reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2846 - MEDICATIONS: STORAGE AND DISPOSAL

Current through Register Vol. 13, July 5, 2024
(1) With
				the exception of resident medication organizers as discussed in ARM
				37.106.2848, all medication must
				be stored in the container dispensed by the pharmacy or in the container in
				which it was purchased in the case of over-the-counter medication, with the
				label intact and clearly legible.
(2) Medications that require refrigeration
				must be segregated from food items and stored within the temperature range
				specified by the manufacturer.
(3)
				All medications administered by the facility shall be stored in locked
				containers in a secured environment such as a medication room or medication
				cart. Residents who are responsible for their own medication administration
				must be provided with a secure storage place within their room for their
				medications. If the resident is in a private room, locking the door when the
				resident leaves will suffice.
(4)
				Over-the-counter medications or home remedies requested by the resident shall
				be reviewed by the resident's practitioner or pharmacist as part of the
				development of a resident's service plan. Residents may keep over-the-counter
				medications in their room with a written order by the residents'
				practitioners.
(5) The facility
				shall develop and implement a policy for lawful disposal of unused, outdated,
				discontinued or recalled resident medications. The facility shall return a
				resident's medication to the resident or resident's legal representative upon
				discharge.
Sec.
					 50-5-103,
					 50-5-226
					 and
					 50-5-227,
					 MCA; IMP, Sec.
					 50-5-225,
					 50-5-226
					 and
					 50-5-227,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2847 - MEDICATIONS: PRACTITIONER ORDERS

Current through Register Vol. 13, July 5, 2024
(1)
				Medication and treatment orders shall be carried out as prescribed. The
				resident has the right to consent to or refuse medications and treatments. The
				practitioner shall be notified if a resident refuses consent to an order.
				Subsequent refusals to consent to an order shall be reported as required by the
				practitioner.
(2) A prescription
				medication for which the dose or schedule has been changed by the practitioner
				must be noted in the resident's medication administration record.
(3) Current practitioners' orders shall be
				documented and kept in all resident files.
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2848 - MEDICATIONS: ADMINISTRATION AND PREPARATION

Current through Register Vol. 13, July 5, 2024
(1) All category A facility residents must
				self-administer their medication. Those category B facility residents that are
				capable of, and who wish to self-administer medications, shall be encouraged by
				facility staff to do so.
(2) Any
				direct care staff member who is capable of reading medication labels may be
				made responsible for providing necessary assistance to any resident in taking
				their medication, as defined in ARM
				37.106.2805.
(3) Resident medication organizers may be
				prepared up to four weeks in advance and injectable medications as specified in
				(4) (c) by the following individuals:
(a) a
				resident or a resident's legal representative;
(b) a resident's family care giver, who is a
				person related to the resident by blood or marriage or who has full
				guardianship; or
(c) as otherwise
				provided by law.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2849 - MEDICATIONS: RECORDS AND DOCUMENTATION

Current through Register Vol. 13, July 5, 2024
(1)
				An accurate medication record for each resident shall be kept of all
				medications, including over-the-counter medications, for those residents whose
				self-administration of medication requires monitoring and/or assistance by the
				facility staff.
(2) The record
				shall include:
(a) name of medication, reason
				for use, dosage, route, and date and time given;
(b) name of the prescribing practitioner and
				their telephone number;
(c) any
				adverse reaction, unexpected effects of medication, or medication error, which
				must also be reported to the resident's practitioner;
(d) allergies and sensitivities, if
				any;
(e) resident specific
				parameters and instructions for PRN medications;
(i) documentation of when and why a PRN was
				administered or self-administered and follow up documentation as to the
				effectiveness of the PRN;
(f) documentation of treatments with resident
				specific parameters;
(g)
				documentation of doses missed or refused by resident and why;
(h) initials of the person monitoring and/or
				assisting with self-administration of medication; and
(i) review date and name of
				reviewer.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2853 - OXYGEN USE

Current through Register Vol. 13, July 5, 2024
(1) A resident who
				requires the use of oxygen:
(a) shall be
				permitted to self-administer the oxygen if the resident is capable of:
(i) determining their need for oxygen;
				and
(ii) administering the oxygen
				to themselves or with assistance.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2854 - USE OF RESTRAINTS, SAFETY DEVICES, ASSISTIVE DEVICES, POSTURAL SUPPORTS, AND SECLUSION ROOMS

