Section 29-9704. STAFFING REQUIREMENTS: GENERAL

 

9704.1Each ADHP shall develop and maintain a staffing and personnel training plan that ensures adequate personnel in number and skill to meet minimum required staffing levels in accordance with this section and to deliver required services to each participant in accordance with the ADHP plan of care.

 

9704.2Each ADHP program shall maintain the following staffing requirements:

 

(a) For acuity level 1 (minimum acuity level), each ADHP program shall maintain a minimum staff to participant ratio of at least one (1)  Direct Support Professional staff member for every ten (10) participants (1:10 ratio);

 

(b) For acuity level 2 (maximum acuity level), each ADHP program shall maintain a minimum staff to participant ratio of at least one (1) Direct Support Professional staff member for every four (4) participants (1:4 ratio);

 

(c) Only Direct Support Professional staff shall be included in calculating the staffing ratios; and

 

(d) Volunteers shall not be used to fulfill the required staffing ratios nor be counted in calculating the staffing ratios. 

 

9704.3Each ADHP program shall conduct staff orientation for new employees and in-service training sessions  consisting of continuing education at least quarterly and as needed, in accordance with its staffing and personnel training plan. The training and orientation shall include, at a minimum, the following topics:

 

(a) Infection control;

 

(b) Developing an ADHP plan of care to  implement a participant’s  person-centered service plan;

 

(c) Procedures to identify, and report abuse, neglect, and exploitation;

 

(d) Body Mechanics (including physically assisting in escorting, lifting and transferring participants);

 

(e) Emergency procedures for evacuation of the building in the case of fire and/or other disaster or emergency; and

 

(f)  Specialized needs of older adults, including Alzheimer’s or dementia.

 

9704.4Each Provider of ADHP services shall employ a full time professional staff member as the Program Director who shall be responsible for the overall management, administration and fiscal operations of the ADHP program including, but not limited to: 

 

(a) Supervising and directing the general administration of the program;

 

(b) Developing and implementing appropriate programmatic policies pursuant to the requirements under Subsection 9703.4;

 

(c) Preparing budgets and required financial reports, ensuring sound fiscal administration including billing and payment;

 

(d) Ensuring that an ADHP plan of care is developed for each participant;

 

(e) Developing and implementing a community outreach plan to publicize the ADHP’s goals, mission, and target population served;

 

(f) Developing and implementing effective strategies to recruit, employ, supervise, and retain qualified staff, including staff orientation and on-going in-service training;

 

(g) Developing and implementing an effective quality assurance program;

 

(h) Overseeing   regulatory and reporting requirements in accordance with this chapter; and

 

(i) Appointing one (1) professional staff member to ensure that there is an Acting Program Director in the absence of the Program Director.

 

9704.5An ADHP program director employed pursuant to Subsection 9704.4 shall meet the following qualifications:

 

(a) Have a bachelor’s degree in a human services field from an accredited college or university and at least four (4) years of experience working with older adults in a social services or health care program; or

 

(b) Have a master’s degree in a human services field and a minimum of one (1) year of experience working with older adults in a social service or health care program; or

 

(c)Is a licensed registered nurse with at least two (2) years working with older adults in a social service or health care program.

 

9704.6Each Provider of ADHP services shall employ a full time registered nurse who shall be responsible for, but not limited to:

 

(a)  Coordinating the implementation and on-going review of each participant’s ADHP plan of care, including making any updates to the plan, and coordinating the sharing of information with the participants’ other health care providers to ensure care is organized;

 

(b) Monitoring the health care needs of each participant and providing or supervising nursing services, including medication administration, for each participant in accordance with the orders of the participant’s physician and the participant’s   ADHP plan of care;

 

(c) Supervising other nursing personnel;

 

(d)  Providing teaching and instruction about a participant’s ADHP plan of care;

 

(e) Providing guidance and counseling that focus on improving the health, safety and psycho-social needs of each participant;

 

(f)  Assisting, as necessary, in the delivery of other required program services;

 

(g)  Updating each participant’s record with progress notes at least monthly or more often if indicated (this activity may be delegated to other nursing personnel); and

 

(h) Notifying the beneficiary’s physician of any significant change in the beneficiary’s condition.

 

9704.8A registered nurse employed pursuant to Subsection 9704.6 shall meet the following qualifications:

 

(a)  Be licensed pursuant to the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2011 Supp.)); and

 

(b) Have at least two (2) years of experience working with older adults in a social services or health care program.

 

9704.9Each Provider of ADHP services shall employ a full time activities coordinator who shall be responsible for developing and implementing a program of therapeutic activities including, but not limited to:

 

(a) Developing and scheduling educational, recreational and community integration activities and events;

 

(b) Supervising activity program assistants;

 

(c) Assisting personnel who are responsible for providing direct care support to the program participants;

 

(d) Participating in reviews of each participant's ADHP plan of care;

 

(e) Ensuring that a comfortable, safe and therapeutic environment for daily program implementation is maintained;

 

(f) Fostering a participant’s freedom of choice, decision making and active participation in daily activities; and

 

(g) Developing monthly progress notes regarding status updates relative to the participant’s engagement and participation in therapeutic activities.

 

9704. 10An activities coordinator employed pursuant to Subsection 9704.9 shall have a minimum of one (1) year of experience working at a social service, health care, or therapeutic recreational program that serves older adults.

