Nevada Regulatory Compliance Resources for Residential Care Facilities

Based on the sources, certain conditions prohibit a person from being admitted to or remaining as a resident in a residential facility for groups, unless an exception is granted or specific conditions are met. These include:

• Being bedfast. This condition means a person is unable to move from a bed to a chair, unable to stand, or unable to walk.
• Requiring the use of restraints. Physical restraints, such as Geri-chairs, Posey vests, full-sided bed rails, wrist restraints, or wheelchair seatbelts, are prohibited unless the resident can leave the chair or bed, or remove the restraints, without assistance. Beds placed against walls are also considered physical restraints.
• Requiring confinement in locked quarters. Locking a resident in a room inside the facility is prohibited.
• Requiring skilled nursing or other medical supervision on a 24-hour basis.
• When the resident’s physician or the Bureau determines that the person does not comply with the requirements for eligibility.
• Requiring gastrostomy care. A resident who requires assistance with the care of a gastrostomy tube, including liquid feeding, medications, and fluids, cannot be admitted or remain in the facility. However, if the resident requires no care or assistance for their gastrostomy tube or site and is able to provide their own care, they may be admitted or remain with an approved medical waiver from HCQC.
• Suffering from a staphylococcus infection or other serious infection. Before admission or re-admission of a resident with a serious infection (like MRSA, VRE, or C-diff), the facility must get confirmation from a medical professional that the resident is no longer infectious.
• Suffering from any other serious medical condition not specifically described elsewhere that prohibits admission or retention. Residents with any type of intravenous catheters are generally not allowed, but the Bureau may consider an exception case-by-case after receiving a medical exemption request.
• Requiring the use of oxygen unless the resident is mentally and physically capable of operating the equipment, or capable of determining their need and administering oxygen to themselves with assistance.
• Requiring the use of intermittent positive pressure breathing equipment unless the resident is mentally and physically capable of operating and disinfecting the equipment and determining when it’s needed, or the equipment is operated by a trained medical professional. Residents using a Bi-pap or C-pap machine must demonstrate their ability to use it; if they cannot, a caregiver must demonstrate this ability.
• Requiring care for a colostomy or ileostomy (which includes urostomy care) unless the resident is mentally and physically capable of caring for it properly, with or without assistance, and a physician states in writing that it is completely healed, or the care is provided by a trained medical professional.
• Requiring care for a Foley catheter unless the resident is mentally and physically capable of caring for it properly, with or without assistance, or the care is provided by a trained medical professional. An indwelling catheter should not be used unless there is valid medical justification.
• Having contractures that negatively affect the resident’s ability to perform normal bodily functions, unless specific (but not detailed in the source) conditions are met.
• Requiring protective supervision if the person is unable to follow instructions or has difficulty making their needs known, unless the facility complies with specific related regulations (NAC 449.2754 and 449.2756).
• Having a tracheostomy or an open wound that requires treatment by a medical professional, unless the wound is healing, the tracheostomy is stable, or the resident can care for it without assistance. Wound care by facility staff who are not medical professionals is limited to changing non-medicated dressings on non-draining wounds, Stage 1 pressure ulcers, skin tears, or minor abrasions, provided they have received specific training.

An administrator may submit a written request to the Division for permission to admit or retain a resident who is otherwise prohibited. This request must include records of the resident's condition, a plan for meeting their needs, a plan for ensuring other residents' care is not affected, and a signed statement from the administrator guaranteeing caregivers can meet the resident's needs. Such a request must be received before admitting the resident or at the onset of the medical condition.

