Ga. Comp. R. & Regs. R. 111-8-63-.09 - Workforce Qualifications, Training and Staffing
(1)
The on-site manager and responsible staff persons must be at least 21 years of
age and responsible for supervising the provision of care by all other staff.
No staff person under the age of 18 is permitted to work in the assisted living
community unless there is direct line-of-sight supervision being provided by
the administrator, on-site manager or a responsible staff person or the staff
member is at least 17 years of age and has successfully completed a vocational
technical training track as a nursing assistant through a Georgia high
school.
(2) Initial Training for
All Staff. The administrator or on-site manager must ensure that any person
working in the assisted living community as staff, receives training within the
first 60 days of employment on the following:
(a) residents' rights and identification of
conduct constituting abuse, neglect or exploitation of a resident and reporting
requirements to include the employee's receipt of a copy of the Long-Term Care
Facility Resident Abuse Reporting Act as outlined in O.C.G.A. §
31-8-81 et seq.;
(b) general infection control principles
including importance of hand hygiene in all settings and attendance policies
when ill;
(c) training necessary to
carry out assigned job duties; and
(d) emergency preparedness.
(3) Initial Training for Staff
Providing Hands-On Personal Services. In addition to the initial training
required of all staff in paragraph (2) above, the administrator must ensure
that staff hired to provide hands-on personal services to residents receive
training within the first 60 days of employment which includes the following:
(a) current certification in emergency first
aid except where the staff person is a currently licensed health care
professional;
(b) current
certification in cardiopulmonary resuscitation where the training course
required return demonstration of competency;
(c) medical and social needs and
characteristics of the resident population, including special needs of
residents with dementia;
(d)
residents' rights and the provision of care to residents that is individualized
and helpful; and
(e) training
specific to assigned job duties, such as, but not limited to, permissible
assistance with medications, contraindications for medications that must be
brought to the attention of appropriate individuals, assisting residents in
transferring, ambulation, proper food preparation, proper performance of health
maintenance activities if serving as a designated proxy caregiver and
responding appropriately to dementia-related behaviors.
(4) Trained Staff Present. At least two staff
who have completed the minimum training requirements of Rule
111-8-63-.09(2)(a) through (d) and (3)(a) through
(e) above must be present in the assisted
living community at all times any residents are present, with at least one
staff person on each occupied floor, to provide necessary oversight and
assistance to staff providing hands-on personal services who have not completed
the training, to ensure that care and services are delivered safely and in
accordance with these rules. The staff person posted on the designated floor
may move about the premises as necessary if the community has implemented a
medical alert system and each resident has been offered a wearable device that
connects to such system when activated to alert an administrator or direct care
staff person of a medical emergency.
(5) Training Hours Required During First Year
of Employment. All staff offering hands-on personal services to the residents,
including the administrator or on-site manager, must satisfactorily complete a
total of at least twenty-four (24) hours of continuing education within the
first year of employment as a direct care worker. The courses offered must be
relevant to assigned job duties and include such topics as cardiopulmonary
resuscitation and first aid certifications, utilizing standard precautions in
working with aging residents, working with residents with Alzheimer's or other
cognitive impairments, working with persons who have developmental disabilities
or persons who have mental illness, providing social and recreational
activities, understanding legal issues, performing necessary physical
maintenance, fire safety, housekeeping activities, recognizing and reporting
abuse, neglect and exploitation, preparing and serving food safely, preserving
the dignity and rights of residents receiving care to make meaningful choices,
providing and documenting medication assistance, or other topics as determined
necessary by the Department to support compliance.
(6) Ongoing Staff Training. Beginning with
the second year of employment, staff providing hands-on personal services must
have a minimum of sixteen (16) hours of job-related continuing education as
referenced in paragraph
111-8-63-.09(5)
above annually.
(7) Training
Records. The community must maintain documentation reflecting course content,
instructor qualifications, agenda and attendance rosters for all trainings
provided.
(8) Proxy Caregiver
Training. An assisted living community employing proxy caregivers must provide
training to the proxy caregivers in accordance with the Rules and Regulations
for Use of Proxy Caregivers, Chapter 111-8-100 subject to the limitation that
only certified medication aides may administer medications on behalf of the
community.
(9) Hospice Training.
The assisted living community shall ensure that any medication aide(s) who will
be administering liquid morphine to any hospice patient(s) residing in the
community receive adequate training from a licensed hospice on the safe and
proper administration of liquid morphine prior to such administration and on an
annual basis thereafter. The community shall maintain documentation of all
training provided.
