Acts and Regulations

85-187 - General

Full text
Document at 28 September 2012
NEW BRUNSWICK
REGULATION 85-187
under the
Nursing Homes Act
(O.C. 85-967)
Filed November 29, 1985
Under section 29 of the Nursing Homes Act, the Lieutenant-Governor in Council makes the following Regulation:
1This Regulation may be cited as the General Regulation - Nursing Homes Act.
2In this Regulation
“Act” means the Nursing Homes Act;
“activation and rehabilitation program” means activities provided to residents depending on their individual needs and limitations, and includes arts and crafts, therapeutic recreation and exercise, self-care activities, reality orientation, remotivation and socialization activities and other therapies;
“care” means a service provided to residents who require assistance with the activities of daily living on a continuing twenty-four hour basis, with some medical and professional nursing attention and supervision;
“care plan” means a plan that establishes care objectives and prescribes an integrated program of actions to meet the medical, nursing, dietary, activation and rehabilitation program, psycho-social and spiritual needs of a resident;
“care staff” includes registered nurses, registered nursing assistants and any other persons engaged in providing care to residents but excludes dietary, laundry and maintenance staff and staff who provide an activation and rehabilitation program;
“controlled dosage system” means a unit dosage system which allows for the control and distribution of prescription and non-prescription drugs on an individual basis;
“notifiable disease” means a notifiable disease specified in New Brunswick Regulation 88-200 under the Health Act;
“nursing care assessment” means an evaluation, in accordance with standards approved by the Minister, of the care required to meet the needs of a prospective resident after eligibility for admission has been established;
“nurse practitioner” means a registered nurse who is the holder of a current certificate of registration for practice as a nurse practitioner under the Nurses Act;
“participating pharmacy” means a pharmacy operated by a pharmacist who is a participating provider under the Prescription Drug Payment Act;
“pharmacist” means a person holding a valid pharmacist’s licence under the Pharmacy Act;(pharmacien)
“physician” means a person duly registered under the laws of the Province as authorized to practice medicine in the Province;
“registered nurse” means the holder of a current certificate of registration under the Nurses Act;
“registered nursing assistant” means a nursing assistant registered under the Registered Nursing Assistants Act and holding active membership with the Association of New Brunswick Registered Nursing Assistants.
91-55; 2002-58; 2009-74
I
CONSTRUCTION, RENOVATIONS
OR ALTERATIONS
3An operator planning new construction of a nursing home or renovations or alterations to a nursing home with a value of more than ten thousand dollars shall submit to the Minister for approval all plans, specifications and financing arrangements prior to any tender call or awarding of contract.
91-55
LICENSING
4(1)An application for a licence to establish a nursing home shall be made to the Minister and shall include the following information:
(a) the population of the surrounding area which it is proposed that the nursing home shall serve;
(b) the proposed program of services and care to be provided in the nursing home;
(c) evidence to demonstrate the availability of professional services required to operate the nursing home; and
(d) the proposed corporate structure of the operator including board and membership if the operator is a corporation.
4(2)An application for a licence to operate or maintain a nursing home shall be made to the Minister and shall include the following information:
(a) the proposed admission policy for the nursing home;
(b) the estimated staffing requirements of the nursing home; and
(c) a plan showing the proposed space allocation of all areas of the nursing home.
5A licence issued by the Minister
(a) shall expire on the date indicated on the licence;
(b) shall specify the name of the operator to whom it is issued and the name of the nursing home the operator is licensed to operate;
(c) shall show the total bed capacity of the nursing home the operator is licensed to operate; and
(d) shall show any exemptions from compliance with the physical standards prescribed in this Regulation.
FEES
6(1)The fee for a licence to establish, operate or maintain a nursing home shall be fifty dollars.
6(2)The fee for a renewal of a licence to establish, operate or maintain a nursing home shall be twenty dollars.
II
ADMINISTRATION
ADMISSION
7An operator of a nursing home with thirty beds or more shall ensure the establishment of an admissions committee whose responsibility shall be to determine persons to be admitted to the nursing home on the basis of the person’s needs and the ability of the nursing home to meet those needs.
91-55
8An admissions committee, established under section 7, shall consist of no fewer than three persons and shall include the administrator and the director of nursing of the nursing home.
9(1)No operator shall admit or permit to be admitted or transferred to a nursing home a person
(a) suffering from a notifiable disease except under conditions determined by a district medical health officer, or
(b) who has not had a physical examination and nursing care assessment before the date of admission.
