8.370.14 NMAC — Ariadne

8.370.14 NMAC active

Assisted Living Facilities for Adults

Jurisdiction: NM Agency: NM Health Care Authority

ALF (100%)

Plain-English summary

This New Mexico regulation establishes comprehensive licensing standards for assisted living facilities serving adults who need assistance with activities of daily living but do not require acute or continuous nursing care. Operators must obtain and maintain a license from the New Mexico Health Care Authority, meet staffing qualifications and training requirements, comply with survey and corrective action processes, and adhere to resident care, medication management, and safety standards. Violations may result in civil monetary penalties, license suspension, or revocation.

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Regulation text

TITLE 8

SOCIAL SERVICES

CHAPTER 370

OVERSIGHT OF LICENSED HEALTHCARE FACILITIES
AND COMMUNITY BASED WAIVER PROGRAMS

PART
14

ASSISTED LIVING FACILITIES FOR
ADULTS

8.370.14.1

ISSUING AGENCY:

New Mexico Health Care Authority.

[8.370.14.1 NMAC - N, 7/1/2024]

8.370.14.2

SCOPE:

This rule applies to all assisted living
facilities, any facility which is operated for the maintenance or care of two
or more adults who need or desire assistance with one or more activities of
daily living.

This rule does not apply
to the residence of an individual who maintains or cares for a maximum of two
relatives.

[8.370.14.2 NMAC - N, 7/1/2024]

8.370.14.3

STATUTORY AUTHORITY:

The requirements
forth herein are promulgated by the secretary of the health
care authority by authority of Subsection E of Section 9-8-6 NMSA 1978
,
and Sections 24-1-2, 24-1-3, 24-1-5 and 24-1-5.2 of the Public Health Act, NMSA
1978, as amended. Section 9-8-1 et seq. NMSA 1978 establishes the health care
authority (authority) as a single, unified department to administer laws and
exercise functions relating health care purchasing and regulation.

[8.370.14.3 NMAC - N, 7/1/2024]

8.370.14.4

DURATION:

Permanent.

[8.370.14.4 NMAC - N, 7/1/2024]

8.370.14.5

EFFECTIVE
DATE:

July 1, 2024, unless a later
date is cited at the end of a section.

[8.370.14.5 NMAC - N, 7/1/2024]

8.370.14.6

OBJECTIVE:

Establish
standards for licensing assisted living facilities in order to ensure that
residents receive appropriate care and services, and regulate to ensure that
the health, safety, and welfare of individuals residing and working in such
facilities are protected.

Establish
requirements for the construction, maintenance and operation of licensed assisted
living facilities that will provide a safe, humane and homelike environment for
adults who need assistance or supervision with activities of daily living but
who do not need acute care, continuous nursing care, skilled nursing care or
care in an intermediate care facility for the mentally retarded.

Regulate
facilities in providing care for residents and utilizing available supportive
services in the community to meet the needs of the residents.

Ensure
facility compliance with these rules through established protocols to identify
circumstances which could be harmful or dangerous to the health, safety, or
welfare of the resident.

[8.370.14.6 NMAC - N, 7/1/2024]

8.370.14.7

DEFINITIONS:

“Abuse”

means

the willful infliction of injury, unreasonable confinement,
intimidation, or punishment with resulting physical harm, pain or mental
anguish and
is defined in the incident reporting intake, processing
& training requirements, 8.370.9 NMAC.

“Activities
of daily living” (ADLs)
means the personal functional activities required
by a resident for continued well-being, which include, but are not limited to:

(1)

eating;

(2)

dressing;

(3)

oral
hygiene;

(4)

bathing;

(5)

grooming;

(6)

mobility;
and

(7)

toileting.

“Adult”

means a person who has a chronological age of 18 years or older.

“Assisted
living facility”
means any licensed facility that meets the requirements
and provides services defined by this rule.

“Administrator, director, or operator”
means the
individual who is in charge of the day-to-day operation of the facility and who
has the responsibility to ensure facility compliance with this rule.

“Advance directives”
means the written document
signed by a competent person granting someone authority in a power of attorney
to make health care decisions for the resident when they are unable to.

“Agent”
means the resident's
surrogate decision maker as applicable to individual resident needs.

“Ambulatory”

means able to walk without assistance.

“A
dministration of medication”
means
delivery of medication by a licensed or certified healthcare professional.

“Assistance”
means prompting, encouragement, or
hands-on help with the activities of daily living by another person.

“Assistance with medication”
means
support provided to residents to assist them with medication delivery by
non-licensed or non-certified paid staff and does not allow for the assessment
of the effects of the medication.

“Bathing unit”
means a tub and shower or combination unit.

“Bed hold”
means the facility's policy for retaining a
bed or room for a resident during the time that the resident is temporarily
absent from the facility; the policy shall include time frames for the bed
hold, acceptable conditions for the bed hold and any associated charges.

“Capacity”

means the maximum number of persons that a facility has been licensed to
accommodate.

“Census”

means the total number of individual residents residing in the facility each
day, including relatives who are residents.

The facility census shall never exceed the
licensed capacity.

“Certified medication aide” (CMA)
means
a person who receives specialized training by the New Mexico board of nursing
pursuant to "the Nursing Practice Act," Section 61-3-1 through
61-3-30 NMSA 1978.

“Chemical restraint”
means any drug administered for
discipline or the convenience of the facility and not required to treat the
resident's medical symptoms.

“Choice
of hospice provider”
means a resident and their family or the resident’s
surrogate decision maker shall be given a list of hospice providers and have
the right to choose a hospice provider; the referring party shall disclose any
ownership interest in a recommended or listed hospice provider if applicable.

“Cognitive status”
means the thinking and reasoning
ability of the resident to manage his or her own affairs and direct his or her
own care.

“Consulting pharmacist”
means an
independent pharmacist hired by a facility to review medications in use,
patient records and possible medication errors on a quarterly basis.

“Continuous nursing care”
means services which are
provided to a resident whose medical needs are of such complexity that the
services of a nurse are required to assess, regularly reevaluate, care plan and
intervene as ordered by a physician.

(1)

This
includes services which are provided to a resident whose condition requires 24
hour monitoring of vital signs and the assessment of cognitive or physical
status on a daily basis.

(2)

These
services are provided by health care professionals, as ordered by a physician
or physician extender.

(3)

The
required services shall be medically complex enough to require ongoing
assessment, planning and intervention by licensed personnel for safe and
effective care on a daily basis and consistent with the nature and the severity
of the resident's condition.

“Convenience”
means any action taken by a facility to
control resident behavior or maintain residents with less effort by the
facility and that is not in the resident's best interest or wishes.

“Current written consent”

means an informed, written consent which identifies the type of medication
delivery and the assistance or administration that the resident requires and is
signed by the resident or surrogate decision maker or other legally appointed
decision maker.

All informed consents
shall be signed annually or when there is any change in either the resident’s
functional ability or the designation of a new surrogate decision maker.

“Crisis prevention/intervention
plan”
means a documented procedure that provides guidance to staff
when a resident has a medical condition or challenging behavior that has the
potential to escalate to a severity level which poses great risk of harm to the
resident or others (e.g., diabetic, seizure disorder, aggression, or combativeness).

Y
.

“Decision
making capacity”
means the ability of the resident to understand and comprehend
the nature and consequences of a proposed decision, including the benefits and
risks of and alternatives to any such proposed decision and to reach an
informed decision.

Z
.

“Designee”

means an individual appointed to assume responsibility for specific assigned duties.

AA.

“Direct
care staff”
means any and all employees or volunteers who work directly
with the residents in daily living activities at the facility.

AB.

“Discipline”

means any action taken by the facility for the purpose of punishing or
penalizing any resident.

AC.

“Facility”

means an assisted living facility.

AD.

“Facility
license”
means the document issued by the licensing authority which
authorizes the operation of a facility.

AE.

“General supervision”
means the availability of direct
care staff in the facility, on a 24 hour basis, to respond to the needs of the
residents and to perform periodic checks on the residents.

AF.

“Health
care professional”
means a New Mexico licensed health care professional
such as a physician, chiropractor, pharmacist, nurse practitioner, physician
assistant, registered nurse, licensed practical nurse, physical therapist,
speech therapist, occupational therapist, psychologist, social worker,
dietitian or dentist.

AG.

“Independent”

means the ability to perform activities of daily living without assistance.

AH.

“Individual service plan” or “ISP”
means a comprehensive
plan, developed by the interdisciplinary team that identifies all treatment,
habilitation and services for a resident.

AI.

“Intramuscular injection”

or “IM”

means the insertion of a needle into a muscle to administer medication.

AJ.

“Intravenous”

or “IV
” means the insertion of a needle
into a vein to administer medication.

AK.

“Licensee”
means the person who, or the organization
that has ownership, leasehold or similar interest in the facility and in whose
name a license for an assisted living facility has been issued and who is
legally responsible for compliance with this rule.

AL.

“Licensing
authority”
means the New Mexico health care authority, health facility licensing
and certification bureau.

AM.

“Licensed or certified personnel”

means New Mexico licensed registered nurses (RNs), licensed practical nurses
(LPNs) and certified medication aides (CMAs), licensed or certified by the New
Mexico board of nursing pursuant to "the Nursing Practice Act",
61-3-1 through 61-3-31 NMSA 1978.

AN.

“Licensed
practical nurse (LPN)”
means a person who has specialized training and is
licensed by the New Mexico board of nursing pursuant to the "Nursing
Practice Act," 61-3-1 through 61-3-31 NMSA 1978.

AO.

“Medication assistance record” (MAR)

means the document that is used to record the details of medication.

The MAR shall include all of the information
pursuant to Subsection G of 8.370.14.35 NMAC of this rule.

AP.

“Medication delivery method”

means the method by which a resident takes or receives medication (i.e., pills,
eye drops, intramuscular injection, other).

AQ.

“Medication error’
means the
administration of any medication incorrectly (i.e., dosage, selection of drug,
selection of resident, time or method of administration, omission of prescribed
medication or the administration of a medication without a valid order).

AR.

“Medication route”
means the
method of medication entry into a resident’s body (e.g., oral, ocular, rectal,
topical, nasal, injection and intravenous).

AS.

“Misappropriation /exploitation”
means
the deliberate misplacement of a
resident’s property, or wrongful, temporary or permanent use of a resident’s
belongings or money without the resident’s consent
and is defined in the
incident reporting intake, processing & training requirements, 8.370.9 NMAC.

AT.

“Mobile”
means able to walk with assistance, or the
ability to move from place to place with the use of a device such as a walker, cane,
crutches, or a wheelchair and the capability of making independent bed-to-chair
transfers.

AU.

“Nebulizer”
means an atomizer equipped
to produce a fine mist for deep inhalation into the lungs.

AV.

“Neglect”
means
the failure to provide goods and services necessary to avoid
physical harm, mental anguish or mental illness
and is defined in the incident
reporting intake, processing & training requirements, 8.370.9 NMAC.

AW.

“New
facility”
means any building not previously or currently licensed as an
assisted living facility.

AX.

“Non-mobile”

means a person who is capable of achieving mobility only with the assistance of
another person plus devices such as a wheel chair.

AY.

“Nurse monitoring”
means a higher level
of monitoring by a registered nurse (RN) for a specified length of time based
on the resident’s need(s) related to a specific condition.

AZ.

“Physician extender”
means the term used to refer to
physician assistants (working in conjunction with a physician) and nurse
practitioners.

BA.

“Physical restraint”
means any manual, physical or
mechanical device, any material or equipment attached to or adjacent to the
resident's body that the resident cannot easily remove which restricts freedom
of movement or is used for discipline or for the convenience of the facility
(e.g., full bed rails).

BB.

“Primary care practitioner” (PCP)

means a physician, nurse practitioner or physician’s assistant (licensed in the
state of New Mexico) who oversees the health care of the resident.

BC.

“Private duty attendant”
means
an individual that provides direct care under the definitions of the nm
caregivers criminal history screening program, 8.370.5 NMAC.

The individual is hired by the resident or
family through a licensed agency, hired directly or works through a separate
arrangement with the family.

BD.

“Pro re nada medication (PRN)”

means prescribed or over-the-counter medications, including comfort medications,
that are administered or taken only on an as needed basis when symptoms warrant
or as directed by the primary care practitioner (PCP).

BE.

“Policy”
means a statement of principle that guides and
determines present and future decisions and actions.

BF.

“Procedure”

means the action(s) that shall be taken in order to implement a policy.

BG.

“Protocols”

are the specific means by which a procedure or treatment is to take place.

BH.

“Programmatic
services”
means services provided to residents as defined by the facilities
program narrative.

BI.

“Program
narrative”
is a written statement identifying the primary population to be
served and the services that will be provided to meet these needs.

BJ.

“Registered nurse” (RN)

means a person that has specialized training and is licensed by the New Mexico
board of nursing pursuant to the “Nursing Practice Act,” 61-3-1 through 61-3-31
NMSA 1978.

BK.

“Relative”

means husband, wife, significant other, mother, father, son, daughter, brother,
sister, brother-in-law, sister-in-law, father-in-law, mother-in-law,
grandfather, grandmother, half-brother or half-sister.

BL.

“Resident”

means an individual receiving services and residing in the licensed facility;
including the relatives of a licensee.

BM.

“Resident
evaluation form”
means a written document of the information acquired
during the assessment of a resident's functional capacities and limitations.

This form is to be utilized for pre-admission
and ongoing evaluation of a resident.

BN.

“Resident preference”
means the resident’s choice or
preferred choice among the available options.

BO.

“Restraints”
means anything which restricts freedom of
movement or is used for discipline or for the convenience of the facility.

This includes both chemical and physical
restraints (e.g., full bed rails, over medicated, etc.).

BP.

“Room
and board”
means living/sleeping space, meals and snacks appropriate to
meet the needs of the residents.

BQ.

“Sanctions”

means a measure imposed on a licensee for a violation(s) of applicable
licensing requirements other than license revocation, suspension, or denial of
renewal of license as provided for by health facility sanctions and civil
monetary penalties, 8.370.4 NMAC.

BR.

“Self
care”
means the performance of ADLs, activities or tasks by the residents themselves
rather than performed by or assisted with the facility staff.

BS.

“Self
medication”
means administration of PCP prescribed medication by the resident
to whom it was prescribed.

BT.

“Side effect”
means a result
of a drug or other form of therapy in addition to or in extension of the
desired therapeutic effect.

BU.

"Significant
change in health status
"

means the resident has experienced one or more of the following:

(1)

a
decline or improvement in physical ability;

(2)

a
decline or improvement in cognitive or functional ability;

(3)

a
new diagnosis or event that requires a change in medication, or treatment or that
requires a revision to an individual service plan; or

(4)

a
change in medication or the medication route that would permanently alter the
level of assistance with medication delivery.

BV.

“Surrogate
decision maker”
means the resident's agent, guardian or surrogate as
defined in the “Uniform Health-Care Decisions Act,” 24-7A-1 through 24-7A-186
NMSA 1978 or other legally appointed decision maker.

BW.

“Survey”

means a monitoring visit by the licensing authority to examine the facility
premises and records and to interview the residents and staff.

BX.

“Stable”
means the
resident’s condition is unchanged; signs or symptoms are within established
ranges, frequencies or patterns.

The
resident’s condition does not require frequent monitoring by a licensed nurse
to determine the resident’s status or the resident’s response to medication or
treatment.

BY.

“Staff or employee”
means
the individuals hired or subcontracted by the facility to implement the
individual service plan for the residents.

