175 Neb. Admin. Code, ch. 4, § 006

Current through September 17, 2024

Section 175-4-006 - STANDARDS OF OPERATION, CARE AND TREATMENT

To provide adequate protection to assisted-living residents and compliance with state statutes, an assisted-living facility must meet the following:

006.01 Licensee Responsibilities

The licensee of each assisted-living facility must assume the responsibility for the total operation of the facility. The licensee responsibilities include:

1. Monitoring policies to assure the appropriate administration and management of the assisted-living facility;

2. Maintaining the assisted-living facility's compliance with all applicable state statutes and relevant rules and regulations;

3. Providing quality care to residents whether care is furnished by assisted-living facility staff or through contract with the facility;

4. Designating an administrator who is responsible for the day to day management of the assisted-living facility and defining the duties and responsibilities of the administrator in writing;

5. Notifying the Department in writing within five working days when a vacancy in the administrator position occurs including who will be designated as the administrator until another administrator is appointed;

6. Notifying the Department in writing within five working days when the vacancy is filled including effective date and name of person appointed administrator; and

7. Assuring that after January 1, 2005, any person designated as administrator of the assisted-living facility meets the initial training requirements specified in 175 NAC 4-006.02A within the first six months of employment as the administrator.

006.02 Administration

Each assisted-living facility must have an administrator who is responsible for the overall operation of the facility. The administrator is responsible for planning, organizing, and directing the day to day operation of the assisted-living facility. The administrator must report all matters related to the maintenance, operation, and management of the assisted-living facility and be directly responsible to the licensee or to the person or persons delegated governing authority by the licensee. The administrator must:

1. Be responsible for the facility's compliance with rules and regulations;

2. Be responsible for the facility's promotion of resident self-direction and participation in decisions which incorporate independence, individuality, privacy and dignity;

3. Be on the premises a sufficient number of hours to permit adequate attention to the management of the facility;

4. Maintain staff with appropriate training and skills and sufficient in number to meet resident needs as defined in resident service agreements;

5. Designate a substitute to act in his or her absence who must be responsible and accountable for management of the facility;

6. Monitor that resident service agreements are established and implemented;

7. Monitor that facility staff identify and review incidents and accidents, resident complaints and concerns, patterns and trends in overall facility operation such as provisions of resident care and service and take action to alleviate problems and prevent recurrence;

8. Develop and implement procedures that require the reporting of any evidence of abuse, neglect, or exploitation of any resident residing in the assisted-living 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;

9. Complete an investigation on suspected abuse, neglect, or misappropriation of money or property and take action to prevent reoccurrence until the investigation is completed;

10. Be at least 21 years of age; and

11. Meet the administrator training requirements as specified in 4-006.02A.

4-006.02AInitial Administrator Training Requirements: After January 1, 2005, the administrator must have completed training consisting of a total of at least 30 hours, including, but not limited to:

1. Resident care and services;

2. Social services;

3. Financial management;

4. Administration;

5. Gerontology; and

6. Rules, regulations, and standards relating to the operation of an assisted-living facility.

4-006.02BVerification of Initial Administrator Training: Verification of initial training completed must be submitted to the Department for approval. Training documentation may include but is not limited to:

1. Evidence of completion of training including documentation of date of training, number of hours, description of training, and trainer qualifications;

2. Evidence of successful completion of college courses and/or degree which includes topics in 4-006.02A; or

3. Evidence of completion of a Department approved training course.

4-006.02B1 Initial training requirements do not apply to an assisted-living facility administrator who also holds an active nursing home administrator license or who is currently employed as a hospital administrator. Verification of nursing home or hospital administrator status must be submitted to the Department. Such verification includes:

1. Proof of current licensure as a nursing home administrator in Nebraska or other jurisdiction; or

2. A statement from the governing authority of the hospital or other authorizing entity that could verify administrator status.

