This regulation establishes the licensing requirements for Supported Residential Health Care Facilities (SRHCFs) in New Hampshire, which are long-term care residences providing personal assistance at the supported residential care level. Operators must obtain and renew a license from the NH Department of Health and Human Services, comply with construction and fire safety standards, and notify the department of organizational or service changes. The regulation covers application procedures, definitions, inspection requirements, and enforcement actions applicable to any entity operating an SRHCF.
View official sourcePART He-P 805 � SUPPORTED RESIDENTIAL HEALTH CARE FACILITY LICENSING RULES REVISION NOTE : ��������� Document #13368, effective 4-19-22, readopted with amendments the �Care Assessment for Residential Services Tool� form pursuant to the expedited revisions to agency forms process in RSA 541-A:19-c. � The form is incorporated by reference in He-P 805.16(d) which requires the supported residential health care facility (SRHCF) to assess each resident�s needs using the �Care Assessment for Residential Services Tool� form. � Document #13368 contained only the amended form, giving it a new effective date, and updated the revision date on the form from the �January 2022 edition� to the �April 2022 edition.� � ��������� The prior filing affecting He-P 805.16 was Document #13333, effective 1-25-22, and the effective date of the rule remained unchanged by Document #13368. � Since Document #13368 updated the revision date on the form from �(January 2022 edition)� to the �(April 2022 edition)�, the revision date was subsequently updated editorially in He-P 805.16(d). � ��������� He-P 805.01 � Purpose . � The purpose of this part is to set forth the classification of and licensing requirements for supported residential health care facilities (SRHCF) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VII(a)(2). Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93, EXPIRED: 7-14-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.02 � Scope . � This part shall apply to any individual, agency, partnership, corporation, government entity, association, or other legal entity operating a SRHCF pursuant to RSA 151:9, VII(a)(2). Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 �������� He-P 805.03 � Definitions . ���������� (a) � �Abuse� means any one of the following: (1) � �Emotional abuse� means the misuse of power, authority, or both, verbal harassment, or confinement which results or could result in the mental anguish or emotional distress of residents; (2) � �Physical abuse� means the misuse of physical force which results or could result in physical injury to residents; or (3) � �Sexual abuse� means contact or interaction of a sexual nature involving residents without their consent. (b) � �Activities of daily living (ADL)� means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management. (c) � �Addition� means an increase in the building area, aggregate floor area, building height, or number of stories of a structure. (d) � �Administer� means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, including RSA 318-B and RSA 326-B. (e) � �Administrative remedy� means an action imposed upon a licensee in response to non-compliance with RSA 151 and He-P 805. (f) � �Administrator� means the licensee or individual appointed by the licensee to be responsible for all aspects of the daily operation of the licensed premises. (g) � �Admission� means the point in time when a resident, who has been accepted by a licensee for the provision of services, physically moves into the facility. �������� (h) � �Advance directive� means a legal document allowing a person to give directions about future medical care or to designate another person to make medical decisions if they should lose the capacity to make health care decisions. This term includes �living wills� and �durable powers of attorney for health care�, in accordance with RSA 137-J, or a �surrogate decision-maker� in accordance with RSA 137-J:35. �������� (i) � �Adverse drug reaction� means harm caused by a drug at normal doses. �������� (j) � �Affiliated parties� means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, or captive or affiliated insurance companies. This term includes �related parties�. (k ) � �Agent� means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision-maker identified under RSA 137-J:35-37. (l) � �Applicant� means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate an SRHCF pursuant to RSA 151. �������� (m) � �Area of non-compliance� means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 805, or other federal or state requirements. (n) � � Assessment � means an evaluation of the resident to determine the care and services that are needed. �������� (o) � � Care assessment for residential services (CARES) tool� means the document developed by the department to assess the needs of a resident or prospective resident as required by RSA 151:5-a, I. (p) � �Care plan� means a documented guide developed by the licensee or their personnel, in consultation with the resident or the resident�s guardian, personal representative, or agent, if any, as a result of the assessment process for the provision of care and services as required by He-P 805.16(e) - (j). (q) � �Change of ownership� means the transfer of the controlling interest of an established SRHCF to any individual, agency, partnership, corporation, government entity, association, or other legal entity. (r) � �Chemical restraints� means any drug or medication that is used as a restriction to manage a resident�s behavior or restrict the resident�s freedom of movement and is not a standard treatment or dosage for the resident�s condition. (s) � �Clinical laboratory improvement amendments (CLIA )� means the requirements outlined at 42 CFR Part 493 which set forth the conditions that all laboratories must meet to be certified to perform testing on human specimens. (t) � �Commissioner� means the commissioner of the New Hampshire department of health and human services, or their designee. �������� (u) � �Controlling interest� means greater than 50% ownership interest. �������� (v) � �Core services� means those services provided by the licensee that are included in the basic rate. �������� ����������������� (w) � �Days� means calendar days unless otherwise specified in the rule. �������� (x) � � Demonstrated competency� means the ability of the employee to demonstrate to an evaluator their ability to complete the required task in a way that reflects the minimum standard to achieve a certificate of completion for a course or to pass a post-test for a training provided. (y) � �Department� means the New Hampshire department of health and human services. (z) � �Direct care� means the hands on care or services provided to a resident, including but not limited to medical, nursing, psychological, or rehabilitative treatments. �������� (aa) � �Direct care personnel� means any person providing hands-on clinical care or hands-on services to a resident including but not limited to medical, psychological, or rehabilitative treatments, bathing, transfer assistance, feeding, dressing, toileting, and grooming. (ab) � �Directed plan of correction� means a plan developed and written by the department that specifies the necessary actions the licensee must take to correct identified areas of non-compliance. �������� (ac) � �Discharge� means moving a resident from a licensed facility or entity to a non-licensed facility or entity. �������� (ad) � �Do not resuscitate order (DNR order)� means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the resident will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes �do not attempt resuscitation order (DNAR order)�. ��������� (ae) � �Drug diversion� means the use of controlled substances for anything other than the intended purpose or not administered to the person to whom it was prescribed. (af) � �Elopement� means when a resident leaves the licensed premises or a safe area unsupervised or unnoticed, without the authorization of the licensee�s personnel. (ag) � �Emergency plan� means a document outlining the responsibilities of personnel in an emergency. �������� (ah) � �Employee� means anyone employed by the licensee and for whom the licensee has direct supervisory authority. �������� (ai) � �Enforcement action� means the imposition of an administrative fine, the denial of an application, or the revocation or suspension of a license in response to non-compliance with RSA 151 or He-P 805. �������� (aj) � �Equipment� means any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services, not to include portable refrigerators. This term includes �fixtures�. (ak) � �Exploitation� means the illegal use of a resident�s person or property for another person�s profit or advantage, or the breach of a fiduciary relationship through the use of a person or person�s property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a resident through the use of undue influence, harassment, duress, deception, or fraud. �������� (al) � �Facility� means �facility� as defined in RSA 151:19, II. (am) � �Guardian� means a person appointed in accordance with RSA 464-A to make informed decisions relative to the resident�s health care and other personal needs. �������� ( an ) � �Health care occupancy� means the use of a building or structure, or a portion thereof, to provide care or supervision to persons who are or are not capable of self-preservation without physical assistance. (ao) � �Household member� means the caregiver, all family members, and any other individuals age 17 or older, other than residents that reside at the licensed premises for more than 30 days. �������� (ap) � �Independent contractor� means an individual or business entity providing service to the licensee or its residents but not employed by the licensee. (aq) � �Infectious waste� means �infectious waste� as defined in Env-Sw 103.28 and described in Env-Sw 904. �������� (ar) � �Informed consent� means the decision by a resident, or their guardian, personal representative, or agent, to agree to a proposed course of treatment, after they have received full disclosure of the facts, including information about risks and benefits of the treatment and available alternatives, needed to make the decision intelligently. (as) � �In-service� means an educational program, which is designed to increase the knowledge, skills, and overall effectiveness of personnel. (at) � �Inspection� means the process used by the department to determine an applicant�s or a licensee's compliance with RSA 151, He-P 805, and all other federal and state requirements or to respond to allegations, pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 805. �������� (au) � �Laboratory� means a facility, or space within a facility, used for the biological, microbiological, serological, chemical, immunohematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of disease. (av) � �License� means the document issued to an applicant or licensee which authorizes operation in accordance with RSA 151 and He-P 805, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, the name of the administrator, the type(s) of services authorized, the number of beds the facility is licensed for, and license number. (aw) � �Licensed practitioner� means a: (1) � Medical doctor; (2) � Physician's assistant; (3) � Advanced practice registered nurse (APRN); (4) � Doctor of osteopathy; (5) � Doctor of naturopathic medicine; or (6) � Any other professional licensed by law with prescriptive powers. (ax) � �Licensed premises� means the physical location that the department has approved for the licensee to conduct operations in accordance with its license. (ay) � �Licensee� means any person or legal entity to which a license has been issued pursuant to RSA 151. ( az ) � �Licensing classification� means the specific category of services authorized by a license. �������� (ba) � �Life safety code� means the adoption by reference of the life safety code, as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5. (bb) � �Mechanical restraint� means locked, secured, or alarmed SRHCFs or units within an SRHCF, or anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within. �������� (bc) � �Medical director� means a licensed practitioner licensed in New Hampshire in accordance with RSA 329 or 326-B who is responsible for overseeing the quality of medical care and services in a SRHCF. �������� (bd) � �Medication� means a substance available with or without a prescription, which is used as a curative, remedial, or palliative supportive substance. ��������� (be) � �Medication error� means any deviation in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a resident�s refusal. (bf) � �Modification� means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. The term does not include �repair� or �replacement� of interior finishes . (bg) � �Neglect� means an act or omission that results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of a resident. (bh) � �Notice to correct� means a report issued pursuant to RSA 151:6-a, II, following a life safety code inspection when a facility is found to be out of compliance with applicable life safety codes or rules. (bi) � �Nursing care plan� means a written guide developed by a nurse in consultation with the resident and the resident�s guardian, personal representative, or agent, that lists the interventions necessary to meet the resident�s nursing needs. (bj) � �Orders� means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner. (bk) � �Over-the-counter medications� means non-prescription medications. �������� (bl) � �Owner� means any person, corporation, association, or any other legal entity, whether organized for profit or not, holding or claiming ownership of, or title to, a license. (bm) � �Patient rights� means the privileges and responsibilities possessed by each resident provided by RSA 151:21. This term includes �resident rights�. �������� (bn) � �Patient�s personal representative� means �patient�s personal representative� as defined in RSA 151:19, V namely, �a person, other than the licensee of, an employee of, or a person having direct or indirect ownership interest, in a facility, who is designated in writing by a patient or patient�s legal guardian for a specific, limited purpose or for the general purpose of assisting the patient in the exercise of any rights�. This term includes �personal representative�. (bo) � �Performance-based design� means an engineering approach to fire protection design and construction based on: (1) � Established fire safety goals and objectives; (2) � Deterministic and probabilistic analysis of fire scenarios; and (3) � Quantitative assessment of design alternatives against the fire safety goals and objectives using accepted engineering tools, methodologies, and performance criteria. (bp) � �Personal care� means services that are non-medical, hands-on services provided to a resident including, but not limited to, assistance with activities of daily living. �������� (bq) � �Personnel� means an individual(s), who is employed by the licensee, a volunteer, or an independent contractor who provides direct care or personal care services to a resident(s). (br) � �Physical restraint� means any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident�s body that the individual cannot remove easily which restricts freedom of movement or normal access to one�s body. (bs) � �Plan of correction (POC)� means a plan developed and written by the licensee, which specifies the actions that will be taken to correct areas of non-compliance with applicable rules or codes identified at the time of a clinical or life safety inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6. �������� (bt) � �Point of care devices� means a system of devices used to obtain medical, diagnostic results including but not limited to: (1) A lancing or finger stick device to get blood specimen; (2) A test strip or reagents to apply a specimen to for testing; or (3) A meter or monitor to calculate and show the results, including: a. Blood glucose meters, also called �glucometers�; b. Prothrombin Time (PT) and International Normalized Ratio (INR) anticoagulation meters; or c. A Cholesterol meter. �������� (bu) � �Point of care testing (POCT)� means laboratory testing performed using either manual methods or hand held instruments at or near the point of care, at the time and place of resident care. (bv) � �Pro re nata (PRN) medication� means medication administered as circumstances might require in accordance with the licensed practitioner�s orders. (bw) � �Procedure� means a licensee�s written, standardized method of performing duties and providing services. (bx) � �Protective care� means the provision of resident monitoring services, including but not limited to: (1) � Knowledge of resident whereabouts; and (2) � Minimizing the likelihood of accident or injury. (by) � �Qualified personnel� means personnel that have been trained and have demonstrated competency to adequately perform tasks which they are assigned such as, nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols . (bz) � �Reconstruction� means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained. (ca) � �Rehabilitation� means any of the following, as defined in this section, undertaken in an existing building: (1) � Addition; (2) � Modification; (3) � Reconstruction; (4) � Renovation; and (5) � Repair. (cb) � �Renovation� means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces. (cc) � �Repair� means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition. (cd) � �Reportable incident� means an occurrence of any of the following while the resident is either in the SRHCF or in the care of SRHCF personnel: (1) � The unanticipated death of the resident; (2) � An injury to a resident that is of a suspicious nature under circumstances where the injury was not observed by any person or the cause of the injury could not be explained by the resident; (3) � The elopement of a resident; (4) � Medication error which resulted in serious bodily injury; and (5) � Drug diversion. (ce) � �Resident� means any person admitted to or in any way receiving care, services, or both who resides in a SRHCF. (cf) � �Residential board and care� means an occupancy used for lodging and boarding of 4 or more residents, not related by blood or marriage to the owners or operators, for the purpose of providing personal care services. (cg) �Resident record� means a separate file maintained for each resident, which includes all documentation required by RSA 151 and He-P 805 and as required by other federal and state law. (ch) � Respite care� means the admission of a person from their primary residence to an SRHCF, on either a planned or emergency basis, for a period not to exceed 30 days in order to relieve the primary caregiver from the demands of providing home-based care. (ci) � �Self administration of medication with assistance� means the resident takes their own medication(s) after being prompted by personnel, but without requiring physical assistance from others. (cj) � �Self administration of medication without assistance� means an act whereby the resident takes their own medication(s) without the assistance of another person. (ck) � �Self directed medication administration� means an act whereby a resident, who has a physical limitation that prohibits them from self-administering, directs personnel to physically assist in the medication process excluding assisting with infusions, injections, or filling insulin syringes. ��������� (cl) � �Self-preservation capability� means the ability of a resident to act on an innate desire to protect oneself from harm without staff intervention. ��������� (cm) � �Serious bodily injury� means an injury involving extreme physical pain, involving substantial risk of death, involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty, or requiring medical intervention such as surgery, hospitalization, or physical rehabilitation. (cn) � �Service� means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a resident. (co) � �Significant change� means a decline or improvement in a resident�s status that: (1) � Will not normally resolve itself without further intervention by personnel or by implementing standard disease-related clinical interventions; (2) � Impacts more than one area of the resident�s health status; and (3) � Requires interdisciplinary review or revision of the care plan. �������� ( cp ) � �State building code� means �state building code� as defined in RSA 155-A:1, IV. ��������� ( cq ) � �State fire code� means �state fire code� as defined in RSA 153:1 and as amended by rules adopted pursuant to RSA 153:5. (cr) � �State monitoring� means the placement of individuals by the department at an SRHCF to monitor the operation and conditions of the facility. (cs) � �Stock medication� means over-the-counter medication available for use by more than one resident. (ct) � �Supported residential health care facility (SRHCF)� means a long-term care residence providing personal assistance at the supported residential care level pursuant to RSA 151:9, VII(a)(2). (cu) � �Therapeutic diet� means a diet ordered by a licensed practitioner or other licensed professional with prescriptive authority as part of the treatment for disease, clinical conditions, or increasing or decreasing specific nutrients in the food consumed by the resident. �������� (cv) � �Transfer� means �transfer� as defined in RSA 151:19, VII. �������� (cw) � Unanticipated death� means the death of a resident that is not related to their diagnosis or underlying condition. �������� (cx) � � Underwriters laboratories (UL) listed� means that the global safety certification company UL has confirmed that the product is safe for use. �������� (cy) � � Visitor � means a family member or non-related person who comes to visit one or more resident(s) temporarily, for their social well-being, amusement, or distraction. �������� (cz) � �Volunteer� means an unpaid person who assists with food services, entertainment, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons or organized groups who provide religious services. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.04 � Initial License Application Submission . (a) � Each applicant for a license shall comply with the requirements of RSA 151:4, I�III-a and submit the following to the department: (1) � A completed application form entitled �Application for Residential, Health Care, or Special Health Care Services� (August 2025), signed by the owner if a private entity, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government agency if a government unit, affirming to the following: �I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of the license and the imposition of a fine.�; (2) � A floor plan of the prospective SRHCF indicating the location of all rooms, number of beds in each bedroom, and fire exits; (3) � If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following: a. � �Certificate of Authority,� if a corporation; b. � �Certificate of Formation,� if a limited liability corporation; or c. �Certificate of Trade Name,� where applicable; (4) � The applicable fee in accordance with RSA 151:5, IX, payable in cash or, if paid by check or money order, in the exact amount of the fee made payable to the �Treasurer, State of New Hampshire�; (5) � A resume identifying the qualifications of the SRHCF administrator and medical director, if applicable; (6) � Copies of applicable licenses for the SRHCF administrator and medical director, if applicable; (7) � The results of a criminal records check to include results for the state of New Hampshire for the applicant(s), licensee if different than the applicant, the administrator, the medical director, if applicable, and each household member 17 years of age or older who resides at the facility, as applicable; (8) � A copy of the non-conviction attestation, as described in He-P 805.18(t), for the administrator and medical director; (9) � The results of a bureau of adult and aging services (BAAS) registry check from the bureau of adult and aging services for the administrator and medical director pursuant to He-P 805.18(e); (10) � Written local approvals as follows: a. � For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials or if there is no such official(s), from the board of selectmen or mayor: 1. � The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements; 2. � The building official verifying that the applicant complies with all applicable state building codes and local building ordinances; 3. � The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and 4. � The fire chief verifying that the applicant complies with the state fire code and local ordinances for a health care facility; and b. � For a building under construction, the written approvals required by a. above shall be submitted at the time of application based on the local official�s review of the building plans and again upon completion of the construction project; (11) � If the SRHCF uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485, Env-Dw 702.02, Env-Dw 704.02, or if a public water supply is used, a copy of a water bill; (12) � Any waiver requests, if applicable; and (13) A list of all employees who have been previously granted waivers for criminal background check results from the department. (b) � The applicant shall mail or hand-deliver the documents to: Department of Health and Human Services Office of Legal and Regulatory Services Health Facilities Administration 129 Pleasant Street Concord, NH 03301; Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.05 � Processing of Applications and Issuance of Licenses . (a) � An application for an initial license shall be complete when the department determines that all items required by He-P 805.04(a) have been received. (b) � If an application does not contain all of the items required by He-P 805.04(a) the department shall notify the applicant in writing of the items required before the application can be processed. (c) � Any licensing fee submitted to the department in the form of a check or money order and returned to the state for any reason, shall be processed in accordance with RSA 6:11-a. (d) � Licensing fees shall not be transferable to any other application(s). (e) � Unless a waiver has been granted, the department shall deny a licensing request in accordance with He-P 805.13(c) when it determines that the applicant, licensee, administrator, or medical director: (1) � Has been convicted of any felony in this or any other state; (2) � Has been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in this state or any other state; (3) � Has had a finding by the department or any other administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person; or (4) � Otherwise poses a threat to the health, safety, or well-being of residents. (f) � Following both a clinical and life safety inspection required in He-P 805.09(b), a license shall be issued if the department determines that an applicant requesting an initial license is in full compliance with RSA 151 and He-P 805. �������� (g) � All licenses issued in accordance with RSA 151 shall be non-transferable by person or location. �������� (h) � A written notification of denial, pursuant to He-P 805.13(b), shall be sent to an applicant applying for an initial license if it has been determined by the inspection in He-P 805.09(b) and a maximum of 2 follow-up inspections that the prospective premises are not in full compliance with RSA 151 and He-P 805. �������� (i) � A written notification of denial, pursuant to He-P 805.13(b)(4), shall be sent to an applicant applying for an initial license if the department has received no communication from the applicant within 3 months of sending written notification to the applicant that their application is complete and an inspection needs to be scheduled. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.06 � License Expirations and Procedures for Renewals . (a) � A license shall be valid on the date of issuance and expire the following year on the last day of the month it was issued unless a completed application for renewal has been received. (b) � Each licensee shall complete and submit to the department an application form pursuant to He-P 805.04(a)(1) at least 120 days prior to the expiration of the current license to include: (1) � The current license number; (2) A request for renewal of any existing non-permanent waiver previously granted by the department, in accordance with He-P 805.10(f), if applicable; (3) � A list of any current employees who have a permanent waiver granted in accordance with He-P 805.18(d)(2); and (4) � A copy of any temporary, new, or existing non-permanent variances or waivers applied for or granted by the state fire marshal, in accordance with RSA 153:5. (c) � In addition to (b) above, if a private water supply is used, the licensee shall provide documentation that every 3 years the water supply has been tested for bacteria and nitrates and determined to be at acceptable levels, in accordance with Env-Dw 702.02 for bacteria and Env-Dw 704.02 for nitrates. (d) � Following an inspection as described in He-P 805.09, a license shall be renewed if the department determines that the licensee: (1) � Submitted an application containing all the items required by He-P 805.06(b) and (c) as applicable, prior to the expiration of the current license; and (2 ) � Is found to be in compliance with RSA 151 and He-P 805, and all the federal requirements, at the renewal inspections, or has submitted a POC that has been accepted by the department and implemented by the licensee if area of non-compliance were cited. ����������� (e) � Any licensee who does not submit a complete application for renewal prior to the expiration of an existing license and does not intend to cease operation shall be required to submit an application for an initial license pursuant to He-P 805.04(a) and shall be subject to a fine in accordance with He-P 805.13(d)(7). Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805 .07 � SRHCF Construction, Modifications, or Structural Alterations . (a) � As required by RSA 151:6, any licensee or applicant desiring to make renovations, modifications, reconstruction, and additions to its facilities or to construct new facilities shall submit plans and specifications to the NH division of fire safety, state fire marshal�s office 60 days prior to commencing such work. �������� (b) � As required by RSA 153:10-b, V, sprinkler and fire alarm plans shall be submitted to the NH division of fire safety, state fire marshal�s office and no device shall be installed until it has been approved by the NH division of fire safety, state fire marshal�s office. �������� (c) � The plans and specifications, sprinkler, and fire alarm plans in (a) and (b) above shall accurately show the room designation(s) and exact measurements of each area to be licensed, including but not limited to window and door sizes and each room�s use. (d) New construction, renovations, modifications, reconstruction, and additions initiated prior to receiving NH state fire marshal�s office approval shall be done at the licensee�s or applicants own risk. �������� (e) � Any licensee or applicant who wants to use performance-based design to meet the fire safety requirements shall provide the department with documentation of fire marshal approval for such methods. �������� (f) � A licensee or applicant undertaking new construction, renovations, modifications, reconstruction, and additions to its facility shall comply with the appropriate chapters and sections of the adopted state fire codes, state building codes, state laws and rules, and local ordinances. �������� (g) � Variances to the state fire code shall be granted by the state fire marshal under the process outlined in Saf-C 6005. �������� (h) � All newly constructed or rehabilitated facilities shall comply with the Facility Guidelines Institute�s (FGI) �Guidelines for Design and Construction of Residential Health, Care, and Support Facilities� (2022 edition), as applicable, as available as noted in Appendix A. ���������� ��������� (i) � Applicants and licensees shall contact the state fire marshal for requests for exceptions to the FGI. �������� (j) � Penetrations , holes, or other openings in fire walls, fire partitions, smoke barriers, floors, and ceilings that allow the transfer of fire, heat, or smoke shall be closed and sealed using a listed or approved fire system that provides an equivalent rating as provided by the original surface. (k) � All new construction and rehabilitated spaces shall be subject to an inspection pursuant to He-P 805.09 prior to its use. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805 .08 � SRHCF Requirements for Organizational or Service Changes . (a) � The SRHCF shall provide the department with written notice at least 30 days prior to changes in any of the following: (1) � Ownership; (2) � Physical location; (3) � Address; (4) � Name; (5) � Number of beds authorized under the current license; or (6) � Services. (b) � The SRHCF shall complete and submit a new application and obtain a new or revised license, as applicable, prior to operating, for: (1) � A change in ownership; (2) � A change in the physical location; (3) � An increase in the number of beds authorized under the current license; or (4) � A change in services. (c) � When there is a change in address without a change in location the SRHCF shall provide the department with a copy of the notification from the local, state, or federal agency that requires the change. (d) � When there is a change in the name, the SRHCF shall submit to the department a copy of the certificate of amendment from the New Hampshire secretary of state, if applicable. (e) � An inspection by the department shall be conducted prior to operation for changes in the following: (1) � Ownership, unless the current licensee is in full compliance, in which case an inspection shall be conducted as soon as practical by the department: (2) � The physical location; (3) � An increase in the number of beds or residents authorized under the current license; (4) � A change in license classification; or (5) � A change that places the facility under a different life safety code occupancy chapter. (f) � A new license shall be issued for a change in ownership, classification, or physical location. (g) � A revised license shall be issued for any of the following: (1) � A change in name; (2) � A change of administrator or medical director; (3) � An increase or decrease in the number of beds; (4) � A change in the scope of services provided; or (5) � When a waiver has been granted in accordance with He-P 805.10. (h) � The SRHCF shall inform the department in writing when there is a change in administrator or medical director no later than 5 days prior to a change, or as soon as practicable in the event of a death or other extenuating circumstances requiring an administrator or medical director change, and provide the department with the following: (1) � A resume identifying the name and qualifications of the new administrator or medical director; (2) � Copies of applicable licenses for the new administrator or medical director; (3) � The results of a criminal background check for the new administrator or medical director which shall include criminal history from the state of New Hampshire; (4) � The results of the non-conviction attestation as described in He-P 805.18(w); and (5) � The results of the BAAS registry check per He-P 805.18(e). (i) � Upon review of the materials submitted in accordance with (h) above, the department shall make a determination as to whether the new administrator or medical director meets the qualifications for the position as specified in He-P 805.18(i) and (j). (j) � If the department determines that the new administrator or medical director does not meet the qualifications, it shall so notify the program in writing so that a waiver can be sought or the program can search for a qualified candidate. (k) � When there is to be a change in the services provided, the SRHCF shall provide the department with a description of the service change and, where applicable, identify what additional personnel will be hired and their qualifications, how the new services will be incorporated into the infection control and quality improvement programs, and describe what changes, if any, in the physical environment will be made. (l) � The department shall review the information submitted under (k) above and determine if the added services can be provided under the SRHCF�s current license. �������� (m) � The SRHCF shall inform the department in writing via email, fax, or mail of any change in the e-mail address no later than 10 days of the change. The department shall use email as the primary method of contacting the facility in the event of an emergency. (n) � A restructuring of an established SRHCF that does not result in a transfer of the controlling interest of the facility, but which might result in a change in the name of the facility or corporation, shall not constitute a change in ownership and a new license shall not be required. (o) � If a licensee chooses to cease operation of a SRHCF, the licensee shall submit written notification to the department at least 60 days in advance which shall include a written closure plan. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805 .09 � Inspections . (a) � For the purpose of determining compliance with RSA 151 and He-P 805, as authorized by RSA 151:6 and RSA 151:6-a, the licensee shall admit and allow any department representative at any time to inspect the following: (1) � The proposed or licensed premises; (2) � All programs and services provided by the SRHCF; and (3) � Any records required by RSA 151 and He-P 805. (b) � The department shall conduct a clinical and life safety code inspection, as necessary, to determine full compliance with RSA 151 and He-P 805 prior to: (1) � The issuance of an initial license; (2) � A change in ownership, except as allowed by He-P 805.08(e)(1); (3) � A change in the physical location of the SRHCF; (4) � A change in the licensing classification; (5) � A change in the life safety code occupancy chapter the facility is licensed under; (6) � An increase in the number of beds; (7) � Occupation of space after construction, renovations, or alterations; or (8) � The renewal of a license. (c) � In addition to (b) above, the department shall conduct an inspection to verify the implementation of any POC accepted or issued by the department as part of an annual inspection, or as a follow-up inspection focused on confirming the implementation of a POC. (d) � A statement of findings for clinical inspections or notice to correct for life safety code inspections shall be issued when, as a result of any inspection, the department determines that the SRHCF is in violation of any of the provisions of He-P 805, RSA 151, or other federal or state requirement(s). (e) � If areas of non-compliance were cited in either a notice to correct or a statement of findings, the licensee shall submit a POC, in accordance with He-P 805, within 21 days of the date on the letter that transmits the inspection report. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.10 � Waivers . (a) � Applicants or licensees seeking waivers of specific rules in He-P 805 shall submit a written request for a waiver to the department that includes: (1) � The specific reference to the rule for which a waiver is being sought; (2) � A full explanation of why a waiver is necessary; (3) � A full explanation of alternatives proposed by the applicant or license holder which shall be equally as protective of public health and residents as the rule from which a waiver is sought or provide a reasonable explanation why the applicable rule should be waived; and (4) � The period of time for which the waiver is sought if the waiver request is not for a permanent waiver. (b) � A waiver shall be permanent unless the department specifically places a time limit on the waiver. (c) � A request for waiver shall be granted if the department determines that the alternative proposed by the applicant or licensee: (1) � Meets the objective or intent of the rule; (2) � Does not negatively impact the health, safety, or well-being of the residents; and (3) � Does not affect the quality of resident services. (d) � The licensee�s subsequent compliance with the alternatives approved in the waiver shall be considered equivalent to complying with the rule from which waiver was sought. (e) � Waivers shall not be transferable. (f) � When a licensee wishes to renew a non-permanent waiver beyond the approved period of time, the licensee shall apply for a new waiver with the renewal application or at least 60 days prior to the expiration of the existing waiver, as appropriate , by submitting the information required by (a) above. (g) If the request in (f) above is not received with the renewal application or at least 60 days prior to the expiration of the existing waiver, the rule(s) for which the waiver was previously requested shall not continue to be waived beyond the expiration of the current license. (h) � The request to renew a waiver shall be subject to (b) through (f) above. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.11 � Complaints . (a) � The department shall investigate any complaint that meets the following conditions: (1) � The alleged violation(s) occurred not more than 6 months prior to the date the department was made aware of the allegation(s); (2) The complaint is based upon the complainant�s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a person who has first-hand knowledge regarding the allegation(s); or (3) � There is sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of RSA 151 or He-P 805. (b) � When practicable the complaint shall be in writing and contain the following information: (1) � The name and address of the SRHCF, or the alleged unlicensed individual or entity; (2) � The name, address, and telephone number of the complainant; and (3) � A description of the situation that supports the complaint and the alleged violation(s) of RSA 151 or He-P 805. (c) � Investigations shall include all techniques and methods for gathering information which are appropriate to the circumstances of the complaint, including, but not limited to: (1) � Requests for additional information from the complainant or the licensee; (2) � A physical inspection of the premises; (3) � Review of any relevant records; and (4) � Interviews with individuals who might have information that is relevant to the investigation. (d) � For a licensed SRHCF, the department shall: (1) � Provide written notification of the results of the investigation to the licensee along with an inspection report if areas of non-compliance were found as a result of the investigation; (2) � Notify any other federal, state, or local agencies of suspected violations of their statutes or rules based on the results of the investigation, as appropriate; (3) � Notify the licensee, in writing, and take no further action if the department determines that the complaint is unfounded, under (a) above, or does not violate any statutes or rules; and (4) � Require the licensee to submit a POC in accordance with He-P 805. (e) � The following shall apply for the unlicensed individual or entity: (1) � In accordance with RSA 151:7-a, II, the department shall provide written notification to the owner or person responsible that includes: ������� a. � The date of investigation; b. � The reasons for the investigation; and c. � Whether or not the investigation resulted in a determination that the services being provided require licensing under RSA 151:2, I(e); (2) � In accordance with RSA 151:7-a, II, the owner or person responsible shall have 7 days from the date of receipt of the notice required by (e)(1) above to submit a written response to the findings or submit a completed application pursuant to He-P 805.04 prior to the department�s issuance of a warning; (3) � In accordance with RSA 151:7-a, I, the department shall issue a written warning, following an investigation conducted under RSA 151:6 or an inspection under RSA 151:6-a, to the owner or person responsible, requiring compliance with RSA 151 and He-P 805, if the owner of an unlicensed SRHCF does not comply with (2) above, or if the department does not agree with the owner�s written response to the findings; (4) � The warning in (e)(3) above, shall include: a. � The time frame within which the owner or person responsible shall comply with the directives of the warning; b. � The final date by which the action or actions requiring licensure shall cease or by which an application for licensure shall be received by the department before the department initiates any legal action available to it to cease the operation of the facility; and c. � The right of the owner or person responsible to appeal the warning under RSA 151:7-a, III, which shall be conducted in accordance with RSA 151:8 and RSA 541-A:30, III, as applicable; and ����������������� (5) � Any person or entity who fails to comply after receiving a warning as described in (e)(3) above shall be subject to an action by the department for injunctive relief under RSA 151:17 and an administrative fine pursuant to He-P 805.13(d)(6). (f) � Complaint investigation files shall be confidential in accordance with RSA 151:13, and shall not be disclosed publicly, but shall be released by the department on written request only: (1) � To the department of justice when relevant to a specific investigation; (2) � To law enforcement when relevant to a specific criminal investigation; (3) � When a court of competent jurisdiction orders the department to release such information; or (4) � In connection with an adjudicative proceeding relative to the licensee. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.12 � Administrative Remedies . (a) � The department shall impose administrative remedies for violations of RSA 151, He-P 805, or other applicable licensing rules, including: (1) � Requiring a licensee to submit a POC in accordance with (c) below; (2) � Imposing a directed POC upon a licensee in accordance with (d) below; (3) � Imposing conditions upon a license; or (4) � Monitoring of a licensee. (b) � When administrative remedies are imposed, the department shall provide written notice, as applicable, which: (1) � Identifies each area in which the licensee is not in compliance with RSA 151, He-P 805, or other applicable licensing rules; and (2) � Identifies the specific remedy(s) that has been imposed. (c) � A POC shall be developed and enforced in the following manner: (1) � Upon receipt of a statement of findings, or a notice to correct, the licensee shall submit its written POC for each item, detailing: a. � How the licensee intends to correct each area of non-compliance; b. � What measures will be put in place, or what system changes will be made to ensure that the non-compliance does not recur, to include how the measures will be evaluated for effectiveness; c. � The date by which each area of non-compliance shall be corrected; and d. � The position of the employee responsible for the corrective action; (2) � The licensee shall submit a POC to the department within 21 days of the date on the letter that transmitted the statement of findings or notice to correct unless the licensee requests, either verbally or in writing, and the department agrees, to extend that deadline, based on the following criteria: a. � The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 21-day period but has been unable to do so; and b. � The department determines that the health, safety, or well-being of a resident will not be jeopardized as a result of granting the extension; (3) � The department shall review and accept each POC that: a. � Achieves compliance with RSA 151 and He-P 805; b. � Addresses all areas of non-compliance as cited in the statement of findings or notice to correct; c. � Prevents a new violation of RSA 151 or He-P 805 as a result of the implementation of the POC; and d. � Specifies the date upon which the areas of non-compliance shall be corrected; (4) � If the POC is acceptable, the department shall issue a license or provide written notification of acceptance of the POC, whichever is applicable; (5) � If the POC is not acceptable, the department shall notify the licensee in writing within 14 days of the reason for rejecting the POC; (6) � The licensee shall develop and submit a revised POC within 14 days of the date of the written notification from the department that states the original POC was rejected, unless, within the 14-day period, the licensee requests an extension, either via telephone or in writing, and the department grants the extension, based on the following criteria: a. � The licensee demonstrates that they have made a good faith effort, as verified by documentation or other means, to develop and submit the POC within the 14-day period but has been unable to do so; and b. � The department determines that the health, safety, or well-being of a resident shall not be jeopardized as a result of granting the extension; (7) � The revised POC shall comply with (c)(1) above and be reviewed in accordance with (c)(3) above; (8) � If the revised POC is not acceptable to the department or is not submitted within 14 days of the date of the written notification from the department that states the original POC was rejected, the licensee shall be subject to a directed POC in accordance with He-P 805.12(d) and a fine in accordance with He-P 805.13(c)(13); (9) � The department shall verify the implementation of any POC that has been submitted and accepted by: a. � Reviewing materials submitted by the licensee; b. � Conducting a follow-up inspection; or c. � Reviewing compliance during the next annual inspection; (10) � Verification of the implementation of any POC shall only occur after the date of completion specified by the licensee in the plan; and (11) � If the POC or revised POC has not been implemented by the completion date at the time of the next inspection, the licensee shall be: a. � Notified by the department in accordance with He-P 805.12(b); and b. � Issued a directed POC in accordance with (d) below and shall be subject to a fine, as appropriate, in accordance with He-P 805.13(d)(14) below. (d) � The department shall develop and impose a directed POC that specifies corrective actions for the applicant or licensee to implement when: (1) � As a result of an inspection, areas of non-compliance were identified that require immediate corrective action to protect the health and safety of the residents and personnel; (2) � A revised POC is not submitted within 14 days of the written notification from the department or such other date as applicable if an extension was granted by the department; or (3) � A revised POC submitted by the licensee or administrator has not been accepted. (e) � If at the time of the next inspection the directed POC referenced in (d) above has not been implemented by the completion date stated in the directed POC, the department shall, as appropriate: (1) � Issue a warning that enforcement action will be taken if the POC is not implemented; (2) � Impose a fine in accordance with He-P 805.13(d); (3) � Deny the application for a renewal of a license in accordance with He-P 805.13(c); or (4) � Revoke or suspend the license in accordance with He-P 805.13. �������� (f) � The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with an area or areas of non-compliance cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution. �������� (g) � The informal dispute resolution shall be requested in writing by the applicant, licensee, or program director no later than 14 days from the date the statement of findings was issued by the department. �������� (h) � The department shall change the statement of findings if, based on the evidence presented, the statement of findings is determined to be incorrect. The department shall provide a written notice to the applicant or licensee of the determination. �������� (i) � The deadline to submit a POC in accordance with (c) above shall not apply until the notice of the determination in (h) above has been provided to the applicant or licensee. �������� (j) � Any violations cited for the state fire code may be appealed to the New Hampshire state fire marshal and shall not be the subject of informal dispute resolutions as described in this section. �������� (k) � An informal dispute resolution shall not be available for any applicant or licensee against whom the department has imposed an administrative fine or initiated action to suspend, revoke, deny, or refuse to issue or renew a license. �������� (l) � The department shall impose state monitoring under the following conditions: (1) � Repeated non-compliance on the part of the SRHCF in areas that impact health, safety, or well-being of residents; (2) � The presence of conditions in the SRHCF that negatively impact the health, safety, or well-being of residents; or (3) � Concern that the SRHCF is not ending the pattern of citations for violations of licensing rules and coming into compliance with those rules. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.13 � Enforcement Actions and Hearings . (a) � As specified in this section, the department shall take the following enforcement actions for violation of RSA 151, He-P 805, or other applicable licensing rules: (1) � Issue a warning; (2) � Impose a fine in accordance with (d) below; (3) � Deny the application for a renewal of a license in accordance with (c) below; (4) � Immediately suspend a license; or (5) � Revoke the license in accordance with (c) below. (b) � Prior to taking enforcement action against an applicant or licensee, the department shall send to the applicant or licensee a written notice that sets forth: (1) � The reasons for the proposed action; (2) � The action to be taken by the department; (3) � If a fine is imposed, the automatic reduction of the fine by 25% if the fine is paid within 10 days of the date on the written notice from the department and the area of non-compliance has been corrected, or a POC has been accepted and approved by the department; and (4) � The right of an applicant or licensee to an administrative hearing in accordance with RSA 151:8 or RSA 541-A:30, II-III, as applicable, before the enforcement action becomes final. (c) � The department shall deny an application or revoke a license if: (1) � An applicant or a licensee violated a provision of RSA 151 or He-P 805 which poses a threat to a resident�s health, safety, or well-being; (2) � An applicant or licensee has failed to pay an administrative fine imposed by the department; (3) � An applicant or licensee had a check returned to the department for insufficient funds and has not re-submitted the outstanding fee in the form of cash, money order, or certified check; (4) � After being notified of and given an opportunity to supply missing information, the applicant or licensee fails to submit an application that meets the requirements of He-P 805.04; (5) � An applicant, licensee, or any representative or employee of the applicant or licensee: a. � Provides false or misleading information to the department; b. � Prevents, interferes, or fails to cooperate with any inspection or inspection conducted by the department; or c. � Fails to provide requested files or documents to the department; (6) � The licensee failed to implement or continue to implement a POC that has been accepted or imposed by the department in accordance with He-P 805.12(c), (d), and (e); (7) � The licensee is cited a third time under RSA 151 or He-P 805 for the same violation within the last 5 inspections; (8) � A licensee, or its corporate officers, has had a license revoked and submits an application during the 5-year prohibition period specified in (j) below; (9) � Unless a waiver has been granted, upon inspection, the applicant�s premise is not in compliance with RSA 151 or He-P 805; (10) � Unless a waiver has been granted, the department makes a determination that the applicant, administrator, licensee, or a household member has been found guilty of or pled guilty to a felony assault, fraud, theft, abuse, neglect, or exploitation adjudicated and founded by the department or any administrative agency in this or any other state; (11) � The applicant or licensee employs an administrator who does not meet the qualifications for the position under circumstances in which the department has not granted a waiver; � (12) � The applicant has had a license revoked by any division or unit of the department within 5 years prior to the application; or (13) � The licensee has submitted a POC that has not been accepted by the department in accordance with He-P 805.12(c)(5) and has not submitted a revised POC in accordance with He-P 805.12(c)(6). (d) � The department shall impose fines as follows: (1) � For a failure to cease providing unlicensed services after being notified by the department of the need for a license, in violation of RSA 151:2, the fine shall be $2000.00 for an applicant or unlicensed entity; (2) � For a failure to cease operations after a denial of a license or after receipt of an order to cease and desist immediately, in violation of RSA 151:2 and RSA 541-A:30, the fine for an applicant, unlicensed provider, or a licensee shall be $2000.00; (3) � For advertising services or otherwise representing themselves as having a license to provide services that they are not licensed to provide, in violation of RSA 151:2, III, the fine for an applicant, licensee, or unlicensed provider shall be $500.00; (4) � For a failure to transfer a resident whose needs exceed the services or programs provided by the SRHCF, in violation of RSA 151:5-a, the fine for a licensee shall be $500.00; (5) � For admission of a resident whose needs exceed the services or programs authorized by the SRHCF licensing classification, in violation of RSA 151:5-a, II, and He-P 805.15(a) and (b), the fine for a licensee shall be $1000.00; (6) � For a failure to comply with the directives of a warning issued by the department, in violation of RSA 151:7-a and He-P 805.11(e)(5), the fine for an unlicensed provider or a licensee shall be $500.00; (7) � For a failure to submit a renewal application for a license at least 120 days prior to the expiration date, in violation of He-P 805.06(b), the fine for a licensee shall be $100.00; (8) � For a failure to notify the department prior to a change of ownership, in violation of He-P 805.08(a)(1), the fine for a licensee shall be $500.00; (9) � For a failure to notify the department prior to a change in the physical location, in violation of He-P 805.08(a)(2), the fine for a licensee shall be $500.00; (10) � For a failure to notify the department of a change in e-mail address as required by He-P 805.08(m), the fine for a licensee shall be $100.00; (11) � For a failure to allow access to the department to the SRHCF�s premises, programs, services, or records, in violation of He-P 805.09(a)(1)-(3), the fine for an applicant, unlicensed individual, or licensee shall be $2000.00; (12) � For a failure to notify the department prior to a change in the administrator or medical director, in violation of He-P 805.08(h), the fine for a licensee shall be $100.00; (13) � For