Texas Department of Aging and Disability Services
Day Activity and Health Services Provider Manual
Revision: 14-2
Effective: November 7, 2014

Section 4000

Staffing

4100  Staff Qualifications

Revision 14-2; Effective November 7, 2014

Rule: 40 Texas Administrative Code (TAC) §98.62, Program Requirements

This section provides additional guidelines for staff qualifications and requirements. It supplements but does not substitute or replace any qualifications or requirements in the adult day care and adult day health care licensing standards.

4110  Director

Revision 14-2; Effective November 7, 2014

A provider must have a director who is responsible for the overall management of the day activity and health services program.

A licensed vocational nurse (LVN) may qualify to serve as a director only if he meets the qualifications for director. An LVN without a degree does not qualify.

To qualify for director, the director must have worked for the required time with people in a human service or medically related program. The definitions in the adult day care and adult day health care licensing standards provide guidelines for determining a person's qualifications to be a facility director. Each applicant must be considered individually.

4120  Activities Director

Revision 14-2; Effective November 7, 2014

A provider must have an activities director who is responsible for planning and directing the daily program of activities. The activities director must meet qualifications listed in §98.62(a)(3), Program Requirements, concerning staff qualifications.

4130  Nurse

Revision 14-2; Effective November 7, 2014

A provider must have a nurse who is responsible for assessing the individual's initial and continued medical needs, developing an individual's plan of care, etc.

The nurse may also fulfill the functions of the director if he meets the qualifications for director.

4140  RN Consultant

Revision 14-2; Effective November 7, 2014

If the facility nurse is an LVN, the provider must have an RN consultant four hours per week. The RN consultant can serve as a substitute for the LVN.

4200  Staff Requirements

Revision 14-2; Effective November 7, 2014

Rule: 40 TAC §98.206, Program Requirements

The intent of the facility staffing requirement is to ensure that a responsible professional is at the facility when individuals are present. The nurse uses professional judgment to determine where he needs to be to meet the needs of the individuals (such as accompanying individuals on outings or staying at the facility).

Because the provider must have services available for at least 10 hours each day (see Section 1400, Required Services), a professional staff person must remain at the facility when individuals are present. A professional staff person is the:

  • facility nurse;
  • facility director; or
  • activities director.

Any time an individual is at the facility, the nurse, the director, or the activities director must be on site, although the individual may be supervised by an attendant.

4210  Director

Revision 14-2; Effective November 7, 2014

The director must perform duties relating to the provision of Day Activity and Health Services (DAHS) for at least 40 hours per week. A director who has a full-time job outside the DAHS facility from 8:00 a.m. to 5:00 p.m., Monday through Friday, does not fulfill the requirement that the director performs duties relating to the provisions of DAHS for at least 40 hours per week. A director who has a full-time job outside the DAHS facility cannot be responsible for the overall management of the facility. The DAHS facility must have services available at least 10 hours each day, five days per week (Monday through Friday). More than one part-time director may fulfill the 40-hour/week requirement.

4220  Activities Director

Revision 14-2; Effective November 7, 2014

The activities director must perform the duties related to the provision of DAHS for at least eight hours per day.

4230  Nurse

Revision 14-2; Effective November 7, 2014

The nurse must be present at the facility at least eight hours a day when one or more individuals are present to provide health care expertise, both ongoing and in case of emergency.

The facility nurse may leave the premises during a lunch break if the facility director or activities director is at the facility.

4240  RN Consultant

Revision 14-2; Effective November 7, 2014

The staff or RN consultant must provide four hours of consultation per week when individuals are present in the facility.

4250  Attendants

Revision 14-2; Effective November 7, 2014

At least one attendant or other direct service staff must be present at the facility when one individual is present.

4260  Registered Dietitian/Consultant

Revision 14-2; Effective November 7, 2014

Although the dietitian may provide individual nutritional consultation to individuals, the dietitian's main task is to:

  • plan or review menus; and
  • develop special diets for individuals that were ordered by their physician.

