This regulation establishes the general licensing framework for organizations and facilities overseen by Rhode Island's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), covering Behavioral Healthcare Organizations (BHOs), Developmental Disability Organizations (DDOs), and Cognitive Disability Organizations (CDOs). It sets out application, issuance, renewal, modification, and revocation procedures for licenses, as well as definitions, monitoring, and enforcement requirements applicable to all three organization types. Operators must apply for and maintain appropriate licenses, submit to inspections and audits, and comply with plans of correction when deficiencies are identified. The regulation explicitly excludes facilities licensed by the Rhode Island Department of Health and the Department of Children, Youth and Families.
View official source1.1 Applicability
A. These regulations are
promulgated pursuant to the authority conferred under R.I. Gen. Laws
§§
23-17.8-9
,
40.1-1-13
,
40.1-2-2
,
40.1-5-3
,
40.1-5.4-11
,
40.1-8.5-7
,
40.1-21-12
,
40.1-22-4
,
40.1-24-9
,
40.1-24.5-2
,
40.1-26-11
,
and
40.1-27-3
;
as well as R.I. Gen. Laws Chapter
42-35
,
and are established for the purpose of adopting prevailing standards
for the licensure and operation of facilities and programs providing
rehabilitation, support, and guidance for individuals with
developmental disabilities or cognitive disabilities.
B. It the expectation of the
Department that each individual’s array of supports and
services be customized to meet the individual needs and desires in
the least restrictive environment.
C. These Rules and Regulations
apply to any licensed organization under
Subchapter
05 Part 1 of this Chapter
(Rules and Regulations for
Developmental Disability Organizations), and
Subchapter
10 Part 1 of this Chapter
(Rules and Regulations for Behavioral
Healthcare Organizations).
D. These Rules and Regulations
do not apply to the following:
1. Health care facilities
licensed by the Rhode Island Department of Health pursuant to R.I.
Gen. Laws Chapter
23-17
;
2. Assisted living residences
licensed by the Rhode Island Department of Health pursuant to R.I.
Gen. Laws Chapter
23-17.4
;
3. Facilities and programs
licensed by the Rhode Island Department of Children, Youth and
Families pursuant to R.I. Gen. Laws Chapter
42-72.1
;
4. Facilities, programs, or
organizations already licensed or certified by any other appropriate
state agency, pursuant to R.I. Gen. Laws.
1.2 Authority
The statutes cited in §
1.1 of this Part delineate the general scope of authority for this
Chapter, as do the Part’s specific provisions.
1.3 Definitions
A. Wherever
used in this Part, the following terms shall be construed to mean:
1. “Abuse” means
the treatment or act toward any person with developmental
disabilities, as defined in R.I. Gen. Laws
§
40.1-27-1
on the part of anyone, including an
employee, intern, volunteer, consultant, contractor, visitor, family
member, caregiver, neighbor, citizen or other person with a
disability, whether or not the person is or appears to be injured or
harmed. The failure to exercise one’s responsibility to
intercede on behalf of a person receiving services also constitutes
abuse. Abuse includes:
a. "Physical abuse"
may include, but is not limited to: physical assault, battery and/or
actions such as: hitting, kicking, biting, pinching, burning,
strangling, shoving, shaking, dragging, yanking, punching, slapping,
pulling hair, grabbing or pushing, or using more force than is
necessary for the safety of the person.
(1) For incidents involving a
caregiver, abuse is defined as the willful subjection of an adult
with developmental disabilities to willful infliction of physical
pain, willful deprivation of services necessary to maintain physical
or mental health, or to unreasonable confinement.
(2) For incidents of physical
abuse involving two people with disabilities, only an attack
resulting in injury in which one person needs medical care beyond
routine first aid or a series of deliberate acts (i.e. hitting,
kicking, slapping, pulling hair, etc.) displayed by one person with a
disability towards another person with a disability should be
reported to the Office of Quality Assurance. Other incidents should
be documented and handled by the agency’s internal Incident
Management Committee.
b. "Sexual abuse"
means any sexual contact, consensual or otherwise, between a person
receiving services and a paid employee, consultant or contractor of
the Organization. Any sexual contact between a person receiving
services and an immediate blood relative is incest and is sexual
abuse. Any non-consensual sexual contact between a person with a
disability and another person with a disability is also sexual abuse.
This includes but is not limited to oral/genital contact, sexual
penetration or fondling and any other assault as defined in R.I. Gen.
Laws §
11-37.1-1
et seq
.
c. "Sexual contact"
means the touching, fondling or intrusion of the genitals or other
intimate parts of the person or offender directly or through clothing
for the purpose of sexual arousal or gratification.
d. "First degree sexual
assault" means any forced or coerced intrusion, however slight,
of the vagina, anus, or mouth, by part of another person’s body
or by an object, including cunnilingus or fellatio.
e. "Second degree sexual
assault" means any forced or coerced or intentional touching or
sexual contact (not penetration) clothed or unclothed, with a
person’s genital area, anal area, groin, buttocks, or the
breasts of a female for the purpose of sexual arousal, gratification
or assault.
f. "Third degree sexual
assault" means penetration where one person is 18 years of age
or older and the other is over the age of 14 years, but under the age
of consent (age 16 years).
g. "Sexual exploitation"
may include, but is not limited to, causing a person to expose or
touch themselves or anyone else for the purpose of demeaning the
person, for the sexual arousal or personal gratification, taking
sexually explicit photographs, forcing or encouraging a person to
view pornographic materials encouraging a person to use sexually
explicit language which he/she may not fully understand, the use of
harmful genital practices such as creams, enemas, etc. to meet the
idiosyncratic needs of an offender, etc.
h. "Psychological/verbal
abuse" means intentionally engaging in a pattern of harassing
conduct which causes or is likely to cause emotional harm. This
includes the use of verbal or non-verbal expression that subjects a
person to ridicule, humiliation, contempt, manipulation, or is
otherwise threatening, socially stigmatizing and fails to respect the
dignity of the individual, including name-calling or swearing at a
person, intimidating or condescending actions, behaviors, or
demeaning tone of voice or any other pattern of harassing conduct.
i. “Mistreatment”
means the inappropriate use of medications, isolation, or use of
physical or chemical restraints as punishment, for staff convenience,
as a substitute for treatment or care, in conflict with a physician's
order, or in quantities, which inhibit effective care or treatment,
which harms or is likely to harm the individual.
j. “Neglect” means
the failure of a person to provide treatment, care, goods and
services necessary to maintain the health and safety of the
individual, as defined in R.I. Gen. Laws §
40.1-27-1
,
and other laws. For the purposes of this Part, “Neglect”
shall also include the failure to report or act on health problems of
the person or changes in his or her health conditions as indicated
within a plan approved by the Department. Neglect also includes lack
of attention to the physical needs of the person including personal
care, cleanliness and personal hygiene, meals and/or failure to
provide appropriate nutrition or a safe and sanitary environment;
failure to carry out a plan of treatment or care prescribed by a
physician and/or other health care professional; failure to provide
services/supports as indicated within an ISP approved by the
Department; and failure to provide proper supervision to the persons
as required within an ISP or by a court.
k. "Financial
exploitation” means the use of funds, personal property or
resources of a person receiving services by an individual for their
own monetary or personal benefit, profit or gain with or without the
informed consent of the person, including but not limited to the
coercion or manipulation of a person to spend their own personal
funds for something they may or may not have use for or soliciting of
gifts, funds or favors. This includes any suspected theft of or
missing property or funds of a person. For incidents involving a
caregiver, financial exploitation is defined as an act or process of
taking pecuniary advantage of a person with a developmental
disability by use of undue influence, harassment, duress, deception,
false misrepresentation, false pretenses, or misappropriation of
funds.
2. “Administer”
means the direct application of a medication, whether by injection,
inhalation, ingestion, or any other means, to the body of an
individual by
a. a licensed and authorized
agent and under his or her direction; or
b. the individual at the
direction and in the presence of the licensed and authorized agent.
3. “Admission”
means acceptance into a program or service, after an initial
biopsychosocial assessment has been conducted and includes opening a
treatment record for the person, orienting him or her to the
organization, and assigning his or her treatment to an appropriate
staff person or team. Individuals shall be admitted to the
organization no later than their third consecutive face-to-face
clinical service.
4. “Advocate”
means a:
a. legal guardian or
b. an individual acting in
support of or on behalf of a person in a manner consistent with the
interests of the person.
5. “Assessment”
means the process of testing, gathering biopsychosocial information,
and making a diagnostic judgment to determine an individual's
behavioral health status and need for services, conducted by a
qualified staff person.
6. “Assistive
technology” means specialized medical equipment and supplies to
include devices, controls, or appliances, specified in the
individualized service plan, that enable individuals to increase
their ability to perform activities of daily living; devices,
controls, or appliances that enable the individual to perceive,
control, or communicate with others in the environment in which they
live; including such other durable and non-durable medical equipment
not available under the state plan that is necessary to address
individual functional limitations. Items reimbursed with waiver funds
are in addition to any medical equipment and supplies furnished under
the state plan and exclude those items that are not of direct medical
or remedial benefit to the individual. All items shall meet
applicable standards of manufacture, design and installation and are
subject to prior approval on an individual basis by the Department.
7. “Authorization”
means the service approved by BHDDH for everyone based upon the ISP
or treatment plan.
8. “Behavioral
healthcare” means the umbrella term that encompasses all mental
health and substance use related assessment, treatment, prevention,
and support services.
