Nevada personal care agency policies and procedures

Hold the license before operating

No services before the license is issued; operating unlicensed is a misdemeanor.

"no person, state or local government or agency thereof may operate or maintain in this State an agency to provide personal care services in the home without first obtaining a license"

Keep records at the licensed location

Client, attendant, staff and operations records are kept at the location named on the license, including when the agency uses work stations.

"A person may operate an agency at multiple work stations if the agency maintains the records for the clients, attendants, other members of the staff of the agency and operations of the agency at the specific location designated on the license."

Responsible person on the license

The person designated as responsible for the agency is named on the license.

"The name of the person who is designated as responsible for the conduct of the agency must appear on the face of the license."

Liability coverage and surety bond

Keep proof of adequate liability coverage and of the surety bond (or approved deposit) sized to the number of employees; the license is suspended while there is no bond.

"Proof that it is adequately covered against liabilities resulting from claims incurred in the course of operation"

Bond amount by employee count

$5,000 under 7 employees, $25,000 for 7 to 25, $50,000 over 25, filed with each application and renewal. Our suggestion: review the amount when headcount changes.

"If the agency employs less than 7 employees, in the amount of $5,000"

Display the license

Display the license in a conspicuous place.

"Upon receipt of a license, the licensee shall display the license at a conspicuous location within the facility."

Report changes

Report a new administrator within 30 days, and changes of ownership, location or services immediately; amendments go through CLICS.

"A licensee shall notify the Division immediately of any change in:"

Renew every year

Renew before the license expires (an expired license cannot be renewed, NAC 449.0116(3)) with the fee and statements of compliance with the background check and elder abuse training rules; late renewal costs an extra charge.

"A statement that the holder of the license, the administrator or other person in charge and employees of the agency are in compliance with the provisions of NRS 449B.225."

Accurate name and advertising

The agency name, signs and listings must not mislead about services.

"must not contain any terms misleading to the public with regard to the services offered"

Policies that protect clients

Practices and policies must provide adequately for the health, safety and well-being of each client.

"provide adequately for the protection of the health, safety and physical, moral and mental well-being of each person served by the agency"

Administrator qualifications

At least 18; high school diploma or equivalent, or a Nevada long-term care administrator license; mature; understands the rules and statute; English literacy. HCQC wants a resume, diploma and ID proving age.

"Be responsible and mature and have the personal qualities which will enable the administrator to understand the problems of elderly persons and persons with disabilities"

Appoint a designee for absences

The administrator represents the licensee day to day and designates one or more employees to be in charge when absent.

"Designating one or more employees of the agency to be in charge of the agency during those times when the administrator is absent"

Designee can access records

The designee has access to all records, except confidential information the administrator keeps separately (see also NAC 449.3976(4)).

"an employee designated to be in charge of the agency when the administrator is absent must have access to all records kept at the agency"

Qualified, trained staff only

Employ qualified staff, ensure all required training, and ensure only trained attendants serve clients, following the assessment, service plan and policies.

"Ensuring that only trained attendants are providing services to a client of the agency"

Accounting and reporting system

Develop and implement an accounting and reporting system showing the agency’s finances.

"Developing and implementing an accounting and reporting system that reflects the fiscal experience and current financial position of the agency"

Contracted services

Negotiate contracted services lawfully and under agency policy.

"Negotiating for services provided by contract in accordance with legal requirements and established policies of the agency"

Oversight of staff

Provide oversight and direction so clients receive needed services.

"Providing oversight and direction for attendants and other members of the staff of the agency as necessary to ensure that the clients of the agency receive needed services"

Develop and implement policies

The administrator develops and implements the agency’s policies, including on terminating services.

"Developing and implementing policies and procedures for the agency, including, without limitation, policies and procedures concerning terminating the personal care services provided to a client"

Resources and capability

Show the Division on request that the agency can meet each service plan, and check capacity before starting or changing services.

"Evaluate whether the agency has sufficient resources and the capability to satisfy the requests of the client"

Keep, review and revise written policies

Keep written policies on staff qualifications, responsibilities and conditions of employment; review and revise them as needed.

"The written policies and procedures must be reviewed and revised as needed."

Give policies to staff on hire and on change

Make the policies available to attendants and staff when hired and whenever revised.

"The written policies and procedures must be made available to the attendants and other members of the staff of the agency upon hire and whenever revisions are made to those policies and procedures."

