410 IAC 16.2-3.1-14 - Personnel
Authority: IC 16-28-1-7
Affected: IC 16-28-5-1; IC 16-28-13-3
Sec. 14.
(a) Each
facility shall have specific procedures written and implemented for the
screening of prospective employees. Specific inquiries shall be made for
prospective employees. The facility shall have a personnel policy that
considers references and any convictions in accordance with IC
16-28-13-3.
(b) A facility must not use any individual
working in the facility as a nurse aide for more than four (4) months on a
full-time, part-time, temporary, per diem, or other basis unless that
individual:
(1) is competent to provide
nursing and nursing-related services; and
(2) has completed a:
(A) training and competency evaluation
program; or
(B) competency
evaluation program; approved by the division.
(c) Each nurse aide who is hired to work in a
facility shall have successfully completed a nurse aide training program
approved by the division or shall enroll in the first available approved
training program scheduled to commence within sixty (60) days of the date of
the nurse aide's employment. The program may be established by the facility, an
organization, or an institution. The training program shall consist of at least
the following:
(1) Thirty (30) hours of
classroom instruction within one hundred twenty (120) days of employment. At
least sixteen (16) of those hours shall be in the following areas prior to any
direct contact with a resident:
(A)
Communication and interpersonal skills.
(B) Infection control.
(C) Safety/emergency procedures, including
the Heimlich maneuver.
(D)
Promoting residents' independence.
(E) Respecting residents' rights.
(2) The remainder of the thirty
(30) hours of instruction shall include the following:
(A) Basic nursing skills as follows:
(i) Taking and recording vital
signs.
(ii) Measuring and recording
height and weight.
(iii) Caring for
residents' environment.
(iv)
Recognizing abnormal changes in body functioning and the importance of
reporting such changes to a supervisor.
(v) Caring for residents when death is
imminent.
(B) Personal
care skills, including, but not limited to, the following:
(i) Bathing.
(ii) Grooming, including mouth
care.
(iii) Dressing.
(iv) Toileting.
(v) Assisting with eating and
hydration.
(vi) Proper feeding
techniques.
(vii) Skin
care.
(viii) Transfers,
positioning, and turning.
(C) Mental health and social service needs as
follows:
(i) Modifying aides' behavior in
response to residents' behavior.
(ii) Awareness of developmental tasks
associated with the aging process.
(iii) How to respond to residents'
behavior.
(iv) Allowing the
resident to make personal choices, providing and reinforcing other behavior
consistent with the resident's dignity.
(v) Using the resident's family as a source
of emotional support.
(D)
Care of cognitively impaired residents as follows:
(i) Techniques for addressing the unique
needs and behaviors of individuals with dementia (Alzheimer's and
others).
(ii) Communicating with
cognitively impaired residents.
(iii) Understanding the behavior of
cognitively impaired residents.
(iv) Appropriate responses to the behavior of
cognitively impaired residents.
(v)
Methods of reducing the effects of cognitive impairments.
(E) Basic restorative services as follows:
(i) Training the resident in self-care
according to the resident's abilities.
(ii) Use of assistive devices in
transferring, ambulation, eating, and dressing.
(iii) Maintenance of range of
motion.
(iv) Proper turning and
positioning in bed and chair.
(v)
Bowel and bladder training.
(vi)
Care and use of prosthetic and orthotic devices.
(F) Residents' rights as follows:
(i) Providing privacy and maintenance of
confidentiality.
(ii) Promoting
residents' right to make personal choices to accommodate their needs.
(iii) Giving assistance in resolving
grievances and disputes.
(iv)
Providing needed assistance in getting to and participating in resident and
family groups and other activities.
(v) Maintaining care and security of
residents' personal possessions.
(vi) Promoting residents' right to be free
from abuse, mistreatment, and neglect, and the need to report any instances of
such treatment to appropriate facility staff.
(vii) Avoiding the need for restraints in
accordance with current professional standards.
(3) Seventy-five (75) hours of supervised
clinical experience, at least sixteen (16) hours of which must be in directly
supervised practical training. As used in this subdivision, "directly
supervised practical training" means training in a laboratory or other setting
in which the trainee demonstrates knowledge while performing tasks on an
individual under direct supervision of a registered nurse or a licensed
practical nurse. These hours shall consist of normal employment as a nurse aide
under the supervision of a licensed nurse.
(4) Training that ensures the following:
(A) Students do not perform any services for
which they have not trained and been found proficient by the
instructor.
(B) Students who are
providing services to residents are under the general supervision of a licensed
nurse.
(d) A
facility must arrange for individuals used as nurse aides, as of the effective
date of this rule, to participate in a competency evaluation program approved
by the division and preparation necessary for the individual to complete the
program.
(e) Before allowing an
individual to serve as a nurse aide, a facility must receive registry
verification that the individual has met competency evaluation requirements
unless the individual:
(1) is a full-time
employee in a training and competency evaluation program approved by the
division; or
(2) can prove that he
or she has recently successfully completed a training and competency evaluation
program approved by the division and has not yet been included in the registry.
Facilities must follow up to ensure that such individual actually becomes registered.
(f) A facility must check with all state
nurse aide registries it has reason to believe contain information on an
individual before using that individual as a nurse aide.
(g) If, since an individual's most recent
completion of a training and competency evaluation program, there has been a
continuous period of twenty-four (24) consecutive months during none of which
the individual provided nursing or nursing-related services for monetary
compensation, the individual must complete a new:
(1) training and competency evaluation
program; or
(2) competency
evaluation program.
(h)
The facility must complete a performance review of every nurse aide at least
once every twelve (12) months and must provide regular inservice education
based on the outcome of these reviews. The inservice training must be as
follows:
(1) Sufficient to ensure the
continuing competence of nurse aides but must be no less than twelve (12) hours
per year.
