This chapter establishes licensing standards for Day Developmental Training Centers in Louisiana, which are day-care and residential facilities providing therapy, training, education, and protective care to persons with handicaps (including intellectual/developmental disabilities). Operators must comply with licensure, relicensure, and appeal procedures administered by the DHHR Licensing and Certification Division, and must meet general standards covering governance, staffing, admissions, health and medical services, nutrition, personnel policies, and individual rights. The standards apply to facilities serving five or more persons and include requirements for individualized treatment plans, interdisciplinary team reviews, and protections against abuse and exploitation.
View official sourceChapter 55.Day Developmental Training Centers §5501.Glossary Administrator―the person appointed by the governing body, in writing, who is responsible for the overall management of the facility and enforces the rules and regulations as set forth by the governing body and appropriate federal, state and local agencies. Agency―any division of government that may have contact with a facility for reasons of certification, funding, placement, licensing, etc. Agency―the term agency whenever capitalized specifically refers to the Department of Health and Human Resources. Chemical Restraint―the use of any drug or chemical to limit over activity or aggressiveness which might be harmful to the resident or other persons. DHHR―the Louisiana Department of Health and Human Resources. Direct-Care Staff―those employees that work directly with individuals under care on a full-time basis. Direct care staff includes, but is not limited to, house parents, attendants, and education and training staff. Administrative personnel, housekeeping and maintenance personnel and consultants shall not be included. Facility―a physical plant and an administrative organizational structure whose primary concern is providing special therapy, training, education or protective care to handicapped persons. The term facility shall include only those structures providing care and/or training to five or more persons and shall include residential, day-care, group homes and special schools. Individual-Person-Child-Student―used interchangeably to indicate those that are receiving care and/ or treatment. In-Service Training Program―an ongoing training process for all staff members in all areas of concern to the facility. Interdisciplinary Teams―a. team composed of both professional and non-professional staff members from all areas of service. Living Unit―that portion of the facility devoted to the personal needs of individuals in a residential facility. Multidisciplinary Teams―a. team composed only of professional staff members. Resident―those persons receiving residential care at the facility. State-Approved Evaluation Team―an evaluation team approved by any funding agency of the state of Louisiana. Training―an ordered design leading to a specific end result. Training services are differentiated from educational services by their emphasis on those skills universally needed to function at a minimum level as part of society. Treatment Plan or Program (Plan of Care)―a written plan setting forth measurable goals or behaviorally stated objectives and prescribing an integrated program of individually designed activities, experiences or therapies necessary to achieve such goals or objectives. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5503.Licensure Procedure A.Application for license is made by applying in writing to the Licensing and Certification Division, Department of Health and Human Resources, P.O. Box 3767, Baton Rouge, Louisiana 70821. This means that the applicant is requesting that the facility be surveyed for licensure. As soon as possible, a surveyor will visit the facility to determine compliance. At the same time, inspections by the Fire and Health Departments will be requested by the Licensing and Certification Division. Copies of these inspection reports which indicate approval by the Fire and Health Departments must be received by the Licensing and Certification Division. B.Any deficiencies found by the surveyor will be discussed with the administrator and/or the governing body of the facility. Within 10 days after official notification of deficiencies noted in the survey, the administrator and/or governing body must reply in writing as to how the deficiencies will be corrected and the dates on which these corrections will be effected. This procedure is also applicable to the relicensure process. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5505.Relicensure Procedure A.Ordinarily, licenses are issued for a period of one year. Two months before the expiration date application for relicensure must be made to the Licensing and Certification Division on forms supplied by that office. The relicensure survey is the same procedure as that of the initial. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5507.Appeal Procedure A.If the license is refused, suspended or revoked because a facility is not suitable, is not properly managed, as such, or does not meet minimum requirements for licensure, the procedure is as follows: 1.The secretary, Department of Health and Human Resources, by registered letter, shall advise the facility administrator of the reasons for refusal, suspension, or revocation, and its right of appeal. 2.Within 30 days after receipt of such notice, the facility administrator may request in writing a hearing in order to appeal the decision. 3.The secretary shall set a hearing to be held within 30 days after receipt of such request. The hearing shall be held in the immediate vicinity of the appellant or other location specified by him. 4.The secretary, or his representative, shall conduct the hearing. Within 10 days after the hearing, he shall advise the appellant, by registered letter, of his decision, either confirming or reversing the original decision. If the license is refused, suspended or revoked, the facility shall be given 30 days to meet those standards delineated by the licensing agent. 5.If the facility is unable to meet the standards within this time frame, funding received from the Department of Health and Human Resources shall be discontinued. B.The licensing standards will be used to license all facilities where DHHR funds are used to care for handicapped persons. Included are those facilities which are specially designed to care for a particular type of handicap, such as mental retardation, mental illness and learning disabilities. Since these types of handicaps may require specialized standards in certain areas, separate appendices containing standards in these areas have been formulated. C.All facilities must meet the general standards. Additionally, each facility must meet the standards in the appendix that applies to the primary type of handicap in which the facility specializes. Should none of the appendices be perfectly suited to the type of disability cared for by the facility, the facility must, nonetheless, meet the additional standards contained in the appendix which most nearly meets the needs of that type of disability. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5509.General Standards A.The following standards must be met by all facilities regardless of the type of disability with which they are primarily concerned. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5511.Compliance with Federal, State and Local Laws A.When state or applicable local law provides for licensing of facilities of this nature, the facility must be licensed pursuant to such law. B.The facility must be in conformity with federal, state and local laws, codes and regulations pertaining to health and safety, including procurement, dispensing, administration, safeguarding and disposal of medication and controlled substances; fire and safety regulations; building construction, maintenance and equipment standards; education and training; labor laws and regulations; sanitation; communicable and reportable diseases and postmortem procedures. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5513.Disclosure of Ownership A.Any facility which is funded, either directly or indirectly, by the Department of Health and Human Resources must supply to the Licensing and Certification Section full and complete information and promptly report any changes which would affect the current accuracy of such information, as to identify: 1.of each person having (directly or indirectly) an ownership interest of 10 percent or more; 2.in case a facility is organized as a corporation, of each officer and director of the corporation; 3.in case a facility is organized as a partnership, of each partner. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5515.Governing Body and Administration A.A governing body of the facility shall exercise general direction and shall establish policies concerning the operation of the facility and the welfare of the individuals served. B.The governing body shall establish appropriate qualifications for the administrator in terms of education, experience, personal factors, and skills. C.The administrator shall make arrangements so that a particular individual is responsible for the administrative direction of the facility at all times. D.A table of organization shall provide for and show the major operating programs of the facility, with staff division and the administrative personnel in charge of program and division, and their lines of authority, responsibility, and communication. E.The administration of the facility shall provide for effective participation and communication between the staff and individuals attending the facility. Standing committees appropriate to the facility, such as human rights, infection control, admission and dismissal, interdisciplinary, etc., shall be constituted and shall meet regularly. Committees shall include the participation of direct-care staff and the persons served, whenever appropriate. Minutes and reports of staff meetings, and of standing and at hoc committee meetings shall include records of recommendation and their implementation, and shall be kept and filed. F.There shall be an active program of ready, open, and honest communication with the children and their families. The facility shall maintain active means of keeping the families or surrogates informed of activities related to the children that may be of interest to them or of significant changes in the child's condition. Communication to the facility from a child's relatives shall be promptly and appropriately handled and answered. Close relatives and parent surrogates shall be permitted to visit at any reasonable hour, and without prior notice unless contraindicated by the child's needs. Steps shall be taken, however, so that the privacy and rights of the other individuals are not infringed by this practice. Parents shall be permitted to visit all parts of the facility that provide services to the children. Frequent and informal visits home shall be encouraged and the regulations of the facility shall facilitate rather than inhibit such visitations. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5517.General Policies and Practices A.The facility shall have written philosophy, objectives and goals that are available to the staff, consumer representatives, the interested public and appropriate state agencies. In addition to the philosophy and objectives of the facility, this written policy must contain the facility's goals for the individuals it cares for and its concept of its relationship to parents or their surrogates. B.The facility shall have a written statement of policies and procedures concerning the rights of the individuals that assures their civil rights. C.The facility shall have a written statement of policies and procedures concerning the admittance of individuals of all races that would prohibit discrimination. D.The facility shall have written policies and procedures that protect the individual's financial interests, provide for counseling concerning use of large sums accrued, protect such funds, and permit normalized possession and use of money earned through work payment programs. E.Policies and procedures in the major operating units (personnel, education and training, resident living, medical, pharmacy, dental, nursing, physical therapy, occupational therapy, speech and audiology, social services, recreation, psychiatric and psychological services, food and nutrition, etc.) of the facility shall be described in manuals that are current, relevant, available, and followed. F.Written policy shall prohibit mistreatment, neglect, or abuse. Alleged violations shall be reported immediately, and there shall be evidence that: 1.all alleged violations are thoroughly investigated; 2.the results of such investigation are reported to the administrator or his designated representative within 24 hours of the report of the incident; 3.the results of such investigation shall also be reported to the appropriate funding office which then has the right to make its own investigation or to refer the problem to the Licensing and Certification Section for that office to investigate; 4.either the facility, the funding agency or the Licensing and Certification Section may impose appropriate sanctions if the allegations are substantiated. G.The facility shall meet all state and federal wage and hour regulations in regard to employment of persons admitted to the facility. Wages earned by persons who are eligible for and receiving state funds shall be reported to the state agency and the facility shall not accept or solicit these funds from persons admitted to the facility. The state may require that these earnings be applied toward the cost of care of the person. H.The facility shall not coerce persons funded by the state to engage in any type of solicitation for funds, equipment, etc., for utilization by the persons in care or the facility. The state funding agency and parent/guardian must be notified before an individual voluntarily engages in these types of activities. I.The facility must maintain full financial records which are certified annually and forthwith submit them to the state funding agency. These records shall be subject to audit at any reasonable time by the Department of Health and Human Resources, the Louisiana legislative auditor, the Department of Health, Education and Welfare, and any authorized representative of the state. All income sources shall be identified, all expenses verified, and other information made available as necessary in order to determine the actual cost per person per day for services available. These records shall be maintained. J.The facility shall have written policies and procedures which safeguard information regarding individuals funded by the state agency, which shall include prohibition of announcement or publication of names or pictures of such persons without the prior written consent of agency and parent/guardian. Confidential information shall not be released to or discussed with an outside source other than the Department of Health and Human Resources and direct collateral services providers without the prior express written consent of the parent/guardian and agency. K.If the facility conducts research, it