175 Neb. Admin. Code, ch. 3, § 007

Current through September 17, 2024

Section 175-3-007 - STANDARDS OF OPERATION, CARE, AND TREATMENT

A Center for the Developmentally Disabled must be organized, managed, and administered by the licensee to ensure each client receiving services at the facility received necessary care and treatment in a safe manner, in accordance with current standards of practice, and in accordance with the Health Care Facility Licensure Act, 175 NAC 1, and this chapter.

007.01ADMINISTRATION. The licensee may be the administrator or may appoint a person to be the administrator. If the administrator is not the licensee, the administrator is directly responsible to the licensee in all matters related to the maintenance, operation, and management of the facility. The administrator is the contact person for the facility. The licensee's responsibilities include:

(A) Designating a house manager in writing;

(B) Being available or ensuring the administrator is available to the house manager at all times;

(C) Ensuring the health, safety and protection of clients residing at the facility;

(D) Maintaining compliance with all applicable state statutes, codes, rules and regulations;

(E) Notifying the Department in writing within 5 working days when:

(i) A vacancy in the administrator position occurs including the name of who will be responsible for the position until another administrator is appointed; and

(ii) A vacancy in the administrator position is filled including the effective date and name of person appointed to that position; and

(F) Establishing, implementing and revising as necessary, written policies and procedures governing the facility operations.

007.02STAFFING.

The licensee must maintain a sufficient number of staff with the required experience, orientation, training, and competency necessary to meet the care and treatment needs of clients and the operations needs of the facility.

007.02(A)PERSONNEL POLICIES. Written personnel policies and procedures must be established and made available to each employee. Personnel policies and procedures must be read by each employee upon employment and as revisions are made. Documentation of this must be maintained in the employee's personnel file. Personnel policies must address hiring, assignment and promotion of employees; grievance procedures; suspension or dismissal of an employee; and ensure that employees with symptoms or signs of communicable disease are not permitted to work.

007.02(B)JOB DESCRIPTIONS. Job descriptions for each consultant and staff position must be established and made available to each consultant and staff person upon employment. Each job description must include but not necessarily be limited to a description of the person's duties and responsibilities and the person's role, if any, in implementing the individual program, plan job descriptions for consultants must be included as a part of the contract with a consultant.

007.02(C)VOLUNTEERS. Policies and procedures must be implemented which specify the training and supervision to be given to volunteers. A volunteer must never be left in charge of the facility.

007.02(D)TRAINING. Policies and procedures must be available which specify the training to be received during the 3 months orientation period and provide for in-service training and staff development on a regular basis thereafter.

007.02(D)(i)INITIAL TRAINING. Staff orientation for new employees must take place during the first 3 months of employment and must begin on the first day of employment. Orientation during the first 3 months must be consistent with the job description for the individual and the needs of the clients served. Training during the first 3 months must include: basic first aid and cardiopulmonary resuscitation, drug administration, (in-service must be completed prior to administration of drugs), Individual Program Plan development and implementation, client rights, and facility policies and procedures.

007.02(D)(ii)ONGOING TRAINING. In-service training and staff development must be available to and attended by all staff on a regular basis. Training must be consistent with the job description for the individual and the needs of the clients to be served. A plan of in-service training and staff development must be established for a 3 month period and must provide for ongoing in-service training and staff development.

007.02(D)(iii)TRAINING DOCUMENTATION. Documentation of all staff training and in-services attended must be kept in each employee's personnel record. In-service records must include topic and content, actual training time and date of training.

007.02(E)STAFFING. Regardless of the organization or design of living units, the staff- client ratios,, must be, morning, awake and present, afternoon and evening, awake and present, and overnight sleeping. For time periods when clients are not present in the facility, staff-ratios will not apply.

007.02(E)(i)STAFFING RATIOS FOR DISABLED. For any unit within a facility that includes clients who are children under the age of 6 years, disabled, physically handicapped, or who are aggressive, assaultive, security risks, or who manifest severely hyperactive or psychotic-like behavior, or who require considerable adult guidance and supervision, the following minimum staff-client ratio must be met:

(1) Morning - 1:4;

(2) Afternoon and evening - 1:4; and

(3) Overnight - 1:8.

