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, division of health improvement.
[7.9.2.1 NMAC - Rp, 7.9.2.1
NMAC, 6/9/2020]
A. Services for residents shall be provided on a continuing 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 Subsection A of Section 24-1-5
NMSA 1978, are subject to all provisions of these regulations.
[7.9.2.2 NMAC - Rp, 7.9.2.2
NMAC, 6/9/2020]
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 Subsection E of Section 9-7-6 NMSA 1978
of the Department of Health Act, as amended; and the authority granted under Subsection
D of Section 24-1-2 NMSA 1978, Subsection I of Section 24-1-3 NMSA 1978 and
24-1-5 NMSA 1978 of the Public Health Act, as amended.
[7.9.2.3 NMAC - Rp, 7.9.2.3
NMAC, 6/9/2020]
[7.9.2.4 NMAC - Rp, 7.9.2.4
NMAC, 6/9/2020]
7.9.2.5 EFFECTIVE
DATE:
June 9, 2020, unless a different date is cited at the end of a section
or paragraph.
[7.9.2.5
NMAC - Rp, 7.9.2.5 NMAC, 6/9/2020]
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.
[7.9.2.6 NMAC - Rp, 7.9.2.6
NMAC, 6/9/2020]
7.9.2.7 DEFINITIONS: For purposes
of these regulations the following shall apply:
A. Definitions beginning with “A”:
(1) “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:
(a) Physical contact
that harms or is likely to harm a resident of a care facility.
(b) Inappropriate
use of physical restraint, isolation, or medication that harms or is likely to
harm a resident.
(c) Inappropriate use
of a physical or chemical restraint, medication or isolation as punishment or
in conflict with a physician’s order.
(d) Medically
inappropriate conduct that causes or is likely to cause physical harm to a
resident.
(e) Medically
inappropriate conduct that causes or is likely to cause great psychological
harm to a resident.
(f) 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.
(2) “Ambulatory” means able to walk without assistance.
(3) “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.
B. Definitions beginning with
“B”: [RESERVED]
C. Definitions beginning with
“C”: [RESERVED]
D. Definitions beginning with “D”:
(1) “Department” means the New Mexico department of health.
(2) “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:
(a) manifested
before the individual reaches age 22;
(b) likely to
continue indefinitely; and
(c) results in
substantial functional limitations in three or more of the following areas of
major life activity:
(i) self-care;
(ii) understanding
and use of language;
(iii) learning;
(iv) mobility;
(v) self-direction;
(vi) capacity
for independent living; and
(vii) economic
self-sufficiency.
(3) “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.
(4) “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.
E. Definitions beginning with “E”: “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.
(1) Exploitation
includes but is not limited to:
(a) manipulating
the patient/client resident by whatever mechanism to give money or property to
any facility staff or management member;
(b) misappropriation
or misuse of monies belonging to a resident or the unauthorized sale, or
transfer or use of a patient/client/residents property;
(c) loans
of any kind from a patient/client/resident to family, operator or families of
staff or operator;
(d) 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.
(e) 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.
(2) Exception:
Testamentary gifts, such as wills, are
not, per se, considered financial exploitation.
F. Definitions beginning with “F”:
(1) “Facility” means a nursing home subject to the requirements of
these regulations.
(2) “Full-time” means at least an average of 37.5 hours each week
devoted to facility business.
G. Definitions beginning with “G”: [RESERVED]
H. Definitions
beginning with “H”: [RESERVED]
I. Definitions
beginning with “I”:
(1) “Intermediate care facility” means a nursing home, which is licensed by the department
as an intermediate care facility to provide intermediate nursing care.
(2) “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.
J. Definitions beginning with “J”: [RESERVED]
K. Definitions
beginning with “K”: [RESERVED]
L. Definitions
beginning with “L”:
(1) “Licensed
practical nurse” means a person
licensed as a licensed practical nurse under Section 61-3-1 through Section
61-3-30 NMSA 1978, Nursing Practice Act.
(2) “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.
M. Definitions beginning with “M”: “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.
N. Definitions beginning with “N”:
(1) “Non-ambulatory” means unable to walk without assistance.
(2) “Non-mobile” means unable to move from place to place.
(3) “Nurse” means registered nurse or licensed practical nurse.
(4) “Nurse practitioner (certified)” means a registered professional nurse who meets the
requirements for licensure as established under Sections 61-3-1 through 61-3-30
NMSA 1978, Nursing Practice Act.
O. Definitions beginning with “O”:
P. Definitions
beginning with “P”:
(1) “Personal care” means personal assistance, supervision and a suitable
activities program. In addition:
(a) 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;
(b) 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
(c) the dietary
needs of residents are met by the provision of adequate general diet or by
therapeutic, medically prescribed diets.
(2) “Pharmacist” means a person registered as a pharmacist under
Section 61-11-1 NMSA 1978, the Pharmacy Act.
(3) “Physical therapist” means a person licensed to practice physical therapy
under Sections 61-12D-1 to Section 61-12D-19 NMSA 1978, the Physical Therapy
Act.
(4) “Physician” means a person licensed to practice medicine or
osteopathy as defined by Section 61-6-1 NMSA 1978, the Medical Practice Act,
and Sections 61-10-1 through 61-10-21 NMSA 1978, the Osteopathic Medicine Act.
(5) “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.
(6) “Physician's assistant” means a person licensed under Section 61-6-7 through
61-6-10 NMSA 1978, the Physician Assistant Act, to perform as a physician's
assistant.
(7) “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.
Q. Definitions beginning with “Q”:
[RESERVED]
R. Definitions
beginning with “R”:
(1) “Registered
nurse” means a person who holds a
certificate of registration as a registered nurse under Section 61-3-1 to
61-3-30 NMSA 1978, the Nursing Practice Act.
(2) “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.
S. Definitions beginning with “S”:
(1) “Skilled nursing facility” means a nursing home which is licensed by the department
to provide skilled nursing services.
(2) “Skilled nursing care” means those services furnished pursuant to a
physician's orders which:
(a) require the skills
of professional personnel such as registered or licensed practical nurses; and
(b) are provided
either directly by or under the supervision of these personnel;
(c) in determining
whether a service is skilled nursing care, the following criteria shall be
used:
(i) 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;
(ii) 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
(iii) 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.
(3) “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.
(4) “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.
T. Definitions beginning with “T”: “Tour of duty” means a portion of the day during which a shift of
resident care personnel are on duty.
U. Definitions beginning with “U”: “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.
V. Definitions beginning with “V”: “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.
W. Definitions beginning with “W”: “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.
[7.9.2.7 NMAC - Rp, 7.9.2.7
NMAC, 6/9/2020]
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 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 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 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.
[7.9.2.8 NMAC - Rp, 7.9.2.8
NMAC, 6/9/2020]
A. Annual license: An annual
license is issued for a one 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 120 days, during which the facility must correct
all specified deficiencies.
(2) In accordance with Subsection D of Section
24-1-5 NMSA 1978, no more than two 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
10 working days of the change.
[7.9.2.9 NMAC - Rp, 7.9.2.9
NMAC, 6/9/2020]
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.
[7.9.2.10 NMAC - Rp, 7.9.2.10
NMAC, 6/9/2020]
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.
[7.9.2.11 NMAC - Rp, 7.9.2.11
NMAC, 6/9/2020]
A. Licensee must submit a renewal application on forms provided by the licensing
authority, along with the required fee at least 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. Subsection A of Section
24-1-5 NMSA 1978, as amended, provides that no health facility shall be
operated without a license.
[7.9.2.12 NMAC - Rp, 7.9.2.12
NMAC, 6/9/2020]
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.
[7.9.2.13 NMAC - Rp, 7.9.2.13
NMAC, 6/9/2020]
A. The licensee shall notify the department in writing of any changes in
the information provided, within 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 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 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 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.
[7.9.2.14 NMAC - Rp, 7.9.2.14
NMAC, 6/9/2020]
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 listed in
7.9.2.15 NMAC must submit an application for initial licensure in accordance
with 7.9.2.8 NMAC of these regulations, at least 30 days prior to the
anticipated change.
[7.9.2.15 NMAC - Rp, 7.9.2.15
NMAC, 6/9/2020]
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
or licensee.
C. On the day a facility changes location.
[7.9.2.16 NMAC - Rp, 7.9.2.16
NMAC, 6/9/2020]
7.9.2.17 SUSPENSION
OF LICENSE WITHOUT PRIOR HEARING: In accordance with Subsection H of Section
24-1-5 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 working days of the suspension,
unless waived by the licensee.
[7.9.2.17 NMAC - Rp, 7.9.2.17
NMAC, 6/9/2020]
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.
[7.9.2.18 NMAC - Rp, 7.9.2.18
NMAC, 6/9/2020]
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 7.9.2.17 NMAC and 7.9.2.18 NMAC 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.
[7.9.2.19 NMAC - Rp, 7.9.2.19
NMAC, 6/9/2020]
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.
[7.9.2.20 NMAC - Rp, 7.9.2.20
NMAC, 6/9/2020]
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 residen;
(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.
[7.9.2.21 NMAC - Rp, 7.9.2.21
NMAC, 6/9/2020]
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 regulations.
(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.
(2) 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 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 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 or 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
or 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 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.
[7.9.2.22 NMAC - Rp, 7.9.2.22
NMAC, 6/9/2020]
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.
[7.9.2.23 NMAC - Rp, 7.9.2.23
NMAC, 6/9/2020]
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.
[7.9.2.24 NMAC - Rp, 7.9.2.24
NMAC, 6/9/2020]
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 90 days from the date of the consent, unless revoked. Consent may be renewed for 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 12 hours. No resident may be confined for more than an
additional hours under order of the physician.
[7.9.2.25 NMAC - Rp, 7.9.2.25
NMAC, 6/9/2020]
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 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 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.
[7.9.2.26 NMAC - Rp, 7.9.2.26
NMAC, 6/9/2020]
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 16 years of age shall be employed to provide direct care to residents.
B. Physical health certifications: Every new
employee shall be certified in writing by a physician as having been screened
for tuberculosis infection and provide a statement of medical evidence that
they are 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 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 Section 27-7-14 NMSA 1978, 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.
[7.9.2.27 NMAC - Rp, 7.9.2.27
NMAC, 6/9/2020]
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.
[7.9.2.28 NMAC - Rp, 7.9.2.28
NMAC, 6/9/2020]
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.
[7.9.2.29 NMAC - Rp, 7.9.2.29
NMAC, 6/9/2020]
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 Paragraph (1) of Subsection B of 7.9.2.30 NMAC. 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.
[7.9.2.30 NMAC - Rp, 7.9.2.30
NMAC, 6/9/2020]
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 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 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.
[7.9.2.31 NMAC - Rp, 7.9.2.31
NMAC, 6/9/2020]
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 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.
[7.9.2.32 NMAC - Rp, 7.9.2.32
NMAC, 6/9/2020]
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.
[7.9.2.33 NMAC - Rp, 7.9.2.33
NMAC, 6/9/2020]
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.
[7.9.2.34 NMAC - Rp, 7.9.2.34
NMAC, 6/9/2020]
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 days a week: With prior
approval, facilities shall take reasonable steps to admit residents seven days
a week.
[7.9.2.35 NMAC - Rp, 7.9.2.35
NMAC, 6/9/2020]
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.
[7.9.2.36 NMAC - Rp, 7.9.2.36
NMAC, 6/9/2020]
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 48 hours
following admission unless an examination was performed within 15 days before
admission.
(2) Evaluation: Within 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 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 48 hours of admission, a comprehensive
assessment within 30 days of admission, after significant change and repeated
at least annually.
[7.9.2.37 NMAC - Rp, 7.9.2.37
NMAC, 6/9/2020]
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 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 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 Subsection A of 7.9.2.38 NMAC a planning conference shall be held
at least three 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 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.
[7.9.2.38 NMAC - Rp, 7.9.2.38
NMAC, 6/9/2020]
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 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 public interest and essential to ensuring nursing facility services in
the community.
[7.9.2.39 NMAC - Rp, 7.9.2.39
NMAC, 6/9/2020]
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 or family of their bedhold
policy.
[7.9.2.40 NMAC - Rp, 7.9.2.40
NMAC, 6/9/2020]
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.
[7.9.2.41 NMAC - Rp, 7.9.2.41
NMAC, 6/9/2020]
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.
[7.9.2.42 NMAC - Rp, 7.9.2.42
NMAC, 6/9/2020]
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.
[7.9.2.43 NMAC - Rp, 7.9.2.43
NMAC, 6/9/2020]
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.
[7.9.2.44 NMAC - Rp, 7.9.2.44
NMAC, 6/9/2020]
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 resident’s 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 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.
[7.9.2.45 NMAC - Rp, 7.9.2.45
NMAC, 6/9/2020]
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.
[7.9.2.46 NMAC - Rp, 7.9.2.46
NMAC, 6/9/2020]
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 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.