a failure to submit a POC or revised POC, within 21 or 14 days, respectively, of the date on the letter that transmits the inspection report, in violation of He-P 805.12(c)(2) and (6), the fine for a licensee shall be $100.00; (14) � For a failure to implement or maintain the corrective action set forth in any POC that has been accepted or issued by the department, in violation of He-P 805.12(c)(11) and (e), the fine for a licensee shall be $1000.00; (15) � For a failure to establish, implement, or comply with licensee policies, as required by He-P 805.14(l), (m), (n), (t), (w), and (x), the fine for a licensee shall be $500.00; (16) � For a failure to provide services or programs required by the licensing classification and specified by He-P 805.14(b), the fine for a licensee shall be $500.00; (17) � For exceeding capacity, in violation of He-P 805.14(p), the fine for a licensee shall be $500.00, per day; (18) � For providing false or misleading information or documentation, in violation of He-P 805.14(u) the fine shall be of $1000.00 per offense; (19) � For a failure to meet the needs of the resident, in violation of He-P 805.15(a), the fine for a licensee shall be $500.00, per resident; (20) � For employing an administrator or other personnel who do not meet the qualifications for the position, in violation of He-P 805.18(i)-(j) and (l), under circumstances where the department has not granted a waiver in accordance with He-P 805.10, the fine for a licensee shall be $500.00; (21) � For failure to cooperate with the inspection or investigation conducted by the department, in violation of He-P 805.09(a), the fine shall be $2000.00; (22) � For failure to submit architectural plans or drawings, when applicable, prior to undertaking construction or renovation of the licensed facility in violation of He-P 805.07(a), the fine for a licensed facility shall be $500.00; (23) � For occupying a renovated area of a licensed facility or a new construction prior to approval by local and state authorities, as required by He-P 805.09(b)(7), the fine shall be $500.00 which shall be assessed daily if the facility fails to vacate the renovated area immediately upon receiving notice from the department; (24) � When an inspection determines that a violation of RSA 151 or He-P 805 has the potential to jeopardize the health, safety, or well-being of a resident, in addition to any other enforcement actions taken by the department, the fines assessed shall be as follows: a. � If the same area of non-compliance is cited within 2 years of the original deficiency the fine for a licensee shall be $1000.00; or b. � If the same area of non-compliance is cited a third time within 2 years of being fined in a. above the fine for a licensee shall be $2000.00; and (25) � Each day that the individual or licensee continues to be in violation of the provisions of RSA 151 or He-P 805 shall constitute a separate violation warranting additional fines in accordance with He-P 805.13(d), provided that if the applicant or licensee is making good faith efforts to comply with the provisions of RSA 151 or He-P 805, as verified by documentation or other means, the department shall not issue a daily fine. (e) � Payment of any imposed fine to the department shall meet the following requirements: (1) � Payment shall be made in the form of check or money order made payable to the �Treasurer, State of New Hampshire� or cash in the exact amount due; and (2) � Cash, money order, or certified check shall be required when an applicant or licensee has issued payment to the department by check, and such check was returned for insufficient funds. (f) � An applicant or licensee shall have 10 days after receipt of the notice of enforcement action to appeal. (g) � If a written request is not made pursuant to (f) above, the action of the department shall become final. (h) � The department shall order the immediate suspension of a license and the provision of services when it finds that the health, safety, or well-being of a resident is in jeopardy and requires emergency action in accordance with RSA 541-A:30, III. (i) � If an immediate suspension is upheld, the licensee shall not resume operating until the department determines through inspection that compliance with RSA 151 and He-P 805 is achieved. (j) � Hearings under this section shall be conducted in accordance with RSA 541-A and He-C 200. (k) � When a SRHCF�s license has been denied or revoked, the applicant, licensee, administrator, or medical director shall not be eligible to reapply for a license, or be employed as an administrator or medical director, for at least 5 years, if the enforcement action pertained to their role in the SRHCF. (l) � RSA 541 shall govern further appeals of the department decisions under this section. (m) � The 5-year period referenced in (k) above shall begin on: (1) � The date of the department�s decision to revoke or deny the license, if no appeal is filed; or (2) � The date a final decision upholding the action of the department is issued, if a request for an administrative hearing is made and a hearing is held. (n) � Notwithstanding (m) above, the department shall consider an application submitted after the decision to revoke or deny becomes final, if the applicant demonstrates that circumstances have changed to the extent that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills, and resources necessary to maintain compliance with the provisions of RSA 151 and He-P 805. (o) � If the department has evidence that a licensee, applicant, administrator, or others are circumventing rule (k) above by applying for a license through an agent or other person and will retain ownership, management authority, or both, the department shall deny the application. (p) � No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 151, RSA 541-A, or He-P 805. Source. � #2261, eff 1-17-83; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92 New. � #5513, eff 11-25-92; ss by #5665, eff 7-14-93; ss by #6895, INTERIM, eff 11-26-98, EXPIRED: 3-26-99 New. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.14 � Duties and Responsibilities of the Licensee . (a) � The licensee shall comply with all relevant federal, state, and local laws, rules, codes, and ordinances as applicable. (b) � The licensee shall provide the following core services: (1) � The presence of staff whenever a resident is in the facility; (2) � Health and safety services to all residents to minimize the likelihood of accident or injury, with protective care and oversight provided 24 hours a day regarding: a. � The residents� functioning, safety, and whereabouts; and b. The residents� health status, including the provision of intervention as necessary or required; (3) � Emergency response and crisis intervention; (4) Assistance with taking and ordering medications as determined by a resident�s ability or inability to safely manage medications as determined by the CARES tool; (5) � The provision of 3 nutritious meals and snacks unless the resident chooses other options according to their residential service agreement; (6) � Housekeeping, laundry, and maintenance services in accordance with the residential service agreement; (7) The availability of on-site activities, which shall include reasonable accommodation for residents with disabilities, to include, but not be limited to, television, radio, internet, games, newspapers, visitors, and music designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the residential service agreement; (8) � Assistance in arranging medical and dental appointments, including assistance in arranging transportation to and from such appointments and reminding the residents of the appointments; and (9) � Personal supervision of residents when necessary to offset cognitive deficits that might pose a risk to the safety of self or others if the resident is not supervised. (c) � The licensee shall provide access, as necessary, to the following services pursuant to RSA 151:2, IV and RSA 151:9, VII(a)(2): (1) � Nursing services, in accordance with RSA 326-B, including supervision and instruction of direct care personnel, relative to the delivery of nursing care; (2) � Rehabilitation services, including documentation of the licensed practitioner�s order for the service, such as physical therapy, occupational therapy, and speech therapy; and (3) � Behavioral health care services. (d) � The licensee shall develop and implement a process for determining adequate staffing levels. (e) � The process required in (d) above shall include an assessment, to be conducted at least quarterly, but more frequently if required, of the appropriateness of staffing levels to ensure: (1) � Sufficient staffing of qualified personnel to meet the resident needs as required by the CARES tool assessments and service plans on a 24-hour-per-day basis; and (2) � Sufficient staffing to respond promptly and effectively to individual resident emergencies and to respond to emergency, safety, and disaster situations affecting residents. (f) � The licensee shall: (1) � Provide basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper; (2) � Not be responsible for the cost of purchasing a specific brand of product at a resident�s request; (3) � Ensure that sufficient numbers of qualified personnel are present in the SRHCF to meet the needs of residents at all times; (4) � Ensure that demonstrated competencies required by the �qualified personnel� referenced �������������� in (e)(1) above are documented in the employee personnel file; (5) � Require any paid provider of direct care, other than an employee, providing health care related services to provide a brief written, signed, and dated note describing the reason for the service(s), and the next planned visit, if known; (6) Assist with arranging transportation to community programs, such as religious services and cultural, social, educational, and recreational activities according to the availability of such services in the surrounding communities; and (7) Require all individuals in contact with residents to wear a form of identification which readily discloses the name, licensure status, if any, and staff position as required per RSA 151:3-b. (g) � The use of chemical or physical restraints as defined under He-P 805.03(r) and (br), respectively, shall only be permitted as allowed by RSA 151:21. (h) � As soon as is practicable, but no longer than 24 hours after the use of a physical or chemical restraint, the resident�s licensed practitioner, the department, and the resident�s guardian, personal representative, or agent shall be notified of the use of such restraints. (i) � The following methods of mechanical restraints shall be allowed, as permitted by the state fire code: � (1) Locked, secured, or alarmed SRHCFs or units within a SRHCF; and (2) Anklets, bracelets, or similar devices that cause a door to automatically lock when approached, thereby preventing a resident from freely exiting the SRHCF or unit within. (j) � The following methods of mechanical restraints shall be prohibited: (1) � Full bed rails; (2) � Gates, if they prohibit a resident�s free movement throughout the living areas of the SRHCF; (3) � Half doors, if they prohibit a resident�s free movement throughout the living areas of the SRHCF; (4) � Geri chairs, when used in a manner that prevents or restricts a resident from getting out of the chair at will; (5) � Wrist or ankle restraints; (6) � Vests or pelvic restraints; or (7) � Other similar devices that prevent a resident�s free movement. (k) � For reportable incidents, the licensees shall have responsibility for: (1) � Completing an investigation to determine if abuse or neglect could have been a contributing factor to the incident; (2) � Submitting via fax to (603) 271-5574 the following information to the department within 48 hours of a reportable incident as defined in He-P 805.03(cd): a. � The SRHCF name and phone number; b. � A description of the incident, including identification of injuries, if applicable; c. � The name of the licensee(s) or personnel involved in, witnessing, or responding to the unusual incident; d. � The name of resident(s) involved in the reportable incident and the name of any witnesses to the reportable incident; e. � The date and time of the reportable incident; f. � The action taken in direct response to the reportable incident; g. � If medical intervention was required, by whom and the date and time; h. � When the resident�s guardian, personal representative, agent, or emergency contact person was notified; i. � The signature of the person reporting the reportable incident; and j. � The date and time the residents licensed practitioner was notified, if applicable; (3) � As soon as practicable, notifying the local police department, the department, and the guardian, personal representative, or agent when a resident has eloped and the licensee has searched the building and the grounds without finding the resident; and (4) � Notifying the department with a written report within 5 days describing the actions taken by personnel, the final outcome or continuation of the reportable incident, and actions taken to prevent a reoccurrence if it was not submitted in the initial report. (l) The licensee shall implement policies to ensure the safety of residents who are assessed as an elopement risk to reduce the risk and define areas recognized as �safe areas� on the licensed premise. (m) � The licensee shall implement policies to ensure the safety of residents who are assessed as a danger to self or others. (n) � The licensee shall implement policies to assure the safety of all visitors. (o) � The licensee shall comply with the patient�s bill of rights as set forth in RSA 151:21. (p) � The licensee shall not exceed the maximum number of residents or beds licensed by the department, unless authorized by the department, such as during an emergency. (q) � The licensee shall give a resident and the resident�s guardian, agent, or personal representative, as applicable, a written notice as follows: (1) � Thirty days advance notice for an increase in the cost or fees for any services except for: a. � Residents receiving medicaid whose financial liability is determined by the state�s standard of need or residents funded by the department�s Choices for Independence program in accordance with He-E 801 and which limitation shall only pertain to costs and fees under the direction of these programs; or b. � A change in the residents� condition or service needs; (2) For an involuntary change in room or bed location, 14 days advance notice along with reasonable accommodations of individual needs and preferences. If the change is required to protect the health, safety, and well-being of the resident or other residents, in such case the notice shall be as soon as practicable. (r) � In addition to the posting requirements specified in RSA 151:29, the licensee shall post the following documents in a public and conspicuous area: (1) � The current license issued in accordance with RSA 151:5; (2) � The most recent inspection report as specified in RSA 151:6-a; (3) � A copy of the patient�s bill of rights specified by RSA 151:21; (4) A copy of the licensee�s policies and procedures relative to the implementation of patients� rights and responsibilities as required by RSA 151:20; (5) � The licensee�s plan for fire safety, evacuation, and emergencies, identifying the location of, and access to all fire exits; and (6) � A copy of the licensee�s complaint procedure, including the address and phone number of the department to which complaints might also be made, which shall also be posted on the SRHCF website if available. (s) � The licensee shall determine the smoking status of the SRHCF. (t) � If smoking is to be allowed, the licensee shall develop and implement smoking policies and designate smoking areas in accordance with RSA 155:66, RSA 155:68, RSA 155:69, and He-P 805.26(f). (u) � The licensee may hold or manage a resident�s funds or possessions only when the licensee receives written authorization in accordance with RSA 151:24 and RSA 151:21, VII, and such funds shall not be used for the benefit of the licensee, other residents, or other household members. (v) � The licensee shall not falsify any documentation required by law or provide false or misleading information to the department. �������� (w) � The licensee shall develop and implement a policy for reporting to the administrator within 24 hours any observed or alleged abuse, neglect, or exploitation allegations. �������� (x) � The licensee shall develop and implement written policies and procedures governing the operation of the SRHCF and all services provided. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.15 � Resident Admission Criteria, Temporary Absence, Transfer, and Discharge Criteria . (a) � The licensee shall only admit an individual or retain a resident whose needs are compatible with the facility and the services and programs offered, and whose needs can be met by the SRHCF. (b) � If the SRHCF admits or retains an individual who: (1) � Requires lift equipment for transfers, all direct care personnel shall document in their personnel file that they have been trained in the correct operation of such equipment; (2) � Has a stage 2, 3, or 4 pressure ulcer, the licensee shall obtain the services of a nurse or other licensed health care professional, who may be a consultant, who has obtained the skills, training, and experience for the prevention of pressure sores in accordance with standards set forth by the National Pressure Ulcer Advisory Panel; (3) � Requires continuing nursing care or monitoring including but not limited to residents who are convalescing from an illness or injury and require short-term medical care, the licensee shall employ or contract for nursing personnel 24 hours per day; or (4) � Requires hospice care and the resident is no longer capable of taking medications supervised by unlicensed staff or unable to self direct the taking of medications, the licensee shall have a nurse available to meet the needs of the resident, with delays no longer than 30 minutes, during all shifts, to administer medications or shall administer medications by nurse delegation in accordance with Nur 404. (c) � A licensee shall not deny admission to any person because that person does not have a guardian or an advance directive, such as a living will or durable power of attorney for health care established in accordance with RSA 137-H or RSA 137-J. (d) � During a temporary absence the licensee shall hold the resident�s bed open in accordance with RSA 151:25. (e) � The resident shall be transferred or discharged, in accordance with RSA 151:5-a, RSA 151:19, RSA 151:21, V, and RSA 151:26. (f) � The licensee shall develop a discharge plan with the input of the resident and the guardian, personal representative, or agent. (g) � The following documents shall accompany the resident upon transfer or discharge: (1) � The most recent CARES tool as described in He-P 805.16(e), care plan, and quarterly progress notes if the resident is being transferred to another health care facility; (2) � The most recent nursing assessment, if applicable; (3) � A copy of the most recent medication administration and assistance record; (4) � A licensed practitioner�s order for transfer, if applicable; and (5) � The information data sheet. (h) � If the transfer or discharge referenced in (e) above is required by the reasons listed in RSA 151:26, II(b), a written notice shall be given to the resident as soon as possible. (i) � If the transfer or discharge referenced in (e) above is required for life safety reasons, the facility shall make a review of the residents needs and options for meeting these needs prior to discharge. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.16 � Required Services . (a) � The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who: (1) � Is responsible for the day-to-day operations of the SRHCF; (2) � Works no less than 35 hours per week at the SRHCF, which may include day, evening, night, and weekend hours; (3) � Meets the requirements of He-P 805.18(i) or He-P 805.18(j); (4) � Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in their absence; and (5) � In the event the administrator will be absent for a period to exceed 30 consecutive days, the facility shall notify the department who the interim administrator will be and submit credentials to verify they meet the requirements of (3) above. (b) � At the time of application for admission, upon request and at least 24 hours prior to signing a residential service agreement, the licensee shall provide the resident, guardian, personal representative, or agent, a written copy of the residential service agreement pursuant to RSA 161-J:4, which shall include: (1) � The base rate and the cost of any available services that are not included in the base rate; (2) � A list of the core services required by He-P 805.14(b) and the list of grooming and personal hygiene supplies required by He-P 805.14(f)(1) that are included in the base rate; (3) � Information regarding the timing and frequency of cost of care increases; (4) � The policies and procedures for termination of the agreement and the time period covered by the agreement; (5) � The amount and purpose of any advance payments required by the facility; (6) � The policy for refund of advance payments; (7) � The licensee�s medication management services; (8) Notice of the resident's rights in the event of a temporary absence from the facility, in accordance with RSA 151:25, and the resident's rights in the event of a proposed transfer or discharge from the facility, in accordance with RSA 151:26; (9) � The circumstances under which a discharge or transfer to another facility might occur, including situations in which the resident's evacuation capability and care needs would exceed what the licensee could provide, and the responsibility of the licensee in transitioning the resident to another location; (10) � A copy of the rules or policies governing resident conduct, house rules and responsibilities, and the procedures for handling resident grievances; (11) � A standard disclosure summary in the form set forth in RSA 161-J:5; (12) A statement affirming that the proposed resident has received the residential services agreement and attached standard disclosure summary, that the resident has read it or it has been read to the resident, and that the resident understands its contents; (13) � Information regarding nursing, other health care services, or supplies and medication management services and associated costs not provided in the core services, to include: a. The availability of services; b. � The licensee�s responsibility for arranging services; and c. � The fee and payment for services, if known; (14) � The licensee�s policy regarding: a. � Arranging for the provision of transportation; b. � Arranging for the provision of third party services, such as a hairdresser or cable television; c. � Acting as a billing agent for third party services; d. � Monitoring third party services contracted directly by the resident and provided on the premises; e. � Handling of resident funds pursuant to RSA 151:24 and He-P 805.14(u); f. � Storage and loss of the resident�s personal property; g. � Smoking; h. � Whether or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid, or both; and i. � Whether or not the facility has an automatic electronic defibrillator (AED) onsite and available for use in an emergency; (15) � A copy of the most current version of the patients� bill of rights under RSA 151:21 and the SRHCF�s policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II; (16) � A copy of the resident�s right to appeal an involuntary transfer or discharge under RSA 151:26, II(a)(5); (17) � The policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169-C:29; (18) � Information on accessing the long-term care ombudsman; and (19) � Information on advance directives. (c) � Residency shall not begin unless the proposed resident, guardian, personal representative, or agent reads and signs a residential services agreement that complies with RSA 161-J. (d) Upon signing of the agreement, the SRHCF shall give the resident and guardian, personal representative, or agent a copy of the agreement and place a copy in the resident's file. (e) � The SRHCF shall assess each resident�s needs using the �Care Assessment for Residential Services (CARES) Tool� (August 2025) which shall: (1) � Be completed no more than 30 days prior to admission to the SRHCF; (2) � Be completed in consultation with the resident, guardian, personal representative, or agent; � (3) � Be repeated every 6 months or after any significant change as defined in He-P 805.03(co); (4) � Be signed and dated by the individual who completed the CARES tool; and (5) � Be signed by the resident, guardian, personal representative, or agent, acknowledging that the CARES tool was completed as directed in (2) above. (f) � All personnel who administer the CARES tool shall be trained to complete the CARES tool by the department or entities listed in RSA 151:5-a, III. (g) � If the guardian, personal representative, or agent, is unable to sign the CARES tool, the facility shall have documented evidence that the guardian, personal representative, or agent has had an opportunity to take part in completing and reviewing the completed CARES tool. (h) � If the CARES tool identifies the need for a nursing assessment, the nursing assessment shall be completed within 72 hours of the completion of the CARES tool. (i) � If the nursing assessment identified in (h) above identifies the need for a care plan it shall be: (1) � Completed within 24 hours of the nursing assessment; (2) � Made available to personnel who assist residents; (3) � Be completed in consultation with the resident and guardian, personal representative, or agent; and (4) � If the resident and guardian, personal representative, or agent are unable or unwilling to participate as required by (3) above, it shall be documented in the resident record. (j) � The care plan identified in (i) above shall include on an ongoing basis: (1) � The date the problem or need was identified; (2) � A description of the problem or need; (3) � The goal or objective of the plan; (4) � The action or approach to be taken; (5) � The responsible person(s) or position; and (6) � The date of reevaluation, review, or resolution. (k) � All care plans shall be reviewed at least every 6 months to determine if: (1) � The care plan will be continued for another 6 months; (2) � The care plan will be revised to meet the needs of the resident; or (3) � The care plan will be discontinued because the plan is no longer needed. (l) � Progress notes shall be written at least every 90 days and include, at a minimum: (1) � Care plan outcomes if a care plan was developed as identified by the CARES tool; (2) � The resident�s physical, functional, and mental abilities; (3) � Changes in behavior, such as eating habits, sleeping pattern, and relationships; and (4) � A summary of visits to licensed practitioners and referrals. (m) � At the time of a resident�s admission, the licensee shall obtain written and signed orders from a licensed practitioner for medications, treatment, special diet, and code status. (n) � The licensee shall have each resident obtain a health assessment by a licensed practitioner within 30 days prior to admission to the SRHCF. (o) � The health assessment referenced in (n) above shall include: (1) � Diagnoses, if any; (2) � The medical history; (3) � A list of current medications including over-the-counter medications, treatments, and special diets, if applicable; (4) � Allergies; and (5) � Code status. (p) � Each resident shall have at least one health assessment annually, unless the licensed practitioner determines annually that a health assessment is not necessary and specifies in writing an alternative time frame, or the resident annually refuses in writing. (q) � A resident may refuse all care and services. (r) � When a resident refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall: (1) � Inform the resident of the potential results of their refusal; (2) � Notify the licensed practitioner and guardian, personal representative, or agent � of the resident�s refusal of care; and (3) � Document in the resident�s record the refusal of care and the resident�s reason for the refusal. (s) � The licensee shall maintain a legible, current, and accurate information data sheet in the resident�s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility which includes the following: (1) � Full name and the name the resident prefers, if different; (2) Name, address, and telephone number of the resident�s next of kin, guardian, personal representative, or agent; (3) � Diagnosis; (4) � Medications, including last dose taken and when the next dose is due; (5) � Allergies; (6) � Functional and cognitive limitations; (7) � Date of birth; (8) � Insurance information; (9) � Advance directives, if any; (10) Code status; and (11) � Any other pertinent information not specified in (1)-(10) above. (t) � The licensee shall only perform point of care testing (POCT), that is waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the state of New Hampshire as a laboratory under He-P 808. (u) � If CLIA-waived laboratory testing is performed by personnel, the licensee shall: (1) � Obtain the appropriate CLIA certificate pursuant to 42 CFR Part 493.15; and (2) �� Develop and implement a point of care testing policy which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel. (v) � The licensee shall have current copies of manufacturer�s instructions and package inserts and shall follow all manufacturer�s instructions and recommendations for the use of POCT meters and devices to include, but not limited to: (1) � Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits; (2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes, reporting results; and (3) � All recommended and required quality control procedures for POCT meters and devices. (w) � Licensee�s performing CLIA-waived laboratory testing or specimen collection shall be in-compliance with He-P 808, He-P 817, and 42 CFR 493, as applicable. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.17 � Medication Services . (a) � All medications shall be made available and administered in accordance with the written and signed orders of the licensed practitioner. (b) � All medications and treatments shall be reviewed, re-ordered, and signed by a licensed practitioner on an annual basis. (c) � All personnel shall follow the written and signed orders of the licensed practitioner for each resident. (d) � Medications, treatments, and diets ordered by the licensed practitioner or other professional with prescriptive powers shall be available to give to the resident within 24 hours or when available as in accordance with the licensed practitioner�s written direction. (e) � The licensee shall have a written policy and system in place instructing how to: (1) � Obtain any medication ordered for immediate use at the SRHCF; (2) � Reorder medications for use at the SRHCF; (3) � Handle unavailable medications at dispensing pharmacy; (4) � Receive, record, and reconcile new medication orders; and (5) � Administer or assist with the administration of medications. (f) � Each medication order shall legibly display the following information: (1) � The resident�s name: (2) � The medication name, strength, prescribed dose, and route of administration; (3) � The frequency of administration; (4) � The indications for use and any special precautions or limitations for use of all medications to include the maximum allowed dose in a 24-hour period, for all pro re nata (PRN) medications; and (5) � The order from the licensed practitioner. (g) � Each prescription medication container shall legibly display the following information unless it is an emergency medication as allowed by (y) below: (1) � The resident�s name; (2) � The medication name, strength, the prescribed dose, and route of administration; (3) � The frequency of administration; (4) � The indications for usage of all pro re nata (PRN) medications; (5) � The date ordered; (6) � The name of the prescribing practitioner; and (7) � The expiration date of the medication(s). (h) � The dosage, frequency, and route of administration on the labels of all prescription medications for each resident shall be identical to the dosage, frequency, and route on the SRHCF medication record except as allowed by (i) below. (i) � The change in the dose of a medication, or the discontinuation of a medication, shall be authorized in writing by a licensed practitioner and the medication record for a change or discontinuance shall indicate in writing the date the dose changed or the discontinuance occurred. (j) � Only a pharmacist shall make changes to prescription medication container labels except as allowed by (k) below. (k) � When the licensed practitioner or other professional with prescriptive powers changes the dose and personnel are unable to obtain a new prescription label, the original container shall be clearly marked without obstructing the pharmacy label to indicate a change in the medication order. (l) � Only a licensed nurse shall accept telephone orders for medications, treatments, and diets, and the licensed nurse shall immediately transcribe and sign the telephone order. (m) � The transcribed order referenced in (l) above shall be counter-signed by the authorized prescriber within 30 days of receipt. (n) � No medications shall be given to or taken by a resident until a written order is received, except as allowed by (m) above. (o) � The medication storage area for medications not stored in the resident�s room shall be: (1) � Locked and accessible only to authorized personnel; (2) � Clean and organized with adequate lighting to ensure correct identification of each resident's medication(s); and (3) � Equipped to maintain medication at the proper temperature. (p) � All medications, including over the counter medications, shall remain in the original containers except as authorized by (ab)(5) below. (q) � Topical liquids, ointments, patches, creams, or powder forms of products shall be stored in such a manner that cross contamination with oral, optic, ophthalmic, and parenteral products shall not occur. (r) � If controlled drugs, as defined by RSA 318-B, are stored in a central storage area in the facility, they shall be kept in a separately locked compartment within the locked medication storage area accessible only to authorized personnel. (s) � The licensee shall develop and implement written policies and procedures regarding a system for maintaining counts of controlled drugs. (t) � Except as required by (u) below, any contaminated, expired, or discontinued medication shall be destroyed within 30 days of the expiration date, the end date of a licensed practitioner�s orders, or the medication becomes contaminated, whichever occurs first. (u) � Destruction of contaminated, expired, or discontinued controlled drugs shall: (1) � Be in accordance with acceptable standards of practice; (2) � Be accomplished in the presence of at least 2 people who shall sign, date, and record the amount destroyed; and (3) � Be documented in the record of the resident for whom the drug was prescribed. (v) � When a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken, the medication container shall be given to the resident if the resident is capable of self-administering without assistance, as described in (ab) below. (w) � If a resident is going to be absent from the SRHCF at the time medication is scheduled to be taken and the resident is not capable of self-administering, the medication container shall be given to the person responsible for the resident while the resident is away from the SRHCF. (x) � Upon discharge or transfer, the licensee shall make the resident�s current medications available to the resident, personal representative, guardian, or agent, and upon death of a resident, the SRHCF shall return or destroy all remaining medications, as appropriate, and document it in the resident record. (y) � A written order from a licensed practitioner shall be required annually for any resident who is authorized to carry emergency medications, including but not limited to nitroglycerine and inhalers. (z) � Residents shall receive their medications by one of the following methods: (1) � Self-administered without assistance as allowed by (ab) below; (2) � Self-directed administration of medication as allowed by (ac) below; (3) � Self-administered with assistance as allowed by (ad) below; or (4) � Administered by individuals authorized by law. ��������� (aa) � If a nurse delegates care, including the task of medication administration, to an individual not licensed to administer medications, the nurse and delegate shall comply with the rules of medication delegation pursuant to Nur 404, as applicable, and RSA 326-B. (ab) � For residents who self-administer without assistance as defined in He-P 805.03(cj) the licensee shall: (1) � Obtain a written order from a licensed practitioner on an annual basis: a. � Authorizing the resident to self-administer medications without assistance; and b. � Authorizing the resident to store the medications in their room; (2) � Evaluate the resident initially and then on a 6 month basis or sooner if the resident experiences a significant change, to ensure they maintain the physical and mental ability to self-administer without assistance; (3) � Have the resident store the medication(s) in their room by keeping them in a locked drawer or container to safeguard against unauthorized access and making sure that this arrangement will maintain the medications at proper temperatures; (4) � Have a copy of the key to access the locked medication storage area in the resident�s room; and (5) � Allow the resident to fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist. (ac) � The licensee shall allow the resident to self-direct administration of medications as defined in He-P 805.03(ck) if the resident: (1) � Has a physical limitation due to a diagnosis that prevents them from self-administration; (2) � Receives evaluations every 6 months or sooner, based on a significant change in the resident, to ensure the resident maintains the physical and mental ability to self-direct administration of medications; (3) � Obtains an annual written verification of their physical limitation and self-directing capabilities from their licensed practitioner and requests the SRHCF to file the verification in their resident record; and (4) � Verbally directs personnel to: a. � Assist them with preparing the correct dose of medication by pouring, applying, crushing, mixing, or cutting; b. � Assist the resident to apply, ingest, or instill the ordered dose of medication; and c. � Fill and utilize a medication system that does not require that medication remain in the container as dispensed by the pharmacist. (ad) � If a resident self-administers medication with assistance, as defined in He-P 805.03(ci), personnel shall only: (1) � Remind the resident to take the correct dose of their medication at the correct time; (2) � Place the medication container within reach of the resident and open the container, if requested by the resident; (3) � Remain with the resident to observe the resident taking the appropriate amount and type of medication as ordered by the licensed practitioner; (4) � Record on the resident's daily medication record that they have observed the resident taking their medication; (5) � Document in