175 Neb. Admin. Code, ch. 18, § 006

Current through September 17, 2024

Section 175-18-006 - STANDARDS OF OPERATION, CARE, AND TREATMENT

Each mental health substance use treatment center must be organized, managed, and administered in a manner consistent with the size, resources, and type of services provided to ensure each client receives necessary care and treatment in a safe manner and in accordance with current standards of practice, and in accordance with the Healthcare Facility Licensure Act, 175 NAC 1, and this chapter.

006.01LICENSEE. The licensee must establish, implement, and revise as necessary written policies and procedures to assure that the mental health substance use treatment center is administered and managed appropriately. The licensee's responsibilities include:

(A) Monitoring policies to assure appropriate administration and management of the facility;

(B) Ensuring the facility's compliance with all applicable state statutes and relevant rules and regulations;

(C) Ensuring the quality of all services, care, and treatment provided to clients whether those services, care, or treatment are furnished by facility staff or through contract with the facility;

(D) Designating an administrator who is responsible for the day to day management of the facility;

(E) Defining the duties and responsibilities of the administrator in writing;

(F) Notifying the Department in writing within 5 working days when a vacancy in the administrator position occurs, including who will be responsible for the position until another administrator is appointed;

(G) Notifying the Department in writing within 5 working days when the administrator vacancy is filled indicating effective date and name of person appointed administrator;

(H) Ensuring clients are provided with a stable and supportive environment, through respect for the rights of clients and responsiveness to client needs;

(I) Receiving periodic reports and recommendations regarding the quality assurance performance improvement program;

(J) Implementing programs and policies to maintain and improve the quality of client care and treatment based on quality assurance performance improvement reports; and

(K) Ensuring that staff levels are sufficient to meet the client's needs.

006.02ADMINISTRATION. The administrator is responsible for planning, organizing, and directing the day to day operation of the mental health substance use treatment center. The administrator must report and be directly responsible to the licensee in all matters related to the maintenance, operation, and management of the facility. The administrator's responsibilities include:

(A) Being on the premises a sufficient number of hours to permit adequate attention to the management of the facility, ensuring the facility's compliance with applicable rules and regulations;

(B) Ensuring that the facility protects and promotes the client's health, safety, and well-being;

(C) Maintaining staff appropriate to meet clients' needs;

(D) Designating a substitute administrator, who is responsible and accountable for management of the facility, to act in the absence of the administrator;

(E) Developing and implementing procedures which require the reporting of any evidence of abuse, neglect, or exploitation of any client 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; and

(F) Ensuring the facility conducts a thorough investigation on suspected abuse, neglect, or exploitation and that steps are taken to prevent abuse and neglect and protect clients.

006.03STAFFING. The mental health substance use treatment center must maintain a sufficient number of staff with the required training and skills necessary to meet the client population's requirements for care and treatment, including needs for therapeutic activities, supervision, support, health, and safety needs. The facility must provide care and treatment to clients in a safe and timely manner.

006.03(A)STAFF CREDENTIALS. Each mental health substance use treatment center must establish, implement, and revise as necessary written policies and procedures to verify and maintain evidence of the current, active licensure, registration, certification or other credential for each staff member in accordance with applicable state law. 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)HEALTH STATUS. The mental health substance use treatment center must establish, implement, and revise as necessary, policies and procedures regarding the health status of staff who provide direct care or treatment to clients to prevent the transmission of infectious disease. The facility:

(i) Must complete a health screening for each staff person prior to assuming job responsibilities; and

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

006.03(C)STAFF TRAINING. The mental health substance use treatment center must provide staff with sufficient initial and ongoing training to meet client needs. Training must be provided by a person qualified by education, experience, and knowledge in the area of the service being provided. A record must be kept of all training including orientation, in-service, or other training programs including names of staff attending, subject matter of the training, names and qualifications of the instructors, dates of the training, length of training sessions and any written materials provided.

006.03(D)INITIAL ORIENTATION. The mental health substance use treatment center must provide staff with orientation prior to the staff person having direct responsibility for care and treatment of clients. The training must include:

(i) Client rights;

(ii) Job responsibilities relating to care and treatment programs and client interactions;

(iii) Emergency procedures including information regarding availability and notification;

(iv) Information on any physical and mental special needs of the clients of the facility; and

(v) Information on abuse, neglect, and misappropriation of money or property of a client and the reporting procedures.

