The Colorado home care manager and supervisor rules

Chapter 26 defines a governing body as "the board of trustees, directors, or other governing entity in whom the ultimate authority and responsibility for the conduct of the home care agency is vested" (Ch. 26, 2.9). A Class B agency does not have to convene one: "An HCA may choose to convene a governing body that shall have legal authority and responsibility for the conduct of the HCA. ... the HCA shall designate an individual who shall have responsibility for all tasks as set forth in this Part 7.1." (Ch. 26, 7.1(A)). Either way, "At least one (1) member of the governing body or designee shall have knowledge of HCA operations." (7.1(B)).

The governing body or designee must:

• keep bylaws or a governing document naming the programs and services offered, reviewed and revised as needed (7.1(C)(1)). Chapter 26 treats "governing documents" and "bylaws" as the same thing (2.3);
• "designate and employ an HCA manager" (7.1(C)(2));
• adopt policies and procedures and review them every year (7.1(C)(3));
• review the agency’s operations at least once a year and keep minutes of all meetings (7.1(C)(5)-(6));
• provide a fixed office (7.1(C)(7); the office rules); and
• set out the agency’s organization and lines of authority in writing, down to the consumer care level (7.1(C)(8)), and carry out a comprehensive evaluation of the whole operation at least once a year (7.1(D)).

The rule says "keep minutes of all meetings" without saying how one designee does that. CareRulebook’s manual has a single designee keep a dated, signed record of each meeting or decision instead, and labels that as the agency’s reading (Policy 1.1). The rule sets no other qualification for the designee, such as ownership; whether the designee may also be the manager is not stated (below).

Chapter 26 uses one definition for both words: "“Manager” or “administrator” means any person who is responsible for and supervises or offers or attempts to oversee and supervise the day-to-day operations of a home care agency or home care placement agency" (Ch. 26, 2.15). For a Class B agency, the governing body or designee "shall appoint an HCA manager to supervise the provision of the HCA’s services" (7.2(A)).

The baseline. "Be at least twenty-one (21) years of age, possess a high school diploma or GED, and have at least one (1) year documented supervisory experience in the provision of personal care services." (7.2(B)(1)) A manager without that year of supervising personal care can use one of two degree routes instead.

Every route also needs the age (21) and the diploma or GED. Two more qualifications apply whatever the route:

• "Be able to communicate and understand return communication effectively in exchanges between the consumer, family representatives, and other providers, including the use of appropriate translator services as needed" (7.2(B)(2))
• "Be familiar with all applicable local, state, and federal laws and regulations concerning the operation and provision of home care services" (7.2(B)(4))

"Documented." The rule asks for documented supervisory experience but does not say what documents count. Our suggestion: a letter from each employer giving dates and the supervisory role, or for the degree routes a diploma or transcript and proof of the health care work, kept in the manager’s personnel file. CDPHE’s guidance lists "Proof of administrator/manager training and qualifications, as applicable" among what must be ready at the initial survey (CDPHE guidance, step 6).

The manager is personnel too. Chapter 26 defines personnel as individuals employed by or working under the direction of the agency, "including but not limited to: managers, administrators, staff, employees, contractors, students, interns, or volunteers" (2.21). By our reading the manager’s file therefore follows the personnel record rule: references, dates of employment, qualifications, orientation, a job description and an annual evaluation (5.9(B)).

The manager must "have successfully completed an eight (8) hour agency manager training course. Additional related annual training that equals twelve (12) hours shall be required in the first year and annually thereafter" (Ch. 26, 7.2(B)(3)). "Any person commencing service as an HCA manager shall meet the minimum training requirements approved by the Department pursuant to Part 7.2(D) of this chapter", or "provide documented and confirmed previous job related experience or related education equivalent to successful completion of such program". "The Department may require additional training to ensure that all the required components of the training curriculum are met." (7.2(B)(3)(a)) And: "A copy of the certificate of completion shall be retained in the HCA manager’s personnel file." (7.2(B)(3)(b))

Which courses are approved

A manager course is approved if it is "conducted by an accredited college, university, or vocational school or by an organization, association, corporation, group, or agency with specific expertise in that area and the curriculum includes at least eight (8) actual hours of training" (7.2(D)(1)). The instruction must cover at least: a home care overview (other agency types, coordination, and the limits of personal care versus health care); regulatory compliance (consumer rights, governing body or designee duties, quality management plans, occurrence reporting, complaint investigation and resolution); personnel qualifications, competency, evaluations, training and supervision; the needs of fragile, ill and disabled people in the community; and behavior management techniques (7.2(D)(2); our summary).