4-006.02CDepartment Responsibilities for Approval of Initial Administrator Training Programs: The Department will:

1. Determine whether the administrator training program meets the course requirements of 175 NAC 4-006.02A and provide written notification of program approval within 90 days of receipt of application; and

2. Establish and maintain a registry of persons who have met the initial training requirements. The registry will contain information the Department deems necessary.

4-006.02DInitial Administrator Training Waiver: Persons employed as assisted-living administrators on January 1, 2005 were allowed to apply within 90 days of that date for a Department waiver of the initial administrator training requirements.

4-006.02EOngoing Administrator Training: Each year of employment, a facility administrator must complete 12 hours of ongoing training in areas related to care and facility management of the population served. The record of such training must be available for Department review and include topic of training, date and length of training and name and title of person providing training. Nursing home and hospital administrators verified under 175 NAC 4-006.02B 1 are not required to fulfill the annual training requirement.

006.03 Staff Requirements

The facility must maintain a sufficient number of staff with the required training and skills necessary to meet the resident population's requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision and other supportive services, as defined in Resident Service Agreements.

4-006.03AEmployment Eligibility: Each assisted-living facility must ensure and maintain evidence of the following:

4-006.03A1 Criminal Background Check: The facility must complete criminal background checks on each member of the unlicensed direct care staff of the facility.

4-006.03A1a Such checks must be done on all new unlicensed direct care staff hired.

4-006.03A1b Such checks must be made through a governmental law enforcement agency or a private entity that maintains criminal background information.

4-006.03A1c It is the responsibility of the facility to:

1. Determine how to use this criminal background information 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. The documentation must include the basis for the decision and how it will not pose a threat to resident safety or resident property.

4-006.03A2 Registry Checks: The facility must check each unlicensed direct care staff 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.

4-006.03A2a Each facility must determine whether to employ or continue employment of any person as direct care staff with adverse registry findings, except for the Nurse Aide Registry.

4-006.03A2b The facility must document any decision to hire as direct care staff a person with 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 resident safety or resident property.

4-006.03A2c Each facility must not employ or continue employment of any person as direct care staff who has adverse findings on the Nurse Aide Registry regarding resident abuse, neglect, or misappropriation of resident property.

4-006.03A3 Health Status: Each assisted-living facility must establish and implement policies and procedures regarding the health status of staff to prevent the transmission of disease to residents.

4-006.03A3a A health history screening for each staff person must be completed prior to assuming job responsibilities. A physical examination is at the discretion of the employer based on results of the health history screening.

4-006.03BDirect Care Staff Training: Each assisted-living facility must ensure direct care staff receive training in order to perform job responsibilities. The facility must provide for and maintain evidence of the following training;

4-006.03B1 Orientation: Orientation must be given within two weeks of employment to each direct care staff person of the facility and must include as a minimum, but is not limited to:

1. Resident's rights;

2. Resident service agreement;

3. Infection Control practices including handwashing techniques, personal hygiene and disposal of infectious material;

4. The facility's emergency procedures and information regarding advance directives;

5. Information on any physical and mental special care needs of the residents in the facility;

6. Information on abuse, neglect and misappropriation of money or property of a resident and reporting procedures; and

7. Disaster preparedness plans.

4-006.03B2 Ongoing Training: Ongoing training must be given to each direct care staff person and must consist of at least 12 hours per year on topics appropriate to the employee's job duties including meeting the physical and mental special care needs of residents in the facility. The record of such training must include topic of training, name of staff, date and length of training and name of person providing the training.

4-006.03CStaffing Resources: The assisted-living facility must ensure that staffing resources and training are sufficient to meet the level of supervision and assistance with activities of daily living, personal care and health maintenance activities that are required by the residents as defined in the resident service agreements.

4-006.03C1 The facility must have at least one staff person on the premises at all times when necessary to meet the needs of the residents as required in the resident service agreements.

4-006.03C2 Registered Nurse: Each assisted-living facility must provide for a registered nurse to review medication administration policies and procedures and to provide or oversee the training of medication aides at such facility. Training of medication aides must include, but is not limited to:

1. Facility procedures for storing, handling and providing medications;

2. Facility procedures for documentation of medications;

3. Facility procedures for documentation and reporting medication errors and adverse reactions;

4. Identification of person(s) responsible for direction and monitoring of medication aides; and

5. Other resident-specific training on providing medications in accordance with the limits and conditions of the Medication Aide Act.