Map policies to HCQC’s checklist

HCQC’s initial inspection workbook ends with a 55-tag policy, form and document checklist. Keeping a crosswalk from each tag to a policy or form makes the prelicensure survey easier (HCQC expectation, not rule text).

"PCS - Policies & Procedures/Form/Document Checklist"

Attendant duties and responsibilities

Describe attendants’ duties and responsibilities. HCQC asks for job descriptions for each position (P0035).

"Provide descriptions of the duties and responsibilities of attendants"

Prohibited activities

List activities attendants may not engage in, at least: personal long-distance calls on the client’s phone or while on duty; lending, borrowing or accepting gifts of money or items; accepting money or tips other than for the client’s groceries or medication; becoming the client’s guardian or attorney-in-fact.

"Becoming the legal guardian of a client or being named as an attorney-in-fact in a power of attorney executed by the client"

No gifts, loans or gratuities

No loaning, borrowing or accepting gifts of money or personal items; no money or gratuities except money for the client’s groceries or medication.

"Accepting or retaining money or gratuities from a client, other than money needed for the purchase of groceries or medication for the client"

Client rights in policy

Set out the rights of clients.

"Set forth the rights of clients"

Ethics and confidentiality

Set out ethics requirements for staff, including confidentiality of client information. HCQC looks for a confidentiality or HIPAA form (P0050).

"Set forth any requirements relating to ethics governing attendants and other members of the staff of the agency, including, without limitation, any requirements concerning the confidentiality of client information"

Infection prevention, control and investigation

Provide for preventing, controlling and investigating infections and communicable diseases.

"Provide for the prevention, control and investigation of infections and communicable diseases"

Services offered

Describe the personal care services the agency provides.

"Provide a description of the personal care services that are provided by the agency to clients"

Assigning and supervising attendants

Describe how attendants are assigned to clients and any supervision provided.

"Provide a description of the manner in which the agency assigns attendants to provide personal care services to clients and any supervision of those services that will be provided by the agency"

Documenting needs and services

Provide for documenting each client’s needs and the services provided (HCQC: include the initial screening and service plan forms, P0070).

"Provide for documentation of the needs of each client and the personal care services that are provided to the client"

Emergency responses

Set out the agency’s responses to medical and nonmedical emergencies.

"Set forth the emergency responses of the agency to both medical and nonmedical situations"

Coordination with community agencies

Set out the agency’s role and coordination with other community service agencies (HCQC: include a list of community resources, P0080).

"Set forth the roles of the agency and any coordination that the agency will provide with services provided by other community service agencies"

Performance evaluations

Provide for periodic performance evaluations of attendants and staff (HCQC: include the evaluation form, P0085).

"Provide for periodic evaluations of the performance of attendants and other members of the staff of the agency"

Current personnel records

Keep current personnel records that confirm the policies are followed.

"Provide for the maintenance of current personnel records which confirm that the policies and procedures are being followed"

Special populations

Set out any specific information needed for the special populations served (HCQC: include examples, P0095).

"Set forth any other specific information that is necessary based on the needs of any special populations served by the agency"

Attendant qualifications

At least 18; mature; understands the rules; communicates effectively with clients; able to meet clients’ needs.

"Demonstrate the ability to meet the needs of the clients of the agency"

8 hours of training a year

Each attendant receives at least 8 hours a year of training on clients’ needs.

"Receive annually not less than 8 hours of training related to providing for the needs of the clients of the agency."

Attendant personnel file contents

Name, address, phone; start date; TB tests and health certificate; reference checks; background check evidence; first aid and CPR within 6 months; proof of age; auto insurance if driving clients; training and evaluations.

"Evidence that the references supplied by the attendant were checked by the agency"

Health certificate and TB tests

Before work: a physical exam or provider certificate of good health free of active TB, and a TB test within 12 months; then yearly TB tests unless a documented risk assessment allows less; chest X-ray route for past positives.

"Documentation that the attendant has had the tests or obtained the certificates required by NAC 441A.375"

First aid and CPR within 6 months

Proof of first aid and CPR certification within 6 months of starting, with live (not prerecorded) skills practice or verification. First aid and CPR are also part of the initial training program (NAC 449.3977(1)(c)(5)), so the manual has attendants certified before their first client.

"is certified in first aid and cardiopulmonary resuscitation"

Auto insurance for attendants who drive clientsif attendants transport clients

Keep proof of at least the state minimum liability insurance for attendants who transport clients.

