1. (a) sufficient numbers of appropriately trained and oriented supervisory staff are available to ensure the quality of patient care services provided by the agency. Such supervision shall include:

   1. (1) ongoing review of cases and delegation of assignments by appropriate health care professionals;
   2. (2) in-home visits to direct, demonstrate and evaluate the delivery of patient care;
   3. (3) provision of clinical consultation; and
   4. (4) professional consultation on agency policies and procedures;

2. (b) all staff delivering care in patient homes are adequately supervised. The department shall consider the following factors as evidence of adequate supervision:

   1. (1) staff regularly provide services at the times and frequencies specified in the patient's plan of care and in accordance with the policies and procedures of their respective services;
   2. (2) staff are assigned to the care of patients in accordance with their licensure, and their training, orientation, and demonstrated skills;
   3. (3) clinical records are kept complete and changes in patient condition, adverse reactions, and problems with informal supports or home environment are charted promptly and reported to supervisory staff; and
   4. (4) plans of care are revised as needed and changes are reported to the patient's authorized practitioner, other staff providing care to the patient, and other agencies which authorize payment for services, as appropriate and necessary;
3. (c) home health aides or personal care aides are supervised, as appropriate, by a registered professional nurse, or a therapist if the aide carries out simple procedures as an extension of physical therapy, occupational therapy or speech/language pathology;

4. (d) in-home supervision by professional staff of home health aides and personal care aides occurs:

   1. (1) to demonstrate to and instruct the aide in the treatments or services to be provided with successful re-demonstration by the aide during the initial service visit or where there is a change in personnel providing care, if the aide does not have documented training and experience in performing the tasks prescribed in the plan of care;
   2. (2) where any of the conditions set forth in paragraph (b)(3) of this section occur, to evaluate the condition and initiate any revision in the plan of care which may be needed; and
   3. (3) to instruct the aide as to the observations and written reports to be made to the supervising nurse or therapist; and

5. (e) direct supervision of an advanced home health aide is conducted by a registered professional nurse who:

   1. (1) provides training, guidance, direction and oversight, and evaluation related to the performance of advanced tasks by the advanced home health aide;
   2. (2) assigns advanced tasks to be performed by the advanced home health aide after completing a nursing assessment to determine the patient’s current health status and care needs;
   3. (3) provides case specific training to the advanced home health aide to verify and ensure the advanced home health aide can safely and competently perform the advanced tasks for the patient;
   4. (4) provides written, patient specific instructions for performing advanced tasks, including the criteria for identifying, reporting, and responding to problems, errors or complications;
   5. (5) conducts a comprehensive medication review including evaluation of the patient’s current medication use, and prescribed drug regimen and identifies and resolves any discrepancies prior to assigning the advanced home health aide to administer medications;
   6. (6) determines direct supervision of the advanced home health aide based on the complexity of advanced tasks, the skill and experience of the advanced home health aide assigned to perform the advanced tasks, and the health status of the patient for whom the advanced tasks are being performed;
   7. (7) while on duty is continuously available to communicate with the advanced home health aide by phone or other means;
   8. (8) conducts home visits or arranges for another qualified registered professional nurse whenever necessary to protect the health and safety of the patient;
   9. (9) performs an initial and ongoing assessments of the patient’s needs; and
   10. (10) conducts a home visit at least every two weeks and more frequently as determined by the registered professional nurse, to observe, evaluate, and oversee services provided by the advanced home health aide;
6. (f) a process is in place to document the limitation or revocation of the assignment of advanced tasks by an advanced home health aide when deemed appropriate by a supervising registered professional nurse and to ensure that such information is available to other registered professional nurses that may supervise such aide; and
7. (g) any failure by a supervising registered professional nurse to comply with the requirements of subdivision (e) of this section shall be reported to the department.

The governing authority shall ensure for all health care services that: