Rhode Island nursing home responsiveness requirements

Any physician, PA, nurse or other facility employee with reasonable cause to believe a resident was abused, exploited, mistreated or neglected, or has an injury of unknown origin, must report within 24 hours to BOTH the licensing agency and the Office of the State Long-Term Care Ombudsman.

Any physician, physician assistant, nurse or other employee of a nursing facility who has reasonable cause to believe that a resident has been abused, exploited, mistreated, neglected or experiences an injury of unknown origin, as outlined in R.I. Gen. Laws Chapter 23-17.8 shall make, within twenty-four (24) hours of the receipt of said information, a report to the licensing agency and to the office of the State long-term care ombudsman.

The state rule expressly adopts the federal clock: 2 hours for allegations involving abuse or serious bodily injury, 24 hours for all other allegations including injuries of unknown source and misappropriation of resident property.

Report all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property; immediately, but not later than two (2) hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than twenty-four (24) hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury (in accordance with 42 C.F.R. § 483.12(c)(1)).

The governing statute requires a telephone report within 24 hours or by the end of the next business day to the Director of Health and, for nursing facilities, also to the State Long-Term Care Ombudsperson, with a written follow-up within 3 business days; reporting to a facility high managerial agent discharges the individual reporter but transfers the same deadline to that agent.

shall make, within twenty-four (24) hours or by the end of the next business day, a telephone report to the director of the department of health, or his or her designee, for those incidents involving healthcare facilities, and in addition to the office of the state long-term care ombudsperson for those incidents involving nursing facilities

Every nursing facility must provide or arrange for physician services 24 hours a day in an emergency, and must keep written emergency medical care policies including a list of physician coverage in each residential area.

Written policies and procedures pertaining to emergency medical care including a listing of physician coverage, shall be established and maintained in each residential area. The nursing facility must provide or arrange for physician's services twenty-four (24) hours a day in case of an emergency.

The facility's medical care supervision policies must require that arrangements be made for physician coverage whenever the attending physician is absent.

That arrangements be made for physician coverage in the absence of the attending physician; and, and progress notes be written and signed by the physician at the time of each visit.

Rhode Island exceeds the federal 8-hour standard: a registered nurse must be physically on the premises 24 hours a day, with enough additional licensed and unlicensed nursing personnel on a 24-hour basis to assess residents, carry out care plans and deliver direct care.

Each facility shall have a registered nurse on the premises twenty-four (24) hours a day. In addition, the necessary nursing service personnel (licensed and non-licensed) shall be in sufficient numbers on a twenty-four (24) hour basis, to assess the needs of resident, to develop and implement resident care plans, to provide direct resident care services, and to perform other related activities to maintain the health, safety and welfare of residents.

At least two people certified in Basic Life Support, one of whom must be a licensed nurse, must be available inside the facility 24 hours a day.

At least two (2) individuals who are certified in Basic Life Support must be available twenty-four (24) hours a day within the nursing facility. One (1) of these individuals must be a licensed nurse.

Residents may associate and communicate privately with anyone they choose and must be allowed freedom and privacy in sending and receiving mail.

Residents may associate and communicate privately with persons of their choice and shall be allowed freedom and privacy in sending and receiving mail.

Every residential area of the facility must have, at minimum, a telephone or cell phone with an outside line.

A telephone or a cell phone with outside line.

The facility must respond in a reasonable manner to a resident's physician's, nurse practitioner's or physician assistant's request for medical services, and to the resident's own requests for other customary services.

The nursing facility shall respond in a reasonable manner to the request of a resident's physician, certified nurse practitioner and/or a physician assistant for medical services to the resident.

Statutory counterpart to the private-communication right: nursing home patients may associate and communicate privately with persons of their choice and have freedom and privacy in sending and receiving mail.

Patients may associate and communicate privately with persons of their choice and shall be allowed freedom and privacy in sending and receiving mail.

The required written Emergency Operations Plan / Continuity of Operations Plan must contain procedures for notifying appropriate persons inside and outside the facility (including local authorities) and for the location and use of alarm systems and signals.

Notification of appropriate persons inside and outside the operation of the home (i.e., local authorities);

Each facility must establish and keep current a facility-specific e-mail address on file with the licensing agency for reaching a high managerial agent with routine communications and emergency notices, and must notify the agency whenever it changes.

Each nursing facility shall establish and maintain a health care facility specific electronic mail address (i.e., e-mail address) to be provided to the licensing agency for the purposes of contacting a high managerial agent for the nursing facility with both routine communications and emergency notices.

Every residential area must have an electrically activated resident call system operable from each resident's bedside and from all resident-used areas including toilets and bathing rooms, capable of alerting on-duty staff 24 hours a day wherever they are stationed, and capable of placing calls both inside and outside the facility.

In addition, each residential area shall be equipped with a communication system which, as a minimum, shall be: 1. Electrically activated; 2. Operated from the bedside of each occupant and from all areas used by occupants, including multipurpose rooms, toilet and bathing facilities; 3. Capable of alerting the responsible person or persons on duty twenty-four (24) hours a day, wherever their station may be; and 4. Capable of providing for calls both internal and external to the nursing facility.

For the optional resident-directed home model, wired call systems and overhead paging are prohibited; the home must instead use a wireless notification system that escalates and re-sends an unanswered signal to other staff.

Utilize a wireless communication and notification system that shall provide for escalation of response if a signal is unanswered for a designated period of time. The signal shall be repeated and sent to other staff who were not designated to receive the original signal.

Each licensed nursing facility must run a facility-wide written quality improvement program with a quality improvement committee that includes the administrator, director of nursing, medical director, a social worker and a dietary representative, meets at least quarterly, keeps records available to surveyors, and drives documented remedial action.

Pursuant to R.I. Gen. Laws § 23-17-12.11, each licensed nursing facility shall develop and implement a quality improvement program and establish a quality improvement committee. The governing body shall ensure that this program is effective, ongoing, nursing facility-wide and shall have a written plan of implementation.

Nursing facilities must additionally meet the RIDOH Health Care Quality Program rules at 216-RICR-10-10-7.

All nursing facilities licensed under R.I. Gen. Laws Chapter 23-17 shall meet all applicable requirements of Part 10-10-7 of this Title, Health Care Quality Program, promulgated by the licensing agency.