TITLE 7 HEALTH
CHAPTER 9 NURSING
HOMES AND INTERMEDIATE CARE FACILITIES
PART 2 REQUIREMENTS
FOR LONG TERM CARE FACILITIES
7.9.2.1 ISSUING
AGENCY: New Mexico Department of Health, Public
Health Division, Health Facility Licensing and Certification Bureau.
[10-31-96; 7.9.2.1 NMAC - Rn,
7 NMAC 9.2.1, 8-31-00]
7.9.2.2 SCOPE:
A. Services for residents shall be provided on a continuing twenty-four
(24) hour basis and shall maintain or improve physical, mental and psychosocial
well-being under plan of care developed by a physician or other licensed health
professional and shall be reviewed and revised based on assessment.
B. All
facilities licensed as nursing homes pursuant to Section 24-1-5 (A) NMSA 1978,
are subject to all provisions of these regulations.
[7-1-60, 5-2-89; 7.9.2.2 NMAC
- Rn, 7 NMAC 9.2.2, 8-31-00]
7.9.2.3 STATUTORY
AUTHORITY: The regulations set forth herein are
promulgated by the Secretary of the New Mexico Department of Health, pursuant
to the general authority granted under Section 9-7-6 (E) of the Department of
Health Act, NMSA 1978, as amended; and the authority granted under Sections
24-1-2 (D), 24-1-3 (I) and 24-1-5 of the Public Health Act, NMSA 1978, as
amended.
[7-1-60, 5-2-89; 7.9.2.3 NMAC
- Rn, 7 NMAC 9.2.3, 8-31-00]
7.9.2.4 DURATION: Permanent
[10-31-96; 7.9.2.4 NMAC - Rn,
7 NMAC 9.2.4, 8-31-00]
7.9.2.5 EFFECTIVE
DATE:
October 31, 1996, unless a different date is cited at the end of a
Section or Paragraph.
[10-31-96; 7.9.2.5 NMAC - Rn,
7 NMAC 9.2.5, 8-31-00]
7.9.2.6 OBJECTIVE:
A. Establish minimum standards for long term care facilities in the State
of New Mexico.
B. Monitor long term care facilities with these regulations through
surveys to identify any areas which could be dangerous or harmful to the
residents or staff.
C. Encourage the maintenance of long term care facilities that will provide
quality services which maintain or improve the health and quality of life to
the residents.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.6 NMAC - Rn, 7 NMAC 9.2.6, 8-31-00]
7.9.2.7 DEFINITIONS: For purposes
of these regulations the following shall apply:
A. “ABUSE”
means any act or failure to act performed intentionally, knowingly, or
recklessly that causes or is likely to cause harm to a resident, including but
not limited to:
(1) Physical contact that
harms or is likely to harm a resident of a care facility.
(2) Inappropriate use of
physical restraint, isolation, or medication that harms or is likely to harm a
resident.
(3) Inappropriate use of
a physical or chemical restraint, medication or isolation as punishment or in
conflict with a physicians order.
(4) Medically
inappropriate conduct that causes or is likely to cause physical harm to a
resident.
(5) Medically
inappropriate conduct that causes or is likely to cause great psychological
harm to a resident.
(6) An unlawful act, a
threat or menacing conduct directed toward a resident that results and might
reasonably be expected to result in fear or emotional or mental distress to a
resident.
B. “AMBULATORY” means able to walk without assistance.
C. “APPLICANT” means the individual who, or organization which,
applies for a license. If the applicant is an organization, then the individual
signing the application on behalf of the organization, must have authority from
the organization. The applicant must be the owner.
D. “DEPARTMENT” means the New Mexico Department of Health.
E. “DEVELOPMENTAL DISABILITY” means mental retardation or a related condition, such
as cerebral palsy, epilepsy or autism, but excluding mental illness and
infirmities of aging, which is:
(1) Manifested before the
individual reaches age twenty-two (22).
(2) Likely to continue
indefinitely; and
(3) Results in
substantial functional limitations in three (3) or more of the following areas
of major life activity:
(a)
Self-care;
(b)
Understanding and use of language;
(c)
Learning;
(d)
Mobility;
(e)
Self-direction;
(f)
Capacity for independent living; and
(g)
Economic self-sufficiency.
F. “DIETITIAN” means a person who is eligible for registration as a
dietitian by the commission on dietetic registration of the American Dietetic
Association under its requirements in effect on January 17, 1982.
G. “DIRECT SUPERVISION” means supervision of an assistant by a supervisor who
is present in the same building as the assistant while the assistant is
performing the supervised function.
H. “EXPLOITATION” of a patient/client/resident consists of the act or
process, performed intentionally, knowingly, or recklessly, of using a
patient/client's property, including any form of property, for another persons,
profit, advantage or benefit. Exploitation includes but is not limited to:
(1) Manipulating the
patient/client resident by whatever mechanism to give money or property to any
facility staff and/or management member.
(2) Misappropriation or
misuse of monies belonging to a resident or the unauthorized sale, or transfer
or use of a patient/client/residents property.
(3) Loans of any kind
from a patient/client/resident to family, operator or families of staff or
operator.
(4) Accepting monetary or
other gifts from a patient /client/resident or their family with a value in
excess of $25 and not to exceed a total value of $300 in one year. All gifts
received by facility operators, their families or staff of the facility must be
documented and acknowledged by person giving the gift and the recipient.
Exception: Testamentary gifts, such as wills, are not, per se, considered
financial exploitation.
I. “FACILITY” means a nursing home subject to the requirements of
these regulations.
J. “FULL-TIME” means at least an average of 37.5 hours each week
devoted to facility business.
K. “INTERMEDIATE CARE FACILITY” means a nursing home, which is licensed by the
Department as an intermediate care facility to provide intermediate nursing
care.
L. “INTERMEDIATE NURSING CARE” means a basic care consisting of physical, emotional,
social and other rehabilitative services under periodic medical supervision.
This nursing care requires the skill of a licensed nurse for observation and
recording of reactions and symptoms, and for supervision of nursing care. Most
of the residents have long-term illnesses or disabilities which may have
reached a relatively stable plateau. Other residents whose conditions are
stabilized may need medical and nursing services to maintain stability.
Essential supportive consultant services are provided in accordance with these
regulations.
M. “LICENSED PRACTICAL NURSE” means a person licensed as a licensed practical nurse
under the Nursing Practice Act Section 61-3-1 through 61-3-30 NMSA 1978.
N. “LICENSEE” means the person(s) who, or organization which, has
an ownership, leasehold, or similar interest in the long term care facility and
in whose name a license has been issued and who is legally responsible for
compliance with these regulations.
O. “MOBILE NON-AMBULATORY” means unable to walk without assistance, but able to
move from place to place with the use of a device such as a walker, crutches, a
wheelchair or a wheeled platform.
P. “NON-AMBULATORY” means unable to walk without assistance.
Q. “NON-MOBILE” means unable to move from place to place.
R. “NURSE” means registered nurse or licensed practical nurse.
S. “NURSE PRACTITIONER (CERTIFIED)” means a registered professional nurse who meets the requirements
for licensure as established under the Nursing Practice Act, Sections 61-3-1
through 61-3-30 NMSA 1978.
T. “PERSONAL CARE” means personal assistance, supervision and a suitable
activities program. In addition:
(1) The services provided
are chiefly characterized by the fact that they can be provided by personnel
other than those trained in medical or allied fields. The services are directed
toward personal assistance, supervision, and protection.
(2) The medical service
emphasizes a preventive approach of periodic medical supervision by the
resident's physician as part of a formal medical program that will provide
required consultation services and also cover emergencies; and
(3) The dietary needs of
residents are met by the provision of adequate general diet or by therapeutic,
medically prescribed diets.
U. “PHARMACIST” means a person registered as a pharmacist under the
Pharmacy Act, Section 61-11-9 NMSA 1978.
V. “PHYSICAL THERAPIST” means a person licensed to practice physical therapy
under the Physical Therapy Act, Sections 61-12-1 to 61-12-21 NMSA 1978.
W. “PHYSICIAN” means a person licensed to practice medicine or
osteopathy as defined by the New Mexico Board of Medical Examiners, Section
61-6-10 NMSA 1978 and Osteopathic Medicine and Surgery, Sections 61-10-1
through 61-10-21 NMSA 1978.
X. “PHYSICIAN'S EXTENDER” means a person who is a physician's assistant or a
nurse practitioner acting under the general supervision and direction of a
physician.
Y. “PHYSICIAN'S ASSISTANT” means a person certified under the New Mexico Board
of Medical Examiners Section 61-6-6 NMSA 1978, to perform as a physician's
assistant.
Z. “PRACTITIONER” means a physician, dentist or podiatrist or other
person permitted by New Mexico law to distribute, dispense and administer a
controlled substance in the course of professional practice.
AA. “REGISTERED NURSE” means a person who holds a certificate of
registration as a registered nurse under the Nursing Practice Act, Section
61-3-1 to 61-3-30 NMSA 1978.
BB. “RESIDENT” means a person cared for or treated in any facility
on a 24-hour basis irrespective of how the person has been admitted to the
facility.
CC. “SKILLED NURSING FACILITY” means a nursing home which is licensed by the
Department to provide skilled nursing services.
DD. “SKILLED NURSING CARE” means those services furnished pursuant to a
physician's orders which:
(1) Require the skills of
professional personnel such as registered or licensed practical nurses; and
(2) Are provided either
directly by or under the supervision of these personnel.
(3) In determining
whether a service is skilled nursing care, the following criteria shall be
used:
(a)
The service would constitute a skilled service where the inherent
complexity of a service prescribed for a resident is such that it can be safely
and effectively performed only by or under the supervision of professional
personnel;
(b)
The restoration potential of a resident is not the deciding factor in
determining whether a service is to be considered skilled or unskilled. Even
where full recovery or medical improvement is not possible, skilled care may be
needed to prevent, to the extent possible, deterioration of the condition or to
sustain current capacities; and
(c)
A service that is generally unskilled would be considered skilled where,
because of special medical complications, its performance or supervision or the
observation of the resident necessitates the use of skilled nursing personnel.
EE. “SPECIALIZED CONSULTATION” means the provision of professional or technical
advice, such as systems analysis, crisis resolution or in-service training, to
assist the facility in maximizing service outcomes.
FF. “SUPERVISION” means at least intermittent face-to-face contact
between supervisor and assistant, with the supervisor instructing and
overseeing the assistant, but does not require the continuous presence of the
supervisor in the same building as the assistant.
GG. “TOUR OF DUTY” means a portion of the day during which a shift of
resident care personnel are on duty.
HH. “UNIT DOSE DRUG DELIVERY SYSTEM” means a system for the distribution of medications in
which single doses of medications are individually packaged and sealed for
distribution to residents.
II. “VARIANCE” means an act on the part of the Licensing Authority
to refrain from pressing or enforcing compliance with a portion or portions of
these regulations for an unspecified period of time where the granting of a
variance will not create a danger to the health, safety, or welfare of
residents or staff of a long term care facility, and is at the sole discretion
of the Licensing Authority.
JJ. “WAIVE/WAIVERS” means to refrain from pressing or enforcing
compliance with a portion or portions of these regulations for a limited period
of time provided the health, safety, or welfare of residents and staff are not
in danger. Waivers are issued at the sole discretion of the Licensing
Authority.
[7-1-60, 5-2-89, 10-31-96,
6-15-98; 7.9.2.7 NMAC - Rn, 7 NMAC 9.2.7, 8-31-00]
7.9.2.8 LICENSURE:
A. APPLICATION/REQUIREMENTS FOR
LICENSURE:
(1) All initial
applications shall be made on forms provided by the Licensing Authority.
(a)
All information requested on the application must be provided.
(b)
The application must be dated and signed by the person who shall be the
licensee.
(c)
The application must be notarized.
(2) In every application,
the applicant shall provide the following information:
(a)
The identities of all persons or business entities having the authority,
directly or indirectly, to direct or cause the direction of the management or
policies of the facility;
(b)
The identities of all persons or business entities having five percent
(5%) ownership interest whatsoever in the facility, whether direct or indirect,
and whether the interest is in the profits, land or building, including owners
of any business entity which owns any part of the land or building, and
(c)
The identities of all creditors holding a security interest in the
premises, whether land or building; and
(d) In the case of a
change of ownership, disclosure of any relationship or connection between the
old licensee and the new licensee, and between any owner or operator of the new
licensee, whether direct or indirect.
(3) The applicant shall provide to the
Department, information including, but not limited to, information regarding
felony convictions, civil actions involving fraud, embezzlement or
misappropriation of property, any state or federal adverse action resulting in
suspension or revocation of license or permit.
(4) The new licensee
shall submit evidence to establish that he or she has sufficient resources to
permit operation of the facility for a period of six (6) months.
(5) No license may be
issued unless and until the applicant has supplied all information requested by
the Department.
(6) Fees: All
applications for initial licensure must be accompanied by the required fee.
(a)
Current fee schedules may be requested from the Licensing Authority.
(b)
Fees must be in the form of a certified check, money order, personal or
business check made payable to the State of New Mexico.
(c)
Fees are non-refundable.
B. ACTION BY THE DEPARTMENT:
(1) After receiving
complete application, the Department shall investigate the applicant to
determine the applicant's ability to comply with these regulations.
(2) Within sixty (60)
days after receiving a complete application for a license, the Department shall
either approve the application and issue a license or deny the application. If
the application for a license is denied, the Department shall give the
applicant reasons, in writing, for the denial.
(3) The Licensing
Authority shall not issue a new license if the applicant has had a health
facility license revoked or denied renewal, or has surrendered a license under
threat of revocation or denial of renewal, or has lost certification as a
Medicaid provider as a result of violations of applicable Medicaid
requirements. The Licensing Authority
may refuse to issue a new license if the applicant has been cited repeatedly
for violations of applicable regulations found to be Class A or Class B
deficiencies as defined in Health
Facility Sanctions and Civil Monetary Penalties, 7NMAC 1.8, or has been
noncompliant with plans of correction .
[7-1-60, 7-1-64, 5-2-89,
10-31-96, 7.9.2.8 NMAC - Rn & A, 7 NMAC 9.2.8, 8-31-00]
7.9.2.9 TYPES
OF LICENSE:
A. ANNUAL LICENSE: An annual
license is issued for a one (1) year period to a long term care facility which
has met all requirements of these regulations.
B. TEMPORARY LICENSE: The Licensing
Authority may, at its sole discretion, issue a temporary license prior to the
initial survey, or when the Licensing Authority finds partial compliance with
these regulations.
(1) A temporary license
shall cover a period of time, not to exceed one-hundred twenty (120) days,
during which the facility must correct all specified deficiencies.
(2) In accordance with Section
24-1-5 (D) NMSA 1978, no more than two (2) consecutive temporary licenses shall
be issued.
C. AMENDED LICENSE: A license must
apply to the Licensing Authority for an amended license when there is a change
of Administrator/Director, when there is a change of name for the facility,
when a change in capacity is sought, a change in bed classification is sought,
or an addition or deletion of any special or operation unit(s) as listed in
these regulations is sought.
(1) Application must be
on a form provided by the Licensing Authority.
(2) Application must be
accompanied by the required fee for amended license.
(3) Application must be
submitted within ten (10) working days of the change.
[7-1-60, 5-2-89, 10-31-96;
7.9.2.9 NMAC - Rn, 7 NMAC 9.2.9, 8-31-00]
7.9.2.10 SCOPE
OF LICENSE:
A. The licensed is issued only for the premises and the persons named in
the license application and may not be transferred or assigned by the licensee.
B. The license shall state any applicable restrictions, including maximum
bed capacity and the level of care that may be provided, and any other
limitations that the department considers appropriate and necessary taking all
facts and circumstances into account.
C. A licensee shall fully comply with all requirements and restrictions of
the license.
[7-1-60, 5-2-89; 7.9.2.10
NMAC - Rn, 7 NMAC 9.2.10, 8-31-00]
7.9.2.11 SEPARATE
LICENSES: Separate licenses shall be required for
facilities which are maintained on separate premises even though they are under
the same management. Separate licenses shall not be required for separate
buildings on the same ground or adjacent ground.
[5-2-89; 7.9.2.11 NMAC - Rn,
7 NMAC 9.2.11, 8-31-00]
7.9.2.12 LICENSE
RENEWAL:
A. Licensee must submit a renewal application on forms provided by the
Licensing Authority, along with the required fee at least thirty (30) days
prior to expiration of the current license.
B. Upon receipt of renewal application and
required fee prior to expiration of current license, the Licensing Authority
will issue a new license effective the day following the date of expiration of
the current license if the facility is in substantial compliance with these
regulations.
C. If a licensee fails to submit a renewal application with the required
fee and the current license expires, the long term care facility shall cease
operation until it obtains a new license through the initial licensure
procedures. Section 24-1-5 (A) NMSA 1978, as amended, provides that no health
facility shall be operated without a license.
[7-1-60, 5-2-89, 10-31-96;
7.9.2.12 NMAC - Rn, 7 NMAC 9.2.12, 8-31-00]
7.9.2.13 POSTING: The license or
a certified copy thereof shall be conspicuously posted in a location or
accessible to public view within the facility.
[7-1-60, 5-2-89; 7.9.2.13
NMAC - Rn, 7 NMAC 9.2.13, 8-31-00]
7.9.2.14 REPORT
OF CHANGES:
A. The licensee shall notify the department in writing of any changes in
the information provided, within ten (10) days of such changes. This
notification shall include information and documentation regarding such
changes.
B. When a change of administrator occurs, the Department shall be notified
within ten (10) days in writing by the licensee. Such writing shall include the name and
license number of the new administrator.