Current through Register Vol. 13, July 5, 2024
(1) The facility
				shall comply with the rules governing the use, in long term care facilities, of
				restraints, safety devices, assistive devices, postural supports, and seclusion
				rooms. The provisions of ARM
				37.106.2901,
				37.106.2902,
				37.106.2904,
				37.106.2905,
				and
				37.106.2908 shall
				apply.
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2855 - INFECTION CONTROL

Current through Register Vol. 13, July 5, 2024
(1) The assisted
				living facility must establish and maintain infection control policies and
				procedures sufficient to provide a safe, sanitary, and comfortable environment
				to help prevent the development and transmission of communicable diseases and
				infections. Such policies and procedures must include, at a minimum, the
				following requirements:
(a) a system for
				preventing, identifying, investigating, and controlling infections and
				communicable diseases for all residents, staff, volunteers, and
				visitors;
(b) standard and
				transmission-based precautions to be followed to prevent spread of
				infections;
(c) when and how
				isolation should be used for a resident, including:
(i) the type and duration of the isolation,
				depending upon the infectious agent or organism involved; and
(ii) a requirement that the isolation should
				be the least restrictive possible for the resident under the
				circumstances;
(d) any
				other circumstances under which the facility must prohibit employees with a
				communicable disease or infected skin lesions from direct contact with
				residents or their food, if direct contact will transmit disease;
(e) if, after admission to the facility, a
				resident is suspected of having a communicable disease that would endanger the
				health and welfare of other residents, the administrator or designee must
				contact the resident's practitioner and assure that appropriate safety measures
				are taken on behalf of that resident and the other residents; and
(f) all staff shall use proper hand washing
				technique after providing direct care to a resident.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2859 - PETS

Current through Register Vol. 13, July 5, 2024
(1) Unless the facility disallows it,
				residents in an assisted living facility may keep household pets, as permitted
				by local ordinance, subject to the following provisions:
(a) pets must be clean and
				disease-free;
(b) the immediate
				environment of pets must be kept clean;
(c) birds must be kept in appropriate
				enclosures, unless the bird is a companion breed maintained and supervised by
				the owner; and
(d) pets that are
				kept at the facility shall have documentation of current vaccinations,
				including rabies, as appropriate.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2860 - FOOD SERVICE

Current through Register Vol. 13, July 5, 2024
(1) The facility
				must establish and maintain standards relative to food sources, refrigeration,
				refuse handling, pest control, storage, preparation, procuring, serving and
				handling food, and dish washing procedures that are sufficient to prevent food
				spoilage and the transmission of infectious disease. These standards must
				include the following:
(a) food must be
				obtained from sources that comply with all laws relating to food and food
				labeling;
(b) the use of
				home-canned foods is prohibited;
(c) food subject to spoilage removed from its
				original container, must be kept sealed, labeled, and
				dated.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2861 - LAUNDRY

Current through Register Vol. 13, July 5, 2024
(1) Laundry service must be provided by the
				facility, either on the premises or off the facility site.
(2) If an assisted living facility processes
				its laundry on the premises it must:
(a)
				equip the laundry room with a mechanical washer and a dryer vented to the
				outside, hand washing facilities, a fresh air supply and a hot water supply
				system which supplies the washer with water of at least 110°F during each
				use;
(b) have ventilation in the
				sorting, holding and processing area that shall be adequate to prevent heat and
				odor build-up;
(c) dry all bed
				linen, towels and washcloths in a dryer; and
(d) ensure that facility staff handling
				laundry wash their hands both after working with soiled laundry and before they
				handle clean laundry.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2862 - HOUSEKEEPING

