N.Y. Comp. Codes R. & Regs. Tit. 18 § 487.7 - Resident services
(a) The
operator shall be responsible for the provision of resident services, which
shall include, at a minimum, room, board, housekeeping, supervision, personal
care, case management and activities.
(b) The operator of a facility in which at
least 25 percent of the resident population or 25 residents, whichever is less,
are mentally disabled persons who have been released or discharged from
facilities operated or certified by an Office of the Department of Mental
Hygiene must arrange, by written agreement, with the outpatient or after-care
service of the nearest State psychiatric or developmental facility, the local
community mental health service, or a community support service provider, for
assistance with the assessment of mental health needs, the supervision of
general mental health care and the provision of related case management
services for those residents enrolled in mental health programs.
(c)
(1) The
agreement developed in satisfaction of subdivision (b) of this section shall be
reviewed and approved, prior to execution, by the appropriate regional offices
of the department and the Department of Mental Hygiene.
(2) The agreement shall address the role and
responsibility, if any, of each party for:
(i) pre- and post-admission assessment and
screening, except that final decisions on admission and retention shall remain
the responsibility of the operator;
(ii) the development of service plans, the
provision of or arrangements for services;
(iii) securing emergency mental health
services and rehospitalization;
(iv) coordination of services within the
facility and the exchange of information;
(v) provision of suitable and adequate
program space; and
(vi) resolving
conflicts or disagreements on individual cases.
(3) The agreement shall not limit or
supersede the authority or the responsibilities of either
party.
(d)
Supervision.
(1) Supervision
services shall include, but are not limited to:
(i) maintaining knowledge of general
whereabouts of each resident;
(ii)
recording a daily census using a department-prescribed form;
(iii) monitoring residents to identify abrupt
or progressive changes in behavior or appearance which may signify the need for
assessment and service;
(iv)
monitoring and guidance to assist residents in performing basic activities of
daily living, including:
(a) attendance at
meals and maintenance of appropriate nutritional intake;
(b) performance of personal hygiene and
grooming activities;
(c)
participation in facility and community programs; and
(d) performance of basic money management and
fulfillment of service needs;
(v) surveillance of grounds, facility, and
activities of residents and staff to protect residents from harm to person and
property;
(vi) monitoring emergency
call systems within the facility;
(vii) handling individual emergencies, or
need for assistance, including arranging for medical or other
services;
(viii) conduct and
supervision of evacuations and fire and evacuation drills;
(ix) implementation of the disaster and
emergency plan; and
(x)
investigation by the administrator or case manager of incidents involving
resident endangerment, injury, occurrences which would constitute reportable
incidents or death.
(2)
All employees shall be trained in the means of rapidly evacuating the
building.
(3) At least one staff
person on each shift shall be designated as responsible for the conduct and
supervision of any evacuation or implementation of the disaster and emergency
plan.
(4) In the event that a
resident is absent from the facility and the resident's whereabouts are
unknown, the operator shall initiate efforts to find the resident and, if the
absence exceeds 24 hours:
(i) immediately
notify the resident's next of kin or representative;
(ii) immediately notify the appropriate law
enforcement agency;
(iii) notify
the appropriate regional office of the department on the first available
working day; and
(iv) send a copy
of the Incident Report to the appropriate regional office of the department
within five working days.
(5) In the event that a resident is unable or
unwilling to consume regular meals for two consecutive days, the operator shall
immediately notify the resident's personal physician, act on the physician's
instruction, and note the call and instructions in the resident's
record.
(6)
(i) In the event that a resident requires
emergency assistance because of illness or injury, the operator shall:
(a) protect the resident's safety and
comfort;
(b) secure necessary
emergency medical assistance; and
(c) if necessary, arrange for transfer to an
appropriate medical facility.
(ii) In the event that a resident becomes ill
or displays a progressive deterioration of health or behavior, the operator
shall:
(a) protect the resident's safety and
comfort;
(b) obtain medical
evaluation and services; and
(c) if
necessary, arrange for transfer to an appropriate medical facility.
