(1) Upon the written recommendation of the resident's physician or assessing nurse, the assisted living program may apply to the Department for a waiver in accordance with Regulation .09 of this chapter to use an electronic monitoring system instead of awake overnight staff. It utilizes clinical competence, observational skills, and assessment expertise from all . assisted living forms. %%EOF Health Assessment Please enable scripts and reload this page. YX023emT\ )(R0^rB,TECN ~\d)>,*Vn. (69) "Secretary" means the Secretary of Health, or the Secretary's designee. (28) "Family council" means a group of individuals who work together to protect the rights of and improve the quality of life of residents of an assisted living program. Learn About COVID-19 in Maryland. 0000002064 00000 n Get Form (78) "Unclaimed deceased resident" means a resident of an assisted living program: (a) Who has not prearranged and prepaid for the disposal of the resident's body; or. 0000004017 00000 n 0000002869 00000 n All rights reserved. 0000002248 00000 n The tool is a combination of the Mini-Cog, a validated cognitive screen, and the Medication Transfer Screen (MTS), a pillbox skills test. This is $400 higher than the national average of $4,500. (52) "Occasional" means occurring from time to time, on an infrequent or irregular basis, with no particular pattern. JavaScript is required to use content on this page. (22) "Delegation of nursing tasks" means the formal process approved by the Maryland Board of Nursing which permits professional nurses to assign nursing tasks to other individuals if the registered nurse: (a) Provides proper training, supervision, and monitoring; and. D. All medication orders are to be entered appropriately on the MAR. 0000004963 00000 n We're available on the following channels. Therefore, when hiring, training or scheduling staff for care of residents, the RN, CM/DN and A.L. (a) "Administration of medication" means the act of preparing and giving a medication to a resident. (2) A full assessment of the resident shall be completed: (a) Within 48 hours but not later than required by nursing practice and the patient's condition after: 0000007877 00000 n 0000002992 00000 n All rights reserved. 7p>gQaaEZ>)0i~zn'5y%5m3~ xref 0000002497 00000 n F. The MAR is a visual picture of that patient's medication use or misuse for the month. 0000003878 00000 n x]{s6U+5(I2_qb]yR^#>}Cw$@ $gVn4H{EXXQ,S(* %PDF-1.4 % 0000002975 00000 n (b) "Involuntary seclusion" does not mean separating a resident from other residents on a temporary and monitored basis. Get the Assisted Living Forms Pdf you require. 0000001277 00000 n (1) For persons admitted for short-term residential care, only the following are required: (a) Current physical condition and medical status as specified in B(4) of this regulation, and functional assessment as specified in C of this regulation; and. 0000003646 00000 n 0000003433 00000 n 0000005915 00000 n HOWEVER, the RN, CM/DN is responsible for determining the skill set and competencies needed of personnel who are assigned to provide assistance in care to residents or to actually provide care to dependent residents. Use professional pre-built templates to fill in and sign documents online faster. (b) Ensure that a full assessment of the resident is conducted within 7 calendar days. % There are no national standardized quality measures for assisted living residences like those for nursing homes and home health agencies. fraud hotline to receive allegations of 20 22 x- [ 0}y)7ta>jT7@t`q2&6ZL?_yxg)zLU*uSkSeO4?c. R -25 S>Vd`rn~Y&+`;A4 A9 =-tl`;~p Gp| [`L` "AYA+Cb(R, *T2B- 03. (24) "Discharge" means releasing a resident from an assisted living program, after which the releasing program no longer is responsible for the resident's care. 0000001361 00000 n Regardless of who arranges this, the AL manager must meet the same requirements as everyone else in the medication technician training program. It is important that persons who provide care to people 65 years or older or those with medical conditions like asthma, diabetes, heart disease, or kidney disease get vaccinated against flu because older age and medical conditions put a person at higher risk for influenza-related complications and death. . Copyright Maryland.gov. 0 The Resident Assessment Tool is based on the Assisted Living Program regulations (COMAR 10.07.14) and is designed to provide the case manager/delegating nurse and the assisted living manager with the necessary resident-based information to provide or arrange for services that meet the needs of the residents in the assisted living program. (2) Other than the information required in D(1) of this