007.02(E)(ii)STAFFING RATIOS FOR BASIC INDEPENDENT SKILLS. For any unit within a facility that includes clients in basic independent living skills, who do not attend vocational training programs but may attend prevocational training programs, the following minimum staff client ratios must be met:

(1) Morning - 1:8;

(2) Afternoon and evening - 1:8; and

(3) Overnight - 1:10.

007.02(E)(iii)STAFFING RATIOS FOR TRAINING PROGRAMS. For any unit serving clients in vocational training programs and adults who work in sheltered employment situations, the following minimum staff- client ratios must be met:

(1) Morning - 1:8;

(2) Afternoon and evening - 1:8; and

(3) Overnight - 1:10.

007.02(E)(iv)ADDITIONAL STAFFING. Additional staff coverage must be provided on call as necessary during emergencies, including illness of a client or clients. Additional staff coverage must be provided on call during emergencies in accordance with the previously stated ratios. These individuals and their phone numbers must be listed near the main telephone for the facility. Volunteers are not included in meeting the staff- client ratios. A licensee that accept any client whose needs require awake overnight care must provide awake and present staff in the prescribed ratios.

007.03EMERGENCY MEDICAL SERVICES. Each licensee must establish, implement and revise as necessary policies and procedures regarding the handling of emergency situations. All employees and volunteers must have immediate access to such information along with the names, telephone numbers, location, and type of medical services available. Emergency information must be maintained in the facility at a location known to all facility employees.

007.03(A)MEDICAL INFORMATION. All staff must have immediate access to clients' medical information including, name of physician(s), person to notify in case of emergency, current medications, and known allergies. Medical information must be maintained in the facility at a location known to all facility employees.

007.03(B)EMERGENCY SITUATIONS. The licensee must maintain a first aid kit adequate to deal with possible emergency situations at each location. This kit must be checked on at least an annual basis and restocked as needed.

007.04PERSONNEL. Personnel files must be maintained in a centralized system and must be subject to inspection by authorized representatives of the Department at any time. Personnel files must be maintained for all personnel and must include:

(1) Job description;

(2) Documentation of completed training and In-service attended;

(3) Documentation of annual performance evaluation;

(4) Pre-employment physical;

(5) Job application;

(6) Credential verification;

(7) Date of hiring; and

(8) Disciplinary actions, if any.

007.04(A)INDIVIDUAL LICENSE 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.

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

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

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

007.04(B)INVESTIGATION. A licensee must ensure any incident where there is 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 Department.

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

007.04(D)CRIMINAL BACKGROUND AND REGISTRY CHECKS. A licensee must complete and maintain documentation of pre-employment criminal background and registry checks on each unlicensed direct care staff member.

007.04(D)(i)CRIMINAL BACKGROUND CHECKS. A licensee must complete criminal background checks through a governmental law enforcement agency or a private entity that maintains criminal background information.

007.04(D)(ii)REGISTRY CHECKS. A licensee 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.

007.04(D)(iii)NURSE AIDE REGISTRY CHECKS. A licensee must not employ staff with adverse findings on the Nurse Aide Registry regarding abuse or neglect of clients served, or misappropriation of the property of clients served. The licensee 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 clients' safety or property.

007.05CLIENT RECORDS. The licensee must establish, implement and revise as necessary policies and procedures regarding the confidentiality, maintenance, storage and destruction of client records. Client records must include:

(A) Documentation of all current evaluations;

(B) Documentation of incident reports;

(C) Documentation of clothing and personal possession inventory;

(D) Documentation of medication histories and response profiles;

(E) Documentation of client consent forms; and

(F) If vocational services are offered to the clients of the facility, the records of the facility must indicate whether or not such services have been approved by the state.

007.06POST-ADMISSION INDIVIDUAL PROGRAM PLAN. A post-admission Individual Program Plan must include measurable goals and objectives, must be developed and implemented within 30 days after admission of any client, and be completed by the interdisciplinary team. Continued placement and programs must be determined, by the interdisciplinary team, in accordance with developmental needs as identified in comprehensive assessments and must not be contingent on age or time restrictions.

