At the time of admission, personnel of the HHCP shall:

 

(1)  Provide, both orally and in writing, to the patient, or the patient’s guardian, agent, or surrogate decision-maker, if applicable the HHCP’s:

 

a.  Policy on patient rights and responsibilities, including a copy of the home care clients’ Bill of Rights, pursuant to RSA 151:21-b;

 

b.  Complaint procedure;

 

c.  List of care and services that are provided directly by the HHCP; and

 

d.  List of the care and services that are provided by contract;

 

(2)  Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, their guardian, agent, or surrogate decision-maker if applicable;

 

(3)  Collect and record the following information:

 

a.  Patient’s name, home address, home telephone number, and date of birth;

 

b.  Name, address and telephone number of an emergency contact and guardian, agent, or surrogate decision-maker if applicable;

 

c.  Name of patient’s primary care provider and their address and telephone number;

 

d.  Copies of all legal directives such as durable power of attorney, legal guardian, or living will; and

 

e.  Written and signed consent for the provision of care and services; and

 

(4)  Obtain documentation of informed consent and consent for release of information.

 

          (c)  The hospice care provider shall ensure that medical direction is provided either from the patients’ attending licensed practitioner or the hospice medical director.

 

          (d)  Patients who are admitted or accepted for services shall:

 

(1)  Be evaluated and assessed by professional staff within 48 hours of admission; and

 

(2)  Have an order for any service for which such order is required by the practice acts of the person providing care.

 

          (e)  Patients who are accepted for services shall have a nursing assessment at the following intervals to determine the level of care and services required by the patient:

 

(1)  Within 48 hours of admission; and

 

(2)  Thereafter as required by the CMS conditions of participation or at least every 90 days at a minimum.

 

          (f)  The assessment required by (e) above shall contain, at a minimum, the following:

 

(1)  Pertinent diagnoses including mental status;

 

(2)  A pain assessment, including symptom control and vital signs;

 

(3)  A physical assessment;

 

(4)  A cognition and mental status assessment;

 

(5)  A behavioral assessment;

 

(6)  A psychosocial assessment;

 

(7)  Medications and treatment needs;

 

(8)  Functional limitations;

 

(9)  Nutritional requirements;

 

(10)  Estimated duration and frequency of care and services;

 

(11)  Any equipment required; and

 

(12)  Any safety precautions.

 

          (g)  In addition to the information in (e) and (f) above, the initial nursing assessment shall include:

 

(1)  Reactions of the patient and family members to terminal illness;

 

(2)  History of the patient’s and family coping strengths and weaknesses;

 

(3)  Social and financial concerns; and

 

(4)  Spiritual beliefs and desires of the patient.

 

          (h)  The licensee shall establish an interdisciplinary hospice care team composed of at least:

 

(1)  A licensed practitioner;

 

(2)  A registered nurse;

 

(3)  A social worker; and

 

(4)  A spiritual and or bereavement counselor.

 

          (i)  The interdisciplinary hospice care team shall:

 

(1)  Establish the care plan;

 

(2)  Be the primary care delivery team for a patient and his or her family through the total duration of hospice care; and

 

(3)  Be responsible for supervising any patient care and services provided by others.

 

          (j)  The interdisciplinary team shall, in conjunction with the patient and the patient’s personal representative, and their family, develop an individualized care plan, which reflects the changing care needs of the patient and family.

 

          (k)  The care plan required by (j) above shall include:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The goal for the patient;

 

(4)  The action or approach to be taken by HHCP personnel;

 

(5)  The responsible person(s) or position; and

 

(6)  The interventions used to address problems identified in the assessment including:

 

a.  Medications ordered;

 

b.  Pain control interventions, both pharmacological and non-pharmacological;

 

c.  Symptom management treatment; and

 

d.  Services required including frequency of visits.

 

          (l)  The care plan required by (j) above shall be:

 

(1)  Developed in conjunction with the patient and their guardian, agent,  or surrogate decision maker;

 

(2)  Completed no later than5 days after completion of the assessment;

 

(3)  Reviewed and revised every 15 days by the interdisciplinary team following the completion of each assessment; and

 

(4)  Made available to all personnel that assist the patients.

 

          (m)  The patient, the patient’s family and guardian , agent, or surrogate decision maker shall be notified in advance of all interdisciplinary team meetings and be given the opportunity to participate in such meetings.

 

          (n)  The patient and their family shall be encouraged to participate in all components of care, including: 

 

(1)  Assessment and problem identification;

 

(2)  Implementation of the care plan; and

 

(3)  Evaluation and revision of the care plan, as needed.

 

          (o)  The care plan shall contain documentation of the patient’s or the patient’s guardian, agent, or surrogate decision-makers' acceptance or rejection of the initial care plan and all subsequent revisions or updates.

 

          (p)  All staff of the HHCP shall carry out the goals stated in the care plan.

 

          (q)  The licensee shall develop a discharge plan with the input of the patient and the guardian, agent, or surrogate decision-maker if any.

 

          (r)  Copies of the following documents shall accompany the transferred patient:

 

(1)  The emergency data sheet;

 

(2)  A copy of the care plan; and

 

(3)  A summary that includes:

 

a.  The date and time the patient was transferred from the HHCP;

 

b.  The place to which the patient was transferred or discharged; and

 

c.  The condition of the patient at the time of transfer or discharge.

 

          (s)  Transfers may occur without prior notification to the guardian or agent pursuant to an activated POA or the licensed practitioner when the patient is in need of immediate emergency care.

 

          (t)  Progress notes shall be written by personnel, as appropriate, at the time of each visit and shall include at a minimum:

 

(1)  Changes in the pateint’s physical, functional, and mental abilities;

 

(2)  Changes in the patient’s behaviors such as eating or sleeping patterns;

 

(3)  The patient’s relief of pain, if applicable; and

 

(4)  Newly identified needs of the patient and their family.

 

          (u)  Written notes shall be documented in the patient’s record for:

 

(1)  All care and services provided by personnel and include the following:

 

a.  Date and time of the care or service;

 

b.  Description of the care or service;

 

c.  Progress notes as required by (t) above; and

 

d.  Signature and title of the person providing care or services; and

 

(2)  Any reportable incident or occurrence involving the patient when HHCP personnel are in the patient home, which shall include the information required by He-P 823.14(o).

 

          (v)  For each patient accepted for care and services by the HHCP, a current and accurate record shall be maintained, including, at a minimum:

 

(1)  The written confirmation required by He-P 823.16(b)(2);

 

(2)  The identification data required by He-P 823.16(b)(3);

 

(3)  Consent and medical release forms, as applicable; 

 

(4)  Pertinent medical information:

(5) Al orders from a licensed practitioner, including the date and signature of the licensed practitioner required by He-P 823.16(c);

 

(6)  Copy of order activating durable power of attorney, if applicable;

 

(7)  Copy of DNR order, if applicable;

 

(8)  All assessments required by He-P 823.16(d) and (e);

 

(9)  All care plans required by He-P 823.16(j)-(l) including documentation that the patient or patient’s guardian, agent, or surrogate decision-maker, if applicable, participated in the development of the care plan;

 

(10)  All written notes required by He-P 823.16(u);

 

(11)  All progress notes as required by He-P 823.16(t);

 

(12)  All daily medication records required by He-P 823.17(d)(9);

 

(13)  A discharge plan or transfer summary as required by He-P 823.16(q) and (r)(3);

 

(14)  Discharge documentation, which shall include:

 

a.  In the case of patient death:

 

1.  Date and place of death; and

 

2.  Bereavement follow-up plan; and

 

b.  In the case of discharge other than patient death:

 

1.  Date and time of patient discharge;

 

2.  The physical, mental, and medical condition of patient at discharge;

 

3.  Discharge instruction and referral;

 

4.  Discharge summary; and

 

5.  Signed licensed practitioner’s order for discharge, if applicable; and

 

(15)  Documentation of any patient refusal of any care or services.

 

          (w)  Patient records shall be available to:

 

(1)  The patient, their guardian, agent,  or surrogate decision-maker;

 

(2)  HHCP personnel as required by their job responsibilities and subject to the licensee's policy on confidentiality;

 

(3)  Any individual given written authorization by the patient or their guardian ,agent and surrogate decision maker;

 

(4)  Any individual authorized by a court of competent jurisdiction; and

 

(5)  The department or any individual authorized by law.

 

          (x)  The licensee shall develop and implement a method for the written release of information in the patient record that is consistent with federal and state statute.

 

          (y)  The HHCP shall store the patient record in the primary or branch office except when they are being utilized by the supervisory and direct care staff.

 

          (z)  Records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by direct care staff.

 

          (aa)  Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

 

          (ab)  The HHCP shall arrange for storage of, and access to, patient records as required by (aa) above in the event that the HHCP ceases operation.

 

          (ac)  If the HHCP is providing any of the following services, they shall be licensed in accordance with the applicable rules:

 

(1)  Home health care provider agency; or

 

(2)  Case management provider agency.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.17  Medications.

 

          (a)  HHCP personnel who are not authorized by law to administer medications may remind and prompt patients to take their medications at the proper time, place medication container(s), including pill planners, within patient reach, and open the medication container(s) when the patient is present, reading the medication label to the patient and utilizing hand over hand technique if the patient is competent and stable, as per the care plan.

 

          (b)  If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse, and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B.

 

          (c)  A licensed nursing assistant (LNA) may perform hand over hand assistance by following the care plan, as delegated by a licensed nurse, to a competent and stable patient pursuant to RSA 326-B.

 

          (d) If personnel, who are authorized by law, administer medication(s), delegate medication administration, or prepare medication in advance for administration in accordance with RSA 318:42, XIII and XIV, the HHCP shall:

 

(1)  Maintain a list of medications currently being taken by the patient;

 

(2)  Administer all medications in accordance with the written and signed orders of the licensed practitioner;

 

(3)  Maintain a written and signed order, or a copy thereof, in the patient’s record that includes:

 

a.  The patient’s name;

 

b.  The medication name, strength, prescribed dose, and route of administration;

 

c.  The frequency of administration;

 

d.  The indications for usage of all PRN medications; and

 

e.  The date ordered;

 

(4)  Only use medications that have been kept in the original containers, as dispensed by the pharmacy, licensed practioner’s samples, or over the counter medications;

 

(5)  Require that any change or discontinuation of medications shall be pursuant to a written and signed order from a licensed practitioner or other individual authorized by law;

 

(6)  Require that all telephone orders for medications or treatments are:

 

a.  Taken only by a licensed health care professional if such action is within the scope of their practice act;

 

b.  Immediately transcribed and signed by the individual taking the order; and

 

c.  Counter-signed by the ordering practioner as soon as possible and with a documented reason if signed more than 30 days after the telephone order being taken;

 

(7)  Require that the medication to be administered by HHCP personnel be:

 

a.  Prepared immediately prior to administration; and

 

b.  Prepared, identified, and administered by the same person in compliance with RSA 318 and RSA 326-B;

 

(8)  Require that when personnel are assisting or administering medication, they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

 

(9)  Maintain documentation for all medications either assisted by or administered by HHCP personnel that includes:

 

a.  The name of the patient;

 

b.  A list of any allergies or allergic reactions to medications;

 

c.  The name, strength, dose, frequency, and route of administration of the medications;

 

d.  The date and time medication was taken;

 

e.  The signature and identifiable initials and job title of:

 

1.  The person assisting or administering the medication; or

 

2.  The person administering or assisting the patient taking his or her medication;

 

f.  Documented reason for any medication refusal or omission; and

 

g.  For PRN medications, the reason the patient required the medication and the effect of the PRN medication at the time of the next patient contact; and

 

(10)  Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

 

a.  Observed adverse reactions to or side effects of medication; and

 

b.  Medication errors such as incorrect medications.

 

          (e)  If the HHCP provides “self-administration of medication with assistance” medication services to a patients defined by He-P 823.03(bk), the HHCP shall:

 

(1)  Maintain, in the home, a list of medications currently being taken by the patient;

 

(2)  Assist with self-administration of medications in accordance with the written and signed orders of the licensed practitioner;

 

(3)  Maintain either the original written and signed order, or a copy thereof, in the patient’s  record that includes:

 

a.  The patient’s name;

 

b.  The medication name, strength, prescribed dose, and route of administration;

 

c.  The frequency of administration;

 

d.  The indications for usage of all PRN medications; and

 

e.  The date ordered;

 

(4)  Not allow personnel to assist with self-administration of medications if anyone other than a pharmacist has changed prescription medication container labels except as allowed by (e)(7)f. below;

 

(5)  Require that any change or discontinuation of medications shall be pursuant to a written and signed order;

 

(6)  Require that all telephone orders for medications or treatments are:

 

a.  Taken only by a licensed health care professional if such action is within the scope of their practice act;

 

b.  Immediately transcribed and signed by the individual taking the order; and

 

c.  Counter-signed by the ordering practioner within 30 days or with a documented reason if more than 30 days;

 

(7)  Allow a patient to self-administer medication with assistance by personnel, as directed by the care plan, and which personnel shall be required to:

 

a.  Remind the patient to take the correct dose of his or her medication at the correct time from the original medication bottle;

 

b.  Place the medication container within reach of the patient;

 

c.  Remain with the patient to observe them taking the appropriate number and type of medication as ordered by the licensed practitioner;

 

d.  Record that they have supervised the patient taking their medication on the patient’s daily medication record;

 

e.  Document in the patient’s record any observed or reported side effects, adverse reactions, refusal to take medications, and medications not taken; and

 

f.  Require that if the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HHCP are unable to obtain a new prescription label:

 

1.  The RN shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HHCP’s written procedure, indicating that there has been a change in the medication order;

 

2.  The RN shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

3.  The change in dosage, without a change in prescription label as described in (e)(7)f.1. and (e)(7)f.2.above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first;

 

(8)  Permit personnel who assist a patient that self-administers medication with assistance to open the medication container and place it within reach of the patient, but not permit that person to physically handle the medication in any manner;

 

(9)  Require that when personnel are assisting that they remain with the patient until the patient has taken all of the medication, excluding infusion therapy;

 

(10)  Maintain documentation for all medications assisted by HHCP personnel that includes:

 

a.  The name of the patient;

 

b.  A list of any allergies or allergic reactions to medications;

 

c.  The name, strength, dose, frequency, and route of administration of the medications;

 

d.  The date and time medication, including PRN medications, was taken;

 

e.  The signature, identifiable initials, and job title of the person assisting the patient taking his or her medication; and

 

f.  Documented reason for any medication refusal or omission;

 

(11)  Develop and implement a system for reporting to the patient’s prescribing, licensed practitioner any:

 

a.  Observed adverse reactions to or side effects of medication; or

 

b.  Medication errors such as incorrect medications; and

 

(12)  Require LNAs who assist patients with self-administration of medications  to comply with the board of nursing requirements according to RSA 326-B.

 

          (f)  A home health personal care service provider shall successfully complete a medication assistance education program taught by a licensed nurse, licensed practitioner, or pharmacist, whether in person or through other means such as electronic media, prior to assisting a patient with self-administration of medication with assistance, self-directed medication administration, or administration via nurse delegation.

 

          (g)  The medication assistance education program required by (f) above shall, at a minimum, include training on the following subjects:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights, including:

 

a.  The right patient;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications such as antihypertensives or antibiotics;

 

(5)  Desired effects and potential side effects versus adverse effects of medications; and

 

(6)  Medication precautions and interactions.

 

            (h)  For patients who qualify for the use of therapeutic cannabis, the licensee shall keep a copy of the registry identification card in the patient’s record.

 

(k)  The licensee shall develop, maintain, and implement a patient specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be handled and  administered to the patient.

 

            (l)  If allowed by the policy in (k) above, cannabis shall be treated  in a manner similar to controlled medications with respect to assisting qualifying patients with the therapeutic use of cannabis.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.18  Personnel.

 

          (a)  The licensee shall develop a job description for each position in the HHCP containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Qualifications and educational requirements of the position.

 

(b)  For all applicants for employment, volunteers, and independent contractors who will provide direct care or personal care services to patients, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check in (1) above in accordance with (c)(1)-(3) below; and

 

(3)  Verify the qualifications of applicants prior to employment.

 

          (c)  Unless a waiver is granted in accordance with He-P 823.10 and (d) below, the licensee shall not offer employment, contract with, or engage a person in (b) above, for any position if the individual:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (d)  If the information identified in (c) above regarding any person identified in (b) above,  is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (c) above.

 

          (e) If a waiver of (c) above is requested, the department shall review the information and the underlying circumstances in (c) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, after investigation, if it determines that the person poses a threat to the health, safety, or well-being of a patient; or

 

(2)  Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

 

          (f)  The licensee shall:

 

(1)  Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the  nursing assistant registry or licensing site with the NH board of nursing.

 

          (g)  In lieu of (b) and (f) above, the licensee may accept, from independent agencies contracted by the licensee to provide direct care or personal care services, a signed statement that the agency’s employees have complied with (b) and (f) above and do not meet the criteria in (c) and (f) above.

 

          (h)  All personnel shall:

 

(1)  Meet the educational and physical qualifications of the position as listed on their job description;

 

(2)  Be licensed, registered, or certified as required by state statute;

 

(3)  Receive an orientation prior to contact with a patient that includes:

 

a.  The HHCP’s policy on patient rights and responsibilities and complaint procedures as required by RSA 151:20;

 

b.  The duties and responsibilities of the position they were hired for;

 

c.  The HHCP’s policies, procedures and guidelines;

 

d.  The HHCP’s infection control program;

 

e.  The HHCP’s fire, evacuation, and emergency plans which outline the responsibilities of personnel in an emergency; and

 

f.  The mandatory reporting requirements such as RSA 161:F: 46-48 and RSA 169-C: 29-31;

 

(4)  Within the first 3 months of employment, receive an orientation to hospice philosophy relative to the delivery of care and services to hospice patients and their families;

 

(5)  Complete mandatory annual in-service education, which includes a review of the HCCP’s:

 

a.  Policies and procedures on patient rights and responsibilities;

 

b.  Infection control program; and

 

c.  Fire and emergency procedures;

 

(6)  Be at least 18 years of age if working as direct care personnel unless they are:

 

a. A licensed nursing assistant working under the supervision of a registered nurse in accordance with Nur 700; or

 

b.  Part of an established educational program working under the supervision of a registered nurse;

 

(7)  Prior to contact with patients or food, submit to the HHCP the results of a physical examination or health screening performed by a licensed nurse or a licensed practitioner and 2-step tuberculosis testing, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment;

 

(8)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first test are negative for TB; and

 

(9)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. Tuberculosis in Health Care Settings (2005 edition),available as noted in Appendix A,  if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (i)  In lieu of (h)(8) above, independent agencies contracted by the facility to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (h)(7) and (9) above before working at the HHCP.

 

          (j)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (k)  Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients or food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

 

          (l)  All personnel shall follow the orders of the licensed practitioner for each patient and encourage patients to follow the practitioner’s order.

 

          (m)  Current, separate, and complete employee files shall be maintained and stored in a secure and confidential manner at the HHCP licensed premises.

 

          (n)  The employee file required by (m) above shall include the following:

 

(1)  A completed application for employment or a resume, including:

 

a.  Identification data, including date of birth; and

 

b.  The education and work experience of the employee;

 

(2)  A signed statement acknowledging the receipt of the HHCP’s policy setting forth the patients’ rights and responsibilities and acknowledging training and implementation of the policy as required by RSA 151:20;

 

(3)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(4)  Record of satisfactory completion of the orientation program required by (h)(4)and (5) above and any required continuing education program;

 

(5)  A copy of each current New Hampshire license, registration, or certification in a health care field, if applicable;

 

(6)  Documentation that the required physical examination or health screening, and TB test results or radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(7)  Documentation of annual in-service education as required by (h)(5) above;

 

(8)  For unlicensed personnel that have been delegated the task of medication administration, the written evaluation by the delegating registered nurse that was used to determine that the personnel member is competent to administer medications;

 

(9)  A statement that shall be signed at the time the initial offer of employment is made and then annually thereafter by all personnel as required by (j) above;

 

(10)  Documentation of the criminal records check;

 

(11)  The results of the registry checks in (f) above; and

 

(12)  Copy of certification of (h)(7) above.

 

          (o)  The HHCP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to patients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (n)(1), (2), (4), and (6)-(11) above; and

 

(2)  For independent contractors, the information in (n)(2), and (4)-(11) above, except that the letter in (g) and (i) above may be substituted for (n)(6), (10), and (11) above, if applicable.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.19  Quality Improvement.

 

          (a)  The HHCP shall develop and implement a quality improvement program that reviews policies and all care and services provided to patients and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of the HHCP quality improvement program, a quality improvement committee shall be established.

 

          (c)  The HHCP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the licensee; and

 

(7)  Evaluate the effectiveness of the corrective actions.

 

          (e)  If the HHCP utilizes nurse delegation for the task of medication administration to an individual not licensed to administer medications, a quarterly written report containing the following information shall be completed and submitted to the quality improvement committee for review:

 

(1)  The patient census;

 

(2)  The number of unlicensed personnel administering medications via nurse delegation;

 

(3)  Categories of medications administered;

 

(4)  Route of administration; and

 

(5)  Any incidents or medication errors and actions taken.

 

          (f)  The quality improvement committee shall meet at least quarterly.

 

          (g)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (h)  Documentation of all quality improvement activities shall be maintained on-site at the primary location for at least 2 years.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.20  Infection Control.

 

          (a)  The HHCP shall develop and implement an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand-washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of patients 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)  Reporting of infectious and communicable diseases as required by He-P 301.

 

          (c)  The HHCP shall appoint an individual who will oversee the development and implementation of the infection control program.

 

          (d)  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.

 

          (e)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious.

 

          (f)  Pursuant to RSA 141-C:1, personnel with a newly positive Mantoux tuberculosis skin test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the workplace until a diagnosis of tuberculosis is excluded or until the person is on tuberculosis treatment and has been determined to be non-infectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who prepares food or provides direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight fitting bandage.

 

          (h)  Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

 

          (i)  If the HHCP has an incident of an infectious disease reported in (b)(5) above, the HHCP shall contact the public health nurse in the county in which the patient resides and follow the instructions and guidance of the nurse.

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-29-17, EXPIRES: 10-26-17

 

New.  #12642, eff 10-9-18

 

          He-P 823.21  Physical Environment and Emergency Preparedness.

 

          (a)  The licensee shall comply with all federal, state and local laws, rules, codes and ordinances for:

 

(1)  Building;

 

(2)  Health, including waste disposal and water;

 

(3)  Fire; and

 

(4)  Zoning;

 

          (b)  The HHCP shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (c)  The HHCP shall be clean, maintained in a safe manner and good repair, and kept free of hazards.

 

          (d)  Each HHCP shall develop a written emergency plan that covers any situation that could prevent the HHCP from providing patient services and which:

 

(1)  Includes site-specific plans for the protection of all persons on-site in their licensed premises in the event of fire, natural disaster, severe weather, and human-caused emergency to include, but not be limited to, a bomb threat;

 

(2) Is approved by the local emergency management director and/or fire department, as appropriate;

 

(3)  Is available to all personnel;

 

(4)  Is based on realistic conceptual events;

 

(5)  Is modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provides that all personnel designated or involved in the emergency preparedness plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Includes the HHCP's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources; and

 

f.  Communications systems;

 

(8)  Includes a plan for alerting and managing personnel in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(9)  Includes a policy detailing the responsibilities of personnel for responding to an emergency while on duty in the home of a patient;

 

(10)  Includes an educational, competency-based program for personnel, to provide an overview of the components of the emergency management program and concepts of the ICS and the personnel’s specific duties and responsibilities; and

 

(11)  If the HHCP is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), includes the required elements of the RERP.

 

          (e)  Each licensee shall annually review and revise, as needed, its emergency plan.

 

Source.  #9292, eff 10-9-08, EXPIRED:  10-9-16

 

New.  #12168, INTERIM, eff 4-28-17, EXPIRED: 10-26-17

 

New.  #12642, eff 10-9-18

 

PART He-P 824  HOSPICE HOUSE

 

          He-P 824.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all hospice houses (HH), pursuant to RSA 151.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a HH, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i); and

 

          (b)  All entities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to patients; and

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving patients with or without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and self-management, monitoring, or supervision of medications.

         

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrative remedy” means a corrective action imposed upon a licensee in response to non-compliance with RSA 151 or He-P 824.

 

          (f)  “Administrator” means the person responsible for the management of the licensed premises who reports to and is accountable to the governing body.

 

          (g)  “Admission” means acceptance by a licensee for the provision of care and services to a patient and when the patient physically moves into the HH.

 

          (h)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

 

          (i)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

 

          (j)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate identified under RSA 137-J:34-37.

 

          (k)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an HH pursuant to RSA 151.

 

          (l)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 806, or other federal or state requirements.

 

          (m)  “Assessment” means a systematic data collection which enables facility personnel to plan care that allows the patient to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

 

          (n)  “Care plan” means a written guide developed by the licensee or their personnel, in consultation with the patient, guardian, agent, or personal representative, if any, as a result of the assessment process for the provision of care and services.

 

          (o)  “Change of ownership” means the transfer of the controlling interest of an established HH to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

 

(p)  “Chemical restraints” means a drug or medication that is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

 

          (q)  “Clinical laboratory improvement amendments (CLIA)” means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens.

 

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

 

          (s) “Contracted employee” means a temporary employee working under the direct supervision of the HH but employed by an outside agency.

 

          (t)  “Coordinator” means a person from the HH who coordinates the care and services necessary to provide optimum health care management for the patient.

 

          (u)  “Core services” means those services provided by the licensee that are included in the facility’s basic rate.

 

          (v)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem. Individuals undergoing CISM are able to discuss the situation that occurred and how it effects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

 

          (w)  “Days” means calendar days unless otherwise specified in the rule.

 

          (x)  “Department” means the New Hampshire department of health and human services.

 

          (y)  “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (z)  “Direct care personnel” means any person providing hands-on clinical care or hands-on services to a patient including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming.

 

          (aa)  “Directed plan of correction” means a plan developed and written by the department that specifies the necessary actions the licensee shall take to correct identified deficiencies.

 

          (ab)  “Discharge” means moving a patient from a licensed facility or entity to a non-licensed facility or entity.

 

          (ac)  “Do not resuscitate order (DNR order)”, means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order)”.

 

          (ad)  “Elopement” means when a patient who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility  unsupervised or unnoticed without knowledge of the licensee’s personnel.

 

          (ae)  “Emergency” means an unexpected occurrence or set of circumstances, which require immediate, remedial attention.

 

          (af)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

         

          (ag)  “Employee” means anyone employed by the HH and for whom the HH has direct supervisory authority.

 

          (ah)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance RSA 151 or He-P 824.

 

          (ai)  “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes “fixtures”.

 

          (aj)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ak)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (al)  “Governing body” means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

 

          (am)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the patient’s health care and other personal needs.

 

(an)  “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant’s control.

 

          (ao)  “Hospice” means a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

 

          (ap)  “Hospice house (HH)” means a residential setting providing a specialized program of care and supportive services, which provide a combination of medical, social, and spiritual services to terminally ill patients and their families.

 

          (aq)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ar)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (as)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (at)  “Informed consent” means the decision by a patient, his or her guardian, agent, or surrogate decision-maker   to agree to a proposed course of treatment, after the patient, guardian, agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (au)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He‑P 824 or to respond to allegations of non‑compliance with RSA 151 and He-P 824.

 

          (av)  “Laboratory” means a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease.

         

          (aw)  “License” means the document issued to an applicant or licensee of an HH which authorizes operation in accordance with RSA 151 and He-P 824, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

 

          (ax)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds that the HH is licensed for.

 

          (ay)  “Licensed practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician’s assistant;

 

(3)  Advanced practice registered nurse;

 

(4)  Doctor of osteopathy; or

 

(5)  Doctor of naturopathic medicine.

 

          (az)  “Licensed premises” means the building(s) that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (ba)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (bb)  “Licensing classification” means the specific category of services authorized by a license.

 

          (bc)  “Life safety code” means the adoption by reference of the life safety code, 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.

 

          (bd)  “Mechanical restraint” means locked, secured, or alarmed HH or units within an HH, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a patient from freely exiting the HH or unit within.

 

          (be)  “Medical director” means a physician licensed in New Hampshire in accordance with RSA 329, who is responsible for overseeing the quality of medical care and services within the HH.

 

          (bf)  “Medication” means a substance available with or without a prescription, used as a curative or remedial substance.

 

          (bg)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

 

          (bh)  “Neglect” means an act or omission, which results, or could result, in the deprivation of essential services necessary to maintain the mental, emotional, or physical health and safety of a patient.

 

          (bi)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (bj)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bk)  “Over-the-counter medications” means non-prescription medications.

 

          (bl)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (bm)  “Patient” means any person admitted to or in any way receiving care, services, or both from a HH licensed in accordance with RSA 151 and He-P 824.

 

          (bn)  “Patient record” means documents maintained for each patient receiving care and services, which includes all documentation required by RSA 151 and He-P 824 and all documentation compiled relative to the patient as required by other federal and state requirements.

 

          (bo)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

 

          (bp)  “Personal assistance” means providing or assisting a patient in obtaining one or more services as determined by their patient assessment.

 

          (bq)  “Personal representative” means a person designated in accordance with RSA 151:19, V to assist the patient for a specific, limited purpose, or for the general purpose of assisting the patient in the exercise of any rights.

 

          (br)  “Personnel” means an individual, who is employed by, a volunteer of, or an independent contractor of the HH who provides services to patient(s).

 

          (bs)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the patient’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques.

 

          (bt)  “Physician” means medical doctor or doctor of osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a doctor of naturopathic medicine licensed in accordance with RSA 328-E.

 

          (bu)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bv)  “Point of care devices” means a system of devices used to obtain medical, diagnostic results including but not limited to:

 

(1)  A lancing or finger stick device to obtain blood specimen;

 

(2)  A test strip or reagents to apply a specimen to for testing; or

 

(3)  A meter or monitor to calculate and show the results, including:

 

       a. Blood glucose meters, also called “glucometers”;

 

       b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation        meters; or

 

       c. A Cholesterol meter.

 

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

 

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

 

          (by)  “Professional management responsibility” means that the professional staff of the HH provider continues to provide guidance and services to the patient regardless of the location of the patient.

 

          (bz)  “Professional staff” means:

 

(1)  Physicians;

 

(2)  Physician assistants;

 

(3)  Advanced registered nurse practitioners;

 

(4)  Registered nurses;

 

(5)  Registered physical therapists;

 

(6)  Speech therapists;

 

(7)  Licensed practical nurses;

 

(8)  Licensed respiratory therapists;

 

(9)  Occupational therapists;

 

(10)  Medical social workers;

 

(11)  Dietitians;

 

(12)  Spiritual care coordinators;

 

(13)  Bereavement counselors; and

 

(14)  Volunteer coordinators.

 

          (ca)  “Protective care” means the provision of patient monitoring services, including but not limited to:

 

(1)  Knowledge of patient whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (cb)  “Qualified personnel” means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (cc)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (cd)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (ce)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (cf)  “Reportable incident” means an occurrence of any of the following while the patient is either in the HH or in the care of HH personnel:

 

(1)  The unanticipated death of a patient which is not related to their diagnosis or underlying condition;

 

(2)  An unexplained accident or other circumstance that is of a suspicious nature of potential abuse or neglect where the injury was not observed or the cause of the injury could not be explained and has resulted in an injury that requires treatment in an emergency room by a licensed practitioner; or

 

(3)  An elopement from the HH or other circumstances that resulted in the notification or involvement of law enforcement or safety officials.

 

          (cg)  “Self-administration of medication” means an act whereby the patient takes his or her own medication(s) without the assistance of another person.

 

          (ch)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient.

 

          (ci)  “Significant change” means a decline or improvement in a patient’s status that:

 

(1)  Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions;

 

(2)  Impacts more than one area of the patient’s health status; and

 

(3)  Requires interdisciplinary review or revision of the care plan.

 

          (cj)  “State Fire Code” means the edition of the Life Safety Code 101 and Fire Code NFPA 1 adopted and amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5.

 

          (ck)  “State Building Code” means the edition of the International Building Code, the International Existing Building Code, the International Plumbing Code, the International Mechanical Code, the International Energy Conservation Code, the International Swimming Pool and Spa Code, and the International Residential Code, as published by the International Code Council, and the National Electrical Code adopted and amended by the state building code review board and ratified by the legislature in accordance with RSA 155-A:10.

 

          (cl)  “State monitoring” means the placement of individuals by the department at an HH to monitor the operation and conditions of the facility.

 

          (cm)  “Temporary manager” means a person appointed by the department to assume responsibility for the day-to-day operation and administration of an HH.

 

          (cn)  “Transfer” means moving a patient from one licensed facility or entity to another licensed facility or entity.

 

          (co)  “Underwriters Laboratories (UL) Listed” means that the global safety certification company UL has confirmed that the product is safe for use.

 

          (cp) “Volunteer” means an unpaid person who assists with the provision of care services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services or entertainment.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a) and submit the following to the department: 

 

(1)  A completed application form entitled “Application for Residential, Health Care License or Special Health Care Service” (February 2023) signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following:

 

“I affirm that I am familiar with the requirements of RSA 151 and the rules adopted there under and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

(2)  A floor plan of the prospective HH;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee, in accordance with RSA 151:5, VII, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire;”;

 

(5)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, and local fire ordinances applicable for a health care facility; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and again upon completion of the construction project; 

 

(6)  If the HH uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02 or, if a public water supply is used, a copy of a water bill;

 

(7)  A resume identifying the qualifications of the HH administrator and medical director;

 

(8)  Copies of applicable licenses for the HH administrator and medical director;

 

(9)  The results of a criminal records check, for the applicant, licensee if different than the applicant, administrator and medical director which includes criminal history from the state of New Hampshire;

 

(10)  A copy of the criminal attestation as described in He-P 824.19(k)(7) for the administrator and medical director; and

 

(11)  The results of a BEAS registry check from the bureau of elderly and adult services for the administrator and medical director.

         

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 824.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 824.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 824.13(b), when it determines that the applicant, licensee, administrator, or medical director:

 

(1)  Has been convicted of any felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this of any other state;

 

(3)  Has had a finding by the department or any other administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  Following both a clinical and life safety inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 824.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)  A written notification of denial, shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 824.05(g) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 824.

 

          (i) A written notification of denial, shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee shall complete and submit to the department an application form pursuant to He-P 824.04(a)(1) at least 120 days prior to the expiration of the current license to include:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 824.10(f), if applicable.  If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 824.10(f), if applicable. If such request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(4)  A list of current employees who have a permanent waiver granted in accordance with He-P 824.17(e)(2); and

 

(5)  A copy of any temporary, new or existing variances or waivers applied for or granted by the state fire marshal in accordance with RSA 153:5 and Saf-C 6005.

 

          (c)  In addition to He-P 824.06(b), if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by He-P 824.06(b) and (c), as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 824, and all the federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.07  HH Construction, Modifications or Renovations.

 

          (a)  For new construction and for rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including stamped architectural, sprinkler, and fire alarm plans, shall be submitted to the department at least 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room

designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety

requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 824 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  The HH shall comply with all applicable state laws, rules, and local ordinances when

undertaking construction or rehabilitation.

 

          (g)  A licensee or applicant undertaking construction, repairs, renovations, rehabilitation or modifications of a building shall comply with the appropriate chapters and sections of the state fire code and state building code.

 

          (h)  All HHs newly constructed or rehabilitated after the 2022 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), as applicable, available as noted in Appendix A.

 

          (i)  Where rehabilitation is done within an existing facility, all such work shall comply with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition), available as noted in Appendix A.

 

          (j) The department shall be the authority having jurisdiction for the requirements in He-P 824.07(h)-(i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 824.10 as appropriate.

 

          (k)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and

ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved

fire system that provides an equivalent rating as provided by the original surface.

 

          (l)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines

above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (m)  Exceptions or variances pertaining to the state fire code referenced in He-P 824.07(g) shall be granted only by the state fire marshal.

 

          (n)  Exceptions or variances pertaining to the state building code shall be granted by the local building official or the state fire marshal if in a state owned building. 

 

          (o)  The building, including all construction and rehabilitated spaces, shall be inspected pursuant to He-P 824.09 prior to its use.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.08  HH Requirements for Organizational or Service Changes.

 

          (a)  The HH shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds authorized under the current license; or

 

(6)  Services.

 

          (b)  The HH shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3)  An increase in the number of beds authorized under the current license; or

 

(4)  A change in services.

 

          (c)  When there is a change in the address without a change in location, the HH shall provide the department with a copy of the notification from the local, state or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the HH shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

 

(2)  The physical location;

 

(3)  A change in the number of beds or patients authorized under the current license;

 

(4)  A change in licensing classification; or

 

(5)  A change that places the facility under a different life safe code occupancy chapter.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the HH’s name or a change in addresses without a change in physical location.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  An increase or decrease in the number of beds;

 

(3)  A change in the scope of services provided; or

 

(4)  When a waiver has been granted in accordance with He-P 824.10.

 

          (i)  The HH shall inform the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses for the new administrator or medical director;

 

(3)  The results of a criminal background check for the new administrator or medical director;

 

(4)  A copy of the criminal attestation as described in He-P 824.19(k) for the new administrator or medical director; and

 

(5)  The results of a BEAS registry check from the bureau of elderly and adult services for the new administrator or medical director.

         

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 824.03(al) and He-P 824.15(h).

        

          (k)  If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

          (l)  When there is to be a change in the services provided, prior to providing the additional services the HH shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, will be made to the physical environment.

 

          (m)  The department shall review the information submitted under (h) above and determine if the added services can be provided under the HH’s current license.

 

          (n)  The HH shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency.

 

          (o)  A restructuring of an established HH that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  If a licensee chooses to cease operation of an HH, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRES: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 824, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the HH; and

 

(3)  Any records required by RSA 151 and He-P 824.

 

          (b)  The department shall conduct a clinical and life safety inspection, as necessary, to determine full compliance with RSA 151 and He-P 824 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 824.08(e)(1);

 

(3)  A change in the physical location of the HH;

 

(4)  An increase in the number of beds;

 

(5)  Occupation of space after construction, renovations or alterations;

 

(6)  A change in the licensing classification; or

 

(7)  The renewal of a non-certified HH license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC.

 

         (d)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the HH is in violation of any of the provisions of He-P 824, RSA 151, or other federal or state requirement(s).

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 824, within 21 days of the date on the letter that transmits the inspection report.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 824 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary;

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought, or provide a reasonable explanation why the applicable rule should be waived; and

 

(4)  The period of time for which the waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the patients; and

 

(3)  Does not affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) 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 complainants’ first-hand knowledge regarding the allegations or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or

 

(3)  There is 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 RSA 151 or He-P 824.

 

          (b)  When practicable, the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the HH, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 824.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed HH, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

       

(3)  Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 824.

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(d);

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings prior to the department’s issuance of a warning;

 

(3)  In accordance with RSA 151:7-a, I, the department may issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 824;

 

(4) The warning in (e)(3) above, shall include:

 

a.  The time frame within which the owner or person responsible shall comply with the directives of the warning;

 

b.  The final date by which the action or actions requiring licensure must cease or by which an application for licensure must be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and

 

c.  The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and

 

(5)  Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 824.13.

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 824, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below; 

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the state notice detailing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur; to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct, unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21 day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 824;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 824 as a result of this implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

(6)  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14 day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14 day period but has been unable to do so; and

 

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

 

(7)  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above;

 

(8)  If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 824.12(d) and a fine in accordance with He-P 824.13(c)(12);

 

(9)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next inspection;

 

(10)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(11)  If the POC has not been implemented by the completion date, at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with He-P 824.12(b); and

 

b.  Issued a directed POC in accordance with He-P 824.12(d) and a fine in accordance with He-P 824.13(f)(12).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine;

 

(3)  Deny the application for a renewal of a license in accordance with He-P 824,13(b); or

 

(4)  Revoke the license in accordance with He-P 824.13(b).

 

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

 

          (g)  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.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section.

 

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

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact health, safety, or well-being of patients;

 

(2)  The presence of conditions in the HH that negatively impact the health, safety, or well-being of patients;

 

(3)  Concern that the facility is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules; or

 

(4)  Conditions exist for implementation of temporary management as described in (i) below but no temporary manager can be found.

 

          (m)  The department shall appoint a temporary manager to assume operation of a HH when, following an inspection, the department determines that:

 

(1)  The licensee has repeatedly failed to manage and operate the HH in compliance with RSA 151 and He-P 824 and such HH practices have failed to meet the needs of the patients;

 

(2)  The licensee has failed to develop or implement policies and procedures for infection control, sanitation or life safety codes, imposing harm or the potential for harm to the patients; or

 

(3)  The health, safety and well-being of the patients are at risk and emergency action is required.

 

Source.  #5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

 

New.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30 III as applicable, before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 824 which poses a threat to the patient’s health, safety, or well-being;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, the applicant or licensee fails to submit an application that meets the requirements of He-P 824.04;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 824.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 824.12(c)(6) and has not submitted a revised POC in accordance with He-P 824.12(c)(6)b.;

 

(8)  The licensee is cited a third time under RSA 151 or He-P 824 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (i) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 824;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee or unlicensed provider shall be $500.00;

 

(4)  For a failure to transfer a patient whose needs exceeds the services or programs provided by the HH, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(5)  For admission of a patient whose needs exceed the services or programs authorized by the HH licensing classification, in violation of RSA 151:5-a, II and He-P 824.15(a) and (b), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 824.11(i), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 824.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 824.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 824.08(a)(2), the fine for a licensee shall be $500.00;

 

(10)  For a failure to allow access by the department to the HH’s premises, programs, services, patients or records, in violation of He-P 824.09(a)(1)-(3), the fine for an applicant, unlicensed individual or licensee shall be $2000.00;

 

(11)  For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 824.08(d), the fine for a licensee shall be $100.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 824.12(c)(2) and (6), the fine for a licensee shall be $100.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 824.12(c)(11), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement or comply with licensee policies, the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 824.14(d), the fine for a licensee shall be $500.00;

 

(16)  For exceeding capacity, in violation of He-P 824.14(m), the fine for a licensee shall be $500.00;

 

(17)  For providing false or misleading information or documentation, in violation of He-P 812.14(g), the fine shall be $1,000.00 per offense;

 

(18)  For a failure to meet the needs of the patient, in violation of He-P 824.15(a), the fine for a licensee shall be $1000.00 per patient;

 

(19)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 824.10 in violation of He-P 824.18(h)-(j), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 824.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities; the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that a violation of RSA 151 or He-P 824 has the potential to jeopardize the health, safety or well-being of a patient, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance, the fine for a licensee shall be double the original fine, but not to exceed $1000.00; and

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be triple the original fine, but not to exceed $2000.00; and

 

(23)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 824 shall constitute a separate violation and shall be fined provided that if the applicant or licensee is making good faith efforts, as verified by documentation or other means, to comply with the provisions of RSA 151 or He-P 824, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to appeal.