C. Each licensee shall notify the Department within ten (10) days in
writing of any change of the mailing address of the licensee. Such writing
shall include the new mailing address of the licensee.
D. When a change in the principal officer of a corporate license
(chairman, president, general manager) occurs the Department shall be notified
within thirty (30) days in writing by the licensee. Such writing shall include the
name and business address of such officer.
E. Any decrease, or increase in licensed bed capacity of the facility
shall require notification by letter to the Department and shall result in the
issuance of a corrected license.
[7-1-60, 5-2-89; 7.9.2.14 NMAC
- Rn, 7 NMAC 9.2.14, 8-31-00]
7.9.2.15 NON-TRANSFERABLE
RESTRICTION ON LICENSE: A license shall not be transferred by
assignment or otherwise to other persons or locations. The license shall be void and must be
returned to the Licensing Authority when any one of the following situations
occur:
A. Ownership of the facility changes.
B. The facility changes location.
C. Licensee of the facility changes.
D. The facility discontinues operation.
E. A facility wishing to continue
operation as a licensed long term care facility under circumstances 15.1
through 15.4 above must submit an application for initial licensure in
accordance with Section 7.9.2.8 of these regulations, at least thirty (30) days
prior to the anticipated change.
[10-31-96; 7.9.2.15 NMAC -
Rn, 7 NMAC 9.2.15, 8-31-00]
7.9.2.16 AUTOMATIC
EXPIRATION OF LICENSE: A license will automatically expire at
midnight on the day indicated on the license as the expiration date, unless
sooner renewed, suspended, or revoked, or:
A. On the day a facility discontinues operation.
B. On the day a facility is sold, leased, or otherwise changes ownership
and/or licensee.
C. On the day a facility changes location.
[10-31-96; 7.9.2.16 NMAC -
Rn, 7 NMAC 9.2.16, 8-31-00]
7.9.2.17 SUSPENSION
OF LICENSE WITHOUT PRIOR HEARING: In accordance with Section 24-1-5 (H) NMSA
1978, if immediate action is required to protect human health and safety, the
Licensing Authority may suspend a license pending a hearing, provided such
hearing is held within five (5) working days of the suspension, unless waived
by the licensee.
[10-31-96; 7.9.2.17 NMAC -
Rn, 7 NMAC 9.2.17, 8-31-00]
7.9.2.18 GROUNDS
FOR REVOCATION OR SUSPENSION OF LICENSE, DENIAL OF INITIAL OR RENEWAL
APPLICATION FOR LICENSE, OR IMPOSITION OF INTERMEDIATE SANCTIONS OR CIVIL
MONETARY PENALTIES: A license may be revoked or suspended, an
initial or renewal application for license may be denied, or intermediate
sanctions or civil monetary penalties may be imposed after notice and
opportunity for a hearing, for any of the following reasons:
A. Failure to comply with any provision of these regulations.
B. Failure to allow survey by authorized representatives of the Licensing
Authority.
C. Any person active in the operation of a facility licensed pursuant to these
regulations shall not be under the influence of alcohol or narcotics or
convicted of a felony.
D. Misrepresentation of falsification of any information or application
forms or other documents provided to the Licensing Authority.
E. Discovery of repeat violations of these regulations during surveys.
F. Failure to provide the required care and services as outlined by these
regulations for the patients receiving care at the long term care facility.
G. Abuse, neglect or exploitation of any patient/client/resident by
facility operator, staff, or relatives or operator/staff.
[10-31-96, 6-15-98; 7.9.2.18
NMAC - Rn, 7 NMAC 9.2.18, 8-31-00]
7.9.2.19 HEARING
PROCEDURES:
A. Hearing procedures for an administrative appeal of an adverse action taken
by the Licensing Authority against the long term care facility as outlined in
Section 7.9.2.17 and 7.9.2.18 above will be held in accordance with
Adjudicatory hearings, New Mexico Department of Health, 7 NMAC 1.2 (2-1-96).
B. A copy of the Adjudicatory Hearing procedures will be furnished to the
long term care facility or agency at the time an adverse action is taken
against its license by the Licensing Authority. A copy may be requested at any
time by contacting the Licensing Authority.
[10-31-96; 7.9.2.19 NMAC -
Rn, 7 NMAC 9.2.19, 8-31-00]
7.9.2.20 PROGRAM
FLEXIBILITY:
A. All facilities shall maintain compliance with the licensee
requirements. If the use of alternate concepts, methods, procedures,
techniques, equipment, personnel qualifications or the conducting of pilot
projects conflicts with requirements, then prior written approval from the
Department shall be obtained in order to ensure provisions for safe and
adequate care. Such approval shall provide for the terms and conditions under
which the exception is granted. A written request and substantiating evidence
supporting the request shall be submitted by the applicant or licensee to the
department.
B. Any approval of the Department granted under this section, or a
certified copy thereof shall be posted immediately adjacent to the facility's
license.
[5-2-89; 7.9.2.20 NMAC - Rn,
7 NMAC 9.2.20, 8-31-00]
7.9.2.21 WAIVERS
AND VARIANCES:
A. DEFINITIONS: As used in
this section:
(1) Waiver: means the
grant of an exemption from a requirement of these regulations.
(2) Variance: means the
granting of an alternate requirement in place of a requirement of these
regulations.
B. REQUIREMENTS FOR WAIVERS AND
VARIANCES: A waiver or variance may be granted if the
Department finds that the waiver or variance will not adversely affect the
health, safety, or welfare of any resident and that:
(1) Strict enforcement of
a requirement would result in unreasonable hardship on the facility or on a
resident.
(2) An alternative to a
rule, including new concepts, methods, procedures, techniques, equipment,
personnel qualifications, or the conducting of pilot projects, is in the
interest of better care or management.
C. APPLICATIONS:
(1) All applications for
waiver or variance from the requirements of these regulations shall be made in
writing to the Department, specifying the following:
(a)
The rule from which the waiver or variance is requested;
(b)
The time period for which the waiver or variance is requested;
(c)
If the request is for a variance, the specific alternative action which
the facility proposes;
(d)
The reasons for the request; and
(e)
Justification that the goal or purpose of the rule or regulations would
be satisfied.
(2) Requests for a waiver
or variance may be made at any time.
(3) The Department may
require additional information from the facility prior to acting on the
request.
D. GRANTS AND DENIALS:
(1) The Department at its
discretion shall grant or deny each request for waiver or variance in writing.
A notice of denials shall contain the reasons for denial.
(2) The terms of a
requested variance may be modified upon agreement between the Department and a
facility.
(3) The Department may
impose such conditions on the granting of a waiver or variance which it deems
necessary.
(4) The Department may
limit the duration of any waiver or variance.
(5) The Department's action on a request for a
waiver is not subject to administrative appeal.
E. REVOCATION: The Department
may revoke a waiver or variance if:
(1) It is determined that
the waiver or variance is adversely affecting the health, safety or welfare of
the resident's; or
(2) The facility has
failed to comply with the variance as granted; or
(3) The licensee notifies
the Department in writing that it wishes to relinquish the waiver or variance
and be subject to the rule previously waived or varied;
(4) Required by a change
in law.
[5-2-89; 7.9.2.21 NMAC - Rn,
7 NMAC 9.2.21, 8-31-00]
7.9.2.22 RIGHTS
OF RESIDENTS: Every resident shall have the right to:
A. COMMUNICATIONS: Have private
and unrestricted communications with the resident's family, physician, attorney
and any other person, unless medically contraindicated as documented by the
resident's physician in the resident's medical record, except that
communications with public officials or with the resident's attorney shall not
be restricted in any event. The right to private and unrestricted
communications shall include, but is not limited to, the right to:
(1) Receive, send, and
mail sealed, unopened correspondence. No resident's incoming or outgoing
correspondence may be opened, delayed, held, or censored, except that a
resident or guardian may direct in writing that specified incoming
correspondence be opened, delayed, or held.
(2) Use a telephone for
private communications during reasonable hours.
(3) Have private visiting
pursuant to a reasonable written visitation policy.
B. ACCESS: Immediate
access by representatives of Human Services Department, Health and Environment
Department, Ombudsman, personal physician and, subject to resident's consent,
immediate family or other relatives or visitors following notification of staff
person in charge and presentation of valid identification. Reasonable access by
providers of health, social, legal or other services must be assured.
C. GRIEVANCES: Present
grievances on one's own behalf or through others to the facility's staff or
administrator, to public officials or to any other person without justifiable
fear of reprisal, and join with other residents or individuals within or
outside of the facility to work for improvements in resident care.
D. FINANCES: Manage one's
own financial affairs, including any personal allowances under federal or state
programs. No resident funds may be held or spent except in accordance with the
following requirements:
(1) A facility may not
hold or spend a resident's funds unless the resident or another person legally
responsible for the resident's funds authorize this action in writing. The
facility shall obtain separate authorization for holding a resident's funds and
for spending a resident's funds. The authorization for spending a resident's
funds may include a spending limit. Expenditures that exceed the designated
spending limit require a separate authorization for each individual occurrence.
(2) Any resident funds
held or controlled by the facility, and any earnings from them, shall be credited
to the resident and may not be comingled with other funds or property except
that of other residents.
(3) The facility shall
furnish a resident, the resident's guardian, or a representative designated by
the resident with at least a quarterly statement of all funds held by the
facility for the resident and all expenditures made from the resident's
account, and a similar statement at the time of the resident's permanent
discharge.
(4) The facility shall
maintain a record of all expenditures, disbursements and deposits made on
behalf of the resident.
E. ADMISSION INFORMATION: Be fully
informed in writing prior to or at the time of admission, of all services and
the charges for these services, and be informed in writing, during the
resident's stay, of any changes in services available or in charges for
services, as follows:
(1) No person may be
admitted to a facility without that person or that person's guardian or
designated representative signing an acknowledgement of having received a
statement of information before or on the day of admission which contains at
least the following information or, in the case of a person to be admitted for
short-term care, the information required under these regulation.
(a)
An accurate description of the basic services provided by the facility,
the rate charged for those services, and the method of payment for them;
(b)
Information about all additional services regularly offered but not
included in the basic services. The facility shall provide information on where
a statement of the fees charged for each of these services can be obtained.
These additional services include pharmacy, x-ray, beautician and all other
additional services regularly offered to residents or arranged for residents by
the facility;
(c)
The method for notifying residents of a change in rates or fees;
(d) Terms for refunding advance payments in
case of transfer, death or voluntary or involuntary discharge.
(e)
Terms of holding and charging for a bed during a resident's temporary
absence.
(f) Conditions for involuntary discharge or
transfer, including transfers within the facility;
(g)
Information about the availability of storage space for personal
effects; and
(h)
A summary of residents' rights
recognized and protected by this section and all facility policies and
regulations governing resident conduct and responsibilities. No statement of admission information may be
in conflict with any part of these regulations.
F. TREATMENT: Be treated
with courtesy, respect, and full recognition of one's dignity and individuality
by all employees of the facility and by all licensed, certified, and registered
providers under contract with the facility.
G. PRIVACY: Have physical
and emotional privacy in treatment, living arrangements, and in caring for
personal needs, including, but not limited to:
(1) Privacy for visits by
spouse. If both spouses are residents of the same facility, they shall be permitted
to share a room unless medically contra-indicated as documented by the
resident's physician in the resident's medical record.
(2) Privacy concerning
health care. Case discussion, consultation, examination, and treatment are confidential
and shall be conducted discreetly. Persons not directly involved in the
resident's care shall require the resident's permission to authorize their
presence.
(3) Confidentiality of
health and personnel records, and the right to approve or refuse their release
to any individual outside the facility, except in the case of the resident's
transfer to another facility or as required by law or third-party payment
contracts.
H. WORK: Not be
required to perform work for the facility, but may work for the facility if:
(1) The work is included
by the physician for therapeutic purposes in the resident's plan of care; and
(2) The work is ordered
by the resident's physician and does not threaten the health, safety, or
welfare of the resident or others.
(3) The resident
volunteers for work and such activities is not contra-indicated by physician.
I. OUTSIDE ACTIVITIES: Meet with and
participate in activities of social, religious, and community groups at the
resident's discretion, unless medically contra-indicated as documented by the
resident's physician in the resident's medical record.
J. PERSONAL POSSESSIONS: Retain and use
personal clothing and effects and to retain, as space permits, other personal
possessions in a reasonably, secure manner.
K. TRANSFER, DISCHARGE AND BEDHOLD: Involuntary
transfer shall be conducted only for resident's welfare, health and safety of
others, or failure to pay. Reasons other than failure to pay must be documented
by a physician in resident's record. Prior to transfer the facility must notify
resident and/or next of kin or responsible party of right to appeal and name
and address of ombudsman.
L. ABUSE AND RESTRAINTS: Be free from
mental and physical abuse, and be free from chemical and physical restraints
except as authorized in writing by a physician for a specified and limited
period of time and documented in the resident's medical record. Physical
restraints may be used in an emergency when necessary to protect the resident
from injury to himself or herself or others or to property. However,
authorization for continuing use of the physical restraints shall be secured
from a physician within 12 hours. Any use of physical. restraints shall be
noted in the resident's medical records. “Physical restraint” includes, but is
not limited to, any article, device, or garment which interferes with the free
movement of the resident and which the resident is unable to remove easily.
M. CARE: Receive
adequate and appropriate care within the capacity of the facility.
N. CHOICE OF PROVIDER: Use the
licensed, certified or registered provider of health care and pharmacist of the
resident's choice. The pharmacist of choice must be able to supply drugs and/or
Biologicals in such a manner as is consistent with the facility's medication
delivery system.
O. CARE PLANNING: Be fully
informed of one's treatment and care and participate in the planning of that treatment
and care, unless contra-indicated by physician order.
P. RELIGIOUS ACTIVITY: Participate in
religious activities and services, of resident's choice and meet privately with
clergy.
Q. NON-DISCRIMINATORY TREATMENT: Be free from
discrimination based on the source from which the facility's charges for the
resident's care are paid, as follows:
(1) No facility may
assign a resident to a particular wing or other distinct area of the facility,
whether for sleeping, dining or any other purpose, on the basis of the source
or amount of payment. A facility only part of which is certified for
Medicare/Medicaid reimbursement under Title XVIII/XIX of the Social Security
Act is not prohibited from assigning a resident to the certified part of the
facility because of the source of payment for the resident's care is
Medicare/Medicaid.
(2) Facilities shall
offer and provide an identical package of basic services meeting the
requirements of these regulations to all individuals regardless of the sources
of a resident's payment or amount of payment. Facilities may offer enhancements
of basic services, provided that these enhanced services are made available at
an identical cost to all residents regardless of the source of a resident's
payment. A facility which elects to offer enhancements to basic services to its
residents must provide all residents with a detailed explanation of enhanced
services and the additional charges for these services.
(3) If a facility offers
at extra charge additional services which are not covered by the facility's
provider agreement under which it provides Medicaid and Medicare services, it
shall provide them to any resident willing and able to pay for them, regardless
of the source from which the resident pays the facility's charges.
(4) No facility may
require, offer or provide an identification tag for a resident that publicly
identifies the source from which the facility's charges for that resident's
care are paid.
R. INCOMPETENCE: If a resident
is found incompetent by a court under New Mexico's Probate Code, (Sections
45-5-101 through 45-5-432 NMSA 1978), and not restored to legal capacity, the
rights and responsibilities established under this section which the resident
is not competent to exercise shall devolve upon the resident's guardian and/or
conservator.
S. CORRECTIONS CLIENTS: Rights
established under this section do not, except as determined by the department,
apply to residents in a facility who are in the legal custody of the department
for correctional purposes.
T. NOTIFICATION:
(1) Serving Notice: Copies of the resident rights provided under this
section and the facility's policies and regulations governing resident conduct
and responsibilities shall be made available to each prospective resident and
his or her guardian, if any, and to each member of the facility's staff.
Facility staff shall verbally explain to each new resident and to that person's
guardian, if any, prior to or at the time of the person's admission to the
facility, these rights and the facility's policies and regulations governing
resident conduct and responsibilities.
(2) Amendments: All amendments to the rights provided under
this section and all amendments to the facility regulations and policies
governing resident conduct and responsibilities require notification of each
resident and guardian, if any, at the time the amendment is put into effect.
The facility shall provide the resident, guardian, if any, and each member of
the facility's staff with a copy of all amendments.
(3) Posting: Copies of
the resident's rights provided under these regulations and the facility's
policies and regulations governing resident conduct and responsibilities shall
be posted in a prominent place in the facility.
U. ENCOURAGEMENT AND ASSISTANCE: Each facility
shall encourage and assist residents to exercise their rights as residents and
citizens and shall provide appropriate training for staff awareness so that
staff are encouraged to respect the rights of residents established under this
section.
[5-2-89; 7.9.2.22 NMAC - Rn,
7 NMAC 9.2.22, 8-31-00]
7.9.2.23 COMPLAINTS:
A. FILING COMPLAINTS: Any person may
file a complaint with a licensee or the Department regarding the operation of a
facility. Complaints may be made orally or in writing.
B. REVIEWING COMPLAINTS: Each facility
shall establish a system of reviewing complaints and allegations of violations
of resident's rights established under this section. The facility shall
designate a specific individual who, for the purpose of effectuating this
section, shall report to the administrator.
C. REPORTING COMPLAINTS: Allegations
that residents' rights have been violated by persons licensed, certified or
registered by any professional licensing board or designated authority shall be
promptly reported by the facility to the appropriate licensing or examining
board or authority and to the person against whom the allegation has been made.
Any employee of the facility and any person licensed, certified, or registered
by any professional licensing board or authority, may also report such
allegations to the board.
