198.088. Facilities to establish policies and procedures, scope, content--rights of residents--complaint--procedure.
Facilities to establish policies and procedures, scope,content--rights of residents--complaint--procedure.
198.088. 1. Every facility, in accordance with the rules applying toeach particular type of facility, shall ensure that:
(1) There are written policies and procedures available to staff,residents, their families or legal representative and the public which governall areas of service provided by the facility. The facility shall also retainand make available for public inspection at the facility to staff, residents,their families or legal representative and the public a complete copy of eachofficial notification from the department of violations, deficiencies,licensure approvals, disapprovals, and responses, a description of services,basic rate and charges for any services not covered by the basic rate, if any,and a list of names, addresses and occupation of all individuals who have aproprietary interest in the facility;
(2) Policies relating to admission, transfer, and discharge of residentsshall assure that:
(a) Only those persons are accepted whose needs can be met by thefacility directly or in cooperation with community resources or otherproviders of care with which it is affiliated or has contracts;
(b) As changes occur in their physical or mental condition,necessitating service or care which cannot be adequately provided by thefacility, residents are transferred promptly to hospitals, skilled nursingfacilities, or other appropriate facilities; and
(c) Except in the case of an emergency, the resident, his next of kin,attending physician, and the responsible agency, if any, are consulted atleast thirty days in advance of the transfer or discharge of any resident, andcasework services or other means are utilized to assure that adequatearrangements exist for meeting his needs through other resources;
(3) Policies define the uses of chemical and physical restraints,identify the professional personnel who may authorize the application ofrestraints in emergencies and describe the mechanism for monitoring andcontrolling their use;
(4) Policies define procedures for submittal of complaints andrecommendations by residents and for assuring response and disposition;
(5) There are written policies governing access to, duplication of, anddissemination of information from the resident's records;
(6) Each resident admitted to the facility:
(a) Is fully informed of his rights and responsibilities as a resident.Prior to or at the time of admission, a list of resident rights shall beprovided to each resident, or his designee, next of kin, or legal guardian. Alist of resident rights shall be posted in a conspicuous location in thefacility and copies shall be available to anyone upon request;
(b) Is fully informed in writing, prior to or at the time of admissionand during stay, of services available in the facility, and of related chargesincluding any charges for services not covered under the federal or stateprograms or not covered by the facility's basic per diem rate;
(c) Is fully informed by a physician of his health and medical conditionunless medically contraindicated, as documented by a physician in his residentrecord, and is afforded the opportunity to participate in the planning of histotal care and medical treatment and to refuse treatment, and participates inexperimental research only upon his informed written consent;
(d) Is transferred or discharged only for medical reasons or for hiswelfare or that of other residents, or for nonpayment for his stay. Noresident may be discharged without notice of his right to a hearing and anopportunity to be heard on the issue of whether his immediate discharge isnecessary. Such notice shall be given in writing no less than thirty days inadvance of the discharge except in the case of an emergency discharge. Inemergency discharges a written notice of discharge and right to a hearingshall be given as soon as practicable and an expedited hearing shall be heldupon request of the resident, next of kin, legal guardian, or nursingfacility;
(e) Is encouraged and assisted, throughout his period of stay, toexercise his rights as a resident and as a citizen, and to this end may voicegrievances and recommend changes in policies and services to facility staff orto outside representatives of his choice, free from restraint, interference,coercion, discrimination, or reprisal;
(f) May manage his personal financial affairs, and, to the extent thatthe facility assists in such management, has his personal financial affairsmanaged in accordance with section 198.090;
(g) Is free from mental and physical abuse, and free from chemical andphysical restraints except as follows:
a. When used as a part of a total program of care to assist the residentto attain or maintain the highest practicable level of physical, mental orpsychosocial well-being;
b. When authorized in writing by a physician for a specified period oftime; and
c. When necessary in an emergency to protect the resident from injury tohimself or to others, in which case restraints may be authorized by designatedprofessional personnel who promptly report the action taken to the physician. When restraints are indicated, devices that are least restrictive, consistentwith the resident's total treatment program, shall be used;
(h) Is ensured confidential treatment of all information contained inhis records, including information contained in an automatic data bank, andhis written consent shall be required for the release of information topersons not otherwise authorized under law to receive it;
(i) Is treated with consideration, respect, and full recognition of hisdignity and individuality, including privacy in treatment and in care for hispersonal needs;
(j) Is not required to perform services for the facility;
(k) May communicate, associate and meet privately with persons of hischoice, unless to do so would infringe upon the rights of other residents, andsend and receive his personal mail unopened;
(l) May participate in activities of social, religious and communitygroups at his discretion, unless contraindicated for reasons documented by aphysician in the resident's medical record;
(m) May retain and use his personal clothing and possessions as spacepermits;
(n) If married, is ensured privacy for visits by his or her spouse; ifboth are residents in the facility, they are permitted to share a room; and
(o) Is allowed the option of purchasing or renting goods or services notincluded in the per diem or monthly rate from a supplier of his own choice;
(7) The resident or his designee, next of kin or legal guardian receivesan itemized bill for all goods and services actually rendered;
(8) A written account, available to residents and their families, ismaintained on a current basis for each resident with written receipts for allpersonal possessions and funds received by or deposited with the facility andfor all disbursements made to or on behalf of the resident.