007.07RESTRAINT DOCUMENTATION. Documentation of monitoring of restraints and time-out rooms which includes extent of time in time-out, reason for use, 15 minute checks of the restraint, release from restraints and exercise every 2 hours, and signature of the individual documenting monitoring of restraints. If a time-out room is used for behavior modification programs the room must provide a minimum of 60 square feet of floor space and have a ceiling height of 9 feet. There must be a means of observing the client while in the time-out room. Appropriate furniture, at least a bed or chair and a light must be provided. The door must be lockable from only the outside.

007.08CLIENT RIGHTS. Each licensee must establish, implement and revise as necessary policies and procedures assuring that each client has the same civil rights unless specific rights have been removed by a court of law after the client has been afforded his or her full due process rights, or for the particular circumstances and with specific safeguards outlined.

007.08(A)HUMAN RIGHTS COMMITTEE. The licensee must have a Human Rights Committee for each facility. Policies and procedures regarding Clients' Rights must be reviewed by the Human Rights Committee at least annually. Any compromise of these rights must be documented with justification. Clients must have a right to treatment, services and habilitation designed to maximize developmental potential of the person and provided in a setting that is least restrictive of the client's personal liberty. A Human Rights Committee must be established for each facility. Reports of the Committee meetings must be available in each facility served or locale and must specify what occurred during the Committee meetings.

007.08(B)PROTECTIVE SAFEGUARDS OF THE CLIENT'S RIGHTS. The Human Rights Committee must review and take action in accordance with written policies and procedures, with respect to alleged instances of mistreatment, neglect, abuse, exploitation, and situations where restraints, psychotropic medication or aversive conditioning are used. Documentation of reviews and actions by the Human Rights Committee must be maintained in the facility for clients. Composition of the Human Rights Committee must be as follows:

(i) Administrative staff representative;

(ii) Residential and service staff;

(iii) Client;

(iv) Indirect consumer, i.e., the parents or guardian of a client; and

(v) Representatives from community concerned with rights of individuals with developmental disabilities.

007.08(C)INFORMATION REGARDING CLIENT RIGHTS. Each client must be informed, by an appropriate communication system, of his or her rights and responsibilities as a client, and of all rules and regulations governing client conduct and responsibilities. Receipt of such information must be acknowledged in writing by the client or his or her family, guardian, or representative, where applicable, and maintained in the client's record in the facility. If written acknowledgement cannot be obtained, information regarding client's rights must be sent to his or her family, guardian or representative by certified mail.

007.08(C)(i)RECOGNITION OF HUMAN DIGNITY. Each client must be treated with consideration, respect, truthfulness and full recognition of his or her dignity and individuality, including privacy in treatment and in care of his or her personal needs. Clients' individual preferences regarding such things as menus, clothing, religious activities, friendships, activity programs, and entertainments must be elicited and respected by the facility. Privacy of a client's body must be maintained during toileting, bathing, and other activities of personal hygiene, except as needed for client safety or assistance.

007.08(C)(ii)INPUT INTO DECISION MAKING. There must be documentation that each client is afforded maximum opportunity to participate in any decisions concerning his or her person, including those decisions involving medical care and treatment, residency, and the development and implementation of the Individual Program Plan. If it is determined that informing clients of their condition is medically contraindicated, this decision and reasons for it must be documented in the facility in the client's record by the physician.

007.08(C)(iii)FREEDOM FROM RESTRAINTS. Physical restraints, psychotropic medications or aversive conditioning techniques must be employed only in accordance with policies and procedures approved by the Human Rights Committee and must be employed only after approval by the same. Physical restraints, psychotropic medication and aversive conditioning techniques, such as using noxious or aversive stimuli, must never be used as a punishment, for the convenience of staff, or as a substitute for programs, and must be applied only after other means of controlling behavior have been tried and have failed. Documentation of the failure of these alternative techniques must be included in a client's record and reviewed by the Human Rights Committee. Prior to the incorporation of physical restraints, psychotropic medications, or aversive conditioning techniques in a client's habilitation plan, except when absolutely necessary in an emergency situation to prevent a client from seriously injuring himself or others:

(1) It must be documented in the client's record in the facility that physical restraints, psychotropic medications or aversive conditioning techniques, or any or all of them, are essential for the client's habilitation and that less restrictive techniques have been attempted and have failed; and

