La. Admin. Code tit. 48 § I-5265

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5265 - Staffing Requirements

A. Administrator. The facility administrator shall be a full time employee of the PDHC facility and shall designate in writing a person to be responsible for the facility when he/she is absent from the facility for more than 24 hours. This person is known as the administrator's designee.

1. Qualifications. The administrator and administator's designee shall have three years of experience in the delivery of health care services and meet one of the following criteria:

a. be a physician currently licensed in Lousiana;

b. be a registered nurse currently licensed in Louisiana;

c. be a college graduate with a bachelors degree; or

d. have an associate's degree, with one additional year of documented management experience.

2. Any licensed person functioning in the role of administrator or adminstrator's designee shall have an unrestricted, current license issued by the appropriate Louisiana licensing board.

3. The administrator and the administrator's designee shall be at least 21 years of age.

4. The administrator or the administrator's designee shall have the following responsibilities:

a. ensuring that the PDHC facility complies with federal, state and local laws, rules and regulations;

b. maintaining the following written records and any other records required by local, state or federal laws and these licensing provisions:

i. daily census record, which shall indicate the name of each child currently receiving services in the facility; and

ii. a record of all accidents, unusual incidents, and incidents involving alleged abuse or neglect involving any child or staff member that caused, or had the potential to cause, injury or harm to any person or property within the facility;

(a). Such records shall contain a clear description of each accident or incident, the names of the persons involved, a description of all medical or other services provided to these, specifying who provided such services, and the steps taken to prevent recurrence of such accident or incidents in the future.

c. ensuring that the facility immediately notifies the parent/guardian of any and all accidents or incidents involving their child;

d. ensuring that the facility provides written notification within 24 hours to the parent/guardian of any and all accidents or incidents; and

e. making all reports and referrals to law enforcement or other authorities as required by Federal or State law, rule or regulation.

5. The administrator shall maintain a copy of current agreements with consultants and contracted individuals utilized by the PDHC facility in the facility's records. The record shall include verification of credentials and relevant experience of each person providing service.

6. The administrator shall maintain a personnel record for each employee which shall contain:

a. a current copy of a Louisiana certificate and/or license as applicable;

b. the original employment application, references, employment history for the preceding five years if applicable; and

c. a copy of all job performance evaluations.

7. The administrator shall ensure that the facility develops and maintains a current job description for each employee.

8. The administrator shall provide each employee access to written personnel policies governing conditions of employment. The PDHC facility shall develop and implement an employee grievance procedure.

9. The administrator shall ensure that the facility conducts annual written job performance evaluations or contract monitoring for each employee and contracted individual. The performance evaluation shall note strengths and weaknesses and shall include plans to correct any job performance weakness. Performance evaluations or contract monitioring shall be reviewed with each employee and each contracted individual.

10. The administrator shall ensure that the facility assigns duties to employees that are consistent with their job descriptions and with their levels of education, preparation and experience.

11. The administrator shall ensure that the facility provides necessary qualified personnel and ancillary services to ensure the health, safety, and proper care of each child.

12. The administrator shall ensure that the facility develops and implements policies and procedures which shall be included in the facility's policy manual.

13. The Administrator shall ensure that the facility has documentation of a satisfactory criminal record check of each non-licensed employee, and shall comply with the provisions of R.S. 40:1300.51-56.

B. Medical Director. The medical director of the PDHC shall be a physician currently licensed in Louisiana without restrictions.

1. The medical director shall be:

a. a board certified pediatrician;

b. a pediatric specialist with knowledge of medically fragile children; or

c. another medical specialist or subspecialist with knowledge of medically fragile children.

2. Responsibilities of the medical director include, but are not limited to:

a. periodic review of the services provided by the PDHC facility to assure acceptable levels of quality of care and services;

b. participation in development and implementation of appropriate performance improvement and safety initiatives;

c. participation in the development of new programs and modifications of existing programs;

d. assurance that medical consultation will be available in the event of the medical director's absence;

e. serving on committees as defined and required by these rules and by the facility's policies;

f. consulting with the facility's administrator on the health status of the facility's personnel as it relates to infection control and or the child's health and safety;

g. reviewing reports of all accidents or unusual incidents occurring on the premises and identifying to the facility's administrator hazards to health and safety; and

h. development and implementation of a policy and procedure for the delivery of emergency services and the delivery of regular physician's services when the child's attending physician or designated alternative is not available.

3. The medical director shall be available for consultation or collaboration with the prescribing physician and/or facility staff.

4. The medical director shall participate in reviews of the plan of care for each child receiving services.

5. The Medical Director may serve as the administrator of the PDHC facility.

C. Director of Nursing (DON). Each PDHC shall have a full time director of nursing.

1. The director of nursing shall be a registered nurse (RN) currently licensed in the state of Louisiana without restrictions, and shall:

a. hold a current certification in Cardio Pulmonary Resuscitation (CPR);

b. hold current certification in Basic Cardiac Life Support (BCLS) and Pediatric Advanced Life Support (PALS); and

c. have a minimum of two years general pediatric nursing experience of which at least six months shall have been spent caring for medically fragile or technology dependent infants or children in one of the following settings:

i. pediatric intensive care;

ii. neonatal intensive care;

iii. pediatric emergency care;

iv. PDHC facility;

v. prescribed pediatric extended care center; or

vi. similar care setting during the previous five years.