4-006.03DGeneral Staff: The assisted-living facility must provide staffing to ensure that services to residents are provided in a safe and timely manner to meet the resident needs as required in the resident service agreements.

4-006.03EEmployment Record: A current employment record must be maintained for each staff person. The record must contain at a minimum, information on orientation, in-services, credentialing and health history screening.

006.04 Resident Rights

The assisted-living facility must provide residents their rights in writing upon admission and for the duration of their stay. The operations of the facility must afford residents the opportunity to exercise their rights. At a minimum, the resident must have the right to:

1. Be treated with dignity and provided care by competent staff;

2. Be an equal partner in the development of the resident service agreement while retaining final decision making authority;

3. Be informed in advance about care and treatment and of any changes in care and treatment that may affect the resident's well-being;

4. Be informed in writing of the pricing structure and/or rates of all facility services;

5. Self direct activities, participate in decisions which incorporate independence, individuality, privacy and dignity and make decisions regarding care and treatment;

6. Choose a personal attending physician;

7. Voice complaints and grievances without discrimination or reprisal and have those complaints/grievances addressed;

8. Examine the results of the most recent survey of the facility conducted by representatives of the Department;

9. Refuse to perform services for the facility;

10. Refuse to participate in activities;

11. Privacy in written communication including sending and receiving mail;

12. Receive visitors as long as this does not infringe on the rights and safety of other residents in the facility;

13. Have access to the use of a telephone with auxiliary aides where calls can be made without being overheard;

14. Have the right to have a telephone in his/her room at the resident's expense;

15. 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 residents;

16. Share a room with a person of his or her choice upon consent of that person;

17. Self-administer medications if it is safe to do so;

18. Be free of chemical and physical restraints;

19. Exercise his or her rights as a resident of the facility and as a citizen or resident of the United States;

20. Form and participate in an organized resident group that functions to address facility issues;

21. Review and receive a copy, within two working days, of their permanent record, as referred to in 175 NAC 4-006.12;

22. Be free from abuse, neglect, and misappropriation of their money and personal property; and

23. Be free from involuntary transfer or discharge without 30 days advance written notice except in situations where the transfer or discharge is necessary to protect the health and safety of the resident, other residents or staff.

4-006.04AGrievances: Each assisted-living facility must establish and implement a process for addressing all grievances received from residents, employees and others. The process includes, but is not limited to:

1. A procedure on submission of grievances available to residents, employees and others;

2. Documentation of efforts to address grievances received from residents, employees and others; and

3. The telephone number and address of the Department is readily available to residents, employees and others who wish to lodge complaints or grievances.

006.05 Consumer Satisfaction/Improvement

Each assisted-living facility must develop and implement a process to measure consumer satisfaction.

006.06 Resident Service Agreements

The assisted-living facility must evaluate each resident and must have a written service agreement negotiated with the resident and authorized representative, if applicable, to delineate the services to be provided to meet the needs identified in the evaluation.

4-006.06A The agreement must contain the following basic components:

1. Services to be provided by the assisted-living facility and from other sources, how often and when the services are provided and by whom, to meet the needs of individuals including those for special populations as specified in 175 NAC 4-006.11E. Such services must not exceed those which are defined in these regulations as shelter, food, activities of daily living, personal care, health maintenance, other supportive services or those which involve complex nursing interventions that are allowed by 175 NAC 4-006.07B;

2. Rights and responsibilities of the facility and of the resident;

3. Costs of services and terms of payment; and

4. Terms and conditions of continued residency.

4-006.06B The Resident Service Agreement must be reviewed and updated as the resident's needs change.

