Based on the comprehensive assessment of a resident, the facility
must ensure that a resident receives treatment and care in accordance
with professional standards of practice, the comprehensive person-centered
care plan, and the resident's choices, including the following:
(1) Vision and hearing. To ensure that a resident receives
proper treatment and assistive devices to maintain vision and hearing
abilities, the facility must, if necessary, assist the resident:
(A) in making appointments; and
(B) by arranging for transportation to and from the
office of a practitioner specializing in the treatment of vision or
hearing impairment or the office of a professional specializing in
the provision of vision or hearing assistive devices.
(2) Skin Integrity.
(A) Pressure ulcers. Based on the comprehensive assessment
of the resident, the facility must ensure that:
(i) a resident receives care, consistent with professional
standards of practice, to prevent pressure ulcers and does not develop
pressure ulcers unless the resident's clinical condition demonstrates
that they are unavoidable; and
(ii) a resident with pressure ulcers receives necessary
treatment and services, consistent with professional standards of
practice, to promote healing, prevent infection, and prevent new ulcers
from developing.
(B) Foot Care. To ensure that a resident receives proper
treatment and care to maintain mobility and good foot health, the
facility must:
(i) provide foot care and treatment, in accordance
with professional standards of practice, including to prevent complications
from the resident's medical condition; and
(ii) if necessary, assist the resident in making appointments
with a qualified person, and arranging for transportation to and from
such appointments.
(3) Incontinence.
(A) The facility must ensure that a resident who is
continent of bladder and bowel on admission receives services and
assistance to maintain continence unless the resident's clinical condition
is or becomes such that continence is not possible to maintain.
(B) For a resident with urinary incontinence, based
on the comprehensive assessment of the resident, the facility must
ensure that:
(i) a resident who enters the facility without an indwelling
catheter is not catheterized unless the resident's clinical condition
demonstrates that catheterization is necessary;
(ii) a resident who enters the facility with an indwelling
catheter or subsequently receives one is assessed for removal of the
catheter as soon as possible unless the resident's clinical condition
demonstrates that catheterization is necessary; and
(iii) a resident who is incontinent of bladder receives
appropriate treatment and services to prevent urinary tract infections
and to restore continence to the extent possible.
(C) For a resident with fecal incontinence, based on
the resident's comprehensive assessment, the facility must ensure
that a resident who is incontinent of bowel receives appropriate treatment
and services to restore as much normal bowel function as possible.
(4) Colostomy, urostomy, or ileostomy care. The facility
must ensure that a resident who requires colostomy, urostomy, or ileostomy
services, receives such care consistent with professional standards
of practice, the comprehensive care plan, and the resident's goals
and preferences.
(5) Mobility. The facility must ensure that:
(A) a resident who enters the facility without a limited
range of motion does not experience reduction in range of motion
unless the resident's clinical condition demonstrates that a reduction
in range of motion is unavoidable;
(B) a resident with a limited range of motion receives
appropriate treatment and services to increase range of motion and
to prevent further decrease in range of motion; and
(C) a resident with limited mobility receives appropriate
services, equipment, and assistance to maintain or improve mobility
with the maximum practicable independence unless a reduction in mobility
is unavoidable.
(6) Assisted nutrition and hydration. (Includes naso-gastric
and gastrostomy tubes, both percutaneous endoscopic gastrostomy and
percutaneous endoscopic jejunostomy, and enteral fluids). Based on
a resident's comprehensive assessment, the facility must ensure that
a resident:
(A) maintains acceptable parameters of nutritional
status, such as usual body weight or desirable body weight range and
electrolyte balance, unless the resident's clinical condition demonstrates
that this is not possible or the resident preferences indicate otherwise;
(B) is offered sufficient fluid intake to maintain
proper hydration and health;
(C) is offered a therapeutic diet when there is a nutritional
problem and the health care provider orders a therapeutic diet;
(D) who has been able to eat enough alone or with assistance
is not fed by enteral methods unless the resident's clinical condition
demonstrates that enteral feeding was clinically indicated and consented
to by the resident; and
(E) who is fed by enteral means receives the appropriate
treatment and services to restore, if possible, oral eating skills
and to prevent complications of enteral feeding including aspiration
pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities,
and nasal-pharyngeal ulcers.
(7) Parenteral fluids. Parenteral fluids must be administered
consistent with professional standards of practice and in accordance
with physician orders, the comprehensive care plan, and the resident's
goals and preferences.
(8) Respiratory care, including tracheostomy care
and tracheal suctioning. The facility must ensure that a resident
who needs respiratory care, including tracheostomy care and tracheal
suctioning, is provided such care, consistent with professional standards
of practice, the comprehensive care plan, the resident's goals and
preferences, and §19.802 of this chapter, (relating to Comprehensive
Person-Centered Care Planning).
(9) Prostheses. The facility must ensure that a resident
who has a prosthesis is provided care and assistance, consistent with
professional standards of practice, the comprehensive care plan, and
the resident's goals and preferences, to wear and be able to use the
prosthetic device.
(10) Pain management. The facility must ensure that
pain management is provided to a resident who requires such services,
consistent with professional standards of practice, the comprehensive
care plan, and the resident's goals and preferences.
(11) Dialysis. The facility must ensure that a resident
who requires dialysis receives such services, consistent with professional
standards of practice, the comprehensive care plan, and the resident's
goals and preferences.
(12) Trauma-informed care. Effective November 28, 2019,
the facility must ensure that a resident who is a trauma survivor
receives culturally-competent, trauma-informed care in accordance
with professional standards of practice and accounting for resident's
experiences and preferences in order to eliminate or mitigate triggers
that may cause re-traumatization of the resident.
(13) Bed rails. The facility must attempt to use appropriate
alternatives before installing a side or bed rail. If a bed or side
rail is used, the facility must ensure correct installation, use,
and maintenance of bed rails, including the following elements:
(A) assess the resident for risk of entrapment from
bed rails before installation;
(B) review the risks and benefits of bed rails with
the resident or resident representative and obtain informed consent
before installation;
(C) ensure the bed's dimensions are appropriate for
the resident's size and weight; and
(D) follow the manufacturers' recommendations and
specifications for installing and maintaining bed rails.
(14) Accidents. The facility must ensure that:
(A) the resident environment remains as free of accident
hazards as possible; and
(B) each resident receives adequate supervision and
assistive devices to prevent accidents.
(15) Pediatric care.
(A) Licensed nursing care of children. A facility caring
for children must have 24 hour a day on-site licensed nursing staff
in numbers sufficient to provide safe care. For any facility with
five or more children under 26 pounds, at least one nurse must be
assigned solely to the care of those children.
(B) Fewer than five pediatric residents. Facilities
with fewer than five pediatric residents must assure that the children's
rooms are in close proximity to the nurses' station.
(C) Respiratory care of children.
Cont'd... |