9. “Behavioral
healthcare organization” or “BHO” means a public or
private establishment primarily constituted, staffed, and equipped to
deliver mental health and/or substance use services to the public.
10. “Board” means
the Board of Directors of the organization and/or the Advisory Board
of a local Organization that is:
a. a for profit entity or
b. a not for profit entity
providing services in Rhode Island.
11. "Caregiver"
means a person who provides care for a person with disabilities
without payment, natural support.
12. “Certification”
shall have the meaning as defined under §
05-1.2(A)(15)
of this Chapter
and
Subchapter
10 Part 1 of this Chapter
depending on the program being
utilized.
13. “Change in operator”
means a transfer of the authority of the Board of Directors, by the
Board of an organization, to any other person or group of persons
(excluding delegations of authority to the medical or administrative
staff of the Organization).
14. “Change in owner”
means:
a. When an Organization is a
partnership: the removal, addition, or substitution of a partner that
results in the new partner acquiring a controlling interest in the
Organization.
b. When an Organization is an
unincorporated sole proprietorship:
the
transfer of the title and property to another person.
c. When an Organization is a
corporation:
(1) A sale, lease, exchange,
or other disposition of all, or substantially all the property and
assets of the corporation.
(2) A merger of the
corporation into another corporation.
(3) The consolidation of two
(2) or more corporations resulting in the creation of a new
corporation.
d. When an Organization is a
for profit corporation: any transfer of corporate stock that results
in a new person acquiring a controlling interest in such corporation.
e. When an Organization is a
non-profit corporation: any change in membership that results in a
person acquiring a controlling vote in such corporation.
15. “CMHC” or
“CMHO” means a private, non-profit community mental
health center organization designated by the Director of the
Department and licensed as such to ensure services are available
through program delivery, local planning, service coordination, and
monitoring outcomes within a specified geographical area according to
R.I. Gen. Laws Chapter
40.1-8.5
for the Department's priority targeted populations within eight (8)
areas according to R.I. Gen. Laws §
40.1-5.4-7(3)
.
16. “Cognitive
disability organization” or “CDO” means an
organization licensed by BHDDH to provide services to adults with
cognitive disorders. As used herein, CDOs shall have the same meaning
as “providers” or “Organizations" and shall
meet the licensing requirements of DDOs.
17. “Community
residence” means a facility that operates twenty-four (24)
hours a day to provide room, board, supervision and supportive
services to three (3) or more people who have developmental, mental
and/or substance related disabilities.
18. "Complaint"
means a formal, written request for further review of an unresolved
concern or an allegation against a licensed organization or provider
regarding an alleged violation of ethical standards, regulations, or
law.
19. “Concern”
means an issue that is perceived as interfering with a person
receiving adequate treatment.
20. "Controlled
medications" or "controlled substances" means
substances pursuant to R.I. Gen. Laws Chapter
21-28
that have a high potential for abuse which may lead to severe
psychological or physical dependence.
21. “Co-occurring
disorder” is the coexistence of two or more behavioral health
conditions, existing simultaneously and often independently of each
other.
22. “Day program
service” means a service offered at a center-based day program
or a community-based day program by a licensed developmental
disability organization. The service includes the provision of
education, training and opportunity to acquire the skills and
experience needed to participate in the community. This may include
activities to support individuals with building problem solving
skills, social skills, adaptive skills, daily living skills, and
leisure skills. Other services include assistance in establishing
friendships, using public transportation, participating in community
events, or otherwise undertaking activities to promote community
integration.
23. "Department”
means the Rhode Island Department of Behavioral Healthcare,
Developmental Disabilities and Hospitals (BHDDH).
24. “Developmental
disability organizations” or “DDOs” means an
organization licensed by BHDDH to provide services to adults with
disabilities, as provided herein. As used herein, DDOs shall have the
same meaning as “providers” or “Organizations."
25. “Director”
means the Director of the Department of Behavioral Healthcare,
Developmental Disabilities and Hospitals (BHDDH).
26. “Evidence-based
practice” is an intervention or service for which there is
strong research demonstrating effectiveness in assisting persons to
achieve desired outcomes.
27. “Facility”
means the physical plant where programs and services are provided
and/or overseen, or could be provided, and as defined in R.I. Gen.
Laws §
40.1-24-1
(6)
and other laws as applicable.
28. "Human rights
committee” or “HRC" means any duly constituted group
of people with developmental disabilities, advocates, volunteers, and
professionals who have training or experience in the area of
behavioral treatment, and other citizens who have been appointed to a
provider’s human rights committee for the purposes of
a. promoting human rights;
b. reviewing, approving and
monitoring individuals’ plans designed to modify behavior which
utilize restrictive interventions techniques or impair the
individual’s liberty, or other plans and procedures that
involve risks to the person’s protection and rights; and,
c. participating in the
provider’s individual grievance procedures.
29. “Incident”
means a situation in which a person who receives services from the
Department and/or an Organization licensed by the Department is
harmed, or is involved in an event, which causes concern for the
person’s health, safety and/or welfare. It also refers to any
adult, whether or not the person is receiving services from the
Department, with developmental disabilities who is harmed or is
involved in an event, which causes concern for the person’s
health, safety and/or welfare.
30. "Independent
contractor" means a person who is not an employee of the
Organization and provides and/or contributes to the direct service to
and/or has responsibility for an individual.
31. “Individual”
or “individual served” means a person who receives
services or is assessed to need services based on the results of an
initial assessment. The term "person served" shall be
synonymous herein with the term "individual" or “individual
served.”
32. "Individual service
plan" or “ISP” means the annual document derived
from a person-centered plan which details the services for an
individual supported.
33. "Integration"
means:
a. The use by individuals with
developmental disabilities of the same community resources that are
used by and available to other persons in the community;
b. Participation in the same
community activities in which persons without a developmental
disability participate, together with regular contact with persons
without a developmental disability; and
c. Individuals with
developmental disabilities who live in homes that are in proximity to
community resources and foster contact with persons in their
community.
34. “Investigation”
means a systematic review and search for facts. It is objective in
nature and is intended to identify facts, sequence and chronology of
events, active failure(s), latent failure(s) and assessment of risk
as pertinent to a specific adverse event. An investigation may be
undertaken because of a complaint, an adverse event or incident
report, or other information that comes to the attention of the
Department or the organization.
35. “Non-congregant
residential support services” means services provided in
residential settings other than a host family that are not Community
Residences as defined herein. The service includes residential
support services and may include specialized residential support
services. Non-congregant residential support services do not include
payments for room and board. Payments for non-congregant residential
support services are based on residential resource levels.
36. “Office of Licensure
and Standards” means the unit within BHDDH that is responsible
for licensing provider organizations and programs.
37. “Office of Quality
Assurance” or “OQA” shall have the same meaning as
the office described in R.I. Gen. Laws §
40.1-26-10
.
38. “Orientation”
means a process to provide initial information about the BHO and DDO
and its services to persons served and to staff of the organization.
For staff, orientation includes an assessment of their competence
relative to their job responsibilities and the organization's
mission, vision, and values.
39. “Outcome”
means the result(s) of the performance or the non-performance of a
function or process.
40. “Participant”
means an adult who has a developmental disability as defined herein.
As used in this Part, “individual” shall have the same
meaning, in addition to its meaning in § 1.3(A)(31) of this
Part.
41. "Person" means
any individual, governmental unit, corporation, company, association,
or joint stock association and the legal successor thereof.
42. "Person-centered"
shall have the meaning as defined in the BHO or DDO regulations,
depending on the program being utilized.
43. “Premises”
means a tract of land and the buildings thereon where direct services
are provided.
44. “Program”
means a planned structured service delivery system structured to
provide specific components that are responsive to the needs of the
persons served.
45. “Provider”
means a person or organization that manages or delivers clinical
and/or support services.
46. "Residential
services” shall have the meaning as defined in the BHO and DDO
regulations, depending on the program being utilized.
47. “Restraint”
means restricting the movement of the whole or a portion of a
person's body as a means of controlling a person's physical activity
to protect the person or others from injury.
a. “Chemical or
pharmacological restraint” means medication that is given for
the emergency control of behavior when the medication is not standard
treatment for the individual's medical or psychiatric condition.
b. “Mechanical
restraint” means the use of an approved mechanical device that
restricts the freedom of movement or voluntary functioning of a limb
or a portion of a person's body as a means to control his or her
physical activities.
c. “Physical restraint”
means the use of approved physical interventions or "hands on"
holds to prevent an individual from moving his or her body to engage
in a behavior that places him, her or others at risk of physical
harm.
48. “Services”
mean individually planned interventions intended to reduce or
ameliorate the symptoms of mental disorders or substance dependence
or abuse through treatment, training, rehabilitation, or other
supports. Services also refer to person-centered interventions
provided to developmentally disabled adults.
49. “Significant others”
mean and include individuals who are important to the person served,
as identified by the person served.
50. “Staff” means,
including but not limited to, any employee, intern, trainee, or
volunteer performing a service or activities for the organization and
for meeting the needs of individuals served for which competent
performance is expected.
51. “Support
coordinator” means the individual employed by the Organization
who delivers Support Coordination services. The term is synonymous
with Case Manager in these regulations and includes, but is not
limited to, the external coordination and monitoring of the Shared
Living Arrangements.
52. “Treatment” or
“Care” means a set of individually planned interventions
or supports that help an individual work towards his or her recovery
goals and obtain or maintain an optimal level of functioning, reduce
the effects of disability or discomfort, or ameliorate symptoms,
undesirable changes or conditions specific to physical, mental,
behavioral or social functions.