 

          (f)  If a written request is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or welfare of a patient is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 824 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  RSA 541 shall govern further appeals of department decisions under this section.

 

          (k)  When an HH’s license has been denied or revoked, the applicant, licensee, administrator or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years, if the enforcement action pertained to their role in the HH.

 

          (l)  The 5-year period referenced in (k) above shall begin on:

 

(1)  The date the department’s decision to revoke or deny the license, if not filed; or

 

(2)  The date a final decision upholding the action of the department is issued, if a request for an administrative hearing was made and a hearing was held.

 

          (m)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 824.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A or He-P 824.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.14  Duties and Responsibilities of All Licensees.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable.

 

          (b)  Each HH shall be owned and operated by a home hospice care provider licensed in New Hampshire in accordance with RSA 151:2.

 

          (c)  The licensee shall have written policies and procedures setting forth:

 

(1)  The rights and responsibilities of patients in accordance with the patients’ bill of rights; and

 

(2)  The policies described in (d), (e), and (w) below.

 

          (d)  The HH shall define, in writing, the scope and type of services to be provided by the HH, which shall include at a minimum, the core services listed in He-P 824.15.

 

          (e)  The HH shall develop and implement written policies and procedures governing the operation and all services and shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (f)  All policies and procedures shall be reviewed annually and revised as needed.

 

          (g)  The HH personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (h)  The HH shall not advertise or provide services that it is not licensed to provide, pursuant to RSA 151:2, III.

 

          (i)  The HH shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (j)  The HH shall have responsibility and authority for:

 

(1)  Managing, controlling, and operating the HH;

 

(2)  Meeting the needs of the patients during those hours that the patient is in the care of the HH;

 

(3)  Initiating action to maintain the HH in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state and local laws, rules, regulations, and ordinances;

 

(4)  The continuity of inpatient care;

 

(5)  Establishing, in writing, a chain of command that sets forth the line of authority for the operation of the HH;

 

(6)  Appointing an administrator;

 

(7)  Verifying the qualifications of all personnel;

 

(8)  Providing sufficient numbers of qualified personnel who are available to meet the needs of patients during all hours that the HH has told the patient that they will provide service;

 

(9)  Providing personnel with sufficient supplies and equipment to meet the needs of the patients;

 

(10)  Requiring all personnel to follow the orders of the licensed practitioner for every patient and to encourage the patient to follow the licensed practitioner’s orders; and

 

(11)  Implementing any POC that has been accepted or issued by the department.

 

          (k)  The licensee shall consider all patients to be competent and capable of making all decisions relative to their own health care unless the patient:

 

(1)  Has a guardian or conservator appointed by a court of competent jurisdiction;

 

(2)  Has a durable power of attorney for health care that has been activated in accordance with RSA 137-J; or

 

(3)  Has a surrogate designated in accordance with RSA 137-J.

 

          (l)  The licensee shall only admit an individual or retain a patient whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the HH.

 

          (m)  If an individual is admitted who requires lift equipment for transfers, all direct care personnel shall have been trained in the correct operation of such equipment.

 

          (n)  A licensee shall not deny admission to any person because that person does not have a guardian or an advance directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

 

          (o)  The patient shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

 

(1)  The patient’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

 

(2)  The patient cannot be safely evacuated in accordance with Saf-C 6000;

 

(3)  The patient or the patient’s guardian, if any, determines that the patient shall leave the facility; or

 

(4)  The patients’ medical condition is no longer compatible with the facility and the services and programs offered.

 

          (p)  The licensee shall develop a discharge plan with the input of the patient and the guardian or agent, if any.

 

          (q)  The following documents shall accompany the patient upon transfer:

 

(1)    The most recent patient assessment tool, care plan, and quarterly progress notes;

 

(2)    The most recent nursing assessment, if applicable;

 

(3)    The most recent multi-disciplinary care plan, if applicable;

 

(4)    Current medication records; and

 

(5)    A licensed practitioner’s order for transfer, if applicable.

 

          (r)  If the transfer or discharge referenced in (d) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the patient as soon as practicable prior to transfer or discharge.

 

          (s)  The licensee shall not exceed the maximum number of patients or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (t)  In addition to the posting requirements specified in RSA 151:29, the HH shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  All inspection reports issued in accordance with He-P 824.09(c) and He-P 824.11(d), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21; 

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  The licensee’s plan for fire safety, evacuation and emergencies, identifying the location of, and access to all fire exits; and

 

(6)  Information on how to contact the office of the long-term care ombudsman.

 

          (u)  The HH shall admit and allow any department representative to inspect the HH and all programs and services that are being provided at any time for the purpose of determining compliance with RSA 151 and He-P 824 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (v)  Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX.  Immediately after the use of a physical or chemical restraint, the patient’s guardian or agent, if any, and the department shall be notified of the use of restraints.

 

          (w)  The HH shall:

 

(1)  Have policies and procedures on:

 

a.  What type of emergency restraints may be used;

 

b.  When restraints may be used; and

 

c.  What professional personnel may authorize the use of restraints; and

 

(2)  Provide personnel with education and training on the limitations and the correct use of restraints.

 

          (x)  The use of mechanical restraints shall be allowed only as defined under He-P 824.03(ak).

 

          (y)  The following methods of mechanical restraints shall be prohibited:

 

(1)  Full bed rails;

 

(2)  Gates, if they prohibit a patient’s free movement throughout the living areas of the HH;

 

(3)  Half doors, if they prohibit a patient’s free movement throughout the living areas of the HH;

 

(4)  Geri chairs, when used in a manner that prevents or restricts a patient from getting out of the chair at will;

 

(5)  Wrist or ankle restraints;

 

(6)  Vests or pelvic restraints; and

 

(7)  Other similar devices that prevent a patient’s free movement.

 

          (z)  For reportable incidents the licensees shall:

         

(1)  Complete an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Fax to 603-271-5574 or, if a fax machine is not available, submit via regular mail, postmarked within 2 business days of the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 2 business days of a reportable incident:

 

a.  The HH name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of the patient involved and the name of any witnesses to the reportable incident;

                         

e.  The date and time of the reportable incident;

                         

f.  The action taken in direct response to the reportable incident, including any follow-up;

                         

g.  If medical intervention was required, by whom and the date and time;

                      

h.  Whether the patient’s guardian, agent, or personal representative, if any, was notified;

              

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the patient’s licensed practitioner was notified;

 

(3)  If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report;

 

(4)  Contact the department immediately by telephone, fax, or e-mail to report the information required by (1) above in the case of the death of any patient who dies within 10 days of a reportable incident;

 

(5)  Provide the information required by (3) above in writing within 3 business days of the unexpected death of any patient or the death of any patient who dies within 10 days of a reportable incident if the initial contact was made by telephone or if additional information becomes available subsequent to the time the initial contact was made; and

                 

                  (6)  Submit any further information requested by the department.

 

          (aa)  The HH shall respond to a notice of deficiencies by providing a POC in accordance with He-P 824.12(c).

 

          (ab)  The HH shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

          (ac)  The HH shall, upon request, provide a patient or their legal guardian or agent, if applicable, with a copy of his or her patient record pursuant to the provisions of RSA 151:21, X.

 

          (ad)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (ae)  Any licensee that maintains electronic records shall develop a system with written policies and procedures designed to protect the privacy of patients and staff that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to patients and staff.

 

          (af)  The licensee shall develop policies and procedures regarding the release of information contained in patient records.

 

          (ag)  At the time of admission, the HH shall give a patient, their guardian or agent, if applicable, a listing of all HH’s charges and identify what care and services are included in the charge.

         

          (ah)  The licensee shall give a patient a written notice as follows:

 

(1)  For an increase in the cost or fees for any HH services 30 days advance notice; or

 

(2)  For an involuntary change in room or bed location 14 day advance notice, unless the change is required to protect the health, safety, and well-being of the patient or other patients, in such case the notice shall be as soon as practicable.

 

          (ai)  The HH shall provide all personnel with education in hospice philosophy and hospice care in compliance with the CMS conditions of participation.

 

          (aj)  The HH shall comply with all federal, state and local health, building, fire and zoning laws, rules and ordinances.

 

          (ak)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68 and RSA 155:69 and He‑P 824.24(h).

 

          (al)  If the HH holds or manages a patient’s funds or possessions, the facility shall have written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other patients, or other household members.

 

          (am)  The HH shall not falsify any documentation required by law or provide false or misleading information to the department.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.15  Required Services.

 

          (a)  The licensee shall provide the following core hospice care services:

 

(1)  Nursing services sufficient to meet the nursing needs of the patient, which are:

 

a.  Determined by the patient’s care plan; and

 

b.  Available, as needed, 24 hours a day;

 

(2)  LNA and personal care services that are provided either directly or by contract as the needs of the patient dictate and as determined by the patient’s care plan;

 

(3)  Providing patients with pharmaceutical services such as equipment, appliances, medical supplies and other pharmaceutical services as the needs of the patient dictate and as determined by the patient’s care plan;

 

(4)  Medical social services shall be based on the patient’s psychosocial assessment and the patient’s and family’s needs and acceptance of these services. Medical social services shall be provided by a qualified social worker;

 

(5)  Hospice volunteer services;

 

(6)  Nutritional counseling, physical or occupational therapy, and speech therapy that are provided or arranged for as needed in accordance with patient’s care plan;

 

(7)  Spiritual services which are offered in accordance with the patient’s and family’s beliefs and values;

 

(8)  Bereavement services that are available to the family for up to one year following the death of the patient;

 

(9)  Health and safety services to minimize the likelihood of accident or injury, with care and oversight provided 24 hours a day regarding:

 

a.  The patients’ functioning, safety, and whereabouts; and

 

b.  The patients’ health status, including the provision of intervention as necessary or required; and

 

(10)  Medication services in accordance with He-P 824.17.

 

          (b)  In addition to the services in (a) above the licensee shall provide the following services:

 

(1)  Food services in accordance with He-P 824.21;

 

(2)  Housekeeping, laundry, and maintenance services; and

 

(3)  Basic supplies necessary for patients to maintain personnel hygiene and grooming.

 

          (c)  If, on a temporary basis, not to exceed 90 days, the hospice care provider cannot provide any of the core care and services in (a) above, the HH shall have a written agreement with another agency to provide the required services.

 

          (d)  Any contractual agreement to provide care and services shall:

 

(1)  Identify the care and services to be provided;

 

(2)  Specify the qualifications of the personnel that will be providing the care and services;

 

(3)  Require that the HH must authorize the services; and

 

(4)  Stipulate the HH retains professional responsibility for all care and services provided.

 

          (e)  The HH shall provide or arrange for the provision of short-term in-patient stays in a hospital or nursing home during those times when the patient’s pain or symptoms are unable to be managed in the HH.

 

          (f)  The HH shall retain professional management responsibility for all services that are provided including contracted services when a hospice patient is in another licensed facility.  These responsibilities shall be defined in a written contractual agreement.

 

          (g)  The licensee shall ensure that the following positions are staffed at the HH location:

 

(1)  An administrator;

 

(2)  A director of patient services, but the administrator may also be the director of patient services if the administrator meets the qualifications of the position;

 

(3)  A volunteer coordinator;

 

(4)  A social services coordinator; and

 

(5)  A spiritual and or bereavement coordinator.

 

          (h)  Any administrator shall:

 

(1)  Have at least a bachelor’s degree in business or a health-related field with a minimum of 3 years’ experience in hospice or palliative care or; 

 

(2)  Be a registered nurse; and

 

(3)  Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence.

 

          (i)  The administrator shall be responsible for maintaining the HH in full compliance with all federal, state and local laws, rules, codes and ordinances at all times.

 

          (j)  The director of patient services shall:

 

(1)  Be a New Hampshire-licensed registered nurse or an advanced practice registered nurse; or

 

(2)  Have a bachelor’s degree in a health field related to hospice care.

 

          (k)  The director of patient services shall:

 

(1)  Be responsible for the overall delivery of patient care and services;

 

(2)  Provide sufficient nursing personnel to meet the need of the patients;

 

(3)  Supervise the overall delivery of patient care and services; and

 

(4)  Coordinate the supervision of licensed practical nurses (LPN), licensed nurse aides (LNA) and or personal care attendants (PCA) by a registered nurse and determine if the LNA or PCA is providing care and services in accordance with the patient’s care plan.

 

          (l)  The medical director, who shall be a physician licensed in the state of New Hampshire, shall be responsible for:

 

(1)  The oversight of the medical component of the HH’s patient care program;

 

(2)  Participating on the interdisciplinary patient care team if the patient’s own licensed practitioner cannot participate; and

 

(3)  Determining, in consultation with the interdisciplinary team, that an individual is appropriate for hospice and or palliative care services.

 

          (m)  Volunteer services shall be provided under the direction of a coordinator of volunteer services who:

 

(1)  Implements a direct service volunteer program;

 

(2)  Coordinates the orientation, education, support, and supervision of direct service volunteers; and

 

(3)  Coordinates the utilization of direct service volunteers with other hospice staff.

 

          (n)  All volunteers shall be oriented and educated relative to their prescribed function according to the hospice care provider’s policies and procedures.

 

          (o)  The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:

 

(1)  Recruitment and retention;

 

(2)  Health screening and 2-step TB testing;

 

(3)  Orientation;

 

(4)  Scope of function;

 

(5)  Supervision;

 

(6)  Ongoing training and support;

 

(7)  Records of volunteer activities; and

 

(8)  Criminal record checks.

 

          (p)  The social services coordinator shall have:

 

(1)  At least a master’s degree from a graduate school of social work; or

 

(2)  A bachelor’s degree in a related health or human services field, have at least 2 years’ experience as a social worker and have established a consultative relationship with a person who qualifies in (1) above.

 

          (q)  The social services coordinator shall:

 

(1)  Participate in the development of the care plan; and

 

(2)  Work in conjunction with the director of patient services to coordinate all social services required by the care plan and ensure their delivery.

 

          (r)  The coordinator of bereavement and spiritual care services shall be a person who has at least a bachelor’s degree in an applicable field such as theology of education, psychology or counseling and who has education in death and dying, grief, and bereavement.

 

          (s)  Persons providing bereavement services shall have education in death and dying, grief and bereavement.

 

          (t)  The coordinator of bereavement and spiritual care services shall be responsible for providing an organized program of bereavement services for up to 12 months after the death of the patient that includes but is not limited to:

 

(1)  Counseling to families after the patient’s death; and

 

(2) Developing a care plan that reflects the needs of the patient’s family.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

          (x)  Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.16  Patient Admission Criteria, Temporary Absence, Transfer and Discharge.

 

          (a)  At the time of admission, personnel of the HH shall:

 

(1)  Provide, both orally and in writing, to the patient, their guardian or agent, if applicable, the HH’s:

 

a.  Policy on patient rights and responsibilities;

 

b.  Complaint procedure;

 

c.  List of care and services that are provided directly by the HH; and

 

d.  List of the care and services that are provided by contract;

 

(2)  Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, their guardian or agent, if applicable;

 

(3)  Collect and record the following information:

 

a.  Patient’s name, home address, home telephone number, and date of birth;

 

b.  Name, address, and telephone number of an emergency contact and guardian and/or agent, if applicable;

 

c.  Name of patient’s primary care provider and their address and telephone number;

 

d.  Copies of all legal directives such as durable power of attorney, legal guardian or living will; and

 

e.  Written and signed consent for the provision of care and services; and

 

(4)  Obtain documentation of informed consent and consent for release of information.

 

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

 

(1)  A patient’s agreement including the following information:

 

a.  The basic daily, weekly, and monthly fee;

 

b.  A list of the core services required by He-P 824.15(a) and (b) that are covered by the basic fee;

 

c.  Information regarding the timing and frequency of cost of care increases;

 

d.  The time period covered by the admissions contract;

 

e.  The HH’s house rules;

 

f.  The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

 

g.  The HH’s responsibility for patient discharge planning;

 

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

 

1.  The availability of services;

 

2.  The HH’s responsibility for arranging services; and

 

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

 

i.  The licensee’s policies and procedures regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

4.  Monitoring third party services contracted directly by the patient and provided on the HH premises;

 

5.  Handling of patient funds pursuant to RSA 151:24 and He-P 824.14(af);

 

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

 

7.  Storage and loss of the patient’s personal property; and

 

8.  Smoking;

 

j.  The licensee’s medication management services; and

 

k.  The list of grooming and personal hygiene supplies provided by the HH as part of the basic daily, weekly, or monthly rate;

 

(2)  A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the HH’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

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

 

(4)  The HH’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29.

 

          (c)  The hospice care provider shall ensure that medical direction is provided either from the patient’s attending licensed practitioner or the hospice medical director.

 

          (d)  Patients who are admitted or accepted for services shall:

 

(1)  Have a nursing assessment at the following intervals to determine the level of care and services required by the patient:

 

a.  Within 48 hours of admission; and

 

b.  Thereafter as required by the CMS conditions of participation; and

 

(2)  Have a signed and dated order for any service for which such order is required by the practice acts of the person providing care, renewed at least every 90 days.

 

          (e)  The assessment required by (d)(1) above shall contain, at a minimum, the following:

 

(1)  Pertinent diagnoses including mental status;

 

(2)  A pain assessment, including symptom control and vital signs;

 

(3)  A physical assessment;

 

(4)  A cognition and mental status assessment;

 

(5)  A behavioral assessment;

 

(6)  A psychosocial assessment;

 

(7)  Medication and treatments;

 

(8)  Functional limitations;

 

(9)  Nutritional requirements;

 

(10)  Any equipment required; and

 

(11)  Any safety precautions.

 

          (f)  In addition to the information required in (e) above, the nursing assessment shall include:

 

(1)  Reactions of the patient and family members to terminal illness;

 

(2)  History of the patient’s and family coping strengths and weaknesses;

 

(3)  Social and financial concerns; and

 

(4)  Spiritual beliefs and desires of the patient.

 

          (g)  If the assessment required by (d) above is completed by an LPN, the assessment shall be reviewed and co-signed by the registered nurse or physician that is supervising the LPN prior to the development of the patient’s care plan.

 

          (h)  The licensee shall establish an interdisciplinary hospice care team composed of at least:

 

(1)  A licensed practitioner;

 

(2)  A registered nurse;

 

(3)  A social worker; and

 

(4)  A clergy person or counselor.

 

          (i)  The interdisciplinary hospice care team shall:

 

(1)  Establish the care plan;

 

(2)  Be the primary care delivery team for a patient and his or her family through the total duration of hospice care; and

 

(3)  Be responsible for supervising any patient care and services provided by others.

 

          (j) The interdisciplinary team shall, in conjunction with the patient, the patient’s personal representative, and their family, develop an individualized care plan, which reflects the changing care needs of the patient and family.

 

          (k)  The care plan required by (j) above shall include:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The goal for the patient;

 

(4)  The action or approach to be taken by HH personnel;

 

(5)  The responsible person(s) or position; and

 

(6)  The interventions used to address problems identified in the assessment including:

 

a.  Medications ordered;

 

b.  Pain control interventions, both pharmacological and non-pharmacological;

 

c.  Symptom management treatment; and

 

d.  Services required including frequency of visits.

 

          (l)  The care plan required by (j) above shall be:

 

(1)  Developed in conjunction with the patient and their guardian or agent, if applicable;

 

(2)  Completed within 3 days after completion of the nursing assessment;

 

(3)  Reviewed and revised at least every 30 days by the interdisciplinary team following the completion of each assessment; and

 

(4)  Made available to all personnel that assist the patients.

 

          (m)  The patient and their family shall be encouraged to participate in all components of care, including: 

 

(1)  Assessment and problem identification;

 

(2)  Implementation of the plan of care; and

 

(3)  Evaluation and revision of the plan, as needed.

 

          (n)  At the time of a patient’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions and diet.

 

          (o)  A patient may refuse all care and services. 

 

          (p)  When a patient refuses care or services that could result in a threat to their safety or that of others, the licensee or their designee shall:

 

(1)  Inform the patient of the potential results of their refusal;

 

(2)  Notify the licensed practitioner and guardian or agent if any, of the patient’s refusal of care; and

 

(3)  Document in the patient’s record the refusal of care and the patient’s reason for the refusal.

 

          (q)  Progress notes shall be written by any member of the interdisciplinary team to document:

 

(1)  Changes in the patient’s physical, functional and mental abilities;

 

(2)  Changes in the patient’s behaviors such as eating or sleeping patterns; and

 

(3)  Newly identified needs of the patient and or their family.

 

          (r)  All staff of the HH shall follow the approaches stated in the care plan. 

 

          (s)  The licensee shall provide an emergency data sheet to emergency medical personnel in the event of an emergency transfer to another medical facility.

 

          (t)  The data sheet referenced in (s) above shall include:

 

(1)  The patient’s full name and the name the patient prefers, if different;

 

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

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advance directive; and

 

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

 

          (u)  Written notes shall be documented in the patient’s record for any unusual incident, occurrence, or explained absence involving the patient which shall include the information required by He-P 824.14(t) and the signature and title of the person reporting the incident or occurrence.

 

          (v)  For each patient accepted for care and services at the HH, a current and accurate record shall be maintained and include, at a minimum:

 

(1)  The written confirmation required by He-P 824.16(b)(1);

 

(2)  The identification data required by He-P 824.16(b)(2);

 

(3)  The admission agreement required by He-P 824.16(c)(1);

 

(4)  Consent and medical release forms, as applicable; 

 

(5)  Pertinent medical information;

 

(6)  The emergency data sheet required by He-P 824.16(t);

 

(7)  All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by He-P 824.16(e)(2);

 

(8)  All assessments required by He-P 824.16(e)(1);

 

(9)  All laboratory and x-ray reports if the tests were taken at the HH;

 

(10)  All consults;

 

(11)  All care plans required by He-P 824.16(k) including documentation that the patient or patient’s guardian or agent, if applicable, participated in the development of the care plan;

 

(12)  All progress notes required by He-P 824.16(r) including the signature of the person providing the care;

 

(13)  All written notes required by He-P 824.16(v) including the signature of the person providing the care;

 

(14)  All daily medication records required by He-P 824.17(aa);

 

(15)  Discharge or transfer documentation, which shall include:

 

a.  In the case of patient death:

 

1.  Date and place of death; and

 

2.  Bereavement follow-up plan; and

 

b.  In the case of discharge other than patient death or transfer:

 

1.  Date and time of patient discharge;

 

2.  The physical, mental, and medical condition of patient at discharge;

 

3.  Discharge instruction and referral; and

 

4.  Signed licensed practitioner’s order for discharge, if applicable; and

 

(16)  Documentation of any unusual incidents involving the patient including the information required by (v) above.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.17 Patient Records

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each patient based on services provided at the HH.

 

          (b)  At a minimum, patient records shall contain the following:

 

(1)  A copy of the patient’s service agreement and/or admission contract and all documents required by He-P 824.16(c)(1);

 

(2)  Notwithstanding (1) above, financial records may be kept in a separate file;

 

(3)  Identification data, including:

 

a.  Vital information including the patient’s name, date of birth, and marital status;

 

b.  Patient’s religious preference, if known;

 

c.  Patient’s veteran status, if known; and

 

d.  Name, address and telephone number of an emergency contact person;

 

(4)  The name and telephone number of the patient’s licensed practitioner(s);

 

(5)  For individuals contracted by the HH or the patient to provide services at the HH, their name, employer, business address and telephone number;

 

(6)  Patient’s health insurance information;

 

(7)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(8)  A record of the health assessment in accordance with He-P 824.16(e)(1);

 

(9)  Written, dated, and signed orders for the following:

 

a.  All medications, treatments and special diets; and

 

b.  Laboratory services and consultations performed at the HH;

 

(10)  Results of any laboratory tests, X-rays, or consultations performed at the HH;

 

(11)  All admission and progress notes;

 

(12)  For services that are provided at the HH by individuals who are not employed by the licensee, documentation shall include the name of the agency providing the services, the date services were provided, the name of the person providing services and a brief summary of the services provided;

 

(13)  Documentation of medical or specialized care;

 

(14)  Documentation of reportable incidents;

 

(15)  The consent for release of information signed by the patient, guardian or agent, if any;

 

(16)  The medication record as required;

 

(17)  Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner;

 

(18)  Documentation of a patient’s refusal of any care or services; and

 

(19)  The licensee shall arrange for and document the immunization of all consenting patients for pneumococcal disease, as applicable, and all consenting patients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (c)  Patient records and patient information shall be kept confidential and only provided in accordance with law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

 

          (e)  When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use or access.

 

          (f)  Records shall be retained for 4 years after discharge, except that when the patient is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge.

 

     (g)  The licensee shall arrange for storage of, and access to, patient records as required by (g) above in the event the HH ceases operation.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.18  Medications.

         

     (a)  All medications shall be administered in accordance with the orders of the licensed practitioner or other professional authorized by law.

 

          (b)  Medications, treatments, and diets ordered by the licensed practitioner or other professional authorized by law shall be available to give to the patient within 24 hours or in accordance with the licensed practitioner’s direction.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the HH;

 

(2)  Reorder medications for use at the HH; and

 

(3)  Receive and record new medication orders.

 

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

 

(1)  The patient’s name:

 

(2)  The medication name, strength, prescribed dose and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated signature of the ordering practitioner.

 

          (e)  For PRN medications the ordering practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (f)  For each prescription medication being taken by a patient, the licensee shall maintain either the original written order or a copy of the order in the patient’s record, signed by a licensed practitioner or other individual authorized by law.

 

          (g)  Each medication, including licensed practitioner’s samples, shall legibly display the following information:

 

(1)  The patient’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 PRN medications; and

 

(5)  The date ordered.

 

          (h)  The label of all medication containers maintained in the HH shall match the current written orders of the licensed practitioner unless authorized by (j) below.

 

          (i)  Only a pharmacist shall make changes to a prescription medication container label. Any change or discontinuation of medications taken at the HH shall be pursuant to a written order licensed practitioner or other professional authorized by law.

 

          (j)  When the licensed practitioner or other professional authorized by law changes the dose of a medication and personnel of the HH are unable to obtain a new prescription label:

 

(1)  The licensed nurse shall clearly and distinctly mark the original container, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the HH’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Licensed nurse shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order, until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (k)  The licensee shall require that all telephone orders for medications or treatments are:

 

(1)  Taken only by a licensed health care professional if such action is within the scope of their practice act;

 

(2)  Immediately transcribed and signed by the individual taking the order; and

 

(3)  Be counter-signed by the authorized licensed practitioner authorized by law within 30 days.

 

          (l)  Over-the-counter medications shall be handled in the following manner:

 

(1)  The licensee shall obtain written approval from the patient’s licensed practitioner annually; and

 

(2)  Over-the-counter medication containers shall be marked with the name of the patient using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (m)  The medication storage area for medications not stored in the patient’s room shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each patient’s medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (n)  All medication at the HH shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use except as authorized by (x)(5) below.

 

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

 

          (p)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the HH, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (q)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (r)  The destruction of contaminated, expired, or discontinued medication shall be completed within 15 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first and shall:

 

(1)  Be accomplished in the presence of at least 2 people if a controlled substance; and

 

(2)  Be documented in the record of the patient for whom the drug was prescribed. 

 

          (s)  Upon discharge or transfer, the licensee shall make the patient’s current medications, except for controlled drugs which shall be destroyed in accordance with (r) above, available to the patient and the guardian or agent, if any.

 

          (t)  Medication(s) may be returned to pharmacies for credit only as allowed by the law.

 

          (u)  When a patient is going to be absent from the HH at the time medication is scheduled to be taken, the medication container shall be given to the patient if the patient is capable of self-administering, as described in (x) below.

 

          (v)  A written order from a licensed practitioner shall be required every 90 days for any patient who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers.

 

          (w)  Patients shall receive their medications by one of the following methods:

 

(1)  Self-administered medication as allowed by (x) below; or 

 

(2)  Administered by individuals authorized by law.

 

          (x)  For patients who self-administer medication as defined in He-P 824.03(bf), the licensee shall:

 

(1)  Obtain a written order from a licensed practitioner on an annual basis:

 

a.  Authorizing the patient to self-administer medications without supervision;

 

b.  Authorizing the patient to store the medications in their room; and

 

c.  Identifying the medications that may be kept in the patient’s room;

 

(2)  Evaluate the patient’s ability to self-administer medication upon admission and whenever there is a significant change in the patient, as defined in 824.03(bg), to ensure they maintain the physical and mental ability to self-administer;

 

(3)  Have the patient store the medication(s) in his or her room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures;

 

(4)  Have a copy of the key to access the locked medication storage area in the patient’s room; and

 

(5)  Allow the patient to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist.

 

          (y)  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.

 

          (z)  Personnel shall remain with the patient until the patient has taken the medication.

 

          (aa)  The licensee shall maintain a written record for each medication taken by the patient at the HH that contains the following information:

 

(1)  Name of the patient;

 

(2)  Any allergies or allergic reactions to medications;

 

(3)  The name, strength dose, frequency, and route of the medication;

 

(4)  The date and the time the medication was taken;

 

(5)  The signature and identifiable initials and job title of the person administering the medication;

 

(6)  Documented reason for any medication refused or omitted; and

 

(7)  For PRN medications, the reason the patient required the medication and the effect of the PRN medication.

 

          (ab)  An LNA who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the HH:

 

(1)  Medicinal shampoos and baths;

 

(2)  Glycerin suppositories and enemas; and

 

(3)  Medicinal topical products to intact skin as ordered by the licensed practitioner.

 

          (ac)  Non-prescription stock medications shall only be accessed and administered by the licensed nurse or medication nurse assistant on duty.

 

          (ad)  An HH shall use emergency drug kits only in accordance with board of pharmacy rule Ph 705.03 under circumstances where the HH:

 

(1)  Has a director of nursing who is a RN licensed in accordance with RSA 326-B; and

 

(2)  Has a contractual agreement with a medical director who is licensed in accordance with RSA 329 and a consultant pharmacist who is licensed in accordance with RSA 318.

 

          (ae)  The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

 

          (af)  If ordered by the department to do so, the HH shall obtain the services of a consulting pharmacist to rectify medication deficiencies, which present a risk to the patient’s health and safety, as identified during an inspection or investigation.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

He-P 824.19  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the HH to meet the needs of patients at all times.

 

          (b)  The licensee shall develop a job description for each position in the HH containing:

 

(1)  Duties of the position;

 

(2)  Physical requirements of the position; and

 

(3)  Qualifications and educational requirements of the position.

 

          (c)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  An LNA working under the supervision of an RN in accordance with Nur 700; or

 

(2)  Part of an established educational program working under the supervision of a registered nurse.

 

          (d)  For all new hires, the licensee shall:

 

(1)  Obtain and review criminal records check in accordance with RSA 151:2-d. Results must include criminal history from the state of New Hampshire;

 

(2)  Verify the qualifications and licenses, as applicable, of all applicants prior to employment; and

 

(3)  Verify that the applicant is not on the BEAS registry maintained by the department’s bureau of elderly and adult services per RSA 161-F:49.

 

          (e)  Unless a waiver is granted in accordance with He-P 824.10, the licensee shall not offer employment for any position if the individual:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  If the information identified in (e) above regarding any person in (d) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (e) above.

         

          (g)  If a waiver of (e) above is requested, the department shall review the information and the underlying circumstances in (e) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee; or

 

(2)  Grant a waiver of (e) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a patient(s).

 

          (h)  The licensee shall not employ, contract with, or engage, any person in (d) above who is listed on the BEAS state registry unless a waiver is granted by BEAS.

 

          (i)  In lieu of (d) and (h) above, the licensee may accept from independent agencies contracted by the licensee or by an individual patient to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) above.

         

          (j)  Prior to having direct care contact with patients, personnel, including volunteers and independent contractors shall:

 

(1)  Submit to the licensee the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, conducted not more than 12 months prior to employment and for personnel other than volunteers and independent contractors, submit the results of a physical examination or a health screening;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB;

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and

 

(4)  In lieu of (1) above, independent contractors hired by the facility may provide the facility with a signed statement that they have complied with (1) and (3) above for their employees working at the HH.

 

          (k)  Within the first 7 days of employment, all personnel who have direct or indirect contact with patients, to include volunteers who have direct care contact or who prepare and serve food shall receive a tour of the HH and an orientation that includes the following:

 

(1)  The patients’ rights in accordance with RSA 151:21;

 

(2)  The HH’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  The HH’s infection control procedures and required by He-P 824.22;

 

(6)  The HH’s emergency and evacuation procedures;

 

(7)  The procedures for food safety for those personnel involved in preparation, serving, and storing of food; and

 

(8)  The mandatory reporting requirements such as RSA 161:F: 46-48 and RSA 169-C: 29-31.

 

          (l)  Within the first 3 months of employment, all personnel who have direct or indirect contact with patients, to include volunteers who have direct care contact or who prepare and serve food shall receive an orientation to hospice philosophy relative to the delivery of care and services to hospice patients and their families.

 

          (m)  All personnel shall complete mandatory annual in-service education, which shall include a review of the information required by (k)(7) and (8) above.

 

          (n)  The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49 including continuing education.

 

          (o)  Such continuing education shall include new information on best practices in the treatment and care of persons with dementia and be provided for:

 

(1)  A minimum of 6 hours for initial continuing education to covered administrative staff members and covered direct service staff members; and

 

(2)  A minimum of 4 hours of ongoing training each calendar year.

 

          (p)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation or pose a threat to the health, safety or well-being of a patient; and

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person.

 

          (q)  Personnel, volunteers, or independent contractors hired by the licensee who will have direct care contact with patients, as defined in He-P 824.03(s), or direct contact with food who have a history of TB or a positive skin test shall have a symptomatology screen in lieu of a TB test.

 

          (r)  The licensee shall inform personnel of the line of authority at the HH.

 

          (s)  The personnel file for each individual shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the patient’s rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (a) above;

 

(5)  A job description signed by the individual that identifies the:

 

a. Position title;

 

b. Qualifications and experience; and

 

c. Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (n) above;

 

(7)  Information as to the general content and length of all in-service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs and demonstrated competencies that is signed and dated by the employee;

 

(9)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and

 

(10)  The statement required by (t) below.

 

          (t)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; or

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (u)  The licensee shall maintain separate personnel records that:

 

(1)  Contain the information required by (s) above; and

 

(2)  Are protected and stored in a secure and confidential manner.

 

          (v)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.20  Quality Improvement.

 

          (a)  The HH shall develop and implement a quality improvement program that reviews policies and all care and services provided to patients and maximize quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The HH shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the licensee;

 

(7)  Evaluate the effectiveness of the corrective actions; and

 

(8)  Meet quarterly.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.21  Infection Control.

 

          (a)  The HH shall appoint an individual who will oversee the development and implementation an infection control program that educates and provides procedures for the prevention, control and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

(4)  The handling, storage, transportation, and disposal of those items specified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and

 

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

 

          (c)  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.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not prepare food or provide direct care in any capacity until they are no longer contagious.

 

          (e)  Personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SRHCF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (f)  Personnel with an open wound who prepare food or provide direct care in any capacity shall cover such wound at all times by an impermeable, durable, tight-fitting bandage.

 

          (g)  Personnel infected with scabies or lice/pediculosis shall not provide direct care to patients or prepare food until such time as they are no longer infected.

 

          (h)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, which means any diseases caused by the growth of microorganisms in the body which might or might not be contagious, the HH shall provide the required procedures, equipment and staff, as specified by the United States Centers for Disease Control and Prevention, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.22  Food Services.

 

          (a)  The licensee shall provide food services that meet:

 

(1)  The US Department of Agriculture recommended dietary allowance as specified in the

US Department of Agriculture’s “Dietary Guidelines for Americans” (2020-2025 edition), available as noted in Appendix A;

 

(2)  The nutritional needs of each patient; and

 

(3)  The special dietary needs associated with health or medical conditions for each patient as identified on the patient assessment.

 

          (b)  Each patient shall be offered at least 3 nutritious meals and snacks in each 24-hour period when the patient is in the licensed premises unless contraindicated by the patient’s care plan.

 

          (c)  Snacks shall be available between meals and at bedtime if not contraindicated by the patient’s

care plan.

 

          (d)  The licensee shall provide therapeutic diets to patients as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (e)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods maintained on the premises for the licensed capacity:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Enough drinking water for a 3-day period.

 

          (f)  All food and drink provided to the patients shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated and stored at proper temperatures;

 

(5)  Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling and all other sources of contamination; and

 

(6)  The use of expired, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

 

          (g)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (h)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

 

          (i)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (j)  Trash receptacles in food service areas shall have covers and shall remain closed except when in

use.

 

          (k)  All HH personnel involved in the preparing and serving of food shall wash their hands and

exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

He-P 824.23  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

 

          (b)  All furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation, pursuant to Env-Ws 315 and 316.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All patient bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination. 

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2,VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and patient supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service areas shall be covered.

 

          (m)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations;

 

(4)  Soiled linens and clothing, which are considered contaminated with infectious waste under Env-Wm 103.28 shall be, handled as infectious waste; and

 

(5)  Soiled materials, linens, and clothing shall be handled as little as possible and transported in a laundry bag, sack or a covered container.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  There shall be a designated work area for soiled materials and linens that contain a work counter of at least 6 linear feet, a sink, and a storage area.

 

          (p)  Any HH that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

 

          (q)  Sterile or clean supplies shall be stored in dust and moisture-free storage containers.

 

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

          He-P 824.24  Physical Environment.

 

          (a)  The HH shall:

 

(1)  Have all entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and patients, including, but not limited to, hazards from falls, burns, or electrical shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take measures to prevent the presence of rodents, insects, and vermin.

 

          (b)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, welfare and comfort of patient(s) and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

 

          (c)  Equipment providing heat within an HH including, but not limited to, gas furnace or boiler, oil furnace or boiler, or wood stove or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where patients have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

 

b.  Be at least 70 degrees Fahrenheit during the day if the patient(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Unvented fuel-fired heaters shall not be used in any HH.

 

          (g)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (h)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows in each room that can be opened.

 

          (i)  Each patient bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage.

 

          (j)  The number of sinks, toilets, tubs or showers shall be in a ratio of at least one for every 6 patients.

 

          (k)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable and impervious to water.

 

          (l)  All hand washing facilities shall be provided with hot and cold running water.

 

          (m)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the patient to reach his or her bedroom without passing through the room of another patient;

 

(3)  Have a side hinge door and not a folding or sliding door or a curtain;

 

(4)  Provide accommodations for family members to remain with the patient throughout the night and physical space for family after a patient’s death;

 

(5)  Be separated from halls, corridors and other rooms by floor to ceiling walls; and

 

(6)  Be located on the same level as the bathroom facilities, if the patient has impaired mobility as identified by the HH assessment.

 

          (n)  The licensee shall provide the following for the patient’s use, as needed:

 

(1)  A bed appropriate to the needs of the patient;

 

(2)  A firm mattress that complies with the state fire code;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  A lamp;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades or curtains that provide privacy.

 

          (o)  The patient may use his or her own personal possessions provided they do not pose a risk to the patient or others.

 

          (p)  The licensee shall provide the following rooms to meet the needs of patients:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all patients.

 

          (q)  Each licensee shall have a UL listed communication system in place so that all patients can effectively contact personnel when they need assistance with care or in an emergency.  

 

          (r)  All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (s)  Screens shall be provided for:

 

(1)  Doors;

 

(2)  Windows; and

 

(3)  Other openings to the outside.

 

          (t)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (s) above.

 

Source.  #9317, eff 11-8-08, EXPIRED: 11-8-16

 

New.  #12169, INTERIM, eff 4-29-17, EXPIRED: 10-26-17

 

New.  #13572, eff 3-1-23

 

He-P 824.25  Emergency and Fire Safety.

 

          (a)  All HHs shall meet the appropriate chapters of the state fire code and state building code.

 

          (b)  All HH’s shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either

hardwired, powered by the HH’s electrical service, or wireless, as approved by the state fire marshal for the HH;

 

(2)  At least one ABC type fire extinguisher on every level or every 75 feet of corridor as required by NFPA 10 that shall:

 

a.  Be manually inspected when initially placed in service;

 

b.  Be inspected either manually or by means of an electronic   monitoring device/system at intervals not exceeding 31 days; and

 

c.  Be inspected at least once per calendar month and include:

 

1.  Documentation of the manual fire extinguisher inspections which shall be maintained on-site in accordance with NFPA 10 and available at the time of the inspection or investigation; and

 

2.  Documentation of electronically monitored fire extinguishers which shall be provided to the department within 2 business days of the completion of the inspection or investigation; and

 

(3)  An approved carbon monoxide monitor on every level.

 

          (c)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  Emergency EMS transport related to pre-existing conditions.

 

          (d)  The written notification under (c) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (e)  For the use and storage of oxygen and other related gases, HHs shall comply with NFPA 99, Health Care Facilities Code including, but not limited to, the following:

 

(1)  All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

 

(2)  Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

 

(3)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

a.  Not be stored with any flammable gas, liquid, or vapor;

 

b.  Be separated from combustibles or incompatible materials by:

 

1.  A minimum distance of 20 ft (6.1 m);

 

2.  A minimum distance of 5 ft (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

3. An approved, enclosed flammable liquid storage cabinet of noncombustible construction having a minimum fire protection rating of one-half hour for cylinder storage; and

 

c.  Shall be secured in an upright position, such as with racks or chains;

 

(4)  A precautionary sign, readable from a distance of 5 ft (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”;

 

(5)  Precautionary signs, readable from a distance of 5 ft (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means; and

 

(6)  Flammable gases and liquids shall be stored in metal fire retardant cabinets.

 

          (f)  If the licensee has chosen to allow smoking, a designated smoking area shall be provided which has, at a minimum:

 

(1)  A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Walls and furnishings constructed of non-combustible materials; and

 

(3)  Metal waste receptacles and safe ashtrays.

 

          (g)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the patient, or the patient’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the patient’s responsibilities shall be provided to the patient. Each patient shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (h)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (i)  Fire drills shall be conducted as follows:

 

(1)  For all HHs which are constructed to meet the Health Care Occupancy Chapter of Life Safety Code, NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf- FMO 300, and the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal’s office and the department to meet the Health Care Occupancy Chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy Chapter of the Life Safety Code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, patients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that patients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including patients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill;

 

8.  The names of all staff members participating in the drill; and

 

9.  Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and

 

h.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(2)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

Source.  #13572, eff 3-1-23

 

          He-P 824.26 Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (b)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

(c)  The plan in (b) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to missing patients and bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats which shall be worn at all times in a visible location during the emergency;

 

(7)  Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Water;

 

c.  Ventilation;

 

d.  Fire protection systems;

 

e.  Fuel sources;

 

f.  Medical gas and vacuum systems, if applicable; and

 

g.  Communications systems;

 

(8)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(9)  Include the management of patients, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of patients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(10)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(11)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(12)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(13)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

 

          (d)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations or both.