(10) Staff
Health Examinations and Screenings. The administrator, on-site manager, and
each employee must have received a tuberculosis screening and a physical
examination by a licensed physician, nurse practitioner or physician's
assistant within twelve months prior to providing care to the residents. The
physical examination must be sufficiently comprehensive to assure that the
employee is physically qualified to work and free of diseases communicable
within the scope of employment. Follow-up examinations must be conducted by a
licensed physician, nurse practitioner or physician's assistant for each
administrator or staff person to determine readiness to return to work
following a significant illness or injury. Health information, screenings,
assessments and medical releases regarding each staff member must be retained
in a readily retrievable format by the assisted living community and made
available for review and/or copying by Department representatives upon
request.
(11) Criminal History
Background Checks for Owners Required. The owner of the business or agency
applying for the license must comply with the requirements of the Rules and
Regulations for Criminal Background Checks, Chapter 111-8-12.
(12) Criminal History Background Checks for
Director, Administrator and Onsite Manager Required. Prior to serving as a
director, administrator or onsite manager of an assisted living community, the
community must obtain a satisfactory fingerprint records check determination
for the person to be hired in compliance with the Rules and Regulations for
Criminal Background Checks, Chapter 111-8-12.
(13) Criminal History Background Checks for
Direct Access Employees Required. Prior to serving as a direct access employee,
the community must obtain a satisfactory fingerprint records check
determination for the person to be hired in compliance with the Rules and
Regulations for Criminal Background Checks, Chapter 111-8-12.
(14) The administrator or on-site manager
must obtain an employment history for each employee and maintain documentation
in the employee's file. If the potential employee has no prior employment
history, then the assisted living community must retain documentation of a
satisfactory personal reference check.
(15) Personnel files must be maintained in
the assisted living community for each employee and for three years following
the employee's departure or discharge. These files must be available for
inspection by departmental staff but must be maintained to protect the
confidentiality of the information contained in them from improper disclosure.
The files must include the following:
(a)
evidence of a satisfactory fingerprint record check determination, if
applicable;
(b) report of physical
examination completed by a licensed physician, nurse practitioner or
physician's assistant, and a TB screening completed within the 12 months
preceding the date of hire;
(c)
evidence of trainings, skills competency determinations and recertifications as
required by these rules and, if applicable, the Rules for Proxy Caregivers,
Chapter 111-8-100;
(d) employment
history, including previous places of work, employers and telephone contacts
with previous employers;
(e)
supporting documentation reflecting that the employee has the basic
qualifications as represented, e.g. documentation of good standing by nursing
board, no findings of abuse, neglect or exploitation entered against the
individual in the nurse aide registry, satisfactory report of motor vehicle
driving record where the employee may be transporting residents; and
(f) written evidence of satisfactory initial
and annual work performance reviews for unlicensed staff providing hands-on
personal care. Where the unlicensed staff perform specialized tasks, such as
health maintenance activities, assistance with medications or medication
administration, such performance reviews must include the satisfactory
completion of skills competency checklists as specified in applicable rules.
Such reviews must be conducted by staff or contractors qualified by education,
training and experience to assess that the assigned duties are being performed
in accordance with these rules and accepted health and safety
standards.
(16) Where the
assisted living community permits a resident to hire his or her own
companion-sitter, proxy caregiver to perform health maintenance activities or
aide of any sort, the assisted living community must require assurance that the
companion-sitter, proxy caregiver or aide so hired is familiar with emergency
evacuation routes and has documentation reflecting compliance with the
provisions of the Rules for Proxy Caregivers, Chapter 111-8-100, as
applicable.
(17) The administrator,
on-site manager, and staff persons must not be under the influence of alcohol
or other controlled substances while engaged in any work-related activity on
behalf of the assisted living community.
(18) The community must maintain an average
monthly minimum on-site staff to resident ratio of one awake direct care staff
person per 15 residents during waking hours and one awake direct care staff
person per 20 residents during non-waking hours where the residents have
minimal care needs. Average monthly minimum staffing levels shall be calculated
and documented by the community using methods and forms specified by the
department. However, the assisted living community must staff above these
minimum on-site staff ratios to meet the specific residents' ongoing health,
safety and care needs.
