6 Colo. Code Regs. § 1011-1 Chapter 07, pt. 7

Current through Register Vol. 47, No. 24, December 25, 2024

Part 7 - PERSONNEL

Criminal History and Adult Protective Services Record Checks

7.1 In order to ensure that staff members and volunteers are of good, moral, and responsible character, the assisted living residence shall request, prior to staff hire or volunteer on-boarding, a name-based criminal history record check for each prospective staff member and volunteer.

(A) If the applicant has lived in Colorado for more than three (3) years at the time of application, the assisted living residence shall obtain a name-based criminal history report conducted by the Colorado Bureau of Investigation (CBI).

(B) If the applicant has lived in Colorado for three years or less at the time of application, the assisted living residence shall obtain a name-based criminal history report for each state in which the applicant has lived for the past three years, conducted by the respective states' bureaus of investigation or equivalent state-level law enforcement agency or other name-based report as determined by the Department.

(C) The cost of obtaining such information shall be borne by the assisted living residence, the contract staffing agency or the individual who is the subject of such check, as appropriate.

7.2 In order to ensure that staff members and volunteers are of good, moral, and responsible character, the assisted living residence shall obtain a check of the Colorado adult protective services data system pursuant to Section 26-3.1-111, C.R.S. Based on the results of the check, the assisted living residence shall ensure it follows its policy regarding the hiring or continued service of any staff member or volunteer, as required by Part 7.4.

Background Check Policies and Procedures

7.3 If the assisted living residence becomes aware of information that indicates a current administrator, individual appointed as an interim administrator, staff member, or volunteer could pose a risk to the health, safety, and welfare of the residents and/or that such individual is not of good, moral, and responsible character, the assisted living residence shall request an updated criminal history and adult protective services record check for such individual from the CBI and/or other relevant law enforcement agency.

7.4 The assisted living residence shall develop and implement policies and procedures regarding the hiring or continued service of any administrator, individual appointed as an interim administrator, staff member, or volunteer whose criminal history or adult protective services records do not reveal good, moral, and responsible character or demonstrate other conduct that could pose a risk to the health, safety, or welfare of the residents.

(A) At a minimum, the assisted living residence shall consider and address the following items:

(1) The history of convictions, pleas of guilty or no contest,

(2) The nature and seriousness of the crime(s),

(3) The time that has elapsed since the convictions,

(4) Whether there are any mitigating circumstances, and

(5) The nature of the position to which the individual will be assigned.

Ability to Perform Job Functions

7.5 Each staff member and volunteer shall be physically and mentally able to adequately and safely perform all functions essential to resident care.

7.6 The assisted living residence shall select direct care staff based on such factors as the ability to read, write, carry out directions, communicate, and demonstrate competency to safely and effectively provide care and services.

7.7 The assisted living residence shall establish written policies concerning pre-employment physical evaluations and employee health. Those policies shall include, at a minimum:

(A) Tuberculin skin testing of each staff member and volunteer prior to direct contact with residents; and

(B) The imposition of work restrictions on direct care staff who are known to be affected with any illness in a communicable stage. At a minimum, such staff shall be barred from direct contact with residents or resident food.

7.8 The assisted living residence shall have policies and procedures restricting on-site access by staff or volunteers with drug or alcohol use that would adversely impact their ability to provide resident care and services.

Staff and Volunteer Orientation and Training

7.9 The assisted living residence shall ensure that each staff member and volunteer receives orientation and training, as follows:

(A) The assisted living residence shall ensure each staff member or volunteer completes an initial orientation prior to providing any care or services to a resident. Such orientation shall include, at a minimum, all of the following topics:

(1) The care and services provided by the assisted living residence;

(2) Assignment of duties and responsibilities, specific to the staff member or volunteer;

(3) Hand Hygiene and infection control;

(4) Emergency response policies and procedures, including:

(a) Recognizing emergencies,

(b) Relevant emergency contact numbers,

(c) Fire response, including facility evacuation procedures

(d) Basic first aid,

(e) Automated external defibrillator (AED) use, if applicable,

(f) Practitioner assessment, and

(g) Serious illness injury, and/or death of a resident.

(5) Reporting requirements, including occurrence reporting procedures within the facility;

(6) Resident rights;

(7) House rules;

(8) Where to immediately locate a resident's advance directive; and

(9) An overview of the assisted living residence's policies and procedures and how to access them for reference.

(B) Dementia Training Requirements

(1) As of January 1, 2024, each assisted living residence shall ensure that its direct-care staff members meet the dementia training requirements in this part 7.8(B).

(2) Definitions: For the purposes of dementia training as required by Section 25-1.5-118, C.R.S.

(a) "Direct-care staff member" means a staff member caring for the physical, emotional, or mental health needs of residents in a covered facility and whose work involves regular contact with residents who are living with dementia diseases and related disabilities.

(b) "Equivalent Training" in this sub-part shall mean any initial training provided by a covered facility meeting the requirements of this sub-part 7.8(B)(3).