Current through Register Vol. 13, July 5, 2024
(1) The following housekeeping rules must be
				followed:
(a) Supplies and equipment must be
				properly stored and must be on hand in a quantity sufficient to permit frequent
				cleaning of floors, walls, woodwork, windows and screens;
(b) Housekeeping personnel must be trained in
				proper procedures for preparing cleaning solutions, cleaning rooms and
				equipment and handling clean and soiled linen, trash and trays;
(c) Cleaners used in cleaning bathtubs,
				showers, lavatories, urinals, toilet bowls, toilet seats and floors must
				contain fungicides or germicides with current EPA registration for that
				purpose; and
(d) Garbage and trash
				must be stored for final disposal in areas separate from those used for
				preparation and storage of food and must be removed from the facility daily.
				Garbage containers must be kept clean.
(i)
				Containers used to store garbage in the kitchen and laundry room of the
				facility must be covered with a lid unless the containers are kept in an
				enclosed cupboard that is clean and prevents infestation by vermin. These
				containers shall be emptied daily and kept clean.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2872 - REQUIREMENTS FOR CATEGORY B FACILITIES ONLY

Current through Register Vol. 13, July 5, 2024
(1) An assisted living category B endorsement
				to the license shall be made by the licensing bureau of the department only
				after:
(a) initial department approval of the
				facility's category B policy and procedures;
(b) evidence of the administrator's and
				facility staff qualifications; and
(c) written approval from the building and
				fire code authorities having jurisdiction.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2873 - ADMINISTRATOR QUALIFICATIONS: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1)
				An assisted living category B facility must be administered by a person who, in
				addition to the requirements found in ARM
				37.106.2814, has one or more years
				experience working in the field of geriatrics or caring for disabled residents
				in a licensed facility.
(2)
				Providers in existence on the date of the final adoption of this rule will be
				granted one year to meet the category B administrator requirements found in
				(1).
Sec.
					 50-5-103,
					 50-5-226
					 and
					 50-5-227,
					 MCA; IMP, Sec.
					 50-5-225,
					 50-5-226
					 and
					 50-5-227,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2874 - DIRECT CARE STAFF QUALIFICATIONS: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1) In addition to the requirements found in
				ARM 37.106.2816, each nonprofessional
				staff providing direct care in an assisted living category B facility shall
				show documentation of in-house training related to the care and services they
				are to provide under direct supervision of a registered nurse or supervising
				nursing service providing category B care, including those tasks that may be
				delegated to licensed practical nurses (LPN) and unlicensed assistive personnel
				in accordance with the Montana Nurse Practice Act.
(2) Staff members whose job responsibilities
				will include supervising or preparing special or modified diets, as ordered by
				the resident's practitioner, shall receive training prior to performing this
				responsibility.
(3) Prior to
				providing direct care, direct care staff must:
(a) work under direct supervision for any
				direct care task not yet trained or properly oriented; and
(b) not take the place of the required
				certified person.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2875 - RESIDENT HEALTH CARE PLAN: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1)
				Within 21 days of admission to a category B status, the administrator or
				designee shall assure that a written resident health care assessment and
				resident certification is performed on each category B resident.
(2) Each initial health care assessment by
				the licensed health care professional shall include, at a minimum, evaluation
				of the following:
(a) cognitive
				status;
(b) communication/hearing
				patterns;
(c) vision
				patterns;
(d) physical functioning
				and structural problems;
(e)
				continence;
(f) psychosocial
				well-being;
(g) mood and behavior
				patterns;
(h) activity pursuit
				patterns;
(i) disease
				diagnosis;
(j) health
				conditions;
(k) oral nutritional
				status;
(l) oral dental
				status;
(m) skin
				condition;
(n) medication use;
				and
(o) special treatment and
				procedures.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2879 - INCONTINENCE CARE: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1) In order to
				maintain normal bladder and bowel functions, the facility shall provide
				individualized attention to each resident that meets the following minimum
				standards:
(a) the facility shall provide a
				resident who is incontinent of bowel or bladder adequate personal care services
				to maintain the person's skin integrity, hygiene and dignity and to prevent
				urinary tract infections.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2880 - PREVENTION AND CARE OF PRESSURE SORES: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1) A resident shall receive skin care that
				meets the following standards:
(a) the
				facility shall practice preventive measures to identify those at risk and
				maintain a resident's skin integrity; and
(b) an area of broken or damaged skin must be
				reported within 24 hours to the resident's practitioner. Treatment must be as
				ordered by the resident's practitioner.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2884 - SEVERE COGNITIVE IMPAIRMENT: CATEGORY B (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 50-5-103,
					 50-5-226
					 and
					 50-5-227,
					 MCA; IMP, Sec.
					 50-5-225,
					 50-5-226
					 and
					 50-5-227,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2885 - ADMINISTRATION OF MEDICATIONS: CATEGORY B

