PURPOSE: This rule prescribes requirements for personnel employed in a semi-independent living arrangement as required by section 630.710, RSMo.

1. (1) Each community residential facility providing semi-independent living arrangements shall have a chief administrative officer referred to as the head of the facility in these rules. The head of the facility shall be empowered to make decisions regarding the operation of the facility.
2. (2) The head of the facility shall report any change in the ownership, management or administration to the department within five
3. (5) days.
4. (3) The head of the facility shall provide business and personal references and shall cooperate with the department in a study of his/her qualifications to manage a semi-independent living arrangement.

5. (4) Each facility shall have, as a minimum, a daily direct care staff to resident ratio as follows, unless program needs justify otherwise:

   1. (A) One to thirty-two (1:32) on the first shift (approximately 7:00 a.m. to 3:00 p.m.);
   2. (B) One to sixteen (1:16) on the second shift (approximately 3:00 p.m. to 11:00 p.m.);
   3. (C) One to thirty-two (1:32) on the third shift (approximately 11:00 p.m. to 7:00 a.m.); and

   4. (D) Program needs or resident needs may justify alternate staffing levels based on the following considerations:

      1. 1. The physical layout of the facility;
      2. 2. If residents in the facility are awake

and active at night;

1. 3. If there are any blind or deaf resi-

dents;

1. 4. Qualifications of the staff;
2. 5. The number of individual goals and

objectives for the residents;

1. 6. Obvious indications that staff is

unable to meet the needs of residents being served or is unable to meet minimum housekeeping and maintenance rules or both; and

1. 7. The availability of backup staff.

1. (5) A resident may be at home without the presence of staff, for a specific period of time, if it is documented in the individual habilitation plan (IHP) or individual treatment plan (ITP) that the resident has the necessary knowledge and skills to function safely.
2. (6) The head of the facility and any additional staff, including physical therapists, occupational therapists and volunteers having frequent (regularly scheduled at least once per week) and direct contact with residents shall meet the following conditions: annually, provide a signed statement from a licensed physician stating they are in good health, free from tuberculosis in its communicable stage and have been screened for communicable diseases. The physician’s statement shall indicate the specific communicable diseases for which the person has been tested.

3. (7) 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 regional center or 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 recipient’s personnel file.

4. (8) 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 facility as indicated by the needs of the residents, 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. 9 CSR 40-7

1. (9) Staff shall be trained in the use of cardiopulmonary resuscitation (CPR) and firstaid so that at least one (1) person with these skills is on duty at all times. Depending on the configuration of the building and the number of residents, more than one (1) trained staff person per shift may be required.The training, and periodic review, shall be consistent with the guidelines of the American Red Cross, the American Heart Association, the National Safety Council or other nationally recognized training organization.
2. (10) Each facility shall provide a staff training program that includes orientation for all new employees to acquaint them with the philosophy, organization, program, practices and goals of the facility.
3. (11) All facility staff shall be knowledgeable about the facility’s policies and procedures.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 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.