He-P 824

Hospice Houses

This New Hampshire regulation (He-P 824) establishes the licensing requirements for Hospice Houses (HH), including application procedures, license issuance and renewal, construction and renovation standards, and organizational change notifications. Operators must submit detailed applications, pass clinical and life safety inspections, and notify the department of ownership, location, service, or personnel changes. The regulation sets definitions and administrative procedures governing all aspects of HH operation under RSA 151.

PART
He-P 824
� 
HOSPICE HOUSE

��������� 
He-P 824.01
� 
Purpose
.
� 
The purpose of this part is to set forth the
licensing requirements for all hospice houses (HH), pursuant to RSA 151.

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.02
� 
Scope
.
�

This part shall apply to any individual, agency, partnership,
corporation, government entity, association, or other legal entity operating a
HH, except:

��������� 
(a)
�

All facilities listed in RSA 151:2, II(a)-(i); and

��������� 
(b)
�

All
 entities which are
owned or operated by the state of New Hampshire, pursuant to RSA 151:2, II(h).

Source.
�

#5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.03
� 
Definitions
.

��������� 
(a)
�

�
Abuse
� means any one of
the following:

(1) 
�
�Emotional abuse� means the misuse of power,
authority, or both, verbal harassment, or unreasonable confinement which
results or could result in the mental anguish or emotional distress of
patients;

(2) 
�
�Physical abuse� means the misuse of physical
force which results or could result in physical injury to patients; and

(3) 
�
�Sexual abuse� means contact or interaction of
a sexual nature involving patients with or without his or her informed consent.

��������� 
(b)
�

�
Activities
 of daily living (ADL)� means
basic daily routine tasks such as eating, transferring, toileting, bathing,
dressing and self-management, monitoring, or supervision of medications.

��������� 

��������� 
(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 a corrective action imposed upon a licensee in response to non-compliance
with RSA 151 or He-P 824.

��������� 
(f)
�

�
Administrator� means the person
responsible for the management of the licensed premises who reports to and is
accountable to the governing body.

��������� 
(g)
�

�
Admission
� means
acceptance by a licensee for the provision of care and services to a patient
and when the patient physically moves into the HH.

��������� 
(h) 
�
�
Advance

directive� means a directive allowing a person to give directions about future
medical care or to designate another person to make medical decisions if he or
she should lose the capacity to make health care decisions. The term �advance
directive� includes living wills and durable powers of attorney for health
care, in accordance with RSA 137-J.

��������� 
(i)
� 
�Affiliated or related 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, captive or affiliated insurance companies. 

��������� 
(j)
�

�
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 identified under RSA 137-J:34-37.

��������� 
(k)
�

�
Applicant
� means an
individual, agency, partnership, corporation, government entity, association,
or other legal entity seeking a license to operate an HH pursuant to RSA 151.

��������� 
(l) 
�
�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 806, or other federal or state requirements.

��������� 
(m)
�

�
Assessment� means a systematic
data collection which enables facility personnel to plan care that allows the
patient to reach his or her highest practicable level of physical, mental, and
psychosocial functioning.

��������� 
(n)
�

�Care plan� means a written guide developed by the licensee or their
personnel, in consultation with the patient, guardian, agent, or personal
representative, if any, as a result of the assessment process for the provision
of care and services. 

��������� 
(o)
�

�Change of ownership� means the transfer of the controlling interest of
an established HH to any individual, agency, partnership, corporation,
government entity, association, or other legal entity.

(p)
� 
�Chemical restraints� 
means a drug or medication that is used as a restriction to manage the
patient�s behavior or restrict the patient�s freedom of movement and is not a
standard treatment or dosage for the patient�s condition. 

��������� 
(q)
�

�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.

��������� 
(r)
�

�Commissioner� means the commissioner of the department of health and
human services or his or her designee.

��������� 
(s) �Contracted employee� means a
temporary employee working under the direct supervision of the HH but employed
by an outside agency.

��������� 
(t)
�

�Coordinator� means a person from the HH who coordinates the care and
services necessary to provide optimum health care management for the patient.

��������� 
(u)
�

�Core services� means those services provided by the licensee that are
included in the facility�s basic rate.

��������� 
(v) 
�
�Critical 
incident

stress management (CISM)� means an adaptive, short-term psychological helping
process that focuses solely on an immediate and identifiable problem.
Individuals undergoing CISM are able to discuss the situation that occurred and
how it effects them and those around them allowing individuals to use this
forum to acquire the tools necessary to hopefully limit post-traumatic stress
related issues in their own lives and recognize it in others.

��������� 
(w)
�

�Days� means calendar days unless otherwise specified in the rule.

��������� 
(x)
�

�Department� means the New Hampshire department of health and human
services.

��������� 
(y)
�

�Direct care� means hands on care or services to a patient, including
but not limited to medical, nursing, psychological, or rehabilitative
treatments.

��������� 
(z)
�

�Direct care personnel� means any person providing hands-on clinical
care or hands-on services to a patient including but not limited to medical,
psychological, or rehabilitative treatments, bathing, transfer assistance,
feeding, dressing, toileting, and grooming.

��������� 
(aa)
�

�Directed plan of correction� means a plan developed and written by the
department that specifies the necessary actions the licensee shall take to
correct identified deficiencies.

��������� 
(ab)
�

�Discharge� means moving a patient from a licensed facility or entity to
a non-licensed facility or entity.

��������� 
(ac)
� 
�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 patient 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)�.

��������� 
(ad) 
�
�Elopement
� means when a
patient who is cognitively, physically, mentally, emotionally, or chemically
impaired or cognitively intact, wanders away, walks away, runs away, escapes,
or otherwise leaves a facility
�

unsupervised or unnoticed without knowledge of the licensee�s personnel.

��������� 
(ae)
� 
�Emergency� means an unexpected occurrence or
set of circumstances, which require immediate, remedial attention.

��������� 
(af)
�

�Emergency plan� means a document outlining the responsibilities of
personnel in an emergency.

��������� 

��������� 
(ag)
�

�Employee� means anyone employed by the HH and for whom the HH has
direct supervisory authority.

��������� 
(ah)
� 
�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 RSA 151 or He-P 824.

��������� 
(ai) 
�
�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�.

��������� 
(aj)
�

�
Exploitation
� means the illegal use of
a patient�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 patient through the use of undue influence,
harassment, duress, deception, or fraud.

��������� 
(ak)
�

�Facility� means �facility� as defined in RSA 151:19, II.

��������� 
(al)
� 
�Governing body� means a group of designated
person(s) functioning as a governing body that appoints the administrator and
is legally responsible for establishing and implementing policies regarding
management and operation of the facility.

��������� 
(am)
�

�Guardian� means a person appointed in accordance with RSA 464-A to make
informed decisions relative to the patient�s health care and other personal
needs.

��������� 
(an)
�

�Health care occupancy� means facilities that provide sleeping
accommodations for individuals who are incapable of self-preservation because
of age, physical or mental disability, or because of security measures not
under the occupant�s control.

��������� 
(ao)
�

�Hospice� means a specialized program of care and supportive services,
which provide a combination of medical, social, and spiritual services to
terminally ill patients and their families.

��������� 
(ap)
�

�Hospice house (HH)� means a residential setting providing a specialized
program of care and supportive services, which provide a combination of
medical, social, and spiritual services to terminally ill patients and their
families.

��������� 
(aq
) 
�
�Incident command system (ICS)� means a
standardized on-scene emergency management system specifically designed to
provide for the adoption of an integrated organizational structure that
reflects the complexity and demands of single or multiple incidents, without
being hindered by jurisdictional boundaries. ICS is the combination of
facilities, equipment, personnel, procedures, and communications operating
within a common organizational structure, designed to aid in the management of
resources during incidents.

��������� 
(ar)
�

�Infectious waste� means those items specified by Env-Sw 103.28. 

��������� 
(as)
�

�In-service� means an educational program, which is designed to increase
the knowledge, skills, and overall effectiveness of personnel.

��������� 
(at)
� 
�Informed consent� means the decision by a
patient, his or her guardian, agent, or 
surrogate decision-maker 
��
to
agree to a proposed course of treatment, after the patient, guardian, agent, or

surrogate decision-maker 
has
received full disclosure of the facts, including information about risks and
benefits of the treatment and available alternatives, needed to make the
decision intelligently.

��������� 
(au)
�

�Inspection� means the process followed by the department to determine
an applicant�s or a licensee�s compliance with RSA 151 and He‑P 824 or to
respond to allegations of non‑compliance with RSA 151 and He-P 824.

��������� 
(av) 
�
�Laboratory� means a facility for the
biological, microbiological, serological, chemical, immunohematological,
hematological, 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 any disease.

��������� 

��������� 
(aw)
�

�
License
� means the document issued to
an applicant or licensee of an HH which authorizes operation in accordance with
RSA 151 and He-P 824, and includes the name of the licensee, the name of the
business, the physical address, the license category, the effective date, and
license number.

��������� 
(ax)
�

�License certificate� means the document issued by the department to an
applicant or licensee that, in addition to the information contained on a
license, includes the name of the administrator, the type(s) of services
authorized, and the number of beds that the HH is licensed for.

��������� 
(ay)
�

�Licensed practitioner� means a:

(1)
� 
Medical doctor;

(2)
� 
Physician�s assistant;

(3)
� 
Advanced practice registered nurse;

(4)
� 
Doctor of osteopathy; or

(5)
� 
Doctor of naturopathic medicine.

��������� 
(az)
�

�Licensed premises� means the building(s) that comprises the physical
location that the department has approved for the licensee to conduct
operations in accordance with its license.

��������� 
(ba)
�

�Licensee� means any person or legal entity to which a license has been
issued pursuant to RSA 151.

��������� 
(bb)
�

�Licensing classification� means the specific category of services
authorized by a license.

��������� 
(bc) 
�
�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.

��������� 
(bd)
�

�Mechanical restraint� means locked, secured, or alarmed HH or units
within an HH, or anklets, bracelets, or similar devices that cause a door to
automatically lock when approached, thereby preventing a patient from freely
exiting the HH or unit within.

��������� 
(be)
�

�Medical director� means a physician licensed in New Hampshire in
accordance with RSA 329, who is responsible for overseeing the quality of
medical care and services within the HH.

��������� 
(bf)
�

�Medication� means a substance available with or without a prescription,
used as a curative or remedial substance.

��������� 
(bg) 
�
�Modification� means the reconfiguration of
any space, the addition, relocation, 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.

��������� 
(bh)
�

�Neglect� means an act or omission, which results, or could result, in
the deprivation of essential services necessary to maintain the mental,
emotional, or physical health and safety of a patient.

��������� 
(bi) 
�
�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 rules or
codes.

��������� 
(bj)
�

�Orders� 
means 
a
document, produced verbally, electronically, or in writing, by a licensed
practitioner for medications, treatments, 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� means any person admitted to or in any way receiving care,
services, or both from a HH licensed in accordance with RSA 151 and He-P 824.

��������� 
(bn) 
�
�Patient record� means documents maintained
for each patient receiving care and services, which includes all documentation
required by RSA 151 and He-P 824 and all documentation compiled relative to the
patient as required by other federal and state requirements.

��������� 
(bo)
�

�Patient rights� means the privileges and responsibilities possessed by
each patient provided by RSA 151:21.

��������� 
(bp)
�

�Personal assistance� means providing or assisting a patient in
obtaining one or more services as determined by their patient assessment.

��������� 
(bq)
�

�Personal representative� means a person designated in accordance with
RSA 151:19, V to assist the patient for a specific, limited purpose, or for the
general purpose of assisting the patient in the exercise of any rights.

��������� 
(br)
�

�Personnel� means an individual, who is employed by, a volunteer of, or
an independent contractor of the HH who provides services to patient(s).

��������� 
(bs)
�

�Physical restraint� means the use of hands-on or other physically
applied technique to physically limit the patient�s freedom of movement, which
includes but are not limited to forced escorts, holding, prone restraints, or
other containment techniques.