(iii) In the event of illness or
injury, the operator shall also:
(a) notify
the resident's personal physician or, in the event such physician is not
available, a qualified alternate;
(b) notify the resident's representative, or
next of kin, if known;
(c) upon
transfer of a resident to a health, mental health or other residential care
facility, send an approved transfer form (or copy of the department-prescribed
medical evaluation and the personal data sheet) and such other information as
the receiving facility requests and the operator is required to
maintain;
(d) in emergency
transfers, the information required in clause (c) of this
subparagraph may be telephoned to the receiving facility and written
information sent within 72 hours; and
(e) make a notation of the illness or
accident and transfer, if any, in the resident's
record.
(7) In
the event that a resident exhibits behavior which constitutes a danger to self
or others, the operator shall:
(i) arrange
for appropriate professional evaluation of the resident's condition;
(ii) if necessary, arrange for transfer of
the individual to a facility providing the proper level of care; and
(iii) notify the resident's representative,
or next of kin, if known.
(8) In the event of the death of a resident,
the operator must:
(i) immediately take
necessary action to notify the resident's next of kin or representative, if
known;
(ii) immediately take
necessary action to notify the appropriate local authorities;
(iii) immediately report the death to the
appropriate regional office of the Department of Health by telephone and submit
a copy of the department-prescribed Incident Report, which must be received by
the appropriate regional office of the Department of Health, within 24 hours of
the death; and
(iv) submit a report
to the Justice Center for the Protection of People with Special Needs ("Justice
Center"), on a form prescribed by the Justice Center, if the resident had at
any time received services from a mental hygiene service provider. Such form
must be received by the Justice Center within twenty-four hours of the
death.
(9) If a resident
attempts suicide, the operator must:
(i)
immediately report the attempted suicide to the appropriate regional office of
the department of health by telephone and submit a copy of the
department-prescribed Incident Report, which must be received by the
appropriate regional office of the Department of Health, within twenty-four
hours of the attempted suicide, and
(ii) submit a report to the Justice Center,
on a form prescribed by the Justice Center, if the resident had at any time
received services from a mental hygiene service provider. Such form must be
received by the Justice Center within twenty-four hours of the attempted
suicide.
(10) If an
operator discovers an incident where the operator believes, or reasonably
should have believed, that a felony crime may have been committed by or against
a resident, the operator shall:
(i)
immediately report the occurrence to the appropriate regional office of the
department of health by telephone and submit a copy of the
department-prescribed Incident Report, which must be received by the
appropriate regional office of the Department of Health, within twenty-four
hours of the occurrence. The operator also must ;
(ii) as soon as practicable, but in no event
longer than twenty-four hours after the occurrence, notify an appropriate law
enforcement authority of the occurrence; and
(iii) submit a report to the Justice Center,
on a form prescribed by the Justice Center, if the resident had at any time
received services from a mental hygiene service provider. Such form shall be
received by the Justice Center within twenty-four hours of the discovery of the
occurrence.
(11) The
operator must prepare an Incident Report, using the department-prescribed form,
whenever:
(i) a resident's whereabouts have
been unknown for more than 24 hours;
(ii) a resident assaults or injures, or is
assaulted or injured by another resident, staff or others;
(iii) a resident attempts or commits
suicide;
(iv) there is a complaint
or evidence of resident abuse;
(v)
a resident dies;
(vi) a resident
behaves in a manner that directly impairs the well-being, care or safety of the
resident or any other resident or which substantially interferes with the
orderly operation of the facility;
(vii) a resident is involved in an accident
on or off the facility grounds which results in such resident requiring medical
care, medical attention or services; or
(viii) it is believed that a felony crime may
have been committed by or against a resident.
