(a) Each facility must have written employment and personnel policies and procedures that will include, as a minimum, the following:

1. (1) All employees caring for residents must be at least eighteen (18) years of age;
2. (2) No person with a communicable disease or infected skin lesion that poses a direct threat to the health or safety of other individuals in the workplace shall be permitted to work in the facility;
3. (3) No person who has been convicted of abusing, neglecting, or mistreating individuals may be employed in the facility;

4. (4)

   1. (A) All employees must have a skin test for tuberculosis within the first two (2) weeks of employment and annually thereafter.
   2. (B) Skin tests for tuberculosis are to be administered and read by the local health department or personal physician.
   3. (C) The results of the test will be listed in the employee's personnel record;
5. (5) A copy of all personnel policies and procedures must be available to all facility personnel and to Office of Long-Term Care personnel and any other departmental entities having legal access authority;
6. (6) Policies and procedures must be developed for personnel about fire safety standards; and
7. (7) Policies and procedures must be developed for smoking in the facility.

(b)

1. (1) Sufficient staff must be present at all times to meet the needs of the residents, including:

   1. (A) Preparation of nutritional meals;
   2. (B) Cleaning of the facility; and
   3. (C) Provision of supportive services.
2. (2) Staffing requirements will be based on current census rather than licensed capacity.
3. (3) Required staff/resident ratios based on current resident census are for large and small facilities: # Residents Direct Care Staff Required Per Shift

   	Day	Evening	Night
   1-16	1	1	1
   17-32	2	1	1
   33-49	2	2	2
   50-66	3	2	2
   67-83	4	2	2
   84-above	5	3	2

4. (4) Other staff requirements that affect small facilities (sixteen (16) or fewer beds) are as follows:

   1. (A) Each staff person on duty may be counted as direct care staff even if they are currently involved in administrative, housekeeping, or dietary activities; and
   2. (B) The night person may be asleep in the facility.

5. (5) Other staff requirements that affect large facilities (over sixteen (16) beds) are as follows:

   1. (A) For large facilities, the staffing table shown above shall apply to direct care staff only and does not include administrative, housekeeping, or dietary staff;
   2. (B) The facility administrator shall not be scheduled as direct care staff for purposes of meeting minimum staffing requirements during normal business hours as referenced in 20 CAR § 401-305(a);
   3. (C) In large facilities with seventeen (17) or more residents, staff involved in food and dietary services shall not be permitted to perform nonfood or nondietary services during the same shift;
   4. (D)

(i) In a multibuilding facility, at least one (1) direct care staff person must be on duty and awake during all hours.

1. (ii) A relief direct care staff person must be available in the facility to relieve direct care staff for meals, breaks, etc. and to cover if a direct care staff person must leave the facility in an emergency;

   1. (E) The staffing schedule must be posted in the facility; and

   2. (F) The office may grant waivers to staffing standards in situations where the facility demonstrates an ability to adequately meet service requirements with fewer staff.

      1. (c) Orientation records will be maintained for each employee to include but not be limited to:
2. (1) Job duties;
3. (2) Orientation to resident rights;
4. (3) Abuse/neglect reporting requirements; and

5. (4) Fire and tornado drills.

   1. (d)
6. (1) Four (4) hours of in-service training or continuing education pertinent to the operation of a residential long-term care facility must be provided on a quarterly basis for all employees who have direct contact with residents.

7. (2) Training must include but not be limited to:

   1. (A) Resident rights;
   2. (B) Evacuation of building;
   3. (C) Safe operation of fire extinguishers;
   4. (D) Incident reporting; and
   5. (E) Medication supervision.

(e)

1. (1) The facility must establish and maintain a personnel file for each employee.

2. (2) At a minimum, each employee's personnel file must contain:

   1. (A) Application for employment, including resume if available;
   2. (B) Reference checks, including name and position of person contacted and a statement that references were checked;
   3. (C) License or certificate, as appropriate (copy on file);
   4. (D) Current health card or copy;
   5. (E) Job description of the position the employee occupies;
   6. (F) Facility orientation documentation;
   7. (G) The employee's signed acknowledgement that he or she has received and read a copy of the resident rights;
   8. (H) Job orientation documentation as required; and
   9. (I) In-service training documentation.

(g) Written job descriptions must be developed for each employee classification (e.g., administrator, housekeepers, etc.), and shall include, as a minimum:

1. (1) The responsibilities and/or actual work to be performed in each classification;
2. (2) The educational qualifications;
3. (3) The physical requirements necessary to perform the essential functions of the job; and
4. (4) The licenses or certificates required for each job classification.