Part III. Personnel
22VAC40-61-100. General qualifications.
All staff members shall:
1. Be of good character and reputation;
2. Be competent, qualified, and capable of carrying out assigned responsibilities;
3. Be considerate, understanding, and respectful of the rights, dignity, and sensitivities of persons who are aged or infirm or who have disabilities;
4. Be clean and well groomed;
5. Be able to speak, read, understand, and write in English as necessary to carry out their job responsibilities;
6. Be able to understand and apply the standards in this chapter as they relate to their respective responsibilities; and
7. Meet the requirements specified in the Regulation for Background Checks for Assisted Living Facilities and Adult Day Centers (22VAC40-90).
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-110. Staff orientation and initial training.
A. Prior to working directly with participants, all staff shall receive training in:
1. Participant rights and responsibilities;
2. Their individual responsibilities in the event of fire, including the location and operation of any fire extinguishers, fire alarm boxes, and approved exits;
3. Their individual responsibilities in the event of illness or injuries, including the location and use of the first aid kit and emergency supplies;
4. Their individual responsibilities in the event of emergencies, such as a lost or missing participant, severe weather, and loss of utilities;
5. Infection control;
6. Requirements and procedures for detecting and reporting suspected abuse, neglect, or exploitation of participants and for the mandated reporters, the consequences for failing to make a required report (§ 63.2-1606 of the Code of Virginia); and
7. Confidential treatment of personal information about participants and their families.
B. Staff who work with participants shall receive training in the following areas or topics no later than three weeks after their starting date of employment; part-time staff shall receive the training no later than six weeks after their starting date of employment. The areas or topics to be covered in the staff training shall include:
1. The purpose and goals of the adult day center;
2. The policies and procedures of the center as they relate to the staff member's responsibilities;
3. Required compliance with regulations for adult day centers as it relates to their duties and responsibilities;
4. The physical, emotional, and cognitive needs of the center's population;
5. The current participants' strengths and preferences, their individualized plans of care, and their service needs and supports;
6. The schedule of activities;
7. Behavioral interventions, behavior acceptance and accommodation, and behavior management techniques;
8. Interdisciplinary team approach;
9. Implementation of advance directives and Do Not Resuscitate Orders;
10. Risk management; and
11. The needs of participants' family members or caregivers.
C. A supervisor or designated trained staff shall be on the premises and closely oversee the individual's work with participants until training required in subsection B of this section is complete.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-120. Reports of abuse, neglect, and exploitation.
A. All staff who are mandated reporters under § 63.2-1606 of the Code of Virginia shall report suspected abuse, neglect, or exploitation of participants in accordance with that section.
B. The center shall notify the participant and the participant's contact person or legal representative when a report is made as referenced in subsection A of this section, without identifying any confidential information unless such notification would jeopardize the participant.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-130. Director.
A. The director, or a designated assistant director who meets the qualifications of the director, shall be responsible for the center's program and day-to-day operations of the center and shall be present at least 51% of the center's weekly hours of operation. The responsibilities of the director shall include the following areas:
1. The content of the program offered to the participants in care.
2. Programmatic functions, including orientation, training, and scheduling of all staff.
3. Management of the supervision provided to all staff.
4. Assignment of a sufficient number of qualified staff to meet the participants' needs for:
a. Adequate nutrition;
b. Health supervision and maintenance;
c. Personal care;
d. Socialization, recreation, activities, and stimulation; and
e. Supervision, safety, and protection.
5. The duties and responsibilities required by this chapter.
B. The director shall meet the following qualifications:
1. Be at least 21 years of age.
2. Have completed, at a minimum, a bachelor's degree from an accredited college or university and two years of experience working with older adults or persons with disabilities. This may be paid full-time employment or its equivalent in part-time employment, volunteer work, or internship. The following qualifications are also acceptable for the director:
a. Current licensure as a nursing home administrator or assisted living facility administrator from the Board of Long-Term Care Administrators; or
b. Current licensure in Virginia as a registered nurse. The requirement for two years of experience working with older adults or persons with disabilities also must be met.
c. An exception to subdivisions 2 a and 2 b of this subsection is made for any person continuously employed in an adult day center licensed prior to July 1, 2000, as either a director or assistant director who has completed at least 48 semester hours or 72 quarter hours of postsecondary education from an accredited college or institution and has completed at least two years' experience working with older adults or persons with disabilities. This may be paid full-time employment or its equivalent in part-time employment or in volunteer work.
