Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 158.000 - Licensure of Adult Day Health Programs
Section 158.033 - Staff Qualifications and Responsibilities

Universal Citation: 105 MA Code of Regs 105.158

Current through Register 1531, September 27, 2024

(A) All personnel shall be currently licensed, registered, or deemed competent in accordance with applicable laws, licensure, registration, or competency requirements, and 105 CMR 158.000.

(B) All Program personnel in direct contact with participants shall be trained in emergency procedures and licensed nurses and Program Aides shall be certified in cardiopulmonary resuscitation (CPR) and basic first aid by an approved instructor.

(C) All personnel shall be assigned duties that are consistent with their training, experience, and written job description, and within their scope of practice.

(D) Registered Nurse.

(1) A Program's registered nurse(s) shall have at least two years of recent experience in the direct care of adults or chronically disabled persons.

(2) The minimum responsibilities of the Program's registered nurse(s) include:
(a) Provision and supervision of all nursing services;

(b) Supervision of staff;

(c) Coordinating the completion of, and ensuring the accuracy of, each participant's assessment;

(d) Coordinating the development, ongoing review, and revision of each participant's plan of care;

(e) Ensuring that nursing notes are written at least one time per month or more often as necessary to reflect each participant's health care status;

(f) Responding appropriately to any acute changes in a participant's health or functioning;

(g) Providing appropriate health care education for each participant and legally authorized representative;

(h) Assisting as necessary in the delivery of other Services;

(i) Ensuring ongoing education, training, and professional development of all Program staff that is relevant to care of participants;

(j) Obtaining, reviewing, and implementing primary care provider orders;

(k) Coordinating the participant's care with the primary care provider and, if applicable, community service providers;

(l) Supervising medication management services; and

(m) Developing medication policies and procedures, in accordance with 105 CMR 158.039.

(E) Licensed Practical Nurse.

(1) The minimum responsibilities of a Program's licensed practical nurse(s) include:
(a) Provision of nursing services and treatments to participants;

(b) Supervision of the care and services provided to participants by Program Aides, volunteers, and other personnel, as applicable;

(c) Participating in the completion of participants' comprehensive assessments and plans of care;

(d) Writing nursing notes at least one time per month or more often as necessary to address significant changes and health care teaching in each participant's health record;

(e) Responding appropriately to any acute changes in a participant's health or functioning;

(f) Providing appropriate health care education for each participant and legally authorized representative;

(g) Obtaining, reviewing, and implementing primary care provider orders; and

(h) Coordinating the participant's care with the primary care provider and, if applicable, community service providers.

(F) Program Aide.

(1) On and after May 1, 2015 a Program may not employ any individual for more than four months as an aide at a Program unless the individual has been determined competent, pursuant to one of the following criteria:
(a) Has demonstrated competence through satisfactory participation in a relevant health care training or competency evaluation program. Said training or competency evaluation program must teach students nursing and nursing related skills including, at minimum, the skills identified at 105 CMR 158.033(F)(1)(b); or

(b) A registered nurse employed by the Program or under contract with the Program has determined the individual is competent to provide direct care to participants based on the individual's demonstration of competency in basic nursing and nursing related skills and techniques. The Program shall provide at least 40 hours of a combination of classroom and experiential training regarding the skills identified at 105 CMR 158.033(F)(1)(b) prior to determining the individual is competent to be a Program Aide. In order to be deemed competent, the individual must demonstrate competency in the following skill areas:
1. Communication and interpersonal skill;

2. Observation, reporting, and documentation of participant status and the care or service furnished;

3. Basic infection control procedures;

4. Basic delegated nursing and nursing related skills including:
a. Basic elements of body functioning and changes in body function that must be reported to the aide's supervisor;

b. Obtaining and recording vital signs;

c. Personal care skills including appropriate and safe participant personal hygiene and grooming techniques;

d. Assisting participants at various levels of functioning with ADL;

e. Basic restorative nursing; and

f. Safety and emergency procedures, including the Heimlich Maneuver.

5. Maintenance of a clean, safe, and healthy environment;

6. Recognizing, responding to, and reporting emergencies and knowledge of emergency procedures;

7. Recognizing the physical, emotional, and developmental needs of participants and working in a manner that respects participants, their privacy, and their property;

8. Prevention of, and reporting, participant abuse, neglect, mistreatment and misappropriation; and

9. Caring for participants enrolled at the Program and participants with Alzheimer's Disease and related disorders.

(2) A Program shall provide each individual who has not been determined competent pursuant to 105 CMR 158.033(F)(1)(a) with at least eight hours of orientation training regarding the skills identified at 105 CMR 158.033(F)(1)(b)1. through 9. before that individual may provide any direct care to participants.

