Nursing Services Requirements for the State of Missouri
19 CSR 30-86.042 Administrative,
Personnel and Resident Care Requirements for
New and Existing Residential Care Facilities I and II
PURPOSE: This rule establishes standards for administration, personnel and resident care in
residential care facilities I and II.
Editor’s Note: All rules relating
to long-term care facilities licensed by the Division of Aging
are followed by a Roman Numeral notation which refers to the
class (either class I, II or III) of standard as designated in
section 198.085.1, RSMo 1986.
(E) There shall be a licensed nurse
employed by the facility to work at least eight
(8) hours per week at the facility
for every thirty (30) residents or additional major fraction of
thirty (30). The nurse’s duties shall include, but shall not be
limited to, review of residents. charts, medications and special
diets or other orders, review of each resident’s adjustment to
the facility and observation of each individual resident’s
general physical and mental condition. The nurse shall inform
the administrator/manager of any problems noted and these shall
be brought to the attention of the resident’s physician. II/III
(26) All residents shall be physically and mentally capable of negotiating a normal path to
safety unassisted or with the use of assistive devices. I/II
(27) Residents suffering from short periods of incapacity due to illness, injury or recuperation
from surgery may be allowed to remain or be readmitted from a
hospital if the period of incapacity does not exceed forty-five
(45) days and written approval of a physician is obtained for
the resident to remain in or be readmitted to the facility.
II/III
24) Staffing for Residential Care Facility I.
(A) The facility shall have an adequate number and type of personnel on duty at all times for
the proper care of residents and upkeep of the facility. At a
minimum, one (1) employee shall be on duty for every forty (40)
residents or fraction of forty (40) to provide protective
oversight to residents and for fire safety. I/II
Staff Residents
1 1.40
2 41.80
3 81.120
4 121.160
(B) The required staff person shall
be in the facility awake, dressed and prepared to assist
residents in case of emergency, except that in a facility
licensed for twelve (12) or fewer residents, this person may be
asleep during the night hours. In a facility licensed for twenty
(20) or fewer residents, the required staff person may be asleep
if there is a sprinkler system or if there is a complete
automatic fire detection system. I/II
(C) In a facility of more than one hundred
(100) residents, the
administration/manager shall not be counted when determining the
personnel required. II
(D) If the facility is opened in
conjunction with and is immediately adjacent to and contiguous
to another licensed long-term care facility and if
1. The resident bedrooms of the
residential care facility I are on the same floor or on the
ground floor immediately below that of the other licensed
facility;
2. There is an approved call system
in each resident’s bedroom and bathroom or a patient-controlled
system connected to a nursing station of the other licensed
facility;
3. There is a complete fire alarm
system in the residential care facility I connected to the
complete fire alarm system in the other licensed facility;
4. The staff of the other licensed
facility is greater than their minimum requirements; and
5. Periodic visits to the
residential care facility I are made by a staff person to
determine the welfare of the resident in the residential care
facility; then, for a facility serving twenty (20) or fewer
residents, there need not be an attendant on duty during the day
and evening shifts and the attendant may be asleep during the
night shift; or if the facility is on the same floor as the
other licensed facility, there need not be an attendant at
night. If there are more than twenty (20) residents, there shall
be at least one (1) staff person awake and dressed at all times
for every forty (40) residents or fraction of forty (40) I/II
(E) Those facilities which have only
an asleep attendant during the night-time period and those
facilities which have only the minimum staff required by
subsection (24)(D) during the night-time period shall not accept
residents who are blind, use assistive devices, such as walkers
or wheelchairs, or who need care greater than can be provided
with the staffing pattern in those facilities. Those residents
who were living in a residential care facility I prior to July
11, 1980, may remain in that facility with an asleep attendant
even though they may be blind, deaf or use assistive devices
provided they can demonstrate the ability to reach safety
unassisted or with assistive devices. II
(25) Staffing for Residential Care
Facility. II
(A) The facility shall have an
adequate number and type of personnel for the proper care of
residents and upkeep of the facility. At a minimum, the staffing
pattern for fire safety and care of residents shall be one (1)
staff person for every fifteen (15) residents or major fraction
of fifteen (15) during the day shift, one (1) person for every
twenty (20) residents or major fraction of twenty (20) during
the evening shift and one (1) person for every twenty-five (25)
residents or major fraction of twenty-five (25) during the night
shift. I/II
Time Personnel Residents
7 a.m. to 3 p.m. (Day)* 1 3.15
3 p.m. to 9 p.m. (Evening)* 1 3.20
9 p.m. to 7 a.m. (Night)* 1 3.25
*If the shift hours vary from those
indicated, the hours of the shifts shall show on the work
schedules of the facility and shall not be less than six (6)
hours. III
(B) The required staff shall be in
the facility awake, dressed and prepared to assist residents in
case of emergency. I/II
(C) In a facility of more than one
hundred
(100) residents, the administrator
shall not be counted when determining the personnel required. II
(D) If a residential care facility
II is operated in conjunction with and is immediately adjacent
to and contiguous to another licensed long-term care facility
and if the resident bedrooms of the residential care facility
II are on the same floor as at least
a portion of a licensed intermediate care or skilled nursing
facility; there is an approved call system in each resident’s
bedroom and bathroom or a patient-controlled call system; and
there is a complete fire alarm system in the facility tied into
the complete fire alarm system in the other licensed facility,
then the following minimum staffing for oversight and care of
residents, for upkeep of the facility and for fire safety shall
be one (1) staff person for every eighteen (18) residents or
major fraction of residents during the day shift, one (1) person
for every twenty-five (25) residents or major fraction or
residents during the evening shift and one (1) person for every
thirty (30) residents or major fraction of residents during the
night shift. I/II
Time Personnel Residents
7 a.m. to 3 p.m. (Day)* 1 3.18
3 p.m. to 9 p.m. (Evening)* 1 3.25
9 p.m. to 7 a.m. (Night)* 1 3.30
*If the shift hours vary from those
indicated, the hours of the shifts shall show on the work
schedules of the facility and shall not be less than six (6)
hours. III
(E) There shall be a licensed nurse
employed by the facility to work at least eight (8) hours per
week at the facility for every thirty (30) residents or
additional major fraction of thirty (30). The nurse’s duties
shall include, but shall not be limited to, review of residents.
charts, medications and special diets or other orders, review of
each resident’s adjustment to the facility and observation of
each individual resident’s general physical and mental
condition. The nurse shall inform the administrator/manager of
any problems noted and these shall be brought to the attention
of the resident’s physician. II/III |