 

          (e)  For the purposes of emergency preparedness, each licensee shall have the following supplies of foods and water maintained on the premises based on the average daily census of patients and staff:

 

(1)  Enough refrigerated, perishable foods for a 3-day period;

 

(2)  Enough non-perishable foods for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

Source.  #13572, eff 3-1-23

 

PART He-P 825  Regulations for Special Hospitals - Substance Abuse - EXPIRED

 

Source.  #5847, eff 6-22-94, EXPIRED: 6-22-00

 

PART He-P 826  SUBSTANCE USE DISORDER RESIDENTIAL TREATMENT FACILITIES

 

Revision Note:

 

          Document #12658, effective 11-1-18, adopted Part He-P 826 titled “Substance Use Disorder Residential Treatment Facilities”.  Part He-P 826 had formerly been titled “Regulations for Special Hospitals—Psychiatric” but those rules, as filed under Document #5848, effective 6-22-94, had expired 6-22-00, and the number He-P 826 had been reserved since then.

 

          He-P 826.01  Purpose.  The purpose of this part is to set forth the licensing requirements for all substance use disorder residential treatment facilities (SUD-RTF) pursuant to RSA 151:2, I(d).

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a SUD-RTF except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(h);

 

(b)  Substance use disorder facilities owned or operated by the department of corrections as part of an inmate's sentencing; and

 

          (c)  All facilities which are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(i).

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administrator” means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.

 

          (f)  “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (g)  “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions.  The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J,or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (h)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J.

 

          (i)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a SUD-RTF pursuant to RSA 151.

 

          (j)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 826, or other federal and state requirements.

 

          (k) “Building rehabilitation” means any of the following undertaken in an existing building, as defined in this section:

 

(1)  Addition;

 

(2)  Modification;

 

(3)  Reconstruction;

 

(4)  Renovation; and

 

(5)  Repair.

 

          (l)  “Change of ownership” means a change in the controlling interest of an established SUD-RTF to an individual or successor business entity.

 

          (m)  “Chemical restraints” means any medication prescribed to control a client’s behavior or emotional state without a supporting diagnosis or when used for the convenience of program staff.

 

          (n)  “Client” means any person admitted to or in any way receiving care, services, or both from a SUD-RTF licensed in accordance with RSA 151 and He-P 826.  This includes children residing in a SUD-RTF with a mother who is receiving SUD-RTF services.

 

          (o)  “Client record” means documents maintained for each client receiving care and services, which includes all documentation required by RSA 151 and He-P 826 and all documentation compiled relative to the client as required by other federal and state requirements.

 

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

 

          (q)  “Contracted employee” means a temporary employee working under the direct supervision of the SUD-RTF but employed by an outside agency.

 

          (r)  “Core services” means those  minimal services to be provided to any client by the licensee that must be included in the basic rate.

 

          (s) “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (t)  “Days” means calendar days unless otherwise specified in the rule.

 

          (u)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that they are able to complete the required task in a way that reflects the minimum standard to a certificate of completion of course material or a post test to the training provided.

 

          (v)  “Department” means the New Hampshire department of health and human services.

 

          (w)  “Direct care” means hands on care and services to a client, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

 

          (x)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (y)  “Dietitian” means a person who is licensed under RSA 326-H.

 

          (z)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the client will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs.  This term also includes “do not attempt resuscitation order (DNAR order).”

 

          (aa)  “Dual-diagnosis” means a client who has signs and symptoms of a concurrent substance related and mental health disorder.

 

          (ab)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency. 

 

          (ac)  “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license in response to non-compliance with RSA 151 or He-P 826.

 

          (ad) “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

 

          (ae)  “Evaluation” means a multi-disciplinary assessment of level of function by healthcare professionals licensed or certified in the field of substance use disorder rehabilitation which enables facility staff to plan care that allows the client to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

 

          (af)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

 

          (ag)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (ah)  "Full medical withdrawal management" means clients who receive 24-hour nursing supervision overseen by a licensed practitioner, who may be incapable of evacuating a facility on their own or may have medical conditions that require immediate medical intervention, such as seizures, tremors, delirium, cardiac, or a danger to themselves or others.

 

          (ai)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and other personal needs.

 

          (aj)  “Health care occupancy” means facilities that provide sleeping accommodations for individuals who are incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupant's control.

 

          (ak) “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries.  ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (al)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (am)  “Informed consent” means the decision by a person, or his or her guardian or agent, or surrogate decision-maker to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (an)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (ao)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 826 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 826.

 

          (ap) “Intoxication” means a clinical state marked by dysfunctional changes in physiological functioning, psychological functioning, mood state, or cognitive process as a consequence of consumption of a psycho-active substance.

 

(aq)  “License” means the document issued by the department to an applicant at the start of operation as a SUD-RTF which authorizes operation of a SUD-RTF in accordance with RSA 151 and He-P 826, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

 

          (ar)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the SUD-RTF is licensed.

 

          (as) “Licensed clinical supervisor” means an 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.

 

          (at) “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.

 

          (au)  “Licensed 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.

 

          (av)  “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (aw)  “Licensee” means any person or other legal entity to which a license has been issued pursuant to RSA 151.

 

          (ax)  “Licensing classification” means the specific category of services authorized by a license.

 

          (ay) “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (az) "Limited medical withdrawal management" means clients are capable of evacuating the facility without assistance, medically cleared to participate in limited medical withdrawal management by a licensed practitioner prior to or at the time of admission, and not a danger to themselves or others.  Clients may be receiving maintenance medication for the symptoms of withdrawal or side effects but not need immediate medical intervention.

 

          (ba)  “Mechanical restraint” means locked or secured SUD-RTFs or units within a SUD-RTF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the SUD-RTF or unit within.

 

          (bb)  “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a SUD-RTF.

 

          (bc)  “Medically cleared” means a determination made within 24 hours prior to admission by the medical director that an individual is physically capable of participating in facility activities and programming and not at risk of medical complications that would be unmanageable by the facility.

 

          (bd)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (be)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment.  The term does not include repair or replacement of interior finishes.

 

          (bf)  “Neglect” means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a client.

 

          (bg)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (bh)  “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.

 

          (bi)  “Orders” means a document, produced verbally, electronically or in writing, by a licensed practitioner for medications, 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.

 

          (bj)  “Over-the-counter medications” means non-prescription medications.

 

          (bk)  “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21.  This term includes “resident rights” and “client rights.”

 

          (bl)  “Personal care” means personal care services that are non-medical, hands-on services provided to a client to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, or walking. .

 

          (bm)  “Personal representative” means a person designated in accordance with RSA 151:19, V to assist the client for a specific limited purpose or for the general purpose of assisting the client in the exercise of any rights.

 

          (bn)  “Personnel” means and individual who is employed by the facility, a volunteer, or  an independent contractor who provides direct or personal care services to clients.

 

          (bo)  “Physical restraint” means the use of hands-on or other physically applied technique to physically limit the client’s freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques.

 

          (bp)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bq)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand held instruments at or near the site of patient care.

 

          (br)  “Point of care devices”  means testing involving a system of devices, typically including:

 

(1)  A lancing or finger stick device to get the blood sample;

 

(2)  A test strip to apply the blood sample; or

 

(3)  A meter or monitor to calculate and show the results; including:

 

a.  Blood glucose meters, also called “glucometers”;

 

b.  Prothrombin time (PT) and international normalized ratio (INR) anticoagulation meters; or

 

c.  Cholesterol meter.

 

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

 

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

 

          (bu)  “Protective care” means the provision of client monitoring services which includes:

 

(1)  Knowledge of client whereabouts;

 

(2)  Minimizing the likelihood of accident or injury; and

 

(3)  Other means of ensuring client safety.

 

          (bv)  “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

 

          (bw)  “Qualified personnel”  means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control or kitchen staff trained in food safety protocols.

 

          (bx)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (by)  “Removal” means requesting an individual to remove himself/herself to an area with fewer distractions until he/she can participate in activities without disrupting the client’s current social environment according to a written behavioral program.

 

          (bz)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (ca)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (cb)  “Reportable incident” means an occurrence of any of the following while the client is either in the SUD-RTF or in the care of SUD-RTF personnel:

 

(1)  The unanticipated death of the client;

 

(2)  An injury to a client, that is of a suspicious nature of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or

 

(3)  The unexplained absence of a client from the SUD-RTF who is determined to be a danger to themselves or others.

 

          (cc)  "Residential treatment" means clients receive clinical treatment for substance use disorder in a residential setting but do not require limited or full medical withdrawal management.  Clients  may or may not require medication supervision and general oversight with regard to knowing the clients whereabouts but do not require medications for the signs and symptoms of withdrawal.  This also includes residential treatment facilities where the residence has paid staff who provide clinical services,  24-hour structure, staff available as needed, urine drug testing conducted, documentation maintained, and clinical treatment services that are required as a condition of residency and provided by the person, owner, developer, business organization, or any subsidiary thereof. This does not apply to intensive outpatient services certified per He-W 513.

 

          (cd)  “Self administration of medication with assistance” means the client takes his or her own medication(s) after being prompted by personnel, but without requiring physical assistance from others.

 

          (ce)  “Self administration of medication without  assistance” means an act whereby the client takes his or her own medication(s) without the assistance of another person.

 

          (cf) “Self-directed medication administration” means an act whereby a patient, who has a physical limitation that prohibits him or her from self-administration of medication without assistance, directs personnel to physically assist in the medication process, which does not include assisting with infusions,  injections, or filling insulin syringes.

 

          (cg) “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

 

          (ch)  “Significant change” means a change in cognitive or physical capabilities that decreases a client's ability to care for himself beyond an episodic event.

 

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

 

          (cj) “State monitoring” means the placement of individuals by the department at a SUD-RTF to monitor the operation and conditions of the facility.

 

          (ck) “Substance use disorder residential treatment facility” (SUD-RTF)  means a place, excluding hospitals as defined in RSA 151-C:2, which provides residential substance use disorder treatment relating to the individual’s medical, physical, psychosocial, vocational, and educational needs.

 

          (cl) “Therapeutic diet” means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the client.

 

          (cm)  “Treatment plan” means a written guide developed by the licensee, in consultation with the licensed practitioner, personnel, the client, or the client’s guardian, agent, surrogate decision-maker, or personal representative, if any, as a result of the evaluation process for the provision of care and services.

 

          (cn)  “Unlicensed staff” means those staff working at the SUD-RTF that perform direct care to clients but do not hold a license issued by the State of New Hampshire.

 

          (co)  “Unexplained absence” means an incident involving a client leaving the premises of the SUD-RTF without the knowledge of the SUD-RTF personnel in a manner that is contrary to their normal routine.

 

          (cp)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons who provide religious services or entertainment.

 

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

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.04  License Application Submission.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III(a) and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License,” (September 2018 edition), signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance.  I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”

 

b.  For any SUD-RTF to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; And

 

c.  For any SUD-RTF to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”:

 

(2)  A floor plan of the prospective SUD-RTF;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee, in accordance with RSA 151:5, XXI, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications of the SUD-RTF administrator and medical director;

 

(6)  Copies of applicable licenses for the SUD-RTF administrator and medical director;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health, drinking water, and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as adopted by the commissioner of the department of safety under RSA 153, and as amended pursuant to RSA 153:5,I, by the state fire marshal with the board of fire control including, at a minimum, the new residential board and care chapter of the life safety code, and the applicable local fire ordinances; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(8)  If the SUD-RTF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill;

 

(9)  The results of a criminal records check from the NH department of safety for the applicant, licensee if different from the applicant, administrator and medical director for which the application is submitted;

 

(10)  A copy of the SUD-RTF’s admission agreement;

 

(11)  A copy of the SUD-RTF’s criminal attestation form as described in He-P 826.18(u);

 

(12)  A complete description of all services provided or to be provided including a determination of which of the following tier(s) the facility falls into:  

 

a.  Tier 1- Full Medical Withdrawal Management;

 

b.  Tier 2- Limited Medical Withdrawal Management; or 

 

c.  Tier 3- Residential Treatment; and

 

(13)  Documentation, required by RSA 151:4, III(a)(5), that the public has been notified of the intent to open a licensed facility by notice published in a newspaper, covering the area in which the licensed facility or service is to be operated, in at least 2 editions of the paper within 10 days of the filing of the application for a license.  Such notice shall include a description of the facility and services to be offered.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 826.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 826.04(a) the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 826.13(b) if it determines that the applicant, administrator, or medical director:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of clients.

 

          (f) The applicant shall have on hand and available for inspection at the time of the initial onsite inspection the following:

 

(1)  A copy of the SUD-RTF’s admission agreement;

 

(2)  Personnel records; and

 

(3)  A copy of the SUD-RTF’s standard disclosure form.

 

          (g)  Following both a clinical and life safety code  inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 826.

 

          (h)  All licenses issued in accordance with RSA 151 shall be non-transferable by person, location, or agency affiliation.

 

          (i)  A written notification of denial, pursuant to He-P 826.13(b)(10) will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (g) above and a maximum of 2 follow-up inspections, if needed, that the prospective premises are not in full compliance with RSA 151 and He-P 826.

 

          (j)  A written notification of denial, pursuant to He-P 826.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 90 days of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall:

 

(1) Complete and submit to the department an application form pursuant to He-P 826.04(a)(1) at least 120 days prior to the expiration of the current license to include:

 

a.  The current license number;

 

b.  A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 826.10(f), if applicable.  If such request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

c.  A list of any current employees who have a permanent waiver granted in accordance with He-P 826.19(f); and

 

d.  A copy of any non-permanent or new variances applied for and granted by the state fire marshal, in accordance with Saf-C 6005.01 - Saf-C 6005.04, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (c)  In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection as described in He-P 826.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 826 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

 

          (f)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation, shall be required to submit an application for an initial license pursuant to He-P 826.04.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.07  SUD-RTF New Construction Existing Building Rehabilitation.

 

          (a)  For new construction and for rehabilitation, renovation, modification, reconstruction, or addition of an existing building, all construction documents, shop drawings, and architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including windows and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d) Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 826 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

 

          (g)  The SUD-RTF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or building rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or building rehabilitation shall comply with the following:

 

(1) The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control,  as follows:

 

a.  For 3 clients or fewer, the One and Two Family Dwelling chapter of the life safety code;

 

b.  For 4 clients or more, the Residential Board and Care Occupancy chapter of the life safety code; and

 

c.  If licensed as a tier 1 program, the Health Care Occupancy chapter of the life safety code; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

          (i)  All SUD-RTF’s newly constructed or rehabilitated after the 2018 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2018 edition, available as listed in Appendix A.

 

          (j)  Where building rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2018 edition, available as listed in Appendix A.

 

          (k)  Per the FGI “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2018 edition, available as listed in Appendix A, and notwithstanding (j) above, where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

 

          (l)  The department shall be the authority having jurisdiction for the requirements in (i)-(k) above and shall negotiate compliance and grant waivers in accordance with He-P 826.10 as appropriate.

 

          (m)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed and approved sealant that provides an equivalent rating as provided by the original surface.

 

          (n)  Waivers granted by the department for construction or building rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (o)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

          (p)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 826.09 prior to its use.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.08  SUD-RTF Requirements for Organizational or Service Changes.

 

          (a)  The SUD-RTF shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Number of beds; or

 

(6)  Services, to include all services referenced in He-P 826.04 (a)(12) or tier or level changes.

 

          (b)  The SUD-RTF shall complete and submit a new application and obtain a new or revised license license certificate or both, as applicable, prior to operating for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in number of clients or services beyond what is authorized under the current license.

 

          (c)  When there is a change in the address without a change in location, the SUD-RTF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the SUD-RTF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  When there is to be a change in the services provided, the SUD-RTF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

 

          (f)  The department shall review the information submitted under (e) above and determine if the added services can be provided under the SUD-RTF’s current license.

 

          (g)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, then an inspection shall be conducted as soon as practical by the department;

 

(2)  The physical location;

 

(3)  An increase in the number of beds or clients;

 

(4)  A change in license classification;

 

(5)  A change that placed the facility under a different life safety code occupancy chapter; or

 

(6)  A change in tier or level.

 

          (h)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

          (i)  A revised license and license certificate shall be issued for a change in the SUD-RTF name.

 

          (j)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in the number of clients from what is authorized under the current license, if applicable;

 

(3)  A change in address without a change in physical location; or

 

(4)  When a waiver has been granted.

 

          (k)  The SUD-RTF shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  The results of the criminal record check conducted under He-P 826.18(c);

 

(3)  Copies of applicable licenses for the new administrator; and

 

(4)  A copy of the criminal attestation as described He-P 826.18(u).

 

          (l)  Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 826.18(i) and (j).

 

          (m)  If the department determines that the new administrator does not meet the qualifications, it shall notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (n)  The SUD-RTF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (o)  An organizational or service restructuring of an established SUD-RTF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  If a licensee chooses to cease operation of a SUD-RTF, the licensee shall submit written notification to the department at least 45 days in advance, which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 826, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the SUD-RTF; and

 

(3)  Any records required by RSA 151 and He-P 826.

 

          (b)  The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 826 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 826.08(g)(1);

 

(3)  A change in the physical location of the SUD-RTF;

 

(4)  A change in the licensing classification;

 

(5)  An increase in the number of beds;

 

(6)  Occupation of space after construction or building rehabilitation; or

 

(7)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or notice to correct for life safety inspections shall be issued when, as a result of any inspection, the department determines that the SUD-RTF is in violation of any of the provisions of He-P 826, RSA 151, or other federal or state requirements.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 826.12(c) within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 826.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 826 shall submit a written request for a waiver to the department that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the clients; and

 

(3)  Does not negatively affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) occurred since the last onsite clinical or life safety inspection;

 

(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 person who has first-hand knowledge regarding the allegation(s); or

 

(3)  There is 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 RSA 151 or He-P 826.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the SUD-RTF, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 826.

 

          (c)  Investigations shall use all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, which include:

 

(1)  Requests for additional information from the complainant;

 

(2)  Physical inspection of the premises;

 

(3)  Review of relevant records that have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  For a licensed SUD-RTF the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 826.12(c) if the inspection results in areas of non-compliance being cited.

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1) The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c. Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license or cease operating services;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 826; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 826.13(c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only as follows:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 826, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a license; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 826;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 826 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing within 14 days of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 826.13(c)(12);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with He-P 826.12(b); and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 826.13(c)(13).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 826.13(b); or

 

(3)  Revoke the license in accordance with He-P 826.13(b).

 

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

 

          (g)  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.

 

          (h)  The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect.  The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 826 which poses a risk of harm to the health, safety, or well-being of a client;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 826.04 or fails to schedule an inspection;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents, interferes, or fails to cooperate with any investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 826.12(c), (d) and (e);

 

(7)  A licensee has submitted a POC that has not been accepted by the department in accordance with He-P 826.12(c)(5) and has not submitted a revised POC as required by He-P 826.12(c)(5)b.;

 

(8)  The licensee is cited a third time under RSA 151 or He-P 826 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 826;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or household member has been found guilty of, or plead guilty to, a felony assault, theft, fraud, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee fails to employ a qualified administrator; or

 

(13) The applicant has had a license revoked or denied by another division or unit of the department within a 5 year period of the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III,and He-P 826.14(k), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a client whose needs exceeds the services or programs provided by the SUD-RTF, in violation of RSA 151:5-a the fine for a licensee shall be $500.00;

 

(5)  For admission of a client whose needs at the time of admission exceed the services or programs authorized by the SUD-RTF licensing classification, in violation of RSA 151:5-a, II, and He-P 826.15(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 826.11(e), the fine for an unlicensed entity or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 826.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 826.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 826.08(a)(2), the fine for a licensee shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address as required by He-P 826.08(n) the fine shall be $100.00;

 

(11)  For a failure to allow access by the department to the SUD-RTF’s premises, programs, services, or records, in violation of He-P 826.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 826.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 826.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 826.14(b)-(d) and (t) and He-P 826.19(d), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 826.16, the fine for a licensee shall be $500.00;

 

(16)  For exceeding the licensed capacity, in violation of He-P 826.14(x), the fine for a licensee shall be $500.00 per day;

 

(17)  For providing false or misleading information or documentation in violation of He-P 826.14(j), the fine for an applicant or licensee shall be $1000.00 per offense;

 

(18)  For a failure to meet the needs of a client or clients, in violation of He-P 826.14(m)(1), the fine for a licensee shall be $1000.00 per client;

 

(19)  For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 826.09(b)(6), the fine for a licensee shall be $500.00;

 

(20)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 826.10, in violation of He-P 826.18(i), the fine for a licensee shall be $500.00;

 

(21)  For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 826.09(a), the fine shall be $2000.00;

 

(22)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 826.07(a), the fine for a licensed facility shall be $500.00;

 

(23)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 826.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(24)  When an inspection determines that a violation of RSA 151 or He-P 826 has the potential to jeopardize the health, safety, or well-being of a client, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non-compliance the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00;

 

(25)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 826 shall constitute a separate violation and shall be subject to fines in accordance with He-P 826.13(c); and

 

(26)  If the applicant or licensee is making good faith efforts to comply with (4) and (10) and (15) above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated poor compliance on the part of the facility in areas that might impact the health, safety, or well-being of clients; or

 

(2)  Concern that the conditions in the SUD-RTF have the potential to worsen.

 

          (f)  An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (g)  If a written request for a hearing is not made pursuant to (f) above, the action of the department shall become final.

 

          (h)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a client is in jeopardy and requires emergency action in accordance with RSA 541:A-30.

 

          (i)  If an immediate suspension is upheld the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 826 is achieved.

 

          (j)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (k)  When a SUD-RTF’s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director for at least 5 years if the denial or revocation specifically pertained to their role in the program.

 

          (l)  The 5-year period referenced in (k) above shall begin on:

 

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

 

(2)  The date the final decision is issued by the department upholding the action, if a request for an administrative hearing was made and a hearing was held.

 

          (m)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 826.

 

          (n)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing rule (k) above by applying for a license through an agent or other individual and will retain ownership or management authority, the department shall deny the application.

 

          (o)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541A:30, III, or He-P 826.

 

          (p)  Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.14  Duties and Responsibilities of the Licensee.

 

          (a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

 

          (b)  The licensee shall have written policies and procedures to include:

 

(1)  The rights and responsibilities of clients in accordance with the patients’ bill of rights under RSA 151:20, II;

 

(2)  A policy that ensures the safety of all persons present on the licensed premises where firearms are permitted; and

 

(3)  All other policies required by He-P 826.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided at the SUD-RTF.

 

          (d)  The licensee shall have a system to regularly identify the SUD-RTF’s daily census, including times client is absent from the SUD-RTF.

 

          (e)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-30.

 

          (f)  The licensee shall develop and implement written policies and procedures governing the operation of the SUD-RTF to include a clinical care manual covering the policies and procedures for all clinical services provided.

 

          (g)  All policies and procedures shall be reviewed annually and revised as needed.

 

          (h)  All clinical services provided by the licensee shall:

 

(1)  Focus on the clients strengths;

 

(2)  Be sensitive and relevant to the diversity of the clients;

 

(3)  Be client and family centered;

 

(4)  Be evidence-based by meeting one of the following:

 

a.  The service shall be included as an evidence-based mental health and substance abuse intervention on the SAMHSA Evidence-Based Practices Resource Center (April 2018 edition) available at https://www.samhsa.gov/ebp-resource-center, or as listed in Appendix A;

 

b.  The services are published in a peer reviewed journal and found to have positive effects; or

 

c.  The treatment and support service provider shall be able to document the services effectiveness based on a theoretical model with validated research or a documented body of research generated from similar services that indicates effectiveness;

 

(5)  Be designed to acknowledge the impact of violence and trauma on client’s lives which shall be addressed in the services provided; and

 

(6)  Be delivered in accordance with  the following:

 

a.  The American Society of Addiction Medicine (ASAM) Criteria, 2013 edition, available as listed in Appendix A; or

 

b. The Treatment Improvement Protocols and Technical Assistance Publications promulgated by SAMSHA: https://www.samhsa.gov/kap/resources, September 2017 edition , available as listed in Appendix A.

 

          (i)  The licensee shall assess and monitor the quality of care and services it provides to clients on an ongoing basis.

 

          (j)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (k)  The licensee shall not advertise or otherwise represent the SUD-RTF as having residential care or health care programs or services for which it is not licensed to provide.

 

          (l)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (m)  Licensees shall:

 

(1)  Meet the needs of the clients during the hours that the clients are in the care of the SUD-RTF;

 

(2)  Initiate action to maintain the SUD-RTF in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the SUD-RTF;

 

(4)  Appoint a medical director who shall meet the requirements of He-P 826.18(k);

 

(5)  Appoint an administrator who shall meet the requirements of He-P 826.18(i);

 

(6)  Verify the qualifications of all personnel;

 

(7)  Provide sufficient numbers of personnel who are present in the SUD-RTF and are qualified to meet the needs of clients during all hours of operation;

 

(8)  All unlicensed clinical staff providing treatment, education, and/or recovery support services shall be under the direct supervision of a licensed clinical supervisor;

 

(9)  Licensed clinical supervisors must provide at least one hour of supervision for all unlicensed clinical staff for every 40 hours of direct client contact which shall include:

 

a.  Review of case records;

 

b.  Observation of interactions with clients;

 

c.  Skill development;

 

d.  Review of case management activities; and

 

e.  The maintenance of a log of the supervision date, duration, content, and the identity of the participants;

 

(10)  Ensure that personnel, licensed or certified, by the NH board of licensing for alcohol and other drug use professionals or any other licensing or certification board, receive supervision in accordance with the requirements set forth for the licenses or certifications held by the individual;

 

(11)  Ensure that no LADC or MLADC shall supervise more than 12 unlicensed staff;

 

(12)  Provide the SUD-RTF with sufficient supplies, equipment, and lighting to ensure that the needs of clients are met;

 

(12)  Implement any POC that has been accepted or issued by the department; and

 

(13)  Require that all personnel follow the orders of the licensed practitioner for each client and encourage the clients to follow the licensed practitioner’s orders.

 

          (n)  The licensee shall employ or contract with a nurse who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN or LPN with at least 2 year's relevant experience in substance use disorder treatment or behavioral health services. 

 

          (o)  The licensee shall employ or contract with a clinical services director who is a LADC or  MLADC licensed by the NH board of licensing for alcohol and other drug use professionals or an individual licensed by the board of mental health practice and who has at least 2 year's relevant experience in substance use disorder treatment or behavioral health services.

 

          (p)  The licensee shall:

 

(1)  Make available basic supplies necessary for clients to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper.  Such basic supplies shall be included in the basic rate, except that there may be an additional charge for specific brands or items required to meet individual clients’ needs or requests;

 

(2)  Not be responsible for the cost of purchasing a specific brand of product at a client’s request;

 

(3)  Identify in the admission agreement the cost, if any, of basic supplies or other services for which there will be a charge;

 

(5)  Ensure that all personnel have received the training necessary to be qualified personnel to include demonstrated competency in the training given with documentation maintained in the employee personnel file;

 

(6)  Require any paid provider providing direct care, other than an employee, to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known;

 

(7)  Have a clearly identified policy for CPR that includes the following:

 

a.  If CPR is not performed, the policy shall include a statement that 911 shall be called in an emergency;

 

b.  If CPR is performed, the policy shall include a statement that 911 shall be called and there shall be either at least one person on duty per shift who is certified to perform CPR or an AED available for use; and

 

c.  This policy shall be signed by each client and their guardian, agent, surrogate decision-maker or personal representative, if any, and be located in the client’s file with their admission agreement; and

 

(8)  There shall be at least one personnel on the premises during all hours the facility is open.

 

          (q)  The licensee shall educate personnel about the needs and services required by the clients under their care and document such education to include demonstrated competencies.

 

          (r)  Physical or chemical restraints shall only be used in the case of an emergency, pursuant to RSA 151:21, IX.

 

          (s)  As soon as is practicable but no longer than 24 hours after the use of a physical or chemical restraint, the client’s licensed practitioner, the department, and the client’s guardian, agent, surrogate decision-maker or personal representative, if any, shall be notified of the use of such restraints.

 

          (t)  The SUD-RTF shall:

 

(1)  Have policies and procedures on:

 

a.  What type of emergency restraints can be used;

 

b.  When restraints can be used; and

 

c.  Who may authorize the use of restraints; and

 

(2)  Provide personnel with education and training on the limitations and the correct use of restraints.

 

          (u)  The use of physical restraints shall be allowed only as defined under He-P 826.03(bl).

 

          (v)  Separation from a situation may be used as an alternative to physical restraint and shall not be considered a form of restraint.

 

          (w)  For reportable incidents, licensees shall have responsibility for:

 

(1)  Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

 

(2)  Faxing to 271-4968 or, if a fax machine is not available, submit via regular mail, postmarked within 48 hours off the incident together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 48 hours of a reportable incident:

 

a.  The SUD-RTF name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing, or responding to the reportable incident;

 

d.  The name of client(s) involved in or witnessing the reportable incident;

 

e.  The date and time of the reportable incident;

 

f.  The action taken in direct response to the reportable incident, including any follow-up;

 

g.  If medical intervention was required, by whom, and the date and time;

 

h.  When the client’s guardian, agent, surrogate decision-maker or personal representative, if any, was notified;

 

i.  The signature of the person reporting the reportable incident; and

 

j.  The date and time the client’s licensed practitioner was notified, if applicable; and

 

k.  The date the facility performed the investigation required by (1) above;

 

(3)  As soon as practicable, notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client has an unexplained absence and the licensee has searched the building and the grounds of the SUD-RTF without finding the client and it has been determined by the facility that the client is a danger to themselves or others; and

 

(4)  If abuse or neglect is suspected, the licensee shall notify the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.

 

          (x)  The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (y)  The licensee shall give a client a written notice as follows:

 

(1)  For an increase in the cost or fees for any SUD-RTF services, 30 days advanced notice shall be required except for clients receiving Medicaid whose financial liability is determined by the state’s standard of need; or

 

(2) For an involuntary change in room or bed location, the facility shall make reasonable accommodation of individual needs and preferences and give 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

 

          (z)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a conspicuous area accessible to clients, employees, and visitors:

 

(1)  The current license and license certificate issued in accordance with RSA 151:2;

 

(2)  All statement of findings for the last 12 months in accordance with He-P 826.09(d) and He-P 826.11(d);

 

(3)  A copy of the patient’s bill of rights specified by RSA 151:21; and

 

(4)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to The Department of Health and Human Services, Office of Legal and Regulatory services, Health Facilities Administration, 129 Pleasant Street, Concord, N.H. 03301 or by calling 1-800-852-3345, and information on how to contact the office of the long-term care ombudsman.

 

          (aa)  The licensee shall not allow smoking in the facility at any time.

 

          (ab)  If smoking is allowed on the grounds of the SUD-RTF, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P 826.26.

 

          (ac)  The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other clients, or other household members.

 

          (ad)  The SUD-RTF may perform the following Clinical Laboratory Improvement Amendments (CLIA) waived tests, as per 42 CFR Part 493.15, without obtaining a NH state laboratory license:

 

(1)  Urine drug screen;

 

(2)  Alcohol screen; and

 

(3)  Urine pregnancy.

 

          (ae)  If the licensee collects urine specimens for laboratory testing, the licensee shall follow the manufacturer’s instructions and the reference laboratory’s instructions for collection, transporting, and storage of urine specimens.

 

          (af)  If the licensee collects other human specimens it shall be licensed as a collection station in accordance with He-P 817.

 

          (ag)  If the SUD-RTF performs any laboratory test other than those exempted by (ad) above, the licensee shall be licensed as a laboratory in accordance with He-P 808.

 

          (ah)  The SUD-RTF shall hold the appropriate CLIA certificate to perform any laboratory tests.

 

          (ai)  The licensee shall maintain the manufacturer’s test system instructions including package inserts and operator’s manuals.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18; amd by#12928, eff 11-26-19

 

          He-P 826.15  Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria.

 

          (a)  The licensee shall only admit an individual or retain a client who has been determined to need the level(s) of care that the facility offers, and whose needs can be met by the SUD-RTF.

 

          (b)  A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

 

          (c)  The client shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including the following:

 

(1)  The client’s medical or other needs exceed the services offered by the licensee or are not otherwise met by third party providers that the licensee has contracted with;

 

(2)  The client cannot be safely evacuated in accordance with Saf-C 6000;

 

(3)  The client or the client’s guardian  agent, or surrogate decision-maker if any, determines that the client shall leave the facility;

 

(4)  The client is a danger to himself/herself or others;

 

(5)  Program completion or transfer based on changes in the client’s functioning relative to ASAM criteria; and

 

(6)  Program termination, including:

 

a.  Administrative discharge;

 

b.  Non-compliance with the program;

 

c.  The client left the program before completion against advice of treatment staff; and

 

d.  The client is inaccessible, such as the client has been jailed or hospitalized.

 

          (d)  In all cases of client discharge or transfer, the counselor shall complete a narrative discharge summary, which includes:

 

(1)  The dates of admission and discharge or transfer;

 

(2)  The client’s psychosocial substance use history and legal history;

 

(3)  A summary of the client’s progress toward treatment goals in all ASAM domains;

 

(4)  The reason for discharge or transfer;

 

(5)  The client’s DSM 5 diagnosis and summary, to include other evaluation testing completed during treatment;

 

(6)  A summary of the client’s physical condition at the time of discharge or transfer;

 

(7)  A continuing care plan, including all ASAM domains;

 

(8)  The dated signature of the counselor completing the summary; and

 

(9)  Any other information pertinent to the client’s discharge or transfer.

 

          (e)  The discharge summary shall be completed:

 

(1)  No later than 7 days following a client’s discharge or transfer from the program; or

 

(2)  For withdrawal management services, by the end of the next business day following a client’s discharge or transfer from the program.

 

          (f)  If the transfer or discharge referenced in (d) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

 

          (g)  When transferring a client, either from one level of care to another within the same certified provider agency or to another treatment provider, the counselor shall:

 

(1)  Complete a progress note on the client’s treatment and progress towards treatment goals, to be included in the client’s record; and

 

(2)  Update the client evaluation and treatment plan.

 

          (h)  When transferring a client to another treatment provider, the current provider shall forward copies of the following information to the receiving provider, only after a release of confidential information is signed by the client:

 

(1)  The discharge summary;

 

(2)  Client demographic information, including the client’s name, date of birth, address, telephone number, and the last 4 digits of his or her Social Security number; and

 

(3)  A diagnostic evaluation statement and other evaluation information, including:

 

a.  TB test results;

 

b.  A record of the client’s treatment history; and

 

c.  Documentation of any court-mandated or agency-recommended follow-up treatment.

 

          (i)  A licensed counselor shall meet with the client at the time of discharge or transfer to establish a continuing care plan that:

 

(1)  Includes recommendations for continuing care in all ASAM domains;

 

(2)  Addresses the use of self-help groups including, when indicated, facilitated self-help; and

 

(3)  Assists the client in making contact with other agencies or services.

 

          (j)  A licensed counselor shall document in the client record if and why the meeting in (i) could not take place.

 

          (k)  A provider may involuntarily discharge a client from a treatment program only if:

 

(1)  The client’s behavior on program premises is abusive, violent, or illegal;

 

(2)  The client is non-compliant with prescription medications;

 

(3)  Clinical staff documents therapeutic reasons for discharge; or

 

(4)  The client violates program rules in a manner that is consistent with the provider’s progressive discipline policy.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.16  Required Services.

 

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

 

(1)  Is responsible for the day-to-day operations of the SUD-RTF;

 

(2)  Meets the requirements of He-P 826.18(i) and (j); and

 

(3)  Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence. The alternate administrator shall not be required to meet the requirements of He-P 826.18(i).

 

          (b)  The clinical services director or designee shall be available for consultation at all times any client is present at the SUD-RTF.

 

          (c)  At the time of application for admission, the licensee shall provide the client a written copy of the clientele service agreement pursuant to RSA 161-J:4.

 

          (d)  In addition to (c) above, at the time of admission, the licensee shall provide a written copy to the client and the guardian, agent, or surrogate decision-maker, if any, or personal representative, and receive written verification of receipt for the following:

 

(1)  An admissions contract including the following information:

 

a.  The basic daily, weekly, or monthly fee;

 

b.  A list of the core services required by He-P 826.16(e) that are covered by the basic fee;

 

c.  Information regarding the timing and frequency of cost of care increases;

 

d.  The time period covered by the admissions contract;

 

e.  The SUD-RTF’s house rules;

 

f.  The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

 

g.  The SUD-RTF’s responsibility for client discharge planning;

 

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

 

1.  The availability of services;

 

2.  The SUD-RTF’s responsibility for arranging services; and

 

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

 

i.  The licensee’s policies and procedures regarding:

 

1.  Arranging for the provision of transportation;

 

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

 

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

 

4.  Handling of client funds pursuant to RSA 151:24 and He-P 826.14(ac); and

 

5.  Storage and loss of the client’s personal property;

 

j.  The licensee’s medication management services; and

 

k.  The list of grooming and personal hygiene supplies provided by the SUD-RTF as part of the basic daily, weekly, or monthly rate;

 

(2)  A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the SUD-RTF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

(3)  The SUD-RTF’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29; and

 

(4)  Information on advanced directives.

 

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

 

(1)  Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight regarding:

 

a.  The clients’ functioning, safety, and whereabouts; and

 

b. The clients’ health status, including the provision of intervention as necessary or required;

 

(2)  Emergency response and crisis intervention;

 

(3)  Assistance with taking and ordering medications as needed;

 

(4)  Provide nutritious meals and snacks in accordance with He-P 826.20 unless the client chooses other options according to their admission agreement;

 

(5) Housekeeping, laundry, and maintenance services in accordance with the admission agreement;

 

(6)  The availability of activities, for which the facility shall make reasonable accommodation for clients with disabilities, including television, radio, internet, games, newspapers, visitors, and music, designed to sustain and promote physical, intellectual, social, and spiritual well-being of all clients in accordance with the admission agreement;

 

(7)  Assistance in arranging medical and dental appointments, which shall include assistance in arranging transportation to and from such appointments and reminding the clients of the appointments;

 

(8)  Supervision of clients when required to offset cognitive deficits that may pose a risk to self or others if the client is not supervised; and

 

(9)  Provide referral to, and assistance in accessing, medication-assisted SUD treatment, either on site or off site, when clinically appropriate.

 

          (f)  The licensee shall provide access to the following services:

 

(1)  A screening and assessment interview conducted or supervised by a licensed counselor to determine:

 

a.  That the client meets the requirements for treatment of a substance use disorder; and

 

b.  A determination of the appropriate ASAM level of care needed.

 

(2)  If the interview in (1) above indicates a need for a clinical evaluation, the clinical evaluation shall be conducted by a licensed counselor in accordance with “TAP 21: Addiction Counseling Competencies,” (2017 revision) available as listed in Appendix A using an evidenced based evaluation tool and addressing all ASAM domains to determine:

 

a.  If the client meets diagnostic criteria as indicated in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision) (DSM-5) (May 2013 edition),  available as listed in Appendix A, for a substance use disorder or other comorbid disorders and formally documents the DSM-5 diagnosis(es) in client record;

 

b.  The appropriate initial level of care for the client based on ASAM criteria; and

 

c.  Areas to be addressed in the treatment plan;

 

(3)  If the clinical evaluation detailed in (2) above was completed by a licensed counselor from a referring agency, the licensee should accept that clinical evaluation as satisfaction of (2) above; and

 

(4)  Behavioral health services on-site or through referral.

 

          (g)  The SUD-RTF shall perform an evaluation of each client’s needs and develop a treatment plan upon admission or within 24 hours following admission as described in (h) below.

 

          (h)  Individual treatment plans shall contain, at a minimum, the following elements:

 

(1)  Goals, objectives, and interventions written in terms that are specific, measurable, attainable, realistic, and timely;

 

(2)  Identifies the client’s clinical needs, treatment goals, and objectives;

 

(3)  Identifies the client’s strengths and resources for achieving goals and objectives in (1) above;

 

(4)  Defines the strategy for providing services to meet those needs, goals, and objectives;

 

(5)  Identifies referral to outside providers for the purpose of achieving a specific goal or objective when the service cannot be delivered by the treatment program;

 

(6)  Provides the criteria for terminating specific interventions;

 

(7)  Includes specification and description of the indicators to be used to assess the client’s progress;

 

(8)  Documentation of participation by the client in the treatment planning process or the reason why the client did not participate;

 

(9)  Signatures of the client and the counselor agreeing to the treatment plan, or if applicable, documentation of the client’s refusal to sign the treatment plan; and

 

(10) Identifies the client’s discharge goals.

 

          (i)  Treatment plans shall be updated weekly based on any changes in any ASAM domain or client status.

 

          (j)  Treatment plan updates shall include:

 

(1)  Documentation of the degree to which the client is meeting treatment plan goals and objectives;

 

(2)  Modification of existing goals or addition of new goals based on changes in the clients functioning relative to ASAM domains and treatment goals and objectives;

 

(3)  The counselor’s evaluation of whether or not the client needs to move to a different level of care based on changes in functioning in any ASAM domain and documentation of the reasons for this evaluation; and

 

(4)  The signature of the client and the counselor agreeing to the updated treatment plan, or if applicable, documentation of the client’s refusal to sign the treatment plan.

 

          (k)  In addition to the individualized treatment planning in (h) above, all providers shall provide client education on:

 

(1)  Substance use disorders;

 

(2)  Relapse prevention;

 

(3)  Infectious diseases associated with injection drug use, including but not limited to, HIV, hepatitis, and tuberculosis (TB);

 

(4) Sexually transmitted diseases;

 

(5) Emotional, physical, and sexual abuse;

 

(6)  Nicotine use disorder and cessation options; and

 

(7)  The impact of drug and alcohol use during pregnancy, risks to the fetus, and the importance of informing medical practitioners of drug and alcohol use during pregnancy.

 

          (l)  When group education and counseling are provided as part of the treatment program, the provider shall:

 

(1)  Maintain an outline of each educational and group therapy session provided;

 

(2) Limit clinical groups to no more than 12 individuals with one licensed counselor present and no more than 16 individuals when that licensed counselor is joined by a CRSW or second licensed counselor; and

 

(3) Limit recovery support groups to include no more than 8 individuals with one CRSW present and no more than 12 individuals when that CRSW is joined by a second CRSW.

 

          (m)  All client activities and services shall be documented in accordance with “TAP 21: Addiction Counseling Competencies,” 2017 revision,  available as listed in Appendix A.

 

          (n)  At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

 

          (o)  The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the SUD-RTF.

 

          (p)  The health examination in (o) above shall include:

 

(1)  Diagnoses, if any;

 

(2)  The medical history;

 

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

 

(4)  Vital signs;

 

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

 

(6)  Allergies; and

 

(7)  Dietary needs.

 

          (q)  The licensee shall maintain a daily shift change log which documents such things as client behavior and significant events that a subsequent shift should be made aware of.

