(c) The operator shall provide staff sufficient in number and qualified by training and experience to render, at a minimum, those services mandated by law or regulation, including:

1. (1) Case management.

   1. (i) Staff shall carry out the functions specified in section 1001.10(i) of this Part.
   2. (ii) In an assisted living residence where the approved capacity is less than 25 beds, a qualified case manager shall be on site for at least 20 hours per week and available to provide case management services.

   3. (iii) In a residence with 25 or more beds, a qualified case manager shall be on site on a basis of one hour per week per each additional bed up to a maximum of 40 hours per week and available to provide case management services as follows:

      Resident census	Case manager hours required
      1-24	20 hours/week
      25-44	20 hours/week +1 hour/week/each bed over 24 up to 40 hours

   4. (iv) In a residence of 45 or more beds one or more case managers must be onsite at least 40 hours and available to assure that case management services adequately meet the needs of the residents.

2. (2) Personal care. The operator shall assign sufficient staff, hereafter referred to as resident aides, to perform personal care functions on a 24-hour basis as specified in 18 NYCRR sections 487.7 and 488.7.

   1. (i) Resident aides shall receive 40 hours of initial training as specified in the department's training requirements and curriculum or an approved equivalent program.
   2. (ii) Resident aides shall receive 12 hours of ongoing, inservice education annually in topics applicable to their responsibilities.
   3. (iii) Records documenting training and education shall be maintained in the personnel record of each resident aide as specified in section 1001.12 of this Part.
   4. (iv) An annual assessment of the performance and effectiveness of all resident aides must be conducted including at least one direct observation of performance.

(h) A program must be implemented and enforced for the prevention of circumstances which could result in an employee, including but not limited to housekeeping and direct care staff, or resident becoming exposed to significant body substance which could put them at significant risk of HIV or other blood-borne pathogen infection during the provision of services, as defined in sections 63.1 and 63.9 of this Title. Such a program shall include:

1. (1) use of scientifically accepted protective barriers during job-related activities which involve, or may involve, exposure to significant risk body substances. Such preventative action shall be taken by the employee with each patient/client and shall constitute an essential element for the prevention of bi-directional spread of HIV or other blood-borne pathogen;
2. (2) use of scientifically accepted preventative practices during job-related activities which involve the use of contaminated instruments or equipment which may cause puncture injuries;
3. (3) training at the time of employment and yearly staff development programs on the use of protective equipment, preventative practices, and circumstances which represent a significant risk for all employees whose job-related tasks involve, or may involve, exposure to significant risk body substances;
4. (4) provision of personal protective equipment for employees which is appropriate to the tasks being performed; and
5. (5) a system for monitoring preventative programs to assure compliance and safety shall be in place.

(i) Policy and procedures shall be implemented and enforced for the management of individuals who are exposed to significant risk body substances under circumstances which constitute significant risk of transmitting or contracting HIV or other blood-borne pathogen infection. The policy and procedure shall include:

1. (1) a system for reporting to a designated individual in the agency exposure thought to represent a circumstance which constitutes significant risk of transmitting or contracting HIV or other blood-borne pathogen infection;

2. (2) evaluation of the circumstances of a reported exposure and services for providing follow-up of the exposed individual which includes:

   1. (i) medical and epidemiological assessment of the individual who is the source of the exposure, where that individual is known and available;

   2. (ii) if indicated epidemiologically, HIV or other blood-borne pathogen counseling and voluntary testing of the source individual. Disclosure of the HIV status of the source individual can be made with the express written consent of the protected individual, or a person authorized pursuant to law to consent to health care for the protected individual if such person lacks capacity to consent, or pursuant to court order, if the HIV status is not known to the exposed individual;

      1. (a) appropriate medical follow-up of the exposed individual; and
      2. (b) assurances for protection of confidentiality for those involved in reported exposures.

(j) An enhanced assisted living residence or a special needs assisted living residence shall provide, either directly or through contract, sufficient nursing staff to meet the health care needs of the residents. Nursing coverage requirements, at a minimum, include:

1. (1) a registered professional nurse on duty and on-site at the residence, for eight hours per day, five days a week, and a licensed practical nurse shall be on duty and onsite at the residence for eight hours per day for the remainder of such week;
2. (2) a registered professional nurse on call and available for consultation 24 hours a day, seven days a week, if not available onsite; and
3. (3) additional nursing coverage, as determined necessary and documented by the resident's medical evaluation or otherwise by the resident's attending physician and/or the ISP.

