Standards of operation, care, and treatment

STANDARDS OF OPERATION, CARE, AND TREATMENT: To provide adequate

protection to assisted-living residents and compliance with state statutes, an assisted-living facility must meet the following:

4-006.01 Licensee Responsibilities: The licensee of each assisted-living facility must assume the responsibility for the total operation of the facility. The licensee responsibilities include:

Monitoring policies to assure the appropriate administration and management of the assisted-living facility;
Maintaining the assisted-living facility’s compliance with all applicable state statutes and relevant rules and regulations;
Providing quality care to residents whether care is furnished by assisted- living facility staff or through contract with the facility;
Designating an administrator who is responsible for the day to day management of the assisted-living facility and defining the duties and responsibilities of the administrator in writing;
Notifying the Department in writing within five working days when a vacancy in the administrator position occurs including who will be designated as the administrator until another administrator is appointed;
Notifying the Department in writing within five working days when the vacancy is filled including effective date and name of person appointed administrator; and
Assuring that after January 1, 2005, any person designated as administrator of the assisted-living facility meets the initial training requirements specified in

175 NAC 4-006.02A within the first six months of employment as the administrator.

4-006.02 Administration: Each assisted-living facility must have an administrator who is responsible for the overall operation of the facility. The administrator is responsible for planning, organizing, and directing the day to day operation of the assisted-living facility. The administrator must report all matters related to the maintenance, operation, and management of the assisted-living facility and be directly responsible to the licensee or to the person or persons delegated governing authority by the licensee. The administrator must:

Be responsible for the facility’s compliance with rules and regulations;
Be responsible for the facility’s promotion of resident self-direction and participation in decisions which incorporate independence, individuality, privacy and dignity;
Be on the premises a sufficient number of hours to permit adequate attention to the management of the facility;
Maintain staff with appropriate training and skills and sufficient in number to meet resident needs as defined in resident service agreements;
Designate a substitute to act in his or her absence who must be responsible and accountable for management of the facility;
Monitor that resident service agreements are established and implemented;
Monitor that facility staff identify and review incidents and accidents, resident complaints and concerns, patterns and trends in overall facility operation such as provisions of resident care and service and take action to alleviate problems and prevent recurrence;
Develop and implement procedures that require the reporting of any evidence of abuse, neglect, or exploitation of any resident residing in the assisted-living facility in accordance with Rev. Stat. §§ 28-372 of the Adult Protective Services Act or in the case of a child, in accordance with Neb. Rev. Stat. § 28-711;
Complete an investigation on suspected abuse, neglect, or misappropriation of money or property and take action to prevent reoccurrence until the investigation is completed;
Be at least 21 years of age; and
Meet the administrator training requirements as specified in 4-006.02A.

4-006.02A Initial Administrator Training Requirements: After January 1, 2005, the administrator must have completed training consisting of a total of at least 30 hours, including, but not limited to:

Resident care and services;
Social services;
Financial management;
Administration;
Gerontology; and
Rules, regulations, and standards relating to the operation of an assisted-living

4-006.02B Verification of Initial Administrator Training: Verification of initial training completed must be submitted to the Department for approval. Training documentation may include but is not limited to:

Evidence of completion of training including documentation of date of training, number of hours, description of training, and trainer qualifications;
Evidence of successful completion of college courses and/or degree which includes topics in 4-006.02A; or
Evidence of completion of a Department approved training

4-006.02B1 Initial training requirements do not apply to an assisted-living facility administrator who also holds an active nursing home administrator license or who is currently employed as a hospital administrator. Verification of nursing home or hospital administrator status must be submitted to the Department. Such verification includes:

Proof of current licensure as a nursing home administrator in Nebraska or other jurisdiction; or
A statement from the governing authority of the hospital or other authorizing entity that could verify administrator

4-006.02C Department Responsibilities for Approval of Initial Administrator Training Programs: The Department will:

Determine whether the administrator training program meets the course requirements of 175 NAC 4-006.02A and provide written notification of program approval within 90 days of receipt of application; and
Establish and maintain a registry of persons who have met the initial training requirements. The registry will contain information the Department deems necessary.

4-006.02D Initial Administrator Training Waiver: Persons employed as assisted- living administrators on January 1, 2005 were allowed to apply within 90 days of that date for a Department waiver of the initial administrator training requirements.

4-006.02E Ongoing Administrator Training: Each year of employment, a facility administrator must complete 12 hours of ongoing training in areas related to care and facility management of the population served. The record of such training must be available for Department review and include topic of training, date and length of training and name and title of person providing training. Nursing home and hospital administrators verified under 175 NAC 4-006.02B1 are not required to fulfill the annual training requirement.

4-006.03 Staff Requirements: The facility must maintain a sufficient number of staff with the required training and skills necessary to meet the resident population’s requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision and other supportive services, as defined in Resident Service Agreements.