006.07 Admission and Retention Requirements

The assisted-living facility must ensure that the resident admission and retention practices conform with the following:

4-006.07AEligibility Criteria: To be eligible for admission to an assisted-living facility, a person must be in need of or wish to have available shelter, food, assistance with or provision of personal care, activities of daily living, or health maintenance activities or supervision due to age, illness, or physical disability. The administrator has the discretion regarding admission or retention of residents subject to the Assisted-Living Facility Act and rules and regulations adopted and promulgated under the act.

4-006.07A1 The assisted-living facility must establish and implement procedures to request that:

1. On and after January 1, 2005, every person seeking admission to an assisted-living facility or the authorized representative of such person must, upon admission and annually thereafter, provide the facility with a list of drugs, devices, biologicals, and supplements being taken or being used by the person, including dosage, instructions for use, and reported use; and

2. Every person residing in an assisted-living facility on January 1, 2005, or the authorized representative of such person must, within 60 days after January 1, 2005, and annually thereafter, provide the facility with a list of drugs, devices, biologicals, and supplements being taken or being used by such person, including dosage, instructions for use, and reported use.

4-006.07BRestrictions on Eligibility Criteria: Residents requiring complex nursing interventions or whose conditions are not stable or predictable must not be admitted, readmitted, or retained by the assisted-living facility unless:

4-006.07B1 The resident, if the resident has sufficient mental ability to understand the situation and make a rational decision as to his or her needs or care and is not a minor, or the resident's authorized representative, and the resident's physician or the registered nurse agree that admission or retention of the resident is appropriate;

4-006.07B2 The resident or his or her authorized representative assumes responsibility for arranging for the resident's care through appropriate private duty personnel, a licensed home health agency, or a licensed hospice agency; and

4-006.07B3 The resident's care does not compromise the assisted-living facility operations or create a danger to others in the facility.

4-006.07C Assisted-living facility staff while on duty must not provide complex nursing interventions for facility residents, except that a registered nurse assessment to determine the suitability of the resident or potential resident for admission to and/or continued residence in the assisted-living facility is permitted.

006.08 Activities

The assisted-living facility must plan and provide activities designed to meet the interests and promote the physical, mental, and psychosocial well-being of residents. Such activities must be on-going and all residents informed of the opportunity to participate. Information about activities must be posted and made available to residents.

006.09 Provision of Medication

Provision of medications may be provided by the assisted-living facility as requested by the resident and in accordance with licensed health care professional statutes and the statutes governing medication provision by unlicensed personnel.

4-006.09ASelf-Administration of Medications: The following requirements apply in those instances when residents self-administer medications. Residents must:

1. Be at least 19 years of age;

2. Have cognitive capacity to make informed decision about taking medication;

3. Be physically able to take or apply a dose of medication;

4. Have capability and capacity to take or apply a dose of medication according to specific directions for prescribed medications or according to a recommended protocol for nonprescription medication; and

5. Have capability and capacity to observe and take appropriate action regarding any desired effects, side effects, interactions, and contraindications associated with a dose of medication.

4-006.09A1 In the event self-administration could potentially result in adverse health consequences, the facility must counsel the resident and the authorized representative, if applicable.

4-006.09A2 Medications may be stored in a resident's room if the resident keeps the room locked when not present; or the medications are stored in a secure location or locked container.

4-006.09A3 Residents who self-medicate must be encouraged to have their medications reviewed on a regular basis by a licensed health care professional.

4-006.09BAdministration of Medication: The assisted-living facility must establish and implement policies and procedures to ensure residents receive medications only as legally prescribed by a medical practitioner, in accordance with the Five Rights and prevailing professional standards. The assisted-living facility must ensure that a registered nurse reviews and documents the review of medication administration policies and procedures at least annually.

4-006.09B1 Methods of Administration: When the facility is responsible for the administration or provision of medications, it must be accomplished by the following methods:

4-006.09B1a Self-Administration of Medication: The facility must allow residents of the facility to self-administer medications, with or without supervision, when assessment determines resident is capable of doing so.

4-006.09B1b Licensed Health Care Professional: When the facility utilizes licensed health care professionals 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.

