Section 340.1505 Medical, Nursing and Restorative Services

Section 340

Section 340.1505  Medical,

Nursing and Restorative Services

a)

Comprehensive

resident care plan.  A facility, with the participation of the resident and the

resident's guardian or representative, as applicable, must develop and

implement a comprehensive care plan for each resident that includes measurable

objectives and timetables to meet the resident's medical, nursing, and mental

and psychosocial needs that are identified in the resident's comprehensive

assessment, which allow the resident to attain or maintain the highest

practicable level of independent functioning, and provide for discharge

planning to the least restrictive setting based on the resident’s care needs.

The assessment shall be developed with the active participation of the resident

and the resident’s guardian or representative, as applicable.

(Section

3-202.2a of the Act)

b)         The facility shall provide the necessary care and services to

attain or maintain the highest practicable physical, mental, and psychosocial

well-being of the resident, in accordance with each resident's comprehensive resident

care plan.  Adequate and properly supervised nursing care shall be provided to

each resident to meet the total nursing care needs of the resident.

1)         The licensed nurse in charge of the restorative/rehabilitative

nursing program shall have successfully completed a course or other training

program that includes at least 60 hours of classroom/lab training in

restorative/rehabilitative nursing as evidenced by a transcript, certificate,

diploma, or other written documentation from an accredited school or recognized

accrediting agency such as a State or National organization of nursing or a

state licensing authority. This person may be the Director of Nursing Services,

Assistant Director of Nursing Services or another nurse designated by the

Director of Nursing Services to be in charge of the restorative/rehabilitative

nursing program

or other written documentation from an accredited school or recognized

accrediting agency such as a State or National organization of nursing or a

state licensing authority. This person may be the Director of Nursing Services,

Assistant Director of Nursing Services or another nurse designated by the

Director of Nursing Services to be in charge of the restorative/rehabilitative

nursing program.

2)         All nursing personnel shall assist and encourage residents so

that a resident who enters the facility without a limited range of motion does

not experience reduction in range of motion unless the resident's clinical

condition demonstrates that a reduction  in range of motion  is unavoidable.

All nursing personnel shall assist and encourage residents so that a resident

with a limited range of motion receives appropriate treatment and services to

increase range of motion and/or prevent further decrease in range of motion.

3)         All nursing personnel shall assist and encourage residents so

that a resident who is incontinent of bowel and/or  bladder receives the

appropriate treatment and services to prevent urinary tract infections and to

restore as much normal bladder function as possible.  All nursing personnel

shall assist residents so that a resident who enters the facility  without an

indwelling catheter is not catherized unless the resident's clinical condition

demonstrates that catheterization was necessary.

4)         All nursing personnel shall assist and encourage residents so

that a resident's abilities in activities of daily living do not diminish

unless circumstances of the individual's clinical condition demonstrate that

diminution was unavoidable.  This includes the resident's abilities to bathe,

dress, and groom; transfer and ambulate; toilet; eat; and use speech, language

or other functional communication systems

onnel shall assist and encourage residents so

that a resident's abilities in activities of daily living do not diminish

unless circumstances of the individual's clinical condition demonstrate that

diminution was unavoidable.  This includes the resident's abilities to bathe,

dress, and groom; transfer and ambulate; toilet; eat; and use speech, language

or other functional communication systems.  A resident who is unable to carry

out activities of daily living shall receive the services necessary to maintain

good nutrition, grooming, and personal hygiene.

5)         All nursing personnel shall assist and encourage residents

with ambulation and safe transfer activities as necessary in an effort to help

them retain or maintain their highest practicable level of functioning.

c)         Each

direct care-giving staff shall review and be knowledgeable about his or her

residents' respective resident care plan.

d)         Pursuant to subsection (a), general nursing care shall include

at a minimum the following and shall be practiced on a 24-hour,

seven-day-a-week basis:

1)         Medications, including oral, rectal, hypodermic, intravenous,

and intramuscular, shall be properly administered.

2)         All treatments and procedures shall be administered as ordered

by the physician.

3)         Objective observations of changes in a resident's conditions,

including mental and emotional changes, as a means for analyzing and

determining care required and the need for further medical evaluation and

treatment shall be made by nursing staff and recorded in the resident's medical

record.

e)         A regular program to prevent and treat pressure sores, heat

rashes or other skin breakdown shall be practiced on a 24-hour,

seven-day-a-week basis so that a resident who enters the facility without

pressure sores does not develop pressure sores unless the individual's clinical

condition demonstrates that the pressure sores were unavoidable

recorded in the resident's medical

record.

e)         A regular program to prevent and treat pressure sores, heat

rashes or other skin breakdown shall be practiced on a 24-hour,

seven-day-a-week basis so that a resident who enters the facility without

pressure sores does not develop pressure sores unless the individual's clinical

condition demonstrates that the pressure sores were unavoidable.  A resident

having pressure sores shall receive treatment and services to promote healing,

prevent infection, and prevent new pressure sores from developing.

f)         If physical therapy, occupational therapy, speech therapy or

any other specialized rehabilitative service is offered, it shall be provided

by, or supervised by, a qualified professional in that specialty and upon the

written order of the physician.

1)         In addition to the provision of direct services, any such

qualified professional personnel shall be used as consultants to the total

restorative program and shall assist with resident evaluation, resident care

planning, and inservice education.

2)         Appropriate records shall be maintained by these personnel.

Direct service to individual residents shall be documented on the individual

clinical record as set forth in Section 340.1800(e) of this Part. A summary of

program consultation and recommendations shall be documented.

g)         All necessary precautions shall be taken to assure that the

resident's environment remains as free of accident hazards as possible.  All

nursing personnel shall evaluate residents to see that each resident receives

adequate supervision and assistance to prevent accidents.