Administration

(A) Every licensee shall designate a qualified administrator and shall establish by-laws or policies describing the organization of the facility, establish authority and responsibility, and identify programs and goals. (B) Administration. (1) Facilities providing Level I care, Level II care in more than one unit, or Level III or IV care in more than two units shall employ a full-time administrator. (2) Facilities providing Level II care with only a single unit, and facilities providing Level III or IV care with less than two units shall employ an administrator for the number of hours as needed in accordance with the size and services provided by the facility. No more than one full-time administrator is required even in facilities providing multiple units or multiple levels of care. (4) A full-time administrator shall be on the premises during the working day. (5) In facilities providing Level I, II or III care, the administrator shall be a nursing home administrator licensed by the Board of Registration of Nursing Home Administrators. (6) The administrator shall be a suitable and responsible person. (7) A responsible person shall be designated to act in the absence of the administrator. (8) The names and telephone numbers of the administrator and his or her alternate shall be posted and available to the individual in charge at all times. (C) The administrator of the facility shall be responsible to the licensee and shall operate the facility to ensure services required by residents at each level of care are available on a regular basis and provided in an appropriate environment in accordance with established policies. (D) The licensee shall be responsible for procurement of competent personnel, and the licensee and the administrator shall be jointly and severallyresponsible for the direction of such personnel and for establishing and maintaining current written personnel policies, and personnel practices and procedures that encourage good resident care. (1) At all times, each facility shall provide a sufficient number of trained, experienced and competent personnel to provide appropriate care and supervision for all residents and to ensure their personal needs are met. Accurate time records shall be kept on all personnel. (2) There shall be written job descriptions for all positions including qualifications, duties and responsibilities. Work assignments shall be consistent with job descriptions and qualifications. (3) There shall be an organized orientation program for all new employees to explain job responsibilities, duties and employment policies. Personnel shall be currently licensed or registered where applicable laws require licensure and registration. (5) Completed and signed application forms and employee records shall be maintained. They shall be accurate, current and available on the premises. Such records shall include the following: (a) Pertinent information regarding identification (including any other name previously used). (b) Social Security number, Massachusetts license or registration number (if applicable) and year of original licensure or registration. (c) Names and addresses of educational institutions attended, dates of graduation, degrees or certificates conferred and name at the time of graduation. (d) All professional experience, on-the-job training and previous employment in chronological order with name and location of employer, dates of employment, and reasons for terminating employment. (6) Employee records shall contain evidence of adequate health supervision. (a) A pre-employment physical examination, including a chest X-ray or an intradermal skin test for tuberculosis, and periodic physical examinations at least every two years shall be performed and recorded. (b) Accurate records of illnesses and incidents involving personnel while on duty shall be kept. (7) No individual shall be employed, or employee permitted to work, if infected with a contagious disease in a communicable form that might endanger the health of residents or other employees. (8) Requirement for Personnel to Be Vaccinated against Influenza Virus. (a) Definitions. 1. For purposes of 105 CMR 150.002(D)(8), personnel means an individual or individuals who either work at or come to the licensed facility site and who are employed by or affiliated with the facility, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid including, but not limited to, employees, members of the medical staff, contract employees or staff, students, and volunteers, whether or not such individual(s) provide direct care. 2. For purposes of 105 CMR 150.002(D)(8), the requirement for influenza vaccine or vaccination means immunization by either influenza vaccine, inactivated or live; attenuated influenza vaccine including seasonal influenza vaccine pursuant to 105 CMR 150.002(D)(8)(b); and/or other influenza vaccine pursuant to 105 CMR 150.002(D)(8)(c). 