2022 Edition

Adult Day Services (CA-AD) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of service recipients.

Currently viewing: ADULT DAY SERVICES (CA-AD)



Individuals who participate regularly in Adult Day Services achieve and maintain an optimal level of well-being, functioning and health, and remain in their preferred community residence.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Documentation tracking staff completion of required trainings and/or competencies
  • Sample job descriptions from across relevant job categories
  • Training curricula
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files


CA-AD 2.01

Personnel are qualified by:
  1. the skill and experience to meet the psychosocial and medical needs of care recipients; and 
  2. the personal characteristics and temperament suitable for working with adults with special needs.


CA-AD 2.02

The program director or administrator is available full time at each site and is qualified:
  1. as a registered nurse; or 
  2. has a bachelor’s degree in a human service field and relevant experience.


If qualified directors or administrators are not employed full-time at every site, a qualified director or administrator should oversee a limited number of sites.


CA-AD 2.03

All direct service personnel are trained on, or demonstrate competency in the following areas, as appropriate to the services provided:
  1. crisis prevention and intervention techniques;
  2. identification of changes in service recipient functioning; 
  3. identification of medical needs or problems;
  4. the organization’s plans for handling medical or psychiatric emergencies;
  5. use of adaptive equipment, such as braces and wheelchairs;
  6. providing personal care; and
  7. specific skills necessary to serve the target population.


CA-AD 2.04

Personnel who lead or facilitate group activities have relevant training or experience.

Fundamental Practice

CA-AD 2.05

There is at least one person on duty at each program site any time the program is in operation that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.


CA-AD 2.06

A recreational therapist is on staff or available for consultation.


CA-AD 2.07

Day programs with a health focus employ an RN or LPN.
NA The day program does not have a health focus.

Fundamental Practice

CA-AD 2.08

An organization that serves a high percentage of multiply handicapped or frail individuals obtains the specialized services of dietitians, nurses, physicians, and physical and/or occupational therapists for consultation, evaluation, or training.


If specialized services are provided off-site, support and transportation are arranged.
NA The organization does not serve a high percentage of handicapped or frail individuals.


CA-AD 2.09

The organization minimizes the number of workers assigned to the individual over the course of their contact with the organization by:
  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.


CA-AD 2.10

Employee workloads support the achievement of client outcomes and are regularly reviewed.
Examples: Examples of factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of need and frequency of contact with persons served.