7.1 OVERALL CARE Residents shall receive the care necessary to meet individual physical, psycho-social and rehabilitative needs and assistance to achieve and maintain their highest possible level of independence, self-care, self-worth and well-being. Provision of care shall be documented in the health information record.
7.2 QUALITY OF LIFE Residents shall be provided a safe, supportive, comfortable, homelike environment; freedom and encouragement to exercise choice over their surroundings, schedules, health care and life activities; the opportunity to be involved with the members of their community inside and outside the nursing care facility; and treatment with dignity and respect.
7.3 PRESSURE ULCER PREVENTION AND CARE A) Upon admission, the facility shall: 1) Assess the potential for skin breakdown during the initial resident assessment; and2) Provide measures to prevent pressure ulcers in residents identified as being at risk of developing them (i.e., a resident exhibiting three or more of the following symptoms: underweight, incontinence, dehydration, disorientation or unconsciousness, or limited mobility).B) For all residents who are admitted with or develop pressure ulcers, the facility shall: 1) As part of the requisite care plan, develop an individualized treatment plan that is designed to alleviate the condition;2) Provide active treatment to improve the condition in accordance with the treatment plan;3) Evaluate the resident's progress and treatment at least weekly and revise the treatment plan as needed; and4) Provide proper nutrition and hydration to promote healing and prevent further breakdown.7.4 ACCIDENT PREVENTION AND ATTENTION The facility shall:A) Investigate all causes of accidents;B) Monitor the resident's response to the accident and obtain a physical and/or mental health evaluation from a practitioner, if needed;C) Identify all residents at high risk for accidents and develop an individualized care plan for each of them to prevent future accidents; andD) Evaluate and revise the plan as needed.7.5 BEHAVIORAL HEALTH CAREA) For residents with behavioral health issues, the facility shall:1) Note the behavioral issue and evaluate it in the resident's assessment;2) Develop and implement an individualized treatment plan designed to address the behavioral health issue;3) Obtain a mental health evaluation in appropriate cases; and4) Evaluate the resident's progress and revise the plan, both as needed and whenever there is a change in the resident's behavioral condition.B) For residents receiving medication for behavior modification, the facility shall indicate in the health information record positive and/or negative effects of the medication and what alternatives to the medication were considered.7.6 CONTRACTURE CARE A) Upon admission, the facility shall: 1) Assess the potential for contracture during the initial resident assessment; and2) Develop, implement and periodically evaluate an individualized treatment plan to prevent contractures for residents identified as being at risk of developing them. a) Such plans shall be reviewed and revised as needed and annually.B) For residents who are admitted with contractures, the facility shall:1) Document the contracture, evaluate it and undertake restorative nursing intervention, if appropriate.C) For residents who develop contractures during their residency, the facility shall: 1) Document that appropriate intervention was performed to treat the condition before the contracture developed. a) If the resident refused treatment or preventive measures, the facility shall document the refusal and that the consequences of the refusal were explained to the resident.7.7 PROMOTION OF MOBILITY The facility shall assess each resident's ambulation potential and capability upon admission, quarterly and upon a change in condition. Each resident's care plan shall be designed to encourage mobility and revised as needed.
A) For residents requiring adaptive devices and/or personal assistance to ambulate, the facility shall provide and maintain such devices according to the manufacturer's recommendations. The facility shall also assist residents in obtaining appropriate footwear and provide residents with assistance to move and transfer.7.8 INDWELLING URINARY CATHETER CAREA) For residents with an indwelling urinary catheter, the facility shall: 1) Evaluate appropriateness of continued use at least monthly;2) Assess the reason for the incontinence;3) Evaluate the potential of bladder retraining and implement retraining, if indicated, or document the reasons if retraining was not indicated; and4) Implement any practitioner order for irrigation or catheter replacement.B) For residents exhibiting signs or symptoms of urinary tract infection, the facility shall notify the practitioner, obtain orders for treatment and implement such treatment plan.7.9 WEIGHT CHANGES For residents with weight changes the facility shall:
A) Evaluate the resident to determine the cause of the weight change;B) Develop and implement an individualized plan of care as part of the requisite care plan that includes intervention by other disciplines, if appropriate; evaluate resident progress and revise the plan as needed;C) Observe food and fluid intake and provide encouragement to residents with eating issues;D) Provide reasonable choices of foods to meet personal preferences and religious needs;E) If nourishments are provided between meals and at bedtime as part of the care plan, document the nourishments provided and whether they are consumed;F) Provide assistance in eating or adaptive eating devices and assist residents in obtaining dentures or dental care, as appropriate to the individual resident; andG) For residents with mouth or gum issues, meet the requirements of section 12 on dental services.7.10 GROOMING A) The facility shall assist the resident to obtain appropriate personal care materials and assist with personal care in a manner that preserves resident dignity and privacy.B) For residents with inappropriate, unclean, or poorly maintained clothing and/or assistive devices, the facility shall assist the residents to obtain clothing, shoes and devices. Such clothing, shoes and devices shall fit properly, be clean and in good repair.7.11 EXCORIATION PREVENTION AND CAREA) For all residents who are incontinent or immobile, have impaired sensation, compromised nutritional or fluid status, or inadequate hygiene, the facility shall:1) Complete an initial skin evaluation upon admission and re-evaluate the condition as needed, but at least weekly.2) Provide measures to prevent the excoriation that include:a) Maintaining clean, dry, well lubricated skin;b) Taking incontinent residents to the bathroom on a regular individualized schedule;c) Evaluating the need for daily baths; andd) Determining potential trouble spots where microbial growth may occur (breasts, gluteal folds, skin folds).B) For residents with excoriations, the facility shall: 1) Develop and implement an individualized treatment plan as part of the care plan for the excoriation;2) Evaluate the resident's progress and review and revise the treatment plan as needed; and3) Enter a progress note at least weekly in the health information record.7.12 FLUID MANAGEMENT The facility shall provide fluid in sufficient quantities to maintain hydration and body weight. In addition, the facility shall:
A) Assess each resident's hydration needs;B) Observe and evaluate food and fluid intake daily and record and report deviations from sufficient food and fluid intake;C) Provide assistance and encouragement to residents requiring assistance to meet their food and fluid requirements; andD) Provide self-help adaptive devices and encourage use.7.13 PERSONAL ENVIRONMENT The facility shall allow for personalization of rooms through the use of residents' personal furniture, appliances, decorations, plants and memorabilia. The facility may limit the number of furniture items in resident rooms if to do so is necessary to accommodate roommate preferences, fire codes, housekeeping or safe movement in the room.