��������� 
(bt)
� 
�Physician� means medical doctor or doctor of
osteopathy licensed in the state of New Hampshire pursuant to RSA 329 or a d
octor
of naturopathic medicine licensed in accordance with RSA 328-E
.

��������� 
(bu)
�

�Plan of correction (POC)� 
means
a plan developed and written by the licensee, which specifies the actions that
will be taken to correct identified 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
.

��������� 
(bv)
�

�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 obtain
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.

��������� 
(bw)
�

�Pro re nata (PRN) medication� means medication taken as circumstances
may require in accordance with licensed practitioner�s orders.

��������� 
(bx)
�

�Procedure� means a licensee�s written, standardized method of
performing duties and providing services.

��������� 
(by)
�

�Professional management responsibility� means that the professional
staff of the HH provider continues to provide guidance and services to the
patient regardless of the location of the patient.

��������� 
(bz)
�

�Professional staff� means:

(1)
� 
Physicians;

(2)
� 
Physician assistants;

(3)
� 
Advanced registered nurse practitioners;

(4)
� 
Registered nurses;

(5)
� 
Registered physical therapists;

(6)
� 
Speech therapists;

(7)
� 
Licensed practical nurses;

(8)
� 
Licensed respiratory therapists;

(9)
� 
Occupational therapists;

(10)
� 
Medical social workers;

(11)
� 
Dietitians;

(12)
� 
Spiritual care coordinators;

(13)
� 
Bereavement counselors; and

(14)
� 
Volunteer coordinators.

��������� 
(ca)
�

�Protective care� means the provision of patient monitoring services,
including but not limited to:

(1)
� 
Knowledge of patient whereabouts; and 

(2)
� 
Minimizing the likelihood of accident or
injury.

��������� 
(cb)
� 
�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
.

��������� 
(cc) 
�
�
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.

��������� 
(cd) 
�
�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.

��������� 
(ce) 
�
�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.

��������� 
(cf)
� 
�Reportable incident� means
an occurrence of any of the following while the patient is either in the HH or
in the care of HH personnel:

(1)
� 
The 
unanticipated

death of a patient which is not related to their diagnosis or underlying
condition; 

(2)
� 
An unexplained accident or other circumstance
that is of a suspicious nature of potential abuse or neglect where the injury
was not observed or the cause of the injury could not be explained and has
resulted in an injury that requires treatment in an emergency room by a
licensed practitioner; or

(3)
� 
An 
elopement
 from
the HH or other circumstances that resulted in the notification or involvement
of law enforcement or safety officials.

��������� 
(cg)
�

�Self-administration of medication� means an act whereby the patient
takes his or her own medication(s) without the assistance of another person.

��������� 
(ch)
� 
�Service� means a specific activity performed
by the licensee, either directly or indirectly, to benefit or assist a patient.

��������� 
(ci)
� 
�Significant change� means a decline or
improvement in a patient�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 patient�s health status; and

(3)
� 
Requires

interdisciplinary review or revision of the care plan.

��������� 
(cj)
�

�State Fire Code� means the edition of the Life Safety Code 101 and Fire
Code NFPA 1 adopted and amended by the state board of fire control and ratified
by the general court pursuant to RSA 153:5.

��������� 
(ck)
�

�
State
 Building Code� means the edition
of the International Building Code, the International Existing Building Code,
the International Plumbing Code, the International Mechanical Code, the
International Energy Conservation Code, the International Swimming Pool and Spa
Code, and the International Residential Code, as published by the International
Code Council, and the National Electrical Code adopted and amended by the state
building code review board and ratified by the legislature in accordance with
RSA 155-A:10.

��������� 
(cl)
�

�
State
 monitoring� means the placement
of individuals by the department at an HH to monitor the operation and
conditions of the facility.

��������� 
(cm)
�

�
Temporary
 manager� means a person
appointed by the department to assume responsibility for the day-to-day
operation and administration of an HH.

��������� 
(cn)
�

�Transfer� means moving a patient from one licensed facility or entity
to another licensed facility or entity.

��������� 
(co)
�

�Underwriters Laboratories (UL) Listed� means that the global safety
certification company UL has confirmed that the product is safe for use.

��������� 
(cp) �Volunteer� means an unpaid
person who assists with the provision of care services, 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 or entertainment.

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.04
� 
Initial License Application Requirements
.

��������� 
(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 License or Special Health Care
Service� (February 2023) signed by the 
owner if a
private facility, 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 there under 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 HH;

(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, VII, 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)
� 
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
fire ordinances applicable 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 the
application based on the local official�s review of the building plans and
again upon completion of the construction project;
� 

(6)
� 
If the HH uses a private water supply,
documentation that the water supply has been tested in accordance with RSA 485
and Env-Dw 702.02, Env-Dw 704.02 or, if a public water supply is used, a copy
of a water bill;

(7)
� 
A resume identifying the qualifications of
the HH administrator and medical director;

(8)
� 
Copies of applicable licenses for the HH
administrator and medical director;

(9)
� 
The results of a criminal records check, for
the applicant, licensee if different than the applicant, administrator and
medical director which includes criminal history from the state of New
Hampshire;

(10)
� 
A copy of the criminal attestation as
described in He-P 824.19(k)(7) for the administrator and medical director; and

(11)
� 
The results of a BEAS registry check from the
bureau of elderly and adult services for the administrator and medical
director.

��������� 

��������� 
(b)
�

The applicant shall mail or hand-deliver the documents to:

Department of
Health and Human Services

Health Facilities
Administration

129 Pleasant
Street

Concord, NH 03301

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.05
� 
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 824.04(a) have been
received.

��������� 
(b)
�

If an application does not contain all of the items required by He-P
824.04(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 824.13(b), 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
of 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 patients.

��������� 
(f)
�

Following both a clinical and life safety inspection, 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 824.

��������� 
(g)
�

All licenses issued in accordance with RSA 151 shall be non-transferable
by person or location.

��������� 
(h)
�

A written notification of denial, shall be sent to an applicant applying
for an initial license if it has been determined by the inspection in He-P
824.05(g) and a maximum of 2 follow-up inspections that the prospective
premises are not in full compliance with RSA 151 and He-P 824.

��������� 
(i) A written notification of denial,
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.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.06
� 
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 824.04(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 824.10(f), if applicable.
� 
If such a
request is not received, the rule(s) for which the waiver was previously
requested shall not continue to be waived beyond the expiration of the current
license;

(3)
� 
A request for renewal of any existing
non-permanent waiver previously granted by the department, in accordance with
He-P 824.10(f), if applicable. If such request is not received, the rule(s) for
which the waiver was previously requested shall not continue to be waived
beyond the expiration of the current license;

(4)
� 
A list of current employees who have a
permanent waiver granted in accordance with He-P 824.17(e)(2); and

(5)
� 
A copy of any temporary, new or existing
variances or waivers applied for or granted by the state fire marshal in
accordance with RSA 153:5 and Saf-C 6005.

��������� 
(c)
�

In addition to He-P 824.06(b), 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 for bacteria and Env-Dw 704.02 for
nitrates. 

��������� 
(d)
�

Following an inspection, a license shall be renewed if the department
determines that the licensee:

(1)
� 
Submitted an application containing all the
items required by He-P 824.06(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 824, 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.

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.07
� 
HH Construction, Modifications or
Renovations
.

��������� 
(a)
�

For
 new construction and
for rehabilitation of an existing building, including, but not limited to,
renovations, modifications, reconstruction, and additions, construction
documents and shop drawings, including stamped architectural, sprinkler, and
fire alarm plans, shall be submitted to the department at least 60 days prior
to the start of such work.

��������� 
(b)
�

The architectural, sprinkler, and fire alarm plans in (a) 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.

��������� 
(c)
�

Architectural, sprinkler, and fire alarm plans shall be submitted to the
state fire marshal�s office as required by RSA 153:10-b, V.

��������� 
(d)
�

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.

��������� 
(e)
�

The department shall review construction documents, drawings, and plans
of a newly proposed or existing facility for compliance with all applicable
sections of RSA 151 and He-P 824 and shall notify the applicant or licensee as
to whether the proposal complies with these requirements.

��������� 
(f)
�

The HH shall comply with all applicable state laws, rules, and local
ordinances when

undertaking
construction or rehabilitation.

��������� 
(g)
�

A licensee or applicant undertaking construction, repairs, renovations,
rehabilitation or modifications of a building shall comply with the appropriate
chapters and sections of the state fire code and state building code.

��������� 
(h)
�

All
 HHs newly constructed
or rehabilitated after the 2022 effective date of these rules shall comply with
the Facility Guidelines Institutes (FGI) �Guidelines for Design and
Construction of Residential Health, Care, and Support Facilities� (2022
edition), as applicable, available as noted in Appendix A.

��������� 
(i)
�

Where rehabilitation is done within an existing facility, all such work
shall comply with applicable sections of the FGI �Guidelines for Design and
Construction of Residential Health, Care, and Support Facilities� (2022
edition), available as noted in Appendix A.

��������� 
(j) The 
department sh
all be the authority having jurisdiction for the 
requirements
 in He-P 824.07(h)-(i) and
shall negotiate compliance with the licensee and their representatives and
grant waivers in accordance with He-P 824.10 
as
 appropriate.

��������� 
(k)
�

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.

��������� 
(l)
�

Waivers granted by the department for construction or rehabilitation
under the FGI guidelines

above shall 
not
 require annual renewal unless the
underlying reason or circumstances for the waivers change.

��������� 
(m)
�

Exceptions or variances pertaining to the state fire code referenced in
He-P 824.07(g) shall be granted only by the 
state
 fire marshal. 

��������� 
(n)
�

Exceptions or variances pertaining to the state building code shall be
granted by the local building official or the state fire marshal if in a state
owned building.
� 

��������� 
(o)
�

The
 building, including
all construction and rehabilitated spaces, shall be inspected 
pursuant
 to He-P 824.09 prior to its
use.

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.08
� 
HH Requirements for Organizational or
Service Changes
.

��������� 
(a)
�

The HH 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 HH shall complete and submit a new application and obtain a new or
revised license, license certificate, or both, 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 the address without a change in location, the
HH shall provide the department with a copy of the notification from the local,
state or federal agency that requires the address change.

��������� 
(d)
� 
When there is a change in the
name, the HH 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 department; 

(2)
� 
The physical location;

(3)
� 
A change in the number of beds or patients
authorized under the current license; 

(4) 
�
A change in licensing classification; or

(5) 
�
A change that places the facility under a
different life safe code occupancy chapter.

��������� 
(f)
�

A new license and license certificate shall be issued for a change in
ownership, classification, or physical location.

��������� 
(g)
�

A revised license and license certificate shall be issued for changes in
the HH�s name or a change in addresses without a change in physical location.

��������� 
(h)
�

A revised license certificate shall be issued for any of the following:

(1)
� 
A change of administrator;

(2) 
�
An increase or decrease in the number of beds;

(3)
� 
A change in the scope of services provided;
or

(4)
� 
When a waiver has been granted in accordance
with He-P 824.10.

��������� 
(i)
�

The HH 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;

(4)
� 
A copy of the criminal attestation as
described in He-P 824.19(k) for the new administrator or medical director; and 

(5)
� 
The results of a BEAS registry check from the
bureau of elderly and adult services for the new administrator or medical
director.

��������� 
(j)
�

Upon review of the materials submitted in accordance with (i) 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
824.03(al) and He-P 824.15(h).

��������� 
(k)
�

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.

��������� 
(l)
�

When there is to be a change in the services provided, prior to
providing the additional services the HH 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, will be made to the
physical environment.

��������� 
(m)
�

The department shall review the information submitted under (h) above
and determine if the added services can be provided under the HH�s current
license.

��������� 
(n)
�

The HH 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.

��������� 
(o)
�

A restructuring of an established HH 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. 

��������� 
(p)
�

If a licensee chooses to cease operation of an HH, the licensee shall
submit written notification to the department at least 60 days in advance which
shall include a written closure plan.