 

          (r)  When a client refuses care or services that could result in a threat to their recovery, health, safety, or well-being, or that of others, the licensee or their designee shall:

 

(1)  Inform the client and guardian, agent, or surrogate decision-maker,  if any, of the potential results of their refusal;

 

(2)  Notify the licensed practitioner of the client’s refusal of care; and

 

(3)  Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

 

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

 

          (t)  The information data sheet in (s) above shall include:

 

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

 

(2)  Name, address, and telephone number of the client’s next of kin, guardian,  agent, or surrogate decision-maker,  if any;

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advanced directives; and

 

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

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.17  Medication Services.

 

          (a)  All medications and treatments shall be administered in accordance with the orders of the licensed practitioner, except as allowed in (b) below.

 

          (b)  The facility shall have written approval from the client's licensed practitioner, at time of admission, of a list of approved over-the-counter (OTC) medications taken in accordance with the directions on the medication container or as ordered by the client’s licensed practitioner.

 

          (c)  Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24-hours or in accordance with the licensed practitioner’s direction.

 

          (d)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the SUD-RTF;

 

(2)  Reorder medications for use at the SUD-RTF; and

 

(3)  Receive and record new medication orders.

 

          (e)  For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

 

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

 

(1)  The client’s name:

 

(2)  The medication name, strength, prescribed dose, and route, if different then by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated signature of the licensed practitioner.

 

          (g)  For PRN medications the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (h)  All prescription medications brought by a client to program shall be in their original containers and comply with (f) above.

 

          (i)  Each prescription medication shall legibly display the following information:

 

(1)  The client’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 PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing licensed practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (j)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee with the client’s name and shall be exempt from (i)(2)-(6) above.

 

          (k)  The label of all medication containers maintained in the SUD-RTF shall match the current written orders of the licensed practitioner unless authorized by (n) below.

 

          (l)  Only a pharmacist shall make changes to prescription medication container labels.

 

          (m)  Any change or discontinuation of medications taken at the SUD-RTF shall be pursuant to a written order from a licensed practitioner.

 

          (n)  When the licensed practitioner changes the dose of a medication and personnel of the SUD-RTF are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the SUD-RTF’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (o)  Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

 

          (p)  All prescription medications, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be kept on the client’s person or stored in the client’s room, 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 client’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.

 

          (q)  Over-the-counter (OTC) medications shall be handled in the following manner:

 

(1)  Only original, unopened containers of OTC medications shall be allowed to be brought into the program;

 

(2)  OTC medication shall be stored in accordance with (p)(1) above; and

 

(3)  OTC medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (r)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (s)  The SUD-RTF shall have a clearly identified policy for storage and administration of naloxone that includes the following:

 

(1)  The process for regularly reviewing and updated 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.

 

          (t)  All medications self-administered by a client, with the exception of nitroglycerin, epi-pens, and rescue inhalers, which may be taken by the client without supervision, shall be supervised by the program staff, as follows:

 

(1)  Staff shall remind the client to take the correct dose of his or her medication at the correct time;

 

(2)  Staff may open the medication container but shall not be permitted to physically handle the medication itself in any manner;

 

(3)  Staff shall remain with the client to observe them taking the prescribed dose and type of medication; and

 

(4)  For each medication taken, staff shall document in an individual client medication log the following:

 

a.  The medication name, strength, dose, frequency, and route of administration;

 

b.  The date and the time the medication was taken;

 

c. The signature or identifiable initials of the person supervising the taking of said medication; and

 

d.  The reason for any medication refused or omitted.

 

          (u)  Except as allowed by (w) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becomes contaminated, whichever occurs first.

 

          (v)  Controlled drugs shall be destroyed only in accordance with state law and;

 

(1)  Be accomplished in the presence of at least 2 people; and

 

(2)  Be documented in the record of the client for whom the drug was prescribed.

 

          (w)  Medication(s) may be returned to pharmacies for credit only as allowed by the law.

 

          (x)  When a client is going to be absent from the SUD-RTF at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering, as described in (ad) and (ae) below.

 

          (y)  If a client is going to be absent from the SUD-RTF at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the SUD-RTF.

 

          (z)  Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian, agent, or surrogate decision-maker if any, unless determined by a licensed practitioner, licensed clinical supervisor, or licensed counselor that the client is a risk to themselves or others.

 

          (aa)  A written order from a licensed practitioner shall be required for any client who is authorized to carry emergency medications, including nitroglycerine and inhalers.

 

          (ab)  Clients shall receive their medications by one of the following methods:

 

(1)  Self-administered as described in (s) above;

 

(2)  Self-directed administration of medication as allowed by (ad) below; 

 

(3)  Self-administered with assistance as allowed by (ae) and (af) below; or

 

(4)  Administered by individuals authorized by law.

 

          (ac)  The licensee shall allow the client to self-direct administration of medications as defined in He-P 826.03(cf) if the client:

 

(1)  Has a physical limitation due to a diagnosis that prevents them from self-administration;

 

(2)  Receives evaluations every month or sooner, based on a significant change in the client, to ensure the client maintains the physical and mental ability to self-direct administration of medications;

 

(3)  Obtains written verification of the client’s physical limitation and self-directing capabilities from their licensed practitioner and requests the SUD-RTF to file the verification in the client record; and

 

(4)  Verbally directs personnel to:

 

a. Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; and

 

b.  Assist the client to apply, ingest, or instill the ordered dose of medication.

 

          (ad)  If a client self-administers medication with assistance, as defined in He-P 826.03(cd), personnel shall:

 

(1)  Remind the client to take the correct dose of his or her medication at the correct time;

 

(2)  Place the medication container within reach of the client;

 

(3)  Remain with the client to observe the client taking the appropriate amount and type of medication as ordered by the licensed practitioner;

 

(4)  Record on the client's daily medication record that they have supervised the client taking his or her medication; and

 

(5)  Document in the client’s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken.

 

          (ae)  If a client self-administers medication with assistance, personnel shall not physically handle the medication in any manner.

 

          (af)  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.

 

          (ag)  Personnel shall remain with the client until the client has taken the medication.

 

          (ah)  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.

 

          (ij)  A licensed nursing assistant (LNA) who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the SUD-RTF:

 

(1)  Medicinal shampoos and baths;

 

(2)  Glycerin suppositories and enemas; and

 

(3)  Medicinal topical products to intact skin as ordered by the licensed practitioner.

 

          (aj)  The licensee shall maintain a written record for each medication taken by the client at the SUD-RTF that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises, or assists the client taking medication;

 

(5)  For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (ak)  Personnel who are not otherwise licensed practitioners, nurses, or medication nursing assistants and who assist a client with self-administration with supervision, self-directed administration, or administration of medication via nurse delegation shall complete, at a minimum, a 4-hour medication supervision education program covering both prescription and non-prescription medication.

 

          (al)  The medication supervision education program shall be taught by a licensed nurse, licensed practitioner, or pharmacist, whether in-person or through other means such as electronic media.

 

          (am)  The medication supervision education program required by (am) above shall include:

 

(1)  Infection control and proper hand washing techniques;

 

(2)  The 5 rights which shall include:

 

a.  The right client;

 

b.  The right medication;

 

c.  The right dose;

 

d.  Administered at the right time; and

 

e.  Administered via the right route;

 

(3)  Documentation requirements;

 

(4)  General categories of medications, such as antidepressants or antibiotics;

 

(5)  Desired effects and potential side effects of medications; and

 

(6)  Medication precautions and interactions.

 

          (an)  The administrator may accept documentation of training required by (am) above if it was previously obtained by the applicant for employment at another licensed facility.

 

          (ao)  The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24-hours of the adverse reaction or medication error.

 

          (ap)  The written documentation of the report in (ak) above shall be maintained in the client’s record.

 

          (aq)  The licensee shall provide an annual review of its policies and procedures for self-administration of medication, self-administration of medication with supervision, and self-directed medication administration to all direct care personnel, as applicable.

 

          (ar)  The facility administrator, licensed nurse if available, or the administrator’s designee who has completed the 4-hour medication assistance supervision program required by He-P 804.17(al) shall provide and document in writing, an annual review of its policies and procedures for self-administration of medication without assistance, self-administration of medication with assistance, and self-directed medication administration to all direct care personnel.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18; amd by #12928, eff 11-26-19

 

          He-P 826.18  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the SUD-RTF to meet the needs of clients at all times.

 

          (b)  There shall be at least one awake personnel member on duty at all times while clients are in the facility.

 

          (c)  For all applicants for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check in accordance with (d) below;

 

(3)  Verify the qualifications of all applicants prior to employment; and

 

(4)  Verify that the applicant is not listed on the BEAS registry maintained by the department’s bureau of elderly and adult services.

 

          (d)  Unless a waiver is granted in accordance with (f)(2) below, the licensee shall not offer employment, contract with, or engage a person in (c) above, if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the clients.

 

          (e)  If the information identified in (d) above regarding any person in (c) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or

 

(2)  Request a waiver of (d) above.

 

          (f)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

 

          (g)  The licensee shall:

 

(1)  Not employ, contract with, or engage, any person in (c) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage persons in (c) above who are listed on the NH board of nursing unless a waiver is granted by the NH board of nursing.

 

          (h)  In lieu of (c) and (g) above, the licensee may accept from independent agencies contracted by the licensee or by an individual client to provide direct care or personal care services a signed statement that the agency’s employees have complied with (c) and (g) above and do not meet the criteria in (d) and (g) above.

 

          (i)  Administrators shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

 

(1)  A bachelor’s degree from an accredited institution and one year of relevant experience working in a health related field;

 

(2)  A New Hampshire license as an RN, with at least one year relevant experience working in a health related field;

 

(3)  An associate’s degree from an accredited institution plus 3 years relevant experience in a health related field;

 

(4)  A MLADC or LADC license issued by the State of New Hampshire; or

 

(5)  Licensed by the board of mental health practice with at least one year of relevant experience working in substance use disorder treatment.

 

          (j)  All administrators shall obtain and document in accordance with (q)(7) and (q)(8) below, 12 hours of continuing education related substance use disorder services each annual licensing period.

 

          (k)  The licensee shall employ or contract with a medical director who is:

 

(1)  A licensed practitioner who is licensed in the state of New Hampshire; and

 

(2)  Has experience providing medical services to clients with behavioral health or substance use disorder needs.

 

          (l)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of licensed staff.

 

          (n)  The licensee shall inform personnel of the line of authority at the SUD-RTF.

 

          (n)  The licensee shall educate personnel about the needs and services required by the clients under their care.

 

          (o)  Prior to having contact with clients or food, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (p)  In lieu of (o)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (o)(1) and (3) above before working at the SUD-RTF.

 

          (q)  Prior to having contact with clients or food, personnel shall receive a tour of and orientation to the SUD-RTF that includes the following:

 

(1)  The clients’ rights in accordance with RSA 151:20;

 

(2)  The SUD-RTF’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 826.21;

 

(7)  The facility confidentiality requirements;

 

(8)  Grievance procedures for both staff and clients;

 

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

 

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

 

          (r)  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 client’s rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan;

 

(4)  The provisions of 42 CFR Part 2;

 

(5)  The licensee’s policies and procedures; and

 

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

 

          (s)  The SUD-RTF shall maintain a separate employee file for each employee, which shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (c) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (r) above;

 

(7)  Information as to the general content and length of all in‑service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs required by (s) above;

 

(9)  A copy of each current driver’s license, including proof of insurance, if the employee transports clients using their own vehicle;

 

(10)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(11)  The statement required by (v) below; and

 

(12)  The results of the registry checks in (g) above. 

 

          (t)  The SUD-RTF shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (s)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (s)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (o) above may be substituted for (s)(4), (10), and (12) above, if applicable.

 

          (u)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a client; or

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (v)  An individual shall not have to re-disclose any of the matters in (u) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

 

          (w)  The licensee shall protect and store in a secure and confidential manner all records described in (s) and (t) above.

 

          (x)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

 

          (y)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (z)  The SUD-RTF shall have a written policy, as described in RSA 151:41, 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.

 

          (aa)  The policy in (z) 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.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.19  Client Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the SUD-RTF.

 

          (b)  Client records shall contain the following:

 

(1)  A copy of the client’s service agreement and all documents required by He-P 826.16(c);

 

(2)  Identification data, including:

 

a.  Vital information including the client’s name, date of birth, and marital status;

 

b.  Religious preference, if any; and

 

c.  Name, address and telephone number of an emergency contact person;

 

(3)  The name and telephone number of the client’s licensed practitioner(s);

 

(4)  Contact information for the person referring the client for services, as applicable;

 

(5)  The name, address, and telephone number of the behavioral health care provider, if applicable;

 

(6)  The client’s health insurance information;

 

(7)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(8)  A record of the health examination(s) in accordance with He-P 826.16(o) and (p);

 

(9)  Written, dated, and signed orders for the following:

 

a.  All medications, treatments, and special diets, as applicable; and

 

b.  Laboratory services and consultations performed at the SUD-RTF;

 

(10)  Results of any laboratory tests, X-rays, or consultations performed at the SUD-RTF;

 

(11)  All evaluations and treatment plans, including documentation that the client and the guardian, agent, or surrogate decision-maker, if any, has participated in the development of the care and treatment plans;

 

(12)  All admission and progress notes;

 

(13)  If services are provided at the SUD-RTF by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

 

(14)  Documentation of any alteration in the client’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(15)  Documentation of any medical or specialized care;

 

(16)  Documentation of unusual incidents;

 

(17)  The consent for release of information signed by the client, guardian, agent, or surrogate decision-maker,  if any;

 

(18)  Discharge summary, planning, and referrals;

 

(19)  Transfer or discharge documentation, including notification to the client, guardian, agent, or surrogate decision-maker, if any, of involuntary room change, transfer, or discharge, if applicable;

 

(20)  The information required by He-P 826.16(k) as applicable;

 

(21)  Information data sheet, which contains the information required by He-P 826.16(s);

 

(22)  Release of information sheet;

 

(23)  Documentation of nurse delegation of medications as required by the nurse practice act, as applicable; and

 

(24)  Documentation of a client’s refusal of any care or services.

 

          (c)  Client records and client information shall be kept confidential and only provided in accordance with 42 CFR Part 2, HIPAA, or any other applicable provision of law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur.  For all SUD-RTF facilities, this shall include compliance with 42 CFR Part 2.

 

          (e)  When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

 

          (f)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (g)  Records shall be retained for at least  7 years after discharge, except that when the client is a minor, records shall, in addition, be retained at least 7 years after the minor reaches the age of majority.

 

          (h)  The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the SUD-RTF ceases operation.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.20  Food Services for Residential Clients.

 

          (a)  The licensee shall provide food services to the clients that:

 

(1)  Meet the US Department of Agriculture recommended dietary allowance as specified in the 2015-2020 Dietary Guidelines for Americans, available as listed in Appendix A;

 

(2)  Meet the special dietary needs associated with health or medical conditions for each client as identified in their client record; and

 

(3)  Offers at least 3 meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

 

          (b)  Snacks shall be available between meals and at bedtime if not contraindicated by the client’s treatment plan.

 

          (c)  If a client refuses the item(s) on the menu, a substitute shall be offered.

 

          (d)  Each day’s menu shall be posted in a place accessible to food service personnel and clients.

 

          (e)  A dated record of menus as served shall be maintained for at least the previous 4 weeks.

 

          (f)  The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (g)  If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

 

          (h)  All food and drink provided to the clients shall be:

 

(1)  Safe for human consumption, free of spoilage, and free from other contamination;

 

(2)  Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and chapter 3 of the U.S. Department of Health and Human Services, Public Health Services, Food and Drug Administration, Food Code, 2013 edition, available as listed in Appendix A;

 

(3)  Served at the proper temperature;

 

(4)  Labeled, dated, and stored at proper temperatures; and

 

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

 

          (i)  The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

 

          (j)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (k)  All work surfaces shall be cleaned and sanitized after each use.

 

          (l)  All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored.

 

          (m) All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (o)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

 

          (p)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (q)  Garbage or trash in the kitchen area shall be placed in lined containers with covers.

 

          (r)  All SUD-RTF persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.21  Infection Control.

 

          (a) The SUD-RTF shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases, to include:

 

(1)  Proper hand-washing techniques;

 

(2)  The utilization of universal precautions;

 

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

 

(4) The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

 

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

 

(6)  Maintenance of a sanitary physical environment.

 

          (b)  The infection control education program shall address:

 

(1)  Causes of infection;

 

(2)  Effects of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (c)  Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

 

          (d)  Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

 

          (e)  Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SUD-RTF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (f)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

          (g) Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” June 2007, available as listed in Appendix A.

 

          (h) The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting personnel and clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (i)  The SUD-RTF shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.22  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations.

 

          (f)  All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination. 

 

          (g)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2,VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications, and client supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas.

 

          (j)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service areas shall be covered.

 

          (m)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(3)  Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

 

          (p)  Any SUD-RTF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services shall notify the department.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.23 Quality Improvement.

 

          (a)  The SUD-RTF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The SUD-RTF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored:

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the SUD-RTF; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

          (e)  The quality improvement committee shall meet at least quarterly.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.24  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

 

          (b)  The SUD-RTF shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and clients, including hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within an SUD-RTF including, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

 

a.  Be at least 65 degrees fahrenheit at night; and

 

b.  Be at least 70 degrees fahrenheit during the day if the client(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Unvented fuel-fired heaters shall not be used in any SUD-RTF.

 

          (f)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (g)  Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

 

          (h)  The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by clients.

 

          (i)  All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (j)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (k)  In an SUD-RTF, there shall be at least 70 square feet per room with a single bed and 120 square feet per room with 2 beds, exclusive of space required for closets, wardrobe and toilet facilities.

 

          (l)  In an SUD-RTF which provides full medical withdrawal management, there shall be at least 120 square feet per room for a single bed, exclusive of space required for closets, wardrobe and toilet facilities.

 

          (m)  If an SUD-RTF was licensed as a He-P 807 residential treatment and rehabilitation facility prior to the implementation of these rules, the licensee shall be exempt from (k) and (l) above.

 

          (n)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the client to reach his or her bedroom without passing through the room of another client;

 

(3)  Have a side hinge or pocket door that latches and meets applicable codes, and not a folding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors, and other rooms by floor to ceiling walls; and

 

(6)  Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the evaluation.

 

          (o)  The licensee shall provide the following for the clients’ use, as needed:

 

(1)  A bed appropriate to the needs of the client;

 

(2)  A firm mattress that complies with Saf-C 6000; as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control;

 

(3)  Clean linens, blankets, and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  Adequate lighting;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades, or curtains that provide privacy.

 

          (p)  The client may use his or her own personal possessions provided they do not pose a risk to the client or others and may waive any of the items in (o) above with a note signed by the client or guardian and which note shall be placed in the client file.

 

          (q)  The licensee shall provide the following rooms to meet the needs of clients:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all clients.

 

          (r)  Each licensee shall have a communication system in place so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

 

          (s)  Lighting shall be available to allow clients to participate in activities such as reading or handicrafts.

 

          (t)  All bathroom, bedroom, and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (u)  Screens shall be provided for:

 

(1)  Doors;

 

(2)  Windows; or

 

(3)  Other openings to the outside.

 

          (v)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (u) above.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.25  Fire Safety.

 

          (a)  All new SUD-RTF’s shall meet at a minimum the residential board and care chapter of NFPA 101 as adopted by the department of safety in Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (b)  If providing withdrawal management, the new SUD-RTF’s shall meet at a minimum the health care occupancy chapter of NFPA 101 as adopted by the department of safety in Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (c)  All SUD-RTF’s shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the SUD-RTF’s electrical service, or wireless, as approved by the state fire marshal for the SUD-RTF;

 

(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 SUD-RTF, in accordance with Saf-C 6015.04.

 

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

 

          (e)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

 

          (f)  The written notification required by (e) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (g)  If the licensee has chosen to allow smoking on the premises of the SUD-RTF, a designated smoking area shall be provided which:

 

(1)  Has a dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room;

 

(2)  Has walls and furnishings constructed of non‑combustible materials;

 

(3)  Has metal waste receptacles and safe ashtrays; and

 

(4)  Is in compliance with the requirements of RSA 155:64–77, the Indoor Smoking Act.

 

          (h)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian or a person with durable power of attorney (DPOA), at the time of admission and a summary of the client’s responsibilities shall be provided to the client.  Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

          (i)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

(j)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the Residential Board and Care or One and Two Family Dwelling Chapters of the Life Safety Code (NFPA 101), the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All SUD-RTF Tier 1, 2, and 3 facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping.  Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape;

 

e.  Facilities shall complete a written record of fire drills that includes the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At admission, the facility shall conduct a client Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the clients’ needs during a fire drill including mobility, assistance to evacuate, staff needed, risk of resistance, clients ability to evacuate on his or her own, and choose an alternate exit; and

 

h.  The fire drills for facilities built to the Residential Board and Care chapter of the Life Safety Code (NFPA 101), shall be permitted to be announced, in advance, to the clients just prior to the drill;

 

(2)  For SUDS-RTF's originally constructed to the Health Care Occupancy chapter of the life safety code and to the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the Health Care Occupancy chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the Health Care Occupancy Chapter of the Life Safety Code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exists;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

h.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(3)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

          He-P 826.26  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.  The committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (b) The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (c)  The plan in (b) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency, to include missing clients and bomb threats;

 

(2)  Be reviewed and approved by the local emergency management director and the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-( 9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least on an annual basis;

 

(12) Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Communications systems; and

 

i.  Essential services, such as kitchen and laundry;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Include the management of clients, particularly with respect to physical and clinical issues to include:

 

a.  Relocation of clients with their medical record including the medicine administration records, if time permits, as detailed in the emergency plan;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they won’t interfere with the operations of the facility;

 

(16) Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities; and

 

(18)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire plan for radiological emergency preparedness, include this plan in the event of a radiological disaster or emergency.

 

          (d)  The facility shall conduct and document with a detailed log, including personnel signatures, 2 drills a year at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations or both as follows:

 

(1) Drills and exercises shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not involved in the exercise;

 

(2)  Drills and exercises shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The facility shall conduct a debriefing session not more than 72-hours after the conclusion of the drill or exercise.  The debriefing shall include all key individuals, including observers; administration; clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement.  The critique shall identify areas of non-compliance and opportunities for improvement based upon monitoring activities and observations during the exercise.  Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

 

          (e)  For the purposes of emergency preparedness, each licensee shall have the following supplies of food and water maintained on the premises based on the average daily census of clients and staff:

 

(1)  Enough refrigerated, perishable food for a 3-day period;

 

(2)  Enough non-perishable food for a 7-day period; and

 

(3)  Potable water for a 3-day period.

 

          (f)  Each licensee shall have, in writing, a plan for the management of emergency food and water supplies required in (e) above, including the following:

 

(1)  Assumptions for calculations of food and water supplies including maximum number of staff and clients, water source of supply, whether tap or commercial, and expiration in months, tracking of supplies, and rotation of products, contracts and memorandums of understanding with food and water suppliers;

 

(2)  Storage location(s); and

 

(3)  Back-up supplies.

 

Source.  (See Revision Note at Part Heading for He-P 826) #12658, eff 11-1-18

 

PART He-P 827  FREESTANDING MEGAVOLTAGE RADIATION THERAPY FACILITY

 

REVISION NOTE:

 

            Document #12751, effective 3-26-19, adopted Part He-P 827 titled “Freestanding Megavoltage Radiation Therapy Facility.”  Part He-P 827 had formerly contained rules titled “Regulations for Special Hospitals-Rehabilitation” which had been adopted by Document #5849, effective 6-22-94, but had expired
6-22-00 and were not adopted again.  The rule number He-P 827 therefore became available for future rulemaking until used for the rules in Document #12751.

 

 

          He-P 827.01  Purpose.  The purpose of this part is to set forth the special health care service licensing requirements for freestanding megavoltage radiation therapy facility (FMRTF) services pursuant to RSA 151:2-e, II(c).

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.02  Scope.  This part shall apply to any organization, business entity, partnership, corporation, government entity, association or other legal entity operating megavoltage radiation therapy equipment in a free standing facility.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” which means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of patients;

 

(2)  “Physical abuse” which means the misuse of physical force which results or could result in physical injury to patients; or

 

(3)  “Sexual abuse” which means contact or interaction of a sexual nature involving patients without his or her informed consent.

 

          (b)  “Accredited hospital” means a hospital accredited by the organizations deemed by the Centers for Medicare and Medicaid Services (CMS) as accrediting organizations.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

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

 

          (e)  “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the FMRTF.

 

          (f)  “Admission” means accepted by a licensee for the provision of services to a patient.

 

          (g)  “Advance directive” means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J.

 

          (h)  “Adverse event” means a negative consequence of care, including any misadministration as defined in He-P 4000, which results in unintended injury which might have been preventable, and which is listed in RSA 151:38.

 

          (i)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies or other companies as the commissioner shall decide.

 

          (j)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (k)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a FMRTF pursuant to RSA 151:2, I(a) and RSA 151:2-e.

 

          (l)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 827, or other federal or state requirements.

 

          (m)  “Care plan or treatment plan” means a documented guide developed by the licensee, in consultation with personnel, the patient, and/or the patient’s guardian, agent, surrogate, or personal representative, if any, as a result of the assessment process for the provision of care and services.

 

          (n)  “Change of ownership” means a change in the controlling interest of an established FMRTF to an individual or successor business entity.

 

          (o)  “Commissioner” means the commissioner of the New Hampshire department of health and human services or his or her designee.

 

          (p)  “Core services” means those minimal services to be provided to any patient by the licensee that must be included in the basic rate.

 

          (q)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem.  Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

 

          (r)  “Days” means calendar days unless otherwise specified in the rule.

 

          (s)  “Demonstrated competency” means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard such as a certificate of completion of course material or a post-test to the training provided.

 

          (t)  “Department” means the New Hampshire department of health and human services.

 

          (u)  “Direct care” means hands on care or services to a patient, including but not limited to medical, nursing, psychological or rehabilitative treatments.

 

          (v)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (w)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs.  This term also includes “do not attempt resuscitation order (DNAR order).”

 

          (x)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (y)  “Employee” means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

 

          (z)  “Enforcement action” means the imposition of an administrative fine, the denial of an application for a license, or the revocation of a license in response to non-compliance with RSA 151 or He-P 827.

 

          (aa)  “Equipment or fixtures” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services.

 

          (ab)  “Exploitation” means the illegal use of a patient’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception or fraud.

 

          (ac)  “Facility” means any hospital, building, residence, or other place or part thereof, where services are provided under the provisions of RSA 151:2-e.

 

          (ad)  “Freestanding megavoltage radiation therapy facility (FMRTF)” means a facility, geographically separate from the parent hospital(s), which is owned or operated, directly or indirectly, by the parent hospital(s) and that performs megavoltage therapy radiation services.

 

          (ae)  “Governing body” means a group of individuals who are responsible for policy direction of the licensee.

 

          (af)  “Guardian” means a person appointed in accordance with RSA 463, RSA 464-A or the laws of another state, to make informed decisions relative to the patient’s health care and other personal needs.

 

          (ag)  “Hospital” means “hospital” as licensed under in RSA 151:2, I(a).

 

          (ah)  “Incident Command System (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (ai)  “Independent contractor” means an individual providing service to the licensee or its clients but employed by an outside agency.

 

          (aj) “Infectious disease” means any disease caused by the growth of microorganisms in the body which might or might not be contagious.

 

          (ak)  “Infectious waste” means those items specified by Env-Sw 904.

 

          (al)  “Informed consent” means the decision by a person or his/her guardian or agent to agree to a proposed course of treatment, after the person has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (am)  “In-service” means an educational program which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (an)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 827 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 827.

 

          (ao)  “License” means the document issued by the department to an applicant at the start of operation as an FMRTF which authorizes operation of an FMRTF in accordance with RSA 151 and He-P 827, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and license number.

 

          (ap)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the FMRTF is licensed.

 

          (aq)  “Licensed 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.

 

          (ar)  “Licensed premises” means the building(s), or portion thereof, that comprise the physical location the department has approved for the licensee to conduct operations in accordance with its license.

 

          (as)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (at)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted by the commissioner of the department of safety in Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (au)  “Medical director” means a licensed practitioner in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a FMRTF.

 

          (av)  “Medical staff” means those physicians and other licensed practitioners permitted by law and policies to provide patient care services independently within the scope of their practice acts.

 

          (aw)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (ax) “Megavoltage” means energy levels equal to or greater than 1.0 million electron volts or one MeV.  MeV stands for megavolts.

 

          (ay)  “Megavoltage radiation therapy equipment” means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues.  The term includes but is not limited to Cobalt-60 and linear accelerator machines.

 

          (az)  “Modification” means the reconfiguration of any space; the addition, relocation, or elimination of any door or window; the addition or elimination of load-bearing elements; the reconfiguration or extension of any system; or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

 

          (ba)  “Neglect” means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional or physical health and safety of any patient.

 

          (bb)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety rules or codes.

 

          (bc)  “Nursing care” means the provision or oversight of a physical, mental, or emotional condition or diagnosis by a nurse.

 

          (bd)  “Orders”  means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, 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.

 

          (be)  “Over-the-counter medications” means non-prescription medication.

 

          (bf)  “Owner” means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license.

 

          (bg)  “Parent hospital” means the hospital which owns and operates a FMRTF.

 

          (bh)  “Patient” means any person admitted to or in any way receiving care, services or both from a hospital or provider of special health care services licensed in accordance with RSA 151 and He-P 827.

 

          (bi)  “Patient record” means documents maintained for each person receiving care and services, which includes all documentation required by RSA 151, He-P 827 and all documentation compiled relative to the patient as required by other federal and state requirements.

 

          (bj)  “Patient rights” means the privileges and responsibilities possessed by each patient provided by RSA 151:21.

 

          (bk)  “Personal care” means personal care services that are non-medical, hands-on services provided to a patient to assist with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, or walking.

 

          (bl)  “Personal representative” means a person designated in accordance with RSA 151:19, V, to assist the patient for a specific, limited purpose or for the general purpose of assisting a patient in the exercise of any rights.

 

          (bm)  “Personnel” means an individual(s), who is employed by the FMRTF, who is a volunteer, or who is an independent contractor who provides direct care or personal care services to patients. 

 

          (bn)  “Physician” means medical doctor currently licensed in the state of New Hampshire pursuant to RSA 329.

 

          (bo)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified areas of non-compliance at the time of clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bp)  “Previously operating special health care service” shall mean a special health care service as defined by RSA 151:2-e that was being offered prior to July 1, 2016 and has continued to be offered since July 1, 2016.

 

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

 

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

 

          (bs)  “Qualified personnel” means personnel that have been trained to adequately perform the tasks which they perform, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (bt)  “Radiographic images” means x-rays or other images which are either on film, discs, paper, or stored electronically.

 

          (bu)  “Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (bv)  “Renovation” means the replacement in kind, strengthening, or upgrading of building elements, materials, equipment or fixtures, that does not result in a reconfiguration of the building spaces within.

 

          (bw)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (bx)  “Reportable incident” means an occurrence of any of the following while the patient is either in the FMRTF or in the care of personnel:

 

(1)  The unanticipated death of the patient; or

 

(2)  An injury to a patient that is potentially due to abuse or neglect.

 

          (by)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

 

          (bz) “Special health care service” shall mean cardiac catheterization laboratory services, open heart surgery or coronary artery bypass graft surgery, or megavoltage radiation therapy.

 

          (ca)  “Staff” means those employees of the licensee who are not subject to the credentialing process.

 

          (cb)  “State monitoring” means the placement of individuals by the department at a FMRTF to monitor the operation and conditions of the facility.

 

          (cc)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.04  License Application Submission.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I–III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (March 2019) signed by the applicant or 2 of the corporate officers, affirming and certifying the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

b.  For any FMRTF to be newly licensed :

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any FMRTF to be newly licensed  and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”;

 

(2)  A floor plan of the prospective FMRTF;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  A $500 fee, in accordance with RSA 151:2-e, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the qualifications of the FMRTF administrator;

 

(6)  Copies of applicable licenses for the FMRTF administrator;

 

(7)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, as adopted by the commissioner of the department of safety, and local fire ordinances applicable for a business; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official’s review of the building plans and upon completion of the construction project;

 

(8)  If the FMRTF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply, a copy of a water bill;

 

(9)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different than the applicant, medical director, and administrator for which the application is submitted; and

 

(10)  A copy of the signed and dated FMRTF’s criminal statement form for the administrator and medical director as described in He-P 827.18(t).

 

         (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Office of Legal and Regulatory Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

         (c)  A previously operating special health care service shall not be required to apply for  a licensed pursuant to RSA 151:2-e.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 827.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 827.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 827.13(b) if it determines that the applicant, licensee, medical director, or administrator:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (f)  At the time of initial onsite inspection, the applicant shall have the following on hand and available for inspection:

 

(1)  A copy of the personnel records; and

 

(2)  A copy of the FMRTF standard disclosure form.

 

          (g)  Following both clinical and life safety code inspections, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 827.

 

          (h)  All licenses issued in accordance with RSA 151 shall be non-transferable by person, location, or agency affiliation.

 

          (i)  A written notification of denial, pursuant to He-P 827.13(b)(10), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (g) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 827.

 

          (j)  A written notification of denial, pursuant to He-P 827.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire the following year on the last day of the month prior to the month in which it was issued unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 827.04(a)(1) at least 120 days prior to the expiration of the current license and include with the application:

 

(1)  The current license number;

 

(2) A request for renewal of any existing non-permanent waivers previously granted by the department, in accordance with He-P 827.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of any current employees who have a permanent waiver granted in accordance with He-P 827.18(e)(2); and

 

(4)  A copy of any non-permanent or new variances applied for and granted by the state fire marshal, in accordance with Saf-C 6005.03 - 6005.04, as amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (c)  In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates.

 

          (d)  Following an inspection as described in He-P 827.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) and (c) above, as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151 and He-P 827 at the renewal inspection, or submitted an acceptable plan of correction if areas of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 827.04.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.07  FMRTF New Construction and Existing Rehabilitation.

 

          (a)  For new construction and for rehabilitation, renovation, modification, reconstruction, or addition of an existing building, all construction documents, shop drawings, and architectural, sprinkler, and fire alarm plans shall be submitted to the department 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to windows and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 827 and shall notify the applicant or licensee as to whether the proposal complies with these requirements.

 

          (f)  Construction and building rehabilitation initiated prior to receiving department approval shall be done at the applicant or licensee’s own risk.

 

          (g)  The FMRTF shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (h)  A licensee or applicant undertaking construction or rehabilitation of a building shall comply with the following:

 

(1)  The state fire code, Saf-C-6000, as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V;

 

          (i)  All FMRTF newly constructed or rehabilitated after the 2019 effective date of these rules shall comply with the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition), as applicable, available as noted in Appendix A.

 

          (j) Where rehabilitation is done within an existing facility, all such work shall comply, insofar as practicable, with applicable sections of the FGI “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the FGI “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition), available as noted in Appendix A.

 

          (k)  Per the FGI “Guidelines for Design and Construction of Hospitals” (2018 Edition) or the FGI “Guidelines for Design and Construction of Outpatient Facilities,” (2018 Edition) available as noted in Appendix A, and notwithstanding (j) above, where it is evident that a reasonable degree of safety is provided, the requirements for existing buildings shall be permitted to be modified if their application would be impractical in the judgment of the authority having jurisdiction.

 

          (l)  The department shall be the authority having jurisdiction for the requirements in (i)-(k) above and shall negotiate compliance and grant waivers in accordance with He-P 827.10 as appropriate.

 

          (m)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved sealant that provides an equivalent rating as provided by the original surface.

 

          (n)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (o)  Exceptions or variances pertaining to the state fire code referenced in (h)(1) above shall be granted only by the state fire marshal.

 

          (p)  The building, including all construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 827.09 prior to its use.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.08  FMRTF Requirements for Organizational or Service Changes.

 

          (a)  The FMRTF shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address; or

 

(4)  Name;

 

          (b)  The FMRTF shall complete and submit a new application and obtain a new or revised license, license certificate, or both, as applicable, prior to operating for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location; or

 

(3)  An increase in number of patients or services beyond what is authorized under the current license.

 

          (c)  When there is a change in the address without a change in location, the FMRTF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the address change.

 

          (d)  When there is a change in the name, the FMRTF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  When there is to be a change in the services provided, the FMRTF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

 

          (f)  The department shall review the information submitted under (e) above and determine if the added services can be provided under the FMRTF’s current license.

 

          (g)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, then an inspection will be conducted as soon as practicable by the department;

 

(2)  The physical location;

 

(3)  A change in licensing classification; or

 

(4)  A change that places the facility under a different life safety code occupancy chapter.

 

          (h)  A new license and license certificate shall be issued for a change in ownership or a change in physical location.

 

          (i)  A revised license and license certificate shall be issued for a change in the FMRTF name.

 

          (j)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in address without a change in physical location;

 

(3) A change in the number of patients from what is authorized under the current license, if applicable; or

 

(4)  When a waiver has been granted.

 

          (k)  The FMRTF shall inform the department in writing no later than 5 days prior to a change in administrator or medical director or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change or medical director change and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator or medical director;

 

(2)  Copies of applicable licenses for the new administrator or medical director;

 

(3)  The results of a criminal records check conducted under He-P 827.18(b)(1); and

 

(4)  A copy of the dated and signed criminal statement as described He-P 827.18(t).

 

          (l)  Upon review of the materials submitted in accordance with (k) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 827.18(h).

 

          (m)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the licensee in writing so that a waiver can be sought or the licensee can search for a qualified candidate.

 

          (n)  The FMRTF shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change as this is the primary method used for all emergency notifications to the facility.

 

          (o)  An organizational restructuring of an established FMRTF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (p)  If a licensee chooses to cease operation of a FMRTF, the licensee shall submit written notification to the department at least 60 days in advance, which shall include a written closure plan that ensures adequate care of patients until they are transferred or discharged to an appropriate alternate setting.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 827 as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The licensed premises;

 

(2)  All programs and services provided by the FMRTF; and

 

(3)  Any records required by RSA 151 and He-P 827.

 

          (b)  The department shall conduct a clinical and life safety code inspection as necessary, to determine full compliance with RSA 151 and He-P 827 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 827.08(g)(1);

 

(3)  A change in the physical location of the FMRTF;

 

(4)  A change in the licensing classification;

 

(5)  Occupation of space after construction, modifications, or structural alterations; or

 

(6)  The renewal of a license.

 

          (c)  In addition to (b) above, the department shall conduct an inspection, as necessary, to verify the implementation of any POC accepted or issued by the department.

 

          (d)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the FMRTF is in violation of any of the provisions of He-P 827, RSA 151, or other federal or state requirement.

 

          (e)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 827.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

          (f)  A written notification of denial will be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in (b) above, that the prospective premises is not in full compliance with RSA 151 and He-P 827.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 827 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and patients as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health, safety, or well-being of the patients; and

 

(3)  Does not negatively affect the quality of patient services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) occurred since the last onsite clinical or life safety inspection;

 

(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 person who has first- hand knowledge regarding the allegation(s); and

 

(3)  There is 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 RSA 151 or He-P 827.

 

          (b)  When practicable the complaint shall be in writing and contain the following information:

 

(1)  The name and address of the FMRTF, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of
RSA 151 or He-P 827.

 

          (c)  Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of relevant records that have probative value; and

 

(4)  Interviews with individuals who might have information that is relevant to the investigation and might have probative value.

 

          (d)  For a licensed FMRTF, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate;

 

(3)  Notify the licensee in writing and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and

 

(4)  Require the licensee to submit a POC in accordance with He-P 827.12(c) if the inspection results in areas of non-compliance being cited.

 

          (e)  The following shall apply to an unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2;

 

(2)  In accordance with RSA 151:7-a, II, the owner or person responsible shall be allowed 7 business days from the date of the notice required by (1) above to submit a completed application for a license;

 

(3)  If the owner of an unlicensed facility does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 827; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above, shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 827.13(c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with an adjudicative proceeding relative to the licensee.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.12  Administrative Remedies.

 

          (a)  The department shall impose administrative remedies for violations of RSA 151, He-P 827, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee; or

 

(4)  Monitoring of a licensee.

 

          (b)  When administrative remedies are imposed, the department shall provide written notice, as applicable, which:

 

(1)  Identifies each area in which the licensee is not in compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been imposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or a notice to correct, the licensee shall submit a written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the area of non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a written POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21 calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review each POC and accept each plan that:

 

a.  Achieves compliance with RSA 151 and He-P 827;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 827 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the areas of non-compliance will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14- day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, unless the department has granted an extension, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He- P 827.13(c)(12) below;

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting an onsite follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be:

 

a.  Notified by the department in accordance with (b) above; and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 827.13(c)(13) below.

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the patients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or

 

(3)  A revised POC submitted by the licensee has not been accepted.

 

         (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate:

 

(1)  Impose a fine;

 

(2)  Deny the application for a renewal of a license in accordance with He-P 827.13(b); or

 

(3)  Revoke the license in accordance with He-P 827.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings or a notice to correct, provided that the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (g) The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings or notice to correct was issued by the department.

 

          (h)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination.

 

          (i)  The deadline to submit a POC in accordance with He-P 827.12(c) shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (j)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (l)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of patients; or

 

(2)  The presence of conditions in the FMRTF that negatively impact the health, safety, or well-being of patients.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable, before the enforcement action becomes final.

