175 Neb. Admin. Code, ch. 15, § 010

Current through September 17, 2024

Section 175-15-010 - STANDARDS OF OPERATION AND CARE

To provide adequate protection to consumers and to be in compliance with state statutes, all respite care services must meet the following requirements:

010.01LICENSEE. The licensee must determine, implement, and monitor policies to assure that the service is administered and managed appropriately. The licensee's responsibilities include:

(A) Maintain the respite care service's compliance with all applicable state statutes and relevant rules and regulations;

(B) Ensure the quality of all services and care provided to consumers, whether furnished by the respite care service staff or through contract with the respite care service;

(C) Ensuring consumers are provided with a stable and supportive environment, through respect for the rights of consumers and responsiveness to consumer needs;

(D) Ensuring that staff levels are sufficient to meet the consumers' needs;

(E) Monitoring policies and procedures to assure the appropriate administration and management of the respite care service; and

(F) Designating an administrator who is responsible for the day to day management of the respite care service and defining the duties and responsibilities of the Administrator in writing.

010.02ADMINISTRATOR. The licensee must designate an administrator and a backup administrator to be in charge of the day-to-day operation of the respite care service. In a freestanding respite care service site, the administrator or backup administrator must be onsite during the hours of operation. The administrator is responsible for planning, organizing, and directing the day to day operation of the respite care service. The administrator must report all matters related to the maintenance, operation, and management of the respite care service and be directly responsible to the licensee or to the person, or persons, delegated governing authority by the licensee. The administrator's responsibilities include:

(A) Being responsible for the respite care service's compliance with rules and regulations;

(B) Being responsible for the respite care service's promotion of consumer self-direction and participation in decisions which incorporate independence, individuality, privacy, and dignity;

(C) Maintaining sufficient number of staff with appropriate training and skills to meet consumers' needs as defined in the consumer's agreement of participation and service plan;

(D) Providing written personnel policies, job descriptions, and current service policies and procedures all of which are consistent with prevailing professional and practice standards and that are made available to all personnel;

(E) Maintaining personnel and administrative records;

(F) Providing orientation for new staff, schedule in-service education programs and opportunities for continuing education for the staff;

(G) Designating a backup administrator to act in the administrator's absence who must be responsible for and accountable for management of the respite care service;

(H) Monitoring that agreements of participation and service plans are established, implemented, and revised, as necessary, to meet the consumers' needs;

(I) Monitoring staff, including contracted staff, identify and review incidents and accidents, consumer complaints and concerns, patterns and trends in overall operation such as provisions of consumer care, treatment and service, and take action to alleviate problems and prevent recurrence;

(J) Developing procedures that require the reporting of any evidence of abuse, neglect or exploitation of any consumer served by the respite care service in accordance with Neb. Rev. Stat. § 28-372 of the Adult Protective Services Act or in the case of a person under the age of 18, in accordance with Neb. Rev. Stat. § 28-711;

(K) Ensuring an investigation is completed on suspected abuse, neglect, exploitation, or misappropriation of money or property and take action to prevent recurrence until the investigation is completed;

(L) Ensuring written policies, procedures and forms are individualized for the respite care service and contain effective dates and revisions dates;

(M) Ensuring the respite care service maintains a copy of all active policies, procedures and forms which are available for staff use; and

(N) Ensuring the respite care service maintains a copy of all inactive policies, procedures and forms for a minimum of 7 years after the document becomes inactive.

010.03STAFF REQUIREMENTS. A sufficient number of staff with the required training and skills necessary to meet the consumers' requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision, and support health and safety must be maintained. Care to consumers must be provided in a safe and timely manner.

010.03(A)EMPLOYMENT ELIGIBILITY. Each licensee must maintain evidence of the following:

010.03(A)(i)CRIMINAL BACKGROUND CHECKS. Complete pre-employment criminal background checks are done on each direct care staff member through a governmental law enforcement agency or a private entity that maintains criminal background information.