Source.
�

#5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRES:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.09
� 
Inspections
.

��������� 
(a)
�

For the purpose of determining compliance with RSA 151 and He-P 824, 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 licensed premises;

(2)
� 
All programs and services provided by the HH;
and

(3)
� 
Any records required by RSA 151 and He-P 824.

��������� 
(b)
�

The department shall conduct a clinical and life safety inspection, as
necessary, to determine full compliance with RSA 151 and He-P 824 prior to:

(1)
� 
The issuance of an initial license;

(2)
� 
A change in ownership, except as allowed by
He-P 824.08(e)(1);

(3)
� 
A change in the physical location of the HH;

(4)
� 
An increase in the number of beds; 

(5)
� 
Occupation of space after construction,
renovations or alterations;

(6)
� 
A change in the licensing classification; or

(7)
� 
The renewal of a non-certified HH 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 a notice to correct
for life safety code inspections shall be issued when, as a result of any
inspection, the department determines that the HH is in violation of any of the
provisions of He-P 824, 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 824, within 21 days of the date on the
letter that transmits the inspection report.

Source.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.10
� 
Waivers
.

��������� 
(a)
�

Applicants or licensees seeking waivers of specific rules in He-P 824
shall submit a written request for a waiver to the commissioner 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 patients 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.

��������� 
(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 commissioner 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 patients; and

(3)
� 
Does not affect the quality of patient
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)
� 
The request to renew a waiver shall be
subject to (b) through (f) above.

Source.
�

#5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.11
� 
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 complainants�
first-hand knowledge regarding the allegations 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 824.

��������� 
(b)
�

When practicable, the complaint shall be in writing and contain the
following information:

(1)
� 
The name and address of the HH, 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 824.

��������� 
(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 facility;

(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 HH, 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 824. 

��������� 
(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(d);

(2)
� 
In accordance with RSA 151:7-a, II, the owner
or person responsible shall be allowed 7 days from the date of receipt of the
notice required by (e)(1) above to submit a written response to the findings
prior to the department�s issuance of a warning;

(3)
�

In accordance with RSA 151:7-a, I, the department may 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 824;

(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 must cease or by which an application for licensure must 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 824.13.

��������� 
(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.
� 
#5648, eff 6-25-93; ss by #7020, INTERIM, eff
6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.12
� 
Administrative Remedies
.

��������� 
(a)
�

The department shall impose administrative remedies for violations of
RSA 151, He-P 824, 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 licensee; or

(4)
� 
Monitoring of a license.

��������� 
(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 or a provision of these rules; and

(2)
� 
Identifies the specific remedy(s) that has
been proposed.

��������� 
(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,
written in the appropriate place on the state notice 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 he or she has
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 patient will not be jeopardized as a result of
granting the extension;

(3)
� 
The department shall review each POC and
accept each plan that:

a.
� 
Achieves compliance with RSA 151 and He-P
824;

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
824 as a result of this implementation of the POC; and

d.
� 
Specifies the date upon which the areas of
non-compliance will be corrected;

(4)
� 
If the POC is acceptable, the department
shall issue a license certificate 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 he or she has
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 patient will 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 824.12(d)
and a fine in accordance with He-P 824.13(c)(12);

(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
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 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 824.12(b); and 

b.
� 
Issued a directed POC in accordance with He-P
824.12(d) and a fine in accordance with He-P 824.13(f)(12).

��������� 
(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 patients 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;

(3)
� 
Deny the application for a renewal of a
license in accordance with He-P 824,13(b); or 

(4)
� 
Revoke the license in accordance with He-P
824.13(b).

��������� 
(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
facility in areas that impact health, safety, or well-being of patients;

(2)
�

The presence of conditions in the HH that negatively impact the health,
safety, or well-being of patients;

(3)
� 
Concern that the facility is not ending the
pattern of citations for violations of licensing rules and coming into
compliance with those rules; or

(4)
� 
Conditions exist for implementation of
temporary management as described in (i) below but no temporary manager can be
found.

��������� 
(m)
�

The department shall appoint a temporary manager to assume operation of
a HH when, following an inspection, the department determines that:

(1)
� 
The licensee has repeatedly failed to manage
and operate the HH in compliance with RSA 151 and He-P 824 and such HH
practices have failed to meet the needs of the patients;

(2)
� 
The licensee has failed to develop or
implement policies and procedures for infection control, sanitation or life
safety codes, imposing harm or the potential for harm to the patients; or

(3)
� 
The health, safety and well-being of the
patients are at risk and emergency action is required.

Source.
�

#5648, eff 6-25-93; ss by #7020, INTERIM, eff 6-23-99, EXPIRED: 10-21-99

New.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.13
� 
Enforcement Actions and Hearings
.

��������� 
(a)
�

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 III as
applicable, before the enforcement action becomes final.

��������� 
(b)
�

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 824 which poses a threat to the patient�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 824.04;

(5)
� 
The 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 824.12(c), (d), and (e); 

(7)
� 
The licensee has submitted a POC that has not
been accepted by the department in accordance with He-P 824.12(c)(6) and has
not submitted a revised POC in accordance with He-P 824.12(c)(6)b.;

(8)
� 
The licensee is cited a third time under RSA
151 or He-P 824 for the same violation within the last 5 inspections;

(9)
� 
A licensee, or its corporate officers, has
had a license revoked and submits an application during the 5-year prohibition
period specified in (i) below; 

(10)
�

Unless a waiver has been granted, upon inspection, the applicant�s
premise is not in compliance with RSA 151 or He-P 824; 

(11)
� 
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;

(12)
�

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; or 

(13) 
�
The applicant has had a license revoked by any
division or unit of the department within 5 years prior to the application.

��������� 
(c)
�

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 provider;

(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 patient whose
needs exceeds the services or programs provided by the HH, in violation of RSA
151:5-a, the fine for a licensee shall be $500.00;

(5)
� 
For admission of a patient whose needs exceed
the services or programs authorized by the HH licensing classification, in
violation of RSA 151:5-a, II and He-P 824.15(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
824.11(i), 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 prior to the expiration date, in violation of He-P 824.06(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 824.08(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 824.08(a)(2), the
fine for a licensee shall be $500.00;

(10)
� 
For a failure to allow access by the
department to the HH�s premises, programs, services, patients or records, in
violation of He-P 824.09(a)(1)-(3), the fine for an applicant, unlicensed
individual or licensee shall be $2000.00;

(11)
� 
For a failure to notify the department prior
to a change in the administrator or medical director, in violation of He-P
824.08(d), the fine for a licensee shall be $100.00;

(12)
� 
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 824.12(c)(2) and (6), the fine for
a licensee shall be $100.00;

(13)
� 
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 824.12(c)(11), the fine for a licensee shall
be $1000.00;

(14)
� 
For a failure to establish, implement or
comply with licensee policies, the fine for a licensee shall be $500.00; 

(15)
� 
For a failure to provide services or programs
required by the licensing classification and specified by He-P 824.14(d), the
fine for a licensee shall be $500.00;

(16)
� 
For exceeding capacity, in violation of He-P
824.14(m), the fine for a licensee shall be $500.00;

(17)
� 
For providing false or misleading information
or documentation, in violation of He-P 812.14(g), the fine shall be $1,000.00
per offense;

(18)
� 
For a failure to meet the needs of the
patient, in violation of He-P 824.15(a), the fine for a licensee shall be
$1000.00 per patient;

(19)
� 
For employing an administrator or other
personnel who do not meet the qualifications for the position, without having a
waiver granted by the department in accordance with He-P 824.10 in violation of
He-P 824.18(h)-(j), the fine for a licensee shall be $500.00; 

(20)
�

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 824.07(a), the fine for a licensed facility shall be $500.00;

(21)
�

For occupying a renovated area of a licensed facility or a new
construction prior to approval by local and state authorities; 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;

(22)
� 
When an inspection determines that a
violation of RSA 151 or He-P 824 has the potential to jeopardize the health,
safety or well-being of a patient, 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 area of non-compliance, the fine for a licensee
shall be double the original fine, but not to exceed $1000.00; and

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 triple the original fine, but not to exceed $2000.00; and

(23)
� 
Each day that the individual or licensee
continues to be in violation of the provisions of RSA 151 or He-P 824 shall
constitute a separate violation and shall be fined provided that if the
applicant or licensee is making good faith efforts, as verified by
documentation or other means, to comply with the provisions of RSA 151 or He-P
824, the department shall not issue a daily fine.

��������� 
(d) 
�
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.

��������� 
(e)
�

An applicant or licensee shall have 30 days after receipt of the notice
of enforcement action to appeal.

��������� 
(f)
�

If a written request is not made pursuant to (e) above, the action of
the department shall become final.

��������� 
(g)
�

The department shall order the immediate suspension of a license and the
provision of services when it finds that the health, safety, or welfare of a
patient is in jeopardy and requires emergency action in accordance with RSA
541-A:30, III.

��������� 
(h)
�

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 824 is achieved.

��������� 
(i)
�

Hearings under this section shall be conducted in accordance with RSA
541-A and He-C 200.

��������� 
(j)
�

RSA 541 shall govern further appeals of department decisions under this
section.

��������� 
(k)
�

When an HH�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 HH.

��������� 
(l) 
�
The 5-year period referenced in (k) above
shall begin on:

(1)
� 
The date the department�s decision to revoke
or deny the license, if not filed; or

(2)
� 
The date a final decision upholding the
action of the department is issued, if a request for an administrative hearing
was made and a hearing was held.

��������� 
(m)
�

Notwithstanding (k) 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 824.

��������� 
(n)
� 
No ongoing enforcement action shall preclude
the imposition of any remedy available to the department under RSA 151, RSA
541-A or He-P 824.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.14
� 
Duties and Responsibilities of All
Licensees
.

��������� 
(a)
�

The licensee shall comply with all relevant federal, state, and local
laws, rules, codes, and ordinances, as applicable. 

��������� 
(b)
�

Each HH shall be owned and operated by a home hospice care provider
licensed in New Hampshire in accordance with RSA 151:2.

��������� 
(c)
�

The licensee shall have written policies and procedures setting forth:

(1) 
�
The rights and responsibilities of patients in
accordance with the patients� bill of rights; and

(2) 
�
The policies described in (d), (e), and (w)
below.

��������� 
(d)
�

The HH shall define, in writing, the scope and type of services to be
provided by the HH, which shall include at a minimum, the core services listed
in He-P 824.15.

��������� 
(e)
�

The HH shall develop and implement written policies and procedures
governing the operation and all services and shall assess and monitor the
quality of care and service provided to patients on an ongoing basis.

��������� 
(f)
�

All policies and procedures shall be reviewed annually and revised as
needed.

��������� 
(g)
�

The HH personnel shall not falsify any documentation or provide false or
misleading information to the department.

��������� 
(h)
�

The HH shall not advertise or provide services that it is not licensed
to provide, pursuant to RSA 151:2, III.

��������� 
(i)
�

The HH shall comply with all conditions of warnings and administrative
remedies issued by the department, and all court orders.

��������� 
(j)
�

The HH shall have responsibility and authority for:

(1) 
�
Managing, controlling, and operating the HH;

(2)
� 
Meeting the needs of the patients during
those hours that the patient is in the care of the HH;

(3)
� 
Initiating action to maintain the HH in full
compliance at all times with all relevant health and safety requirements
contained in applicable federal, state and local laws, rules, regulations, and
ordinances;

(4)
� 
The continuity of inpatient care;

(5)
� 
Establishing, in writing, a chain of command
that sets forth the line of authority for the operation of the HH;

(6)
� 
Appointing an administrator;

(7)
� 
Verifying the qualifications of all
personnel;

(8)
� 
Providing sufficient numbers of qualified
personnel who are available to meet the needs of patients during all hours that
the HH has told the patient that they will provide service;

(9)
� 
Providing personnel with sufficient supplies
and equipment to meet the needs of the patients; 

(10)
� 
Requiring all personnel to follow the orders
of the licensed practitioner for every patient and to encourage the patient to
follow the licensed practitioner�s orders; and

(11)
� 
Implementing any POC that has been accepted
or issued by the department.