BZ
.

“Subcutaneous injection”

means the insertion of a needle under the skin but above the muscle layer to
administer medication.

CA
.

“Therapeutic diet”
means a diet
other than a regular diet, ordered by a physician to manage a health condition.

CB
.

“Volunteers”
means unpaid
individuals who provide care or services for the residents.

CC
.

“Variance”
means a decision that is
made at the discretion of the licensing authority to allow a facility to deviate
from a portion(s) or to modify a provision of this rule for an unspecified
period of time, provided that the health, safety, or welfare of the residents
and staff are not in danger.

CD
.

“Visit
notes”
means the documentation of services provided by outside agencies for
ongoing care coordination of the resident.

CE
.

“Waive or waiver”
means a decision that
is made at the discretion of the licensing authority to allow a facility to
deviate from a portion(s) or to modify a provision of this rule for a limited and
specified period of time, provided that the health, safety, or welfare of the
residents and staff are not in danger.

[8.370.14.7 NMAC - N, 7/1/2024]

8.370.14.8

GENERAL LICENSING REQUIREMENTS:

Licensure is required.

No person or entity shall establish, maintain
or operate an assisted living facility without first obtaining a license.

Application for licensure.

An initial or renewal application shall be
made on the forms prescribed by and available from the licensing authority.

The issuance of an application form is not a
guarantee that the completed application will be accepted, or that the authority
will issue a license.

Information
provided by the facility and used by the licensing authority for the licensing
process shall be accurate and truthful.

The licensing authority will not issue a new license
if the applicant has had a health facility license revoked or renewal denied or
has surrendered a license under threat of revocation or denial of renewal.

The licensing authority may not issue a new
license if the applicant has been cited repeatedly for violations of applicable
rules found to be class A or class B deficiencies as defined in health facility
sanctions and civil monetary penalties, 8.370.4 NMAC or has been non-compliant
with plans of correction.

The licensing
authority will not issue a license until the applicant has supplied all of the
information that is required by this rule.

Any facility that fails to participate in good faith by falsifying
information presented in the licensing process shall be denied licensure by the
authority.

The following information
shall be submitted to the licensing authority for approval:

(1)

a
letter of intent that includes the proposed physical address, the primary
population of the facility and a summary of the proposed services; after the
letter of intent has been received, an application packet including; the
application form, fee schedule and the licensing rule will be issued to the
applicant by the licensing authority;

(2)

the
completed and notarized application and the appropriate non-refundable fee(s);

(3)

a
program narrative identifying and detailing the geographic service area, the primary
population including any special needs requirements, along with a full
description of the services that the applicant proposes to provide including:

(a)

a
description of the characteristics of the proposed population of the facility;

(b)

a
description of the services and care that will be provided to the residents;

(c)

a
description of the anticipated professional services to be offered to the
residents; and

(d)

a
description of the facility’s relationship to other services and related
programs in the service area and how the applicant will collaborate with them
to achieve a system of care for the residents.

(4)

policies
and procedures annotated to this rule;

(5)

evidence
to establish that the applicant has sufficient financial assets to permit
operation of the facility for a period of six months; the evidence shall
include a credit report from one of the three recognized credit bureaus with a
minimum credit score of 650 or above;

(6)

copies
of organizational documents to include the following list of items:

(a)

the
names of all persons or business entities that have at least five percent ownership
interest in the facility, whether direct or indirect and whether in profits,
land or building; this includes the owners of any business entity which owns
all or part of the land or building;

(b)

the
identities of all creditors that hold a security interest in the premises,
whether land or building;

(c)

any
changes in ownership or management shall be reported to the authority within thirty
(30) days;

(7)

building
plans as required at 8.370.14.41 NMAC of this rule;

(8)

fire
authority approval as required at 8.370.14.60 NMAC of this rule;

(9)

a
letter of approval or exemption from the local health authority having
jurisdiction for the food service and the kitchen facility;

(10)

a
copy of liquid waste disposal and treatment system permit from local health
authority having jurisdiction;

(11)

approval
from local zoning authority;

(12)

building
approval (certificate of occupancy); and

(13)

any
other information that the applicant wishes to provide or that the licensing
authority may request.

Application for amended license.

A licensee shall submit an application for an
amended license and the required non-refundable fee to the licensing authority
prior to a change with the facility.

An
amended license is required for a change of: location, administrator, facility
name, capacity or any modification or addition to the building.

(1)

An
application for a change of the facility administrator or change of the
administrator’s name shall be submitted to the licensing authority within 10
business days of the change.

(2)

An
application for increase in capacity shall be accompanied by a building plan
pursuant to 8.370.14.41 NMAC of this rule.

A facility shall not increase census until the
licensing authority has reviewed and approved the increase and has issued a new
license that reflects the approved increase in capacity.

Application for license renewal.

Each facility shall apply for a renewal of the
annual license within thirty (30) business days prior to the license expiration
date by submitting the following items:

(1)

an
application and the required fee;

(2)

an
updated program narrative, if the facility has changed the program or the focus
of services;

(3)

the
annual fire inspection report; and

(4)

the
licensing authority may not issue a new license if the applicant has been cited
repeatedly for violations of this rule or has been noncompliant with plans of
correction or payment of civil monetary penalties.

License.

Any person or entity that establishes,
maintains or operates an assisted living facility shall obtain a license as
required in this rule before accepting residents for care or providing
services.

(1)

Each
facility that provides care or treatment shall obtain a separate license.

The license is non-transferable and is only
valid for the facility to which it is originally issued and for the owner or
operator to whom it is issued.

It shall
not be sold, reassigned or transferred.

(2)

The
maximum capacity specified on the license shall not be exceeded.

(3)

If
the facility is closed and the residents are removed from the facility, the
license shall be returned to the licensing authority.

Written notification shall be issued to all
residents or the residents’ surrogate decision maker and the licensing
authority at least 30 calendar days prior to the closure.

Temporary
license.

(1)

A
temporary license may be issued to a new facility before residents are admitted
provided that the facility has met all of the life safety code requirements as
stated in this rule and policies and procedures for the facility have been
reviewed and approved.

(2)

Upon
receipt of a temporary license, the facility may begin to admit up to three residents.

(3)

After
the facility has admitted up to three residents, the facility operator or owner
shall request an initial health survey from the licensing authority.

(4)

Following
a determination of compliance with this rule by the licensing authority, an
annual license will be issued.

The renewal
date of the annual license is based on the initial date of the first temporary
license.

(5)

The
licensing authority has the right to determine compliance or noncompliance.

(6)

A
temporary license shall cover a period of time, not to exceed 120 calendar
days.

(7)

No
more than two consecutive temporary licenses shall be issued.

If a second temporary license is issued, an
additional non-refundable fee is required.

If all requirements are not met within the 240
day time frame, the applicant shall repeat the application process.

Annual
license.

An annual license is issued
for one year for a facility that has met all the requirements of this rule.

Display
of license.

The facility shall
display the license in a conspicuous public place that is visible to residents,
staff and visitors.

Unlicensed
facilities.

Any person or entity
that opens or maintains an assisted living facility without a license is
subject to the imposition of civil monetary penalties by the licensing
authority.

Failure to comply with the
licensure requirements of this rule within 10 days of notice by the licensing
authority may result in the following penalties pursuant to health facility
sanctions and civil monetary penalties, 8.370.4 NMAC.

(1)

A
civil monetary penalty not to exceed $5,000 per day.

(2)

A
base civil monetary penalty, plus a per-day civil monetary penalty, plus the doubling
of penalties as applicable, that continues until the facility is in compliance
with the licensing requirements in this rule.

(3)

A
cease and desist order to discontinue operation of a facility that
is operating without a license.

(4)

Additional
criminal penalties may apply and shall be imposed as necessary.

[8.370.14.8 NMAC - N, 7/1/2024]

8.370.14.9

WAIVERS AND VARIANCES.

The licensing authority may vary or waive
certain licensure requirements for facilities, provided that it would not
adversely affect the health, safety or welfare of the residents or staff.

Requests
for a variance or waiver may be made at any time, shall be made in writing to
the licensing authority and shall specify the following:

(1)

the
section of the rule for which the variance or wavier is requested;

(2)

the
time period for which the waiver is requested;

(3)

if
the request is for a variance; the specific alternative action that the
facility proposes;

(4)

the
reason(s) for the request and an explanation of why and how the health, safety
and welfare of the residents or staff are not endangered by the requested
variance or waiver; and

(5)

justification
that the goal or purpose of the rule would be satisfied.

The
licensing authority may require additional information from the facility prior
to acting on the request.

The
licensing authority may impose conditions on the variance or waiver.

The
licensing authority shall limit the duration of any waiver.

Variances
and waivers are nontransferable and shall be kept on file and readily available
at the facility.

Variances
and waivers are granted at the discretion of the licensing authority.

[8.370.14.9 NMAC - N, 7/1/2024]

8.370.14.10

AUTOMATIC EXPIRATION OF A LICENSE:

A license shall automatically expire:

at
midnight on the day indicated as the expiration date on the license;

when
the operation of a facility is discontinued;

when
a facility is sold or leased or the licensee changes; or

when there is a change of location for a facility.

[8.370.14.10 NMAC - N, 7/1/2024]

8.370.14.11

SURVEY OR MONITORING VISITS:

The
licensing authority shall perform on-site survey or monitoring visits at all assisted
living facilities to determine compliance with this rule.

The
facility shall provide the licensing authority full access to all facility
operations, buildings and information related to the operation of the facility.

The
most recent survey inspection reports and related correspondence shall be
posted in a conspicuous public place in the facility.

Failure
by the facility to provide the licensing authority access to the premises or
information, including resident records, may result in the imposition of
sanctions including but not limited to civil monetary penalties, license
revocation or an order to cease and desist, as deemed appropriate by the
licensing authority.

[8.370.14.11 NMAC - N, 7/1/2024]

8.370.14.12

CORRECTIVE
ACTION:

If violations of this rule
are cited, the facility will be provided with an official statement of
deficiencies within 10 business days following the survey.

Informal
dispute review

(IDR).

The facility may request an informal review of
survey deficiencies by providing a written request to the licensing authority
within 10 calendar days of receipt of the written survey findings.

With the request, the facility shall include information
or evidence that justifies the disagreement with a cited deficiency.

(1)

The
licensing authority will review the submitted information and make a
determination.

(2)

If
the deficiency is removed, a new statement of deficiencies will be issued to
the facility.

(3)

The
facility shall provide a new plan of correction for all remaining deficiencies upon
receipt of the new statement of deficiencies.

(4)

A
copy of the “IDR operating rules” is available upon request.

Plan
of correction (POC).

The facility
shall submit a plan of correction within 10 calendar days of receipt of the
statement of deficiencies and after receipt of a revised statement of
deficiencies, when the findings are changed pursuant to an IDR.

(1)

If
the first plan of correction (POC) is rejected by the licensing authority, the
facility will be sent a second (2nd) copy of the statement of deficiencies.

The facility shall complete and return the
second copy of the statement of deficiencies with an acceptable plan of
correction within three business days.

The process will repeat until an acceptable plan of correction is
received by the authority.

(2)

Failure
to provide an acceptable plan of correction (POC) within a reasonable period of
time, may lead to civil monetary penalties or other sanctions.

(3)

The
plan of correction shall:

(a)

address
how all violations identified in the official statement of deficiencies will be
corrected;

(b)

address
how the facility will monitor the corrective action and ensure ongoing
compliance; and

(c)

specify
the date that the corrective action will be completed.

(4)

All
cited violations shall be corrected within 30 calendar days from the date of
the survey; unless the licensing authority approves an extended date.

(5)

Failure
to submit an acceptable plan of correction may result in sanctions, including
but not limited to civil monetary penalties, suspension or non-renewal of the
facility license.

(6)

The
licensing authority may accept, reject, or direct the plan of correction.

[8.370.14.12 NMAC - N, 7/1/2024]

8.370.14.13

GROUNDS FOR REVOCATION, SUSPENSION OR
DENIAL OF INITIAL OR RENEWAL OF LICENSE, OR THE IMPOSITION OF SANCTIONS OR
CIVIL MONETARY PENALTIES:

When the licensing authority determines that an
application for the renewal of a license will be denied or that a license will
be revoked, the licensing authority shall provide written notification to the
facility, the residents and the surrogate decision makers for the residents.

After
notice to the facility and an opportunity for a hearing, the authority may deny
an initial or renewal application, revoke or suspend the license of a facility
or may impose an intermediate sanction and a civil monetary penalty as provided
in accordance with the Public Health Act, Section 24-1-5.2 NMSA 1978.

Grounds for implementing these penalties may be based
on the following:

(1)

failure
to comply with any provision of this rule;

(2)

failure
to allow a survey by authorized representatives of the licensing authority;

(3)

the
hiring or retaining of any staff or permitting any private duty attendant or
volunteer to work with residents that has a disqualifying conviction under the requirements
of the caregiver’s criminal history screening program, 8.370.5 NMAC;

(4)

the
misrepresentation or falsification of any information on the application forms
or other documents provided to the licensing authority;

(5)

repeat
violations of this rule;

(6)

failure
to maintain or provide services as required by this rule;

(7)

exceeding
licensed capacity;

(8)

failure
to provide an acceptable plan of correction within the time period established
by the licensing authority;

(9)

failure
to correct deficiencies within the time period established by the licensing
authority;

(10)

failure
to comply with the incident reporting requirements pursuant to incident
reporting, intake processing and training requirements, 8.370.9 NMAC; and

(11)

failure
to pay civil monetary penalties pursuant to health facility sanctions and civil
monetary penalties, 8.370.4 NMAC.

[8.370.14.13 NMAC - N, 7/1/2024]

8.370.14.14

HEARING
PROCEDURES:

Hearing
procedures for an adverse action taken against a facility by the authority will
be conducted in accordance with adjudicatory hearings for licensed facilities, 8.370.2
NMAC.

The
facility will receive a copy of the hearing procedures at the time that an
adverse action is taken or may request a copy by contacting the licensing
authority.

If
immediate action is required to protect human health and safety, the licensing authority
may suspend a license or impose an intermediate sanction pending a hearing,
provided that the hearing is held within five working days of the suspension or
the sanction, unless waived by the facility, in accordance with the Public
Health Act, Subsection H of Section 24-1-5 NMSA.

[8.370.14.14 NMAC - N, 7/1/2024]

8.370.14.15

APPEALS
:

A
licensee that is subject to an adverse action may request an administrative
appeal.

Hearing procedures for an
administrative appeal of an adverse action taken by the licensing authority
against the facility is in accordance with adjudicatory hearings for licensed
facilities, 8.370.2 NMAC.

A
copy of the adjudicatory hearing procedures will be forwarded to the facility when
an adverse action is taken against the licensee by the licensing authority.

All
notices, orders or decisions which the licensing authority issues to a facility
prior to a transfer of ownership shall be in effect against both the former
owner and the new owner, unless the transfer of penalties to the new owner is rescinded
in writing by the authority.

[8.370.14.15 NMAC - N, 7/1/2024]

8.370.14.16

STAFF
QUALIFICATIONS:

A facility shall
employ staff with the following qualifications.

Administrator,
director, operator:

an assisted
living facility shall be supervised by a full-time administrator.

Multiple facilities that are located within a
40-mile radius may have one full-time administrator.