4-006.09B1c Provision of Medication by a Person Other Than a Licensed Health Care Professional: When the facility utilizes persons 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. Each facility must establish and implement policies and procedures:

1. To ensure that medication aides who provide medications are trained and have demonstrated the minimum competency standards specified in 172 NAC 95-004;

2. To ensure that competency assessments and/or courses for medication aides have been completed in accordance with the provisions of 172 96-005;

3. That specify how direction and monitoring will occur when the facility allows medication aides to perform the routine/acceptable activities authorized by 172 NAC 95-005 and as follows:

a. Provide routine medication; and

b. Provision of medications by the following routes:

(1) Oral, which includes any medication given by mouth including sublingual (placing under the tongue) and buccal (placing between the cheek and gum) routes and oral sprays;

(2) Inhalation, which includes inhalers and nebulizers, including oxygen given by inhalation;

(3) Topical application of sprays, creams, ointments, and lotions, and transdermal patches; and

(4) Instillation by drops, ointments and sprays into the eyes, ears and nose.

4. That specify how direction and monitoring will occur when the assisted-living facility allows medication aides to perform the additional activities authorized by 172 NAC 95009, which include, but are not limited to:

a. Provision of PRN medications;

b. Provision of medications by additional routes, including, but not limited to, gastrostomy tube, rectal, and vaginal; and/or

c. Participation in monitoring.

5. That specify how competency determinations will be made for medication aides to perform routine and additional activities pertaining to medication provision;

6. That specify how written direction will be provided for medication aides to perform the additional activities authorized by 172 NAC 95-009;

7. That specify how records of medication provision by medication aides will be recorded and maintained; and

8. That specify how medication errors made by medication aides and adverse reactions to medications will be reported. The reporting must be:

a. Made to the identified person responsible for direction and monitoring;

b. Made immediately upon discovery; and

c. Documented in resident medical records.

4-006.09CHandling of Medications: Each assisted-living facility must have procedures to ensure that residents receive medications as prescribed by a medical practitioner including a method for verifying the identity of each resident.

4-006.09C1 Medications sent with a resident for temporary absences from the assisted-living facility must be in containers identified for the resident.

4-006.09C2 Medications must be sent with a resident upon discharge upon resident request.

4-006.09C3 Medications authorized for one resident must not be used for another resident or staff.

4-006.09C4 Any errors in administration or provision of prescribed medications must be reported to the resident's licensed health care professional in a timely manner upon discovery and a written report of the error prepared.

4-006.09C5 Any adverse reaction to a medication must be reported immediately upon discovery to the resident's licensed health care professional and recorded in the resident's record.

4-006.09DMedication Record: The assisted-living facility must maintain records in sufficient detail to assure that residents receive the medications authorized by a medical practitioner and maintain records to protect medications against theft and loss.

4-006.09D1 When facility staff administer or provide medication, each resident must have an individual medication administration record which includes:

1. The identification of the resident;

2. The name of the medication given;

3. The date, time, dosage, method of administration or provision for each medication, the identification of the person who administered or provided the medication and any refusal by the resident; and

4. The resident's medication allergies and sensitivities, if any.

4-006.09EStorage: All medications must be stored in locked areas and stored in accordance with the manufacturer's or dispensing pharmacist's instructions for temperature, light, humidity, or other storage instructions. Only authorized personnel who are designated by the facility responsible for administration or provision of medications must have access to the medications.

4-006.09E1 Medications for external use must be stored separately from other medications.

4-006.09FDisposal of Medications: Medications that are discontinued by the medical practitioner, those medications leftover at the time of death or those medications which are beyond their expiration date, must be destroyed in accordance with facility policy.

006.10 Food Service

The assisted-living facility must provide food service as specified in the resident service agreement and may include special diets if offered by the facility.

4-006.10AMenus: When the facility provides food service, meals and snacks must be appropriate to the resident's needs and preferences and must meet daily nutritional requirements.

4-006.10A1 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 resident and specified in the resident services agreement. Menus are made accessible to residents.