3. For purposes of 105 CMR 150.002(D)(8), mitigation measures mean measures that personnel who are exempt from vaccination must take to prevent viral infection and transmission. (b) Each facility shall ensure all personnel are vaccinated annually with seasonal influenza vaccine, consistent with any guidelines of the Commissioner, unless an individual is exempt from vaccination in accordance with 105 CMR 150.002(D)(8)(f). (c) Each facility also shall ensure all personnel are vaccinated against other pandemic or novel influenza virus(es) as specified in guidelines of the Commissioner, unless an individual is exempt from vaccination in accordance with 105 CMR 150.002(D)(8)(f). Such guidelines may specify: 1. The categories of personnel to be vaccinated and the order of priority of vaccination of personnel, with priority for personnel with responsibility for direct care; 2. The influenza vaccine(s) to be administered; 3. The dates by which personnel must be vaccinated; and 4. Any required reporting and data collection relating to the personnel vaccination requirement of 105 CMR 150.002(D)(8)(c). (d) Each facility shall provide all personnel with information about the risks and benefits of influenza vaccine. (e) Each facility shall notify all personnel of the influenza vaccination requirements of 105 CMR 150.002(D)(8) and shall, at no cost to any personnel, provide or arrange for vaccination of all personnel who cannot provide proof of current immunization against influenza unless an individual is exempt from vaccination in accordance with 105 CMR 150.002(D)(8)(f). (f) Exemptions. 1. Subject to the provisions set forth in 105 CMR 150.002(D)(8)(f)(2), a facility shall not require an individual to receive an influenza vaccine pursuant to 105 CMR 150.000(D)(8)(b) or (c) if the individual declines the vaccine. 2. For anyindividual subject to the exemption, a facilityshall require such individual take mitigation measures, consistent with guidance from the Department. 3. An individual who is exempt from vaccination shall sign a statement certifying that they are exempt from vaccination and they received information about the risks and benefits of influenza vaccine. (g) Unavailability of Vaccine. A facility shall not be required to provide or arrange for influenza vaccination during such times the vaccine is unavailable for purchase, shipment, distribution, or administration by a third-party or when complying with an order of the Commissioner restricting the use of the vaccine. A facility shall obtain and administer influenza vaccine in accordance with 105 CMR 150.002(D)(8) as soon as vaccine becomes available. (h) Documentation. 1. A facility shall require and maintain for each individual proof of current vaccination against influenza virus pursuant to 105 CMR 150.008(D)(8)(b) and (c), or the individual’s exemption statement pursuant to 105 CMR 150.002(D)(8)(f). 2. Each facility shall maintain a central system to track the vaccination status of all personnel. 3. If a facility is unable to provide or arrange for influenza vaccination for any individual, it shall document the reasons such vaccination could not be provided or arranged for. (i) Reporting and Data Collection. Each facility shall report information to the Department documenting the facility’s compliance with the personnel vaccination requirements of 105 CMR 150.002(D)(8), in accordance with reporting and data collection guidelines of the Commissioner. (j) 105 CMR 150.002(D) establishes requirements for influenza vaccination of long-term care facility personnel. Nothing in 105 CMR 150.000 shall be read to prohibit facilities from establishing policies and procedures for influenza vaccination of personnel that exceed the requirements set forth in 105 CMR 150.002(D). (9) A facility may not hire any individual, whom the facility knows or should have reason to know, who cannot perform the duties of his or her job or whose employment could pose a threat to the health, safety or welfare of the residents. (10) The Department shall be notified as specified in the guidelines of the department of the resignation or dismissal of the administrator, the director of nurses and the name and qualifications of the new employee. In the case of dismissal, notice to the Department shall state the reasons. Requirement for Personnel to Be Vaccinated against Coronavirus Disease 2019 (COVID-19) Caused by the Virus SARS-CoV-2. (a) Definitions. 1. For purposes of 105 CMR 150.002(D)(11), personnel means an individual or individuals who either work at or come to the licensed facility site and who are employed by or affiliated with the facility, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid including, but not limited to, employees, members of the medical staff, contract employees or staff, students, and volunteers, whether or not such individual(s) provide direct care. 2. For purposes of 105 CMR 150.002(D)(11), COVID-19 vaccination means being up to date with COVID-19 vaccines as recommended by the Centers for Disease Control and Prevention (CDC). 3. For purposes of 105 CMR 150.002(D)(11), mitigation measures mean measures that personnel who are exempt from vaccination must take to prevent viral infection and transmission. (b) Each facility shall ensure all personnel have received COVID-19 vaccination in the timeframe specified in Department guidelines, unless an individual is exempt from vaccination in accordance with 105 CMR 150.002(D)(11)(e). (c) Each facility shall provide all personnel with information about the risks and benefits of COVID-19 vaccination. (d) Each facility shall notify all personnel of the COVID-19 vaccination requirements of 105 CMR 150.002(D)(11) and shall, at no cost to any personnel, provide or arrange for vaccination of all personnel who cannot provide proof of current vaccination against COVID-19 unless an individual is exempt from vaccination in accordance with 105 CMR 150.002(D)(11)(e). (e) Exemptions. 