The administrator shall:

(1)

be
at least 21 years of age;

(2)

have
a high school diploma or its equivalent;

(3)

comply
with the requirements of the New Mexico caregivers criminal history screening act,
8.370.5 NMAC;

(4)

complete
a state approved certification program for assisted living administrators;

(5)

be
able to communicate with the residents in the language spoken by the majority
of the residents;

(6)

not
work while under the influence of alcohol or illegal drugs;

(7)

have
evidence of education and experience to prove the ability to administer, direct
and operate an assisted living facility; the evidence of education and
experience shall be directly related to the services that are provided at the
facility;

(8)

provide
three notarized letters of reference from persons unrelated to the applicant;
and

(9)

comply
with the pre-employment requirements pursuant to the employee abuse registry, 8.370.8
NMAC.

Direct care staff:

(1)

shall
be at least 16 years of age;

(2)

shall
have adequate education, relevant training, or experience to provide for the
needs of the residents;

(3)

shall
comply with the pre-employment requirements pursuant to the Employee Abuse
Registry, 8.370.8 NMAC; and

(4)

shall
comply with the current requirements of reporting and investigating incidents
pursuant to incident reporting, intake processing and training requirements, 8.370.9
NMAC;

(5)

if
a facility provides transportation for residents, the employees of the facility
who drive vehicles and transport residents shall have copies of the following
documents on file at the facility:

(a)

a
valid New Mexico driver’s license with the appropriate classification for the
vehicle that is used to transport residents;

(b)

documentation
of training in transportation safety for the elderly and disabled, including
safe vehicle operation;

(c)

proof
of insurance; and

(d)

documentation
of a clean driving record;

(6)

any
person who provides direct care who is not employed by an agency that is
covered by the requirements of the caregivers criminal history screening
requirements, 8.370.5 NMAC, shall provide current (within the last 6 months)
proof of the caregiver’s criminal history screening to the facility; the
facility shall maintain and have proof of such screening readily available; and

(7)

employers
shall comply with the requirements of the caregivers criminal history screening
requirements, 8.370.5 NMAC.

[8.370.14.16 NMAC - N, 7/1/2024]

8.370.14.17

STAFF
TRAINING:

Training
and orientation for each new employee and volunteer that provides direct care
shall include a minimum of 16 hours of supervised training prior to providing
unsupervised care for residents.

Documentation
of orientation and subsequent trainings shall be kept in the personnel file at
the facility.

Training
shall be provided at orientation and at least 12 hours annually, the
orientation, training and proof of competency shall include:

(1)

fire
safety and evacuation training;

(2)

first
aid;

(3)

safe
food handling practices (for persons involved in food preparation), to include:

(a)

instructions
in proper storage;

(b)

preparation
and serving of food;

(c)

safety
in food handling;

(d)

appropriate
personal hygiene; and

(e)

infectious
and communicable disease control;

(4)

confidentiality
of records and resident information;

(5)

infection
control;

(6)

resident
rights;

(7)

reporting
requirements for abuse, neglect or exploitation in accordance with 8.370.9 NMAC;

(8)

smoking
policy for staff, residents and visitors;

(9)

methods
to provide quality resident care;

(10)

emergency
procedures;

(11)

medication
assistance, including the certificate of training for staff that assist with
medication delivery; and

(12)

the
proper way to implement a resident ISP
for staff
that assist with ISPs.

If
a facility provides transportation to residents, employees of the facility who drive
vehicles and transport residents shall have training in transportation safety
for the elderly and disabled, including safe vehicle operation.

[8.370.14.17 NMAC - N, 7/1/2024]

8.370.14.18

POLICIES:

The facility shall have and implement written
personnel policies for the following:

staff,
private duty attendant and volunteer qualifications;

staff,
private duty attendant and volunteer conduct;

staff,
private duty attendant and volunteer training policies;

staff
and private duty attendant and volunteer criminal history screening;

emergency
procedures;

medication
administration;

the
retention and maintenance of current and past personnel records; and

facilities
shall maintain records and files that reflect compliance with NM and federal
employment rules.

[8.370.14.18 NMAC - N, 7/1/2024]

8.370.14.19

STAFFING RATIOS:

The following staffing levels are the minimum

requirements.

The
facility shall employ the sufficient number of staff to provide the basic care,
resident assistance and the required supervision based on the assessment of the
residents’ needs.

(1)

During
resident waking hours, facilities shall have at least one direct care staff
person on duty and awake at all times for each 15 residents.

(2)

During
resident sleeping hours, facilities with 15 or fewer residents shall have at
least one direct care staff person on duty, awake and responsible for the care
and supervision of the residents.

(3)

During
resident sleeping hours, facilities with 16 to 30 residents shall have at least
one direct care staff person on duty and awake at all times and at least one
additional staff person available on the premises.

(4)

During
resident sleeping hours, facilities with 31 to 60 residents shall have at least
two direct care staff persons on duty and awake at all times and at least one
additional staff person immediately available on the premises.

(5)

During
resident sleeping hours, facilities with more than 61 residents shall have at
least three direct care staff persons on duty and awake at all times and one additional
staff person immediately available on the premises for each additional 30
residents or fraction thereof in the facility.

Upon
request of the authority, the facility shall provide the staffing ratios per each
24 hour day for the past 30 days.

[8.370.14.19 NMAC - N, 7/1/2024]

8.370.14.20

ADMISSIONS AND DISCHARGE:

The facility shall complete an admission
agreement for each resident.

The administrator
of the facility or a designee responsible for admission decisions shall meet
with the resident or the resident’s surrogate decision maker prior to
admission.

No resident shall be admitted
who is below the age of eighteen (18) or for whom the facility is unable to
provide appropriate care.

Admission agreement:

The admission agreement shall include the
following information:

(1)

the
parties to the agreement;

(2)

the
program narrative;

(3)

the
facility's rules;

(4)

the
cost of services and the method of payment;

(5)

the
refund provision in case of death, transfer, voluntary or involuntary discharge;

(6)

information
to formulate advance directives;

(7)

a
written description of the legal rights of the residents translated into
another language, if necessary;

(8)

the
facility's staffing ratio;

(9)

written
authorization for staff to assist with medications;

(10)

notification
of rights and responsibilities pursuant to the incident reporting intake,
processing and training requirements, 8.370.9 NMAC;

(11)

the
facility’s bed hold policy; and

(12)

the
admission agreement may be terminated if an appropriate placement is found for
the resident, under the following circumstances:

(a)

there
shall be a 15 day written notice of termination given to the resident or his or
her surrogate decision maker, unless the resident requests the termination;

(b)

the
resident has failed to pay for a stay at the facility as defined in the
admission agreement;

(c)

the
facility ceases to operate or is no longer able to provide services to the
resident;

(d)

the
resident’s health has improved sufficiently and therefore no longer requires the
services of the facility;

(e)

termination
without prior notice is permitted in emergency situations for the following
reasons:

(i)

the
transfer or discharge is necessary for the resident's safety and welfare;

(ii)

the
resident's needs cannot safely be met in the facility; or

(iii)

the
safety and health of other residents and staff in the facility are endangered;

(13)

the
facility shall provide a 30 day written notice to residents regarding any
changes in the cost or the material services provided; a new or amended
admission agreement must be executed whenever services, costs or other material
terms are changed; and

(14)

facilities
representing their services as “specialized” must disclose evidence of staff
specialty training to prospective residents.

Restrictions
in admission:

The facility shall not
admit or retain individuals that require 24 hour continuous nursing care, refer
to Subsection U of 8.370.14.7 NMAC definitions.

This rule does not apply to hospice residents
who have elected to receive the hospice benefit.

Conditions or circumstances that usually
require continuous nursing care may include but are not limited to the
following:

(1)

ventilator
dependency;

(2)

pressure
sores and decubitus ulcers (stage III or IV);

(3)

intravenous
therapy or injections;

(4)

any
condition requiring either physical or chemical restraints;

(5)

nasogastric
tubes;

(6)

tracheostomy
care;

(7)

residents
that present an imminent physical threat or danger to self or others;

(8)

residents
whose psychological or physical condition has declined and placement in the
current facility is no longer appropriate as determined by the PCP;

(9)

residents
with a diagnosis that requires isolation techniques;

(10)

residents
that require the use of a hoyer lift; and

(11)

ostomy
(unless resident is able to provide self-care).

Exceptions
to admission,

readmission and retention:

If a resident requires a greater degree of
care than the facility would normally provide or is permitted to provide and
the resident wishes to be re-admitted or remain in the facility and the
facility wishes to re-admit or retain the resident.

The facility shall comply with the following
requirements.

(1)

Convene
a team, comprised of:

(a)

the
facility administrator and a facility health care professional if desired;

(b)

the
resident or resident’s surrogate decision maker; and

(c)

the
hospice or home health clinician.

(2)

The
team shall jointly determine if the resident should be admitted, readmitted or
allowed to remain in the facility.

Team
approval shall be in writing, signed and dated by all team members and the
approval shall be maintained in the resident's record and shall:

(a)

be
based upon an individual service plan (ISP) which identifies the resident's
specific needs and addresses the manner that such needs will be met;

(b)

ensure
that if the facility is licensed for more than eight residents and does not
have complete fire sprinkler coverage, the facility shall maintain an
evacuation rating score of prompt as determined by the fire safety equivalency system
(FSES);

(c)

evaluate
and outline how meeting the specific needs of the resident will impact the
staff and the other residents; and

(d)

include
an independent advocate such as a certified ombudsman if requested by the
resident, the family or the facility.

(3)

The
team recommendation shall be maintained on site in the resident’s file.

(4)

When
a resident is discharged, the facility shall record where the resident was
discharged to and what medications were released with the resident.

Coordination of care:

(1)

Assisted
living facilities shall have evidence of care coordination on an ISP for all
services that are provided in the facility by an outside health care provider,
such as hospice or home health providers.

(2)

Residents
shall be given a list of providers, including hospice and home health if
applicable, and have the right to choose their provider.

If applicable, the referring party shall
disclose any ownership interest in a recommended or listed provider.

[8.370.14.20 NMAC - N, 7/1/2024]

8.370.14.21

RESIDENT RECORDS:

Record
contents:

A record for each resident
shall be maintained in accordance with the specific requirements of this
section.

Entries in each resident's
record shall be legible, dated and authenticated by the signature of the person
making the entry.

Resident records shall
be readily available on site and organized utilizing a table of contents.

Each resident record shall include:

(1)

the
admission agreement records, as set forth in 8.370.14.20 NMAC;

(2)

the
resident evaluation form
,
that is to
be completed within 15 days prior to admission and updated at a minimum of
every six months;

(3)

the
current ISP, that is to be completed within 10 calendar days of admission and
updated at a minimum of every six months;

(4)

the
physical examination report; the physical examination report shall have been completed
within the past six months, by a primary care physician, a nurse practitioner
or a physician’s assistant and shall be on file in the resident’s record within
10 days of admission;

(5)

personal
and demographic information for the resident, to include:

(a)

current
names, addresses, relationship and phone numbers of family members, or
surrogate decision makers updated as necessary;

(b)

resident's
name;

(c)

age;

(d)

recent
photograph;

(e)

marital
status;

(f)

date
of birth;

(g)

sex;

(h)

address
prior to admission;

(i)

religion
(optional);

(j)

personal
physician;

(k)

dentist;

(l)

social
history;

(m)

surrogate
decision maker or other emergency contact person;

(n)

language
spoken and understood;

(o)

legal
documentation relevant to commitment or guardianship status;

(p)

current
medications list; and

(q)

required
diet;

(6)

unless
included in the admission agreement, a separate written agreement between the
facility and the resident relating to the resident's funds, in accordance with
the facility's policy and procedures;

(7)

entries
by direct care staff, appropriate health care professionals and others
authorized to care for the resident; entries shall be dated and signed by the
person making the entry and shall include significant information related to
the ISP;

(8)

entries
that provide a written account of all accidents, injuries, illnesses, medical
and dental appointments, any problems or improvements observed in the resident,
any condition that would indicate a need for alternative placement or medical
attention and entries reflecting appropriate follow-up; the maintenance of such
written documentation in the resident record may be by copy of an incident or
accident report, if the original incident or accident report is maintained
elsewhere by the facility;

(9)

the
medication assistance record (MAR); the MAR is the document that details the
resident's medication; the MAR shall include all of the information pursuant to
Subsection G of 8.370.14.35 NMAC of this rule;

(10)

progress
notes completed

by any contract
agency (e.g., hospice, home health); the progress notes shall include the date,
time and type of health services provided;

(11)

copies
of all

completed and signed transfer
forms from the accepting facility when a resident is transferred to a hospital or
another health care facility and when the resident is transferred back to the
facility; and

(12)

upon
the death or transfer of a resident, documentation of the disposition of the
resident's personal effects and money or valuables that are deposited with the
assisted living facility.

Resident records maintenance:

(1)

Current
resident records shall be maintained on-site and stored in an organized,
accessible and permanent manner.

(2)

The
facility shall establish a policy to maintain and ensure the confidentiality of
resident records, including the authorized release of information from the resident
records.

(3)

Non-current
resident records shall be maintained by the facility against loss, destruction
and unauthorized use for a period of not less than five years from the date of
discharge and readily available within 24 hours of request.

(4)

There
shall be a policy and procedure in place for record retention in the event of
facility closure.

(5)

Failure
to follow facility policies is grounds for sanctions.

[8.370.14.21 NMAC - N, 7/1/2024]

8.370.14.22

FACILITY REPORTS, RECORDS, RULES,
POLICIES AND PROCEDURES:

Reports
and records:

Each facility shall
keep the following reports, records, policies and procedures on file at the
facility and make them available for review upon request by the licensing
authority, residents, potential residents or their surrogate decision makers:

(1)

fire
inspection report;

(2)

zoning
approval;

(3)

building
official approval (certificate of occupancy);

(4)

a
copy of the approved building plans;

(5)

a
copy of the most recent survey conducted by the licensing authority, to include
adverse actions or appeals and complaints;

(6)

for
facilities with food establishments/kitchens that require a permit from the local
health authority that has jurisdiction, a copy of the current inspection report
in accordance with the applicable, municipal, or federal laws and regulations and
pursuant to Subsection B of 7.6.2.8 NMAC, regarding kitchen and food management;
if a facility is considered a licensed private home and not required to meet
specific requirements by the local health authority, a copy of that
determination must also be maintained;

(7)

where
necessary, a copy of the liquid waste disposal and treatment system permit from
the local health authority that has jurisdiction;

(8)

30
days of menus as planned, including snacks and 30 days of menus as served,
including snacks;

(9)

record
of monthly fire drills conducted at the facility and the fire safety evaluation
system (FSES) rating, if applicable;

(10)

written
emergency plans, policies and procedures for medical emergencies, power
failure, fire or natural disaster; plans shall include evacuation, persons to
be notified, emergency equipment, evacuation routes, refuge areas and the
responsibilities of personnel during emergencies; plans shall also include a
list of transportation resources that are immediately available to transport
the residents to another location in an emergency; the emergency preparedness
plan shall address two types of emergencies:

(a)

an
emergency that affects just the facility; and

(b)

a
region/area wide emergency;

(11)

a
copy of this rule, requirements for assisted living facilities for adults, 8.370.14
NMAC;

(12)

for
facilities with two or more residents (that are not related to the owner), a valid
custodial drug permit issued by the NM board of pharmacy, that supervise
administration and self-administration of medications or safeguards with regard
to medications for the residents; and

(13)

vaccination
records for pets in the facility.

