N.D. Admin. Code 75-03-40-28

Current through Supplement No. 395, January, 2025

Section 75-03-40-28 - Minimum employee requirements

1. For purposes of this section:

a. "Reside" means to sleep and keep personal belongings; and

b. "Structure" means a building that is or may be free standing. The existence of a walkway, tunnel, or other connecting device on, above, or below ground is not effective to make one structure from two or more component structures.

2. Each facility shall adopt a policy specific to employee coverage for facility operations, including holidays, weekends, on-call clinical team rotations, daytime and overnight hours. Policy must address:

a. Designated employees required for the facility on-call clinical team;

b. Number of qualified employees onsite to sufficiently meet the needs of residents and respond to emergency situations;

c. Evaluation of the number of employees necessary to meet the age, developmental level, length of treatment, and the service needs of the resident population;

d. Ability to ensure the safety of all residents and allow adequate space to properly separate residents based on the needs of the facility populations served;

e. Ability to schedule same gender or cross gender supervision if indicated by resident treatment needs; and

f. Employees hired specific to the onsite educational program may not be counted as direct care employees, treatment coordinator employee, family engagement specialist, facility administrator, or a clinical director during any time educational services are provided.

3. Each facility that operates more than one structure in which residents reside shall count the total number of residents admitted to the facility, residing in all structures collectively for purposes of determining the required number of clinical and treatment employees to meet employee-to-resident ratios.

4. Each facility shall comply with the following minimum employee-to-resident ratio requirements:

a. A rotating on-call clinical team must be available twenty-four hours a day, seven days a week to meet the needs of resident emergency and crisis situations. The on-call clinical team must include at a minimum one nurse and one clinical employee;

b. No less than one half-time facility administrator for a facility providing treatment for up to nine residents;

c. No less than one full-time facility administrator for a facility providing treatment for ten or more residents;

d. No less than one full-time clinical director;

e. No less than one full-time nurse;

f. No less than one full-time treatment coordinator employee for each ten residents; and

g. No less than one full-time family engagement specialist for each twenty residents or aftercare clients.

5. During awake hours each facility shall meet the standards of the facility's accrediting body or the ratios set forth in this subsection, if the ratios set forth in this subsection are greater than the employee-to-resident ratios set by the accrediting body.

a. Two employees who are qualified to provide direct care for one to twelve residents; and

b. One additional employee who is qualified to provide direct care for every one through six additional residents thereafter.

6. During overnight hours each facility shall have:

a. Awake employees at all times;

b. Employee-to-resident ratio at a rate not less than:

(1) Two employees who are qualified to provide direct care for one to twenty residents; and

(2) One additional employee who is qualified to provide direct care for every one through ten additional residents thereafter; and

c. A policy that includes a requirement that an employee will check on residents during overnight hours at a minimum of every fifteen minutes, and more frequently if the acuity of the resident demands greater supervision. The overnight checks must be:

(1) Documented and available for review; and

(2) Conducted in the least invasive manner to not disrupt the residents.

7. The facility shall notify the department, in writing, if the minimum employee-to-resident ratios are not met based on position vacancies. An interim plan to cover the employee duties must be approved by the department.

N.D. Admin Code 75-03-40-28

Adopted by Administrative Rules Supplement 374, October 2019, effective 10/1/2019.

Amended by Administrative Rules Supplement 2021-382, October 2021, effective 10/1/2021.

Amended by Administrative Rules Supplement 2024-392, April 2024, effective 4/1/2024.

General Authority: NDCC 50-11-03

Law Implemented: NDCC 50-11-02