4-006.10A2 Menus should reflect the food preferences of the resident population to the extent possible.

4-006.10A3 Records of menus with food actually served must be maintained for a period not less than 14 days.

4-006.10BNutritional Supervision: The facility must monitor residents for potential problems involving nutritional status as follows:

1. Weigh each resident at the time of admission and record the weight in the resident's record; and

2. Weigh each resident identified as having potential problems with nutritional status at least quarterly and record the weight in the resident's record. The facility must follow up to address or rectify any weight gains or losses that equal or exceed: 7.5 % gain or loss in three months or 10% gain or loss in 6 months.

4-006.10CFood Safety: The assisted-living facility must store, prepare, protect, serve and dispose of food in a safe and sanitary manner and in accordance with the Food Code.

006.11 Resident Care

Each assisted-living facility must provide residents care and services in accordance with their established resident service agreements which maximize the residents' dignity, autonomy, privacy and independence.

4-006.11A Evidence that the facility is meeting each resident's needs for personal care, assistance with activities of daily living and health maintenance include the following outcomes for residents:

4-006.11A1 Physical well-being of the resident:

1. Clean and groomed hair, skin, teeth and nails;

2. Nourished and hydrated;

3. Free of pressure sores, skin breaks, chaps and chafing;

4. Appropriately dressed for the season in clean clothes;

5. Protected from accident, injury and infection; and

6. Receives prompt emergency care for the following but not limited to: illnesses, injuries, and life threatening situations.

4-006.11A2 Behavioral/emotional well-being of the resident:

1. Opportunity to participate in age appropriate activities that are meaningful to the resident, if desired;

2. Sense of security and safety;

3. Reasonable degree of contentment; and

4. Feeling of stable and predictable environment.

4-006.11A3 In agreement that the resident:

1. Is free to go to bed at the time desired;

2. Is free to get up in the morning at the time desired;

3. Is free to have visitors;

4. Has privacy;

5. Is free to self direct his/her own care and treatment and change their plan at any time;

6. Is assisted to maintain a level of self-care and independence;

7. Is assisted as needed to have good oral hygiene;

8. Has been made as comfortable as possible by the facility;

9. Is free to make choices and assumes the risk of those choices;

10. Is fully informed of the services he/she can expect to be provided by the facility;

11. Is free of abuse, neglect and exploitation;

12. Is treated with dignity; and

13. Has the opportunity to participate in activities, if desired.

4-006.11BHealth Maintenance Activities: All health maintenance activities must be performed in accordance with the Nurse Practice Act and the rules and regulations adopted and promulgated under the act.

4-006.11COther Supportive Services: A assisted-living facility may provide other supportive services to assist residents. These services could include, but are not limited to: transportation, laundry, housekeeping, financial assistance/management, behavioral management, case management, shopping, beauty/barber and spiritual services.

4-006.11DSpecial Populations Services: Each assisted-living facility that provides services to special populations such as, but not limited to, those individuals with disabilities, mental impairments, dementia, or other disorders must:

1. Evaluate each resident to identify the abilities and special needs;

2. Ensure the administrator and staff assigned to provide care are trained to meet the special needs of those residents. Such training must be done by a person(s) qualified by experience and knowledge in the area of special services being provided;

3. Prepare and implement each resident service agreement to address the special needs; and

4. Provide a physical environment that maintains the safety and dignity of residents and accommodates residents' special needs, such as physical limitations, and visual and cognitive impairments.

4-006.11ERequirements for Facilities or Special Care Units for Persons with Alzheimer's Disease, Dementia or a Related Disorder: Each assisted-living facility or special care unit that specializes in providing care for persons who have Alzheimer's disease, dementia or a related disorder must meet the following requirements:

1. Care and services must be provided in accordance with the resident service agreement and the stated mission and philosophy of the facility.

2. Prior to admission, the facility must inform the resident or authorized representative in writing of the facility's criteria for admission, discharge, transfer, resident conduct and responsibilities.

