1. (a) The licensee shall provide administrative services that include the appointment of an administrator who:

   1. (1) Is responsible for the day-to-day operations of the ALR-RC;
   2. (2) Works no less than 35 hours per week at the ALR-RC, which may include day, evening, night, and weekend hours;
   3. (3) Meets the requirements of He-P 804.18(k);
   4. (4) Designates, in writing, a staff member who shall assume the responsibilities of the administrator in his or her absence; and
   5. (5) In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify he or she meets the requirements of (3) above.
2. (b) At the time of application for admission, the licensee shall provide the resident and the guardian, agent, or personal representative, if any, a written copy of the residential service agreement pursuant to RSA 161-J, except that a copy of the residential service agreement shall not be required if the facility admission agreement includes all of the provisions of a residential service agreement.

3. (c) In addition to (b) above, at the time of admission, the licensee shall provide the resident and the guardian, agent, or personal representative, if any, and receive written verification of receipt, a written copy of the admission agreement that includes the following:

   1. (1) The basic daily, weekly, and monthly fee;
   2. (2) A list of the core services required by He-P 804.14(c) that are covered by the basic rate;
   3. (3) Information regarding the timing and frequency of cost of care increases;
   4. (4) The time period covered by the admission agreement;
   5. (5) The criteria and acuity level that the resident must maintain in order to remain a resident at an ALR-RC in accordance with He-P 804.15(a);
   6. (6) The ALR-RC’s house rules;
   7. (7) The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;
   8. (8) The ALR-RC’s responsibility for resident discharge planning;

   9. (9) Information regarding care, services, or supplies not provided in the core services, to include:

      1. a. The availability of services;
      2. b. The ALR-RC’s responsibility for arranging services; and
      3. c. The fee and payment for services, if known;

   10. (10) The licensee’s policies and procedures regarding:

       1. a. Arranging for the provision of transportation;
       2. b. Arranging for the provision of third party services, such as a hairdresser or cable television;
       3. c. Monitoring third party services contracted directly by the resident and provided on the ALR-RC premises;
       4. d. Handling of resident funds pursuant to RSA 151:24 and He-P 804.14(s);
       5. e. Bed hold, in compliance with RSA 151:25;
       6. f. Storage and loss of the resident’s personal property; and
       7. g. Smoking;
   11. (11) The licensee’s medication management services;
   12. (12) The list of grooming and personal hygiene supplies provided by the ALR-RC as part of the basic daily, weekly, or monthly rate;
   13. (13) A copy of the most current version of the patients’ bill of rights under RSA 151: 21 and the ALR-RC’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;
   14. (14) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(a)(5);
   15. (15) The ALR-RC’s policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169‑C:29;
   16. (16) Information on accessing the long-term care ombudsman;
   17. (17) Information on advanced directives;
   18. (18) Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both, or whether or not the facility has an AED on-site and available for use in an emergency;
   19. (19) Information that if the facility changes its current acceptance of payment sources, it shall provide 60 days’ notice of such change; and
   20. (20) A statement that a resident’s inability to cover the cost of care may result in discharge.
4. (d) The ALR-RC shall assess each resident’s needs using the “CARES Tool” (January 2022).
5. (e) All personnel who administer the CARES Tool shall be trained to complete the CARES Tool by the department or entities listed in RSA 151:5-a, III.

6. (f) The assessment described in (d) above shall:

   1. (1) Be completed no more than 30 days prior to or within 24 hours following admission to the ALR-RC;
   2. (2) Be completed in consultation with the resident and guardian, agent, or personal representative, if any;
   3. (3) Be repeated every 6 months or after any significant change as defined in He-P 804.03(ch);
   4. (4) Be signed and dated by the individual who completed the CARES Tool; and
   5. (5) Be signed by the resident and guardian, agent, or personal representative, acknowledging that the CARES Tool was completed as directed in (2) above.
7. (g) If the guardian, agent, or personal representative if any is unable to sign the Cares Tool the facility shall have documented evidence that the guardian, agent, or personal representative has had an opportunity to take part in completing and reviewing the completed Cares Tool..
8. (h) If the CARES Tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES Tool.
9. (i) If the nursing assessment indicates that the resident cannot safely evacuate, the resident shall be ineligible for care and services at the ALR-RC.
10. (j) If the nursing assessment completed in accordance with (h) above is completed by a licensed practical nurse (LPN), the assessment shall be reviewed and co-signed by the registered nurse (RN) or physician that is supervising the LPN prior to implementation.

11. (k) If the Cares Tool indicates a need for a care plan, the care plan shall be:

    1. (1) Completed within 24 hours of the initial Cares Tool and within 24 hours of the completion of all subsequent Cares Toolsexcept where a nursing assessment is required in which case, the care plan shall be completed within 24 hours following the nursing assessment;
    2. (2) Made available to personnel who assist residents;
    3. (3) Completed in consultation with the resident and guardian, agent, or personal representative, if any; and
    4. (4) If the resident and guardian, agent, or personal representative, if any, are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

12. (l) The care plan identified in (k) above shall include on an ongoing basis:

    1. (1) The date the problem or need was identified;
    2. (2) A description of the problem or need;
    3. (3) The goal or objective of the plan;
    4. (4) The action or approach to be taken;
    5. (5) The responsible person(s) or position; and
    6. (6) The date of reevaluation, review, or resolution.