 

         (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee violated a provision of RSA 151 or He-P 827 which poses a risk of harm to the health, safety, or well-being of a patient;

 

(2)  An applicant or licensee has failed to pay an administrative fine imposed by the department;

 

(3)  An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information or schedule an initial inspection, the applicant or licensee fails to submit an application that meets the requirements of He-P 827.04 or fails to schedule an inspection;

 

(5)  The applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b.  Prevents, interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 827.12(c), (d), and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 827.12(c)(5) and has not submitted a revised POC in accordance with He-P 827.12(c)(5)b.;

 

(8)  The licensee is cited a third time under RSA 151 or He-P 827 for the same violation within the last 5 inspections;

 

(9)  A licensee, or its corporate officers, has had a license revoked and submits an application during the 5 year prohibition period specified in (k) below;

 

(10)  Unless a waiver has been granted, upon inspection, the applicant is not in compliance with RSA 151 or He-P 827;

 

(11)  Unless a waiver has been granted, the department makes a determination that the applicant, administrator, or licensee has been found guilty of or plead guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation of any person, in this or any other state, or had an investigation for abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee fails to employ a qualified administrator; or

 

(13)  The applicant has had a license revoked or denied by another division or unit of the department within a 5 year period of the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity;

 

(2)  For a failure to cease operations after a denial of a license, after receipt of an order to cease and desist operations, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, and He-P 827.14(h), the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a patient whose needs exceed the services or programs provided by the FMRTF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00;

 

(5)  For admission of a patient whose needs at the time of admission exceed the services or programs authorized by the FMRTF licensing classification, in violation of RSA 151:5-a, II, and He-P 827.16(a), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department in violation of RSA 151:7-a and He-P 827.11(e), the fine for an unlicensed provider or a licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 827.06(b), the fine for a licensee shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 827.08(a)(1), the fine for a licensee shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He P 827.08(a)(2), the fine for a licensee shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address as required by He-P 827.08(n), the fine for a licensee shall be $100.00;

 

(11)  For a failure to allow access by the department to the FMRTF’s premises, programs, services, or records, in violation of He-P 827.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a timely POC in violation of He-P 827.12(c)(2), or a timely or acceptable revised POC in violation of He-P 827.12(c)(5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 827.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 827.14(d) and (s), 827.16(c), 827.17(c), (r), and (v), 827.18(H)(2)g. and (x),  827.19(d) and (h), and 827.20(c), (l), and (n), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 827.14(c), the fine for a licensee shall be $500.00;

 

(16)  For providing false or misleading information or documentation, in violation of He-P 827.14(g), the fine for an applicant or licensee shall be $1000.00 per offense;

 

(17)  For a failure to meet the needs of a patient, as described in He-P 827.14(j), the fine for a licensee shall be $1000.00 per patient;

 

(18)  For employing an administrator or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 827.10, in violation of He-P 827.18(h), the fine for a licensee shall be $500.00;

 

(19)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 827.07(a), the fine for a licensed facility shall be $500.00;

 

(20)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 827.09(b)(5), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(21)  When an inspection determines that there is a violation of RSA 151 or He-P 827 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original area of non- compliance, the fine for a licensee shall be $1000.00; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in

a. above, the fine for a licensee shall be $2000.00;

 

(22)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 827 shall constitute a separate violation and shall be subject to fines in accordance with He-P 827.13(c); and

 

(23)  If the applicant or licensee is making good faith efforts to comply with (4),(6), and (15) above, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant, licensee, or unlicensed entity shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license and the cessation of operations when it finds that the health, safety, or welfare of a patient is in jeopardy and requires emergency action in accordance with RSA 541:A-30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 827 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a FMRTF’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to apply for a license or be employed as an administrator for 5 years if the denial or revocation specifically pertained to their role in the program.

 

         (k)  The 5-year period referenced in (j) above shall begin on:

 

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

 

(2)  The date a final decision upholding the action of the department is issued, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 827.

 

          (m)  If the department has reasonable information or evidence that a licensee, applicant, administrator, or others are circumventing (j) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A:30, III, or He-P 827.

 

          (o)  Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.14  Duties and Responsibilities of the Licensee.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and

ordinances, as applicable, including RSA 161-F:49 and rules promulgated under CMS  regulation at 42 CFR Part 482;

 

          (b)  The licensee shall comply with the patients’ bill of rights as set forth in RSA 151:19-21.

 

          (c)  The licensee shall define, in writing, the scope and type of services to be provided by the FMRTF, which shall include, at a minimum, the required services listed in He-P 827.16.

 

          (d)  The licensee shall develop and implement written policies and procedures governing the operation and all services provided by the facility.

 

          (e)  All policies and procedures shall be reviewed per licensee policy.

 

          (f)  The licensee shall assess and monitor the quality of care and service provided to patients on an ongoing basis.

 

          (g)  The licensee or any employee shall not falsify any documentation or provide false or misleading information to the department.

 

          (h)  Except for the requirements of RSA 151:4, III(a)(5), the licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating as a special health care service provider, unless it is licensed; and

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (i)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

          (j)  Licensees shall:

 

(1)  Meet the needs of the patients during those hours that the patients are in the care of the special health care service provider;

 

(2)  Initiate action to maintain the FMRFT in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, and ordinances;

 

(3)  Establish, in writing, a chain of command that sets forth the line of authority for the provision of FMRTF;

 

(4)  Appoint an administrator;

 

(5)  Appoint a medical director;

 

(6)  Appoint a chief of radiation therapy who shall be a medical radiation oncologist or a consulting medical radiation oncologist that meets the qualifications according to He-P 4000;

 

(7) Appoint a radiation therapy physicist who shall be a qualified medical physicist that meets the qualifications of He-P 4000;

 

(8)  Verify the qualifications of all personnel;

 

(9)  Provide sufficient numbers of qualified personnel who are present in the facility and are qualified to meet the needs of patients during all hours of operation;

 

(10)  Provide the facility with sufficient supplies, equipment, and lighting to meet the needs of the patients; and

 

(11)  Implement any POC that has been accepted by the department.

 

          (k)  The licensee shall consider all patients to be competent and capable of making health care decisions unless the patient:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney for health care or surrogate that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (l)  The licensee shall not exceed the number of occupants authorized by NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000 under RSA 153, and as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, and identified on the licensing certificate.

 

          (m)  If the licensee accepts a patient who is known to have a disease reportable under He-P 301 or an infectious disease, the licensee shall follow the required procedures for the care of the patients, as specified by the Centers for Disease Control and Prevention 2007 “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007 edition), available as noted in Appendix A.

 

          (n)  The licensee shall report all positive tuberculosis test results for personnel to the office of disease control in accordance with RSA 141-C:7, He-P 301.02 and He-P 301.03.

 

          (o)  The licensee shall implement measures to ensure the safety of patients who are assessed as a danger to self or others.

 

          (p)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2-e;

 

(2)  All inspection reports issued in accordance with He-P 827.09(b), for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of patient rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted, in writing, to the Department of Health and Human Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301 or by calling 1-800-852-3345, the address and phone number of the department to which complaints may also be made, which shall also be posted on the hospital website if available; and

 

(6)  The licensee’s evacuation floor plan for fire safety, evacuation, and emergencies identifying the location of, and access to, all fire exits.

 

          (q)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 827 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (r)  Licensees shall, in accordance with He-P 827.15:

 

(1)  Report all adverse events to the department as required by He-P 827.15(a)-(c);

 

(2)  Submit additional information if required by the department; and

 

(3)  Report the event to other agencies as required by law.

 

          (s)  The licensee shall develop policies and procedures regarding the release of information contained in patient records.

 

          (t)  The licensee shall provide cleaning and maintenance services, as needed to protect patients, personnel, and the public.

 

          (u)  The building housing the licensee shall comply with all state and local:

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

          (v)  Smoking shall be prohibited in the facility as required by RSA 155:66, I(b).

 

          (w)  If the licensee is not on a public water supply, the water used by the licensee shall be suitable for human consumption, pursuant to Env-DW 702.02 and Env-DW 704.02.

 

          (x)  If the licensee holds or manages a patient’s funds or possessions, it shall first receive written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other patients.

 

          (y)  At the time of admission, the licensee shall give a patient and the patient’s guardian, agent, or personal representative, a listing of all known applicable charges and identify what care and services are included in the charge.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.15  Adverse Event Reporting.

 

          (a)  Pursuant to RSA 151:37, the FMRTF administrator or designee, as a part of the parent hospital, shall report to the department the following adverse events:

 

(1)  Serious reportable events and specifications published in the National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update” http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573, available as noted in Appendix A.

 

(2)  Any misadministration as defined in He-P 4047.03(f); and

 

(3)  The exposure of a patient to a non-aerosolized blood borne pathogen by a health care worker's intentional, unsafe act.  An act by FMRTF staff resulting in an infection or disease shall be considered to be purposefully unsafe if it meets the following criteria:

 

a.  There was an intentional act or reckless behavior;

 

b.  No reasonable person with similar qualifications, training, and experience would have acted the same way under similar circumstances; and

 

c.  There were no extenuating circumstances that could justify the act.

 

          (b)  If the licensee suspects an adverse event occurred, the administrator or designee shall send a report to the department in electronic or paper format, within working 15 days after discovery of event, including:

 

(1)  Provider information;

 

(2)  Patient information;

 

(3)  Event information; and

 

(4)  Type of occurrence as listed in (a) above.

 

          (c)  For events reported in (b) above the FMRTF shall within 60 days provide the department:

 

(1)  An analysis that includes the type of harm and contributing factors; and

 

(2)  A corrective action plan that includes what corrective actions are planned, who is responsible for implementation, when the action will be implemented, and what measurements will be used to evaluate the corrective action plan or the justification for not implementing a corrective action plan if the FMRTF determines that one is not required.

 

          (d)  Upon receipt of a report of an adverse event, the department shall:

 

(1)  Acknowledge receipt of event and review information for completeness;

 

(2)  Review corrective action plan for system changes that reduce the risk repeat of similar adverse events;

 

(3)  Communicate specific concerns to the FMRTF if the department does not find the corrective action plan credible;

 

(4)  Track and analyze adverse events for trends, underlying system problems; and

 

(5)  Provide information and make referrals to other state agencies as appropriate.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.16  Required Services.

 

          (a)  The licensee shall only provide the services that have been disclosed on its application and have been approved by the department.

 

          (b)  If the licensee wishes to provide services other than the ones it is already licensed to provide, the licensee shall submit a letter of intent to provide the additional services, prior to providing the new service(s), to the department which shall include:

 

(1)  A listing of the additional services to be provided;

 

(2)  The physical resources and staffing necessary to provide the additional services;

 

(3)  Floor plans describing change(s) or architectural plans if structural changes are involved;

 

(4)  The date the licensee wishes to start such services; and

 

(5)  Documentation of compliance with the requirements of He-P 827 applicable to the service.

 

          (c)  The licensee shall have a policy governing CPR.

 

          (d)  The licensee shall establish health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the patient is at the FMRTF that includes: 

 

(1)  Monitoring the patients’ functioning, safety, and whereabouts; and

 

(2)  Emergency response and crisis intervention.

 

          (e)  All FMRTF laboratories, if applicable, shall comply with He-P 808, He-P 817, and CMS 42 CFR Part 493 – Laboratory Requirements.

 

          (f)  There shall be adequate toilet and dressing rooms for patients;

 

          (g)  Radiation therapy equipment shall be registered and radioactive material shall be licensed, in accordance with RSA 125-F and shall meet all applicable requirements of He-P 4000;

 

          (h)  The technical staff employed by the FMRTF shall perform the service as assigned by the radiation oncologist for the therapeutic uses of radiation, and in accordance with He-P 4000;

 

          (i)  The licensee must appoint a chief of radiation oncology who shall be certified in radiation oncology and responsible for:

 

(1)  Overseeing the services provided to ensure safe and quality care;

 

(2) Ensuring personnel are qualified to perform megavoltage radiation therapy services in accordance with He-P 4000; and

 

(3)  Establishing procedures necessary to ensure the safe and proper use of all therapeutic radiation machines and therapeutic uses of radioactive material in accordance with He-P 4000, including that technologists be trained and licensed commensurate to their duties in the operation and use of x-ray or radiation therapy equipment;

 

          (j)  A radiation oncologist shall supervise the therapeutic uses of radiation, including the use of radiation therapy machines, in accordance with He-P 4000;

 

          (k)  A licensee providing treatment on megavoltage radiation therapy equipment shall ensure the provision of a comprehensive coordinated care plan which may include:

 

(1)  Clinical oncology services, including chemotherapy and surgical treatment of tumors and follow-up capabilities;

 

(2)  Services of a tumor registry;

 

(3)  Services of a simulation capability and dose computation equipment;

 

(4)  Services of a pathology laboratory;

 

(5)  Services of a physics laboratory or equivalent;

 

(6)  Computerized tomography, magnetic resonance imaging, and position emission tomography capability;

 

(7)  Social work and counseling;

 

(8)  Brachytherapy or a referral arrangement for provision of the service;

 

(9)  Nutrition and dietary consultation; and

 

(10)  In-house capabilities encompassing the full range of radiation therapy modalities, including megavoltage equipment and superficial treatment equipment and systemic therapy or referral arrangements for the provision of these services.

 

          (l)  All licensees providing megavoltage radiation therapy shall have sufficient personnel to meet the needs of the patients.

 

          (m)  No licensee shall provide megavoltage radiation therapy services unless the program will treat a minimum of 200 patients on an annual basis by the end of the third year of operation. This may be demonstrated by the number of claims the licensee files in any twelve-month period for cognitive planning process codes;

 

          (n)  Any licensee holding a special health care service license to provide megavoltage radiation therapy services outside of a hospital shall adopt protocols for the transportation of patients for the provision of necessary support and emergency services, which shall include a written agreement for the acceptance and transfer of patients needing such emergency care, with the nearest acute care hospital or any acute care hospital within 30 minutes travel time.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.17  Medication Services.

 

          (a)  All medications shall be made available to the patient in accordance with the written and signed orders of the licensed practitioner or other professional with prescriptive powers.

 

          (b)  All medications and treatments shall be reviewed and signed by a licensed practitioner at each visit or when indicated by a change in the patient’s condition.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain and store any medication ordered for use at the FMRTF;

 

(2)  Reorder medications for use at the FMRTF; and

 

(3)  Receive and record new medication orders.

 

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

 

(1)  The patient’s name;

 

(2)  The medication name, strength, prescribed dose, and route, if different than by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage, to include the maximum allowed dose in a 24-hour period, for all medications that are used PRN; and

 

(5)  The dated signature of the ordering practitioner as allowed by He-P 827.03(bd).

 

          (e)  Except for pharmaceutical samples, each prescription medication container and medication record together shall collectively legibly display the following information in such a way so as to clearly identify the intended recipient:

 

(1)  The patient’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 PRN medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (f)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee, or their designee, with the patient’s name, and shall be exempt from (e)(2)-(6) above.

 

          (g)  The dosage, frequency, and route of administration on the labels of all prescription medications for each patient shall be identical to the dosage, frequency, and route of administration on the facility medication record except as allowed by (i) or (j) below.

 

          (h)  The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the FMRTF shall indicate in writing, in the medication record, the date the change in dose or the discontinuance occurred.

 

          (i)  Only a pharmacist shall make changes to prescription medication container labels except as allowed by (j) below.

 

          (j)  When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order.

 

          (k)  Only a licensed nurse shall accept telephone orders for medications, treatments, and therapeutic diets, and the licensed nurse shall immediately transcribe and sign the order.

 

          (l)  The transcribed order in (k) above shall be counter-signed by the authorized prescriber within 30 days of receipt.

 

          (m)  No medications shall be given to or taken by a patient until a written order is received, except as allowed by (k) and (l) above.

 

          (n)  The medication storage area for medications shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each patient’s medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (o)  All medication at the FMRTF shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

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

 

          (q)  If controlled substances, as defined by RSA 318-B, are stored in a central storage area in the FMRTF, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (r)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (s)  Except as required by (t) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days following the expiration date, the date a licensed practitioner discontinued the order, or the medication becomes contaminated, whichever occurs first.

 

          (t)  Destruction of contaminated, expired, or discontinued controlled drugs shall:

 

(1)  Be in accordance with all applicable standards of practice;

 

(2)  Be accomplished in the presence of at least 2 people who shall sign, date, and record the    amount destroyed; and

 

(3)  Be documented in the record of the patient for whom the drug was prescribed.

 

          (u) The licensee shall maintain a written record for each medication taken by a patient at the FMTRF that contains the following information:

 

(1)  Any allergies or adverse reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials, and job title of the person who administers, supervises, or assists the patient taking medication;

 

(5)  For PRN medications, the reason the patient required the medication, and the effect of the PRN medication; and

 

(6)  Documented reason for any medication refusal or omission.

 

          (v)  The facility shall have a written policy that incorporates the requirements listed in (t) through (v) for use in training and for reference by employees supervising medication administration.

 

          (w)  The licensee shall report any adverse reactions and side effects to medications or treatments, or any medication or treatment errors, to the patient’s licensed practitioner immediately but not to exceed 24 hours depending on the severity of the reaction or error, and shall document in the patient’s record the reaction, the error, and date, time, and person notified.

 

          (x)  An FMRTF shall have written orders from the licensed practitioner for all medications being taken by patients while under the care of the FMRTF.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.18  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present at the FMTRF to meet the needs of patients.

 

          (b)  For all applicants for employment, for all volunteers, and for all independent contractors who will provide direct care to patients or who will be unaccompanied by an employee while performing non-direct care within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety, except, pursuant to RSA 151:2-d, VI, for those licensed by the New Hampshire board of nursing;

 

(2)  Review the results of the criminal records check in (1) above in accordance with (e) below; and

 

(3)  Verify the qualifications of all applicants prior to employment; and

 

(4)  Check the names of the persons in (b) above against the bureau of elderly and adult services (BEAS) state registry maintained pursuant to RSA 161-F:49 and He-E 720 and the NH board of nursing, nursing assistant registry, maintained pursuant to RSA 326-B:26 and 42 CFR 483.156.

 

          (c)  Unless a waiver is granted in accordance with (e)(2) below, the licensee shall not offer employment, contract with, or engage a person in (b) above if the person:

 

(1)  Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of patients.

 

          (d)  If the information identified in (c) above regarding any person in (b) above is learned after the person is hired, contracted with, or engaged, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (c) above.

 

          (e)  If a waiver of (c) above is requested, the department shall review all relevant information and the underlying circumstances and either:

 

(1)  Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of patients; or

 

(2)  Grant a waiver of (c) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of patients.

 

          (f)  The licensee shall:

 

(1)  Not employ, contract with, or engage, any person in (b) above who is listed on the BEAS state registry unless a waiver is granted by BEAS; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the licensing site with the New Hampshire board of nursing or with a compact state.

 

          (g)  In lieu of (b) above, the licensee may accept from independent agencies contracted by the licensee a signed statement that the agency’s employees have complied with (b) and do not meet the criteria in (c) and (f)(1) above.

 

          (h)  Each FMRTF shall have a full time administrator who:

 

(1)  Has a master’s degree from an accredited institution and at least 4 years of experience working in a health related field or has a bachelor’s degree from an accredited institution and at least 8 years of experience working in a health related field; and

 

(2)  Shall be responsible to the governing body for the daily management and operation of the FMRTF including:

 

a.  Management and fiscal matters;

 

b.  The employment and termination of managers and staff necessary for the efficient operation of the FMRTF;

 

c. The designation of an alternate, in writing, who shall be responsible for the daily management and operation of the FMRTF in the absence of the administrator;

 

d.  To serve as a liaison to the parent hospital;

 

e.  The planning, organizing, and directing of such other activities as may be delegated by the parent hospital;

 

f.  The delegation of responsibility to subordinates as appropriate;

 

g.  Ensuring development and implementation of hospital policies and procedures on:

 

1.  Patient’s rights as required by RSA 151:20;

 

2.  Advanced directives as required by RSA 137-J;

 

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

 

5.  Withholding of resuscitative services from patients pursuant to RSA 137-H and RSA 137-J;

 

6.  Adverse event reporting; and

 

7.  Any other policies and procedures required by law or rule; and

 

h.  Notifying the department, directly or through delegation, as specified in He-P 827.15 of any adverse event involving a patient.

 

          (i)  All administrators shall obtain and document 12 hours of continuing education related to the operation and services of the FMRTF each annual licensing period, in accordance with (p) and (q) below.

 

          (j)  All direct care personnel shall be at least 18 years of age unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of a nurse or radiation therapist.

 

          (k)  The licensee shall inform personnel of the line of authority at the FMRTF.

 

          (l)  The licensee shall educate personnel about the needs and services required by the patients under its care.

 

          (m)  Prior to having contact with patients, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (n)  In lieu of (m)(1) and (3) above, independent agencies contracted by the facility to provide direct care may provide the licensee with a signed statement that its employees have complied with (m)(1) and (3) above before working at the FMRTF.

 

          (o)  Prior to having contact with patients, personnel shall receive a tour of and orientation to the FMRTF that includes the following:

 

(1)  The patient’s rights in accordance with RSA 151:20;

 

(2)  The FMRTF patient complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The emergency medical procedures;

 

(5)  The emergency and evacuation procedures;

 

(6)  The infection control procedures as required by He-P 827.20;

 

(7)  The facility confidentiality requirements;

 

(8)  The grievance procedures for both staff and patients; and

 

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

 

          (p)  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 patients’ rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan;

 

(4)  The licensee’s policies and procedures; and

 

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

 

          (q)  The FMRTF or parent hospital shall maintain a separate employee file for each employee, which shall include the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the patient’s rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (b) above;

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (p) above;

 

(7)  Information as to the general content and length of all in-service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs and demonstrated competencies that are signed and dated by the employee;

 

(9)  A copy of each current driver’s license, including proof of insurance, if the employee transports patients using their own vehicle;

 

(10)  Documentation that the required physical examinations or health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(11)  The statement required by (w) below; and

 

(12)  The results of the registry checks in (h) above.

 

          (r)  Personnel records may be stored at a parent hospital provided that:

 

(1)  The personnel record is available to the department at the licensed premises within 2 hours of being requested; and

 

(2)  The records are maintained in accordance with (q) above.

 

          (s)  The FMRTF shall maintain the records for all volunteers, and for all independent contractors who provide direct care to patients or who will be unaccompanied by an employee while performing non-direct care services within the facility, as follows:

 

(1)  For volunteers, the information in (q)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (q)(3), (4), (6), and (8)-(12) above, except that the letter in (g) and (n) above may be substituted for (q)(4), (10), and (12) above, if applicable.

 

          (t)  All personnel shall sign a statement at the time the initial offer of employment, contract, or engagement is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, theft, fraud, abuse, neglect, or exploitation or pose a threat to the health, safety, or well-being of a patient; and

 

(3)  Have not had a finding upheld by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person.

 

          (u)  An individual shall not have to re-disclose any of the matters in (t) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment, contract, or engagement.

 

          (v)  The licensee shall protect and store in a secure and confidential manner all records described in (q) and (r) above.

 

          (w)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (x)  The FMRTF shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of controlled substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

 

          (y)  The policy in (x) above shall include:

 

(1)  Education;

 

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

 

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

 

(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 abuse, misuse, and diversion prevention policy.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.19  Patient Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each patient receiving the services provided at the FMRTF.

 

          (b)  At a minimum, patient records shall contain the following:

 

(1)  Identification data, including:

 

a.  The patient’s name, date of birth, and marital status;

 

b.  Home address and telephone number;

 

c.  Name, address, and telephone number for an emergency contact person;

 

d.  Patient’s veteran status, if known; and

 

e.  Guardian or agent, if applicable;

 

(2)  The name and telephone number of the patient’s licensed practitioner(s);

 

(3)  A signed acknowledgment of receipt of patient bill of rights by the patient, guardian, or agent;

 

(4) If services are provided at the FMRTF by individuals not employed by the licensee, documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, and the business address and telephone number;

 

(5)  Patient’s health insurance information;

 

(6)  A written or electronic record of a health examination by a licensed practitioner;

 

(7)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will;

 

(8)  Written, dated, and signed orders for the all medications, treatments, and therapeutic diets ordered at the FMRTF;

 

(9)  Copies of the patient’s consent for treatment and DNR;

 

(10)  Results of any laboratory tests, X-rays, or consultations performed at FMRTF;

 

(11)  All assessments and care plans, and documentation that the patient and the guardian or agent, if any, has participated in the development of the care plan;

 

(12)  The consent for release of information signed by the patient, guardian, or agent, if any;

 

(13) All consult and progress notes;

 

(14)  Documentation of medical, nursing, or other specialized care, as applicable;

 

(15)  Documentation of reportable incidents;

 

(16)  The consent for release of information signed by the patient, guardian, or agent, if any;

 

(17)  Discharge planning and referrals;

 

(18)  The medication record as required by He-P 827.17(u);

 

(19)  Documentation of any accident or injuries occurring while in the care of the facility and requiring medical attention by a practitioner; and

 

(20)  Documentation of a patient’s refusal of any care or services.

 

          (c)  Patient records and information shall be kept confidential and only provided in accordance with all applicable federal and state law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a patient’s record shall occur.

 

          (e)  When not being used by authorized personnel, patient records shall be safeguarded against loss or unauthorized use or access.

 

          (f)  A licensee shall, upon request, provide a patient or the patient’s guardian or agent, if any, with a copy of his or her patient record pursuant to the provisions of RSA 151:21.

 

          (g)  All personnel records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (h)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of patients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to patients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to patients and staff.

 

          (i)  Patient records shall be retained 7 years after discharge of a patient, and in the case of minors, patient records shall be retained until at least one year after reaching age 18, but in no case shall they be retained for less than 7 years after discharge.

 

          (j)  The licensee shall arrange for storage of, and access to, patient records in the event the FMRTF ceases operation.

 

          (k) Electronic records shall be maintained according to current HIPAA regulations to ensure confidentiality and adequate security.

 

          (l)  If the facility uses an electronic record storage system, it shall provide computer access to all patient records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 827 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.20  Infection Control.

 

          (a)  The licensee shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

          (b)  The FMRTF shall appoint an individual who will oversee the development and implementation of the infection control program.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of patients with infectious or communicable diseases or illnesses;

 

(4)  The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Wm 2604;

 

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

 

(6)  Evaluating and revising the infection control program in accordance with current CDC recommended actions;

 

(7)  Maintenance of a sanitary physical environment; and

 

(8)  Infection control policies specific to each department.

 

          (d)  The infection control education program shall be completed by all new employees, all current employees, and all contracted employees on an annual basis and 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.

          (e)  Personnel infected with a disease or illness transmissible through food, formites, or droplets shall not provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

 

          (f)  Personnel infected with scabies or lice shall not provide direct care to patients until such time as they are no longer infected as determined by a licensed practitioner.

 

          (g)  Pursuant to RSA 141-C:1, personnel with a newly positive TB test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the FMRTF until a diagnosis of tuberculosis is excluded, or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (h)  Personnel with an open wound who provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, fitted bandage.

 

          (i)  If the FMRTF has an incident of an infectious diseases reported in (c)(5) above, the facility shall contact the public health nurse in the county in which the facility is located and follow the instructions and guidance of the nurse.

 

          (j)  Each licensee caring for patients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by the Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A.

 

          (k)  If a licensee offers influenza or pneumococcal immunizations for patients or staff, the licensee shall document the administration of the immunization as applicable, and such report immunization data to the department’s immunization program.

 

          (l)  The FMRTF shall develop and implement a point of care testing policy, if they provide POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

 

          (m)  The licensee shall have available space, supplies, and equipment for proper handling of suspected or actual infectious conditions.

 

          (n)  The licensee shall have a policy requiring employees to make a report to the infection control officer if the employee suspects that they, another employee, or patient has a communicable disease.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.21  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption.

 

          (d)  A supply of hot and cold running water shall be available at all times, and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the patients.

 

          (e)  All patient toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (f)  Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2 VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from medications and program supplies.

 

          (g)  Toxic materials shall not be used in a way that contaminates equipment or in any way other than in full compliance with the manufacturer’s labeling.

 

          (h)  Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, for rodent or cockroach control.

 

          (i)  Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects, rodents, and outdoor animals.

 

          (j)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (k)  Bathrooms shall have non-porous floors.

 

          (l)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas or containers.

 

          (m)  If equipment or supplies need to be sterilized in order to prevent contamination, the FMRTF shall develop and maintain written procedures for cleaning, packaging, and sterilization that includes:

 

(1)  Testing and documenting sterilization processes used;

 

(2)  Testing and documenting the effectiveness of sterilization equipment for adequate sterilization in accordance with the manufacturer’s recommendations or using industry acceptable quality control standards;

 

(3)  Documentation when supplies are outdated; and

 

(4)  Ensuring that all sterile packages are stored separately from non-sterile supplies in an enclosed area.

 

          (n)  Any FMRTF that has its own water supply and whose water has been tested and failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.22  Quality Improvement.

 

          (a)  The FMRTF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  The FMRTF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (c)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored;

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the FMRTF;

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective action as applicable;

 

(8)  Meet at least quarterly;

 

(9)  Generate dated, written minutes after each meeting; and

 

(10)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

 

          (d)  Mandatory monitoring of radiological safety practice standards according to He-P 4000 shall be part of the quality improvement program.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.23  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.

 

          (b)  The FMRTF shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to:

 

a.  Repairing holes and caulking of pipe channels; and

 

b.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within an FMRTF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall:

 

(1)  Maintain a temperature of at least 70 degrees fahrenheit during the day if patients are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (c)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following conditions are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees fahrenheit.

 

          (f)  Unvented fuel-fired heaters shall not be used in any FMRTF.

 

          (g)  Plumbing shall be sized, installed, and maintained in accordance with the state plumbing code as adopted under RSA 329-A:15 and RSA 155-A.

 

          (h)  Ventilation shall be provided in all enclosed areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (i)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (j)  In accordance with RSA 155:66, I(b), smoking shall be prohibited in the FMRTF.

 

          (k)  Each FMRTF shall have a bathroom with a toilet, a hand washing sink, soap dispenser, paper towels or a hand-drying device providing heated air, and hot and cold running water.

 

          (l)  Notwithstanding (k) above, if the FMRTF is located within a multi-use business or facility that has a public bathroom with a toilet and the bathroom complies with all applicable sanitation and construction regulations, the facility shall not be required to have its own bathroom but shall have its own hand washing sink with hot and cold running water, soap dispenser, and paper towels or a hand-drying device providing heated air.

 

          (m)  There shall be sufficient space and equipment for the services provided at the FMRT facility.

 

          (n)  All exam tables shall be changed with clean linens or common paper between use by different patients.

 

          (o)  The licensee shall provide patients with continuous access to a device or means that will signal FMRTF personnel when they are in need of assistance.

 

          (p)  All bathroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (q)  If available, all showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.

 

          (r)  All mattresses and new upholstered furniture or draperies shall comply with the applicable portions of Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control.

 

          (s)  A privacy partition, curtain, or screen shall be required between patient care areas.

 

          (t)  The FMRTF facility shall keep all entrances and exits to the licensed premises accessible at all times during hours of operation.

 

          (u)  The FMRTF facility shall be clean, sanitary, maintained in a safe manner and good repair, and kept free of hazards.

 

          (v)  The FMRTF facility shall provide the following:

 

(1)  Reception and waiting areas that include a reception desk or counter, chairs, tables, and lighting adequate to read materials and complete forms as required;

 

(2)  Public access to toilet facilities with non-porous floors;

 

(3)  A number of examination and treatment rooms adequate to provide services to the average number of patients seen daily; and

 

(4)  Hot water available at all times from taps available to patients and not less than 105 degrees Fahrenheit or more than 120 degrees Fahrenheit.

 

          (w)  Medical waste shall be disposed of in accordance with the requirements of Env-Sw 904.

 

          (x)  Except as described in (b) above, the FMRTF facility shall comply with all federal, state and, local health, building, fire, and zoning laws, rules, and ordinances.

 

          (y)  The water used in the FMRTF facility shall be suitable for human consumption, pursuant to Env-Ws 315 and Env-Ws 316.

 

          (z)  The licensee shall comply with all state and local codes and ordinances for:

 

(1)  Zoning;

 

(2)  Building;

 

(3)  Health;

 

(4)  Fire;

 

(5)  Waste disposal; and

 

(6)  Water.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.24  Fire Safety.

 

          (a)  All FMRTF shall have:

 

(1)  Smoke detectors on every level that are interconnected and either hardwired, powered by the FMRTF’s electrical service, or wireless, as approved by the state fire marshal.

 

(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, and which meets the following requirements:

 

a.  Maximum travel distance to each extinguisher shall not exceed 50 feet;

 

b. 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;

 

c.  Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period;

 

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

 

e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer’s listed maintenance manual; and

 

(3)  An approved carbon monoxide monitor on every level.

 

          (b)  A fire safety program shall be developed and implemented to provide for the safety of patients and personnel.

 

          (c)  Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of:

 

(1)  A false alarm or emergency medical services (EMS) transport for a non-emergent reason; or

 

(2)  Emergency EMS transport related to pre-existing conditions.

 

          (d)  The written notification required by (c) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or patients who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or patients who required medical treatment as a result of the incident, if applicable; and

 

(6) The name of the individual the licensee wishes the department to contact if additional information is required.

 

          (e)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change.

 

          (f)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the health care occupancy chapter of the life safety code and to the rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed fire protection engineer, the state fire marshal’s office, and the department to meet the health care occupancy chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10.  Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter in place, also known as defend in place, shall have this plan approved by the department and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

 

e.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time including AM/PM the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including patients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility or to an approved area of refuge or through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and

 

(2)  The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal’s office, or the local fire department upon request.

 

          (g)  For the use and storage of oxygen and other related gases, a FMRTF shall comply with NFPA 99 as adopted by the commissioner of the department of safety under Saf-C 6000, as amended pursuant to RSA 153:5, I, by the state fire marshal with the board of fire control, including, but not limited to, the following:

 

(1)  All freestanding compressed gas cylinders shall be firmly secured to the adjacent wall or secured in a stand or rack;

 

(2)  Storage locations shall be outdoors in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors, or with gates if outdoors, that can be secured against unauthorized entry;

 

(3)  Oxidizing gases, such as oxygen and nitrous oxide, shall:

 

a.  Not be stored with any flammable gas, liquid, or vapor;

 

b.  Be separated from combustibles or incompatible materials by:

 

1.  A minimum distance of 20 ft. (6.1 m);

 

2.  A minimum distance of 5 ft. (1.5 m) if the entire storage location is protected by an automatic sprinkler system designed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems; or

 

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour; and

 

c.  Shall be secured in an upright position, such as with racks or chains;

 

(4)  A precautionary sign, readable from a distance of 5 ft. (1.5 m), shall be conspicuously displayed on each door or gate of the storage room or enclosure, and shall include, at a minimum, the following: “CAUTION, OXIDIZING GAS(ES) STORED WITHIN - NO SMOKING”; and

 

(5)  Precautionary signs, readable from a distance of 5 ft. (1.5 m), and with language such as “OXYGEN IN USE, NO SMOKING”, shall be conspicuously displayed wherever supplemental oxygen is in use and in aisles and walkways leading to the area of use, and shall be attached to adjacent doorways or to building walls or be supported by other appropriate means.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

          He-P 827.25  Emergency Preparedness.

 

          (a)  Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program.

 

          (b)  The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate.

 

          (c)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan, as described in (d) and (e) below;

 

(2)  The roles and responsibilities of the committee members; and

 

(3)  How the plan is implemented, exercised, and maintained;

 

          (d)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

          (e)  The plan in (d) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, or severe weather and human-caused emergency to include, but not be limited to, bomb threat;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the Incident Command System (ICS) in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment, the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies and to determine the outcome of prior strategies at least an annually;

 

(12)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  HVAC;

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing Critical Incident Stress Management (CISM), if necessary;

 

(14)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(15)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(16)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s

specific duties and responsibilities; and

 

(17)  If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP.

 

Source.  (See Revision Note at part heading for He-P 827) #12751, eff 3-26-19

 

PART He-P 828  REGULATIONS FOR FREESTANDING HOSPITAL EMERGENCY FACILITIES - EXPIRED

 

Source.  #5850, eff 6-22-94, EXPIRED: 6-22-00

 

PART He-P 829 REGULATIONS FOR HEALTH PROMOTION, DISEASE PREVENTION AND SCREENING CLINICS - EXPIRED

 

Source.  #5900, eff 9-22-94, EXPIRED: 9-22-00

 

PART He-P 830  PSYCHIATRIC RESIDENTIAL TREATMENT PROGRAMS

 

          He-P 830.01  Purpose.  The purpose of this part is to set forth the classification of and licensing requirements for psychiatric treatment residential programs pursuant to RSA 151:2, I(e)(2), and as described in RSA 151:9, VII(a)(4).  Psychiatric treatment programs are designed and structured to provide intensive short term, intermediate, and long-term mental health services to persons who have psychiatric disorders or are in an acute phase of their mental illness.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.02  Scope.  This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a psychiatric residential treatment program, except:

 

          (a)  All facilities listed in RSA 151:2, II(a)-(i); and

 

          (b)  All entities that are owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.03  Definitions.

 

          (a)  “Abuse” means any one of the following:

 

(1)  “Emotional abuse” means the misuse of power, authority, or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of clients;

 

(2)  “Physical abuse” means the misuse of physical force which results or could result in physical injury to clients; or

 

(3)  “Sexual abuse” means contact or interaction of a sexual nature involving clients without his or her informed consent.

 

          (b)  “Activities of daily living (ADL)” means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing and medication management.

 

          (c)  “Addition” means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

 

          (d)  “Administer” means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B.

 

          (e)  “Administration of medication” means the provision of one or more doses of medication to clients by licensed nurses or other personnel qualified by law or rule to administer medication.

 

          (f)  “Administrator” means the individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premise.

 

          (g)  “Admission” means the point in time when a client, who has been accepted by a licensee for the provision of services, physically moves into the facility.

 

          (h)  “Admission agreement” means the document signed by the client and the facility administrator detailing what both the client and the facility agree to do.

 

          (i)  “Adult” means persons 18 years or older.

 

          (j)  “Advance directive(s)” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directive” includes living wills and durable powers of attorney for health care, in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA 137-J:35.

 

          (k)  “Adverse reaction” means a physical or mental negative change after taking medication.

 

          (l)  “Affiliated or related parties” means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, captive or affiliated insurance companies.

 

          (m)  “Agent” means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker in accordance with RSA-J:34-37.   

 

          (n)  “Ambulatory” means an individual who is able to walk about and is not bedridden.

 

          (o)  “Applicant” means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a psychiatric residential treatment program (PRTP) pursuant to RSA 151.

 

          (p)  “Area of non-compliance” means any action, failure to act, or other set of circumstances that cause a license to be out of compliance with RSA 151, He-P 830, or other federal or state requirements.

 

          (q)  “Assessment” means an evaluation of the client to determine the care and services that are needed.

 

          (r)  “Change of ownership” means change in the controlling interest of an established PRTP to an individual or successor business entity.

 

          (s)  “Chemical restraint” means any medication prescribed to control a client’s behavior or emotional state without a supporting diagnosis or for the convenience of program personnel.      

 

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

 

          (u)  “Client” means any person admitted to or in any way receiving care, services or both from an PRTP licensed in accordance with RSA 151 and He-P 830.

 

          (v)  “Client record” means documents maintained for each client, which includes all documentation required by RSA 151 and He-P 830, and all documentation compiled relative to the client as required by other federal or state laws.

 

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

 

          (x)  “Contracted employee” means a temporary employee working under the direct supervision of the PRTF but employed by an outside agency.

 

          (y)  “Core services” means those services provided by the licensee that are included in the basic rate.

 

          (z)  “Critical incident stress management (CISM)” means an adaptive, short-term psychological helping process that focuses solely on an immediate and identifiable problem.  Individuals undergoing CISM are able to discuss the situation that occurred and how it affects them and those around them allowing individuals to use this forum to acquire the tools necessary to hopefully limit post-traumatic stress related issues in their own lives and recognize it in others.

 

          (aa)  “Days” means calendar days, unless otherwise specified.

 

          (ab)  “Department” means the New Hampshire department of health and human services.

 

          (ac)  “Direct care” means the provision of services to a patient that require some degree of interaction between the patient and the health care provider including but not limited to assessment, performing procedures, teaching, and implementation of a treatment plan.

 

          (ad)  “Direct care personnel” means any person providing direct care to a client.

 

          (ae)  “Directed plan of correction” means a plan developed and written by the department that specifies the actions the licensee must take to correct identified areas of non-compliance.

 

          (af)  “Do not resuscitate order (DNR order)” means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes “do not attempt resuscitation order (DNAR order).

 

          (ag)  “Elopement” means when a resident who is cognitively, physically, mentally, emotionally, or chemically impaired or cognitively intact, wanders away, walks away, runs away, escapes, or otherwise leaves a facility unsupervised or unnoticed without knowledge of the licensee’s personnel.

 

          (ah)  “Emergency” means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

 

          (ai)  “Emergency plan” means a document outlining the responsibilities of personnel in an emergency.

 

          (aj)  “Employee” means anyone employed by the PRTP and for whom the facility has direct supervisory authority.

 

          (ak)  “Enforcement action” means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 830.

 

          (al)  “Equipment” means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services”, not to include portable refrigerators. This term includes fixtures.

 

          (am)  “Exploitation” means the illegal use of a client’s person or property for another person’s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person’s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a client through the use of undue influence, harassment, duress, deception, or fraud.

 

          (an)  “Facility” means “facility” as defined in RSA 151:19, II.

 

          (ao)  “Guardian” means a person appointed in accordance with RSA 464-A to make informed decisions relative to the client’s health care and personal needs.

  

          (ap)  “Health care occupancy” means an occupancy used for purposes of medical or other treatment of care of 4 or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupant's control.

 

          (aq)  “Impaired” means when a physician or health care worker whose ability to function in his or her usual role has been reduced or otherwise compromised by  any substances including but not limited to legally prescribed medications or alcohol.

 

          (ar)  “Incident command system (ICS)” means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

 

          (as)  “Infection Control Risk Assessment (ICRA)” means a determination of the potential risk of transmission of various infectious agents in the facility. A classification of those risks, and a list of required practices for mitigating those risks during construction or renovation.

 

          (at)  “Infectious waste” means those items specified by Env-Sw 103.28.

 

          (au)  “Informed consent” means the decision by a client, his or her guardian or agent, or surrogate decision maker to agree to a proposed course of treatment, after the client, guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently.

 

          (av)  “In-service” means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel.

 

          (aw)  “Inspection” means the process followed by the department to determine an applicant’s or a licensee’s compliance with RSA 151 and He-P 830 or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 or He-P 830.

 

          (ax)  “Involuntary admission” means an order of involuntary commitment made pursuant to RSA l35-C:34-54 by a probate court.

 

          (ay)  “Involuntary emergency admission” means an order of emergency involuntary admission made pursuant to RSA 135-C:27-33.

 

          (az)  “License” means the document issued by the department to an applicant at the start of operation as a PRTP which authorizes operation as a PRTP in accordance with RSA 151 and He-P 830, and includes the name of the licensee, the name of the business, the physical address, the license classification, the effective date, and the license number.

 

          (ba)  “License certificate” means the document issued by the department to an applicant or licensee that, in addition to the information contained on a license, includes the name of the administrator, the type(s) of services authorized and the number of beds that the PRTP is licensed for.

 

          (bb)  “Licensed practitioner” means:

 

(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 New Hampshire licensing board.

 

          (bc)  “Licensed premises” means the building or buildings that comprise the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

 

          (bd)  “Licensee” means any person or legal entity to which a license has been issued pursuant to RSA 151.

 

          (be)  “Licensing classification” means the specific category of services authorized by a license.

 

          (bf)  “Life safety code” means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

 

          (bg)  “Mechanical restraint” means  locked or secured PRTPs or units within a PRTP, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a client from freely exiting the PRTP or unit within.

 

          (bh)  “Medical director” means a psychiatrist licensed in New Hampshire pursuant to RSA 329 who is responsible for the implementation of client care policies and the coordination of medical care in the facility.

 

          (bi)  “Medication” means a substance available with or without a prescription, which is used as a curative or remedial substance.

 

          (bj)  “Mental illness” means “mental illness” as defined in RSA 135-C:2, X, namely “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)  Continue 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”.

 

          (bk)  “Modification” means the reconfiguration of any space, the addition, relocation, elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include repair or replacement of interior finishes.

 

          (bl)  “Neglect” means an act or omission, which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional, or physical health and safety of any client.

