District of Columbia nursing home responsiveness requirements

Every incident must be documented in the resident's record and reported to the licensing agency within 48 hours, except that incidents and accidents resulting in harm to a resident must be reported to the licensing agency within 8 hours.

3232.4 Each incident shall be documented in the resident's record and reported to the licensing agency within forty-eight (48) hours of occurrence, except that incidents and accidents that result in harm to a resident shall be reported to the licensing agency within eight (8) hours of occurrence.

Abuse or neglect resulting in resident injury, or misappropriation of a resident's funds, must be reported immediately to four separate bodies: the Department of Health, the Metropolitan Police Department, the Long-Term Care Ombudsman, and Adult Protective Services.

3232.5 Incidents of abuse or neglect resulting in injury to a resident, or incidents of misappropriation of a resident's funds, shall be reported immediately to the appropriate agencies, including the Department of Health, the Metropolitan Police Department, the Long-Term Care Ombudsman and Adult Protective Services.

DC's Adult Protective Services statute makes health-care administrators and licensed health professionals mandated reporters who must immediately report a substantial-cause belief that an adult needs protective services because of abuse, neglect, or exploitation by another.

whenever a conservator, court-appointed mental retardation advocate, guardian, health-care administrator, licensed health professional, police officer, ... has as a result of his or her appointment, employment, or practice substantial cause to believe that an adult is in need of protective services because of abuse, neglect, or exploitation by another, he or she shall immediately report this belief in accordance with subsection (c) of this section.

The facility's Medical Director must arrange for medical care to be available twenty-four hours a day, must assist the Administrator in arranging continuous 24-hour physician services for medical emergencies, and an on-call schedule with each physician's name and telephone number must be kept at every nursing station.

3207.9 The Medical Director shall make arrangements for the provision of medical care twenty-four (24) hours a day.

A DC-specific duty with no federal counterpart: before calling 911 the facility must obtain a medical order from the resident's attending physician, the medical director, an on-staff physician, or an advanced practice registered nurse, unless immediate hospital transfer is required, and must document in the record why a prior order was not practicable.

3207.15 Each facility shall obtain a medical order from a resident's attending physician, the facility's medical director, an on-staff physician, or an advance practice registered nurse prior to calling 911 for emergency medical assistance, except that a prior medical order shall not be required if it is determined that there is a situation that requires an immediate transfer to a hospital.

DC exceeds the federal 8-hours-a-day RN rule: every nursing facility must have at least one registered nurse on duty 24 hours a day, 7 days a week, 24-hour licensed nursing staff sufficient for all residents, a charge nurse (RN or LPN) on each unit at all times, and at least two nursing employees per unit per shift.

3211.2 Each facility shall have at least the following employees: (a) At least one (1) registered nurse on a twenty-four (24) hour basis, seven (7) days a week;

A charge nurse must be employed on each unit twenty-four hours a day, and when that charge nurse is an LPN he or she must have ready access to consultation with a registered nurse (the closest DC analog to a duty that an RN be reachable by phone).

3210.1 Each facility shall employ a charge nurse on each unit twenty-four (24) hours a day. ... 3210.3 When a licensed practical nurse serves as a charge nurse, he or she shall have ready access to consultation with a registered nurse.

Each facility must have a physician, physician assistant, or advanced practice registered nurse available on-site at least 0.2 hours per week per resident, excluding hours attributable to medical director duties.

3211.4 Beginning January 1, 2011, each facility shall have either a physician, physician assistant, or an advanced practice registered nurse, excluding hours per week attributed to medical director duties, available on-site for a minimum of two tenths (0.2) hours per week for each resident at the facility.

The facility must make a semiprivate space where a telephone can be used accessible to residents and must provide at least one amplified telephone for resident use; newly built facilities must also install telephone jacks in each resident bedroom.

3249.14 The facility shall make accessible to residents a semiprivate space where a telephone can be used. 3249.15 At least one (1) telephone equipped with an amplifier shall be available to residents.

Every nursing facility resident has the right to associate and communicate privately with persons of the resident's choice unless medically contraindicated, and to send and receive personal mail unopened by facility personnel.

(f) To associate and communicate privately with persons of the resident's choice, unless medically contraindicated;

The facility's fire and emergency instructions manual must specify the plan to be followed in a fire, explosion, or other emergency and must identify the persons to be notified, evacuation routes and procedures, and per-shift task assignments; plans must be posted conspicuously on each floor (§ 3259.5).

3259.2 The fire instructions manual shall specify the following: (a) The plan to be followed in case of fire, explosion, or other emergency; (b) The persons to be notified;

The facility must maintain written resident-care policies covering emergency care, fire and disaster preparedness, and resident emergency and non-emergency transportation, reviewed at least annually by a committee including the Medical Director and Director of Nursing.

3206.1 There shall be written policies to govern nursing care and related medical and other services provided, including written policies on: ... (c) Emergency care; ... (n) Fire and disaster preparedness; (o) Resident emergency and non-emergency transportation;

A resident call system must be provided that is accessible to every resident and signals from each bed, toilet, bath/shower and other resident rooms; in new or majorly renovated facilities the call may be terminated only in the resident's own room; and it must be kept in good working order at all times.

3245.10 A call system that meets the following requirements shall be provided: (a) Be accessible to each resident, indicating signals from each bed location, toilet room, and bath or shower room and other rooms used by residents; (b) In new facilities or when major renovations are made to existing facilities, be of a type in which the call can be terminated only in the resident's room; (c) Be of a quality which is, at the time of installation, consistent with current technology; and (d) Be in good working order at all times.

A connection to the nurses call system must be provided in every toilet, tub and shower stall and in every toilet or wash room used by a resident.

3247.9 Connection to the nurses call system shall be provided in each toilet, tub, and shower stall and in each toilet room or wash room that is used by a resident.

Sufficient nursing time must be given to each resident to ensure, among other things, prompt response to an activated call bell or call for help - making call-light response a staffing duty, not just an equipment requirement.

(j) Prompt response to an activated call bell or call for help.

DC has no free-standing QAPI rule of its own; instead § 3200.1 expressly incorporates 42 C.F.R. Part 483, Subpart B, §§ 483.1 to 483.75 (which contains the federal QAPI rule at 483.75) as District licensing standards, so a federal QAPI deficiency is directly a DC licensure violation.

3200.1 Each nursing facility shall comply with the Act, these rules and the requirements of 42 C.F.R. Part 483, Subpart B, Sections 483.1 to 483.75; Subpart D, Sections 483.150 to 483.158; and Subpart E, section 483.200 to 483.206, all of which shall constitute licensing standards for nursing facilities in the District of Columbia.

The only quality-assurance plan DC writes itself is narrow: a facility operating a ventilator unit must have a DOH-approved plan of operation containing a quality assurance plan that assigns monitoring responsibility, identifies clinical indicators, and sets thresholds triggering evaluation of care - it does NOT apply facility-wide.

(d) A quality assurance plan which shall include: (1) Assignment of responsibility for monitoring and evaluation activities; (2) Identification of indicators and appropriate clinical critical criteria for monitoring the most important aspects; and (3) Establishment of thresholds (levels or trends) for the indicators that will trigger evaluation of care;