(3) Initial Training: Each assisted living residence is responsible for ensuring that all direct-care staff members are trained in dementia diseases and related disabilities.

(a) Initial training shall be available to direct-care staff at no cost to them.

(b) The training shall be competency-based and culturally-competent and shall include a minimum of four hours of training in dementia topics including the following content:

(i) Dementia diseases and related disabilities;

(ii) Person-centered care of residents with dementia;

(iii) Care planning for residents with dementia;

(iv) Activities of daily living for residents with dementia; and

(v) Dementia-related behaviors and communication.

(c) For direct-care staff members already employed prior to January 1, 2024, the initial training must be completed as soon as practical, but no later than 120 days after January 1, 2024, unless an exception, as described in sub-part 7.8(B)(4)(a), applies.

(d) For direct-care staff members hired or providing care on or after January 1, 2024, the initial training must be completed as soon as practical, but no later than 120 days after the start of employment or the provision of direct-care services, unless an exception, as described in sub-part 7.8(B)(4)(B), applies.

(4) Exception to Initial Dementia Training Requirement

(a) Any direct-care staff member who is employed by or providing direct-care services prior to the January 1, 2024, may be exempted from the residence's initial training requirement if sub-parts I and II below are met:

(i) The direct-care staff member has completed an equivalent training, as defined in these rules, within the 24 months immediately preceding January 1, 2024; and

(ii) The direct-care staff member can provide documentation of the satisfactory completion of the equivalent training; and

(iii) If the equivalent training was provided more than 24 months prior to the date of hire as allowed in this exception, the individual must document participation in both the equivalent training and all required continuing education subsequent to the initial training.

(b) Any direct-care staff member who is hired by or begins providing direct-care services on or after January 1, 2024, may be exempted from the residence's initial training requirement if the direct-care staff member:

(i) Has completed an equivalent training, as defined in these rules, either:

(A) within the 24 months immediately preceding January 1, 2024; or

(B) Within the 24 months immediately preceding the date of hire or the date of providing direct-care services; and

(ii) Provides documentation of the satisfactory completion of the initial training; and

(iii) Provides documentation of all required continuing education subsequent to the initial training.

(c) Such exceptions shall not negate the requirement for dementia training continuing education as described in sub-part 7.8(B)(5).

(5) Dementia Training: Continuing Education

(a) After completing the required initial training, all direct-care staff members shall have documented a minimum of two hours of continuing education on dementia topics every two years.

(b) Continuing education on this topic must be available to direct-care staff members at no cost to them.

(c) This continuing education shall be culturally competent; include current information provided by recognized experts, agencies, or academic institutions; and include best practices in the treatment and care of persons living with dementia diseases and related disabilities.

(6) Minimum Requirements for Individuals Conducting Dementia Training

(a) Specialized training from recognized experts, agencies, or academic institutions in dementia disease;

(b) Successful completion of the training being offered or other similar initial training which meets the minimum standards described herein; and

(c) Two or more years of experience in working with persons living with dementia diseases and related disabilities.

(C) The assisted living residence shall provide each staff member or volunteer with training relevant to their specific duties and responsibilities prior to that staff member or volunteer working independently. This training may be provided through formal instruction, self-study courses, or on-the-job training, and shall include, but is not limited to, the following topics:

(1) Overview of state regulatory oversight applicable to the assisted living residence;

(2) Person-centered care;

(3) The role of and communication with external service providers;

(4) Recognizing behavioral expression and management techniques, as appropriate for the population being served;

(5) How to effectively communicate with residents that have hearing loss, limited English proficiency, dementia, or other conditions that impair communication, as appropriate for the population being served;

(6) Training related to fall prevention and ways to monitor residents for signs of heightened fall potential such as deteriorating eyesight, unsteady gait, and increasing limitations that restrict mobility;

(7) How to safely provide lift assistance, accompaniment, and transport of residents;

(8) Maintenance of a clean, safe and healthy environment including appropriate cleaning techniques;

(9) Food safety; and

(10) Understanding the staff or volunteer's role in end of life care including hospice and palliative care.

Personnel Policies

7.10 The assisted living residence shall develop and maintain written personnel policies, job descriptions and other requirements regarding the conditions of employment, management of staff and resident care to be provided, including, but not limited to, the following:

(A) The assisted living residence shall provide a job-specific orientation for each new staff member and volunteer before they independently provide resident services;

(B) All staff members and volunteers shall be informed of the purpose and objectives of the assisted living residence;

(C) All staff members and volunteers shall be given access to the ALR's personnel policies and the ALR shall provide evidence that each staff member and volunteer has reviewed them; and

(D) All staff members shall wear name tags or other identification that is visible to residents and visitors.

(1) The requirement for name tags may be waived if a majority of attendees at a regularly scheduled assisted living resident meeting agree to do so.

(a) The assisted living residence shall maintain documentation showing that all residents and family members were provided advance notice regarding the topic and meeting details.

(b) The decision to waive the name tag requirement shall be raised and reviewed at the assisted living resident meeting at least annually.

