481—58.11 (135C) Personnel.
	 58.11(1) General qualifications.
	  a.   	 No person with a current record of habitual alcohol intoxication or addiction to the use of drugs shall serve in a managerial role of a nursing facility. (II)
	  b.   	 No person under the influence of alcohol or intoxicating drugs shall be permitted to provide services in a nursing facility. (II)
	  c.   	 No person shall be allowed to provide services in a facility if the person has a disease:
	 (1) 	 Which is transmissible through required workplace contact, (I, II, III)
	 (2) 	 Which presents a significant risk of infecting others, (I, II, III)
	 (3) 	 Which presents a substantial possibility of harming others, and (I, II, III)
	 (4) 	 For which no reasonable accommodation can eliminate the risk. (I, II, III)
Refer to Guidelines for Infection Control in Hospital Personnel, Centers for Disease Control, U.S. Department of Health and Human Services, PB85-923402 to determine (1), (2), (3) and (4).
	  d.   	 Reserved.
	  e.   	 Individuals with either physical or mental disabilities may be employed for specific duties, but only if that disability is unrelated to that individual’s ability to perform the duties of the job. (III)
	  f.   	 Persons employed in all departments, except the nursing department of a nursing facility shall be qualified through formal training or through prior experience to perform the type of work for which they have been employed. Prior experience means at least 240 hours of full-time employment in a field related to their duties. Persons may be hired in laundry, housekeeping, activities and dietary without experience or training if the facility institutes a formal in-service training program to fit the job description in question and documents such as having taken place within 30 days after the initial hiring of such untrained employees. (III)
	  g.   	 Rescinded, effective 7/14/82.
	  h.   	 The health services supervisor shall be a qualified nurse as defined in these regulations. (II)
	  i.   	 Those persons employed as nurse’s aides, orderlies, or attendants in a nursing facility who have not completed the state-approved 75-hour nurse’s aide program shall be required to participate in a structured on-the-job training program of 20 hours’ duration to be conducted prior to any resident contact, except that contact required by the training program. This educational program shall be in addition to facility orientation. Each individual shall demonstrate competencies covered by the curriculum. This shall be observed and documented by an R.N. and maintained in the personnel file. No aide shall work independently until this is accomplished, nor shall the aide’s hours count toward meeting the minimum hours of nursing care required by the department. The curriculum shall be approved by the department. An aide who has completed the state-approved 75-hour course may model skills to be learned.
Further, such personnel shall be enrolled in a state-approved 75-hour nurse’s aide program to be completed no later than six months from the date of employment. If the state-approved 75-hour program has been completed prior to employment, the on-the-job training program requirement is waived. The 20-hour course is in addition to the 75-hour course and is not a substitute in whole or in part. The 75-hour program, approved by the department, may be provided by the facility or academic institution.
Newly hired aides who have completed the state-approved 75-hour course shall demonstrate competencies taught in the 20-hour course upon hire. This shall be observed and documented by an R.N. and maintained in the personnel file.
All personnel administering medications must have completed the state-approved training program in medication administration. (II)
	  j.   	 There shall be an organized ongoing in-service educational and training program planned in advance for all personnel in all departments. (II, III)
	  k.   	 Nurse aides, orderlies or attendants in a nursing facility who have received training other than the Iowa state-approved program, must pass a challenge examination approved by the department of inspections and appeals. Evidence of prior formal training in a nursing aide, orderly, attendant, or other comparable program must be presented to the facility or institution conducting the challenge examination before the examination is given. The approved facility or institution, following department of inspections and appeals guidelines, shall make the determination of who is qualified to take the examination. Documentation of the challenge examinations administered shall be maintained.
