Staffing Plans a Focus in Assisted Living Surveys

The assisted living rule contains specificity regarding several requirements of the assisted living statute, including staffing plans. The rule requires the Clinical Nurse Supervisor (CNS) to develop a staffing plan that considers several vital elements.

The plan must provide an adequate number of qualified direct-care staff to meet the residents' needs 24 hours a day, seven days a week. When developing a direct-care staffing plan, the CNS must ensure that staffing levels are adequate to address the following:

  • Each resident's needs, as identified in the resident's service plan and assisted living contract;
  • Each resident's acuity level, as determined by the most recent assessment or individualized review;
  • The ability of staff to timely meet the residents' scheduled and reasonably foreseeable unscheduled needs given the physical layout of the facility premises;
  • Whether the facility has a secured dementia care unit; and
  • Staff experience, training, and competency.

The staffing plan should consider the missing resident and emergency and disaster plans, and the needs of individual residents. There is no prescribed process to calculate staffing levels; however, the CNS should show how they addressed these considerations.

Then, based on the plan, the CNS must develop a 24-hour daily staffing schedule.

The schedule must:

  • Include direct-care staff work schedules for each direct-care staff member showing all work shifts, including days and hours worked; and
  • Identify the direct-care staff member's resident assignments or work location.

No resident or staff names need to be on the posted schedule. The daily work schedule must be posted at the beginning of each work shift in a central location in each building of a facility or campus, accessible to staff, residents, volunteers, and the public.

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