[5-2-89; 7.9.2.23 NMAC - Rn,
7 NMAC 9.2.23, 8-31-00]
7.9.2.24 COMMUNITY
ORGANIZATION ACCESS:
A. In this section, “access” means the right to:
(1) Enter any facility;
(2) Seek a resident's agreement
to communicate privately and without restriction with the resident.
(3) Communicate privately
and without restriction with any resident who does not object to communication.
B. Any employee, agent, or designated representative of a community legal
services program or community service organization shall be permitted access to
any facility whenever visitors are permitted by the written visitation policy
referred to in these regulations, but not before 8:00 am., nor after 5:00 p.m.
The facility visitation policy shall include provisions for scheduling visits
after 5:00 p.m.
C. CONDITIONS:
(1) The employee, agent,
or designated representative shall, upon request of the facility's
administrator or administrator's designee, present valid and current
identification signed by the principal officer of the agency, program or
organization represented.
(2) Access shall be
granted for visits which are consistent with an express purpose of an
organization the purpose of which is to:
(a)
Visit, talk with, or offer personal, social, and legal services to any
resident, or obtain information from the resident about the facility and its
operations.
(b) Inform residents of
their rights and entitlements and their corresponding obligations under federal
and state law, by means of educational materials and discussions in groups or
with individual residents.
(c) Assist any residents in asserting legal
rights regarding claims for public assistance, medical assistance and social
security benefits, and in all other matters in which a resident may be
aggrieved.
(d)
Engage in any other method of advising and representing residents so as
to assure them full enjoyment of their rights.
[5-2-89; 7.9.2.24 NMAC - Rn,
7 NMAC 9.2.24, 8-31-00]
7.9.2.25 HOUSING
RESIDENTS IN LOCKED UNITS: Definitions as used in this section:
A. LOCKED UNIT: means a ward,
wing or room which is designated as a protected environment and is secured in a
manner that prevents a resident from leaving the unit at will. A physical
restraint applied to the body is not a locked unit. A facility locked for purposes
of security is not a locked unit, provided that residents may exit at will. An
alarmed unit does not constitute a locked unit.
B. CONSENT: means a
written, signed request given without duress by a resident capable of
understanding the nature of the locked unit, the circumstances of one's
condition, and the meaning of the consent to be given.
(1) A resident or
responsible party may give consent to reside in a locked unit.
(2) The consent shall be
effective only for ninety (90) days from the date of the consent, unless
revoked. Consent may be renewed for ninety (90) day periods pursuant to this
subsection.
(3) The consent may be
revoked by the resident if competent or by legal guardian at any time. The
resident shall be transferred to an unlocked unit promptly following
revocation.
C. EMERGENCIES: In an
emergency, a resident may be confined in a locked unit if necessary to protect
the resident or others from injury or to protect property, providing the
facility immediately attempts to notify the physician for instructions. A
physician's orders for the confinement must be obtained within twelve (12)
hours. No resident may be confined for more than an additional seventy-two (72)
hours under order of the physician.
[5-2-89; 7.9.2.25 NMAC - Rn,
7 NMAC 9.2.25, 8-31-00]
7.9.2.26 ADMINISTRATOR/STATUTORY
REFERENCE: A nursing home shall be supervised by an
administrator licensed under the Nursing Home Administrators Act, Sections
61-13-16 through 61-13-16 NMSA 1978. Supervision shall include, but not be
limited to, taking all reasonable steps to provide qualified personnel to
assure the health, safety, and right's of the residents.
A. FULL-TIME ADMINISTRATOR: Every nursing
home shall be supervised full-time by an administrator licensed under the
Nursing Home Administrators Act, except multiple facilities. If more than one nursing home or other
licensed health care facility is located on the same or contiguous property,
one full-time administrator may serve all the facilities.
B. ABSENCE OF ADMINISTRATOR: A person
present in and competent to supervise the facility shall be designated to be in
charge whenever there is not an administrator in the facility, and shall be
identified to all staff.
C. CHANGE OF ADMINISTRATOR:
(1) Replacement of
administrator: If it is necessary immediately to terminate an administrator, or
if the licensee loses an administrator for other reasons, a replacement shall
be employed or designated as soon as possible within one-hundred twenty (120)
days of vacancy.
(2) Temporary
replacement: During any vacancy in the position of administrator, the licensee
shall employ or designate a person competent to fulfill the functions of an
administrator immediately.
(3) Notice of change of
administrator: When the licensee loses an administrator, the licensee shall
notify the department within two (2) Department working days of such loss and
provide written notification to the Department of the name and qualifications
of the person in charge of the facility during the vacancy; and the name and
qualifications of the replacement administrator, when known.
[7-1-60, 5-2-89; 7.9.2.26
NMAC - Rn, 7 NMAC 9.2.26, 8-31-00]
7.9.2.27 EMPLOYEES: In this
section, “employee” means anyone directly employed by the facility on other
than a consulting or contractual basis.
A. QUALIFICATIONS AND RESTRICTIONS: No person
under eighteen (18) years of age shall be employed to provide direct care to
residents.
B. PHYSICAL HEALTH CERTIFICATIONS: New Employees:
Every employee shall be certified in writing by a physician as having been
screened for tuberculosis Infection and provide a statement of medical evidence
that he/she is currently free from communicable disease prior to beginning
work.
C. DISEASE SURVEILLANCE AND CONTROL: Facilities
shall develop and implement written policies for control of communicable
diseases which ensure that employees and volunteers with systems or signs of
communicable disease or infected skin lesions are not permitted to work unless
authorized to do so by a physician or physician extender.
D. VOLUNTEERS: Facilities may
use volunteers provided that the volunteers receive the orientation, training,
and supervision necessary to assure resident health, safety and welfare.
E. ABUSE OF RESIDENTS:
(1) Orientation for all employees: Except in an emergency, before performing any
duties, each new employee, including temporary help, shall receive appropriate
orientation to the facility and its policies, including, but not limited to,
policies relating to fire prevention, accident prevention, and emergency procedures.
All employees shall be oriented to resident's rights and to their position and
duties by the time they have worked thirty (30) days.
(2) Training: Except for nurses, all employees who provide
direct care to residents shall be trained through a program approved by the
Department.
(3) Assignments: Employees shall be assigned only to resident
care duties consistent with their training.
(4) Reporting: All employees will be instructed in the
reporting requirements of the Adult Protective Services Act of abuse, neglect
or exploitation of any resident.
F. CONTINUING EDUCATION:
(1) Nursing
in-service: The facility shall require
employees who provide direct care to residents to attend educational programs
desired to develop and improve the skill and knowledge of the employees with
respect to the needs of the facility's residents, including rehabilitative
therapy, oral health care, wheelchair safety and transportation and special
programming for developmentally disabled residents if the facility admits
developmentally disabled person. These programs shall be conducted quarterly to
enable staff to acquire the skills and techniques necessary to implement the individual
program plans for each resident under their care.
(2) Dietary in-service:
Educational programs shall be held quarterly for dietary staff, and shall
include instruction in the proper handling of food, personal hygiene and grooming,
and nutrition and modified diet patterns served by the facility.
(3) All other staff
in-service: The facility shall provide in-service designed to improve the
skills and knowledge of all other employees.
[7-1-60, 5-2-89; 7.9.2.27
NMAC - Rn & A, 7 NMAC 9.2.27, 8-31-00]
7.9.2.28 RECORDS
- GENERAL: The administrator or administrator's designee
shall provide the Department with any information required to document
compliance with these regulations and shall provide reasonable means for
examining records and gathering the information.
[7-1-60, 7-1-64; 7.9.2.28
NMAC - Rn, 7 NMAC 9.2.28, 8-31-00]
7.9.2.29 PERSONNEL
RECORDS: A separate record of each employee shall be
maintained, be kept current, and contain sufficient information to support
assignment to the employee's current position and duties.
[7-1-60, 5-2-89; 7.9.2.29
NMAC - Rn, 7 NMAC 9.2.29, 8-31-00]
7.9.2.30 MEDICAL
RECORDS - STAFF:
A. TIMELINESS: Duties
relating to medical records shall be completed in a timely manner.
B. Each facility shall designate an employee of the facility as the person
responsible for the medical record service, who:
(1) Is a graduate of a
school of medical record science that is accredited jointly by the council on medical
education of the American Medical Association; or
(2) Receives regular
consultation but not less than four hours quarterly as appropriate from a
person who meets the requirements of Section 30.2.1. Such consultation shall not
be substituted for the routine duties of staff maintaining records. The records
consultant shall evaluate the records and records service, identify problem
areas, and submit written recommendations for change to the administrator.
(3) Sufficient time will
be allocated to the person who is designated responsible for medical record
service to insure that accurate records are maintained.
[7-1-60, 5-2-89; 7.9.2.30
NMAC - Rn, 7 NMAC 9.2.30, 8-31-00]
7.9.2.31 MEDICAL
RECORDS - GENERAL:
A. AVAILABILITY OF RECORDS: Medical
records of current residents shall be stored in the facility and shall be
easily accessible, at all times, to persons authorized by the resident to
obtain the release of the medical records.
B. ORGANIZATION: The facility
shall maintain a systematically organized records system appropriate to the
nature and size of the facility for the collection and release of resident
information.
C. UNIT RECORD: A unit record
shall be maintained for each resident and day care client.
D. INDEXES: A master
resident index shall be maintained.
E. MAINTENANCE: The facility
shall safeguard medical records against loss, destruction, or unauthorized use,
and shall provide adequate space and equipment to efficiently review, index,
file and promptly retrieve the medical records.
F. RETENTION AND DESTRUCTION:
(1) The medical record
shall be completed and stored within sixty (60) days following a resident's
discharge or death.
(2) An original medical
record and legible copy or copies of court orders or other documents, if any,
authorizing another person to speak or act on behalf of this resident shall be
retained for a period of at least ten (10) years following a resident's
discharge or death. All other records required by these regulations shall be
retained for the period for which the facility is under review.
(3) Medical records no
longer required to be retained under this section may be destroyed, provided:
(a) The confidentiality
of the information is maintained; and
(b)
The facility permanently retains at least identification of the
resident, final diagnosis, physician, and dates of admission and discharge.
(4) A facility shall
arrange for the storage and safekeeping of records for the periods and under
the conditions required by this paragraph in the event the facility closes.
(5) If the ownership of a facility changes,
the medical records and indexes shall remain with the facility.
G. RECORDS DOCUMENTATION:
(1) All entries in
medical records shall be legible, permanently recorded, dated, and
authenticated with the name and title of the person making the entry.
(2) Symbols and
abbreviations may be used in medical records if approved by a written facility
policy which defines the symbols and abbreviations and which controls their
use.
[7-1-60, 5-2-89; 7.9.2.31
NMAC - Rn, 7 NMAC 9.2.31, 8-31-00]
7.9.2.32 MEDICAL
RECORDS - CONTENT: Except for persons admitted for short-term
care, each resident's medical record shall contain:
A. IDENTIFICATION AND SUMMARY SHEET:
B. PHYSICIAN'S DOCUMENTATION:
(1) An admission medical
evaluation by a physician, including:
(a)
A summary of prior treatment;
(b)
Current medical findings;
(c) Diagnosis at the time
of admission to the facility;
(d)
The resident's rehabilitation potential;
(e)
The results of the required physical examination;
(f) Level of care;
(2) All physician's
orders including:
(a)
Admission to the facility;
(b)
Medications and treatments;
(c) Diets;
(d)
Rehabilitative services;
(e)
Limitations on activities;
(f)
Restraint orders;
(g)
Discharge or transfer orders.
(3) Physician progress
notes following each visit.
(4) Annual physical
examination.
(5) Alternate visit
schedule, and justification for such alternate visits, not to exceed ninety
(90) days.
C. NURSING SERVICE DOCUMENTATION:
(1) An assessment of the
resident's nursing needs.
(2) Initial nursing care
plan and any revisions.
(3) Nursing notes are
required as follows:
(a)
For residents requiring skilled care, a narrative nursing note shall be
required as often as needed to document the resident's condition, but at least
weekly; and
(b) For residents not
requiring skilled care, a narrative nursing note shall be required as often as
needed to document the resident's condition, but at least monthly;
(4) In addition to the
nursing care plan, nursing documentation describing:
(a)
The general physical and mental condition of the resident, including any
unusual symptoms or actions;
(b)
All incidents or accidents including time, place, injuries or potential
complications from injury or accident, details of incident or accident, action
taken, and follow-up care;
(c)
The administration of all medications, the need for PRN medications and
the resident's response, refusal to take medication, omission of medications,
errors in the administration of medications, and drug reactions;
(d)
Food intake, when the monitoring of intake is necessary;
(e) Fluid Intake when monitoring of intake is
necessary;
(f)
Any unusual occurrences of appetite or refusal or reluctance to accept
diets;
(g)
Summary of restorative nursing measures which are provided;
(h)
Summary of the use of physical and chemical restraints;
(i)
Other non-routine nursing care given;
(j)
The condition of a resident upon discharge; and
(k)
The time of death, the physician called, and the person to whom the body
was released.
D. SOCIAL SERVICES RECORDS:
(1) A social history of
the resident; and
(2) Notes regarding
pertinent social data and action taken.
E. ACTIVITIES RECORDS: Documentation
of activities programming, a history and assessment, a summary of attendance,
and quarterly progress notes.
F. REHABILITATIVE SERVICES:
(1) An evaluation of the rehabilitative needs
of the resident.
(2) Plan of treatment.
(3) Progress notes
detailing treatment given, evaluation, and progress.
G. DIETARY ASSESSMENT: Record of the
dietary assessment.
H. DENTAL SERVICES: Summary of all
dental services resident has received.
I. DIAGNOSTIC SERVICES: Records of all
diagnostic tests performed during the resident's stay in the facility.
J. PLAN OF CARE: Plan of care which
includes integrated program activities, therapies and treatments designed to
help each resident achieve specific goals as developed by an interdisciplinary
team.
K. AUTHORIZATION OR CONSENT: A photocopy of
any court order, power of attorney or living will authorizing another person to
speak or act on behalf of the resident and any resident consent forms.
L. DISCHARGE OR TRANSFER INFORMATION: Documents,
prepared upon a resident's discharge or transfer from the facility,
summarizing, when appropriate:
(1) Current medical
finding and condition;
(2) Final diagnosis;
(3) Rehabilitation
potential;
(4) A summary of the
course of treatment;
(5) Nursing and dietary
information;
(6) Ambulation status;
(7) Administrative and
social information; and
(8) Needed continued care
and instructions.
[7-1-60, 5-2-89; 7.9.2.32
NMAC - Rn, 7 NMAC 9.2.32, 8-31-00]
7.9.2.33 OTHER
RECORDS: The facility shall retain:
A. DIETARY RECORDS: All menus and
therapeutic diets for one year.
B. STAFFING RECORDS: Records of
staff work schedules and time worked for one year.
C. SAFETY TESTS: Records of
tests of fire detection, alarm, and extinguishment equipment.
D. RESIDENT CENSUS: At least a
daily census of all residents, indicating number of residents requiring each
level of care.
E. PROFESSIONAL CONSULTATIONS: Documentation
of professional consultations by:
(1) A dietician.
(2) A registered nurse.
(3) Others, as may be
used by the facility.
F. IN-SERVICE AND ORIENTATION
PROGRAMS: Subject matter, instructors and attendance
records of all in-service and orientation programs.
G. TRANSFER AGREEMENTS: Transfer agreements.
H. FUNDS AND PROPERTY STATEMENT: The statement
prepared upon a resident's discharge or transfer from the facility that
accounts for all funds and receipted property held by the facility for the
resident.
I. COURT ORDERS AND CONSENT FORMS: Copies of
court orders or other documents, if any, authorizing another person to speak or
act on behalf of the resident.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.33 NMAC - Rn, 7 NMAC 9.2.33, 8-31-00]
7.9.2.34 LICENSE
LIMITATIONS:
A. BED CAPACITY: No facility
may house more residents than the maximum bed capacity for which it is
licensed. Persons participating in a day care program are not residents for purposes
of these regulations.
B. CARE LEVELS: No person who
requires care greater than that which the facility is licensed to provide may
be admitted to or retained in the facility, unless under waiver according to
State guidelines.
C. OTHER CONDITIONS: The facility
shall comply with all other conditions of the license.
[5-2-89; 7.9.2.34 NMAC - Rn,
7 NMAC 9.2.34, 8-31-00]
7.9.2.35 OTHER
LIMITATIONS ON ADMISSION:
A. PERSONS REQUIRING UNAVAILABLE
SERVICES: Persons who require services which the facility
does not provide or make available shall not be admitted or retained.
B. COMMUNICABLE DISEASES:
(1) Restriction: No person suspected of having a disease in a
communicable state shall be admitted or retained unless the facility has the
means to manage the condition.
(2) Isolation
techniques: Persons suspected of having
a disease in a communicable state shall be managed according to Isolation
Techniques for use in Hospitals, published by the U.S. Department of Health and
Human Services, Public Health Services, Center for Disease Control, or with
comparable methods as developed by facility policies.
(3) Reportable diseases:
Suspected diseases reportable by law shall be reported to the local public
health agency and the Division of Health, Bureau of Community Health and
Prevention within time frames specified by these agencies.
C. DESTRUCTIVE RESIDENTS: Residents who
are known to be destructive of property, self-destructive, disturbing or
abusive to other residents, or suicide, shall not be admitted or retained,
unless the facility has and uses sufficient resources to appropriately manage
and care for them.
