Staffing Pattern. Staffing Ratio. The staff to participant ratio at each center shall be a minimum of one staff to seven participants (1:7) for a period of 2 years after the final adoption of COMAR 10.12.04.14A(1)(a). Two years after the final adoption of COMAR 10.12.04.14A(1)(a), the staffing ratio at each center shall be determined by the needs of each program participant as determined in the ADCAPS. Staffing shall at all times be sufficient to meet the needs of the participants. The center shall have experienced and competent relief personnel, with licenses and levels of skill comparable to regular staff, to operate during absences, vacations, or other periods necessitating substitute staff. Relief personnel shall be oriented to the operation of the center. Required Staff. Director. The center shall have a director who is responsible for the overall conduct of the center and for compliance with applicable laws and regulations. The director shall have a bachelor's degree, preferably in a health and human services field, from an accredited college or university, or the individual shall be a registered nurse. The director's duties shall be limited to the administration and provision of services at the center. If a center is part of another center, the center shall have its own director and center staff. A center with a licensed capacity of 35 or more participants shall have a full-time director. A center with a licensed capacity of 34 or fewer participants may appoint a director who serves on less than a full-time basis. A licensee operating two adult medical day care sites that are located within 50 miles of each other may utilize one on-site manager instead of a director at one of the sites if there are fewer than 50 participants at each site. The on-site manager shall have the appropriate background, education, and experience to oversee the administration and provision of services at the center. Nursing Services. A center shall have the services of a registered nurse with at least 3 years experience in a health care setting. A registered nurse shall be on-site or readily available by phone at other times to satisfy the requirements listed in §B(2)(c) of this regulation. The duties of the registered nurse shall include: Completion of the ADCAPS and the nursing plan of care. Provision or supervision, or both, of required nursing services to each participant; Supervision of the LPN and other nursing care staff in accordance with COMAR 10.27.09, 10.27.10, and 10.27.11.05H(1); Development and ongoing review of the participant's plan of care; and Assisting, as necessary, in the delivery of other required services. A licensed practical nurse performs in a team relationship with the registered nurse and shall be on site to meet the nursing services of each participant consistent with COMAR 10.27.10 when the registered nurse is not on site. A certified nursing assistant shall be present and on site when a registered nurse or licensed practical nurse is not on site. Full-time Activities Coordinator. The center shall have the services of a full-time activities coordinator who shall have: A high school diploma or general equivalency diploma (GED); and At least 3 years experience in activities coordination or therapeutic recreation for: The aged; Individuals with disabilities; or Other special populations. Staff. Program assistants shall: Have a high school diploma or general equivalency diploma (GED); or Be enrolled currently in a program leading to a high school diploma or GED. The center shall employ sufficient staff to meet the participants' needs. Personnel Policies. The center shall have written personnel policies, including at least the following: Annual leave; Pay practices; Employee benefits; Termination procedures; Hiring and firing responsibility; Review of applicant and employee criminal conviction histories; New employee orientation; and Use and duration of a probationary period. The center shall make a copy of its policies and procedures available to each employee. Before hiring, staff: Shall have a criminal background check as required in Health-General Article, §19-1901, et seq., Annotated Code of Maryland; and May not have criminal convictions or criminal history that indicates behavior that is potentially harmful to participants, as evidenced through a criminal history records check. Position Description. There shall be a written position description for each job that specifies: The qualifications for the job; A delineation of the tasks; and The supervisor of the employee. Staff Training. When job duties involve the provision of individual care services, employees shall receive a minimum of 2 hours of training on cognitive impairment and mental illness within the first 90 days of employment, including the following as appropriate: Overview of normal aging and conditions causing cognitive impairment; Risk factors for cognitive impairment; Health conditions that affect cognitive impairment; and Early identification of and intervention for cognitive impairment; Overview of normal aging and conditions causing mental illness; Risk factors for mental illness; Health conditions that affect mental illness; Early identification of and intervention for mental illness; and Procedures for reporting cognitive, behavioral, and mood changes; Effective communication including: The effect of cognitive impairment on expressive and receptive communication; The effect of mental illness on expressive and receptive communication; Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and Environmental stimuli and influences on communication; and Behavioral intervention, including: Identifying and interpreting behavioral symptoms; Problem solving for appropriate intervention; Risk factors and safety precautions to protect the individual and other participants; and De-escalation techniques. The director shall ensure that: Per the center’s policies, staff and volunteers receive orientation and training; and An ongoing educational program is planned and conducted for the development and improvement of skills of all the center's personnel, including training related to problems and needs of the elderly, health impaired, and disabled. The center shall maintain records that demonstrate proof of employee attendance and training content of orientation and in-service programs. The center shall provide a minimum of eight in-service training sessions annually, which shall include, but is not limited to: Prevention and control of infections; Fire prevention programs and participant-related safety procedures in emergency situations or conditions; Accident prevention; Training on care of individuals that is appropriate to the population served by the center, such as: Alzheimer's disease; Mental illness; Developmental disabilities; and Cognitive impairment; Recognition of, and duty to report, abuse, exploitation, neglect, and self-neglect; and Safe food handling and service. The training that is described in §F of this regulation may be provided through various means including: Classroom instruction; In-service training; Internet courses; Correspondence courses; Prerecorded training; or Other training methods. When the training method does not involve direct interaction between faculty and trainee, the center shall make available to the trainee a trained individual to answer questions and respond to issues raised by the training. Proof of training shall include: Date of class; Course content; Documentation of successful completion of the training content; and Qualifications and contact information for the trainer.