Senate Bill No. 530
(By Senator Manchin)
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[Introduced March 22, 1993; referred to the Committee
on Health and Human Resources; and then to the
Committee on the Judiciary.]
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A BILL to amend and reenact section one, article five, chapter
sixty-four of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, relating to authorizing the
department of health and human resources to promulgate
legislative rules relating to residential board and care
homes.
Be it enacted by the Legislature of West Virginia:
That section one, article five, chapter sixty-four of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 5. AUTHORIZATION FOR DEPARTMENT OF HEALTH AND HUMAN
RESOURCES TO PROMULGATE LEGISLATIVE RULES.
§64-5-1. Department of health and human resources.
(a) The legislative rules filed in the state register on the
twenty-second day of January, one thousand nine hundred ninety,
modified by the secretary of the department of health and humanresources to meet the objections of the legislative rule-making
review committee and refiled in the state register on the twenty-
fifth day of January, one thousand nine hundred ninety, relating
to the secretary of the department of health and human resources
(implementation of omnibus health care act), are authorized.
(b) The legislative rules filed in the state register on the
twenty-second day of January, one thousand nine hundred ninety,
modified by the secretary of the department of health and human
resources to meet the objections of the legislative rule-making
review committee and refiled in the state register on the twenty-
fifth day of January, one thousand nine hundred ninety, relating
to the secretary of the department of health and human resources
(implementation of omnibus health care act payment provisions),
are authorized.
(c) The legislative rules filed in the state register on the
third day of September, one thousand nine hundred ninety-two,
modified by the department of health and human resources to meet
the objections of the legislative rule-making review committee
and refiled in the state register on the twenty-seventh day of
January, one thousand nine hundred ninety-three, relating to the
department of health and human resources (residential board and
care homes), are authorized with the amendments set forth below:
8.3. Accident and Illness Procedures; Waiver for Nursing
Care (Class I).
8.3.1. When a resident suffers a serious accident or
illness, professional medical attention shall be securedimmediately.
8.3.2. The residential board and care home shall document
monitoring of the resident's condition for a period of twenty-
four (24) hours following the accident or the onset of the
illness or as specified by the professional care provider.
Monitoring shall be performed every fifteen (15) minutes for the
first hour; every thirty (30) minutes for the next three (3)
hours; hourly for the next four (4) hours; and every four (4)
hours for the next sixteen (16) hours.
8.3.3. A residential board and care home which wishes to
provide nursing care and services which exceed personal
assistance shall submit to the secretary a written application
for a waiver to provide nursing care services on a form approved
by the secretary.
8.3.4. The application for a waiver for nursing care shall
include:
8.3.4.1. The name, address, telephone number, and license
number of a registered nurse who has agreed, in writing, to
assume responsibility for the oversight of care and services
required by this rule to all residents of the residential board
and care home;
8.3.4.2. Assurances that the residential board and care
home is familiar with and prepared to comply with the
requirements of Sections 8.3.3 through and including 8.3.9 and
8.3.11 of this rule; and
8.3.4.3. The signature of the residential board and carehome operator.
8.3.5. A residential board and care home granted a waiver
for nursing care shall:
8.3.5.1. Make arrangements for a registered nurse to manage
and provide nursing services for all residents of the residential
board and care home as specified in this rule. Arrangements for
nursing services for individual residents may be made by contract
with an individual, a nursing service, or a home health agency,
or the registered nurse may be an employee or the operator of the
residential board and care home. Arrangements with a home health
agency do not satisfy requirements for nursing management
oversight of all residents as specified in Section 8.3.8 of this
rule but may be used to satisfy the requirements for services to
individual residents. The registered nurse shall sign a written
agreement specifying all services the registered nurse agrees to
provide;
8.3.5.2. Implement, within reasonable expectation, the
recommendations for the registered nurse regarding care, services
and staff training intended to protect the residents;
8.3.5.3. Not accept for admission an individual who is in
need of nursing care at the time of admission;
8.3.5.4. Provide written notice as required by Section
8.3.6 of this rule to each resident regarding the waiver to
provide nursing services at the time of admission, or, for
residents at the time the waiver is granted, within seven (7)
days of the receipt of the approval of the nursing care waiver;
8.3.5.5. House only in rooms on the first floor of the
residential board and care home any residents who are unable, due
to impaired physical or mental status, to recognize danger or
walk independently; and
8.3.5.6. Have a minimum of two (2) individuals awake and on
duty in the residential board and care home twenty-four (24)
hours a day to meet the care and safety needs of the residents.
