(a)

1. (1) The facility must develop, maintain, follow, and make available for public inspection the following policies and procedure:

   1. (A) Client policies and procedures as set forth in 20 CAR § 409-304;
   2. (B) Admission policies as set forth in 20 CAR § 409-402;
   3. (C) Discharge policies as set forth in 20 CAR § 409-403;
   4. (D) Incident report policies and procedures including procedures for reporting suspected abuse or neglect as set forth in 20 CAR § 409-305;
   5. (E) Client rights policies and procedures as set forth in 20 CAR § 409-403;
   6. (F) Fire safety standards as set forth in 20 CAR § 409-701 et seq.;
   7. (G) Smoking policies for clients and facility personnel as set forth in 20 CAR §§ 409-303(b), 409-705, and 409-501(d)(1);
   8. (H) Emergency treatment plan policies and procedures as set forth in 20 CAR § 409-306;
   9. (I) Medication storage and administration policies and procedures as set forth in 20 CAR § 409-501(c); and
   10. (J) Policy and procedures for the relocation of clients in cases of emergencies (such as fires, natural disasters, or utility outages) in 20 CAR § 409-704.
2. (2) Failure of a facility to meet the requirements of this subsection shall be a violation pursuant to Arkansas Code § 20-10-205 et seq.

(b)

1. (1) Each facility must have written employment and personnel policies and procedures.

2. (2) Personnel records shall include, as a minimum, the following:

   1. (A) Employment applications for each employee;
   2. (B) Written functional job descriptions for each employee that are signed and dated by the employee;
   3. (C)

(i) Minimum qualifications, to include educational qualification and documentation of continuing training, including orientation training and continuing education units (CEU) related to professional licensure, personal care, food management, etc.

1. (ii)

(b) (b) Each facility is responsible for maintaining employee educational records;

1. (D) Evidence of credentials, including current professional licensure or certification;

   1. (E)

      1. (i) Written statements of reference or documentation of verbal reference check.
      2. (ii) Verbal check documentation must include the:

(b) (b) Substance of any statements made;

1. (c) (c) Date and time of the call; and

   1. (d) (d) Name of the facility employee who is making the call;
   2. (F) Employee’s signed acknowledgement that he or she has received and read a copy of the Clients’ Bill of Rights;
   3. (G) Verification that the employee is at least eighteen (18) years of age;

   4. (H)

      1. (i) Verification that the employee has not been convicted or does not have a substantiated report of abusing or neglecting clients or misappropriation of client property.
      2. (ii) The facility shall, at a minimum, prior to employing any individual or any individuals working in the facility through contract with a third party, make inquiry to the Employment Clearance Registry of the Office of Long-Term Care and the Adult and Long-Term Care Facility Resident Maltreatment Central Registry maintained by the Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services, and shall conduct rechecks of all employees every five (5) years.
      3. (iii) Inquiries to the Adult and Long-term Care Facility Resident Maltreatment Central Registry shall be made by requesting a Request for Information form addressed to: Adult Protective Services Central Registry P.O. Box 1437, Slot S540 Little Rock, AR 72203;
   5. (I) Documentation that all employees and other applicable individuals utilized by the facility as staff have successfully completed a criminal background check pursuant to Arkansas Code § 20-33-201 et seq. and in accordance with the Rules for Conducting Criminal Record Checks for Employees of Long-Term Care Facilities, 20 CAR pt. 404;
   6. (J) A copy of a current health card issued by the Department of Human Services or other entities as provided by law;

   7. (K)

      1. (i) Documentation that the employee has been provided a copy of all personnel policies and procedures.
      2. (ii) A copy of all personnel policies and procedures must be made available to office personnel or any other Department of Human Services personnel;
   8. (L) Documentation that policies and procedures developed for fire safety standards and evacuation of building have been provided to the employee; and
   9. (M) Documentation that policies and procedures developed for tobacco use have been provided to the employee.

2. (3) The facility shall meet all rules issued by the Department of Health regarding communicable diseases.

   1. (c) Failure to comply with the provisions of this subsection or violation of any policies and procedures developed pursuant to this subsection shall be a violation pursuant to Arkansas Code § 20-10-205 or may constitute a deficiency finding against the facility.

      1. (d) Orientation records will be maintained for each employee to include but not limited to:
3. (1) Job duties;
4. (2) Orientation to client rights;
5. (3) Abuse/neglect reporting requirements; and
6. (4) Fire and tornado drills.

(e)

1. (1) In-service training sessions for direct care staff are required at a minimum of four (4) hours per annual quarter for a total of sixteen (16) hours per year.

2. (2) Training shall be appropriate to job function and shall include but is not limited to:

   1. (A) Client rights;
   2. (B) Safety standards;
   3. (C) Abuse reporting;
   4. (D) Normal signs of aging;
   5. (E) Health problems of aging;
   6. (F) Communications; and
   7. (G) Alzheimer’s or dementia training.

(h) Staffing.

1. (1)

   1. (A) The staffing pattern shall be dependent upon the enrollment criteria and the particular needs of the clients who are to be served.
   2. (B) The ratio of paid staff to client shall be adequate to meet the goals and objectives of the program.
   3. (C) The minimum ratios shall be one (1) paid full-time staff position with the responsibility for direct care for each five (5) clients.
   4. (D) The office may require additional staff when it is determined that the needs and services of the clients are not being met.
   5. (E) Secretaries, accountants, and other non-direct care staff shall not be considered in the staffing ratio.
   6. (F) In case of an emergency, when a direct care staff must leave, one (1) non-direct care staff may count until the emergency has been resolved.