��������� 
(k)
�

The licensee shall consider all patients to be competent and capable of
making all decisions relative to their own health care unless the patient: 

(1)
� 
Has a guardian or conservator appointed by a
court of competent jurisdiction; 

(2)
� 
Has a durable power of attorney for health
care that has been activated in accordance with RSA 137-J; or

(3)
� 
Has a surrogate designated in accordance with
RSA 137-J.

��������� 
(l)
�

The licensee shall only admit an individual or retain a patient whose
needs are compatible with the facility and the services and programs offered,
and whose needs can be met by the HH.

��������� 
(m)
�

If an individual is admitted who requires lift equipment for transfers,
all direct care personnel shall have been trained in the correct operation of
such equipment.

��������� 
(n)
�

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.

��������� 
(o)
�

The patient shall be transferred or discharged, as defined under RSA
151:19, I-a and VII, in accordance with RSA 151:21, V, for reasons including,
but not limited to, the following:

(1)
� 
The patient�s medical or other needs exceed
the services offered by the licensee or are not otherwise met by third party
providers that the licensee has contracted with;

(2)
� 
The patient cannot be safely evacuated in
accordance with Saf-C 6000;

(3) 
�
The patient or the patient�s guardian, if any,
determines that the patient shall leave the facility; or

(4) 
�
The patients� medical condition is no longer
compatible with the facility and the services and programs offered.

��������� 
(p)
�

The licensee shall develop a discharge plan with the input of the
patient and the guardian or agent, if any.

��������� 
(q)
�

The following documents shall accompany the patient upon transfer:

(1)

The most recent patient assessment
tool, care plan, and quarterly progress notes;

(2)

The most recent nursing assessment,
if applicable;

(3)

The most recent multi-disciplinary
care plan, if applicable;

(4)

Current medication records; and

(5)

A licensed practitioner�s order for
transfer, if applicable.

��������� 
(r)
�

If the transfer or discharge referenced in (d) above is required by the
reasons listed in RSA 151:26, II(b), a written notice shall be given to the
patient as soon as practicable prior to transfer or discharge.

��������� 
(s)
�

The licensee shall not exceed the maximum number of patients or beds
licensed by the department, unless authorized by the department, such as during
an emergency.

��������� 
(t)
�

In addition to the posting requirements specified in RSA 151:29, the HH
shall post the following documents in a public area:

(1)
� 
The current license certificate issued in
accordance with RSA 151:2;

(2)
� 
All inspection reports issued in accordance
with He-P 824.09(c) and He-P 824.11(d), for the previous 12 months;

(3)
� 
A copy of the patients� bill of rights
specified by RSA 151:21;
� 

(4)
� 
A copy of the licensee�s policies and
procedures relative to the implementation of patient 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)
� 
Information on how to contact the office of
the long-term care ombudsman.

��������� 
(u)
�

The HH shall admit and allow any department representative to inspect
the HH and all programs and services that are being provided at any time for
the purpose of determining compliance with RSA 151 and He-P 824 as authorized
by RSA 151:6 and RSA 151:6-a.

��������� 
(v)
�

Physical or chemical restraints shall only be used in the case of an
emergency, pursuant to RSA 151:21, IX.
�

Immediately after the use of a physical or chemical restraint, the
patient�s guardian or agent, if any, and the department shall be notified of
the use of restraints.

��������� 
(w)
�

The HH shall:

(1)
� 
Have policies and procedures on:

a.
� 
What type of emergency restraints may be
used;

b.
� 
When restraints may be used; and

c.
� 
What professional personnel may authorize the
use of restraints; and

(2)
� 
Provide personnel with education and training
on the limitations and the correct use of restraints.

��������� 
(x)
�

The use of mechanical restraints shall be allowed only as defined under
He-P 824.03(ak).

��������� 
(y)
�

The following methods of mechanical restraints shall be prohibited:

(1)
� 
Full bed rails;

(2)
� 
Gates, if they prohibit a patient�s free
movement throughout the living areas of the HH;

(3)
� 
Half doors, if they prohibit a patient�s free
movement throughout the living areas of the HH;

(4)
� 
Geri chairs, when used in a manner that
prevents or restricts a patient from getting out of the chair at will;

(5)
� 
Wrist or ankle restraints;

(6)
� 
Vests or pelvic restraints; and

(7)
� 
Other similar devices that prevent a
patient�s free movement.

��������� 
(z)
� 
For 
reportable
 incidents the licensees shall:

��������� 

(1)
� 
Complete
 an investigation to determine if abuse or neglect could have been a
contributing factor to the incident;

(2)
� 
Fax 
to
 603-271-5574 or, if a fax machine is not
available, submit via regular mail, postmarked within 2 business days of the
incident together with a telephone call to the department reporting the
incident and notifying the department of the mailed report, the following
information to the department within 2 business days of a reportable incident:

a.
� 
The HH 
name
;

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 reportable incident;

d.
� 
The name of the patient
involved 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, including any follow-up;

g.
� 
If medical intervention was
required, by whom and the date and time;

h.
� 
Whether 
the
 patient�s guardian, agent, or personal
representative, if any, was notified;

i.
� 
The 
signature
 of the person reporting the reportable
incident; and

j.
� 
The date and time the patient�s
licensed practitioner was notified;

(3)
� 
If 
abuse
 or neglect is suspected, the licensee shall
notify 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;

(4) 
�
Contact the department
immediately by telephone, fax, or e-mail to report the information required by
(1) above in the case of the death of any patient who dies within 10 days of a
reportable incident;

(5) 
�
Provide
 the information required by (3) above in writing within 3 business days
of the unexpected death of any patient or the death of any patient who dies
within 10 days of a reportable incident if the initial contact was made by
telephone or if additional information becomes available subsequent to the time
the initial contact was made; and

(6) 
�
Submit any further information
requested by the department. 

�

��������� 
(aa)
�

The HH shall respond to a notice of deficiencies by providing a POC in
accordance with He-P 824.12(c).

��������� 
(ab)
�

The HH shall comply with all conditions of warnings and administrative
remedies issued by the department and all court orders.

��������� 
(ac)
�

The HH shall, upon request, provide a patient or their legal guardian or
agent, if applicable, with a copy of his or her patient record pursuant to the
provisions of RSA 151:21, X. 

��������� 
(ad)
�

All records required for licensing shall be legible, current, accurate,
and available to the department during an inspection or investigation conducted
in accordance with RSA 151:6 and RSA 151:6-a.

��������� 
(ae)
�

Any licensee that maintains electronic records shall develop a system
with written policies and procedures designed to protect the privacy of
patients and staff that, at a minimum, include:

(1)
� 
Procedures for backing up files to prevent
loss of data;

(2)
� 
Safeguards

for maintaining the confidentiality of information pertaining to patients and
staff; and

(3)
� 
Systems to prevent tampering with information
pertaining to patients and staff.

��������� 
(af)
�

The licensee shall develop policies and procedures regarding the release
of information contained in patient records.

��������� 
(ag)
�

At the time of admission, the HH shall give a patient, their guardian or
agent, if applicable, a listing of all HH�s charges and identify what care and
services are included in the charge. 

��������� 

��������� 
(ah)
�

The licensee shall give a patient a written notice as follows:

(1)
� 
For an increase in the cost or fees for any
HH services 30 days advance notice; or

(2)
� 
For 
an

involuntary change in room or bed location 14 day advance notice, unless the
change is required to protect the health, safety, and well-being of the patient
or other patients, in such case the notice shall be as soon as practicable. 

��������� 
(ai)
�

The HH shall provide all personnel with education in hospice philosophy
and hospice care in compliance with the CMS conditions of participation.

��������� 
(aj)
�

The HH shall comply with all federal, state and local health, building,
fire and zoning laws, rules and ordinances.

��������� 
(ak)
�

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 and RSA 155:69 and He‑P 824.24(h).

��������� 
(al)
�

If the HH holds or manages a patient�s funds or possessions, the
facility shall have 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 patients, or other household members.

��������� 
(am)
� 
The HH shall not falsify any documentation
required by law or provide false or misleading information to the department.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.15
� 
Required Services
.

��������� 
(a)
� 
The licensee shall provide the following core
hospice care services:

(1)
� 
Nursing services sufficient to meet the
nursing needs of the patient, which are:

a.
� 
Determined by the patient�s care plan; and

b.
� 
Available, as needed, 24 hours a day; 

(2)
� 
LNA and personal care services that are
provided either directly or by contract as the needs of the patient dictate and
as determined by the patient�s care plan;

(3)
� 
Providing

patients with pharmaceutical services such as equipment, appliances, medical
supplies and other pharmaceutical services as the needs of the patient dictate
and as determined by the patient�s care plan;

(4)
� 
Medical social services shall be based on the
patient�s psychosocial assessment and the patient�s and family�s needs and
acceptance of these services. Medical social services shall be provided by a
qualified social worker;

(5)
� 
Hospice volunteer services;

(6)
� 
Nutritional counseling, physical or
occupational therapy, and speech therapy that are provided or arranged for as
needed in accordance with patient�s care plan;

(7)
� 
Spiritual services which are offered in
accordance with the patient�s and family�s beliefs and values; 

(8)
� 
Bereavement services that are available to
the family for up to one year following the death of the patient; 

(9)
� 
Health and safety services to minimize the
likelihood of accident or injury, with care and oversight provided 24 hours a
day regarding:

a.
� 
The patients� functioning, safety, and
whereabouts; and

b.
� 
The patients� health status, including the
provision of intervention as necessary or required; and

(10)
� 
Medication services in accordance with He-P
824.17.

��������� 
(b)
�

In addition to the services in (a) above the licensee shall provide the
following services:

(1)
� 
Food services in accordance with He-P 824.21;

(2)
� 
Housekeeping, laundry, and maintenance
services; and

(3)
� 
Basic supplies necessary for patients to
maintain personnel hygiene and grooming.

��������� 
(c)
�

If, on a temporary basis, not to exceed 90 days, the hospice care
provider cannot provide any of the core care and services in (a) above, the HH
shall have a written agreement with another agency to provide the required
services.

��������� 
(d)
�

Any contractual agreement to provide care and services shall:

(1)
� 
Identify the care and services to be
provided;

(2)
� 
Specify the qualifications of the personnel
that will be providing the care and services;

(3)
� 
Require that the HH must authorize the
services; and

(4)
� 
Stipulate the HH retains professional
responsibility for all care and services provided.

��������� 
(e)
�

The HH shall provide or arrange for the provision of short-term
in-patient stays in a hospital or nursing home during those times when the
patient�s pain or symptoms are unable to be managed in the HH.

��������� 
(f)
�

The HH shall retain professional management responsibility for all
services that are provided including contracted services when a hospice patient
is in another licensed facility.
� 
These
responsibilities shall be defined in a written contractual agreement. 

��������� 
(g)
�

The licensee shall ensure that the following positions are staffed at
the HH location:

(1)
� 
An administrator;

(2)
� 
A 
director

of patient services, but the administrator may also be the director of patient
services if the administrator meets the qualifications of the position;

(3)
� 
A volunteer coordinator;

(4)
� 
A social services coordinator; and

(5)
� 
A spiritual and or bereavement coordinator.

��������� 
(h)
�

Any administrator shall:

(1)
� 
Have at least a bachelor�s degree in business
or a health-related field with a minimum of 3 years� experience in hospice or
palliative care or;
� 

(2)
� 
Be a registered nurse; and

(3)
� 
Designate
,
in writing, an alternate administrator who shall assume the responsibilities of
the administrator in his or her absence.

��������� 
(i)
�

The administrator shall be responsible for maintaining the HH in full
compliance with all federal, state and local laws, rules, codes and ordinances
at all times. 

��������� 
(j)
�

The director of patient services shall:

(1)
� 
Be a New Hampshire-licensed registered nurse
or an advanced practice registered nurse; or

(2)
� 
Have

a bachelor�s degree in a health field related to hospice care.

