c. Equipment shall include an adequate supply of: (1 Wet and dry mops (improvised mops shall be prohibited) (2) Mop pails (3) Radiator brushes (4) Cleaning supplies d. Non-skid floor wax shall be used. e. A vacuum cleaner shall be provided for each home, and kept in good repair. f. All housekeeping equipment and clean ng supplies shall be kept in good condition, maintained in a san'tary manner and stored in suitable storage areas. Such equipment shall not be stored in lavator es, bathrooms or halls or on stairs. g. Wet mops shall be laundered daily. h. Dry mops, if washable, shall be laundered twice a week. i. Dusters and cleaning cloths shall be laundered daily. B. ACCOMMODATIONS AND EQUIPMENT FOR RESIDENTS 1. Floor Area For licenses in existence on the effective date of these regulations, a. Single rooms shall have a minimum of 60 square feet of floor area. b. Multi-bed rooms shall have a minimum of 60 square feet of floor area per adult bed, with at least 3 feet between beds. 2. Floor area For all new licenses issued after the effective date of these regulations, a. Single rooms shall have a minimum of 100 square feet of floor area. b. Multi-bed rooms shall have a minimum of 70 square feet of floor area per adult bed, with a least 3 feet between beds. 3. Quota Increase Any increase in quota granted after the effective date of the se regulations must provide n the room or rooms under consideration: a. 100 square feet of floor area in single rooms. b. 70 square feet of floor area per adult bed, with at least 3 feet between beds in multi-bed rooms. 4. Window Area For new licenses issued after the effective date of these regulations, the minimum window area shall be at least one-eighth of the floor area. 5. Rooms for Residents a. All rooms used for residents shall be outside rooms. b. No room or ward off a kitchen shall be used for resident care unless another acceptable means of entrance is provided. c. A well lighted and ventilated sitting room shall be provided for residents. A reception hall or any facility cannot be used if it blocks an egress. d. Each home with eighteen or more residents in which residents do not have a private room shall have a suitable room which can be used for serious illness pending the transfer of the resident. e. Provision shall be made for the immediate removal of a body from a multi-bed room in the event of death. 6. Equipment a. Beds of household height shall be used and spaced three feet apart Beds shall be arranged so as to avoid drafts, heat from radiators and other discomforts. Cots and folding beds are not permitted. b. Each resident shall be provided with: (1) A comfortable bed, bed spring and mattress, which shall be maintained in a sanitary condition and kept in good repair. The mattress shall be protected by a cover and pad. (2) An adequate number of bed pillows of good quality for each resident, maintained in a sanitary co.. dition and in good repair. (3) An adequate supply of bed linen, bed blankets, bedspreads, towels and washcloths of good quality for each resident, maintained in a sanitary manner and kept in good condition. (4) A bedside table adequate for individual needs, maintained in a sanitary condition and kept in good repair. (5) A comfortable chair suited to individual needs, maintained in a sanitary manner and kept in good repair. 78681 0-62—pt. 4- -4 (6) Footstools according to residents' needs, maintained in a sanitary manner and kept in good repair. (9) Washable window curtains or draperies for all resident bedrooms, kept clean and in good condition. (11) An individual soap dish and bar of soap. (12) Individual sputum receptacles of a sanitary type shall be provided when needed and maintained in a sanitary manner. (13) Sufficient bedpans, urinals, hand wash basins, bath basins and emesis basins for emergency use when (14) A portable screen or other suitable facility when needed to insure resident privacy. c. A standard scale for weighing residents shall be provided. Bathrooms and d. All stairways used by boarders shall be well lighted, and provided with hand rails on both sides. e. Grip bars properly placed shall be in all bathrooms used by residents. f. An adequate number of wastebaskets of a sanitary type shall be provided in each resident's room and sitting room and maintained in a sanitary manner. 7. Adequate facilities and equipment shall be provided for the proper disinfection of: a. Beds b. Bedsprings c. Bed pillows d. Mattresses 8. Adequate storage space shall be provided for the following: a. Residents' towels and washcloths, when not in use. b. Beds, bedsprings, mattresses, bed pillows and blankets. c. Residents' clothing during all seasons of the year, personal effects and valuables. C. MEDICAL SUPERVISION 1. Each resident or his guardian or the agency responsible for his care shall on admission designate the name and address of a physician registered to practice medicine in Massachusetts to be responsible for his medical supervision, including periodic checkups. 2. Each resident on admission shall have a physical examination, including blood pressure, and these findings, with the routine to be carried out, shall be recorded and signed by a physician registered to practice medicine in Massachusetts. 3. No person requiring nursing care shall be admitted to a rest home. 4. No person who develops a need for nursing care shall be cared for in a rest home. Arrangements shall be made for the transfer of such individuals to a suitable facility. (Exception: Care for temporary short-term illness, such as cold or grippe.) 5. No resident shall be transferred or discharged from the home without a dated, recorded, signed statenent of his or her physical condition made by the attending physician at the time of transfer or discharge. 6. All medical and psychiatric consultations shall be dated, recorded and signed by the examining physician at the time of examination. 