"Proof of possession by the attendant of at least the minimum liability insurance coverage required by state law if the attendant will be providing transportation to a client in a motor vehicle"

Training records

For each course: content, date, hours, instructor name and signature, and a completion certificate.

"The name and signature of the instructor of the training course"

Evaluate competency of trained hires

Evaluate competency in each required area when an attendant brings proof of earlier training; further training can target gaps.

"shall evaluate the competency of an attendant in each competency area required by the agency if the attendant provides written proof of his or her current or previous training"

Secure personnel files, open to the Division

Files may be locked with restricted access but must be available to the Division on request (HCQC checks secured filing, P0145).

"The administrator may keep the personnel files of the agency in a locked cabinet"

Give attendants the rules

Give each attendant a copy of the licensing rules before they serve clients; they gain a working knowledge (HCQC: acknowledgement form, P0150).

"Obtain a working knowledge of the provisions of this chapter which govern the licensing of agencies before providing personal care services to the clients of the agency."

Training program with supervised on-the-job instruction

Complete a training program, including on-the-job instruction supervised by the administrator or designee, before working independently.

"The training program must include an opportunity for the attendant to receive on-the-job instruction provided to clients of the agency"

Required training topics

Documentation and time records; client rights and confidentiality; aging and disability needs; communication skills; first aid and CPR; and service-specific topics: duties and techniques, emergencies, adverse behaviors, nutrition, bowel and bladder care, skin care, preventing skin breakdown, contractures and falls, hand washing and infection control, body mechanics and transfers, clean and safe environment.

"Related to communication skills, including, without limitation, active listening, problem solving, conflict resolution and techniques for communicating through alternative modes with persons with communication or sensory impairments."

Competency in every training area

Each attendant is evaluated and found competent in the required training areas (HCQC: competency evaluation or exam after initial training, P0155).

"Each attendant of an agency must be evaluated and determined to be competent by the agency in the required areas of training"

Training within 12 months before first care

Evidence of the full training program completed within the 12 months before the attendant first provides care.

"within the 12 months immediately preceding the date on which the attendant first begins providing care to a client"

Agency pays for training

Provide or arrange required training; pay course and travel costs and wages for training and travel time; keep completion documents in the personnel file.

"Maintain such documentation in the personnel file of the employee."

Vital signs, glucose tests and weighingif attendants take vital signs, run blood glucose tests or weigh clients

Only after task training (before, yearly and on device change) by a qualified trainer covering infection control, interpreting results and actions to take; follow manufacturer instructions and CLIA; one glucose meter per person; weigh only with consent. HCQC checks for a CLIA waiver and consent forms (P0320, P0340).

"An attendant may weigh a client of an agency only if:"

One glucose meter per personif attendants run blood glucose tests

A blood glucose meter is never used on more than one person.

"an attendant who conducts a blood glucose test must ensure that the device for monitoring blood glucose is not used on more than one person"

Insulin by auto-injector onlyif attendants assist with insulin

Pharmacist-furnished insulin by FDA-approved auto-injector, client stable per physician, PA or APRN, maintenance dose with no sliding scale.

"A physician, physician assistant or advanced practice registered nurse has determined that the client’s physical and mental condition is stable and following a predictable course"

Who may train tasksif attendants perform tasks under NAC 449.39775

A physician, PA or licensed nurse; a pharmacist for insulin and glucose tasks; or an employee trained by one of them with a year of experience and shown competency (HCQC P0350).

"A physician, physician assistant or licensed nurse"

Nail care limitsif the agency offers nail care

Attendants may trim nails unless the provider restricts toenail care to a podiatrist or nail technologist; consult the provider first for clients with diabetes.

"If the client has been diagnosed with diabetes, the attendant shall consult with the client’s physician or other provider of health care before trimming or cutting the toenails of the client."

Exercise assistance limitsif the agency offers exercise assistance

No exercises the client’s provider has said the client should not do.

"An attendant shall not assist a client with any exercises in which the physician or other provider of health care of the client has determined that the client should not participate."

Appointments and sharing health informationif attendants accompany clients to appointments or communicate with providers

Attendants may help with appointments and pass information to and from providers and the client’s representatives, within the laws on protected health information.