006.03(E)ONGOING TRAINING. The mental health substance use treatment center must provide each staff person ongoing training in topics appropriate to the staff person's job duties, including meeting the needs, preferences, and protecting the rights of the clients in the facility.

006.03(F)DOCUMENTATION. The mental health substance use treatment center must maintain written documentation in each employee's file:

(i) To support facility decisions regarding staffing of the facility, staff credentials, and staff health status; and

(ii) Regarding staff orientation and ongoing training.

006.03(G)CRIMINAL BACKGROUND AND REGISTRY CHECKS. Each mental health substance use treatment center must complete and maintain documentation of pre-employment criminal background and registry checks on each unlicensed direct care staff member.

006.03(G)(i)CRIMINAL BACKGROUND CHECKS. The mental health substance use treatment center must complete criminal background checks through a governmental law enforcement agency or a private entity that maintains criminal background information.

006.03(G)(ii)REGISTRY CHECKS. The mental health substance use treatment center must check for adverse findings on the following 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(G)(iii)ADVERSE FINDINGS. The mental health substance use treatment center must not employ staff with adverse findings on the Nurse Aide Registry regarding abuse or neglect of individuals served, or misappropriation of the property of clients served. The mental health substance use treatment center must:

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

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

006.04CLIENT RIGHTS. A mental health substance use treatment center must protect and promote each client's rights. This includes the establishment, implementation, and revision as necessary of written policies and procedures to ensure clients are afforded the opportunity to exercise their rights and documented evidence that all clients have been informed of their rights in a manner and format that they can easily understand. Each client must have the right to:

(A) Be informed in advance about care and treatment and of any changes in care and treatment that may affect the client's well-being;

(B) Self-direct activities and participate in decisions regarding care and treatment;

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

(D) Voice complaints and file grievances without discrimination or reprisal and to have those complaints and grievances addressed;

(E) Examine the results of the most recent survey of the facility conducted by representatives of the Department;

(F) Be free of restraints except when indicated in 175 NAC 18.006.05(A),(B),(C),(D), and (E);

(G) Be free of seclusion in a locked room, except when indicated in 175 NAC 18-006.05(A),(B),(C),(D), and (E) and except in cases of civil protective custody;

(H) Be free of physical punishment;

(I) Exercise his or her rights as a client of the facility and as a citizen of the United States;

(J) Be free from arbitrary transfer or discharge;

(K) Be free from involuntary treatment, unless the client has been involuntarily committed by appropriate court order and except in cases of civil protective custody;

(L) Be free from abuse and neglect and misappropriation of their money and personal property;

(M) Be informed prior to or at the time of admission and during stay at the facility of charges for care, treatment, or related charges;

(N) Privacy in written communication including sending and receiving mail consistent with individualized service plans (ISP);

(O) Receive visitors as long as this does not infringe on the rights and safety of other clients and is consistent with individualized service plans (ISP);

(P) Have access to a telephone where calls can be made without being overheard when consistent with individualized service plans (ISP); and

(Q) Retain and use personal possessions, including furnishings and clothing as space permits, unless to do so would infringe upon the rights and safety of other clients.

006.05RESTRAINTS AND SECLUSION. A mental health substance use treatment center must not use restraints or seclusion for clients except as set forth in this section.

006.05(A)CIVIL PROTECTIVE CUSTODY. When a client is placed at the mental health substance use treatment center under civil protective custody, in which case restraint may be used only to the extent necessary to protect the client and others from harm. The facility must comply with Building Code and Life Safety Code requirements for locked or secured environments.

006.05(B)RESTRAINT AND SECLUSION. Restraint and seclusion includes the following interventions:

(i) Seclusion;

(ii) Mechanical restraint;

(iii) Chemical restraint;

(iv) Manual restraint; and

(v) Time-out.

006.05(C)SECURED ENVIRONMENT. A mental health substance use treatment center may provide a secured and protective environment by restricting a client's exit from the facility or its grounds through the use of approved locking devices on exit doors or other closures that must be accredited by an approved qualifying organization. The approved qualifying organizations include:

(i) The Joint Commission;

(ii) Commission on Accreditation of Rehabilitation Facilities; and

(iii) Council on Accreditation for Children and Family Services.