8.3.6. The written notice required by Section 8.3.5.4 of
this rule shall contain at a minimum:
8.3.6.1. Notification that the residential board and care
home has a waiver for the provision of nursing care services
which is dependent upon compliance with the terms of Sections
8.3.3 through and including 8.3.9 and 8.3.11 of this rule;
8.3.6.2. Notification that the waiver may be lost for at
least twelve (12) months if the secretary finds that the
residential board and care home has abused, neglected a resident
or has misappropriated a resident's personal funds or property;
8.3.6.3. Notification that, in the event of loss of the
nursing care waiver, the residential board and care home is
required to notify all residents immediately in writing and to
discharge all residents with nursing care or other needs which
exceed the capability of the residential board and care home
within thirty (30) days from the date of notification to the
residential board and care home by the secretary; and
8.3.6.4. The dated signature for the resident acknowledging
receipt of the written notice. A copy or second original of thesigned notice shall be given to the resident and an original
shall be retained in the resident's file at the residential board
and care home.
8.3.7. The registered nurse shall:
8.3.7.1. Complete a written comprehensive assessment form
approved by the secretary for each resident within twenty-four
(24) hours following admission, and annually thereafter, or at
the time of any significant temporary or permanent change in the
resident's condition.
8.3.7.2. Coordinate the development of a written plan of
care with the resident and the attending physician or other
licensed health care professional authorized to develop such
plans of care by applicable State laws and rules, which shall be
signed and dated by the attending physician or other licensed
health care provider. This plan of care shall be completed
within seven (7) days after admission and shall be reviewed by
the registered nurse at least every ninety (90) days or at the
time of a significant temporary or permanent change in condition;
8.3.7.3. Assure that the plan of care is implemented and
that the resident's physical, mental and social well-being are
not compromised;
8.3.7.4. Assure that treatment involving medical management
of a resident is carried out only in accordance with an order
from a physician or other licensed health care provider
authorized by State law and rules to issue the order, and that
the order with the physician's or other licensed health careprovider's signature is placed in the resident's care record;
8.3.7.5. Assure that all verbal orders are recorded in the
resident's care record, signed by the registered nurse, and
countersigned by the physician or other licensed health care
provider who issued the order;
8.3.7.6. Assure that all physician's orders specify the
type, frequency, duration, and dosage for each medication,
treatment or special feeding;
8.3.7.7. Assure that treatment measures are performed only
by qualified staff;
8.3.7.8. Assure that sterile procedures and treatments are
performed only by a licensed registered or practical nurse;
8.3.7.9. Assure that interventions which require the use of
a temporary or permanent feeding tube are performed only by a
licensed nurse under a written physician's order in the
resident's record, which order specifies the name of the product,
the amount and frequency of feedings, the total amount of feeding
and other fluids and the caloric equivalent in twenty-four (24)
hours;
8.3.7.10. Assure that in the event that tube feeding is
used, a record of each feeding, including the time for the
feeding, the amount given, initials of the nurse (identified by
signature elsewhere), and verification that the placement of the
tube has been checked prior to the feeding, and the total amount
of fluid and calories received each twenty-four (24) hours daily;
8.3.7.11. Report suspected abuse, neglect, ormisappropriation of personal funds or property to the State
licensure and certification agency, the State commission on
aging, and the State adult protective services agency (see
Section 6.3.2.14 of this rule). Failure to report is punishable
as a crime under the Code and the secretary may report the
failure to report to the West Virginia Board of Examiners for
Registered Nurses. This requirement does not relieve the
residential board and care home operator, owner, staff or any
other individual of any responsibilities for reporting abuse or
neglect of a resident or misappropriation of a resident's funds
or property;
8.3.7.12. Provide oversight of the care and services
through visits to the residents at least five (5) times a week.