13. (m) Each care plan shall be reviewed at least every 6 months to determine if:

    1. (1) All items identified in the care plan are being met;
    2. (2) The care plan will be continued for another 6 months; and
    3. (3) The care plan will be revised to meet the current needs of the resident.

14. (n) Progress notes for each resident shall be written at least quarterly and include, at a minimum:

    1. (1) Changes in mobility, weight, memory, skin integrity, continence, medications, behavior, and personal care needs; and
    2. (2) A summary of visits to licensed practitioners and referrals.

15. (o) For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, the facility shall ensure that a discipline specific care plan:

    1. (1) Is completed within 24 hours of the discipline specific assessment;
    2. (2) Is completed in consultation with the resident and guardian, agent, or personal representative, if any;
    3. (3) Is updated following the completion of all future discipline specific assessments;
    4. (4) Is available to personnel who assist residents in the implementation of the discipline specific care plan;
    5. (5) Addresses the needs identified in the discipline specific assessment;
    6. (6) Includes the date the medical, nursing, or rehabilitative care or services, or hospice care need was identified;
    7. (7) Identifies the resident goal or approach to be taken to address the medical, nursing, or rehabilitative care or services, or hospice care need;
    8. (8) Includes the date of reevaluation of the medical, nursing, or rehabilitative care or services, or hospice care need and the name of the responsible person; and
    9. (9) Is maintained in the resident’s record.
16. (p) For individuals receiving medical, nursing, or rehabilitative care or services, or hospice care, progress notes shall be written at every visit by the practitioner performing the service.
17. (q) At the time of a resident’s admission, the licensee shall obtain orders from a licensed practitioner for medications, prescriptions, and therapeutic diets, as applicable.
18. (r) The licensee shall have each resident obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the ALR-RC.

19. (s) The health examination referenced in (r) above shall include:

    1. (1) Diagnoses, if any;
    2. (2) The medical history;
    3. (3) A list of current medications including over-the-counter medications, treatments, and therapeutic diets, if applicable; and
    4. (4) Allergies.
20. (t) Each resident shall have at least one health examination every 12 months by a licensed practitioner, unless the licensed practitioner determines that an annual health examination is not necessary and specifies in writing an alternative time frame, or unless the resident refuses in writing. Any such resident refusal shall be made annually.
21. (u) A resident may refuse all care and services.

22. (v) When a resident refuses care or services that could result in a threat to the resident’s health, safety, or well-being, or that of others, the licensee or personnel shall:

    1. (1) Inform the resident of the potential consequences of their refusal;
    2. (2) Notify the licensed practitioner and guardian, if any, of the resident’s refusal of care or services; and
    3. (3) Document in the resident’s record the items in (1) and (2) above, the refusal of care or services, and the resident’s reason for the refusal.
23. (w) The licensee shall maintain an emergency data sheet, updated as needed and at a minimum at the conclusion of each RAT assessment, in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

24. (x) The emergency data sheet referenced in (w) above shall include:

    1. (1) Full name and the name the resident prefers, if different;
    2. (2) Name, address, and telephone number of the resident’s next of kin, guardian, or agent, if any;
    3. (3) Diagnosis;
    4. (4) Medications, including last dose taken and when the next dose is due;
    5. (5) Allergies;
    6. (6) Functional limitations to include but not be limited to physical limitations, hearing loss, visual imparement, and cognitive challenges;
    7. (7) Date of birth;
    8. (8) Insurance information;
    9. (9) Advanced directives; and
    10. (10) Any other pertinent information not specified in (1)-(9) above.
25. (y) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.

26. (z) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

    1. (1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15; and
    2. (2) Develop and implement a point of care testing policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

27. (aa) The licensee shall have current copies of manufacturer’s instructions and package inserts and follow all manufacturer’s instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

    1. (1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;
    2. (2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, and messages, reporting results; and
    3. (3) All recommended and required quality control procedures for POCT meters and devices.
28. (ab) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be incompliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.
29. (ac) If a facility has independent living units within the same structure which are not separated by a firewall from the licensed facility, they shall be subject to the same requirements as licensed units with regard to fire and building codes, including inspections.
30. (ad) If ALR-RC services as defined by He-P 804.03(l) are provided by the staff of the facility to individuals in an independent living unit, the unit(s) shall be redesignated as licensed units in the ALR-RC and an application for a bed increase shall be completed as required by He-P 804.08(a)(5) and (b)(3).

Source. #9121, eff 4-3-08, EXPIRED: 4-3-16 New. #12047, INTERIM, eff 11-19-16, EXPIRED: 5-18-17 New. #12414, eff 11-3-17; ss by #13339, eff 1-29-22