 

          (bm)  “Notice to correct” means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable  life safety rules or codes.

 

          (bn)  “Nutritional requirements” means the necessary food and liquid intake required to maintain acceptable parameters of nutritional status.

 

          (bo)  “Orders” means a document, produced verbally, electronically, or in writing, by a licensed practitioner for medications, treatments, 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.

 

          (bp)  “Over-the-counter medications” means non-prescription medications.

 

          (bq)  “Owner” means a person or organization who has controlling interest in the PRTP.

 

          (br)  “Patient rights” means the privileges and responsibilities possessed by each client provided by RSA 151:21.

 

          (bs)  “Performance-based design” means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions.

 

          (bt)  “Personal representative” means a person, other than the licensee of, an employee of, or a person having a direct or indirect ownership interest in the licensed facility, who is designated in writing by a client or client’s legal guardian for a specific limited purpose or for the general purpose of assisting the client in the exercise of any rights as defined by RSA 151:19, V.

 

          (bu)  “Personnel” means individual(s) employed by the facility, volunteer(s), or independent contractor(s), who provide direct care or services to a client.

 

          (bv)  “Physical restraint” means the use of any hands-on or other physically applied techniques to physically limit the client’s freedom of movement, which includes but are not limited to forced escorts, holding, prone restraints, or other containment techniques. 

 

          (bw)  “Plan of correction (POC)” means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

 

          (bx)  “Point of care testing (POCT)” means laboratory testing performed using either manual methods or hand-held instruments at or near the site of client care.

 

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

 

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

 

          (ca)  “Protective care” means the provision of client monitoring services, including but not limited to:

 

(1)  Knowledge of client whereabouts; and

 

(2)  Minimizing the likelihood of accident or injury.

 

          (cb)  “Psychiatric residential treatment program (PRTP)” means a non-hospital-based program which provides 24 hour, intensive short term, intermediate and long term psychiatric treatment and care to persons who have psychiatric symptoms and disorders or are in an acute phase of their mental illness. This definition includes the term “psychiatric residential treatment facility (PRTF)”.

 

          (cc)  “Qualifications” means education, experience, and skill requirements specified by the federal government, state government, an accredited professional review agency, or by policy of the licensee.

 

          (cd)  “Qualified personnel” means facility staff that have been trained to adequately perform certain assigned tasks, such as housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

 

          (ce) “ Reconstruction” means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

 

          (cf)  “Renovation” means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

 

          (cg)  “Repair” means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

 

          (ch)  “Reportable incident” means an occurrence of any of the following while the client is either in the PRTF or in the care of the PRTF personnel:

 

(1)  The unanticipated death of the client;

 

(2)  An injury to a client, that is indicative of potential abuse or neglect under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the client; or

 

(3)  The unexplained absence of a client from the PRTF who is determined to be a danger to themselves or others.

 

          (ci)  “Self-evacuate” means the client can initiate and complete movement from any location in the facility to an exit with or without staff assistance.

 

          (cj)  “Service” means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a client.

 

          (ck)  “Short term” means that a client is expected to remain in the facility less than 14 days.

 

          (cl)  “Significant change” means a visible or observable change in functional, cognitive, or daily activity ability or limitations of the client.

 

          (cm)  “Stock medications” means medications, to be determined by the medical director, that are kept onsite for use by clients and to be administered as ordered by the medical director or the clients' licensed provider.

 

(cn)  “Surrogate decision-maker” means a health care proxy or an agent, who is an advocate for incompetent patients.

 

          (co)  “Supervision” means the process by which the client is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

 

          (cp)  “Therapeutic diet” means a diet ordered by a licensed practitioner as part of the treatment for disease or clinical conditions.

 

          (cq)  “Treatment plan” means a documented guide developed, as a result of the assessment process, for the provision of care and services to a client.

 

          (cr)  “Unexplained absence” means an incident involving a client leaving the premises of the PRTP without the knowledge of the PRTP personnel.

 

          (cs)  “Volunteer” means an unpaid person who assists with the provision of personal care services, food services, or activities, and who does not provide direct care or assist with direct care.  This term does not include visitors or those persons who provide religious services or entertainment.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.04  Initial License Application Requirements.

 

          (a)  Each applicant for a license shall comply with the requirements of RSA 151:4, I-III(a), and submit the following to the department:

 

(1)  A completed application form entitled “Application for Residential or Health Care License” (April 2021), signed by the applicant or 2 of the corporate officers, affirming to the following:

 

a.  “I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.”;

 

b.  For any new PRTP to be newly licensed:

 

“I certify that I have notified the public of the intent to file this application with a description of the facility to be licensed by publishing a notice in a newspaper of general circulation covering the area where the facility is to be located in at least 2 separate issues of the newspaper no less than 10 business days prior to the filing of this application.”; and

 

c.  For any PRTP to be newly licensed and to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c):

 

“I certify that the facility is to be located within a radius of 15 miles of a hospital certified as a critical access hospital, pursuant to 42 C.F.R. 485.610 (b) and (c), and that I have given written notice of the intent to file this application with a description of the facility to be licensed to the chief executive officer of the hospital by registered mail no less than 10 business days prior to the filing of this application.”

 

(2)  A floor plan of the prospective PRTP;

 

(3)  If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following:

 

a.  “Certificate of Authority,” if a corporation;

 

b.  “Certificate of Formation,” if a limited liability corporation; or

 

c.  “Certificate of Trade Name,” where applicable;

 

(4)  The applicable fee in accordance with RSA 151:5, V, payable in cash or, if paid by check or money order, the exact amount of the fee made payable to the “Treasurer, State of New Hampshire”;

 

(5)  A resume identifying the name, qualifications, and copies of applicable licenses for the PRTP administrator;

 

(6)  Written local approvals as follows:

 

a.  For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor:

 

1.  The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;

 

2.  The building official verifying that the applicant complies with all applicable state building codes and local building ordinances;

 

3.  The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and

 

4.  The fire chief verifying that the applicant complies with the state fire code, RSA 153:1, VI-a, including the appropriate occupancy chapter of the life safety code 101 and the uniform fire code, NFPA 1, 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; and

 

b.  For a building under construction, the written approvals required by a. above shall be submitted at the end of construction based on the local official’s review of the building plans and their final on-site inspection of the construction project;

 

(7)  If the PRTP uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02 and Env-Dw 704.02, or if a public water supply is used, a copy of a water bill; and

 

(8)  The results of a criminal records check from the NH department of safety for the applicant(s), licensee if different from the applicant and the administrator for which the application is submitted.

 

          (b)  The applicant shall mail or hand-deliver the documents to:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street

Concord, NH 03301

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.05  Processing of Applications and Issuance of Licenses.

 

          (a)  An application for an initial license shall be complete when the department determines that all items required by He-P 830.04(a) have been received.

 

          (b)  If an application does not contain all of the items required by He-P 830.04(a), the department shall notify the applicant in writing of the items required before the application can be processed.

 

          (c)  Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason shall be processed in accordance with RSA 6:11-a.

 

          (d)  Licensing fees shall not be transferable to any other application(s).

 

          (e)  Unless a waiver has been granted pursuant to He-P 830.10, the department shall deny a licensing request in accordance with He-P 830.13(b) if, it determines that the applicant, administrator, or proposed licensee:

 

(1) Has been convicted of a felony in this or any other state;

 

(2)  Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of residents.

 

          (f)  Following both a clinical and a life safety code inspection, a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 830.

 

          (g)  All licenses issued in accordance with RSA 151 shall be non-transferable by person or location.

 

          (h)  A written notification of denial, pursuant to He-P 830.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in (f) above and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 830.

 

          (i)  A written notification of denial, pursuant to He-P 830.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled.

 

          (j)  A written notification of denial shall be sent to an applicant applying for an initial license if it has been determined by the inspection mentioned in He-P 830.09(b) that the prospective premises are not in full compliance with RSA 151 and He-P 830.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.06  License Expirations and Procedures for Renewals.

 

          (a)  A license shall be valid on the date of issuance and expire one year from the date of issuance, unless a completed application for renewal has been received.

 

          (b)  Each licensee seeking renewal shall complete and submit to the department an application form pursuant to He-P 830.04(a)(1) at least 120 days prior to the expiration of the current license to include:

 

(1)  The current license number;

 

(2)  A request for renewal of any existing waivers previously granted by the department, in accordance with He-P 830.10(f), if applicable. If such a request is not received, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license;

 

(3)  A list of current employees who have a permanent waiver granted in accordance with He-P 830.18(f); and

 

(4)  A copy of any non-permanent or new variances applied for or granted by the state fire marshal, in accordance with Saf-C 6005, or successor rules, whether adopted by the department of safety, or amended pursuant to RSA 153:5, I by the state fire marshal, with the board of fire control.

 

          (c)  In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702 for bacteria and Env-Dw 704 for nitrates.

 

          (d)  Following an inspection, as described in He-P 830.09, a license shall be renewed if the department determines that the licensee:

 

(1)  Submitted an application containing all the items required by (b) and (c) above as applicable, prior to the expiration of the current license; and

 

(2)  Is found to be in compliance with RSA 151, He-P 830, and all federal requirements at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if areas of non-compliance were cited.

 

          (e)  Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 830.04 and shall be subject to a fine in accordance with He-P 830.13.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.07  PRTP Construction, Modifications or Structural Alterations.

 

          (a)  For new construction or rehabilitation of an existing building, including, but not limited to, renovations, modifications, reconstruction, and additions, construction documents and shop drawings, including architectural, sprinkler, and fire alarm plans, and ICRA results shall be submitted to the department at least 60 days prior to the start of such work.

 

          (b)  The architectural, sprinkler, and fire alarm plans in (a) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room’s use.

 

          (c)  Architectural, sprinkler, and fire alarm plans shall be submitted to the state fire marshal’s office as required by RSA 153:10-b, V.

 

          (d)  Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods.

 

          (e)  The department shall review construction documents, drawings, and plans of a newly proposed or existing facility for compliance with all applicable sections of RSA 151 and He-P 830 and notify the applicant or licensee as to whether the proposed changes comply with these requirements.

 

          (f)  The PRTP shall comply with all applicable state laws, rules, and local ordinances when undertaking construction or rehabilitation.

 

          (g)  A licensee or applicant undertaking constructing or rehabilitation of a building shall comply with the following:

 

 

(1)  Saf-C 6000 and the state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300, as follows:

 

a.  NFPA 101, Life Safety Code Residential Board and Care Occupancy Chapter; or

 

b.  NFPA 101, Life Safety Code Health Care Occupancy Chapter; and

 

(2)  The state building code as defined in RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155-A:10, V.

 

          (h)  All PRTPs newly constructed or renovated after the 2021 effective date of these rules shall follow the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 edition),  available as noted in Appendix A, and including the ANSI/ASHREA/ASHE Standard “Ventilation of Health Care Facilities” (170-2017) as incorporated in the referenced in the FGI guidelines.

 

          (i)  Where rehabilitation is done within an existing facility, all such work shall comply with the  FGI’s “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A.

 

          (j)  The department shall be the authority having jurisdiction for the requirements in He-P 830.07(h) and (i) and shall negotiate compliance with the licensee and their representatives and grant waivers in accordance with He-P 830.10 as appropriate.

 

          (k)  Penetrations, holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface.

 

          (l)  Waivers granted by the department for construction or rehabilitation under the FGI guidelines above shall not require annual renewal unless the underlying reason or circumstances for the waivers change.

 

          (m)  Exceptions or variances pertaining to the state fire code referenced in He-P 830.07(g)(1) above shall be granted only by the state fire marshal.

 

          (n)  The building, including all construction and rehabilitated spaces, shall be subject to an inspection pursuant to He-P 830.09 prior to its use.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.08  PRTP Requirements for Organizational Changes.

 

          (a)  The PRTP shall provide the department with written notice at least 30 days prior to changes in any of the following:

 

(1)  Ownership;

 

(2)  Physical location;

 

(3)  Address;

 

(4)  Name;

 

(5)  Bed increase; or

 

(6)  Services.

 

          (b)  The PRTP shall complete and submit a new application and obtain a new or revised license, license certificate or both, as applicable, prior to operating, for:

 

(1)  A change in ownership;

 

(2)  A change in the physical location;

 

(3) An increase in the number of clients beyond what is authorized under the current license; or

 

(4) A change in services, including a change in level of client safety, security, and environment.

 

          (c)  When there is a change in address without a change in location the PRTP shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change.

 

          (d)  When there is a change in the name, the PRTP shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable.

 

          (e)  An inspection by the department shall be conducted prior to operation for changes in the following:

 

(1)  Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by department;

 

(2)  The physical location;

 

(3)  A change in licensing classification;

 

(4)  A change that places the facility under a different life safety code occupancy chapter;

 

(5)  An increase in the number of clients beyond what is authorized under the current license; or

 

(6)  A change in services.

 

          (f)  A new license and license certificate shall be issued for a change in ownership, classification, or a change in physical location.

 

          (g)  A revised license and license certificate shall be issued for changes in the PRTF’s name.

 

          (h)  A revised license certificate shall be issued for any of the following:

 

(1)  A change of administrator;

 

(2)  A change in address without a change in physical location;

 

(3)  When a waiver has been granted in accordance with He-P 830.10; or

 

(4)  An increase in the number of clients;

 

          (i)  The PRTP shall inform the department in writing when there is a change in administrator no later than 5 days prior to a change  or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator change, and provide the department with the following:

 

(1)  A resume identifying the name and qualifications of the new administrator;

 

(2)  The results of a NH criminal background check conducted pursuant to He-P 830.18(d)(1);

 

(3)  Copies of applicable licenses for the new administrator; and

 

(4)  A copy of the criminal attestation as described in He-P 830.18(t).

 

          (j)  Upon review of the materials submitted in accordance with (i) above, the department shall make a determination as to whether the new administrator meets the qualifications for the position as specified in He-P 830.16(a) and He-P 830.18(i).

 

          (k)  If the department determines that the new administrator does not meet the qualifications, it shall so notify the PRTP in writing so that a waiver can be sought or the program can search for a qualified candidate.

 

          (l)  The PRTP shall inform the department in writing via e-mail, fax, or mail of any change in the e-mail address as soon as practicable and in no case later than 10 days of the change. The department shall use email as the primary method of contacting the licensee in the event of an emergency.

 

          (m)  A restructuring of an established PRTP that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required.

 

          (n)  When there is to be a change in the services provided, the PRTP shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs and describe what changes, if any, in the physical environment will be made.

 

          (o)  The department shall review the information submitted under (n) above and determine if the added services can be provided under the PRTP’s current license including physical plan restrictions.

 

          (p)  If a licensee chooses to cease operation of an PRTP, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan that ensures adequate care of clients until they are transferred or discharged to an appropriate alternate setting that is consistent with the clinical needs of the resident based on assessment including but not limited to another PRTP, a higher level of care facility, a lower level of care facility, or a home.

 

          (q)  The licensee shall arrange for storage of, and access to, client records in the event the PRTP ceases operation.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.09  Inspections.

 

          (a)  For the purpose of determining compliance with RSA 151 and He-P 830, as authorized by RSA 151:6 and RSA 151:6-a, the applicant or licensee shall admit and allow any department representative at any time to inspect the following:

 

(1)  The proposed or licensed premises;

 

(2)  All programs and services provided by the PRTP; and

 

(3)  Any records required by RSA 151 and He-P 830.

 

          (b)  The department shall conduct a clinical and life safety code inspection, as necessary  to determine full compliance with RSA 151 and He-P 830 prior to:

 

(1)  The issuance of an initial license;

 

(2)  A change in ownership, except as allowed by He-P 830.08(e)(1);

 

(3)  A change in the licensee’s physical location;

 

(4)  A change in licensing classification;

 

(5) An increase in the number of clients beyond what was authorized under the initial license;

 

(6)  Occupation of a space after construction, renovations or structural alterations; or

 

(7)  The renewal of a license.

 

          (c)  A statement of findings for clinical inspections or a notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the PRTP is in violation of any of the provisions of He-P 830, RSA 151, or other federal or state requirement.

 

          (d)  If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 830.12(c), within 21 days of the date on the letter that transmits the inspection report.

 

          (e)  In addition to (b) above, the department shall verify the implementation of any POC accepted or issued by the department.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.10  Waivers.

 

          (a)  Applicants or licensees seeking waivers of specific rules in He-P 830 shall submit a written request for a waiver to the commissioner that includes:

 

(1)  The specific reference to the rule for which a waiver is being sought;

 

(2)  A full explanation of why a waiver is necessary; and

 

(3)  A full explanation of alternatives proposed by the applicant or license holder, which shall be equally as protective of public health and clients as the rule from which a waiver is sought.

 

          (b)  A waiver shall be permanent unless the department specifically places a time limit on the waiver.

 

          (c)  A request for waiver shall be granted if the commissioner determines that the alternative proposed by the applicant or licensee:

 

(1)  Meets the objective or intent of the rule;

 

(2)  Does not negatively impact the health or safety of the clients; and

 

(3)  Does not negatively affect the quality of client services.

 

          (d)  The licensee’s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought.

 

          (e)  Waivers shall not be transferable.

 

          (f)  When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to expiration of the existing waiver, as appropriate, by submitting the information required by (a) above.

 

          (g)  The request to renew a waiver shall be subject to (b) through (f) above.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.11  Complaints.

 

          (a)  The department shall investigate any complaint that meets the following conditions:

 

(1)  The alleged violation(s) of RSA 151 or He-P 830 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 person who has first-hand knowledge regarding the allegation(s); and

 

(3)  There is sufficient specific information for the department to determine that the allegations(s), if proven true, would constitute a violation of any of the provisions of RSA 151 or He-P 830.

 

          (b)  The complaint shall be in writing and contain the following information:

 

(1)  The name and address, if known of the PRTP, or the alleged unlicensed individual or entity;

 

(2)  The name, address, and telephone number of the complainant; and

 

(3)  A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 830.

 

          (c)  Investigations shall include all techniques and methods for gathering information that are appropriate to the circumstances of the complaint, which include:

 

(1)  Requests for additional information from the complainant or the facility;

 

(2)  A physical inspection of the premises;

 

(3)  Review of any relevant records; and

 

(4) Interviews with individuals who might have information that is relevant to the investigation.

 

          (d)  For a licensed PRTP, the department shall:

 

(1)  Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation;

 

(2)  Notify any other federal, state, or local agencies of suspected violations of their statutes, rules, or regulations based on the results of the investigation, as appropriate;

 

(3)  If the department determines the complaint is unfounded, and does not violate their statutes, rules, or regulations the licensee will be notified in writing of such determination and the department will take no further action; and

 

(4)  If areas of non-compliance are found, require the licensee to submit a POC in accordance with He-P 830.12(c).

 

          (e)  The following shall apply for the unlicensed individual or entity:

 

(1)  The department shall provide written notification to the owner or person responsible that includes:

 

a.  The date of investigation;

 

b.  The reasons for the investigation; and

 

c.  Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, IV;

 

(2)  In accordance with RSA 151:7-a II, the owner or person responsible shall be allowed 7 days from the date of receipt of the notice required by He-P 830.11(e)(1) to submit a completed application for a license;

 

(3)  If the owner of an unlicensed PRTP does not comply with (2) above, the department shall issue a written warning to immediately comply with RSA 151 and He-P 830; and

 

(4)  Any person or entity who fails to comply after receiving a warning as described in (3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 830.13(c)(6).

 

          (f)  Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly but shall be released by the department on written request only:

 

(1)  To the department of justice when relevant to a specific investigation;

 

(2)  To law enforcement when relevant to a specific criminal investigation;

 

(3)  When a court of competent jurisdiction orders the department to release such information; or

 

(4)  In connection with any adjudicative proceedings relative to the licensee.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.12  Administrative Remedies.

 

          (a)  The department shall, after notice and opportunity to be heard, impose administrative remedies for violations of RSA 151, He-P 830, or other applicable licensing rules, including:

 

(1)  Requiring a licensee to submit a POC in accordance with (c) below;

 

(2)  Imposing a directed POC upon a licensee in accordance with (d) below;

 

(3)  Imposing conditions upon a licensee;

 

(4)  Monitoring of a license;

 

(5)  Immediate suspension of a license; or

 

(6)  Revocation of a license.

 

          (b)  When administrative remedies are imposed, the department shall provide a written notice, as applicable, which:

 

(1)  Identifies each area of non-compliance with RSA 151 or a provision of these rules; and

 

(2)  Identifies the specific remedy(s) that has been proposed.

 

          (c)  A POC shall be developed and enforced in the following manner:

 

(1)  Upon receipt of a statement of findings or notice to correct, the licensee shall submit its written POC for each item, written in the appropriate place on the statement or notice and containing:

 

a.  How the licensee intends to correct each area of non-compliance;

 

b.  What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness;

 

c.  The date by which each area of non-compliance shall be corrected; and

 

d.  The position of the employee responsible for the corrective action;

 

(2)  The licensee shall submit a POC to the department within 21 calendar days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria:

 

a.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 21-calendar day period but has been unable to do so; and

 

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

 

(3)  The department shall review and accept each POC that:

 

a.  Achieves compliance with RSA 151 and He-P 830;

 

b.  Addresses all areas of non-compliance as cited in the statement of findings or notice to correct;

 

c.  Prevents a new violation of RSA 151 or He-P 830 as a result of the implementation of the POC; and

 

d.  Specifies the date upon which the deficiencies will be corrected;

 

(4)  If the POC is acceptable, the department shall issue a license certificate or provide written notification of acceptance of the POC, whichever is applicable;

 

(5)  If the POC is not acceptable:

 

a.  The department shall notify the licensee in writing of the reason for rejecting the POC;

 

b.  The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria:

 

1.  The licensee demonstrates that he or she has made a good faith effort to develop and submit the POC within the 14-day period but has been unable to do so; and

 

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

 

c.  The revised POC shall comply with (1) above and be reviewed in accordance with (3) above; and

 

d.  If the revised POC is not acceptable to the department, or is not submitted within 14days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with (d) below and a fine in accordance with He-P 830.13(c)(12);

 

(6)  The department shall verify the implementation of any POC that has been submitted and accepted by:

 

a.  Reviewing materials submitted by the licensee;

 

b.  Conducting a follow-up inspection; or

 

c.  Reviewing compliance during the next annual inspection;

 

(7)  Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and

 

(8)  If the POC or revised POC has not been implemented by the completion date at the time of the next inspection the licensee shall be:

 

a.  Notified by the department in accordance with (b) above; and

 

b.  Issued a directed POC in accordance with (d) below and shall be subject to a fine in accordance with He-P 830.13(c)(12).

 

          (d)  The department shall develop and impose a directed POC that specifies corrective actions for the licensee to implement when:

 

(1)  As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the clients and personnel;

 

(2)  A revised POC is not submitted within 14 days of the written notification from the department; or

 

(3)  A revised POC submitted by the licensee or administrator has not been accepted.

 

          (e)  If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC the department shall:

 

(1)  Issue a warning that enforcement action will be taken if the POC is not implemented;

 

(2)  Impose a fine according to He-P 830.13(c)(13);

 

(3)  Deny the application for a renewal of a license in accordance with He-P 830.13(b)(6); or

 

(4)  Revoke or suspend the license in accordance with He-P 830.13(b).

 

          (f)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings if the applicant or licensee submits a written request for an informal dispute resolution to the department.

 

          (g)  The informal dispute resolution shall be requested in writing by the applicant, licensee, or administrator no later than 14 days from the date the statement of findings was issued by the department and shall include any evidence that has not yet been reviewed by the department.

 

          (h)  Upon receipt of the requested informal dispute resolution made by the applicant, licensee, or administrator, the department shall review the evidence presented and, if requested within the informal dispute resolution request, meet with the applicant, licensee, or administrator, in person or via telephone.

 

          (i)  The department shall change the statement of findings or notice to correct if, based on the evidence presented, the statement of findings is determined to be incorrect. 

 

          (j)  The statement of findings or notice to correct shall not be changed, if based on the evidence presented, the statement of findings is determined to be correct.

 

          (k)  The department shall provide a written notice to the applicant or licensee notifying the applicant, licensee, or administrator of such determination.

 

          (l)  The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee.

 

          (m)  Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolution as describe in this section.

 

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

 

          (o)  The department shall impose state monitoring under the following conditions:

 

(1)  Repeated non-compliance on the part of the facility in areas that impact the health, safety, or well-being of clients; or

 

(2)  The presence of conditions in the PRTF that negatively impact the health, safety, or well-being of clients.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.13  Enforcement Actions and Hearings.

 

          (a)  Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth:

 

(1)  The reasons for the proposed action;

 

(2)  The action to be taken by the department;

 

(3)  If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and

 

(4)  The right of an applicant or licensee to a hearing in accordance with RSA 151:8 or RSA 541-A:30, III, as applicable before the enforcement action becomes final.

 

          (b)  The department shall deny an application or revoke a license if:

 

(1)  An applicant or a licensee has violated provisions of RSA 151 or He-P 830, which poses a risk of harm a client’s health, safety, or well-being;

 

(2)  An applicant or a licensee has failed to pay a fine imposed under administrative remedies;

 

(3)  An applicant or a licensee has had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check;

 

(4)  After being notified of and given an opportunity to supply missing information, an applicant or licensee fails to submit an application that meets the requirements of He-P 830.04;

 

(5)  An applicant, licensee, or any representative or employee of the applicant or licensee:

 

a.  Provides false or misleading information to the department;

 

b. Prevents or interferes, or fails to cooperate with any inspection or investigation conducted by the department; or

 

c.  Fails to provide requested files or documents to the department;

 

(6)  The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 830.12(d) and (e);

 

(7)  The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 830.12(c)(5) and has not submitted a revised POC as required by He-P 830.12(c)(5);

 

(8)  The licensee is cited a third time under RSA 151 or He-P 830 for the same violations within the last 5 inspections;

 

(9)  A licensee, or its corporate officers has had a license revoked and submits an application during the 5-year prohibition period specified in (h) below;

 

(10)  Unless a waiver has been granted upon inspection, the applicant’s premise is not in compliance with RSA 151 or He-P 830;

 

(11)  Unless a waiver has been granted the department makes a determination that the applicant, administrator, or licensee has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state;

 

(12)  The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; or

 

(13)  The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application.

 

          (c)  The department shall impose fines as follows:

 

(1)  For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed provider;

 

(2)  For a failure to cease operations after a denial of a license and after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, or continuing to operate after a failure to renew the license by the expiration date, the fine for an applicant, unlicensed entity, or a licensee shall be $2000.00;

 

(3)  For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed entity shall be $500.00;

 

(4)  For a failure to transfer a client whose needs exceeds the services or programs provided by the PRTP, in violation of RSA 151:5-a, the fine shall be $500.00;

 

(5)  For admission of a client whose needs at the time of registration exceed the services or programs authorized by the PRTP, in violation of RSA 151:5-a, II and He-P 830.15(b), the fine for a licensee shall be $1000.00;

 

(6)  For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 830.11(e)(4), the fine for an unlicensed provider or licensee shall be $500.00;

 

(7)  For a failure to submit a renewal application for a license prior to the expiration date, in violation of He-P 830.06(e), the fine shall be $100.00;

 

(8)  For a failure to notify the department prior to a change of ownership, in violation of He-P 830.08(a)(1), the fine shall be $500.00;

 

(9)  For a failure to notify the department prior to a change in the physical location, in violation of He-P 830.08(a)(2), the fine shall be $1000.00;

 

(10)  For a failure to notify the department of a change in e-mail address, in violation of He-P 830.08(l), the fine shall be $100.00;

 

(11)  For a refusal to allow access by the department to the PRTP’s premises, programs, services or records, in violation of He-P 830.09(a), the fine for an applicant, unlicensed entity, or licensee shall be $2000.00;

 

(12)  For a failure to submit a POC or revised POC, within 21 or 14-days, respectively, of the date on the letter that transmits the inspection report, or the date of an extension as granted, in violation of He-P 830.12(c)(2) and (5), the fine for a licensee shall be $500.00;

 

(13)  For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 830.12(c)(8), the fine for a licensee shall be $1000.00;

 

(14)  For a failure to establish, implement, or comply with licensee policies, as required by He-P 830.14(a), (d), and (e), the fine for a licensee shall be $500.00;

 

(15)  For a failure to provide services or programs required by the licensing classification and specified by He-P 830.14(c), the fine for a licensee shall be $500.00; 

 

(16)  For providing false or misleading information or documentation, in violation of He-P 830.14(h), the fine shall be $1000.00 per offense;

 

(17)  For failure to meet the needs of a client or clients, as described in He-P 830.18(a) and He-P 830.24(i), the fine for a licensee shall be $1000 per client;

 

(18)  For placing a client in a room that has not been approved or licensed by the department, in violation of He-P 830.09(b)(5), the fine for a licensee shall be $500;

 

(19)  For employing an administrator, or other personnel who do not meet the qualifications for the position, without having a waiver granted by the department in accordance with He-P 830.10, in violation of He-P 80.16(a), the fine for a licensee shall be $500.00;

 

(20)  For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 830.07(a), the fine for a licensed facility shall be $500.00;

 

(21)  For occupying a renovated area of a licensed facility or new construction prior to approval by local and state authorities, as required by He-P 830.09(b)(6), the fine shall be $500 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department;

 

(22)  When an inspection determines that there is a violation of RSA 151 or He-P 830 for which a fine was previously imposed, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows:

 

a.  If the same area of non-compliance is cited within 2 years of the original non-compliance, the fine for a licensee shall be $1000; or

 

b.  If the same area of non-compliance is cited a third time within 2 years of being fined in (a) above, the fine for a licensee shall be $2000.00;

 

(23)  For refusal to cooperate with the inspection or investigation conducted by the department the fine shall be $ 2000.00;

 

(24)   For failure to report an unusual incident as required by He-P 830.14(w), the fine for a licensee shall be $500.00 per occurrence or;

 

(25)  Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 830 shall constitute a separate violation and shall be fined in accordance with He-P 830.13(c), provided that if the applicant or licensee is making good faith efforts to comply with  the provisions of RSA 151 or He-P 830, as verified by documentation or other means, the department shall not issue a daily fine.

 

          (d)  Payment of any imposed fine to the department shall meet the following requirements:

 

(1)  Payment shall be made in the form of check or money order made payable to the “Treasurer, State of New Hampshire” or cash in the exact amount due; and

 

(2)  Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds.

 

          (e)  An applicant or licensee shall have 30 days after receipt of the notice of enforcement action to request a hearing to contest the action.

 

          (f)  If a written request for a hearing is not made pursuant to (e) above, the action of the department shall become final.

 

          (g)  The department shall order the immediate suspension of a license, the cessation of operations, and the transfer of care of clients when it finds that the health, safety or well-being of clients is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III.

 

          (h)  If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 830 is achieved.

 

          (i)  Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200.

 

          (j)  When a PRTP’s license has been denied or revoked, the applicant, licensee, or administrator shall not be eligible to reapply for a license or be employed as an administrator for 5 years if the enforcement action pertained to their role in the PRTP.

 

          (k)  The 5-year period referenced in (j) above shall begin on:

 

(1)  The date of the department’s decision to revoke or deny the license, if appeal is filed; or

 

(2)  The date a final decision upholding the action of the department, if a request for a hearing is made and a hearing is held.

 

          (l)  Notwithstanding (k) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent 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 151 and He-P 830.

 

          (m)  If the department has credible information or evidence that a licensee, applicant, administrator, or others are circumventing (k) above by applying for a license through an agent or other individual and will retain ownership, management authority, or both, the department shall deny the application.

 

          (n)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 830.

 

          (o)  Any violations cited for fire code shall be appealed to the New Hampshire state fire marshal.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.14  Duties and Responsibilities of the Licensee.

 

          (a)  The licensee shall comply with all relevant federal, state, and local laws, rules, codes and ordinances as applicable.

 

          (b)  The licensee shall have written policies and procedures setting forth:

 

(1)  The rights and responsibilities of clients in accordance with the patients’ bill of rights;

 

(2)  The policies described in He-P 830.14, He-P 830.16, He-P 830.19, and He-P 830.26; and

 

(3)  A policy that ensures the safety of all persons present on the licensed premises where

firearms are permitted.

 

          (c)  The licensee shall admit only those clients whose needs can be met by the PRTP.

 

          (d)  The licensee shall define, in writing, the scope and type of services to be provided by the PRTP.

 

          (e)  The licensee shall comply with the Patients’ Bill of Rights as set forth in RSA 151:19-30.

 

          (f)  The licensee shall develop and implement written policies and procedures governing the operation of the PRTP and all services provided by the facility and for:

 

(1)  Reviewing the policies and procedures every 3 years; and

 

(2)  Revising them as needed.

 

          (g)  The licensee shall assess and monitor the quality of care and service provided to clients on an ongoing basis.

 

          (h)  The licensee or personnel shall not falsify any documentation or provide false or misleading information to the department.

 

          (i)  The licensee shall not:

 

(1)  Advertise or otherwise represent itself as operating a PRTF, unless it is licensed; or

 

(2)  Advertise that it provides services that it is not authorized to provide.

 

          (j)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department, and all court orders.

 

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

 

(1)  Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight provided regarding:

 

a.  The clients’ functioning, safety, and whereabouts;

 

b. The clients’ health status, including the provision of intervention as necessary or required; and

 

c.  Personnel safety;

 

(2)  Emergency response and crisis intervention;

 

(3)  Medication services in accordance with He-P 830.17;

 

(4)  Food services in accordance with He-P 830.20;

 

(5)  Housekeeping, laundry, and maintenance services;

 

(6)  On-site activities designed to sustain and promote physical, intellectual, social, and spiritual well-being of all clients;

 

(7)  Assistance in arranging medical and dental appointments, including assistance in arranging transportation to and from such appointments and reminding the clients of the appointments; and

 

(8)  Personal supervision of clients when necessary to prevent unreasonable risks to the safety of self or others if the client is not supervised.

 

          (l)  The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(4):

 

(1)  Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;

 

(2)  Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and

 

(3)  Behavioral health care services.

 

          (m)  Licensees shall:

 

(1)  Appoint an administrator;

 

(2)  Establish, in writing, a chain of command that sets forth the line of authority for the operation of the PRTP;

 

(3)  Verify the qualifications of all personnel;

 

(4)  Provide sufficient numbers of qualified personnel to meet the needs of adult clients;

 

(5)  Maintain a minimum staff-to-client ratio of one staff person to 6 clients during awake hours and one staff person to 12 clients during sleeping hours, for children or youth clients;

 

(6)  Provide additional staff when a client’s treatment plan requires a more stringent staff to client ratio than required above;

 

(7)  Provide sufficient supplies, equipment, and lighting to meet the needs of the clients;

 

(8)  Require all personnel to follow the orders of the licensed practitioner for every client that has such orders and encourage the client to follow the licensed practitioner’s orders;

 

(9)  Initiate action to maintain the PRTP in full compliance at all times with all relevant health and safety requirements contained in applicable federal, state, and local laws, rules, regulations, accreditations, and ordinances; and

 

(10)  Implement any POC that has been accepted by the department.

 

          (n)  The licensee shall educate personnel about the needs and services required by the clients under their care.

 

          (o)  Physical or chemical restraints shall only be used as allowed by RSA 151:21, IX.

 

          (p)  The licensee shall consider all clients competent and capable of making health care decisions unless the client:

 

(1)  Has a guardian appointed by a court;

 

(2)  Has a durable power of attorney for health care or surrogate decision making that has been activated; or

 

(3)  Is an un-emancipated minor.

 

          (q)  In accordance with RSA 141-C:7, He-P 301.02, and He-P 301.03 the licensee shall report all positive tuberculosis test results for personnel to the office of infectious disease control by:

 

(1)  Telephone at 603-271-4496;

 

(2)  Telephone at 603-271-5300 after business hours; or

 

(3)  Fax to 603-271-0545.

 

          (r)  If the licensee registers and treats a client who is known to have a disease reportable under He-P 301 or an infectious disease, which is any disease caused by the growth of microorganisms in the body which might or might not be contagious, the licensee shall:

 

(1)  Follow the required procedures and personnel training for the care of the clients, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition), available as noted in Appendix A; and

 

(2)  Have an Airborne Infection Isolation (AII) Room, compliant with the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A.  

 

          (s)  Immediately after the use of a physical or chemical restraint, the client’s guardian or agent, if any, and the department shall be notified of the use of restraints.

 

          (t)  The PRTP shall:

 

(1)  Have policies and procedures on:

 

a.  What type of emergency restraints may be used;

 

b.  When restraints may be used; and

 

c.  Who may authorize the use of restraints; and

 

(2)  Provide personnel with education and training on the limitations and the correct use of restraints.

 

          (u)  The use of chemical, mechanical, or physical restraints, as defined by He-P 830.03(q), (aq), and (bb), respectively, shall only be permitted as allowed by RSA 151:21.

 

          (v)  For reportable incidents, allegations of abuse, neglect, mistreatment, or misappropriation of property, the licensee shall have responsibility for:

 

(1)  Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

(2)  Faxing to 603 271-4968, or if a fax machine is not available, submitting via regular mail, postmarked within 24 hours of the incident, together with a telephone call to the department reporting the incident and notifying the department of the mailed report, the following information to the department within 24 hours of the reportable incident:

 

a.  The PRTP name;

 

b.  A description of the incident, including identification of injuries, if applicable;

 

c.  The name of the licensee(s) or personnel involved in, witnessing or responding to the incident;

 

d.  The name or identifying code for client(s) involved in or witnessing the incident;

 

e.  The date and time of the incident;

 

f.  The action taken in direct response to the incident;

 

g.  If medical intervention was required, by whom and the date and time;

 

h. Whether the client’s guardian or agent, surrogate decision-maker, or personal representative, or emergency contact person was notified;

 

i.  The signature of the person reporting the incident; and

 

j.  The date and time the client’s licensed practitioner was notified, if applicable;

 

(3)  Within 5 days, submitting a completed investigation report to the department containing the following information: 

 

a.  All items referenced in (1) above;

 

b.  The names and results of interview(s) with all personnel, resident(s) or other individuals involved in the reportable incident, including all applicable statement signatures; and

 

c.  The action taken by the licensee in direct response to the incident(s), including any and all follow-ups;

 

(4)  Immediately notifying the local police department, the department, and the guardian, agent, surrogate decision-maker, or personal representative, if any, when a client who has been assessed or is known as being a danger to self or others, has eloped after the licensee has searched the building and the grounds of the PRTP; and

 

(5)  Submit additional information, if required to the department, to support the incident report referenced in (w)(3) above;

 

          (w)  The licensee shall:

 

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

 

(2)  Not be responsible for the cost of purchasing a specific brand of product at a client’s request.

 

          (x)  The licensee shall not exceed the maximum number of clients or beds licensed by the department, unless authorized by the department, such as during an emergency.

 

          (y)  In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public area:

 

(1)  The current license certificate issued in accordance with RSA 151:2;

 

(2)  The most recent inspection report as specified in RSA 151:6-a; for the previous 12 months;

 

(3)  A copy of the patients’ bill of rights specified by RSA 151:21;

 

(4)  A copy of the licensee’s policies and procedures relative to the implementation of clients’ rights and responsibilities as required by RSA 151:20;

 

(5)  A copy of the licensee’s complaint procedure, including a statement that complaints may be submitted in writing to the:

 

Department of Health and Human Services

Health Facilities Administration

129 Pleasant Street, Concord, NH 03301,

 

or by calling 1-800-852-3345; and

 

(6)  The licensee’s evacuation floor plan identifying the location of, and access to all fire exits.

 

          (z)  The licensee shall give a client a written notice as follows:

 

(1)  For an increase in the cost or fees for any PRTP services 30 days advanced notice; or

 

(2)  For an involuntary change in room or bed location, 14 days advanced notice, unless the change is required to protect the health, safety, and well-being of the client or other clients, in such case the notice shall be as soon as practicable.

 

          (aa)  The licensee shall admit and allow any department representative to inspect the premises and all programs and services that are being provided by the licensee at any time for the purpose of determining compliance with RSA 151 and He-P 830 as authorized by RSA 151:6 and RSA 151:6-a.

 

          (ab)  A licensee shall, upon request, provide a client or the client’s guardian, agent, or surrogate decision-maker if any, with a copy of his or her client record pursuant to the provisions of RSA 151:21, X.

 

          (ac)  All records required for licensing shall be legible, current, accurate, and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a.

 

          (ad)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (ae)  The licensee shall develop policies and procedures regarding the release of information contained in client records.

 

          (af)  The licensed premises shall comply with all state and local: 

 

(1)  Health requirements;

 

(2)  Building ordinances;

 

(3)  Fire ordinances; and

 

(4)  Zoning ordinances.

 

          (ag)  The licensee shall determine the smoking status of the PRTP.

 

          (ah)  If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66–69 and He‑P

830.24(f).

 

(ai)  The licensee may hold or manage a client’s funds or possessions only when the facility receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee or other clients.

 

(aj)  The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.

 

(ak)  The licensee shall comply with all conditions of warnings and administrative remedies issued by the department and all court orders.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.15  Client Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria.

 

          (a)  Except for emergency treatment or involuntary admissions ordered under RSA 135-C:27-54, all placements of clients in the programs and services of the PRTP shall be voluntary and shall require the documented consent of the client or guardian. Placements shall be made into those programs and services which least restrict the client's freedom of movement, ability to make decisions, and participation in his community while achieving the purposes of habilitation and treatment.

 

          (b)  The licensee shall only admit an individual or retain a client whose needs are compatible with the facility and the services and programs offered, whose needs can be met by the PRTP, and who are:

 

(1)  Mobile and can self-evacuate. However, reasonable accommodation shall be made when possible to admit clients who have mobility impairment, provided that evacuation assistance needs can be met;

 

(2)  A voluntary admission in accordance with He-M 405;

 

(3)  A voluntary admission by guardian;

 

(4)  An involuntary emergency admission (IEA) pursuant to RSA 135-C:27–33 beginning with initial custody and continuing through the day of the probable cause hearing;

 

(5)  An IEA pursuant to RSA 135-C:27–33 for the period of such admission following the probable cause hearing; or

 

(6)  Non-emergency involuntary admissions (IA) pursuant to RSA 135-C:34–54.

 

          (c)  At the time of admission, the licensee shall provide a written copy to the client and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

 

(1)  An admissions contract including the following information:

 

a.  The basic daily or weekly fee;

 

b.  A list of the core services required by He-P 830.14(c) that are covered by the basic fee;

 

c.  The APRTP’s house rules;

 

d.  The APRTP’s responsibility for client discharge planning;

 

e.  The licensee’s policies and procedures regarding:

 

1.  Arranging for the provision of transportation;

 

2.  Handling of client funds pursuant to RSA 151:24 and He-P 830.14(p);

 

3.  Storage and loss of the client’s personal property; and

 

4.  Smoking; and

 

f.  The licensee’s medication management services;

 

(2)  A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the APRTP’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

 

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

 

(4)  Information on advanced directives;

 

(5)  Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid or both; and

 

(6)  A copy of the facility’s policy on restraint usage.