Personnel Files

7.11 The assisted living residence shall maintain a personnel file for each of its employees and volunteers.

7.12 Personnel files for current employees and volunteers shall be readily available onsite for Department review.

7.13 Each personnel file shall include, but not be limited to, written documentation regarding the following items:

(A) A description of the employee or volunteer duties;

(B) Date of hire or acceptance of volunteer service and date duties commenced;

(C) Orientation and training, including first aid and CPR certification, if applicable;

(D) Verification from the Department of Regulatory Agencies, or other state agency, of an active license or certification, if applicable;

(E) Results of background checks and follow up, as applicable; and

(F) Tuberculin test results, if applicable.

(G) Documentation of initial dementia training and continuing education for direct-care staff members:

(1) The residence shall maintain documentation of each employee's completion of initial dementia training and continuing education. Such records shall be available for inspection by representatives of the Department.

(2) Completion shall be demonstrated by a certificate, attendance roster, or other documentation.

(3) Documentation shall include the number of hours of training, the date on which it was received, and the name of the instructor and/or training entity.

(4) Documentation of the satisfactory completion of an equivalent training as defined in sub-part 7.8(B)(2)(b) and as required in the criteria for an exception discussed in sub-part 7.8(B)(4), shall include the information required in this sub-part 7.12 (G)(2) and (3).

(5) After the completion of training and upon request, such documentation shall be provided to the staff member for the purpose of employment at another covered facility. For the purpose of dementia training documentation, covered facilities shall include assisted living residences, nursing care facilities, and adult day care facilities as defined in Section 25.5-6-303(1), C.R.S.

7.14 If the employee or volunteer is a qualified medication administration person, the following shall also be retained in the employee's or volunteer's personnel file:

(A) Documentation that the individual's name appears on the Department's list of individuals who have successfully completed the medication administration competency evaluation; and

(B) A signed disclosure that the individual has not had a professional medical, nursing, or pharmacy license revoked in this or any other state for reasons directly related to the administration of medications.

7.15 Personnel files shall be retained for three years following an employee's separation from employment or a volunteer's separation from service and include the reason(s) for the separation.

Personal Care Worker

7.16 The assisted living residence shall ensure that each personal care worker attends the initial orientation required in Part 7.8(A). The assisted living residence shall also require that each personal care worker receives additional orientation on the following topics before providing care and services to a resident:

(A) Personal care worker duties and responsibilities;

(B) The differences between personal services and skilled care; and

(C) Observation, reporting and documentation regarding a resident's change in functional status along with the assisted living residence's response requirements.

7.17 Orientation and training is not required for a personal care worker who is returning to an assisted living residence after a break in service of three years or less if that individual meets all of the following conditions:

(A) The personal care worker completed the assisted living residence's required orientation, training, and competency assessment at the time of initial employment;

(B) The personal care worker successfully completed the assisted living residence's required competency assessment at the time of rehire or reactivation;

(C) The personal care worker did not have performance issues directly related to resident care and services in the prior active period of employment; and

(D) All orientation, training, and personnel action documentation is retained in the personal care worker's personnel file.

7.18 The assisted living residence shall designate an administrator, nurse or other capable individual to be responsible for the oversight and supervision of each personal care worker. Such supervision shall include, but not be limited to:

(A) Being accessible to respond to personal care worker questions, and

(B) Evaluating each personal care worker at least annually.

(1) Each evaluation shall include observation of the personal care worker's performance of his or her assigned tasks.

7.19 The assisted living residence shall only allow a personal care worker to perform tasks that have a chronic, stable, predictable outcome and do not require routine nurse assessment.

7.20 The potential duties of a personal care worker range from observation and monitoring of residents to ensure their health, safety, and welfare, to companionship and personal services.

7.21 Before a personal care worker independently performs personal services for a resident, the supervisor designated by the assisted living residence shall observe and document that the worker has demonstrated his or her ability to competently perform every personal task assigned. This competency check shall be repeated each time a worker is assigned a new or additional personal care task that he or she has not previously performed.

7.22 Only appropriately skilled professionals may train personal care workers and their supervisors on specialized techniques beyond general personal care and assistance with activities of daily living as defined in these rules. (Examples include, but are not limited to, transfers requiring specialized equipment and assistance with therapeutic diets). Personal care workers and their supervisors shall be evaluated for competency before the delivery of each personal service requiring a specialized technique.

(A) Documentation regarding competency in specialized techniques shall be included in the personnel files of both personal care workers and supervisors.

(B) A registered nurse who is employed or contracted by the assisted living residence may delegate to a personal care worker in accordance with the Nursing Practice Act if the registered nurse is the supervising nurse for the personal care worker.

7.23 The assisted living residence shall ensure that each personal care worker complies with all assisted living residence policies and procedures and not allow a personal care worker to perform any functions which are outside of his or her job description, written agreements, or a resident's care plan.

6 CCR 1011-1 Chapter 07, pt. 7

46 CR 24, December 25, 2023, effective 11/15/2023, exp. 3/14/2024 (Emergency)

46 CR 24, December 25, 2023, effective 1/14/2024