(2) Incorporation of aversive conditioning techniques, physical restraints, or psychotropic medications in the client's habilitation plans has been with the informed consent of the client, or his or her family, guardian, or representative, when applicable, and documented in the r client's record in the facility. The written policies and procedures of the facility governing the use of restraints must delineate the following:

(a) Physician's orders must indicate the specific reasons for the use of restraints and must specify the type of restraints used;

(b) The use of restraints must be temporary and the client must not be restrained for an indefinite amount of time;

(c) Orders for restraints must not be enforced for longer than 12 hours, unless the client's condition warrants and must be reordered every 12 hours by the physician;

(d) A client placed in the restraint must be checked at least every 15 minutes by appropriately trained staff and an account must be kept of this surveillance;

(e) Reorders shall be issued only after a review of the client's condition;

(f) The use of restraints must not be employed as punishment, for the convenience of the staff, or as a substitute for supervision;

(g) Mechanical restraints must avoid physical injury to the client and provide a minimum of discomfort;

(h) The opportunity for motion and exercise must be provided for a period of not less than 10 minutes during each 2 hours in which restraints are employed, except at night, if the client is asleep; and

(i) The following documentation is required before incorporation in the client's habilitation plan of more restrictive methods of managing behavior, i.e., psychotropic medication, restraint, and a complete description of the maladaptive behavior must include:

(i) The form of the behavior;

(ii) Where and when the behavior occurred;

(iii) The frequency of the occurrence of the behavior;

(iv) The results of this occurrence;

(v) The previous intervention approaches tried;

(vi) The description of the teaching procedures;

(vii) The persons responsible;

(viii) The setting;

(ix) The time spent per day and week;

(x) The results of the alternative approaches;

(xi) The proposed procedure

(xii) The description of the proposed procedure;

(xiii) The persons responsible;

(xiv) The setting;

(xv) The rationale for choosing this specific procedure

(xvi) The evaluation of the program (data collection);

(xvii) Who will review it;

(xviii) The proposed length of the implementation;

(xix) Who can terminate the procedure; and

(xx) Who will monitor and how frequently will monitoring occur.

007.08(C)(iv)FREEDOM FROM SECLUSION. Seclusion is prohibited.

007.08(C)(v)FREEDOM FROM ABUSE AND NEGLECT. Mistreatment, neglect, physical, mental or verbal abuse, or exploitation of clients in any form is prohibited. The licensee must have a written policy that defines use of behavior modification programs, the staff members who may authorize their use, and a mechanism for monitoring and controlling their use.

007.08(C)(vi)BEHAVIOR MANAGEMENT CONSENT. For discontinuation of a behavior management program associated with the use of psychotropic medication(s), the client record must contain documentation that the cessation of psychotropic medication does not interfere with a client's habilitation program and that there is documentation of no problematic behavior. Once a maintenance dose for psychotropic medication has been established, there must be provision in the client's Individual Program Plan for quarterly review of the client's status and documentation of the review maintained in the facility's records for the client.

007.08(C)(vii)DISCIPLINE OF CLIENTS. Clients must not discipline other clients, except as part of an organized self-government program which is conducted in accordance with written policy of the facility.

007.08(C)(viii)FREEDOM OF ASSOCIATION AND COMMUNICATION. Each client must be afforded the right to communicate, associate, and meet privately with persons of his or her own choice; to send and receive his or her personal mail unopened; and to participate in activities of social, religious, and community groups at his or her discretion. There will be documentation of the rationale for the restriction of any of these rights. A decision to restrict a visitor is reviewed and re-evaluated each time the client's Individual Program Plan is reviewed by the Interdisciplinary Team and medical orders are reviewed by the physician or at the client's request. Close relatives must be permitted to visit clients at reasonable hours without prior notice.

007.08(C)(ix)CONFIDENTIAL TREATMENT OF CLIENT INFORMATION. Each client must be assured of confidential treatment of all information contained in his or her records and his or her written, informed consent, or the written, informed consent of his or her family, guardian, or representative, if applicable, must be required for the release of information to persons not authorized under law to receive it.