 

          (d)  A licensee shall not deny admission to any person because that person does not have a guardian or an advanced directive, such as a living will or durable power of attorney for health care, established in accordance with RSA 137-H or RSA 137-J.

 

          (e)  The client shall be transferred or discharged, as defined under RSA 151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including, but not limited to, the following:

 

(1)  The client’s medical or other needs exceed the services offered by the licensee;

 

(2)  The client cannot be safely evacuated in accordance with RSA 153:1, VI-a, except as modified in Saf-FMO 300;

 

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

 

(4) For documented non-compliance with the facility’s rules included in the admission agreement provided said rules are not in conflict with RSA 151:21, V.

 

          (f)  The licensee shall develop a discharge plan with the input from the client, guardian, agent, or surrogate decision maker, if any.

 

          (g)  The following documents shall accompany the client upon transfer:

 

(1)  The most recent client assessment tool, treatment plan, and quarterly progress notes;

 

(2)  The most recent nursing assessment, if applicable;

 

(3)  The most recent multi-disciplinary treatment plan, if applicable;

 

(4)  Current medication records; and

 

(5)  A licensed practitioner’s order for transfer, if applicable.

 

          (h)  If the transfer or discharge referenced in (c) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the client as soon as practicable prior to transfer or discharge.

 

          (i)  Notwithstanding (b) and (c) above, a client receiving hospice care from a licensed home health hospice caregiver may remain in the PRTP upon written agreement with the client or his or her legal guardian and the PRTP.

 

Source.  #6154, eff 12-29-95, EXPIRED: 12-29-03

 

New.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.16  Required Services.

 

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

 

(1)  Is responsible for the day-to-day operations of the PRTP;

 

(2)  Meets the requirements of He-P 830.18(j);

 

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

 

(4)  In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (2) above.

 

          (b)  Upon admission or within 24 hours following admission, the APRTP shall perform a comprehensive intake assessment of each client’s needs and develop a preliminary treatment plan.

 

          (c)  The comprehensive intake assessment required by (b) above shall include, at a minimum, the following:

 

(1)  A mental health status examination and medication review;

 

(2)  An initial diagnostic impression;

 

(3)  Safety risk assessment and presence or absence of communicable disease;

 

(4)  A functional assessment of those specific skills and behaviors required for the client to be in a less restrictive setting;

 

(5)  A statement by the treating licensed practitioner that the PRTP represents the appropriate level of treatment for the client;

 

(6)  Serve as a basis for treatment plan;

 

(7)  Historical and current information and assessments; and

 

(8)  Medical, psychiatric, and social information containing the following:

 

a.  For medical information:

 

1.  A statement of the individual’s general physical health status;

 

2.  Medical history, including current weight, height, blood pressure, pulse, and smoking status;

 

3. When applicable, medical diagnosis, and the results or any medical or neurological screenings, examinations, or tests; and

 

4.  The name and contact information for the individual’s primary care physician;

 

b. For psychiatric information:

 

1.  History of mental illness or serious emotional disturbance, including onset and severity;

 

2.  Previous services and treatments, including medications and hospitalizations;

 

3.  Individual’s strengths;

 

4.  Illness self-management skills;

 

5.  Precipitating events for current psychiatric symptoms, as applicable;

 

6.  Documentation of medical necessity for services;

 

7.  Current diagnosis;

 

8.  Medication orders;

 

9.  Current medications; and

 

10.  Results of formalized psychiatric or psychological tests, if applicable;

 

c.  For social information:

 

1.  Developmental history;

 

2.  Educational history and current status, if applicable;

 

3.  Family history and current family status;

 

4.  History and current family status;

 

5.  History of trauma, including domestic violence;

6.  Results of a substance use screening tool;

 

7.  Employment history including work skills and types, and lengths of employment;

 

8.  Military history and veteran’s status, if applicable;

 

9.  Current living situation including type of environment and nature of relationship with any room/house mates or family;

 

10.  Social and leisure time activities and skills;

 

11.  Ability to develop and maintain friendships;

 

12.  Involvement with or history of involvement with other social service agencies or the criminal justice system;

 

13.  Guardianship, if applicable; and

 

14.  Other legal documents.

 

          (d)  The intake assessment and updates shall be signed and dated by the person completing the assessment.

 

          (e)  A treatment plan shall:

 

(1)  Be completed within 24 hours of the comprehensive assessment in (c) above;

 

(2)  Be updated following the completion of each future assessment;

 

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

 

(4)  Address the needs identified by the comprehensive assessment.

 

          (f)  The licensee shall provide each client, or their agent, the opportunity to participate in the development of the treatment plan.

 

          (g)  The treatment plan required by (e) above, shall contain, at a minimum, the following:

 

(1)  The date the problem or need was identified;

 

(2)  A description of the problem or need;

 

(3)  The objectives, which shall be measurable, attainable, realistic, and timely;

 

(4) The interventions, which shall be specifically provided on behalf of the program to the clients;

 

(5)  The client’s clinical needs, treatment goals, and objectives;

 

(6)  The client’s strengths and resources for achieving goals and objectives as identified in (3) above;

 

(7)  The strategy for providing services to meet those needs, goals, and objectives;

 

(8) The specification and description of the indicators to be used to assess the client’s progress;

 

(9)  The date of re-evaluation, review, or resolution;

 

(10)  Psychiatric evaluation, including mental status and alcohol/substance abuse evaluations, as determined necessary by the treating licensed practitioner;

 

(11)  Individual and group therapeutic activity directed towards stabilization of psychiatric crises or extended care;

 

(12)  Family education, consultation, and therapy, as clinically indicated; and

 

(13) For children or youth clients, the determination made by a licensed practitioner, that the child or youth client is eligible for PRTF level of care.

 

          (h)  The treatment plan shall be reviewed at least every 30 days or as medically indicated.

 

          (i)  For each client, progress notes shall be written daily and include at a minimum:

 

(1)  Any treatment plan goals addressed;

 

(2)  Changes in the client’s physical and mental status, as applicable;

 

(3)  Changes in behavior, such as eating habits, sleeping pattern, and relationships; and

 

(4)  Summary of protective care that has been provided.

 

          (j)  At the time of a client’s admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

 

          (k)  All personnel shall follow the orders of the licensed practitioner for each client and encourage clients to follow the practitioner’s orders.

 

          (l)  The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the PRTP.

 

          (m)  The health examination in (l) above shall include:

 

(1)  Diagnoses, if any;

 

(2)  The medical history;

 

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

 

(4)  Vital signs;

 

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

 

(6)  Allergies;

 

(7)  Dietary needs;

 

(8)  Pain assessment; and

 

(9)  Safety risk assessment.

 

          (n)  Each client shall have at least one health examination every 12 months, unless the licensed practitioner determines that an annual physical examination is not necessary and specifies in writing an alternative time frame, or the client refuses in writing. 

 

          (o)  A client may refuse all care and services.

 

          (p)  When a client refuses care or services that could result in a threat to their health, safety or well-being, or that of others, the licensee or their designee shall:

 

(1)  Inform the client and guardian of the potential results of their refusal;

 

(2)  Notify the licensed practitioner of the client’s refusal of care; and

 

(3)  Document in the client’s record the refusal of care and the client’s reason for the refusal if known.

 

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

 

          (r)  The information data sheet in (q) above shall include:

 

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

 

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

 

(3)  Diagnosis;

 

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

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information;

 

(9)  Advanced directives including DNR or DNAR orders, if applicable; and

 

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

 

          (s)  Services shall be age and developmentally appropriate.

 

          (t)  PRTP’s shall offer psychotherapeutic services.

 

          (u)  Individual psychotherapy shall:

 

(1)  Include therapy, crisis intervention, or assessment and monitoring necessary to determine the course and progress of therapy or to stabilize an individual experiencing an acute psychiatric episode; and

 

(2)  Be verbal, with the therapist in direct, personal, involvement with the resident to the exclusion of other residents, individuals, and duties.

 

          (v)  Group psychotherapy, per person, shall include therapy or assessment and monitoring necessary to determine the course and progress of therapy that is performed in a direct, personal involvement with the resident in a setting with other residents or individuals.

 

          (w)  Group psychotherapy shall meet the following criteria:

 

(1)  Limit clinical groups to no more than 8 individuals with one licensed counselor present and no more than 12 individuals when that licensed counselor is joined by a second licensed counselor;

 

(2)  Sessions shall be scheduled often enough to provide effective treatment;

 

(3)  The group focus shall be face to face dialogue of a verbal rather than performance nature; and

 

(4)  Individual progress notes for each session shall be recorded in each recipient’s record with specific attention directed toward goal achievement as stated in the resident’s treatment plan.

 

          (x)  Family therapy shall be:

 

(1)  The resident and their natural or surrogate family member(s); or

 

(2)  The natural or surrogate family member(s) without the resident present.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.17  Medication Services.

 

          (a)  All medications and treatments shall be administered in accordance with the orders of the licensed practitioner.

 

          (b)  Medications, treatments, and diets ordered by the licensed practitioner shall be available to give to the client within 24 hours of the order or in accordance with the licensed practitioner’s direction.

 

          (c)  The licensee shall have a written policy and system in place instructing how to:

 

(1)  Obtain any medication ordered for immediate use at the PRTP;

 

(2)  Reorder medications for use at the PRTP; and

 

(3)  Receive and record new medication orders.

 

          (d)  For each prescription medication being taken by a client, the licensee shall maintain, in the client’s record, either the original or a copy of the written order signed by a licensed practitioner.

 

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

 

(1)  The client’s name;

 

(2)  The medication name, strength, prescribed dose, and route of administration, if different than by mouth;

 

(3)  The frequency of administration;

 

(4)  The indications for usage for all medications that are used PRN; and

 

(5)  The dated signature of the licensed practitioner.

 

          (f)  For PRN medications the licensed practitioner or a pharmacist shall indicate, in writing, the indications for use and any special precautions or limitations to use of the medication, including the maximum allowed dose in a 24-hour period.

 

          (g)  Each prescription medication shall legibly display the following information:

 

(1)  The client’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 pro re nata (PRN) medications;

 

(5)  The date ordered;

 

(6)  The name of the prescribing licensed practitioner; and

 

(7)  The expiration date of the medication(s).

 

          (h)  Pharmaceutical samples shall be used in accordance with the licensed practitioner’s written order and labeled by the licensed practitioner, the administrator, licensee or their designee with the client’s name and shall be exempt from (g)(2)-(6) above.

 

          (i)  The label of all medication containers maintained in the PRTP shall match the current written orders of the licensed practitioner unless authorized by (l) below.

 

          (j)  Only a pharmacist shall make changes to prescription medication container labels.

 

          (k)  Any change or discontinuation of medications taken at the PRTP shall be pursuant to a written order from a licensed practitioner.

 

          (l)  When the licensed practitioner changes the dose of a medication and personnel of the PRTP are unable to obtain a new prescription label:

 

(1)  The original container shall be clearly and distinctly marked, for example, with a colored sticker that does not cover the pharmacy label, in a manner consistent with the PRTP’s written procedure, indicating that there has been a change in the medication order;

 

(2)  Personnel shall cross out the previous order on the daily medication record, indicating that the dose has been changed, and write the new order in the next space available on the medication record; and

 

(3)  The change in dosage, without a change in prescription label as described in (1) and (2) above, shall be allowed for a maximum of 90 days from the date of the new medication order or until the medications in the marked container are exhausted or, in the case of PRN medications, until the expiration date on the container, whichever occurs first.

 

          (m)  Telephone orders shall be counter-signed by the licensed practitioner within 15 days of receipt.

 

          (n)  Over-the-counter medications shall be handled in the following manner:

 

(1)  The licensee shall obtain written approval from the client’s licensed practitioner annually; and

 

(2)  Over-the-counter medication containers shall be marked with the name of the client using the medication and taken in accordance with the directions on the medication container or as ordered by a licensed practitioner.

 

          (o)  The medication storage area shall be:

 

(1)  Locked and accessible only to authorized personnel;

 

(2)  Clean and organized with adequate lighting to ensure correct identification of each client's medication(s); and

 

(3)  Equipped to maintain medication at the proper temperature.

 

          (p)  All medication at the PRTP shall be kept in the original containers as dispensed by the pharmacy and properly closed after each use.

 

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

 

          (r)  Schedule II substances, as defined by RSA 318-B, shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel.

 

          (s)  The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs.

 

          (t)  Except as required by (u) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner’s orders or the medication becoming contaminated, whichever occurs first.

 

          (u)  Controlled drugs shall be destroyed only in accordance with state law and:

 

(1)  Be accomplished in the presence of at least 2 people; and

 

(2)  Be documented in the record of the client for whom the drug was prescribed. 

 

          (v)  When a client is going to be absent from the PRTP at the time medication is scheduled to be taken, the medication container shall be given to the client if the client is capable of self-administering medications.

 

          (w)  If a client is going to be absent from the PRTP at the time medication is scheduled to be taken and the client is not capable of self-administering, the medication container shall be given to the person responsible for the client while the client is away from the PRTP.

 

          (x)  Upon discharge or transfer, the licensee shall make the client’s current medications available to the client and the guardian or agent, if any.

 

          (y)  Except as described in (ab) below, medications shall only be administered by individuals authorized by law to administer medications in the PRTP.

 

          (z)  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.

 

          (aa)  Personnel shall remain with the client until the client has taken the medication.

 

          (ab)  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.

 

          (ac) Nursing assessment and evaluation for the purpose of reviewing medication compliance, educations, and symptomatology shall be completed.

 

          (ad)  Comprehensive medication assessment for those medications requiring specialized therapeutic monitoring shall:

 

(1)  Ensure that the required blood sample is drawn;

 

(2)  Ensure that the lab values are within established limits;

 

(3)  Record results; and

 

(4)  Ensure appropriate does is adjusted as needed.

 

          (ae)  A licensed nursing assistant (LNA) who is not licensed as a medication nurse assistant in accordance with RSA 326-B may administer the following when under the direction of the licensed nurse employed by the PRTP:

 

(1)  Medicinal shampoos and baths;

 

(2)  Glycerin suppositories and enemas; and

 

(3)  Medicinal topical products to intact skin as ordered by the licensed practitioner.

 

          (af)  The licensee shall maintain a written record for each medication taken by the client at the PRTP that contains the following information:

 

(1)  Any allergies or allergic reactions to medications;

 

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

 

(3)  The date and the time the medication was taken;

 

(4)  The signature, identifiable initials and job title of the person who administers, supervises, or assists the client taking medication;

 

(5)  For PRN medications, the reason the client required the medication and the effect of the PRN medication; and

 

(6)  Documentation of any medication refusal or omission.

 

          (ag)  The licensee shall develop and implement a system for reporting any observed adverse reactions to medication and side effects, or medication errors such as incorrect medications, within 24 hours of the adverse reaction or medication error.

 

          (ah)  The written documentation of the report in (ae) above shall be maintained in the client’s record.

 

          (ai)  If multiple medication problems are identified during the department’s annual survey or other investigations in which the safety of clients might be at risk, the department shall require the facility to obtain the routine services of a consultant pharmacist as a condition of continued licensure.  This requirement shall be reviewed at the next inspection to determine if consultant pharmacy services shall continue to be required.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.18  Personnel.

 

          (a)  The licensee shall ensure that sufficient numbers of qualified personnel are present in the PRTP to meet the needs of clients at all times.

 

          (b)  In an acute setting or facilities approved for IEA’s there shall be at least 2 staff members on duty at all times while clients are in the facility, one of whom shall be a registered nurse.

 

          (c)  A psychiatrist shall be available to the PRTP 24 hours a day for face-to-face consultation.

 

          (d)  For all applicants for employment, volunteers, contracted employees, and independent contractors who will provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, the licensee shall:

 

(1)  Obtain and review a criminal records check from the New Hampshire department of safety in accordance with RSA 151:2-d;

 

(2)  Review the results of the criminal records check in accordance with (e) below;

 

(3) Verify that the potential employee is not listed on the state registry maintained by the department’s bureau of elderly and adult services in accordance with RSA 161-F:49;

 

(4)  Verify that the applicant meets the qualifications of the position prior to employment; and

 

(5)  If the applicant will be employed by a child or youth program, verify that the potential employee is not listed in the DCYF central registry.

 

          (e)  Unless a waiver is granted in accordance with (g) below, the licensee shall not offer employment, contract with, or otherwise engage a person in (d) above if the individual:

 

(1)  Has been convicted of a felony in this of any other state;

 

(2)  Has been convicted for sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this or any other state;

 

(3)  Has been found by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation of any person; or

 

(4)  Otherwise poses a threat to the health, safety, or well-being of the clients.

 

          (f)  If the information identified in (e) above regarding any person subject to (d) above is learned after the person is hired, contracted with, or engaged with, the licensee shall immediately notify the department and either:

 

(1)  Cease employing, contracting with, or engaging the person; or

 

(2)  Request a waiver of (d) above.

 

          (g)  If a waiver of (d) above is requested, the department shall review the information and the underlying circumstances in (d) above and shall either:

 

(1)  Notify the licensee that the person shall not or no longer shall be employed, contracted with, or engaged by the licensee, or the person shall not or no longer shall reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a client; or

 

(2)  Grant a waiver of (d) above if, after investigation, it determines that the person does not pose a current threat to the health, safety, or well-being of a client(s).

 

          (h)  The licensee shall:

 

(1)  Not employ, contract with, or engage any person in (d) above who is listed on the BEAS state registry or DCYF central registry unless a waiver is granted by BEAS and/or DCYF; and

 

(2)  Only employ, contract with, or engage board of nursing licensees who are listed on the nursing assistant registry or licensing site with the NH board of nursing or are licensed with a reciprocal multi-compact state.

 

          (i)  Administrators appointed after the 2021 effective date of these rules shall be at least 21 years of age and have a minimum of one of the following combinations of education and experience:

 

(1)  A clinician licensed by the New Hampshire board of mental health or board of psychology practice with at least one year of relevant experience;

 

(2)  A master’s degree in counseling, psychology, or mental health from an accredited institution and 3 years of relevant experience;

 

(3)  A bachelor’s degree in counseling, psychology, or mental health from an accredited institution and 5 years of relevant experience working in a behavioral health related field;

 

(4)  A New Hampshire license as an RN, with at least 5 year of relevant experience working in a behavioral health related field; or

 

(5)  A degree which would make them eligible for licensure from the board of mental health or psychology.

 

          (j)  All personnel providing care to adult clients shall be at least 18 years of age if working as direct care personnel unless they are:

 

(1)  A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or

 

(2)  Involved in an established educational program working under the supervision of a licensed clinical supervisor.

 

          (k)  All personnel providing care to children and youth shall be at least 21 years of age if working as a direct care personnel.

 

          (l)  The licensee shall inform personnel of the line of authority at the PRTP.

 

          (m)  Prior to having contact with clients or food, personnel shall:

 

(1)  Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or licensed practitioner and submit results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement;

 

(2)  Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; and

 

(3)  Comply with the requirements of the Centers for Disease Control “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition), available as noted in Appendix A, if the individual has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis.

 

          (n)  In lieu of (l)(1) above, independent agencies contracted by the facility or by an individual client to provide direct care or personal care services may provide the licensee with a signed statement that its employees have complied with (l)(1) and (3) above before working at the PRTF.

 

          (o)  Prior to having contact with clients or food, personnel shall receive a tour of the PRTF and an orientation that explains the following:

 

(1)  The clients’ rights in accordance with RSA 151:20;

 

(2)  The PRTF’s complaint procedures;

 

(3)  The duties and responsibilities of the position;

 

(4)  The medical emergency procedures;

 

(5)  Education focused on treating and caring for residents with acute and persistent mental illness;

 

(6)  The emergency and evacuation procedures;

 

(7)  The infection control procedures as required by He-P 830.21;

 

(8)  The facility confidentiality requirements;

 

(9)  Grievance procedures for both staff and clients;

 

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

 

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

 

          (p)  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 clients’ rights and complaint procedures required under RSA 151;

 

(2)  The licensee’s infection control program;

 

(3)  The licensee’s written emergency plan;

 

(4)  The licensee’s policies and procedures;

 

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

 

(6)  Education on treating and caring for residents with acute and persistent mental illness.

 

          (q)  The PRTP shall maintain a separate employee file for each employee, which includes the following:

 

(1)  A completed application for employment or a resume;

 

(2)  Proof that the individual meets the minimum age requirements;

 

(3)  A statement signed by each individual that he or she has received a copy of and received training on the implementation of the licensee’s policy setting forth the clients rights and responsibilities as required by RSA 151:21;

 

(4)  A copy of the results of the criminal record check as described in (d) above and a copy of initial and annual signed conviction statement per He-P 830.18(r);

 

(5)  A job description signed by the individual that identifies the:

 

a.  Position title;

 

b.  Qualifications and experience; and

 

c.  Duties required by the position;

 

(6)  Record of satisfactory completion of the orientation program required by (q) above;

 

(7)  Information as to the general content and length of all in‑service or educational programs attended;

 

(8)  Record of satisfactory completion of all required education programs required above;

 

(9)  A copy of a current, valid driver’s license, including proof of insurance, if the employee transports clients;

 

(10)  Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals;

 

(11)  The statement required by (u) below; and

 

(12)  The results of the registry checks in (h) above.

 

          (r)  The PRTP shall maintain the records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to clients or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility, as follows:

 

(1)  For volunteers, the information in (p)(1), (3), (4), (6), and (8)-(12) above; and

 

(2)  For independent contractors, the information in (p)(3), (4), (6), and (8)-(12) above, except that the letter in (h) and (p) above may be substituted for (p)(4), (10), and (12) above, if applicable.

 

          (s)  Personnel records shall be maintained in a confidential manner by:

 

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

 

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

 

          (t)  All personnel shall sign a statement at the time the initial offer of employment is made and then annually thereafter stating that they:

 

(1)  Do not have a felony conviction in this or any other state;

 

(2)  Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a client; or

 

(3)  Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

 

          (u)  For individuals with the waiver described in (f) above, the statement required by (s) above shall cover the period of time since the waiver was granted.

 

          (v)  An individual shall not be required to re-disclose any of the matters in (r) above if the documentation is available and the department has previously reviewed the material and determined that the individual can continue employment.

 

          (w)  An individual shall disclose any new convictions, as soon as practicable, to the facility administrator. Any such convictions shall be reported to the department for review.

 

          (x)  The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting employees and shall provide to its consenting employees annual immunizations against influenza, to include:

 

(1)  That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and

 

(2)  The facility shall have a plan that identifies and documents, with dates, employees that have received or declined to receive immunizations.

 

          (y)  Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, therapeutic cannabis, or alcohol.

 

          (z)  The PRTF shall have a written policy, as described in RSA 151:41, 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.

 

          (aa)  The policy in (y) above shall include provisions relating to the following:

 

(1)  Education;

 

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

 

(3)  Procedures for 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 of misuse or diversion by personnel exists;

 

(6)  Employee assistance procedures;

 

(7)  Confidentiality of investigations, reports, and resolutions of controlled drug misuse or diversion;

 

(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.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.19  Client Records.

 

          (a)  The licensee shall maintain a legible, current, and accurate record for each client based on services provided at the PRTP.

 

         (b)  At a minimum, client records shall contain the following:

 

(1)  A copy of the client’s service agreement and/or admission contract and all documents required by He-P 830.16(d);

 

(2)  Identification data, including:

 

a.  Vital information including the client’s name, date of birth, and marital status;

 

b.  Client’s religious preference, if known;

 

c.  Client’s veteran status, if known;

 

d.  Name, address, and telephone number of an emergency contact person;

 

(3)  The name and telephone number of the client’s licensed practitioner(s);

 

(4)  The client’s health insurance information;

 

(5)  Copies of any executed legal orders and directives, such as guardianship orders issued under RSA 464-A, a durable power of attorney for healthcare, or a living will and DNR or DNAR orders, if applicable;

 

(6)  A record of medical clearance in accordance with He-P 830.16(n);

 

(7)  Written, dated and signed orders for the following:

 

a.  All medications, treatments, and special diets, as applicable; and

 

b.  Laboratory services and consultations performed at the PRTP;

 

(8)  Results of any laboratory tests, X-rays, or consultations performed at the PRTP;

 

(9)  All assessments and treatment plans, including documentation that the client and the guardian or agent, if any, has participated in the development of the treatment plans;

 

(10)  All admission and progress notes, including any use of restraints;

 

(11) If services are provided at the PRTP by individuals not employed by the licensee, documentation that includes the name of the agency providing the services, the date services were provided, the name of the person providing services, and a brief summary of the services provided;

 

(12)  Documentation of any alteration in the client’s daily functioning such as:

 

a.  Signs and symptoms of illness; and

 

b.  Any action that was taken including practitioner notification;

 

(13)  Documentation of any medical or specialized care;

 

(14)  Documentation of unusual incidents;

 

(15)  The consent for release of information signed by the client, guardian, or agent, if any;

 

(16)  Discharge planning and referrals;

 

(17)  Transfer or discharge documentation, including notification to the client, guardian, or agent, if any, of involuntary room change, transfer or discharge, if applicable;

 

(18)  The information required by He-P 830.17(ad) as applicable;

 

(19)  The information data sheet required by He-P 830.16(o) and (p);

 

(20)  Documentation of nurse delegation of medications as required by the nurse practice act, as applicable;

 

(21)  Documentation of a client’s refusal of any care or services; and

 

(22)  The licensee shall arrange for and document the immunization of all consenting clients for pneumococcal disease, as applicable, and all consenting clients for influenza in accordance with RSA 151:9-b and report immunization data to the department’s immunization program.

 

          (c)  Client records and client information shall be kept confidential and only provided in accordance with law.

 

          (d)  The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a client’s record shall occur.  For all substance abuse rehabilitation facilities, this shall include compliance with 42 CFR Subpart 2C of the Centers for Medicare and Medicaid Services regulations.

 

          (e)  When not being used by authorized personnel, client records shall be safeguarded against loss or unauthorized use or access.

 

          (f)  Any licensee that maintains electronic records shall develop written policies and procedures designed to protect the privacy of clients and personnel that, at a minimum, include:

 

(1)  Procedures for backing up files to prevent loss of data;

 

(2)  Safeguards for maintaining the confidentiality of information pertaining to clients and staff; and

 

(3)  Systems to prevent tampering with information pertaining to clients and staff.

 

          (g)  Records shall be retained for at least 7 years after discharge, except that when the client is a minor, records shall be retained for at least 7 years after the minor reaches the age of majority.

 

          (h)  The licensee shall arrange for storage of, and access to, client records as required by (g) above in the event the PRTP ceases operation.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.20  Food Services.

 

          (a)  The licensee shall provide food services that meet:

 

(1)  Meet the US Department of Agriculture recommended dietary allowance as specified in the United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition), available as listed in Appendix A;

 

(2)  Meet the special dietary needs associated with health or medical conditions for each client as identified in their client record; and

 

(3)  Offer at least 3 meals in each 24-hour period when the client is in the licensed premise unless contraindicated by the client’s treatment plan.

 

          (b)  Snacks shall be available between meals and at bedtime if not contraindicated by the client’s treatment plan.

 

          (c)  If a client refuses the item(s) on the menu, a substitute shall be offered.

 

          (d)  Each day’s menu shall be posted in a place accessible to food service personnel and clients.

 

          (e)  A dated record of menus as served shall be maintained for at least the previous 4 weeks.

 

          (f)  The licensee shall provide therapeutic diets to clients only as directed by a licensed practitioner or other professional with prescriptive authority.

 

          (g)  If a client has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the client’s medical record and notify the client’s licensed practitioner.

 

          (h)  All food and drink provided to the clients shall be:

 

(1)  Safe for human consumption and free of spoilage or other contamination;

 

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

 

(3)  Served at the proper temperatures;

 

(4)  Labeled, dated, and stored at proper temperatures; and

 

(5)  Stored to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

 

          (i)  The use of outdated, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded.

 

          (j)  All food not in the original package shall be stored in labeled and dated containers designed for food storage.

 

          (k)  All work surfaces shall be cleaned and sanitized after each use.

 

          (l)  All dishes, utensils and glassware shall be in good repair, cleaned and sanitized after each use and properly stored.

 

          (m)  All food service equipment shall be kept clean and maintained according to manufacturer’s guidelines.

 

          (n)  Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms.

 

          (o)  If soiled linen is transported through food service areas, the linen shall be in an impervious container.

 

          (p)  Garbage or trash in the kitchen area shall be placed in lined containers with covers.

 

          (q)  All PRTP persons involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.21  Infection Control.

 

          (a)  The PRTP shall develop and implement an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases.

 

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

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007), available as noted in Appendix A;

 

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

 

(4)  The handling, storage, transportation and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904;

 

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

 

(6)  Maintenance of a sanitary physical environment.

 

          (c)  The infection control education program shall address:

 

(1)  Causes of infection;

 

(2)  Effects of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

          (d)  Personnel infected with a disease or illness transmissible through food, fomites or droplets, shall not work in food service or provide direct care in any capacity without personal protection equipment to prevent disease transmission until they are no longer contagious.

 

          (e)  Personnel infected with scabies or lice shall not provide direct care to clients or work in food services until such time as they are no longer infected.

 

          (f)  Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the PRTP until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner.

 

          (g)  Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage.

 

          (h)  Each licensee caring for clients with infectious or contagious diseases shall have available appropriate isolation accommodations, equipment, rooms, and personnel as specified by:

 

(1)  The United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” (June 2007), available as listed in Appendix A; and

 

(2)  The Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition) available as noted in Appendix A.  

 

          (i)  The PRTP shall develop and implement a Point of Care Testing (POCT) policy, if it provides POCT that educates and provides procedures for the proper handling and use of POCT devices, as well as prevention, control, and investigation of infectious and communicable diseases.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.22  Sanitation.

 

          (a)  The licensee shall maintain a clean, safe and sanitary environment, both inside and outside.

 

          (b)  The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary and in good repair.

 

          (c)  A supply of potable water shall be available for human consumption and food preparation.

 

          (d)  A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to the clients.

 

          (e)  Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations, as required in the FGI “Guidelines for the Design and Construction of Hospitals” (2018 edition), available as noted in Appendix A, and summarized as follows:

 

(1)  One hundred and five to 120 degrees Fahrenheit for clinical areas, the range represents the minimum and maximum allowable temperatures;

 

(2)  One hundred and twenty degrees Fahrenheit for dietary areas. Provisions shall be made to provide 180 degrees Fahrenheit rinse water at the warewasher, and may be by separate booster, unless a chemical rinse is provided; and

 

(3)  One hundred and sixty degrees Fahrenheit for laundry by steam jet or separate booster heater, unless a proven process which allows cleaning and disinfection of linen with decreased water temperatures is used, but the process shall meet the designed water temperatures specified by the manufacturer.

 

          (f)  All client bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination.

 

          (g)  Cleaning solutions, compounds and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked box, separate from food, medications and client supplies.

 

          (h)  Toxic materials shall not be used in a way that contaminates food, equipment or utensils or in any way other than in full compliance with the manufacturer’s labeling.

 

          (i)  Only individuals authorized under RSA 430:33 shall apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation or dining areas.

 

          (j)  Solid waste, garbage and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets.

 

          (k)  In-house trash and garbage receptacles shall be emptied in a timely manner and lined, or cleaned and disinfected after emptying or when visibly soiled.

 

          (l)  Trash receptacles in food service areas shall be covered at all times during except during food preparation and subsequent clean up.

 

          (m)  Laundry and laundry rooms shall meet the following requirements:

 

(1)  Laundry and laundry rooms shall be kept separate from kitchen and dining areas;

 

(2)  Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times;

 

(3)  Soiled materials, linens and clothing shall be transported in a laundry bag, sack or container and washed in a sanitizing solution used in accordance with the manufacturer’s recommendations; and

 

(4)  Soiled linens and clothing which are considered contaminated with infectious waste under Env-Sw 103.28 shall be handled as infectious waste.

 

          (n)  Laundry rooms and bathrooms shall have non-porous floors.

 

          (o)  Sterile or clean supplies shall be stored in dust and moisture-free storage areas.

 

          (p)  Any PRTP that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services shall notify the department.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.23  Quality Improvement.

 

          (a)  The PRTP shall develop and implement a quality improvement program that review policies and services and maximizes quality by preventing or correcting identified problems.

 

          (b)  As part of its quality improvement program, a quality improvement committee shall be established.

 

          (c)  The PRTP shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided.

 

          (d)  The quality improvement committee shall:

 

(1)  Determine the information to be monitored:

 

(2)  Determine the frequency with which information will be reviewed;

 

(3)  Determine the indicators that will apply to the information being monitored;

 

(4)  Evaluate the information that is gathered;

 

(5)  Determine the action that is necessary to correct identified problems;

 

(6)  Recommend corrective actions to the PRTP; and

 

(7)  Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable.

 

          (e)  The quality improvement committee shall meet at least quarterly.

 

          (f)  The quality improvement committee shall generate dated, written minutes after each meeting.

 

          (g)  Documentation of all quality improvement activities, including minutes of meetings, shall be maintained on-site for at least 2 years from the date the record was created.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

          He-P 830.24  Physical Environment.

 

          (a)  The physical environment shall be maintained, inside and outside, to provide for the health, safety, well-being and comfort of client(s) and personnel, including reasonable accommodations for clients and personnel with mobility limitations.

 

          (b)  The PRTP shall:

 

(1)  Have all emergency entrances and exits accessible at all times;

 

(2)  Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks;

 

(3)  Be free from environmental nuisances, including excessive noise and odors;

 

(4)  Keep all corridors free from obstructions; and

 

(5)  Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not be limited to:

 

a.  Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;

 

b.  Repairing holes and caulking of pipe channels; and

 

c.  Extermination by a pesticide applicator licensed under RSA 430.

 

          (c)  Equipment providing heat within an PRTP including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove or pellet stove shall:

 

(1)  Maintain a temperature as follows, except where clients have control of the thermostat in their own room:

 

a.  Be at least 65 degrees Fahrenheit at night; and

b.  Be at least 70 degrees Fahrenheit during the day if the client(s) are present; and

 

(2)  Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.

 

          (d)  Electric heating systems shall be exempt from (b)(2) above.

 

          (e)  Portable space heating devices shall be prohibited, unless the following are met:

 

(1)  Such devices are used only in employee areas where personnel are present and awake at all times; and

 

(2)  The heating elements of such devices do not exceed 212 degrees Fahrenheit.

 

          (f)  Unvented fuel-fired heaters shall not be used in any PRTP.

 

          (g)  Plumbing shall be sized, installed, and maintained in accordance with the  \International Plumbing Code, as specified in the state building code under RSA 155-A:1, IV, as amended by the building code review board pursuant to RSA 155:A:10,V.

 

          (h)  Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened.

 

          (i)  Each client bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room’s gross square footage or comparable artificial lighting.

 

          (j)  The number of sinks, toilets, tubs or showers shall be in a ratio of one for every 6 individuals, unless personnel have separate bathroom facilities not used by clients.

 

          (k)  All showers and tubs shall have slip resistant floors and surfaces, which are intact, easily cleanable, and impervious to water.

 

          (l)  All hand-washing facilities shall be provided with hot and cold running water.

 

          (m)  In a PRTP there shall be at least 100 square feet per room with a single bed and 160 (80 square feet per client) square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities.

 

          (n)  Each bedroom shall:

 

(1)  Contain no more than 2 beds;

 

(2)  Have its own separate entry to permit the client to reach his/her bedroom without passing through the room of another client;

 

(3)  Have a side hinge or pocket door, that meets applicable codes, and not a folding door or a curtain;

 

(4)  Not be used simultaneously for other purposes;

 

(5)  Be separated from halls, corridors and other rooms by floor to ceiling walls;

 

(6)  Be located on the same level as the bathroom facilities, if the client has impaired mobility as identified by the assessment; and

 

(7)  If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom within 24 hours and without requiring additional construction or renovation.

 

          (o)  The licensee shall provide the following for the clients’ use, as needed, unless clinically indicated otherwise:

 

(1)  A bed appropriate to the needs of the client;

 

(2)  A firm mattress that complies with the state fire code and codes adopted by reference as defined in RSA 153:1, VI-a, except as modified in Saf-FMO 300;

 

(3)  Clean linens, blankets and a pillow;

 

(4)  A bureau;

 

(5)  A mirror;

 

(6)  A bedside table;

 

(7)  Adequate lighting;

 

(8)  A chair;

 

(9)  A closet or storage space for personal belongings; and

 

(10)  Window blinds, shades or curtains that provide privacy.

 

          (p)  The resident or guardian may indicate and the home shall document that the resident does not wish or need to have one of more of the items in (p) above and the reason for the removal.

 

          (q)  The licensee at a minimum shall provide the following rooms to meet the needs of clients:

 

(1)  One or more living rooms or multi-purpose rooms; and

 

(2)  Dining facilities with a seating capacity capable of meeting the needs of all clients.

 

          (r)  For PRTP licensees who will be involuntarily admitting persons a secure environment shall be provided. This may include the use of restraints in personal safety emergencies, as permitted by RSA 151:21.

 

          (s)  Doors on locked units shall comply with He-P 830.24(z).

 

          (t)  If a client is determined to be a danger to themselves or others per the assessment in He-P 830.16(c), the licensee must comply with the Facility Guideline Institute (FGI), “Guidelines for Design and Construction of Hospitals” (2018 edition) with regard to protection features, available as noted in Appendix A.

 

          (u)  Each area should be evaluated to identify the architectural details, surfaces, and furnishings and exposed mechanical and electrical devices and components in areas where clients might be such as:

 

(1)  Seclusion rooms;

 

(2)  Patient bedrooms and toilet rooms;

 

(3)  An area under good supervision but dealing with unpredictable patients under initial evaluation and if under heavy medication;

 

(4)  Activity spaces, group rooms, and treatment spaces;

(5)  Dining rooms and recreation spaces, both indoor and outdoor;

 

(6)  Corridors;

 

(7)  Exam rooms; and

 

(8)  Staff and support areas if accessible by clients.

 

          (v)  Each licensee shall have a communication system, such as nurse call, so that all clients can effectively contact personnel when they need assistance with care or in an emergency.

 

          (w)  Lighting shall be available to allow clients to participate in activities such as reading.

 

          (x)  All bathroom, bedroom and closet door latches or locks shall be designed for easy opening from the inside and outside in an emergency.

 

          (y)  Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (v) above.

 

          (z)  If present, seclusion rooms, shall, at a minimum be:

 

(1)  Equipped with an observation window;

 

(2)  Only for one client at a time;

 

(3)  Under constant observation when clients or others are present in them; and

 

(4)  Locked only under the following conditions:

 

a.  If there is immediate threat of bodily harm to staff or other clients; and

 

b.  If the reason for locking the seclusion room is documented in the client record.

 

         (aa)  Any locked door providing egress from within the  PRTP, shall meet the requirements of the Residential Board and Care or Health Care Occupancy chapter, whichever chapter the facility was designed to meet based on the resident’s needs, of NFPA 101,  as adopted by reference  in RSA 153:1, VI-a, except as modified in Saf-FMO 300. 

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

         He-P 830.25  Fire Safety.

 

         (a)  All PRTPs shall meet the appropriate occupancy chapter of NFPA 101, as adopted by reference in RSA 153:1, VI-a, except as modified in Saf-FMO 300, based on the scope of services provided by the licensee.

 

         (b)  All PRTPs, including those with 3 or fewer clients, shall have:

 

(1)  Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the PRTP’s electrical service, or wireless, as approved by the state fire marshal for the PRTP;

 

(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)  An approved carbon monoxide monitor on every level.

 

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

 

         (d)  Immediately following any fire or emergency, including but not limited to, gas leak or evacuation of the facility due to flooding or an explosion, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason.

 

         (e)  The written notification required by (d) above shall include:

 

(1)  The date and time of the incident;

 

(2)  A description of the location and extent of the incident, including any injury or damage;

 

(3)  A description of events preceding and following the incident;

 

(4)  The name of any personnel or clients who were evacuated as a result of the incident, if applicable;

 

(5)  The name of any personnel or clients who required medical treatment as a result of the incident, if applicable; and

 

(6)  The name of the individual the licensee wishes the department to contact if additional information is required.

 

         (f)  A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the client, or the client’s guardian or a person with durable power of attorney (DPOA) over the client, at the time of admission and a summary of the client’s responsibilities shall be provided to the client. Each client shall receive an individual fire drill walk-through within 5 days of admission, as appropriate.

 

         (g)  The fire safety plan shall be reviewed and approved as follows:

 

(1)  A copy of the fire safety plan shall be made available annually, and whenever changes are made, to the local fire chief for review and approval;

 

(2)  The local fire chief shall give written approval initially to all fire safety plans; and

 

(3)  If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, prior to the change.

 

         (h)  Fire drills shall be conducted as follows:

 

(1)  For buildings constructed to the residential board and care or one- and two- family dwelling chapters of the life safety code (NFPA 101), the following shall be required:

 

a.  The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary;

 

b.  Clients shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk;

 

c.  All PRTP facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when clients are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative;

 

d.  The drills shall involve the actual evacuation of all clients to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide clients with experience in egressing through all exits and means of escape, except as noted in c. above; 

 

e.  Facilities shall complete a written record of fire drills that include the following:

 

1.  The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill;

 

f.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility;

 

g.  At admission, the facility shall conduct a client Fire Safety Evacuation Scoring System (FSES) as listed in NFPA 101A, Alternatives to Life Safety, to determine the clients’ needs during a fire drill including mobility, assistance to evacuate, staff needed, risk of resistance, clients’ ability to evacuate on his or her own, and choosing an alternate exit; and

 

h.  The fire drills for facilities built to the residential board and care chapter of the life safety code (NFPA 101), shall be permitted to be announced, in advance, to the clients just prior to the drill; and

(2)  For PRTPs originally constructed to the health care occupancy chapter of the life safety code and to the codes,  rules and regulations adopted and enforced by the state fire marshal’s office and/or the municipality, or which have been physically evaluated, rehabilitated, and approved by a New Hampshire licensed engineer qualified in fire protection, the state fire marshal’s office, and the department pursuant to He-P 830.07, to meet the health care occupancy chapter, the following shall be required:

 

a.  The facility shall develop a fire safety plan, which provides for the following:

 

1.  Use of alarms;

 

2.  Transmission of alarms to fire department;

 

3.  Emergency phone call to fire department;

 

4.  Response to alarms;

 

5.  Isolation of fire;

 

6.  Evacuation of immediate area;

 

7.  Evacuation of smoke compartment;

 

8.  Preparation of floors and building for evacuation;

 

9.  Extinguishment of fire; and

 

10. Written emergency telephone numbers for key staff, fire, and police departments, poison control center, 911, and ambulance service(s);

 

b.  Fire drills shall be conducted quarterly on each shift to familiarize facility personnel such as medical personnel, maintenance engineers, and administrative staff with the signals and emergency action required under varied conditions;

 

c.  Fire drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions;

 

d.  Buildings that have a shelter-in-place plan, also known as defend-in-place plan, shall have this plan approved by the department per the state fire code, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5, and their local fire chief and shall be constructed to meet the health care occupancy chapter of the life safety code;

 

e.  When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms;

 

f.  If the facility has an approved defend or shelter in place plan, then all personnel, clients, and visitors shall evacuate to that appropriate location or to the outside of the building to a selected assembly point, and drills shall be designed to ensure that clients shall be given the experience of evacuating to the appropriate location or exiting through all exits;

 

g.  Facilities shall complete a written record of fire drills and include the following:

 

1.  The date and time, including AM/PM, the drill was conducted and if the actual fire alarm system was used;

 

2.  The location of exits used;

 

3.  The number of people, including clients, personnel, and visitors, participating at the time of the drill;

 

4.  The amount of time taken to completely evacuate the facility to an approved area of refuge or through a horizontal exit;

 

5.  The name and title of the person conducting the drill;

 

6.  A list of problems and issues encountered during the drill, if any;

 

7.  A list of improvements and resolution to the issues encountered during the fire drill; and

 

8.  The names of all staff members participating in the drill; and

 

h.  At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility.