2. The DON's responsibilities shall include, but are not limited to:

a. the supervision of all aspects of patient care to ensure compliance with the plan of care;

b. all activities of professional nursing staff and direct care staff to ensure compliance with current standards of accepted nursing and medical practice;

c. compliance with all federal and state laws, rules and regulation related to the delivery of nursing care and services;

d. daily clinical operations of the PDHC facility;

e. implementation of personnel and employment policies to assure that only qualified personnel are hired, including verification of licensure and/or certification prior to employment and anually thereafter;

f. maintaining records to support competency of all nursing and direct care staff;

g. implementation of PDHC facility policy and procedures that establish and support quality patient care;

h. development, implementation and supervision of an employee health program in accordance with state laws, rules or regulations;

i. providing for orientation and in-service training to employees to promote effective PDHC services and safety to the patient and to familiarize staff with regulatory issues, as well as agency policy and procedures;

j. performing timely annual nursing and direct care personnel perforamance evaluations;

k. ensuring the PDHC facility has mechanisms for disciplinary action for nursing and direct care personnel;

l. assuring participation in regularly scheduled appropriate continuing education for all nursing and direct care personnel;

m. assuring that the care provided by the nursing and direct care personnel promotes effective PDHC services and the safety of the child; and

n. being on-site during normal operating hours.

3. The agency shall designate in writing a registered nurse who will assume the responsibilities of the DON during his/her absence.

4. The DON may serve as the administrator or administrator's designee if qualified. If the DON is functioning as the administrator or administrator's designee, the DON shall not be included in the total staffing ratio for nursing or direct care services.

D. Registered Nurse (RN). Each PDHC shall have sufficient RN staffing to ensure that the care and services provided to each child is in accordance with the child's plan of care.

1. Each RN employed by the facility shall have at least the following qualifications and experience:

a. be currently licensed in the state of Louisiana without restrictions as a registered nurse;

b. hold a current certification in CPR; and

c. have either:

i. one or more years of pediatric experience as an RN, with at least six months experience caring for medically fragile or technologically dependent children; or

ii. two or more years of documented prior pediatric nursing experience as a licensed practical nurse (LPN)and with at least six months experience caring for medically fragile or technologically dependent children.

E. Licensed Practical Nurse(LPN). Each PDHC facility shall have sufficient LPN staffing to ensure that the care and services provided to each child is in accordance with the child's plan of care.

1. Each LPN employed by the facility shall have at least the following qualifications and experience:

a. be currently licensed in the state of Louisiana without restrictions as a licensed practical nurse; and

b. hold a current certification in CPR; and

c. have either:

i. one year or more years experience in pediatrics as an LPN; or

ii. two years of documented prior pediatric experience working as a direct care worker caring for medically fragile child(ren).

F. Direct Care Staff. Direct care staff shall work under the supervision of the registered nurse and shall be responsible for providing direct care to children at the PDHC facility.

1. For the purposes of this Section, other direct care staff shall include:

a. nursing assistants;

b. certified nursing assistants;

c. patient care technicians;

c. medical assistants;

e. emergency medical technicians (EMT);

f. on-site therapists; and

g. individuals with training and experience in education, social services or child care related fields.

2. Each direct care staff person employed by the facility shall have at least the following qualifications and experience:

a. one year documented employment experience in the care of infants or children or one year experience in caring for a medically fragile child;

b. be able to demonstrate the necessary skills and competency to meet the direct care needs of the child(ren) to which they are assigned;

c. be currently registered with the Certified Nurse Aide (CNA) Registry or Direct Service Worker (DSW) Registry as a CNA or DSW in good standing and without restrictions;

d. hold a current certification in Cardio Pulmonary Resuscitation (CPR); and

e. be 18 years of age or older.

G. Nursing and Direct Care Staffing Levels

1. PDHC facilities shall have sufficient nursing and direct care staff to meet the needs of each infant and child receiving services in the PDHC facility in accordance with the plan of care.

2. Total staffing for nursing services and direct care shall, at a minimum, meet the following ratios according to the daily census.

Children	Total Nursing or Direct Care Staff	RN	RN or LPN	RN, LPN, or Direct Care staff
1	1	1
2-6	2	1	1
7-9	3	1	1	1
10-12	4	1	1	2
13-15	5	2	1	2
16-18	6	2	1	3
19-21	7	2	2	3
22-24	8	2	2	4
25-27	9	3	2	4
28-30	10	3	2	5
31-33	11	3	3	5
34-36	12	3	3	6
37-39	13	4	3	6
40-42	14	4	3	7
43-45	15	4	4	7

3. If the PDHC facility has a census of more than 45 children, the staffing shall increase by one staff for every three children alternating between a direct care staff, an RN, and an LPN in such order.

La. Admin. Code tit. 48, § I-5265

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 35:2773 (December 2009), Amended by the Department of Health, Bureau of Health Services Financing, LR 482973 (12/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2193-40:2193.4.