Current through Register Vol. 50, No. 9, September 20, 2024
A. There
shall be a single organized professional staff that has the overall
responsibility for the quality of all clinical care provided to clients, for
the ethical conduct and professional practices of its members, as well as for
accounting therefore to the governing body. The manner in which the
professional staff is organized shall be consistent with the TGH's documented
staff organization and policies and shall pertain to the setting where the TGH
is located. The organization of the professional staff and its policies shall
be approved by the TGH's governing body.
B. The staff of a TGH shall have the
appropriate qualifications to provide the services required by its clients
comprehensive treatment plans. Each member of the direct care staff may not
practice beyond the scope of his/her license or certification.
C. Staffing Ratios
1. All staffing shall be adequate to meet the
individualized treatment needs of the clients and the responsibilities of the
staff. Staffing schedules shall reflect overlap in shift hours to accommodate
information exchange for continuity of client treatment, adequate numbers of
staff reflective of the tone of the unit, appropriate staff gender mix and the
consistent presence and availability of professional staff. In addition,
staffing schedules should ensure the presence and availability of professional
staff on nights and weekends, when parents are available to participate in
family therapy and to provide input on the treatment of their child.
2. A TGH shall have a minimum of two staff on
duty per shift in each living unit, with at least one staff person awake during
overnight shifts with the ability to call in as many staff as necessary to
maintain safety and control in the facility, depending upon the needs of the
current population at any given time.
3. A ratio of not less than one staff to five
clients is maintained at all times; however, two staff shall be on duty at all
times with at least one being direct care staff when there is a client present.
D. The staff shall have
the following acceptable hours and ratios:
1.
Supervising Practitioner. The supervising practitioner's hours shall be
adequate to provide the necessary direct services and to meet the
administrative and clinical responsibilities of supervision and of directing
the care in a TGH. The number of hours the supervising practitioner needs to be
on-site is dependent upon the size of program and the unique needs of each
individual client.
2. Clinical
Director. The clinical director shall have adequate hours to fulfill the
expectations and responsibilities of the clinical director.
3. Nurse. The TGH shall have at least one
licensed nurse available to meet the nursing health care needs of the clients
and who is on-call 24 hours a day and can be on-site within 30 minutes as
needed.
4. Therapist. Each
therapist shall be available at least three hours per week for individual and
group therapy and two hours per month for family therapy.
5. Direct Care Staff. The ratio of direct
care staff to clients served shall be 1:5 with a minimum of two staff on duty
per shift for a 10 bed capacity. This ratio may need to be increased based on
the assessed level of acuity of the youth or if treatment interventions are
delivered in the community and offsite.
E. Orientation
1. All staff shall receive orientation prior
to being assigned to provide client care without supervision.
2. Orientation includes, but is not limited
to:
a. confidentiality;
b. grievance process;
c. fire and disaster plans;
d. emergency medical procedures;
e. organizational structure;
f. program philosophy;
g. personnel policy and procedure;
h. detecting and mandatory reporting of
client abuse, neglect or misappropriation;
i. detecting signs of illness or dysfunction
that warrant medical or nursing intervention;
j. basic skills required to meet the health
needs and problems of the client;
k. crisis intervention and the use of
nonphysical intervention skills, such as de-escalation, mediation conflict
resolution, active listening and verbal and observational methods to prevent
emergency safety situations;
l. the
safe use of time out and passive physical restraint (including a practice
element in the chosen method); and
m. recognizing side effects of all
medications including psychotropic drugs.
F. Training. All staff shall receive training
according to provider policy at least annually and as deemed necessary
depending on the needs of the clients. The TGH shall maintain documentation of
all training provided to its staff. The TGH shall meet the following
requirements for training.
1. Staff shall
have ongoing education, training and demonstrated knowledge of at least the
following:
a. techniques to identify staff
and client behaviors, events, and environmental factors that may trigger
emergency safety situations;
b. the
use of nonphysical intervention skills, such as de-escalation, mediation
conflict resolution, active listening, and verbal and observational methods, to
prevent emergency safety situations;
c. the safe use of time out for behavior
management, including the ability to recognize any adverse effects as a result
of the use of time out; and
d. the
safe use of passive physical restraint (including a practice element in the
chosen method).
2.
Certification in the use of cardiopulmonary resuscitation, including periodic
recertification, is required within 30 days of hire.
3. Training shall be provided only by staff
who are qualified by education, training, and experience.
4. Staff training shall include training
exercises in which staff members successfully demonstrate in practice the
techniques they have learned for managing emergency safety
situations.
5. Staff shall be
trained and demonstrate competency before participating in an emergency safety
intervention.
6. All training
programs and materials used by the TGH shall be available for review by
HSS.
G. Staff
Evaluation. The TGH shall complete an annual performance evaluation of all
staff members. For any person who interacts with clients, the provider's
performance evaluation procedures shall address the quality and nature of a
staff member's relationships with clients.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and
R.S.
40:2009.