the resident�s record any observed or reported side effects, adverse reactions, and refusal to take medications and or medications not taken; and (6) � Personnel shall not physically handle the medication in any manner. (ae) � Except for those residents who self-administer medication without assistance, the licensee shall maintain a daily medication administration record for each medication taken by the resident at the SRHCF that contains the following information: (1) � Any allergies or allergic reactions to medications; (2) � The medication name, strength, dose, frequency, and route of administration; (3) � The date and the time the medication was taken; (4) � The signature, identifiable initials, and job title of the person who administers, supervises, or assists the resident taking medication; (5) � For PRN medications, the reason the resident required the medication and the effect of the PRN medication within 4 hours of consumption; (6) � Documented reason for any medication refusal or omission; and (7) � Any observed or reported side effects and adverse drug reactions. (af) � Unlicensed staff who assist a resident with self administration with assistance, self directed administration, or administration medication via nurse delegation shall complete a medication assistance education program described in (ag) below. (ag) � The medication assistance education program required by (af) above shall be taught by a licensed nurse or practitioner and include: (1) Four hours of initial instruction; (2) � Two hours of annual continuing education; (3) � The rights of medication administration to include: a. � Right patient; b. � Right drug; c. � Right dosage; d. � Right route; e. � Right time; and f. � Right documentation; (4) � Infection control specific to medication administration and proper hand washing techniques; (5) � Documentation requirements; (6) � General categories of medications; (7) � Desired effects and potential side effects of medications; (8) � Medication precautions and interactions; (9) � Both prescription and non-prescription medications; (10) � Methods of medication administration to include demonstrations; (11) � Common abbreviations; (12) � PRN protocols; and (13) � Final exam. (ah) � The licensee shall: (1) Accept documentation of training required by (ag) above, if previously completed by an individual; and (2) Maintain initial and annual certificates of the medication assistance education in the personnel file. (ai) � The SRHCF shall use emergency drug kits only under circumstances where the SRHCF: (1) � Has a director of nursing who is an RN licensed in accordance with RSA 326-B; and (2) � Has a contractual agreement with a consultant pharmacist who is licensed in accordance with RSA 318. (aj) � The licensee shall document in the resident record and report any observed adverse drug reactions and side effects to the licensed practitioner and the guardian, personal representative, or agent. (ak) � The licensee shall document in the resident record and report any medication errors that cause adverse reactions that require medical intervention to the licensed practitioner and the guardian, personal representative, or agent. (al) � The licensee shall report to the department any medication error that requires medical intervention as required by He-P 805.14(k). (am) � The written documentation of the reports in (aj) and (ak) above shall be maintained in the resident�s record. (an) � No medication, whether prescription medication or over-the-counter medication, shall be borrowed from another resident. ��������� (ao) � Medications shall be prepared immediately prior to assisting, supervising, or administering. (ap) � Over-the-counter medications that are not labeled for a specific resident, including but not limited to pharmaceutical samples and �house stock� medications, may be kept at the SRHCF provided that these medications are only dispensed to a resident with a signed order from an authorized licensed practitioner specifying that the resident may take the medication according to the instructions of the manufacturer, or specifying the dosage, frequency, and route. (aq) � The department shall order a SRHCF to obtain the routine services of a consultant pharmacist for 12 months if areas of noncompliance regarding medications, which the department determines present a potential risk to residents health, are found during any inspection or investigation. (ar) � The licensee shall develop and implement policies and procedures for each medication administration method. (as) � The therapeutic use of cannabis by residents who are qualifying residents possessing a registry identification card shall be permitted provided: (1) � The facility designates itself as a facility caregiver as allowed by RSA 126-X:2, XVI; or (2) � The facility permits a resident to possess and use cannabis at the licensed premises, the resident is able to self-administer medication without assistance, and the cannabis remains in the possession of the resident. (at) � The facility that permits the therapeutic use of cannabis in accordance with (as) above shall develop, maintain, and implement a general policy relative to resident use of cannabis at the licensed premises, including storage, security, and administration. � (au) � The facility that designates itself as a facility caregiver according to (as)(1) above shall: (1) Have a resident-specific policy relative to the therapeutic use of cannabis that identifies how the cannabis will be obtained, stored, and administered to the resident; and (2) Treat cannabis in a manner similar to medications with respect to its storage and security when assisting qualifying residents with the therapeutic use of cannabis. � (av) � The SRHCF shall not permit the smoking of cannabis if smoking is not allowed on the SRHCF premises. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.18 � Personnel . (a) � For all applicants considered for employment, for all volunteers, for all independent contractors who will provide direct care or personal care services to residents or who will be unaccompanied by an employee while performing non-direct care or non-personal care services within the facility , and for all household members, the licensee shall: (1) � Obtain and review a criminal records check in accordance with RSA 151:2-d, which shall include criminal history from the state of New Hampshire; (2) � Review the results of the criminal records check in accordance with (b) below; and (3) � Verify the qualifications prior to employment. (b) � Unless a waiver is granted in accordance with (c) below, the licensee shall not offer employment contract with, or engage a person for any position or allow a household member to continue to reside in the residence if the individual: (1) � Has been convicted of a felony in this or any other state; (2) � Has been convicted of a sexual assault, other violent crime, assault, fraud, abuse, theft, neglect, or exploitation in this or any other state; (3) � Has a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person; or (4) � Otherwise poses a threat to the health, safety, or well-being of the residents. (c) � If the information identified in (b) above regarding any person in (a) above is learned after the person is hired, contracted with, or engaged, or after the person becomes a household member, the licensee shall immediately notify the department and either: (1) � Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or (2) � Request a waiver of (b) above. (d) � If a waiver of (b) above is requested, the department shall review the information and the underlying circumstances in (b) above and shall either: (1) � Notify the licensee that the person cannot or can no longer be employed, contracted with, or engaged by the licensee, or the person cannot or can no longer reside in the facility if, after investigation, it determines that the person poses a threat to the health, safety, or well-being of a resident(s); or (2) � Grant a waiver of (b) above if, reviewing the underlying circumstances, it determines that the person does not pose a current threat to the health, safety, or well-being of a resident(s). (e) � Upon hire and annually thereafter, the licensee shall check the names of the persons in (a) above against the bureau of adults and aging services (BAAS) state registry maintained pursuant to RSA 161-F:49 prior to employing and continuing to employ, contracting with, or engaging them, or prior to allowing or continuing to allow a household member to reside at the residence. (f) � The licensee shall not employ, contract with, engage, or allow to reside in the facility any person in (a) above who is listed on the BAAS state registry unless a waiver is granted by BAAS. (g) � If any person in (a) above is listed on the BAAS state registry, and it is learned after the person is hired, contracted with, engaged with, or after the person becomes a household member, the licensee shall immediately notify the department and either: (1) � Cease employing, contracting with, or engaging the person, or not permit the household member to continue to reside in the residence; or (2) � Request a waiver from BAAS of (f) above. ������� (h) � In lieu of (a) and (e) above, the licensee may accept a signed statement from independent agencies contracted by the licensee or by an individual resident to provide direct care or personal care services, that the agency�s employees have complied with (a) and (e) above and do not meet the criteria in (b) and (f) above. (i) � For an SRHCF licensed for 17 or more beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience: (1) � A bachelor�s degree from an accredited institution and 2 years of relevant experience working in a health care setting; (2) � A New Hampshire license as an RN, with at least 2 years of relevant experience working in a health care setting; (3) � An associate�s degree from an accredited institution plus 4 years of relevant experience working in a health care setting; or (4) � A New Hampshire license as an LPN, with at least 4 years of relevant experience working in a health care setting. (j) � For an SRHCF licensed for 16 or fewer beds, all administrators shall be at least 21 years of age and have one of the following combinations of education and experience: (1) � A bachelor�s degree from an accredited institution and one year of relevant experience working in a health care setting; (2) � A New Hampshire license as an RN, with at least one year of relevant experience working in a health care setting; (3) � An associate�s degree from an accredited institution plus 2 years of relevant experience working in a health care setting; (4) � A New Hampshire license as an LPN, with at least 2 years of relevant experience working in a health care setting; or (5) � Be a high school graduate or have a GED with 6 years of relevant experience working in a health care setting with at least 2 of those years as direct care personnel in a long-term care setting within the last 5 years. (k) � All administrators shall obtain and document in accordance with (v)(7) and (8) below, 12 hours of continuing education related to the operation and services of the SRHCF each annual licensing period. (l) � All direct care personnel shall be at least 18 years of age unless they are: (1) � A licensed nursing assistant working under the supervision of a nurse in accordance with Nur 700; or (2) � Involved in an established educational program working under the supervision of a nurse. (m) � The licensee shall inform personnel of the line of authority at the SRHCF. (n) � The licensee shall educate personnel about the needs and services required by the residents under their care. (o) � Prior to having direct care contact with residents, personnel, including volunteers and independent contractors, shall: (1) � Submit to the licensee the results of a physical examination or a health screening performed by a licensed nurse or a licensed practitioner and the results of a 2-step tuberculosis (TB) test, Mantoux method, or other method approved by the Centers for Disease Control, both conducted not more than 12 months prior to employment, contract, or engagement; (2) � Be allowed to work while waiting for the results of the second step of the TB test when the results of the first step are negative for TB; (3) � Comply with the requirements of the Centers for Disease Control and Prevention �Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings� (2005 edition), available as noted in Appendix A, if the person has either a positive TB test, or has had direct contact or potential for occupational exposure to M. tuberculosis through shared air space with persons with infectious tuberculosis; and (4 ) � In lieu of (1) above, independent agencies contracted by the SRHCF or by an individual resident, to provide direct care or personal care services, may provide the licensee with a signed statement that their employees have complied with (1) and (3) above before working at the SRHCF. (p) � Prior to having contact with residents or food, all personnel shall receive a tour of and orientation to the facility that includes the following: (1) � The residents� rights in accordance with RSA 151:21; (2) � The licensee�s complaint procedures; (3) � The duties and responsibilities of the position; (4) � The medical emergency procedures; (5) � The emergency and evacuation procedures; (6) � The infection control procedures as required by He-P 805.22; (7) � The procedures for food safety for personnel involved in preparation, serving, and storing of food; (8) � The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29; (9) � The licensee�s policies and procedures specific to the duties and responsibilities of the staff position; and (10) Policies and procedures for medication administration for personnel involved with supervision, assistance, or administration of medications. (q) � The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following: (1) � The licensee�s resident�s rights and complaint procedures required under RSA 151; (2) � The licensee�s infection control program; (3) � The licensee�s written emergency plan; (4) � The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29; (5) � Policies and procedures for medication administration for personnel involved with supervision, assistance, or administration of medications; (6) � Procedures for food safety for personnel involved in preparation, serving, and storing of food; and (7) The licensee�s policies and procedures specific to the duties and responsibilities of the staff position. (r) � The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49. (s) � The training required in (r) above shall include new information on best practices in the treatment and care of persons with dementia and be provided for: (1) � A minimum of 6 hours for initial training to covered administrative staff members and covered direct service staff members within the first 90 days of hire; and (2) � A minimum of 4 hours of continuing training each calendar year. �������� (t) � Pursuant to RSA 151:52, I(e) licensee�s seeking extensions for compliance with any specific provision of RSA 151:48, RSA 151:49, or RSA 151:50 shall submit a written request to the commissioner that includes: (1) � A full explanation of why an extension is necessary; (2) � A reasonable explanation of why the extension should be granted; (3) � The period of time for which the extension is sought; and (4) � What good faith efforts, as verified by documentation or other means, the licensee has made to comply with the requirements of RSA 151:50 but has been unable to do so. (u) � A request for extension for compliance with RSA 151:50 shall be granted if the commissioner determines that the alternative proposed does not negatively impact the health, safety, or well-being of the residents. (v) � The SRHCF shall maintain a separate employee file for each employee, which shall include the following: (1) � A completed application for employment or a resume; (2) � Proof that the individual meets the minimum age requirements; (3) � A statement signed by each individual that they have received a copy of and received training on the implementation of the licensee�s policy setting forth the residents rights and responsibilities as required by RSA 151:21; (4) � A copy of the results of the criminal record check and BAAS state registry check; (5) � A job description signed by the individual that identifies the: a. � Position title; b. � Qualifications and experience; and c. � Duties required by the position; (6) � Record of satisfactory completion of the orientation program required by (p) above; (7) � Information as to the general content and length of all in-service or educational programs attended; (8) � Record of satisfactory completion of all required education programs and demonstrated competencies that is signed and dated by the employee; (9) � Documentation that the required physical examinations, health screenings, TB test results, and radiology reports of chest x-rays, if required, have been completed by the appropriate health professionals; and (10) � The statement required by (w) below. (w) � All personnel shall sign a non-conviction attestation at the time the initial offer of employment is made and then annually thereafter stating that they: (1) � Do not have a felony conviction in this or any other state; (2) � Have not been convicted of a sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a resident in this or any other state; or (3) � Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person. (x) � The licensee shall protect and store in a secure and confidential manner all records described in (v) above. Personnel records shall be retained for 4 years after termination. (y) � The licensee shall provide to its consenting employees annual immunizations against influenza in accordance with RSA 151:9-b. (z) � If the facility uses an electronic record storage system, it shall provide computer access to all personnel records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 805 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed. (aa) � All personnel electronic records shall have security provisions to ensure confidentiality. (ab) � Personnel shall not be impaired while on the job by any substances including, but not limited to, legally prescribed medication, cannabis, or alcohol. (ac) � The licensee shall have a written policy, as described in RSA 151:41, establishing procedures for the prevention, detection, and resolution of substance abuse, misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team and include: (1) � Education; (2) � Procedures for monitoring the distribution and storage of controlled substances; (3) � Voluntary self-referral by employees who are addicted; (4) � Co-worker reporting procedures; (5) � Drug testing procedures to include, at a minimum, testing where reasonable suspicion exists; (6) � Employee assistance procedures; (7) � Confidentiality; (8) � Investigation, reporting, and resolution of controlled drug misuse or diversion as required per He-P 805.14(k); and (9) The consequences for violation of the controlled substance abuse, misuse, and diversion prevention policy. ������� (ad) � The licensee shall maintain records, but not necessarily a separate file, for all volunteers and for all independent contractors who provide direct care or personal care services to residents that includes: (1) � A signed and dated job description; (2) � A record of satisfactory completion of the orientation program; (3) � Documentation that the required physical examination, or health screening, and TB test have been completed; (4) � A statement, which shall be signed at the time the initial contract or engagement is made, and then annually thereafter, stating that they: a. � Do not have a felony conviction in this or any other state; b. � Have not been convicted of a sexual assault, other violent crime, assault, fraud, theft, abuse, neglect, or exploitation, or pose a threat to the health, safety, or well-being of a resident in this or any other state; and c. � Have not had a finding by the department or any administrative agency in this or any other state for assault, fraud, theft, abuse, neglect, or exploitation of any person in this or any other state; (5) � A copy of the criminal records check; (6) � A copy of the BAAS � state registry check; and (7) � A waiver as required per (b) above, if applicable. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.19 � Resident Records . (a) � The licensee shall maintain a legible, current, and accurate record for each resident based on services provided at the SRHCF. (b) � At a minimum, resident records shall contain the following: (1 � A copy of the resident�s residential service agreement and standard disclosure agreement, and all documents required by He-P 805.16(b); (2) � Notwithstanding (1) above, financial records may be kept in a separate file; (3) � Identification data, including: a. � The resident�s name, date of birth, and marital status; b. � If the resident is receiving respite care as described in He-P 805.20, the resident�s home address and phone number; c. � The resident�s religious preference, if known; d. � The resident�s veteran status, if known; and e. � The name, address, and telephone number of an emergency contact person; (4) � The name and telephone number of the resident�s licensed practitioner(s); (5) � If services are provided at the SRHCF by individuals not employed by the licensee, documentation that includes the name of the agency or individual providing the services, the date services were provided, a brief summary of the services provided, the business address, and telephone number; (6) � The resident�s health insurance information; (7) � Copies of any executed legal orders and directives, such as guardianship orders, surrogacy orders, a durable power of attorney for healthcare, or a living will; (8) � A record of the health assessment in accordance with He-P 805.16(n) and (o); (9) � Written, dated, and signed orders for all medications, treatments, and therapeutic diets; (10) � Results of any laboratory tests, X-rays, or consultations performed at the SRHCF; (11) � All admission and progress notes; (12) � Documentation of any alteration in the resident�s daily functioning such as: a. � Signs and symptoms of illness; and b. � Any action that was taken including licensed practitioner and family notification; (13) � Documentation of medical, nursing, or other specialized care, if applicable; (14) � Documentation of reportable incidents; (15) The consent for release of information signed by the resident, guardian, personal representative, or agent; (16) � Discharge planning and referrals; (17) � Transfer or discharge documentation, including notification to the resident, guardian, personal representative, or agent, and ombudsman of involuntary room change, transfer, or discharge; (18) � The medication record as required by He-P 805.17(ac)(3), (ad)(4), and (ae); (19) � Information data sheet, which contains the information required by He-P 805.16(g)(5); (20) � Documentation of nurse delegation as required by He-P 805.17(af); (21 ) � Documentation of any accident or injuries occurring while in the care of the SRHCF and requiring medical attention by a licensed practitioner; and (22) � Documentation of a resident�s refusal of any care or services. (c ) � The licensee shall document evidence of immunization against influenza and pneumococcal disease for all consenting residents, to include: (1) � That immunizations shall be provided and reported in accordance with RSA 151:9-b, I-V; and (2) � The SRHCF shall have a plan that identifies and documents, with dates, all residents that have received or declined to receive immunizations, to be included in the resident record in (b) above. (d) � Resident records and resident information shall be kept confidential and only provided in accordance with law. (e) � The licensee shall develop and implement a written policy and procedure document that specifies the method by which release of information from a resident�s record shall occur. (f) � When not being used by authorized personnel, resident records shall be safeguarded against loss or unauthorized use or access. (g) � Records shall be retained for 4 years after discharge, except that when the resident is a minor, records shall be retained until the person reaches the age of 19, but no less than 4 years after discharge. (h) � The licensee shall arrange for storage of, and access to, resident records as required by (g) above in the event the SRHCF ceases operation. (i) � If the facility uses an electronic record storage system, it shall provide computer access to all resident records for the purpose of verifying compliance with all provisions of RSA 151 and He-P 805 for the onsite inspection. Access shall include assistance navigating the database and printing portions of the record, if needed. (j) � All resident electronic records shall have security provisions to ensure confidentiality. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.20 � Respite Care. (a) � The licensee shall only admit an individual for respite care services when the needs of the individual are compatible with the services and programs offered by the facility and the facility can meet the needs of the individual in accordance with He-P 805.14(e)(3). (b) � When a temporary admission to an SRHCF occurs and the individual is scheduled for a stay of no more than 30 consecutive days as agreed upon by the individual and the licensee as part of a discharge plan, the licensee shall: (1) � Obtain written verification signed by the resident, guardian, personal representative, or agent, indicating they have been given a copy of the resident rights and responsibilities as required by RSA 151:21; (2) � Obtain a signed residential service agreement listing the services that shall be provided; (3) � Obtain information regarding allergies, diagnoses, if any, and written and signed orders for medications, treatments, and special diets from the licensed practitioner; (4) � Be permitted to use the prescription label on the medication container supplied by the individual as the licensed practitioner�s order provided that: a. � The medication is in the original bottle as dispensed by the pharmacy; b. � The pharmacy label has not been altered in any manner; and c. � The prescription label indicates that the medication is still current; (5) � Complete the CARES tool prior to admission to determine that the potential residents� needs can be met by the facility; (6) � Note in the resident�s record any allergies, diagnoses, and history of wandering or unexplained absences; and (7) � Obtain advance directives information, if available. (c) � For planned recurrent respite care the resident shall be discharged but may be readmitted using the same admission documents completed within the previous 6 months, as long as there are no identified changes in the resident�s condition or care needs except that the medication requirement in (b)(3) above shall be re-verified. (d) � If the resident exceeds the 30-day time period, the resident shall no longer be considered to be receiving respite care and: (1) � A complete admission shall occur within 72 hours; or (2) � The resident shall be discharged from the facility. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.21 � Food Services . (a) � The licensee shall provide food services that: (1) � Meet the U.S. Department of Agriculture�s recommended dietary allowance as specified in the United States Department of Agriculture�s �Dietary Guidelines for Americans 2020-2025� (Ninth Edition), available as noted in Appendix A; (2) � Provide the nutritional needs of each resident; and (3) � Meet the special dietary needs associated with health or medical conditions for each resident as identified on the CARES tool. (b) � Each resident shall be offered at least 3 meals in each 24-hour period when the resident is in the licensed premises unless contraindicated by the resident�s care plan. (c) � Snacks shall be available and offered between meals and at bedtime if not contraindicated by the resident�s care plan. (d) � If a resident refuses the item(s) on the menu, a substitute shall be offered. (e) � Each day�s menu shall be posted in a place accessible to food service personnel and residents. (f) � A dated record of menus as served shall be maintained for at least the previous 4 weeks. (g) � The licensee shall provide therapeutic diets to residents only as ordered by a licensed practitioner or other professional with prescriptive authority. (h) � If a resident has a pattern of refusing to follow a prescribed diet, personnel shall document the reason for the refusal in the resident�s medical record and notify the resident�s licensed practitioner. (i) � All food and drink provided to the residents shall be: (1) � Safe for human consumption and free of spoilage or other contamination; (2) � Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including but not limited to those set forth in He-P 2300 and Chapter 3, entitled �Food�, of the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administrations� �Food Code� (2017 Edition), available as noted in Appendix A; (3) � Served at the proper temperatures; (4) � Labeled, dated, and stored at proper temperatures; (5) � Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination; and (6) � Stored in labeled and dated containers designed for food storage, if not in the original package. (j) � The use of expired, unlabeled food or canned goods that have damage to their hermetic seal shall be prohibited and such goods shall be immediately discarded. The dates associated with such terms as �sell by�, �use by�, or �best if used by� shall not constitute the expiration date. (k) � All work surfaces shall be non-porous and cleaned and sanitized after each use. (l) � All dishes, utensils, and glassware shall be in good repair, cleaned, and sanitized after each use and properly stored. (m) All food service equipment shall be kept clean and maintained according to manufacturer�s guidelines. (n) � Food service areas shall not be used to empty bedpans or urinals or as access to toilet and utility rooms. (o) � If soiled linen is transported through food service areas, the linen shall be in an impervious container. (p) � Garbage or trash in the kitchen area shall be placed in lined containers with covers which shall remain closed except when in use. (q) � All personnel involved in the preparing and serving of food shall wash their hands and exposed portions of their arms with liquid soap and running water before handling or serving food. (r) � Regularly scheduled training programs including sanitation and safety shall be made available to food service personnel. Information as to the content and length of this training shall be documented and kept in employee records. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805.22 � Infection Control . (a) � The SRHCF shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for the prevention, control, and investigation of infectious and communicable diseases. (b) � The infection control program shall include written procedures for: (1) � Proper hand washing techniques; (2) � The utilization of standard precautions, as specified by the United States Centers for Disease Control and Prevention�s �2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings,� (June 2007), available as noted in Appendix A; (3) � The management of residents with infectious or communicable diseases or illnesses; (4) � The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 103.28 and regulated by Env-Sw 904; and (5) � The reporting of infectious and communicable diseases as required by He-P 301. (c) � The infection control education program shall address at a minimum the: (1) � Causes of infection; (2) � Effects of infections; (3) � Transmission of infections; (4) � Prevention and containment of infections; and (5) � Use of standard precautions. (d) � Personnel infected with a disease or illness transmissible through food, fomites, or droplets, shall not work in food service or provide direct care in any capacity until they are no longer contagious. (e) � Personnel infected with scabies, lice, pediculosis, or any communicable disease shall not provide direct care to residents or work in food services until such time as they are no longer infected. (f) � Pursuant to RSA 141-C:1, personnel with a newly positive tuberculosis test or a diagnosis of suspected active pulmonary or laryngeal tuberculosis shall be excluded from the SRHCF until a diagnosis of tuberculosis is excluded or until the person is receiving tuberculosis treatment and has been determined to be noninfectious by a licensed practitioner. (g) � Personnel with an open wound who work in food service or provide direct care in any capacity shall cover the wound at all times by an impermeable, durable, tight fitting bandage. (h) � If the SRHCF has an incident of an infectious diseases reported in (b)(5) above, the SRHCF shall contact the county, municipality, or state public health nurse as applicable, in which the facility is located and follow the instructions and guidance of the nurse. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 ��������� He-P 805 .23 � Sanitation . (a) � The licensee shall maintain a clean, safe, and sanitary environment, both inside and outside. (b) � The furniture, floors, ceilings, walls, and fixtures shall be clean, sanitary, and in good repair. (c) � A supply of potable water shall be available for human consumption and food preparation. (d) � A supply of hot and cold running water shall be available at all times and precautions, such as temperature regulation, shall be taken to prevent a scalding injury to residents and staff. (e) � Hot water shall be of a high enough temperature to ensure sanitation and food safety when used for laundry and food preparations. (f) � All resident bathing and toileting facilities shall be cleaned and disinfected as often as necessary to prevent illness or contamination. (g) � Cleaning solutions, compounds, and substances considered hazardous or toxic materials, as defined in RSA 147-A:2, VII, shall be distinctly labeled and legibly marked so as to identify the contents and stored in a place, such as a locked closet or cabinet, separate from food, medications, and resident supplies. (h) � Toxic materials shall not be used in a way that contaminates food, equipment, or utensils or in any way other than in full compliance with the manufacturer�s labeling. (i) � Only individuals authorized under RSA 430:33 may apply pesticides, as defined by RSA 430:29, XXVI, in food storage, food preparation, or dining areas. (j) � Solid waste, garbage, and trash shall be stored in a manner to make it inaccessible to insects and rodents, outdoor animals, and facility pets. (k) � In-house trash and garbage receptacles shall be emptied in a timely manner and lined or cleaned and disinfected after emptying or when visibly soiled. ��������� (l) � Trash receptacles in food service areas shall be covered at all times, except during food preparation and subsequent clean-up. (m) � Laundry and laundry rooms shall meet the following requirements: (1) � Laundry and laundry rooms shall be kept separate from kitchen and dining areas; (2) � Clean linen shall be stored in a clean area and shall be separated from soiled linens at all times; (3) � Soiled materials, linens, and clothing shall be transported in a laundry bag, sack, or container and washed in a sanitizing solution used in accordance with the manufacturer's recommendations; and (4) � Soiled linens and clothing, which are considered contaminated with infectious waste under Env-Sw 904 shall be handled as infectious waste. (n) � Laundry rooms and bathrooms shall have non-porous floors. (o) � Sterile or clean supplies shall be stored in dust and moisture-free storage containers. (p) � Any SRHCF that has its own water supply and whose water has been tested and has failed to meet the acceptable levels identified in this section, or as required by the department of environmental services, shall notify the department. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805.24 � Quality Improvement . (a) � The SRHCF shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems. (b) � As part of its quality improvement program, a quality improvement committee shall be established. (c) � The SRHCF shall determine the size and composition of the quality improvement committee based on the size of the facility and the care and services provided. (d) � The quality improvement committee shall: (1) � Determine the information to be monitored; (2) � Determine the frequency with which information will be reviewed; (3) � Determine the indicators that will apply to the information being monitored; (4) � Evaluate the information that is gathered; (5) � Determine the action that is necessary to correct identified problems; (6) � Recommend corrective actions to the SRHCF; and (7) � Evaluate the effectiveness of the corrective actions and determine additional corrective actions as applicable. (e) � The quality improvement committee shall meet at least quarterly. (f) � The quality improvement committee shall generate dated, written minutes after each meeting. (g) Documentation of all quality improvement activities, including minutes of meetings, shall be confidential in accordance with RSA 151:5-c. Source. � #14358, eff 8-28-25, EXPIRES: 8-28-35 He-P 805 .25 � Physical Environment . (a) � The physical environment shall be maintained, inside and outside, so as to provide for the health, safety, well-being, and comfort of resident(s) and personnel, including reasonable accommodations for residents and personnel with disabilities. (b) � The SRHCF shall: (1) � Have all emergency entrances and exits accessible at all times; (2) � Be maintained in good repair and kept free of hazards to personnel and residents, including but not limited to hazards from falls, burns, or electric shocks; (3) � Be free from environmental nuisances, including excessive noise and odors; (4) � Keep all corridors free from obstructions; and (5) � Take reasonable measures to prevent the presence of rodents, insects, and vermin to include but not limited to: a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use; b. Repairing holes and caulking of pipe channels; and c. Extermination by a pesticide applicator licensed or certified under RSA 430. (c) � Equipment providing heat within an SRHCF including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood stove, or pellet stove shall: (1) � Maintain a temperature as follows, except where residents have control of the thermostat in their own room: a. � Be at least 65 degrees Fahrenheit at night; and b. � Be at least 70 degrees Fahrenheit during the day if the resident(s) are present; and (2) � Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years. (d) � Electric heating systems shall be exempt from (c)(2) above. (e) � Portable space heating devices shall be prohibited, unless the following are met: (1) � Such devices are used only in employee areas where personnel are present and awake at all times; and (2) � The heating elements of such devices do not exceed 212 degrees Fahrenheit. (f) � Unvented fuel-fired heaters shall not be used in any SRHCF. (g) � Plumbing shall be sized, installed, and maintained in accordance with the 2021 International Plumbing Code (IPC) as adopted under the state building code, pursuant to RSA 155-A. (h) � Ventilation shall be provided in all enclosed living areas by means of a mechanical ventilation