(a) Staff, such as
cooks and maintenance staff, who do not receive on-going direct care training
and whose job duties do not routinely involve the oversight or delivery of
direct personal care to the residents, must not be counted towards these
minimum staffing ratios. Personnel who work for another entity, such as a
private home care provider, hospice, etc. or private sitters cannot be counted
in the staff ratios for the assisted living community.
(b) At least two on-site direct care staff
persons must be on the premises 24 hours per day providing supervision whenever
residents are present, with at least one staff person on each occupied
floor.
(c) A registered
professional nurse or licensed practical nurse must be on-site to support care
and oversight of the residents, as follows:
(i) For communities with one to 30 residents,
a minimum of 8 hours per week;
(ii)
For communities with 31 to 60 residents, a minimum of 16 hours per
week;
(iii) For communities with 61
to 90 residents, a minimum of 24 hours per week;
(iv) For communities with more than 90
residents, a minimum of 40 hours per week;
(d) Residents must be supervised consistent
with their needs.
(19)
Sufficient staff time must be provided by the assisted living community such
that each resident:
(a) receives services,
treatments, medications and diet as prescribed;
(b) receives proper care to prevent decubitus
ulcers and contractures;
(c) is
kept comfortable and clean;
(d) is
treated with dignity, kindness, and consideration and respect;
(e) is protected from avoidable injury and
infection;
(f) is given prompt,
unhurried assistance if she or he requires help with eating;
(g) is given assistance, if needed, with
daily hygiene, including baths and oral care; and
(h) is given assistance in transferring and
assisted self-preservation when needed.
(20) All persons, including the administrator
or on-site manager, who offer direct care to the residents on behalf of the
assisted living community, must maintain an awareness of each resident's normal
appearance and must intervene, as appropriate, if a resident's state of health
appears to be in jeopardy.
(21) All
assisted living communities must develop and maintain accurate staffing plans
that take into account the specific needs of the residents and monthly work
schedules for all employees, including relief workers, showing planned and
actual coverage for each day and night. The assisted living community must
retain the completed staff schedules for a minimum of one year.
(22) Staff must wear employee identification
badges which are readily visible with abbreviations for professional/special
credentials displayed on the badges, if any.
(23) Medical Alert Systems. Homes utilizing
medical alert systems to allow on-site staff to move about as specified in Rule
111-8-63-.09(4)
must meet the following requirements:
(a) The
medical alert system must include a wearable sensor device that enables the
resident to request help when needed.
(b) The home may encourage, but not require,
residents to wear the sensor device and must ensure that residents who do not
consistently wear the sensor device receive appropriate monitoring from
staff.
(c) The wearable sensor
device must be programmed to immediately notify appropriate staff, and to
identify the specific resident or location from which the alert signal has been
made, by:
(i) activating a portable electronic
device worn by the administrator and/or a direct care staff person with an
audible tone or vibration; or
(ii)
sending a signal to a stationary electronic device located in a designated area
monitored by staff.
(d)
The home must establish policies and procedures which address the following
requirements and must maintain documentation to demonstrate compliance with
such policies and procedures:
(i) routine
testing and maintenance of the medical alert system;
(ii) initial training for residents and staff
on use of the system and additional training as needed;
(iii) procedures for electrical outages or
severe weather events that include making more frequent rounds to check on
residents if the system is not working, as well as testing the system following
such events to ensure operability; and
(iv) a process for reviewing any
documentation produced by the system for opportunities to enhance
individualized care and service.
(e) The department may prohibit a home from
using or relying on a medical alert system if the above requirements are not
met.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) The on-site manager and responsible staff persons must be at least 21 years of age and responsible for supervising the provision of care by all other staff . No staff person under the age of 18 is permitted to work in the assisted living community unless there is direct line-of-sight supervision being provided by the administrator , on-site manager or a responsible staff person or the staff member is at least 17 years of age and has successfully completed a vocational technical training track as a nursing assistant through a Georgia high school.
(2) Initial Training for All Staff . The administrator or on-site manager must ensure that any person working in the assisted living community as staff , receives training within the first 60 days of employment on the following:
(a) residents' rights and identification of conduct constituting abuse , neglect or exploitation of a resident and reporting requirements to include the employee 's receipt of a copy of the Long-Term Care Facility Resident Abuse Reporting Act as outlined in O.C.G.A. § 31-8-81 et seq.;
(b) general infection control principles including importance of hand hygiene in all settings and attendance policies when ill;
(c) training necessary to carry out assigned job duties; and
(d) emergency preparedness.