 

9704.11 Each ADHP shall employ a full time social service professional who shall be responsible for, but not be limited to the following:

 

(a) Assisting in developing activities designed to improve a participant's self-awareness, level of functioning and psycho-social needs;

 

(b) Incorporating the interest and therapeutic needs of participants in the development of the activity programs;

 

(c) Coordinating and conducting individual, group and family counseling services;

 

(d) Entering monthly notes in each participant's record; 

 

(e) Referring the participant and the participant’s family to appropriate community services and resources, as needed;

 

(f) Assisting staff with ongoing program services;

 

(g) Offering guidance through counseling and teaching to the participant and the participant’s family on matters related to a participant’s health, safety and general welfare;

 

(h) Assisting in the coordination of non-ADHP services, including but not limited to case management services, medical, personal care assistance services, skilled therapies, waiver services, transportation services, home-delivered meals; and

(i)Assisting participants to access and maintain public benefits.

 

9704.12A social service professional(s) employed in accordance with Subsection 9704.11 shall:

 

(a) Have a master’s degree in social work, psychology, counseling, gerontology, sociology, therapeutic recreation or a related field and at least one (1) year of experience working with older adults in social service, health care or therapeutic recreational settings; or

 

(b)Have a four (4) year degree from an accredited university or college in social work, counseling, psychology, gerontology or therapeutic recreation or a related field and at least two (2) years of experience working with older adults and/or adults with disabilities in a social, health or recreational setting/; and

 

(c)Obtain the requisite licensure under the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.01), if required.

 

9704.13Each ADHP shall have a medical director who shall be responsible for:

 

(a)  Providing guidance, leadership, oversight and quality assurance for the development and implementation of policies and practices to promote the appropriate medical management and care of participants, including in emergency situations;

 

(b)  Consulting with the participant’s physician, when necessary;

 

(c)Taking professional responsibility for each participant’s medical care in emergency situations or when the participant’s personal physician is unavailable when the medical director is on-site at the facility;

 

(d) Overseeing the delivery of all required medical services to ensure that needed services are provided in a timely manner by the appropriate personnel, consistent with each participant’s  ADHP plan of care; and

 

(e)Participating in support team conferences, care planning and case reviews.

 

9704.14 A medical director employed by or under contract to an ADHP shall be licensed as a physician in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2011 Supp.));

 

9704.15Each ADHP shall have a dietician or nutritionist who shall be responsible for, including but not limited to, the following:

 

(a) Developing and designing menus for meals and snacks to accommodate daily nutrient requirements of each ADHP participant.

 

(b) Collaborating with the participant’s support team members as described  in Subsection 9711.4, to ensure that a participant’s nutritional needs are addressed;

 

(c) Providing nutritional education, training and counseling to each participant, the participant’s family and ADHP staff;

 

(d) Conducting and recording periodic inspections of the food service program and the food service area; and

 

(e) Ensuring that special or modified diets are developed and offered in accordance with the participant’s  ADHP plan of care.

 

9704.16A dietician or nutritionist employed or under contract to an ADHP shall be licensed in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2011 Supp.)).

 

9704.17If required, other health and social service professionals employed or under contract to an ADHP shall be licensed in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2007 Repl. & 2011 Supp.)).

 

9704.18Each ADHP shall employ a direct support professional who shall be responsible for, but not be limited to, the following:

 

(a) Assisting participants with personal care tasks and other activities of daily living;

 

(b) Providing  guidance to participants during group activities; 

 

(c) Supporting and encouraging a participant’s participation in scheduled activities;

 

(d) Monitoring and reporting any change in a participant’s health status as appropriate;

 

(e) Assisting in the implementation of each participant’s ADHP  plan of care as a member of the participant’s support team;

 

(f) Documenting daily attendance and participation for each participant; and

 

(g) Assisting participants with maintaining their optimal physical and mental health.

 

9704.19A direct support professional employed by an ADHP shall:

 

(a)   Be at least eighteen (18) years of age;

 

(b)   Be a citizen of the United States or a non-citizen who is lawfully authorized to work in the United States;

 

(c)  Be mentally, physically and emotionally competent to provide services;

 

(d)  Be free of tuberculosis and other communicable diseases as certified in writing by a physician on an annual basis;

 

(e)Be able to read and write the English language at least at the fifth (5th) grade level and carry out instructions and directions in English;

 

(f) Be certified in cardiopulmonary resuscitation (CPR), and first aid certification and maintain current certifications;

 

(g)  Complete three (3) hours of continuing education at quarterly intervals, in addition to annual CPR re-certification;

 

(h) Be trained on the participant’s ADHP plan of care prior to assisting any participant;

 

(i)Be able to recognize an emergency and be knowledgeable about emergency procedures;

 

(j)   Pass a reference check and criminal background check pursuant to the Health-Care Facility Unlicensed Personnel Criminal Background Check Act of 1988, effective April 20, 1999 (D.C. Law 12-238; D.C. Official Code, §§ 44-441 et seq. (2005 Repl. & 2012 Supp.)); and

 

(k)  Have at least a high school diploma or General Educational Development certificate.   

 

 

authority

An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2014 Repl.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 63 DCR 1031 (January 29, 2016).