"In accordance with the requirements of federal and state law and regulations concerning protected health information, communicate and share information pursuant to this subsection"

Prohibited services

The administrator keeps attendants within their scope and professional; attendants must not provide the listed skilled services (HCQC: list specific prohibited services, P0165; reviewed with each client, P0220).

"The administrator of an agency shall ensure that each attendant working for the agency is working within the attendant’s scope of service and conducts himself or herself in a professional manner."

The prohibited list

Catheter insertion or irrigation; body cavity irrigation; prescription or aseptic dressings; injections except as allowed; physical assessments; specialized feeding; digital rectal exams; massage; skilled nursing tasks beyond CNA scope.

"Irrigation of any body cavity, including, without limitation, irrigation of the ear, insertion of an enema or a vaginal douche"

When attendants may assist with medicationif attendants assist with medication

Written agreement where NRS 453.375 or 454.213 requires one; completed medication training; medication prescribed or ordered and given per written instructions. NAC 449.3978 limits still apply.

"The medication has been prescribed or ordered by a practitioner for whom the prescribing or ordering of the medication is within his or her scope of practice and is administered in accordance with the written instructions of that practitioner."

Medication trainingif attendants assist with medication

16 hours from a Division-approved course with a certificate before assisting, then 8 hours a year with evidence to the agency.

"Successfully complete annually not less than 8 hours of training in the management of medication from a course approved by the Division"

Medication training program and recordsif attendants assist with medication

A program ensuring the training, and a medication record per client: type, date and time, refusals or missed doses, current instructions.

"The date and time that a client refuses or otherwise misses an administration of medication"

Written agreement for controlled substancesif attendants assist with medication

A controlled substance may be handled by a person the ultimate user designates in a written agreement.

"An ultimate user or any person whom the ultimate user designates pursuant to a written agreement."

Written disclosure statement

Give each new client a written disclosure statement, have it signed, and file a copy (HCQC P0175).

"Ensure that a copy of the written disclosure statement is incorporated into the record of the client"

Disclose that unstable conditions are out of scope

An easy-to-understand statement that managing unstable or unpredictable medical conditions is outside the license.

"it is not within the scope of the license of the agency to manage the medical and health conditions of clients should the conditions become unstable or unpredictable"

Disclose attendant qualifications and training

State the qualifications and training requirements for attendants.

"The qualifications and training requirements for the attendants who provide personal care services to the clients of the agency"

Charges, billing and price increase policy

Charges; billing methods, payment systems and due dates; the policy for notifying clients of price increases.

"the policy for notifying clients of increases in the costs of personal care services provided by the agency"

Termination criteria and notice policy

The criteria for ending services and the policy for notifying clients.

"The criteria, circumstances or conditions which may result in the termination of personal care services by the agency and the policy for notifying clients of such termination"

Contacting the administrator; on-call policy

How to reach the administrator or designee during all service hours, and the on-call policy.

"Procedures for contacting the administrator of the agency or the administrator’s designee during all hours in which personal care services are provided and the on-call policy of the agency"

Rights and grievance procedure in the disclosure

Information on client rights and the grievance procedure.

"Information concerning the rights of clients and the grievance procedure of the agency"

Clients may speak with advocates

No client is stopped from speaking with an advocate for clients’ rights (HCQC P0185).

"a client is not prohibited from speaking to any person who advocates for the rights of the clients of the agency"

Grievance, incident and complaint procedure

Administrator or designee notified of each grievance, incident or complaint, investigates personally and promptly, and tells the client the action taken or why none (HCQC: policy, report form and tracking, P0190).

"A client who files a grievance or complaint or reports an incident concerning the agency must be notified of the action taken in response to the grievance, complaint or report or must be given a reason why no action was taken."

Comply with the patients’ rights law

The administrator ensures compliance with NRS 449A.100 to 449A.118.

"The administrator of an agency shall ensure that the agency is in compliance with NRS 449A.100 to 449A.118, inclusive."

Tell clients their statutory rights on admission

Inform each client or representative on admission of the rights in NRS 449A.100 and 449A.106 to 449A.115 (information, billing explanation, considerate care, refusing treatment, privacy, confidentiality and others).

"shall inform each patient or the patient’s legal representative, upon the admission of the patient to the facility, of the patient’s rights as listed in NRS 449A.100 and 449A.106 to 449A.115, inclusive"

No bequests to owners or administrators

Owners and administrators may not take money or property under a client’s will or life insurance (unless spouse, guardian or next of kin).