7. No medication or therapeutic diet shall be given to a resident except on the written order of a physicianregistered to practice medicine in Massachusetts. D. SUPERVISION AND CARE OF MEDICATIONS 1. A medicine cabinet or closet of a type approved by the Department shall be provided for the proper storage of all residents' drugs. 2. The medicine cabinet or closet shall be located in an area that is inaccessible to residents or visitors. 3. The medicine cabinet shall be well lighted, shall have running water easily accessible, and shall be provided with a suitable lock and kept locked at all times. 4. There shall be a separate locked compartment within the locked medicine closet for the proper storage of prescribed narcotics and sedatives. 5. Poisons and medications for external use only shall be kept separate and apart from internal medications in a locked compartment. 6. A responsible person shall be in charge of and administer all medications to residents. 7. Custody of the key to the medicine closet shall be assigned to a responsible person at all times. 8. All medications shall be accurately recorded and accounted for at all times. 9. No medication for a specific resident shall be administered to another resident. 10. Medications shall not be stored in residents' rooms. 11. Medicines shall not be removed from their original containers. 12. Prescription labels shall not be defaced. 13. Medications having a specific expiration date shall not be used after date of expiration. 14. Medicines shall be properly refrigerated when required. 15. Following a resident's transfer or discharge, all drugs prescribed for said resident, if not transferred with the resident, shall be disposed of as follows: a. Narcotics and sedatives shall be destroyed in the home in the presence of the hospital inspector and the fact duly recorded, dated, timed, signed and witnessed in the Narcotic and Sedative Book (Sec. I - 2c) b. All other drugs shall be disposed of as directed by the hospital inspector. 16. Upon the death of a resident, all drugs prescribed for said resident shall be disposed of as follows: a. Narcotics and sedatives shall be destroyed in the home in the presence of the hospital inspector, and the fact duly recorded, dated, timed, signed and witnessed in the Narcotic and Sedative Book. b. All other drugs shall be disposed of immediately as directed by the hospital inspector. 17. The medicine cabinet or closet shall be used exclusively for the storage of medications and equipment required for their administration. This cabinet or closet shall be maintained in a sanitary manner. 18. Rubbing alcohol, when not in use, shall be stored in a locked closet. E. PERSONNEL 1. There shall be at least one person physically and temperamentally qualified who is responsible for the supervision and care of the residents at all times. 2. There shall be sufficient and adequate personnel maintained to provide adequate supervision and care of the residents, and for the satisfactory maintenance of the home at all times. 3. No male individual shall care for female residents. 4. There shall be sufficient personnel maintained for relief and vacation periods. 5. Homes with 18 or more residents shall provide a person for night duty to supervise residents' needs at night. F. SUPERVISION OF CARE INCIDENT TO OLD AGE 1. Health Supervision a. In the event of illness or accident the resident's physician shall be notified immediately. b. Each resident shall have a complete physical examination at least once a year. Special examinations, when indicated, shall be arranged for the care of the residents' eyes, ears and teeth. Ey glasses, hearing aids and dentures shall be provided when indicated by the responsible individuals or agencies. c. Proper arrangements shall be provided for residents reporting to clinics or to a doctor's office. 2. Personal Hygiene The functions to be supervised by the licensee shall include: a. A bath at least twice a week b. A shampoo at least twice a month c. A shave at least twice a week d. A haircut as needed e. The care of feet, hands and nails 3. Clothing Supervision of residents shall insure the following: a. That proper seasonal clothing and footwear are provided and maintained in good condition. b. That proper seasonal clothing and footwear are worn. c. The care of personal laundry, mending and dry cleaning. d. Provision of adequate night attire. 4. Occupational Therapy and Rehabilitation These shall be supervised as prescribed (see Section III). Arrangements shall be made with the Division of the Blind of the Massachusetts Department of Education for provision for occupational therapy and recreational facilities for residents who are blind or have impaired vision. 5. Care During Temporary Illness In the event a resident is temporarily ill, the following shall be provided: a. Adequate equipment for care during temporary short-term illness, kept in good repair and maintained in a sanitary manner. This equipment, when not in use, shall be stored in a manner approved by the Department. b. Tray service if a resident is temporarily ill and unable to go to the dining-room. G. ADMISSIONS 1. Admissions to rest homes are restricted to persons who are ambulatory and who are not in need of nursing care. 2. No rest home shall admit a person suffering from a contagious disease, or a person requiring prenatal or maternity care. 3. No rest home shall admit or care for persons who are suffering from insanity or abnormal mental conditions, or persons who are addicted to the use of narcotics or stimulants. 4. Persons released by and under the supervision of the Department of Mental Health are eligible for admission provided prior approval has been received from the Department of Public Health. 5. No person receiving shock therapy shall be admitted to a rest home. 6. No person shall receive shock therapy in the home. H. RESIDENT TRANSFER OR DISCHARGE 1. No licensee shall arrange for the transfer of a resident from one home to another or for his or her discharge without the written permission of the resident, a responsible individual or relative, or a responsible publicor private agency. 