Current through Register Vol. 13, July 5, 2024
(1)
				Written, signed practitioner orders shall be documented in all category B
				resident facility records by a legally authorized person for all medications
				and treatments which the facility is responsible to administer. Medication or
				treatment changes shall not be made without a practitioner's order. Order
				changes obtained by phone must be confirmed by written, signed orders within 21
				days.
(2) All medications
				administered to a category B resident shall be administered by a licensed
				health care professional or by an individual delegated the task under the Nurse
				Practice Act and ARM Title 24, chapter 159. Those category B residents, who are
				capable of medication self-administration shall be given the opportunity and
				encouraged to do so.
(3) Residents
				with a standing PRN medication order, who cannot determine their own need for
				the medication by making a request to self-administer the medication or in the
				case of the cognitively impaired cannot respond to caretaker's suggestions for
				over-the-counter PRN pain medications shall:
(a) have the medication administered by a
				licensed health care professional after an assessment and the determination of
				need has been made; and
(b) be
				classified as a category B resident because a nursing decision to determine the
				resident's need for the medication was required.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2886 - MEDICATIONS: RECORDS AND DOCUMENTATION: CATEGORY B (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2891 - ADMINISTRATOR QUALIFICATIONS: CATEGORY C

Current through Register Vol. 13, July 5, 2024
(1)
				An assisted living category C facility must be administered by a person who
				meets the conditions of ARM
				37.106.2814 and has:
(a) three or more years experience in working
				in the field of geriatrics or caring for disabled residents in a licensed
				facility; or
(b) a documented
				combination of education and training that is equivalent to the experience
				required in (1), as determined by the department.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2892 - DIRECT CARE STAFF: CATEGORY C

Current through Register Vol. 13, July 5, 2024
(1) In
				addition to meeting all other requirements for direct care staff stated in this
				subchapter, assisted living category C facility direct care staff must receive
				additional documented training in:
(a) the
				facility or unit's philosophy and approaches to providing care and supervision
				for persons with severe cognitive impairment;
(b) the skills necessary to care for,
				intervene and direct residents who are unable to perform activities of daily
				living;
(c) techniques for
				minimizing challenging behavior including:
(i) wandering;
(ii) hallucinations, illusions and delusions;
				and
(iii) impairment of
				senses;
(d) therapeutic
				programming to support the highest possible level of resident function
				including:
(i) large motor
				activity;
(ii) small motor
				activity;
(iii) appropriate level
				cognitive tasks; and
(iv)
				social/emotional stimulation;
(e) promoting residents' dignity,
				independence, individuality, privacy and choice;
(f) identifying and alleviating safety risks
				to residents;
(g) identifying
				common side effects and untoward reactions to medications; and
(h) techniques for dealing with bowel and
				bladder aberrant behaviors.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2895 - HEALTH CARE PLAN: CATEGORY C

Current through Register Vol. 13, July 5, 2024
(1) Within 21
				days of admission of a resident to an assisted living category C facility, a
				resident certification must be conducted, and a written health care plan shall
				be developed which meets the requirements of ARM
				37.106.2875, and which also
				includes detailed assessment, therapeutic management and intervention
				techniques for the following behaviors and resident needs:
(a) memory;
(b) judgement;
(c) ability to care for oneself;
(d) ability to solve problems;
(e) mood and character changes;
(f) behavioral patterns;
(g) wandering; and
(h) dietary needs.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2896 - DISCLOSURES TO RESIDENTS: CATEGORY C