9(2)Notwithstanding subsection (1), an operator may admit for temporary residence in a nursing home for the purpose of providing relief care a person who has given a complete medical history and has received a physical examination and a nursing care assessment prior to admission.
9(3)Notwithstanding subsections (1) and (2), an operator may admit a person for temporary residence in a nursing home under emergency conditions if the person gives a complete medical history and receives a physical examination and a nursing care assessment within seventy-two hours after admission.
91-55; 92-142
9.1No operator or admissions committee established for a nursing home shall refuse to admit a person to a nursing home where the person has been determined to be eligible for admission to a nursing home by the Minister, the person has applied for admission to the nursing home and the nursing home has a vacancy for a resident.
91-56
RECORDS
10An operator of a nursing home shall ensure that the staff promptly complete, in writing, an incident report and submit it to the administrator each time an incident or accident takes place that affects or may affect the health and safety of the residents or staff.
91-55
GENERAL AND SAFETY
11An operator shall ensure that the buildings, equipment and surroundings of a nursing home are maintained in a clean, neat and safe condition.
12An operator shall ensure that all corridors, stairs, landings, ramps and doorways of a nursing home are kept clear and free from obstruction.
13An operator shall develop a fire and safety program for a nursing home that shall include
(a) a smoking policy which contemplates supervised smoking when circumstances so require,
(b) the designation of personnel to be responsible for ensuring strict compliance with fire safety standards,
(c) evacuation and disaster plans, a copy of which shall be filed with the Minister, and the posting of basic evacuation and emergency orders,
(d) fire drills as required to ensure that all staff are familiar with their duties and the recording of these drills, and
(e) an electrical appliance policy governing the use and maintenance of any electrical appliances intended to be used in residents’ rooms.
14(1)Every person to be employed in a nursing home shall, before entering employment,
(a) give a complete medical history and receive a physical examination,
(b) submit to such examinations as are required to ensure that he is free from a notifiable disease, and
(c) submit the results of the examinations referred to in paragraphs (a) and (b) to the employer.
14(2)No person employed in a nursing home shall work in the nursing home while a carrier of or sick from a notifiable disease.
14(3)No person employed in a nursing home shall refuse without valid reason to submit to such preventive procedures with respect to health and safety as the Minister may from time to time require.
91-55
USE OF OXYGEN
15No person shall use tank oxygen for medical purposes in a nursing home except where tank oxygen is used for emergency purposes or where the use of tank oxygen is shown on the licence in accordance with paragraph 5(d) as a service that may be provided.
16No person shall administer tank oxygen except in emergency care situations and from small portable containers.
III
CARE SERVICES
17An operator shall establish a program with respect to the orientation and in-service training of all employees.
18An operator shall ensure that
(a) in nursing homes with thirty beds or more, the care of each resident is carried out by or under the supervision of a registered nurse as directed by the attending physician, or as directed by a nurse practitioner
(b) in nursing homes with thirty beds or more, at least one registered nurse is on duty on the premises at all times,
(c) in addition to the registered nurse referred to in paragraph (a), care staff is in attendance at all times in appropriate ratios, and
(d) a comprehensive care plan is developed for each resident upon admission, reviewed at least annually and evaluated on an ongoing basis.
2002-58
MEDICAL AND DENTAL CARE
19An operator shall ensure that
(a) an attending physician is appointed to be responsible for the care of a resident on admission and shall be either the resident’s regular physician or a physician appointed by the operator with the consent of the resident or his legal representative,
(b) the services of a physician are available at all times upon request,
(c) Repealed: 91-55
(d) where a resident dies in a nursing home, the resident’s attending physician as appointed under paragraph (a) shall be notified, and he shall prepare a written report indicating the cause and time of death to be entered into the deceased resident’s medical record.
91-55
20(1)An operator shall ensure that a device for restraining a resident shall only be applied
(a) when necessary to protect the resident from injury to himself or others, and
(b) on the written order of a physician, nurse or nurse practitioner who has attended the resident and approved the device as appropriate for its intended use.
20(2)Repealed: 2002-58
20(3)Where a device for restraining a resident is applied, the device shall
(a) be designed so as not to cause physical injury to the resident,
(b) be designed so as to cause the least possible discomfort to the resident,
(c) be examined at least every two hours by a registered nurse or some other person on the direction of a nurse, and
(d) be applied in such a manner that quick release of the restrained resident can be effected by staff.