4270  Housekeeper

Revision 14-2; Effective November 7, 2014

40 TAC §98.62(a)(6)(A), Program Requirements

4280  Driver

Revision 14-2; Effective November 7, 2014

40 TAC §98.62(a)(6)(B) and §98.62(a)(4)(A), Program Requirements

4290  Volunteers

Revision 14-2; Effective November 7, 2014

4291  Under 18 Years of Age

Revision 14-2; Effective November 7, 2014

Summer youth students under 18 years of age may volunteer their services. However, they cannot serve as substitutes for regular staff. The volunteers may:

  • help with group activities (educational, social, recreational, etc.); and
  • assist with administrative tasks.

Volunteers may not assist and/or provide any personal care tasks. These volunteers may not be included in the staff-individual ratio because they do not meet staff qualifications.

4292  18 Years of Age or Older

Revision 14-2; Effective November 7, 2014

Volunteers must be able to perform duties prescribed. They must also receive the training required of direct delivery staff. These volunteers may be included in the staff-individual ratio. Note: An individual cannot perform any duties related to the delivery of DAHS services.

4300 Staff-Individual Ratios

Revision 14-2; Effective November 7, 2014

Rule: 40 TAC §98.62(b), Staffing Ratio

To safeguard the health and safety of individuals, a certain number of direct service staff must be present at the facility at all times. The number of staff required is determined by the number of individuals present each day, but must be at least one care giver to every eight individuals served.

Direct service staff include the director, licensed nurse, activity director and attendants.

A provider must maintain the required staff-individual ratio at the facility at all times. For staffing purposes, any individuals receiving DAHS, including DADS individuals and/or private-pay individuals, are included in the ratio.

Although the staff-individual ratio does not apply when individuals are in transit, the provider must assure the individual's health and/or safety outside the facility. When the provider takes the individual on activities outside the facility, such as zoos, movies, malls, etc., the provider must maintain the required staff-individual ratio at the destination.

4400  Criminal History Checks

Revision 14-2; Effective November 7, 2014

House Bill 1510 requires that persons convicted of certain crimes may not be employed in most facilities and agencies providing care to the aged and disabled. Therefore, criminal history checks on certain employees must be performed prior to an offer of employment except in emergency situations.

The law requiring criminal history checks provides protection of confidentiality, which prevents a provider or DADS from sharing the results of a criminal history check with anyone. Information obtained as a result of a criminal history check may not be shared with anyone except the employee affected and DADS.

If a provider receives inquiries from an individual, individual's family, potential employer or other interested parties, explain the following:

  • that the provider is required by law to conduct criminal history checks on all attendants;
  • that the provider is complying with the law; and
  • that the provider is being monitored for compliance with the law.

A provider must not share the reason for termination of the attendant with an individual or an individual's family if the termination is the result of a criminal history check. If the attendant shares the information with an individual, the provider may not confirm the reason for termination.

Procedures for conducting criminal history checks may be found in Appendix VII, Criminal History Check of Employees in Certain Agencies/Facilities Serving the Elderly or Persons with Disabilities.

4410 HIV/AIDS in the Workplace

Revision 14-2; Effective November 7, 2014

DADS guidelines are based on the Texas Department of State Health Services Model Education Program. The guidelines are found in Appendix IV, HIV/AIDS in the Workplace.

4420  Occupational Exposure to Bloodborne Pathogens

Revision 14-2; Effective November 7, 2014

Occupational Safety and Health Administration (OSHA) standards require that employers make available the Hepatitis B vaccine and vaccination series to all employees who have occupational exposure. Resources can be found at the Texas Department of State Health Services website for Bloodborne Pathogen Resources.

If a provider offers the vaccine, the full cost of vaccination expenses incurred may be reported on the cost report. The cost to provide vaccinations is currently included in the reimbursement rate.

4430  Training

Revision 14-2; Effective November 7, 2014

Rules for initial and ongoing training can be found in 40 TAC §98.62, Program Requirements.