53. “Violation of human
rights” means any action or inaction which deprives an
individual of any of his or her civil rights, as articulated in
federal or state law or in this Part.
1.4 Application for Licensure,
Renewal, or Change in Licensure Status
1.4.1 Application for
Licensure, Renewal, or Change in Licensure Status
A. To apply for a license,
renew an existing license, or remove or replace the provisional or
conditional status of a license, an applicant or licensee shall
contact the Department’s Office of Licensure and Standards.
The Office of Licensure and Standards shall provide an applicant or
licensee with the appropriate Departmental license forms.
B. Application for a license
to conduct, maintain or operate a BHO, DDO, or Cognitive Disability
Organization shall be made to the Department upon forms provided by
the Department and shall contain such information as the Department
requires, including but not limited to evidence of ability to comply
with any and all applicable Department rules and regulations.
C. The Department shall either
deny an application or renewal, or shall issue or renew a provisional
license, conditional license or license.
D. Such license shall be
issued to the applicant or licensee for the operation of specific
agencies and facilities and shall not be transferable or assignable
except with the written approval of the Director.
1.4.2 Licensed
Organizations
A. An Organization that wishes
to provide services shall apply for a License under the relevant
Organizational category:
1. Behavioral Healthcare
Organization ("BHO").
2. Developmental Disability
Organization ("DDO").
3. Cognitive Disability
Organization (“CDO”), which shall also meet all DDO
licensing requirements.
B. Authorization to provide
services to individuals will require meeting approved certification
standards by BHDDH. The Department will grant licenses to agencies
providing services and to agency premises in which services are
delivered. Services may be delivered in the community in accordance
with the needs of individuals.
1.5 License Issuance and Renewal
and Initial Licensure Review
1.5.1 General Requirements
An application for licensure
is required for an initial license; for license renewal; for changes
in owner, operator, or lessee; and when there is a new legal
affiliation of two (2) or more Organizations.
1.5.2 Licensure
A. All licensed DDOs, BHOs and
CDOs that provide services to adults in Rhode Island must meet all
the requirements contained in these regulations.
B. An entity seeking to become
a licensed DDO, BHO or CDO shall complete initial applications for
licensure using the forms and in the format specified by the
Department. Upon approval by the Department, an applicant shall be
granted a license for a period of two (2) years.
C. Upon approval by the
Department, including an on-site review, an applicant for
certification shall be granted provider service certifications that
shall remain in effect for up to two (2) years. To remain a licensed
provider, the provider must maintain active approved certifications.
1.5.3 Components of
Licensing
A. The licensing process shall
include but is not limited to a review of the prospective
Organization’s:
1. Mission.
2. Corporate philosophy.
3. Organizational background
and corporate history.
4. Experience providing
services to individuals in RI and other states.
5. Corporate experience.
6. Demonstrated commitment to
individuals.
7. Provisions for how
individuals who are served participate in the operation of the
Organization.
8. Strategies for promoting
community inclusion and membership. (DDO specific)
9. Approach to the respectful,
age-appropriate imagery of people with developmental disabilities,
and strategies for increasing valued roles and perceptions of people
in the community.
10. Strategies for providing a
voice in all aspects of daily life for the individuals the
Organization serves.
11. Human Rights Committee.
12. Board of Directors.
13. Staffing.
14. Staff experience.
15. Job descriptions.
16. Staff resumes.
17. Staff recruitment,
selection, training and supervision approach.
18. Criminal background
checks.
19. Conflicts of interest.
20. Financial disclosure
information.
21. Audit (annually audited
financial statements for past three (3) years).
22. Fiscal capacity (including
business plan if it is a new entity).
23. Tax compliance.
24. References.
25. Written policies and
procedures.
26. Certification Standards
Application.
B. The Organization shall
demonstrate compliance with applicable laws and regulations. The
Organization shall submit to readiness reviews and onsite visits to
ensure preparedness for service provision.
C. If an applicant fails to
provide complete, accurate, and truthful information during the
application and licensing process, the Department may cause licensure
to be delayed, or may deny or revoke the license.
D. Any applicant or person
with a controlling interest in a BHO or DDO will be considered
responsible for acts occurring during, and relating to, the operation
of licensed services or Organization for purpose of licensing.
E. The Department may consider
the background and operating history of the applicant(s) and each
person with a controlling ownership interest when determining to
issue a license.
F. When an application for
initial licensure is made by an applicant(s) who owns or operates
other licensed Community Residences or facilities in Rhode Island,
the Department may deny the license if the applicant’s existing
Community Residences or facility(ies) are not, or have not been, in
substantial compliance with the applicable Rhode Island licensing
authority regulations and/or health and safety standards.
G. All applicants must fulfill
the applicable requirements described in this Part.
1.5.4 Application Process
A. Upon receipt and approval
of an application for a license, the Department shall issue a license
or renewal thereof for a period of no more than two (2) years, if the
applicant meets the requirements of the rules and regulations herein
and the other applicable standards and requirements contained in
other regulations.
1. A license shall not be
transferable, except with the written approval of the Department.
The license shall be issued only for the individual owner, program
sponsor, operator, or lessee or to the corporate entity responsible
for its governance.
B. The procedure for renewing
a license is to submit a renewal application on a form provided by
the Department sixty (60) days prior to the expiration date of the
current license.
C. A license continues in
effect after the end of the licensure period if the Organization has
submitted a timely and sufficient renewal application and there are
no grounds to deny the license under any provision of this Part.
D. The Organization shall
notify the Office of Licensure and Standards in writing of any plans
to suspend services or end services or to close a program at least
ninety (90) days prior to any proposed suspension, cessation or
closure.
E. The license shall be
returned to the Department immediately upon surrender, suspension or
revocation of the license.
F. The procedure for applying
for approval for alterations or additions to a current facility may
be made by completing an application change form provided by the
Department and by attaching plans and specifications prior to
commencement of construction pursuant to R.I. Gen. Laws §
40.1-24-11
.
1.5.5 License Modification
A. Upon written request of the
Organization, on the license change form provided by the Department,
the license may be modified during the term of the license with
respect to the populations served, the programs and services offered,
the locations where programs and services are provided, the maximum
number of persons served in residential programs and homes, and any
stipulations. Approval of such request shall be at the sole
discretion of the Department.
B. Any change which requires a
license modification shall not be implemented prior to approval by
the Department.
1.6 Mergers, Affiliations, Change
of Ownership or Operator
A. The Department, and if
required, any federal, state or accrediting authority, shall be
notified of any proposed mergers, affiliations or change of
ownership, program sponsor, or operator at least ninety (90) days
prior to that proposed merger, affiliation or change. Any such
change or action will require the application for and issuance of a
new license.
B. In cases where the
application involves a merger, consolidation or otherwise legal
affiliation of two (2) or more Organizations, the application shall
include the proposed immediate and long-term plans of such
Organizations with respect to the programs to be offered and services
to be provided by such Organizations because of the merger,
consolidation or otherwise legal affiliation.
1.7 Types of Licenses
1.7.1 Provisional License
A. A Provisional License may
be issued to a new Organization that demonstrates compliance with:
1. administrative and
policy-related regulations;
2. all health and safety
requirements; and
3. has demonstrated the
ability to perform services to individuals in accordance to this
Part;
B. A Provisional License may
be issued to a new Organization that has not demonstrated compliance
with all the regulations.
C. A Provisional License:
1. may not exceed six (6)
months.
2. may be renewed but the
cumulation the original provisional license and all renewals shall
not exceed twelve (12) successive months;
3. will be issued only if such
issuance will not result in undue hazard to residents or persons
served, as determined by the Department, or by the State Fire
Marshal, or by the State Fire Marshal’s delegated authority.
D. An Organization holding a
Provisional License shall demonstrate ongoing progress toward
compliance remaining requirements for full licensure.
1.7.2 Conditional License
A. A Conditional License may
be issued to an Organization that has demonstrated:
1. an inability to maintain
compliance with regulations;
2. has a serious violation of
human rights or applicable regulations;
3. has multiple violations of
human rights or licensing regulations;
4. has demonstrated conduct or
practice found by the Department to be detrimental to the welfare of
the persons served; or
5. has failed to comply with a
previous plan of correction.
B. A Conditional License may
be issued at any time during either the issuance or renewal process
or during the term of a license at the discretion of the Department.
C. The term of a Conditional
License may not exceed six (6) months.
D. A Conditional License may
be renewed; however, a Conditional License and any renewals shall not
exceed twelve (12) successive months for all Conditional Licenses and
renewals combined.
E. An Organization holding a
Conditional License shall demonstrate progress towards full
compliance with the regulations.
F. The Department may issue a
Conditional License if the Department determines that denial of a
renewal application or Revocation of an existing license would not be
in the best interests of the persons served by the licensee or in the
best interests of the community served by the licensee. The
Department shall state the requirements of and orders with which a
licensee must comply to receive a Conditional License in lieu of
denial of a renewal application or Revocation.
G. A Conditional License shall
be issued only if such issuance shall not result in undue hazard to
residents or persons served, as determined by the Department or by
the State Fire Marshal or the State Fire Marshal’s delegated
authority.
1.7.3 License with
Stipulations and Restrictions
A license may bear
stipulations. Stipulations may be limitations on the Organization or
may impose additional requirements. Stipulations may be added at any
time at the discretion of the Department subject to R.I. Gen. Laws
Chapter
42-35
.
Terms of any such stipulations shall be listed on the Organization’s
license.
