Current through Register Vol. 63, No. 3, March 1, 2024
(1) STAFFING
REQUIREMENTS. Facilities must have qualified awake direct care staff,
sufficient in number to meet the 24-hour scheduled and unscheduled needs of
each resident. Direct care staff provide services for residents that include
assistance with activities of daily living, medication administration,
resident-focused activities, supervision, and support.
(a) If a facility employs universal workers
whose duties include other tasks (e.g., housekeeping, laundry, food service),
in addition to direct resident care, staffing must be increased to maintain
adequate resident care and services.
(b) Prior to providing care and services to
residents, direct care staff must be trained as required in sections (2) - (4)
of this rule.
(c) The following
facility employees are ancillary to the caregiver requirements in this section:
(A) Individuals whose duties are exclusively
housekeeping, building maintenance, clerical, administrative, or food
preparation.
(B) Licensed nurses
who provide services as specified in OAR 411-054-0045 (Resident Health
Services).
(C)
Administrators.
(d) The
Department retains the right to require minimum staffing standards based on
acuity, complaint investigation or survey inspection.
(e) Based on resident acuity and facility
structural design there must be adequate direct care staff present at all
times, to meet the fire safety evacuation standards as required by the fire
authority or the Department.
(f)
The licensee is responsible for assuring that staffing is increased to
compensate for the evaluated care and service needs of residents at move-in and
for the changing physical or mental needs of the residents.
(g) A minimum of two direct care staff must
be scheduled and available at all times whenever a resident requires the
assistance of two direct care staff for scheduled and unscheduled
needs.
(h) In facilities where
residents are housed in two or more detached buildings, or if a building has
distinct and segregated areas, a designated caregiver must be awake and
available in each building and each segregated area at all times.
(i) Facilities must have a written, defined
system to determine appropriate numbers of direct care staff and general
staffing based on resident acuity and service needs. Such systems may be either
manual or electronic.
(A) Guidelines for
systems must also consider physical elements of a building, use of technology
if applicable and staff experience.
(B) Facilities must be able to demonstrate
how their staffing system works.
(2) REQUIREMENTS APPLICABLE TO ALL TRAINING.
The facility shall:
(a) Have a training
program that includes methods to determine competency of direct care staff
through evaluation, observation, or written testing. Facility shall also
maintain documentation regarding each direct care staff's demonstrated
competency.
(b) Maintain written
documentation of all trainings completed by each employee.
(3) PRE-SERVICE ORIENTATION FOR ALL
EMPLOYEES.
(a) Prior to beginning their job
responsibilities, all employees must complete an orientation that includes
training regarding:
(A) Residents' rights and
the values of community-based care.
(B) Abuse and reporting
requirements.
(C) Standard
precautions for infection control.
(D) Fire safety and emergency
procedures.
(b) If the
staff member's duties include preparing food, they must have a food handler's
certificate.
(c) All staff must
receive a written description of their job responsibilities.
(d) PRE-SERVICE INFECTIOUS DISEASE PREVENTION
TRAINING. Prior to beginning their job responsibilities, unless the employee
received the training described below within the 24-month period prior to the
time of hiring, all employees must complete training addressing the prevention,
recognition, control and reporting of the spread of infectious disease. The
Department, in consultation with the Oregon Health Authority, has determined
this training must address the following curricula:
(A) Transmission of communicable disease and
infections, including:
(i) Policy with
criteria directing staff to stay home when ill with a communicable disease, so
as not to transmit disease.
(ii)
Respiratory hygiene and coughing etiquette.
(B) Standard precautions.
(C) Hand hygiene.
(D) Use of personal protective
equipment.
(E) Cleaning of physical
environment, including, but not limited to:
(i) Disinfecting high-touch surfaces and
equipment.
(ii) Handling, storing,
processing and transporting linens to prevent the spread of
infection.
(F) Isolating
and cohorting of residents during a disease outbreak.
(G) Employees must also receive training on
the rights and responsibilities of employees to report disease outbreaks under
ORS
433.004
and safeguards for employees who report disease outbreaks.
(H) Facilities will be required to have all
staff trained, as described in this rule, by July 1, 2022.
(e) INFECTIOUS DISEASE TRAINING CURRICULUM.
Pre-service infectious disease training curriculum must be approved by the
Department before facilities may offer training to staff.
(A) The pre-service training may be provided
in person, in writing, by webinar or by other electronic means.
(B) Online training will be made available by
the Department by January 1, 2022.
(C) Facilities or other entities that want to
provide training curriculum to facilities must first present that curriculum to
the Department for review and approval.
(D) The Department will review training from
facilities or other entities with the goal of making training available to
facilities by January 1, 2022.
(4) PRE-SERVICE TRAINING FOR ALL DIRECT CARE
STAFF.
(a) Prior to providing care to
residents, all direct care staff must complete an approved pre-service dementia
training.
(b) Pre-service dementia
care training requirements for:
(A) 2018 -
Direct care staff hired on or before December 31, 2018 shall complete
pre-service dementia care training outlined in OAR 411-054-0070 by December 31,
2018, regardless of when they first provide direct care to residents.
(B) 2019 and beyond - Direct care staff hired
on or after January 1, 2019 shall complete required pre-service dementia
training prior to providing direct care to residents.