"an owner or administrator of a medical facility or facility for the dependent is not entitled to receive, and must not receive:"

Written rights with six statements, signed receipt

Written description of rights with the six required statements, given at the start of the service plan, signed and dated receipt in the record (HCQC P0195).

"The agency shall develop a written description of the rights of clients and provide a copy to each client or a representative of the client upon initiation of the service plan established for the client."

Bureau phone number and record access notice

The rights statement gives the Bureau’s complaint phone number and notice that the Division may examine client records.

"To receive notification of any authority of the Division to examine the records of the client as related to the regulation and evaluation of the agency by the Division"

Privacy and confidentiality duties

Confidentiality of sexual orientation, transgender status and HIV status; no non-care staff present during unclothed care without permission; visual barriers; right to refuse educational observation.

"Maintain the confidentiality of personally identifiable information concerning the sexual orientation of a client"

Initial screening and service plan

Administrator or designee screens each prospective client and develops or accepts a service plan; documented, dated and signed (HCQC P0210).

"shall conduct an initial screening to evaluate each prospective client’s requests for personal care services and to develop a service plan for the client or to accept a service plan established for the client"

Review the plan with the client before starting

Review the schedule, the procedure if an attendant does not deliver the plan, hiring and training policies, agency responsibilities, the grievance procedure and the prohibited services (HCQC P0220).

"Review the service plan with the client, including, without limitation, the schedule for the provision of personal care services to the client"

No-show and extra visit procedures

Review with the client what happens if an attendant does not arrive and how an additional visit is arranged (HCQC: no-show policy, P0220).

"Review the procedure to be followed if an attendant does not appear for a scheduled visit and the procedure to be followed if an additional visit from an attendant is required"

Services assist with daily living

Confirm requested services assist with activities of daily living before starting and on each plan change.

"Ensure that the personal care services requested by the client are services which assist the client with the activities of daily living"

Coordinate with other providers

Coordinate the agency’s services with care from other organizations and people.

"Ensure that the agency is coordinating the personal care services that it will be providing to the client with the care and services available to the client from other organizations and persons"

Supervisory visits or calls

Administrator or designee makes supervisory home visits or calls to each client; HCQC expects the policy to state frequency and who does them (P0225).

"The administrator of an agency or the administrator’s designee shall conduct supervisory home visits or telephone calls"

Five-point supervisory record

Each visit or call documented, dated and signed, evaluating safe techniques, plan followed, plan meeting needs, attendant training and needed follow-up.

"The attendant providing personal care services to the client has received sufficient training relating to the personal care services that the attendant is providing to the client"

Documentation and time records

Attendants are trained to document services and verify time records, so the agency needs a visit and time record system.

"Verification of time records."

Dietitian after hospital dischargewhen a client comes home from hospital

Consult a dietitian as appropriate when a hospital discharges a patient home to the agency’s care.

"If a patient is released by a hospital to his or her residence to receive care from an agency to provide personal care services in the home"

No referrals to unlicensed or unsuitable group homes

Never refer a person to an unlicensed residential facility for groups or one that does not suit their condition.

"Refer a person to a residential facility for groups if the agency to provide personal care services in the home or its employee knows or reasonably should know"

Explain transfers and alternatives

Provide needed services or arrange transfer to a provider that can; explain the need for transfer and the alternatives, unless the client’s condition needs an immediate transfer to a higher level of care and the client cannot understand the explanation.

"A patient may be transferred to another facility only if the patient has received an explanation of the need to transfer the patient and the alternatives available"

Discharge and service policies blind to payer

Transfer, discharge and service policies do not discriminate by payment source (HCQC P0600).

"A facility shall adopt and maintain policies and procedures for the transfer and discharge of, and the provision of services to, patients or residents in the facility"

Protect clients from abuse

The administrator ensures clients are not abused, neglected or exploited by staff, or by visitors while staff are present (HCQC: elder abuse recognition, prevention and reporting policy, P0030).

"The clients of the agency are not abused, neglected or exploited by an attendant or another member of the staff of the agency, or by any person who is visiting the client when an attendant or another member of the staff of the agency is present"

Report suspected abuse within 24 hours

Every owner and employee reports suspected abuse, neglect, exploitation, isolation or abandonment of an older or vulnerable person to ADSD, police or ADSD’s toll-free line within 24 hours.

