Staffing Requirements

No person working in an Assisted Living Residence shall have been convicted of a felony related to the theft or illegal sale of a Controlled Substance. (1) Qualifications for the Executive Director. The Executive Director of an Assisted Living Residence shall be at least 21 years old and must have demonstrated experience in administration, supervision, and management skills. The Executive Director must also have a Bachelor's degree or equivalent experience in human services management, housing management or nursing home management. The Executive Director must be of good moral character, and must never have been convicted of a felony. (2) Qualifications for the Resident Care Director. The Resident Care Director of an Assisted Living Residence must have a minimum of five years' experience working with older adults or persons with disabilities or have a nursing degree with a minimum of two years' experience working with older adults or persons with disabilities. The Resident Care Director shall be qualified by experience and training to develop, maintain and implement or arrange for the implementation of individualized Service Plans. The Resident Care Director must also have a Bachelor's degree or equivalent experience, and knowledge of aging and disability issues. The requirement mandating a minimum of five years' experience working with older adults or persons with disabilities or having a nursing degree with a minimum of two years' experience working with older adults or persons with disabilities shall be effective as of January 1, 2027. This requirement shall not apply to a Resident Care Director hired before January 1, 2027. The qualification requirements for a Resident Care Director hired before January 1, 2027 are that the Resident Care Director must have a minimum of two years' experience working with older adults or persons with disabilities. The Resident Care Director shall be qualified by experience and training to develop, maintain and implement or arrange for the implementation of individualized Service Plans. The Resident Care Director must also have a Bachelor's degree or equivalent experience, and knowledge of aging and disability issues. (3) General Staffing Requirements. (a) All staff shall possess appropriate qualifications to perform the job functions assigned to them. (b) The Residence must have a minimum of one staff member available at all times who is certified in cardiopulmonary resuscitation (CPR) and in the use of an automated external defibrillator (AED). This requirement shall apply starting on January 1, 2027. 1. All persons certified to provide automated external defibrillation and cardiopulmonary resuscitation shall: a. Successfully complete a course in cardiopulmonary resuscitation and in the use of an automated external defibrillator that meets or exceeds the standards established by the American Heart Association or the American National Red Cross; b. Have evidence that course completion is current and not expired; c. Complete a recertification course prior to the expiration date on their certification. (c) No person working in a Residence shall have been determined by an administrative board or court to have violated any local, state or federal statute, regulation, ordinance, or other law reasonably related to the safety and well-being of a Resident at an Assisted Living Residence or patient at a health care facility. (d) The Residence shall designate at least one licensed nurse employed by or under written agreement with the Residence to: 1. Conduct introductory visits pursuant to 651 CMR 12.07(8); 2. Conduct initial clinical assessments prior to a Resident moving to the Residence pursuant to 651 CMR 12.04(7)(a); 3. Oversee Self-Administered Medication Management (SAMM); 4. Conduct 20 hours of the Personal Care Services Training Requirements that is specific to the provision of Personal Care Services pursuant to 651 CMR 12.07(7) for all applicable staff. This requirement must be fulfilled be a qualified Registered Nurse with a valid Massachusetts license; 5. Conduct biannual evaluation of the provision of Personal Care Services by Personal Care Staff pursuant to 651 CMR 12.07(9); 6. Oversee and provide Limited Medication Administration (LMA) to Residents; and 7. Develop and oversee Service Plans as required in 651 CMR 12.04(8)(a) and 651 CMR 12.04(9)(c). The designated licensed nurse must provide on site services for a minimum number of hours each week, scaled to the Residence's size, Resident acuity and needs, and be available on call 24 hours a day to support staff and respond to changes in Resident condition. (e) The Residence shall contract with or employ a responsible clinician who is a licensed provider in the Commonwealth (e.g. a registered nurse, nurse practitioner, or physician) who shall be the automated external defibrillator person in charge for the Residence. The responsible clinician shall oversee and coordinate the following: 1. Maintenance and testing of equipment in accordance with the manufacturer's guidelines; 2. Certification and training of Residence personnel; 3. Periodic performance review of the Residence's automated external defibrillation activity; and 4. Development of policies and procedures consistent with current medical practice regarding the use of automated external defibrillators. (f) All employees of the Residence shall know the names and be able to readily obtain the contact