D. DEVELOPMENTAL DISABILITIES: No person who
has a primary diagnosis of developmental disability may be admitted to a
facility unless the facility is certified as in intermediate care facility for
the mentally retarded, except that a person who has a developmental disability
and who requires skilled nursing care services may be admitted to a skilled
nursing facility if approved for such level of care by the State Developmental
Disability Authority.
E. MENTAL ILLNESS: No person with
a primary diagnosis of mental illness may be admitted to Long Term Care
Facilities except that a person who has a diagnosis of mental illness and who
requires skilled nursing care services may be admitted to a Long Term Care
Facility if approved for such level of care by-the State Mental Illness
Authority.
F. ADMISSION SEVEN (7) DAYS A WEEK: With prior
approval, facilities shall take reasonable steps to admit residents seven days
a week.
[7-1-60, 5-2-89; 7.9.2.35
NMAC - Rn, 7 NMAC 9.2.35, 8-31-00]
7.9.2.36 PROGRAM
STATEMENT FOR DEVELOPMENTALLY DISABLED RESIDENTS:
A. APPROVAL: Each facility
serving residents who have a developmental disability and require active
treatment shall submit a written program statement to the department for
approval.
B. CONTENTS: The program
statement shall detail the following:
(1) Services to be provided.
(2) Admission policies
for developmentally disabled persons.
(3) Program goals for
developmentally disabled residents.
(4) Description of
program elements, including relationships, contracted services and arrangements
with other health and social services agencies and programs.
(5) A designation of
staff assigned to the care of developmentally disabled residents. Staff
scheduling shall demonstrate consistency of staff involvement. Staff members
shall have demonstrated skill in the management of these residents; and
(6) A description of care
evaluation procedures for developmentally disabled residents. These procedures
shall require that case evaluation results be incorporated into the individual
resident's care plan and that individual plans of care be reviewed and revised
as indicated by resident need.
[5-2-89; 7.9.2.36 NMAC - Rn,
7 NMAC 9.2.36, 8-31-00]
7.9.2.37 PROCEDURES
FOR ADMISSION OF RESIDENTS:
A. “APPLICABILITY”: The procedures
in this section apply to all persons admitted to facilities except persons
admitted for short-term care.
B. “PHYSICIANS ORDERS”: No person may
be admitted as a resident except upon:
(1) Order of a physician.
(2) Receipt of
information from a physician, before or on the day of admission, about the
person's current medical condition and diagnosis, and receipt of a physician's
initial plan of care and orders from a physician for immediate care of the
resident; and
(3) Receipt of
certification in writing from a physician that the person is free of active
tuberculosis and clinically apparent communicable disease the person may be found
to have.
C. “MEDICAL EXAMINATION AND
EVALUATION”:
(1) Examination: Each
resident shall have a physical examination by a physician or physician extender
within forty-eight (48) hours following admission unless an examination was
performed within fifteen (15) days before admission.
(2) Evaluation: Within
forty-eight (48) hours after admission the physician or physician extender
shall complete the resident's medical history and physical examination record.
If copies of previous evaluations are used, the physician must authenticate
such findings within forty-eight (48) hours of admission.
D. “RESIDENT ASSESSMENT”: A
comprehensive accurate assessment of each resident's functional capacity and
impairment, as basis for care delivery, shall be conducted by designated
qualified staff. A preliminary assessment shall be completed within forty-eight
(48) hours of admission, a comprehensive assessment within thirty (30) days of
admission, after significant change and repeated at least annually.
[7-1-60, 5-2-89; 7.9.2.37
NMAC - Rn, 7 NMAC 9.2.37, 8-31-00]
7.9.2.38 REMOVALS
FROM THE FACILITY: The provisions of this section shall apply to
all resident removals.
A. CONDITIONS: No resident
may be temporarily or permanently removed from this facility except:
(1) Voluntary removal:
Upon the request or with the informed consent of the resident or guardian.
(2) Involuntary removal:
(a)
For nonpayment of charges, following seven (7) days notice and
opportunity to pay any deficiency.
(b)
If the resident requires care other than that which the facility is
licensed to provide.
(c)
For medical reasons as ordered by a physician.
(d)
In case of a medical emergency or disaster.
(e)
For the resident's welfare or the welfare of other residents.
(f) If the resident does not need nursing home
care, and alternate placement is identified and arrangements for transfer have
been completed.
(g)
If the short-term care period for which the resident was admitted has
expired; and
(h)
As otherwise permitted by law.
(3) Alternate placement:
Except for removal under the preceding section, no resident may be
involuntarily removed unless an alternate placement is arranged for the
resident.
B. PERMANENT REMOVALS:
(1) Notice: The facility shall provide a resident, the
resident's physician and guardian, relative, or other responsible person, at
least thirty (30) days notice of removal under Subsection A of 7.9.2.38 NMAC,
except Subparagraph (a) of Paragraph (2) of Subsection A of 7.9.2.38 NMAC, unless the continued presence
of the resident endangers the health, safety, or welfare of the resident or
other residents.
(2) Removal procedures:
(a)
The resident, shall be given a notice containing the time and place of a
planning conference; a statement informing the resident that any persons of the
resident's choice may attend the conference; and the -procedure for submitting
a complaint to the Department.
(b)
Unless the resident is receiving respite care or unless precluded by
circumstances posing a danger to the health, safety, or welfare of a resident,
prior to involuntary removal under Section 7.9.2.38A NMAC a planning conference
shall be held at least three (3) days before removal with the resident,
guardian, if any, any appropriate county agency, and others designated by the
resident, including the resident's physician, to review the need for
relocation, assess the effect of relocation on the resident, discuss
alternative placements, and develop a relocation plan which includes at least
those activities listed below.
(c) Removal activities shall include: counseling regarding the impending removal;
arrangements for the resident to visit the potential alternative placement
and/or meeting with that facility's admissions staff, unless medically
contra-indicated or waived by the resident; assistance to the resident in
planning the moving of belongings and funds to the new facility or quarters;
and provisions for needed medications and treatments during relocation.
(d)
Discharge records. Upon removal of a resident, all relevant documents
shall be prepared and provided to the facility admitting the resident.
[5-2-89; 7.9.2.38 NMAC - Rn,
7 NMAC 9.2.38, 8-31-00]
7.9.2.39 TRANSFER
AGREEMENTS:
A. REQUIREMENT: Each facility
shall have in effect a transfer agreement with one or more hospitals under
which in-patient hospital care or other hospital services are available
promptly to the facility's resident's when needed. Facilities under same
management having identified distinct parts are exempt from transfer
agreements.
B. TRANSFER OF RESIDENTS: A hospital and
a facility shall be considered to have a transfer agreement in effect if there
is a written agreement between them or, when the two (2) Institutions are under
common control, if there is a written statement by the person or body which
controls them, which gives reasonable assurance that:
(1) Transfer of residents
will take place between the hospital and the facility ensuring timely
admission, whenever such transfer is medically appropriate as determined by the
attending physician; and
(2) There shall be
interchange of medical and other information necessary for the care and
treatment of individuals transferred between the institutions or for determining,
whether such individuals can be adequately cared for somewhere other than in
either of the institutions.
C. EXEMPTION: A facility
which does not have a resident transfer agreement in effect, but which is found
by the Department to have attempted in good faith to enter into such an
agreement with a hospital sufficiently close to the facility to make feasible
the transfer between the two facilities and the information referred to in
Subsection (B) of 7.9.2.39 NMAC above, shall be considered to have such an
agreement in effect if and for so long as the department finds that to do so is
in the pubic interest and essential to ensuring nursing facility services in
the community.
[5-2-89; 7.9.2.39 NMAC - Rn,
7 NMAC 9.2.39, 8-31-00]
7.9.2.40 BEDHOLD:
A. BEDHOLD: A resident who
is on leave or temporarily discharged has expressed an intention to return to
the facility under the terms of the admission policy for bedhold, shall not be
denied readmission, if level of care remains the same.
B. LIMITATION: The facility
shall hold a resident's bed until the resident returns, until the resident
waives his right to have the bed held or until the maximum time allowable as
defined by facility policies expires. The facility is responsible for notifying
resident and/or family of their bedhold policy.
[5-2-89; 7.9.2.40 NMAC - Rn,
7 NMAC 9.2.40, 8-31-00]
7.9.2.41 TRANSFER
WITHIN THE FACILITY: Prior to any transfer of a resident between
rooms or beds within a facility, the resident or guardian, if any, and any other
person designated by the resident shall be given a reasonable notice and
explanation of the reasons for transfer. Transfer of a resident between rooms
or beds within a facility may be made only for medical reasons or for the
resident's welfare or the welfare of other residents, or voluntarily with the
residents' approval.
[5-2-89; 7.9.2.41 NMAC - Rn,
7 NMAC 9.2.41, 8-31-00]
7.9.2.42 INDIVIDUAL
CARE:
Each resident shall receive care based upon individual needs.
A. HYGIENE:
(1) Each resident shall
be kept comfortably clean and well groomed.
(2) Beds shall be made
daily, with a complete change of linen to be provided as often as necessary,
but at least once a week.
(3) Residents shall have
clean clothing as needed to present a neat appearance and to be free of odors.
Residents who are not bedfast shall be dressed each day, in their own clothing,
as appropriate to their activities, preferences, and comforts.
B. DECUBITI PREVENTION: Nursing
personnel shall employ appropriate nursing management techniques to promote the
maintenance of skin integrity and to prevent development of decubiti filed in
the resident's clinical record, except as provided in this section.
(1) Verbal orders: Verbal orders from physicians or dentists may
be accepted by a nurse or pharmacist, or, in the case of verbal orders for
rehabilitative therapy, by a therapist. Verbal orders shall be immediately
written, signed and dated by the nurse, pharmacist or therapist on a
requirement may be waived if:
(a)
Facility has made unsuccessful good faith effort; and
(b)
The Health and Environment Department determines residents will not be
endangered; or
(c)
Staffing is sufficient to meet residents' needs.
(2) Nursing personnel
shall provide care, including proper hydration, designated to maintain current functioning
and to improve the resident's ability to carry out activities of daily living,
including assistance with maintaining good body alignment and proper
positioning to prevent deformities.
(3) Each resident shall
be encouraged to be up and out of bed as possible, unless otherwise ordered by
a physician.
(4) Any significant
changes in the condition of any resident shall be reported to the nurse in
charge or on call, who shall take appropriate action.
C. REHABILITATIVE MEASURES: Residents
shall be assisted in carrying out rehabilitative measures initiated by a
rehabilitative therapist ordered by a physician, including assistance with
adjusting to any disabilities and using any prosthetic devices.
D. TUBERCULOSIS RETESTING: Resident's
shall be retested for tuberculosis infection based on the prevalence of
tuberculosis in the community and the likelihood of exposure to tuberculosis in
the facility.
E. NOURISHMENT:
(1) Diets: Residents shall be served diets as prescribed
by a physician.
(2) Adaptive
devices: Adaptive self-help devices
shall be available to residents assessed as capable of using such devices and
these residents shall be trained in their use to contribute to independence in
eating.
(3) Assistance: Residents who require assistance with food or
fluid intake shall be helped as necessary.
(4) Food and fluid intake
and diet acceptance: A resident's food
and fluid intake and acceptance of diet shall be monitored and documented, and
significant deviations from normal eating patterns shall be reported to the
nurse and either the resident's physician or dietician as appropriate.
[7-1-60, 7-1-64, 5-2-89; 7.9.2.42
NMAC - Rn, 7 NMAC 9.2.42, 8-31-00]
7.9.2.43 NOTIFICATION
OF CHANGES IN CONDITION OR STATUS OF RESIDENT:
A. CHANGES IN CONDITION: A resident's
physician, guardian, if any, and any other responsible person designated in
writing by the resident or guardian to be notified shall be notified promptly
of any significant accident, injury, or adverse change in the resident's
condition.
B. CHANGES IN STATUS: A resident's
guardian and other person designated in writing by the resident or guardian
shall be notified promptly of any significant nonmedical change in the
resident's status, including financial situation, any plan to discharge the
resident, or any plan to transfer the resident within the facility or to
another facility.
[5-2-89; 7.9.2.43 NMAC - Rn,
7 NMAC 9.2.43, 8-31-00]
7.9.2.44 TREATMENT
AND ORDERS:
A. ORDERS:
(1) Restriction.
Medications, treatments and rehabilitative therapies shall be administered as ordered
by a physician or dentist subject to the resident's rights to refuse them. No
medication, treatment or changes in medication or treatment may be administered
to a resident without a physician's or dentists written order which shall be
filed in the resident's clinical record, except as provided in this section.
(2) Verbal orders: Verbal
orders from physicians or dentists may be accepted by a nurse or pharmacist,
or, in the case of verbal orders for rehabilitative therapy, by a therapist.
Verbal orders shall be immediately written, signed and dated by the nurse,
pharmacist or therapist on a not specifically limited as to time or number of
doses when ordered shall be automatically stopped in accordance with the stop
order policy required by Subsection A of 7.9.2.57 NMAC of these regulations.
(3) Notice to physicians
or dentists: Each resident's attending physician or dentist shall be notified
of stop order policies and contacted promptly for renewal of orders which are
subject to automatic termination.
B. STOP ORDERS: Medications
shall be in accordance with the stop order policy required by Subsection E of
7.9.2.57 NMAC of these regulations.
(1) Notice to physicians
or dentists: Each resident's attending physician or dentist shall be notified
of stop order policies and contacted promptly for renewal of orders which are
subject to automatic termination.
C. RELEASE OF MEDICATIONS TO RESIDENTS: Medications
shall be released to residents who are on leave or have been discharged only on
order of the physician.
D. ADMINISTRATION OF MEDICATIONS:
(1) Personnel who may
administer medications: In a nursing
home, medications may be administered only by a nurse or other licensed medical
professional whose, licensed scope of practice permits administration of
medication.
(2) Responsibility for
administration: Policies and procedures
designed to provide safe and accurate administration of medications shall be
developed by the facility and shall be followed by personnel assigned to
prepare and administer medication except when a single unit dose package
distribution system is used. Person administering medication will immediately
record in the resident's clinical records.
(3) Omitted doses: If, for any reason, a medication is not
administered as ordered the omission shall be noted in the resident's
medication record with explanation of the omission.
(4) Self-administration: Self-administration of medications by
residents shall be permitted on order of the resident's physician.
(5) Errors and
reactions: Medication errors and
suspected or apparent drug reactions shall be reported to the nurse in charge
or on call as soon as discovered and any entry made in the resident's clinical
record. The nurse shall take appropriate action, including notifying the
physician.
(6) Day care: The handling and administration of
medications for day care clients shall comply with the requirements of this
subsection.
[7-1-60, 5-2-89; 7.9.2.44
NMAC - Rn, 7 NMAC 9.2.44, 8-31-00]
7.9.2.45 PHYSICAL
AND CHEMICAL RESTRAINTS:
A. DEFINITIONS: As used in
this subsection, the following definitions apply:
(1) Physical
restraint: means any article, device, or
garment which is used primarily to modify, resident behavior by interfering
with the free movement of the resident, and which the resident is unable to remove
easily, or confinement in a locked room. Mechanical supports shall not be
considered physical restraints.
(2) Mechanical
support: means any article, device, or
garment which is used only to achieve the proper position or balance of the
resident, which may include but is not limited to a geriatric chair, posey
belt, or jacket, waist belt, pillows, or wedges. Necessity for mechanical
support use must be documented in the residents record and such use must be
outlined in the resident's care plan.
(3) Chemical
restraint: means a medication used
primarily to modify behavior by interfering with the resident's freedom of
movement or mental alertness.
B. ORDERS REQUIRED: Physical or
chemical restraints shall be applied or administered only on the written order
of a physician which shall indicate the resident's name, the type of
restraint(s), the reason for restraint, the type of restraint authorized, and
the period during which the restraint(s) is (are) to be applied.
C. EMERGENCIES: A physical
restraint may be applied temporarily without an order if necessary to protect
the resident or another person from injury or to prevent physical harm to the
resident or another person resulting from the destruction of property, provided
that the physician is notified immediately and authorization for continued use
is obtained from the physician within twelve (12) hours.
D. RESTRICTION: If the
mobility of a resident is required to be restrained and can be appropriately restrained
either by a physical or chemical restraint or by a locked unit, the provisions
of this section shall apply.
E. TYPE OF RESTRAINTS: Physical
restraints shall be of a type which can be removed promptly in an emergency,
and shall be the least restrictive type appropriate to the resident.
F. PERIODIC CARE: Nursing
personnel shall check a physically restrained resident as necessary, but at
least every 30 minutes to see that the resident's personal needs are met and to
change the resident's position if necessary. The restrained resident shall have
restraints released and shall have opportunity for toileting, hydration, and
exercise at least every two hours. Cheeks and releases will be documented.
G. RECORDS: Any use of
restraints shall be noted, dated, and documented in the resident's clinical
record on each tour of duty during which the restraints are in use.
[5-2-89; 7.9.2.45 NMAC - Rn,
7 NMAC 9.2.45, 8-31-00]
7.9.2.46 USE
OF OXYGEN:
A. ORDERS OF OXYGEN: Except in an
emergency, oxygen shall be administered only on order of a physician.
B. PERSON ADMINISTERING: Oxygen shall
be administered to residents only by a capable person trained in its
administration and use.
C. SIGNS: “No Smoking”
signs shall be posted at the entrance of the room in which oxygen is in use.
D. FLAMMABLE GOODS: Prior to
administering oxygen, all matches and other smoking material shall be removed
from the room.