"Make such a report as soon as reasonably practicable but not later than 24 hours"

Where reports go

Local ADSD office, police or sheriff, or ADSD’s toll-free service; if ADSD or police are involved in the abuse, report to a different agency.

"The local office of the Aging and Disability Services Division of the Department of Human Services"

Deaths from abuse or neglect

If a reporter believes an older or vulnerable person died from abuse, neglect, isolation or abandonment, report it to the medical examiner or coroner.

"report this belief to the appropriate medical examiner or coroner"

Work assignment records for nursing staffif the agency employs a nurse, nursing assistant or medication aide - certified

Keep a record of the work assignments of each nurse, nursing assistant or medication aide - certified the agency employs, for at least 5 years.

"shall prepare and maintain, for at least 5 years, a record of the work assignments of each licensee, nursing assistant or medication aide - certified."

Report nursing licensee misconduct

Report in writing to the State Board of Nursing any conduct of a Board licensee or certificate holder (nurse, nursing assistant, medication aide) that violates the nursing law.

"shall report in writing to the Executive Director of the Board any conduct of a licensee or holder of a certificate which constitutes a violation of the provisions of this chapter"

Child abuse reportingif the agency serves clients under 18

Our reading: when serving a child, staff report suspected child abuse or neglect to child welfare or police within 24 hours, and the agency informs each new employee in writing and keeps their acknowledgement.

"Obtain a written acknowledgment or electronic record from the person that he or she has been informed of his or her duty pursuant to this section"

Elder abuse training

Administrator before care begins and yearly; each care employee before their first client and yearly; topics include recognizing and responding to abuse and the relevant laws; the agency pays (HCQC P0099).

"The topics of instruction that must be included in the training required by this section must include, without limitation:"

Anti-discrimination policies

Develop and carry out policies to prevent the prohibited types of discrimination, including indirect discrimination and harassment or bullying (HCQC P0405).

"Develop and carry out policies to prevent the specific types of prohibited discrimination described in the regulations adopted by the Board"

Website non-discrimination statementif the agency markets on a website

Post the statutory statement prominently on any website used to market the agency (HCQC P0410).

"does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment"

Complaint policy and discrimination complaint log

A written policy on how complaints may be filed and will be documented, investigated and resolved, and a log of discrimination complaints and actions (HCQC P0620).

"Maintain a log that lists:"

Preferred names and pronouns

Policies to address clients by preferred name and pronoun; adapt records where practicable (HCQC P0700).

"To the extent practicable and available within the systems in use at the facility:"

Notices in appropriate languages and formats

Non-discrimination statements and notices in English and other appropriate languages, with reasonable accommodations for clients who cannot read, are blind, have communication impairments or do not read English.

"A facility must make reasonable accommodations in providing the statements, notices and information described in subsection 1 for patients or residents who:"

Cultural competency training

Approved course within 90 days of hire and at least 2 hours every two years for staff with weekly direct client contact and their supervisors; proof in the personnel file (HCQC P0640).

"Within 90 days ... after contracting with or hiring the agent or employee"

Proof of cultural competency training or exemption

Keep proof of completion, or of the professional license that makes a staff member exempt, in the personnel file or electronic system.

"the facility shall keep documentation in the personnel file of"

Written infection control plan, updated yearly, given to all

Develop and annually update a written plan for the control of infectious diseases; give a copy to each employee, contractor and client.

"Develop and annually update a written plan for the control of infectious diseases"

What the plan must contain

A coordinator; evidence-based policies (for example CDC) fitting the services; procedures to find and correct lapses; review of activities; investigating and reporting communicable diseases under chapter 441A; an outbreak strategy covering staffing, admissions and protecting clients. Our reading: these contents apply because R063-21 was adopted for the same statutory plan now in NRS 449B.220 (see R063-21 section 5(2)).

"Include a strategy for addressing an outbreak of an infectious disease and the effects of such an outbreak at the facility"

Annual infection control training for caregivers

Each unlicensed caregiver completes the annual training on the six topics, gives proof to the administrator, and it is documented in the personnel file; best practices are put in place (HCQC P0950).

"Ensure that each unlicensed caregiver who provides care for the agency completes the training required by the regulations adopted pursuant to subsection 1 and document the completion of the training in the personnel file of each unlicensed caregiver"

PPE supply, supplier contract and tracking

Use PPE per the adopted publications; keep a 30-day supply (or document shortage attempts); contract with a supplier and track stock and usage (HCQC P0910, P0915).