007.08(C)(x)FREEDOM FROM INTERFERENCE WITH PERSONAL FINANCIAL AFFAIRS. Each client must be afforded the right to manage his or her personal financial affairs. In the event a client has had a conservator appointed by a court of law, the conservator must be free to manage the client's personal financial affairs within the bounds of the court order appointing the conservator. Each client and his or her parent(s), or conservator, if applicable, shall be informed orally and in writing of all financial responsibilities involved in being a client.

007.08(D)AUTHORIZATION. Written authorization from the client or his or her conservator, if applicable, must be obtained when the licensee is handling the client's funds and the authorization must be in the client's record in the facility.

007.08(D)(i)CLIENT FUNDS. licensee must maintain a written account of all clients' funds received by or deposited with the facility. The facility may, at the client's request, keep on deposit personal funds over which the client has control. Should the client or conservator, where applicable, request these funds, they must be given to him or her on request with receipts maintained by the facility and a copy to the client.

007.08(D)(ii)FINANCIAL TRANSACTIONS. If the licensee makes financial transactions on a client's behalf, the client or his or her representative must receive, or acknowledge thaThe or she has seen, an itemized accounting of disbursements and current balances at least quarterly. A copy of this statement must be maintained in the client's financial or business record.

007.08(D)(iii)FREEDOM FROM INVOLUNTARY SERVITUDE. No client must ever be required to perform labor which involves the operation and maintenance of the facility or the regular care, treatment, or supervision of other clients. Clients may voluntarily perform any work available to them. Clients may be required however, to perform tasks of a housekeeping nature (such as the making of their own beds) without compensation.

007.08(D)(iv)TRANSFER OR DISCHARGE OF CLIENTS. When the client is transferred or discharged, the reason for the transfer or discharge and a summary of findings, progress and plans must be recorded and made available to both the transferring facility and the facility to which the client is transferred. Except in an emergency, the client or his or her parents, guardian, or representative, if applicable, must be informed in writing at least 30 days in advance of transfer and at least 60 days in advance of discharge, and his or her written consent obtained. The Interdisciplinary Team must convene prior to transfer or discharge of a client and must review the move.

007.08(D)(v)FEE SCHEDULE. Each client has the right to a copy and to view a fee schedule of charges for services to the client.

007.09CLIENT SERVICES. A licensee must not admit any client to a facility if the individual need for that client cannot be met. An e valuation by a physician, a psychologist, a social worker and residential staff must be completed prior to admission for each client.

007.09(A)INTERDISCIPLINARY TEAM. The interdisciplinary team is responsible for development of a preliminary program plan at the time of admission, complete Individual Program Plan with 30 days, after the date of admission and must complete an annual review of each client's program plan. The Interdisciplinary Team must include:

(i) The client's case manager;

(ii) The client's parent or guardian, if applicable;

(iii) The client to be served, or reason for nonattendance,

(iv) A representative from the residential program staff; and

(v) Professionals from those disciplines for which the individual has specialized needs, including vocational staff, if applicable and school system representatives, if applicable.

007.09(B)NONPARTICIPATION IN INTERDISCIPLINARY TEAM. If any member(s) of the previous team are not involved in the development or review of the program plan, the reasons for their nonparticipation must be documented in the minutes of the Interdisciplinary Team meeting. Program Plans must include signatures of the individual or the individual's legal representative participation, in the Interdisciplinary Team meeting.

007.09(C)PROFESSIONALS WHO PARTICIPATE ON THE INTERDISCIPLINARY TEAM. Professionals who participate on the Interdisciplinary Team must meet the following requirements:

(i) A psychologist must have a current active license in Nebraska;

(ii) Social Services Workers must have a bachelor's degree in social work, developmental or intellectual disabilities, or a related field;

(iii) Physicians must have a current active license in Nebraska;

(iv) Dentists must have a active license in Nebraska;

(v) Licensed Medical Nutrition Therapists must have a current active license in Nebraska;

(vi) Speech pathologists or audiologists must have a current active license in Nebraska;

(vii) Physical Therapists must have a current active license in Nebraska; and

(viii) Occupational Therapists must be:

(1) Graduates of an occupational therapy curriculum accredited jointly by the Council on Medical Education of the American Medical Association and the American Occupational Therapy Association; or

(2) Eligible for certification by the American Occupational Therapy Association under its requirements in effect on the effective date of these regulations; or

(3) Have 2 years of competent experience as an occupational therapist.

