Other Staff — Qualifications

Other Staff — Qualifications

The licensee shall employ or contract with sufficient numbers of other staff to ensure that the assisted living program is capable of meeting the requirements of this chapter, and all other applicable laws and regulations, in a manner consistent with the philosophy of assisted living and in compliance with generally accepted standards of care for the specific conditions of the residents the assisted living program intends to serve.
Qualifications of Other Staff. At a minimum, all other staff shall:

(1) Be 18 years old or older unless licensed as a nurse or the age requirement is waived by the Department for good cause shown;

(2) As evidenced by a physician’s statement be free from:

(a) Tuberculosis, measles, mumps, rubella, and varicella through appropriate screening procedures such as tuberculosis skin tests, positive disease histories, or antibody serologies; and

(b) Any impairment which would hinder the performance of assigned responsibilities;

(3) Have no criminal convictions or criminal history that indicates a behavior that is potentially harmful to residents, as evidenced through a criminal background check completed within 30 days before employment;

(4) Have sufficient skills, education, training, and experience to serve the residents in a manner that is consistent with the philosophy of assisted living;

(5) Participate in an orientation program and ongoing training to ensure that the residents receive services that are consistent with their needs and generally accepted standards of care for the specific conditions of those residents to whom staff will provide services;

(6) Receive initial and annual training in:

(a) Fire and life safety, including the use of fire extinguishers;

(b) Infection control, including standard precautions, contact precautions, and hand hygiene;

(d) Emergency disaster plans; and

(e) Basic first aid by a certified first aid instructor;

(7) Have training or experience in:

(a) The health and psychosocial needs of the population being served as appropriate to their job responsibilities;

(b) The resident assessment process;

(d) Resident’s rights; and

(8) Hold appropriate licensure or certification as required by law.

With the exception of certified nursing assistants (CNAs) and geriatric nursing assistants (GNAs), if job duties involve the provision of personal care services as described in Regulation .28D of this chapter, an employee:

(1) Shall demonstrate competence to the delegating nurse before performing these services; and

(2) May work for 7 days before demonstrating to the delegating nurse that they have the competency to provide these services if the employee is performing tasks accompanied by:

(a) A certified nursing assistant;

(b) A geriatric nursing assistant; or

Basic CPR training shall be provided on an initial and ongoing basis to a sufficient number of staff by a certified CPR instructor to ensure that a trained staff member is available to perform CPR in a timely manner, 24 hours a day.
Relief personnel shall be available at all times in the event that the regularly scheduled staff members are unavailable. Relief personnel shall meet the requirements of §B of this regulation.
Proof of training shall include:

(1) Date of class;

(2) Course content;

(3) Documentation of successful completion of the training content;

(4) Signatures of the trainer and attendees; and

(5) Qualifications and contact information for the trainer.

Training in Cognitive Impairment and Mental Illness.

(1) When job duties involve the provision of personal care services as described in Regulation .28D of this chapter, employees shall receive a minimum of 5 hours of training on cognitive impairment and mental illness within the first 90 days of employment.

(2) The training shall be designed to meet the specific needs of the program’s population as determined by the assisted living manager including the following as appropriate:

(a) An overview of the following:

(i) A description of normal aging and conditions causing cognitive impairment;

(ii) A description of normal aging and conditions causing mental illness;

(iv) Risk factors for mental illness;

(v) Health conditions that affect cognitive impairment;

(vi) Health conditions that affect mental illness;

(vii) Early identification of and intervention for cognitive impairment;

(viii) Early identification of and intervention for mental illness; and

(ix) Procedures for reporting cognitive, behavioral, and mood changes;

(b) Effective communication including:

(i) The effect of cognitive impairment on expressive and receptive communication;

(ii) The effect of mental illness on expressive and receptive communication;

(iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and

(iv) Environmental stimuli and influences on communication;

(i) Identifying and interpreting behavioral symptoms;

(ii) Problem solving for appropriate intervention;

(iii) Risk factors and safety precautions to protect the individual and other residents; and

(iv) De-escalation techniques;

(d) Making activities meaningful including:

(i) Understanding the therapeutic role of activities;

(ii) Creating opportunities for productive, leisure, and self-care activities; and

(iii) Structuring the day;

(e) Staff and family interaction including:

(i) Building a partnership for goal-directed care;

(ii) Understanding families needs; and

(iii) Effective communication between family and staff;

(f) End of life care including:

(i) Pain management;

(ii) Providing comfort and dignity; and

(iii) Supporting the family; and

(g) Managing staff stress including:

(i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;

(ii) Identification of stress triggers;

(iii) Self-care skills;

(iv) De-escalation techniques; and

(v) Devising support systems and action plans.

(3) When job duties do not involve the provision of personal care services as described in Regulation .28D of this chapter, employees shall receive a minimum of 2 hours of training on cognitive impairment and mental illness within the first 90 days of employment. The training shall include:

(a) An overview of the following:

(i) A description of normal aging and conditions causing cognitive impairment;

(ii) A description of normal aging and conditions causing mental illness;

(iii) Risk factors for cognitive impairment;

(iv) Risk factors for mental illness;

(v) Health conditions that affect cognitive impairment;

(vi) Health conditions that affect mental illness;

(vii) Early identification and intervention for cognitive impairment;

(viii) Early identification and intervention for mental illness; and

(ix) Procedures for reporting cognitive, behavioral, and mood changes;

(b) Effective communication including:

(i) The effect of cognitive impairment on expressive and receptive communication;

(ii) The effect of mental illness on expressive and receptive communication;

(iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and

(iv) Environmental stimuli and influences on communication; and

(4) Ongoing training in cognitive impairment and mental illness shall be provided annually consisting of, at a minimum:

(a) 2 hours for employees whose job duties involve the provision of personal care services as described in Regulation .28D of this chapter; and

(b) 1 hour for employees whose job duties do not involve the provision of personal care services as described in Regulation .28D of this chapter.

