DAR File No. 43773

Health, Family Health and Preparedness, Licensing

Section R432-270-8

Personnel

Notice of Proposed Rule

(Amendment)

DAR File No.: 43773
Filed: 06/05/2019 01:54:48 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to modify the section regulating the staff qualifications for licensed assisted living facilities. The Health Facility Committee reviewed and approved this rule amendment on 02/13/2019.

Summary of the rule or change:

This amendment removes the requirement for all direct care staff to be Certified Nurse Aides (CNA) in an Assisted Living Level II Facility. The rule requiring the facility to have one Certified Nurse Aide on staff at all times remains in effect.

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

The state government assisted living facility survey process was thoroughly reviewed. This proposed rule amendment could lead to decreased health care facility deficiencies, however, with all the variables within the survey process and the facility practices this is an inestimable benefit.

local governments:

Local governments' city business licensing requirements were considered. This proposed rule amendment should not impact local governments' revenues or expenditures.

small businesses:

After conducting a thorough analysis, it was determined that this rule amendment should not impact costs for small business licensed assisted living facilities. There are 169 non-small and small businesses (NAICS codes used - Homes for the Elderly 623312). The Type II small business assisted living facilities will still need the same amount of staffing to operate. They will not need to hire CNAs, but costs for care staff will remain the same. The industry reports no difference in costs for staffing due to this rule.

persons other than small businesses, businesses, or local governmental entities:

After conducting a thorough analysis, it was determined that this rule amendment will not result in a fiscal impact to affected persons because this amendment modifies health care facility requirements and therefore, would not add costs for persons, businesses, or local government entities.

Compliance costs for affected persons:

After conducting a thorough analysis, it was determined that this proposed rule change will not result in a fiscal impact to affected persons because this amendment modifies health care facility requirements and therefore, would not add costs to persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that this proposed rule change will not result in fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Kristi Grimes at the above address, by phone at 801-273-2821, by FAX at , or by Internet E-mail at kristigrimes@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/31/2019

This rule may become effective on:

08/07/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

There are 169 assisted living facilities that operate in Utah. These facilities are a mix of non-small businesses and small businesses. This rule change that is to no longer require assisted living level II facilities to have certified nurse aides (CNA) providing personal care is not expected to have any fiscal impacts on these businesses' revenues or expenditures, because employee wages are comparable for CNA and non-CNA caregivers.

 

The Department of Health Executive Director Joseph K. Miner, MD, has reviewed and approved this fiscal analysis.

 

 

R432. Health, Family Health and Preparedness, Licensing.

R432-270. Assisted Living Facilities.

R432-270-8. Personnel.

(1) Qualified competent direct-care personnel shall be on the premises 24 hours a day to meet residents needs as determined by the residents' assessment and service plans. Additional staff shall be employed as necessary to perform office work, cooking, housekeeping, laundering and general maintenance.

(2) The services provided or arranged by the facility shall be provided by qualified persons in accordance with the resident's written service plan.

(3) All personnel who provide personal care to residents in a Type I and Type II facility shall be at least 18 years of age or be a certified nurse aide and shall have related experience in the job assigned or receive on the job training.

[(4) Personnel who provide personal care to residents in a Type II facility must be certified nurse aides or complete a state certified nurse aide program within four months of the date of hire.]

[(5)](4) Personnel shall be licensed, certified, or registered in accordance with applicable state laws.

[(6)](5) The administrator shall maintain written job descriptions for each position, including job title, job responsibilities, qualifications or required skills.

[(7)](6) Facility policies and procedures must be available to personnel at all times.

[(8)](7) Each employee must receive documented orientation to the facility and the job for which they are hired. Orientation shall include the following:

(a) job description;

(b) ethics, confidentiality, and residents' rights;

(c) fire and disaster plan;

(d) policy and procedures;

(e) reporting responsibility for abuse, neglect and exploitation; and

(f) dementia specific training including:

(i) communicating with dementia patients and their caregivers;

(ii) communication methods and when they are appropriate;

(iii) types and stages of dementia including information on the physical and cognitive declines as the disease progresses;

(iv) person centered care principles; and

(v) how to maintain safety in the dementia patient environment.

(8) Each direct-care employee shall receive 16 hours of documented one-on-one training with a direct-care employee, with at least 3 months of experience and who has completed orientation, or the supervising nurse at the facility.

(a) This training is not transferrable to another facility and must include:

(i) transfer assistance; and

(ii) activities of daily living.

(b) Direct-care employees hired from a staffing agency must be certified nurse aides and are exempt from the 16 hours of one-on-one training.

(9) Each employee shall receive documented in-service training. The training shall be tailored to annually include all of the following subjects that are relevant to the employee's job responsibilities:

(a) principles of good nutrition, menu planning, food preparation, and storage;

(b) principles of good housekeeping and sanitation;

(c) principles of providing personal and social care;

(d) proper procedures in assisting residents with medications;

(e) recognizing early signs of illness and determining when there is a need for professional help;

(f) accident prevention, including safe bath and shower water temperatures;

(g) communication skills which enhance resident dignity;

(h) first aid;

(i) resident's rights and reporting requirements of Section 62A-3-201 to 312; and

(j) Dementia/Alzheimer's specific training.

(10) The facility administrator shall annually receive a total of 4 hours of Dementia/Alzheimer's specific training.

(11) An employee who reports suspected abuse, neglect, or exploitation shall not be subject to retaliation, disciplinary action, or termination by the facility for that reason alone.

(12) The facility shall establish a personnel health program through written personnel health policies and procedures which protect the health and safety of personnel, residents and the public.

(13) The facility must complete an employee placement health evaluation to include at least a health inventory when an employee is hired. Facilities may use their own evaluation or a Department approved form.

(a) A health inventory shall obtain at least the employee's history of the following:

(i) conditions that may predispose the employee to acquiring or transmitting infectious diseases; and

(ii) conditions that may prevent the employee from performing certain assigned duties satisfactorily.

(b) The facility shall develop employee health screening and immunization components of the personnel health program.

(c) Employee skin testing by the Mantoux Method or other FDA approved in-vitro serologic test and follow up for tuberculosis shall be done in accordance with R388-804, Special Measures for the Control of Tuberculosis.

(i) The licensee shall ensure that all employees are skin-tested for tuberculosis within two weeks of:

(A) initial hiring;

(B) suspected exposure to a person with active tuberculosis; and

(C) development of symptoms of tuberculosis.

(ii) Skin testing shall be exempted for all employees with known positive reaction to skin tests.

(d) All infections and communicable diseases reportable by law shall be reported to the local health department in accordance with the Communicable Disease Rule, R386-702-3.

(14) The facility shall develop and implement policies and procedures governing an infection control program to protect residents, family and personnel; which includes appropriate task related employee infection control procedures and practices.

(15) The facility shall comply with the Occupational Safety and Health Administration's Blood-borne Pathogen Standard.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [August 27, 2018]2019

Notice of Continuation: February 20, 2019

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-1