105 1 goals, consistency of management methods with the 2 3 goals, and the achievement of progress toward the goals. "(h) Special attention shall be given those residents who, without active intervention, are at risk of further loss 5 of function, by means that include— 4 6 7 8 9 10 11 121 13 15 16 "(1) early diagnosis of disease; "(2) prompt treatment in the early stages of disease; "(3) limitation of disability by arresting the dis ease process; and "(4) prevention of complications and sequelae; "(5) rehabilitation services to raise the affected individual to his greatest possible level of function, in spite of his handicap, by maximizing the use of his remaining capabilities. 17 "(i) Preventive health services to residents shall "(1) means for the prompt detection and referral of health problems, through adequate medical surveil- "(2) annual physical examinations, that include- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 106 tions, as determined by the physician, and special studies when the index of suspicion is high; "(3) maintenance of a graphic record of height and weight for each resident, in a form that permits ready reference to standardized norms; "(4) immunizations, using as a guide the recommendations of the United States Public Health Service Advisory Committee on Immunization Practices and of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics; "(5) tuberculosis control, in accordance with the recommendations of the American College of Chest Physicians and/or the section on diseases of the chest of the American Academy of Pediatrics, as appropriate to the facility's population; and "(6) reporting of communicable diseases and infections in accordance with law. "(j) Preventive health services to staff shall include— "(1) preemployment physical examinations; and "(2) surveys for the detection and prevention of communicable diseases. "(k) There shall be a formal arrangement for qualified 23 medical care for the facility, including care for medical 24 emergencies on a twenty-four-hour, seven-days-a-week basis. 25 A physician, fully licensed to practice medicine in the State 107 1 in which the facility is located, shall be designated to be 2 responsible for 3 4 5 6 7 8 "(1) maintaining standards of professional and ethical practice in the rendering of medical services in the facility; and "(2) maintaining the general health conditions and practices of the facility and/or system of health services. 9 Each resident shall have a personal (primary) physician, 10 who maintains familiarity with his state of health and with 11 conditions within the residential living unit that bear on his 12 health. Qualified medical specialists of recognized profes13 sional ability shall be 14 15 16 17 "(1) available for a broad range of specialized care and consultation; and "(2) appropriately used. "(1) Appropriate to the size of the facility, an ongoing 18 inservice training program shall be conducted that is de19 signed to maintain and improve the medical skills of its phy20 sicians and their knowledge of developmental disabilities, 21 through methods such as staff seminars, outside speakers, 22 attendance at professional medical meetings, and informational exchanges with universities and teaching hospitals. 23 24 "(m) There shall be adequate space, facilities, and 108 1 equipment to fulfill the professional, educational, and ad 2 ministrative needs of the medical service. 3 4 "Subchapter VII-Nursing Services "SEC. 1168. (a) Residents shall be provided with nurs 5 ing services, in accordance with their needs, in order to 6 7 8 9 10 11 12 "(1) develop and maintain an environment that will meet their total health needs; "(2) foster optimal health; 66 (3) encourage maximum self-care and independ ence; and "(4) provide skilled nursing care as needed. "(b) There shall be a written statement of nursing phi13 losophy and objectives that are consistent with the purpose 14 of the facility and that given direction to the nursing pro15 gram. Nursing personnel shall be responsible for the formu16 lation, review, and revision of the philosophy and objectives. 17 The philosophy and objectives shall be "(1) distributed to all nursing personnel; and "(2) made available and interpreted to all other personnel. "(c) Nursing services should be provided through— "(1) direct nursing intervention; "(2) instruction and supervision of facility staff rendering nursing care; "(3) supporting, counseling, and teaching the resi 109 1 2 3 4 5 6 7 dent, his family, and his direct-care staff, at the facility or in the home; "(4) consultation and followthrough in the interest of the resident; and "(5) participation on appropriate facility committees. "(d) Nursing services to residents shall include, when 8 appropriate 9 10 11 "(1) professional nurse participation in plan; “(A) the preadmission evaluation study and "(B) the evaluation study, program design, and placement of the resident at the time of admission to the facility; "(C) the periodic reevaluation of the type, ex tent, and quality of services and programing; "(D) the development of discharge plans; resources; "(2) services directed toward the promotion of health, including "(A) observation and assessment of the developmental function of the resident, within his environment; "(B) training in habits of personal hygiene; |