1.8 Reports of Deficiencies
Reports of deficiencies noted
in inspections conducted in accordance with these and other
applicable Regulations, and results of any Departmental
investigation, and plans of correction or compliance orders as
described herein, shall be maintained on file in the Department, and
shall be considered by the Department in rendering determinations to
deny, condition, limit, suspend or revoke the license or to curtail
certain specific activities and programs of an Organization.
1.9 Suspension in Emergencies
If the Director finds that
public health, safety, or welfare requires emergency action and the
Department incorporates such findings in an order, the Director may
order summary suspension of the license or curtailment of activities
as enumerated above, pending proceedings for revocation; or other
action in accordance with R.I. Gen. Laws §
42-35-14
(c).
1.10 Suspension, Revocation,
Curtailment, and Denial
The Department may deny,
suspend, annul, withdraw, amend, refuse to issue or renew, or revoke
the license of, or the operation of a specific program authorized
under the license of, or curtail some or all the activities of, any
Organization if the Department has sufficient evidence to establish
that the licensee has violated federal or state statute or regulation
subject to § 1.9 or § 1.12 of this Part.
1.11 Licensing Actions
A. The Department may take
licensing action against the license in whole and/or in part:
1. The Department may curtail,
revoke, suspend or place on conditional status certain services,
programs and/or facilities or premises without revoking or otherwise
taking sanctions against the Organization’s license.
2. The Department shall
determine, in part or in whole, which of those applied for services,
programs, and/or facilities or premises included by the Organization
on the application for licensure or certification issuance or renewal
shall be granted.
1.12 Right of Appeal
A licensee has the right to
appeal any decision made by the Department. All appeals will be
addressed in accordance with the Appeals Process and Procedures for
EOHHS Agencies and Programs,
210-RICR-10-05-2
.
1.13 Monitoring and Auditing
A. The Department shall make
or cause to be made such inspections and investigations that it deems
necessary, in accordance with the Department rules and regulations.
1. Authorized persons from the
Department shall have free access to the grounds, buildings, and all
books and records relating to any Organization.
2. The Department shall be
entitled to receive from all persons connected in any way with the
Organization, such information and assistance for any examination or
inquiry as the Department may require.
3. The Department shall
investigate complaints regarding potential violations of licensing
regulations. Organizations shall cooperate fully with any complaint
investigation.
B. Any non-compliance with the
regulations cited herein shall constitute a valid ground for
licensure action.
C. If an Organization has
received certification from an acceptable national accreditation
body, the Department shall substitute relevant accreditation review
findings for related licensure requirements.
1. The following documentation
will be required from the Organization for consideration:
a. A copy of the certificate
awarded by the accrediting body.
b. The written report from
the accrediting body regarding the results of its survey.
c. The Organization’s
response, if any, to the report of results from the accrediting body.
D. The Department may deem the
Organization in compliance with relevant licensure standards, in part
or in whole, after consideration of the extent of compliance with the
accrediting body’s standards.
E. The Organization shall also
be prepared for periodic full quality program reviews.
1.14 Plans of Correction
A. The Department shall notify
the Executive Director or other Organization legal authority of
violations of any Subchapter of this Chapter through a notice of
deficiencies which shall be sent to the Organization, unless the
Department determines that immediate action is necessary to protect
the health, welfare, or safety of the public (or any member thereof)
through the issuance of an immediate Compliance Order.
B. If the Department rejects
the plan of correction, or if the Organization does not provide a
plan of correction within the stipulated period, or if the
Organization whose plan of correction has been approved by the
Department fails to execute its plan within a reasonable time, as
determined by the Department, the Department may invoke the sanctions
enumerated herein.
C. The Organization that
receives a notice of deficiencies must submit a plan of correction,
which shall include time frames for completion, to the Department
within thirty (30) days of the date the Organization receives notice
of the deficiencies. The plan of correction may include any requests
for variances in accordance with the Variance Procedures
requirements. The plan shall include evidence of compliance for each
resolution or a plan for how evidence will be presented upon
resolution.
1. Upon request from the
Department, the provider shall submit a Plan of Correction in a time
frame that is less than thirty (30) days.
2. An amended plan of
correction shall be submitted if the Department determines that the
initial submission is insufficient to address the deficiencies. The
amended plan of correction must be submitted to the Department within
ten (10) business days of the date of the Organization’s
receipt of the request for an amended plan of correction.
a. An immediate Compliance
Order shall identify violations of the applicable licensing standards
and instruct the Organization to immediately comply with such order.
A copy of the compliance order shall be maintained in the agency
record file of the Licensing Office.
D. If the Organization is
aggrieved by the action of the Department, the Organization may
appeal the decision and request a hearing in accordance with R.I.
Gen. Laws Chapter
42-35
.
1. The notice of the hearing
to be given by the Department shall comply in all respects with the
provisions of R.I. Gen. Laws Chapter
42-35
.
The hearing shall in all respects comply with the provisions therein.
E. All actions of this Section
are subject to the provision of § 1.12 of this Part.
1.15 Variances
A. An Organization may apply
for a variance.
B. A variance, at the
discretion of the Department, may be granted if it is determined that
the variance does not adversely impact the health, safety or welfare
of individuals receiving services.
C. The Organization shall also
demonstrate how meeting the regulation as written will cause undo
harm.
D. The request for variance
should be sent to the Department’s Office of Licensure and
Standards in writing with an explanation of the Organization’s
intent to meet the spirit of the regulation being varied and/or its
intent over time to meet the stated regulation as written.
E. The regulation may not be
varied by the Organization until the Organization has received
written approval from the Department.
F. No provision or procedure
prescribed by state or federal statute shall be waived.
1.16 Operation of Unlicensed
Agency
Operation of an unlicensed
agency may be fined in accordance with R.I. Gen. Laws §
40.1-24-14
.
1.17 Licensure
1.17.1 Provider Governance
A. Leadership and Organization
Planning
1. The Organization shall
operate in accordance with all applicable local, state and federal
laws, rules, and regulations.
2. Each Organization shall
have an organized Board that functions as its governing body and that
is ultimately responsible for:
a. Program and fiscal
management and operation of the Organization;
b. Assurance of the quality of
services;
c. Compliance with all
federal, state, and local laws and regulations pertaining to
Organizations, and the regulations herein; and
d. Compliance with all
applicable components of the Americans with Disabilities Act and
other federal and state disability civil rights laws.
3. The Board shall provide
appropriate Organizational oversight.
4. The Board shall include
persons who represent the greater community, including individual and
family participation. At least twenty-five percent (25%) of the Board
shall be persons who reflect the population served by the
Organization and/or family members of individuals. At a minimum, one
(1) Board member shall be an individual served. Evidence of
compliance shall be provided to the Department upon request but shall
be non-public for purposes of R.I. Gen. Laws Chapter
38-2
.
Efforts shall be made to recruit members who represent the cultural
diversity and population of the local community of the Organization.
5. The Board of Directors
shall adopt by-laws, or an acceptable equivalent, that shall:
a. Describe the lines and
levels of authority for relationships among itself, the executive
director, or equivalent position and the community;
b. Define the ethical
standards and the responsibilities for the governance of the
operation and performance of the Organization; and
c. Stipulate at least four (4)
regular meetings of the Board of Directors each year and shall
describe qualifications for membership, quorum requirements and
require recording of minutes.
6. There shall be a written
statement of the specific responsibilities of the Board of Directors.
7. The Board of Directors
shall review and approve major program changes recommended by the
executive director, or equivalent position or and equivalent
position.
8. The Board of Directors
shall adopt an annual budget, approve policies, and receive written
reports of income and expenditures by program and receive a copy of
the annual audit.
9. The Board of Directors
shall be responsible for annually evaluating the performance of the
executive director, or equivalent position, or a person serving in an
equivalent position, of the Organization.
10. A written plan shall
define the mission, vision, and values for the Organization as well
as strategic, operational, program-related, and other plans and
policies to achieve them.
11. The Organization shall
have a written policy and procedure manual that shall be implemented,
reviewed, and updated as necessary.
12. The leadership of an
Organization shall develop programs to promote staff recruitment,
retention, development, and continuing education.
B. Financial Management
1. The Organization shall
develop an annual operating budget and long-term capital expenditure
plan and strategy to monitor the implementation of the plan, both of
which will be approved by the Board of Directors. The plan shall
include:
a. An authorized budget with a
review of financial performance at least quarterly;
b. Provisions for meeting the
needs of individuals and producing the desired outcomes;
c. Attention to long-term
financial solvency;
d. Processes to ensure that
agency systems are in place to ensure agency appropriate funding
streams are available to carry out the purpose for which the provider
is licensed;
e. Identification of the
sources of funding for the operations of the Organization.
2. The Organization shall
contract with an independent certified public accountant to conduct
an annual audit of the Organization’s financial statements.
3. The Organization shall
provide audited financial statements, audit findings and any
recommendations, including corrective action plans, and any
supplemental schedules, as may be required by the Department.
4. The Organization shall
secure insurance to:
a. Cover damage, injury, or
loss of life caused by fire, accident, or any other dangers that
might occur during the operation of the Organization;
b. Provide liability coverage
for all vehicles owned, leased or operated by the Organization;
c. Carry worker’s
compensation insurance in accordance with the laws of the State of
Rhode Island.; and,
d. Protect the personal funds
of individuals, to cover damage, injury or loss of life caused by
fire, accident or any other dangers which might arise in the
operation of the Organization.
5. The Organization shall
maintain its financial records in accordance with generally accepted
accounting and bookkeeping practices
6. The Organization shall have
the infrastructure and ability to develop, support, and maintain a
billing system that can track services provided and bill accordingly.