[7-1-60, 5-2-89; 7.9.2.46
NMAC - Rn, 7 NMAC 9.2.46, 8-31-00]
7.9.2.47 RESIDENT
CARE PLANNING:
A. DEVELOPMENTAL AND CONTENT OF CARE
PLANS: Except In the case of a person admitted for
short-term care, within two (2) weeks following admission a written care plan
shall be developed, based on the resident's history and assessments from all
appropriate disciplines and the physician's evaluations and orders, which shall
include:
(1) Measurable goals with
specific time limits for attainment.
(2) The specific approaches
for delivery needed care, and indication of which professional disciplines are
responsible for delivering the care.
B. EVALUATIONS AND UPDATES: The care of
each resident shall be reviewed by each of the services involved in the
resident's care and the care plan evaluated and updated no less than quarterly
or more often as needed.
C. IMPLEMENTATION: The care plans
shall be substantially followed.
[7-1-60, 5-2-89; 7.9.2.47
NMAC - Rn, 7 NMAC 9.2.47, 8-31-00]
7.9.2.48 MEDICAL
DIRECTION IN SKILLED CARE FACILITIES:
A. MEDICAL DIRECTOR: Every skilled
care facility shall retain, pursuant to a written agreement, a physician to
serve as medical director on a part-time or full-time basis as is appropriate
for the needs of the residents and the facility. If the facility has an
organized medical staff, the medical director shall be designated by the
medical staff with approval of the licensee.
B. COORDINATION OF MEDICAL CARE: Medical
direction and coordination of medical care in the facility shall be provided by
the medical director. The medical director shall be responsible for development
of written rules and regulations which shall be approved by the licensee and
include delineation of the responsibilities of attending physicians. If there
is an organized medical staff, by-laws also shall be developed by the medical
director and approved by the licensee. Coordination of medical care shall
include liaison with attending physician to provide that physicians' orders are
written promptly upon admission of a resident, that periodic evaluations of the
adequacy and appropriateness of health professional and supportive staff and
services are conducted, and that the medical needs of the residents are met.
C. RESPONSIBILITIES TO THE FACILITY: The medical
director shall monitor the health status of the facility's employees. Incidents
and accidents that occur on the premises shall be reviewed by the medical
director to identify hazards to health and safety.
[7-1-60, 5-2-89; 7.9.2.48
NMAC - Rn, 7 NMAC 9.2.48, 8-31-00]
7.9.2.49 PHYSICIAN
SERVICES IN ALL FACILITIES: The facility shall assure that the following
services are provided:
A. ATTENDING PHYSICIANS: Each resident
shall be under the supervision of a physician of the resident's or guardian's
choice who evaluates and monitors the resident's immediate and long-term needs
and prescribes measures necessary for the health, safety and welfare of the
resident. Each attending physician shall make arrangements for the medical care
of the physician's residents in the physician's absence.
B. PHYSICIAN'S VISIT:
(1) Each resident who
requires skilled nursing care shall be seen by a physician at least every
thirty (30) days and an intermediate care resident at least every sixty (60)
days unless the physician specifies and justifies in writing an alternate
schedule of visits.
(2) The physician shall
review the plan of care required at the time of each visit.
(3) The physician shall
review the resident's medications and other orders at least at the time of each
visit.
(4) The physician shall
review the resident's medications and orders at least at the time of each
visit.
C. AVAILABILITY OF PHYSICIANS FOR
EMERGENCY PATIENT CARE: The facility shall have written procedures,
available at each nurse's station, for procuring a physician to furnish
necessary medical care In emergencies and for providing care pending arrival of
a physician. The names and telephone numbers of the physicians or medical
service personnel available for emergency care shall be posted at each nursing
station.
[7-1-60, 5-2-89; 7.9.2.49
NMAC - Rn, 7 NMAC 9.2.49, 8-31-00]
7.9.2.50 NURSING
SERVICES:
A. DEFINITIONS:
(1) Nursing personnel:
means nurses, nurse aides, nursing assistants, and orderlies.
(2) Ward clerk: means an
employee who performs clerical duties of the nursing personnel.
B. DIRECTOR OF NURSING SERVICES IN
SKILLED CARE AND INTERMEDIATE CARE FACILITIES:
(1) Staffing requirement:
Every skilled care facility and every intermediate care facility shall employ a
full-time director of nursing services who may also serve as a charge nurse.
The director of nursing services shall work only on the day shift except as in
an emergency or required for the proper supervision of nursing personnel.
(2) Qualifications: The
director of nursing services shall:
(a)
Be a registered or licensed practical nurse; and
(b)
Be trained or experienced in areas such as nursing service
administration, restorative nursing, psychiatric nursing, or geriatric nursing.
(3) Duties: The director of
nursing services shall be responsible for:
(a)
Supervising the functions, activities and training of the nursing
personnel;
(b)
Developing and maintaining standard nursing practice, nursing policy and
procedure manuals, and written job descriptions for each level of nursing
personnel;
(c)
Coordinating nursing services with other resident services;
(d)
Designating the charge nurses provided for by this section;
(e)
Ensuring that the duties of nursing personnel shall be clearly defined
and assigned to staff members consistent with the level of education,
preparation, experience, and licensing of each.
C. CHARGE NURSES IN SKILLED CARE
FACILITIES AND INTERMEDIATE CARE FACILITIES:
(1) Staffing requirement:
(a)
A skilled nursing facility shall have at least one charge nurse on duty
at all times.
(b)
An intermediate care facility shall have a charge nurse during every
tour of duty.
(2) Qualifications: Unless otherwise required under this
paragraph, the charge nurses shall be registered nurses or licensed practical
nurses, and shall have had training, or be acquiring training, or have had
experience in areas such as nursing service administration, restorative
nursing, psychiatric nursing, or geriatric nursing.
(3) Duties:
(a)
The charge nurse, if a registered nurse, shall supervise the nursing
care of all assigned residents, and delegate the duty to provide for the direct
care of specific residents, including administration of medications by nursing
personnel based upon individual resident needs,, the facility's physical
arrangement, and the staff capability;
(b)
The charge nurse, if a licensed practical nurse, shall manage and direct
the nursing and other activities of other licensed practical nurse and less
skilled assistants and shall arrange for the provision of direct care to
specific residents, including administration of medications, by nursing
personnel based upon individual resident needs, the facility's physical
arrangement, and the staff capability.
[7-1-60, 5-2-89; 7.9.2.50
NMAC - Rn, 7 NMAC 9.2.50, 8-31-00]
7.9.2.51 NURSING
STAFF: In addition to the requirements of Section
7.9.2.50 NMAC, the following conditions shall be met:
A. ASSIGNMENTS: There shall be
sufficient nursing service personnel assigned to care for the specific needs of
each resident on each tour of duty. Those personnel shall be briefed on the
condition and appropriate care of each resident prior to beginning hands-on
care of residents.
B. RELIEF PERSONNEL: Facilities
shall obtain qualified relief personnel.
C. RECORDS, WEEKLY SCHEDULES: Weekly time
schedules shall be planned at least one week in advance, shall be posted and
dated, shall indicate the names and classifications of nursing personnel and
relief personnel assigned on each nursing unit for each tour of duty, and shall
be updated as changes occur.
D. STAFF MEETINGS: Meetings shall
be held at least quarterly for the nursing personnel to brief them on new
developments, raise issues relevant to the service, and for such other purposes
as are pertinent.
E. TWENTY-FOUR (24) HOUR COVERAGE: All facilities
shall have at least one nursing staff person on duty at all times.
F. STAFFING PATTERNS: The assignment
of the nursing personnel required by this subsection to each tour of duty shall
be sufficient to meet each resident’s needs and implement each resident’s
comprehensive care plan.
(1) Nursing department
personnel means, the director of nursing, the assistant director of nursing,
nursing department directors, licensed nursing personnel, certified nursing
assistants, nursing assistants who have completed 16 hours or more of
orientation and demonstrated competency and restorative nursing assistants.
(2) The director of
nursing, the assistant director of nursing, and nursing department directors
may be counted towards the minimum staffing requirements only for the time
spent on the shift providing direct resident care services.
(a)
A skilled nursing facility or facility that offers intermediate and
skilled nursing shall maintain a nursing department minimum staffing level of
two and a half (2.5) hours per patient day calculated on a seven (7) day
average.
(b)
An intermediate care facility shall maintain a nursing department
minimum staffing level of two and three-tenths (2.3) hours per patient day
calculated on a seven (7) day average.
(c) Within one hour of
shift change, facilities shall post the number of nursing personnel on duty in
a conspicuous and consistent location for public review. Shifts are informally defined as the day
shift, evening shift, and night shift.
Employees working variations of these shifts shall be included within
the shift count where a majority of the hours fall. EXAMPLE:
For a facility with 100 patients, 2.3 hours per patient day averages one
nursing department employee on duty for approximately every 10 to 11
patients. For a facility with 100
patients, 2.5 hours per patient day averages one nursing department employee
for every 9 to 10 patients. These are daily
averages that will vary from shift to shift so that actual staffing might
approximate:
2.3 Hours Per
Patient Day 2.5 Hours Per
Patient Day
Day Shift 1 staff for 8 patients 1 staff for 7
patients
Evening Shift 1 staff for 10 patients 1 staff for 10 patients
Night Shift 1 staff for 13 patients 1 staff for 12 patients
[7-1-60, 5-2-89; 7.9.2.51
NMAC - Rn & A, 7 NMAC 9.2.51, 8-31-00]
7.9.2.52 DIETARY
SERVICE: The facility shall provide a dietary service
or contract for a dietary service which meets the requirements of this section.
A. STAFF:
(1) Full or part-time
supervisor: The dietary service shall be
supervised by a full-time supervisor, except that an intermediate care facility
with fewer than fifty (50) residents may employ a person to work as supervisor
part-time.
(2) Qualifications: The dietary service supervisor shall be
either:
(a)
A dietitian; or
(b) Shall receive
necessary consultation from a dietitian and shall have completed a course of study of not less
than ninety (90) hours credit in food service supervision at a vocational,
technical, or adult education school or equivalent, or presently be enrolled in
such a course of study; or hold an associate degree as a dietetic technician.
(3) Staff: There shall be dietary service personnel on
duty at least twelve (12) hours daily who may include the supervisor.
B. HYGIENE OF STAFF: Dietary staff
and other personnel who participate in dietary service shall be in good health
and practice hygienic food handling techniques.
C. MENUS:
(1) Menus shall be
planned and written at least two (2) weeks in advance of their use, and shall
be adjusted for seasonal availability of foods.
(2) Menus shall be
planned, to the extent medically possible, in accordance with the “Recommended
Daily Dietary Allowances”, of the Food and Nutrition Board of the National
Research Council, National Academy of Sciences.
(3) Food sufficient to
meet the needs of each resident shall be planned, prepared and served for each
meal. When changes in the menu are necessary, substitutions shall provide equal
nutritive value. Record of menus as served, including substitutions shall be
retained for one (1) year.
(4) The facility shall
make reasonable adjustments to accommodate each resident's preferences, habits,
customs, appetite, and physical condition.
(5) A file of tested
recipes shall be maintained.
(6) A variety of protein
food, fruits, vegetables, dairy products, breads, and cereals shall be provided.
D. THERAPEUTIC DIETS:
(1) Therapeutic diets
shall be served only on order of the physician, and shall be consistent with
such orders.
(2) Therapeutic menus
shall be planned with supervision and/or consultation from a qualified
dietitian.
(3) Vitamin and mineral
supplements shall be given only on order of the physician.
E. MEAL SERVICE: All diets
shall be prescribed by the attending physician.
(1) Schedule: At least three (3) meals or their equivalent
shall be offered to each resident daily, not more than six (6) hours apart,
with not more than a fourteen (14) hour span between a substantial evening meal
and the following breakfast.
(2) Identification to trays: Trays, if used, shall be identified with the
resident's name and type diet.
(3) Table service: Table service shall be provided for all
residents who can and want to eat at a table.
(4) Re-service: Food served to a resident in an unopened
manufacturer's package may not be re-served unless the package remains unopened
and maintained at the proper temperature.
(5) Temperature: Food shall be served and maintained at proper
temperatures, according to standards established by Environmental Improvement
Division.
(6) Snacks: If not prohibited by the resident's diet or
condition, nourishments shall be offered routinely to all residents between the
evening meal and bedtime.
(7) Drinking water: When a resident is confined to bed, a covered
pitcher of drinking water and a glass shall be provided on a beside stand. The
water shall be changed frequently during the day, and pitchers and glasses
shall be sanitized daily. Single-service disposable pitchers and glasses may be
used. Common drinking utensils shall not be used.
(8) Food
transportation: Food transported into
public areas other than the dining room shall be protected from environmental
contamination.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.52 NMAC - Rn, 7 NMAC 9.2.52, 8-31-00]
7.9.2.53 FOOD
SUPPLIES AND PREPARATION:
A. SUPPLIES: Food shall be
purchased or procured from approved sources or sources meeting federal, state,
and local standards or laws.
B. PREPARATION: Food shall be
cleaned and prepared by methods that conserve nutritive value, flavor and
appearance. Food shall be cut, chopped, or ground as needed for individual
residents.
C. MILK: Only
pasteurized fluid milk which is certified Grade A shall be used for beverages.
Powdered milk may be used for
cooking if it meets Grade A standards or is heated to a temperature of 165
degrees Fahrenheit during cooking
[7-1-60, 7-1-64, 5-2-89; 7.9.2.53
NMAC - Rn, 7 NMAC 9.2.53, 8-31-00]
7.9.2.54 SANITATION:
A. EQUIPMENT AND UTENSILS:
(1) All equipment,
appliances and utensils used in preparation or serving of food shall be
maintained in a functional, sanitary, and safe condition. Replacement equipment
shall meet criteria established in “Listing of Food Service Equipment” by the
national sanitation foundation.
(2) The floors, walls,
and ceilings of all rooms in which food or drink is stored or prepared or In
which utensils are washed shall be kept clean, smooth, and in good repair.
(3) All furnishings,
table linens, drapes, and furniture shall be maintained in a clean and sanitary
condition.
(4) Single-service,
individually packaged, utensils shall be stored in the original, unopened
wrapper until used, may not be made of toxic material and may not be re-used or
re-distributed if the original wrapper has been opened.
B. STORAGE AND HANDLING OF FOOD:
(1) Food shall be stored,
prepared, distributed, and served under sanitary conditions which prevent
contamination.
(2) All readily
perishable food and drink, except when being prepared or served, shall be kept
in a refrigerator which shall have a temperature maintained at or below forty
(40) degrees Fahrenheit.
C. ANIMALS: Animals shall
not be allowed where food is prepared, served or stored, or where utensils are
washed or stored except in eating areas when food is not being served.
D. DISHWASHING: Whether washed
by hand or mechanical means, all dishes, plates, cups, glasses, pots, pans, and
utensils shall be cleaned in accordance with accepted procedures which shall
include separate steps for prewashing, washing, rinsing, and sanitizing by
means of hot water or chemicals or a combination approved by the department.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.54 NMAC - Rn, 7 NMAC 9.2.54, 8-31-00]
7.9.2.55 REHABILITATIVE
SERVICES: Each facility shall either provide or arrange
for, under written agreement, specialized rehabilitative services as needed by
residents to improve and maintain functioning.
A. CONFORMITY WITH ORDERS AND PLAN: Rehabilitative
services shall be administered under a written plan of care that is developed
in consultation with the attending physician and the therapist(s). The plan of
care will be based on physician orders and assessment by the therapist(s).
B. REPORT TO PHYSICIAN: Within two (2)
weeks of the initiation of rehabilitative treatment, a report of the resident's
progress shall be made to the physician.
C. REVIEW OF PLAN: Rehabilitative
services shall be reevaluated at least quarterly by the physician and
therapists, and the plan of care updated as necessary.
[5-2-89; 7.9.2.54 NMAC - Rn,
7 NMAC 9.2.55, 8-31-00]
7.9.2.56 SPECIALIZED
SERVICES-QUALIFICATIONS:
A. PHYSICAL THERAPY: Physical
therapy shall be given or supervised only by a licensed physical therapist.
B. SPEECH AND HEARING THERAPY:
(1) Speech and hearing
therapy shall be given or supervised only by a therapist who is licensed under
the New Mexico Speech-Language and Pathology and Audiology Act, (Sections
61-14B-1 through 61-14B-16 NMSA 1978).
(2) Meets the educational
standards, and is in the process of acquiring the supervised experience
required for the certification of Speech-Language Pathologists.
C. OCCUPATIONAL THERAPY: Occupational
therapy shall be given or supervised only by a therapist who meets the standard
for registration as an occupational therapist of the American Occupational
Therapy Association.
D. EQUIPMENT: Equipment
necessary for the provision of therapies required by the residents shall be
available and used as needed.
[5-2-89; 7.9.2.56 NMAC - Rn,
7 NMAC 9.2.56, 8-31-00]
7.9.2.57 PHARMACEUTICAL
SERVICES:
A. DEFINITIONS: As used in
this section:
(1) Medication: has the
same meaning as the term “drug”.
(2) Prescription medication: has the same meaning
as the term “prescription drug”.
B. SERVICES: Each facility
shall provide for obtaining medications for the residents from licensed
pharmacies.
C. SUPERVISION:
(1) Medication Consultant: Each facility shall retain a registered
pharmacist who shall visit the facility at least monthly to review the drug
regimen of each resident and medication practices.
(2) The pharmacist shall
submit a written report of findings at least monthly to the facility's
administrator.
D. EMERGENCY MEDICATION KIT:
(1) A facility may have
one or more emergency medication kits available to each charge nurse. All emergency
kits shall be under the control of a pharmacist.
(2) The emergency kit
shall be sealed and stored in a locked area. The facility shall have a policy
and procedures for access by staff to the emergency kit in case of need.