(k) An applicant for, or operator of, an enhanced assisted living residence or special needs assisted living residence with 40 or fewer operational beds may submit to the department a written request for a waiver of the minimum requirements for nursing coverage set forth in paragraph (j)(1) of this section. This subdivision will apply to such requests, in place of section 1001.6(e) of this Part. Such waiver request must contain the following:

1. (1) documentation acceptable to the department that either:

   1. (i) the applicant or operator is unable to meet such minimum requirements; or
   2. (ii) the current needs of the residents can be appropriately and safely met with coverage that is less than or otherwise different from the minimum requirements; and
2. (2) a description acceptable to the department of what will be done by the operator to protect the health, safety and well-being of the residents, and specifically how the nursing needs of the residents will be addressed, in accordance with the medical evaluations and ISPs of the residents; and
3. (3) documentation acceptable to the department that the operator will include in its disclosure statements provided to prospective residents, residents and their representatives the details of any such waiver of the minimum nursing coverage requirements, if approved by the department; and
4. (4) acknowledgment that the operator will be required to comply with paragraphs (j)(3) and (4) of this section.

(m) A licensed nurse assuming nursing coverage responsibilities in an enhanced assisted living residence or special needs assisted living residence as specified in subdivision (j) of this section may also provide:

1. (1) case management services as specified in subdivision (c) of this section; or
2. (2) serve as administrator, so long as the nursing care needs and case management needs of the residents, and the administration needs of the residence, are adequately met.

(q) In addition to the assessed and documented health status of all new personnel required pursuant to subdivision (d) of this section, the operator shall maintain a record of the following tests for direct care staff of an enhanced assisted living residence or a special needs assisted living residence:

1. (1) a certificate of immunization against rubella;
2. (2) a certificate of immunization against measles for all personnel born on or after January 1, 1957;
3. (3) a written statement, if applicable from any licensed physician, physician assistant, special assistant, licensed midwife or nurse practitioner, which certifies that immunization with measles and/or rubella vaccine may be detrimental to the person's health. The requirements of paragraphs (1) and (2) of this subdivision relating to measles and/or rubella immunizations shall be inapplicable until such immunization is found no longer to be detrimental to such person's health. The nature and duration of the medical exemption must be stated in the individual's personnel record and must be in accordance with generally accepted medical standards (for example, the recommendations of the Immunization Practices Advisory Committee of the U.S. Department of Health and Human Services);
4. (4) for all personnel prior to employment or affiliation, except for personnel with no clinical or patient contact responsibilities who are located in a building or site with no patient care services, an initial individual tuberculosis (TB) risk assessment, symptom evaluation, and TB test (either tuberculin skin test or Food and Drug Administration [FDA] approved blood assay for the detection of latent tuberculosis infection), and annual assessments thereafter. Positive findings shall require appropriate clinical follow-up. The residence shall develop and implement policies regarding follow-up of positive test results, including procedures for facilitating and documenting treatment for latent TB infection where indicated. Annual TB assessment shall include education, individual risk assessment, and follow-up tests as indicated; and
5. (5) documentation of COVID-19 vaccination or a valid medical exemption to such vaccination, pursuant to section 2.61 of this Title, in accordance with applicable privacy laws, and making such documentation available immediately upon request by the department, as well as any reasonable accommodation addressing such exemption.

(r) If an enhanced assisted living residence employs or uses advanced home health aides, the operator must ensure that every advanced home health aide:

1. (1) is listed on the home care worker registry maintained by the department; and
2. (2) is trained as specified in section 700.2 of this Title and receives 18 hours of in-service education annually to include medication management, infection control, injection safety and other topics relevant to their responsibilities which must be directly supervised by a registered professional nurse; and

3. (3) is directly supervised by a registered professional nurse who:

   1. (i) provides training, guidance, direction and oversight, and evaluation related to the performance of advanced tasks by the advanced home health aide;
   2. (ii) assigns advanced tasks to be performed by the advanced home health aide after completing a nursing assessment to determine the resident’s current health status and care needs;
   3. (iii) 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 resident;
   4. (iv) provides written, patient specific instructions for performing advanced tasks, including the criteria for identifying, reporting, and responding to problems, errors or complications;
   5. (v) conducts a comprehensive medication review including evaluation of the resident’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. (vi) 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 resident for whom the advanced tasks are being performed;
   7. (vii) while on duty is continuously available to communicate with the advanced home health aide by phone or other means;
   8. (viii) conducts home visits or arranges for another qualified registered professional nurse whenever necessary to protect the health and safety of the resident;
   9. (ix) performs an initial and ongoing assessments of the resident’s needs; and
   10. (x) visits the resident in the residence 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;
4. (4) 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
5. (5) any failure by a supervising registered professional nurse to comply with the requirements of paragraph (3) of this subdivision shall be reported to the department.