(12) The operator must:
(i) place a copy of the Incident Report in
the resident's individual record;
(ii) maintain a chronological log or record
of all Incident Reports prepared, which includes identification of the resident
or residents involved and the type of incident;
(iii) submit a copy of any Incident Reports
required in paragraph (11) of this subdivision to the appropriate regional
office of the Department; and
(iv)
contact the Justice Center if that resident had, at any time, received mental
hygiene services.
(13)
The operator must include the resident's version of the events leading to an
accident or incident involving such resident, unless the resident objects, on
all required Incident Reports.
(14)
If the facility falls within the definition of a facility as
defined in section 488 (4) of the Social Services Law, the operator shall
immediately upon discovery, orally or electronically inform the Justice Center,
as required by the Justice Center, of any occurrence constituting a reportable
incident, as defined in section 488 (1) of the Social Services Law, including
the name, title and contact information of every person known to have the same
information as the person reporting concerning the reportable incident. Such
report must be received by the Justice Center within 24 hours of the discovery
of such occurrence.
(e)
Personal care.
(1) Each resident
shall be provided such personal care as is necessary to enable the resident to
maintain good personal hygiene, to carry out the activities of daily living, to
maintain good health, and to participate in the ongoing activities of the
facility.
(2) Personal care
functions shall include direction and some assistance with:
(i) grooming, including care of hair, shaving
and ordinary care of nails, teeth and mouth;
(ii) dressing;
(iii) bathing;
(iv) toileting;
(v) walking and ordinary movement from bed to
chair or wheelchair;
(vi)
eating;
(vii) taking and recording
weights monthly; and
(viii)
assisting with self-administration of medications, as defined in subdivision
(f) of this section.
(3)
Personal care functions to participate in the ongoing activities of the
facility shall include assistance to:
(i) use
central dining;
(ii) consume meals;
and
(iii) participate in the
activities program.
(4)
Residents shall not be permitted, except as may be necessary for the treatment
of a short-term illness, to be confined to their room or bed.
(5) Commodes shall not be permitted, except
as may be necessary for a short-term illness or for night use as a safety
measure as confirmed by the written order of a physician.
(6) Residents shall not be provided in-room
tray services, except as may be necessary for a short-term illness.
(7) Physical restraints,
i.e., any apparatus which prevents the free movement of a
resident's arms or legs, or which immobilizes a resident and which the resident
is unable to remove, shall not be used.
(8) An operator may set up a sick bay, or
isolation area, to serve residents who have short- term illnesses, provided
that:
(i) the combined occupancy of the sick
bay and the rest of the facility does not exceed the certified capacity of the
facility; and
(ii) the sick bay is
not used for a resident who is inappropriate for continued retention in the
adult home.
(9) The
operator shall establish a system which assures that information regarding
incidents or changes in residents' conditions affecting their need for personal
care or supervision is available on an ongoing basis to all
shifts.
(f)
Medication management.
(1) Each
resident capable of self-administration of medication shall be permitted to
retain and self-administer medications, provided that:
(i) the resident's physician attests, in
writing, that the resident is capable of self- administration; and
(ii) the resident keeps the operator informed
of all medications being taken, including name, route, dosage, frequency,
times, and any instructions, including any contraindications, indicated by the
physician.
(2) Residents
capable of self-administration are those who are able to:
(i) correctly read the label on the
medication container;
(ii)
correctly interpret the label;
(iii) correctly ingest, inject or apply the
medication;
(iv) correctly follow
instructions as to the route, time, dosage and frequency;
(v) open the container;
(vi) measure or prepare medications,
including mixing, shaking and filling syringes; and
(vii) safely store the medication.
(3) A resident needing assistance
with self-administration is one who needs assistance to properly carry out one
or more of the activities listed in paragraph (2) of this
subdivision.
(4) Assistance with
self-administration shall include assistance with any activity which the
resident would ordinarily be capable of carrying out pursuant to paragraph (2)
of this subdivision.