information of the current Executive Director and Resident Care Director of the Residence at all times. (4) Staffing Levels. (a) Each Residence must develop and implement a process for determining its staffing levels. The plan must include an assessment, to be conducted at least quarterly but more frequently if the Residence so chooses, of the appropriateness of staffing levels. (b) The Residence shall have sufficient staffing at all times to meet the scheduled and reasonablyforeseeable unscheduled Resident needs as required bythe Residents' assessments and Service Plans on a 24-hour per day basis. The Residence's staffing shall be sufficient to respond promptly and effectively to individual Resident emergencies. The Residence's staff is required to be awake at all times while on duty. The Residence shall have a plan to secure staffing necessary to respond to emergency, life safety and disaster situations affecting Residents. (c) If the Residence accepts Residents who require the use of a Lift Device, the Residence shall have sufficient staffing at all times to meet the needs of these Residents in accordance with the Residence's Lift Device policy. The Residence must follow the manufacturer's guidance in determining the number of staff required to safely use and operate Lift Devices. (d) If a Residence uses a third-party vendor for staffing, the Residence shall have an employee of the Residence who is trained on the Residence's policies and procedures working on the premises at all times or the third-party vendor must have completed the Residence's general training and orientation. (e) The Residence is responsible for ensuring all staff and third-party vendors are following the Residence's policies and procedures. (f) If a public health emergency is declared, EOAI may issue directions and guidance related to staffing on how to address the public health emergency. (5) Special Care Residence Staffing. (a) A Special Care Residence shall have sufficient staff qualified by training and experience awake and on duty at all times to meet the 24-hour per day scheduled and reasonably foreseeable unscheduled needs of all Residents of a Special Care Residence based upon the Resident assessments and Service Plans. A Special Care Residence's staffing shall be sufficient to respond promptly and effectively to individual Resident emergencies. (b) For the purposes of 651 CMR 12.06(5)(a), it shall never be considered sufficient to have fewer than two staff members in a Special Care Residence. (c) Staffing Exemption: 1. At their sole discretion, the Secretary may grant an exemption from the requirement set forth in 651 CMR 12.06(5)(b) and allow one staff member and one Floater to be on duty during an overnight shift if it is determined that: a. the physical design of the Special Care Residence is conducive to the provision of sufficient care to all Residents; b. staff members possess the means to conduct immediate communication with each another; c. the waiver request is not based on a fluctuation in Residence occupancy; and d. the safety and welfare of Residents are not compromised. 2. The Applicant/Sponsor shall request such an exemption in writing and shall enclose supporting documentation. The Secretary may grant such an exemption at their sole discretion. The Secretary's granting of the staffing exemption in a Special Care Residence shall expire on the stated expiration date of the Certification. The Applicant/Sponsor must reapply for the staffing exemption at least 30 days before the stated expiration date of the Certification. The Secretary may, at any time, revoke such an exemption. The decision to revoke the exemption is final. (6) Staffing for Basic Health Services. (a) Basic Health Services must be provided by a Clinical Professional capable of providing such services within their scope of practice. (b) The Residence shall designate a qualified member of staff to: 1. ensure compliance with the Basic Health Services operating plan and relevant policies, procedures, and other applicable regulations; 2. monitor the provision of Basic Health Services to Residents; 3. obtain and update Medical Orders as necessary; 4. ensure complete and accurate records are kept in accordance with the requirements of 651 CMR 12.00 and other applicable regulations; 5. assign duties and communicate with Personal Care Staff as needed; 6. review quality control and assurance practices concerning the provision of Basic Health Services at the Residence; 7. track and evaluate the performance of those providing Basic Health Services; and 8. ensure Resident Service Plans are updated as soon as necessary. (c) The Residence must ensure sufficient staffing levels to provide the Basic Health Services required by Residents in a safe and effective manner. (d) The Residence shall have a licensed nurse working on the Residence's premises for at least 16 hours during the day (e.g., 7:00 A.M. through 11:00 P.M.) each day. (e) The Residence must provide staff access to a licensed practical nurse or registered nurse who has knowledge of the Residents' clinical needs for consultation at all times related to the administration of Basic Health Services and to ensure patient safety and clinical competence in the application of Basic Health Services. The consultative nurse shall not be required to be physically present on the premises but must have the ability to virtually assess the Resident. The Residence and nurse must have