Reports and records:

Each facility shall keep the following
reports, records, policies and procedures on file at the facility and make them
available for review upon request by the licensing authority:

(1)

a
copy of the facility license;

(2)

employee
personnel records, including an application for employment, training records
and personnel actions:

(a)

caregiver
criminal history screening documentation pursuant to 8.370.5 NMAC;

(b)

employee
abuse registry documentation pursuant to 8.370.8 NMAC; and

(3)

a
copy of all waivers or variances granted by the licensing authority.

Rules:

Prior to admission to a facility a prospective
resident or his or her representative shall be given a copy of the facility
rules.

Each facility shall have written
rules pertaining to resident’s rights and shall include the following:

(1)

resident
use of tobacco and alcohol;

(2)

resident
use of facility telephone or personal cell phone;

(3)

resident
use of television, radio, stereo and cd;

(4)

the
use and safekeeping of residents’ personal property;

(5)

meal
availability and times;

(6)

resident
use of common areas;

(7)

accommodation
of resident’s pets; and

(8)

resident
use of electric blankets and appliances.

Policies and procedures:

All facilities shall have written policies and
procedures covering the following areas:

(1)

actions
to be taken in case of accidents or emergencies;

(2)

policy
and procedure for updating and consolidating the resident’s current physician
or PCP orders, treatments and diet plans every six months or when a significant
change occurs, such as a hospital admission;

(3)

policy
for medication errors;

(4)

method
of staying informed when residents are away from the facility (e.g., sign-out
sheets or other record indicating where the resident will be, cell phone
contact, etc.);

(5)

the
handling of resident's funds, if the facility provides such services;

(6)

reporting
of incidents, including abuse, neglect and misappropriation of property,
injuries of unknown cause, environmental hazards and law enforcement
interventions in accordance with 8.370.9 NMAC;

(7)

reporting
and investigating internal complaints;

(8)

reporting
and investigating complaints to the incident management bureau;

(9)

staff
and resident fire and safety training;

(10)

smoking
policy for staff, residents and visitors;

(11)

the
facility's bed hold policy;

(12)

admission
agreement;

(13)

admission
records;

(14)

resident
records including maintenance and record retention if the facility closes;

(15)

program
narrative;

(16)

resident's
rights with regard to making health care decisions and the formulation of
advance directives;

(17)

personnel
policies;

(18)

identifying
and safeguarding resident possessions;

(19)

securing
medical assistance if a resident's own physician is not available;

(20)

staff
training appropriate to staff responsibilities;

(21)

staff
training for employees who provide assistance to residents with boarding or
alighting from motor vehicles and safe operation of motor vehicles to transport
residents;

(22)

witnessed
destruction of unused, outdated or recalled medication by the facility
administrator with the consulting pharmacist present; and

(23)

mealtimes,
daily snacks, menus, special diets, resident’s personal preference for eating
alone or in the dining room setting.

[8.370.14.22 NMAC - N, 7/1/2024]

8.370.14.23

PETS:

Pets are permitted in a licensed facility, in
accordance with the facility's rules.

Prohibited
areas:

Animals are not permitted in food
processing, preparation, storage, display and serving areas, or in equipment or
utensil washing areas.

Guide dogs for
the blind and deaf and service animals for the handicapped shall be permitted
in dining areas pursuant to Subsection K of 7.6.2.9 NMAC.

Vaccination:

Pets shall be vaccinated in accordance
with all state and local requirements and records of such vaccination shall be
kept on file in the facility.

[8.370.14.23 NMAC - N, 7/1/2024]

8.370.14.24

ASSISTANCE WITH DAILY LIVING:

The facility shall supervise and assist the
residents, as necessary, with health, hygiene and grooming needs, to include
but not limited to the following:

eating;

dressing;

oral hygiene;

D
.

bathing;

grooming;

mobility; and

toileting.

[8.370.14.24 NMAC - N, 7/1/2024]

8.370.14.25

RESIDENT EVALUATION:

A resident evaluation shall be completed by an
appropriate staff member within 15 days prior to admission to determine the
level of assistance that is needed and if the level of services required by the
resident can be met by the facility.

The
initial resident evaluation shall establish a baseline in the resident’s
functional status and thereafter assist with identifying resident changes.

The resident evaluation shall be reviewed and
updated at a minimum of every six months or when there is a significant change
in the resident’s health status.

The
resident’s evaluation shall be documented on a resident evaluation form and at
a minimum include the following abilities, behaviors or status:

(1)

activities
of daily living;

(2)

cognitive
abilities; reasoning and perception; the ability to articulate thoughts, memory
function or impairment, etc.;

(3)

communication
and hearing; ability to communicate needs and understand instructions, etc.;

(4)

vision;

(5)

physical
functioning and skeletal problems;

(6)

incontinence
of bowel/bladder;

(7)

psychosocial
well-being;

(8)

mood
and behavior;

(9)

activity
interests;

(10)

diagnoses;

(11)

health
conditions;

(12)

nutritional
status;

(13)

oral
or dental status;

(14)

skin
conditions;

(15)

medication
use and level of assistance needed with medications;

(16)

special
treatments and procedures or special medical needs such as hospice; and

(17)

safety
needs/high risk behaviors; history of falls agitation, wandering, fire safety
issues, etc.

The resident evaluation shall include a history and
physical examination and an evaluation report by a physician or a physician
extender within six months of admission.

A resident shall have a medical evaluation by a physician or a physician
extender at least annually.

The resident evaluation shall be reviewed and if
needed revised by a licensed practical nurse, registered nurse or physician
extender at the time the individual service plan is reviewed, at a minimum of
every six months or when a significant change in health status occurs.

[8.370.14.25 NMAC - N, 7/1/2024]

8.370.14.26

INDIVIDUAL SERVICE PLAN (ISP):

An ISP shall be developed and implemented
within 10 calendar days of admission for each resident residing in the
facility.

The
ISP shall address those areas of need as identified in the resident evaluation and
through staff observation.

(1)

The
ISP shall detail the services that are provided by the facility as well as the services
to be provided by other agencies.

(2)

The
resident evaluation and the ISP shall be reviewed and if needed revised by a licensed
practical nurse, registered nurse or a physician extender.

(3)

The
ISP shall be reviewed and or revised at a minimum of every six months or when
there is a significant change in the resident’s health status.

The ISP shall include the following:

(1)

a
description of identified needs as noted in the resident evaluation;

(2)

a
written description of all services to be provided;

(3)

who
will provide the services;

(4)

when
or how often the services will be provided;

(5)

how
the services will be provided;

(6)

where
the services will be provided;

(7)

expected
goals and outcomes of the services;

(8)

documentation
of the facility’s determination that it is able to meet the needs of the
resident;

(9)

the
level of assistance that the resident will require with activities of daily
living and with medications;

(10)

a
crisis prevention/intervention plan when indicated by diagnosis or behavior;
and

(11)

current
orders for all medications, including those authorized for PRN usage.

[8.370.14.26 NMAC - N, 7/1/2024]

8.370.14.27

RESIDENT ACTIVITIES:

Each facility shall provide or make available
recreational and social activities appropriate to the residents’ abilities that
meet their psychosocial needs and are relevant to their social history;
including a balance of cognitive, reminiscence, physical and social activities.

The facility shall post the activities and
encourage residents to participate.

[8.370.14.27 NMAC – N, 7/1/2024]

8.370.14.28

PERSONAL POSSESSIONS:

Each resident shall be permitted to keep personal
property in their possession at the facility, if it is not detrimental to the
health and safety of anyone in the facility.

These possessions may include, but are not
limited to the following items:

(1)

clothing;
the facility shall ensure that each resident has his or her own clothing; residents
shall be allowed and encouraged to select their daily clothing and change their
clothing to suit their activities and the weather conditions;

(2)

personal
care items; each resident shall have his or her own personal care items such as,
but not limited to, a comb, razor, hairbrush, toothbrush, toothpaste and like
items.

The facility shall have policies and procedures for
identifying and safeguarding resident possessions.

[8.370.14.28 NMAC - N, 7/1/2024]

8.370.14.29

TRANSPORTATION
:

The facility shall either provide
transportation or assist the resident in using public transportation.

The facility’s motor vehicle transportation
assistance program shall include the following elements:

(1)

resident
evaluation;

(2)

staff
training in hazardous driving conditions;

(3)

safe
passenger transport and assistance;

(4)

emergency
procedures and use of equipment;

(5)

supervised
practice in the safe operation of motor vehicles, maintenance and safety record
keeping; and

(6)

copies
of employee training certificates that give evidence of successful completion
of any applicable course(s) shall be kept on site in the employee files.

To assist residents in using public transportation, the
facility shall provide information on bus schedules, location of bus stops and
telephone numbers of taxi cab companies.

[8.370.14.29 NMAC - N, 7/1/2024]

8.370.14.30

HANDLING OF RESIDENT FUNDS:

Each resident has the right to manage their personal
funds in accordance with state or federal laws.

If the facility agrees, the resident may entrust his
or her personal funds to the facility for safekeeping and management.

In such cases, the facility shall:

(1)

have
written authorization from the resident or his or her surrogate decision maker;

(2)

maintain
a written record of all financial transactions and arrangements involving the
resident's funds and make this written record available upon request, to the
resident, his or her surrogate decision maker and the licensing authority;

(3)

safeguard
any and all funds received from the resident in an account separate from all
other funds of, or held by, the facility;

(4)

upon
written or verbal request by the resident or his or her surrogate decision
maker, return to the resident all or any part of the resident's funds given to
the facility for safekeeping and management, including all accrued interest if
applicable; and

(5)

upon
the resident's death, will transfer all personal funds held by the facility to
the resident’s estate in accordance with Section 45-3-709 NMSA 1978.

The facility shall not commingle the resident’s
funds, valuables or property with that of the licensee.

Resident’s funds, valuables or property shall
be maintained separate, intact and free from any liability of the licensee,
staff and management.

[8.370.14.30 NMAC - N, 7/1/2024]

8.370.14.31

HANDLING OF EMERGENCIES:

Upon
admission, each resident or surrogate decision maker shall designate a primary
care practitioner (PCP) to be called in case of a medical necessity.

Each resident or representative shall also
designate a concerned person to be called in case of an emergency.

The facility shall establish a policy to
secure medical assistance if the resident's own physician is not available.

In the event of an illness or an injury to the
resident, the PCP or a physician extender shall be notified by the facility.

The
facility shall have a first aid kit that contains at a minimum, gauze, adhesive
tape, antiseptic ointment and bandages for emergencies.

The first aid kit shall be kept in a
designated, easily accessible place within the facility.

An
easily accessible and functional telephone shall be available in each facility
for summoning help in case of an emergency.

A pay telephone does not fulfill this
requirement.

A
list of emergency numbers including: fire department, police department,
ambulance services and poison control shall be posted near each public
telephone in the facility.

[8.370.14.31 NMAC - N, 7/1/2024]

8.370.14.32

REPORTING OF INCIDENTS:

The
facility shall insure that all suspected cases or known incidents of resident
abuse, neglect or exploitation are reported in accordance with 8.370.9 NMAC.

(1)

The
facility shall also report any incident or unusual occurrence which has or
could threaten the health, safety, or welfare of the residents and staff to the
licensing authority complaint hotline within 24 hours or by the next business
day, if it is a weekend or a holiday.

(2)

The
facility shall not delay a report to the complaint hotline while an internal
investigation is conducted.

The
facility is responsible for conducting and documenting the investigation of all
incidents within five business days and shall submit a copy of the investigation
report to the licensing authority.

A
copy of the report and the documentation, including the date and time that it
was submitted to the licensing authority, shall be maintained on file at the
facility.

The investigation shall
include the following:

(1)

a
narrative description of the incident;

(2)

the
result of the facility's investigation shall be recorded on the state approved
incident report form for the current year, pursuant to 8.370.9 NMAC; and

(3)

plans
for further actions in response to the incident.

[8.370.14.32 NMAC - N, 7/1/2024]

8.370.14.33

RESIDENT RIGHTS:

All licensed facilities shall understand,
protect and respect the rights of all residents.

Prior
to admission to a facility, a resident and legal representative shall be given
a written description of the legal rights of the resident, translated into
another language, if necessary, to meet the resident’s understanding.

If
the resident has no legal representative and is incapable of understanding his
or her legal rights, a written copy of the resident's legal rights shall be
provided to the most significant responsible party in the following order:

(1)

the
resident's spouse;

(2)

significant
other;

(3)

any
of the resident's adult children;

(4)

the
resident's parents;

(5)

any
relative the resident has lived with for six or more months before admission;

(6)

a
person who has been caring for, or paying benefits on behalf of the resident;

(7)

a
placing agency;

(8)

resident
advocate; or

(9)

the
ombudsman.

The
resident rights shall be posted in a conspicuous public place in the facility
and shall include the telephone numbers for the incident management hotline and
for the state ombudsman program.

To
protect resident rights, the facility shall:

(1)

treat
all residents with courtesy, respect, dignity and compassion;

(2)

not
discriminate in admission or services based on gender, sexual orientation,
resident's age, race, religion, physical or mental disability, or nationality;

(3)

provide
residents written information about all services provided by the facility and
their costs and give advance written notice of any changes;

(4)

provide
residents with a safe and sanitary living environment;

(5)

provide
humane care for all residents;

(6)

provide
the right to privacy, including privacy during medical examinations,
consultations and treatment;

(7)

protect
the confidentiality of the resident’s medical record;

(8)

protect
the right to personal privacy, including privacy in personal hygiene; privacy
during visits with a spouse, family member or other visitor; and privacy in the
resident's own room;

(9)

protect
the right to communicate privately and freely with any person, including
private telephone conversations and private correspondence; and the right to
receive visits from family, friends, lawyers, ombudsmen and community
organizations;

(10)

prohibit
the use of any and all physical and chemical restraints;

(11)

ensure
that residents:

(a)

are
free from physical and emotional abuse neglect and misappropriation/or
exploitation;

(b)

are
free from financial abuse and misappropriation by facility staff or management;

(c)

are
free to participate in religious, social, community and other activities and
freely associate with persons in and out of the facility;

(d)

are
free to leave the facility and return without unreasonable restriction;

(e)

are
given a 15 calendar day, written notice before room transfers or discharge from
the facility unless there is immediate danger to self or others in the
facility;

(f)

have
an environment that fosters social interaction and avoids social isolation;

(g)

or
their surrogate decision makers, are informed of and consent to the services
provided by the facility;

(h)

have
the right to voice grievances to the facility staff, public officials, the
ombudsmen, any state agency, or any other person, without fear of reprisal or
retaliation;

(i)

have
the right to have their complaints addressed within 14 calendar days or sooner;

(j)

have
the right to participate in the development of their care plan/ISP;

(k)

have
the right to choose a doctor, pharmacist and other health care provider(s);

(l)

have
the right to participate in medical treatment decisions and formulate advance
directives such as living wills and powers of attorney;

(m)

have
the right to keep and use personal possessions without loss or damage;

(n)

have
the right to manage and control their personal finances;

(o)

have
the right to freely organize and participate in a resident association that may
recommend changes in the facility's policies, services and management;

(p)

shall
not be required to work for the facility; and

(q)

are
protected from unjustified room transfers or discharge.

The
resident's rights shall not be restricted unless this restriction is for the
health and safety of the resident, agreed to by the resident or the resident’s surrogate
decision maker and outlined in the resident’s individual service plan.

[8.370.14.33 NMAC - N, 7/1/2024]

8.370.14.34

CUSTODIAL DRUG PERMITS:

A facility with two or more residents that is
licensed pursuant to this rule and that assists with self-administration or
safeguards medications for residents shall have a current custodial drug permit
issued by the state board of pharmacy.

