Training Requirements

The purposes of the requirements of 651 CMR 12.07 are to ensure employees of Assisted Living Residences have a clear understanding of their jobs and the way in which their work intersects with and supports the work of other employees, of the policies and procedures of the Residence, of the rights of the Residents, and of the particular and distinctive service needs and health concerns of the Residents. All curricula for training should reflect current standards of practice and care, be designed to enhance the professionalism of the employees, and to enable employees to provide good service. Training requirements may be satisfied by such means as practical demonstration, lectures, lectures with accompanying role playing, video with facilitated discussion, and other generally accepted techniques. No more than two of the seven hours required for orientation may be conducted by un-facilitated media presentations by such means as video or audio. Instructors and facilitators shall be appropriately qualified by training or demonstrated experience. The Residence shall maintain documentation in the employee's personnel file regarding the completion of training or eligibility for any exemption. (1) General Orientation. Prior to active employment, all staff and contracted providers who will have direct contact with Residents and all food service personnel must receive a seven-hour orientation which includes the following topics: (a) Philosophy of independent living in an Assisted Living Residence; (b) Resident Bill of Rights; (c) Elder Abuse, Neglect and Financial Exploitation; (d) Residence policies and procedures related to disaster and emergency preparedness; (e) Communicable diseases, including but not limited to, AIDS/HIV and Hepatitis B; (f) Infection control in the Residence and the principles of universal precautions based on DPH guidelines; (g) Communication Skills; (h) Review of the aging process; (i) Dementia/Cognitive Impairment including a basic overview of the disease process, communication skills and behavioral interventions; (j) Resident health and related problems; (k) General overview of the employee's specific job requirements; (l) The Residence's policy on emergency response to acute health issues, and first aid; (m) Sanitation and Food Safety; (n) The policies concerning smoking on the Residence's premises; (o) The proper use, administration, and maintenance of oxygen, including safety protocols; and (p) the disaster and emergency preparedness plan required in 651 CMR 12.04(12)(a). (2) Additional General Orientation Requirements. (a) At least one hour of general orientation training shall be devoted to the topic of elder abuse, neglect, and financial exploitation. (b) At least two hours of general orientation training shall be devoted to the topic of dementia and cognitive impairments. All curricula for training related to dementia shall reflect current standards of practice and care. (c) In addition to the requirements relative to the general orientation set forth in 651 CMR 12.07(1)(a) through (p), all personnel providing Personal Care Services shall receive at least one additional hour of orientation devoted to the topic of Self-administered Medication Management provided by a nurse. (d) Both the Executive Director and Resident Care Director shall receive an additional two-hour training devoted to dementia care topics. (e) A Residence may include the use of techniques such as the shadowing of more experienced employees during the first five days of an employee's tenure. (3) Orientation for Staff Working within Special Care Residences. In addition to completing requirements for general orientation as set forth under 651 CMR 12.07(1)(a) through (p), all new employees who work within a Special Care Residence and have direct contact with Residents must receive seven hours of additional training on topics related to the specialized care needs of the Resident population (e.g., communication skills, creating a therapeutic environment, interpretingmanifestations of distress, decisional capacity, sexuality, familyissues, and caregiver support). (4) Training for Employees Supporting Basic Health Services. (a) Prior to providing Basic Health Services to Residents, all Clinical Professionals employed byResidences certified to provide Basic Health Services to Residents must receive a minimum of two hours of training designed to ensure employee understanding and competency with the provision of Basic Health Services to Residents, including the Residence's Basic Health Services operating plan, policies and procedures concerning Basic Health Services, and the requirements of 651 CMR 12.00. (b) On an ongoing basis, all Personal Care Staff employed by Residences certified to provide Basic Health Services must receive two hours of training every 12 months. The training must be designed to ensure that the Personal Care Staff understand the Basic Health Services provided, understand the Residence's policies and procedures concerning Basic Health Services, understand how to provide Resident care in coordination with Basic Health Services, and how to report changes in a Resident's condition to a licensed nurse or other Clinical Professional. (c) All completed trainings must be documented and maintained in the employee's personnel file. (5) Ongoing In-Service Education and Training. (a) A minimum of ten hours per year of ongoing education and training is required for all employees, with at least two hours on the specialized needs of Residents with Alzheimer's disease and related dementia. The curriculum used for the ongoing education and training shall cover the following topics: Alzheimer's disease and dementia; person-centered care; assessment and care planning; activities of daily living; and dementia-related behaviors and communication. The ongoing education and training must also include the policies concerning smoking on the Residence's premises, the proper use, maintenance and safety protocols concerning oxygen, and the disaster and emergency preparedness plan required pursuant to 651 CMR 12.04(12)(a). (b) All Personal Care Staff and Clinical Professionals must receive training on: 1. The proper installation, use, and maintenance of Transfer Assistive Devices or Mobility Assistive Devices; 2. How to instruct Residents on the safe use of Transfer Assistive Devices or Mobility Assistive Devices; 3. The difference between Transfer Assistive Devices and prohibited Restraints; 4. Recognizing and reporting potential safety hazards related to Transfer Assistive Device or Mobility Assistive Device use; and 5. Monitoring Residents for changes in condition that may affect the safe use of the Transfer Assistive Device or Mobility Assistive Device. (c) All Personal Care Staff and all Clinical Professionals must complete an initial training regarding the Lift Device program, if applicable. The Lift Device training shall also be completed by Personal Care Staff and Clinical Professionals