007.10CLIENT EVALUATIONS. Client evaluations conducted by the disciplinary areas must include:

(A) Summary of progress towards meeting the current Individual Program Plan's goal and objectives and assessments of continuing need for care;

(B) Identification of the tools or methods used for assessment;

(C) Needs, strengths and weaknesses (barriers);

(D) Recommendations if the client has habilitative needs; and

(E) Written in language clearly understandable by all.

007.11INDIVIDUAL PROGRAM PLAN. The Individual Program Plan must include:

(A) Long term goals and short term objectives, that are stated separately, and each objective is stated in terms of a single behavioral outcome;

(B) Projected completion dates;

(C) Measurable indicators of progress expressed in behavioral terms inclusive of a pass and a fail criteria;

(D) Be sequenced within a developmental progression appropriate to the individual; and

(E) Assigned priorities.

007.11(A)INDIVIDUAL PROGRAM PLAN OBJECTIVES. The Individual Program Plan objectives must include a description of the manner in which objectives will be achieved and possible barriers to the achievement of them in common language understandable by all concerned; a training plan shall be written for the implementation of each objective specifying:

(i) Data collection procedures;

(ii) Training procedures;

(iii) Staff responsible for training;

(iv) Conditions or (environment) and materials needed; and

(v) Method by which effectiveness of program will be evaluated.

007.11(B)INDIVIDUAL PROGRAM PLAN SPECIFICATIONS. The Individual Program Plan must include statement s (in readily understandable form) of specific habilitation services to be provided, containing the identity of the client (by name and title) or agency which will deliver each service, and specifying the date of the initiation of each service to be provided and the proposed duration of each service.

007.11(C)ACTIVITY SCHEDULES. Activity schedules are an active extension of the Individual Program Plan. The schedule must be recorded and must include:

(i) Client's schedules on a weekly basis;

(ii) Time periods in which staff are working with clients on their Individual Program Plans;

(iii) Time periods clients are working alone or together on skill attainment;

(iv) Times for the client to choose activities that interest him or her;

(v) Ongoing staff services (responsible persons);

(vi) Restrictions of client rights;

(vii) Barriers to programming, i.e., blind, non-ambulatory;

(viii) Guardianship status;

(ix) Admission date; and

(x) Primary relative, guardian or advocate.

007.11(C)(1)INDIVIDUALIZED SERVICE PLAN. At the time of admission, a preliminary program plan shall be developed by an Interdisciplinary Team which may provide for the continuation of existing programs from previous facility. Comprehensive evaluations of a client's developmental must be completed within 30 days following admission. Reassessments must be completed annually or more frequently if needed as determined by the needs of the client. Comprehensive evaluations must include:

(a) Medical evaluation, upon admission and thereafter as needed, must address physical and mental health and include a medication history;

(b) Dental evaluation, upon admission and thereafter as needed, must include complete extra and intra-oral examinations;

(c) Sensorimotor Development evaluation;

(d) Communicative Development evaluation;

(e) Social Development evaluation; upon admission and thereafter as needed;

(f) Affective Development evaluation;

(g) Cognitive Development evaluation;

(h) Adaptive behaviors or independent living skills evaluation;

(i) Dietary, if applicable. Dietary evaluations must address eating skills; adaptive equipment; modified diets; edible reinforcers, and nutritional inducements;

(j) Speech, if applicable. Speech evaluations must include appraisal of articulation, voice, rhythm, and language;

(k) Audiology, if applicable. Audiology evaluations must include tests of puretone air and bone conduction, speech audiometry, and other procedures as necessary, and include assessment of the use of visual cues, and use of amplification;

(l) Physical therapy, if applicable. Physical therapy evaluations must address the preservation and improvement of abilities for independent function such as range of motion, strength tolerance, coordination, and activities of daily living; and prevention, insofar as possible of irreducible or progressive disabilities through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adaptations, and sensory stimulation;

(m) Occupational therapy, if applicable. Occupational therapy evaluations must address the preservation and improvement of abilities for independent function such as range of motion, strength, tolerance, coordination, and activities of daily living; and prevention, insofar as possible of irreducible or progressive disabilities through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adaptations, and sensory stimulation;

(n) Psychological initial evaluation upon admission and bi-annually. Psychological evaluations must address perceptual skills, social skills, self-direction, emotional stability, and effective use of time, including leisure time. Full-scale must include non-adaptive and adaptive behavior scale; and

(o) Vocational, if applicable. Vocational evaluations must address client aptitudes, abilities, interests, work attitudes, work habits, work tolerances, community and social skills.