E. REQUIREMENTS FOR ALL MEDICATION
SYSTEMS:
(1) Obtaining new
medications: When medications are needed which are not stocked, a licensed
nurse shall telephone an order to the pharmacist who shall fill the order.
(2) Storing and labeling medications: All
medications shall be handled in accordance with the following provisions:
(a)
The storage and labeling of medications shall be based on currently
acceptable professional practices.
(b)
The consulting pharmacist shall be responsible to develop policies and
procedures governing all aspects of storage and labeling of medications.
(c)
The consulting pharmacist shall be responsible for assuring the facility
meets all requirements for storage and labeling as required by New Mexico Board
of Pharmacy.
(3) Destruction of
medications:
(a) Time limit:
Unless otherwise ordered by a physician, a resident's medication not
returned to the pharmacy for credit shall be removed to a locked storage area
when discontinued by a physician's order. Such discontinued medications will be
destroyed within thirty (30) days of the physician's discontinuance of use.
(b)
Procedure: Records shall be kept
of all medication returned for credit and/or disposal.
(c)
Remaining controlled substances:
Any controlled substances remaining after the discontinuance of
physician's orders or the discharge or death of the resident shall be
inventoried on the appropriate U.S. drug enforcement agency form and one copy
shall be kept on file in the facility.
(4) Control of
medication:
(a)
Receipt of medications: The
administrator or a physician, nurse, or pharmacist, may be an agent of the
resident for the receipt of medications.
(b) Signatures: When the medication is received by the
facility, the person completing the control record shall sign the record
indicating the amount received.
(c)
Discontinuance of medications:
The consulting pharmacist shall assist the facility to develop policies
for the automatic discontinuance of medications.
(5) Proof-of-use record:
(a)
For schedule II drugs, a proof-of-use record shall be maintained which
lists, on separate proof-of-use sheets for each type and strength of schedule
II drug, the date and time administered, resident's name, physician's name,
dose, signature of the person administering dose, and balance.
(b) Proof-of-use records shall be audited
daily by the registered nurse or licensed practical nurse.
(6) Resident control and
use of medications:
(a)
Residents may have medications in their possession or stored at their
bedside on the order of a physician.
(b)
Medications which, if ingested or brought into contact with the nasal or
eye mucosa, would produce toxic or irritant effects shall be stored and used only
in accordance with the health, safety, and welfare of all residents.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.57 NMAC - Rn, 7 NMAC 9.2.57, 8-31-00]
7.9.2.58 DIAGNOSTIC
SERVICES:
A. REQUIREMENT OF SERVICES: The facility
shall provide for promptly obtaining required laboratory, x-ray, and other
diagnostic services.
B. FACILITY-PROVIDED SERVICES: Any laboratory
and x-ray services provided by the facility shall meet the applicable
requirements for hospitals.
C. OUTSIDE SERVICES: If the
facility does not provide these services, arrangements shall be made for
obtaining the services from a physician's office, hospital, nursing facility,
portable x-ray supplier, or independent laboratory.
D. PHYSICIAN'S ORDER: No services
under the subsection may be provided without an order of a physician.
E. NOTICE OF FINDINGS: The attending
physician shall be notified promptly of the findings of all tests provided
under this subsection.
F. TRANSPORTATION: The facility
shall assist the resident, if necessary, in arranging for transportation to and
from the provider of service.
(1) Any employee or agent
of a regulated facility or agency who is responsible for assisting a resident
in boarding or alighting from a motor vehicle must complete a state-approved
training program in passenger transportation assistance before assisting any
resident. The passenger transportation
assistance program shall be comprised of but not limited to the following
elements: resident assessment, emergency
procedures, supervised practice in the safe operation of equipment, familiarity
with state regulations governing the transportation of persons with
disabilities, and a method for determining and documenting successful
completion of the course. The course
requirements above are examples and may be modified as needed.
(2) Any employee or agent
of a regulated facility or agency who drives a motor vehicle provided by the
facility or agency for use in the transportation of clients must complete:
(a) A state approved
training program in passenger assistance and
(b)
A state approved training program in the operation of a motor vehicle to
transport clients of a regulated facility or agency. The motor vehicle transportation assistance
program shall be comprised of but not limited to the following elements: resident assessment, emergency procedures,
supervised practice in the safe operation of motor vehicles, familiarity with
state regulations governing the transportation of persons with disabilities,
maintenance and safety record keeping, training on hazardous driving conditions
and a method for determining and documenting successful completion of the
course. The course requirements above
are examples and may be modified as needed.
(c)
A valid New Mexico drivers license for the type of vehicle being
operated consistent with State of New Mexico requirements.
(3) Each regulated facility
and agency shall establish and enforce written polices (including training) and
procedures for employees who provide assistance to clients with boarding or
alighting from motor vehicles.
(4) Each regulated
facility and agency shall establish and enforce written polices (including
training and procedures for employees who operate motor vehicles to transport
clients.
[5-2-89; 7.9.2.58 NMAC - Rn
& A, 7 NMAC 9.2.58, 8-31-00]
7.9.2.59 BLOOD
AND BLOOD PRODUCTS: Any blood-handling and storage facilities
shall be safe, adequate, and properly supervised. If the facility provides for
maintaining and transferring blood and blood products, it shall meet the
appropriate requirements for licensed hospitals. If the facility only provides
transfusion services, it shall meet the requirements of applicable regulations.
[5-2-89; 7.9.2.59 NMAC - Rn,
7 NMAC 9.2.59, 8-31-00]
7.9.2.60 DENTAL
SERVICES:
A. ADVISORY DENTIST: The facility
shall retain an advisory dentist to participate in the staff development
program for nursing and other appropriate personnel to recommend oral hygiene
policies and practices for the care of residents.
B. ATTENDING DENTISTS:
(1) Arrangements for
dental care: The facility shall make
arrangements for dental care for residents who do not have a private dentist.
(2) Transportation: The facility shall assist the resident, if
necessary, in arranging for transportation to and from the dentist's office.
C. DENTAL EXAMINATION OF RESIDENTS: Dental health
care shall be provided or arranged for the resident as needed.
D. EMERGENCY DENTAL CARE: The facility
shall arrange for emergency dental care when a resident's attending dentist is
unavailable.
[7-1-60, 5-2-89; 7.9.2.60 NMAC
- Rn, 7 NMAC 9.2.60, 8-31-00]
7.9.2.61 SOCIAL
SERVICES:
A. PROVISION OF SERVICES: Each facility
shall provide for social services in conformance with this section.
B. STAFF:
(1) Social worker: Each facility shall employ or retain a person
full-time or part-time to coordinate the social services, to review the social
needs of residents, and to make referrals.
(2) Qualifications: The person shall:
(a)
Have a bachelor's degree in social work, sociology, or psychology; and
have one year of social work experience in a health care setting; or
(b)
Have a master's degree in social work from a graduate school of social
work accredited by the Council on Social Work Education; or
(c)
If the designated person is not a qualified social worker, the facility
shall receive at least monthly consultation from a social worker who meets the
required standards.
C. ADMISSION:
(1) Interviews: Before or
at a time of admission, each resident and guardian, if any, and any other
person designated by the resident or guardian, shall be interviewed by the
social service designee to assist the patient in adjusting to the social and
emotional aspects of illness, treatment, and stay in the facility.
(2) Admission history: A
social history of each resident shall be prepared.
D. CARE PLANNING:
(1) Within two (2) weeks
after admission, an evaluation of social needs and potential for discharge
shall be completed for each resident.
(2) A social component of
the plan of care, including preparation for discharge, if appropriate, shall be
developed and included in the plan of care; required by these regulations.
(3) Social services care
and plan shall be evaluated every ninety (90) days.
E. SERVICES: Social
services staff shall provide the following:
(1) Referrals: If necessary, referrals for legal services,
or to appropriate agencies in cases of legal, financial, psychiatric,
rehabilitative or social problems which the facility cannot serve.
(2) Adjustment
assistance: Assistance with adjustment
to the facility, and continuing assistance to and communication with the
resident, guardian, family, or other responsible persons.
(3) Discharge planning: Assistance to other facility staff and the
resident in discharge planning at the time of admission and prior to removal
under this chapter.
(4) Training: Participation in in-service training for direct
care staff on the emotional and social problems and needs of the aged and ill
and on methods for fulfilling these needs.
[5-2-89; 7.9.2.61 NMAC - Rn,
7 NMAC 9.2.61, 8-31-00]
7.9.2.62 ACTIVITIES:
A. PROGRAM:
(1) Every facility shall
provide an activities program which meets the requirements of this section. The
program may consist of any combination of activities provided by the facility
and those provided by other community resources.
(2) The activities
program shall be planned for group and individual activities, and shall be
designed to meet the needs and interests of each resident and to be consistent
with each resident's plan of care.
B. STAFF:
(1) Definition: “Qualified activities coordinator” means, in
a skilled nursing facility, a person who:
(a)
Has a bachelor's degree in recreation therapy and is eligible for
registration as a therapeutic recreation specialist with the National Therapeutic
Recreation Society; or
(b)
Is an occupational therapist or occupational therapy assistant who meets
the requirements for certification by the American Occupational Therapy
Association; or
(c)
Has two (2) years of experience in a social or recreational program
within the last five years, one year of which was full-time in a patient
activities program in a health care setting; or
(d)
Has completed a state approved program.
(e)
In an intermediate care facility, a staff member who is qualified by
experience or training in directing group activity.
(2) Supervision: The activity program shall be supervised by:
(a)
A qualified activities coordinator; or
(b)
An employee who receives at least monthly consultation from a qualified
activities coordinator.
[5-2-89; 7.9.2.62 NMAC - Rn,
7 NMAC 9.2.62, 8-31-00]
7.9.2.63 EQUIPMENT
AND SUPPLIES:
A. BEDS:
(1) Each resident shall
be provided a bed which is at least thirty-six (36) inches wide, is equipped
with a headboard of sturdy construction and is in good repair. Roll-away beds,
day beds, cots, or double or folding beds shall not be used.
(2) Each bed shall be in
good repair and provided with a clean, firm mattress of appropriate size for
the bed.
(3) Side rails shall be installed
for both sides of the bed when required by the resident's condition.
B. BEDDING:
(1) Each resident shall
be provided at least one (1) clean, comfortable pillow. Additional pillows
shall be provided if requested by the resident or required by the resident's
condition.
(2) Each bed shall have a
mattress pad unless contraindicated by special use equipment.
(3) If mattress is not
moisture-proof, a moisture-proof mattress cover shall be provided. A
moisture-proof pillow cover shall be provided to keep each mattress and pillow
clean and dry.
(a)
A supply of sheets and pillow cases sufficient to keep beds clean, dry
and odor-free shall be stocked. At least two (2) sheets and two (2) pillow
cases shall be furnished to each resident each week.
(b)
Beds occupied by bedfast or incontinent residents shall be provided
drawsheets or appropriate pads.
(4) A sufficient number
of blankets shall be provided to keep each resident warm. Blankets shall be
changed and laundered as often as necessary to maintain cleanliness and freedom
from odors.
(5) Each bed shall have a
clean, washable bedspread.
C. OTHER FURNISHINGS:
(1) Each resident who is
confined to bed shall be provided with a bedside storage unit containing at
least one (1) drawer for personal items and a drawer or compartment for
necessary nursing equipment. All other residents shall be provided with a
storage unit in the resident's room, containing at least one drawer for
personal items and a drawer or compartment for necessary nursing equipment.
(2) At least one (1) arm
chair shall be available for each room for each bed. A folding chair shall not
be used.
(3) A properly shaded
reading light in working condition shall be installed over or at each bed.
(4) Adequate compartment
or drawer space shall be provided in each room for each resident to store
personal clothing and effects and to store, as space permits, other personal
possessions in a reasonably secure manner.
(5) A sturdy and stable
table that can be placed over the bed or armchair shall be provided to every
resident who does not eat in the dining room.
D. TOWELS, WASHCLOTHS, AND SOAP:
(1) Clean towels and washcloths
shall be provided to each resident as needed. Towels shall not be used by more
than one resident between launderings.
(2) An individual towel
rack shall be installed at each resident's bedside or at the lavatory.
(3) Single service towels
and soap shall be provided at each lavatory for use by staff.
E. WINDOW COVERINGS: Every window
in patient care area shall be supplied with flame retardant shades, draw drapes
or other covering material or devices which, when properly used and maintained,
shall afford privacy and light control for the resident.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.63 NMAC - Rn, 7 NMAC 9.2.63, 8-31-00]
7.9.2.64 RESIDENT
CARE EQUIPMENT:
A. PERSONAL NEED ITEMS: When a
resident because of his or her conditions needs a mouthwash cup, a wash basin,
a soap dish, a bedpan, an emesis basin, or a standard urinal and cover, that
item shall be provided to the resident. This equipment may not be interchanged
between residents until it is effectively washed and sanitized.
B. THERMOMETERS: If reusable
oral and rectal thermometers are used, they shall be cleaned and disinfected
between use.
C. FIRST AID SUPPLIES: Each nursing
unit shall be supplied with first aid supplies, including bandages, sterile
gauze dressings, bandage scissors, tape, and a sling tourniquet.
D. OTHER EQUIPMENT: Other
equipment, such as wheelchairs with brakes, footstools, commodes, foot cradles,
footboards, under-the-mattress bedboards, walkers, trapeze frames, transfer boards,
parallel bars, reciprocal pulleys, suction machines, patient lifts and Stryker
or Froster frames, shall be used as needed for the care of the residents.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.64 NMAC - Rn, 7 NMAC 9.2.64, 8-31-00]
7.9.2.65 MAINTENANCE: All facility
furnishings and equipment shall be maintained in a usable, safe and sanitary
condition.
[7-1-60, 5-2-89; 7.9.2.65
NMAC - Rn, 7 NMAC 9.2.65, 8-31-00]
7.9.2.66 STERILIZATION
OF SUPPLIES AND EQUIPMENT: Each facility shall provide sterilized supplies
and equipment by one or more of the following methods:
A. Use of an autoclave.
B. Use of disposable, individually wrapped, sterile supplies such as
dressings, syringes, needles, catheters, and gloves.
C. Sterilization services under a written agreement with another facility;
or
D. Other sterilization procedures when approved in writing by the
Department.
[7-1-60, 5-2-89; 7.9.2.66
NMAC - Rn, 7 NMAC 9.2.66, 8-31-00]
7.9.2.67 SANITIZATION
OF UTENSILS: Utensils such as individual bedpans, urinals and
wash basins which are in use shall be sanitized in accordance with acceptable
sanitization procedures on a routine schedule. These procedures shall be done
in an appropriate area.
[7-1-60, 5-2-89; 7.9.2.67
NMAC - Rn, 7 NMAC 9.2.67, 8-31-00]
7.9.2.68 DISINFECTION
OF RESIDENT GROOMING UTENSILS: Hair care tools such as combs, brushes, metal
instruments, and shaving equipment which are used for more than one resident
shall be disinfected before each use.
[7-1-60, 5-2-89; 7.9.2.68
NMAC - Rn, 7 NMAC 9.2.68, 8-31-00]
7.9.2.69 OXYGEN:
A. No oil or grease shall be used on oxygen equipment.
B. When placed at the resident's bedside, oxygen tanks shall be securely
fastened to a tip-proof carrier or base.
C. Oxygen regulators shall not be stored with solution left in the
attached humidifier bottle.
D. When in use at the resident's bedside, cannulas, hoses, and humidifier
bottles shall be changed at least every thirty (30) days.
E. Disposable inhalation equipment shall be pre-sterilized and kept in
contamination-proof containers until used, and shall be replaced at least every
thirty (30) days when in use.
F. With other inhalation equipment such as intermittent positive pressure
breathing equipment, the entire resident breathing circuit, including
nebulizers and humidifiers, shall be changed at least every seven (7) days.
[5-2-89; 7.9.2.69 NMAC - Rn,
7 NMAC 9.2.69, 8-31-00]
7.9.2.70 HOUSEKEEPING
SERVICES:
A. REQUIREMENT: Facilities
shall develop and implement written policies that ensure a safe and sanitary
environment for personnel and residents at all times.
B. CLEANING:
(1) General: The facility shall be kept clean and free
from offensive odors, accumulations of dirt, rubbish, dust, and safety hazards.
(2) Floors:
Floors and carpeting shall be kept clean. Polishes on floors shall
provide a non-slip finish. Carpeting or any other material covering the floors
that is worn, damaged, contaminated or badly soiled shall be replaced, repaired
or cleaned.
(3) Other surfaces: Ceiling and walls shall be kept clean and in
good repair at all times. The interior and exterior of the buildings shall be
painted or stained as needed to protect the surfaces. Loose, cracked, or
peeling wallpaper or paint shall be replaced or repaired.
(4) Furnishings: All furniture and other furnishings shall be
kept clean and in good repair at all times.
(5) Combustibles in
storage areas: Attics, cellars and other
storage areas shall be kept safe and free from dangerous accumulations of
combustible materials. Combustibles such as cleaning rags and compounds shall
be kept in closed metal containers.
(6) Grounds: The grounds shall be kept free from refuse,
litter, and wastewater. Areas around buildings, sidewalks, gardens, and patios
shall be kept clear of dense undergrowth.
C. POISONS: All poisonous
compounds shall be clearly labeled as poisonous and, when not in use, shall be
stored in a locked area separate from food, kitchenware, and medications.
D. GARBAGE:
(1) Storage
containers: All garbage and rubbish
shall be stored in leak-proof, non-absorbent containers with close-fitting
covers, and in areas separate from those used for the preparation and storage
of food. Containers shall be cleaned regularly. Paperboard containers shall not
be used.
(2) Disposal: Garbage and rubbish shall be disposed of
promptly in a safe and sanitary manner.