7. Organizations shall bill
the appropriate entity for services rendered to individuals in
accordance with the appropriate program requirements.
C. Organization Ethics
1. Each Organization shall
have a written Code of Ethical Conduct.
2. The Organization's written
Code of Ethical Conduct shall address ethical issues in the
management and provision of services and in the implementation of
clinical practices pursuant to §§ 1.17, 1.21, and 1.26 of
this Part.
3. All staff, volunteers,
independent contractors directly involved in support services and
shared living arrangement contractors shall adhere to both the Code
of Ethics of their respective disciplines, as applicable, and the
Organization's Code of Ethical Conduct that will include:
a. the use of accurate and
respectful language in all communications to and about persons
served.
b. the prohibition from
engaging in or promising to engage in a personal, scientific,
professional, financial, or other relationship, that is outside the
professional relationship sanctioned by the Organization, with
persons currently or formerly served by the Organization.
c. the prohibition of taking
advantage of any professional relationship or exploit others for
their personal, religious, financial, sexual, political, or business
interests.
d. the respect for the
confidentiality of each person served.
4. The Organization's policies
and procedures shall reflect ethical practices for marketing,
admission, transfer and billing.
5. The Organization 's Code of
Ethical Conduct shall address the provision of appropriate care
without consideration of the individual's personal financial
resources.
6. The Organization’s
Code of Ethical Conduct shall include a policy regarding gifts,
goods, or services given to or received from persons served.
7. The Code of Ethical Conduct
shall be made available, in a written or electronic format, in all
licensed facilities where services are provided and shall be
communicated to all personnel and to all persons served during
orientation to the Organization and shall be available upon verbal or
written request.
8. Training regarding the Code
of Ethical Conduct shall be provided to all staff, volunteers,
consultants, and shared living arrangement contractors, as
applicable.
a. A record of this training
shall be maintained by the Organization.
9. The Organization shall have
a written policy and procedure to address any violation of the Code
of Ethical Conduct.
10. All staff and volunteers
affiliated with the Organization shall sign a copy of the Code of
Ethical Conduct to indicate that they understand their responsibility
to abide by these standards and maintained in the individual's
personnel file.
11. The Organization shall not
take retaliatory or punitive action against any employee or person
served for his or her report of a possible or perceived violation of
any rule, regulation, standard, or statute committed by the
Organization or by an employee of the Organization.
1.18 Quality
Performance/Improvement and Individual Satisfaction
A. All Organizations shall
have written policies and procedures for assessing individual
satisfaction with services and supports received, individual choice
regarding services received, and individual involvement in monitoring
and directing the provision of services.
B. The Organization shall have
an effective, ongoing, Organization-wide quality
performance/improvement program to evaluate the provision of services
and supports to individuals that addresses the quality requirements
of the BHO and DDO regulations.
1.19 Program Documentation
Requirements
A. All records, entries and
documentation required by these regulations shall be:
1. Prepared at the time, or
immediately following, the event being recorded;
2. Accurate and contain no
willful falsifications;
3. Legible, dated, and signed
by the person making the entry; and
4. Maintained in accordance
with EOHHS Records Retention requirements pursuant to R.I. Gen. Laws
§
38-3-6
(a)(c)(k)(1).
1.20 Abuse, Neglect, Mistreatment,
and Other Human Rights Violations
1.20.1 Duty to Report
A. Any Organization shall be
responsible to make a telephone report to the Department’s
Office of Quality Assurance (OQA) within twenty-four (24) hours after
an observation of an overt act, after an observation of physical harm
to an individual, after receipt of an individual’s oral,
written, or gestured disclosure, any of which make a reasonable
person believe that the individual was subjected to a violation of
his or her civil rights, including but not limited to financial
exploitation, mistreatment, neglect, and/or verbal, mental, sexual,
and physical abuse, injury of unknown source, death that may have
been caused by abuse or neglect, financial exploitation, and/or
misappropriation of client property by anyone,
B. Any Organization that has
reasonable cause to believe that an assault or a battery has been
committed upon an individual shall make an immediate report to the
Department’s OQA, and such report shall include the identity of
parties and witnesses, and details of the incident. The Department
shall cause the report to be investigated immediately. The
Department shall, and the Organization may if the law otherwise
allows, notify the Mental Health Advocate and appropriate law
enforcement agencies of the Department investigation of such assault
or battery.
C. Any health care
professional who is licensed in Rhode Island, and any police officer,
emergency medical technician, firefighter, or any person (within the
scope of their employment at a facility or in their professional
capacity) who has knowledge, or reasonable cause to believe, that a
patient or resident in a facility has been abused, mistreated, or
neglected shall make, within twenty-four (24) hours or by the end of
the next business day, a telephone report to the Department’s
OQA for those incidents involving community residences for people
with developmental disabilities; and a telephone report to the
Department of Health of the same such knowledge or reasonable cause
to believe if the patient is a on a long-term unit in Eleanor Slater
Hospital.
D. Any caregiver or person
within the scope of their employment at an Organization or in their
professional capacity who has knowledge of or reasonable cause to
believe that an individual in a program has been abused, mistreated
or neglected shall file within twenty-four (24) hours or by the end
of the next business day, a written report.
E. If an individual in a
Department-operated community residence dies, the managing officer
shall furnish to the Department Director within twenty-four (24)
hours after the death the date and cause of death, and other facts as
the Department requires. In case of an accident, injury, or death of
an individual, the managing officer shall complete a written report,
and also telephone the Department’s OQA, within twenty-four
(24) hours of the individual’s accident, injury or death. The
writer of the report shall include the circumstances of the injury or
death as fully as possible, including but not limited to the
information listed in § 1.20.1(A) of this Part. Any such record
shall be accessible only to the Director of the Department or any
such employee designated by the Director as having a need to know
such information, unless an applicable law or regulation otherwise
permits.
F. For every report required
by §§ 1.20.1(A), (B), (C), or (D) of this Part the
information in such telephone or written report shall include at
least the following:
1. The caregiver or
employee’s name, Organization address, Organization telephone
number, direct extension if applicable, and occupation,
2. The name and address of
the individual who is believed to be the victim of the abuse,
mistreatment, or neglect;
3. The details, observations,
and beliefs concerning the incident(s);
4. The individual’s
oral, written or gestured statements regarding the incident(s), to
whom they were made, and at what date and time they were made;
5. The date, time, and place
of each incident;
6. The name of all
individuals believed to have knowledge of the incident(s); and
7. The name of all
individuals believed to have been responsible for the incident(s) or
could have been responsible for the incident if unknown cause and
unknown perpetrator.
G. Such written report that is
filled in by the deadline in this section shall be made available to
the Office of Quality Assurance upon request, or within five (5) days
of the incident(s), whichever occurs earlier.
H. Any deadline in this
section to file a written and/or telephone report of an alleged
violation of civil rights, or of an alleged act of abuse, neglect,
mistreatment or exploitation against an individual, shall not be
extended even if a reporter is allowed to inform a “high
managerial officer” of the reporter’s Organization.
I. At the requested/or with
the consent of the individual, the Organization shall immediately
inform the legal guardians and/or others of any situation involving
abuse, neglect, mistreatment, or human rights violations against the
individual. If an individual in a Department-operated community
residence dies, the managing officer shall furnish to the Department
Director within twenty-four (24) hours after the death the date and
cause of death, and other facts as the Department requires. In case
of an accident, injury, or death of an individual, the managing
officer shall complete a written report, and also telephone the
Department’s OQA, within twenty-four (24) hours of the
individual’s accident, injury or death. The writer of the
report shall include the circumstances of the injury or death as
fully as possible, including but not limited to the information
listed in § 1.20.1(A) of this Part. Any such record shall be
accessible only to the Director of the Department or any such
employee designated by the Director as having a need to know such
information, unless an applicable law or regulation otherwise
permits.
J. Such written report that is
filled in by the deadline in this section shall be made available to
the Office of Quality Assurance upon request, or within five (5) days
of the incident(s), whichever occurs earlier.
1.20.2 Internal
Investigation Protocol
A. The Organization shall have
a written policy specifying designated, authorized individuals who
are responsible for conducting investigations in the event of a
serious reportable incident and specifying the action or procedures
the employee may take.
1. The Organization will
establish capacity to implement investigatory protocol established by
the department.
2. The Organization’s
policy shall specify the intent of an investigation to determine all
the facts around a reported incident and to protect any individual
with a developmental disability from any further harm.
B. The Organization shall
provide information/data on the numbers/types of incidents that are
internally reported at the request of the Office of Quality
Assurance.
C. Nothing herein shall change
the timeframe for report to the Office of Quality Assurance pursuant
to R.I. Gen. Laws §
40.1-27-2
(a).
D. Based upon the results of
its investigation, the Organization shall provide the Department with
written recommendations to prevent further abuse, mistreatment or
neglect of the individual or other program individuals.
1. The investigative analysis
will evaluate if any other risk to the individual or other
individuals remain.
2. The Organization shall
complete a final investigative analysis report using current
standardized forms and protocol provided by the Department and shall
submit the report to the Department.
E. The Organization shall take
all necessary steps to prevent and protect an individual who has been
a victim of abuse, neglect, mistreatment, or other violation of his
or her basic human rights from further abuse.
F. When abuse is alleged or
death of an individual has occurred and a law enforcement agency, or
the Department, or the Department's designee, has determined to
initiate an investigation, the Organization shall not endeavor to
investigate unless directed by the Department to do so.