annually, if applicable. The completion of the initial and annual Lift Device trainings shall be documented in the employee's personnel file. The Lift Device program is required to ensure Personal Care Staff and Clinical Professionals understand the proper use and operation of Lift Devices. The training shall include the correct use and understanding of safe Resident movement. The training must include a lift program guide, pertinent instruction materials from lift equipment manufacturers, and also include a practice evaluation. (d) Employees working in a Special Care Residence must receive an additional four hours of training per year related to the Residents' specialized needs. Such training shall include the development of communications skills for Residents with dementia. (e) In addition to the general ten-hour continuing education requirement for all employees, Executive Directors shall complete an additional five hours of training which shall be intended to complement the individual's background and experience. Credits for completing annual continuing education requirements for Executive Directors may be transferable to other Residences. (f) No more than 50% of the ongoing training requirement may be conducted by unfacilitated media presentations by such means as video or audio. (g) Upon submitting proof in a manner and form prescribed by EOAI, training received within the past 18 months at another Assisted Living Residence, a similar facility or agency may be used to satisfy the requirements of 651 CMR 12.07. Satisfaction of the requirements of the general orientation shall not be used to fulfill the requirements of 651 CMR 12.04(5). (h) Specialized Training Requirements. 1. All Personal Care Staff shall be trained in the Residence's policy on emergency response to acute health issues and first aid, and must also complete at least one hour of ongoing education and training per year on the topic of Self-administered Medication Management; and 2. All employees and providers shall receive ongoing in-service education and training, provided bya professional with relevant experience, that is designed to ensure orientation training is reinforced, from among the following topics: a. Behavioral interventions, including prevention of manifestations of distress such as aggressive behavior and de-escalation techniques (mandatory); b. Defining, recognizing and reporting elder abuse (mandatory); c. Communication and teamwork; d. The aging process, including typical changes and those related to disease; e. The causes and prevention of falls and related injuries, and the Residence's established policies and procedures for an Evidence Informed Falls Prevention Program; f. The effects of dehydration; g. Alzheimer's disease and cognitive impairments; h. Conflict resolution; i. Resident rights; j. Self-administered Medication Management; k. Death and dying; l. Maintaining skin integrity; m. Nutrition; n. Emergency procedures; and o. Training which addresses topics required in the general orientation. (6) Each residence shall conduct an annual training needs assessment to prepare the curriculum for its required training and establish a process by which it will evaluate the efficacy of its training program. (7) Personal Care Services Provider Training Requirements. Assisted Living Residence Personal Care Staff and contracted providers of Personal Care Services must complete an additional 54 hours of training prior to providing Personal Care Services to a Resident, 20 hours of which must be specific to the provision of Personal Care Services. The 20 hours of Personal Care training must be conducted by a qualified Registered Nurse with a valid Massachusetts license. (a) The 54 hours of training must include the following topics: 1. Bathing and personal care; 2. The effects of dehydration; 3. Maintaining skin integrity; 4. Self-administered Medication Management; 5. Elimination; 6. Nutrition; 7. Human Growth, Development and Aging; 8. Family Dynamics; 9. Grief, Loss, Death and Dying; 10. Mobility; 11. Fall prevention; 12. Mental health, depression and loneliness; 13. Maintenance of a Clean, Safe and Healthy Environment; 14. Home Safety; and 15. Assistance with Appliances. (b) Documentation of completion of the 54-hour training for Assisted Living Residence Personal Care Staff and contract providers who provide Personal Care Services shall be transferable for each employee from one Residence to another. (8) Introductory Visit and Review. Prior to or within 48 hours after the provision of Personal Care Services to a Resident, a licensed nurse shall review the Resident's Service Plan with all relevant Personal Care Staff. This review may be conducted in the Resident's Unit or at another appropriate location within the Residence, as determined by the nurse. The Personal Care Staff must demonstrate competence in the assigned personal care tasks (including Self-administered Medication Management) in the Resident's Service Plan. Suchcompetencemaybedemonstrated either through a verbal review of these tasks or, if deemed necessary by the licensed nurse, by the demonstrated performance of the tasks by such workers. An Introductory Visit shall also be conducted and documented in the Resident's record whenever the Resident's personal care needs change significantly, as determined by the nurse. Such documentation shall be kept current. (9) Supervision. A qualified nurse shall, at least once every six months, evaluate the Personal Care Services provided by Personal Care Staff of the Residence or by contracted providers. A written record of the staff or provider's performance of personal care skills shall be completed after each evaluation and shall be kept in the employee's personnel file. Personal Care Staff who provide Self-administered Medication Management shall also be evaluated on their awareness of and compliance with SAMM regulations and the applicable Residence policies and procedures. (10) Exemptions. The following individuals are exempt from Personal Care Services Provider Training Requirements as set forth in 651 CMR 12.07(7). However, these individuals must complete the general orientation and Ongoing In-service Education and Training as set forth in 651 CMR 12.07(1) through (3) and 651 CMR 12.07(5). (a) Registered Nurse (RN) and a Licensed Practical Nurse (LPN) with a valid license in Massachusetts; (b) Nurse's Aides with documentation of successful completion of nurse's aide training; (c) Home Health Aides with documentation of having successfully completed the Certified Health Aide training program; and (d) Personal Care Homemakers with documentation of having successfully completed a Personal Care Homemaker training program (54 Hours). (11) Food Service Personnel. Before commencing employment in an Assisted Living Residence, the person(s) managing the dietary department (e.g. food services manager and chef) must complete a food service sanitation course which meets the applicable requirements of 105 CMR 590.003: Food.