1. (a) The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable.

2. (b) The licensee shall provide the following core services:

   1. (1) The presence of staff whenever a resident is in the facility;

   2. (2) Health and safety services to all residents to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding:

      1. a. The residents’ functioning, safety, and whereabouts; and
      2. b. The residents’ health status, including the provision of intervention as necessary or required;
   3. (3) Emergency response and crisis intervention;
   4. (4) Assistance with taking and ordering medications as determined by a resident’s ability or inability to safely manage medications as determined by the CARES tool;
   5. (5) The provision of 3 nutritious meals and snacks unless the resident chooses other options according to their residential service agreement;
   6. (6) Housekeeping, laundry, and maintenance services in accordance with the residential service agreement;
   7. (7) The availability of on-site activities, which shall include reasonable accommodation for residents with disabilities, to include, but not be limited to, television, radio, internet, games, newspapers, visitors, and music designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the residential service agreement;
   8. (8) Assistance in arranging medical and dental appointments, including assistance in arranging transportation to and from such appointments and reminding the residents of the appointments; and
   9. (9) Personal supervision of residents when necessary to offset cognitive deficits that might pose a risk to the safety of self or others if the resident is not supervised.

3. (c) The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(2):

   1. (1) Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care;
   2. (2) Rehabilitation services, including documentation of the licensed practitioner’s order for the service, such as physical therapy, occupational therapy, and speech therapy; and
   3. (3) Behavioral health care services.
4. (d) The licensee shall develop and implement a process for determining adequate staffing levels.

5. (e) The process required in (d) above shall include an assessment, to be conducted at least quarterly, but more frequently if required, of the appropriateness of staffing levels to ensure:

   1. (1) Sufficient staffing of qualified personnel to meet the resident needs as required by the CARES tool assessments and service plans on a 24-hour-per-day basis; and
   2. (2) Sufficient staffing to respond promptly and effectively to individual resident emergencies and to respond to emergency, safety, and disaster situations affecting residents.

6. (f) The licensee shall:

   1. (1) Provide basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper;
   2. (2) Not be responsible for the cost of purchasing a specific brand of product at a resident’s request;
   3. (3) Ensure that sufficient numbers of qualified personnel are present in the SRHCF to meet the needs of residents at all times;
   4. (4) Ensure that demonstrated competencies required by the “qualified personnel” referenced in (e)(1) above are documented in the employee personnel file;
   5. (5) Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known;
   6. (6) Assist with arranging transportation to community programs, such as religious services and cultural, social, educational, and recreational activities according to the availability of such services in the surrounding communities; and
   7. (7) Require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b.
7. (g) The use of chemical or physical restraints as defined under He-P 805.03(r) and (br), respectively, shall only be permitted as allowed by RSA 151:21.
8. (h) As soon as is practicable, but no longer than 24 hours after the use of a physical or chemical restraint, the resident’s licensed practitioner, the department, and the resident’s guardian, personal representative, or agent shall be notified of the use of such restraints.

9. (i) The following methods of mechanical restraints shall be allowed, as permitted by the state fire code:

   1. (1) Locked, secured, or alarmed SRHCFs or units within a SRHCF; and
   2. (2) Anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within.

10. (j) The following methods of mechanical restraints shall be prohibited:

    1. (1) Full bed rails;
    2. (2) Gates, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;
    3. (3) Half doors, if they prohibit a resident’s free movement throughout the living areas of the SRHCF;
    4. (4) Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will;
    5. (5) Wrist or ankle restraints;
    6. (6) Vests or pelvic restraints; or
    7. (7) Other similar devices that prevent a resident’s free movement.

11. (k) For reportable incidents, the licensees shall have responsibility for:

    1. (1) Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident;

    2. (2) Submitting via fax to (603) 271-5574 the following information to the department within 48 hours of a reportable incident as defined in He-P 805.03(cd):

       1. a. The SRHCF name and phone number;
       2. b. A description of the incident, including identification of injuries, if applicable;
       3. c. The name of the licensee(s) or personnel involved in, witnessing, or responding to the unusual incident;
       4. d. The name of resident(s) involved in the reportable incident and the name of any witnesses to the reportable incident;
       5. e. The date and time of the reportable incident;
       6. f. The action taken in direct response to the reportable incident;
       7. g. If medical intervention was required, by whom and the date and time;
       8. h. When the resident’s guardian, personal representative, agent, or emergency contact person was notified;
       9. i. The signature of the person reporting the reportable incident; and
       10. j. The date and time the residents licensed practitioner was notified, if applicable;
    3. (3) As soon as practicable, notifying the local police department, the department, and the guardian, personal representative, or agent when a resident has eloped and the licensee has searched the building and the grounds without finding the resident; and
    4. (4) Notifying the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report.
12. (l) The licensee shall implement policies to ensure the safety of residents who are assessed as an elopement risk to reduce the risk and define areas recognized as “safe areas” on the licensed premise.
13. (m) The licensee shall implement policies to ensure the safety of residents who are assessed as a danger to self or others.
14. (n) The licensee shall implement policies to assure the safety of all visitors.
15. (o) The licensee shall comply with the patient’s bill of rights as set forth in RSA 151:21.
16. (p) The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency.

17. (q) The licensee shall give a resident and the resident’s guardian, agent, or personal representative, as applicable, a written notice as follows:

    1. (1) Thirty days advance notice for an increase in the cost or fees for any services except for:

       1. a. Residents receiving medicaid whose financial liability is determined by the state’s standard of need or residents funded by the department’s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs; or
       2. b. A change in the residents’ condition or service needs;
    2. (2) For an involuntary change in room or bed location, 14 days advance notice along with reasonable accommodations of individual needs and preferences. If the change is required to protect the health, safety, and well-being of the resident or other residents, in such case the notice shall be as soon as practicable.

18. (r) In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public and conspicuous area:

    1. (1) The current license issued in accordance with RSA 151:5;
    2. (2) The most recent inspection report as specified in RSA 151:6-a;
    3. (3) A copy of the patient’s bill of rights specified by RSA 151:21;
    4. (4) A copy of the licensee’s policies and procedures relative to the implementation of patients’ rights and responsibilities as required by RSA 151:20;
    5. (5) The licensee’s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits; and
    6. (6) A copy of the licensee’s complaint procedure, including the address and phone number of the department to which complaints might also be made, which shall also be posted on the SRHCF website if available.
19. (s) The licensee shall determine the smoking status of the SRHCF.
20. (t) If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68, RSA 155:69, and He-P 805.26(f).
21. (u) The licensee may hold or manage a resident’s funds or possessions only when the licensee receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members.
22. (v) The licensee shall not falsify any documentation required by law or provide false or misleading information to the department.
23. (w) The licensee shall develop and implement a policy for reporting to the administrator within 24 hours any observed or alleged abuse, neglect, or exploitation allegations.
24. (x) The licensee shall develop and implement written policies and procedures governing the operation of the SRHCF and all services provided.

Source. #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35