"Enter into a contract with a supplier of personal protective equipment"

Infection control program reviewed yearly (HCQC expectation)

HCQC’s workbook expects an infection control program and policy based on national guidelines and reviewed every year, with a named responsible person and designee who complete 15 hours of training within 3 months and yearly, at the agency’s cost. The rule text names facilities for the dependent; we treat this as HCQC’s survey expectation.

"NAC 449.0109 - Infection Control and Prevention Program -Infection Control program and policy. Must"

Emergency preparedness plan (HCQC expectation)

A plan covering internal and external, local and widespread emergencies, including emerging infectious diseases.

"Emergency Preparedness Plan - Must address internal and external emergencies, including emerging infectious diseases."

Background check within 10 days of hire

Signed conviction statement, oral and written confirmation, license or certificate proof, fingerprints with written authorization submitted to the Central Repository, and screening on the state website where one exists; for employees, temporary agency workers and contractors (HCQC: through NABS).

"Obtain a written statement from the employee, employee of the temporary employment service or independent contractor stating whether he or she has been convicted of any crime listed in NRS 449B.440"

Complete checks and repeat every 5 years

Complete the investigation as soon as practicable and repeat at least every 5 years.

"At least once every 5 years after the date of the initial investigation."

Keep background check records

Fingerprint copy or electronic submission proof, written authorization and other documentation, kept for the length of employment and available to the Division (HCQC adds the signed waiver and NABS clearance letter).

"Maintained for the period of the employment of the person with the agency"

Disqualifying results

End employment or the contract of a person convicted of a listed crime; if the person disputes the result, first allow at least 30 days to correct it; tell temporary agencies their worker is ineligible.

"the administrator of, or the person licensed to operate, the agency shall terminate the employment or contract of that person"

Undetermined results and pending charges

Notify the person within 10 working days to supply information within 30 days; protect clients meanwhile (leave, direct supervision or investigation); terminate a person who willfully fails to comply.

"shall take actions to ensure the safety of its patients, residents or clients, including:"

No unsupervised child contact before resultsif the agency serves clients under 18

Before results arrive, a new worker may not have unsupervised contact with a child.

"shall not have contact with a child without supervision before such information is received"

Temporary staffing agreementsif the agency uses temporary staffing services

Require any temporary employment service to prove continuous employment since each worker’s last check and to tell the agency if a check is more than 5 years old.

"Notify the agency if the investigation conducted of an employee of the temporary employment service pursuant to NRS 449B.310 has not been conducted within the immediately preceding 5 years."

Contracted attendantsif the agency uses contracted attendants

Attendants may be employees or contractors; contractors meet the same qualification, check, training and file rules.

"“Attendant” means a person who is employed by or retained pursuant to a contract by an agency"

Allow inspections at any time

Division staff may enter and inspect at any time, with or without notice; ADSD designees may investigate complaints.

"Any authorized member or employee of the Division may enter and inspect any building or premises at any time"

Plan of correction within 10 days

Submit a plan of correction with specific actions and timeframes within 10 days of a statement of deficiencies.

"The plan of correction must include specific requirements for corrective action, which must include times within which the deficiencies are to be corrected."

Cooperate with investigations

Refusing to cooperate fully with an investigation or inspection is a ground for denial, suspension or revocation.

"The failure or refusal to cooperate fully with an investigation or inspection by the Bureau."

EVV for Medicaid visitsif the agency bills Nevada Medicaid

Medicaid personal care services are recorded in a Cures Act compliant EVV system.

"Utilize an EVV system that meets the requirements of the 21st Century Cures Act"

24-hour phone line and backup caregiversif the agency bills Nevada Medicaid

A phone line available 24 hours a day for recipients, and a backup mechanism when the regular caregiver is absent.

"The provider shall maintain an available telephone line 24 hours per day, seven days per week for recipient contact."

Serious occurrence reportsif the agency bills Nevada Medicaid

Serious Occurrence Report to the Medicaid district office (or the waiver case manager’s ADSD office) within 24 hours of discovery.

"must be completed within 24 hours of discovery and submitted to the local Nevada Medicaid District Office"

Incident log and review

Recommended: log incidents alongside grievances and complaints with investigation and outcome, so the administrator can show the procedure works.

"The procedure established and enforced by the administrator must include a method for ensuring that the administrator or the administrator’s designee is notified of each grievance, incident or complaint."