010.03(A)(ii)REGISTRY CHECKS. A check is completed for each direct care staff for adverse findings on the following Nebraska registries:

(1) Nurse Aide Registry;

(2) Adult Protective Services Central Registry;

(3) Central Register of Child Protection Cases; and

(4) Sex Offender Registry.

010.03(A)(iii)HIRING DECISIONS. The licensee must:

(1) Determine how to use the criminal background and registry information, except for the Sex Offender Registry and Nurse Aide Registry, in making hiring decisions;

(2) Decide whether employment can begin prior to receiving the criminal background and registry information; and

(3) Document any decision to hire a person with a criminal background or adverse registry findings, except for the Sex Offender Registry and the Nurse Aide Registry. The documentation must include the basis for the decision and how it will not pose a threat to consumer safety or consumer property.

010.03(A)(iv)ADVERSE FINDINGS. The licensee must not employ a person with adverse findings on the Sex Offender Registry or on the Nurse Aide Registry regarding consumer abuse, neglect, or misappropriation of property.

010.03(A)(v)HEALTH STATUS. Written policies and procedures must be implemented and revised, as necessary, regarding the health status of staff to prevent transmission of disease to consumers. The licensee:

(1) Must complete a health screening for each staff person prior to the staff person having contact with or providing direct care, treatment, or services for consumers; and

(2) May, in its discretion, based on the health screening, require a staff person to have a physical examination.

010.03(B)STAFF TRAINING. The licensee must provide staff with sufficient training to meet consumer needs for care.

010.03(B)(i)ORIENTATION. The licensee must provide staff with orientation prior to staff having direct responsibility for care and services to consumers. The training must include:

(1) Job duties and responsibilities;

(2) Consumer rights;

(3) Consumer service agreements;

(4) Infection control practices including hand washing techniques, personal hygiene, and disposal of infectious material;

(5) Information on any physical and mental special care needs of the consumers;

(6) Emergency procedures and information regarding advance directives;

(7) Information on abuse, neglect, and misappropriation of money or property of a consumer and reporting procedures; and

(8) Disaster preparedness plans.

010.03(B)(ii)ONGOING TRAINING. Ongoing in-services or continuing education for staff must be provided. A record of such education must be maintained and include the date of the training, the topic, and participants.

010.03(C)EMPLOYMENT RECORD. A current employment record must be maintained for each staff person. The record must contain at a minimum, information on orientation, in-services, employment eligibility information, and health history screening.

010.03(D)STAFFING RESOURCES. Written policies and procedures must be implemented and revised, as necessary, to provide appropriate supervision of consumers. Staffing resources and training must be sufficient to meet the level of supervision and provision of care, treatment, and services necessary to meet the consumers' needs and are provided in a safe and timely manner. Services must meet the needs of the consumer and be provided in accordance with instructions and directions from the caregiver.

010.03(D)(i)SUPERVISION. The licensee must establish, implement, and revised, as necessary, policies and procedures regarding appropriate consumer supervision.

010.04CONSUMER RIGHTS. Consumer's rights must be protected and promoted. Written policies and procedures must be implemented and revised, as necessary, to ensure consumers are given the opportunity to exercise his or her rights. At a minimum, each consumer must have the right to:

(A) Respectful and safe care by competent personnel;

(B) Be free from abuse, neglect, exploitation, and to be treated with dignity;

(C) Receive respite care services without discrimination based upon race, color, religion, sex, age, ancestry, or national origin;

(D) Confidentiality of all records, communications, and personal information;

(E) Be free of chemical and physical restraints;

(F) Voice complaints or grievances and suggest changes without fear of reprisal; and

(G) Be informed of changes in policies, procedures, and charges for care, treatment, and services.

010.05DESIGNEE AND CAREGIVER RIGHTS. Each designee or caregiver must have the right to:

(A) Be informed of any changes in the respite care service description as indicated in 175 NAC 15-010.07;

(B) Voice complaints without discrimination or reprisal against themselves or the consumer and have those complaints addressed;

(C) Be informed of consumer and designee or caregiver rights during admittance; and

(D) Be informed of changes in policies, procedures, and charges for care, treatment, and services.