(3) Initial Training for Staff Providing Hands-On Personal Services. In addition to the initial training required of all staff in paragraph (2) above, the administrator must ensure that staff hired to provide hands-on personal services to residents receive training within the first 60 days of employment which includes the following:
(a) current certification in emergency first aid except where the staff person is a currently licensed health care professional;
(b) current certification in cardiopulmonary resuscitation where the training course required return demonstration of competency;
(c) medical and social needs and characteristics of the resident population, including special needs of residents with dementia;
(d) residents' rights and the provision of care to residents that is individualized and helpful; and
(e) training specific to assigned job duties, such as, but not limited to, permissible assistance with medications, contraindications for medications that must be brought to the attention of appropriate individuals, assisting residents in transferring, ambulation, proper food preparation, proper performance of health maintenance activities if serving as a designated proxy caregiver and responding appropriately to dementia-related behaviors.
(4) Trained Staff Present. At least two staff who have completed the minimum training requirements of Rule 111-8-63-.09(2)(a) through (d) and (3)(a) through (e) above must be present in the assisted living community at all times any residents are present, with at least one staff person on each occupied floor, to provide necessary oversight and assistance to staff providing hands-on personal services who have not completed the training, to ensure that care and services are delivered safely and in accordance with these rules.
(5) Training Hours Required During First Year of Employment. All staff offering hands-on personal services to the residents, including the administrator or on-site manager , must satisfactorily complete a total of at least twenty-four (24) hours of continuing education within the first year of employment as a direct care worker. The courses offered must be relevant to assigned job duties and include such topics as cardiopulmonary resuscitation and first aid certifications, utilizing standard precautions in working with aging residents, working with residents with Alzheimer's or other cognitive impairments, working with persons who have developmental disabilities or persons who have mental illness, providing social and recreational activities, understanding legal issues, performing necessary physical maintenance, fire safety, housekeeping activities, recognizing and reporting abuse , neglect and exploitation , preparing and serving food safely, preserving the dignity and rights of residents receiving care to make meaningful choices, providing and documenting medication assistance, or other topics as determined necessary by the Department to support compliance.
(6) Ongoing Staff Training. Beginning with the second year of employment, staff providing hands-on personal services must have a minimum of sixteen (16) hours of job-related continuing education as referenced in paragraph 111-8-63-.09(5) above annually.
(7) Training Records. The community must maintain documentation reflecting course content, instructor qualifications, agenda and attendance rosters for all trainings provided.
(8) Proxy Caregiver Training. An assisted living community employing proxy caregivers must provide training to the proxy caregivers in accordance with the Rules and Regulations for Use of Proxy Caregivers, Chapter 111-8-100 subject to the limitation that only certified medication aides may administer medications on behalf of the community .
(9) Hospice Training. The assisted living community shall ensure that any medication aide(s) who will be administering liquid morphine to any hospice patient (s) residing in the community receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The community shall maintain documentation of all training provided.
(10) Staff Health Examinations and Screenings. The administrator , on-site manager , and each employee must have received a tuberculosis screening and a physical examination by a licensed physician , nurse practitioner or physician 's assistant within twelve months prior to providing care to the residents. The physical examination must be sufficiently comprehensive to assure that the employee is physically qualified to work and free of diseases communicable within the scope of employment. Follow-up examinations must be conducted by a licensed physician , nurse practitioner or physician 's assistant for each administrator or staff person to determine readiness to return to work following a significant illness or injury . Health information, screenings, assessments and medical releases regarding each staff member must be retained in a readily retrievable format by the assisted living community and made available for review and/or copying by Department representatives upon request.
(11) Criminal History Background Checks for Owners Required. The owner of the business or agency applying for the license must comply with the requirements of the Rules and Regulations for Criminal Background Checks, Chapter 111-8-12.
(12) Criminal History Background Checks for Director , Administrator and Onsite Manager Required. Prior to serving as a director , administrator or onsite manager of an assisted living community , the community must obtain a satisfactory fingerprint records check determination for the person to be hired in compliance with the Rules and Regulations for Criminal Background Checks, Chapter 111-8-12.
(13) Criminal History Background Checks for Direct Access Employees Required. Prior to serving as a direct access employee , the community must obtain a satisfactory fingerprint records check determination for the person to be hired in compliance with the Rules and Regulations for Criminal Background Checks, Chapter 111-8-12.
(14) The administrator or on-site manager must obtain an employment history for each employee and maintain documentation in the employee 's file. If the potential employee has no prior employment history, then the assisted living community must retain documentation of a satisfactory personal reference check.
