Section 164.424 - Staffing PatternResidential Rehabilitation programs for adults are exempt from the requirements set forth in 105 CMR 164.048(A)(2). Staffing pattern shall include the following positions:
(A)Direct Care Staff. Job descriptions shall specify that direct care staff have knowledge of and ability to promote recovery. Each program must, at a minimum, include the following direct care staff: clinical supervisor, counselor/case manager, and a recovery specialist or case aide.(B)Coverage. At minimum, the staffing pattern must include a full time Clinical Supervisor meeting the definition of a Senior Clinician present to provide oversight of clinical services and at least two FTE direct care staff present on each shift as outlined below, seven days per week, 24 hours per day, which shall be adjusted upward to address resident acuity and programmatic need. No staff on any shift shall be permitted to sleep during the shift. Any program which serves persons who identify as male or female must have a plan in place for ensuring at least one direct care staff person on-site who identifies as female, and one direct care staff person who identifies as male on each shift. (1) At minimum, there shall be at least one recovery specialist or case aide and at least one full-time counselor or case manager present on each day and evening shift.(2) At minimum, there shall be at least two recovery specialists or case aides present for each overnight shift.(3) Where the resident census exceeds 100 residents, the Licensed or Approved Provider shall ensure four direct care staff are present on all shifts.(C) Licensed or Approved Providers providing Transitional Support Services shall ensure a registered nurse, advanced practice registered nurse, physician assistant, or licensed practical nurse is available on-site at least four hours each day and shall ensure that supervision of nursing staff is overseen by either a registered nurse, or a Licensed Practical Nurse (LPN) or other Qualified Health Care Professional provider defined under 105 CMR 164.005 who possesses the skills and supervision experience as determined by program and/or meets the requirements under professional licensure; provided, however that the supervisor shall be educationally prepared at or above the level of the nursing staff under his or her supervision.(D)Administrative Staff. Each residential rehabilitation program shall have a full-time manager who is responsible for the administration and operation of the residential rehabilitation program. A full-time administrative staff, or designee on duty on the premises, shall be available to respond to emergencies at all times.Amended by Mass Register Issue 1482, eff. 11/11/2022.