91-55; 2002-58
21An operator shall ensure that
(a) all prescription and non-prescription medications are administered only on the order of a physician, pharmacist, nurse practitioner or dentist, which order, if verbally given, is confirmed in writing on the physician’s, nurse practitioner’s or dentist’s next visit;
(b) all medications in nursing homes with a rated capacity of thirty beds or more are purchased from one participating pharmacy in the form of the controlled dosage system in accordance with the physician’s, pharmacist’s or nurse practitioner’s written prescription;
(c) all prescribed medications are kept in containers supplied by the participating pharmacy bearing the original label on which shall be legibly recorded the prescription number, the name or content of the medication, the resident’s name, the directions for use, the prescriber’s name, the date of issue and the name of the pharmacy from which the medication was issued;
(d) medication is not administered to any resident other than to the resident for whom such medication was prescribed;
(e) no resident keeps or is permitted to keep medication on his or her person or in his or her room unless authorized by the resident’s attending physician, a pharmacist, a nurse practitioner or a nurse under such conditions as he or she may impose;
(f) any unused medication remaining upon the death of the resident for whom it was prescribed, or any medication discontinued permanently, is returned to the pharmacy from which the medication was issued;
(g) any unused medication remaining to a resident upon his transfer or discharge is taken with the resident if so approved by the resident’s attending physician, a pharmacist, a nurse practitioner or a nurse, or is returned to the pharmacy from which the medication was issued;
(h) subject to paragraph (a), there is a limited supply at the nursing home of only those most commonly used medications which are readily available without prescription at any commercial pharmacy;
(i) subject to paragraph (a), there is for use in emergency situations at the nursing home a limited supply of prescription medications as determined necessary by a physician, a pharmacist, a nurse practitioner who is employed by the nursing home, if any, the nursing home’s administrator, the nursing home’s director of nursing and a participating pharmacy; and
(j) medications are stored in locked cabinets and prepared in an appropriately equipped area.
91-55; 2002-58; 2009-74
22The medical record of a resident shall contain the following:
(a) the date, time and findings of an examination and treatment; and
(b) confirmation in writing of all verbal orders for treatment, medications or other medical procedures.
DIETARY AND FOOD SERVICE
STANDARDS
23An operator shall ensure that service of food in a nursing home is in accordance with the following requirements:
(a) the basic daily dietary requirements for each resident shall be provided in accordance with the nutritional standards developed by the Department of National Health and Welfare, and known as the Canada Food Guide, and shall be supplemented to meet the nutritional needs of the individual resident;
(b) a minimum three week cycle menu prepared at least a week in advance shall be posted in the dietary department serving the nursing home and copies of the menu shall be retained on file for a period of at least three months, and any changes or substitutions thereto shall be noted on the menu;
(c) menus shall be prepared so that a satisfactory variety of food is offered to residents in order that nutritional and dietary needs and problems may be satisfied;
(d) at least three meals shall be served to residents each day at regular times and at reasonable hours and there shall be no more than a fifteen-hour period between a substantial supper and breakfast, and supplementary feeding shall be provided as required; and
(e) therapeutic special diets shall be served to a resident as and when ordered by his physician or a nurse practitioner employed by the nursing home and such diets shall be recorded on the resident’s medical record.
91-55; 2002-58
ACTIVATION AND REHABILITATION
PROGRAMS
24An operator shall ensure that appropriate activation and rehabilitation programs are provided to residents.
IV
PHYSICAL STANDARDS FOR
NURSING HOMES
25(1)An operator shall ensure compliance with the physical standards set out in this Part except as otherwise indicated.
25(2)Notwithstanding subsection (1), an operator may make application to the Minister for an exemption with respect to specific provisions under this Part which, upon approval, shall be listed on the face of the licence.
26The furnishings and equipment in all residential areas of a nursing home shall be adequate for the safety, comfort and convenience of residents.
27Emergency lighting shall be provided in the corridors and at the exits of all nursing homes from a source of energy separate from the electrical supply of the building and shall be automatically activated when the electrical supply is interrupted.
28Every nursing home shall have a heating system capable of maintaining a consistent 23° Celsius temperature throughout the nursing home and the temperature in the nursing home shall be maintained at a level consistent with the comfort of the residents therein.