3. The director shall demonstrate knowledge, skills, and abilities in the administration and management of the adult day program, including (i) knowledge and understanding of the population being served by the center, (ii) supervisory and interpersonal skills, (iii) ability to plan and implement the program, and (iv) knowledge of financial management sufficient to ensure program development and continuity.
C. The director shall complete 24 hours of continuing education training annually to maintain and develop skills. At least two of the required hours of training shall focus on infection control and prevention. When adults with mental impairments participate at the center, at least four of the required hours shall focus on topics related to participants' mental impairments. This training shall be in addition to first aid, CPR, orientation, or initial or refresher medication aide training. Documentation of attendance shall be retained at the center and shall include type of training, name of the entity that provided the training, and date and number of hours of training.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-140. Direct care staff qualifications.
A. All staff persons who work with participants and who are counted in the staff-to-participant ratio shall be at least 18 years of age unless certified in Virginia as a nurse aide.
B. Direct care staff shall meet one of the requirements in this subsection. If the staff does not meet the requirement at the time of employment, he shall successfully meet one of the requirements in this subsection within two months of employment. Licensed health care professionals practicing within the scope of their profession are not required to complete the training in this subsection.
1. Certification as a nurse aide issued by the Virginia Board of Nursing.
2. Successful completion of a Virginia Board of Nursing-approved nurse aide education program.
3. Successful completion of a personal care aide training program that meets the requirements of the Elderly or Disabled with Consumer Direction Waiver program for adult day health care as required by the Department of Medical Assistance Services.
4. Successful completion of an educational program for geriatric assistant or home health aide or for nurse aide that is not covered under subdivision 2 of this subsection. The program shall be provided by a hospital, nursing facility, or educational institution and may include out-of-state training. The program must be approved by the department. To obtain department approval:
a. The center shall provide to the department's representative an outline of course content, dates and hours of instruction received, the name of the entity that provided the training, and other pertinent information.
b. The department will make a determination based on the information in subdivision 4 a of this subsection and provide written confirmation to the center when the educational program meets department requirements.
5. Successful completion of the department-approved 40-hour Assisted Living Facility Direct Care Staff Training curriculum.
6. Successful completion of at least 40 hours of training as taught by a licensed health care professional or, if online training is accessed, accredited by a national association. Topics for this training shall include the following:
a. Participant rights;
b. Physical, biological, and psychological aspects of aging;
c. Health care needs such as hypertension, arthritis, diabetes, heart disease, osteoporosis, stroke, incontinence, or skin care;
d. Functional needs, limitations, and disabilities including sensory, physical, and developmental disabilities; mental illness; substance abuse; and aggressive behavior;
e. Dementia and other cognitive impairment;
f. Assistance with activities of daily living;
g. Body mechanics, ambulation, and transfer;
h. Infection control;
i. Meals and nutrition;
j. Activities; and
k. Safety and accident prevention.
C. The center shall obtain a copy of the certificate issued or other documentation indicating that the person has met one of the requirements of subsection B of this section, which shall be part of the staff member's record in accordance with 22VAC40-61-180.
D. Direct care staff employed by the center prior to December 29, 2019, who do not meet one of the requirements in subsection B of this section shall do so by December 29, 2020.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-150. Staff training.
A. Staff who provide direct care to participants shall attend at least 12 hours of training annually.
1. The training shall be relevant to the population in care and shall be provided by a qualified individual through in-service training programs or institutes, workshops, classes, or conferences.
2. At least two of the required hours of training shall focus on infection control and prevention.
3. When adults with mental impairments participate at the center, at least four of the required hours shall focus on topics related to participants' mental impairments.
B. Documentation of the type of training received, the entity that provided the training, number of hours of training, and dates of the training shall be kept by the center in a manner that allows for identification by individual staff person and is considered part of the staff member's record.
C. The required hours of training shall be in addition to first aid, CPR, orientation, or initial or refresher medication aide training.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-160. First aid and CPR certification.
A. First aid.
1. Each direct care staff member shall maintain current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. The certification must either be in adult first aid or include adult first aid. To be considered current, the certification shall have been issued within the past three years.
2. Each direct care staff member who does not have current certification in first aid as specified in subdivision 1 of this subsection shall receive certification in first aid within 60 days of employment.
3. A direct care staff member who is a registered nurse or licensed practical nurse does not have to meet the requirements of subdivisions 1 and 2 of this subsection. With current certification, an emergency medical technician, first responder, or paramedic does not have to meet the requirements of subdivisions 1 and 2 of this subsection.
4. There shall be at least one staff person on the premises at all times who has current certification in first aid that meets the specifications of this section, unless the center has an on-duty registered nurse or licensed practical nurse.