��������� 
(k)
�

The director of patient services shall:

(1)
� 
Be responsible for the overall delivery of
patient care and services;

(2)
� 
Provide sufficient nursing personnel to meet
the need of the patients;

(3)
� 
Supervise the overall delivery of patient
care and services; and

(4)
� 
Coordinate

the supervision of licensed practical nurses (LPN), licensed nurse aides (LNA)
and or 
personal
 care attendants
(PCA) by a registered nurse and determine if the LNA or PCA is providing care
and services in accordance with the patient�s care plan.

��������� 
(l)
�

The medical director, who shall be a physician licensed in the state of
New Hampshire, shall be responsible for:

(1)
� 
The oversight of the medical component of the
HH�s patient care program;

(2)
� 
Participating on the interdisciplinary
patient care team if the patient�s own licensed practitioner cannot
participate; and

(3)
� 
Determining
,
in consultation with the interdisciplinary team, that an individual is
appropriate for hospice and or palliative care services.

��������� 
(m)
�

Volunteer services shall be provided under the direction of a
coordinator of volunteer services who:

(1)
� 
Implements a direct service volunteer
program;

(2)
� 
Coordinates the orientation, education,
support, and supervision of direct service volunteers; and

(3)
� 
Coordinates the utilization of direct service
volunteers with other hospice staff.

��������� 
(n)
�

All volunteers shall be oriented and educated relative to their
prescribed function according to the hospice care provider�s policies and
procedures.

��������� 
(o)
�

The licensee shall develop and maintain policies and procedures for its
volunteer services that address the following areas:

(1)
� 
Recruitment and retention;

(2)
� 
Health screening and 2-step TB testing;

(3)
� 
Orientation;

(4)
� 
Scope of function;

(5)
� 
Supervision;

(6)
� 
Ongoing training and support; 

(7)
� 
Records of volunteer activities; and

(8)
� 
Criminal record checks.

��������� 
(p)
�

The social services coordinator shall have:

(1)
� 
At least a master�s degree from a graduate
school of social work; or

(2)
� 
A bachelor�s degree in a related health or
human services field, have at least 2 years� experience as a social worker and
have established a consultative relationship with a person who qualifies in (1)
above.

��������� 
(q)
�

The social services coordinator shall:

(1)
� 
Participate in the development of the care
plan; and

(2)
� 
Work in conjunction with the director of
patient services to coordinate all social services required by the care plan
and ensure their delivery.

��������� 
(r)
�

The coordinator of bereavement and spiritual care services shall be a
person who has at least a bachelor�s degree in an applicable field such as
theology of education, psychology or counseling and who has education in death
and dying, grief, and bereavement.

��������� 
(s)
�

Persons providing bereavement services shall have education in death and
dying, grief and bereavement.

��������� 
(t)
�

The coordinator of bereavement and spiritual care services shall be
responsible for providing an organized program of bereavement services for up
to 12 months after the death of the patient that includes but is not limited
to:

(1)
� 
Counseling to families after the patient�s
death; and 

(2) Developing a
care plan that reflects the needs of the patient�s family.

��������� 
(u)
�

The licensee may only perform POCT, that are 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.

��������� 
(v)
�

If CLIA-waived laboratory testing is performed by personnel, the
licensee shall:

(1)
� 
Obtain the appropriate CLIA certificate as
per 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.

��������� 
(w)
�

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 and messages, reporting results; and

(3)
� 
All recommended and required quality control
procedures for POCT meters and devices.

��������� 
(x)
�

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.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.16
� 
Patient Admission Criteria, Temporary
Absence, Transfer and Discharge
.

��������� 
(a)
�

At the time of admission, personnel of the HH shall:

(1)
� 
Provide, both orally and in writing, to the
patient, their guardian or agent, if applicable, the HH�s:

a.
� 
Policy on patient rights and
responsibilities;

b.
� 
Complaint procedure;

c.
� 
List of care and services that are provided
directly by the HH; and

d.
� 
List of the care and services that are
provided by contract;

(2)
� 
Obtain written confirmation acknowledging
receipt of the items in (1) above from the patient, their guardian or agent, if
applicable; 

(3)
� 
Collect and record
the following information:

a.
� 
Patient�s name, home address, home telephone
number, and date of birth;

b.
� 
Name, address, and telephone number of an
emergency contact and guardian and/or agent, if applicable;

c.
� 
Name of patient�s primary care provider and
their address and telephone number; 

d.
� 
Copies of all legal directives such as
durable power of attorney, legal guardian or living will; and

e.
� 
Written and signed consent for the provision
of care and services; and

(4)
� 
Obtain documentation of informed consent and
consent for release of information.

��������� 
(b)
�

In addition to (a) above, at the time of admission, the licensee shall
provide a written copy to the patient and the guardian or agent, if any, or
personal representative, and receive written verification of receipt for the
following:

(1)
� 
A patient�s agreement including the following
information:

a.
� 
The basic daily, weekly, and monthly fee;

b.
� 
A list of the core services required by He-P
824.15(a) and (b) that are covered by the basic fee;

c.
� 
Information regarding the timing and
frequency of cost of care increases;

d.
� 
The time period covered by the admissions
contract;

e.
� 
The HH�s house rules;

f.
� 
The grounds for immediate termination of the
agreement, pursuant to RSA 151:21, V;

g.
� 
The HH�s responsibility for patient discharge
planning;

h.
� 
Information regarding nursing, other health
care services or supplies not provided in the core services, to include:

1.
� 
The
availability of services;

2.
� 
The HH�s
responsibility for arranging services; and

3.
� 
The fee and
payment for services, if known;

i.
� 
The licensee�s policies and procedures
regarding:

1.
� 
Arranging
for the provision of transportation;

2.
� 
Arranging
for the provision of third party services, such as a hairdresser or cable
television;

3.
� 
Acting as a
billing agent for third party services;

4.
� 
Monitoring
third party services contracted directly by the patient and provided on the HH
premises;

5.
� 
Handling of
patient funds pursuant to RSA 151:24 and He-P 824.14(af);

6.
� 
Bed hold, in
compliance with RSA 151:25; 

7.
� 
Storage and
loss of the patient�s personal property; and

8.
� 
Smoking;

j.
� 
The licensee�s medication management
services; and

k.
� 
The list of grooming and personal hygiene
supplies provided by the HH as part of the basic daily, weekly, or monthly
rate;

(2)
� 
A copy of the most current version of the
patients� bill of rights under RSA 151: 21 and the HH�s policy and procedure
for implementing the bill of rights pursuant to RSA 151:20, II;

(3)
� 
A 
copy

of the patient�s right to appeal an involuntary transfer or discharge under RSA
151:26, II(5); and

(4)
� 
The HH�s 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.

��������� 
(c)
�

The hospice care provider shall ensure that medical direction is
provided either from the patient�s attending licensed practitioner or the
hospice medical director.

��������� 
(d)
�

Patients who are admitted or accepted for services shall:

(1)
� 
Have a nursing assessment at the following
intervals to determine the level of care and services required by the patient:

a.
� 
Within 48 hours of admission; and

b.
� 
Thereafter as required by the CMS conditions
of participation; and

(2)
� 
Have

a signed and dated order for any service for which such order is required by
the practice acts of the person providing care, renewed at least every 90 days.

��������� 
(e)
�

The assessment required by (d)(1) above shall contain, at a minimum, the
following:

(1)
� 
Pertinent diagnoses including mental status;

(2)
� 
A pain assessment, including symptom control
and vital signs;

(3)
� 
A physical assessment;

(4)
� 
A cognition and mental status assessment;

(5)
� 
A behavioral assessment; 

(6)
� 
A psychosocial assessment;

(7)
� 
Medication and treatments;

(8)
� 
Functional limitations;

(9)
� 
Nutritional requirements;

(10)
� 
Any equipment required; and

(11)
� 
Any safety precautions.

��������� 
(f)
�

In addition to the information required in (e) above, the nursing
assessment shall include:

(1)
� 
Reactions of the patient and family members
to terminal illness;

(2)
� 
History of the patient�s and family coping
strengths and weaknesses; 

(3)
� 
Social and financial concerns; and

(4)
� 
Spiritual beliefs and desires of the patient.

��������� 
(g)
�

If the assessment required by (d) above is completed by an LPN, the
assessment shall be reviewed and co-signed by the registered nurse or physician
that is supervising the LPN prior to the development of the patient�s care
plan.

��������� 
(h)
�

The licensee shall establish an interdisciplinary hospice care team
composed of at least:

(1)
� 
A licensed practitioner;

(2)
� 
A registered nurse;

(3)
� 
A social worker; and

(4)
� 
A 
clergy

person or counselor. 

��������� 
(i)
�

The interdisciplinary hospice care team shall:

(1)
� 
Establish the care plan;

(2)
� 
Be

the primary care delivery team for a patient and his or her family through the
total duration of hospice care; and

(3)
� 
Be responsible for supervising any patient
care and services provided by others.

��������� 
(j) The interdisciplinary team shall,
in conjunction with the patient, the patient�s personal representative, and
their family, develop an individualized care plan, which reflects the changing
care needs of the patient and family.

��������� 
(k)
�

The care plan required by (j) above shall include:

(1)
� 
The date the problem or need was identified;

(2)
� 
A description of the problem or need;

(3)
� 
The goal for the patient;

(4)
� 
The action or approach to be taken by HH
personnel;

(5)
� 
The responsible person(s) or position; and

(6)
� 
The interventions used to address problems
identified in the assessment including:

a.
� 
Medications ordered;

b.
� 
Pain control interventions, both
pharmacological and non-pharmacological;

c.
� 
Symptom management treatment; and

d.
� 
Services required including frequency of
visits.

��������� 
(l)
�

The care plan required by (j) above shall be:

(1)
� 
Developed in conjunction with the patient and
their guardian or agent, if applicable;

(2)
� 
Completed within 3 days after completion of
the nursing assessment;

(3)
� 
Reviewed

and revised at least every 30 days by the interdisciplinary team following the
completion of each assessment; and

(4)
� 
Made available to all personnel that assist
the patients.

��������� 
(m)
�

The patient and their family shall be encouraged to participate in all
components of care, including:
� 

(1)
� 
Assessment and problem identification;

(2)
� 
Implementation of the plan of care; and 

(3)
� 
Evaluation and revision of the plan, as
needed.

��������� 
(n)
�

At the time of a patient�s admission, the licensee shall obtain orders
from a licensed practitioner for medications, prescriptions and diet.

��������� 
(o)
�

A patient may refuse all care and services.
� 

��������� 
(p)
�

When a patient refuses care or services that could result in a threat to
their safety or that of others, the licensee or their designee shall:

(1) 
�
Inform the patient of the potential results of
their refusal;

(2)
� 
Notify the licensed practitioner and guardian
or agent if any, of the patient�s refusal of care; and 

(3)
� 
Document in the patient�s record the refusal
of care and the patient�s reason for the refusal.

��������� 
(q)
�

Progress notes shall be written by any member of the interdisciplinary
team to document:

(1)
� 
Changes in the patient�s physical, functional
and mental abilities;

(2)
� 
Changes 
in
 the patient�s behaviors such as eating or sleeping patterns;
and

(3)
� 
Newly identified needs of the patient and or
their family.

��������� 
(r)
�

All staff of the HH shall follow the approaches stated in the care
plan.
� 

��������� 
(s)
�

The licensee shall provide an emergency data sheet to emergency medical
personnel in the event of an emergency transfer to another medical facility.

��������� 
(t)
�

The data sheet referenced in (s) above shall include:

(1)
� 
The patient�s full name and the name the
patient prefers, if different;

(2)
� 
Name, address and telephone number of the
patient�s next of kin, guardian or agent, if any;

(3)
� 
Diagnosis;

(4)
� 
Medications, including last dose taken and
when the next dose is due;

(5)
� 
Allergies;

(6)
� 
Functional limitations;

(7)
� 
Date of birth;

(8)
� 
Insurance information;

(9)
� 
Advance directive; and 

(10)
� 
Any other pertinent information not specified
in (1)-(9) above.