29(1)No portable heater shall be used in a nursing home except in emergency situations and subject to the fire and safety program prescribed in section 13.
29(2)Notwithstanding subsection (1), no kerosene heater shall be used in a nursing home at any time.
30(1)Sprinkler systems, approved by the fire marshal, shall be installed in all nursing homes of thirty beds or more.
30(2)Where, on the coming into force of this Regulation, a nursing home of thirty beds or more does not have a sprinkler system, installation of such a system, approved by the fire marshal, shall be initiated prior to March 31, 1986 and completed within one year.
31Every nursing home constructed after the coming into force of this Regulation shall meet the current standards of the National Building Code of Canada and, where this Regulation provides for higher standards, shall meet the requirements of this Regulation.
32In every nursing home constructed after the coming into force of this Regulation, an easily accessible electrically operated individual call system shall be installed and this call system shall operate from bedside, bathing areas, toilet facilities and other areas in which residents and the public gather and register at the site of the operation, in the corridor and at the nursing station.
33In every nursing home constructed after the coming into force of this Regulation, all exit doors, except the main entrance, leading to the outside of the nursing home and to which residents have access shall be connected to an automatic alarm system and the alarm shall have a cancel and reset switch at each nursing station.
V
FINANCIAL REPORTING
34This Part applies to nursing homes with thirty beds or more except that section 40 applies to all nursing homes.
35The fiscal year of a nursing home commences on the first day of April in each year and ends on the thirty-first day of March in the following year.
36To qualify for financial assistance under the Act, an operator shall submit to the Minister such statements, reports and other evidence as may at any time be required by the Minister which may include an annual budget indicating the estimated cost of providing all services in the nursing home.
37(1)Not later than the thirty-first day of July in each year, an operator shall submit to the Minister financial statements for the preceding fiscal year, audited by a practising public accountant acceptable to the Minister.
37(2)The financial statements of a nursing home submitted under subsection (1) shall be in a form acceptable to the Minister and shall provide detailed information concerning the total revenue, including the type and amount of provincial contributions, and all expenditures.
38Repealed: 2006-83
2006-83
39Under section 22 of the Act, the Minister may provide financial assistance of up to one hundred thousand dollars to a nursing home without the approval of the Lieutenant-Governor in Council.
40Before providing financial assistance under section 23 of the Act the Minister shall ensure that a financial assessment has been completed.
VI
91-55
DUTIES OF INSPECTORS
91-55
40.1An inspector shall, during an inspection of a nursing home, visually examine, in accordance with requirements set by the Minister, one or more residents of the nursing home in order to assess the over-all health and well-being of the resident or residents and to determine if the resident or residents are receiving adequate care.
91-55
VII
91-55
BOARDS OF DIRECTORS OF NON-PROFIT
NURSING HOMES
91-55
40.2(1)A board of directors of a nursing home that is operated on a non-profit basis shall have a minimum of ten to a maximum of fifteen members.
40.2(2)No person shall serve more than nine consecutive years as a member of a board of directors of a nursing home that is operated on a non-profit basis.
40.2(3)A person who has served nine consecutive years as a member of a board of directors of a nursing home that is operated on a non-profit basis is not eligible to serve again as a member of the board of directors until one year after the person ceased to serve as a member of the board of directors.
40.2(4)The following persons are not eligible to serve as members of a board of directors of a nursing home that is operated on a non-profit basis:
(a) an employee of the nursing home;
(b) the spouse, child, parent, brother or sister of an employee of the nursing home;
(c) an employee of the Department of Social Development;
(d) a member of the Legislative Assembly of New Brunswick; or
(e) a health care professional delivering health care services to the residents of the nursing home or receiving a retainer from the nursing home.
40.2(5)A member of the board of directors of a nursing home that is operated on a non-profit basis shall not vote on any matter considered by the board in which the member has a financial or other interest, and the member shall declare such interest before a vote is taken.
91-55; 2000, c.26, s.231; 2008, c.6, s.34
40.3A person who selects or appoints a member to a board of directors of a nursing home that is operated on a non-profit basis shall attempt to ensure that the selection or appointment results in the composition of the board of directors of the nursing home generally reflecting the composition of the population of the area in which the nursing home is situated.
91-55
41New Brunswick Regulation 82-112 under the Nursing Homes Act is repealed.
N.B. This Regulation is consolidated to July 22, 2009.