G. The Organization shall
provide information on the conclusion and recommendations of a
completed investigation to the alleged victim or his or her legal
guardian, as requested by the individual and/or their legal guardian.
1. The Organization shall
develop a safety plan as well as a risk assessment for the alleged
victim because of any investigation in which the allegation has been
substantiated or inconclusive.
2. The Organization shall
develop a quality improvement plan within twenty (20) working days to
ensure the health and safety of the individual.
3. The Organization shall
complete a status report within three (3) months, responding to the
recommendations that were made.
1.20.3 Policies and
Training
A. The Organization shall have
written policies and procedures for assuring the health, safety and
well-being of the population participating in their programs that are
consistent with these regulations. The policy shall:
1. Include definitions of
abuse, neglect, mistreatment, other human rights violation, and
serious incidents; and
2. Explain the types of
incidents which need to be reported within the agency; and
3. Explain the process for
reporting and documenting the incident in accordance with §
1.25.1 of this Part; and
4. Delineate the
responsibilities of employees for conducting and/or participating in
investigations that involve a violation of a person’s rights or
a serious incident; and
5. Include provisions for
administrative action, disciplinary action, and dismissal of
employees, contractors, and volunteers involved with abuse, neglect,
mistreatment or other human rights violations.
B. Staff Training
1. The Organization shall have
established orientation and annual training programs for all new and
existing employees as required in their job description. Staff
training records shall contain dated documentation of completion,
including verification. Orientation and annual training shall
include education in the following areas:
a. Minimum training for all
employees:
(1) Fire training, which
includes training in the program’s emergency evacuation
procedures;
(2) Code of ethical conduct;
(3) Rights of individuals,
human rights, and the provider’s human rights committee;
(4) Detection and prevention
of abuse, neglect, mistreatment, financial exploitation and other
human rights violations;
(5) Procedures for reporting
allegations of abuse, neglect, mistreatment or other human rights
violations to the Office of Quality Assurance, various state agencies
or other entities such as police and human rights committee; and
(6) Confidentiality.
b. Job-specific training:
(1) Grievance and appeal
procedures;
(2) Service quality;
(3) Overview of
person-centered planning in compliance with Medicaid Home and
Community Based Services (HCBS) regulations (
210-RICR-50-10-1
);
(4) Behavioral supports,
healthcare and medication administration training; and
(5) Development and
implementation of behavioral supports.
2. Organizations that utilized
an online learning management system shall have a protocol in place
that requires employee registration. The evidence of training may
include a completion certificate and/or access to the system for
review by staff.
3. Organizations shall
determine staff training needs and develop a schedule of ongoing
training programs that will be offered to employees. The training
opportunities will be individualized based on the needs of the
individuals served by the Organization.
1.21 Personnel
A. Basic Personnel Policies
and Procedures
1. The Organization shall have
and shall implement personnel policies and procedures that:
a. Comply with all applicable
state and federal statutes, rules, and regulations regarding
non-discrimination in employment practices.
b. Include language for
conducting reference, employment, and background checks from the BCI
and NCIC within the Office of the Attorney General.
c. Exclude the employment
and/or volunteering of any person who has been convicted of child
abuse or of a felony for sexual or physical assault including all
consultants and/or contractors.
d. Require employees to report
to the Organization any changes in the status of their criminal
background checks subsequent to their being hired by the
Organization.
e. Provide for any fringe
benefits provided to full time and part time employees and any
reimbursement procedures (as applicable and appropriate).
f. Address suspension,
increased supervision, or other appropriate disciplinary employment
procedures.
g. Provide written job
descriptions that include minimal qualifications for each position,
major duties, responsibilities, reporting supervisors and positions
supervised.
h. Include a process for
evaluating the job performance of each staff member at the end of his
or her initial training period and annually thereafter.
B. “Duty to Report”
Personnel Policies and Procedures
1. The Organization shall have
policies and procedures that prohibit retaliation against any staff,
who reports suspected abuse/neglect/mistreatment or retaliation
against the individual with respect to any report. Language must
also include:
a. A requirement that all
personnel participate and cooperate with all authorized persons
conducting investigations/regulatory reviews involving the
Organization and/or any person receiving supports/services from the
Organization.
b. A process for annual
notification of mandatory reporting statutes to all employees,
advisors, skill trainers, respite providers, contractors, and
volunteers of the Organization.
C. Staff Qualifications and
Personnel Files
1. Any employee providing
direct assistance to individuals shall meet the following criteria:
a. Be at least eighteen (18)
years of age
b. Have clear job
responsibilities as described in a current and dated job description;
c. Have a high school diploma
or a GED®.
2. The Organization shall
maintain the personnel record for all employees and contractors that
includes the following information as applicable:
a. Reference and qualification
checks;
b. An approved BCI and NCIC;
c. Annual job-related
training, as applicable to the position, including current valid
certification of cardiopulmonary resuscitation (CPR) and biennial
first aid training;
d. Evidence of professional
licensure or certification, including renewals, as applicable.
3. The Organization shall
maintain a record for each volunteer that includes the following
documentation:
a. References and
qualifications checks;
b. A completed BCI and NCIC;
c. A detailed list of
functions for each position.
D. If a criminal background
check contains positive findings, the Organization’s Human
Resources, with input and guidance from the Organization’s
Senior Management, shall make and document a judgment regarding the
employment of the prospective employee. The following offenses shall
be determined to be disqualifying for employment by the Organization:
1. Any facility or program
licensed or operated by the department shall require all applicants
for employment -- if that employment involves routine contact with
patients, residents or clients without the presence of other
employees -- to apply to the bureau of criminal identification (BCI)
of the state police or the local police department for a nationwide
criminal records center (NCIC) background check. The check will
conform to the applicable federal standards, including the taking of
fingerprints of the applicant.
2. Any conviction for an
offense listed in paragraph 2(b) (Category One) below creates a
rebuttable presumption that an individual is disqualified from
serving in a caring capacity in a program or service operated or
licensed by BHDDH, or from residing in a household wherein such a
program or service is provided or from owning or operating any such
program or service or from serving as a BHDDH employee, intern,
volunteer or consultant or from functioning in any other capacity
that is subject to a statewide or nationwide criminal record
background check in accordance with federal and/or state law or BHDDH
regulation.
a. If a criminal background
check contains conviction(s) for any of the crimes listed below in
paragraph 4(a) while the applicant was an adult, the Organization
shall provide notice to the applicant that the conviction for such
crime is presumed to be disqualifying for employment, but the
applicant may appeal to rebut such presumed disqualification through
the hearing process pursuant to EOHHS regulations.
b. Category One (1) OFFENSES:
(1) Murder, voluntary
manslaughter, involuntary manslaughter
(2) First-degree sexual
assault
(3) Second-degree sexual
assault
(4) Assault on persons sixty
(60) years of age or older
(5) Assault with intent to
commit specified felonies (murder, robbery, rape, burglary, or the
abominable and detestable crimes against nature)
(6) First-degree arson
(7) Crime under section
1128(a) of the Social Security Act (
42
U.S.C. § 1320a-7(a)
)
(8) Criminal offense related
to person's involvement in any program under Medicare, Medicaid, or
the Title XX services program.
(9) Felony Domestic Violence
committed less than five (5) years ago
(10) 1st Degree Child
Molestation
(11) 2nd Degree Child
Molestation
(12) Child Pornography
(13) Sale or exhibition to
minor of indecent publications, pictures or articles
(14) Child nudity in
publication
(15) Kidnapping
(16) Car-jacking
(18) Mayhem
(19) Felony Assault committed
less than five (5) years ago
(20) Felony Battery committed
less than five (5) years ago
(21) A person convicted of any
crime under R.I. Gen. Laws Chapters
40.1-24
,
40.1-24.5
,
or
40.1-26
.
c. Category Two (2) OFFENSES:
If an individual has been convicted of any of the following offenses
that was (were) committed within the previous ten (10) years from the
date of the application for the background check, the individual will
be presumed to be disqualified to work for an Organization, but such
presumption may be determined to be rebutted by the Organization
after its Administration and/or Board of Directors considers and
documents the factors related to current qualification in the context
of conviction for any of the crimes listed in this paragraph.
(1) Transportation for
Indecent purposes
(2) Harboring
(3) Felony Assault committed
over five (5) years ago that resulted in injury to the victim
(4) Felony Battery committed
over five (5) years ago
(5) Felony Drug Offense
committed less than five (5) years ago
(6) Robbery
(7) Breaking and Entering
(8) Burglary
(9) Illegal Possession of a
Firearm
(10) Misdemeanor Domestic
Assault
(11) 3rd Degree Sexual Assault
(12) Child Abuse or Neglect
Indicated by DCYF or similar out of state agency.
(13) Circulation of obscene
publications and shows
(14) First or Second-Degree
Arson
(15) Any substantiated finding
by a State agency under 42 U.S.C. 1395i–3(g)(1)(C),
1396r(g)(1)(C)) or a Federal agency that a direct patient access
employee has committed an act of patient or resident abuse or neglect
or a misappropriation of patient or resident property.
