Competency Requirements for Nursing Home Staff

Nursing Homes Must Demonstrate Competency in Skills and Techniques
Nursing Homes Must Demonstrate Competency in Skills and Techniques

Nursing Homes Must Demonstrate Competency in Skills and Techniques

Pursuant to Minnesota Administrative Rule 4658.0105, a nursing home must ensure that direct care staff are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through the comprehensive resident assessments and described in the comprehensive plan of care, and are able to perform their assigned duties.

Additional Federal Competency Regulations

Pursuant to federal regulations including 42 CFR § 483.151, state review and approval of nurse aide training and evaluation programs.

(a) State review and administration. (1) The State—

(i) Must specify any nurse aide training and evaluation programs that the State approves as meeting the requirements of §483.152 and/or competency evaluations programs that the State approves as meeting the requirements of §483.154; and

(ii) May choose to offer a nurse aide training and competency evaluation program that meets the requirements of §483.152 and/or a competency evaluation program that meets the requirements of §483.154.

(2) If the State does not choose to offer a nurse aide training and competency evaluation program or competency evaluation program, the State must review and approve or disapprove nurse aide training and competency evaluation programs and nurse aide competency evaluation programs upon request.

(3) The State survey agency must in the course of all surveys, determine whether the nurse aide training and competency evaluation requirements of §§483.35(c) and (d) and 483.95(g) are met.

The nursing home staff needs to be also trained on Survey protocols and Interpretive Guidelines are established to provide guidance to personnel conducting surveys.  They serve to clarify and/or explain the intent of the regulations and all surveyors are required to use them in assessing compliance with Federal requirements. The purpose of the protocols and guidelines is to direct the surveyor’s attention to certain avenues for investigation in preparation for the survey, in conducting the survey, and in evaluation of the survey findings.

The nursing home survey is conducted in accordance with the appropriate protocols (Appendix P) and substantive requirements in the statute and regulations to determine whether a citation of non-compliance is appropriate.

Deficiencies are based on a violation of the statute or regulations, which, in turn, is to be based on observations of the nursing home’s performance or practices.

The Interpretive Guidelines (Appendix P and PP) include three parts:

The first part contains the survey tag number.

The second part contains the wording of the regulation.

The third part contains guidance to surveyors, including additional survey procedures and probes.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home skills and techniques requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore@ MNnursinghomeneglect.com.

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Orientation of Nursing Home Employees in Minnesota

Nursing Home Orientation and Training Requirements
Nursing Home Orientation and Training Requirements

Required Nursing Home Employee Orientation

Pursuant to Minnesota Administrative Rule 4658.0100 EMPLOYEE ORIENTATION AND IN-SERVICE EDUCATION, Subpart 1. Orientation and initial training. All personnel must be instructed in the requirements of the law and the rules pertaining to their respective duties and the instruction must be documented. All personnel must be informed of the policies of the nursing home, and procedure manuals must be readily available to guide them in the performance of their duties.

Subp. 2. In-service education. A nursing home must provide in-service education. The in-service education must be sufficient to ensure the continuing competence of employees, must address areas identified by the quality assessment and assurance committee, and must address the special needs of residents as determined by the nursing home staff. A nursing home must provide an in-service training program in rehabilitation for all nursing personnel to promote ambulation; aid in activities of daily living; assist in activities, self-help, maintenance of range of motion, and proper chair and bed positioning; and in the prevention or reduction of incontinence.

Subp. 3. Reference materials. Textbooks, periodicals, dictionaries, and other reference materials must be available and kept current. A nursing home must review the currency of these reference materials at least annually.

Coordination of Orientation and In-Service Education

Subp. 4. Coordination of in-service education programs. In a nursing home with over 90 beds, one person must be designated as responsible for coordination of all in-service education programs.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home employee orientation and traning requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Minnesota Change in Condition Rules in Nursing Homes

Required Notifications for Change in Health Status for Nursing Home Residents
Required Notifications for Change in Health Status for Nursing Home Residents

Nursing Home Rules Pertaining to Change in Resident Health

Pursuant to Minnesota Administrative Rules 4658.0085 NOTIFICATION OF CHANGE IN RESIDENT HEALTH STATUS, a nursing home must develop and implement policies to guide staff decisions to consult physicians, physician assistants, and nurse practitioners, and if known, notify the resident’s legal representative or an interested family member of a resident’s acute illness, serious accident, or death. At a minimum, the director of nursing services, and the medical director or an attending physician must be involved in the development of these policies. The policies must have criteria which address at least the appropriate notification times for:

A. an accident involving the resident which results in injury and has the potential for requiring physician intervention;

B. a significant change in the resident’s physical, mental, or psychosocial status, for example, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications;

C. a need to alter treatment significantly, for example, a need to discontinue an existing form of treatment due to adverse consequences, or to begin a new form of treatment;

