1. (a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

   1. (1) Is responsible for the day-to-day operations of the SRHCF;
   2. (2) Works no less than 35 hours per week at the SRHCF, which may include day, evening, night, and weekend hours;
   3. (3) Meets the requirements of He-P 805.18(i) or He-P 805.18(j);
   4. (4) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their 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 they meet the requirements of (3) above.

2. (b) At the time of application for admission, upon request and at least 24 hours prior to signing a residential service agreement, the licensee shall provide the resident, guardian, personal representative, or agent, a written copy of the residential service agreement pursuant to RSA 161-J:4, which shall include:

   1. (1) The base rate and the cost of any available services that are not included in the base rate;
   2. (2) A list of the core services required by He-P 805.14(b) and the list of grooming and personal hygiene supplies required by He-P 805.14(f)(1) that are included in the base rate;
   3. (3) Information regarding the timing and frequency of cost of care increases;
   4. (4) The policies and procedures for termination of the agreement and the time period covered by the agreement;
   5. (5) The amount and purpose of any advance payments required by the facility;
   6. (6) The policy for refund of advance payments;
   7. (7) The licensee’s medication management services;
   8. (8) Notice of the resident's rights in the event of a temporary absence from the facility, in accordance with RSA 151:25, and the resident's rights in the event of a proposed transfer or discharge from the facility, in accordance with RSA 151:26;
   9. (9) The circumstances under which a discharge or transfer to another facility might occur, including situations in which the resident's evacuation capability and care needs would exceed what the licensee could provide, and the responsibility of the licensee in transitioning the resident to another location;
   10. (10) A copy of the rules or policies governing resident conduct, house rules and responsibilities, and the procedures for handling resident grievances;
   11. (11) A standard disclosure summary in the form set forth in RSA 161-J:5;
   12. (12) A statement affirming that the proposed resident has received the residential services agreement and attached standard disclosure summary, that the resident has read it or it has been read to the resident, and that the resident understands its contents;

   13. (13) Information regarding nursing, other health care services, or supplies and medication management services and associated costs not provided in the core services, to include:

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

   14. (14) The licensee’s policy 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. Acting as a billing agent for third party services;
       4. d. Monitoring third party services contracted directly by the resident and provided on the premises;
       5. e. Handling of resident funds pursuant to RSA 151:24 and He-P 805.14(u);
       6. f. Storage and loss of the resident’s personal property;
       7. g. Smoking;
       8. h. Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both; and
       9. i. Whether or not the facility has an automatic electronic defibrillator (AED) onsite and available for use in an emergency;
   15. (15) A copy of the most current version of the patients’ bill of rights under RSA 151:21 and the SRHCF’s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;
   16. (16) A copy of the resident’s right to appeal an involuntary transfer or discharge under RSA 151:26, II(a)(5);
   17. (17) The 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;
   18. (18) Information on accessing the long-term care ombudsman; and
   19. (19) Information on advance directives.
3. (c) Residency shall not begin unless the proposed resident, guardian, personal representative, or agent reads and signs a residential services agreement that complies with RSA 161-J.
4. (d) Upon signing of the agreement, the SRHCF shall give the resident and guardian, personal representative, or agent a copy of the agreement and place a copy in the resident's file.

5. (e) The SRHCF shall assess each resident’s needs using the “Care Assessment for Residential Services (CARES) Tool” (August 2025) which shall:

   1. (1) Be completed no more than 30 days prior to admission to the SRHCF;
   2. (2) Be completed in consultation with the resident, guardian, personal representative, or agent;
   3. (3) Be repeated every 6 months or after any significant change as defined in He-P 805.03(co);
   4. (4) Be signed and dated by the individual who completed the CARES tool; and
   5. (5) Be signed by the resident, guardian, personal representative, or agent, acknowledging that the CARES tool was completed as directed in (2) above.
6. (f) 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.
7. (g) If the guardian, personal representative, or agent, is unable to sign the CARES tool, the facility shall have documented evidence that the guardian, personal representative, or agent 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 identified in (h) above identifies the need for a care plan it shall be:

   1. (1) Completed within 24 hours of the nursing assessment;
   2. (2) Made available to personnel who assist residents;
   3. (3) Be completed in consultation with the resident and guardian, personal representative, or agent; and
   4. (4) If the resident and guardian, personal representative, or agent are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record.

10. (j) The care plan identified in (i) 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.

11. (k) All care plans shall be reviewed at least every 6 months to determine if:

    1. (1) The care plan will be continued for another 6 months;
    2. (2) The care plan will be revised to meet the needs of the resident; or
    3. (3) The care plan will be discontinued because the plan is no longer needed.

12. (l) Progress notes shall be written at least every 90 days and include, at a minimum:

    1. (1) Care plan outcomes if a care plan was developed as identified by the CARES tool;
    2. (2) The resident’s physical, functional, and mental abilities;
    3. (3) Changes in behavior, such as eating habits, sleeping pattern, and relationships; and
    4. (4) A summary of visits to licensed practitioners and referrals.
13. (m) At the time of a resident’s admission, the licensee shall obtain written and signed orders from a licensed practitioner for medications, treatment, special diet, and code status.
14. (n) The licensee shall have each resident obtain a health assessment by a licensed practitioner within 30 days prior to admission to the SRHCF.

15. (o) The health assessment referenced in (n) 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 special diets, if applicable;
    4. (4) Allergies; and
    5. (5) Code status.
16. (p) Each resident shall have at least one health assessment annually, unless the licensed practitioner determines annually that a health assessment is not necessary and specifies in writing an alternative time frame, or the resident annually refuses in writing.
17. (q) A resident may refuse all care and services.

18. (r) When a resident refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

    1. (1) Inform the resident of the potential results of their refusal;
    2. (2) Notify the licensed practitioner and guardian, personal representative, or agent of the resident’s refusal of care; and
    3. (3) Document in the resident’s record the refusal of care and the resident’s reason for the refusal.

19. (s) The licensee shall maintain a legible, current, and accurate information data sheet 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 which includes the following:

    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, personal representative, or agent;
    3. (3) Diagnosis;
    4. (4) Medications, including last dose taken and when the next dose is due;
    5. (5) Allergies;
    6. (6) Functional and cognitive limitations;
    7. (7) Date of birth;
    8. (8) Insurance information;
    9. (9) Advance directives, if any;
    10. (10) Code status; and
    11. (11) Any other pertinent information not specified in (1)-(10) above.
20. (t) The licensee shall only perform point of care testing (POCT), that is 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.

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

    1. (1) Obtain the appropriate CLIA certificate pursuant to 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.

22. (v) The licensee shall have current copies of manufacturer’s instructions and package inserts and shall 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, reporting results; and
    3. (3) All recommended and required quality control procedures for POCT meters and devices.
23. (w) Licensee’s performing CLIA-waived laboratory testing or specimen collection shall be in-compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable.

Source. #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35