Residential facilities for groups are required to maintain various types of documentation:

• Licensure and Facility Information:
  • A complete application for license with proof of identity and the appropriate fee. For entities, this includes references and information for members and the person in charge.
  • Full, complete, and accurate information regarding facility ownership and any changes while the application is pending, including the name of each natural person owner.
  • Evidence satisfactory to the Division that the facility meets all applicable federal, state, and local safety, health, building, and fire codes.
  • A copy of the certificate of occupancy, the applicant’s business license, and any special use permits.
  • A copy of any property lease or rental agreements.
  • If the applicant is a corporation, a copy of its bylaws and articles of incorporation.
  • A satisfactory report of inspection from the State Fire Marshal or local fire department must be received by the Division before a license is issued.
  • Written notification to the Division within 10 days of a transfer of real property with no change in operator, including a copy of any lease agreement.
  • Written notification to the Division within 10 days of a change in the administrator.
  • An adequate plan of correction must be returned to the Division within 10 days after receiving a statement of deficiencies. Failure to do so is grounds for disciplinary action.
  • Evidence that the applicant and facility comply with regulations and zoning ordinances must be submitted with the license application.
  • Written documentation (e.g., resident rental agreements) may be reviewed by inspectors if the facility appears to have more residents than licensed for.
  • A current copy of the regulations for Residential Facilities for Groups (NAC 449.156 to 449.27706) and the report of the latest Bureau investigation (annual survey, re-survey, complaint investigations) must be maintained in the facility and available for review.
  • If a facility was licensed for fewer than 7 beds before January 1997 and wants to increase the number of beds, documentation related to the installation of an automatic sprinkler system would be implied. Similar requirements apply for facilities licensed for Category 1 residents only wishing to add Category 2 residents, or facilities not licensed for Alzheimer’s/dementia care wishing to add such residents.
  • Evidence of a contract of insurance for protection against liability must be furnished to the Division before license issuance. The contract must include an endorsement for a 30-day notice to the bureau before cancellation or change.
  • A written statement for residential facilities providing Alzheimer’s/dementia care must include specific descriptions of services, activities, behavior/medication management, family involvement, and wandering prevention/response. This statement must be available for review.
• Personnel and Training Records:
  • A separate personnel file must be kept for each staff member.
  • Personnel files must include the employee’s name, address, telephone number, and social security number(can be captured on application or copies of ID, passport, SS card).
  • The date employment began.
  • A list of topics covered by training, which may be a syllabus or outline. This includes evidence of required caregiver training, CPR/first aid, medication training, and special endorsement training.
  • Evidence that references supplied by the employee were checked (minimum two references requested, authors of written references contacted). Contacts must be documented in the employee file.
  • Health certificates, including written documentation of a pre-employment physical examination and initial tuberculin (TB) testing. TB testing must comply with requirements in NAC 441A.380.
  • A written statement from the employee regarding any conviction of crimes listed in NRS 449.174. Oral and written confirmation of this information is also required.
  • Proof that the employee/contractor holds any required license, permit, or certification.
  • Written statement or other evidence indicating the employee/contractor has not been convicted of any crimelisted in NRS 449.174.
  • Records related to background checks (authorization, proof fingerprints submitted, other documentation) must be maintained for the period of employment and available for Division inspection; copies must be furnished upon request.
  • If the Central Repository is unable to complete a background check, the administrator must send a notice to the employee/contractor within 10 working days. Attempts at contact should be documented.
  • A caregiver’s personnel file must include a certificate of current certification in first aid and cardiopulmonary resuscitation.
  • A caregiver’s personnel file must include proof that they are 18 years of age or older (copy of legal documentation like driver’s license, ID, or passport).
  • A written statement signed by the caregiver confirming they have read and understand the relevant regulations (NAC 449.156 to 449.27706 and sections 2 to 16) must be in their file within the first week of employment.
  • Documentation of cultural competency training completion must be kept in the personnel file.
  • For facilities providing Alzheimer’s/dementia care, documentation regarding dementia training for direct care employees, including date, instructor name, length, and content, must be available in the personnel file.
• Resident Records:
  • Administrator must ensure resident records are complete and accurate.
  • Written documentation on residents is reviewed by inspectors.
  • Records of services or assistance provided for dental, optical, hearing care, and social services must be maintained.
  • A record of the behavior of a resident who has been prescribed a sedative must be made by a caregiver.