006.05(D)USE OF RESTRAINTS AND SECLUSION IN ACCREDITED FACILITIES. A mental health substance use treatment center that is accredited by an approved qualifying organization may use restraint and seclusion methods as part of a client's treatment plan. The facility must comply with the approved qualifying organization's requirements for initiation and continued use of restraint and seclusion.

006.05(E)USE OF RESTRAINTS AND SECLUSION IN NON-ACCREDITED FACILITIES. Except in the case of civil protective custody, a non-accredited mental health substance use treatment center is prohibited from using mechanical and chemical restraints and seclusion. The facility must establish alternative and less restrictive methods for staff to use in the place of restraints and seclusion to deal with client behaviors. A non-accredited mental health substance use treatment center may use manual restraint and time out as therapeutic techniques only after it has:

(i) Written policies and procedures for the use of manual restraint and time-out;

(ii) Documented physician approval of the methods used by the facility;

(iii) Trained all staff who might have the occasion to use manual restraints and time-out in the appropriate methods to use in order to protect client safety and rights; and

(iv) Developed a system to review each use of manual restraint or time-out. The facility must ensure the process includes the following:

(1) That each use of manual restraint or time-out has been reported to the administrator for review of compliance with facility procedures;

(2) That documentation of each use of manual restraint or time-out include a description of the incident and identification of staff involved;

(3) A situation where the safety of the client or others is threatened;

(4) The implementation and failure of other less restrictive behavior interventions have not been effective; and

(5) Use of manual restraints or time out only by staff who are trained.

006.06FACILITY HOUSE RULES. Except for emergency detoxification programs, the facility must develop reasonable house rules outlining operating protocols. The facility must provide the clients an opportunity to review and provide input into any proposed changes to house rules before the revisions become effective. The house rules must be:

(A) Consistent with client rights;

(B) Posted in an area readily accessible to clients; and

(C) Reviewed and updated, as necessary.

006.07CARE AND TREATMENT REQUIREMENTS. The facility must ensure that all clients receive care and treatment in accordance with the facility's program and that the facility meets each client's identified needs.

006.07(A)PROGRAM DESCRIPTION. The facility must have a written program description that is available to staff, clients, and members of the public that explains the range of care and treatment activities provided. The description must include the following:

(i) The mission statement, program philosophy, goals and objectives developed by the governing body;

(ii) The levels of care and treatment provided, including inpatient and outpatient components, when applicable;

(iii) The client population served, including age groups and other relevant characteristics;

(iv) The hours and days the facility provides care and treatment;

(v) Staff composition and staffing qualification requirements to sufficiently provide care and treatment to meet facility goals and objectives;

(vi) Staff job responsibilities for meeting care and treatment facility goals and objectives;

(vii) The admission and discharge processes, including criteria for admission and discharge;

(viii) A system of referral for alternative services for those individuals who do not meet admission criteria;

(ix) The client admission and ongoing assessment and evaluation procedures used by the program, including individualized service plan (ISP) process;

(x) A plan for providing emergency care and treatment, including use of facility approved interventions to be used by staff in an emergency situation;

(xi) Quality assurance and improvement processes, including who will be responsible for the program and how results will be utilized to improve care and treatment;

(xii) A system governing the reporting, investigation, and resolution of allegations of abuse, neglect, and exploitation; and

(xiii) Clients rights and the system for ensuring client rights will be protected and promoted.

006.07(B)ANNUAL REVIEW. The facility must review all elements of the written program description at least annually. The facility must document the results of the annual review. Relevant findings from facility's quality assurance performance improvement program for the purpose of improving client treatment and resolving problems in client care and treatment must be included in the review process. The licensee must revise the program description, as necessary, to reflect accurately care and treatment the facility is providing.

006.08CLIENT ADMISSION. The facility must ensure that its admission practices meet the client's identified needs and conform with the facility's program description.

006.08(A)ADMISSION CRITERIA. The facility must have written criteria for admission that includes each level of care and the components of care and treatment provided by the facility. The written criteria must include how eligibility for admission is determined based on:

(i) Identification of client need for care and treatment, including the severity of the presenting problem;

(ii) Rationale for determining appropriate level of care and treatment; and

(iii) Need for supervision and other issues related to providing care and treatment.