[7.9.2.47 NMAC - Rp, 7.9.2.47
NMAC, 6/9/2020]
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.
[7.9.2.48 NMAC - Rp, 7.9.2.48
NMAC, 6/9/2020]
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 30 days and an
intermediate care resident at least every 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.
[7.9.2.49 NMAC - Rp, 7.9.2.49
NMAC, 6/9/2020]
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.
[7.9.2.50 NMAC - Rp, 7.9.2.50
NMAC, 6/9/2020]
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 hours
per patient day calculated on a seven 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 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, two and three-tenths (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, two and five tenths (2.5) hours per patient day averages one
nursing department employee for every nine 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
[7.9.2.51 NMAC - Rp, 7.9.2.51
NMAC, 6/9/2020]
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
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 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 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 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 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 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 meals or their equivalent
shall be offered to each resident daily, not more than six hours apart, with
not more than a 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.
[7.9.2.52 NMAC - Rp, 7.9.2.52
NMAC, 6/9/2020]
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
[7.9.2.53 NMAC - Rp, 7.9.2.53
NMAC, 6/9/2020]
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 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.
[7.9.2.54 NMAC - Rp, 7.9.2.54
NMAC, 6/9/2020]
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
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.
[7.9.2.55 NMAC - Rp, 7.9.2.55
NMAC, 6/9/2020]
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.
[7.9.2.56 NMAC - Rp, 7.9.2.56
NMAC, 6/9/2020]
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 30 days of the physician's discontinuance of use.
(b) Procedure: Records shall be kept of all medication
returned for credit 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.
[7.9.2.57 NMAC - Rp, 7.9.2.57
NMAC, 6/9/2020]
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.
(a) the passenger
transportation assistance program shall be comprised of but not limited to the
following elements:
(i) resident
assessment;
(ii) emergency
procedures;
(iii) supervised
practice in the safe operation of equipment;
(iv) familiarity
with state regulations governing the transportation of persons with
disabilities;
(v) and
a method for determining and documenting successful completion of the course.
(b) 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.
(c) the motor
vehicle transportation assistance program shall be comprised of but not limited
to the following elements:
(i) 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;
(ii) the
course requirements above are examples and may be modified as needed.
(d) 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.
[7.9.2.58 NMAC - Rp, 7.9.2.58
NMAC, 6/9/2020]
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.
[7.9.2.59 NMAC - Rp, 7.9.2.59
NMAC, 6/9/2020]
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.
[7.9.2.60 NMAC - Rp, 7.9.2.60
NMAC, 6/9/2020]
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 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 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.
[7.9.2.61 NMAC - Rp, 7.9.2.61
NMAC, 6/9/2020]
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 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.
[7.9.2.62 NMAC - Rp, 7.9.2.62
NMAC, 6/9/2020]
7.9.2.63 EQUIPMENT
AND SUPPLIES:
A. Beds:
(1) Each resident shall be provided a bed
which is at least 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 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 sheets and two
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 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 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.
[7.9.2.63 NMAC - Rp, 7.9.2.63
NMAC, 6/9/2020]
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.
[7.9.2.64 NMAC - Rp, 7.9.2.64
NMAC, 6/9/2020]
7.9.2.65 MAINTENANCE: All facility
furnishings and equipment shall be maintained in a usable, safe and sanitary
condition.
[7.9.2.65 NMAC - Rp, 7.9.2.65
NMAC, 6/9/2020]
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.
[7.9.2.66 NMAC - Rp, 7.9.2.66
NMAC, 6/9/2020]
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.
[7.9.2.67 NMAC - Rp, 7.9.2.67
NMAC, 6/9/2020]
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.
[7.9.2.68 NMAC - Rp, 7.9.2.68
NMAC, 6/9/2020]
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 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
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 days.
[7.9.2.69 NMAC - Rp, 7.9.2.69
NMAC, 6/9/2020]
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 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 days.
[7.9.2.70 NMAC - Rp, 7.9.2.70
NMAC, 6/9/2020]
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 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 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 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 feet wide.
(3) Doors:
(a) Size: Doors to residents' rooms shall not be less
than three feet eight inches wide and six feet eight 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 feet zero inches by six feet eight 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 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 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 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 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 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 and an 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
duplex-type outlets shall be provided for each bed.