  • A written request from the resident or representative is required before an employee handles a resident’s money.
  • If a resident requests temporary placement of funds without authorizing management, the facility must obtain the request in writing detailing the date, time, amount, duration, and resident signature, provide a receipt, and retain a copy.
  • An accurate record must be kept of all money deposited with the facility, including withdrawals. This record must include a separate accounting, receipts for expenditures, and a written acknowledgement by the resident for each withdrawal. If authorized to manage funds, the facility must act as a fiduciary and be able to report quarterly; receipts for deposits and expenditures must be provided.
  • A procedure to respond immediately to grievances, incidents, and complaints must be provided, ensuring the administrator or designee is notified. A log must list complaints, actions taken, and reasons if no action taken.
  • A written policy on admissions is required, including a statement of nondiscrimination and eligibility requirements.
  • A written description of the services included in the person-centered service plan must be provided upon admitting a resident, changing services/costs, or upon request.
  • Contracts with residents must be in writing and include specific elements, such as the basic rate, services included, charges for optional services, billing procedures, contract duration, termination criteria, and complaint resolution information.
  • Attempts to resolve issues before resident discharge must be documented in the resident’s file, occurring before discharge.
  • If a resident returns after an emergency transfer/discharge, the facility is not in violation if the emergency was necessary to address needs outside the scope of care; this would imply documentation of the situation.
  • Requests for permission to admit/retain residents with otherwise prohibited conditions must be submitted in writing. This written request must include the resident’s current medical records (updated medical reports, other health documentation, prognosis, duration), a plan for meeting the resident’s medical needs, a plan for ensuring other residents’ care will not suffer, and a statement signed by the administratorguaranteeing caregiver ability to meet the needs. It should also include a history and physical assessment/plan of care from home health/hospice, the facility’s care plan, a plan for other residents, and the administrator’s signed guarantee.
  • Documentation is required to monitor the resident’s ability to care for their own health conditions and any significant changes.
  • If a resident rejects medical care, an employee must record the rejection in writing and request the resident sign it.
  • Medication orders must be accurately transcribed in the record of medication administered. For changes, interpretation by a medical professional must be included in the record within 5 days.
  • Written information describing the side effects, adverse reactions, contraindications, and toxicity of medication must be obtained before assisting administration.
  • The resident file must contain a written and signed physician’s order approving medication.
  • Documentation is needed if medications are missing, including details of the medication, how it was prescribed, delivery logs, physician orders, administration records (missed doses/reasons), incident reports, and evidence the physician was notified.
  • A statement of the resident’s allergies, special diet, and required medication must be in their file.
  • Resident files should be stored in a locked, fire-resistant place and kept confidential. They must be available to Bureau employees upon request.
  • A copy of guardianship papers is needed if applicable.
  • A statement from the resident’s physician about their mental and physical condition, required medical services, method, and resident capability must be in the file.
  • The types and amounts of protective supervision and personal services needed must be documented.
  • An evaluation of the resident’s ability to perform activities of daily living (ADLs) and needed assistance must be prepared upon admission, whenever there is a significant change in condition, and at least annually. This must be done by a facility employee.
  • A list of facility rules signed by the administrator and the resident or representative must be included.
  • The name and telephone number of vendors and medical professionals providing services for the resident must be in the file.
  • Resident files must be maintained for 5 years after the resident permanently leaves or is discharged.
  • If providing hospice care, the facility must obtain a copy of the hospice plan of care.
  • Documentation for assisted living endorsements must include procedures for quarterly assessment and monitoring by a medical professional for residents with declining conditions.
  • Policies must be developed for addressing residents by their preferred name and pronoun and in accordance with their gender identity/expression. Medical records must be adapted to include preferred name/pronoun, gender identity/expression (assigned at birth and current), sexual orientation, history of gender transition, current anatomy, and organ inventory if gender identity differs from assigned birth gender.
  • Written notices about patient rights and the right to file a complaint about prohibited discrimination with the facility and the Division are required.
  • Documentation of a 30-day supply of personal protective equipment (PPE) must be maintained, or if unavailable due to shortage, documentation of attempts to obtain it.
  • Documentation of tracking the amount of PPE available, usage rate, and orders is required.

