(B) Licensed Nursing Staff.

1. (1) All Programs shall provide sufficient, licensed nursing staff to ensure that preventive measures, treatments, medications, nutritional care, rehabilitation services, therapeutic activities, and related services are carried out, recorded, and reviewed, in accordance with participant assessments and plans of care.

   1. (a) A Program must ensure licensed nursing staff are on-site for a minimum of eight hours per day, four of which must be provided by a registered nurse. The balance of the coverage may be provided by a licensed practical nurse.
   2. (b) When the census reaches 35 members or more, the Program must provide nursing coverage on-site for a minimum of 12 hours per day, four hours of which must be provided by a registered nurse.
   3. (c) When the census reaches 50 members or more, the Program must provide nursing coverage on-site for a minimum of 16 hours per day, eight hours of which must be provided by a registered nurse.
   4. (d) When the census reaches over 75 members, the Program must increase the nursing coverage in proportion to the requirements listed in 105 CMR 158.032(B)(1)(a) through (d).
2. (2) When a registered nurse is absent from the Program due to vacation or other temporary circumstances, the Program shall designate a licensed nurse to fulfill the nursing duties within the designee's scope of practice to act as a relief nurse in accordance with Department guidance.

(C) Program Aide Staff.

1. (1) A Program shall provide at least one qualified Program Aide per 12 participants attending the Program.
2. (2) A Program shall ensure a sufficient number of qualified Program Aide staff are available at all times to provide necessary supervision and assistance for each participant in accordance with participant needs and plans of care, written policies and procedures, and 105 CMR 158.000.
3. (3) Licensed nursing staff shall supervise Program Aides.

(F) Dietary Staff.

1. (1) Registered Dietitian. A Program shall provide a registered dietitian to monitor dietary services. A registered dietitian shall be on-site for a minimum of four hours every six months.
2. (2) Qualified Cook. A Program that prepares meals on-site shall employ a qualified cook. A Program shall ensure the qualified cook is available on-site for a sufficient number of hours to effectively manage all aspects of the meal service and kitchen functions.
3. (3) A Program shall provide sufficient numbers of adequately trained personnel to plan, prepare, and serve the proper diets to participants. All dietary staff shall be 18 years of age or older.

(G) Direct Care Staff.

1. (1) A Program shall provide at least one direct care staff person per six participants attending the Program.
2. (2) A Program shall ensure a sufficient number of qualified direct care staff are available at all times to provide necessary care, supervision, and assistance for each participant in accordance with participant assessed needs, plans of care, written policies and procedures, and 105 CMR 158.000.