006.08(B)ADMISSION DECISIONS. The facility must ensure that the decision to admit a client is based upon the facility's admission criteria and the facility's capability to meet the identified needs of the client.

006.08(C)ADMISSION ASSESSMENT. The facility must develop an assessment of the client to identify the effects of substance abuse on the client's life, except for a client in an emergency detoxification program. The facility must complete the assessment process for each client within the following timelines within 15 days of the client admission to the facility. The assessment must include:

(i) An evaluation of the client which satisfies the facility's admission criteria;

(ii) The type and extent of any clinical examinations that were determined necessary; and

(iii) Information on associated medical and psychological issues.

006.08(D)EMERGENCY DETOXIFICATION PROGRAM. The facility must evaluate a client in an emergency detoxification program as to his or her immediate need and implement the facility's procedures for its emergency detoxification program.

006.08(E)INDIVIDUALIZED SERVICE PLAN (ISP). Each client, except for a client admitted to an emergency detoxification program, must have an individualized service plan (ISP) based on the assessment of the client's needs. The facility must assign overall responsibility for development and implementation of the individualized service plan (ISP) to a qualified staff person in accordance with facility's program description. The facility must base the intensity of care and treatment provided on the client's need. The facility must:

(i) Begin to develop the initial individualized service plan (ISP) of care upon admission;

(ii) Implement the individualized service plan (ISP) as soon as it has been established; and

(iii) Complete development of the individualized service plan (ISP) when the assessment process is finished. The individualized service plan (ISP) must:

(1) Specify the care and treatment necessary to meet the client's assessed needs;

(2) Include referrals for needed services that the facility does not provide;

(3) Contain specific goals and the measurement the client will use to achieve reduction or elimination of substance abuse;

(4) Specify the extent and frequency of care and treatment;

(5) Specify criteria to be met for termination of care and treatment;

(6) Define therapeutic activity;

(7) Document client participation in the development of the individualized service plan (ISP) by client signature and dates of participation or justification for the lack of the client's signature; and

(8) Estimate the length of stay and the plan for discharge.

006.08(F)EVALUATION OF CARE AND TREATMENT. The facility must periodically evaluate the client's individualized service plan (ISP) as indicated by the client's need and response to care and treatment. The maximum intervals between evaluations of the individualized service plan (ISP) are:

(i) Every 30 days for intensive treatment which consists of any level of inpatient treatment or outpatient treatment involving ten or more hours of therapeutic activity per week. This does not include client participation in self-help groups; and

(ii) Every 90 days for less intensive treatment which consists of less than ten hours of therapeutic activity per week either at an inpatient or outpatient facility. This does not include client participation in self-help groups.

006.08(G)CARE AND TREATMENT PROVIDED. Care and treatment must meet client needs on an ongoing basis in a manner that respects clients' rights, promotes recovery and affords personal dignity, it must also include a communication component which encompasses methods and interventions outlining how facility staff need to communicate with the client and their designee in a manner and method the patient and designee can comprehend.

006.08(G)(i)INPATIENT FACILITY. An inpatient facility must, at a minimum, provide the following:

(1) Therapeutic activities as described in the facility program description;

(2) Adequate food and shelter;

(3) Medical and clinical oversight of client needs as identified in the client assessment;

(4) Assistance and support, as necessary, to enable the client to meet personal hygiene and clothing needs;

(5) Assistance and support, as necessary, to enable the client to meet laundry needs, which may include access to washers and dryers so that clients can do their own personal laundry if included in the client's individualized service plan (ISP);

(6) Assistance and support, as necessary, to enable the client to meet his or her housekeeping needs including access to materials needed to perform his or her own housekeeping duties as determined by the client's individualized service plan (ISP); and

(7) Health-related care and treatment, as necessary.

006.08(G)(ii)EMERGENCY DETOXIFICATION PROGRAM. An inpatient facility must provide an emergency detoxification program. Beds in an emergency detoxification program must be considered inpatient beds for calculation of licensure fees. Types of emergency detoxification include:

(1) Civil protective custody which:

(a) Is involuntary;

(b) Is initiated by a law enforcement office; and

(c) Has a maximum duration of 24 hours; and

(2) Social setting emergency detoxification which:

(a) Is voluntary;

(b) Is initiated by the client or designee; and

(c) Has a maximum duration of 5 calendar days.

006.08(G)(iii)POLICIES AND PROCEDURES. A mental health substance use treatment center providing one or both types of emergency detoxification programs must have policies and procedures for the assessment, observation, and routine monitoring of clients. A licensed physician must document the appropriateness of the facility's policies and procedures. The policies and procedures must include:

(1) Recording the client's identifying information, if available;

(2) Determining the client's level of consciousness;

(3) Monitoring vital signs including temperature, respirations, pulse, and blood pressure;

(4) Observing and monitoring at specific time intervals;

(5) Determining the onset of acute withdrawal or psychiatric emergency according to methods established by the facility;

(6) Assessing the need for medical treatment and initiating appropriate, established procedures for referral to a medical facility; and

(7) Managing observation and monitoring according to methods established by the facility when the client is not cooperative.

006.09DISCHARGE AND TRANSFER REQUIREMENTS. The facility must establish discharge criteria and use those criteria in developing an appropriate plan for discharge jointly with the client. A discharge plan is not required for clients in an emergency detoxification program. The discharge plan must include:

(1) A relapse prevention plan, which includes triggers and interventions for client to activate;

(2) The client's plan for follow up, continuing care, or other post-care and treatment services;

(3) Documentation of referrals made for the client by the facility;

(4) The client's plan to further his or her recovery;

(5) The client's signature and the date; and

(6) A treatment summary that will be completed no later than 30 days after the client's discharge. The summary must include a description of the client's progress under his or her individualized service plan (ISP), the reason for discharge, and any recommendations to the client.

006.09(A)DISCHARGE AND TRANSFER CRITERIA. A facility must establish written discharge criteria which is used by the facility administrator or designee to determine appropriate discharge or transfer for each client. The criteria establishing the basis for discharge must include:

(i) Client no longer is needing or desiring services provided at the facility;

(ii) Client is requiring services or treatment not available at the facility;

(iii) Client behavior is posing a threat to the health or safety of him or herself or to others and cannot be addressed with care and treatment available at the facility;

(iv) Non-payment of fees in accordance with fee policy; and

(v) Client is violating house rules resulting in significant disturbance to other clients or members of the community.

006.09(B)DISCHARGE PLAN. Within the first 30 days of admission a discharge plan must be developed including:

(i) Plan for follow up or continuing care; and

(ii) Documentation of referrals made for the client.

006.10MENTAL AND HEALTH MANAGEMENT. The facility must offer the client medical attention when needed. Arrangements for health services must be made with the consent of the client or designee.

006.10(A)PROFESSIONAL SERVICES. The facility must arrange for licensed mental health professional services consistent to meet client population served and individual client needs on an ongoing basis.

006.10(B)EMERGENCY MEDICAL SERVICES. The facility must have a plan delineating the manner in which medical emergency services is accessed to ensure timely response to emergency situations.

006.10(C)HEALTH SCREENINGS. The facility must ensure that each client has access to a qualified health care professional who is responsible for monitoring the client's health care. Health screenings must be done in accordance with the recommendations of a qualified health care professional.

006.10(D)SUPERVISION OF NUTRITION. The facility must:

(i) Monitor clients whose assessment indicates potential nutritional problems; and

(ii) Provide care and treatment to meet the identified nutritional needs.

006.10(E)ADMINISTRATION OR PROVISION OF MEDICATIONS. Each facility must establish and implement policies and procedures to ensure that clients receive medications only as legally prescribed by a medical practitioner in accordance with the five rights and with prevailing professional standards.

006.10(E)(i)METHODS OF ADMINISTRATION OF MEDICATION. When the facility is responsible for the administration of medication, it must be accomplished as set out in this section.

006.10(E)(i)(1)SELF-ADMINISTRATION OF MEDICATIONS. Clients may be allowed to self-administer medications, with or without visual supervision, when the facility determines that the client is competent and capable of doing so and has the capacity to make an informed decision about taking medications in a safe manner. The facility must develop and implement policies to address client self-administration of medication, including:

(a) Storage and handling of medications;

(b) Inclusion of the determination that the client may self-administer medication in the client's individualized service plan (ISP); and

(c) Monitoring the plan to assure continued safe administration of medications by the client.

