Haw. Code R. § 17-1737-36 - Inspection of care (IOC) reviews in ICF-MR facilities

(1) Inspection of care team members shall be employees of the department, and may consist of a physician or a registered nurse, and a social worker. One of the team members shall be a QMRP. If a physician is not on the team, a physician shall be available to provide consultation to the team;

(2) Frequency of inspection shall be based on the quality of care and services provided by the facility, and on the condition of clients in the facility. However, at the minimum, each client shall be evaluated once annually;

(3) No facility shall be notified of the time of inspection more than forty-eight hours before the scheduled arrival of the team;

(4) Method of inspection shall be by personal contact with and observation of each client, and review of each client's medical record to determine the following:

(A) Whether the facility services are adequate to meet the health needs of each client, the rehabilitative and social needs of each client and to promote maximum physical, mental, and psychosocial functioning;

(B) Whether continued stay in the facility is necessary and desirable;

(C) Whether it is feasible to meet the client's health needs, and in an ICF-MR the client's rehabilitative needs through alternative institutional or noninstitutional services; and

(D) Whether each client is receiving active treatment in accordance with the provisions of section 17-1737-30;

(5) The determinations on adequacy of services and related matters stipulated in paragraph (4) shall be based on, but not limited to, such items as whether:

(A) The medical evaluation, any required social and psychological evaluations, and the Individual Program Plans, where required, are followed; and all ordered services, including dietary orders, are provided and properly recorded;

(B) The attending physician reviews prescribed medications at least quarterly;

(C) Tests or observations of each client indicated by his medication regimen are made at appropriate times and are properly recorded;

(D) The individual program plan must be reviewed at least every ninety days by the QMRP and revised as necessary;

(E) For those clients certified as not needing a medical care plan, a review of their health status must be a direct physical examination by a licensed nurse on a quarterly or more frequent basis depending on client need and the result of any action (including referral to a physician to address client health problems) shall be recorded in the client's record;

(F) Progress notes by physicians, nurses, social workers, and other professionals are made as indicated and are reflective of the need for the specific professional's intervention consistent with the observed condition of the client, and support the need for continued stay at the ICF-MR;

(G) Progress notes shall be dated and signed followed by the professional's professional acronym;

(H) The client receives adequate services, based on such observations as cleanliness, absence of bedsores, absence of signs of malnutrition or dehydration, and apparent maintenance of maximum physical, mental, and psychosocial function;

(I) The client receives active treatment as defined in section 17-1737-30;

(J) The client needs any service that is not furnished by the facility through arrangements with others; and

(K) The client needs continued placement in the facility or there is an appropriate plan to transfer the patient to an alternate method of care;

(6) The inspection of care team shall prepare a report promptly after each inspection. The report shall contain:

(A) The observations, conclusions, and recommendations of the team concerning the adequacy, appropriateness, and quality of all services provided in the facility or through other arrangements, including physician services to client's, and specific findings about individual clients in the facility; and

(B) The dates of the inspection and the names and qualifications of the members of the team; and

(7) The department shall send a copy of each inspection report to the facility inspected, the facility's utilization review committee, and the state department of health.

Notes

Haw. Code R. § 17-1737-36

[Eff 08/01/94] (Auth: HRS § 346- 14; 42 C.F.R. §§430.10, 431.10) (Imp: 42 C.F.R. §§456.600 - 456.613)