4-006.03A Employment Eligibility: Each assisted-living facility must ensure and maintain evidence of the following:

4-006.03A1 Criminal Background Check: The facility must complete criminal background checks on each member of the unlicensed direct care staff of the facility.

4-006.03A1a Such checks must be done on all new unlicensed direct care staff hired.

4-006.03A1b Such checks must be made through a governmental law enforcement agency or a private entity that maintains criminal background information.

4-006.03A1c It is the responsibility of the facility to:

Determine how to use this criminal background information in making hiring decisions;
Decide whether employment can begin prior to receiving the criminal background information; and
Document any decision to hire a person with a criminal background. The documentation must include the basis for the decision and how it will not pose a threat to resident safety or resident

4-006.03A2 Registry Checks: The facility must check each unlicensed direct care staff for adverse findings on the following registries:

Nurse Aide Registry;
Adult Protective Services Central Registry;
Central Register of Child Protection Cases; and
Nebraska State Patrol Sex Offender Registry.

4-006.03A2a Each facility must determine whether to employ or continue employment of any person as direct care staff with adverse registry findings, except for the Nurse Aide Registry.

4-006.03A2b The facility must document any decision to hire as direct care staff a person with adverse registry findings, except for the Nurse Aide Registry. The documentation must include the basis for the decision and how it will not pose a threat to resident safety or resident property.

4-006.03A2c Each facility must not employ or continue employment of any person as direct care staff who has adverse findings on the Nurse Aide Registry regarding resident abuse, neglect, or misappropriation of resident property.

4-006.03A3 Health Status: Each assisted-living facility must establish and implement policies and procedures regarding the health status of staff to prevent the transmission of disease to residents.

4-006.03A3a A health history screening for each staff person must be completed prior to assuming job responsibilities. A physical examination is at the discretion of the employer based on results of the health history screening.

4-006.03B Direct Care Staff Training: Each assisted-living facility must ensure direct care staff receive training in order to perform job responsibilities. The facility must provide for and maintain evidence of the following training;

4-006.03B1 Orientation: Orientation must be given within two weeks of employment to each direct care staff person of the facility and must include as a minimum, but is not limited to:

Resident’s rights;
Resident service agreement;
Infection Control practices including handwashing techniques, personal hygiene and disposal of infectious material;
The facility’s emergency procedures and information regarding advance directives;
Information on any physical and mental special care needs of the residents in the facility;
Information on abuse, neglect and misappropriation of money or property of a resident and reporting procedures; and
Disaster preparedness

4-006.03B2 Ongoing Training: Ongoing training must be given to each direct care staff person and must consist of at least 12 hours per year on topics appropriate to the employee’s job duties including meeting the physical and mental special care needs of residents in the facility. The record of such training must include topic of training, name of staff, date and length of training and name of person providing the training.

4-006.03C Staffing Resources: The assisted-living facility must ensure that staffing resources and training are sufficient to meet the level of supervision and assistance with activities of daily living, personal care and health maintenance activities that are required by the residents as defined in the resident service agreements.

4-006.03C1 The facility must have at least one staff person on the premises at all times when necessary to meet the needs of the residents as required in the resident service agreements.

4-006.03C2 Registered Nurse: Each assisted-living facility must provide for a registered nurse to review medication administration policies and procedures and to provide or oversee the training of medication aides at such facility. Training of medication aides must include, but is not limited to:

Facility procedures for storing, handling and providing medications;
Facility procedures for documentation of medications;
Facility procedures for documentation and reporting medication errors and adverse reactions;
Identification of person(s) responsible for direction and monitoring of medication aides; and
Other resident-specific training on providing medications in accordance with the limits and conditions of the Medication Aide Act.

4-006.03D General Staff: The assisted-living facility must provide staffing to ensure that services to residents are provided in a safe and timely manner to meet the resident needs as required in the resident service agreements.

4-006.03E Employment Record: A current employment record must be maintained for each staff person. The record must contain at a minimum, information on orientation, in-services, credentialing and health history screening.

4-006.04 Resident Rights: The assisted-living facility must provide residents their rights in writing upon admission and for the duration of their stay. The operations of the facility must afford residents the opportunity to exercise their rights. At a minimum, the resident must have the right to:

Be treated with dignity and provided care by competent staff;
Be an equal partner in the development of the resident service agreement while retaining final decision making authority;
Be informed in advance about care and treatment and of any changes in care and treatment that may affect the resident’s well-being;
Be informed in writing of the pricing structure and/or rates of all facility services;
Self direct activities, participate in decisions which incorporate independence, individuality, privacy and dignity and make decisions regarding care and treatment;
Choose a personal attending physician;
Voice complaints and grievances without discrimination or reprisal and have those complaints/grievances addressed;
Examine the results of the most recent survey of the facility conducted by representatives of the Department;
Refuse to perform services for the facility;
Refuse to participate in activities;
Privacy in written communication including sending and receiving mail;
Receive visitors as long as this does not infringe on the rights and safety of other residents in the facility;
Have access to the use of a telephone with auxiliary aides where calls can be made without being overheard;
Have the right to have a telephone in his/her room at the resident’s expense;
Retain and use personal possessions, including furnishings, and clothing, as space permits, unless to do so would infringe upon the rights and safety of other residents;
Share a room with a person of his or her choice upon consent of that person;
Self-administer medications if it is safe to do so;
Be free of chemical and physical restraints;
Exercise his or her rights as a resident of the facility and as a citizen or resident of the United States;
Form and participate in an organized resident group that functions to address facility issues;
Review and receive a copy, within two working days, of their permanent record, as referred to in 175 NAC 4-006.12;
Be free from abuse, neglect, and misappropriation of their money and personal property; and
Be free from involuntary transfer or discharge without 30 days advance written notice except in situations where the transfer or discharge is necessary to protect the health and safety of the resident, other residents or staff.

4-006.04A Grievances: Each assisted-living facility must establish and implement a process for addressing all grievances received from residents, employees and others. The process includes, but is not limited to:

A procedure on submission of grievances available to residents, employees and others;
Documentation of efforts to address grievances received from residents, employees and others; and
The telephone number and address of the Department is readily available to residents, employees and others who wish to lodge complaints or

4-006.05 Consumer Satisfaction/Improvement: Each assisted-living facility must develop and implement a process to measure consumer satisfaction.

4-006.06 Resident Service Agreements: The assisted-living facility must evaluate each resident and must have a written service agreement negotiated with the resident and authorized representative, if applicable, to delineate the services to be provided to meet the needs identified in the evaluation.

4-006.06A The agreement must contain the following basic components:

Services to be provided by the assisted-living facility and from other sources, how often and when the services are provided and by whom, to meet the needs of individuals including those for special populations as specified in 175 NAC 4-006.11E. Such services must not exceed those which are defined in these regulations as shelter, food, activities of daily living, personal care, health maintenance, other supportive services or those which involve complex nursing interventions that are allowed by 175 NAC 4-006.07B;

Rights and responsibilities of the facility and of the resident;
Costs of services and terms of payment; and
Terms and conditions of continued

4-006.06B The Resident Service Agreement must be reviewed and updated as the resident’s needs change.

4-006.07 Admission and Retention Requirements: The assisted-living facility must ensure that the resident admission and retention practices conform with the following:

4-006.07A Eligibility Criteria: To be eligible for admission to an assisted-living facility, a person must be in need of or wish to have available shelter, food, assistance with or provision of personal care, activities of daily living, or health maintenance activities or supervision due to age, illness, or physical disability. The administrator has the discretion regarding admission or retention of residents subject to the Assisted-Living Facility Act and rules and regulations adopted and promulgated under the act.

4-006.07A1 The assisted-living facility must establish and implement procedures to request that:

On and after January 1, 2005, every person seeking admission to an assisted-living facility or the authorized representative of such person must, upon admission and annually thereafter, provide the facility with a list of drugs, devices, biologicals, and supplements being taken or being used by the person, including dosage, instructions for use, and reported use; and

Every person residing in an assisted-living facility on January 1, 2005, or the authorized representative of such person must, within 60 days after January 1, 2005, and annually thereafter, provide the facility with a list of drugs, devices, biologicals, and supplements being taken or being used by such person, including dosage, instructions for use, and reported

4-006.07B Restrictions on Eligibility Criteria: Residents requiring complex nursing interventions or whose conditions are not stable or predictable must not be admitted, readmitted, or retained by the assisted-living facility unless:

4-006.07B1 The resident, if the resident has sufficient mental ability to understand the situation and make a rational decision as to his or her needs or care and is not a minor, or the resident’s authorized representative, and the resident’s physician or the registered nurse agree that admission or retention of the resident is appropriate;

4-006.07B2 The resident or his or her authorized representative assumes responsibility for arranging for the resident’s care through appropriate private duty personnel, a licensed home health agency, or a licensed hospice agency; and

4-006.07B3 The resident’s care does not compromise the assisted-living facility operations or create a danger to others in the facility.

4-006.07C Assisted-living facility staff while on duty must not provide complex nursing interventions for facility residents, except that a registered nurse assessment to determine the suitability of the resident or potential resident for admission to and/or continued residence in the assisted-living facility is permitted.

4-006.08 Activities: The assisted-living facility must plan and provide activities designed to meet the interests and promote the physical, mental, and psychosocial well-being of residents. Such activities must be on-going and all residents informed of the opportunity to participate. Information about activities must be posted and made available to residents.

Standards of operation, care, and treatment | NE

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