Staffing Requirements

PURPOSE: This rule establishes the minimum requirements for adult day care program staff, ratio of numbers of staff to participants and staff training. (1) The adult day care provider, as defined in 19 CSR 30-90.010, shall be responsible for assuring compliance with all applicable laws and rules. (2) The adult day care program shall have a program director who is responsible for the day-to-day operation of the program. Either the program director or the program director’s designee shall be present and in charge during all hours that participants are on the premises. The program director and any such designee shall be qualified by demonstrated competence, specialized background, education or experience to manage the dayto-day operation of an adult day care program. (3) The program director’s responsibilities shall include, but not be limited to: (A) Managing the adult day care program as necessary for the health, safety and welfare of the participants; (B) Complying with the laws and rules pertaining to the adult day care program; (C) Ensuring that participants receive appropriate care according to their needs; (D) Preserving the rights of participants; (E) Meeting staffing, record keeping, facility and fire safety requirements; (F) Directing and supervising staff, as required, to meet the needs of the participants; (G) Conducting background checks and criminal record reviews as required and necessary to protect the health, safety and welfare of participants; (H) Providing staff training as needed and appropriate to meet the needs of the participants; and (I) Providing direct care services when necessary to meet the needs of the participants. (4) Direct care paid staff shall be at least eighteen (18) years of age and qualified by education, training, experience or demonstrated competence in order to perform the duties required by the written job description. (5) Volunteer staff shall be qualified by education, training, experience or demonstrated competence to perform the duties required by the written job description. (6) The adult day care provider shall provide a sufficient number of direct care staff on duty at all times to meet the needs of each participant and assure that participants are never left unattended. At a minimum, there shall be at least two (2) direct care staff persons when two through sixteen (2–16) participants are present and one (1) additional direct care staff person for any portion of eight (8) additional participants present. In calculating the staffing ratios: (A) The program director shall not be counted to meet the required direct care staff ratio if serving as an administrator or manager in a long-term care facility on the same premises; (B) The program director may be counted only when it is necessary for the program director to provide direct care in order to ensure that the needs of the participants are met; (C) In an associated adult day care program, direct care staff shall not be counted simultaneously to meet the required staffing ratios for both the long-term care or medical care facility and the associated adult day care or any other affiliated program; (D) Secretaries, cooks, accountants and other staff members who provide no direct care shall not be considered in calculating the staffing ratio, but such staff may be counted only if and when they are providing direct care to the participants; and (E) Trained volunteer staff at least eighteen (18) years of age may be counted in the direct care staff to participant ratio provided a written volunteer program description includes in-service training and a system for ensuring the presence of volunteer help as scheduled. (7) All staff who have direct contact with participants shall be able to perform the assigned job duties in the adult day care program and shall be free of communicable disease in accordance with the department’s regulations pertaining to communicable diseases, specifically 19 CSR 20-20.010 through 19 CSR 2020.100, as amended. Persons who have been diagnosed with a communicable disease may return to duty only with written approval from a physician or the physician’s designated agent. The program director shall be responsible for monitoring the health of employees. (8) No person shall be employed to work or allowed to volunteer, as defined in 19 CSR 30-90.010, in any capacity in the adult day care program who left or was discharged from employment with any other employer due to abuse or neglect to patients, residents or clients and the dismissal or departure has not been reversed by any tribunal or agency. (9) Each adult day care provider shall require all new applicants for employment in positions involving contact with participants to: (A) Disclose if he or she is listed on the Employee Disqualification List (EDL); and (B) Disclose his or her criminal history, including any conviction or a plea of guilty to a misdemeanor or felony charge and any suspended imposition of sentence, any suspended execution of sentence or any period of probation or parole; and (C) Sign a consent form authorizing a criminal record review with the Missouri Highway Patrol through: 1. The Missouri Highway Patrol in accordance with requirements of Chapter 43, RSMo; or 2. A private investigatory agency; or 3. The Family Care Safety Registry (FCSR), providing the applicant is registered and listed in the registry. (10) The adult day care provider shall make periodic checks of the EDL to determine whether any current employee, contractor or volunteer has been recently added to the list. These checks shall be made at least every ninety (90) days by contacting the FCSR once the individual is registered and listed on the registry. (11) Prior to allowing any person who has been hired as a full-time, part-time or temporary position to have contact with participants, the adult day care provider shall, or in the case of temporary employees hired