Section 340.1505  Medical, Nursing and Restorative Services

a)         Comprehensive resident care plan.  A facility, with the participation of the resident and the resident's guardian or representative, as applicable, must develop and implement a comprehensive care plan for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment, which allow the resident to attain or maintain the highest practicable level of independent functioning, and provide for discharge planning to the least restrictive setting based on the resident’s care needs.  The assessment shall be developed with the active participation of the resident and the resident’s guardian or representative, as applicable. (Section 3-202.2a of the Act)

b)         The facility shall provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of the resident, in accordance with each resident's comprehensive resident care plan.  Adequate and properly supervised nursing care shall be provided to each resident to meet the total nursing care needs of the resident.

1)         The licensed nurse in charge of the restorative/rehabilitative nursing program shall have successfully completed a course or other training program that includes at least 60 hours of classroom/lab training in restorative/rehabilitative nursing as evidenced by a transcript, certificate, diploma, or other written documentation from an accredited school or recognized accrediting agency such as a State or National organization of nursing or a state licensing authority. This person may be the Director of Nursing Services, Assistant Director of Nursing Services or another nurse designated by the Director of Nursing Services to be in charge of the restorative/rehabilitative nursing program.

2)         All nursing personnel shall assist and encourage residents so that a resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction  in range of motion  is unavoidable.  All nursing personnel shall assist and encourage residents so that a resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion.

3)         All nursing personnel shall assist and encourage residents so that a resident who is incontinent of bowel and/or  bladder receives the appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.  All nursing personnel shall assist residents so that a resident who enters the facility  without an indwelling catheter is not catherized unless the resident's clinical condition demonstrates that catheterization was necessary.

4)         All nursing personnel shall assist and encourage residents so that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that diminution was unavoidable.  This includes the resident's abilities to bathe, dress, and groom; transfer and ambulate; toilet; eat; and use speech, language or other functional communication systems.  A resident who is unable to carry out activities of daily living shall receive the services necessary to maintain good nutrition, grooming, and personal hygiene.

5)         All nursing personnel shall assist and encourage residents with ambulation and safe transfer activities as necessary in an effort to help them retain or maintain their highest practicable level of functioning.

c)         Each direct care-giving staff shall review and be knowledgeable about his or her residents' respective resident care plan. 

d)         Pursuant to subsection (a), general nursing care shall include at a minimum the following and shall be practiced on a 24-hour, seven-day-a-week basis:

1)         Medications, including oral, rectal, hypodermic, intravenous, and intramuscular, shall be properly administered.

2)         All treatments and procedures shall be administered as ordered by the physician.

3)         Objective observations of changes in a resident's conditions, including mental and emotional changes, as a means for analyzing and determining care required and the need for further medical evaluation and treatment shall be made by nursing staff and recorded in the resident's medical record.

e)         A regular program to prevent and treat pressure sores, heat rashes or other skin breakdown shall be practiced on a 24-hour, seven-day-a-week basis so that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that the pressure sores were unavoidable.  A resident having pressure sores shall receive treatment and services to promote healing, prevent infection, and prevent new pressure sores from developing.

f)         If physical therapy, occupational therapy, speech therapy or any other specialized rehabilitative service is offered, it shall be provided by, or supervised by, a qualified professional in that specialty and upon the written order of the physician.

1)         In addition to the provision of direct services, any such qualified professional personnel shall be used as consultants to the total restorative program and shall assist with resident evaluation, resident care planning, and inservice education.

2)         Appropriate records shall be maintained by these personnel. Direct service to individual residents shall be documented on the individual clinical record as set forth in Section 340.1800(e) of this Part. A summary of program consultation and recommendations shall be documented.

g)         All necessary precautions shall be taken to assure that the resident's environment remains as free of accident hazards as possible.  All nursing personnel shall evaluate residents to see that each resident receives adequate supervision and assistance to prevent accidents.

(Source:  Amended at 35 Ill. Reg. 11896, effective June 29, 2011)