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<regulation prefix="Regulation" num=".19" citation="COMAR 10.07.14.19" title_num="10" subtitle_num="07" chapter_num="14" heading="Other Staff — Qualifications.">
  <paragraph num="A.">
    <text>Age Requirements of Other Staff.</text>
    <paragraph num="(1)">
      <text>Direct resident care staff shall be:</text>
      <paragraph num="(a)">
        <text>18 years old or older;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>16 or 17 years old who are enrolled in a certified nursing assistant training program and are supervised until certified; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>16 or 17 years old and are certified as a nursing assistant.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Other staff not performing direct resident care may be younger than 18 years old.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Qualifications of Other Staff. The qualifications of other staff include:</text>
    <paragraph num="(1)">
      <text>Evidence that the staff is:</text>
      <paragraph num="(a)">
        <text>Free from tuberculosis in a communicable form in accordance with Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Immune to measles, mumps, rubella, and varicella as evidenced by history of disease or vaccination; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Free from any impairment which would hinder the performance of assigned responsibilities;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Having no criminal convictions or criminal history that indicates behavior that is potentially harmful to residents, as evidenced through a  background check completed within 30 calendar days before employment;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Having sufficient skills, education, training, and experience to serve the residents in a manner that is consistent with the philosophy of assisted living;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Participating in and completing an orientation program and ongoing training to ensure that the residents receive services that are consistent with their needs and generally accepted standards of care for the specific conditions of those residents to whom staff will provide services;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Receiving initial and annual training in:</text>
      <paragraph num="(a)">
        <text>Fire and life safety, including the use of fire extinguishers;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Infection control, including standard precautions, contact precautions, and hand hygiene;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Basic food safety; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Emergency disaster plans;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Completing basic first aid training taught by a first aid instructor certified by a national organization and recertification every 2 years;</text>
      <paragraph num="(a)">
        <text>Licensed practical nurses and registered nurses are exempted from basic first aid training and retraining.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Having training or experience in:</text>
      <paragraph num="(a)">
        <text>The health and psychosocial needs of the population being served as appropriate to their job responsibilities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The resident assessment process;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The use of service plans; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Resident’s rights; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>Holding appropriate licensure or certification as required by law.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>With the exception of certified nursing assistants (CNAs) and geriatric nursing assistants (GNAs), if job duties involve the provision of personal care services as described in Regulation .30E of this chapter, an employee:</text>
    <paragraph num="(1)">
      <text>Shall demonstrate competence to the delegating nurse before performing these services; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May work for 10 calendar days before demonstrating to the delegating nurse that they have the competency to provide these services, if the employee performing the tasks is accompanied by:</text>
      <paragraph num="(a)">
        <text>A certified nursing assistant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A geriatric nursing assistant; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An individual who has been approved by the delegating nurse.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Basic cardiopulmonary resuscitation (CPR) training, including a hands-on component, taught by a CPR instructor certified by a nationally recognized organization shall be provided on an initial and ongoing basis to a sufficient number of staff to ensure that a trained staff member is available to perform CPR in a timely manner, 24 hours a day.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Relief personnel shall be available at all times in the event that the regularly scheduled staff members are unavailable. Relief personnel shall meet the requirements of §B of this regulation.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Proof of training shall include:</text>
    <paragraph num="(1)">
      <text>Date of class;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Course content;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Documentation of successful completion of the training content;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Written, electronic, or video proof of attendee participation; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Signature, qualifications, and contact information of each trainer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Training with No Direct Interaction. When the training method does not involve direct interaction between faculty and participant, the assisted living program shall make available to the participant a trained individual to answer questions and respond to issues during the training.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Training in Cognitive Impairment, Mental Illness, and Behavioral Health.</text>
    <paragraph num="(1)">
      <text>When job duties involve the provision of personal care services as described in Regulation .30E of this chapter, employees shall receive a minimum of 6 hours of initial training on cognitive impairment, mental illness, and behavioral health within the first 120 calendar days of employment.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The training shall be designed to meet the specific needs of the assisted living program’s population as determined by the assisted living manager, including the following, as appropriate:</text>
      <paragraph num="(a)">
        <text>An overview of the following:</text>
        <paragraph num="(i)">
          <text>A description of normal aging and conditions causing cognitive impairment;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A description of normal aging and conditions causing mental illness;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Risk factors for cognitive impairment;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Risk factors for mental illness;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Health conditions that affect cognitive impairment;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Health conditions that affect mental illness;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Early identification of and intervention for cognitive impairment;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Early identification of and intervention for mental illness; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Procedures for reporting cognitive, behavioral, and mood changes;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Effective communication, including:</text>
        <paragraph num="(i)">
          <text>The effect of cognitive impairment on expressive and receptive communication;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The effect of mental illness on expressive and receptive communication;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Environmental stimuli and influences on communication;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Behavioral intervention, including:</text>
        <paragraph num="(i)">
          <text>Identifying and interpreting behavioral symptoms;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Problem solving for appropriate intervention;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Risk factors and safety precautions to protect the individual and other residents; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>De-escalation techniques;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Making activities meaningful, including:</text>
        <paragraph num="(i)">
          <text>Understanding the therapeutic role of activities;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Creating opportunities for productive, leisure, and self-care activities; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Structuring the day;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Staff and family interaction, including:</text>
        <paragraph num="(i)">
          <text>Building a partnership for goal-directed care;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Understanding the needs of families; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Effective communication between family and staff;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>End of life care, including:</text>
        <paragraph num="(i)">
          <text>Pain management;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Providing comfort and dignity; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Supporting the family; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Managing staff stress, including:</text>
        <paragraph num="(i)">
          <text>Understanding the impact of stress on job performance, staff relations, and overall facility environment;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Identification of stress triggers;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Self-care skills;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>De-escalation techniques; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Devising support systems and action plans.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>When job duties do not involve the provision of personal care services as described in Regulation .30E of this chapter, employees shall receive a minimum of 2 hours of training on cognitive impairment, mental illness, and behavioral health within the first 120 calendar days of employment. The training shall include:</text>
      <paragraph num="(a)">
        <text>An overview of the following:</text>
        <paragraph num="(i)">
          <text>A description of normal aging and conditions causing cognitive impairment;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A description of normal aging and conditions causing mental illness;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Risk factors for cognitive impairment;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Risk factors for mental illness;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Health conditions that affect cognitive impairment;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Health conditions that affect mental illness;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Early identification and intervention for cognitive impairment;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Early identification and intervention for mental illness; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Procedures for reporting cognitive, behavioral, and mood changes;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Effective communication, including:</text>
        <paragraph num="(i)">
          <text>The effect of cognitive impairment on expressive and receptive communication;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The effect of mental illness on expressive and receptive communication;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Environmental stimuli and influences on communication; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Behavioral intervention including risk factors and safety precautions to protect the individual and other residents.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Ongoing training in cognitive impairment and mental illness shall be provided annually consisting of, at a minimum:</text>
      <paragraph num="(a)">
        <text>2 hours for employees whose job duties involve the provision of personal care services as described in Regulation .30E of this chapter; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>1 hour for employees whose job duties do not involve the provision of personal care services as described in Regulation .30E of this chapter.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Training may be provided through various means, including:</text>
    <paragraph num="(1)">
      <text>Classroom instruction;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>In-service training;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Internet courses;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Correspondence courses;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Prerecorded training; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Other training methods approved by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>When the training method does not involve direct interaction between faculty and participant, the assisted living program shall make available to the participant during the training a trained individual to answer questions and respond to issues raised by the training.</text>
  </paragraph>
</regulation>