through or contracted for an employment agency, the employment agency shall prior to sending a temporary employee to a provider: (A) Request a criminal background check for the person as provided in section 43.540, RSMo. Each adult day care provider must maintain in its records a copy of documents verifying that the background checks were requested and the nature of the response received for each such request: 1. The adult day care provider must ensure that any applicant or person hired or retained who discloses prior to the receipt of the criminal background check that he/she has been convicted of, pled guilty or nolo contendere to in this state or any other state, or has been found guilty of a crime, which if committed in Missouri would be a class A or B felony violation of Chapter 565, 566, or 569, RSMo, or any violation of subsection 3 of section 198.070, RSMo, or of section 568.020, RSMo, will not have contact with participants; 2. Upon receipt of the criminal background check, the adult day care provider must ensure that if the criminal background check indicates that the person hired or retained by the adult day care provider has been convicted of, pled guilty or nolo contendere to in this state or any other state, or has been found guilty of a crime, which if committed in Missouri would be a class A or B felony violation of Chapter 565, 566, or 569, RSMo, or any violation of subsection 3 of section 198.070, RSMo, or of section 568.020, RSMo, that person will not have contact with participants; (B) Make an inquiry to the department whether the person is listed on the Employee Disqualification List as provided in section 660.315, RSMo; or (C) If the person has registered with the department’s Family Care Safety Registry, the adult day care provider may contact the Registry in order to meet the requirements of (11)(A) and (11)(B). (12) All persons employed in an adult day care program shall be registered in the FCSR. Any person hired on or after the effective date of this rule, who is not listed in the Registry, shall complete a Worker Registration form (MO 580-2421), and submit it to the FCSR within fifteen (15) days of the beginning of employment pursuant to sections 210.900 through 210.936, RSMo and 19 CSR 30-80.010 through 19 CSR 30-80.040. The Worker Registration form may be downloaded from the Department of Health and Senior Services website (http://www.dhss. mo.gov/). (13) The adult day care program or adult day care provider shall use its business judgement in determining whether to utilize any person as an employee, independent contractor, or volunteer who is listed on the EDL. (14) Any person who may be refused or terminated from employment based on a criminal history described in section 660.317.6, RSMo, may apply to the division for a good cause waiver under the provisions of 19 CSR 30-82.060. (15) The adult day care provider may consider for employment any person who has been granted a good cause waiver in accordance with the provisions of section 660.317, RSMo and 19 CSR 30-82.060, in positions which have contact with participants. The adult day care provider shall be responsible for contacting the division to confirm the validity of an applicant’s good cause waiver prior to hiring the applicant. (16) At least one (1) staff person trained and certified in first aid and cardiopulmonary resuscitation (CPR) shall be on the premises and available at all times. First aid and CPR training shall be taken from the American Red Cross or from another comparable source. Certification in first aid shall be renewed every three (3) years and certification in CPR shall be renewed annually for each staff person assigned to and performing first aid and CPR responsibilities. The program director or designee shall be responsible for ensuring that first aid supplies recommended by the American Red Cross or other comparable source are readily available. (17) All staff, including nondirect care, direct care and volunteers, shall be given an orientation to the adult day care program, its policies, fire, safety and emergency procedures prior to performing job responsibilities. The orientation shall be sufficient in depth to enable staff to perform their assigned job responsibilities and meet the individual needs or participants. (18) At least quarterly, or as needed based on participants’ needs, in-service training shall be provided to staff, as appropriate to their job function or participant care needs. At a minimum, in-service training shall address: (A) Participant care needs, both general and individualized; (B) Participants’ rights; (C) Program policies; and (D) Specialized care needs, such as Alzheimer’s disease or related dementias, appropriate to the needs of participants, as follows: 1. For employees providing direct care to persons with Alzheimer’s disease or related dementia, the training shall include— A. An overview of Alzheimer’s disease and related dementia; B. Communicating with persons with dementia; C. Behavior management; D. Promoting independence in activities of daily living; and E. Understanding and dealing with family issues; and 2. For employees who do not provide direct care for, but may have daily contact with, persons with Alzheimer’s disease or related dementia, the training shall include— A. An overview of dementia; and B. Communicating with persons with dementia. AUTHORITY: sections 660.050, RSMo Supp. 2003 and 660.418, RSMo 2000.* This rule was originally filed as 13 CSR 15-8.040. Original rule filed Oct. 15, 1984, effective Jan. 11, 1985. Moved to 19 CSR 30-90.040, effective Aug. 28, 2001. Amended: Filed Sept. 14, 2004, effective March 30, 2005. ** *Original authority: 660.050, RSMo 1984, amended 1988, 1992, 1993, 1994, 1995, 2001 and 660.418, RSMo 1984, amended 1993, 1994. **Pursuant to Executive Order 21-07, 19 CSR 30-90.040, sections (6), (7) and (18) was suspended from April 22, 2020 through August 31, 2021.