Current through Register Vol. 13, July 5, 2024
(1) Each
				assisted living category C facility or unit must, prior to admission, inform
				the resident's legal representative in writing of the following:
(a) the overall philosophy and mission of the
				facility regarding meeting the needs of residents afflicted with severe
				cognitive impairment and the form of care or treatment offered;
(b) the process and criteria for move-in,
				transfer, and discharge;
(c) the
				process used for resident assessment;
(d) the process used to establish and
				implement a health care plan, including how the health care plan will be
				updated in response to changes in the resident's condition;
(e) staff training and continuing education
				practices;
(f) the physical
				environment and design features appropriate to support the functioning of
				cognitively impaired residents;
(g)
				the frequency and type of resident activities;
(h) the level of involvement expected of
				families and the availability of support programs; and
(i) any additional costs of care or
				fees.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2898 - REQUIREMENTS FOR SECURED UNITS: CATEGORY C

Current through Register Vol. 13, July 5, 2024
(1)
				In addition to meeting all other requirements for assisted living facilities
				stated in this subchapter, if a secured distinct part or locked unit within a
				category C assisted living facility is designated for the exclusive use of
				residents with severe cognitive impairment, the facility must:
(a) staff the unit with direct care staff at
				all times there are residents in the unit;
(b) provide a separate dining area, at a
				ratio of 30 square feet per resident on the unit; and
(c) provide a common day or activities area,
				at a ratio of 30 square feet per resident on the unit. The dining area listed
				in (1) (b) or day rooms, sun porches and common areas accessible to all
				residents, may serve this purpose.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899 - CATEGORY D: CONSTRUCTION

Current through Register Vol. 13, July 5, 2024
(1) Category D
				services must be provided in a secured care unit and meet all requirements in
				ARM
				37.106.316.
(2) A category D facility will be either:
(a) a stand-alone secured facility;
				or
(b) a separate, secured unit
				attached to a category A, B, and/or C facility.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899A - CATEGORY D: ADMINISTRATOR QUALIFICATIONS

Current through Register Vol. 13, July 5, 2024
(1)
				In addition to requirements in ARM
				37.106.2873,
				an administrator for a category D facility must have a least three years of
				experience in the field of mental health and mental disorders.
(2) Of the 16 hours of annual continued
				education training required in ARM
				37.106.2814, eight
				hours must be in the field of mental health and mental disorders.
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA; IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899B - CATEGORY D: DISCLOSURE TO CATEGORY D RESIDENTS

Current through Register Vol. 13, July 5, 2024
(1) Each assisted living category D facility
				or unit must, prior to admission, inform the resident or resident's legal
				representative in writing of the following:
(a) the overall philosophy and mission of the
				facility regarding meeting the needs of residents with mental illness and the
				form of care or treatment offered;
(b) the process and criteria for admission
				and discharge;
(c) the process used
				for resident assessments;
(d) the
				process used to establish and implement a health care plan, including how the
				health care plan will be updated in response to changes in the resident's
				condition;
(e) staff training and
				continuing education practices;
(f)
				the physical environment and design features appropriate to support the
				functioning of mentally disabled residents, including features for the resident
				who requires seclusion and restraint;
(g) the frequency and type of resident
				activities; and
(h) any additional
				costs of care or fees.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899C - CATEGORY D: STAFF

Current through Register Vol. 13, July 5, 2024
(1) A category D
				facility must have the following staff:
(a) a
				registered nurse (RN) must be on duty or on call and available physically to
				the facility within one hour;
(b) a
				licensed mental health professional who must be site-based; and
(c) direct care staff in sufficient number to
				meet the needs of the residents. Direct care staff must be certified nursing
				assistants.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899D - CATEGORY D: RESIDENT ASSESSMENTS

Current through Register Vol. 13, July 5, 2024
A category D facility must obtain or conduct three types of
				  resident assessments for each resident:
(1) Prior to move in, the facility shall
				obtain the court determination documentation required in 53-21-199, MCA, as
				applicable, as well as a full medical history and physical and mental health
				and mental disorders assessment.
(2) A resident needs assessment must be
				completed within seven days prior to admission to facility. The assessment must
				be reviewed/updated quarterly, and upon significant change in status.
(3) The administrator, or designee, will
				request and retain copies of the healthcare assessment and written order for
				care completed monthly by the practitioner as defined in
				50-5-226(5),
				MCA.
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA; IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899E - CATEGORY D: HEALTH CARE PLAN