��������� 
(u)
�

Written notes shall be documented in the patient�s record for any
unusual incident, occurrence, or explained absence involving the patient which
shall include the information required by He-P 824.14(t) and the signature and
title of the person reporting the incident or occurrence.

��������� 
(v)
�

For each patient accepted for care and services at the HH, a current and
accurate record shall be maintained and include, at a minimum:

(1)
� 
The written confirmation required by He-P
824.16(b)(1);

(2)
� 
The identification data required by He-P
824.16(b)(2);

(3)
� 
The admission agreement required by He-P
824.16(c)(1);

(4)
� 
Consent and medical release forms, as
applicable;
� 

(5)
� 
Pertinent medical information;

(6)
� 
The emergency data sheet required by He-P
824.16(t);

(7)
� 
All orders from a licensed practitioner,
including the date and signature of the licensed practitioner required by He-P
824.16(e)(2);

(8)
� 
All assessments required by He-P
824.16(e)(1);

(9)
� 
All laboratory and x-ray reports if the tests
were taken at the HH;

(10)
� 
All consults;

(11)
� 
All care plans required by He-P 824.16(k)
including documentation that the patient or patient�s guardian or agent, if
applicable, participated in the development of the care plan;

(12)
� 
All 
progress

notes required by He-P 824.16(r) including the signature of the person
providing the care; 

(13)
� 
All written notes required by He-P 824.16(v)
including the signature of the person providing the care;

(14)
� 
All daily medication records required by He-P
824.17(aa);

(15)
� 
Discharge or transfer documentation, which
shall include:

a.
� 
In the case of patient death:

1.
� 
Date and
place of death; and

2.
� 
Bereavement
follow-up plan; and

b.
� 
In the case of discharge other than patient
death or transfer:

1.
� 
Date and
time of patient discharge;

2.
� 
The
physical, mental, and medical condition of patient at discharge;

3.
� 
Discharge
instruction and referral; and

4.
� 
Signed
licensed practitioner�s order for discharge, if applicable; and

(16)
� 
Documentation

of any unusual incidents involving the patient including the information
required by (v) above.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.17 
�
Patient Records

��������� 
(a)
�

The licensee shall maintain a legible, current, and accurate record for
each patient based on services provided at the HH.

�

��������� 
(b)
�

At a minimum, patient records shall contain the following:

�

(1)
� 
A copy of the patient�s service agreement
and/or admission contract and all documents required by He-P 824.16(c)(1);

�

(2) 
�
Notwithstanding (1) above, financial records
may be kept in a separate file;

�

(3)
� 
Identification data, including:

�

a.
� 
Vital information including the patient�s
name, date of birth, and marital status;

b.
� 
Patient�s religious preference, if known;

�

c.
� 
Patient�s veteran status, if known; and

�

d.
� 
Name, address and telephone number of an
emergency contact person;

�

(4)
� 
The name and telephone number of the
patient�s licensed practitioner(s);

�

(5)
� 
For 
individuals

contracted by the HH or the patient to provide services at the HH, their name,
employer, business address and telephone number;

�

(6)
� 
Patient�s health insurance information;

�

(7)
� 
Copies of any executed legal orders and
directives, such as guardianship orders issued under RSA 464-A, a durable power
of attorney for healthcare, or a living will;

�

(8)
� 
A record of the health assessment in
accordance with He-P 824.16(e)(1);

�

(9)
� 
Written, dated, and signed orders for the
following:

�

a.
� 
All medications, treatments and special
diets; and

�

b.
� 
Laboratory services and consultations
performed at the HH;

�

(10)
� 
Results of any laboratory tests, X-rays, or
consultations performed at the HH;

�

(11)
� 
All admission and progress notes;

�

(12)
� 
For 
services

that are provided at the HH by individuals who are not employed by the
licensee, documentation shall include the name of the agency providing the
services, the date services were provided, the name of the person providing
services and a brief summary of the services provided;

(13)
� 
Documentation of medical or specialized care;

�

(14)
� 
Documentation of reportable incidents;

�

(15)
� 
The consent for release of information signed
by the patient, guardian or agent, if any;

�

(16)
� 
The medication record as required;

�

(17)
� 
Documentation of any accident or injuries
occurring while in the care of the facility and requiring medical attention by
a practitioner; 

�

(18)
� 
Documentation of a patient�s refusal of any
care or services; and

(19) 
�
The licensee shall arrange for and document
the immunization of all consenting patients for pneumococcal disease, as
applicable, and all consenting patients for influenza in accordance with RSA
151:9-b and report immunization data to the department�s immunization program.

�

��������� 
(c)
�

Patient records and patient information shall be kept confidential and
only provided in accordance with law.

�

��������� 
(d)
�

The licensee shall develop and implement a written policy and procedure
document that specifies the method by which release of information from a
patient�s record shall occur.

�

��������� 
(e)
�

When not being used by authorized personnel, patient records shall be
safeguarded against loss or unauthorized use or access.

�

��������� 
(f)
�

Records shall be retained for 4 years after discharge, except that when
the patient is a minor, records shall be retained until the person reaches the
age of 19, but no less than 4 years after discharge.

�

��������� 
(g)
�

The licensee shall arrange for storage of, and access to, patient
records as required by (g) above in the event the HH ceases operation.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.18
� 
Medications
.

��������� 

��������� 
(a)
�

All medications shall be administered in accordance with the orders of
the licensed practitioner or other professional authorized by law.

��������� 
(b)
�

Medications, treatments, and diets ordered by the licensed practitioner
or other professional authorized by law shall be available to give to the
patient within 24 hours or in accordance with the licensed practitioner�s
direction.

��������� 
(c)
�

The licensee shall have a written policy and system in place instructing
how to:

(1)
� 
Obtain any medication ordered for immediate
use at the HH;

(2)
� 
Reorder medications for use at the HH; and 

(3)
� 
Receive and record new medication orders.

��������� 
(d)
�

Each medication order shall legibly display the following information:

(1)
� 
The patient�s name:

(2)
� 
The medication name, strength, prescribed
dose and route, if different then by mouth;

(3)
� 
The frequency of administration;

(4)
� 
The indications for usage for all medications
that are used PRN; and

(5)
� 
The dated signature of the ordering
practitioner.

��������� 
(e)
�

For PRN medications the ordering practitioner or a pharmacist shall
indicate, in writing, the indications for use and any special precautions or
limitations to use of the medication, including the maximum allowed dose in a
24-hour period.

��������� 
(f)
�

For each prescription medication being taken by a patient, the licensee
shall maintain either the original written order or a copy of the order in the
patient�s record, signed by a licensed practitioner or other individual
authorized by law. 

��������� 
(g)
�

Each medication, including licensed practitioner�s samples, shall
legibly display the following information:

(1)
� 
The patient�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 PRN
medications; and

(5)
� 
The date ordered.

��������� 
(h)
�

The label of all medication containers maintained in the HH shall match
the current written orders of the licensed practitioner unless authorized by
(j) below.

��������� 
(i)
�

Only a pharmacist shall make changes to a prescription medication
container label. Any change or discontinuation of medications taken at the HH
shall be pursuant to a written order licensed practitioner or other
professional authorized by law.

��������� 
(j)
�

When the licensed practitioner or other professional authorized by law
changes the dose of a medication and personnel of the HH are unable to obtain a
new prescription label:

(1)
� 
The licensed nurse shall clearly and
distinctly mark the original container, for example, with a colored sticker
that does not cover the pharmacy label, in a manner consistent with the HH�s
written procedure, indicating that there has been a change in the medication
order;

(2)
� 
Licensed

nurse shall cross out the previous order on the daily medication record,
indicating that the dose has been changed, and write the new order in the next
space available on the medication record; and

(3)
� 
The change in dosage, without a change in
prescription label as described in (1) and (2) above, shall be allowed for a
maximum of 90 days from the date of the new medication order, until the
medications in the marked container are exhausted or, in the case of PRN
medications, until the expiration date on the container, whichever occurs
first.

��������� 
(k)
�

The licensee shall require that all telephone orders for medications or
treatments are:

(1)
� 
Taken only by a licensed health care
professional if such action is within the scope of their practice act; 

(2)
� 
Immediately

transcribed and signed by the individual taking the order; and 

(3)
� 
Be counter-signed by the authorized licensed
practitioner authorized by law within 30 days.

��������� 
(l)
�

Over-the-counter medications shall be handled in the following manner: 

(1)
� 
The licensee shall obtain written approval
from the patient�s licensed practitioner annually; and

(2)
� 
Over-
the
-counter
medication containers shall be marked with the name of the patient using the
medication and taken in accordance with the directions on the medication
container or as ordered by a licensed practitioner.

��������� 
(m)
�

The medication storage area for medications not stored in the patient�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 patient�s medication(s); and

(3)
� 
Equipped to maintain medication at the proper
temperature.

��������� 
(n)
�

All medication at the HH shall be kept in the original containers as
dispensed by the pharmacy and properly closed after each use except as
authorized by (x)(5) below.

��������� 
(o)
�

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.

��������� 
(p)
�

If controlled substances, as defined by RSA 318-B, are stored in a
central storage area in the HH, they shall be kept in a separately locked
compartment within the locked medication storage area accessible only to
authorized personnel.

��������� 
(q)
�

The licensee shall develop and implement written policies and procedures
regarding a system for maintaining counts of controlled drugs.

��������� 
(r)
�

The destruction of contaminated, expired, or discontinued medication
shall be completed within 15 days of the expiration date, the end date of a
licensed practitioner�s orders or the medication becomes contaminated,
whichever occurs first and shall:

(1)
� 
Be 
accomplished

in the presence of at least 2 people if a controlled substance; and

(2)
� 
Be documented in the record of the patient
for whom the drug was prescribed.
� 

��������� 
(s)
�

Upon discharge or transfer, the licensee shall make the patient�s
current medications, except for controlled drugs which shall be destroyed in
accordance with (r) above, available to the patient and the guardian or agent,
if any.

��������� 
(t)
�

Medication(s) may be returned to pharmacies for credit only as allowed
by the law. 

��������� 
(u)
�

When a patient is going to be absent from the HH at the time medication
is scheduled to be taken, the medication container shall be given to the
patient if the patient is capable of self-administering, as described in (x)
below.

��������� 
(v)
�

A written order from a licensed practitioner shall be required every 90
days for any patient who is authorized to carry emergency medications,
including but not limited to nitroglycerine and inhalers.

��������� 
(w)
�

Patients shall receive their medications by one of the following
methods:

(1)
� 
Self-administered medication as allowed by
(x) below; or
� 

(2)
� 
Administered

by individuals authorized by law.

��������� 
(x)
�

For patients who self-administer medication as defined in He-P
824.03(bf), the licensee shall:

(1)
� 
Obtain

a written order from a licensed practitioner on an annual basis:

a.
� 
Authorizing the patient to self-administer
medications without supervision;

b.
� 
Authorizing the patient to store the
medications in their room; and

c.
� 
Identifying the medications that may be kept
in the patient�s room; 

(2)
� 
Evaluate

the patient�s ability to self-administer medication upon admission and whenever
there is a significant change in the patient, as defined in 824.03(bg), to
ensure they maintain the physical and mental ability to self-administer;

(3)
� 
Have the patient store the medication(s) in
his or her 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 patient�s room; and

(5)
� 
Allow the patient to fill and utilize a
medication system that does not require that medication remain in the container
as dispensed by the pharmacist.

��������� 
(y)
�

Medication administered by individuals authorized by law to administer
medications shall be: 

(1)
� 
Prepared

immediately prior to administration; and 

(2)
� 
Prepared, identified, and administered by the
same person in compliance with RSA 318-B and RSA 326-B.

��������� 
(z)
�

Personnel shall remain with the patient until the patient has taken the
medication.