2. Each facility and the department shall encourage and assist residentsin the free exercise of the resident's rights to civil and religiousliberties, including knowledge of available choices and the right toindependent personal decision. Each resident shall be given a copy of astatement of his rights and responsibilities, including a copy of thefacility's rules and regulations. Each facility shall prepare a written planto ensure the respect of each resident's rights and privacy and shall provideappropriate staff training to implement the plan.
3. (1) Each facility shall establish written procedures approved by thedepartment by which complaints and grievances of residents may be heard andconsidered. The procedures shall provide for referral to the department ofany complaints or grievances not resolved by the facility's grievanceprocedure.
(2) Each facility shall designate one staff member, employed full time,referred to in this subsection as the "designee", to receive all grievanceswhen they are first made.
(3) If anyone wishes to complain about treatment, conditions, orviolations of rights, he shall write or cause to be written his grievance orshall state it orally to the designee no later than fourteen days after theoccurrence giving rise to the grievance. When the department receives acomplaint that does not contain allegations of abuse or neglect or allegationswhich would, if substantiated, constitute violation of a class I or class IIstandard as defined in section 198.085, and the complainant indicates that thecomplaint was not filed with the facility prior to the reporting of it to thedepartment, the department may in such instances refer the complaint to thestaff person who is designated by the facility to receive all grievances whenthey are first made. In such instances the department shall assureappropriate response from the facility, assure resolution at a subsequenton-site visit and provide a report to the complainant. The designee shallconfer with persons involved in the occurrence and with any other witnessesand, no later than three days after the grievance, give a written explanationof findings and proposed remedies, if any, to the complainant and to theaggrieved party, if someone other than the complainant. Where appropriatebecause of the mental or physical condition of the complainant or theaggrieved party, the written explanation shall be accompanied by an oralexplanation.
(4) The department shall establish and implement procedures for themaking and transmission of complaints to the department by any person allegingviolation of the provisions of sections 198.003 to 198.186, 198.200, 208.030,and 208.159, RSMo, and the standards established thereunder. The departmentshall promptly review each complaint. In the case of a refusal toinvestigate, the department shall promptly notify the complainant of itsrefusal and the reasons therefor; and in every other case, the departmentshall, following investigation, notify the complainant of its investigationand any proposed action.
4. Whenever the department finds upon investigation that there have beenviolations of the provisions of sections 198.003 to 198.186, 198.200, 208.030,and 208.159, RSMo, or the standards established thereunder by any personlicensed under the provisions of chapter 330, 331, 332, 334, 335, 336, 337,338, or 344, RSMo, the department shall forward a report of its findings tothe appropriate licensing or examining board for further investigation.
5. Each facility shall maintain a complete record of complaints andgrievances made against such facility and a record of the final disposition ofthe complaints and grievances. Such record shall be open to inspection byrepresentatives of the department during normal business hours.
6. Nothing in this section shall be construed as requiring a resident toexhaust grievance procedures established by the facility or by the departmentprior to filing a complaint pursuant to section 198.090.
(L. 1979 S.B. 328, et al. § 29, A.L. 1988 S.B. 602, A.L. 1989 S.B. 203 & 270, A.L. 1994 H.B. 1335 & 1381)