Current through Register Vol. 13, July 5, 2024
(1) In addition
				to requirements in ARM
				37.106.2875,
				the health care plan for a category D resident must include:
(a) de-escalation techniques individualized
				to the resident;
(b) circumstances
				when the resident may need to be isolated from other residents;
(c) behaviors and/or situations in which a
				staff member may need to obtain orders for restraints and/or seclusion;
				and
(d) the requirements listed in
				ARM
				37.106.2905.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899F - CATEGORY D: MEDICATION USE AND PHYSICIAN ORDERS

Current through Register Vol. 13, July 5, 2024
(1) All category D residents must be assessed
				on their ability and be encouraged to self-administer their own medication. If
				a resident is unable or unwilling to self-administer his or her medication, a
				licensed nurse shall administer all medication and the resident must be
				classified as a category B resident.
(2) When a resident refuses a medication, the
				resident's practitioner shall be notified within 24 hours and notification
				documented.
AUTH:
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 MCA; IMP:
					 50-5-225,
					 50-5-226,
					 50-5-227,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899G - CATEGORY D: DISCHARGE

Current through Register Vol. 13, July 5, 2024
(1) A comprehensive
				discharge plan directly linked to the behaviors and symptoms that resulted in
				admission and estimated length of stay must be developed upon
				admission.
(2) A resident's
				diversion order is discontinued when:
(a) the
				resident and facility choose to allow continued residency; a resident needs
				assessment must be completed to determine category and placement within the
				facility;
(b) the resident chooses
				not to remain in the facility; the facility shall issue a 30-day notice and
				conduct discharge planning. Discharge planning must include involvement from
				community resources.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.28 - Assisted Living Facilities › Rule 37.106.2899H - CATEGORY D: SECLUSION ROOM REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1)
				A category D facility or unit must have at least one room designated to be used
				for seclusion for every 24 beds.
(2) The location of these rooms must
				facilitate staff observation and monitoring of residents in these
				rooms.
(3) Seclusion rooms may only
				be used by one resident at a time.
(4) Seclusion rooms must:
(a) be a minimum of 60 square feet, and a
				minimum of 80 square feet if restraint beds are used;
(b) be a minimum length of 7 feet and maximum
				wall length of 11 feet;
(c) be a
				minimum height of 9 feet;
(d) be
				accessed by an anteroom or vestibule that provides direct access to a toilet
				room;
(e) have door openings to the
				anteroom and toilet room with a minimum clear width of 3 feet 8
				inches;
(f) be constructed to
				prevent hiding, escape, injury, or suicide;
(g) have walls designed to withstand direct
				and forceful impact and have materials that meet Class A or Class B finishes as
				defined by the 2012 National Fire Protection Association (NFPA) 101;
(h) have monolithic ceilings;
(i) not contain outside corners or
				edges;
(j) have doors that swing
				out, have a clear opening of 3 feet 8 inches, and permit staff observation
				through a vision panel, while maintaining provisions for privacy;
(k) have tamper resistant fixtures, such as
				light fixtures, vent covers, and cameras;
(l) have electrical switches and outlets that
				are restricted within the seclusion room; and
(m) have door lever handles that point
				downward when in the latched or unlatched position, except for specifically
				designed anti-ligature hardware.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2901 - RULE APPLICABILITY