(15) Personnel files must be maintained in the assisted living community for each employee and for three years following the employee 's departure or discharge. These files must be available for inspection by departmental staff but must be maintained to protect the confidentiality of the information contained in them from improper disclosure. The files must include the following:
(a) evidence of a satisfactory fingerprint record check determination, if applicable;
(b) report of physical examination completed by a licensed physician , nurse practitioner or physician 's assistant, and a TB screening completed within the 12 months preceding the date of hire;
(c) evidence of trainings, skills competency determinations and recertifications as required by these rules and, if applicable, the Rules for Proxy Caregivers, Chapter 111-8-100;
(d) employment history, including previous places of work, employers and telephone contacts with previous employers;
(e) supporting documentation reflecting that the employee has the basic qualifications as represented, e.g. documentation of good standing by nursing board , no findings of abuse , neglect or exploitation entered against the individual in the nurse aide registry, satisfactory report of motor vehicle driving record where the employee may be transporting residents; and
(f) written evidence of satisfactory initial and annual work performance reviews for unlicensed staff providing hands-on personal care. Where the unlicensed staff perform specialized tasks, such as health maintenance activities , assistance with medications or medication administration, such performance reviews must include the satisfactory completion of skills competency checklists as specified in applicable rules. Such reviews must be conducted by staff or contractors qualified by education, training and experience to assess that the assigned duties are being performed in accordance with these rules and accepted health and safety standards.
(16) Where the assisted living community permits a resident to hire his or her own companion-sitter, proxy caregiver to perform health maintenance activities or aide of any sort, the assisted living community must require assurance that the companion-sitter, proxy caregiver or aide so hired is familiar with emergency evacuation routes and has documentation reflecting compliance with the provisions of the Rules for Proxy Caregivers, Chapter 111-8-100, as applicable.
(17) The administrator , on-site manager , and staff persons must not be under the influence of alcohol or other controlled substances while engaged in any work-related activity on behalf of the assisted living community .
(18) The community must maintain an average monthly minimum on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours and one awake direct care staff person per 20 residents during non-waking hours where the residents have minimal care needs. Average monthly minimum staffing levels shall be calculated and documented by the community using methods and forms specified by the department . However, the assisted living community must staff above these minimum on-site staff ratios to meet the specific residents' ongoing health, safety and care needs.
(a) Staff , such as cooks and maintenance staff , who do not receive on-going direct care training and whose job duties do not routinely involve the oversight or delivery of direct personal care to the residents, must not be counted towards these minimum staffing ratios. Personnel who work for another entity, such as a private home care provider , hospice , etc. or private sitters cannot be counted in the staff ratios for the assisted living community .
(b) At least two on-site direct care staff persons must be on the premises 24 hours per day providing supervision whenever residents are present, with at least one staff person on each occupied floor.
(c) A registered professional nurse or licensed practical nurse must be on-site to support care and oversight of the residents, as follows:
(i) For communities with one to 30 residents, a minimum of 8 hours per week;
(ii) For communities with 31 to 60 residents, a minimum of 16 hours per week;
(iii) For communities with 61 to 90 residents, a minimum of 24 hours per week;
(iv) For communities with more than 90 residents, a minimum of 40 hours per week;
(d) Residents must be supervised consistent with their needs.
(19) Sufficient staff time must be provided by the assisted living community such that each resident :
(a) receives services, treatments, medications and diet as prescribed;
(b) receives proper care to prevent decubitus ulcers and contractures;
(c) is kept comfortable and clean;
(d) is treated with dignity, kindness, and consideration and respect;
(e) is protected from avoidable injury and infection;
(f) is given prompt, unhurried assistance if she or he requires help with eating;
(g) is given assistance, if needed, with daily hygiene, including baths and oral care; and
(h) is given assistance in transferring and assisted self-preservation when needed.
(20) All persons , including the administrator or on-site manager , who offer direct care to the residents on behalf of the assisted living community , must maintain an awareness of each resident 's normal appearance and must intervene, as appropriate, if a resident 's state of health appears to be in jeopardy.
(21) All assisted living communities must develop and maintain accurate staffing plans that take into account the specific needs of the residents and monthly work schedules for all employees, including relief workers, showing planned and actual coverage for each day and night. The assisted living community must retain the completed staff schedules for a minimum of one year.
(22) Staff must wear employee identification badges which are readily visible with abbreviations for professional/special credentials displayed on the badges, if any.