2. (2) Substitutes.

   1. (A) Whenever paid staff are absent, substitutes must be used to:

      1. (i) Maintain the staff-client ratio; and
      2. (ii) Ensure proper supervision and delivery of health services.
   2. (B) In the absence of a regular staff person a substitute staff person may be used in order to maintain the required staff-client ratio.
   3. (C) Such substitute staff shall have the same qualifications, training, and personal credentials as the regular staff position they are substituting.
   4. (D) Trained volunteers, with the same qualifications, training, and personal credentials as the regular staff they are volunteering may be used instead of paid substitutes.

3. (3) Program director.

   1. (A) The program director shall:

      1. (i) Have the authority and responsibility for the management of activities and direction of staff; and
      2. (ii) Ensure that activities and services are appropriate and in accordance with established policies.
   2. (B) ADHC facilities licensed for more than fifteen (15) clients must have a full-time director.

   3. (C) Facilities licensed for fifteen (15) or fewer clients may have a full-time director who also serves as the health care coordinator, provided that:

      1. (i) This individual meets all the qualifications of both positions; and
      2. (ii) The requirements for the staffing pattern are met.

   4. (D) The director shall meet all the minimum qualifications:

      1. (i) Shall be at least twenty-one (21) years of age;
      2. (ii) Shall have at least one (1) year of work experience in the area of human services (e.g., services to the elderly, disabled, or adults with disabilities);
      3. (iii) Shall have demonstrated ability in supervision and administration;
      4. (iv) Shall have a current health card; and
      5. (v) Shall have knowledge of the aspects of aging and appropriate activity programming.
4. (4) Executive director. In adult day health care programs where the executive director is responsible for more than adult day health care services, the executive director may not be counted as direct care staff.

5. (5) Health care coordinator.

   1. (A) The program must have a full-time health care coordinator to supervise the delivery of health care services.

   2. (B) Responsibilities include but are not limited to:

      1. (i) Periodic screening of vital signs, weight, dental health, general nutrition, and hygiene of clients;
      2. (ii) Monitoring medical regimen;
      3. (iii) Monitoring provision of personal care, coordinating with other health care professionals and family members concerning health matters;
      4. (iv) Educating other staff members about emergency procedures and educating staff and family members about health concerns and conditions of clients;
      5. (v) Providing minor first aid treatment as needed; and
      6. (vi) Administration of medication.

   3. (C) The health care coordinator shall meet all the minimum qualifications:

      1. (i) Shall be at least twenty-one (21) years of age;
      2. (ii)

(b) (b) No individual who is unlicensed may be employed as a registered nurse (RN).

1. (iii)

(b) (b) A statement from the supervising RN must be on file as well as a copy of the RN’s current license; and

1. (iv) Shall have a current health card.

   1. (D) Prior experience shall include at least:

      1. (i) Managerial and administrative skills, including the ability to supervise staff and to plan and coordinate meaningful staff training; and
      2. (ii) Knowledge and understanding of the physical and emotional aspects of aging, its associated diseases and infirmities, and related medication and rehabilitative measures.
   2. (E) To be qualified as a health care coordinator in an ADHC program, the health care professional must have knowledge of the aspects of aging and appropriate activity programming.

2. (6) Personal care staff.

   1. (A) The ADHC shall have sufficient other staff responsible for personal care to comply with this part and the care requirements of the clients.

   2. (B) Minimum requirements are:

      1. (i) Be at least eighteen (18) years of age;
      2. (ii) Have a current health card;
      3. (iii) Have successfully completed an approved training course for nurse’s aides, patient care technicians, or home health aides; and
      4. (iv) In-service training sessions are required for all direct care staff.
   3. (C) In-service sessions are four (4) hours per annual quarter for a total of sixteen (16) hours per year.

3. (7) Volunteers.

   1. (A) The ADHC shall comply with the following in regard to utilization of volunteers who provide direct care in lieu of paid staff:

      1. (i) Volunteers shall:

(b) (b) Have a current health card;

1. (ii)

(b) (b) These shall describe in detail:

1. (1) (1) Task or tasks to be performed; and

2. (2) (2) Qualifications for performing assigned task;

   1. (iii) Paid staff position who is responsible for supervising the volunteer and specifics regarding:

(b) (b) Days; and

1. (c) (c) Length of commitment of volunteer’s services.

   1. (iv) Volunteers shall receive a formal orientation.

   2. (B)

      1. (i) In-service training sessions are required for all volunteers.
      2. (ii) In-service sessions shall total a minimum of four (4) hours per annual quarter for full-time volunteers and eight (8) hours per year for part time volunteers (less than twenty (20) hours per week).
   3. (C) Paid staff shall be informed of their responsibilities to the volunteer prior to the volunteer’s working in the program.
   4. (D) The volunteer’s job performance shall be evaluated as necessary.
   5. (E) Provision shall be made for recognition and appreciation of the volunteer, at least on an annual basis.

   6. (F)

      1. (i) Trained volunteers may be counted in the direct care staff-client ratio.
      2. (ii) When counted in direct care staff-client ratio, the volunteer shall have the same qualifications as the staff position being substituted for.
2. (8) Universal worker. Each staff person on duty may be counted as direct care staff even if they are currently involved in housekeeping, laundry, or dietary activities as long as universal precautions are followed.