(16) Prior employment history
of child or client abuse, neglect or Mistreatment
d. If the BCI check reveals
conviction of the applicant as an adult for any crime described in
Category One (1) in paragraph 2(b), or if the BCI check reveals
conviction of the applicant during the ten (10) years prior to the
date of application for the background check for any crime listed in
Category Two (2) in paragraph 2(c), the BCI of the state police or
the local police department will inform the employer, in writing,
without disclosing the nature of the disqualifying information, that
an item of disqualifying nature has been discovered. In addition, the
BCI of the state police or the local police department will inform
the applicant, in writing, of the nature of the disqualifying
information. An applicant against whom disqualifying information has
been found may request that a copy of the criminal background report
be sent to the employer.
e. In considering a request to
rebut a disqualifying presumption for a Category One (1) or Category
Two (2) conviction, the following factors shall be considered and
documented:
(1) the circumstances,
severity and duration of the crime;
(2) whether the victim of the
crime was a child or was an individual with a developmental or other
disability;
(3) circumstances such as
illegal use of drugs or alcohol, or addiction to substances, at the
time the crime was committed;
(4) length of time that has
elapsed since the commission of the crime for which the individual
was convicted,
(5) length of time that has
elapsed since the completion of any imposed sentence;
(6) length of time with no
further convictions of crimes;
(7) the individual’s
conduct in seeking and actively engaging in rehabilitation;
(8) the individual’s
ability to explain their remorse for the crime and/or efforts to
prevent commission of such a crime in the future;
(9) the extent to which the
crime bears a direct impact on performing the job for which the
individual is applying;
(10) any expert opinions of
health care providers and clinicians who have worked with the
individual if the individual chooses to share such confidential
information; and
(11) any work history,
education and job training before and after the commission of the
crime.
3. The annual evaluation
process shall include the following:
a. An assessment of job
performance in relation to the required skills and expectations set
forth in the job description;
b. A documented review of the
evaluation with the staff person maintained within the personnel
record;
c. Documentation that
individuals served by the employee had input into this process, to
the extent possible.
d. Review status of employee
criminal background check and enquire about possible criminal
conviction(s) since the occurrence of the previous background check.
1.22 Physical Environment
Requirements for Licensed Physical Entities
A. The Organization shall
ensure that all the locations where services are provided are
accessible to meet the needs of people receiving services from the
Organization and designed to protect the health and safety of all
persons. The Organization shall also ensure that all the locations
where services are provided are clean, sanitary, in good repair, free
from accumulation of combustible debris and waste material, and free
from offensive odors and insects.
B Reasonable accommodations
shall be made available to all individuals living in residential
settings, including but not limited to the following:
1. the provision of
specialized safety equipment such as irons, toasters, coffee pots,
and other equipment that shut off when unattended;
2. an accessible working
telephone;
3. any other such services or
equipment deemed necessary to assist individuals; and/or,
4. with maximizing
independence and living successfully within the home.
C. Restrooms shall be
available and accessible for individuals and staff in all the
facilities where licensed services are provided.
D. First-aid kits and
first-aid manuals shall be readily available to staff in a designated
location in all facilities where licensed services are provided.
E. A documented safety review
shall be conducted by the Organization every six (6) months to ensure
that each facility where licensed services are provided, including,
but not limited to community residences, is free of hazards. The
documentation shall include date of inspections, name of the
person(s) the inspection is conducted by, identification of areas
inspected, any corrective actions taken in response to deficiencies
cited, and date completed.
F. All the settings where
services are provided shall meet the State Fire Code requirements for
such facilities and/or occupancies.
G. It is the responsibility of
the Organization to ensure that each licensed site, has received an
initial and thereafter routine fire and life safety inspections that
meet the approval of the Office of the State Fire Marshal. It is the
responsibility of the Organization to communicate with the Office of
the State Fire Marshal and comply with the State Fire Code,
including, but is not limited to, scheduling re-inspections after a
violation(s) is resolved.
H. It is the responsibility of
the Organization to ensure that each licensed site shall have on
site: fire extinguishers, smoke detectors, and any other fire
detection and suppression system(s) required by law.
I. All compliance records will
be Maintained in accordance with EOHHS Records Retention requirements
pursuant to R.I. Gen. Laws §§
38-3-6
(a),
(c), and (k)(1).
J. The Organization shall
comply with all applicable federal, state, and local governmental
safety and sanitation laws, rules and regulations.
K. All toxic materials
including, but not limited to, poisons, chemicals, and pesticides
shall be:
1. Properly labeled;
2. Stored in original
container separate from all foods, food preparation utensils, linens
and medications; and
3. Stored in a locked area.
L. All flammable and
combustible materials shall be properly labeled, stored and locked in
accordance with the State Fire Safety Code.
M. The temperature within
premises shall be maintained within a normal comfort range. During
times of extreme summer heat, the provider shall make reasonable
efforts to keep individuals comfortable using ventilation, fans, or
air conditioning.
N. Equipment and supplies
shall be provided for cleaning of all surfaces. Such equipment shall
be maintained in a safe, sanitary condition and shall be properly
stored.
1. Hazardous cleaning
solutions, compounds, and substances shall be labeled, stored in a
safe place, and kept in an enclosed section separate from other
cleaning materials.
1.23 Community Residence;
Additional Physical Environment Requirements
A. The interior and exterior
of a community residence shall be kept free of litter, garbage and
refuse.
B. The exterior of a community
residence shall be maintained and kept neat with regular yard work
performed as appropriate to the season, including, but not limited
to, mowing the lawn, raking the leaves, and snow removal.
C. All measures necessary
shall be taken to prevent the entry of and to eradicate the presence
of rodents, flies, mosquitoes and other insects at community
residences.
D. All well water sources at a
community residence shall be tested every three (3) years.
E. Septic tanks or other
private sewage disposal systems at community residences shall be in
good working order.
F. The water temperature shall
not exceed one hundred and twenty (120) degrees Fahrenheit.
G. All heating and cooling
devices in a community residence shall be installed in accordance
with current building codes and maintained in good working order.
H. Handrails shall be provided
on all stairways in a community residence in accordance with any and
all federal and state statutes and regulations.
I. All furniture shall be
clean and in good repair.
J. Bedroom furniture shall be
provided in a community residence for each individual and shall
include:
1. A bed, including a frame
unless otherwise documented by a clinical team decision, a clean
comfortable mattress, a waterproof mattress cover, if the individual
is incontinent, and a pillow;
2. A private dresser or
similar storage area for personal belongings that is readily
accessible to the individual;
3. A closet or similar storage
area for clothing that is readily accessible to the individual;
4. Individuals have the
freedom to furnish sleeping or living units within the lease or other
agreements;
5. Sufficient supply of
personal linens.
K. Providers will take all
possible steps to ensure privacy is maintained.
L. Swimming pools, hot tubs,
saunas, or spas located on the premises of a community residence
shall be equipped with safety barriers and devices designed to
prevent injury and unsupervised access and shall be clean, sanitary,
and maintained in good working order.
M. Sanitation for household
pets and other domestic animals shall be adequate to prevent health
hazards. Proof of current vaccinations that are required for the pet
by a licensed veterinarian shall be maintained on the premises. Pets
not confined in enclosures shall be under control and shall not
present a danger or health risk to individuals or their guests.
N. Operative flashlights, at
least one (1) per floor, shall be readily available to staff in case
of emergency within each community residence.
O. Sleeping or living units
must have entrance doors lockable by the resident with only
appropriate staff having keys to doors. In the case of BHOs, refer to
program specific guidelines in cases when this regulation is not
applicable by an overriding federal or state statute or regulation.
1.24 Nutrition
A. Foods shall be served in a
form consistent with the individuals’ needs and provide
opportunities for choice in food selection. The Organization will
ensure that there is adequate food available at any time, that it is
stored appropriately, that it reflects individual preferences and
needs. In the case of DDO, for individuals with physician or health
care provider ordered modified or special needs diets, plans shall be
annually reviewed and contained in the ISP.
B. Adequate supplies of staple
foods for a minimum of one (1) week and perishable foods for a
minimum of two (2) days shall be maintained on the premises.
C. Food shall be stored,
prepared and served in a sanitary manner.
1.25 Safety
1.25.1 Transportation
A. Organizations, including
employees and volunteers, who own or operate vehicles that transport
individuals, shall:
1. Maintain the vehicles in
safe operating condition. All vehicles utilized by employees of the
Organization to transport individuals shall have a current vehicle
inspection sticker from the state where the car is registered.
2. Comply with Division of
Motor Vehicles laws, rules and regulations;
3. Maintain or assure
insurance coverage including liability, on all vehicles and all
authorized drivers;
4. Carry a stocked first aid
kit in agency vehicles used to transport individuals:
5. The Organization shall be
responsible for ensuring that only properly licensed drivers operate
Organization vehicles or use their own personal vehicles to transport
individuals.
1.25.2 Individual Summary
Information
A. A current summary sheet
must be maintained by DDOs and updated as necessary for each
individual receiving services from the Organization. The summary
sheet shall be reviewed annually at a minimum and shall include:
1. The individual’s
name, current address, date of birth, sex, marital status, religious
preference, preferred hospital, medical insurance information, and
guardianship status where applicable; and
2. The name, address and
telephone number of:
a. The individual’s
legal guardian, family, advocate or other significant person;
b. The individual’s
primary care provider, secondary provider or clinic;
c. The individual’s
dentist;
d. The individual’s
pharmacy;
e. The individual’s day
program, or employer, if applicable;
f. The individual’s
Support Coordinator/Case Manager; and
g. Other Organizations
providing services to the individual.
1.25.3 Emergency
Information
A. Subject to the protection
of federal and state healthcare confidentiality statutes and
regulations, the DDOs and all BHO residential programs shall maintain
emergency information for each individual receiving services from the
program in addition to the individual summary sheet identified above
in this Part.
