Current through Register Vol. 51, No. 19, September 20, 2024
A. Following an
analysis of the number of residents that the assisted living program intends to
serve and the individual needs of each resident, the licensee shall develop a
staffing plan that identifies the type and number of staff needed to provide
the services required by this chapter.
B. The staffing plan shall include on-site
staff sufficient in number and qualifications to meet the 24-hour scheduled and
unscheduled needs of the residents. When a resident is in the facility, a staff
member shall be present.
C. Awake
Overnight Staff. An assisted living program shall provide awake overnight staff
when a resident's assessment using the Resident Assessment Tool, as provided in
Regulation .21A or .26B of this chapter, indicates that awake overnight staff
is required according to instructions on that tool. If a physician or assessing
nurse, in the physician's or nurse's clinical judgment, does not believe that a
resident requires awake overnight staff, the physician or assessing nurse shall
document the reasons in the area provided in the Resident Assessment Tool. The
licensee shall retain this documentation in the resident's record.
D. Electronic Monitoring Systems.
(1) Upon the written recommendation of the
resident's physician or assessing nurse, the assisted living program may apply
to the Department for a waiver in accordance with Regulation .09 of this
chapter to use an electronic monitoring system instead of awake overnight
staff.
(2) If an electronic
monitoring system is approved by the Department for the assisted living program
to use, the licensee shall document the approval of the electronic monitoring
system in the area provided on the Resident Assessment Tool.
(3) When a resident is assessed or reassessed
using the Resident Assessment Tool, as provided in Regulation .21A or .26B of
this chapter, the physician or assessing nurse shall review and document:
(a) The need for awake overnight staff if the
resident's previous assessment or review of an assessment indicated awake
overnight staff was not necessary at the time; and
(b) The continued appropriateness of a waiver
to use an approved electronic monitoring system instead of awake overnight
staff.
E.
On-Site Nursing Requirements.
(1) An assisted
living program shall provide on-site nursing when a delegating nurse or
physician, based upon the needs of a resident, issues a nursing or clinical
order for that service.
(2) If an
assisted living manager determines that a nursing or clinical order should not
or cannot be implemented, the manager, delegating nurse, and resident's
physician shall discuss any alternatives that could safely address the
resident's needs. The assisted living manager shall document in the resident's
record this discussion and all individuals who participated in the
discussion.
(3) If there are
alternatives that could safely address the resident's needs, the assisted
living manager shall notify the resident and, if appropriate, the resident's
legal representative, the delegating nurse, and resident's physician of the
change to the order. The assisted living manager shall document in the
resident's record this change and the date of notification.
(4) If a manager fails to implement a nursing
or clinical order without identifying and providing alternatives to the care or
service order, the delegating nurse shall notify the resident's physician, the
OHCQ, and the resident or, if appropriate, the legal representative of the
resident.
(5) Failure to implement
a nursing or clinical order, without demonstrating why the order should not be
followed or without identifying alternatives to care, may result in sanctions
against the assisted living program.
F. On-site nursing personnel shall work in
partnership with the delegating nurse and assisted living program staff to
ensure:
(1) Adequate assessment of
residents;
(2) Planning of medical
services; and
(3) Oversight of
nursing activities.