regulation, additional information is not required for subsequent short-term admissions if the resident or the resident's representative certifies that there has been no significant change in the resident's service needs. (c) Determines whether the resident needs awake overnight monitoring. (39) "Intermittent nursing care" means nursing care which is provided episodically, irregularly, or for a limited time period. Indicate the resident's ability to take his/her own medications safely & appropriately: Independently without assistance Can do so with physical assistance, reminders, or supervision only Needs to have medications administered by someone else General Comments. (a) Significant problems with family circumstances and personal relationships; (c) Ability to participate in structured and group activities, and the resident's current involvement in these activities. Assisted living assessment forms Get the up-to-date assisted living assessment forms 2023 now Show details 4.9 out of 5 46 votes 44 reviews 23 ratings 15,005 10,000,000+ 303 100,000+ users Here's how it works 02. All rights reserved. However it is the AL manager's responsibility to arrange this clinical. customers, and stakeholders with A. (b) Insured by the Federal Deposit Insurance Corporation. (75) "Staff" means supervisors, assistants, aides, or other employees, including independent contractors retained by an assisted living program, to provide the care and services required by this chapter. W(=4mQn9 %PDF-1.5 0000009961 00000 n (a) "Restraint" means any chemical restraint or physical restraint as defined in B(16) and (58) of this regulation. HyTSwoc [5laQIBHADED2mtFOE.c}088GNg9w '0 Jb E. The RN, CM/DN is to utilize his or her review of the MAR as a means to teach and remediate the medication technician as necessary. (21) "Delegating nurse" means a registered nurse who: (a) Is licensed to practice registered nursing in this State as defined in Health Occupations Article, Title 10, Annotated Code of Maryland; and. (49) "Minimal" means the least amount required to produce the desired result. However, the patients service plan is a collaborative effort between both the A.L. (36) "Informal dispute resolution (IDR)" means an informal process that provides a licensee the opportunity to question the Department about deficiencies cited on a recent inspection. Yes, the RN filling in will need to interact with and direct the activities of the medication technician and/or the CNA and/or the unlicensed person. (5) If the resident's previous assessment did not indicate the need for awake overnight staff, each full assessment or review of the full assessment shall include documentation as to whether awake overnight staff is required due to a change in the resident's condition. 0000011082 00000 n 0000003309 00000 n A service plan for each resident shall be developed in a manner that enhances the principles of dignity, privacy, resident choice, resident capabilities, individuality, and independence without compromising the health or reasonable safety of other residents. . If a physician or assessing nurse, in the physician's or nurse's clinical judgment, does not believe that a resident requires awake overnight staff, the physician or assessing nurse shall document the reasons in the area provided in the Resident Assessment Tool. Neither the Board or the OHCQs regulations require the RN, CM/DN to prepare or sign the service plan. 0000002898 00000 n Therefore, if the LPN is administering all the medications, a 45 day RN, CM/DN site visit with assessment is not needed. The inspections occur every one to two years or any time in between as a result of a complaint received by the state. 0000004750 00000 n Put the day/time and place your electronic signature. (b) "Significant change of condition" does not include any ordinary, day-to-day fluctuations in health status, function, or behavior, or an acute short-term illness, such as a cold, unless these fluctuations continue to recur. yJGex!X,/xV$ [llRVtzA.:lLpdlDbH[` E8?J (1) The resident's service plan shall be based on assessments of the resident's health, function, and psychosocial status using the Resident Assessment Tool. (b) The resident's needs can be met by the program. (18) "Common-use telephone" means a telephone: (c) That is located so that residents can have private conversations; and. manager and the RN, CM/DN. (42) "Law enforcement agency" means the Maryland State Police or a police agency of a county or municipal corporation. Journal of the American Geriatric Society. You may be trying to access this site from a secured browser on the server. trailer It is designed to help the case 0000002538 00000 