1. Subject to the provisions set forth in 105 CMR 150.002(D)(11)(e)(2), a facility shall not require an individual to receive a COVID-19 vaccine pursuant to 105 CMR 150.002(D)(11)(b) if the individual declines the vaccine. 2. For any individual subject to the exemption, a facility shall require such individual take mitigation measures, consistent with guidance from the Department. 3. An individual who is exempt from vaccination shall sign a statement certifying that they are exempt from vaccination and they received information about the risks and benefits of COVID-19 vaccine. (f) Unavailability of Vaccine. A facility shall not be required to provide or arrange for COVID-19 vaccination during such times the vaccine is unavailable for purchase, shipment, distribution, or administration by a third-party or when complying with an order of the Commissioner restricting the use of the vaccine. A facility shall obtain and administer COVID-19 vaccine in accordance with 105 CMR 150.002(D)(11) as soon as vaccine becomes available. (g) Documentation. 1. A facility shall require and maintain for each individual proof of current vaccination against COVID-19 virus pursuant to 105 CMR 150.002(D)(11)(b) or the individual's exemption statement pursuant to 105 CMR 150.002(D)(11)(e). 2. Each facility shall maintain a central system to track the vaccination status of all personnel. 3. If a facility is unable to provide or arrange for COVID-19 vaccination for any individual, it shall document the reasons such vaccination could not be provided or arranged for. (h) Reporting and Data Collection. Each facility shall report information to the Department documenting the facility's compliance with the personnel vaccination requirements of 105 CMR 150.002(D)(11) in accordance with reporting and data collection guidelines of the Commissioner. (i) 105 CMR 150.002(D) establishes requirements for COVID-19 vaccination of long-term care facility personnel. Nothing in 105 CMR 150.000 shall be read to prohibit facilities from establishing policies and procedures for COVID-19 vaccination of personnel that exceed the requirements set forth in 105 CMR 150.002(D). (E) The administrator shall establish procedures for notifying the resident or the resident’s legal representative in the event of significant change in a resident’s charges, billings, benefit status and other related administrative matters. (1) The administrator shall establish provisions for the safekeeping of personal effects, funds and other property brought to the facility by residents except, when necessary for the protection of valuables and to avoid unreasonable responsibility, the administrator may require such valuables be excluded or removed from the premises. (2) If the facility assumes the responsibility for safekeeping of residents’ possessions and valuables, an accurate, written record of all valuables and possessions shall be maintained. A receipt for all items placed in safekeeping shall be provided to the resident or resident’s guardian. (3) If the facility assumes the responsibility for managing a resident’s funds, such funds shall be placed in an insured interest bearing account with the clear written understanding the facility has only a fiduciary interest in the funds of this account. The account may be either individual or collective at the election of the facility and shall be deposited at the prevailing market rate of interest for deposits in Massachusetts and shall conform to the requirements associated with the particular account. (a) Interest earned by any such funds so deposited shall be credited to each resident. (b) For individual accounts, the interest earned must be prorated to each resident on an actual interest earned basis. (c) The interest earned on any collective account must be prorated to each resident on the basis of his or her end of quarter or nearest end of the month balance. NON-TEXT PAGE (d) The facility may keep a portion of a resident’s money in a personal needs petty cash fund. The amount kept in this petty cash fund shall not be greater than the limit set and must be administered in accordance with the Department of Transitional Assistance. The personal needs petty cash fund shall not be co-mingled with any operational petty cash fund the facility may maintain nor shall it be used for facility operational expenses. A record of money spent for each resident shall be kept. (e) No fee or other charges shall be applied to any individual resident for such managing of funds or distribution of interest. (f) The facility shall provide the resident or the resident’s guardian with an accounting report every three months of financial transactions made in his or her behalf. (g) In the event of discharge of a resident, except if the resident’s bed is being held for anticipated readmission, all funds of that resident shall be returned to the resident or to the resident’s guardian with a written accounting in exchange for a signed receipt. Funds maintained outside of the facility shall be returned within ten business days. (h) In the event of the death of a resident, the facility shall provide a complete accounting of that resident’s funds to the administrator or executor of the resident’s estate. (4) A statement of all funds, valuables and possessions shall be prepared on admission, transfer or discharge and shall be verified, dated and signed by the resident or the resident’s guardian and by a witness. A copy of the list shall be given to the resident, or the resident’s guardian. (5) The admission of a resident to a long-term