[7.9.2.71 NMAC - Rp, 7.9.2.71
NMAC, 6/9/2020]
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 100 square feet in single rooms and 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 feet from the
nearest walls.
(3) Ceilings shall be at least eight feet
in height.
E. Windows: The bottom
sill of windows in bedrooms shall be no more than three feet from the floor.
F. Bed Capacity: No rooms shall
house more than four beds.
G. Bed arrangements: The beds shall
be arranged so that the beds shall be at least three feet apart and clear aisle
space of at least three 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 15 inches wide by 18 inches deep by five 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.
[7.9.2.72 NMAC - Rp, 7.9.2.72
NMAC, 6/9/2020]
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 residents'
rooms, and not more than four beds per toilet room.
(2) One toilet and one lavatory for not
more than four residents shall be provided and separate facilities shall be
provided for each sex.
(3) One tub or shower for every 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 Subsection A of 7.9.2.72 NMAC if the facilities are not used by
other residents.
[7.9.2.73 NMAC - Rp, 7.9.2.73
NMAC, 6/9/2020]
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 7.9.2.75 NMAC.
(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.
[7.9.2.74 NMAC - Rp, 7.9.2.74
NMAC, 6/9/2020]
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 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.
[7.9.2.75 NMAC - Rp, 7.9.2.75
NMAC, 6/9/2020]
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 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 25
square feet per bed. Solaria and lobby
sitting areas, exclusive of traffic areas, shall be categorized as living room
space.
[7.9.2.76 NMAC - Rp, 7.9.2.76
NMAC, 6/9/2020]
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 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 degrees Fahrenheit or one 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.
[7.9.2.77 NMAC - Rp, 7.9.2.77
NMAC, 6/9/2020]
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.
[7.9.2.78 NMAC - Rp, 7.9.2.78
NMAC, 6/9/2020]
7.9.2.79 FAMILY
AND EMPLOYEE LIVING QUARTERS: Any family and employee living quarters shall
be separate from the residents' area.
[7.9.2.79 NMAC - Rp, 7.9.2.79
NMAC, 6/9/2020]
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.
[7.9.2.80 NMAC - Rp, 7.9.2.80
NMAC, 6/9/2020]
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.
[7.9.2.81 NMAC - Rp, 7.9.2.81
NMAC, 6/9/2020]
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 Subsection A of 7.9.2.82 NMAC and Subsection
B of 7.9.2.82 NMAC, 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.
[7.9.2.82 NMAC - Rp, 7.9.2.82
NMAC, 6/9/2020]
7.9.2.83 ISOLATION: For every 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.
[7.9.2.83 NMAC - Rp, 7.9.2.83
NMAC, 6/9/2020]
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 Subsection B of 7.9.2.84 NMAC 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) in-service training area.
C. Resident activities areas shall include:
(1) occupational therapy;
(2) physical therapy;
(3) activity area; and
(4) beauty and barber shop.
[7.9.2.84 NMAC - Rp, 7.9.2.84
NMAC, 6/9/2020]
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.
[7.9.2.85 NMAC - Rp, 7.9.2.85
NMAC, 6/9/2020]
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.
[7.9.2.86 NMAC - Rp, 7.9.2.86
NMAC, 6/9/2020]
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 Subsection B of 7.9.2.87 NMAC 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
months of the date of approval of the working plans and specifications under Subsection
B of 7.9.2.87 NMAC, 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.
[7.9.2.87 NMAC - Rp, 7.9.2.87
NMAC, 6/9/2020]
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 (10/31/1996).
B. Health facility sanctions and civil monetary penalties, New Mexico department
of health, 7 NMAC 1.8 (10/31/1996).
C. Adjudicatory
hearings, New Mexico department of health, 7 NMAC 1.2 (2-1-96).
[7.9.2.88 NMAC - Rp, 7.9.2.88
NMAC, 6/9/2020]
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, 5/2/1989.
History of Repealed Material:
7.9.2 NMAC - Requirements for
Long Term Care Facilities (filed 8/31/2000) - Repealed effective 6/9/2020.
Other History:
7 NMAC 9.2, Requirements for
Long Term Care Facilities, filed 10/18/1996, reformatted, renumbered and
amended to 7.9.2 NMAC, effective 8/31/2000.
7.9.2 NMAC - Requirements for
Long Term Care (filed 8/31/2000), was replaced by 7.9.2 NMAC, - Requirements for Long Term Care,
effective 6/9/2020.