(3) The Program shall maintain documentation of each Program Aide's training and competency determination in his or her personnel file.

(4) The responsibilities of the Program Aide include assisting the nursing staff and the therapeutic activities director as required, and in accordance with participant plans of care, written policies and procedures, and 105 CMR 158.000, in order to meet the needs of individual participants.

(5) A Program Aide may not simultaneously perform maintenance, food preparation, or extensive housekeeping tasks during Program hours of operation and serve as a Program Aide necessary to satisfy minimum staffing requirements in 105 CMR 158.032(C).

(G) Service Coordination Staff.

(1) The responsibilities of the Program's social worker(s) or other staff person(s) who is appropriately licensed or supervised pursuant to 258 CMR 12.00: Scope of Practice shall include:
(a) Informing participants of and referring participants to available community services;

(b) Participating in the completion of comprehensive assessments and plans of care;

(c) Writing service coordination notes in the participant's health record upon service commencement, when significant changes occur, and at least one time every 90 days or more often as necessary to ensure the health record reflects the current clinical needs of the participant;

(d) Providing, as appropriate, coordination of the medically-related physical, mental, and behavioral, service needs of a participant at the time of enrollment, during treatment and care in the Program, or at the time of discharge;

(e) Assisting with any personal, social, family, or adjustment problems the participant may experience at the Program;

(f) Referring the participant or family to the appropriate community resources if the participant or the participant's family requires specialized counseling; and

(g) Coordinating services if a participant needs services from other community agencies, and no agency is acting as coordinator of services for that participant.

(h) Assessing, planning, implementing, coordinating, monitoring, and evaluating the services required to meet a participant's needs.

(2) Any staff person who performs service coordination shall have a minimum of a bachelor's degree in human services or a related field from an accredited college or university and at least one year of relevant and recent experience working with adults in a professional capacity.

(H) Therapeutic Activity Director.

(1) The therapeutic activity director shall be a therapeutic recreation specialist or an activities professional who:
(a) Is certified as a therapeutic recreation specialist or an activities professional by an accrediting body recognized by the Department; or

(b) Is a qualified occupational therapist; or

(c) Is an occupational therapy assistant; or

(d) Has at least two years of experience working in a social or recreational program within the last five years, one of which was full-time in an activities program in a health care setting.

(2) If the activity director is not certified as a therapeutic recreation specialist or an activities professional by an accrediting body recognized by the Department, or is not a qualified occupational therapist, the activity director and the Program shall:
(a) consult with an occupational therapist in the development of a therapeutic activities program that meets the individual needs of each participant; or

(b) adopt a model therapeutic activities program, provided that the model activities program is developed in consultation with an occupational therapist, and implement such activities program in a manner that meets the individual needs of each participant.

(3) The responsibilities of the therapeutic activity director shall include:
(a) Developing and implementing the therapeutic activity program for each participant;

(b) Supervising the program aides who assist with therapeutic activities;

(c) Planning and scheduling activities and events;

(d) Posting in a conspicuous place a monthly calendar of activities and events;

(e) Contributing to each participant's comprehensive assessment and plan of care;

(f) Writing a therapeutic activity note at least one time every 90 days or more often as necessary in each participant's health record that documents the participant's therapeutic activity needs, participation in, reaction to, and current preference for activities; and

(g) Assisting as necessary with other Services.

(I) Rehabilitation Services. Rehabilitation services shall be provided by licensed physical therapists, occupational therapists, and speech, hearing, and language therapists.

(J) Registered Dietitian.

(1) The responsibilities of the registered dietitian shall include:
(a) Ensuring dietary services are provided and the nutritional needs of participants are met;

(b) Providing, as applicable, consultation and training to the qualified cook regarding dietary personnel, food production, service procedures, maintenance of records, training programs, and sanitation;

(c) Providing consultation and education to staff regarding the nutritional requirements of participants, meal service, distribution, sanitation, and disaster dietary plans; and

(d) Evaluating and approving the nutritional adequacy of the menus as planned.

(K) Qualified Cook. The qualified cook shall be responsible for the following:

(1) Managing all aspects of the meal service and kitchen;

(2) Preparing menus;

(3) Procuring food from approved sources; and

(4) Storing, preparing, distributing, and serving food under sanitary conditions.

(L) Volunteers.

(1) The Program Director shall determine the duties and responsibilities of volunteers.

(2) If a volunteer provides direct participant care, the volunteer shall, at minimum, meet the qualifications of program aide staff specified at 105 CMR 158.033(F).

(3) A volunteer may not be counted as a licensed nurse, Program Aide, social worker or any individual(s) supervised by a social worker in accordance with 258 CMR 12.00: Scope of Practice, or activity director for the purpose of satisfying the minimum staffing requirements specified in 105 CMR 158.032.

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