010.06DESIGNEE RIGHTS. Each designee must have the right to formulate advance directives and have the licensee comply with the directives unless the licensee notifies the consumer or designee of an inability to do so as required by law.

010.07SERVICE DESCRIPTION. A written description which explains the range of respite care services that can be provided must be available to staff, consumers, caregivers, designees, and members of the public. The description must include the following:

(A) Goals and objectives of the licensee;

(B) Hours and days when care is provided;

(C) Description of the types of consumers to be served, including age, sex, care needs, and any other relevant characteristics;

(D) Composition of staff and his or her qualifications;

(E) Job responsibilities of staff; and

(F) The system used for the reporting, investigating, and resolving allegations of consumer abuse, neglect, and exploitation.

010.08ADMISSION, EVALUATION, ASSESSMENT, AND DISCHARGE OF CONSUMERS. Written policies and procedures must be implemented and revised, as necessary, for consumer admission and discharge, consumer evaluation, and development of a written, consumer-specific agreement of participation and service plan. The plan must be developed with consumer or designee participation.

010.08(A)ADMISSION CRITERIA AND DECISIONS. The licensee must have written criteria for admission that includes each level and components of care, treatment and services provided. The decision to admit a consumer must be is based upon the admission criteria and the capability to meet the identified needs of the consumer.

010.08(B)AGREEMENT OF PARTICIPATION. The license must develop and have an agreement of participation with the consumer or designee. This agreement must be updated, as needed, to ensure it meets the consumers' needs. This agreement must meet the following requirements:

(i) The service to be provided within the scope of the respite care service; and

(ii) The responsibilities of the consumer or designee.

010.08(C)SERVICE PLAN. The licensee must evaluate each consumer, and when necessary have the consumer assessment by a licensed professional of the appropriate discipline, and must have a written service plan which identifies how care, treatment, and services are to be provided to the consumer by the licensee to meet the consumers' needs. The service plan must be updated, as needed, to ensure it meets the consumers' needs. The service plan must have a strategy for addressing care, treatment, and services to meet those needs within the scope of the respite care service and must address the following basic needs of the consumer:

(i) Health;

(ii) Psychosocial; and

(iii) Functional.

010.08(D)DISCHARGE CRITERIA AND DECISIONS. The licensee must have written criteria for the discharge of consumers. The decision to discharge a consumer must be based upon the licensee's discharge criteria.

010.09ADMINISTRATION OR PROVISION OF MEDICATIONS. Consumers must receive medications only as legally prescribed by a medical practitioner in accordance with the 5 rights and with prevailing professional standards.

010.09(A)METHODS OF ADMINISTRATION OF MEDICATION. When the licensee is responsible for the administration of medication, it must be accomplished by the following methods:

010.09(A)(i)SELF-ADMINISTRATION OF MEDICATIONS. Consumers may be allowed to self-administer medications, with or without visual supervision, when the licensee determines that the consumer is competent and capable of doing so and has the capacity to make an informed decision about taking medications in a safe manner. Written policies and procedures must be implemented and revised, as necessary, regarding self-administration of medication and must include the following:

(1) Storage and handling of medications

(2) The licensee's written determination that the consumer may self-administer medication in the consumer's individualized service plan; and

(3) Monitoring the consumer's individualized service plan to assure continued safe administration of medications by the consumer.

010.09(A)(ii)LICENSED HEALTH CARE PROFESSIONAL. When the licensee uses a licensed health care professional for whom medication administration is included in the scope of practice, the licensee must ensure the medications are properly administered in accordance with prevailing professional standards and state and federal law.

010.09(A)(iii)PROVISION OF MEDICATION BY A PERSON OTHER THAN A LICENSED HEALTH CARE PROFESSIONAL. When the licensee uses a person other than a licensed health care professional in the provision of medications, the licensee must only use individuals who are registered medication aides and must comply with the regulations set out in 175 NAC 95 and 175 NAC 96.