B. The emergency information
shall be reviewed annually, updated as needed, and shall include:
1. The individuals name, date
of birth, and medical insurance information;
2. The Organization's name,
address and telephone number;
3. The address and telephone
number where the individual lives;
4. The individual’s
physical description, which could include a picture and the date it
was taken, and identification of:
a. The individual’s
race, gender identity, height, weight range, hair and eye color; and
b. Any other identifying
characteristics that could assist in identifying the individual
should the need arise, such as marks or scars, tattoos, or body
piercings.
5. Information on the
individual’s abilities and characteristics including:
a. How the individual
communicates;
b. The language the individual
uses or understands;
c. Any additional information
that could assist a person not familiar with the individual to
understand what the individual can do for him/herself.
6. The individual’s
health support needs including:
a. Diagnosis;
b. Allergies or adverse drug
reactions;
c. Health issues that a person
would need to know when taking care of the individual;
d. Name(s) and telephone
number(s) of the primary care provider, and other relevant health
care providers/specialists;
e. Date of last annual
physical;
f. Special dietary or
nutritional needs, such as requirements around the textures or
consistency of foods and fluids;
g. Food or fluid limitations,
due to allergies, diagnosis or medications the individual is taking,
that may be an aspiration risk or other risk for the individual;
h. Additional special
requirements the individual has related to eating or drinking, such
as special positional needs or a specific way foods or fluids are
given to the individual;
i. Immunization information,
including date of last tetanus, including DTap (Diptheria-Tetanus
Toxoids & Acellular Pertussis);
j. List of current medications
and dosages;
k. Protocol for emergency
treatment and advance directives (if applicable);
(1) Guardian and/or next of
kin’s name(s) and telephone number(s);
l. Physical limitations that
may affect the individual’s ability to communicate, respond to
instructions or follow directions; and
m. Assistive technology needed
for mobility, positioning, communication, or other health related
needs.
7. The individual’s
emotional and behavioral support needs including:
a. Mental health or behavioral
diagnosis and the behaviors displayed by the individual; and
b. Approaches to use when
dealing with the individual to minimize emotional and physical
outbursts, including an approved behavioral treatment plan.
8. Any court ordered or
guardian authorized contacts or limitations;
9. The individual’s
supervision requirements and why; and
10. Any additional pertinent
information the Organization has that could assist in the care and
support of the individual should an emergency or disaster occur.
1.25.4 Emergency Management
Plan
A. Subject to the protection
of federal and state healthcare confidentiality statutes and
regulations, the Organization shall develop, maintain, update, and
implement a written Emergency Management Plan for the protection of
all individuals in the event of an emergency or disaster, including
911.
B. The Emergency Management
Plan shall:
1. Be practiced annually at a
minimum. The Emergency Management Plan practice may consist of a
walk-through of the duties or a discussion exercise dealing with a
hypothetical event, commonly known as a tabletop exercise;
2. Consider the needs of the
individuals being served and address all natural and man-made events
identified as a significant risk for the facility where a licensed
service is provided, (i.e.- terrorist attack, a pandemic or an
earthquake, etc.).
3. Include provisions for
evacuation and relocation:
a. A method for tracking and
reporting to the Department, the physical location of each individual
until a different entity resumes responsibility for the individual.
4. Address the needs of the
individuals, including provisions to provide:
a. Immediate and continued
access to medical treatment and continued access to life-sustaining
pharmaceuticals, medical supplies and equipment during and after an
evacuation and relocation;
C. Applicable parts of the
emergency management plan shall coordinate with each affected program
to address the possibility of an emergency or disaster.
1.25.5 Fire Safety and Fire
Drill Requirements
A. The Organization shall
assess, within twenty-four (24) hours of entry to the premises, the
individual’s ability to evacuate the residential setting in
response to an alarm or simulated emergency. At a minimum, each
individual’s ability to evacuate shall be reassessed and
documented in each individual’s Emergency Management Plan on an
annual basis and when there is a substantial change in the
individual’s functional capacity (physical and/or mental).
Individual Safety Plans shall be maintained in each community
residence’s or non-congregant residential setting’s fire
book.
B. The Organization shall
document in each individual’s Emergency Management Plan the
level of assistance needed by each individual to safely evacuate the
premises within twenty-four (24) hours of entry to the premises and
on an annual basis and when there is a substantial change in the
individual’s functional capacity (physical and/or mental). Such
documentation shall be maintained both in the premises and the
individual’s records. Staffing shall reflect the level of
assistance required for evacuation and provide for the health and
safety of all the individuals as included in the core residential and
day program services requirements.
C. A written emergency
evacuation plan shall be in effect and available at each location
where licensed services are delivered, including but not limited to,
community residences. This plan shall include policies and procedures
for the evacuation of all occupants from the building in the event of
fire, and for their relocation to a safe area outside the building.
This plan shall be reviewed annually and updated as the needs of the
building occupants change. Staffing shall reflect the level of
assistance required for evacuation and provide for the health and
safety of all the individuals as included in the core residential and
day program services requirements contained herein.
D. All direct service staff
shall have specific fire training, consisting of not less than four
(4) documented hours per year, and shall include training in the
Organization’s emergency evacuation procedures. Staff working
in multiple service locations shall review the emergency evacuation
plan for each service delivery location at which they work.
E. All individuals residing in
premises and/or participating in a day program shall be trained in
and practice the proper actions to take in the event of fire. This
training shall include actions to take in the event the primary
escape route is blocked.
F. Fire exit drills shall be
conducted not less than six (6) times per year on a bimonthly basis
for community residences with not less than two (2) drills conducted
during the night when individuals are sleeping. Drills shall occur at
different times of the day, evening and night shifts with exit routes
being varied based on the location of a simulated fire. The complete
drill shall involve the actual evacuation of the building to a
meeting place outside the home where the individuals know to
congregate as specified in the written emergency evacuation plan.
G. Fire exit drills shall be
conducted not less than quarterly for non-residential programs. The
complete drill shall involve the actual evacuation of the building to
a meeting place outside the building where the individuals know to
congregate as specified in the written emergency evacuation plan.
H. Written documentation shall
be made at the time of the fire drill and shall be kept maintained in
accordance with EOHHS Records Retention requirements pursuant to R.I.
Gen. Laws §§
38-3-6
(a),
(c), and (k)(1).
I. Fire drill documentation
shall include:
1. For a community residence:
a. The date and time of the
drill and the type of drill (obstructed or unobstructed);
b. The location of the
simulated fire and exit route;
c. The names of all
individuals and staff present on the premises at the time of the
drill;
d. The type of evacuation
assistance provided by staff to individuals as specified in each
individual's safety plan;
e. The amount of time required
by each individual to evacuate;
f. The amount of time taken to
evacuate the building;
g. The signature of the staff
conducting the drill; and
h. The record of problems
identified during the drill and a detailed plan of correction to
resolve the problems identified.
2. For a non-residential
program:
a. The date and time of the
drill;
b. The location of the
simulated fire and exit route;
c. The names of all staff
present on the premises at the time of the drill;
d. The number of individuals
present on the premises and evacuated at the time of the drill;
e. The amount of time taken to
evacuate the building;
f. The signature of the staff
conducting the drill; and
g. The record of problems
identified during the drill and a detailed plan of correction to
resolve the problems identified.
1.26 Individual (Participant)
Rights
A. Organizations shall
establish written policies and procedures that promote the highest
practicable professional standards related to individual rights.
These policies and procedures shall be adhered to always, in all
settings, and during all interactions.
B. Each individual will be
informed of their rights in a way they understand.
C. Organizations shall follow
these procedures throughout the entire process of care, including but
not limited to, initial contact, application, eligibility
determination, admission, orientation, delivery of services, revision
of direct services, transfer of services, and discharge from
services.
D. Organizations shall
continually afford each person these rights and inform them of these
rights, as appropriate, and in a manner consistent with his or her
individual learning style.
E. Organizations shall
maintain a written statement of rights for individuals receiving
services and those requesting services.
F. Individuals requesting
services shall have the right to receive an individualized
assessment.
G. Each individual, legal
guardian, and/or advocate shall be provided with a written statement
of the “Rights of individuals” that shall contain, the
following:
1. This Part hereby adopts and
incorporates by reference R.I. Gen. Laws §§
40.1-24.5-3
,
40.1-24.5-5
,
40.1-24.5-6
,
and
40.1-24.5-7
and
40.1-26-3
as applicable to each individual.
2. Each Organization and its
employees and volunteers shall mindfully and carefully follow all
federal and state confidentiality laws and regulations to protect the
privacy and dignity of each individual as much as possible and
necessary:
a. to the extent any exception
may apply that allows lawful disclosure, including but not limited
to, by court order or in emergencies to legally define persons, such
Organization will exercise due diligence to ensure compliance with
the letter and spirit of the statutory and/or regulatory exception in
the applicable confidentiality law.
3. Each Organization will
ensure individual’s rights of privacy, dignity and respect and
freedom from coercion and restraint.
4. Individuals will be
provided with the right to full access to the community, including
the right to engage in community life, to control personal resources,
and to receive services in the community to the same degree as those
not receiving Medicaid HCBS, in accordance with
42
C.F.R. §
441.301
(C)(4)(I-vi).
5. Each individual has privacy
in their sleeping or living unit:
a. Units have lockable doors
by the individual with only appropriate staff having keys to the
doors;
b. Individuals sharing units
have a choice of roommates in that setting;
c. Individuals have the
freedom to furnish and decorate their sleeping or living units within
the lease or other agreement.
d. Individuals have the
freedom and support to control their own schedules and activities;
e. Individuals have access to
food at any time;
f. Individuals may have
visitors of their choosing at any time.
g. The setting is physically
accessible to the individual.