Georgia home care administrator and RN requirements

Chapter 111-8-65 does not say who must sit on the governing body. In a small agency it may be the owner alone, or the members or board of the company. Our suggestion, not rule text: write down who the governing body is, and record its decisions (adopting policies, appointing the administrator) with a date, so you can show a surveyor who decided what.

A change to the governing body matters to DCH: "No license issued under these rules is assignable or transferable. Each license or provisional license shall be returned to the department in cases of changes in name, location, ownership or governing body" 111-8-65-.05(2)(c) A change of ownership has its own process, with at least 30 days’ notice to DCH. DCH CHOW FAQ See the Georgia license application.

There is one administrator, appointed by the governing body, with "full authority and responsibility for the operation of the private home care provider". 111-8-65-.09(3) That is the whole of the role description in the rules: Georgia does not list the administrator’s duties one by one or set training hours just for administrators.

Who qualifies

The rules set no education, license or experience requirement. The rule as printed lists three minimum qualifications. The first is a statement at application that the person has never been shown by credible evidence to have abused, neglected or exploited anyone. The other two read: "Participate in the orientation and training required by these rules" and "Not have made any material false statements concerning qualifications requirements either to the department or the provider." 111-8-65-.09(3)(a) .09(3)(a)1

Qualifications matter for the whole license: "In order to obtain or retain a license or provisional license, the provider's administrator and its employees must be qualified, as defined in these rules, to direct or work in a program." DCH "may require additional reasonable verification of the qualifications of the administrator and employees either at the time of application for a license or provisional license or at any time during the license period". 111-8-65-.05(2)

Orientation, before the application

The administrator takes part in the same orientation every employee gets before working with clients. DCH asks for evidence of it with the application, and the evidence must cover all four items, "signed and dated by the Administrator". DCH checklist, item 10

Because item 1 is your own written policies, the policies need to exist before the administrator can be oriented on them, which fits DCH’s reminder that "all policies and procedures must be established as part of the requirements for regulations and readily available upon request." DCH checklist, p. 1 After the first year, the administrator, like every employee, gets at least eight clock hours of training a year. 111-8-65-.09(6)(b)

Changing administrator

DCH’s checklist sends administrator and contact information updates to the Private Home Care Team at hfrd.phcp@dch.ga.gov. DCH checklist, p. 1 A new administrator needs their satisfactory fingerprint determination before they start, because the 30-day grace period never applies to an administrator. 111-8-12-.06(3)(a)

DCH’s checklist already asks for fingerprints at application: "All administrators and individual owners with 10% or more ownership interest must complete a fingerprint-based background check through GCHEXS." The satisfactory determination letter must be dated within 12 months of submitting the application. DCH checklist, items 7 and 9 Chapter 111-8-12 also puts the administrator on the list for registry checks before the criminal background check. 111-8-12-.04(1)

This one is easy to miss. DCH’s checklist says: "Regardless of the service level provided, an RN is required for the initial application." It applies to a companion-only agency as much as one offering nursing, and the checklist asks for a "Copy of current Georgia Registered Nurse License". DCH checklist, p. 2 and item 11

The RN does not have to be a separate hire: "An RN is permitted to hold the positions of Administrator, Owner, and Certified Nursing Assistant." DCH checklist, p. 2 A nurse founder can be the owner, the administrator and the RN at once.

It is a DCH application requirement, not a line in Chapter 111-8-65. DCH’s 2022 packet said only: "The Administrator and at least one other employee is required to open a PHCP." Older guides may not mention the RN. DCH 2022 application packet, item 9 If you are unsure how it applies to your agency, confirm with the Private Home Care Team at hfrd.phcp@dch.ga.gov.

Where the rules themselves need a nurse

• Nursing services: a fully licensed Georgia RN supervises them. .10(2)(a)
• Medically frail personal care clients: an RN or LPN supervises, and an RN completes the initial service plan. .10(2)(b)
• Aide training, if you run your own 40-hour course: "must be conducted under the direction of a licensed registered professional nurse, or a health care professional with commensurate education and experience." .09(5)(c)2
• On-call access to a nurse supervisor when aides serve medically frail clients. .10(2)(d)

What “medically frail” means

"Medically frail or medically compromised client" means a client whose health status, as determined by appropriate provider staff in accordance with accepted standards of practice, is likely to change or has changed because of a disease process, injury, disability or advanced age and underlying disease process(es). 111-8-65-.03(l) Your staff make that call, so your policy should say who decides and how it is recorded.

Supervisors can wear other hats

"Such supervisor may perform other duties provided he or she is able to fulfill the supervisory responsibilities described in these rules." 111-8-65-.10(2)(a)-(b) In a small agency the RN who is also the administrator can supervise every category, as long as the visits and plans get done on time.

Contractors are supervised too

If contracted nurses give services for you, the rule is clear: "The services must be supervised, as outlined in rule .10(2) (Supervision of Services), by a supervisor of the licensed provider." 111-8-65-.09(7)

Visits are made in the client’s home and documented in the client file or service plan. .10(2)(b)2, (c)2 The limit is a number of days, not a calendar quarter: two visits in consecutive quarters can be close to six months apart. Our suggestion: book the next visit at the end of each one, and diary it a week or two before the 92 or 122 days run out.