n 137 0 obj<>stream (60) "Protective device" means any device or equipment, except bed side rails: (ii) Prevents a resident from aggravating an existing physical problem; or. 0000008082 00000 n The RN, CM/DN can assist the AL manager obtain this clinical experience. (46) "Management firm" means an organization, under contract with an applicant for a license or a current licensee, that is intended to have or has full responsibility and control over the day-to-day operations of the assisted living program. facility. maryland assisted living resident assessment and level of care scoring tool health care physical form maryland health assessment form Create this form in 5 minutes! The resident specific waiver is specific to the health and safety needs of that client, and to the resources of the specific facility- including the level of staff available to care for the resident (CNA, medication technician, unlicensed person, LPN or RN). These requirements include completing all three (3) components of the medication technician training program within 44 days e.g. %%EOF Copyright Maryland.gov. 0 LltUxb}P)hfj7W045 (2) When the resident scores in any of the areas identified as "Triggers for Awake Overnight Staff" in the Resident Assessment Tool, the assisted living program shall provide awake overnight staff or document why awake overnight staff is not necessary in accordance with Regulation .14C of this chapter. 0000007266 00000 n (61) "Quality assurance" means a system for maintaining professionally acceptable standards of care by: (a) Identifying opportunities to improve; (b) Studying problems if any, and their root causes; and. (1) The resident's service plan shall be based on assessments of the resident's health, function, and psychosocial status using the Resident Assessment Tool. 0000007581 00000 n 0000002083 00000 n The Maryland General Assemblys Office Health and Fire Safety Inspection Reports are obtained from the inspections completed by the Maryland State Office of Health Care Quality (OHCQ). All rights reserved. ,L!QV7 1823 form. The State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. n3kGz=[==B0FX'+tG,}/Hh8mW2p[AiAN#8$X?AKHI{!7. In this chapter, the following terms have the meanings indicated. Level 1 (low) refers to a resident needing . (48) "Mental abuse" means an intentional course of conduct resulting in emotional harm. (57) "Physical abuse" means the sustaining of any physical injury or pain to a resident as a result of cruel or inhumane treatment, or as a result of a malicious act by any individual. (7) "Alzheimer's special care unit" means a secured or segregated special unit or program specifically designed for individuals with dementia, including a probable or confirmed diagnosis of Alzheimer's disease or a related disorder. (2) Within 30 days before admission, the assisted living manager or designee shall determine admission eligibilities described in A (1) of this regulation based on completion of a resident assessment using the Resident Assessment Tool as described in B of this regulation. 0000000016 00000 n Open it up with cloud-based editor and begin adjusting. (b) "Assisted living program" does not include: (i) A nursing home, as defined under Health-General Article, 19-301, Annotated Code of Maryland; (ii) A State facility, as defined under Health-General Article, 10-101, Annotated Code of Maryland; (iii) A program licensed or approved by the Department under Health-General Article, Title 7 or Title 10, Annotated Code of Maryland; (iv) A hospice care program licensed by the Department under Health-General Article, Title 19, Annotated Code of Maryland; (vi) Services provided by a licensed residential service agency or licensed home health agency in an individual's own home; or. (37) "Instrumental activities of daily living" means home management skills, such as shopping for food and personal items, preparing meals, or handling money. fraud and/or abuse of State government D. Resident Requirements for Awake Overnight Staff. (g) An emergency situation or natural disaster. The RN, CM/DN 45 day nursing assessment is required when a medication technician is performing the delegated nursing function of medication administration. }U~'ln. Fill the empty areas; engaged parties names, addresses and phone numbers etc. "w/:_BDJkf=P[j3gvC:$*=|F]+F%:F_$;s#FxM3NN ]Pb1o "Q9 Re~m l#0hZ~&9%E_Kg:_vXSt|.Ae!?,F9B#^_Ey}G>@i[kU&L ' "XtANM4-YQ}xVB [Ap[` >Ccq4] The State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. Be sure to obtain the Resident Assessment form from OHCQ. (b) "Facilitating access" does not mean guaranteeing payment for services that: (i) Are not covered by the resident agreement; or. (12) "Authorized prescriber" means an individual who is authorized to prescribe medications under Health Occupations Article, Annotated Code of Maryland. (79) "Verbal abuse" means the use of any oral or gestured language that includes disparaging or derogatory terms, which is directed to a resident, or within a resident's hearing distance, regardless of the resident's age, ability to comprehend, or disability. (53) "Office of Health Care Quality (OHCQ)" means the Office of Health Care Quality of the Maryland Department of Health. manager and the RN, CM/DN. b7">/.gH>\g cQ#B$:Z'3,Ytj'U:N.