3. The facility or unit must maintain a sufficient number of direct care staff with the required training and skills necessary to meet the resident population's requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision and other supportive services. Such staff must remain awake, fully dressed and be available in the facility or unit at all times to provide supervision and care to the residents.

4. The administrator and direct care staff must be trained in:

a. The facility or unit's philosophy and approaches to providing care and supervision for persons with Alzheimer's disease;

b. The Alzheimer's disease process; and

c. The skills necessary to care for, and intervene and direct residents who are unable to perform activities of daily living, personal care, or health maintenance and who may exemplify behavior problems or wandering tendencies.

5. The facility must not admit or retain residents if any one of the following conditions exists, unless the criteria in 4-006.07B are met:

a. The resident poses a danger to self or to others; or

b. The resident requires complex nursing interventions.

006.12 Record Keeping Requirements

Each assisted-living facility must maintain records and reports in such a manner to ensure accuracy.

4-006.12AResident Records: Each assisted-living facility must ensure a permanent record of all assisted-living services is established for each resident. The record must be established within five working days of admission.

4-006.12A1 Content: Entries in the permanent resident record must be dated, legible and indelible. The author of each entry must be identified and authenticated. Authentication must include signature, written initials or computer entry. Resident records must contain information that includes, but is not limited to:

1. Date of admission;

2. Name of resident;

3. Gender and date of birth;

4. Physical description or photo of resident;

5. Resident Services Agreement;

6. Licensed practitioner's orders where applicable;

7. Significant medical conditions;

8. Medications and any special diet;

9. Allergies;

10. Any unusual event or occurrence;

11. Person to contact in emergency situations;

12. Designated physician or registered nurse;

13. Advance directives if available;

14. Monthly documentation of assistance with activities of daily living, personal care, health maintenance activities or supervision, if such is required or requested by the resident; and

15. Date and destination of discharge or transfer.

4-006.12A2 Retention: Each assisted-living facility must maintain and preserve all resident records in original, microfilm, electronic or other similar form, for a period of at least two years from date of resident's discharge. If a resident is transferred to another licensed health care facility or service, a copy of the record or abstract must be sent with the resident. When an assisted-living facility ceases operation, all resident records must be transferred to the licensed health care facility or health care service to which the resident is transferred. All other resident records that have not reached the required time for destruction must be stored to assure confidentiality and the Department must be notified of the address where stored.

4-006.12A3 Confidentiality: The facility must keep such records confidential and available only for use by authorized persons or as otherwise permitted by law. Records must be available for examination by authorized representatives of the Department.

4-006.12A4 Access: Resident information and/records will be released only with consent of the resident or authorized representative, if applicable, or as permitted by law.

4-006.12A5 Destruction: Resident records may be destroyed only when they are in excess of retention requirements specified in 175 NAC 4-006.12A 2. In order to ensure the resident's right of confidentiality, resident records must be destroyed or disposed of by shredding, incineration, electronic deletion or another equally effective protective measure.

006.13 Environmental Services

An assisted-living facility must provide a safe, clean, comfortable and homelike environment, allowing residents to use personal belongings to the extent possible. Every detached building on the same premises used for care and treatment must comply with these regulations.

4-006.13AHousekeeping and Maintenance: The assisted-living facility must provide the necessary housekeeping and maintenance to protect the health and safety of residents.

4-006.13A1 The facility's buildings and grounds must be kept clean, safe and in good repair.

4-006.13A2 The facility must take into account resident habits and lifestyle preferences when housekeeping services are provided in the resident bedrooms/living area.

4-006.13A3 All garbage and rubbish must be disposed of in such a manner as to prevent the attraction of rodents, flies, and all other insects and vermin. Garbage must be disposed in such a manner as to minimize the transmission of infectious diseases and minimize odor.

4-006.13A4 The facility must maintain adequate lighting, environmental temperatures and sound levels in all areas that are conducive to the care provided.

4-006.13A5 The facility must maintain and equip the premises to prevent the entrance, harborage, or breeding of rodents, flies, and all other insects and vermin.

