North Carolina nursing home responsiveness requirements

NC expressly incorporates 42 CFR 483.12 by reference and adds state duties: the administrator, DHSR Complaint Intake and adult protective services must all be notified of abuse/neglect/exploitation allegations within the federal timeframes; facility-property misappropriation, drug diversion and fraud must be reported to DHSR within 24 hours; and a written investigation report with seven specified elements must reach DHSR within five working days.

Nursing homes shall comply with 42 CFR 483.12, which is incorporated by reference, including subsequent amendments. ... A facility shall ensure that the administrator of the facility, the Division of Health Service Regulation, Complaint Intake and Health Care Investigation Section, and adult protective services are notified about all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of an unknown source and misappropriation of patient property within the time periods for notification specified in 42 CFR 483.12.

A separate statewide rule requires every health care facility to report any allegation against health care personnel, including injuries of unknown source, to DHSR within 24 hours of becoming aware of it - a state clock that runs alongside the federal 2-hour/24-hour deadlines.

The reporting by health care facilities to the Department of all allegations against health care personnel as defined in G.S. 131E-256 (a)(1), including injuries of unknown source, shall be done within 24 hours of the health care facility becoming aware of the allegation. The results of the health care facility's investigation shall be submitted to the Department in accordance with G.S. 131E-256(g).

By statute, health care facilities must notify DHHS of all allegations against health care personnel including injuries of unknown source, must protect residents during the investigation, and must report investigation results within five working days of the initial notification.

Health care facilities shall ensure that the Department is notified of all allegations against health care personnel, including injuries of unknown source, which appear to be related to any act listed in subdivision (a)(1) of this section. Facilities must have evidence that all alleged acts are investigated and must make every effort to protect residents from harm while the investigation is in progress. The results of all investigations must be reported to the Department within five working days of the initial notification to the Department.

North Carolina's universal mandatory-reporter statute: any person with reasonable cause to believe a disabled adult needs protective services must report to the county department of social services director, with immunity for good-faith reports; the statute itself states no deadline.

Any person having reasonable cause to believe that a disabled adult is in need of protective services shall report such information to the director.

The facility must ensure each patient's care is physician-supervised and must arrange emergency physician coverage when the attending physician is unavailable, with the designated physicians' names and telephone numbers posted at every nurse's station.

A facility shall ensure each patient's care is supervised by a physician and that provisions are made for emergency physicians when attending physicians are unavailable. The names and telephone numbers of the designated physicians shall be posted at each nurse's station.

Every nursing home must have at least one licensed nurse on duty for direct patient care at all times and a registered nurse on duty at least eight consecutive hours a day, seven days a week.

daily direct patient care nursing staff, licensed and unlicensed, shall include: (1) at least one licensed nurse on duty for direct patient care at all times; and (2) a registered nurse for at least eight consecutive hours a day, seven days a week.

Nursing staff must evaluate any acute change in a patient's physical, mental or psychosocial status and report it to the physician or other legally authorized prescriber - the closest NC analog to a duty to reach a physician, though it sets no telephone-response deadline.

Acute changes in the patient's physical, mental, or psychosocial status shall be evaluated and reported to the physician or other persons legally authorized to perform medical acts.

Every nursing home patient has a statutory right to communicate privately and without restriction at any reasonable hour, including access at any reasonable hour to a telephone where the patient may speak privately, and to send and receive mail unopened.

To associate and communicate privately and without restriction with persons and groups of the patient's choice on the patient's initiative or that of the persons or groups at any reasonable hour; to send and receive mail promptly and unopened, unless the patient is unable to open and read personal mail; to have access at any reasonable hour to a telephone where the patient may speak privately; and to have access to writing instruments, stationery, and postage;

Every nursing home patient has a statutory right to receive a reasonable response to all requests from the administrator or facility staff - the state's general responsiveness duty.

To receive from the administrator or staff of the facility a reasonable response to all requests;

As a physical-plant requirement, each facility must provide at least one telephone accessible to patients, residents and families for local calls, plus cordless phones or telephone jacks in patient and resident rooms so residents can reach a phone when needed.

A facility shall provide: (1) at least one telephone located to be accessible by patients, residents, and families for making local phone calls; and (2) cordless telephones or telephone jacks in patient and resident rooms to allow access to a telephone by patients and residents when needed.

The licensure rule itself makes the statutory Nursing Home Patients' Bill of Rights (G.S. 131E-115 through 131E-127) directly enforceable against the facility as a condition of licensure.

The facility shall enforce the Nursing Facility Patient's Bill of Rights as described in G.S. 131E-115 through G.S. 131E-127.

Facilities must maintain detailed written emergency and disaster plans covering fire, severe weather and missing patients, make them available to local or regional emergency management offices, train all employees on admission and annually, and run unannounced drills.

The facility shall have detailed written plans and procedures to meet potential emergencies and disasters, including fire, severe weather, and missing patients or residents. The plans and procedures shall be made available upon request to local or regional emergency management offices.

A facility must notify the DHSR Nursing Home Licensure and Certification Section within one working day of a change in administrator, director of nursing, or facility mailing address or telephone number, and must notify the Section before moving patients in an emergency requiring relocation (or as soon as possible if advance notice is not feasible) - NC's closest analog to keeping emergency contact information current with the state.

The facility shall notify the Nursing Home Licensure and Certification Section of the Division of Health Service Regulation of emergencies or situations requiring relocation of patients to a temporary location away from the facility before patients are moved, unless doing so is not reasonably possible. If not possible, the facility shall notify the Section as soon as possible under the circumstances.

Each patient room must have at least one calling station and each bed a call button; calls must register with floor staff and light a visible signal in the corridor at the patient's door, with additional signals at corridor intersections on multi-corridor units, and an emergency call button at every patient toilet, bath and shower.

In general patient areas of a facility, each room shall be served by al least one calling station and each bed shall be provided with a call button. ... Calls shall register with the floor staff and shall activate a visible signal in the corridor at the patient's or resident's door. ... A nurses' call emergency button shall be provided for patients' and residents' use at each patient and resident toilet, bath, and shower.

The administrator must establish a quality assessment and assurance committee comprising the director of nursing, a facility-designated physician, a pharmacist and at least three other staff; it must meet at least quarterly and must develop and implement corrective plans of action for identified quality-of-care problems.

Administrators shall establish a quality assessment and assurance committee that consists of the director of nursing, a physician designated by the facility, a pharmacist, and at least three other staff members. (b) The committee shall meet at least quarterly. (c) The committee shall develop and implement appropriate plans of action which will correct identified quality care problems.