2. The resident shall be examined by a physician prior to transfer or discharge. The physical findings of this examination shall be recorded and signed and dated on the resident's record by the examining physician. 3. A record shall be kept of all drugs transferred with a resident at the time of discharge or transfer. This record shall include: a. Date, name and new address of resident b. Name of resident's physician c. List and amount of medications d. Prescription numbers e. Name of pharmacy that dispensed medications f. Signature of person taking medication from the home g. Witnessed signature of the responsible individual on duty in the home at the time of transfer 1. RECORDS 1. Each home shall provide a suitable area, conveniently located, for the recording and storage of resident records. The following equipment shall be provided: a. Desk or table and chair b. Adequate lighting c. File cabinets for active and inactive records 2. Required record material for each home shall include: a. A standard type bound Resident Register Book for the recording of admissions, transfers, discharges, deaths and other required data b. A bound Doctor's Order Book with a stiff cover and numbered pages c. A bound Narcotic and Sedative Book with a stiff cover and numbered pages d. Heavy cardboard folders and/or file cabinet for filing of individual resident records e. Record forms for all pertinent medical and other data, as required by the Department f. Record form for listing residents' clothing, personal effects and valuables at time of admission 3. All records shall be permanent, either type written or legibly written with pen and ink (no record shall be written with pencil). No erasures or ink eradicator shall be used. No pages shall be removed from bound books. 4. A complete and accurate record shall be maintained for each resident from the time of admission to the time of discharge. This record shall be kept in an individual folder or file and shall include all pertinent medical and other data in chronological order. This record shall be filed in a safe manner and kept in the home for not less than five years following the resident's discharge or death. 5. Resident's record shall include: a. Identification data Date and time of admission; resident's name, previous address, age, sex, color, race, marital status (married, single, divorced or widowed) and religion; name and address of referring physician or hospital; name and address of attending physician; name, address and telephone number of person or agency responsible for resident. b. Medical records (1) A statement of the resident's physical condition and diagnosis at the time of admission, transfer or discharge, dated and signed by the attending physician, shall be incorporated in the resident's record within twenty-four hours after admission and prior to transfer or discharge. (2) All doctors' visits and orders for treatments and diet during period of temporary illness shall be dated, recorded and signed in the Doctor's Order Book by the attending physician. (3) Residents shall be examined at least annually and said physical examination shall be dated, recorded and signed by the attending physician and incorporated in the resident's record. (4) All medical and psychiatric consultations shall be dated, recorded and signed by the examining physician and incorporated in the resident's record. (5) A record shall be kept of all accidents occurring to residents in the home including the date and time of accident, physical findings and treatment prescribed. This record shall be signed by the attending physician and incorporated in the resident's record. c. Residents' individual records (1) Admission data How admitted referred by whom and accompanied by whom, date and time (2) Description of resident's condition upon admission, including weight, recorded and signed by admitting personnel. (3) Date, time, dosage and method of administration of any medications administered during period of temporary illness. (4) The person administering medications shall record and sign them on the residents' record. (5) All pertinent data relating to residents shall be recorded on the weekly resident's record and signed by the individual responsible for resident supervision. Weight shall be recorded monthly. (6) A list of the resident's clothing, personal effects and valuables shall be entered at time of admission on a form, dated and signed by the resident or responsible person and witnessed. shall be given to the resident or other responsible person. (7) Discharge or transfer data (a) Date and time of discharge or transfer (b) Reason for discharge or transfer (c) Condition of resident at time of discharge or transfer (d) Address to which discharged or transferred (e) Accompanied by whom A copy of this list (8) An individual narcotic and sedative record shall be maintained for each narcotic or sedative prescribed for each resident during period of temporary illness. This record shall be kept in the Narcotic and and Sedative Book in a manner approved by the Department and shall include: (a) Resident's name (b) Name of physician prescribing the medication (c) Name of medication, strength of dosage prescribed (d) Amount of medication received (e) Date medication received, prescription number, name of pharmacy dispensing medication (f) Date, time, dosage and method of administration of medication (g) Signature of person administering medication (f) There shall be a recorded, dated narcotic and sedative count checked daily and signed by the responsible person in charge. J. RESPONSIBILITIES OF THE LICENSEE 1. To insure humane understanding care of the residents. Their personal and spiritual rights and privileges shall be respected at all times by all employees. |