{L"(,n3ti99Wfb o6F7RqUg}%d'x}G_sMlJ).d-~ H.9A'.fP`;H }p!Y["PpkY]Nf&i+8zs*WGw4u#4?/cgp`aMTr^K};}:*H6m//z )75c)`u;.r&Dw7d{u1[;b%78es\(ccXaGOj-2VRI)sxWG5 d]6J)*h#pSxbqLqj1oOgLS.t_( KcWcNYj: Fj~?*;_ Wv_%of`B[L~2Uk The 45 day site visit, which includes an assessment of: the client; the task; the caregiver to whom the task has been delegated; and the environment in which the task is to be performed may not be delegated to an LPN. Nursing oversight is different from Delegation of Nursing functions see OHCQS regulations COMAR 10.07.14(.02) (.04F) and (.21) F.). 0000012867 00000 n H0si_k'>$,+ Ce[5d]<1c;IBOs|_A@]8~qQI0RJC8WiE?L&aURiAq9Q,|%oh5o; &[A>:o7PeBe * 17. 45 day nursing assessment. r7^9g K*]ttcK$P#^On`CJ@TR $ALJJ qyXQD#iTRSBkhh4!l (llE@aV5h+9f `T[8:x.V0za l8XD:pax@>b; A (19) "Contact isolation" means the creation of barriers and other protection such as gloves, masks, or gowns to prevent the spread of an infection by close or direct contact between an infected individual and others. 0000001041 00000 n (b) "Cognitive impairment" includes lack of judgment, planning, organization, self-control, and the persistence needed to manage normal demands of the individual's environment. The Assisted Living Resident Assessment Tool consists of four components, which include the Health Care Practitioner's Resident Physical Assessment, the Assisted Living Manager's Resident Assessment, the Level of Care Scoring Tool, and the Identifiers for Awake Overnight Staff. %PDF-1.4 % No absolutely not. (ii) Compliance with a valid advance directive. The RN, CM/DN training is designed to provide the RN with information he/she needs to keep the resident safe, the facility safe and the RN safe and in compliance with all State laws and regulations. SECTION 1. (10) "Assisted living manager" means the individual who is: (a) Designated by the licensee to oversee the day-to-day operation of the assisted living program; and. 135 0 obj <> endobj Copyright Maryland.gov. assessment tool used to identify resident care proble ms that are addressed in an . 0000001337 00000 n (i) Making appropriate referrals for care and treatment; (ii) Arranging for the appointment and involvement of appropriate health care decision makers, when necessary; and. 0000003214 00000 n responsive, accurate and consistent, That means the RN, CM/DN must vary the date and time of the 45 day site visit to assure that all medication technicians who administer meds 24-7 are seen with some regularity. (62) "Relief personnel" means qualified individuals who have been hired to substitute for staff members: (b) When the assisted living manager or other staff is absent from the program for extended hours. How do I fill out a 4506 T non filing? . An assisted living program shall provide awake overnight staff when a resident's assessment using the Resident Assessment Tool, as provided in Regulation .21A or .26B of this chapter, indicates that awake overnight staff is required according to instructions on that tool. We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems. The assisted living manager, or designee, shall ensure that all services are provided in a manner that respects and enhances the dignity, privacy, and independence of each resident. )WGn}{":N a<4soEJL Please enable scripts and reload this page. Each assisted living residence is required by law to have the latest inspection results on hand for public inspection. Please enable JavaScript in your browser. The RN, CM\DN must obtain the approved final version of the tool from OHCQ. JavaScript is required to use content on this page. 0000003954 00000 n endobj National Human Trafficking Hotline - 24/7 Confidential. (2) A full assessment of the resident shall be completed: (a) Within 48 hours but not later than required by nursing practice and the patient's condition after: (i) A significant change of condition; and, (ii) Each nonroutine hospitalization; and. CY2020 Assisted Living Facility Utilization Reports, CY2019 Assisted Living Facility Utilization Reports, 4160 Patterson Avenue, Baltimore, MD 21215 5`&j7kRh>`g_d9B$j p!