The training that is described in §F of this chapter may be provided through various means including:

(1) Classroom instruction;

(2) In-service training;

(3) Internet courses;

(4) Correspondence courses;

(5) Prerecorded training; or

(6) Other training methods.

When the training method does not involve direct interaction between faculty and participant, the assisted living program shall make available to the participant during the training a trained individual to answer questions and respond to issues raised by the training.

Delegating Nurse.

The assisted living program shall have a current and signed agreement with a registered nurse for services of a delegating nurse and delegation of nursing tasks. If the delegating nurse is an employee of the assisted living program, the employee’s job description may satisfy this requirement.
The program shall maintain documentation that the delegating nurse has completed the mandatory training course developed by the Board of Nursing.
Duties. The delegating nurse shall:

(1) Be on-site to observe each resident at least every 45 days;

(2) Be available on call as required under this chapter or have a qualified alternate delegating nurse available on call; and

(3) Have the overall responsibility for:

(a) Managing the clinical oversight of resident care in the assisted living program;

(b) Issuing nursing or clinical orders, based upon the needs of residents;

(d) Appropriate delegation of nursing tasks; and

(e) Notifying the OHCQ:

(i) If the delegating nurse’s contract or employment with the assisted living program is terminated; and

(ii) Of the reason why the contract or employment was terminated.

When an assisted living manager fails to implement nursing or clinical orders without identifying alternatives to the care or service order, the delegating nurse shall notify the resident’s physician, the OHCQ, and the resident, or if applicable, the legal representative of the resident.
Preadmission Requirements.

Before Move-In.

(1) Before admission the assisted living manager or designee shall determine whether:

(a) The resident may be admitted under the assisted living program’s licensure category; and

(b) The resident’s needs can be met by the program.

(2) Within 30 days before admission, the assisted living manager or designee shall determine admission eligibilities described in §A(1) of this regulation based on completion of a resident assessment using the Resident Assessment Tool as described in §B of this regulation. The Department may modify the level of care determination made by the assisted living program at any time. The Resident Assessment Tool:

(a) Determines the resident’s required level of care;

(b) Forms the basis for the development of the resident’s service plan; and

Resident Assessment Tool.

(1) Within 30 days before admission, the assisted living program shall collect, on the Resident Assessment Tool wrote information about a potential resident’s physical condition and medical status.

(2) Information on the Resident Assessment Tool shall be based on an examination conducted by a primary physician, certified nurse practitioner, certified registered nurse midwife, registered nurse, or physician assistant who shall certify that the information on the Assessment reflects the resident’s current health status.

(3) If the potential resident is admitted on an emergency basis by a local department of social services, the required assessment using the Resident Assessment Tool shall be completed as soon as possible but no later than 14 days of the emergency admission.

(4) Information on the assessment shall include at a minimum:

(a) Recent medical history, including any acute medical conditions or hospitalizations;

(b) Significant medical conditions affecting functioning, including the individual’s ability for self-care, cognition, physical condition, and behavioral and psychosocial status;

(d) Known allergies to foods and medications;

(e) Medical confirmation that the individual is free from communicable tuberculosis, and other active reportable airborne communicable diseases;

(f) Current and other needed medications;

(g) Current and other needed treatments and services for medical conditions and related problems;

(h) Current nutritional status, including height, weight, risk factors, and deficits;

(i) Diets ordered by a physician;

(j) Medically necessary limitations or precautions; and

(k) Monitoring or tests that need to be performed or followed up after admission.

Functional Assessment. Within 30 days before admission, the assisted living manager, or designee, shall collect on the Resident Assessment Tool the following information regarding the current condition of each resident:

(1) Level of functioning in activities of daily living;

(2) Level of support and intervention needed, including any special equipment and supplies required to compensate for the individual’s deficits in activities of daily living;

(3) Current physical or psychological symptoms requiring monitoring, support, or other intervention by the assisted living program;

(4) Capacity for making personal and healthcare-related decisions;

(5) Presence of disruptive behaviors, or behaviors which present a risk to the health and safety of the resident or others; and

(6) Social factors, including:

(a) Significant problems with family circumstances and personal relationships;

(b) Spiritual status and needs; and

(c) Ability to participate in structured and group activities, and the resident’s current involvement in these activities.

Resident Requirements for Awake Overnight Staff.

(1) Before admission, the assisted living manager shall ensure that the resident is assessed using the Resident Assessment Tool.

(2) When the resident scores in any of the areas identified as “Triggers for Awake Overnight Staff” in the Resident Assessment Tool, the assisted living program shall provide awake overnight staff or document why the awake overnight staff is not necessary for accordance with Regulation .14C of this chapter.

Short-Term Residential Care Requirements.

(1) For persons admitted for short-term residential care, only the following are required:

(a) Current physical condition and medical status as specified in §B(4) of this regulation, and functional assessment as specified in §C of this regulation; and

(b) A resident agreement, in accordance with Regulations .24 and .25 of this chapter.

(2) Other than the information required in §D(1) of this regulation, additional information is not required for subsequent short-term admissions if the resident or the resident’s representative certifies that there has been no significant change in the resident’s service needs.

A resident admitted as an emergency placement by a local department of social services is exempt from all physical examination and assessment requirements of this regulation if the resident is in temporary emergency shelter and services status, not to exceed 14 days, with notification to the Department of the placement within 48 hours.