E. LINEN AND TOWELS: Linens shall
be handled, stored, processed, and transported in such a manner as to prevent
the spread of infection. Soiled linen shall not be sorted, rinsed, or stored in
bathrooms, residents' rooms, kitchens, food storage areas, nursing units,
common hallways.
F. PEST CONTROL:
(1) Requirement: The facility shall be maintained reasonably
free from insects and rodents, with harborage and entrances of insects and
rodents eliminated.
(2) Provision of
service: Pest control shall be provided
when required for the control of insects and rodents.
(3) Screening of windows
and doors: All windows and doors used
for ventilation purposes shall be provided with wire screening of not less than
number sixteen (16) mesh or its equivalent, and shall be properly installed and
maintained to prevent entry of insects. Hinged screen days when in use.
(4) With other inhalation
equipment such as intermittent positive pressure breathing equipment, the
entire resident breathing circuit, including nebulizers and humidifiers, shall
be changed at least every seven (7) days.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.70 NMAC - Rn, 7 NMAC 9.2.70, 8-31-00]
7.9.2.71 PHYSICAL
ENVIRONMENT:
A. GENERAL: The buildings
of the nursing facility shall be constructed and maintained so that they are
functional for diagnosis and treatment and for the delivery services
appropriate to the needs of the community and with due for protecting the
health and safety of the patients. The provisions of this section apply to all
new, remodeled and existing construction unless otherwise noted. Existing
waivers at the time these regulations are enacted would continue to be accepted
unless it is determined that the facility is unable to protect the health and
safety of the resident.
B. DEFINITIONS: The
definitions in the applicable life safety code required under these regulations
apply to this subchapter. In addition, in this subchapter:
(1) Existing
construction: means a building which is in place or is being constructed with
plans approved by the department prior to the effective date of this chapter.
(2) Life safety code:
means the National Fire Protection Association's standard 101.
(3) 1981 Code: means
facilities with construction plans first approved by the Department on or after
November 26, 1982, shall be free from dangerous accumulations of combustible
materials. Combustibles such as cleaning rags and compounds shall be kept in
closed metal containers.
(4) Fire safety
evaluation system: means a proposed or existing facility not meeting all
requirements of the applicable life safety code shall be considered in compliance
if it achieves a passing score on the Fire Safety Evaluation System (FSES),
developed by the United State Department of Commerce, National Bureau of
Standards, to establish safety equivalencies under the Life Safety Code.
(5) New construction:
means construction for the first time of any building or addition to an
existing building, the plans for which are approved after the effective date of
this chapter.
(6) Remodeling: means to
make over or rebuild any portion of a building or structure and thereby modify
its structural strength, fire hazard character, exists, heating and ventilating
system, electrical system or internal circulation, as previously approved by
the Department. Where exterior walls are in place but interior walls are not in
place at the time of the effective date of this chapter, construction of
interior walls shall be considered remodeling. “Remodeling” does not include
repairs necessary for the maintenance of a building structure.
C. APPROVALS: The facility
shall keep documentation of approvals on file in the facility following all
inspections by state and local authorities.
D. FIRE PROTECTION:
(1) Basic responsibility:
The facility shall provide fire protection adequate to ensure the safety of
patients, staff and others on the premises. Necessary safeguards such as
extinguishers, sprinkling and detection devices, fire and smoke barriers, and
ventilation control barriers shall be installed to ensure rapid and effective
fire and smoke control.
(2) New construction: Any
new construction or remodeling shall meet the applicable provisions of the 1981
edition of the Life Safety Code.
(3) Existing facilities: Any
existing facility shall be considered to have met the requirements of this
subsection if, prior to the promulgation of this chapter, the facility complied
with and continues to comply with the applicable provisions of the 1967, 1973,
or 1981 edition of the Life Safety Code, with or without waivers.
(4) Equivalent
Compliance: An existing facility that does not meet all requirements of the
applicable Life Safety Code may be considered in compliance with it if it
achieves a passing score on the Fire Safety Evaluation System (FSES) developed
by the U.S. Department of Commerce National Bureau of Standard, to establish
safety equivalencies under the Life Safety Code.
(5) Note: See Appendix C
of the 1981 Life Safety Code.
E. GENERAL CONSTRUCTION: All capital investment plans subject to these
regulations, shall be submitted to the Department for review and approval.
(1) One copy of
preliminary or schematic plans shall be submitted to the Department for review
and approval.
(2) One copy of final
plans and specifications which are used for bidding purposes shall be submitted
to the Department for review and approval before construction is started. Plans
must be prepared and stamped by an architect registered in the State of New
Mexico.
(3) If on-site
construction above the foundation is not started within twelve (12) months of
the date of approval of the final plans and specifications, the approval under
these regulations shall be void and the plans and specifications shall be
resubmitted for reconsideration of approval.
(4) Any changes in the
approved final plans affecting the application of the requirements of this
subchapter shall be shown on the approved final plans and shall be submitted to
the Department for approval before construction is undertaken. The Department
shall notify the facility in writing of any conflict with this subchapter found
in its review of modified plans and specifications.
(5) General: Projects
involving alterations of and additions to existing buildings shall be
programmed and phased so that on-site construction will minimize disruptions of
existing functions. Access, exit ways, and fire protection shall be so
maintained that the safety of the occupants will not jeopardized during
construction.
(6) Minimum requirements:
All requirements listed in New Construction, relating to new construction
projects, are applicable to renovation projects involving additions or
alterations, except that when existing conditions make changes impractical to
accomplish, minor deviations from functional requirements may be permitted if
the intent of the requirements is met and if the care and safety of patients
will not be jeopardized.
(7) Non-conforming
conditions: When doing renovation work, if it is found to be unfeasible to
correct all of the nonconforming conditions in the existing facility in accordance
with these standards, acceptable compliance status may be recognized by the
Licensing Agency if the operation of the facility, necessary access by the
handicapped, and safety of the patients, are not jeopardized by the remaining
non-conforming conditions.
(8) Note #1: Plan
approval by Construction Industries Division, labor and human relations under
these regulations is also required for any new construction or remodeling.
(9) Note #2: Copies of
the 1967, 1973, and 1981 Life Safety Codes and related codes can be obtained
from the National Fire Protection Association, Battery March Park, Quincy, PA
02269.
F. CONSTRUCTIONS AND INSPECTIONS:
(1) General:
Construction, of other than minor alterations, shall not be commenced until
plan-review deficiencies have been satisfactorily resolved.
(a)
The completed construction shall be in compliance with the approved
drawings and specifications, including all addenda or modifications approved
for the project.
(b)
A final inspection of the facility will be scheduled for the purpose of
verifying compliance with the approved drawings and specifications including
all addenda or modifications approved for the project.
(2) In addition to
compliance with these standards, all other applicable building codes,
ordinances, and regulations under city, county, or other state agency
jurisdiction shall be observed. Compliance with local codes shall be
prerequisite for licensing. In areas not subject to local building codes, the
state building codes, as adopted, shall apply insofar as such codes are not in
conflict with these standards.
(a)
New Construction is governed by the current editions of the following
Codes Standards:
(b)
Uniform Building Code (UBC), Uniform Plumbing Code (UPC), Uniform
Mechanical Code (UMC), National Electrical Code (NEC), National Fire Protection
Association Standards (NFPA), American National Standard Institute (ANSI),
American Society of Heating, Refrigerating, and Air Conditioning Engineers
(ASHRAE), Department of Health and Human Services (DHHS) Guidelines for
Construction and Equipment of Hospital and Medical Facilities.
G. RESIDENT SAFETY AND DISASTER PLAN:
(1) Disaster Plan:
(a)
Each facility shall have a written procedure which shall be followed in
case of fire or other disasters, and which shall specify persons to be
notified, locations of alarm signals and fire extinguishers, evacuation routes,
procedures for evacuating helpless residents, frequency of fire drills and
assignment of specific tasks and responsibilities to the personnel of each
shift and each discipline.
(b)
The plan developed by the facility shall be submitted to qualified fire
and safety experts, including the local fire authority, for review and
approval. The facility shall maintain documentation of approval by the
reviewing authority.
(c)
All employees shall be oriented to this plan and trained to perform
assigned tasks.
(d)
The plan shall be available at each nursing station.
(e)
The plans shall include a diagram of the immediate floor area showing
the exits, fire alarm stations, evacuation routes and location of fire
extinguishers. The diagram shall be posted in conspicuous locations in the
corridor throughout the facility.
(2) Drills: Fire drills shall be held at irregular
intervals at least four (4) times a year on each shift and the plan shall be
reviewed and modified as necessary. Records of drills and dates of drills shall
be maintained.
(3) Fire inspections: The
administrator of the facility shall arrange for fire protection as follows:
(a)
At least annual inspection of the facility shall be made by the local
fire inspection authorities. Signed certificates of such inspections shall be
kept on file in the facility.
(b)
Certification by the local fire authority as to the fire safety of the
facility and to the adequacy of a written fire plan for orderly evacuation of
residents shall be obtained and kept on file in the facility.
(c)
Where the facility is located in a city, village, or township that does
not have an official established fire department, the licensee shall obtain and
maintain a continuing contract for fire protection service with the nearest
municipality providing such service. A certification of the existence of such
contract shall be kept on file in the facility.
(4) Fire equipment: All
fire protection equipment shall be maintained in readily usable condition and
inspected annually. In addition to any other equipment, a fire extinguisher suitable
for grease fires shall be provided in or adjacent to the kitchen. Each
extinguisher shall be provided with a tag for the date of inspection.
(5) Fire Report: All
incidents of fire in a facility shall be reported to the department within
seventy-two (72) hours.
(6) Smoking: Smoking by
residents shall be permitted only in designated areas supervised in accordance
with the conditions, needs, and safety of residents.
(7) Prevention of
ignition: Heating devices and piping shall be designed or enclosed to prevent
the ignition of clothing or furniture.
(8) Floor coverings:
Scatter rugs and highly polished, slippery floors are prohibited, except for
non-slip entrance mats. All floor coverings and edging shall be securely
fastened to the floor or so constructed that they are free of hazards such as
curled and broken edges.
(9) Roads and sidewalks:
The ambulatory and vehicular access to the facility shall be kept passable and
open at all times of the year. Sidewalks, drives, fire escapes, and entrances
shall be kept free of ice, snow, and other obstructions.
H. SAFETY AND SYSTEMS:
(1) Maintenance: The
building shall be maintained in good repair and kept free of hazards such as
those created by any damaged or defective building equipment.
(2) Corridors:
(a)
Handrails. Corridors used by residents shall be equipped with handrails
firmly secured on each side of the corridor.
(b)
Size. All corridors in resident use areas shall be at least eight (8)
feet wide.
(3) Doors:
(a)
Size. Doors to residents' rooms shall not be less than three (3) feet
eight (8) inches wide and six (6) feet eight (8) inches in height, and shall be
at least one and three-quarter inches solid core wood or equivalent
construction.
(b) Latches. Each designated fire exit door
shall have such latches or hardware that the door can be opened from the inside
by pushing against a single bar or plate or by turning a single knob or handle.
(c)
Locks on exit doors from the building and from nursing areas and wards
may not be hooked or locked to prevent exit from the inside, shall be installed
on the door of the resident's room, unless the lock is operable from inside the
room with a simple one-hand, one-motion operation without the use of a key
unless the resident is confined; a master-key is available to emergency
personnel such as the fire department.
(4) Toilet room doors:
Resident toilet room doors shall be not less than three (3) feet zero (0)
inches by six (6) feet eight (8) inches, and shall not swing into the toilet
room unless they are provided with two way hardware.
(5) Thresholds: Raised
thresholds which cannot be traversed easily by a bed on wheels, a wheelchair, a
drug cart, or other equipment on wheels shall not be used.
I. EMERGENCY POWER: Emergency
electrical service with an independent power source which covers lighting as
nursing stations, telephone switchboards, exit and corridor lights, boiler
room, and fire alarm systems, shall be provided. The service may be battery
operated if effective for at least four (4) hours.
J. FIRE PROTECTION:
(1) Carpeting: Carpeting shall not be installed in rooms
used primarily for the following purposes: food preparation and storage, dish
and utensil washing, soiled utility workroom, janitor closet, laundry
processing, hydro-therapy, toilet and bathing, resident isolation, and resident
examination.
(2) Carpet
fireproofing: Carpeting, including
underlying padding, if any, shall have a flamespread rating of seventy-five
(75) or less when tested in accordance with standard 255 of the National Fire
Protection Association (NFPA), or a critical radiant flux of more than 0.45
watts per square centimeter when tested in accordance with NFPA standard 253,
1978 edition. Certified proof by the manufacturer of the aforementioned test
for the specific product shall be available in the facility. Certification by
the installer that the material installed is the product referred to in the
test shall be obtained by the facility. Carpeting shall not be applied to walls
in any case except where the flamespread rating can be shown to twenty-five
(25) or less.
(3) Acoustical tile: Acoustical tile shall be
non-combustible.
(4) Wastebaskets:
Wastebaskets shall be of non-combustible materials.
(5) Vertical exit
stairways: At least one interior exit stairway shall be provided to that an
enclosed protected path of at least one-hour fire resistive construction is
available for occupants to proceed with safety to the exterior of the facility.
(6) Housing blind,
non-ambulatory, or handicapped residents: In an existing facility of two (2) or
more stories which is not of at least two-hour fire resistive construction,
blind, non-ambulatory, or physically handicapped residents shall not be housed
above the street level floor unless the facility is either of one-hour
protected non-combustible construction (as defined in national fire protection
standard 200), fully sprinklered one-hour protected ordinary construction, or
fully sprinklered one-hour protected wood frame construction.
(7) Storage of oxygen:
Oxygen tanks, when not in use, shall be stored in a ventilated closet
designated for that purpose only or stored outside the building of the home in
an enclosed secured area. Oxygen storage areas must comply with NFPA 99.
K. SPRINKLERS FOR FIRE PROTECTION: Facilities
shall have automatic sprinkler protection throughout buildings. In the event of
an addition to, or remodeling of a facility, the entire facility shall have
automatic sprinkler protection throughout unless there is a two (2) hour fire
rated partition wall between the old and new construction, in which case only
the new or remodeled area shall be sprinklered.
L. MECHANICAL SYSTEMS:
(1) Water supply:
(a)
A portable water supply shall be available at all times. If a public
water supply is available, it shall be used. If a public water supply is not
available, the well or wells shall comply with applicable regulations.
(b)
An adequate supply of hot water shall be available at all times. The
temperature of hot water at plumbing fixtures used by residents may not exceed
110 degrees Fahrenheit (43 degrees C.) and shall be automatically regulated by
control valves or by another approved device.
(2) Sewage disposal: All
sewage shall be discharged into a municipal sewage system if available.
Otherwise, the sewage shall be collected, treated, and disposed of by means of
an independent sewage system approved under applicable state law and local
authority.
(3) Plumbing: The
plumbing for potable water and drainage for the disposal of excreta, infectious
discharge, and wastes shall comply with applicable state plumbing standards.
(4) Heating and air conditioning:
(a)
The heating and air conditioning systems shall be capable of maintaining
adequate temperatures and providing freedom from drafts.
(b)
A minimum temperature of at least 70 degrees Fahrenheit (21 degrees C.)
in all bedrooms and in all other areas used by residents, unless resident
preference is documented for deviations.
(5) Incineration:
(a)
Facilities for the incineration
of soiled dressings and similar wastes, as well as garbage and refuse, shall be
provided when other methods of disposal are not available.
(b)
An incinerator shall not be flue fed nor shall any upper floor charging
chute be connected with the combustion chamber.
(6) Telephone: There shall be at least one operational
non-pay telephone on the premises and as many additional telephones as are
deemed necessary in an emergency.
(7) General lighting:
(a)
Adequate lighting shall be provided in all areas of the facility.
Lighting shall be of a type that does not produce discomfort due to high
brightness, glare or reflecting surface. No candles, oil lanterns, or other
open flame method of illumination may be used.
(b)
Facilities shall have lighting during the evening and night hours that
is commensurate with staff needs.
(8) Ventilation:
(a)
The facility shall be well-ventilated through the use of windows,
mechanical ventilation, or a combination of both. Rooms and areas which do not
have outside windows and which are used by residents or personnel shall be
provided with functioning mechanical ventilation to change the air on a basis
commensurate with the type of occupancy.
(b)
All inside bathrooms and toilet rooms shall have mechanical ventilation to
the outside.
(c)
Mechanical ventilation shall be provided to the resident area corridors,
solaria, dining, living and recreation areas, and nursing stations. These areas
shall be under positive pressure;
(d) All rooms in which
food is stored, prepared or served, or in which utensils are washed shall be
well-ventilated. Refrigerated storage rooms need not be ventilated.
(e)
Kitchens, bathrooms, utility rooms, janitor closets, and soiled linen
rooms shall be ventilated.
(9) Elevators: At least
one elevator shall be provided in the facility if resident beds or activities
are located on more than one floor. The platform size of the elevator shall be
large enough to hold a resident bed as and attendant.
(10) Electrical:
(a)
In all facilities, non-conductive wall plates shall be provided where
the system is not properly grounded.
(b)
In new construction begun after the effective date of these regulations,
at least two (2) duplex-type outlets shall be provided for each bed.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.71 NMAC - Rn, 7 NMAC 9.2.71, 8-31-00]
7.9.2.72 RESIDENTS'
ROOMS:
A. ASSIGNMENT OF RESIDENTS: Residents
co-habiting a double occupancy room or a ward shall be of the same sex unless
residents are married, related, or are consenting adults.
B. LOCATION: No bedroom
housing or resident shall:
(1) Open directly to a
kitchen or laundry.