7.14 PERSONAL CHOICE The facility shall: A) Make reasonable efforts to accommodate preferences of roommate, including the right of each resident so requesting to be assigned to a room with non-smokers;B) Allow residents flexibility in times to eat main meals, consistent with requirements of section 13.2 on dietary services and with its own reasonable staffing and scheduling requirements;C) Allow residents flexibility in times to bathe, rise and retire, consistent with its own reasonable staffing and scheduling requirements; andD) Provide at least one alternative menu choice for each meal of similar nutritive value. The same alternative shall not be used for two consecutive meals.7.15 PROBLEM RESOLUTION The facility shall inform members of the resident council about grievance procedures; the name, address and phone number of the state and local Long-Term Care Ombudsman; and the address and phone number of the Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division. Staff shall assist residents in raising issues to the facility's administration or appropriate outside agencies.
7.16 RESIDENT ASSESSMENT A) Within 24 hours of admission to the nursing care facility, a licensed nurse shall collect objective and subjective data on each resident's physical, mental and functional status including strengths; impairments; rehabilitative needs; special treatments; capability for self-administration of medications; dependence and independence in activities of daily living. This information shall form the basis of the preliminary care plan.B) Within 14 days of admission, the nurse shall also collaborate with social services staff in assessing discharge potential and shall coordinate assessments with social services, dietetic and activity staff. These assessments shall form the basis of the interdisciplinary care plan required by section 7.21. 1) The continuing assessment shall reflect resident status.2) The assessment shall be updated at least every three months, as well as whenever a significant change of resident condition occurs.3) The current resident assessment shall be a part of the resident's health information record and available for direct care staff and others as identified by facility policy.7.17 NURSING CARE PLANNING Under the direction of a registered nurse, an individualized nursing care plan shall be prepared for each resident based on the resident assessment and applicable practitioner treatment orders. The purpose of the care plan is to create an individualized tool for carrying out preventive, therapeutic, and rehabilitative nursing care.
A) Within 24 hours of admission, nursing staff shall prepare and implement a preliminary nursing care plan to meet each resident's immediate needs.B) Within 21 days of admission, nursing staff shall prepare and implement a comprehensive nursing care plan for each resident.C) The nursing care plan shall meet each resident's unique needs, problems and strengths by identifying resident strengths, needs and problems; specifying care interventions to capitalize on the strengths and meet those needs or problems; and defining the frequency of each intervention.D) The nursing care plan shall be current and evaluated and revised following each assessment and whenever the resident's condition changes.7.18 SOCIAL SERVICES CARE PLANNING Social services staff shall assess the social services needs of each resident within 14 days of admission. Within 21 days of admission, staff shall develop a social services care plan to meet each resident's needs.
7.19 ACTIVITIES CARE PLANNING Each resident shall be assessed for activity involvement within 14 days of admission. Within 21 days of admission, the facility shall develop an activities care plan to meet each resident's needs.
7.20 NUTRITIONAL CARE PLANNING A) The dietary supervisor or consultant shall prepare an initial nutritional history and assessment for each resident within 14 days of admission that includes special needs, likes and dislikes, nutritional status and need for adaptive cutlery and dishes.B) Within 21 days of admission, the dietary supervisor or consultant shall develop a nutritional plan of care to meet each resident's identified needs.C) In the event the facility elects to utilize feeding assistants pursuant to section 14 of this chapter, the interdisciplinary team shall, as part of the history and assessment required in section 7.16 , evaluate each resident for his/her need for assistance with eating and drinking. Such evaluation shall include, but need not be limited to, the resident's level of care, functional status concerning feeding and hydration, and ability to cooperate and communicate with staff.7.21 INTERDISCIPLINARY CARE PLANNING Within 21 days of admission, a nursing care facility interdisciplinary team shall develop a personalized overall care plan for each resident based on the resident assessments and applicable practitioner orders.
A) The overall care plan shall contain a list of resident problems and the discipline that will address each problem in its own more detailed plan of care.B) The overall care plan shall be evaluated according to the goals set out in the plan, following each assessment and whenever the resident's condition changes.C) The interdisciplinary team shall consist of representatives of resident services inside and outside the facility, as appropriate, including at least nursing, social services, activities and dietetic staff. Representatives from other areas such as medical, pharmacy and special therapies, shall be included as appropriate. Residents and resident representatives shall be invited to participate in care planning. Refusal to participate shall be documented.