Procurement,
labeling and storage:

The facility
shall provide assistance to the resident in obtaining the necessary
medications, treatment and medical supplies as identified in the ISP.

The facility shall procure, label and store
medications for residents who require assistance with self-administration of
medication in compliance with state and federal laws.

(1)

All
medications, including non-prescription drugs, shall be stored in a locked
compartment or in a locked room, as approved by the board of pharmacy and the
key shall be in the care of the administrator or designee.

(2)

Internal
medication shall be kept separate from external medications.

Drugs to be taken by mouth shall be separated
from all other delivery forms.

(3)

A
separate, locked refrigerator shall be provided by the facility for medications.

The refrigerator temperature shall be
kept in compliance with the state board of pharmacy requirements for
medications.

(4)

All
medications, including non-prescription medications, shall be stored in
separate compartments for each resident and all medications shall be labeled
with the resident's name.

(5)

A
resident may be permitted to keep his or her own medication in a locked
compartment in his or her room for self-administration, if the physician's
order deems it appropriate.

(6)

The
facility shall not require the residents to purchase medications from any pharmacy.

(7)

Medical gases (oxygen) and equipment
used for the administration of inhalation therapy and for resuscitative
purposes shall comply with the national fire protection association (NFPA) 99.

(8)

A
proof of use record shall be maintained separately for each schedule II through
IV drug (controlled substances).

The
proof of use sheet shall document:

(a)

the
type and strength of the schedule II through IV drugs;

(b)

the
date and time staff assisted with self-administration;

(c)

the
resident’s name;

(d)

the
prescriber’s name;

(e)

the
dose;

(f)

the
signature of the person assisting with delivery of the medication; and

(g)

the
balance of medication remaining.

(9)

Any
remaining medication discontinued by a physician’s order, or upon discharge or
death of the resident shall be inventoried and moved to a separate locked
storage container.

Such discontinued
medications shall be destroyed upon the next quarterly visit by the consulting pharmacist
in accordance with 16.19.11.10 NMAC.

(10)

The
record of medication destruction shall be signed by the administrator or
designee and the pharmacist and shall be kept on file at the facility.

Consulting
pharmacist:

The facility shall maintain
records demonstrating that the consulting pharmacist provides the following
oversight and guidance.

(1)

Reviews
the medication regimen as needed, but at least quarterly/every three months, to
determine that all medications and records are accurate and current.

All irregularities shall be reported to the
administrator of the facility and these irregularities shall be resolved by the
administrator within 72 hours.

(2)

A
system of records of receipt and disposition of all drugs in sufficient detail
to enable an accurate reconciliation.

(3)

Consultation
shall be provided on all aspects of pharmacy services in the facility,
including reference information regarding side effects and, when needed,
physician consultation in cases involving the use of psychotropic medications.

(4)

The
consulting pharmacist will be responsible for assuring that the facility meets
all requirements for storage, labeling, destruction and documentation of
medications as required by the state board of pharmacy, 16.19.11.10 NMAC and 8.370.14
NMAC.

[8.370.14.34 NMAC - N, 7/1/2024]

8.370.14.35

MEDICATIONS:

Administration of medications or staff
assistance with self-administration of medications shall be in accordance with
state and federal laws.

No medications,
including over-the-counter medications, PRN (when needed) medications, or
treatment shall be started, changed or discontinued by the facility without an
order from the physician, physician assistant or nurse practitioner and with entry
into the resident's record.

State board of nursing licensed or certified
health care professionals are responsible for the administration of
medications.

Administration may only be
performed by these individuals.

Facility staff may assist a resident
with the self-administration of medications if written consent by the resident
is given to the administrator of the facility or the administrator’s designee.

If the resident is incapable of giving
consent, the surrogate decision maker named in accordance with New Mexico law
may give written consent for assistance with self-administration of
medications.

All staff that assist with
self-administration of medications shall have successfully completed a state
approved assistance with self-administration of medication training program or
be licensed or certified by the state board of nursing.

PRN (pro re nada) medication:

(1)

Physician
or physician extender’s orders for PRN medications shall clearly indicate the
circumstances in which they are to be used, the number of doses that may be
given in a 24-hour period and indicate under what circumstances the primary
care practitioner (PCP) is to be notified.

(2)

The
utilization of PRN medications shall be reviewed routinely.

Frequent or escalating use of PRN medications
shall be reported to the PCP.

Only
a licensed nurse (RN or LPN) shall administer any medications or conduct any
invasive procedures provided by the following routes: intravenous (IV), subcutaneous
(SQ), intramuscular (IM), vaginal or rectal.

Only a licensed nurse shall administer non-premixed nebulizer
treatments.

The facility shall have medication reference material
that contains information relating to drug interactions and side effects on the
premises.

Staff that assist in the
self-administration of medications shall know interactions or possible side
effects that might occur.

Medications prescribed for one resident shall not be used
for another resident.

Medication assistance
record (MAR):

For residents who are
not independent and require assistance with self-administration, the facility
shall have a MAR that documents the details of the residents' medication,
including PRN and over-the-counter medication that is assisted with self-administration
by qualified staff or administered to the resident by licensed or certified
staff.

The information in the MAR shall
include:

(1)

the
resident's name;

(2)

any
known allergies to medication that the resident has;

(3)

the
name of the resident's PCP or the prescriber of the medication;

(4)

the
diagnosis or reason for the medication;

(5)

the
name of the medication, including the drug product brand name and the generic
name;

(6)

notation
if the medication is a schedule II-IV drug;

(7)

the
dosage of the medication;

(8)

the
strength of the medication;

(9)

the
frequency or how often the medication is to be taken or given;

(10)

the
route of delivery for the medication (mouth, eye, ear, other);

(11)

the
method of delivery for the medication (pills, drops, IM injection, other);

(12)

the
date that the medication was started or discontinued;

(13)

any
change in the medication order;

(14)

pre-medication
information (i.e., pulse, respiration, blood pressure, blood sugar) as required
by the medication order;

(15)

the
date and time that the medication is self-administered, administered with
assistance or is administered;

(16)

the
initials and signature of the person assisting with or administering the
medication;

(17)

the
desired results obtained from or problems encountered with the medication (pain
relieved, allergic reaction, etc.);

(18)

any
refused dose of medication;

(19)

any
missed dose of medication; and

(20)

any
medication error.

No
medication shall be stopped or started without specific orders from the primary
care physician.

If
a resident refuses to take a prescribed medication, it shall be documented and
the facility shall report it to the prescriber.

A suspected adverse reaction to a medication shall
be documented on the MAR and reported immediately to the PCP and the resident's
surrogate decision maker.

If applicable,
emergency medical treatment shall be arranged.

Documentation of the event shall be kept in the resident's record.

Prescription
medication, other than blister packs and unit dose containers, shall be kept in
the original container with a pharmacy label that includes the following:

(1)

the
resident's name;

(2)

the
name of the medication;

(3)

the
date that the prescription was issued;

(4)

the
prescribed dosage and the instructions for administration of the medication;
and

(5)

the
name and title of the prescriber.

Any medication that is removed from the pharmacy
container or blister pack shall be given immediately and documented by the
staff that assisted with the medication delivery.

The facility shall report all medication errors to the
physician, documentation of medication errors and the prescriber's response
shall be kept in the resident's record.

The facility shall develop and follow a written policy
for unused, outdated, or recalled medications kept in the facility in
accordance with 16.19.11.10 NMAC.

[8.370.14.35 NMAC - N, 7/1/2024]

8.370.14.36

NUTRITION:

The facility shall provide planned and
nutritionally balanced meals from the basic food groups in accordance with the “recommended
daily dietary allowance” of the American dietetic association, the food and
nutrition board of the national research council, or the national academy of
sciences.

Meals shall meet the
nutritional needs of the residents in accordance with the “2005 USDA dietary guidelines
for Americans.”

Vending machines shall
not be considered a source of snacks.

Dietary
services policies and procedures:

The facility will develop and implement
written policies and procedures that are maintained on the premises and that
govern the following requirements.

(1)

Meal service:

The facility shall:

(a)

serve
at least three meals or their equivalent each day at regular times with no more
than 16 hours between the evening meal and morning meal with snacks freely available;

(b)

provide
snacks of nourishing quality and post on the daily menu;

(c)

develop
menus enjoyed by the residents and served at normal intervals appropriate to
the residents’ preferences;

(d)

post
the weekly menu, including snacks where residents and families are able to view
it; posted menus shall be followed and any substitution shall be of equivalent
nutritional value and recorded on the posted menu; identical menus shall not be
used within a one week cycle;

(e)

have
special menus or meal items following guidelines from the resident’s physician
for residents who have medically prescribed special diets;

(f)

serve
all residents in a dining room except for residents with a temporary illness,
or with documented specific personal preference to have meals in their room;

(g)

allow
sufficient time for meals to enable residents to eat at a leisurely pace and to
socialize; and

(h)

contact
the resident’s PCP within 48 hours if a resident consistently refuses to eat.

(2)

Staff in-service training:

The facility shall provide an in-service
training program for staff that are involved in food preparation at orientation
and at least annually and that includes:

(a)

instruction
in proper food storage;

(b)

preparation
and serving food;

(c)

safety
in food handling;

(d)

appropriate
personal hygiene; and

(e)

infectious
and communicable disease control.

Dietary
records:

The facility shall maintain
the following documentation onsite:

(1)

a
systematic record of all menus and revisions, including snacks, for a minimum
of thirty (30) calendar days;

(2)

a
systematic record of therapeutic diets as prescribed by a PCP;

(3)

a
copy of the most recent licensing inspection and for facilities with 10 or more
residents, a copy of the New Mexico environment department inspection with
notations made by the facility of action taken to comply with recommendations
or citations; and

(4)

a
daily log of the recorded temperatures for all facility refrigerators, freezers
and steam tables maintained and available for inspection for 30 calendar days.

Clean
and sanitary conditions:

All
practices shall be in accordance with the standards of the state environment
department, pursuant to 7.6.2 NMAC.

(1)

Kitchen sanitation:

(a)

Equipment
and work areas shall be clean and in good repair.

Surfaces with which food or beverages come
into contact shall be of smooth, impervious material free of open seams, not
readily corrodible and easily accessible for cleaning.

(b)

Utensils
shall be stored in a clean, dry place protected from contamination.

(c)

The
walls, ceiling and floors of all rooms that food or drink is stored, prepared
or served shall be kept clean and in good repair.

(2)

Washing and sanitizing kitchenware:

(a)

All
reusable tableware and kitchenware shall be cleaned in accordance with
procedures that include separate steps for prewashing, washing, rinsing and
sanitizing.

(b)

Proper
dishwashing procedures and techniques shall be utilized and understood by the
dishwashing staff.

(c)

Periodic
monitoring of the operation of the detergent dispenser, washing, rinsing and
sanitizing temperatures shall be performed and documented.

(d)

When
a dishwashing machine is utilized, the cleanliness of the machine, its jets and
its thermostatic controls shall be monitored and documented by the facility.

A monthly log of the recorded temperature of
the dishwasher shall be maintained in the facility and available for
inspection.

(3)

Sinks
for hand washing shall include hot and cold running water, hand-washing soap and
disposable towels.

(4)

All
garbage and kitchen refuse that is not disposed of through a garbage disposal
unit shall be kept in watertight containers with close-fitting covers and
disposed of daily in a safe and sanitary manner.

(5)

Cooks
and food handlers shall wear clean outer garments and hair nets or caps and
shall keep their hands clean at all times when engaged in handling food, drink,
utensils or equipment in accordance with the local health authority.

Disposable gloves shall be used in accordance
with the local health authority.

Food
management:

The facility shall
store, prepare, distribute and serve food under sanitary conditions and in
accordance with the regulations governing food establishments of local health
authority having jurisdiction.

(1)

The
facility shall ensure that a minimum of a three calendar day supply of
perishables and a five calendar day supply of non-perishables or canned foods
is available for the residents.

(2)

The
facility refrigerator and freezer shall have an accurate thermometer which
reads within or not more than plus or minus three degrees fahrenheit of the
required temperature, located in the warmest section of the refrigerator and
freezer and shall be accessible and easily read.

(a)

The
temperature of the refrigerator shall be 35 - 41 degrees fahrenheit.

(b)

Freezer
temperatures shall be maintained at zero degrees fahrenheit or below.

(3)

Refrigerators
and freezers shall be kept clean and sanitary at all times. Food stored in
refrigerators and freezers shall be covered, dated and labeled.

Unused leftover food shall be discarded after
three calendar days.

(4)

Steam
tables, hot food tables, slow cookers, crock pots and other hot food holding
devices shall not be used in heating or reheating food.

Hot food temperatures shall be checked
periodically to insure that a minimum of 140 degrees fahrenheit is maintained.

(5)

Medication,
biological specimens, poisons, detergents and cleaning supplies shall not be
kept in the same storage areas used for storage of foods.

Medications shall not be stored in the
refrigerator with food; an alternate refrigerator for medication shall be used.

(6)

Canned or preserved foods shall be
procured from sources that process the food under regulated quality and
sanitation controls. This does not preclude the use of local fresh produce.

The facility shall not use home-canned foods.

(7)

Dry
or staple food items shall be stored at least six inches off the floor in a
ventilated room that is not subject to sewage, waste water back-flow or
contamination by condensation, leakage, rodents or vermin.

(8)

The
facility shall ensure the following:

(a)

all
perishable food is refrigerated and the temperature is maintained no higher
than 41 degrees fahrenheit;

(b)

the
temperature for all hot foods is maintained at 140 degrees fahrenheit; and

(c)

all
displayed or transported food is protected from environmental contamination and
maintained at proper temperatures in clean containers, cabinets or serving
carts.

Milk:

(1)

Raw
milk shall not be used.

(2)

Condensed,
evaporated, or dried milk products that are nationally recognized may be
employed as “additives” in cooked food preparation but shall not be substituted
or served to residents in place of milk.

Collateral requirements:

Compliance with this rule does not relieve a
facility from the responsibility of meeting more stringent municipal
regulations, ordinances or other requirements of state or federal laws
governing food service establishments.

Local health authority having jurisdiction means municipal, county,
state or federal agency(s) that have laws and regulations governing food
establishments, liquid waste disposal, treatment facilities and private wells.

[8.370.14.36 NMAC - N, 7/1/2024]

8.370.14.37

LAUNDRY SERVICES:

General
requirements:

The facility shall
provide laundry services for the residents, either on the premises or through a
commercial laundry and linen service.

(1)

On-site
laundry facilities shall be located in areas separate from the resident units
and shall be provided with necessary washing and drying equipment.

(2)

Soiled
laundry shall be kept separate from clean laundry, unless the laundry facility
is provided for resident use only.

(3)

Staff
shall handle, store, process and transport linens with care to prevent the
spread of infectious and communicable disease.

(4)

Soiled
laundry shall not be stored in the kitchen or dining areas.

The building design and layout shall ensure
the separation of laundry room from kitchen and dining areas.

An exterior route to the laundry room is not
an acceptable alternative, unless it is completely enclosed.

(5)

In
new construction or newly licensed facilities with more than 15 residents,
washers shall be in separate rooms from dryers.

The rooms with washers shall have negative air pressure from the other
facility rooms.

(6)

All
linens shall be changed as needed and at least weekly or when a new resident is
to occupy the bed.

(7)

The
mattress pad, blankets and bedspread shall be laundered as needed and at least
once per month or when a new resident is to occupy the bed.