006.10(E)(i)(2)LICENSED HEALTH CARE PROFESSIONAL. When the facility uses a licensed health care professional for whom medication administration is included in the scope of practice, the facility must ensure the medications are properly administered in accordance with prevailing professional standards.

006.10(E)(i)(3)PROVISION OF MEDICATION BY A PERSON OTHER THAN A LICENSED HEALTH CARE PROFESSIONAL. When the facility uses a person other than a licensed health care professional in the provision of medications, the facility must follow 172 NAC 95, Regulations Governing the Provision of Medications by Medication Aides and Other Unlicensed Persons and 172 NAC 96, Regulations Governing the Medication Aide Registry.

006.10(E)(ii)SUPERVISION. When the facility is not responsible for medication administration or provision, the facility must maintain responsibility for overall supervision, safety, and welfare of the client.

006.10(F)REPORTING OF MEDICATION ERRORS. The facility must establish, implement, and revise as necessary policies and procedures for reporting errors in administration or provision of prescribed medication and adverse reactions to medication. Any variance from the five rights must be reported as an error. Reporting must be in writing to the client's medical practitioner in a timely manner upon discovery.

006.10(G)STORAGE OF MEDICATION. 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.

006.10(H)ACCESS TO MEDICATION. The facility must ensure that only authorized staff who are designated by the facility to be responsible for administration or provision of medications have access to medications.

006.10(I)AS PRESCRIBED. The facility must ensure that clients receive medications as prescribed by a medical practitioner.

006.10(J)MEDICATION RECORD. The facility must maintain records in sufficient detail to assure clients receive medications prescribed by a medical practitioner and maintain records to protect medications against theft or loss. Each client must have an individual medication administration record which includes:

(i) Identification of the client;

(ii) Name of the medication given;

(iii) Date, time, dosage, and method of administration for each medication administered or provided, and the identification of the person who administered or provided the medication and any refusal by the client; and

(iv) Client's medication allergies and sensitivities, if any.

006.10(K)DISPOSAL OF MEDICATIONS. Medications that are discontinued and medications which are beyond their expiration date, must be destroyed. The facility must develop and implement policies and procedures to identify who will be responsible for disposal of medications and how disposal will occur.

006.10(L)MEDICATION PROVISION DURING TEMPORARY ABSENCES. When a client is temporarily absent from the facility, the facility must put medication scheduled to be taken by the client in a container identified for the client.

006.11RESTRAINTS AND SECLUSION. A mental health substance use treatment center must not use restraints or seclusion for clients except as set forth in this section.

006.11(A)CIVIL PROTECTIVE CUSTODY. When a client is placed at the mental health substance use treatment center under civil protective custody, restraint may be used only to the extent necessary to protect the client and others from harm, in accordance with Neb. Rev. Stat. § 53-1,121. The facility must comply with Building Code and Life Safety Code requirements for locked or secured environments.

006.11(B)RESTRAINT AND SECLUSION. Restraint and seclusion includes the following interventions:

(i) Seclusion;

(ii) Mechanical restraint;

(iii) Chemical restraint;

(iv) Manual restraint; and

(v) Time-out.

006.11(C)SECURED ENVIRONMENT. A mental health substance use treatment center may provide a secured and protective environment by restricting a client's exit from the facility or its grounds through the use of approved locking devices on exit doors or other closures that must be accredited by an approved qualifying organization. The approved qualifying organizations include:

(i) The Joint Commission;

(ii) Commission on Accreditation of Rehabilitation Facilities; and

(iii) Council on Accreditation for Children and Family Services.

006.11(D)USE OF RESTRAINTS AND SECLUSION IN ACCREDITED FACILITIES. A substance abuse treatment center that is accredited by an approved qualifying organization may use restraint and seclusion methods as part of a client's treatment plan. The facility must comply with approved qualifying organization's requirements for initiation and continued use of restraint and seclusion.