adequate technology, including video conferencing and monitoring capabilities (e.g., visual assessment of vital signs such as oxygen saturation levels), so that the nurse can obtain the clinical information necessary to make informed decisions, provide timely interventions, and help reduce unnecessary emergency room visits. (f) The Residence shall have a plan to secure staffing necessary to ensure the continuation of Basic Health Services as required by a Resident's Service Plan, and in response to emergency, safety, and disaster situations affecting Residents. (g) All Clinical Professionals employed by Residences certified to provide Basic Health Services to Residents must be Basic Life Support (BLS) certified. (7) Emergency Situations. The Residence shall have a plan to secure staffing necessary to respond to emergency, safety and disaster situations affecting Residents. (8) Special Care Residence Manager. A Special Care Residence must designate an individual who will be responsible for all Special Care operations. The Manager of a Special Care Residence shall be at least 21 years old, must have a minimum of two years' experience working with older adults or individuals with disabilities, knowledge of aging and disability issues, demonstrated experience in administration, and demonstrated supervisory and management skills. The Special Care Residence Manager must also have a Bachelor's degree or equivalent experience in human services management, housing management or nursing home management. The Special Care Residence Manager must be of good moral character and must never have been convicted of a felony. (9) Contagious Disease and Vaccination Requirements. (a) No person shall be permitted to work in a Residence if infected with a contagious disease in a communicable form that could endanger the health of residents or other employees. The Residence shall maintain accurate records of illnesses and associated incidents involving staff as part of its Communicable Disease Control Plan pursuant to 651 CMR 12.04(13). (b) Consistent with anyguidelines, schedules, and reportingrequirements established bythe Secretary, each Residence shall ensure that all personnel comply with the vaccination requirements of 651 CMR 12.06. (c) For the purposes of 651 CMR 12.06, "personnel" means an individual or individuals who either work at or come to the Residence and who are employed by or affiliated with the Residence, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid including, but not limited to, employees, members of the medical staff, contract employees or staff, students, and volunteers, whether or not such individual(s) provide direct care. (d) For the purposes of 651 CMR 12.06, "mitigation measures" mean measures that personnel who are exempt from vaccination in accordance with 651 CMR 12.06(9)(g) must take to prevent viral infection and transmission. (e) Influenza Vaccine. 1. Subject to the provisions of 651 CMR 12.06(9)(g), each Residence shall ensure that all personnel are vaccinated annuallywith seasonal influenza vaccine, inactivated or live, or an attenuated influenza vaccine, including a seasonal influenza vaccine. 2. Each Residence shall provide all personnel with information about the risks and benefits of influenza vaccine. 3. Each Residence shall notify all personnel of the influenza vaccination requirements of this section and provide guidance to personnel regarding how to receive influenza vaccination. (f) Coronavirus Disease 2019 (COVID-19) Vaccine. 1. For the purposes of 651 CMR 12.06, "COVID-19 vaccination" means being up to date with COVID-19 vaccines as recommended by the Centers for Disease Control and Prevention (CDC). 2. Subject to the provisions of 651 CMR 12.06(9)(g), each Residence shall ensure all personnel have received the COVID-19 vaccination. 3. Each Residence shall provide all personnel with information about the risks and benefits of COVID-19 vaccination. 4. Each Residence shall notify all personnel of the COVID-19 vaccination requirements of 651 CMR 12.06(9) and provide guidance to personnel regarding how to receive COVID-19 vaccination. (g) Exemptions. 1. A Residence shall not require personnel to receive a vaccine pursuant to 651 CMR 12.06(9)(e) or (f) if the individual declines the vaccine. 2. An individual who is exempt from vaccination shall sign a statement certifying that they are exempt from vaccination and they received information about the risks and benefits of influenza vaccination and COVID-19 vaccination. 3. For any individual subject to the exemption, the Residence shall require such individual to take mitigation measures, consistent with guidance from EOAI. (h) Documentation. A Residence shall require, and maintain for all personnel, proof of current vaccination pursuant to 651 CMR 12.06(9)(e) and (f), or the personnel's exemption statement as required by 651 CMR 12.06(9)(g). Such information shall be made available by the Residence for review by EOAI during a Compliance Review pursuant to 651 CMR 12.09. (i) Each Residence shall ensure all personnel are vaccinated against other novel pandemic or novel influenza virus(es) in accordance with guidelines issued by the Commissioner of the Department of Public Health. (j) Nothing in 651 CMR 12.00 shall be read to prohibit facilities from establishing policies and procedures for influenza and COVID-19 vaccination of personnel that exceed the requirements set forth in 651 CMR 12.06(9).