CDPHE’s list. CDPHE says "A list of training providers whose courses have already been reviewed and approved by CDPHE are available in the List of Approved Trainings." We counted eleven providers on that list, two of them for their own employees only (CDPHE, approved educational opportunities). The list adds: "CDPHE cannot guarantee that the information provided in the courses is always accurate and in accordance with regulatory requirements or professional standards of practice." (CDPHE, List of Approved Trainings)

A page written for Class A. CDPHE’s page about the list describes the 24 clock hours of training in 6.4(D), which is the rule for a first-time Class A administrator, and cites Chapter 26 sections 7.6(D) and 8.3(D)(1), which do not match the current chapter (CDPHE page). The Class A rule is 6.4 (Ch. 26, 6.4(B), (D)); the Class B rule is the 8-hour course in 7.2(B)(3). Our suggestion: ask the provider in writing whether its course meets 7.2(B)(3) and 7.2(D), keep the course outline with the certificate, and ask CDPHE if the answer is unclear.

The 12 hours a year

The rule says 12 hours of "additional related annual training" in the first year and every year after. It does not say what counts as related, who may provide it, or whether the year runs from the start date or another date. CDPHE’s approved-education page lists, as approved offerings, courses from accredited colleges and universities, courses accredited by ACCME, ACPE or ANCC, and "all educational offerings that apply to the individual’s position responsibilities in home care provided by recognized national and state home care and health care professional associations" (CDPHE page). That page sets them out under first-time administrator training, so whether they define "related" training for the Class B 12 hours is not stated. CareRulebook’s manual counts each year from the manager’s start date and logs every session with proof, and says that counting choice is the agency’s (Policy 1.2).

The manager is responsible for "designating in writing the qualified staff member to act in the absence of the manager" (Ch. 26, 7.2(C)(7)). The rule does not say what "qualified" means here, what the written designation must contain, or whether the acting manager must meet the manager qualifications in 7.2(B).

CareRulebook’s manual uses a designation form signed and dated by the manager and the acting manager, replaced whenever either changes, and reads "qualified" as a staff member who knows the manual, the consumers and the workers and whom the manager judges able to act for a short time. It suggests, as recommended practice, choosing someone who also meets the manager qualifications so a longer absence does not leave the agency without a qualified person in charge (Policy 1.2). Those are the manual’s choices, not the rule’s.

Two rules cover availability, one for the manager and one for supervisors:

• The manager or a designee. "Availability of the manager or designee for all hours that personnel are providing services" (Ch. 26, 7.2(C)(8))
• A supervisor. Supervision is performed by an employee "qualified as a supervisor under Part 7.7, who is in a designated supervisory capacity and available to the worker at all times care and services are being provided" (7.8(A)(1)).

Both follow your care hours, not your office hours. If a worker is in a consumer’s home at 8 p.m. or on a Sunday, someone acting for the manager and a supervisor must be available then. Neither rule says whether "available" means on site or by phone, or how quickly a call must be answered, and "designee" is not defined.

CareRulebook’s manual offers two after-hours set-ups: the manager, supervisor or their backups answering in turns, or designated staff on a written on-call schedule, with whoever answers reaching the manager or acting manager at once for a manager’s decision and putting a worker through to the supervisor on duty (Policies 1.2 and 4.7). Those set-ups are the manual’s choices.

Chapter 26, 7.7 says the supervisor shall:

• be at least 18 years old;
• "have appropriate experience or training in the home care industry or closely related personal care services in accordance with HCA policy"; and
• have completed training in the provision of personal care services (7.7(A)).