(5) For
residents in need of supervision and assistance, the operator shall establish a
system for staff to:
(i) provide the resident
with the proper dosage of medication at the designated time; and
(ii) observe and record that the resident
takes the medication.
(6)
In any system for supervision and assistance, removal of a dose from the
container, or measurement or preparation of medications, must be performed by
the person providing assistance with intake, except that insulin syringes may
be prefilled by a nurse.
(7) Staff
shall not be permitted to administer injectable medications to a resident;
except that staff holding a valid license from the State of New York Education
Department authorizing them, among other things, to administer injectable
medications, may do so, provided that the injectable medication is one which
licensed health care providers would customarily train a patient or his family
to administer.
(8) If a resident
refuses to take medications or appears unable to independently administer
medications, the operator shall notify the prescribing physician and, if
different, the primary physician.
(9) Under no circumstances shall staff make a
change in the dosage or schedule of administration of medication without the
prior written authorization of a physician or, in case of an emergency, by
telephone with written confirmation from the physician within seven
days.
(10) If medication is
prescribed or discontinued by someone other than the resident's primary
physician, the operator shall notify the primary physician within one business
day to advise of the medication and dosage prescribed or discontinued and shall
note the call or retain a copy of the correspondence in the resident's
record.
(11) Storage of
medications.
(i) Medication shall be kept in
a secure storage area at all times, whether kept by a resident or kept by the
operator for the resident, except when required to be kept by a resident on his
person for frequent or emergency use.
(ii)
Secure storage shall
mean an area or a cabinet which cannot be removed or entered at will, and which
cannot be opened except by a key.
(iii) An operator retaining controlled
substance prescriptions for residents shall first obtain a class 3a controlled
substance license as an Institutional Dispenser, Limited from the Department of
Health. Standards for storage and recording set forth by the Department of
Health shall be applicable.
(iv)
Drugs for external use shall be stored separately from internal and injectable
medications.
(v) Refrigerators used
for the storage of pharmaceuticals shall not be used for the storage of food or
beverages, unless the drugs are stored in a separate, locked
compartment.
(vi) Medications shall
not be emptied from one container into another, except when necessary to enable
a resident to take medications during temporary absences from the
facility.
(vii) Directions on
labels shall not be changed by anyone other than a physician or pharmacist.
When a change in dosage or schedule has been made, the container must be tagged
until the label is corrected. The label must be corrected within 30 days of the
change.
(viii) Stock supplies of
prescription medications are prohibited.
(ix) Stock supplies of nonprescription
over-the-counter items for use in self-medication may be maintained.
(x) Prescribed or dated medication shall be
current.
(xi) Any medication which
has been prescribed, but is no longer in use by a resident, shall be destroyed
or disposed of in accordance with the Public Health Law, unless the resident's
physician requests that the medication be discontinued for a specific temporary
period.
(12) Recording
for medications.
(i) Information on the
medication regimen of each resident shall be retained on file in a manner which
assures both resident privacy and accessibility, for assistance and supervision
or in time of emergency.
(ii) The
following information shall be maintained for each resident:
(a) the person's name;
(b) identification of each
medication;
(c) the current dosage,
frequency, time and route of each medication;
(d) the physician's name for each prescribed
medication;
(e) the dates of each
prescription change;
(f) any
contraindications noted by the physician;
(g) the type of supervision and assistance,
if any, needed by the resident; and
(h) a record of assistance.
(iii) When a resident is assisted in taking
medications, the name of the resident, the medication, the staff assisting and
the date and time of assistance shall be recorded. Recording shall occur at the
time of assistance to each resident. In no event shall recording be done by a
person who has not observed the taking of the
dose.
(g)
Case management.