(8)

Bath
linens consisting of hand towel, bath towel and washcloth shall be changed as
needed and at least weekly.

(9)

There
shall be a clean, dry, well ventilated storage area provided for clean linen.

(10)

Facility
laundry supplies and cleaning supplies shall not be kept in the same storage
areas used for the storage of foods and clean storage and shall be kept in a secured
room or cabinet.

Residents
may do their own laundry, if it is their preference and they are capable of
doing so, or if it is part of their skill-building for independent living and
is documented as part of their ISP.

[8.370.14.37 NMAC - N, 7/1/2024]

8.370.14.38

HOUSEKEEPING SERVICES:

The facility shall maintain the interior and
exterior of the facility in a safe, clean, orderly and attractive manner.

The facility shall be free from offensive
odors, safety hazards, insects and rodents and accumulations of dirt, rubbish
and dust.

All
common living areas and all bathrooms shall be cleaned as often as necessary to
maintain a clean and sanitary environment.

Combustibles
such as cleaning rags or flammable substances shall be stored in closed metal
containers in approved areas that provide adequate ventilation.

Combustibles shall be stored away from the
food preparation areas and away from the resident rooms.

Poisonous
or flammable substances shall not be stored in residential areas, food
preparation areas or food storage areas.

If hazardous chemicals are stored on the property, material safety data
sheets shall be maintained and stored in the same area as the chemicals,
pursuant to state environment department requirements,

11.5.2.9 NMAC.

[8.370.14.38 NMAC - N, 7/1/2024]

8.370.14.39

SITE REQUIREMENTS:

The facility shall be located and maintained
free from environmental and other factors that are detrimental to the residents
and staff's health, safety or welfare.

The facility site shall be designed and maintained to encourage outdoor
activities by the residents.

[8.370.14.39
NMAC - N, 7/1/2024]

8.370.14.40

CAPACITY OF BUILDING(S):

No facility shall house more residents than
the maximum bed capacity for which it is licensed.

Each
individual building containing resident activities, services or sleeping rooms on
the premises shall be separately licensed.

Buildings
on the grounds of the licensed facility and all rooms within the licensed
buildings that are used by the residents of the facility shall be subject to
inspection for health and safety standards.

All
facilities shall comply with the state building code and fire codes, pursuant
to 14.7 NMAC.

(1)

Facilities
with 16 residents or fewer are classified as “group R.”

(2)

Facilities
with more than 16 residents are classified as “group I-1.”

(3)

Facilities
with more than five residents who are not capable of self-preservation are
classified as “group I-2.”

Facilities
shall provide separate sleeping quarters for male and female residents unless
they are married or the arrangement is consensual.

[8.370.14.40 NMAC - N, 7/1/2024]

8.370.14.41

BUILDING CONSTRUCTION:

All building construction shall be based upon
the facility occupancy in accordance with the state building code and fire
codes, pursuant to 14.7 NMAC.

New facilities:

All new facilities, relocated into existing
building(s) or remodeled facilities shall conform to the current edition of the
state building code, accessibility code, mechanical code, plumbing code, fire
code and the electrical code.

(1)

With
regard to building height, allowable area or construction type, the state
building code shall prevail.

(2)

Minimum
construction requirements shall comply with all applicable state building
codes.

(3)

A
facility may share a building with another health care facility licensed by the
authority or other suitable facility with prior approval from the licensing
authority.

(4)

Where
there are conflicts between the requirements in the codes and the provisions of
this rule, the most restrictive condition shall apply.

Access for persons with disabilities;
Facilities with
four or more residents shall provide

accessibility
to residents with disabilities in accordance with the state building code and
the American Disabilities Act.

Areas of
specific concern are as follows:

(1)

the
main entry into the facility and all required exits shall provide access to
persons with disabilities;

(2)

the
building shall allow access to persons with disabilities to all common areas;

(3)

at
least one bedroom, for every eight residents, shall have a door clearance of 36
inches for access by persons with disabilities;

(4)

at
least one toilet and bathing facility, for every eight residents, shall have a
minimum door clearance of 36 inches for access by persons with disabilities; this
toilet and bathing room shall provide a minimum 60 inch diameter clear space to
accommodate the turning radius of a wheelchair;

(5)

when
ramps are used, each ramp shall have a minimum slope of 12 inches horizontal
run for each one inch of vertical rise; ramps exceeding a six inch rise shall
be provided with handrails on both sides of the ramp;

(6)

landings
at doorways shall have a level area, at a minimum of five feet by five feet, to
provide clear space for wheelchair maneuvering;

(7)

parking
spaces shall provide access aisles with a minimum width of 60 inches and 96 inches
for van parking; a minimum of one van-accessible parking space with a minimum
width of 96 inches shall be provided;

(8)

an
accessible route for persons with disabilities from the parking area to the
main entrance(s) shall be provided; and

(9)

changes
in elevation of one half inch or greater shall be sloped to a minimum of 12 inches
horizontal run for each one inch of vertical rise.

Construction
drawings:

Prior to commencement of
all new construction, remodeling, relocations, additions or renovations to
existing buildings; the facility shall submit preliminary plans and final
construction drawings with specifications to the licensing authority for review
and approval.

(1)

Building
plans and specifications shall be submitted and approved by the authority when:

(a)

construction
for a new facility is proposed;

(b)

a
building that has not previously licensed as a facility is proposed as a
location for a facility;

(c)

any
renovation that increases the number of beds is proposed;

(d)

any
addition to an existing structure is proposed; or

(e)

any
renovation to the existing structure is proposed, regardless of the size of the
facility.

(2)

The
codes that are in effect at the time of the submittal of building plans shall
be the codes used through the end of the project.

(3)

Drawings
and specifications shall be prepared for the architectural, structural,
mechanical and electrical branches of work for each construction project and
shall include the following:

(a)

the site plan
(s) showing property
lines, finish grade, location of existing and proposed structures, roadways,
walks, utilities and parking areas;

(b)

the floor plan
(s) showing scale
drawings of typical and special rooms, indicating all fixed and movable
equipment and major items of furniture;

(c)

the separate life safety plans
showing
the fire and smoke compartment(s), all means of egress and exit markings, exits
and travel distances, dimensions of compartments and calculation and tabulation
of exit units, all fire and smoke walls shall be graphically coded;

(d)

the
exterior elevation of each facade;

(e)

the
typical sections throughout the building;

(f)

the
schedule of finishes;

(g)

the
schedule of doors and windows;

(h)

the
roof plans; and

(i)

the
building code analysis.

(4)

For facilities with more than 15 residents:

architectural drawings shall be stamped,
signed and dated by a licensed architect registered in New Mexico.

In addition to items listed in section (3)
above, the drawings shall include the following:

(a)

the
building code analysis; and

(b)

when
an elevator is required, the details and dimensions of the elevator.

(5)

Structural drawings
shall include the
following:

(a)

a
certification that all structural design and work are in compliance with all
applicable local codes;

(b)

the
plans of foundations, floors, roofs and intermediate levels that show a
complete design with sizes, sections and the relative location of the various
members; and

(c)

the
schedules of beams, girders and columns.

(6)

Mechanical drawings
shall include the
following:

(a)

a
certification that all mechanical work and equipment are in compliance with all
applicable local codes and laws and that all materials are listed by recognized
testing laboratories;

(b)

the
water supply, sewage and heating, ventilation and air conditioning piping
systems;

(c)

the
heating, ventilating, HVAC piping and air conditioning systems with all related
piping and auxiliaries, if any, to provide a satisfactory installation;

(d)

the
water supply, sewage and drainage with all lines, risers, catch-basins,
manholes and cleanouts clearly indicated as to location, size, capacities and
location and dimensions of septic tank and disposal field;

(e)

the
sprinkler head layout; and

(f)

the
graphic coding (with a legend) to show supply, return and exhaust systems.

(7)

Electrical drawings
shall include the
following:

(a)

a
certification that all electrical work and equipment are in compliance with all
applicable local codes and laws and that all materials are currently listed by
recognized testing laboratories;

(b)

all
electrical wiring, outlets, riser diagrams, switches, special electrical
connections, electrical service entrance with service switches, service feeders
and characteristics of the light and power current and transformers when
located within the building;

(c)

a
fixture legend; and

(d)

a
graphic coding (with a legend) to show all items on emergency power.

(8)

Include
additional information as needed and requested by the licensing authority.

(9)

Final
working drawings and specifications shall be accurately dimensioned and include
all necessary explanatory notes, schedules, legends and have all rooms
labeled.

The working drawings and
specifications shall be complete and adequate for contract purposes.

(10)

One
set of final plans shall be submitted to the licensing authority for review and
approval prior to the commencing of construction.

All construction shall be executed in
accordance with the approved final plans and specifications.

(11)

Review
and approval of building plans by the licensing authority does not eliminate
responsibility of the applicant to comply with all applicable laws, rules and
ordinances.

(12)

The
final approval of building plans and specifications shall be acknowledged in
writing by the licensing authority.

(13)

The
approved building plans shall be kept at the facility and readily available at
all times.

Fire resistance:

Required building construction and fire
resistance shall be in accordance with the state building code and the fire
code.

Facilities with nine or more
residents shall be protected throughout by an approved automatic fire
protection (sprinkler) system.

Prohibition of mobile homes:

For facilities with four or more residents,
trailers and mobile homes shall not be used.

Construction:

Construction shall commence within 180 calendar
days of the date of receipt of approval (unless a written extension is
requested by the facility and approved by authority).

This approval shall in no way permit or
authorize any omission or deviation from the requirements of any restrictions,
laws, ordinances, codes or standards of any regulatory agency.

[8.370.14.41 NMAC - N, 7/1/2024]

8.370.14.42

MAINTENANCE OF BUILDING AND GROUNDS:

The building(s) shall be maintained in
good repair at all times.

Such
maintenance shall include, but is not limited to, the following areas:

Storage
areas/grounds:

Storage areas and
grounds shall be maintained in a safe, sanitary and presentable condition at
all times.

Storage areas and grounds
shall be kept free from accumulation of refuse, weeds, discarded furniture, old
newspapers or other items that create a fire hazard.

Floors:

Floors shall be maintained stable, firm
and free of tripping hazards.

[8.370.14.42 NMAC - N, 7/1/2024]

8.370.14.43

HAZARDOUS AREAS:

Hazardous areas include:

Fuel fired equipment rooms (not a typical
residential kitchen), bulk laundries or laundry rooms with more than 100 sq.
ft., storage rooms more than 50 sq. ft. but less than 100 sq. ft. not storing
combustibles, storage rooms with more than 100 sq. ft. storing combustibles,
chemical storage rooms with more than 50 sq. ft., garages and maintenance
shops/rooms.

Hazardous areas on the same floor as, and in or
abutting, a primary means of escape or a sleeping room shall be protected by
either:

(1)

an
enclosure of at least one hour fire rating with self-closing or automatic
closing on smoke detection fire doors having a three-quarter of an hour rating;
or

(2)

an
automatic fire protection (sprinkler) and separation of hazardous area with
self-closing doors or doors with automatic-closing on smoke detection; or

(3)

other
hazardous areas shall be enclosed with walls with at least a 20 minute fire
rating and doors equivalent to one and three-quarter inches solid bonded wood
core, operated by self-closures or automatic closing on smoke detection.

Boiler, furnace or fuel fired water heater
rooms:

For facilities with four or
more residents: all boiler, furnace or fuel fired water heater rooms shall be
protected from other parts of the building by construction having a fire
resistance rating of not less than one hour.

Doors to these rooms shall be one and three-quarter inches solid core.

[8.370.14.43 NMAC - N, 7/1/2024]

8.370.14.44

HEATING, AIR-CONDITIONING AND
VENTILATION:

Heating,
air-conditioning, piping, boilers and ventilation equipment shall be furnished,
installed and maintained to meet all requirements of current state and local
mechanical, electrical and construction codes.

All facilities shall have documentation that fuel-fire heating systems
have been checked, tested and maintained annually by qualified personnel.

The heating method used by the facility shall provide
a minimum temperature of 70 degrees fahrenheit, measured at three feet above
the floor, in all rooms used by the residents.

No open-face gas or electric heater nor unprotected
single shell gas or electric heating device shall be used for heating the
facility.

Portable heating units shall
not be used for heating the facility.

All
heating appliances shall be permanently anchored and kept away from flammables
such as curtains, bedcovering, trash containers, or clothing.

No heating appliance shall be located where
the unit or wiring is a tripping hazard or presents danger from electrical
shock.

Fireplaces and open flame heating shall not be
utilized in sleeping rooms.

Gas fired water heaters shall not be located in
sleeping rooms, bathrooms, or rooms opening into sleeping rooms.

The facility shall be adequately ventilated at all
times to provide fresh air and the control of unpleasant odors by either
mechanical or natural means.

All openings to the outside air used for ventilation
shall be screened for the control of insects and rodents.

Screen doors shall be equipped with
self-closing devices.

The facility shall have a system for maintaining the
residents comfort during periods of hot weather.

Fans shall not be located where the unit or
wiring is a tripping hazard.

Fans shall
be provided with protective shields when there is a potential for contact by
any individual.

[8.370.14.44 NMAC - N, 7/1/2024]

8.370.14.45

WATER:

Pursuant to the current New Mexico drinking
water requirements:

The water supply system shall be constructed,
protected, operated and maintained in conformance with applicable local, state
and federal laws, ordinances and regulations.

Where
a facility is supplied by its own water system, the system shall meet the
sampling and construction requirement of a non-community water system as
defined by the current New Mexico drinking water requirements.

All water that is not piped into the facility
directly from a public water supply system shall be from an approved source,
disinfected, transported, handled, stored and dispensed in a sanitary
manner.

Such water shall be prevented
from entering potable water systems by appropriate cross connection and
backflow prevention devices.

Hot and cold running water, under pressure shall be
provided in all areas where food is prepared and where equipment and utensils
are washed, sinks, lavatories, washrooms and laundries.

The hot water temperature that is accessible to
residents shall be maintained at a minimum of 95 degrees fahrenheit and a
maximum of 110 degrees fahrenheit.

Hot
water in excess of 110 degrees fahrenheit is permitted in kitchen and laundry
areas, provided that residents are supervised in order to prevent injury.

[8.370.14.45 NMAC - N, 7/1/2024]

8.370.14.46

SEWAGE AND WASTE DISPOSAL:

All sewage and liquid wastes shall be disposed of
into a municipal sewage system where such facilities are available.

Where a municipal sewage system is not available, the
system that is used shall be inspected and approved by the state environmental
authority, pursuant to 20.7.3 NMAC, prior to licensure.

Where
municipal or community garbage collection and disposal service are not
available, the method of collection, storage and disposal of garbage used by
the facility shall be environmentally safe and sound and not create an
objectionable environment and be in accordance with state environmental
authority, pursuant to 20.9.2 NMAC.

[8.370.14.46 NMAC - N, 7/1/2024]

8.370.14.47

LIGHTING AND LIGHTING FIXTURES:

All areas of the facility, including storerooms,
stairways, hallways, and interior and exterior entrances shall be lighted to
make the area clearly visible.

Exits, exit-access ways and other areas used at night
by residents and staff shall be illuminated by night lights or other continuous
lighting.

Lighting fixtures shall be selected and located to
accommodate the needs and activities of the residents, with the comfort and
convenience of the residents in mind.

Lamps
and lighting fixtures shall be shaded to prevent glare to the eyes of residents
and staff, and protected from accidental breakage or shattering.