Your policy sets the experience. "In accordance with HCA policy" means the standard is the one you write down, and by our reading a surveyor can compare each supervisor with it (7.7). The rule sets no number of years, no credential and no nurse. We found no rule setting how many supervisors you need or how many workers each may supervise. CareRulebook’s builder suggests a starting standard (at least one year of paid experience giving or supervising personal care in a home care agency, assisted living residence or similar setting) that you can change; that suggestion is ours, not CDPHE’s (Policy 4.1).

An employee, designated. The supervisor is an employee of the agency in a designated supervisory capacity (7.8(A)(1)). By our reading that rules out a contractor as supervisor, and CareRulebook’s manual never uses one.

What supervisors do

• Every three months, in person or by telehealth, each worker is supervised, covering consumer satisfaction, the worker’s competence and adherence to the service plan (7.8(A)(2); 7.9).
• Once a year, in person, in a consumer’s home, observing the tasks and the relationship with the consumer (7.8(A)(3)).
• In person for care complaints that cannot be resolved by an audiovisual connection (7.8(C)).
• Documented in the consumer’s record: date, time, method, location, people present, tasks evaluated and outcome, and any retraining (7.8(B)).
• Proof of competency before a personal care worker is assigned, by the manager or a supervisor (7.4(C)(3)(a)).
• Their own training: supervisory and direct care staff cover at least six topics every 12 months (7.4(C)(4)).

Branches. For a branch of an agency giving only personal care, "personnel that meet the qualifications of a supervisor shall be available during all operating hours" (5.2(E)(1)). Branches and workstations →

More on worker training and supervision is in the guide (training and supervision).

The sources do not answer this. What they do say:

• Separate parts. The governing body or designee is in 7.1, the manager in 7.2 and the supervisor in 7.7 and 7.8, each with its own duties and qualifications (Ch. 26, 7.1; 7.2; 7.7).
• The designee appoints the manager. The governing body or designee designates, employs and appoints the manager (7.1(C)(2)).
• A manager who supervises meets both standards. Anyone supervising workers must be qualified as a supervisor under 7.7 (7.8(A)(1)).

Nothing in Chapter 26, Chapter 2 or CDPHE’s application checklist and guidance says the manager and a supervisor must be different people, or that the designee may not be the manager, and nothing says they may be combined. Ask CDPHE’s licensing team before you build your plan around one person.

If one person does hold more than one role, CareRulebook’s manual has them meet the qualifications of each, shows each role on the organization chart, and names other people as the acting manager and the backup supervisor; it also tells the manager to ask CDPHE at licensing (Policy 1.2, item 14). That is the manual’s approach, not a CDPHE ruling.

• CBI fingerprints for owners and the manager. "Each owner and each manager or administrator of a home care agency shall submit a complete set of their fingerprints to the Colorado Bureau of Investigation for the purpose of conducting a state and national fingerprint-based criminal history record check." This happens with the application, or within 10 calendar days after a change in the owner, manager or administrator, and each person pays CBI’s fee (Ch. 26, 4.2(D)). For these rules an owner holds at least 50% (2.17). CBI lists $39.50 for the home care agency fingerprint check (CBI), and the fingerprinting vendor charges its own fee on top (CBI). These are CBI’s and the vendor’s fees, not CareRulebook’s.
• HCA Form 1 starts it. CDPHE’s checklist says Form 1 is "signed by the Administrator and Owners with 50% or greater direct ownership", and: "Please do not complete your fingerprint background check prior to submitting the Form 1, or prior to receiving the background check instructions directly from CDPHE." (CDPHE checklist, HCA Form 1)
• Convictions. The statute says "The department shall not issue a license or registration if the owner, manager, or administrator of the home care agency or home care placement agency has been convicted of a felony or of a misdemeanor" involving conduct CDPHE decides could put consumers at risk (C.R.S. 25-27.5-106(4)). Chapter 26’s version names the owner, applicant or licensee, and covers renewal as well (Ch. 26, 4.2(D)(3)).
• As a new hire. Chapter 26 requires "any individual seeking employment with the agency" to submit to a criminal history record check, done no more than 90 days before employment (5.9(C)). By our reading that covers a manager or supervisor you hire, on top of the fingerprints. A supervisor who will give direct care also needs the CAPS and DORA checks (5.9(D); 5.9(E)). Background checks in the guide →