 

         (i)  Storage and use of oxygen cylinders or systems shall comply with NFPA 99, Health Care Facilities Code.

 

Source.  #10059, eff 12-23-11; ss by #12952, INTERIM, eff 12-21-19, EXPIRED: 6-18-20

 

New.  #13195, eff 4-24-21

 

         He-P 830.26  Emergency Preparedness.

 

         (a)  Each facility shall have an emergency management committee, of which the facility administrator must be a member. 

 

         (b)  The emergency management committee shall have the authority for developing, implementing, exercising, and evaluating an emergency management program.

 

         (c)  The emergency management committee shall include other individuals who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation including but not limited to:

 

(1)  Elected state and local officials;

 

(2)  Police, fire, civil defense, and public health professionals;

 

(3)  Environment, transportation, and hospital officials;

 

(4)  Facility representatives; and

 

(5)  Representatives from community groups and the media.

 

         (d)  An emergency management program shall include, at a minimum, the following elements:

 

(1)  The emergency management plan as described in (e) and (f) below;

 

(2)  The roles and responsibilities of the committee members;

 

(3)  A description of how the plan is implemented, exercised, and maintained; and

 

(4)  Accommodation for emergency food and water supplies.

 

         (e)  The emergency management committee shall develop and institute a written emergency preparedness plan (plan) to respond to a disaster or an emergency.

 

         (f)  The plan in (e) above shall:

 

(1)  Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather or human-caused emergency such as missing residents and bomb threats;

 

(2)  Be approved by the local emergency management director and reviewed and approved, as

appropriate, by the local fire department;

 

(3)  Be available to all personnel;

 

(4)  Be based on realistic conceptual events;

 

(5)  Be modeled on the ICS in coordination with local emergency response agencies;

 

(6)  Provide that all personnel designated or involved in the emergency operations plan of the facility shall be supplied with a means of identification, such as vests, baseball caps, or hard hats, which shall be worn at all times in a visible location during the emergency;

 

(7)  Develop and implement a strategy to prevent an incident that threatens life, property, and the environment of the facility;

 

(8)  Develop and implement a mitigation strategy that includes measures to be taken to limit or control the consequences, extent, or severity of an incident that cannot be prevented;

 

(9)  Develop and implement a protection strategy to protect life, property, and the environment from human caused incidents and events and from natural disasters;

 

(10)  For (7)-(9) above, incorporate the findings of a hazard vulnerability assessment including the results of an analysis of impact, program constraints, operational experience, and cost-benefit analysis to provide strategies that can realistically be implemented without requiring undue expenses to the facility;

 

(11)  Conduct a facility-wide inventory and review, to include the property that the facility is located on, to determine the status of hazards that may be incorporated into the prevention, protection, and mitigation strategies, and to determine the outcome of prior strategies at least annually;

 

(12)  Include the facility’s response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as

applicable:

 

a.  Electricity;

 

b.  Potable water;

 

c.  Non-potable water;

 

d.  Heating, ventilation, and air conditioning (HVAC);

 

e.  Fire protection systems;

 

f.  Fuel required for building operations to include fuel loss, fuel spill, and fuel exposure

that creates a hazardous incident;

 

g.  Fuel for essential transportation to include fuel loss, fuel spill, and fuel exposure that

creates a hazardous incident;

 

h.  Medical gas and vacuum systems, if applicable;

 

i.  Communications systems; and

 

j.  Essential services, such as kitchen and laundry services;

 

(13)  Include a plan for alerting and managing staff in a disaster, and accessing CISM, if necessary;

 

(14)  Include the management of residents, particularly with respect to physical and clinical issues, to include:

 

a.  Relocation of residents, with their medical record, including the medicine administration records, if time permits;

 

b.  Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and

 

c.  How to provide security during the disaster;

 

(15)  Identify a designated media spokesperson to issue news releases and an area where the media can be assembled, where they will not interfere with the operations of the facility;

 

(16)  Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption;

 

(17)  Include an educational, competency-based program for the staff, to provide an overview of the components of the emergency management program and concepts of the ICS and the staff’s specific duties and responsibilities;

 

(18)  If the facility is located within 10 miles of a nuclear power plant and is part of the New

Hampshire Radiological Emergency Response Plan (RERP), include the required elements of the RERP;

 

(19)  Each license shall:

 

a.  Annually review and revise, as needed, its emergency plan;

 

b.  Submit its emergency plan to the local emergency management director for review and approval when initially written and whenever the plan is revised; and

 

c.  Maintain documentation on site which establishes that the emergency plan has been approved as required under (b) above;

 

(20)  Each PRTF that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of the PRTF’s their local community provided that:

 

a.  It has a generator capable of supplying the entire facility;

b.  It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

 

c.  It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.

 

         (g)  The facility shall conduct and document, with a detailed log including personnel signatures, 2 drills a year, at least one of which shall rehearse mass casualty response for the facility with emergency services, disaster receiving stations, or both, as follows:

 

(1)  Drills shall be monitored by at least one designated evaluator who has knowledge of the facility’s plan and who is not otherwise involved in the drill;

 

(2)  Drills shall evaluate program plans, procedures, training, and capabilities to identify opportunities for improvement;

 

(3)  The facility shall conduct a debriefing session not more than 72 hours after the conclusion of the drill. The debriefing shall include all key individuals, including observers, administration, clinical staff, and appropriate support staff; and

 

(4)  Exercises and actual events shall be critiqued to identify areas for improvement. The critique shall identify deficiencies and opportunities for improvement based upon monitoring activities and observations during the exercise. Opportunities for improvement identified in critiques shall be incorporated in the facility’s improvement plan.

 

         (h)  For the purposes of emergency preparedness, each licensee shall have in writing, a plan for the management of emergency food, water, and other supplies, which shall include:

 

(1)  Assumptions for calculations of food and water supplies, for maximum number of staff and residents, water source of supply, either tap or commercial, and expiration in months, tracking of supplies, rotation of products, and contracts and memorandums of understanding with food and water suppliers such as;

 

a.  Enough refrigerated, perishable foods for a 3-day period;

 

b.  Enough non-perishable foods for a 7-day period; and

 

c.  Potable water for a 3-day period;

 

(2)  Designated storage location(s); and

 

(3)  Non-food and water, back-up supplies including but not limited to medical, office, and other supplies necessary to continue operation of the facility and provide necessary care and oversight of residents during the emergency.

 

         (i)  Each PRTP that has been pre-approved in writing by the local emergency management director as an emergency shelter may accept, on an emergency basis, clients of PRTP’s their local community provided that:

 

(1)  It has a generator capable of supplying the entire facility;

 

(2)  It has sufficient personnel and food to meet the needs of both the clients and any evacuees; and

 

(3)  It makes arrangements to transfer the evacuee as soon as practicable if they learn after accepting the evacuee that they cannot meet his or her needs.

 

         (j)  The licensee shall annually review and revise, as needed, its emergency plan.

 

Source.  #13195, eff 4-24-21

 

Appendix A: Incorporation by Reference Information

 

Rule

Title

Obtain at:

He-P 802.07(f), He-P 802.25(e), He-P 802.27(e) and (g), He-P 802.33(d)(6), and He-P 802.37(c)(3)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Hospitals”

(2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 802.07(f), He-P 802.25(e), He-P 802.27(e) and (g), He-P 802.33(d)(6), and He-P 802.37(c)(3)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities”

(2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 802.11(b)(1)

Centers for Medicare and  Medicaid Services’ “Life safety Code & Health Care Facilities Code Requirements” (2017 Update)

Publisher: CMS

Cost: Free of Charge

The incorporated document is available at:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/LSC

He-P 802.11(b)(2)

Centers for Medicare and Medicaid Services’, Publication #100-07 “State Operations Manual”

Publisher: CMS

Cost: Free of Charge

The incorporated document is available at:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984

He-P 802.14(n)

United States Center for Disease Control and Prevention “2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

 

He-P 802.15(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at:

 

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

 

He-P 802.17(i)(8)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 802.24(a)(1)

United States Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 802.34(a)

American College of Emergency Physicians (ACEP) “Emergency Department Planning and Resource Guidelines” (2014 Edition)

Publisher: American College of Emergency Physicians (ACEP)

Cost: Free of Charge

The incorporated document is available at:

https://www.acep.org/globalassets/new-pdfs/policy-statements/emergency-department-planning-and-resource-guidelines.pdf

 

He-P 802.39(l)

ACCF/AHA/SCAI’s “2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures” (July 2013)

Publisher: ACCF/AHA/SCAI

Cost: Free to the Public

https://www.ahajournals.org/doi/full/10.1161/CIR.0b013e318299cd8a?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

 

He-P 803.07(e)(3), (f), (g), and (h)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher:  Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 803.07(f), (g), (h), and (i)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher:  Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 803.14(l)

United States Centers for Disease Control and Prevention’s  “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher:  United States Centers for Disease Control and Prevention

Cost:  Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 803.14(l) and He-P 803.23(b)(2)

United States Centers for Disease Control and Prevention’s  “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher:  United States Centers for Disease Control and Prevention

Cost:  Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 803.18(j)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher:  United States Centers for Disease Control and Prevention

Cost:  Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 803.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher:  United States Department of Agriculture

Cost:  Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 803.25(e)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities Table 2.5-1” (2018 Edition)

Publisher:  Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 804.07 (h)(3), (i), and (j)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 804.07(i)-(k)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com or http://www.fgiguidelines.org. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00.

He-P 804.18(p)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 804.21(a)(1)

“2015-2020 Dietary Guidelines for Americans”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

 

Available free of charge from the HHS/USDA website at: https://health.gov/dietaryguidelines/2015/guidelines/

 

He-P 804.21(j)(2)

US Department of Health and Human Services, Public Health Services, Food and Drug Administration, “Food Code,” 2013 edition

Available free of charge from the FDA website at:

 

https://www.fda.gov/downloads/food/guidanceregulation/retailfoodprotection/ foodcode/ucm374510.pdf

 

He-P 805.07(h)-(j)

Facility Guidelines Institute “Guidelines for Design and Construction of Health Care Facilities,” “Residential Healthcare” chapter, 2010 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com. This publication is available in three formats: Bound Book Catalog #055373, Secure PDF on CD Catalog # 055374, and Three-Hole Punched Loose Leaf Catalog #055375. The cost of this publication is $168.00 each.

 

He-P 805.07 (h)(3), (i), and (j)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

 

Cost: $75.00/book or $200.00/user, per year for subscription to website.

 

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 805.18(m)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 805.21(a)(1)

“Dietary Guidelines for Americans, 2005”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

 

Available free of charge from the HHS/USDA website at: http://www.health.gov/dietaryguidelines/dga2005/document/

 

This publication can also be ordered by calling the U.S. Government Printing Office (GPO) at (866)512-1800 and asking for stock number 001-000-04719-1, or by accessing the GPO Online Bookstore at http://bookstore.gpo.gov.

 

He-P 806.07(i), (j), and (k); He-P 806.20(e); and He-P 806.21(c)w

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities”

(2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available at:

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 806.14(o)

Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

 

He-P 806.16(k)(10)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at

 

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

 

He-P 807.07(g)(3), (h), and (i)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 807.14(o) and He-P 807.21(a)(2), and (g)

United States Centers for Disease Control and Prevention’s  “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 807.18(o)(3)

Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 807.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

He-P 807.22(e)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities Table 2.5-1” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 808.07(i) and (j)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2022 Edition)

Publisher: Facility Guidelines Institute

He-P 808.17(d)

Centers for Disease Control “Guidelines for Preventing the Transmission of Tuberculosis in Health Facilities Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 808.17(d)(5)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

He-P 809.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 809.17(j)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 810.18(h)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 810.18(j)(2) & (n)(11)b.

American Heart Association and American Academy of Pediatrics “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines”

Available free of charge from the Ameican Academy of Pediatrics website at: http://pediatrics.aappublications.org/content/117/5/e1029.

 

He-P 810.20(h)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 812.07(h),(i), and (j), He-P 812.18(f)(6), He-P 812.22(e), and He-P 812.24(al)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 812.14(l) and He-P 812.20(b)(2)

United States Centers for Disease Control and Prevention’s  “2007 Guideline for Isolation Precautions Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 812.15(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

Cost: Free of Charge

The incorporated document is available at

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

 

He-P 812.17(i)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 812.24(af) and (ag)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.7 Requirements for Outpatient Surgery Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 812.24(ag)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.1 Common Elements for Outpatient Facilities” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

Cost: $200.00

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 814.15(m)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 815.07 (h)(3), (i), and (j)

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 Edition)

Publisher: Facility Guidelines Institute (FGI)

 

Cost: Digital $90.00 per year/ Book $235 per copy

 

The incorporated document is available for purchase at

https://fgiguidelines.org/guidelines/editions/

 

He-P 815.14(m) and He-P 815.19(b)(2)

United States Center for Disease Control and Prevention “2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: United States Center for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 815.17(j)(3)

United States Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: United States Centers for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

 

He-P 815.25(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2020-2025” (Ninth Edition)

Publisher: United States Department of Agriculture

 

Cost: Free to the Public

 

The incorporated document is available at:

https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

 

He-P 816.07(h)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Common Elements for Non-Residential Support Facilities chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00. There is a no-cost, read-only version available here: http://www.fgiguidelines.org.

 

He-P 816.14(o) and 816.20(i)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 816.18(i)(3)

United States Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 817.17(i)(5)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 818.07(h)

Facility Guidelines Institute (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Adult Day Care chapter, 2014 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com. This publication is available in multiple formats and at different price points. The standard price of this publication is $200.00. There is a no-cost, read-only version available here: http://www.fgiguidelines.org.

 

He-P 818.14(n)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 818.15(g)(1)

“2015-2020 Dietary Guidelines for Americans”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

 

Available free of charge from the HHS/USDA website at: https://health.gov/dietaryguidelines/2015/guidelines/

He-P 818.19(m)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 819.17(b)(6

United States Centers

for Disease Control

and Prevention,

“Guidelines for

Preventing the

Transmission of M.

tuberculosis in

Health-Care Settings”

(2005 edition

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

 

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e

 

He-P 822.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.

He-P 822.17(j)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov/tb/publications/guidelines/infectioncontrol.html.

He-P 823.14(l)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 edition)

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 823.18(i)(9)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of

M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 824.07(h) and (i)

Facility Guidelines Institutes (FGI), “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities” (2022 edition)

Publisher: Facility Guidelines Institutes

Cost: $235-multiple user/$90-single user

The incorporated document is available at:

https://fgiguidelines.org/guidelines/2022-edition/

 

He-P 824.19(j)(3)

United States Centers for Disease Control and Prevention, “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e

He-P 824.21(h)

United States Centers for Disease Control and Prevention, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in healthcare Settings” (June 2007 edition)

Publisher: United States Center for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at: https://www.cdc.gov/coronavirus/mers/downloads/Isolation2007.pdf

 

 

He-P 824.22(a)(1)

US Department of Agriculture’s, “Dietary Guidelines for Americans” (2020-2025 edition)

Publisher: US Department of Agriculture

Cost: Free of Charge

The incorporated document is available at: https://www.dietaryguidelines.gov/

He-P 826.07(i)-(k)

Facility Guidelines Institutes (FGI) “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities,” Residential Healthcare chapter, 2018 edition

This publication is published and may be obtained by contacting the Facilities Guidelines Institute (formerly the American Institute of Architects) either by phone: 1-800-242-2626; or in writing via www.ashestore.com or http://www.fgiguidelines.org. This publication is available in multiple formats and at different price points.  The standard price of this publication is $200.00.

 

He-P 826.14(h)(4)a.

Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices (NREPP), 

Available free of charge from the SAMSHA website at https://www.samhsa.gov/nrepp

 

He-P 826.14(h)(6)

 

 

 

 

 

 

 

Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Improvement Protocols and Technical Assistance Publications

Available free of charge from the SAMSHA website at https://www.samhsa.gov/kap/resources

He-P 826.14(h)(6)

American Society of Addiction Medicine (ASAM) Criteria, 3rd edition (2013)

Available free of charge from the American Society of Addiction Medicine (ASAM)website at

http://www.asam.org/quality-practice/guidelines-and-consensus-documents/the-asam-criteria/about

 

He-P 826.14(h)(6)

National Alliance for Recovery Residences

Available free of charge from the National Alliance for Recovery Residences website at

http://narronline.org/resources/

 

He-P 826.16(f)(2)intro. & He-P 826.16(m)

TAP 21: Addiction Counseling Competencies, (2017 revision)

 

Available free of charge from the SAMSHA website at http://store.samhsa.gov/product/TAP-21-Addiction-Counseling-Competencies/SMA15-4171

 

He-P 826.16(f)(2)a.

Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision) (DSM-5)(May 2013 edition)

Available from the publisher, American Psychiatric Publishing (http://www.appi.org/Home), a division of the American Psychiatric Association (APA) (www.psychiatry.org).

Cost is $155.00.

 

He-P 826.18(o)(3)

Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings,” 2005 edition

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 826.20(a)(1)

“2015-2020 Dietary Guidelines for Americans”

Publisher: US Department of Health and Human Services, & US Department of Agriculture

 

Available free of charge from the HHS/USDA website at: https://health.gov/dietaryguidelines/2015/guidelines/

 

He-P 826.20(h)(2)

US Department of Health and Human Services, Public Health Services, Food and Drug Administration, “Food Code” Chapter 3, 2013 edition

Available free of charge from the FDA website at:

 

https://www.fda.gov/downloads/food/guidanceregulation/retailfoodprotection/ foodcode/ucm374510.pdf

 

He-P 826.21(h)

United States Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,” June 2007

Available free of charge from the CDC website at www.cdc.gov.

 

He-P 827.07(i),(j), and (k)

Facility Guideline Institutes (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

 

Cost: $200.00

 

The incorporated document is available for purchase at

 

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 827.07(i), (j), and (k)

Facility Guideline Institutes (FGI) “Guidelines for Design and Construction of Outpatient Facilities ” (2018 Edition)

Publisher: Facility Guidelines Institutes (FGI)

 

Cost: $200.00

 

The incorporated document is available for purchase at

 

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

 

He-P 827.14(m) and He-P 827.20(j)

Centers for Disease Control and Prevention “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007 Edition)

Publisher: Centers for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at

 

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

 

He-P 827.15(a)(1)

National Quality Forum’s “Serious Reportable Events in Healthcare- 2011 Update”

Publisher: National Quality Forum

 

Cost: Free of Charge

 

The incorporated document is available at

 

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=69573

 

He-P 827.18(m)(3)

“Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

 

Cost: Free of Charge

 

The incorporated document is available at

 

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

 

He-P 830.07(h) and (i);

He-P 830.14(r)(2); He-P 830.21(h)(2); He-P 830.22(e); and He-P 830.24(t)

 

Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals” (2018 Edition)

Publisher: Facility Guidelines Institute (FGI)

Cost: $75.00/book or $200.00/user, per year for subscription to website.

The incorporated document is available for purchase at

https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/

He-P 830.14(r)(1) and He-P 830.21(b)(2); He-P 830.21(h)(1)

United States Centers for Disease Control and Prevention’s  “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (June 2007)

Publisher: United States Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

 

He-P 830.18(m)(3)

Centers for Disease Control and Prevention’s “Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings” (2005 Edition)

Publisher: Centers for Disease Control and Prevention

Cost: Free of Charge

The incorporated document is available at:

https://www.cdc.gov/tb/publications/slidesets/infectionguidelines/default.htm

He-P 830.20(a)(1)

United States Department of Agriculture’s “ Dietary Guidelines for Americans 2015-2020” (Eighth Edition)

Publisher: United States Department of Agriculture

Cost: Free to the Public

The incorporated document is available at:

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

 

 

Appendix B

 

Rule

Specific State or Federal Statutes the Rule Implements

He-P 802.01 – He-P 802.03

RSA 151:9,I(a) and (b)

He-P 802.04 – He-P 802.07

RSA 151:2,I and II and RSA 151:9,I

He-P 802.08

RSA 151:9,I(a)

He-P 802.09

RSA 151:9,I(e) and RSA 151:6-a

He-P 802.10

RSA 151:9,I(a) and (b)

He-P 802.11

RSA 151:9,I(e) and RSA 151:6

He-P 802.12

RSA 151:9,I(f)(g)(l)(m)

He-P 802.13

RSA 151:9,I(f)(h)(l)

He-P 802.14 – He-P 802.41

RSA 151:9,I(a)

He-P 803.01 – He-P 803.03

RSA 151:9,I(a) and (b)

He-P 803.04 – He-P 803.07

RSA 151:2,I and II and RSA 151:9,I

He-P 803.08

RSA 151:9,I(a)

He-P 803.09

RSA 151:9,I(e) and RSA 151:6-a

He-P 803.10

RSA 151:9,I(a) and (b)

He-P 803.11

RSA 151:9,I(e) and RSA 151:6

He-P 803.12

RSA 151:9,I(f), (g), (l), and (m)

He-P 803.13

RSA 151:9,I(f), (h), and (l)

He-P 803.14 –He-P 803.27

RSA 151:9,I(a)

He-P 803.28

RSA 151:9,I(a)

He-P 804.01

He-P 804.01

He-P 804.02

He-P 804.02

He-P 804.03

He-P 804.03

He-P 804.04

He-P 804.04

He-P 804.05

He-P 804.05

He-P 804.06

He-P 804.06

He-P 804.07

He-P 804.07

He-P 804.08

He-P 804.08

He-P 804.09

He-P 804.09

He-P 804.10

He-P 804.10

He-P 804.11

He-P 804.11

He-P 804.12

He-P 804.12

He-P 804.13

He-P 804.13

He-P 804.14

He-P 804.14

He-P 804.15 – He-P 804.25

He-P 804.15 – He-P 804.25

He-P 804.26 – He-P 804.27

He-P 804.26 – He-P 804.27

He-P 805.01 – 805.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 805.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 805.05 – 805.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 805.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a)

He-P 805.08 – 805.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a;

 RSA 151:9, I(a) & (e)

He-P 805.11

RSA 151:6, I; RSA 151:9, I(e)

He-P 805.12 – 805.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) & (l); RSA 151:16-a

He-P 805.14

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.15

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.16

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.17

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.18

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2); and RSA 151:49-50

H-P 805.19

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.20

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.21

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.22

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.23

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.24

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.25

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 805.26

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 806.01 – He-P 806.03

RSA 151:9,I(a) and (b)

He-P 806.04 – He-P 806.06

RSA 151:2,I and II and RSA 151:9,I

He-P 806.07

RSA 153:10-b, V; RSA 151; RSA 153:5, I; RSA 155-A:1, IV; and RSA 155-A:10, V

He-P 806.08

RSA 151:9,I(a)

He-P 806.09

RSA 151:9,I(a)

He-P 806.10

RSA 151:9,I(e)

He-P 806.11

RSA 151:9,I(f), (g), (l), and (m)

He-P 806.12

RSA 151:9,I(f), (h), and (l)

He-P 806.13 – He-P 806.23

RSA 151:9,I(a), (f), (h), (l), and (o); RSA 151:8; RSA 541-A:30, III; RSA 151; RSA 151:2, RSA 151:5-a; RSA 151:7-a; RSA 541-A; RSA 161-F:49; RSA 151: 19-21; RSA 151:21-b; RSA 141-C:7; RSA 151:29; RSA 151:6-a; RSA 151:21, X; RSA 155:66, I(b); RSA 151:2-d; RSA 326-B:26; 42 CFR 483.156; RSA 328, I; RSA 161-F:46-48; RSA 169-C: 29-31; RSA 141-C:1; RSA 151:9-b; RSA 141-C; RSA151:33; RSA 147-A:2, VII; RSA 430:33; RSA 430:29, XXVI; RSA 430; RSA 155-A:1, IV; RSA 155-A:10, V; RSA 155:66, I(b)

He-P 806.24 – He-P 806.26

RSA 151:9, I(a); RSA 318-B: 1-a; RSA 318-B; 42 CFR 493; RSA 151:9, I

He-P 807.01-He-P 807.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 807.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 807.05-He-P 807.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 807.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a)

He-P 807.08-He-P 807.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 807.11

RSA 151:6, I; RSA 151:9, I(e)

He-P 807.12-He-P 807.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) & (l); RSA 151:16-a

He-P 807.14-He-P 807.25

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 808.01 – He-P 808.03

RSA 151:2,I(c); RSA 151:2,II; RSA 151:9,I(a)&(b), 42 CFR Part 493, 42 CFR § 493.1411, 42 CFR § 493

He-P 808.04 – He-P 808.06

RSA 151:9,I

He-P 808.07 – He-P 808.08

RSA 151:9,I(a)

He-P 808.09

RSA 151:9,I(e)

He-P 808.10

RSA 151:9,I(a)

He-P 808.11

RSA 151:9,I(e)

He-P 808.12

RSA 151:9,I(f),(g),(i),(l)

He-P 808.13

RSA 151:9,I(f),(h),(l),(m)

He-P 808.14 – He-P 808.23

RSA 151:9,I(a), 42 CFR § 493.1405,  42 CFR § 493.1443, 42 CFR § 493.1417, 42 CFR § 493.1455, 42 CFR § 493.1411, 42 CFR § 493.1449, 1461and 1469, 42 CFR § 493, 29 CFR § 1910.1030

He-P 809.01

RSA 151:9, I(a),(b)

He-P 809.02

RSA 151:9, I(a),(b); RSA 151:2, II(i)

He-P 809.03

RSA 151:9, I(a),(b)

He-P 809.04 – He-P 809.07

RSA 151:2, I and II; RSA 151:9, I

He-P 809.08

RSA 151:9, I(a)

He-P 809.09

RSA 151:9, I(e)

He-P 809.10

RSA 151:9, I(a)

He-P 809.11

RSA 151:9, I(e)

He-P 809.12

RSA 151:9, I(f),(g),(l),(m)

He-P 809.13

RSA 151:9, I(f),(h),(l)

He-P 809.14 – He-P 809.21

RSA 151:9, I(a)

He-P 810.01 - He-P 810.03

RSA 151:9, I(a) & (b)

He-P 810.04 - He-P 810.06

RSA 151:9, I(c); RSA 151:4, II and III-a; RSA 151:5, I(c)

He-P 810.07

RSA 151:9, I(a) & (e); RSA 151:9, III; RSA 151:6, II

He-P 810.08

RSA 151:9, I(a) & (f)

He-P 810.09

RSA 151:9, I(a) & (e); RSA 151:6, III; RSA 151:6-a

He-P 810.10

RSA 151:9, I(a) & (b)

He-P 810.11

RSA 151:9, I(a) & (e); RSA 151:6

He-P 810.12 – He-P 810.13

RSA 151:9, I(a), (f)-(i), (l) & (m); RSA 151:7; RSA 151:7-a; RSA 151:8

He-P 810.14 – He-P 810.22

RSA 151:9, I(a); RSA 151:20; RSA 151:21, RSA 151:22; RSA 151:29

He-P 810.23 – He-P 810.24

RSA 151:9, I(a); RSA 151:9, III

He-P 810.23 – He-P 810.24

RSA 151:9, I(a); RSA 151:9, III

He-P 811.01 – He-P 811.03

RSA 151:9, I(a) and (b)

He-P 811.04 – He-P 811.06

RSA 151:2, I and II; RSA 151:9, I(c)

He-P 811.07 – He-P 811.08

RSA 151:9, I(a)

He-P 811.09

RSA 151:9, I(e)

He-P 811.10

RSA 151:9, I(a)

He-P 811.11

RSA 151:9, I(e)

He-P 811.12

RSA 151:9, I(f), (g), (l) and (m)

He-P 811.13

RSA 151:9, I(f), (h) and (l)

He-P 811.14 – He-P 811.24

RSA 151:9, I(a)

He-P 812.01 – He-P 812.03

RSA 151:9, I(a) and (b)

He-P 812.04 – He-P 812.07

RSA 151:2, I and II and RSA 151:9,I

He-P 812.08

RSA 151:9, I(a)

He-P 812.09

RSA 151:9, I(e) and RSA 151:6-a

He-P 812.10

RSA 151:9, I(a) and (b)

He-P 812.11

RSA 151:9, I(e) and RSA 151:6

He-P 812.12

RSA 151:9, I(f), (g), (l), and (m)

He-P 812.13

RSA 151:9, I(f), (h), and (l)

He-P 812.14 – He-P 812.26

RSA 151:9, I(a)

He-P 813.01 - 813.03

RSA 151:2, IV; Section 1915(c) of the Social Security Act

He-P 813.04

RSA 151:9,VIII

He-P 813.05

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.06

RSA 151:2, IV, Section 1915(c) of the Social Security Act

He-P 813.07 - 813.08

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.09

RSA 151:6-a

He-P 813.10 - 813.23

RSA 151:2, IV; RSA 151:9, VIII

He-P 813.24

RSA 151:9,I(b)

He-P 813.25

RSA 151:9, VIII

He-P 814.01 – He-P 814.03

RSA 151:9,I(a)(b)

He-P 814.04 – He-P 814.07

RSA 151:2,I(e); RSA 151:2,II; RSA 151:9,I(a) and (b)

He-P 814.08 – He-P 814.09

RSA 151:9,I(a)

He-P 814.10

RSA 151:9,I(e)

He-P 814.11

RSA 151:9,I(a)

He-P 814.12

RSA 151:9,I(e)

He-P 814.13

RSA 151:9,I(f)(g)(l)(m)

He-P 814.14

RSA 151:9,I(f)(h)

He-P 814.15 – He-P 814.16

RSA 151:9,I(a)

He-P 814.18 – He-P 814.22

RSA 151:9,I(a)

He-P 814.23 – He-P 814.24

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 815.01

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.02

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.03

RSA 151:9, I; RSA 151:9, VII(a)(2)

He-P 815.04

RSA 151:4, I – III-a and IV; RSA 151:9, I(c);

He-P 815.05

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 815.06

RSA 151:4, I – III-a; RSA 151:5; RSA 151:7, I; RSA 151:9, I(c) & (d)

He-P 815.07

RSA 151:9, I; RSA 151:3-a; RSA 151:6, II; RSA 151:9, I(a)

He-P 815.08

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.09

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.10

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.11

RSA 151:9, I and I(b); RSA 151:6, I; RSA 151:6-a; RSA 151:9, I(a) & (e)

He-P 815.12

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) &

(l); RSA 151:16-a

He-P 815.13

RSA 151:7, II – IV; RSA 151:7-a; RSA 151:8; RSA 151:9, I(f), (g), (h) &

(l); RSA 151:16-a

He-P 815.14

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.15

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.16

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.17

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.18

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.19

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.20

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.21

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.22

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.23

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.24

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 815.25

RSA 151:9, I and I(a); RSA 151:9, VII(a)(1) & (2)

He-P 816.01 – He-P 816.03

RSA 151:9, I(a)(b)

 

 

He-P 816.04 – He-P 816.06

RSA 151:2, I(a); RSA 151:2, II; RSA 151:9, I(a)

He-P 816.04(a)(1)b.

RSA 151:4, III(a)(5)

He-P 816.04(a)(1)c.

RSA 151:4, III(a)(6) & (7)

He-P 816.07 – He-P 816.08

RSA 151:9, I(a)

He-P 816.09

RSA 151:9, I(e)

He-P 816.10

RSA 151:9, I(a)

He-P 816.11

RSA 151:9, I(e)

He-P 816.12

RSA 151:9, I(f)(g)(l)(m)

He-P 816.13

RSA 151:9, I(f)(h)

He-P 816.14 – He-P 816.22

RSA 151:9, I(a)

He-P 816.23 – He-P 816.24

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 817.01 – 817.03

RSA 151:9, I

He-P 817.04

RSA 151:9, I(c)

He-P 817.05

RSA 151:9, I(c)

He-P 817.06

RSA 151:9, I(d)

He-P 817.07

RSA 151:3-a; RSA 151:9, I(a)

He-P 817.08

RSA 151:9, I(a)

He-P 817.09

RSA 151:6-a; RSA 151:9, I(e) and (f)

He-P 817.10

RSA 151:9, I(a)

He-P 817.11

RSA 151:6

He-P 817.12

RSA 541-A:30; RSA 151:7-a; RSA 151:9, I(f), (g) and (l); RSA 151:16-a

He-P 817.13

RSA 541-A:30; RSA 541-A:30-A; RSA 151:9, (I)(f) and (l); RSA 151:7

He-P 817.14

RSA 151:9, (I)(a); RSA 151:20; RSA 151:29

He-P 817.15

RSA 151:9, I(a); 42 CFR 493

He-P 817.16

RSA 151:9, I(a); 42 CFR 493

He-P 817.17

RSA 151:9, I(a); 42 CFR 493

He-P 817.18

RSA 151:9, I(a); 42 CFR 493

He-P 817.19

RSA 151:9, I(a); 29 CFR 1910.1030

He-P 817.20

RSA 151:9, I(a)

He-P 817.21

RSA 151:9, I(a), (c) and (d); 42 CFR 493

He-P 818.01

RSA 151:9, I(a)

He-P 818.02

RSA 151:9, I(b) and (f)

He-P 818.03

RSA 151:9, I

He-P 818.04 – 818.06

RSA 151:9, I(c) and (d)

He-P 818.04(a)(1)b.

RSA 151:4, III(a)(5)

He-P 818.04(a)(1)c.

RSA 151:4, III(a)(6) & (7)

He-P 818.07

RSA 151:9, I(a), RSA 151:9, III; RSA 153; RSA 155-a:I, IV

He-P 818.08

RSA 151:9, I(a)

He-P 818.09

RSA 151:9, I(e)

He-P 818.10

RSA 151:9, I(b)

He-P 818.11

RSA 151:9, I(e); RSA 151:6

He-P 818.12

RSA 151:6; RSA 151:6-a; RSA 151:7; RSA 151:7-a; RSA 151:8; RSA 151:8-a; RSA 159:9, I(a), (e)–(i), (l) and (m); RSA 151:16(a)

He-P 818.13

RSA 151:7; RSA 151:8; RSA 151:9, I(f) and (h)

He-P 818.14 – 818.15

RSA 151:9, I(a)

He-P 818.16

RSA 151:9, I(a); RSA 151:21; RSA 151:26

He-P 818.17

RSA 151:9, I(a)

He-P 818.18

RSA 151:9, I(a); RSA 318; RSA 318-B; RSA 326-B

He-P 818.19

RSA 151:9, I(a)

He-P 818.20

RSA 151:9, I(a)

He-P 818.21

RSA 151:9, I(a); RSA 141-C; RSA 151:9-b

He-P 818.22

RSA 151:9, I(a)

He-P 818.23

RSA 151:9, I(a); RSA 155-A

He-P 818.24 – 818.25

RSA 151:9, I(a); RSA 155:68; RSA 155:69; RSA 153:4 and 5

He-P 819.01 – He-P 819.03

RSA 151:9,I(a) and (b) RSA 151:2-b

He-P 819.04 – He-P 819.06

RSA 151:9,I(c) and (d)

He-P 819.07 – He-P 819.08

RSA 151:9,I(a)

He-P 819.09

RSA 151:9,I(e)

He-P 819.10

RSA 151:9,I(a) and (b)

He-P 819.11

RSA 151:9,I(e)

He-P 819.12

RSA 151:9,I(g)(l) and (m)

He-P 819.13

RSA 151:9,I(f) and (m)

He-P 819.14 – He-P 819.19

RSA 151:9,I(a), RSA 151:13-b

He-P 820.01-He-P 820.03

RSA 151:9, I(a), (b); RSA 151:2, I(b); RSA 151:2-b; RSA 151:9-a, I

He-P 820.04-He-P 820.06

RSA 151:2, I and II and RSA 151:9, I; RSA 151:9-a, I and XII

He-P 820.07-He-P 820.08

RSA 151:9, I(a); RSA 151:9-a,I and XII

He-P 820.09

RSA 151:6,I; RSA 151:9, I(e); RSA 151:9-a, VIII

He-P 820.10

RSA 151:9, I(f), (g), (l), (m); RSA 151:9-a, IX, X, and XI

He-P 820.11

RSA 151:9, I(f), (h), (l); RSA 151:16-a; RSA 151:9-a,IX

He-P 820.12

RSA 151:9, I(a); RSA 151:9-a, I and VIII

He-P 822.01

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.02

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.03

RSA 151:9,I(a),(b); RSA 151:2, I(b); RSA 151:2-b

He-P 822.04 – He-P 822.07

RSA 151:2,I and II; RSA 151:9, I

He-P 822.08

RSA 151:9,I(a)

He-P 822.09

RSA 151:9,I(e)

He-P 822.10

RSA 151:9,I(a)

He-P 822.11

RSA 151:9,I(e)

He-P 822.12

RSA 151:9,I(f),(g),(l),(m)

He-P 822.13

RSA 151:9,I(f),(h),(l)

He-P 822.14 – He-P 822.20

RSA 151:9,I(a)

He-P 823.01 – He-P 823.03

RSA 151:9,I(a),(b)

He-P 823.04 – He-P 823.07

He-P 823.04 – He-P 823.07

He-P 823.08

RSA 151:9,I(a)

He-P 823.09

RSA 151:9,I(e)

He-P 823.10

RSA 151:9,I(a)

He-P 823.11

RSA 151:9,I(e)

He-P 823.12

RSA 151:9,I(f),(g),(l),(m)

He-P 823.13

RSA 151:9,I(f),(h),(l)

He-P 823.14 – He-P 823.21

RSA 151:9,I(a)

He-P 824.01 – He-P 824.03

RSA 151:9, I(a) and (b) and RSA 151:9, VII(a)(2)

He-P 824.04 – He-P 824.07

RSA 151:2, I and II and RSA 151:9, I(c) and (d)

He-P 824.08

RSA 151:9, I(a)

He-P 824.09

RSA 151:9, I(e)

He-P 824.10

RSA 151:9, I(a)

He-P 824.11

RSA 151:9, I(e)

He-P 824.12

RSA 151:9, I(f), (g), (l) and (m)

He-P 824.13

RSA 151:9, I(f), (h) and (l)

He-P 824.14 – He-P 824.26

RSA 151:9, I(a) and RSA 151:9, VII(a)(2)

He-P 826.01

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.02

RSA 151:2, II(i); RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.03

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.04 – He-P 826.06

RSA 151:9, I(c); RSA 151:9, VII(a)(1)

He-P 826.07 – He-P 826.08

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.09

RSA 151:9, I(e); RSA 151:9, VII(a)(1)

He-P 826.10

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 826.11

RSA 151:9, I(e); RSA 151:9, VII(a)(1)

He-P 826.12

RSA 151:9, I(l); RSA 151:9, VII(a)(1)

He-P 826.13

RSA 151:9, I(f); RSA 151:9, VII(a)(1)

He-P 826.14 – He-P 826.26

RSA 151:9, I(a); RSA 151:9, VII(a)(1)

He-P 827.01

RSA 151; RSA 151:2-e, II(c)

He-P 827.02

RSA 151:2

He-P 827.03

RSA 151; RSA 137-J; RSA 151:38; RSA 137-J; RSA 137-J:35;

RSA 151:2, I(a) and RSA 151:2-e; RSA 151:19, II; RSA 463, RSA 464-A; RSA 151:2, I(a); RSA 151:6; RSA 153; RSA 153:5, I; RSA 329;

RSA 326-B; RSA 151:6-a, II; RSA 151:21; RSA 151:19, V; RSA 329;

RSA 151:6-a; RSA 151:2-e

He-P 827.04 – He-P 827.06

RSA 151: RSA 151:4, I-III(a); 42 C.F.R. 485.610(b) and (c);

RSA 151:5, IX; RSA 485; RSA 6:11-a

He-P 827.07 – He-P 827.08

RSA 151; RSA 153:5, I; RSA 153:10-b, V; RSA 155-A:I, IV;

RSA 155-A:10, V

He-P 827.09

RSA 151

He-P 827.10

RSA 151

He-P 827.11

RSA 151; RSA 151:2; RSA 151:7-a, II; RSA 151:17; RSA 151:13

He-P 827.12

RSA 151

He-P 827.13

RSA 151; RSA 151:8; RSA 541-A:30, III; RSA 151:2; RSA 151:5-a;

RSA 151:5-a, II; RSA 151:7-a

He-P 827.14 – He-P 827.25

RSA 161-F:49; 42 CFR Part 482; RSA 151:19-21; RSA 153; RSA 153:5, I; RSA 141-C:7; RSA 151:29; RSA 151:2; RSA 151:20; RSA 151:6; RSA 151:6-a; RSA 155:66, I(b); RSA 151:24; RSA 151:21, VII; RSA 151:37; CMS 42 CFR Part 493; RSA; RSA 318 and RSA 318-B; RSA 125-F; RSA 151:2-d, VI; RSA 161-F:49; RSA 326-B:26; 42 CFR 483.156; RSA 151:20; RSA 137-J; RSA 151:26; RSA 137-H; RSA 137-J; RSA 161-F:46; RSA 169-C:29; RSA 151:9-b, IV; RSA 151:41; RSA 464-A; RSA 141-C:I; RSA 151:9-b; RSA 151:33; RSA 147-A:2, VII; RSA 430:33; RSA 430:29, XXVI; RSA 430; RSA 329-A:15; RSA 155-A; RSA 155:66, I(b); RSA 155:64-77; 42 CFR 493

He-P 830.01 – He-P 830.03

RSA 151:9, I(a) & (b)

He-P 830.04 – He-P 830.07

RSA 151:2, I & II; RSA 151:9, I

He-P 830.08

RSA 151:9, I(a)

He-P 830.09

RSA 151:9, I(e); RSA 151:6-a

He-P 830.10

RSA 151:9, I(a) & (b)

He-P 830.11

RSA 151:9, I(e); RSA 151:6

He-P 830.12

RSA 151:9, I(f), (g), (l), & (m)

He-P 830.13

RSA 151:9, I(f), (h), & (l)

He-P 830.14

RSA 151:9, I(a)

He-P 830.15 –He-P 830.25

RSA 151:9, I(a)

He-P 830.26

RSA 151:9, I(a)