4-006.13BEquipment, Fixtures, Furnishings: The assisted-living facility must provide and maintain all facility owned equipment, fixtures, and furnishings clean, safe and in good repair.

4-006.13B1 Any specialized assistive devices or equipment needed to meet resident needs must be provided as specified in each resident service agreement.

4-006.13B2 Common areas and resident sleeping areas must be furnished with beds, chairs, sofas, tables, and storage items that are comfortable and reflective of resident needs and preferences. Furnishings may be provided by either the resident or the facility.

4-006.13B3 A process must be established and implemented for routine and preventative maintenance of facility-owned equipment and furnishings to ensure that such equipment and furnishings are safe and function to meet the intended use.

4-006.13CLaundry Services: Bed and bath linens must be provided as specified in the resident service agreement by either the resident or the facility. The resident service agreement must also address if the facility or the resident will be responsible for laundering of resident personal items.

4-006.13C1 When bed and bath linens are provided by the facility, the facility must maintain an adequate supply of clean linens in good repair.

4-006.13C2 The facility must establish and implement procedures for the storage and handling of soiled and clean linens.

4-006.13C3 When the facility launders bed and bath linens and items for more than one resident together, water temperatures to laundry equipment must exceed 140 degrees Fahrenheit or the laundry may be appropriately sanitized or disinfected by another acceptable method in accordance with manufacturer's instructions.

4-006.13DPets: The assisted-living facility must assure any facility owned pet does not negatively affect residents. The assisted-living facility must have policies and procedures regarding pets that include:

1. An annual examination by a licensed veterinarian;

2. Vaccinations as recommended by the licensed veterinarian that include, at a minimum, current vaccination for rabies for dogs, cats and ferrets;

3. Provision of pet care necessary to prevent the acquisition and spread of fleas, ticks and other parasites; and

4. Responsibility for care or supervision of the pet by facility staff.

4-006.13EEnvironmental Safety: The assisted-living facility is responsible for maintaining the facility in a manner that minimizes accidents.

4-006.13E1 The facility must maintain the environment to protect the health and safety of residents by keeping surfaces smooth and free of sharp edges, mold or dirt; keeping floors free of objects and slippery or uneven surfaces and keeping the environment free of other conditions which may pose a potential risk.

4-006.13E2 The facility must maintain all doors, stairways, passageways, aisles or other means of exit in a manner that provides safe and adequate access for care.

4-006.13E3 The facility must provide and maintain water for bathing and handwashing at safe and comfortable temperatures to protect residents from potential for burns or scalds. The water temperature at resident bathing fixtures must not exceed 115 degrees Fahrenheit, except in existing and new facilities where the resident is capable of managing water temperatures.

4-006.13E4 The facility must ensure hazardous/poisonous materials utilized by the facility are properly handled and stored to prevent accidental ingestion, inhalation, or consumption of the hazardous/poisonous materials by residents.

4-006.13E5 The facility must restrict access to mechanical equipment which may pose a danger to residents.

4-006.13FDisaster Preparedness and Management: The assisted-living facility must establish and implement disaster preparedness plans and procedures to ensure that resident care, safety, and well-being are provided and maintained during and following instances of natural (tornado, flood, etc.) or other disasters, disease outbreaks, or other similar situations. Such plans and procedures must address and delineate:

1. How the facility will maintain the proper identification of each resident to ensure that care coincides with the resident's needs;

2. How the facility will move residents to points of safety or provide other means of protection when all or part of the building is damaged or uninhabitable due to natural or other disaster;

3. How the facility will protect residents during the threat of exposure to the ingestion, absorption, or inhalation of hazardous substances or materials;

4. How the facility will provide food, water, medicine, medical supplies, and other necessary items for care in the event of a natural or other disaster; and

5. How the facility will provide for the comfort, safety, and well-being of residents in the event of 24 or more consecutive hours of:

a. Electrical or gas outage;

b. Heating, cooling, or sewer system failure; or

c. Loss or contamination of water supply.

175 Neb. Admin. Code, ch. 4, § 006