(a) A CSU nursing supervisor, or designee, must adhere to nurse staffing requirements delineated in §510.41(c)(8) and (j) of this title (relating to Facility Functioning and Services) and the following parameters when determining minimum staffing plans required by subsections (b) - (d) of this section.
  (1) Staff included in the minimum staffing plan must:
    (A) always be physically available while on duty; and
    (B) have job duties that do not prevent ongoing and consistent supervision of individuals receiving crisis stabilization services.
  (2) The minimum staffing plan must increase or decrease based on CSU census and acuity, individual level of monitoring and precautions, and developmental level, gender, age, and other individual needs and characteristics of individuals receiving crisis stabilization services.
  (3) A staff member on one-to-one supervision of an individual cannot be included in the CSU's minimum staffing plan.
(b) The minimum staffing plan includes:
  (1) one physician, preferably a psychiatrist, or physician-delegated PA or APRN, onsite or at minimum immediately available through telecommunication or telephone 24 hours a day, seven days a week;
  (2) one LVN or one RN physically present and on duty 24 hours a day, seven days a week, when an individual is present in the CSU;
  (3) one RN available onsite within ten minutes after being contacted by a staff member, if an RN is not physically present and on duty when an individual is in the CSU;
  (4) one QMHP-CS onsite from 8:00 a.m. to 5:00 p.m., Monday through Friday; and
  (5) two UPs onsite 24 hours a day, seven days a week.
(c) A nursing supervisor or an RN charge nurse receiving clinical and administrative consultation from the facility administrator and medical director or on-call physician, APRN, or PA must be available, in person or by telephone, 24 hours a day, seven days a week, to provide clinical oversight to CSU RNs, LVNs, QMHP-CSs, and UPs.
(d) The nursing supervisor or designee must develop and implement a written staffing plan describing the number of RNs, LVNs, and UPs on each unit for each shift, in accordance with subsections (a) and (b) of this section, that meet the following requirements:
  (1) The staffing plan must be based on the census, needs, and characteristics of individuals, and acuity of the CSU.
  (2) The nursing supervisor or designee must document the nursing supervisor's or designee's determinations regarding the factors described in paragraph (1) of this subsection:
    (A) at the time the staffing plan is developed; and
    (B) when the nursing supervisor or designee makes any revisions to the staffing plan based on a change in such factors.
  (3) A CSU nursing supervisor must retain the staffing plan and the documentation required by paragraph (2) of this subsection for two years.
  (4) The nursing supervisor or designee must revise the staffing plan, as necessary.

Source Note: The provisions of this §306.85 adopted to be effective May 27, 2021, 46 TexReg 3257