(c) Documentation of dementia training:
(A) A certificate of completion shall be
issued to direct care staff who satisfactorily complete approved dementia
training. Facilities shall also maintain records of all direct care staff who
have successfully completed pre-service dementia training.
(B) Each facility shall maintain written
documentation of continuing education completed, including required pre-service
dementia training, for all direct care staff.
(d) Portability of pre-service dementia
training: After completing the pre-service training, if a direct care staff
person is hired within 24 months by a different facility, the hiring facility
may choose to accept the previous training or require the direct care staff to
complete the hiring facility's pre-service dementia training.
(e) A certificate of completion must be made
available to the Department upon request.
(f) Pre-service dementia care training must
include the following subject areas:
(A)
Education on the dementia disease process, including the progression of the
disease, memory loss, and psychiatric and behavioral symptoms.
(B) Techniques for understanding,
communicating, and responding to distressful behavioral symptoms, including,
but not limited to, reducing the use of antipsychotic medications for
non-standard uses.
(C) Strategies
for addressing social needs of persons with dementia and engaging them with
meaningful activities.
(D)
Information concerning specific aspects of dementia care and ensuring the
safety of residents with dementia, including, but not limited to, how to:
(i) Identify and address pain.
(ii) Provide food and fluids.
(iii) Prevent wandering and
elopement.
(iv) Use a
person-centered approach.
(g) Pre-service orientation to resident:
(A) Prior to providing personal care services
for a resident, direct care staff must receive an orientation to the resident,
including the resident's service plan.
(B) Staff members must be directly supervised
by a qualified person until they have successfully demonstrated satisfactory
performance in any task assigned and the provision of individualized resident
services, as applicable.
(5) ANNUAL INSERVICE FOR ALL STAFF. Annual
infectious disease training requires the following:
(a) Administrators and employees will be
required to complete annual training on infectious disease outbreak and
infection control. Such training will be included within the current number of
required annual training hours and will not necessitate additional hours of
training.
(b) Annual in-service
training must be documented in the employee record.
(c) These annual training requirements will
be required as of July 1, 2023.
(6) TRAINING WITHIN 30 DAYS OF HIRE FOR
DIRECT CARE STAFF.
(a) The facility is
responsible to verify that direct care staff have demonstrated satisfactory
performance in any duty they are assigned.
(b) Knowledge and performance must be
demonstrated in all areas within the first 30 days of hire, including, but not
limited to:
(A) The role of service plans in
providing individualized resident care.
(B) Providing assistance with the activities
of daily living.
(C) Changes
associated with normal aging.
(D)
Identification of changes in the resident's physical, emotional and mental
functioning and documentation and reporting on the resident's changes of
condition.
(E) Conditions that
require assessment, treatment, observation and reporting.
(F) General food safety, serving and
sanitation.
(G) If the direct care
staff person's duties include the administration of medication or treatments,
appropriate facility staff, in accordance with OAR 411-054-0055 (Medications
and Treatments) must document that they have observed and evaluated the
individual's ability to perform safe medication and treatment administration
unsupervised.
(7) ANNUAL IN-SERVICE TRAINING FOR DIRECT
CARE STAFF.
(a) All direct care staff must
complete and document a minimum of 12 hours of in-service training annually on
topics related to the provision of care for persons in a community-based care
setting, including training on chronic diseases in the facility population and
dementia training. Annual in-service training hours are based on the
anniversary date of hire.
(b)
Requirements for annual in-service dementia training:
(A) Except as provided in paragraph (B) of
this section, each direct care staff must complete 6 hours of annual in-service
training on dementia care.
(B)
Exception: Staff hired prior to January 1, 2019 must complete 6 hours of
dementia care in-service training by the anniversary of their hire date in 2020
and annually thereafter.
(C)
Dementia care training may be included in the required minimum 12 hours of
annual in-service training described in subsection (a) above.
(D) Dementia care training must reflect
current standards for dementia care and be informed by the best evidence in the
care and treatment of dementia.
(E)
The facility shall determine the competency of direct care staff in dementia
care in the following ways:
(i) Utilize
approved dementia care training for its direct care staff, coupled with methods
to perform a competency assessment as defined in OAR 411-054-0005(19).
(ii) Ensure direct care staff have
demonstrated competency in any duty they are assigned. Facility staff in a
supervisory role shall perform assessment of each direct care staff.
(iii) Maintain written documentation of all
dementia care training completed by each direct care staff and shall maintain
documentation regarding each employee's assessed competency.
(8) APPROVAL
OF DEMENTIA TRAINING CURRICULUM. All dementia care training provided to direct
care staff must be approved by a private or non-profit organization that is
approved by the Department through a "Request for Application" (RFA) process.
(9) ADDITIONAL REQUIREMENTS.
Staff:
(a) Under 18 years of age may not
perform medication administration or delegated nursing tasks. Staff under the
age of 18 must be directly supervised when providing bathing, toileting,
incontinence care or transferring services.
(b) Must be trained in the use of the
abdominal thrust and First Aid. Cardiopulmonary resuscitation (CPR) training is
recommended, but not required.
(c)
Must have sufficient communication and language skills to enable them to
perform their duties and communicate with residents, other staff, family
members, and health care professionals, as needed.
Statutory/Other Authority: ORS
410.070,
443.012
& 443.450
Statutes/Other Implemented: ORS
443.400
- 443.455 & 443.991