_6O"h/(Cc=8B00#v!3` *Cdf7P;bCE}g!9T]D`5K9q National Human Trafficking Hotline - 24/7 Confidential. (b) A resident agreement, in accordance with Regulations .24 and .25 of this chapter. 0000008536 00000 n 20 0 obj <> endobj The Resident Assessment form in the 16 hour RN, CM/DN Training Program is a Sample form. 13. \/N.GTs8#r$2J8ZEjq.20PCe`e.2(0 G&Cs.2e0S:NE= (29) "Financial exploitation" means the misappropriation of a resident's assets or income, including spending the resident's assets or income: (a) Against the will of or without the consent of the resident or the resident's agent; or. trailer C. The assisted living manager, or designee, shall ensure that: (1) A written service plan or other documentation sufficiently recorded in the resident's record is developed by staff, which at a minimum addresses: (a) The services to be provided to the resident, which are based on the assessment of the resident; (b) When and how often the services are to be provided; and. (76) "Substantial" means considerable in importance, degree, amount, frequency, or extent. (iv) Giving the medication to the resident. (68) "Sanction" means a disciplinary penalty imposed for a violation of statutes or regulations relating to the operation of an assisted living program, including but not limited to, those penalties referenced in Regulations .56, .57, .60, .62, and .63 of this chapter. C. Awake Overnight Staff. Abby's Assisted Living II 3071 S Rosemary (720) 338-3606 Care provided: Assisted Living, Respite Care Aladdin at Brush Assisted Living 428 Western Ave (970) 842-5463 Care provided: Assisted Living, Respite Care Serene Nature Assisted Living 10987 Luddington Street (818) 253-5989 Care provided: Assisted Living, Respite Care Brookdale Vista Grande (77) "Treatment" means medical or psychological management to cure or improve a disease or condition. ^!J@Zc$BX- +FF*1!fN? Mail or fax the completed IRS Form 4506-T to the address (or FAX number) provided on page 2 of Form 4506-T. . trailer (14) "Bank" means a bank, trust company, savings bank, savings and loan association, or financial institution that is: (a) Authorized to do business in this State; and. &HZ$H>4c Jg> /0 0000008909 00000 n (45) "Licensee" means the person, association, partnership, or corporation to whom a license is issued. Questions noted with an asterisk are "triggers" for awake overnight staff. The RN, CM/DN in assessing the resident and the staff providing care to the resident during the 45 day site visit, must review the MAR which includes but is not limited to: A. The performance measures reported for assisted living residences include: 1) the results of Inspection surveys performed on-site; 2) influenza vaccination rates of assisted living staff, and 3) facility mandatory influenza vaccination policies. B. Please enable JavaScript in your browser. The AL Manager is expected to make arrangements with another AL facility for the AL manager to do his/her clinical medication technician experience at the second AL facility. The State of Maryland pledges 0000002662 00000 n Within 30 days before admission, a resident must be assessed using the Residential Assessment Tool to gauge health, function, and emotional and social well-being. The RN, CM/DN in assessing the resident and the staff providing care to the resident during the 45 day site visit, must review the MAR which includes but is not limited to: B.The RN, CM/DN checking to assure that all medication boxes have been appropriately signed. 0000000616 00000 n stream (13) "Background check" means a check of court and other records by a private agency. (4) If a manager fails to implement a nursing or clinical order without identifying and providing alternatives to the care or service order, the delegating nurse shall notify the resident's physician, the OHCQ, and the resident or, if appropriate, the legal representative of the resident. |z :Y"+UQM2:|doseC021)~rh7OS+jwE^/bP'Gw*:.kPT/~Hvh$X|`CAPHF:VvguHzc*ik)u^PZ2 }V{q)Ktg'P+sEmR9S^>z"? qgE2H6`tIl8fX;:qxmM%p gAV}5Pp!oae; Keo401|`Y;@j AK%Jk],}5AK2.;/7jk~{ws:4x[c]d8MXL.I9YiuvYM i#M6E g * 19. We're available on the following channels. F. On-site nursing personnel shall work in partnership with the delegating nurse and assisted living program staff to ensure: National Human Trafficking Hotline - 24/7 Confidential. The reason that exams are given is so those applicants who can not do simple math or read English are not admitted or permitted to progress through the medication technician class. You may be trying to access this site from a secured browser on the server. Assisted Living Manager's Assessment Assisted Living Manager's Assessment This form is to be completed by the Assisted