Cal. Code Regs. Tit. 17, § 56756 - Staffing Ratio

(a) A staffing ratio shall be approved for each adult day program by the Department pursuant to this section. This ratio shall be based on the program design, the curriculum as vendored, the characteristics and needs of the consumers to be served, and the number of consumers enrolled.

(b) For activity centers, adult development centers, behavior management programs, and social recreation programs, the vendor may supplement direct care staff by one staff person, six hours per day, for every ten non-mobile consumers attending. Programs serving more or less than ten non-mobile consumers shall have their supplemental staff calculated on a proportionate basis. For the purpose of this section, non-mobile means persons who are confined to wheelchairs or gurneys and who are unable to independently move from one place to another place.

(1) Vendors shall submit requests for supplemental staff in writing to the regional center.

(2) Regional centers shall notify vendors in writing that they are authorized to receive payment to maintain the staffing ratio specified in (b) above for non-mobile consumers.

(c) The vendoring regional center shall provide the Department with its recommendations for those vendors requesting a staffing ratio pursuant to (d)(1) or (e)(1) below.

(d) Activity centers shall provide a direct care staff-to-consumer ratio of 1:8.

(1) The vendor is authorized to request Department approval for modification of the staffing for an Activity Center to an overall direct care staff-to-consumer ratio of 1:7 or 1:6. A written request and justification shall be submitted to the Department by the regional center which documents the findings pursuant to the criteria listed below. The overall direct care staffing ratio shall be determined by averaging the specific staff-to-consumer ratio needed for each individual consumer. The regional center shall consider whether the activity center meets at least one of the following criteria for modification of the direct care staffing ratio of 1:8:

(A) The activity center is providing community integration or employment training in natural environments to groups of three or fewer consumers for at least two hours in duration on a daily basis.

1. If each group of consumers receives at least one two-hour session per week, then the staffing ratio shall be 1:7.

2. If each group of consumers receives at least two-hour sessions per week, then the staffing ratio shall be 1:6.

(B) The activity center is providing services to consumers whose IPPs include an objective to modify behaviors that may represent a threat to the individual, others, and/or property.

1. If consumers require intermittent spontaneous/unplanned behavior intervention to prevent or minimize disruption of activities or injury to persons or property, the staffing ratio shall be 1:7. For purposes of this paragraph and (d)(1)(C)1. below, "intermittent" means more often than once a week, but less than once per day.

2. If consumers require frequent spontaneous/unplanned behavior intervention to prevent or minimize disruption of activities or injury to persons or property, the staffing ratio shall be 1:6. For purposes of this paragraph and (d)(1)(C)2. below, "frequent" means at least once per day.

3. Such behaviors may include:

a. Physical aggression resulting in physical injury to others;

b. Displays of self-injurious behavior that could result in serious injury;

c. Causing severe damage to property;

d. Running or wandering away;

e. Smearing of feces;

f. Displays of inappropriate sexual behavior.

(C) Additional staffing assistance is required in meeting consumer personal needs, specifically:

1. If consumers require intermittent, as defined in (d)(1)(B)1. above, assistance or supervision in eating, toileting or caring for their personal hygiene needs, then the staffing ratio shall be 1:7.

2. If consumers require frequent, as defined in (d)(1)(B)2.above, assistance or constant supervision in eating, toileting or caring for their personal hygiene needs, then the staffing ratio shall be 1:6.

(2) If a given consumer meets more than one criterion as specified in (d)(1)(A) through (d)(1)(C) above, the staffing ratio which provides the most direct care staff for the vendor shall prevail.

(3) Modifications approved under (d)(1) above shall be reviewed at least annually by the regional center to assure that the condition on which the modification was approved continues.

(e) Adult development centers shall provide a direct care staff to-consumer ratio of 1:4.

(1) The vendor is authorized to request Department approval for modification of the staffing for an Adult Development Center to an overall direct care staff-to-consumer ratio of 1:3. A written request and justification shall be submitted to the Department by the regional center which documents the findings pursuant to the criteria listed below. The overall direct care staffing ratio shall be determined by averaging the specific staff-to-consumer ratio needed for each individual consumer. The regional center shall consider whether the Adult Development Center meets the following criteria for modification of the direct care staffing ratio of 1:4.

(A) The Adult development center is providing community integration or employment training in natural environments to groups of three or fewer consumers for at least two hours duration on a daily basis with each group of consumers receiving at least two two-hour sessions per week; and

(B) The consumers receiving community integration or employment training require constant assistance and constant supervision. For purposes of this section, "constant assistance" means providing direct physical aid and help with self-care needs at all times during service hours. For purposes of this section "constant supervision" means maintaining visual or physical proximity to an individual consumer during all service hours.

(2) Modifications approved under (e)(1) above, shall be reviewed at least annually by the regional center to assure that the conditions on which modifications were approved continue.

(f) Behavior management programs shall provide a direct care staff-to-consumer ratio of 1:3.

(g) Social recreation programs shall provide a direct care staff-to-consumer ratio of 1:10.

(h) Independent living programs shall provide a direct care staff-to-consumer ratio of:

(1) 1:1 when the service is conducted on an individual basis;

(2) 1:2 when the service is provided to two consumers; or

(3) 1:3 when the service is conducted on a group basis.

(i) The vendor shall maintain the approved staffing ratio during its direct service hours. The vendor shall not be required to schedule the ratio with each subgroup of consumers at all times, but shall maintain both:

(1) The ratio of staff on duty to consumers in attendance during all service hours which shall be determined by a numerical comparison of the number of individuals on duty as direct care staff with the number of consumers in attendance. If the numerical comparison results in a fraction, more than one-half of a staff person shall be rounded up to the next whole number. Less than one-half of a staff person shall be rounded up to the next one-half of a whole number. One-half of a staff person shall not be rounded.

(2) Sufficient supervision for each subgroup to protect the health and safety of the consumers.

(j) The vendor shall not count consumers, or subcontractors authorized pursuant to section 56710(b) of these regulations, as staff for the purpose of computing the direct care staff-to-consumer ratio or for rate-setting purposes.

Notes

Cal. Code Regs. Tit. 17, § 56756

1. New section filed 6-26-90 as an emergency; operative 7-1-90 (Register 90, No. 36). A Certificate of Compliance must be transmitted to OAL by 10-29-90 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 6-26-90 order transmitted to OAL 9-28-90 and filed 10-29-90 (Register 90, No. 46).
3. New subsection (h)(2), subsection redesignation and amendment of NOTE filed 6-20-94 as an emergency; operative 6-20-94. Submitted to OAL for printing only pursuant to Chapter 722, Statutes of 1992, Section 147 (Register 94, No. 25).
4. Certificate of Compliance as to 6-20-94 order transmitted to OAL 2-20-96 and filed 3-29-96 (Register 96, No. 13).
5. Change without regulatory effect amending section filed 1-17-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 3).

Note: Authority cited: Chapter 722, Statutes of 1992, Section 147; and Sections 4691 and 4791(i), Welfare and Institutions Code. Reference: Sections 4691 and 4791, Welfare and Institutions Code.

1. New section filed 6-26-90 as an emergency; operative 7-1-90 (Register 90, No. 36). A Certificate of Compliance must be transmitted to OAL by 10-29-90 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 6-26-90 order transmitted to OAL 9-28-90 and filed 10-29-90 (Register 90, No. 46).
3. New subsection (h)(2), subsection redesignation and amendment of Note filed 6-20-94 as an emergency; operative 6-20-94. Submitted to OAL for printing only pursuant to Chapter 722, Statutes of 1992, Section 147 (Register 94, No. 25).
4. Certificate of Compliance as to 6-20-94 order transmitted to OAL 2-20-96 and filed 3-29-96 (Register 96, No. 13).
5. Change without regulatory effect amending section filed 1-17-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 3).