Visits shall be of sufficient duration to perform all required
duties;
8.3.7.13. Be on call at all times or arrange for like
relief coverage by another registered nurse to assure that the
care and needs of the residents are satisfactorily met;
8.3.7.14. Maintain records of each visit;
8.3.7.15. Evaluate each resident's functional capabilities
to assure that each joint is maintained with an optimal range of
motion;
8.3.7.16. Evaluate each resident's medication
administration in accordance with the physician's orders, and
report adverse signs or symptoms related to medications to the
physician immediately;
8.3.7.17. If physical or chemical restraints are used,
evaluate and recommend to the resident's physician alternatives
to maintain the resident at an optimum level of functioning;
8.3.7.18. Institute and monitor compliance with a procedure
for the residential board and care home operator or staff to
report falls or other incidents immediately to the registered
nurse and for notification of the physician and the resident's
family;
8.3.7.19. Assess the severity and cause of the fall or
other incident;
8.3.7.20. Advise the residential board and care home as to
the need to seek emergency assistance related to the fall or
other incident. If the resident has an obvious need for
emergency assistance, the person on duty should call 911, and
then call the registered nurse;
8.3.7.21. Evaluate methods to prevent reoccurrence of such
falls or incidents, make recommendations to the residential board
and care home, and record actions taken in the resident's record,
and, if the actions taken are relevant for other residents, in
the general record required by Section 8.3.8 of this rule;
8.3.7.22. Review training needs of residential board and
care home staff members;
8.3.7.23. Provide needed training or recommend to the
residential board and care home appropriate training for staff;
8.3.7.24. Provide to the residential board and care home a
written record of training provided by the registered nurse toindividuals or groups with an outline of items discussed, date,
time of the session, and signature of individual(s) involved in
the training;
8.3.7.25. Participate with the operator in the hiring of
care givers, including verification that the care giver is not on
the Nurse Aide Abuse Registry maintained by the State licensure
and certification agency;
8.3.7.26. Recommend, in writing, the addition of care
givers necessary to meet the needs of residents; and
8.3.7.27. Evaluate alterations in the physical, mental and
social well-being of residents as potential cases of abuse or
neglect.
8.3.8. The registered nurse shall keep a general record
which shall include at least:
8.3.8.1. The date, time in and time out for each visit;
8.3.8.2. A list of duties performed by the registered nurse
during each visit;
8.3.8.3. A brief statement regarding identified concerns
and recommended actions taken to resolve them;
8.3.8.4. A weekly evaluation of each resident for any signs
of alteration in skin integrity; and
8.3.8.5. Initials for each entry and a complete signature
of the registered nurse at the bottom of each page of the record.
8.3.9. The registered nurse shall enter statements
regarding the following into each resident's individual case
record:
8.3.9.1. The presence or absence of bruises, discoloration,
redness, skin turgor;
8.3.9.2. The specific location of any change in skin color,
turgor or integrity and a detailed description for each area
noted, including the size of the area in centimeters, its
appearance, the presence or absence of drainage, its color and a
plan of treatment; and
8.3.9.3. An evaluation of weekly food and fluid intake, any
changes in eating patterns, and any actions needed and taken as
a result.
8.3.10. The secretary may withdraw a nursing care waiver
for at least twelve (12) months if the secretary determines that:
8.3.10.1. The residential board and care home is admitting
individuals who are in need of nursing care at the time of
admission to the residential board and care home;
8.3.10.2. The residential board and care home has abused or
neglected any resident, or has misappropriated the personal funds
or property of a resident; and
8.3.10.3. Residents are not receiving nursing care suitable
to their needs.
8.3.11. In the event that a waiver is withdrawn, the
secretary shall notify the residential board and care home by
certified mail return receipt requested or by personal delivery.
8.3.12. In the event that a waiver is withdrawn, the
residential board and care home shall:
8.3.12.1. Notify all residents orally of the withdrawal ofthe nursing care waiver within twenty-four (24) hours and in
writing within five (5) days of receipt of the withdrawal notice,
with notification to be acknowledged by the resident's signature
on a copy of the notification retained in the resident's file and
providing a copy of the notice for the resident to retain; and
8.3.12.2. Discharge all residents requiring nursing care
within thirty (30) days of receipt of the withdrawal notice to
the residential board and care home by the secretary.
8.3.13. In the event that a residential board and care home
has been granted a waiver for the provision of nursing care,
compliance with provisions of this rule prohibiting the provision
of nursing care services is not required.
NOTE: The purpose of this bill is to authorize the
Department of Health and Human Resources to promulgate
legislative rules relating to residential board and care homes.
The proposed changes are keyed to the modified proposed
Residential Board and Care Home rule filed with the Secretary of
State on January 27, 1993.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.