PURPOSE: This rule prescribes requirements for personnel employed in a day program serving people who are mentally ill or mentally disordered as required by section 630.710, RSMo.

1. (1) Each day program shall have a chief administrative officer referred to as the head of the day program in these rules. 9 CSR 40-10
2. (2) The head of the day program shall have a bachelor’s degree or be a licensed registered nurse (RN) and shall have at least two (2) years’ relevant work experience.
3. (3) The head of the day program shall report any change in location, ownership, management or administration to the department within five (5) days.
4. (4) All personnel, including physical therapists, occupational therapists and volunteers who have frequent, regularly scheduled at least once per week, and direct contact with clients, shall have a tuberculin skin test or chest X-ray and a statement from their physician stating they have been screened for contagious diseases at the time of employment and annually after that. The physician’s statement shall indicate the specific communicable diseases for which the person has been tested.
5. (5) Any employee diagnosed or suspected of having a contagious or infectious disease shall not work or be in the facility until a written statement is obtained from a physician that the disease is no longer contagious or is found to be noninfectious.
6. (6) The program shall give each employee a written job description.
7. (7) The program shall keep job descriptions for all positions on file.
8. (8) Each day program shall have, as a minimum, a daily direct care staff to client ratio of one to sixteen (1:16) unless program needs or client mix require otherwise.

9. (9) Program needs or client needs may justify alternate staffing levels based on the following considerations:

   1. (A) The physical layout of the day program;
   2. (B) If there are any blind or deaf clients;
   3. (C) Qualifications of the staff;
   4. (D) The number of individual goals and objectives for the clients;
   5. (E) Obvious indications that staff is unable to meet the needs of clients being served or is unable to meet minimum housekeeping and maintenance rules, or both; and
   6. (F) The availability of backup staff.
10. (10) All day program direct care staff shall have a high school diploma or General Educational Development (GED) Certificate.
11. (11) The head of the program shall designate a person capable to act for him/her when unavailable.
12. (12) The program shall have sufficient backup staff to provide services to clients and to meet licensing staffing requirements at all times.

13. (13) The day program shall provide orientation and training as follows:

    1. (A) New employees and volunteers shall receive orientation to acquaint them with the philosophy, organization, program, practices and goals of the program;
    2. (B) Each employee shall receive a minimum of six (6) hours of training annually. The training shall include the use of physical restraint, and training in cardiopulmonary resuscitation (CPR) and first-aid. The training shall be in accordance with the guidelines of the American Red Cross, the American Heart Association, the National Safety Council, or other nationally recognized organization. Training review must be consistent with the guidelines of the certifying authority. At least one (1) staff person with these skills will be on duty at all times and in close proximity to the clients. Based on the configuration of the building and the number of clients, more than one (1) trained staff may be required in the program; and
    3. (C) The day program shall provide documentation of the training.
14. (14) All day program staff shall be knowledgeable about the program’s policies and procedures.
15. (15) The day program staff, or other personnel, shall not be under the influence of alcohol or illegal drugs while on the premises. The day program staff or other personnel shall not be in a state of impaired ability because of medication use.
16. (16) All staff and volunteers responsible for direct care of clients shall be eighteen (18) years of age or older.

17. (17) All staff administering medications shall have successfully completed a course on medication administration. This training shall be updated every two (2) years. The initial training and biennial update shall—

    1. (A) Be approved by the placement office;
    2. (B) Be offered by an instructor who is a licensed practical nurse (LPN) certified by the Division of Aging as an instructor, a registered nurse (RN), a pharmacist or a physician;
    3. (C) Not apply to LPNs, RNs or certified medication technicians with lifetime certificates ; and
    4. (D) Be documented in the personnel file of the recipient of the training.

18. (18) The course to update training in medication administration shall address at least the following:

    1. (A) Review of Basics.

       1. 1. Medication ordering and storage.

       2. 2. Medication administration.

          1. A. Use of generic drugs.
          2. B. How to pour, chart, administer and

document.

1. C. Information and techniques specif-

ic to the following: inhalers, eye drops, topical medications, insulin injections and suppositories.

1. D. Infection control.
2. 3. Individual rights and refusal of med-

ications and treatment;

1. (B) Issues specific to the program as indicated by the needs of the clients and the medications and treatments currently being administered.

   1. 1. Emergency response.
   2. 2. Medication allergies.
   3. 3. Corrective actions based on problems

identified by the staff, the trainees or issues identified by regulatory and accrediting bodies, professional consultants or by any other authoritative source; and

1. (C) Updates on new medications or new procedures.

1. (19) No clients shall be present at the day program unless at least one (1) staff person is also present.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Emergency rule filed June 17, 1986, effective July 1, 1986, expired Oct. 29, 1986. Original rule filed June 17, 1986, effective Nov. 13, 1986. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996.

*Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.