1. (a)

   1. (1) To effectuate the intent of this part, the assisted living facility shall develop a staffing plan to ensure sufficient personnel/staff/employees are available to meet the needs of the residents.
   2. (2) A facility shall meet minimum staffing ratios set forth below at all times, and shall utilize sufficient staff to meet each resident’s particular direct care needs as agreed to and specified in the resident’s direct care services plan portion of the occupancy admission agreement.

2. (b)

   1. (1) The facility administrator may be counted as direct care staff on shifts on which he or she is not performing or required to perform the duties of an administrator.
   2. (2) The administrator must meet all licensing or certification requirements for the duties that the administrator is performing.

3. (c)

   1. (1) The facility shall have as many personnel/staff/employees awake and on duty at all times as may be needed to properly safeguard the health, safety, or welfare of the residents.

   2. (2) For purposes of this part, “on duty” means that the individual is:

      1. (A) On the premises of the facility;
      2. (B) Awake; and
      3. (C) Able to meet residents’ needs.
   3. (3) Residents shall not be left unsupervised, as that term is defined in 20 CAR § 411-803(b)(1)(A).
   4. (4) A minimum on-site staff-to-resident ratio shall be one (1) staff person per fifteen (15) residents from 7:00 a.m. to 8:00 p.m., and one (1) staff person per twenty-five (25) residents from 8:00 p.m. to 7:00 a.m., but in no event shall there be fewer than two (2) staff persons on duty at all times, one (1) of which shall be a CNA.
   5. (5) The facility shall designate one (1) staff member as the on-site manager outside normal business hours.
   6. (6) In addition to the staff requirements set forth above in this section, facilities shall have an administrator on-site during normal business hours, as required in 20 CAR § 411-401(a) – (e).
   7. (7) Staff persons who live on site but are sleeping shall not be counted for minimum staffing.
   8. (8) All needed direct care staff may be PCAs, unless otherwise specified elsewhere in this part.

4. (d)

   1. (1) Facilities may employ flex staffing.
   2. (2) Flex staffing permits facilities to vary the beginning and ending hours for shifts, so that facilities may maximize staff time to the benefit of residents.
   3. (3) Facilities can designate that their shifts will begin earlier or later than specified above.

   4. (4)

      1. (A) When facilities utilize flex staffing, the shifts must meet the staffing requirements set forth herein for the entire period of the shift.
      2. (B) As way of example only, if a facility begins a shift at 6:00 a.m., rather than 7:00 a.m. in the example above, the minimum staffing requirement of one (1) staff person per fifteen (15) residents will be required until 7:00 p.m., and those minimums must be maintained throughout the entire period.

   5. (5)

      1. (A) The Office of Long-Term Care shall be notified in writing when a facility implements a flex staffing schedule.
      2. (B) The written notice shall state the beginning and ending hours of each shift under the flex staffing.
5. (e) 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.

Codification Notes: “CNA” means certified nursing assistant. "PCA" means personal care aide.