010.09(B)MAINTAIN OVERALL SUPERVISION, SAFETY, AND WELFARE OF CONSUMERS. When the licensee is not responsible for medication administration or provision, the licensee still retains responsibility for overall supervision, safety, and welfare of the consumer.

010.09(C)REPORTING OF MEDICATION ERRORS AND ADVERSE REACTIONS TO A MEDICATION BY THE CONSUMER. When the licensee provides for medication administration or provision, the licensee must implement, and revise, as necessary, policies and procedures for reporting any adverse reactions to a medication by a consumer and any medication errors in administration or provision of any medications to the consumer. Such reports must be made to the consumer, the consumer's designee, and the consumer's licensed practitioner immediately upon discovery and a written report of the adverse reaction and medication error prepared. Errors must include any variance from the 5 rights and any variance between the prescription and the administration or provision of the medication.

010.09(D)STORAGE OF MEDICATION. Except when the respite care service is provided in the consumer's home, all medications must be stored in locked areas and stored in accordance with the manufacturer's instructions for temperature, light, humidity, or other storage instructions. If children under the age of 13 are being served, all medications must be locked.

010.09(E)ACCESS TO MEDICATION. Except when the respite care service is provided in the consumer's home, the licensee must only permit authorized staff who are designated by the licensee to be responsible for administration or provision of medications have access to medications.

010.09(F)MEDICATION RECORD. The licensee must maintain medication records with sufficient detail to assure that:

(i) Consumers receive the medications authorized by a licensed health care professional;

(ii) The respite care service is alerted to theft or loss of medication; and

(iii) An individual medication administration record is maintained for each consumer.

This record must include:

(1) Identification of the consumer;

(2) Name of the medication given;

(3) Date, time, dosage and method of administration for each medication administered or provided;

(4) Identification of the person who administered or provided the medication;

(5) Any refusal by the consumer; and

(6) Consumer's medication allergies and sensitivities, if any.

010.09(G)DISPOSAL OF MEDICATIONS. The licensee must destroy medications that are discontinued by the licensed health care professional and those medications which are beyond the expiration date. The licensee must develop, implement, and revise, as necessary, policies and procedures to identify who will be responsible for disposal of medications and how disposal will occur in compliance with state and federal law.

010.10FOOD SERVICE. Food must be served as specified in the consumer service plan, agreement of participation, and may include special diets. When the licensee provides food service, meals and snacks must be appropriate to the consumer's needs and preferences, and must meet daily nutritional requirements.

010.10(A)MENUS. When the licensee provides food service, menus must be planned and written based on the Food Guide Pyramid, or equivalent, and modified to accommodate special diets and texture adaptations as needed by the consumers. Menus must be made accessible to consumers, caregivers, and designees.

010.10(B)FOOD SAFETY. The licensee must store, prepare, protect, serve and dispose of food in a safe and sanitary manner and in accordance with the Food Code. If consumers are involved in food service, the licensee must train consumers on food safety.

010.11CONSUMER INFORMATION. The licensee must obtain written, accurate consumer information from the consumer and caregiver. The licensee must ensure a permanent record for all consumers. The record must be established prior to the provision of care, treatment, or services for each consumer and contain documentation completed immediately after the provision of such.

010.11(A)RECORDS. Consumer records must contain information as required in 175 NAC 1 and the following additional information:

(i) Significant medical conditions;

(ii) Medications and any special diet;

(iii) Designated physician or registered nurse;

(iv) Consumer's agreement of participation;

(v) Consumer's service plan;

(vi) Any unusual event or occurrence; and

(vii) Daily documentation of assistance with activities of daily living, personal care, health maintenance activities, or supervision, when provided for the consumer.

010.11(B)CONSUMER IDENTIFICATION. The licensee must implement, and revise, as necessary, a system for identifying a consumer when there are multiple consumers at a site.

175 Neb. Admin. Code, ch. 15, § 010

Adopted effective 5/5/2024