006.11(E)USE OF RESTRAINTS AND SECLUSION IN NON-ACCREDITED FACILITIES. Except in the case of civil protective custody, a non-accredited mental health substance use treatment center is prohibited from using mechanical and chemical restraints and seclusion. The facility must establish alternative and less restrictive methods for staff to use in the place of restraints and seclusion to deal with client behaviors. A non-accredited mental health substance use treatment center may use manual restraint and time out as therapeutic techniques only after it has:

(i) Written policies and procedures for the use of manual restraint and time-out;

(ii) Documented physician approval of the methods used by the facility;

(iii) Trained all staff who might have the occasion to use manual restraints and time-out in the appropriate methods to use in order to protect client safety and rights; and

(iv) Developed a system to review each use of manual restraint or time-out. The facility must ensure the process includes the following:

(1) That each use of manual restraint or time-out has been reported to the administrator for review of compliance with facility procedures;

(2) That documentation of each use of manual restraint or time-out include a description of the incident and identification of staff involved;

(3) A situation where the safety of the client or others is threatened;

(4) The implementation and failure of other less restrictive behavior interventions; and

(5) Use of manual restraints or time out only by staff who are trained.

006.12FOOD SERVICE. When the facility provides food service, it must ensure the food is of good quality, properly prepared, and served in sufficient quantities and frequency to meet the daily nutritional needs of each client. The facility must ensure that clients receive special diets when ordered by a licensed health care professional. Food must be prepared in a safe and sanitary manner.

006.12(A)FOOD PREPARATION. If food preparation is provided on site, the facility must have dedicated space and equipment for the preparation of meals. Facilities licensed for more than 16 individuals must comply with the Nebraska Food Code

006.12(B)MENUS. The facility must ensure that menus as served are maintained for at least 14 days, and must ensure that:

(i) Meals and snacks are appropriate to the client's needs and preferences;

(ii) A sufficient variety of foods must be planned and served in adequate amounts for each client at each meal. Menus must be adjusted for seasonal changes; and

(iii) Written menus are based on the Food Guide Pyramid or equivalent and modified to accommodate special diets as needed by the client.

006.13RECORD KEEPING REQUIREMENTS. The facility must maintain complete and accurate records to document the operation of the facility and care and treatment of the clients.

006.14CLIENT RECORDS. A record must be established for each client upon admission. Each record must contain sufficient information to identify clearly the client, to justify the care and treatment provided and to document the results of care and treatment accurately. Each record must contain the following information:

(1) Dates of admission and discharge;

(2) Name of client;

(3) Gender and date of birth;

(4) Demographic information, including address and telephone number;

(5) Physical description or client photo identification;

(6) Admission assessment information and determination of eligibility for admission;

(7) Health screening information;

(8) Individualized service plans (ISP);

(9) Physician orders;

(10) Medications and any special diet;

(11) Significant medical conditions;

(12) Allergies;

(13) Person to contact in an emergency, including telephone number;

(14) Fee agreement;

(15) Documentation of care and treatment provided, client's response to care and treatment, change in condition and changes in care and treatment;

(16) Discharge and transfer information;

(17) Client rights; and

(18) Referral information.

006.15(A)DISCHARGE SUMMARY. The facility must document a summary in the client record which includes description of client's progress under the individualized service plan (ISP) and reason or reasons for discharge or transfer from the facility.

006.15(B)TIMELY TRANSFER. The facility must ensure the timely transfer of a client and must provide appropriate client record information as authorized by the client or designee by a signed release of information.

006.16CLIENT RECORD ORGANIZATION. The facility must ensure that records are systematically organized to ensure permanency and completeness.

006.17RECORD ENTRIES. All record entries must be dated, legible and indelibly verified. In the case of electronic records, signatures may be replaced by an approved, uniquely identifiable electronic equivalent.

006.18CONFIDENTIALITY. The facility must keep records confidential unless medically contraindicated. Records are subject to inspection by authorized representative of the Department.

006.19RETENTION. Client records must be retained for a minimum of two years.

006.20DESTRUCTION. Client records may be destroyed only when they are in excess of the retention requirement. In order to ensure the right of confidentiality, records must be destroyed or deposed of by shredding, incineration, electronic deletion, or another equally effective protective measure.

006.21ACCESS. Client information or records may be released only with the consent of the client or client's designee or as required by law. When a client is transferred to another facility or service, appropriate information must be sent to the receiving facility or service.

006.22ADMINISTRATIVE CHANGES. If a facility changes ownership or Administrator, all client records must remain in the facility. Prior to the dissolution of any facility, the administrator must notify the Department in writing as to the location and storage of client records.

175 Neb. Admin. Code, ch. 18, § 006

Amended effective 3/20/2024