| (E) enters, dates, and signs monthly progress notes
on medical care provided;
(F) administers medication and treatments;
(G) provides health education; and
(H) maintains medical records.
(3) The activities director:
(A) plans and directs the daily program of activities,
including physical fitness exercises or other recreational activities;
(B) records the individual's social history;
(C) assists the individual's related support needs;
(D) assures that the identified related support services
are included in the individual's plan of care; and
(E) signs and dates monthly progress notes about social
and related support services activities provided.
(4) An attendant:
(A) provides personal care services to assist with
activities of daily living;
(B) assists the activities director with recreational
activities; and
(C) provides protective supervision through observation
and monitoring.
(5) Food service personnel:
(A) prepare meals and snacks; and
(B) maintain the kitchen area and utensils in a safe
and sanitary condition.
(6) A facility must obtain consultation at least four
hours per month from a dietitian consultant.
(A) The dietitian consultant plans and reviews menus
and must:
(i) approve and sign snack and luncheon menus;
(ii) review menus monthly to ensure that substitutions
were appropriate; and
(iii) develop a special diet for an individual, if
ordered by a physician.
(B) A facility must obtain consultation from a dietitian
consultant, even if the facility has meals delivered from another
facility with a dietitian consultant or the facility contracts for
the preparation and delivery of meals with a contractor that employs
a registered dietician. A consultant who provides consultation to
several facilities must provide at least four hours of consultation
per month to each facility.
(7) If a facility employs an LVN as the facility nurse,
the facility must ensure that an RN consultant provides consultation
at the facility at least four hours per week. The RN consultant must
document the consultation provided. The RN consultant must provide
the consultation when individuals are present in the facility. The
RN consultant may provide the following types of assistance:
(A) review plans of care and suggest changes, if appropriate;
(B) assess individuals' health conditions;
(C) consult with the LVN in solving problems involving
care and service planning;
(D) counsel individuals on health needs;
(E) train, consult, and assist the LVN to maintain
proper medical records; and
(F) provide in-service training for direct service
staff.
(e) Training.
(1) Initial training.
(A) A facility must:
(i) provide direct service staff with training in the
fire, disaster, and evacuation procedures within three workdays after
the start of employment and document the training in the facility
records; and
(ii) provide direct service staff a minimum of 18 hours
of training during the first three months after the start of employment
and document the training in the facility records.
(B) The training provided in accordance with subparagraph
(A)(ii) of this paragraph must include:
(i) any nationally or locally recognized adult CPR
course or certification;
(ii) first aid; or
(iii) orientation to health care delivery, including
the following topics:
(I) safe body function and mechanics;
(II) personal care techniques and procedures; and
(III) overview of the population served at the facility;
and
(iv) identification and reporting of abuse, neglect,
or exploitation.
(2) Ongoing training.
(A) A facility must provide at least three hours of
ongoing training to direct service staff quarterly. The facility must
ensure that direct delivery staff maintain current certification in
CPR.
(B) A facility must practice evacuation procedures
with staff and individuals at least once a month. The facility must
document evacuation results in the facility records.
(3) Policy for individuals with Alzheimer's disease
or a related disorder. A facility must adopt, implement, and enforce
a written policy that:
(A) requires a facility employee who provides direct
care at the facility to an individual with Alzheimer's disease or
a related disorder to successfully complete training in the provision
of care to individuals with Alzheimer's disease or related disorders;
and
(B) ensures the care and services provided by a facility
employee to an individual with Alzheimer's disease or a related disorder
meet the specific identified needs of the individual relating to the
diagnosis of Alzheimer's disease or a related disorder.
(C) The training required for facility employees under
paragraph (3)(A) of this subsection must include information about:
(i) symptoms and treatment of dementia;
(ii) stages of Alzheimer's disease;
(iii) person-centered behavioral interventions; and
(iv) communication with an individual with Alzheimer's
disease or a related disorder.
(f) Medications.
(1) Administration.
(A) A facility must ensure that a person who holds
a current license under state law that authorizes the licensee to
administer medications to individuals who choose not to or cannot
self-administer their medications.
(B) A facility must ensure that all medication prescribed
to an individual that is administered at the facility is dispensed
through a pharmacy or by the individual's treating physician or dentist.
(C) A facility may administer physician sample medications
at the facility if the medication has specific dosage instructions
for the individual.
(D) A facility must record an individual's medications
on the individual's medication profile record. The recorded information
must be obtained from the prescription label and must include the
medication name, strength, dosage, amount received, directions for
use, route of administration, prescription number, pharmacy name,
and the date each medication was issued by the pharmacy.
(2) Assistance with self-administration. A nurse may
assist with self-administration of an individual's medication if
the individual is unable to administer the medication without assistance.
Assistance with self-administration of medication is limited to the
following activities:
(A) reminding an individual to take medications at
the prescribed time;
(B) opening and closing containers or packages;
(C) pouring prescribed dosage according to the individual's
medication profile record;
(D) returning medications to the proper locked areas;
(E) obtaining medications from a pharmacy; and
(F) listing on an individual's medication profile record
the medication name, strength, dosage, amount received, directions
for use, route of administration, prescription number, pharmacy name,
and the date each medication was issued by the pharmacy.
(3) Self-administration.
(A) A nurse must counsel an individual who self-administers
medication or treatment at least once per month to ascertain if the
individual continues to be able to self-administer the medication
or treatment. The facility must keep a written record of the counseling.
(B) A facility may permit an individual who chooses
to keep the individual's medication locked in the facility's central
medication storage area to enter or have access to the area for the
purpose of self-administering medication or treatment. A facility
staff member must remain in or at the storage area the entire time
the individual is present.
(4) General.
(A) A facility director, an activities director, or
a facility nurse must immediately report to an individual's physician
and responsible party any unusual reactions to a medication or treatment.
(B) When a facility supervises or administers medications,
the facility must document in writing if an individual does not receive
or take the medication and treatment as prescribed. The documentation
must include the date and time the dose should have been taken, and
the name and strength of medication missed.
(5) Storage.
Cont'd... |