	 58.11(2) Nursing supervision and staffing.
	  a.   	 Rescinded IAB 8/7/91, effective 7/19/91.
	  b.   	 Where only part-time nurses are employed, one nurse shall be designated health service supervisor. (III)
	  c.   	 A qualified nurse shall be employed to relieve the supervising nurses, including charge nurses, on holidays, vacation, sick leave, days off, absences or emergencies. Pertinent information for contacting such relief person shall be posted at the nurse’s station. (III)
	  d.   	 When the health service supervisor serves as the administrator of a facility 50 beds and over, a qualified nurse must be employed to relieve the health service supervisor of nursing responsibilities. (III)
	  e.   	 The department may establish on an individual facility basis the numbers and qualifications of the staff required in the facility using as its criteria the services being offered and the needs of the residents. (III)
	  f.   	 Additional staffing, above the minimum ratio, may be required by the department commensurate with the needs of the individual residents. (III)
	  g.   	 The minimum hours of resident care personnel required for residents needing intermediate nursing care shall be 2.0 hours per resident day computed on a seven-day week. A minimum of 20 percent of this time shall be provided by qualified nurses. If the maximum medical assistance rate is reduced below the 74th percentile, the requirement will return to 1.7 hours per resident per day computed on a seven-day week. A minimum of 20 percent of this time shall be provided by qualified nurses. (II, III)
	  h.   	 The health service supervisor’s hours worked per week shall be included in computing the 20 percent requirement.
	  i.   	 A nursing facility of 75 beds or more shall have a qualified nurse on duty 24 hours per day, seven days a week. (II, III)
	  j.   	 In facilities under 75 beds, if the health service supervisor is a licensed practical nurse, the facility shall employ a registered nurse, for at least four hours each week for consultation, who must be on duty at the same time as the health service supervisor. (II, III)
	 (1) 	 This shall be an on-site consultation and documentation shall be made of the visit. (III)
	 (2) 	 The registered nurse-consultant shall have responsibilities clearly outlined in a written agreement with the facility. (III)
	 (3) 	 Consultation shall include but not be limited to the following: counseling the health service supervisor in the management of the health services; (III) reviewing and evaluating the health services in determining that the needs of the residents are met; (II, III) conducting a review of medications at least monthly if the facility does not employ a registered nurse part-time. (II, III)
	  k.   	 Facilities with 75 or more beds must employ a health service supervisor who is a registered nurse. (II)
	  l.   	 There shall be at least two people who shall be capable of rendering nursing service, awake, dressed, and on duty at all times. (II)
	  m.   	 Physician’s orders shall be implemented by qualified personnel. (II, III)
	 58.11(3) Personnel histories.
	  a.   	 Each health care facility shall submit a form specified by the department of public safety to the department of public safety, and receive the results of a criminal history check and dependent adult abuse record check before any person is employed in a health care facility. The health care facility shall submit a form specified by the department of human services to the department of human services to request a child abuse history check. For the purposes of this subrule, “employed in a facility” shall be defined as any individual who is paid, either by the health care facility or any other entity (i.e., temporary agency, private duty, Medicare/Medicaid or independent contractors), to provide direct or indirect treatment or services to residents in a health care facility. Direct treatment or services include those provided through person-to-person contact. Indirect treatment or services include those provided without person-to-person contact such as those provided by administration, dietary, laundry, and maintenance. Specifically excluded from the requirements of this subrule are individuals such as building contractors, repair workers or others who are in a facility for a very limited purpose, are not in the facility on a regular basis, and do not provide any treatment or services to the residents of the health care facility. (I, II, III)
	  b.   	 A person who has a criminal record or founded dependent adult abuse report cannot be employed in a health care facility unless the department of human services has evaluated the crime or founded abuse report and concluded that the crime or founded abuse report does not merit prohibition from employment. (I, II, III)
	  c.   	 Each health care facility shall ask each person seeking employment in a facility “Do you have a record of founded child or dependent adult abuse or have you ever been convicted of crime in this state or any other state?” The person shall also be informed that a criminal history and dependent adult abuse record check will be conducted. The person shall indicate, by signature, that the person has been informed that the record checks will be conducted. (I, II, III)
	  d.   	 If a person has a record of founded child abuse in Iowa or any other state, the person shall not be employed in a health care facility unless the department of human services has evaluated the crime or founded report and concluded that the report does not merit prohibition of employment. (I, II, III)
	  e.   	 Proof of dependent adult abuse and criminal history checks may be kept in files maintained by the temporary employee agencies and contractors. Facilities may require temporary agencies and contractors to provide a copy of the results of the dependent adult abuse and criminal history checks. (I, II, III)