system or one or more screened windows that can be opened. (i) � Each resident bedroom shall have natural lighting provided by at least one operable window with a screen to the outside, which is of a size equivalent to or greater than 8% of the room�s gross square footage. (j) � The number of sinks, toilets, tubs, or showers shall be in a ratio of one for every 6 individuals, unless household members and personnel have separate bathroom facilities not used by residents. (k) � All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water. (l) � All hand-washing facilities shall be provided with hot and cold running water. (m) � In an SRHCF licensed for 16 or fewer residents, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with 2 beds, exclusive of space required for closets, wardrobe, and toilet facilities. (n) � In an SRHCF licensed for 17 or more residents, there shall be at least 100 square feet for each resident in each private-bedroom and at least 80 square feet for each resident in a semi- private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities. (o) � The space requirements in (m) and (n) above shall be exclusive of space required for closets, wardrobes, and bathroom. (p) � Each bedroom shall: (1) � Contain no more than 2 beds; (2) � Have its own separate entry to permit the resident to reach their bedroom without passing through the room of another resident; (3) � Have a side hinge door and not a folding or sliding door or a curtain; (4) � Not be used simultaneously for other purposes; (5) � Be separated from halls, corridors, and other rooms by floor to ceiling walls; (6) � Be located on the same level as the bathroom facilities, if the resident has impaired mobility as identified by the CARES tool; and (7) � If a licensed bedroom is temporarily being utilized for another purpose, it shall retain the capability of being restored to meet the requirements of a licensed bedroom without requiring additional construction or renovation. (q) � The licensee shall provide the following for the residents� use, except as requested by the resident, guardian, personal representative, or agent and documented in the resident�s record: (1) � Clean linens, blankets, and a pillow; (2) � A closet or storage space for personal belongings; and (3) � Window blinds, shades, or curtains that provide privacy. (r) � The resident may use their own personal possessions provided they do not pose a risk to the resident or others as evidenced by documented inspection for fire safety and insect infestation. (s) � The licensee shall provide the following rooms to meet the needs of residents: (1) � One or more living rooms or multi-purpose rooms; and (2) Dining facilities with a seating capacity capable of meeting the needs of all residents. (t) � Each licensee shall have an underwriters laboratories (UL) listed communication system in place so that all residents can effectively contact personnel when they need assistance with care or in an emergency. (u) � Lighting shall be available to allow residents to participate in activities such as reading or handicrafts. (v) � All bathroom, bedroom, and closet doors shall swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency. (w) � Screens shall be provided for doors, windows, and other openings to the outside. (x) � Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (w) above. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.24) ��������� He-P 805.26 � Fire Safety . (a) � The facility shall meet one of the following appropriate chapters and sections of the adopted state fire code and state building code: (1) � Residential board and care occupancies for facilities in which the residents are capable of self-preservation; (2) � Health care occupancy for facilities or portions of a facility in which the residents are not capable of self-preservation; or (3) � If the building is being designed as a mixed-use facility, a portion of residents are capable of self-preservation and another portion the residents are not capable of self-preservation, then the areas shall be appropriately separated into their use groups as defined under the state fire code and state building code. � (b) � The facility shall have: (1) � Smoke detectors on every level and in every bedroom that are interconnected and either hardwired, powered by the SRHCF�s electrical service, or wireless, as approved by the state fire marshal for the facility; (2) � At least one UL listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building, and which meet the following requirements: a. � Maximum travel distance to each extinguisher shall not exceed 50 feet; � b. � Be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days; c. � Records for manual inspection or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed for the most recent 12-month period; d. � Annual maintenance shall be performed on each extinguisher by trained personnel, and each extinguisher shall have a tag or label securely attached that indicates that maintenance was performed; and e. The components of the electronic monitoring device or system shall be tested and maintained annually in accordance with the manufacturer�s listed maintenance manual; and (3) � An approved carbon monoxide monitor on every level. (c) � A written emergency and fire safety program shall be developed and implemented to provide for the safety of residents and personnel. (d) � Immediately following any fire or emergency situation, licensees shall notify the department by phone to be followed by written notification within 72 hours, with the exception of a false alarm or emergency medical services (EMS) transport for a non-emergent reason. (e) � The written notification required by (d) above shall include: (1) � The date and time of the incident; (2) � A description of the location and extent of the incident, including any injury or damage; (3) � A description of events preceding and following the incident; (4) � The name of any personnel or residents who were evacuated as a result of the incident, if applicable; (5) � The name of any personnel or residents who required medical treatment as a result of the incident, if applicable; and (6) � The name of the individual the licensee wishes the department to contact if additional information is required. (f) � If the licensee has chosen to allow smoking, a designated smoking area shall be provided which has, at a minimum: (1) � A dedicated ventilation system, so that smoke or odors cannot escape or be detected outside the designated smoking room; (2) � Walls and furnishings constructed of non-combustible materials; (3) � Metal waste receptacles and safe ashtrays; and (4) � Is in compliance with the requirements of RSA 155:64�77. (g) � A copy of the fire safety plan including fire drill actions shall be made available to and reviewed with the resident, guardian, personal representative, or agent, at the time of admission and a summary of the resident�s responsibilities shall be provided to the resident. Each resident shall receive an individual fire drill walk-through within 5 days of admission, as appropriate. (h) � The fire safety plan shall be reviewed and approved as follows: (1) � A copy of the fire safety plan shall be made available, annually and whenever changes are made, to the local fire chief for review and approval; (2) � The local fire chief shall give written approval initially to all fire safety plans; and (3) � If changes are made to the plan, they shall be submitted to the local fire chief for review and approval, as appropriate, prior to the change. (i) � Fire drills shall be conducted as follows: (1) � For buildings constructed to the Residential Board and Care or One and Two Family Dwelling chapters of the life safety code (NFPA 101), the following shall be required: a. � The administration of every residential board and care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for protecting all persons in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary; b. � Residents shall be trained to assist each other in case of fire or emergency to the extent that their physical and mental abilities permit them to do so, without additional personal risk; c. � All SRHCF facilities shall conduct fire drills not less than 6 times per year on a bimonthly basis, with not less than 2 drills conducted during the night when residents are sleeping. Actual exiting from windows shall not be required, however opening the window and signaling for help shall be an acceptable alternative; d. � The drills shall involve the actual evacuation of all residents to an assembly point, as specified in the emergency plan, and approved by the department and the local fire authority based on construction of the building and shall provide residents with experience in egressing through all exits and means of escape; e. � Facilities shall complete a written record of fire drills that includes the following: 1. � The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used; 2. � The location of exits used; 3. � The number of people, including residents, personnel, and visitors, participating at the time of the drill; 4. � The amount of time taken to completely evacuate the facility; 5. � The name and title of the person conducting the drill; 6. � A list of problems and issues encountered during the drill; 7. � A list of improvements and resolution to the issues encountered during the fire drill; and 8. � The names of all staff members participating in the drill; f. � At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; g. � The fire drills for facilities shall be permitted to be announced, in advance, to the residents just prior to the drill; and h. � Evacuation drills shall include the transmission of a fire alarm signal, and simulation of emergency fire conditions; (2) � For facilities originally constructed to meet the Health Care Occupancy chapter of the life safety code, NFPA 101 or have been physically evaluated, renovated, and approved by a New Hampshire licensed fire protection engineer, the NH state fire marshal�s office, and the department to meet the Health Care Occupancy chapter, the following shall be required: a. � The facility shall develop a fire safety plan, which provides for the following: 1. � Use of alarms; 2. � Transmission of alarms to fire department; 3. � Emergency phone call to fire department; 4. � Response to alarms; 5. � Isolation of fire; 6. � Evacuation of immediate area; 7. Evacuation of smoke compartment; 8. � Preparation of floors and building for evacuation; 9. � Extinguishment of fire; and 10. � Written emergency telephone numbers for key staff, fire and police departments, poison control center, 911, and ambulance service(s); b. � Fire drills shall be conducted quarterly on each shift to familiarize facility personnel including, but not limited to, medical personnel, maintenance engineers, and administrative staff, with the signals and emergency action required under varied conditions; c. � Evacuation drills shall include the transmission of a fire alarm signal and simulation of emergency fire conditions; d. � When drills are conducted between 9:00 p.m. and 6:00 a.m., a coded announcement shall be permitted to be used instead of audible alarms; e. � Buildings that have a shelter in place, also known as defend in place, shall: 1. � Have the plan approved by the department and their local fire official; 2. � Be constructed to meet the Health Care Occupancy chapter of the life safety code; and 3. � Require all personnel, residents, and visitors to evacuate to the identified assembly point during drills to ensure that residents shall be given the experience of evacuating to the appropriate location or exiting through all exists; f. � Facilities shall complete a written record of fire drills and include the following: 1. � The date and time, including AM or PM, the drill was conducted and if the actual fire alarm system was used; 2. � The location of exits used; 3. � The number of people, including residents, personnel, and visitors, participating at the time of the drill; 4. � The amount of time taken to completely evacuate the facility, evacuate to an approved area of refuge, or evacuate through a horizontal exit; 5. � The name and title of the person conducting the drill; 6. � A list of problems and issues encountered during the drill; 7. � A list of improvements and resolution to the issues encountered during the fire drill; 8. � The names of all staff members participating in the drill; and 9. � Written records of the fire drills shall be maintained on site and available to the department during an inspection or investigation conducted in accordance with RSA 151:6 and RSA 151:6-a; and g. � At no time shall a staff member who has not participated in a fire drill be the only staff member on duty within the facility; and (3) � The facility shall conduct a fire drill in the presence of a representative of the department, state fire marshal�s office, or the local fire department upon request. Source. � #8746, eff 10-25-06; ss by #10813, eff 4-21-15; ss by #13333, eff 1-25-22; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.25) ��������� He-P 805.27 � Emergency Preparedness . (a) � Each facility shall have an individual or group, known as an emergency management committee, with the authority for developing, implementing, exercising, and evaluating the emergency management program. (b) � The emergency management committee shall include the facility administrator and others who have knowledge of the facility and the capability to identify resources from key functional areas within the facility and shall solicit applicable external representation, as appropriate. (c) � The emergency management committee shall develop and institute a written emergency preparedness plan to respond to a disaster or an emergency that shall be reviewed and updated at least annually. (d) � The emergency preparedness plan in (c) above shall: (1) � Comply with all relevant federal, state, and local laws, rules, codes, and ordinances, as applicable; (2) � Include site-specific plans for the protection of all persons on-site in the event of fire, natural disaster, severe weather, interruptions of any utility or services to the facility, and human-caused emergencies to include, but not be limited to, missing resident(s), bomb threat, and active shooter; (3) � Be approved by the local emergency management director or local authority having jurisdiction, and reviewed and approved by the local authority having jurisdiction when a change to the plan causes significant material difference; (4) � Be available to all personnel at all times; (5) � Be based on realistic conceptual events; (6) � Develop and implement strategies to prevent an incident that threatens life, property, and the environment of the facility to include measures to be taken to limit or control the consequences, extent, or severity or an incident that cannot be prevented; (7) � Include the facility's response to both short-term and long-term interruptions in the availability of utility service in the disaster or emergency, including establishing contingency plans for continuity of essential building systems or evacuation to include the following, as applicable: a. � Electricity; b. � Potable water; c. � Non-potable water; d. � HVAC; e. � Fire protection systems; f. � Fuel � required for building operations and essential transportation to include fuel loss, fuel spill, and fuel exposure that created a hazardous incident; g. � Medical gas and vacuum systems, if applicable; h. � Communications systems; and i. � Essential services, such as kitchen and laundry services; (8) � Include and maintain a communication plan that includes the following: a. � Names and contact information for the following: 1. � Staff; 2. � Entities providing services under arrangement; 3. � Resident�s licensed practitioner; 4. � Other nearby facilities; and 5. � Volunteers; b. � Contact information for the following: 1. � Federal, state, or local emergency preparedness staff; 2. � The state licensing unit; 3. � The office of the state long-term care ombudsman; and 4. � Other sources of assistance; c. � Primary and alternate means for communication with the facility�s staff and federal, state, or local emergency management agencies; d. � A method for sharing information and medical documentation for the residents under the facility�s care, as necessary, with other health care providers to maintain the continuity of care; and e. � A means of providing information about the facility�s occupancy, needs, and its ability to provide assistance to the authority having jurisdiction; (9) � Include the management of residents, particularly with respect to physical and clinical issues to include: a. � Relocation of residents with their medical record(s) including the medicine administration record(s), as detailed in the emergency plan; b. � Access, as appropriate, to critical materials such as pharmaceuticals, medical supplies, food supplies, linen supplies, and industrial and potable water; and c. � How to provide security during the disaster; (10) � Reflect measures needed to restore operational capability with consideration of fiscal aspects because of restoration costs and possible cash flow losses associated with the disruption; (11) � Plans for the provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, to include, but not be limited to the following: a. � Food, water, medical, and pharmaceutical supplies calculated for the maximum number of staff and residents; b. � Source of water support, either tap or commercial; c. � Expiration dates, tracking of supplies, and rotation of products; d. � Contracts and memorandums of understanding with food and water suppliers; e. � Storage location(s); f. � Back-up supplies; and g. � Alternate sources of emergency power to maintain: 1. � Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions; 2. � Emergency lighting; 3. � Fire detection, extinguishing, and alarm systems; and 4. � Sewage and waste disposal; and (12) � If the facility is located within 10 miles of a nuclear power plant and is part of the New Hampshire radiological emergency response plan (RERP), include the required elements of the RERP. (d) � The facility shall develop and maintain emergency preparedness training for all staff, individuals providing services under arrangement, and volunteers which shall include: (1) � Initial emergency preparedness training upon hire consistent with roles and specific duties and responsibilities during an emergency; (2) � Provide emergency preparedness training at least annually; (3) � Maintain documentation of the training; and (4) � Demonstrate staff knowledge and competency of emergency procedures. (e) � The facility shall conduct and document exercises to test the emergency preparedness plan at least twice per year that includes the following: (1) � Participation in an annual full-scale exercise that is community-based. When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. If the facility experiences and documents an actual natural or man-made emergency that requires the activation of the emergency plan, the facility is exempt from engaging in another full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event; (2) � Conduct an additional annual exercise that may include, but is not limited to, the following: a. � A second full-scale exercise that is community-based or an individual, facility-based functional exercise; b. � A mock disaster drill; or c. � A tabletop exercise or workshop that is led by a facilitator that includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan; and (3) � Analyze the facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the facility's emergency plan, as needed. � Source. � #10813, eff 4-21-15; ss by #14358, eff 8-28-25, EXPIRES: 8-28-35 (formerly He-P 805.26)