B. Cardiopulmonary resuscitation. There shall be at least two direct care staff on the premises at all times who have current certification in CPR from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. The certification must either be in adult CPR or include adult CPR. To be considered current, the certification must have been issued within the past two years.
C. A staff person with current certification in first aid and CPR shall be present for the duration of center-sponsored activities off the center premises.
D. Direct care staff employed by the center prior to December 29, 2019, who do not meet the requirement of subsections A and B of this section shall do so by March 27, 2020.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.
22VAC40-61-170. Volunteers.
A. Individuals who volunteer at the center shall:
1. Have qualifications appropriate to the services they render; and
2. Be subject to laws and regulations governing confidential treatment of personal information.
B. No volunteer shall be permitted to serve in an adult day center without the permission or unless under the supervision of a person who has received a criminal record clearance pursuant to § 63.2-1720 of the Code of Virginia.
C. Duties and responsibilities of all volunteers shall be clearly defined in writing.
D. At least one staff member shall be assigned responsibility for overall selection, supervision, and orientation of volunteers.
E. All volunteers shall be under the supervision of a designated staff person when participants are present.
F. Prior to beginning volunteer service, all volunteers shall attend an orientation, including information on their duties and responsibilities, participant rights, confidentiality, emergency procedures, infection control, the name of their supervisor, and reporting requirements. All volunteers shall sign and date a statement that they have received and understood this information.
G. Volunteers may be counted in the staff-to-participant ratio if both of the following criteria are met:
1. These volunteers meet the qualifications and training requirements for staff; and
2. For each volunteer, there shall be at least one staff also counted in the staff-to-participant ratio.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019; amended, Virginia Register Volume 40, Issue 24, eff. August 14, 2024.
22VAC40-61-180. Staff records and health requirements.
A. A record shall be established for each staff member and shall be kept in a locked cabinet or area, or secured electronically, and retained at the center for currently employed staff and for two years after termination of employment, unless otherwise required by other state or federal regulations.
B. All staff records shall be kept confidential.
C. Records shall be updated and kept current as changes occur.
D. Personal and social data to be maintained on staff are as follows:
1. Name;
2. Birth date;
3. Current address and telephone number;
4. Position title and date employed;
5. Last previous employment;
6. An original criminal record report and a sworn disclosure statement;
7. Previous experience or training or both;
8. Documentation of qualifications for employment related to the staff person's position, including any specified relevant information;
9. Verification of current professional license, certification, registration, or completion of a required approved training course;
10. Name and telephone number of a person to contact in an emergency;
11. Documentation of attendance of formal training received after employment, including title of course, location, date, number of contact hours, and name of the entity that provided the training; and
12. Date of termination of employment.
E. The following required health information shall be maintained at the center and be included in the staff record for each staff member and also for each volunteer counted in the staff-to-participant ratio.
1. Initial tuberculosis (TB) examination and report.
a. Each staff person and volunteer identified in this subsection shall obtain an evaluation by a qualified licensed practitioner that completes an assessment for tuberculosis in a communicable form no earlier than 30 days before or no later than seven days after employment or contact with participants.
b. The tuberculosis evaluation shall be consistent with the TB risk assessment as published by the Virginia Department of Health, with additional testing, singly or in combination, as deemed necessary.
c. Documentation of this evaluation shall include all pertinent information contained on the "Report of Tuberculosis Screening" form recommended by the Virginia Department of Health. This documentation shall be maintained at the facility.
d. An evaluation shall not be required for an individual who (i) has separated from employment with a facility or center licensed or certified by the Commonwealth of Virginia, (ii) has had a break in service of six months or less, and (iii) submits the original statement of tuberculosis screening to the new employer.
2. Subsequent evaluations for tuberculosis.
a. All staff and volunteers identified in this subsection shall be screened annually in accordance with subdivision 1 of this subsection, with the exception that annual chest x-rays are not required in the absence of symptoms for those with prior positive test results for TB infection (tuberculin skin test or interferon gamma release assay blood test).
b. Any staff person and volunteer identified in this subsection who develops chronic respiratory symptoms of three weeks duration shall be evaluated immediately for the presence of infectious tuberculosis. Any staff suspected of having infectious tuberculosis shall not be allowed to return to work or have any contact with the participants and staff of the center until a physician has determined that the staff person is free of infectious tuberculosis.
c. Any staff person and volunteer identified in this subsection who comes in contact with a known case of infectious tuberculosis shall be screened as determined appropriate based on consultation with the local health department.
3. The center shall report any active case of tuberculosis developed by a staff member to the local health department.
Statutory Authority
§ 63.2-1733 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 3, eff. December 29, 2019.