Facilities
with four or more residents shall have emergency lighting to light exit
passageways and the exterior area near the exits that activates automatically
upon disruption of electrical service.

Facilities
with three or fewer residents shall have a flashlight that is immediately
available for use in lieu of electrically interconnected emergency lighting.

[8.370.14.47 NMAC - N, 7/1/2024]

8.370.14.48

ELECTRICAL SYSTEM:

All fuse and breaker boxes shall be labeled to
indicate the area of the facility to which each fuse or circuit breaker
provides service.

All staff personnel of the facility shall know the
location of the electrical disconnect switch and how to operate it in case of
emergency.

Electrical cords and appliances shall be U/L
approved.

(1)

Electrical
cords shall be replaced as soon as they show wear.

(2)

Extension
cords shall not be used.

The use of a multi-socket united laboratories
approved (U/L APPROVED) surge protector with integrated circuit breaker no
greater than six feet in length is permitted for the intended purpose and not
as an extension cord.

[8.370.14.48 NMAC - N, 7/1/2024]

8.370.14.49

DOORS:

No door in any means of egress shall be locked
against egress when the building is occupied.

(1)

Exit
doors may be provided with a night latch, dead bolt, or security chain,
provided these devices are operable from the inside, by any occupant, without
the use of a key, tool, or any special knowledge and are mounted at a height
not to exceed 48 inches above the finished floor.

(2)

If
locks are not readily operable by all occupants within the building, the locks
must:

(a)

unlock
upon activation of the fire detection or sprinkler system; and

(b)

unlock
upon loss of power in the facility.

Prior to installing such locking devices, the facility shall have
written approval from the building, fire and licensing authorities having
jurisdiction.

All exit doors shall have a minimum width of 36
inches.

(1)

Facilities
with a capacity of 10 or more residents shall have exit doors leading to the
outside of the facility that open outward.

(2)

Facilities
with a capacity of 50 or more residents must provide panic hardware at the exit
doors.

(3)

No
door or path of travel to a means of egress shall be less than 28 inches wide.

All resident sleeping room doors must be at least one
and three-quarters inches solid core construction.

Bathroom
doors may be 24 inches wide.

Facilities
with four or more residents shall have at least one bathroom for every eight
residents with a door clearance of 36 inches for access by persons with
disabilities.

Locks on doors to toilet rooms and bathrooms shall be
capable of release from the outside.

All doors shall readily open from the inside.

Doors
shall be provided for all resident sleeping rooms, all restrooms and all
bathrooms.

[8.370.14.49 NMAC - N, 7/1/2024]

8.370.14.50

EXITS:

The facility shall have at least two approved exits,
that do not involve windows and which are remote from each other.

Facilities
with 10 or more residents shall have each exit clearly marked with lighted
signs having letters at least six inches high and at least three-quarters of an
inch wide.

Exit signs shall be visible
at all times.

Facilities with three or fewer residents shall have a
flashlight that is immediately available for use in lieu of electrically
interconnected emergency lighting.

Exits shall be clear of obstructions at all times.

Exits, exit paths, or means of egress shall not pass
through hazardous areas, garages, storerooms, closets, utility rooms, laundry
rooms, bedrooms, or spaces subject to locking.

For
facilities with four or more residents, sliding doors are not acceptable as a
required exit.

EXCEPTION:

Assisted living facilities with three or
fewer residents may have sliding doors as required exits.

When the yard gate(s) is part of the exit access and
is locked, the gate shall be connected to the fire protection system and
release upon activation of the fire/smoke system or shall have the ability to
be unlocked at the gate site.

[8.370.14.50 NMAC - N, 7/1/2024]

8.370.14.51

SEPARATION OF SLEEPING ROOMS:

All
sleeping rooms shall be separated from escape route corridors by walls and
doors that are smoke resistant.

There
shall be no passages, louvers, or transfer grills penetrating the wall to other
spaces in the building.

All
sleeping rooms shall be provided latches suitable for keeping the doors closed.

Every
sleeping room shall have access to a primary means of escape that provides a
path to the exterior, without exposure to unprotected vertical openings.

Where sleeping rooms are above or below the
level of exit discharge, the primary means of escape shall be:

(1)

an
enclosed interior stair; or

(2)

an
exterior stair; or

(3)

a
horizontal exit; or

(4)

an
existing approved fire escape stair.

Every sleeping room shall provide a secondary means
of escape which may be any one of the following:

(1)

a
door leading directly to the outside, at or to grade level;

(2)

a
door, stairway, passage or hall remote from the primary escape and to the exterior;
or

(3)

an
outside window or door, operable without tools from the inside with a minimum
clear opening measured 20 inches wide, measured 24 inches high; the distance of
the bottom of the opening from the floor is a maximum of 44 inches; this means
of escape is acceptable if the bottom of the window is no more than 20 feet
above grade or is accessible by fire department rescue apparatus, approved by
the authority having jurisdiction, or it opens onto an exterior balcony; and

(4)

bars,
grills, grates or similar devices that are installed on emergency escape or
rescue windows or doors shall be equipped with release mechanisms which are
operable from the inside without the use of a key or special knowledge or
effort.

Stairways and other vertical openings between floors
shall be enclosed with construction to provide a smoke and fire resistance
rating of not less than 20 minutes.

Open
stairways between floors shall not be permitted.

[8.370.14.51 NMAC - N, 7/1/2024]

8.370.14.52

CORRIDORS:

Corridors in an existing building shall have a
minimum width of 36 inches.

Corridors in
newly constructed facilities shall have a minimum width of 44 inches.

Corridors shall have a clear ceiling height of not
less than seven feet measured to the lowest projection from the ceiling.

Corridors shall be maintained clear and free of
obstructions at all times.

The
floors of corridors and hallways shall be waterproof, greaseproof, smooth,
slip-resistant and durable.

[8.370.14.52 NMAC
- N, 7/1/2024]

8.370.14.53

MINIMUM
ROOM DIMENSIONS:

All habitable rooms in a
facility shall have a ceiling height of not less than seven feet six
inches.

Kitchens, halls, bathrooms and
toilet compartments shall have a ceiling height of not less than seven feet.

Any room with sloped ceiling where any portion of the
room is less than seven feet in height is subject to review and approval or
disapproval by the licensing authority.

[8.370.14.53 NMAC - N, 7/1/2024]

8.370.14.54

RESIDENT ROOMS:

The facility’s bed capacity shall not exceed the
capacity approved by the licensing authority.

Each resident room shall have an outside room with a
window.

The area of the outdoor window
shall be at least one tenth of the floor area of the room.

Resident
rooms shall not be less than seven feet wide in any horizontal dimension.

There must be no through traffic in resident
rooms.

Resident rooms must connect
directly to other internal common areas of the facility.

The
window shades, drapes, curtains, or blinds in the resident rooms shall be in
good repair and of flame-retardant materials.

Resident rooms may be private or semi-private.

Semi-private rooms may not house more than
two residents.

(1)

Private
rooms shall have a minimum of 100 square feet of floor area.

The closet and locker area shall not be
counted as part of the available floor space.

(2)

Semi-private
rooms shall have a minimum of 80 square feet of floor area for each bed and
shall be furnished in such a manner that the room is not crowded and passage
out of the room is not obstructed.

A
separate closet for each resident shall be provided.

The closet and locker area shall not be
counted as part of the available floor space.

The beds shall be spaced at least three feet apart.

If a resident chooses not to bring their own
furnishings to the facility; each resident room shall be provided with, as a
minimum, the following furnishings per resident:

(1)

a
bed that shall be at least 36 inches wide, of sturdy construction and in good
repair;

(2)

each
bed shall be provided with a clean, comfortable mattress of at least four
inches in thickness, which is waterproof, or protected with a waterproof
covering and a mattress pad;

(3)

each
bed shall be provided with a clean, comfortable pillow;

(4)

each
bed shall be provided with a pillow case, two clean sheets, blankets and a
bedspread appropriate for the weather and the climate;

(5)

an
individual closet or closet area with a clothes rack for hanging clothes and
shelves or drawers that are accessible to the resident;

(6)

a
dresser with drawers;

(7)

a
bedside table or desk;

(8)

a
chair;

(9)

a
reading lamp; and

(10)

a
mirror.

[8.370.14.54 NMAC - N, 7/1/2024]

8.370.14.55

TOILET AND BATHING FACILITIES:

Toilet and bathing facilities shall be
located appropriately to meet the needs of residents.

A minimum of one toilet, one sink and one bathing
unit shall be provided for every eight residents or fraction thereof.

(1)

The
facility shall provide at least one tub and one shower or combination unit to
allow for residents bathing preference.

(2)

Facilities
with four or more residents shall provide a handicap accessible bathroom for
every thirty (30) residents that allows for a bathing preference.

Facilities
with four or more residents must comply with accessibility requirements for the
disabled.

Toilet,
sink and bathing facilities shall be readily available to the residents.

passage through a resident room by another resident to reach a toilet, bathing
unit or sink facility shall be permitted.

The combination type tub and shower shall be
permitted.

A facility with four or more residents that has
live-in staff shall provide a separate toilet, sink and bathing facility for
staff.

Toilets,
tubs and showers shall be provided with grab bars.

Tubs and showers shall have a slip resistant surface.

The
floors of bathrooms and bathing facilities shall have smooth, waterproof and
slip-resistant surfaces.

Toilet paper and soap shall be provided in each
toilet room.

The use of a common towel shall be prohibited.

Bathrooms and lavatories shall be cleaned as often as
necessary to maintain a clean and sanitary condition.

[8.370.14.55 NMAC - N, 7/1/2024]

8.370.14.56

LIVING OR MULTIPURPOSE ROOM:

The facility shall provide a minimum of 40
square feet per resident for common living, dining and social spaces.

The facility shall have a living or multipurpose room
for the use of the residents.

Such rooms
shall be provided with reading lamps, tables and chairs or couches.

These furnishings shall be well constructed,
comfortable and in good repair.

The living room or multipurpose rooms shall be
provided with supplies to meet the varied interests and needs of the residents.

Each activity room shall have a window area of at
least one tenth of the floor area with a minimum of at least ten square feet.

[8.370.14.56 NMAC - N, 7/1/2024]

8.370.14.57

MEETING ROOM:

The facility shall have
adequate meeting rooms and
office space for use by staff and the interdisciplinary care team.

Other rooms may serve as meeting rooms,
provided resident confidentiality is maintained.

[8.370.14.57 NMAC - N, 7/1/2024]

8.370.14.58

DINING AREA:

A dining area shall be provided for meals.

Each dining area shall be designed and have
furnishings to meet the individual needs of the residents.

(1)

Facilities
with 60 or fewer residents shall have tables and chairs in the dining area to
accommodate the total number of residents in one sitting.

(2)

Facilities
with more than 60 residents shall provide seating for at least 60 residents at
one time, but may serve meals in shifts to accommodate the total capacity of
the facility.

(a)

No
more than three shifts are permitted for each meal.

(b)

Facilities
with more than 60 residents and serving meals in shifts must have other social
areas for residents to congregate during the meal service.

(c)

All
seating arrangements during meals shall allow clear access to the exits.

The living or multi-purpose room may be used as a
dining area if the dining area portion does not exceed fifty percent of the
available floor space and still allows a comfortable arrangement of the
necessary furnishings for a living area.

[8.370.14.58 NMAC - N, 7/1/2024]

8.370.14.59

WINDOWS:

Each
sleeping room shall be provided with an exterior window.

(1)

The
window shall be operable, screened and have a clear operable area of 5.7 square
feet minimum; measured 20 inches wide minimum and measured 24 inches high
minimum.

(2)

The
top of the window sill shall not be more than 44 inches above the finished
floor.

Screens
shall be provided on all operable windows.

The
proposed use of bars, grilles, grates or similar devices shall be reviewed and
approved by the licensing authority prior to installation.

Sleeping
rooms, living rooms, activity room areas and dining room areas shall have a
window area of at least one tenth of the floor area with a minimum of 10 square
feet.

[8.370.14.59 NMAC - N, 7/1/2024]

8.370.14.60

FIRE CLEARANCE AND INSPECTIONS:

Written documentation of a facility's compliance with
applicable fire prevention codes shall be obtained from the state fire
marshal’s office or the fire prevention authority with jurisdiction and shall
be submitted to the licensing authority prior to the issuance of an initial
license.

The facility shall request an annual fire inspection
from the local fire prevention authorities.

If the policy of the local fire department does not provide an annual
inspection of the facility, the facility will document the date the request was
made and to whom and then contact licensing authorities.

If the local fire prevention authorities do
make annual inspections, a copy of the latest inspection must be kept on file
in the facility.

[8.370.14.60 NMAC - N, 7/1/2024]

8.370.14.61

FIRE ALARMS, SMOKE DETECTORS AND OTHER
EQUIPMENT:

Fire alarm system.

Facilities with four or more residents shall have a manual fire alarm
system.

The manual fire alarm shall be
inspected and approved in writing by the fire authority with jurisdiction.

Smoke and heat detection.

Approved smoke detectors shall be installed
on each floor that when activated provides an alarm which is audible in all
sleeping areas.

Areas of assembly, such
as the dining and living room(s) must also be provided with smoke detectors.

(1)

Detectors
shall be powered by the house electrical service and have battery backup.

(2)

Construction
of new facilities or facilities remodeling or replacing existing smoke
detectors shall provide detectors in common living areas and in each sleeping
room.

(3)

Smoke
detectors shall be installed in corridors at no more than 30 foot spacing.

(4)

Heat
detectors shall be installed in all kitchens and also powered by the house
electrical service.

[8.370.14.61 NMAC - N, 7/1/2024]

8.370.14.62

AUTOMATIC FIRE PROTECTION (SPRINKLER)
SYSTEM:

Facilities with nine or more
residents shall have an automatic fire protection (sprinkler) system.

The system shall be in accordance with NFPA
13 or NFPA 13D or its subsequent replacement as applicable.

[8.370.14.62 NMAC - N, 7/1/2024]

8.370.14.63

FIRE EXTINGUISHERS:

Fire extinguisher(s) must be located in the
facility, as approved by the state fire marshal or the fire prevention
authority with jurisdiction.

Facilities must as a minimum have two 2A10BC fire
extinguishers:

(1)

one
extinguisher located in the kitchen or food preparation area;

(2)

one
extinguisher centrally located in the facility;

(3)

all
fire extinguishers shall be inspected yearly and recharged as needed; all fire
extinguishers must be tagged noting the date of the inspection;

(4)

the
maximum distance between fire extinguishers shall be 50 feet.

Fire extinguishers, alarm systems, automatic
detection equipment and other firefighting equipment shall be properly
maintained and inspected as recommended by the manufacturer, state fire
marshal, or the local fire authority.

[8.370.14.63 NMAC - N, 7/1/2024]

8.370.14.64

FIRE SAFETY EQUIVALENCY SYSTEM RATING:

In facilities without a sprinkler system; the
fire safety equivalency system shall be conducted at least annually.

The facility shall maintain an evacuation
rating score of prompt when a fire safety equivalency system is required.

[8.370.14.64 NMAC - N, 7/1/2024]

8.370.14.65

FIRE DRILLS:

All facilities shall conduct monthly fire
drills which are to be documented.

There
shall be at least one documented fire drill per month and at a minimum, one
documented fire drill each eight hours (day, evening, night) per quarter that
employs the use of the fire alarm system or the detector system in the
facility.

A
record of the monthly fire drills shall be maintained on file in the facility
and readily available.