Residential facilities for groups must meet specific staffing requirements:

• The facility must be operated under the supervision of an administrator. The administrator is responsible for the day-to-day management.
• The administrator must ensure a sufficient number of caregivers are present to conduct activities and provide care and protective supervision.
• There must be at least one caregiver on the premises if one or more residents are present. This caregiver must be qualified.
• Family members of staff/owners or volunteers left alone with residents are not counted towards required staffing.
• Facilities with more than 20 residents must ensure that at least one employee is awake and on duty at all times. An additional employee must be available within 10 minutes after being informed their services are needed. Caregivers are not allowed to sleep while on duty in these facilities.
• For residential facilities providing care to persons with Alzheimer’s disease or other forms of dementia who meet certain criteria, there must be at least one staff member assigned for every six residents during the hours when the residents are awake.
• These Alzheimer’s/dementia care facilities must have at least one member of the staff awake and on duty at all times. One caregiver cannot work 24-hour shifts and meet this requirement.
• Facilities with 50 or more residents must appoint a staff member responsible for the organization, conduct, and evaluation of activities for the residents, and other staff as necessary to assist them.
• Caregivers must be at least 18 years of age.
• Caregivers must be responsible, mature, and possess personal qualities that enable them to understand the problems of elderly persons and persons with disabilities.
• Caregivers must understand the relevant regulations.
• Caregivers must receive not less than 4 hours of a combination of Tier 1 and Tier 2 training related to resident care within 60 days of commencing employment. Specific Tier 2 requirements are referenced.
• Employees must receive training on recognizing and responding to the abuse of older persons (including sexual abuse) before providing care and annually thereafter.
• Caregivers must be currently certified to perform first aid and cardiopulmonary resuscitation within 30 days of hire and maintain current certification. Nevada Registered Nurses are exempt from first aid training but need CPR; Licensed Practical Nurses are exempt from first aid only if under RN supervision.
• Caregivers must be capable of providing protective supervision for residents requiring it without neglecting other residents.
• Caregivers who may be required to administer oxygen must have demonstrated the ability to operate the equipment properly.
• If residents require care for conditions like intermittent positive pressure breathing equipment, colostomies, ileostomies, urostomies, or Foley catheters and cannot provide self-care, the care must be provided by a medical professional. Caregivers emptying catheter bags need instruction in handling waste and recognizing signs of urinary tract infections and dehydration.
• Facility staff who are not medical professionals cannot provide wound care unless they are specifically trained to change non-medicated dressings on non-draining wounds, Stage 1 pressure ulcers, skin tears, or minor abrasions. Any other wound care or treatment must be provided by a medical professional or a trained independent contractor following a doctor’s order.
• Medical care, when needed, must be provided by a trained caregiver, trained independent contractor, or a medical professional. The caregiver must be trained and capable of delivering the required care and assistance.
• Caregivers assist residents with medication administration if needed. Specific requirements apply for assisting with controlled substances, dangerous drugs, and insulin using auto-injection devices. Assistance with controlled substances/dangerous drugs requires a written care plan by a physician or registered nurse.
• For facilities providing Alzheimer’s/dementia care, each employee with direct contact and care must successfully complete the required training and continuing education. Within 3 months of hire, 8 hours of Tier 2 training is required. Licensed/certified employees need 3 hours of continuing education in dementia care annually.
• Caregivers may perform certain tasks as authorized by NRS 449.0304 if they receive specific training and demonstrate understanding annually or when devices change.