��������� 
(aa)
�

The licensee shall maintain a written record for each medication taken
by the patient at the HH that contains the following information:

(1)
� 
Name of the patient;

(2)
� 
Any allergies or allergic reactions to
medications;

(3)
� 
The name, strength dose, frequency, and route
of the medication;

(4)
� 
The date and the time the medication was
taken;

(5)
� 
The signature and identifiable initials and
job title of the person administering the medication; 

(6)
� 
Documented reason for any medication refused
or omitted; and

(7)
� 
For PRN medications, the reason the patient
required the medication and the effect of the PRN medication.

��������� 
(ab)
�

An LNA who is not licensed as a medication nurse assistant in accordance
with RSA 326-B may administer the following when under the direction of the
licensed nurse employed by the HH:

(1)
� 
Medicinal shampoos and baths;

(2)
� 
Glycerin suppositories and enemas; and

(3)
� 
Medicinal topical products to intact skin as
ordered by the licensed practitioner.

��������� 
(ac)
�

Non-prescription stock medications shall only be accessed and
administered by the licensed nurse or medication nurse assistant on duty.

��������� 
(ad)
�

An HH shall use emergency drug kits only in accordance with board of
pharmacy rule Ph 705.03 under circumstances where the HH:

(1)
� 
Has a director of nursing who is a RN
licensed in accordance with RSA 326-B; and

(2)
� 
Has a contractual agreement with a medical
director who is licensed in accordance with RSA 329 and a consultant pharmacist
who is licensed in accordance with RSA 318. 

��������� 
(ae)
�

The licensee shall develop and implement a system for reporting any
observed adverse reactions to medication and side effects, or medication errors
such as incorrect medications, within 24 hours of the adverse reaction or
medication error.

��������� 
(af)
�

If ordered by the department to do so, the HH shall obtain the services
of a consulting pharmacist to rectify medication deficiencies, which present a
risk to the patient�s health and safety, as identified during an inspection or
investigation.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

He-P 824.19
� 
Personnel
.

��������� 
(a)
�

The licensee shall ensure that sufficient numbers of qualified personnel
are present in the HH to meet the needs of patients at all times.

��������� 
(b)
�

The licensee shall develop a job description for each position in the HH
containing:

(1)
� 
Duties of the position; 

(2)
� 
Physical requirements of the position; and 

(3)
� 
Qualifications and educational requirements
of the position.

��������� 
(c)
�

All direct care personnel shall be at least 18 years of age unless they
are:

(1)
� 
An LNA working under the supervision of an RN
in accordance with Nur 700; or

(2) 
�
Part of an established educational program
working under the supervision of a registered nurse.

��������� 
(d)
�

For all new hires, the licensee shall: 

(1) 
�
Obtain and review criminal records check in
accordance with RSA 151:2-d. Results must include criminal history from the
state of New Hampshire;

(2) 
�
Verify the qualifications and licenses, as
applicable, of all applicants prior to employment; and 

(3) 
�
Verify that the applicant is not on the BEAS
registry maintained by the department�s bureau of elderly and adult services
per RSA 161-F:49.

��������� 
(e)
�

Unless a waiver is granted in accordance with He-P 824.10, the licensee
shall not offer employment for any position 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, theft, abuse, neglect, or exploitation in this
or any other state;

�

(3)
� 
Has 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; or

�

(4)
� 
Otherwise

poses a threat to the health, safety, or well-being of patients.

��������� 
(f) 
�
If the information identified in (e) above
regarding any person in (d) above is learned after the person is hired,
contracted with, or engaged, the licensee shall immediately notify the
department and either: 

(1) 
�
Cease

employing, contracting with, or engaging the person; or 

(2) 
�
Request a waiver of (e) above.

��������� 

��������� 
(g) 
�
If a waiver of (e) above is requested, the
department shall review the information and the underlying circumstances in (e)
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 

(2) 
�
Grant

a waiver of (e) above if, after investigation, it determines that the person
does not pose a current threat to the health, safety, or well-being of a
patient(s).

��������� 
(h) 
�
The licensee shall not employ, contract with,
or engage, any person in (d) above who is listed on the BEAS state registry
unless a waiver is granted by BEAS. 

��������� 
(i) 
�
In lieu of (d) and (h) above, the licensee may
accept from independent agencies contracted by the licensee or by an individual
patient to provide direct care or personal care services a signed statement
that the agency�s employees have complied with (c) and (g) above and do not
meet the criteria in (d) above.

��������� 

��������� 
(j) 
�
Prior to having direct care contact with
patients, personnel, including volunteers and independent contractors shall:

(1) 
�
Submit

to the licensee the results of a 2-step tuberculosis (TB) test, Mantoux method,
or other method approved by the Centers for Disease Control, conducted not more
than 12 months prior to employment and for personnel other than volunteers and
independent contractors, submit the results of a physical examination or a
health screening; 

(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 M. 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 contractors
hired by the facility may provide the facility with a signed statement that
they have complied with (1) and (3) above for their employees working at the
HH. 

��������� 
(k) 
�
Within the first 7 days of employment, all
personnel who have direct or indirect contact with patients, to include
volunteers who have direct care contact or who prepare and serve food shall
receive a tour of the HH and an orientation that includes the following:

(1)
� 
The patients� rights in accordance with RSA
151:21;

(2)
� 
The HH�s complaint procedures;

(3)
� 
The duties and responsibilities of the
position;

(4)
� 
The medical emergency procedures;

(5)
� 
The HH�s infection control procedures and
required by He-P 824.22;

(6)
� 
The HH�s emergency and evacuation procedures;

(7)
� 
The procedures for food safety for those
personnel involved in preparation, serving, and storing of food; and

(8)
� 
The mandatory reporting requirements such as
RSA 161:F: 46-48 and RSA 169-C: 29-31.

��������� 
(l)
� 
Within the first 3 months of employment, all
personnel who have direct or indirect contact with patients, to include
volunteers who have direct care contact or who prepare and serve food shall
receive an orientation to hospice philosophy relative to the delivery of care
and services to hospice patients and their families.

��������� 
(m)
�

All personnel shall complete mandatory annual in-service education,
which shall include a review of the information required by (k)(7) and (8)
above. 

��������� 
(n) 
�
The licensee shall comply with all dementia
training requirements pursuant to RSA 151:47-49 including continuing education.

��������� 
(o) 
�
Such continuing education 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 continuing
education to covered administrative staff members and covered direct service
staff members; and 

(2) 
�
A minimum of 4 hours of ongoing training each
calendar year.

��������� 
(p)
�

All personnel shall sign a statement 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 patient; and 

(3)
� 
Have not had a finding by the department or
any administrative agency in this or any other state for assault, fraud, abuse,
neglect or exploitation of any person.

��������� 
(q)
�

Personnel, volunteers, or independent contractors hired by the licensee
who will have direct care contact with patients, as defined in He-P 824.03(s),
or direct contact with food who have a history of TB or a positive skin test
shall have a symptomatology screen in lieu of a TB test.

��������� 
(r)
�

The licensee shall inform personnel of the line of authority at the HH.

��������� 
(s) 
�
The personnel file for each individual 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 he
or she has received a copy of and received training on the implementation of
the licensee�s policy setting forth the patient�s rights and responsibilities
as required by RSA 151:21; 

(4) 
�
A copy of the results of the criminal record
check as described in (a) above; 

(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 (n) 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 (t) below. 

��������� 
(t) 
�
All personnel shall sign a statement 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 patient; or 

(3)
� 
Have

not had a finding by the department or any administrative agency in this or any
other state for assault, fraud, abuse, neglect, or exploitation of any person. 

��������� 
(u) 
�
The licensee shall maintain separate personnel
records that: 

(1)
� 
Contain the information required by (s)
above; and 

(2) 
�
Are protected and stored in a secure and
confidential manner.

��������� 
(v) 
�
The licensee shall document evidence of
immunization against influenza and pneumococcal disease for all consenting
employees and shall provide to its consenting employees annual immunizations
against influenza, to include:

(1) 
�
That immunizations shall be provided and
reported in accordance with RSA 151:9-b, I-V; and

(2) 
�
The facility shall have a plan that identifies
and documents, with dates, employees that have received or declined to receive
immunizations.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.20
� 
Quality Improvement
.

��������� 
(a)
�

The HH shall develop and implement a quality improvement program that
reviews policies and all care and services provided to patients and maximize
quality by preventing or correcting identified problems.

��������� 
(b)
�

As part of its quality improvement program, a quality improvement
committee shall be established.

��������� 
(c)
�

The HH 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 licensee;

(7)
� 
Evaluate the effectiveness of the corrective
actions; and

(8) 
�
Meet quarterly.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.21
� 
Infection Control
.

��������� 
(a)
�

The HH shall appoint an individual who will oversee the development and
implementation 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 universal precautions;

(3)
� 
The management of patients with infectious or
contagious diseases or illnesses; 

(4)
� 
The 
handling
,
storage, transportation, and disposal of those items specified 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; and

(4)
� 
Prevention and containment of infections.

��������� 
(d)
�

Personnel infected with a disease or illness transmissible through food,
fomites or droplets, shall not prepare food or provide direct care in any
capacity until they are no longer contagious.

��������� 
(e)
�

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.

��������� 
(f)
�

Personnel with an open wound who prepare food or provide direct care in
any capacity shall cover such wound at all times by an impermeable, durable,
tight-fitting bandage.

��������� 
(g)
�

Personnel infected with scabies or lice/pediculosis shall not provide
direct care to patients or prepare food until such time as they are no longer
infected.

��������� 
(h)
�

If the licensee accepts a patient who is known to have a disease
reportable under He-P 301 or an infectious disease, which means any diseases
caused by the growth of microorganisms in the body which might or might not be
contagious, the HH shall provide the required procedures, equipment and staff,
as specified by the 
United States
Centers for Disease Control and Prevention, �2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings� (June 2007), available as noted in Appendix A.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.22
� 
Food Services
.

��������� 
(a)
�

The licensee shall provide food services that meet:

(1)
� 
The

US Department of Agriculture recommended dietary allowance as specified in the

US Department of
Agriculture�s �Dietary Guidelines for Americans� (2020-2025 edition), available
as noted in Appendix A;

(2)
� 
The nutritional needs of each patient; and

(3)
� 
The special dietary needs associated with
health or medical conditions for each patient as identified on the patient
assessment.

��������� 
(b)
�

Each patient shall be offered at least 3 nutritious meals and snacks in
each 24-hour period when the patient is in the licensed premises unless
contraindicated by the patient�s care plan.

��������� 
(c)
�

Snacks shall be available between meals and at bedtime if not
contraindicated by the patient�s

care plan.

��������� 
(d)
�

The licensee shall provide therapeutic diets to patients as directed by
a licensed practitioner or other professional with prescriptive authority.

��������� 
(e)
�

For the purposes of emergency preparedness, each licensee shall have the
following supplies of foods maintained on the premises for the licensed
capacity: 

(1)
� 
Enough refrigerated, perishable foods for a
3-day period; 

(2)
� 
Enough non-perishable foods for a 7-day
period; and

(3)
� 
Enough drinking water for a 3-day period.

��������� 
(f)
�

All food and drink provided to the patients 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 those set forth in
He-P 2300;

(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)
� 
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.

��������� 
(g)
�

All food service equipment shall be kept clean and maintained according
to manufacturer�s guidelines.

��������� 
(h)
�

Food service areas shall not be used to empty bedpans or urinals or as
access to toilet and utility rooms.

��������� 
(i)
�

If soiled linen is transported through food service areas, the linen
shall be in an impervious container.

��������� 
(j)
�

Trash receptacles in food service areas shall have covers and shall
remain closed except when in

use.

��������� 
(k)
�

All HH 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.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.23
� 
Sanitation
.

��������� 
(a)
�

The licensee shall maintain a clean, safe and sanitary environment, both
inside and outside.

��������� 
(b)
�

All 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, pursuant to Env-Ws 315 and 316.

��������� 
(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 the patients. 