(2) Be located so that a
person must pass through a resident's bedroom, toilet room, or bathroom to gain
access to any other part of the facility.
(3) Be located so that a person must pass
through a kitchen or laundry to gain access to the resident's room or other
part of the facility.
C. ACCESS TO CORRIDOR AND OUTSIDE: Each bedroom shall
have direct access to a corridor and outside exposure with the floor at or
above grade level.
D. SIZE:
(1) The minimum floor
area per bed shall be one hundred (100) square feet in single rooms and eighty
(80) square feet per bed in multiple bedrooms, exclusive of vestibule, closets,
built-in vanity and wardrobe, toilet rooms and built-in lockers. The department
may waive this requirement in individual cases where the facility has
demonstrated in writing that such variations are in accordance with the
particular needs of the residents and will not adversely affect their health
and safety.
(2) Resident rooms shall
be large enough to permit the sides and feet of all beds to be not less than
two (2) feet from the nearest walls.
(3) Ceilings shall be at
least eight (8) feet in height.
E. WINDOWS: The bottom
sill of windows in bedrooms shall be no more than three (3) feet from the
floor.
F. BED CAPACITY: No rooms shall
house more than four (4) beds.
G. BED ARRANGEMENTS: The beds shall
be arranged so that the beds shall be at least three (3) feet apart and clear
aisle space of at least three (3) feet from the entrance to the room to each
bed shall be provided.
H. CLOSET SPACE: A closet or
locker shall be provided for each resident in each bedroom. Closets or lockers
shall afford a space of not less than fifteen (15) inches wide by eighteen (18)
inches deep by five (5) feet in height for each resident bed.
I. CUBICLE CURTAINS: Each bed in a
multiple-bed room shall have a flame retardant or flameproof cubicle curtain or
an equivalent divider that will assure resident privacy.
J. ROOM IDENTIFICATION: Each bedroom
shall be identified with a unique number placed on or near the door.
K. DESIGN AND PROXIMITY TO BATHS: Residents'
bedrooms shall be designed and equipped for adequate nursing care and the
comfort and privacy of residents. Each bedroom shall have or shall be
conveniently located near adequate toilet and bathing facilities.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.72 NMAC - Rn, 7 NMAC 9.2.72, 8-31-00]
7.9.2.73 TOILET
AND BATHING FACILITIES:
A. GENERAL: All lavatories
required by this subsection shall have hot and cold running water. Toilets
shall be water flushed and equipped with open front seats without lids.
(1) Toilet facilities
shall be provided in conjunction with each resident's rooms, with not more than
two (2) residents' rooms, and not more than four (4) beds per toilet room.
(2) One toilet and one
lavatory for not more than four (4) residents shall be provided and separate
facilities shall be provided for each sex.
(3) One tub or shower for
every twenty (20) residents shall be provided. The bath or shower shall be
located on the same floor as the residents served. Facilities for showering
with a wheeled shower chair shall be provided.
(4) Every tub, shower, or
toilet shall be separated in such a manner that it can be used independently
and afford privacy.
(5) On floors where
wheelchair residents are cared for, there shall be a toilet room large enough
to accommodate a wheelchair and attendant.
B. EMPLOYEE AND FAMILY FACILITIES: Toilets,
baths, and lavatories for use by employees or family members shall be separate
from those used by residents.
C. GRAB BARS: Firmly secured
grab ban shall be installed in every toilet and bathing compartment used by
residents.
D. WHEELCHAIR FACILITIES:
(1) On floors housing
residents who use wheelchairs, there shall be at least one toilet room large
enough to accommodate wheelchairs.
(2) In all facilities
licensed for skilled care, a bathtub or shower room large enough to accommodate
a wheelchair and attendant shall be provided.
E. The requirement of separate facilities for male and female residents is
not applicable to facilities used by married couples sharing a room, or those
referenced in Section 9.2.72.A if the facilities are not used by other
residents.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.73 NMAC - Rn, 7 NMAC 9.2.73, 8-31-00]
7.9.2.74 NURSING
FACILITIES:
A. ALL FACILITIES: Each facility
shall have:
(1) A medicine storage
area.
(2) Space for storage of
linen, equipment, and supplies.
(3) Utility rooms, which
shall be located, designed and equipped to provide areas for the separate
handling of clean and soiled linen, equipment, and supplies.
B. Each resident care area on each floor shall have:
(1) A centrally located
nurse station located to provide visual control of all resident room corridors;
equipped with storage for records and charts, a desk or work counter,
operational telephone, and nurse call system as required in Section 7.9.2.75.
(2) A medicine
preparation room immediately adjacent to the nurse station with a work counter,
refrigerator, sink, and a well-lighted medicine cabinet with lock and space for
medicine cart. The room shall be mechanically ventilated.
(3) A soiled utility room
with a flush-rim siphon jet service sink cabinet counter, and sink with hot and
cold running water. The utility shall be mechanically ventilated and under
negative pressure.
(4) A cleaning area or
room with a sink with hot and cold running water, counter, and cabinets.
(5) Staff toilet and
lavatory facilities separate from those of residents, near nursing station.
(6) If a kitchen is not
open at all times, a nourishment station with sink, hot and cold running water,
refrigerator, and storage for serving between meal nourishment. Each station
may service more than one nursing area.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.74 NMAC - Rn, 7 NMAC 9.2.74, 8-31-00]
7.9.2.75 NURSE
CALL SYSTEM: A nurse call station shall be installed at
each resident's bed, in each resident's toilet room, and at each bathtub and
shower. The nurse call at the toilet, bath, and shower rooms shall be an
emergency call equipped with pull cords of sufficient length to extend to
within eighteen (18) inches off the floor. All calls shall register at the
nurse station and shall actuate a visible signal in the corridor where
visibility to corridors is obstructed at the room door. In multi-corridor
nursing units, additional visible signals shall be installed at corridor
intersections. An emergency call station shall also be provided in any enclosed
room used by residents.
[7-1-60, 5-2-89; 7.9.2.75
NMAC - Rn, 7 NMAC 9.2.75, 8-31-00]
7.9.2.76 DINING,
RECREATION AND ACTIVITY AREAS:
A. MULTI-PURPOSE SPACE: The facility
shall provide one or more furnished multi-purpose areas of adequate size for
dining, diversional, and social activities of residents.
B. LOUNGE: At least one
dayroom or lounge, shall be provided for use of the residents.
C. SIZE OF DINING ROOMS: Dining rooms
shall be of sufficient size to seat all residents at no more than two (2)
shifts. Dining tables and chairs shall be provided. TV trays or portable card
tables shall not be used as dining tables.
D. SPACE: If a
multi-purpose room is used for dining and diversional and social activities of
residents, there shall be sufficient space to accommodate all activities and
minimize their interference with each other.
E. TOTAL AREA: The combined
floor space of dining, recreation, and activity areas shall not be less than
twenty-five (25) square feet per bed. Solaria and lobby sitting areas, exclusive
of traffic areas, shall be categorized as living room space.
[7-1-60, 5-2-89; 7.9.2.76
NMAC - Rn, 7 NMAC 9.2.76, 8-31-00]
7.9.2.77 FOOD
SERVICE - GENERAL:
A. The facility shall have a kitchen or
dietary area which shall be adequate to meet food service needs and shall be
arranged and equipped for the refrigeration, storage and preparation, and
serving of food, as well as for dish and utensil cleaning and refuse storage
and removal.
B. Dietary areas shall comply with the
local health or food handling codes. Food preparation space shall be arranged
for the separation of functions and shall be located to permit efficient
services to residents and shall not be used for non-dietary functions.
(1) Kitchen and
dietary: Kitchen and dietary facilities
shall be provided to meet food service needs and arranged and equipped for
proper refrigeration, heating, storage, preparation, and serving of food.
Adequate space shall be provided for proper refuse handling and washing of
waste receptacles, and for storage of cleaning components.
(2) Traffic: Only traffic incidental to the receiving,
preparation and serving of food and drink shall be permitted.
(3) Toilets: No toilet facilities may open directly into
the kitchen.
(4) Food storage: Food day-storage space shall be provided
adjacent to the kitchen and shall be ventilated to the outside.
(5) Handwashing: A separate handwashing sink with soap
dispenser, single service towel dispenser, or other approved hand drying
facility shall be located in the kitchen.
(6) Dishwashing: A separate dishwashing area, preferably a
separate room, with mechanical ventilation shall be provided.
(7) Sink: At least a three-compartment sink shall be
provided for washing, rinsing and sanitizing utensils, with adequate
drainboards, at each end. In addition, a single-compartment sink located adjacent
to the soiled utensil drainboard shall be available for prewashing. The
additional sink may also be used for liquid waste disposal. The size of each
sink compartment shall be adequate to permit immersion of at least fifty (50)
percent of the largest utensil used. In lieu of the additional sink for
prewashing, a well type garbage disposal with overhead spray wash may be
provided.
(8) Mechanical
dishwashers: Mechanical dishwashers and
utensil washers, where provided, shall meet the requirements of the current
approved list from the national sanitation foundation or equivalent with
approval of the Department.
(9) Temperature: Temperature gauges shall be located in the
wash compartment of all mechanical dishwashers and in the rinse water line at
the machine of a spray-type mechanical dishwasher or in the rinse water tank of
in immersion-type dishwasher. The temperature gauges shall be readily visible,
fast-acting and accurate to plus or minus two (2) degrees Fahrenheit or one (1)
degree (C.).
(10) Fire
extinguishers: Approved automatic fire
extinguishing equipment shall be provided in hoods and attached ducts above all
food cooking equipment.
(11) Walls: The walls shall be of plaster or equivalent
material with smooth, light- colored, non-absorbent, and washable surface.
(12) Ceiling: The ceiling shall be of plaster or equivalent
material with smooth, light-colored, non-absorbent, washable, and seamless
surface.
(13) Floors: The floors of all rooms, except the eating
areas of dining rooms, in which food or drink is stored, prepared, or served,
or in which utensils are washed, shall be of such construction as to be
non-absorbent and easily cleaned.
(14) Screens: All room openings to the out- of-doors shall
be effectively screened. Screen doors shall be self-closing.
(15) Lighting: All rooms in which food or drink is stored or
prepared or in which utensils are washed shall be well lighted.
(16) Sewage
contamination: Rooms subject to sewage
or wastewater backflow or to condensation or leakage from overhead water or
wastelines shall not be used for storage of food preparation unless provided
with acceptable protection from such contamination.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.77 NMAC - Rn, 7 NMAC 9.2.77, 8-31-00]
7.9.2.78 STORAGE:
A. GENERAL STORAGE: A general
storage area shall be provided for supplies, equipment, and wheelchairs.
B. LINEN: Facilities
shall provide a linen storage space or cabinet for each nursing unit.
[7-1-60, 7-1-64, 5-2-89;
7.9.2.78 NMAC - Rn, 7 NMAC 9.2.78, 8-31-00]
7.9.2.79 FAMILY
AND EMPLOYEE LIVING QUARTERS: Any family and employee living quarters shall
be separate from the residents' area.
[7-1-60, 5-2-89; 7.9.2.79
NMAC - Rn, 7 NMAC 9.2.79, 8-31-00]
7.9.2.80 EMPLOYEE
FACILITIES: The following shall be provided for
employees, and shall not be located in food preparation, food storage, utensil
washing area or in resident's rooms:
A. An area, room, or rooms for employee wraps, with lockers for purses and
other personal belongings when on duty.
B. Handwashing lavatories with soap dispenser, single service towel
dispenser, or other approved hand drying equipment.
C. Toilet facilities separate from those used by residents.
[7-1-60, 5-2-89; 7.9.2.80
NMAC - Rn, 7 NMAC 9.2.80, 8-31-00]
7.9.2.81 JANITOR
FACILITIES: Facilities shall have a mechanically
ventilated janitor closet of adequate size on each floor and in the food
service area, equipped with hot and cold running water and a service sink or
receptor.
[7-1-60, 5-2-89; 7.9.2.81
NMAC - Rn, 7 NMAC 9.2.81, 8-31-00]
7.9.2.82 LAUNDRY
FACILITIES:
A. FACILITIES: A laundry room
shall be provided unless commercial laundry facilities are used. Laundry
facilities shall be located in areas separate from resident units and shall be
provided with necessary washing and drying equipment.
B. WORK ROOM: When
commercial laundries are used, a room for sorting, processing, and storing
soiled linen shall be provided and shall have mechanical exhaust ventilation.
C. In addition to the requirements of Sections 7.9.2.82.A and 7.9.2.82.B,
facilities shall have:
(1) A soiled linen sorting room separate from
the laundry, which shall be mechanically ventilated and under negative
pressure.
(2) A lavatory with both
hot and cold running water, soap, and individual towels in the laundry area.
[7-1-60, 5-2-89; 7.9.2.82
NMAC - Rn, 7 NMAC 9.2.82, 8-31-00]
7.9.2.83 ISOLATION: For every one
hundred (100) beds or fraction thereof, facilities shall have available one
separate room, equipped with separate toilet, handwashing, and bathing facilities,
for the temporary isolation of a resident. The isolation room bed shill be
considered part of the licensed bed capacity of the facility.
[7-1-60, 5-2-89; 7.9.2.83
NMAC - Rn, 7 NMAC 9.2.83, 8-31-00]
7.9.2.84 ADMINISTRATION
AND ACTIVITY AREAS:
A. ADMINISTRATION AND RESIDENT ACTIVITY
AREAS: Administration and resident activities areas
shall be provided. The sizes of the various areas will depend upon the
requirements of the facility. Some functions allotted separate spaces or rooms
under Section 7.9.2.84B may be combined, provided that the resulting plan will
not compromise acceptable standards of safety, medical and nursing practices,
and the social needs of residents.
B. Administration department areas shall include:
(1) Business office.
(2) Lobby and information
center.
(3) Office of
administrator.
(4) Admitting and medical
records area.
(5) Public and staff
toilet room.
(6) Office of director of nurses; and
(7) ln-service training
area.
C. Resident activities areas shall include:
(1) Occupational therapy.
(2) Physical therapy.
(3) Activity area; and
(4) Beauty and barber
shop.
[5-2-89; 7.9.2.84 NMAC - Rn,
7 NMAC 9.2.84, 8-31-00]
7.9.2.85 MIXED
OCCUPANCY: Rooms or areas within the facility may be
used for occupancy by individuals other than residents and facility staff if
the following conditions are met:
A. The use of these rooms does not interfere with the services provided to
the residents; and
B. The administrator takes reasonable steps to ensure that the health and
safety and rights of the residents are protected.
[5-2-89; 7.9.2.85 NMAC - Rn,
7 NMAC 9.2.85, 8-31-00]
7.9.2.86 LOCATION
AND SITE:
A. ZONING: The site shall
adhere to local zoning regulations.
B. OUTDOOR AREAS: Areas shall be
provided for outdoor recreation area, exclusive of driveways and parking area.
C. PARKING: Space for
off-street parking for staff and visitors shall be provided.
[5-2-89, 7-1-60; 7.9.2.86
NMAC - Rn, 7 NMAC 9.2.86, 8-31-00]
7.9.2.87 SUBMISSION
OF PLANS AND SPECIFICATIONS: For all new construction:
A. One copy of schematic and preliminary plans shall be submitted to the
Department for review and approval of the functional layout.
B. One copy of working plans and specifications shall be submitted to and
approved by the Department before construction is begun. The Department shall
notify the facility in writing of any divergence in the plans and
specifications, as submitted, from the prevailing rules.
C. The plans specified in Section 7.9.2.87 shall show the general
arrangement of the buildings, including a room schedule and fixed equipment for
each room and a listing of room numbers, together with other pertinent
information. Plans submitted shall be drawn to scale.
D. Any changes in the approved working plans affecting the application of
the requirements herein established shall be shown on the approved working
plans and shall be submitted to the Department for approval before construction
is undertaken. The Department shall notify the facility in writing of any
divergence in the plans and specifications as submitted, from the prevailing
rules.
E. If on-site construction above the foundation is not started within six
(6) months of the date of approval of the working plans and specifications
under Section 7.9.2.87.B, the approval shall be void and the plans and
specifications shall be resubmitted for reconsideration of approval.
F. If there are no divergences from the prevailing rules, the Department
shall provide the facility with written approval of the plans as submitted.
[7-1-60, 5-2-89; 7.9.2.87
NMAC - Rn, 7 NMAC 9.2.87, 8-31-00]
7.9.2.88 RELATED
REGULATIONS AND CODES: Long term care facilities subject to these
regulations are also subject to other regulations, codes and standards as the same
may, from time to time, be amended as follows:
A. Health Facility Licensure Fees and Procedures, New Mexico Department of
Health, 7 NMAC 1.7 (10-31-96).
B. Health Facility Sanctions and Civil Monetary Penalties, New Mexico
Department of Health, 7 NMAC 1.8 (10-31-96).
C. Adjudicatory
Hearings, New Mexico Department of Health, 7 NMAC 1.2 (2-1-96).
[10-31-96; 7.9.2.88 NMAC -
Rn, 7 NMAC 9.2.88, 8-31-00]
History of 7.9.2 NMAC:
Pre-NMAC History: Material in this part was
derived from that previously filed with the supreme court law library:
New Mexico Department of
Public Health Licensing Regulations Part 3, Nursing Homes, June 1964.
The commission of public
records, state records center and archives:
HED 89-2, Regulations
Governing Long Term Care Facilities, 05-02-89.
Other History:
7 NMAC 9.2, Requirements for
Long Term Care Facilities, filed 10-18-96, reformatted, renumbered and amended
to 7.9.2 NMAC, effective 08-31-00.