007.11(C)(2)POST-ADMISSION INDIVIDUAL PROGRAM PLAN. The post-admission Individual Program Plan, which must include measurable goals and objectives, is developed and implemented within 30 calendar days after admission by the Interdisciplinary Team.

(a) Continued placement and programs must be determined in accordance with developmental needs as identified by comprehensive assessments and not be contingent on age or time restrictions.

007.11(D)PROGRAMS. Programs must be implemented as specified on the Individual Program Plan. The frequency of implementation of a program must be in accordance with normal life activities.

007.11(E)ONGOING IMPLEMENTATION AND CONTINUING APPROPRIATENESS. The Individual Program Plan must be reviewed at least quarterly by the client's Interdisciplinary Team for assuring implementation and whether it continues to be appropriate for the client.

007.11(F)MODIFICATION AND REVIEW OF THE INDIVIDUAL PROGRAM PLAN. The Individual Program Plan itself must also be reviewed and modified as necessary by the client's Interdisciplinary Team at intervals determined by the team, and at least annually.

007.11(G)LEISURE TIME ACTIVITIES. Clients must be provided with leisure time activities and must be directed at keeping the client both physically and mentally alert and active.

007.11(H)GENERIC SERVICES AND RESOURCES. The licensee must utilize, as extensively as possible, generic services and resources appropriate to the needs of the clients served, including introducing clients into the environments available in the community that are most appropriate to addressing their needs. There must be written policies and procedures to utilize these resources within the scope of availability.

007.11(I)COMMUNITY ACTIVITIES. Services must be provided in settings that are appropriate for and that encourage disabled clients to experience relationships with non-disabled persons in community activities.

007.11(J)STAFF PERSON RESPONSIBILITY FOR SERVICES. The Interdisciplinary Team must identify one staff person as responsible for coordinating all services provided to the client by the facility. This person must be designated on the client's Individual Program Plan.

007.12MEDICATIONS. Each licensee must establish, implement and revise as necessary policies and procedures governing the handling, storage and administration of medications that must be in compliance with current standards of practice and state and federal law.

007.12(A)MEDICATION STORAGE AND HANDLING. All medications must be prescribed for the client by a licensed medical practitioner and dispensed by a licensed pharmacist.

007.12(B)ADMINISTRATION OF MEDICATION. The licensee must ensure clients receive medications only as legally prescribed by a medical practitioner in accordance with the prescription and prevailing professional standards.

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

007.12(B)(i)(1)SELF ADMINISTRATION. The licensee must allow clients to self-administer medication, with or without supervision, unless an Interdisciplinary Team has determined the client is not capable of doing so safely.

007.12(B)(i)(2)LICENSED HEALTH CARE PROFESSIONAL. When the licensee utilizes licensed health care professionals for whom medication administration is included in their scope of practice, the licensee must ensure the medications are properly administered in accordance with prevailing professional standards.

007.12(B)(i)(3)PERSONS OTHER THAN A LICENSED HEALTH CARE PROFESSIONAL. When the licensee utilizes persons other than licensed health care professionals in the provision of medications, the licensee 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.

007.12(C)FACILITY RESPONSIBILITY. When the licensee is not responsible for medication administration or provision of medication, the licensee maintains responsibility for the overall supervision, safety and welfare of the client.

007.12(D)DISPOSAL OF MEDICATIONS. Medications that are discontinued by the medical practitioner, and those medications which are beyond their expiration date, must be destroyed. The licensee 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 disposal should be documented and such documentation should be retained for a minimum of 5 years.

175 Neb. Admin. Code, ch. 3, § 007

Adopted effective 3/17/2024