175 Neb. Admin. Code, ch. 17, § 006

Current through June 17, 2024

Section 175-17-006 - STANDARDS OF OPERATION, CARE AND TREATMENT

Each Intermediate Care Facility for Individuals with Intellectual Disabilities must be organized, managed and administered in a manner by the licensee consistent with the size, resources, and type of services provided to ensure each client receives appropriate care and treatment in a safe manner and in accordance with current standards of practice. Each Intermediate Care Facility for Individuals with Intellectual Disabilities must meet the regulations identified in 175 NAC 1, this chapter, and must satisfy all the elements of the Centers for Medicare and Medicaid (CMS) Conditions of Participation for an Intermediate Care Facility for Individuals with Intellectual Disabilities as set out in 42 Code of Federal Regulations (CFR) 483.150 - 483.480, the Conditions of Coverage for Emergency Preparedness Requirements for an Intermediate Care Facility for Individuals with Intellectual Disabilities, and the State Fire Code and Life Safety Code.

006.01LICENSEE RESPONSIBILITIES. The licensee has the legal responsibility for the total operation of the facility. The responsibilities of the licensee include:

(A) Monitoring policies to assure the appropriate administration and management of the Intermediate Care Facility for Individuals with Intellectual Disabilities;

(B) Ensuring the Intermediate Care Facility for Individuals with Intellectual Disabilities is in compliance with all applicable and state and federal statutes and rules and regulations;

(C) Ensuring quality services are provided to all clients whether services are furnished directly by the facility or through contract with another entity;

(D) Periodically reviewing reports and recommendations regarding the Quality Assurance Performance Improvement (QAPI) program and implementing programs and policies to maintain and improve the quality of services;

(E) Designating an administrator who is responsible for the day to day management of the Intermediate Care Facility for Individuals with Intellectual Disabilities and defining the duties and responsibilities of the administrator in writing;

(F) Notifying the Division of Public Health in writing within 5 working days when a vacancy in the administrator position occurs including who will be responsible for the position duties until another administrator is appointed; and

(G) Notifying the Division of Public Health in writing within 5 working days when the vacancy of the administrator position is filled including the effective date and name of the person appointed.

006.02ADMINISTRATION. The administrator is responsible for planning, organizing, and directing the operation of the Intermediate Care Facility for Individuals with Intellectual Disabilities. The administrator must report in all matters related to maintenance, operation, and management of the Intermediate Care Facility for Individuals with Intellectual Disabilities to the licensee and be responsible to the licensee. The administrator's responsibilities include:

(1) Ensuring that the facility protect and promote the health, safety, and well-being of the individuals;

(2) Maintaining staff appropriate to meet individuals' needs;

(3) Designating a substitute, who is responsible and accountable for management of the ICF/ID, to act in the absence of the administrator;

(4) Developing procedures which require the reporting of any evidence of abuse, neglect, or exploitation of any individual served by the facility in accordance with Neb. Rev. Stat. § 28-372 of the Adult Protective Services Act or in the case of a child, in accordance with Neb. Rev. Stat. § 28-711.

006.02(A)REPORTING. Each licensee must ensure that any incident where staff has reason to believe that abuse, neglect, or exploitation of a client has occurred is reported to:

(i) The Adult and Child Abuse and Neglect Hotline via telephone immediately; and

(ii) Local law enforcement as required by state and federal laws.

006.02(B)INVESTIGATION. Each must ensure any incident where staff has reason to believe that abuse, neglect, or exploitation of a client has occurred is thoroughly investigated and the investigation documented in a written report. Within 5 working days of the incident, the facility must submit the written investigative report to the Division of Public Health.

006.02(C)PROTECTION. Each licensee must ensure that clients are protected throughout the investigation. Actions must be taken as a result of the investigation to ensure client safety and to prevent the potential for recurrence.

006.03STAFF REQUIREMENTS. The licensee must ensure all persons who provide a service to clients meet applicable state laws. The licensee must ensure that all persons for whom a license, certification or registration is required hold the license, certification or registration in accordance with applicable state laws. Staff may not provide care or treatment that is outside of the scope of practice permitted by the credential held by the individual.