(1)
Case management services
shall include:
(i) initial, episodic, and
periodic evaluation, not less than once in every 12-month period, of the needs
and goals of each resident and of the capability of the facility program to
meet those needs and expressed goals;
(ii) orientating a new resident and family to
the daily routine;
(iii) assisting
each resident to adjust to life in the facility;
(iv) assisting each resident to maintain
family and community ties and to develop new ones;
(v) encouraging resident participation in
facility and community activities;
(vi) establishing linkages with and arranging
for services from public and private sources for income, health, mental health
and social services;
(vii)
assisting residents in making application for, and maintaining, income
entitlements and public benefits;
(viii) assisting the resident in obtaining
and maintaining a primary physician or source of medical care of choice, who is
responsible for the overall management of the individual's health and mental
health needs;
(ix) assisting the
resident in making arrangements to obtain services, examinations and reports
needed to maintain or document the maintenance of the resident's health or
mental health, including but not limited to:
(a) health and mental health
services;
(b) dental services;
and
(c) medications;
(x) providing information and
referral;
(xi) coordinating the
work of other case management and service providers within the
facility;
(xii) assisting residents
in need of alternative living arrangements to make and execute sound discharge
or transfer plans;
(xiii)
documenting each resident's understanding of their rights and responsibilities
afforded under this Part; and
(xiv)
assisting in the establishment and operation of a system to enable residents to
participate in planning for change or improvement in facility operations and
programs and to present grievances and recommendations.
(2) Each resident shall be provided such case
management services as are necessary to support the resident in maintaining
independence of function and personal choice, including, but not limited to,
decisions regarding which daily activities to participate in, individuals with
whom to interact, and the physical environment in which the resident
resides.
(3) The operator shall
establish a system of recordkeeping which documents the case management needs
of each resident and records case management activities undertaken to meet
those needs.
(4) The operator and
case management staff within the facility shall utilize and cooperate with
external service providers.
(5) The
operator shall:
(i) provide, without charge,
space for residents to meet in privacy with service providers;
(ii) not inhibit access to individual
residents who request services;
(iii) identify persons in need of services
and assist external service providers in establishing a relationship with these
residents;
(iv) work with these
service providers in executing a plan for service for individual residents;
and
(v) assist in arranging for
transportation as necessary to ensure that residents are able to attend
required services provided in an external
location.
(h)
Activity services.
(1) The
operator shall maintain an organized and diversified program of individual and
group activities which will enable each resident to engage in cultural,
spiritual, diversional, physical, political, social and intellectual activities
within the facility and the community, in order to sustain and promote an
individual's potential and a sense of usefulness to self and others.
(2) Activities services shall include, but
not be limited to:
(i) direct provision,
within the facility, of programs and activities for group and individual
participation;
(ii) arrangement for
provision of program and activities within the facility by community groups and
service providers;
(iii)
arrangement for resident participation in community-based and
community-sponsored activities; and
(iv) arrangement for transportation or such
other resources as are necessary to enable residents to participate in
community activities.
(3)
Activities shall be planned and available to each resident for a minimum of 10
hours per week.
(4) Activities
shall be scheduled during evenings and weekends as well as during the
weekday.
(5) A monthly schedule of
activities shall be prepared one week in advance of its proposed
implementation, and amended to reflect changes as they occur.
(6) Activities scheduling shall take into
account and reflect the age, sex, physical and mental capabilities, interests
and the cultural and social background of the residents.
(7) Each activities schedule shall include:
(i) individual, small group and large group
activities;
(ii) facility-based and
community activities;
(iii)
physical exercise or other physical activities;
(iv) intellectual activities;
(v) social interaction; and
(vi) opportunities for both active and
passive resident involvement.
(8) Each activities schedule shall identify
the location, time, the provider of each activity and a facility staff contact
person responsible for or knowledgeable about each activity.
(9) The current schedule of activities shall
be conspicuously posted in a public area accessible to all residents and
visitors.
(10) A record of the
schedule of activities, as planned and as implemented, shall be maintained for
six months.
(11) The operator shall
provide equipment and supplies sufficient to implement the program of
activities.
(12) Accommodations and
space shall be provided for activity and socialization services in accordance
with section
487.11 of this
Part.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.