Section 350.1230 Nursing Services

Section 350

Section 350.1230  Nursing

Services

a)         Each facility shall have a full-time director of nursing

services (DON) who is a registered nurse (RN) and whose only responsibility is

the immediate supervision of the facility's health services.  This person shall

be on duty a minimum of 36 hours, four days per week.  At least 50 percent of

this person's hours shall be regularly scheduled between 7 A.M. and 7 P.M.

1)         A registered nurse or licensed practical nurse shall be on

duty 24 hours per day and seven days per week in charge of health services at all

times when the director of nursing services is not on duty.  The nurse shall be

a registered nurse when required by the medical and/or nursing needs of the

residents.

2)         A facility may, with written approval from the Department,

have two registered nurses share the duties of this position if the facility is

unable to obtain a full-time person.  Such an arrangement will be granted

approval only through written documentation that the facility was unable to

obtain the full-time services of a qualified individual to fill this position.

Such documentation shall include, but not be limited to:  an advertisement that

has appeared in a newspaper of general circulation in the area for at least

three weeks; the names, addresses and phone numbers of all persons who applied

for the position and the reasons why they were not acceptable or would not work

full time; and information about the number and availability of registered

nurses in the area.  The Department will grant approval only when such

documentation indicates that there were no qualified applicants who were

willing to accept the job on a full-time basis, and the pool of registered

nurses available in the area cannot be expected to produce, in the near future,

a qualified person who is willing to work full time

ut the number and availability of registered

nurses in the area.  The Department will grant approval only when such

documentation indicates that there were no qualified applicants who were

willing to accept the job on a full-time basis, and the pool of registered

nurses available in the area cannot be expected to produce, in the near future,

a qualified person who is willing to work full time.

3)         In facilities with a capacity of fewer than 50 beds, this

person (or these persons) may also provide direct patient care, and this

person's time may be included in meeting the staff to resident ratio

requirements.

b)         Residents shall be provided with nursing services, in

accordance with their needs, which shall include, but are not limited to, the

following: The DON shall participate in:

1)         Pre-admission evaluation study and plan.

2)         Evaluation study, program design, and placement of the resident

at the time of admission to the facility.

3)         Periodic reevaluation of the type, extent, and quality of

services and programming.

4)         Development of discharge plans, and the referral to

appropriate community resources.

5)         Training in habits in personal hygiene and activities of daily

living.

6)         Development of a written plan for each resident to provide for

nursing services as part of the total habilitation program.

7)         Modification of the resident care plan, in terms of the

resident's daily needs, as needed.

c)         A registered nurse shall participate, as appropriate, in

planning and implementing the training of facility personnel.

d)         Direct care personnel shall be trained in, but are not limited

to, the following:

1)         Detecting signs of illness, dysfunction or maladaptive

behavior that warrant medical, nursing or psychosocial intervention.

2)         Basic skills required to meet the health needs and problems of

the residents.

3)         First aid in the presence of accident or illness

facility personnel.

d)         Direct care personnel shall be trained in, but are not limited

to, the following:

1)         Detecting signs of illness, dysfunction or maladaptive

behavior that warrant medical, nursing or psychosocial intervention.

2)         Basic skills required to meet the health needs and problems of

the residents.

3)         First aid in the presence of accident or illness.

e)         Sufficient, appropriately qualified nursing staff shall be

available, which may include licensed practical nurses and other supporting

personnel, to carry out the various nursing service activities.

f)         The individual responsible for providing nursing services

shall have knowledge and experience in the field of developmental disabilities.

g)         Nursing service personnel at all levels of competence and experience

shall be assigned responsibilities in accordance with their qualifications.