Current through Register Vol. 13, July 5, 2024
(1) The
				provisions of the rules in this subchapter that govern the use of restraints do
				not apply to a category A personal care facility as defined in
				50-5-227(2)
				(a), MCA, because such a facility is
				prohibited by law from accepting and serving any resident who is in need of
				medical, chemical or physical restraint.
Sec.
					 50-5-103,
					 50-5-226,
					 50-5-227
					 and
					 50-5-1205,
					 MCA; IMP, Sec.
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 50-5-1202
					 and
					 50-5-1203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2902 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The following definitions, in addition to those contained in
				  50-5-1202,
				  MCA, apply to this chapter:
(1)
				"Assistive device" means any device whose primary purpose is to maximize the
				independence and the maintenance of health of an individual who is limited by
				physical injury or illness, psychosocial dysfunction, mental illness,
				developmental or learning disability, the aging process, cognitive impairment
				or an adverse environmental condition. If the device is primarily used to
				restrict an individual's movement, it is considered a safety device or
				restraint rather than an assistive device.
(2) "Licensed health care professional" means
				a physician, a physician assistant-certified, a nurse practitioner or a
				registered or practical nurse licensed in the state of Montana.
(3) "Medical symptom", as defined in
				50-5-1202,
				MCA, means an indication of a physical or psychological condition or of a
				physical or psychological need expressed by the patient. For example, a concern
				for the resident's physical safety by any person listed in
				50-5-1201(1),
				MCA, or a resident's fear of falling may constitute a medical
				symptom.
(4) "Postural support"
				means an appliance or device used to achieve proper body position and balance,
				to improve a resident's mobility and independent functioning, or to position
				rather than restrict movement, including, but not limited to, preventing a
				resident from falling out of a bed or chair. A postural support does not
				include tying a resident's hands or feet or otherwise depriving a resident of
				their use.
(5) "Restraint" means
				any method (chemical or physical) of restricting a person's freedom of movement
				that prevents them from independent and purposeful functioning. This includes
				seclusion, controlling physical activity, or restricting normal access to the
				resident's body that is not a usual and customary part of a medical diagnostic
				or treatment procedure to which the resident or the authorized representative
				has consented.
(6) "Safety
				devices", as defined in
				50-5-1202,
				MCA, means side rails, tray tables, seat belts and other similar devices. The
				department interprets that definition to mean that a safety device is used to
				maximize the independence and the maintenance of health and safety of an
				individual by reducing the risk of falls and injuries associated with the
				resident's medical symptom.
Sec.
					 50-5-103,
					 50-5-226,
					 50-5-227
					 and
					 50-5-1205,
					 MCA; IMP, Sec.
					 50-5-103,
					 50-5-226,
					 50-5-227,
					 50-5-1202
					 and
					 50-5-1203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2904 - USE OF RESTRAINTS, SAFETY DEVICES, ASSISTIVE DEVICES, AND POSTURAL SUPPORTS

Current through Register Vol. 13, July 5, 2024
(1) The application
				or use of a restraint, safety device, or postural support is prohibited except
				to treat a resident's medical symptoms and may not be imposed for purposes of
				coercion, retaliation, discipline, or staff convenience.
(2) A restraint may be a safety device when
				requested by the resident or the resident's authorized representative or
				physician to reduce the risk of falls and injuries associated with a resident's
				medical symptoms and used in accordance with
				50-5-1201,
				MCA.
(3) To the extent that a
				resident needs emergency care, restraints may be used for brief periods:
(a) to permit medical treatment to proceed
				unless the health care facility has been notified that the resident has
				previously made a valid refusal of the treatment in question; or
(b) if a resident's unanticipated violent or
				aggressive behavior places the resident or others in imminent danger, in which
				case the resident does not have the right to refuse the use of restraints. In
				this situation:
(i) the use of restraints is a
				measure of last resort to protect the safety of the resident or others and may
				be used only if the facility determines and documents that less restrictive
				means have failed;
(ii) the size,
				gender, physical, medical, and psychological condition of the resident must be
				considered prior to the use of a restraint;
(iii) a licensed nurse shall contact a
				resident's physician for restraint orders within one hour of application of a
				restraint;
(iv) the licensed nurse
				shall document in the resident file the circumstances requiring the restraints
				and the duration;
(v) a restrained
				resident must be monitored as their condition warrants, and restraints must be
				removed as soon as the need for emergency care has ceased, and the resident's
				safety and the safety of others can be assured; and
(vi) a licensed nurse must provide one on one
				supervision to a resident who has a restraint applied for the reasons listed in
				(3).
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2905 - DOCUMENTATION IN RESIDENT'S MEDICAL RECORDS

Current through Register Vol. 13, July 5, 2024
(1) Prior to the use of a restraint or safety
				device, the following items must be included in the resident's record:
(a) a consent form signed by the resident or
				authorized representative that includes documentation that:
(i) the resident or the resident's authorized
				representative was given a written explanation of the alternatives and any
				known risks associated with the use of the restraint or safety
				device;
(ii) cites any pre-existing
				condition that may place a patient at risk of injury; and
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2906 and 37.106.2907 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.29 - Restraints, Safety Devices, Assistive Devices, and Postural Supports › Rule 37.106.2908 - STAFF TRAINING