D. a decision to transfer or discharge the resident from the nursing home; or

E. expected and unexpected resident deaths.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home licensing requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Licensee Requirements for Operators of Nursing Homes

Nursing Home Licensee Rules and Requirements
Nursing Home Licensee Rules and Requirements

Nursing Home Licensee Requirements

Pursuant to Minnesota Administrative Rules, 4658.0050 LICENSEE. Subpart 1. General duties. The licensee of a nursing home is responsible for its management, control, and operation. A nursing home must be managed, controlled, and operated in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

Subp. 2. Specific duties. The licensee must develop written bylaws or policies for the management and operation of the nursing home and for the provision of resident care, which must be available to all members of the governing body, and must assume legal responsibility for matters under its control, for the quality of care rendered and for compliance with laws and rules relating to the safety and sanitation of nursing homes, or which otherwise relate directly to the health, welfare, and care of residents.

Responsibilities for Minnesota Nursing Home Licensee

Subp. 3. Responsibilities. A licensee is responsible for the duties in items A to F.

A. Full disclosure of each person having an interest of ten percent or more of the ownership of the home to the department with any change reported in writing within 14 days after the licensee knew of or should have known of the transfer, whichever occurs first. In case of corporate ownership, the name and address of each officer and director must be specified. If the home is organized as a partnership, the name and address of each partner must be furnished. In the case of a home operated by a lessee, the persons or business entities having an interest in the lessee organization must be reported and an executed copy of the lease agreement furnished. If the home is operated by the holder of a franchise, disclosure must be made as to the franchise holder who must also furnish an executed copy of the franchise agreement.

B. Appointment of a licensed nursing home administrator who is responsible for the operation of the home in accordance with law and established policies and whose authority to serve as administrator is delegated in writing.

C. Notification of the termination of service of the administrator and the appointment of a replacement within five working days in writing to the department. If a licensed nursing home administrator is not available to assume the position immediately, notification to the department must include the name of the person temporarily in charge of the home. The governing body of a nursing home must not employ an individual as the permanent administrator until it is determined that the individual qualifies for licensure as a nursing home administrator in Minnesota under Minnesota Statutes, section 144A.04. The governing body of the nursing home must not employ an individual as an acting administrator or person temporarily in charge for more than 30 days unless that individual has secured an acting administrator license, as required by Minnesota Statutes, section 144A.27.

D. Provision of an adequate and competent staff and maintenance of professional standards in the care of residents and operation of the nursing home.

E. Provision of facilities, equipment, and supplies for care consistent with the needs of the residents.

F. Provision of evidence of adequate financing, proper administration of funds, and the maintenance of required statistics. A nursing home must have financial resources at the time of initial licensure to permit full service operation of the nursing home for six months without regard to income from resident fees.

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about Minnesota nursing home licensee requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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Violation Rules for Minnesota Nursing Homes

Rules for Violation of Nursing Home Regulations
Rules for Violation of Nursing Home Regulations

Regulations for Violation of Minnesota Nursing Homes

Pursuant to Minnesota Administrative Rule 4658.0045 PENALTIES FOR LICENSING RULE VIOLATIONS, penalty assessments will be assessed on a daily basis for violations of parts 4658.0010 to 4658.0035 and are as follows:

Rules Setting Forth When Violation of Minnesota Regulations for Nursing Homes

A. part 4658.0020, subparts 1, 2, and 3, $250;

B. part 4658.0020, subparts 4 and 5, $50;

C. part 4658.0025, $250;

D. part 4658.0030, $100; and

E. part 4658.0035, $100.

Federal requirements specify that each NF must provide, (and residents may not be charged for), at least:

Nursing and Pharmaceutical services (with assurance of accurate acquiring, receiving, dispensing, and administering of drugs and biologicals)

Dietary services individualized to the needs of each resident

Professionally directed program of activities to meet the interests and needs d related services

Specialized rehabilitative services (treatment and services required by residents with mental illness or intellectual disability, not provided or arranged for by the state)

Medically-related social servicesfor well being of each resident

Emergency dental services (and routine dental services to the extent covered under the state plan)

Room and bed maintenance services

Routine personal hygiene items and services

Residents may be charged for:

Private room, unless medically needed

Specially prepared food, beyond that generally prepared by the facility

Telephone, television, radio

Personal comfort items including tobacco products and confections

Cosmetic and grooming items and services in excess of those included in the basic service

Personal clothing

Personal reading materials

Gifts purchased on behalf of a resident

Flowers and plants

Social events and activities beyond the activity program

Special care services not included in the facility’s Medicaid payment

Common areas of cases I see include:  Falls from Beds, Hoyer Lifts and in the Bathroom; Sexual Abuse; Medication Errors and Others.  STOP ELDER ABUSE AND NEGLECT!

For more information about nursing home licensing violation requirements or other questions about elder abuse and neglect contact Nursing Home Neglect Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore @ MNnursinghomeneglect.com.

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