(2) Address areas of
weakness as determined in nurse aides' performance reviews and may address the
special needs of residents as determined by the facility staff.
(3) For nurse aides providing services to
individuals with cognitive impairments, also address the care of the
cognitively impaired.
(i)
The facility must ensure that nurse aides and qualified medication aides are
able to demonstrate competency in skills and techniques necessary to care for
residents' needs as identified through resident assessments and described in
the care plan.
(j) Medication shall
be administered by licensed nursing personnel or qualified medication aides. If
medication aides handle or administer drugs or perform treatments requiring
medications, the facility shall ensure that the persons have been properly
qualified in medication administration by a state-approved course. Injectable
medications shall be given only by licensed personnel.
(k) There shall be an organized ongoing
inservice education and training program planned in advance for all personnel.
This training shall include, but not be limited to, the following:
(1) Residents' rights.
(2) Prevention and control of
infection.
(3) Fire
prevention.
(4) Safety and accident
prevention.
(5) Needs of
specialized populations served.
(6)
Care of cognitively impaired residents.
(l) The frequency and content of inservice
education and training programs shall be in accordance with the skills and
knowledge of the facility personnel as follows. For nursing personnel, this
shall include at least twelve (12) hours of inservice per calendar year and six
(6) hours of inservice per calendar year for nonnursing personnel.
(m) Inservice programs for items required
under subsection (k) shall contain a means to assess learning by
participants.
(n) The administrator
may approve attendance at outside workshops and continuing education programs
related to that individual's responsibilities in the facility. Documented
attendance at these workshops and programs meets the requirements for inservice
training.
(o) Inservice records
shall be maintained and shall indicate the following:
(1) The time, date, and location.
(2) The name of the instructor.
(3) The title of the instructor.
(4) The names of the participants.
(5) The program content of inservice.
The employee will acknowledge attendance by written signature.
(p)
Initial orientation of all staff must be conducted and documented and shall
include the following:
(1) Instructions on
the needs of the specialized population or populations served in the facility,
for example:
(A) aged;
(B) developmentally disabled;
(C) mentally ill;
(D) children; or
(E) care of cognitively impaired;
residents.
(2) A review
of residents' rights and other pertinent portions of the facility's policy
manual.
(3) Instruction in first
aid, emergency procedures, and fire and disaster preparedness, including
evacuation procedures and universal precautions.
(4) A detailed review of the appropriate job
description, including a demonstration of equipment and procedures required of
the specific position to which the employee will be assigned.
(5) Review of ethical considerations and
confidentiality in resident care and records.
(6) For direct care staff, instruction in the
particular needs of each resident to whom the employee will be providing care.
(q) Each facility shall
maintain current and accurate personnel records for all employees. The
personnel records for all employees shall include the following:
(1) The name and address of the
employee.
(2) Social Security
number.
(3) Date of beginning
employment.
(4) Past employment,
experience, and education if applicable.
(5) Professional licensure, certification, or
registration number or dining assistant certificate or letter of completion if
applicable.
(6) Position in the
facility and job description.
(7)
Documentation of orientation to the facility and to the specific job
skills.
(8) Signed acknowledgement
of orientation to residents' rights.
(9) Performance evaluations in accordance
with the facility's policy.
(10)
Date and reason for separation.
(r) The employee's personnel record shall be
retained for at least three (3) years following termination or separation of
the employee from employment.
(s)
Professional staff must be licensed, certified, or registered in accordance
with applicable state laws or rules.
(t) A physical examination shall be required
for each employee of a facility within one (1) month prior to employment. The
examination shall include a tuberculin skin test, using the Mantoux method (5
TU PPD), administered by persons having documentation of training from a
department-approved course of instruction in intradermal tuberculin skin
testing, reading, and recording unless a previously positive reaction can be
documented. The result shall be recorded in millimeters of induration with the
date given, date read, and by whom administered. The tuberculin skin test must
be read prior to the employee starting work. The facility must assure the
following:
(1) At the time of employment, or
within one (1) month prior to employment, and at least annually thereafter,
employees and nonpaid personnel of facilities shall be screened for
tuberculosis. For health care workers who have not had a documented negative
tuberculin skin test result during the preceding twelve (12) months, the
baseline tuberculin skin testing should employ the two-step method. If the
first step is negative, a second test should be performed one (1) to three (3)
weeks after the first step. The frequency of repeat testing will depend on the
risk of infection with tuberculosis.
(2) All employees who have a positive
reaction to the skin test shall be required to have a chest x-ray and other
physical and laboratory examinations in order to complete a
diagnosis.
(3) The facility shall
maintain a health record of each employee that includes:
(A) a report of the preemployment physical
examination; and
(B) reports of all
employment-related health examinations.
(4) An employee with symptoms or signs of
active disease, (symptoms suggestive of active tuberculosis, including, but not
limited to, cough, fever, night sweats, and weight loss) shall not be permitted
to work until tuberculosis is ruled out.
(u) In addition to the required inservice
hours in subsection (l), staff who have regular contact with residents shall
have a minimum of six (6) hours of dementia-specific training within six (6)
months of initial employment, or within thirty (30) days for personnel assigned
to the Alzheimer's and dementia special care unit, and three (3) hours annually
thereafter to meet the needs or preferences, or both, of cognitively impaired
residents and to gain understanding of the current standards of care for
residents with dementia.
(v) For
purposes of IC
16-28-5-1,
a breach of:
(1) subsection (c), (e), (f),
(g), (i), (j), or (s) is a deficiency;
(2) subsection (a), (b), (d), (h), (k), (l),
(m), (n), (o), (p), (t), or (u) is a noncompliance; and
(3) subsection (q) or (r) is a
nonconformance.
Notes
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