006.03(A)STAFF CREDENTIALS. Each licensee must verify and maintain evidence of the current, active licensure, registration, certification or other credential for each staff member. This must include, but is not limited to, verification prior to staff assuming assigned job duties; and evidence that such status is checked and maintained throughout the entire time of employment.

006.03(B)CRIMINAL BACKGROUND AND REGISTRY CHECKS. Criminal background and registry checks must be completed prior to employment for each licensed and unlicensed direct care staff members. Documentation of such check must be retained in each staff member's personnel file for the duration of employment.

006.03(B)(i)CRIMINAL BACKGROUND CHECKS. Criminal background checks must be completed through a governmental law enforcement agency or a private entity that maintains criminal background information.

006.03(B)(ii)REGISTRY CHECKS. A check 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) Nebraska State Patrol Sex Offender Registry.

006.03(B)(iii)COMPLIANCE. The licensee must:

(1) Not employ staff with a conviction or prior employment history of child or vulnerable adult abuse, neglect, or mistreatment or with adverse findings on the Nurse Aide Registry regarding abuse or neglect of individuals served, or misappropriation of the property of individuals served;

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

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

006.04ADMINISTRATION OF MEDICATION. individuals must receive medications only as legally prescribed by a medical practitioner in accordance with the five rights and prevailing professional standards.

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

006.04(A)(i)SELF ADMINISTRATION. Individuals must be permitted to self-administer medications if desired, with or without supervision, when the interdisciplinary team has determined the individual is capable of doing so safely. When individuals self-administer medication, the licensee maintains responsibility for the overall supervision, safety and welfare of the individual.

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

006.04(A)(iii)PERSONS OTHER THAN A LICENSED HEALTH CARE PROFESSIONAL. When persons other than a licensed health care professional are used in the provision of medications, the licensee must only use individuals who are registered medication aides and must comply with 172 NAC 95 and 172 NAC 96.

006.04(B)HANDLING OF MEDICATIONS. The licensee must ensure clients receive medications as prescribed by a medical practitioner. There must be a method for verifying the identity of each client and the following:

(i) Medications sent with a client for temporary absences from the premises are in containers identified for the client;

(ii) Medications must be sent with a client upon discharge upon client request;

(iii) Medications authorized for one client must not be used for another client or staff;

(iv) Any errors in administration or provision of prescribed medications must be reported to the client's licensed health care professional in a timely manner upon discovery and a written report of the error prepared; and

(v) Any adverse reaction to a medication must be reported immediately upon discovery to the client's licensed health care professional and recorded in the client's record.

006.04(C)DISPOSAL OF MEDICATIONS. Medications that are discontinued by the medical practitioner, and those medications which are beyond their expiration date, must be destroyed. The facility must identify who will be responsible for disposal of medications and the method to dispose of medications in a timely and safe manner. Documentation of the destruction of medications must be retained for a minimum of 5 years.

006.05ADMISSION AND RETENTION. Written policies and procedures must be implemented and revised, as necessary, for admission and retention to ensure admission only of clients who have developmental disabilities or related conditions who are in need of an active treatment program; and retention only of such clients unless the following exception applies to the client.

006.05(A)EXCEPTION. If the licensee chooses to participate in providing services to individuals who meet the exception to the retention requirements, the licensee must implement and revise, as necessary, written policies and procedures to address the retention of individuals who have been receiving and benefiting from active treatment in the Intermediate Care Facility for Individuals with Intellectual Disabilities and who have developed conditions where they no longer can benefit from an active treatment program. These conditions are associated with aging, dementia, decline in health, and terminal illness. The facility must ensure the following:

(i) Documentation from the individual's attending physician that the transfer or discharge of the individual would be harmful to the individual's physical, emotional, or mental health;

(ii) Current and accurate assessments relevant to the individual's condition and needs;

(iii) The individual program plan or plan of care must document:

(1) The continued stay is in the best interest of the individual, and that transfer or discharge would be harmful to the individual;

(2) The interdisciplinary team rationale for the decision for continued stay;

(3) The specific current needs of the individual; and

(4) The plan and treatment approach to address the individual's current needs and conditions;

(iv) The licensee must provide services to meet the individual's current needs and condition(s); and

(v) The licensee must primarily serve individuals who are receiving and benefiting from an active treatment program.

175 Neb. Admin. Code, ch. 17, § 006

Amended effective 5/5/2024