care facility and his or her presence therein shall not confer on the facility or its owner, administrator, employees or representatives authority to manage, use or dispose of any property (except drugs) of such resident without written, signed permission to do so by the resident or the resident’s guardian. (6) The name, address and the phone number of the resident’s emergency contact shall be kept readily available in the resident’s chart. The designated individual shall be contacted immediately in an emergency involving the resident. Such notification shall be recorded in writing in the clinical record. (F) The administrator shall establish procedures for the notification of the primarycare provider and the resident’s emergency contact in the event of an emergency. (G) The administrator shall be responsible for ensuring all required records, reports and other materials are complete, accurate, current and available within the facility and the following requirements are met: (1) Each facility shall immediately report to the Department any of the following events occuring on premises covered by its license: (a) A death that is unanticipated, not related to the natural course of the resident’s illness or underlying condition, or is the result of an error or other incident as specified in the Department’s guidelines; (b) Full or partial evacuation of the facility; (c) Fire; (d) Suicide; (e) Serious criminal act; (f) Pending or actual strike action by its employees, and contingency plans for operation of the facility; (g) Reportable conditions and illness as defined in 105 CMR 300.020: Report of a Disease when such illness is: 1. Believed to be part of a suspected or confirmed cluster or outbreak; 2. Believed to be unusual as defined in 105 CMR 300.020: Unusual Illness; or 3. Related to food consumption or believed to be transmissible through food; or (h) Other serious incidents or accidents as specified in the Department’s guidelines. (2) Each facility shall immediately report to the Department any suspected instance(s) of resident abuse, neglect, mistreatment or misappropriation of a resident’s personal property, as defined in 105 CMR 155.000: Patient and Resident Abuse Prevention, Reporting, Investigation, Penalties and Registry. (3) Within seven days of the date of occurrence of the event, each facility shall report to the Department any other incident or accident occurring on premises covered by the facility’s license that seriously affects the health or safety of a resident(s) or causes serious physical injury to a resident(s). (4) The Department shall establish guidelines for reporting serious incidents and accidents, including the means of reporting. (5) A facility shall provide the Department with all information that may be relevant to the Department’s investigation of any incident or complaint, regardless of how reported to the Department. (6) A facility shall make all reasonable efforts to facilitate the Department’s attempts to interview all potential witnesses who may have information relevant to the Department’s investigation of any incident or complaint, regardless of how reported to the Department. (H) The administrator shall develop and implement policies and procedures governing emergency transport. Such policies and procedures shall include criteria for deciding whether to call the emergencytelephone access number 911 or its local equivalent, or a contracted private ambulance service provider, if any, in response to an emergency medical condition. The criteria for determining whether to call 911 versus the contracted provider shall address such factors as the nature of the emergency medical condition, and the time to scene arrival specified in relevant agreements with the contracted provider, if any. (I) The administrator of a nursing facility shall ensure the facility has an automated external defibrillator and policies and procedures for the rendering of automated external defibrillation in the facility. (1) All persons certified to provide automated external defibrillation shall: (a) successfully complete a course in cardiopulmonary resuscitation and in the use of an automated external defibrillator that meets or exceeds the standards established by the American Heart Association or the American National Red Cross; and (b) have evidence that course completion is current and not expired. (2) The facility shall contract with or employ a physician who shall be the automated external defibrillation medical director for the facility who shall oversee and coordinate the following: (a) maintenance and testingof equipment in accordance with manufacturer’s guidelines; (b) certification and training of facility personnel; (c) periodic performance review of the facilityautomated external defibrillation activity; (d) development of policies and procedures consistent with current medical practice regarding the use of automated external defibrillators. (J) Upon change of ownership, the medications, funds and personal belongings of all residents shall be checked and identified by the licensee and the new owner. A complete count of controlled substances under the federal Comprehensive Drug Abuse Prevention and Control Act of 1970 shall be made, recorded and signed by the licensee and the new owner. (K) The facility shall provide Resident survey reports, annual reports and such other reports and information as may be required to the Department in the manner and within the time period prescribed.