481—67.9 (231B,231C,231D) Staffing.
	   67.9(1) Number of staff. A sufficient number of trained staff shall be available at all times to fully meet tenants’ identified needs.
	   67.9(2) Emergency procedures. All program staff shall be able to implement the accident, fire safety, and emergency procedures.
	   67.9(3) Training documentation. The program shall have training records and staffing schedules on file and shall maintain documentation of training received by program staff, including training of certified and noncertified staff on nurse-delegated procedures.
	   67.9(4) Nurse delegation procedures. The program’s registered nurse shall ensure certified and noncertified staff are competent to meet the individual needs of tenants. Nurse delegation shall, at a minimum, include the following:
	      a.    	 The program’s newly hired registered nurse shall within 60 days of beginning employment as the program’s registered nurse document a review to ensure that staff are sufficiently trained and competent in all tasks that are assigned or delegated.
	      b.    	 Within 30 days of beginning employment, all program staff shall receive training by the program’s registered nurse(s).
	      c.    	 Training for noncertified staff shall include, at a minimum, the provision of activities of daily living and instrumental activities of daily living.
	      d.    	 Certified and noncertified staff shall receive training regarding service plan tasks (e.g., wound care, pain management, rehabilitation needs and hospice care) in accordance with medical or nursing directives and the acuity of the tenants’ health, cognitive or functional status.
	      e.    	 The program’s registered nurse(s) shall provide direct or indirect supervision of all certified and noncertified staff as necessary in the professional judgment of the program’s registered nurse and in accordance with the needs of the tenants and certified and noncertified staff.
	      f.    	 Services shall be provided to tenants in accordance with the training provided.
	      g.    	 The program shall have in place a system by which certified or noncertified staff communicate in writing occurrences that differ from the tenant’s normal health, functional and cognitive status. The program’s registered nurse or designee shall train certified and noncertified staff on reporting to the program’s registered nurse or designee and documenting occurrences that differ from the tenant’s normal health, functional and cognitive status. The written communication required by this paragraph shall be retained by the program for a period of not less than three years, and shall be accessible to the department upon request.
	      h.    	 In the absence of the program’s registered nurse due to vacation or other temporary circumstances, the nurse assuming the duties of the program’s registered nurse shall have access to staff training in relation to tenant needs.
	   67.9(5) Prohibited services. A program staff member shall not be designated as attorney-in-fact, guardian, conservator, or representative payee for a tenant unless the program staff member is related to the tenant by blood, marriage, or adoption.
	   67.9(6) Dependent adult abuse training. Program staff shall receive training relating to the identification and reporting of dependent adult abuse as required by Iowa Code section 235B.16.
[ARC 8174B, IAB 9/23/09, effective 1/1/10; ARC 0961C, IAB 8/21/13, effective 9/25/13; ARC 0963C, IAB 8/21/13, effective 9/25/13; ARC 2463C, IAB 3/16/16, effective 4/20/16]