Fire drill records
shall show:

(1)

the
date of the drill;

(2)

the
time of the drill;

(3)

the
number of staff participating in the drill;

(4)

any
problem noted during the drill; and

(5)

the
evacuation time in total minutes.

If
applicable, the local fire department may be requested to supervise and
participate in fire drills.

[8.370.14.65 NMAC - N, 7/1/2024]

8.370.14.66

STAFF AND RESIDENT FIRE AND SAFETY
TRAINING:

All staff of the facility shall know the location and
the proper use of fire extinguishers and the other procedures to be followed in
case of fire or other emergencies.

The
facility should request the local fire prevention authority to give periodic
instructions in the use of fire prevention and techniques of evacuation.

Facility staff shall be instructed as part of their
duties to constantly strive to detect and eliminate potential safety hazards,
such as loose handrails, frayed electrical cords, blocked exits or exit-ways
and any other condition which could cause burns, falls, or other personal
injury to the residents or staff.

Each new resident admitted to the facility shall be
given an orientation tour of the facility to include the location of the exits,
fire extinguishers and telephones and shall be instructed in the actions to be
taken in case of fire or other emergencies.

Fire drill procedures:

The facility must conduct at least one fire
drill each month.

(1)

Fire
drills shall be held at different times of the day, evening and night.

(2)

The
fire alarm system or detector system in the facility shall be used in the fire
drills.

During the night, the fire drill
alarm may be silenced.

(3)

During
the fire drills, emphasis shall be placed upon orderly evacuation under proper
discipline rather than upon speed.

(4)

A
record of the conducted fire drills shall be maintained on file in the
facility.

The record shall show the date
and time of the drill, the number of personnel participating in the drill, any
problem(s) noted during the drill and the evacuation time in total minutes.

(5)

The
local fire department may be requested to supervise and participate in the fire
drills.

[8.370.14.66 NMAC - N, 7/1/2024]

8.370.14.67

SMOKING:

Smoking by residents and staff shall take place only
in supervised areas designated by the facility and approved by the state fire
marshal or local fire prevention authorities.

Smoking shall not be allowed in a kitchen or food preparation area.

All designated smoking areas shall be provided with
suitable ashtrays that are not made of combustible material.

Residents shall not be permitted to smoke in bed.

Smoking shall not be permitted where oxygen is in
use, is present or is stored.

[8.370.14.67 NMAC - N, 7/1/2024]

8.370.14.68

HOSPICE:

An assisted living facility that provides or
coordinates hospice care and services shall meet the requirements in this
section, in addition to the rules applicable to all assisted living facilities,
8.370.14 NMAC.

Definitions:

in
addition to the requirements for all assisted living facilities pursuant to “definitions,”
8.370.14.7 NMAC, the following definitions shall also apply.

(1)

“Hospice agency”
means an organization,
company, for-profit or non-profit corporation or any other entity which
provides a coordinated program of palliative and supportive services for
physical, psychological, social and the option of spiritual care of terminally
ill people and their families.

The services
are provided by a medically directed interdisciplinary team in the person's
home and the agency is required to be licensed pursuant to 8.370.19 NMAC.

(2)

“Hospice care”
means a focus on palliative, rather than curative care.

The goal of the plan of care is to help the
patient live as comfortably as possible, with emphasis on eliminating or
decreasing pain and other uncomfortable symptoms.

(3)

“Licensed
assisted living provider”

means a facility that provides 24 hour assisted living and is licensed by the health
care authority.

(4)

“Hospice services”
means a program of
palliative and supportive services which provides physical, psychological,
social and spiritual care for terminally ill patients and their family members.

(5)

“Care coordination requirements”
means a
written document that outlines the care and services to be provided by the hospice
agency for assisted living residents that require hospice services.

(6)

“Palliative care”
means a
form of medical care or treatment that is
intended to reduce the severity of disease symptoms, rather than to reverse
progression of the disease itself or provide a cure.

(7)

“Terminally ill”
means a diagnosis by a physician for a patient with a
prognosis of six (6) months or less to live.

(8)

“Visit notes”
means the documentation
of the services provided for hospice residents and includes ongoing care
coordination.

Employee
training and support:

A facility that provides hospice services
shall provide the following education and training for employees who assist
with providing these services:

(1)

provide
a minimum of six hours per year of palliative/hospice care training, which
includes one hour specific to the hospice resident’s ISP, in addition to the
basic staff education requirements pursuant to
8.370.14.17 NMAC; and

(2)

offer

an ongoing employee psychological support program for end of life care
issues.

Individual service plan (ISP) requirements:

(1)

Ea
ch
resident who receives hospice services shall be provided the necessary
palliative care to meet the individual resident’s needs as outlined in the ISP
and shall include one hour of training specific to the resident for all direct
care staff.

(2)

The
assisted living facility, in coordination with the hospice provider, shall
create an ISP that identifies how the resident's needs are met and includes the
following:

(a)

the
requirements set forth in the “individual service plan,” 8.370.14.26 NMAC, and “Exceptions
to
admission, readmission and retention
,”
Subsection C of 8.370.14.20 NMAC
;

(b)

what
services are to be provided;

(c)

who
will provide the services;

(d)

how
the services will be provided;

(e)

a
delineation of the role(s) of the hospice provider and the assisted living
facility in the ISP process;

(f)

documentation
(visit notes) of the care and services that are provided with the signature of
the person who provided the care and services; and

(g)

a
list of the current medications or biologicals that the resident receives and who
is authorized to administer them.

(3)

Medications
shall be self-administered, self-administered with assistance by an individual
that has completed a state approved program in medication assistance or
administered by the following individuals:

(a)

a
physician;

(b)

a
physician extender (PA or NP);

(c)

a
licensed nurse (RN or LPN);

(d)

the
resident if their PCP has approved it;

(e)

family
or family designee; and

(f)

any
other individual in accordance with applicable state and local laws.

Care coordination.

(1)

The
assisted living facility shall be knowledgeable with regard to the hospice
requirements pursuant to 8.370.19 NMAC and ensure that the hospice agency is well
informed with regard to the assisted living provisions pursuant to Subsection C
of 8.370.14.20 NMAC.

(2)

The
assisted living facility shall hold a team meeting prior to accepting or
retaining a hospice resident in accordance with “exceptions to admission, readmission
and retention,” Subsection C of 8.370.14.20 NMAC.

(3)

Upon
admission of a resident into hospice care, the assisted living facility shall
designate a section of the resident’s record for hospice documentation.

(a)

The
facility shall provide individual records for each resident.

(b)

The
hospice agency shall leave documentation at the facility in the designated
section of the resident’s record.

(4)

The
assisted living facility shall provide the resident and family or surrogate
decision maker with information on palliative care and shall support the
resident’s freedom of choice with regard to decisions.

(5)

Hospice
services shall be available 24 hours a day, seven days a week for hospice
residents, families and facility staff and may include continuous nursing care
for hospice residents as needed.

These
services shall be delivered in accordance with the resident’s individual
service plan (ISP) and pursuant to 8.370.14 26 NMAC.

(6)

The
assisted living facility shall ensure the coordination of services with the
hospice agency.

(a)

The
resident's individual service plan (ISP) shall be updated with significant changes
in the resident’s condition and care needs.

(b)

The
assisted living facility shall receive information and communication from the
hospice staff at each visit.

(i)

The
information shall include the resident status and any changes in the ISP (i.e.,
medication changes, etc.).

(ii)

The
information shall be in the form of a verbal report to the assisted living
facility staff and also in the form of written documentation.

(c)

The
assisted living facility or the family/resident shall reserve the right to
schedule care conferences as the needs of the resident and family dictate.

The care conferences shall include all care
team members.

(d)

Concerns
that arise with regard to the delivery of services from either the assisted
living facility or the hospice agency shall first be addressed with the
facility administrator and the hospice agency administrator.

(i)

The
process may be informal or formal depending on the nature of the issue.

(ii)

If
an issue cannot be resolved or if there is an immediate danger to the resident
the appropriate authority shall be notified.

Additional provisions:

An assisted living facility that provides or
coordinates hospice care and services shall make additional provisions for the
following requirements:

(1)

individual

services
and care:

each
resident receiving hospice services shall be provided the necessary palliative
procedures to
meet
individual
needs as defined in the ISP;

(2)

private

visiting space:

(a)

physical
space for private family visits;

(b)

accommodations
for family members to remain with the patient throughout the night; and

(c)

accommodations
for family privacy after a resident’s death.

Medicare and Medicaid restrictions:

Assisted
living facilities shall not accept a resident considered “hospice general inpatient”
which would be billable to medicare or medicaid because the facility will not
qualify for payment by medicare or medicaid.

[8.370.14.68 NMAC - N, 7/1/2024]

8.370.14.69

MEMORY CARE UNITS:

An assisted living facility that provides a
memory care unit to serve residents with dementia shall comply with the provisions
of subsection A-J below in addition to the rules applicable to all assisted
living facilities, 8.370.14 NMAC.

Additional definitions:

The following definitions, in addition to
those in 8.370.14.7 NMAC, shall apply.

(1)

“Alzheimer’s”
means a brain disorder that
destroys brain cells, causing problems with memory, thinking and behavior that are
severe enough to affect work, lifelong hobbies or social life.

Alzheimer’s gets progressively worse and is
fatal.

(2)

“Care coordination agreement requirement”

means a written document that outlines the care and services that are provided
by other outside agencies for assisted living residents that require additional
care and services.

(3)

“Dementia”
means loss of memory and
other mental abilities severe enough to interfere with daily life.

It is caused by changes in the brain.

(4)

“Memory care unit”
means an assisted
living facility or part of or an assisted living facility that provides added
security, enhanced programming and staffing appropriate for residents with a
diagnosis of dementia, Alzheimer’s disease or other related disorders causing
memory impairments and for residents whose functional needs require a
specialized program.

(5)

“Secured environment”
means locked
(secured/monitored) doors/fences that restrict access to the public way for
residents who require a secure unit.

Care coordination requirement.
An assisted living
facility that accepts residents with memory issues shall determine which additional
services and care requirements are relevant to the resident and disease
process.

(1)

The
medical diagnosis and ISP shall be utilized in the determination of the need
for additional services.

(2)

The
assisted living facility shall ensure the coordination of services and shall
have evidence of an agreement of care coordination for all services provided in
the facility by an outside health care provider.

Employee training:

In addition to the training requirements for
all assisted living facilities, pursuant to 8.370.14.17 NMAC, all employees
assisting in providing care for memory unit residents shall have a minimum of 12
hours of training per year related to dementia, Alzheimer’s disease, or other
pertinent information.

Individual service plan (ISP):

An assisted living facility that admits
memory care unit residents shall create an ISP in coordination with the
resident’s primary care practitioner, in compliance with the requirements
outlined in “individual service plan,” 8.370.14.26 NMAC, pursuant to a team
meeting as described in “exceptions to admission, readmission and retention,”
Subsection C of 8.370.14.20 NMAC, and which ensures the following criteria:

(1)

identification
of the resident's needs

specific to
the memory care unit and the services that are provided; each memory unit
resident shall receive the services necessary to meet the individual resident’s
needs;

(2)

medications
shall be self-administered, self-administered with assistance by an individual
that has completed a state approved program in medication assistance or
administered by the following individuals:

(a)

a
physician;

(b)

a
physician extender (PA or NP);

(c)

a
licensed nurse (RN or LPN);

(d)

the
resident if their PCP has approved it;

(e)

family
or family designee; and

(f)

any
other individual in accordance with applicable state and local laws.

Assessments and reevaluations:

(1)

An
assessment shall be completed by a registered nurse or a physician extender
within 15 days prior to admission.

When
emergency placement is warranted the 15 day assessment shall be waived and the
assessment shall be completed within five days after admission.

(a)

The
resident shall have a medical evaluation and documentation by a physician,
physician's assistant or a nurse practitioner within six months of admission.

(b)

The
pre-admission assessment shall include written findings, an evaluation of less
restrictive alternatives and the basis for the admission to the secured
environment.

The written documentation
shall include a diagnosis from the resident's PCP of Alzheimer's disease or
other dementia and the need for the resident to reside in a memory care unit.

(c)

Only
those residents who require a secured environment placement or whose needs can
be met by the facility, as determined by the assessment prior to admission or
on review of the individual service plan (ISP), shall be admitted.

(2)

A
re-evaluation must be completed every six months and when there is a
significant change in the medical or physical condition of the resident that
warrants intervention or different care needs, or when the resident becomes a
danger to self or others, to determine whether the resident’s stay in the assisted
living facility memory care unit is still appropriate.

Documentation in the resident’s record:

In addition to the required documentation
pursuant to 8.370.14.21 NMAC, the following information shall be documented in
the resident’s record:

(1)

the
physician’s diagnosis for admission to a secure environment or a memory care
unit;

(2)

the
pre-admission assessment; and

(3)

the
re-evaluation(s).

Secured environment:

(1)

Memory
care unit residents may require a secure environment for their safety.

A secured environment is any locked
(secured/monitored) area in which doors and fences restrict access to the
public way.

These include but are not
limited to:

(a)

double
alarm systems;

(b)

gates
connected to the fire alarm; and

(c)

tab
alarms for residents at risk for elopement.

(2)

In
addition to the interior common areas required by this rule, the facility shall
provide a safe and secure outdoor area for the year round use by the residents.

(a)

Fencing
or other enclosures shall prevent elopement and protect the safety and security
of the residents.

(b)

Residents
shall be able to independently access the outdoor areas.

(3)

Locked
areas shall have an access code or key which facility employees shall have
available on their person or on the locking unit itself at all times.

Resident rights:

addition to the requirements pursuant to 8.370.14.32 NMAC, the following shall
apply:

(1)

the
resident's rights may be limited as required by their condition and as
identified in the ISP;

(2)

the
resident who believes that he or she has been inappropriately admitted to the
secured environment may request the facility in contact the resident’s legal
guardian, or an advocate such as the ombudsman or the primary care practitioner;
upon request, the facility shall assist the resident in making such contact.

Disclosure to residents:

A facility that operates a secured
environment shall disclose to the resident and the resident’s legal
representative, if applicable and prior to the resident’s admission to the
facility, that the facility operates a secured environment.

(1)

The
disclosure shall include information about the types of resident diagnosis or
behaviors that the facility provides services for and for which the staff are
trained to provide care for.

(2)

The
disclosure shall include information about the care, services and the type of
secured environment that the facility and trained staff provide.

Staffing:

The
facility shall provide the sufficient number of trained staff members to meet
the additional needs of the residents in the secured environment.

There must be at least one trained staff
member awake and in attendance in the secured environment at all times.

[8.370.14.69 NMAC - N, 7/1/2024]

8.370.14.70

INCORPORATED
AND RELATED RULES AND CODES
:

The
facilities that are subject to this rule are also subject to other rules, codes
and standards that may, from time to time, be amended.

This includes the following:

Health facility licensure fees and procedures, New
Mexico Health care authority, 8.370.3 NMAC.

Health
facility sanctions and civil monetary penalties, New Mexico Health care
authority, 8.370.3 NMAC.

Adjudicatory
hearings for licensed facilities, New Mexico health care authority, 8.370.2 NMAC.

Caregiver's
criminal history screening requirements, 8.370.5 NMAC.

Employee
abuse registry 8.370.8 NMAC.

Incident
reporting, intake processing and training requirements 8.370.9 NMAC.

[8.370.14.70 NMAC - N, 7/1/2024]

History of 8.370.14
NMAC:

[RESERVED]