Current through Register Vol. 13, July 5, 2024
(1) Restraints,
				safety devices or postural supports may only be applied by staff who have
				received training in their use, as specified below and appropriate to the
				services provided by the facility.
(2) Staff training shall include, at a
				minimum, information and demonstration in:
(a) the proper techniques for applying and
				monitoring restraints, safety devices or postural supports;
(b) skin care appropriate to prevent redness,
				breakdown and decubiti;
(c) active
				and passive assisted range of motion to prevent joint contractures;
(d) assessment of blood circulation to
				prevent obstruction of blood flow and promote adequate circulation to all
				extremities;
(e) turning and
				positioning to prevent skin breakdown and keep the lungs clear;
(f) potential risk for residents to become
				injured or asphyxiated because the resident is entangled in a bed rail or
				caught between the bed rail and mattress if the mattress or mattress pad is
				ill-fitted or is out of position;
(g) provision of sufficient bed clothing and
				covering to maintain a normal body temperature;
(h) provision of additional attention to meet
				the physical, mental, emotional and social needs of the resident; and
(i) techniques to identify behavioral
				symptoms that may trigger a resident's need for a restraint or safety device
				and to determine possible alternatives to their use. These include:
(i) observing the intensity, duration and
				frequency of the resident's behavior;
(ii) identifying patterns over a period of
				time and factors that may trigger the behavior; and
(iii) determining if the resident's behavior
				is:
(A) new or if there is a prior history of
				the behavior;
(B) the result of
				mental, emotional, or physical illness;
(C) or a radical departure from the
				resident's normal personality.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.30 - Eating Disorder Centers › Rule 37.106.3001 - EATING DISORDER CENTERS (EDC): APPLICATION OF OTHER RULES

Current through Register Vol. 13, July 5, 2024
(1) In addition to these rules, an EDC must
				comply with licensure rules in ARM Title 37, chapter 106, subchapter 3. To the
				extent that licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict
				with the terms of ARM Title 37, chapter 106, subchapter 12, the terms of
				subchapter 12 will apply to an EDC.
AUTH:
					 50-5-247,
					 MCA; IMP:
					 50-5-247,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.30 - Eating Disorder Centers › Rule 37.106.3002 - EATING DISORDER CENTERS (EDC): DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Clinical director" means a social
				worker, psychologist, or clinical professional counselor licensed under Title
				37, MCA, who oversees an EDC's clinical services. A clinical director cannot be
				a licensure candidate.
(2) "Eating
				disorder" means any of several psychological disorders such as anorexia
				nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder,
				avoidant/restrictive food intake disorder, or other specific feeding or eating
				disorders characterized by serious disturbances to a person's eating
				behaviors.
(3) "Intensive
				outpatient program" means a program that provides more structure and support
				than standard outpatient therapy.
(4) "Meal support" means the provision of
				support during meal times, focused specifically on helping the individual to
				consume the food on their meal plan and redirecting behaviors that sabotage
				eating and recovery.
(5) "Medical
				director" means a psychiatrist licensed under Title 37, MCA, who oversees an
				EDC's services.
(6) "Mental health
				professional" means a psychologist, social worker, or professional counselor
				licensed under Title 37, MCA, or a licensure candidate registered under Title
				37, MCA.
AUTH:
					 50-5-247,
					 MCA; IMP:
					 50-5-247,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.106 - HEALTH CARE FACILITIES › Subchapter 37.106.30 - Eating Disorder Centers › Rule 37.106.3005 - EATING DISORDER CENTERS (EDC): LICENSES

Current through Register Vol. 13, July 5, 2024
(1) The department shall issue a license from
				one to three years in duration for an EDC to any applicant meeting all the
				requirements established by these rules and the governing statutes, as
				determined by the department after a licensing survey.
(2) The department will issue a renewal
				license for a period of one to three years in duration for an EDC if:
(a) the EDC makes written application for
				renewal at least 30 days prior to the expiration date of the current license;
				and
(b) the EDC continues to meet
				all requirements established by these rules and governing statutes, as
				determined by the department after a licensing survey.