��������� 
(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 patient 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 box, separate from food, medications and patient 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.

��������� 
(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;

(4)
� 
Soiled

linens and clothing, which are considered contaminated with infectious waste
under Env-Wm 
103.28
 shall be, handled as
infectious waste; and

(5)
� 
Soiled materials, linens, and clothing shall
be handled as little as possible and transported in a laundry bag, sack or a
covered container.

��������� 
(n)
�

Laundry rooms and bathrooms shall have non-porous floors.

��������� 
(o)
�

There shall be a designated work area for soiled materials and linens
that contain a work counter of at least 6 linear feet, a sink, and a storage
area.

��������� 
(p)
�

Any HH 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.

��������� 
(q) 
�
Sterile or clean supplies shall be stored in
dust and moisture-free storage containers.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.24
� 
Physical Environment
.

��������� 
(a)
�

The HH shall:

(1)
� 
Have all entrances and exits accessible at
all times;

(2)
� 
Be 
maintained

in good repair and kept free of hazards to personnel and patients, including,
but not limited to, hazards from falls, burns, or electrical shocks;

(3)
� 
Be free from environmental nuisances,
including excessive noise and odors;

(4)
� 
Keep all corridors free from obstructions;
and

(5)
� 
Take measures to prevent the presence of
rodents, insects, and vermin.

��������� 
(b)
�

The physical environment shall be maintained, inside and outside, so as
to provide for the health, safety, welfare and comfort of patient(s) and
personnel, including reasonable accommodations for patients and personnel with
mobility limitations.

��������� 
(c)
�

Equipment providing heat within an HH including, but not limited to, gas
furnace or boiler, oil furnace or boiler, or wood stove or pellet stove shall:

(1)
� 
Maintain a temperature as follows, except
where patients 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 patient(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 HH.

��������� 
(g)
�

Plumbing shall be sized, installed, and maintained in accordance with
the state plumbing code as adopted under RSA 329-A:15 and 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 in each room that
can be opened.

��������� 
(i)
�

Each patient 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 at
least one for every 6 patients.

��������� 
(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)
�

Each bedroom shall:

(1)
� 
Contain no more than 2 beds;

(2)
� 
Have its own separate entry to permit the
patient to reach his or her bedroom without passing through the room of another
patient; 

(3)
� 
Have a side hinge door and not a folding or
sliding door or a curtain;

(4)
� 
Provide accommodations for family members to
remain with the patient throughout the night and physical space for family
after a patient�s death; 

(5)
� 
Be separated from halls, corridors and other
rooms by floor to ceiling walls; and

(6)
� 
Be located on the same level as the bathroom
facilities, if the patient has impaired mobility as identified by the HH
assessment.

��������� 
(n)
�

The licensee shall provide the following for the patient�s use, as
needed:

(1)
� 
A bed appropriate to the needs of the
patient;

(2)
� 
A firm mattress that complies with the state
fire code;

(3)
� 
Clean linens, blankets, and a pillow;

(4)
� 
A bureau;

(5)
� 
A mirror;

(6)
� 
A bedside table;

(7)
� 
A lamp;

(8)
� 
A chair;

(9)
� 
A closet or storage space for personal
belongings; and

(10)
� 
Window blinds, shades or curtains that
provide privacy.

��������� 
(o)
�

The patient may use his or her own personal possessions provided they do
not pose a risk to the patient or others.

��������� 
(p)
�

The licensee shall provide the following rooms to meet the needs of
patients:

(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 patients.

��������� 
(q)
�

Each licensee shall have a UL listed communication system in place so
that all patients can effectively contact personnel when they need assistance
with care or in an emergency.
�� 

��������� 
(r)
�

All bathroom, bedroom, and closet door latches or locks shall be
designed for easy opening from the inside and outside in an emergency.

��������� 
(s)
�

Screens shall be provided for: 

(1)
� 
Doors; 

(2)
� 
Windows; and 

(3)
� 
Other openings to the outside.

��������� 
(t)
�

Doors that are self-closing and remain closed when not in use shall be
exempt from the requirement in (s) above.

Source.
� 
#9317, eff 11-8-08, EXPIRED: 11-8-16

New.
� 
#12169, INTERIM, eff 4-29-17, EXPIRED:
10-26-17

New.
� 
#13572, eff 3-1-23

��������� 
He-P 824.25
� 
Emergency and Fire Safety
.

��������� 
(a)
�

All HHs shall meet the appropriate chapters of the state fire code and
state building code.

��������� 
(b)
�

All HH�s shall have:

(1)
� 
Smoke

detectors on every level and in every bedroom that are interconnected and
either

hardwired, powered
by the HH�s electrical service, or wireless, as approved by the state fire
marshal for the HH;

(2) 
�
At 
least

one ABC type fire extinguisher on every level or every 75 feet of corridor as
required by NFPA 10 that shall:

a. 
�
Be manually inspected when initially placed in
service;

b. 
�
Be inspected either manually or by means of an
electronic
�� 
monitoring device/system at
intervals not exceeding 31 days; and

c. 
�
Be inspected at least once per calendar month
and include: 

1.
�

Documentation of the manual fire extinguisher inspections which shall be
maintained on-site in accordance with NFPA 10 and available at the time of the
inspection or investigation; and

2.
�

Documentation of electronically monitored fire extinguishers which shall
be provided to the department within 2 business days of the completion of the
inspection or investigation; and

(3)
� 
An approved carbon monoxide monitor on every
level. 

��������� 
(c) 
�
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:

(1) 
�
A false alarm or emergency medical services
(EMS) transport for a non-emergent reason; or

(2) 
�
Emergency EMS transport related to
pre-existing conditions.

��������� 
(d)
�

The written notification under (c) above shall include:

(1)
� 
The date and time of the incident;

(2)
� 
A description of the location and extent of
the incident, including any damage;

(3)
� 
A description of events preceding and
following the incident;

(4) 
�
The

name of any personnel or patients who were evacuated as a result of the
incident, if applicable;

(5)
� 
The name of any personnel or patients 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.

��������� 
(e)
�

For the use and storage of oxygen and other related gases, HHs shall
comply with NFPA 99, Health Care Facilities Code including, but not limited to,
the following:

(1)
� 
All
 freestanding
compressed gas cylinders shall be firmly secured to the adjacent wall or
secured in a stand or rack;

(2)
� 
Storage locations shall
be outdoors in an enclosure or within an enclosed interior space of
noncombustible or limited-combustible construction, with doors, or with gates
if outdoors, that can be secured against unauthorized entry;

(3)
� 
Oxidizing gases, such
as oxygen and nitrous oxide, shall:

a.
� 
Not 
be
 stored with
any flammable gas, liquid, or vapor;

b.
� 
Be 
separated
 from
combustibles or incompatible materials by:

1.
�

A 
minimum

distance of 20 ft (6.1 m);

2.
�

A 
minimum

distance of 5 ft (1.5 m) if the entire storage location is protected by an
automatic sprinkler system designed in accordance with NFPA 13, Standard for
the Installation of Sprinkler Systems; or

3. An 
approved
, enclosed flammable liquid storage cabinet of
noncombustible construction having a minimum fire protection rating of one-half
hour for cylinder storage; and

c.
� 
Shall 
be
 secured in an
upright position, such as with racks or chains; 

(4)
� 
A 
precautionary
 sign, readable from a distance of 5 ft (1.5 m), shall be
conspicuously displayed on each door or gate of the storage room or enclosure,
and shall include, at a minimum, the following: �CAUTION, OXIDIZING GAS(ES)
STORED WITHIN - NO SMOKING�;

(5)
� 
Precautionary
 signs, readable from a distance of 5 ft (1.5 m), and with
language such as �OXYGEN IN USE, NO SMOKING�, shall be conspicuously displayed
wherever supplemental oxygen is in use and in aisles and walkways leading to
the area of use, and shall be attached to adjacent doorways or to building
walls or be supported by other appropriate means; and

(6)
� 
Flammable gases and liquids shall be stored
in metal fire retardant cabinets.

��������� 
(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; and 

(3) 
�
Metal waste receptacles and safe ashtrays. 

��������� 
(g) 
�
A copy of the fire safety plan including fire
drill actions shall be made available to and reviewed with the patient, or the
patient�s guardian or a person with durable power of attorney (DPOA), at the
time of admission and a summary of the patient�s responsibilities shall be
provided to the patient. Each patient 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 
all

HHs which are constructed to meet the Health Care Occupancy Chapter of Life
Safety Code, NFPA 101 as defined in RSA 153:1, VI-a, except as modified in Saf-
FMO 300, and the rules and regulations adopted and enforced by the state fire
marshal�s office and/or the municipality 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. 
�
Fire drills shall include the transmission of
a fire alarm signal and simulation of emergency fire conditions; 

d. 
�
Buildings that have a shelter in place, also
known as defend in place, shall have this plan approved by the department and
their local fire chief and shall be constructed to meet the Health Care
Occupancy Chapter of the Life Safety Code; 

e. 
�
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;

f. 
�
If the facility has an approved defend or
shelter in place plan, then all personnel, patients, and visitors shall
evacuate to that appropriate location or to the outside of the building to a
selected assembly point and drills shall be designed to ensure that patients
shall be given the experience of evacuating to the appropriate location or
exiting through all exists;

g. 
�
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 patients, 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 

h. 
�
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 

(2) 
�
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.
� 
#13572, eff 3-1-23

��������� 
He-P 824.26 
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. The 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.

��������� 
(b)
�

The emergency management committee shall develop and institute a written
emergency preparedness plan (plan) to respond to a disaster or an emergency.

(c)
� 
The plan in (b) above shall:

(1)
� 
Include site-specific plans for the
protection of all persons on-site in the event of fire, natural disaster, or
severe weather and human-caused emergency to include, but not be limited to
missing patients and bomb threat;

(2)
� 
Be 
approved

by the local emergency management director and reviewed and approved, as
appropriate, by the local fire department;

(3)
� 
Be available to all personnel;

(4)
� 
Be based on realistic conceptual events;

(5)
� 
Be modeled on the Incident Command System
(ICS) in coordination with local emergency response agencies;

(6)
� 
Provide that all personnel designated or
involved in the emergency operations plan of the facility shall be supplied
with a means of identification, such as vests, baseball caps, or hard hats
which shall be worn at all times in a visible location during the emergency;

(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.
� 
Water;

c.
� 
Ventilation;

d.
� 
Fire protection systems;

e.
� 
Fuel sources;

f.
� 
Medical gas and vacuum systems, if
applicable; and

g.
� 
Communications systems;

(8)
� 
Include a plan for alerting and managing
staff in a disaster, and accessing Critical Incident Stress Management (CISM),
if necessary;

(9)
� 
Include the management of patients,
particularly with respect to physical and clinical issues to include:

a.
� 
Relocation of patients with their medical
record including the medicine administration records, if time permits, 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)
� 
Identify a designated media spokesperson to
issue news releases and an area where the media can be assembled, where they
won�t interfere with the operations of the facility;

(11)
� 
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;

(12)
� 
Include an educational, competency-based
program for the staff, to provide an overview of the components of the
emergency management program and concepts of the ICS and the staff�s specific
duties and responsibilities; and

(13)
� 
If the facility is located within 10 miles of
a nuclear power plant and is part of the New Hampshire plan for radiological
emergency preparedness, include this plan in the event of a radiological
disaster or emergency.

��������� 
(d)
�

The facility shall conduct and document with a detailed log, including
personnel signatures, 2 drills a year at least one of which shall rehearse mass
casualty response for the facility with emergency services, disaster receiving
stations or both.

��������� 
(e)
�

For the purposes of emergency preparedness, each licensee shall have the
following supplies of foods and water maintained on the premises based on the
average daily census of patients and staff:

(1)
� 
Enough refrigerated, perishable foods for a
3-day period; 

(2)
� 
Enough non-perishable foods for a 7-day
period; and

(3)
� 
Potable water for a 3-day period.

Source.
� 
#13572, eff 3-1-23