Living Manager or their designee. (73) "Short-term residential care" means a stay, either continuous or intermittent, in an assisted living program of not more than 30 days from the date of initial admission, which cannot exceed 30 days per year. Maryland Quality Reporting Your resource for information on the quality and performance of nursing homes, hospitals, hospice, assisted living . (43) "License" means a document issued by the Secretary to operate an assisted living program in Maryland. If themedication box is empty, the reason for it is noted on the back of the MAR. (b) For whom no individual has claimed the body and assumed funeral or burial responsibility. <> (41) "Lavatory" means a basin used to maintain personal cleanliness that has hot and cold running water and sanitary drainage. Level 1 = 1-20 points Key to Level of Care Level 2 = 21-40 points Level 3 = 41 points or higher AWAKE OVERNIGHT STAFF REQUIREMENT If the Assessment results in responses as noted to any of the questions marked with an asterisk (*), awake overnight staff is presumed to be required for the resident. 3 0 obj The assisted living manager shall document in the resident's record this change and the date of notification. endobj Contact for Research Inquiries Johns Hopkins Bayview Medical Center 5300 Alpha Commons Drive Alpha Commons The regulations do not specify a minimum number of residents for licensure. * 15. Toll Free 1 (877) 245-1762 TTY Number: 1-800-735-2258 Fax (410) 0000001663 00000 n to provide constituents, businesses, (33) "Home health services" means those services provided under the provisions of Health-General Article, 19-404, Annotated Code of Maryland, and COMAR 10.07.10. (38) "Intensive" means highly concentrated. (66) "Resident Assessment Tool" means Maryland's Assisted Living Resident Assessment and Level of Care Scoring Tool that is: (a) Incorporated by reference in Regulation .03 of this chapter; and (b) Used by assisted living facilities to assess the current health, physical, and psychosocial status of prospective and current residents. 135 16 (5) Failure to implement a nursing or clinical order, without demonstrating why the order should not be followed or without identifying alternatives to care, may result in sanctions against the assisted living program. Further evaluation by a health care practitioner is required and changes shall be made to the resident's service plan, if there is a score change in any of the following areas: (b) Ability to self-administer medications; and. Background: There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). (a) "Physical restraint" means the use of a device or physical action to prevent, suppress, or control head, body, or limb movement, that cannot be readily and easily removed by the resident. Get access to thousands of forms. WPTHcA I"gEji6y5gC+wdt#|lZBf]3ZxHKl#v&oCNU |YYOY&SzaR/b>n0L496.x. E. Short-Term Residential Care Requirements. There are three levels of care of which three is the highest. Please enable scripts and reload this page. The RN, CM/DN is not responsible for signing time cards/time sheets for any A.L. (b) "Administration of medication" includes: (i) Identifying the time to administer the medication; (iii) Removing the medication from the container; or. 0000000736 00000 n ]/\Ws])\&P2VP&}$ pp)2F7z~2tL=P*hsQd>hT1rwb66@ cSl 7sn8_r^RD%oraEUi.#)7cDalch|b=^._6U2a=[}-;VF)4nUM(I3iDH 6DNytbZCaH(L6M pf %5m:\'**HNnU%rEiuYP_$1KbcH*?h #K^:>xZ emg:{&W^xCgDtdLQE$ 1@2s$S2 (63) "Representative" means a person referenced in Regulation .34 of this chapter. 0000001468 00000 n 0000000961 00000 n %%EOF g ew?H& (ii) Cannot be paid for by the resident or the resident's agent. (a) "Assisted living program" means a residential or facility-based program that provides housing and supportive services, supervision, personalized assistance, health-related services, or a combination of these services to meet the needs of individuals who are unable to perform, or who need assistance in performing, the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence for the individuals. of Legislative Audits operates a toll-free xb```e960900 ilY@Lk D%bn&Vxq'Hl`PJYDg AMd`g`KL@l` ! The RN, CM/DN at the time of the 45 day site visit is to assess the client; the environment; the nursing task to be delegated; and the clinical competency of the medication technician who is in the facility at the time of the site visit. An assisted living program shall provide awake overnight staff when a resident's assessment using the Resident Assessment Tool, as provided in Regulation .21A or .26B of this chapter, indicates that awake overnight staff is required according to instructions on that tool.