Minimum Staffing

8.1 Whenever one or more residents are present in the assisted living residence, there shall be at
least one staff member present who meets the criteria in section 8.7 and is capable of responding
to an emergency.
(A) Residents shall not be transferred off site solely for the convenience of the assisted living
residence or its staff.

8.2 Between 10 PM and 6 AM, staff shall conduct at least one safety check of all consenting
residents. Staffing Levels

8.3 To determine appropriate routine staffing levels, the assisted living residence shall consider, at a
minimum, the following items:
(A) The acuity and needs of the residents;
(B) The services outlined in the care plan; and
(C) The services set forth in the resident agreement.

8.4 Staff shall be sufficient in number to help residents needing or potentially needing assistance,
considering individual needs such as the risk of accident, hazards, or other challenging events.
First Aid, Obstructed Airway Technique and Cardiopulmonary Resuscitation Trained Staff

8.5 The assisted living residence shall ensure that it has sufficient staff members who are currently
certified in first aid and cardiopulmonary resuscitation to meet the requirements of this section.

8.6 Each assisted living residence shall have at least one staff member onsite at all times who has
current certification in first aid from a nationally recognized organization such as the American
Red Cross, the American Heart Association, National Safety Council, or American Safety and
Health Institute. The certification shall either be in Adult First Aid or include Adult First Aid.

8.7 Each assisted living residence shall have at least one staff member onsite at all times who has
current certification in cardiopulmonary resuscitation (CPR) and obstructed airway techniques
from a nationally recognized organization such as the American Red Cross, the American Heart
Association, the National Safety Council or the American Safety and Health Institute. The
certification shall either be in Adult CPR or include Adult CPR.

8.8 Each assisted living residence shall place in a visible location a list of all staff who have current
certification in first aid or CPR so that the information is readily available to staff at all times. The
list shall be kept up to date and indicate by staff person whether the certification is in first aid or
CPR or both.

8.9 Each assisted living residence shall require that all staff who are certified in first aid and/or
obstructed airway techniques promptly provide those services in accordance with their training.

8.10 Each assisted living residence shall require that all staff who are certified in CPR promptly
provide those services in accordance with their training, unless the affected resident has a do not
resuscitate order.

8.11 Each assisted living residence shall require that staff, even if not certified in first aid or CPR,
promptly respond to an emergency and follow the instructions of a 911 emergency call operator
until a medically trained provider can assume care.
Use of Volunteers and Residents

8.12 Volunteers and residents may assist with the provision of resident care and services, but the
assisted living residence shall not consider the use of either volunteers or resident helpers in
determining the appropriate staffing level.
Use of Hospice Providers

8.13 When licensed hospice care is provided in an assisted living residence, there shall be a written
agreement regarding the provision of that care by a hospice provider. The written agreement shall
be signed by authorized representatives of the hospice and assisted living residence prior to the
provision of hospice care. The written agreement shall include, at a minimum, the following:
(A) How the assisted living residence and hospice will coordinate and communicate with
each other to ensure that the needs of the resident are being fully met;
(B) A provision that the assisted living residence shall immediately notify the hospice if:
(1) There is a significant change in the resident’s physical, mental, social or
emotional status that may necessitate a change to the resident’s care plan;
(2) There is a need to transfer the resident from the assisted living residence, in
which case the hospice shall coordinate any necessary care related to the
terminal illness and related conditions; or
(3) The resident dies.
(C) A provision stating that the hospice assumes responsibility for determining the
appropriate course of hospice care, including the determination to change the level of
services provided; and
(D) A provision stating that it is the responsibility of the assisted living residence to provide
24-hour room and board and the other services required by this Chapter 7.
8.14 If a hospice provider fails to provide services when they are necessary, the assisted living
residence shall follow the requirements of section 12.5 regarding a resident’s significant change
in baseline status and request a practitioner assessment.
Contracted Personnel and Services

8.15 An assisted living residence that uses a separate agency, organization or individual to provide
services for the ALR or residents shall have a written agreement that sets forth the terms of the
arrangement. The agreement shall specify, at a minimum, the following items:
(A) The specific services to be provided;
(B) The time frame for the provision of such services;
(C) The contractor’s obligation to comply with all applicable assisted living residence policies
and procedures, including personnel qualifications;
(D) How such services will be coordinated and overseen by the assisted living residence; and
(E) The procedure for payment of services provided under the contract.

8.16 If contract personnel and/or services are used, the contractor shall meet all applicable
requirements of these regulations.

8.17 Notwithstanding the above criteria, the assisted living residence shall retain responsibility for
oversight of all contracted personnel and services to ensure the health, safety and welfare of the
residents.

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