shall follow and comply with the statement of assurances on researh involving human subjects required by the United States Department of Health, Education and Welfare for projects supported by that department. L.The facility shall release information to an organization or individual engaged in research only for purposes directly and previously approved by the state funding agency with assurances that the information will be used only for the purpose for which it is provided, that it will not be released to persons not connected with the study under consideration, and that the final product of the research will not reveal any information that may serve to identify any person funded by the state without written consent of such person and the state agency. M.Each individual funded by state shall be entitled to receive and send sealed mail, without any form of censorship or invasion of privacy, unless, in the case of a person who is emotionally disturbed, a restriction on incoming mail is recommended by a qualified professional as being necessary to prevent serious harm to the person, and such restriction is prescribed in writing by that qualified professional for a definite period not to exceed one month, in conjunction with therapy being received by the person. In the event that such a restriction is prescribed, a letter may be censored only after a qualified professional has reviewed the contents of that letter and determined that withholding of the letter from that person is necessary to prevent serious harm to the person; the entire letter must be withheld; a copy of the withheld letter must be returned to the sender, along with notification that the letter was withheld and the reasons for the censorship; the facility must retain copies of both the letter withheld and the notification letter sent to the sender, in conformity with the above, and the facility must maintain a log listing all letters withheld; and the facility must make available copies of the letters and log, described in the above, to DHHR and authorized state and federal representative, upon request. Anything in this paragraph to the contrary notwithstanding, it shall be the duty of the institution to furnish to each person all materials and assistance reasonably necessary to facilitate sending and reading mail. N.Under appropriate supervision, each individual funded by state shall be provided with suitable opportunities for interaction with members of the opposite sex, except where a qualified professional responsible for the formulation of a particular person's treatment plan writes an order to the contrary and explains the reasons therefore. O.The following rules shall govern performance of work by individuals funded by agency: No person shall be required to perform work of any kind that involves the operation and maintenance of an institution, nor shall privileges or release from an institution be conditioned upon performance of any work. However, a person may be required to perform vocational training tasks, provided each task is part of the person's individual treatment plan and has been approved as a program activity by a professional responsible for supervising the individual's program, supervised by a qualified professional, and not continued for longer than six months, unless it is specifically reinstated by the person's treatment plan. A person may be required to perform without compensation such housekeeping tasks as would be performed by a person in a natural home, foster home or group home, provided that the person's individual treatment plan does not forbid such work. In no case, however, may a person be required to perform housekeeping tasks for more than 12 other people. 1.An individual may voluntarily engage in work during non-program hours, provided that the person's individual treatment plan does not forbid it, the particular work has been approved by the qualified professional responsible for supervising the implementation of the person's treatment plan, the particular work is supervised by qualified staff, and the conditions of employment and the compensation are in full compliance with all applicable federal laws. 2.No person funded by the state shall be involved in the care, feeding, clothing, training or supervision of other individuals unless the qualified professional responsible for supervising the implementation of the person's treatment plan certifies in writing in the person's record that the particular task will not in any way endanger the life or health or be detrimental to the development of the particular individuals who receive such care. P.Each individual funded by state shall have the unrestricted right, consistent with reasonable institutional regulations, to visits by and to his parents, foster family or tutor. Visits by and to other persons shall be limited only to the extent that a special restriction is required by the person's individual treatment plan as necessary to prevent serious harm to the individual. The reasons for any such restriction must be explained in writing. The written order must be reviewed at the end of 30 days and shall be renewed only by the interdisciplinary team. Reasons for renewal must be recorded in the person's records. Q.Each individual funded by state shall have the right to telephone communication with his parents or tutor to the extent consistent with reasonable institutional regulatiojs. The person shall also have the right to telephone communication with others except to the extent that an appropriately qualified professional responsible for formulation of a particular person's habilitation plan writes an order imposing special restrictions and explains the reasons for any such restrictions. The written order must be renewed semi-annually if any restrictions are to be continued. AUTHORITY NOTE:Promulgated in accordance with R. S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5519.Personnel Policies A.The hiring, assignment, and promotion of employees shall be based on their qualifications and abilities, without regard to sex, race, color, creed, age, ethnic or national origin. Written job descriptions shall be available for all positions. Licensure, certification, or standards such as are required in community practice shall be required for all comparable positions in the facility. These ethical standards of professional conduct, as developed by professional societies, shall be recognized as applying in the facility. There shall be an authorized procedure, consistent with due process, for suspension and/or dismissal of an employee for cause. The facility's personnel policies and practices are in writing and are available to all its employees. B.Staffing shall be sufficient so that the facility is not dependent upon the use of residents or volunteers for productive services. There shall be a written policy to protect residents from exploitation when engaged in productive work. C.Appropriate to the size and nature of the facility there shall be a staff training program that includes: 1.orientation for all new employees to acquaint them with the philosophy, organization, program practices, and goals of the facility; 2.inservice training for employees who have not achieved the desired level of competence and continuous inservice training to update and improve the skills and competencies of all employees; 3.supervisory and management training for all employees in, or candidates for, supervisory positions; 4.an individual designated the responsibility for staff development and training; 5.minutes of training sessions which indicate the subjects covered in the session, the names of the staff members in attendance and the date of the session; 6.written policies must be in effect to insure that employees with symptoms or signs of communicable disease are not permitted to work. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5521.Admission and Release A.No individual whose needs cannot be met by the facility shall be admitted to it. The needs of these individuals shall be determined by an evaluation team approved by the funding agency. The number of individuals admitted to the facility shall not exceed its rated capacity and its provisions for adequate programming. The facility shall admit only those individuals who have had a comprehensive evaluation by an appropriate state-approved evaluation team covering physical, emotional, social, and cognitive factors. B.The regulations and procedures concerning admission, readmission, and release shall be summarized and available. C.Procedures shall be established so that parents or guardians who request the release of their child are counseled concerning the advantages and disadvantages of such release. When the facility wishes to dismiss or transfer an individual, there shall be written evidence of the reason for the transfer, and, except in an emergency, 30 days prior knowledge, and ordinarily the written consent of the student's parents and the funding agency. At the time of any permanent release or transfer, there shall be recorded a summary of findings, progress, and plans, if any. D.In the event of any unusual occurrence, including serious illness or accident, impending death, or death, the student's next of kin, or the person who functions in that capacity (a guardian or citizen advocate) shall be notified promptly. Also, the funding agency will be notified at this same time. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5523.General Staffing Provisions A.To conduct the direct-care program, staff personnel shall be sufficient, appropriately qualified, and adequately trained. All direct-care personnel shall be administratively responsible to a person whose training and experience is appropriate to the program. B.There shall be at least one direct-care staff person on duty in any area of the facility where children are present or are expected to be present. C.The number of appropriate direct-care staff will be determined by a consideration of the following factors: 1.the number of children; 2.the type and severity of their handicaps; 3.the amount of time that the children are under the care of the facility; 4.the type of program offered by the facility. D.Regardless of the organization or design of the facility, the overall direct care staff ratio shall be 5 to 16 unless program needs justify otherwise. This means 5 direct care staff on duty each day to every 16 persons in care. For example, there should be present and on duty, on every day of the year, at least one direct care person for each eight residents on the first shift, one direct care person for each eight residents on the second shift, and one direct care person for each 16 residents on the third shift. E.The above direct care ratio may be waived by the certifying agency if the facility has documented evidence that there is not a need for staff in these numbers and that the health and safety of the residents would not be impaired. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5525.Staff Responsibilities and Activities A.The facility shall develop a program that is based on each person growing at his own rate, yet keeping general development in mind. The facility shall create an atmosphere in which self-confidence and ability can be cultivated. The program shall be geared to meet the individual needs of those served. B.Within the period of one month after admission there shall be, by professional as well as direct-care staff, a review and updating of the preadmission evaluation and a treatment plan shall be developed for the individual by this time. The above-mentioned review must be recorded in the individual's record and a written interpretation of the review made to the direct-care and special services staff responsible for carrying out the treatment plan. C.Six months after admission of each person to a facility and at least annually thereafter, a comprehensive psychological, social, educational and medical diagnosis and evaluation shall be prepared for that person, and his treatment plan shall be reviewed and adjusted as necessary by an appropriate interdisciplinary team of the facility. This review and evaluation shall include consideration of the advisability of the continued stay in the program and alternative programs. Where possible, the person's parents shall be involved in the planning and decision making for programming. Also, these reviews shall be interpreted to the individual, when appropriate. The results of this annual review shall be recorded in the individual's record and a written interpretation of the review, in layman's terms, made to the direct-care and the special services personnel responsible for carrying out the individual's program. His parents or his surrogates and the funding agency will also get copies of this review. D.There shall be a schedule of the day's plan of activities, providing flexibility and changes, as deemed necessary. The program of activities shall be adhered to with reasonable closeness but shall accommodate and have due regard to individual differences among those served. The program shall provide time and material for both vigorous and quiet activity for children to share or do alone as well as indoor and outdoor play and rest periods. Regular time should be allowed for routines such as washing, lunch, rest, snacks, and putting away toys. For children under 6 years of age, quiet play, story telling, or quiet music should precede the lunch hour, which then should be followed by the rest period. E.The aims and activities of the facility shall be shared with parents or guardians by planned individual conferences and group meetings at least quarterly with written minutes kept. F.There shall be planned daily activities and exercise periods for multiple handicapped and non-ambulatory individuals who shall be rendered mobile whenever possible by various methods and devices. G.All individuals shall have planned periods out of doors on a year- round basis. H.There shall be a written statement of policies and procedures for the control and discipline of individuals in care that is available to parents or guardians and the funding agency, and which is, where appropriate, for mulcted with participation of the individuals cared for by the facility. This policy shall not permit corporal punishment or seclusion (defined as the placement of a person alone in a locked room) to be used. I.The staff shall not mistreat or abuse those in care in any way. J.Normal time-out procedures may be utilized, such as turning a student’s chair away from the class, or having the student move to another part of the room. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5527.Health, Hygiene and Grooming A.All persons, both residential and day-care, shall be trained to exercise maximum independence in health, hygiene, and grooming practices, as appropriate (including bathing, brushing teeth, shampooing combing and brushing hair, shaving and caring for toenails and fingernails, except where detrimental to the individual's treatment plan. B.Anyone who does not eliminate appropriately and independently, shall be engaged in a toilet training program unless to do so would be detrimental to his treatment plan. The training program shall be applied systematically and regularly. Records shall be kept of the progress of each person receiving toilet training. Those who are incontinent shall be immediately bathed or cleansed upon voiding and soiling, unless specifically contraindicated by the training program in which they are enrolled, an all soiled items shall be changed. C.These procedures shall be established for persons in residential care: 1.monthly weighing, with greater frequency for those with special needs; 2.quarterly measurement of height, until the age of maximum growth; 3.maintenance of weight and height records; and 4.assuring that residents maintain normal weights. D.Orders prescribing bed rest or prohibiting persons in residential care from being taken out-of-doors shall be reviewed by a physician at least every three days. E.Provisions shall be made for persons in residential care to furnish, maintain in good repair, and encourage the use of dentures, eyeglasses, hearing aids, braces, and so forth, prescribed by appropriate specialists. AUTHORITY NOTE:Promulgated in accordance with R. S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5529.Food and Nutrition A.When meals are provided to day-care students: 1.the food service for such meals shall include menu planning, storing and handling of food, food preparation, and food serving. The food and food service shall maintain sanitary standards in compliance with state and local regulations; 2.a nourishing, well-balanced diet shall be provided to all persons. Modified diets shall be prescribed or approved by the attending physician and planned, prepared, and served by persons who have received adequate instruction. These diets must be periodically reviewed and adjusted as needed; 3.the food and nutrition needs of the individuals shall be met in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences, adjusted for age, sex, activity, and disability, through a nourishing, well-balanced diet unless contraindicated by medical needs; 4.denial of a nutritionally adequate meal shall not be used as a punishment; 5.menus shall be written in advance and shall provide for a sufficient variety of foods served in adequate amounts. Menus shall be written so that meals will not be the same for the same day of the week, to keep every Monday from being known as "red beans and rice day". Menus shall be adjusted for seasonal changes. Records of menus as served shall be filed and maintained for at least 30 days; 6.food shall be served in appropriate quantity, at appropriate temperature, in a form consistent with the developmental level of the student, and with appropriate utensils. Food served to students and not consumed shall be discarded; 7.all students, including the mobile nonambulatory, shall eat or be fed in dining rooms, except where contraindicated for health reasons, or by decision of the team responsible for the student's program. Table service shall be provided for all who can and will eat at a table, including students in wheelchairs. The dining areas shall be equipped with tables, chairs, eating utensils, and dishes designed to meet the developmental needs of each student; 8.students shall be provided with systematic training to develop appropriate eating skills, utilizing adaptive equipment where it serves the developmental process. B.When meals are not provided to day care students by the facility (students bring own lunch): 1.the food service shall include: a.mid-morning snack; b.adequate refrigeration; c.supply of food or provision made for obtaining food for students who forget to or do not bring their own lunch. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5531.Medical Services A.The consultation services of a licensed physician shall be made available not only for emergencies, but for overall counseling for all health aspects of the center. B.This physician shall visit the facility at least twice a year and on the outbreak of any epidemic to review the health practices of the center, and to make pertinent recommendations. C.The medical consultant of the facility will cooperate with the local public health agency in supervising all the health conditions and practices of the facility's program: 1.to approve the facility's written statement regarding the procedures described above; 2.to make recommendations regarding diet, rest, or any other aspects of the program affecting the health of the students; 3.to certify to the facility in writing once a year either that the health aspects of care in the facility conform to the procedure the physician and the local health agency have approved, or that certain irregularities exist. Those reports shall be the basis of the Licensing and Certification study of health aspects of care. D.The medical consultant and operator should prepare a written statement outlining the procedures governing: 1.routine health inspection that can be given by the staff; 2.treatment of first aid that may be given without specific orders from a physician; 3.circumstances under which a physician should be called; 4.action to be taken by the center in case of emergency or suspected illness. E.Each person shall have an annual physical examination and a statement from the physician or health unit that he is in good health and free from communicable disease. F.Upon arrival each day, the student shall be checked for possible signs of illness, colds, skin infection and contagious skin disease. If there are signs of communicable disease, the student shall not be permitted to attend the facility until he is in good health. G.If symptoms of communicable diseases develop while the student is in care of the facility, he shall be placed in isolation and prevented from mingling with others until a physician or registered nurse has been consulted and has pronounced it safe for him to be with other students. H.When a student has been sick with a highly communicable disease, such as mumps, whooping cough, measles, ringworm or impetigo, a physician or nurse must certify that he is in sufficiently good health and that he can return to the facility. I.If a student develops symptoms of illness or suffers an accident while under the care of the facility, the parent shall be notified as soon as possible. If the symptoms are severe and the parent is not available, medical advice shall be sought from the child's or the facility's physician. J.If students in the facility are known to have been exposed to a communicable disease, prompt notice shall be given to the parents of all attending the facility. K.The facility shall keep on hand first-aid equipment approved by its medical consultant. L.No drug of any type, including aspirin, should be given by the staff unless prescribed by the student's or facility's physician. M.When it is necessary for the student to be given medication while at the facility, directions must be given in writing, by the physician. Medicine containers must be plainly marked with student's name and directions for administering and kept in a safe place out of the student's reach. N.There shall be an agreement with the local health unit or a physician's office for consultation with a nurse when necessary. O.Students shall be provided with nursing services according to their needs. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5533.Services for Education, Training and Habilitation A.In those instances where the Department of Education has assumed the responsibility for the educational services at a facility or has imposed licensing requirements for special schools, the standards governing educational service shall be established by the Department of Education and shall supersede the standards set forth below. B.Students of grossly different ages, developmental levels, and social needs shall not be grouped in close physical or social proximity, unless such grouping is planned to promote the growth and development of all those grouped together. Students who are mobile-nonambulatory, deaf, blind, epileptic, and so forth, shall be integrated with peers of comparable social and intellectual development, and shall not be segregated on the basis of their handicaps. C.All residential facilities shall provide educational, training and habilitation services as appropriate to the needs of the individuals admitted either directly or through arrangements with agency approved outside resources, including the public school system. D.The residential facility which provides these services directly shall have an educational, training and habilitation staff which is in a ratio of one staff member to five persons. However, the staff members providing these services may also be used in other capacities by the facility when not engaged in classroom training. The above-mentioned ratio may be waived by the certifying agency if the facility has documented evidence that there is not a need for training staff in these numbers and that the educational, training, and habilitation needs of the individuals would not be impaired. E.All day-care facilities shall provide directly for educational, training and habilitation services appropriate to the needs of the person. There shall be at least one training staff member for every five persons in day-care facilities. The above-mentioned ratio may be waived by the certifying agency if the facility has documented evidence that there is not a need for training staff in these numbers and that the educational, training, and habilitation needs of the individuals would not be impaired. F.Training and habilitation services shall be available to all students. G.The educational services should be structured to develop proficiency in the following areas: 1.communication skills; 2.computational skills; 3.language arts; 4.aesthetic and cultural development; 5.physical education and recreation; 6.motor development (perceptual and fitness); 7.pre-academic education; 8.academic education; 9.pre-vocational education; 10. vocational education. H.The program must be designed as a whole to maximize the student's human abilities, to enhance his ability to cope with his environment, to enable him to develop and realize his fullest potential and to equip him to live as normally as possible. I.Individual evaluations of students shall: 1.be based upon the use of empirically reliable and valid instruments, whenever such tools are available; and 2.provide the basis for prescribing an appropriate program of experiences for the student. J.Physicians shall participate when appropriate: 1.in the continuing interdisciplinary evaluation of individual residents for the purpose of initiation, monitoring, and follow-up of individualized habitation programs; and 2.in the development for each person of a detailed written statement of treatment goals, encompassing the areas of physical and mental health, education, and functional and social competence, and in the development of a treatment plan, detailing the various habilitation modalities that are to be applied in order to achieve the specified goals with clear designation of responsibility for implementation. K.Nursing services shall include as appropriate: 1.registered nurse participation in: a.the evaluation study, treatment plan, and placement of the individual at the time of admission to the facility; b.the periodic re-evaluation of the type, extent, and quality of services and programming; c.the development of discharge plans; and d.the referral to appropriate community resources; 2.development of a written plan for each student to provide for nursing services as a part of the total habilitation program. L.The educational, training and habilitation program for each student shall be determined according to the handicapping conditions of the student, based upon complete and relevant diagnostic and prognostic data, and stated in specific behavioral terms that permit the progress of the individual to be assessed. M.There shall be evidence of educational, training and habilitation services activities designed to meet the objective set for every student in these areas. There shall be a functional educational, training, and rehabilitation record for each student maintained by, and available to, the staff members in this area. Appropriate educational, training and habilitation programs shall be provided students with hearing, vision, perceptual, or motor impairments, in cooperation with appropriate staff. N.There shall be available sufficient, appropriately qualified educational, training and habilitation personnel, and necessary supporting staff, to carry out the programs. Supervision of delivery of these services shall be the responsibility of a person who is a professional qualified in the area of the particular disability that is the primary handicap of the student. For facilities caring primarily for learning disable children, the supervisor of delivery of these services shall be the responsibility of a person qualified at the master's level in the area of special educational services. The above-mentioned supporting staff shall possess the necessary background to meet the educational, training and habilitation needs of the persons served. O.There shall be evidence of equipment generally accepted as necessary to providing educational, training and habilitation services. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5535.Social Services A.Social services, as part of an interdisciplinary spectrum of services, shall be provided through the use of social work methods directed toward: 1.maximizing the social functioning of each person; 2.enhancing the coping capacity of his family; and 3.assenting and safeguarding the human and civil rights of the individual and his family and fostering the human dignity and personal worth of each individual. B.Social workers shall participate, when appropriate, in the continuing interdisciplinary evaluation of individual students for the purposes of initiation, monitoring, and follow-up of individualized habilitation programs. C.During the person's admission to, and residence in, the facility, or while he is receiving services from the facility, social workers shall, as appropriate, provide liaison between him, the facility, the family, and the community, so as to: 1.help the staff to: a.individualize and understand the needs of the individual and his family in relation to each other; b.understand social factors in the person's day-to-day behavior, including his relationship with the staff; and c.prepare the individual for changes in his living situation; 2.help the family to develop constructive and personally meaningful ways to support his experience in the facility, through: a.counseling concerned with problems associated with changes in family structure and functioning; b.referral to specific services, as appropriate; and 3.help the family to participate in planning for his return to home or other community placement. D.There shall be available sufficient, appropriately qualified staff, either full-time or through arrangement, and necessary supporting personnel to carry out the various social service activities. Social workers providing service to the facility shall be graduates of a master's program in an accredited school of social work. Social work assistants or aides employed by the facility shall work under the supervision of, or get consultation from, a social worker who is a graduate of a master's program of an accredited school of social work. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5537.Physical and Occupational Therapy Services A.If a facility admits persons that have a need for either physical or occupational therapy, those services shall be provided. These services may be provided either directly or through arrangements with an outside resource or with consultation from a qualified therapist. Therapy shall be done through personal contact between therapists and the persons in care or indirectly through contact between therapists and other persons involved with the individual. B.Physical therapy and/or occupational therapy staff shall provide treatment training programs that are designed to preserve and improve abilities for independent function, such as range of motion, strength, tolerance, coordination, and activities of daily living. Also, to prevent, insofar as possible, irreducible or progressive disabilities, through means such as the use of orthotic and prosthetic appliances, assistant and adaptive devices, positioning, behavior adaptions, and sensory stimulation. C.The therapist shall function closely with the individual's primary physician and with other medical specialists. Treatment-training progress shall be regularly recorded, evaluated periodically, and used as the basis for continuation or change of the person's program. D.Evaluation results, treatment objectives, plans, procedures and continuing observations of treatment progress shall be recorded accurately, summarized and communicated to all physicians and other staff involved. These reports shall be used in evaluating progress and included in the individual's record. E.There shall be available sufficient, appropriately qualified staff, and supporting personnel, to carry out the various physical and occupational therapy services in accordance with stated goals and objectives. Physical and occupational therapy personnel shall be assigned responsibilities in accordance with their qualification, delegated authority commensurate with their responsibilities and provided appropriate professional direction and consultation. F.To provide efficient and effective physical and occupational therapy services, there shall be adequate space, facilities, equipment, supplies and resources. AUTHORITY NOTE:Promulgated in accordance with R. S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5539.Speech Pathology and Audiology A.If a facility admits persons with a need for speech pathology and/or audiology services, these shall be rendered as appropriate through: 1.direct contact between speech pathologists, audiologists and the students; and 2.working with other personnel, such as teachers and direct-care staff, in implementing communication improvement programs in environmental settings. B.Speech pathology and audiology services available to the facility shall include: 1.screening and evaluation of the persons in care with respect to speech and hearing functions; 2.comprehensive audiological assessment of all persons, as indicated by screening results, to include tests of puretone air and bone conduction, speech audiometry, and other procedures, as necessary, and to include assessment of the use of visual cues; 3.assessment of the use of amplification; 4.provision for procurement, maintenance and replacement of hearing aids, as specified by a qualified audiologist; 5.comprehensive speech and language evaluation of each person, as indicated by screening results, including appraisal of articulation, voice, rhythm, and language; 6.participation in the continuing interdisciplinary evaluation of individuals for purposes of initiation, monitoring, and follow-up of individualized habilitation programs; 7.treatment services interpreted as an extension of the evaluation process, that include: a.direct counseling with the persons in care; b.consultation with appropriate staff for speech improvement and speech education activities; and c.collaboration with appropriate staff to develop specialized programs for developing the communication skills of individuals in comprehensive (for example, speech, reading, auditory training, and hearing aid utilization) as well as expression (for example, improvement in articulation, voice, rhythm, and language); and 8.participation in in-service training programs for direct-care and other staff. Evaluation and assessment results shall be reported accurately and systematically, and in such manner as to, where appropriate, provide information useful to other staff working directly with the resident; and provide evaluative and summary reports for inclusion in the individual's record. C.There shall be available sufficient, appropriately qualified staff, and necessary supporting personnel to carry out the various speech pathology and audiology services, in accordance with stated goals and objectives. Staff who assume independent responsibilities for clinical services shall be licensed, if applicable, by the state in which practicing, and: 1.shall be eligible for a certificate of clinical competence in the appropriate area (speech pathology or audiology) granted by the American Speech and Hearing Association under its requirements in effect on the publication of this provision; or 2.meet the educational requirements for certification, and be in the process of accumulating the supervised experience required for certification. Adequate, direct and continuing supervision shall be provided personnel, volunteers, or supportive personnel utilized in providing clinical services. D.To provide efficient and effective speech pathology and audiology services, there shall be adequate space, facilities, equipment and supplies. E.Speech pathology and/or audiology services, when needed, shall be provided through any reasonable arrangement including, but not limited to, consultation with a speech pathologist/audiologist. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5541.Recreation Services A.Recreational services shall be coordinated with other services and programs which are provided, in order to make fullest possible use of the facility's resources and to maximize benefits to all concerned. B.Records concerning those in care shall include periodic surveys of their recreation interests and the extent and level of each person's participation in the activities program. C.There shall be sufficient, appropriately qualified recreation staff and necessary supporting staff to carry out the various recreation services in accordance with stated goals and objectives. Personnel conducting the recreation program shall have at least demonstrated proficiency and experience in conducting activities in one or more program areas. D.Recreation areas and facilities shall be designated and constructed or modified so as to be easily accessible to all persons regardless of their disabilities. This area shall be of such a design or location as to be safe and not be a hazard. E.Recreation equipment and supplies in sufficient quantity and variety shall be provided to carry out the stated objectives of the activities programs. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5543.Design and Equipage A.Plant 1.The Day Care Center shall be constructed, equipped, and maintained to insure the safety of all concerned. It is structurally sound and satisfies the following. a.The facility complies with all applicable state and local codes governing constructions. b.Fire resistant and flame-spread ratings of construction, materials, and finishes comply with current state and local fire protection codes and ordinances. c.Fire extinguishers are conveniently located on each floor and in special hazard areas such as boiler rooms, kitchens, laundries, and storage rooms. Fire regulations are prominently posted and carefully observed. d.Unless the facility is of fire resistant construction, individuals physically handicapped or mentally retarded are not permitted to occupy floors above the street level. e.The building shall be maintained in good repair and kept free of hazards such as those created by any damaged or defective parts of the building. B.Space Required 1.Indoor Space a.There shall be a minimum of 35 square feet of space per student. Kitchens, bathrooms, halls used as passageways, family bedrooms, lockers, laundry rooms, built-in cabinets and any other quarters with furniture used as family living space shall not be considered as floor space available for students. b.There shall be open shelves within easy reach of the students for the storage of play material and closed shelves for the storage of school supplies and equipment. c.There shall be individual space for students' clothing, such as lockers or low hooks. d.The rooms used primarily for the students should be located so as to receive the maximum amount of sunlight and shall be well ventilated and lighted. 2.Outdoor Space a.There shall be outdoor play space provided for the students; there shall be a minimum of 75 square feet for each student in the group at any one time. The minimum outdoor play space shall be available for at least one-half the number of students in care. b.The outdoor play space shall be enclosed in such a manner as to protect the children from traffic hazards and to prevent the children from leaving the premises without proper supervision. For centers located away from streets or other hazards, enclosing of the outside play space may be waived. c.The outdoor play space shall be kept free of broken glass and other debris. The grounds will be well groomed at all times. d.Equipment and placement of equipment shall be such that it will not be dangerous to the life or health of the person using it. 3.Furnishings and Equipment a.Chairs and tables shall be adequate in number to serve the students. They shall be of a size suitable to the group in care. b.Each child under 6 years of age shall be provided with a cot or bed or pallet for rest periods. If beds or cots are provided, the beds or cots shall be at least 18" apart. c.Individual bedding, sufficient to maintain warmth, shall be provided either by the parents or the school. Covers shall be laundered as needed and always upon change of occupancy. 4.Environmental Hygiene a.Minimum Toilet Facilities. There shall be adequate, separate toilet facilities for male and female students. b.Hand Washing Facilities. There shall be adequate lavatories to meet the needs of the students. There shall also be a soap dispenser and individual towels, preferably paper towels. c.Drinking Fountains. Drinking fountains, when available, shall be of a type approved by the State Board of Health. If a fountain is not available, disposable paper cups must be used. d.Refrigeration. Adequate refrigeration for food must be maintained. Refrigerators should be kept at 50 degrees Fahrenheit or below. Drink or milk bottles must not be submerged in liquid. Where food is prepared in the facility, adequate means of washing and sanitizing dishes and utensils shall be provided. All food, especially meats, milk, eggs, and seafood must be obtained from approved sources. 5.Heating a.An approved heating system for the building must be used. All gas heaters or stoves must be vented to the outside air. Open fireplaces and accessible heaters must be screened or guarded to protect against burn accidents. 6.Safety Aspects a.Stairwells shall be kept free of obstruction and fire exit doors maintained and in working order, and swing to the egress. All stairways shall be equipped with handrails. b.Materials harmful to children, such as cleaning materials, cleaning solvents, detergents, and matches shall be kept out of the reach of students. Medication shall be stored separately and in locked facilities. c.All gas appliances shall be solidly connected with rigid piping and installed in accordance with the rules and regulations of the local building code. All unused gas connections shall be removed or properly capped. No open electric sockets or loose electric wires shall be within the reach of the persons cared for. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5545.Safety and Sanitation A.There shall be a written staff organization plan and detailed written procedures for meeting all potential emergencies and disasters pertinent to the area, such as fire, severe weather, and missing persons. These plans and procedures shall be posted at suitable locations throughout the facility. B.Evacuation drills shall be held at least quarterly for each shift of facility personnel, in residential facilities. (Monthly for day-care facilities). C.Drills shall be held under varied conditions in order to insure that all personnel are trained to perform assigned tasks and that all personnel are familiar with the use of the firefighting equipment in the facility. D.Evacuation drills shall include actual evacuation of all persons to safe areas during at least one drill each year, on each shift. There shall be special provisions for the evacuation of the physically handicapped. There shall be a written, filed report and evaluation of each evacuation drill. E.Paint used inside the facility shall be lead-free. Old paint or plaster containing lead shall have been removed, or covered in such manner that is not accessible to those in care. F.The facility shall be accessible to and functional for those cared for, the staff, and the public. All necessary accommodations must be made to meet the needs of persons with semi-ambulatory disabilities, sight and hearing disabilities of coordination, as well as other disabilities. G.Necessary accommodations shall include: 1.the facility grounds must be graded to the same level as the primary entrance so that the building is accessible to the physically handicapped; 2.the width and grade of walks used by handicapped individuals and the public, must be designed so that they can be utilized by the handicapped; 3.if the facility has a parking lot, a properly designated parking space available near the building, allowing room for the physically handicapped to get in and out of an automobile onto a surface suitable for wheeling and walking, must be provided; 4.all ramps shall be designed so that they can be negotiated by individuals in wheelchairs; 5.there shall be a primary entrance usable by persons in wheelchairs; 6.doors used by the handicapped and the public shall be of sufficient width and so equipped and of a weight to permit persons in wheelchairs to open them with a single effort; 7.stairs that may be used by the physically handicapped shall be of a height and design that allows such individuals to negotiate them without assistance; 8.stairs shall be equipped with handrails, at least one of which must extend past the top and bottom steps; 9.there shall be an appropriate number of toilet rooms accessible to and usable by the handicapped; 10.there shall be an appropriate number of water fountains accessible to and usable by the handicapped; 11.there shall be an appropriate number of public telephones accessible to and usable by the handicapped; 12.switches and controls of frequent or essential use shall be within reach of wheelchair users; 13.the facility shall provide appropriate means for the blind to identify rooms, facilities, and hazardous areas; 14.safeguards shall be taken to eliminate hazards for the handicapped; 15.closets assigned to physically handicapped residents shall be accessible to and usable by him; 16.beds assigned to residents in wheelchairs shall be of a height that permits them to get in and out of bed unassisted. H.The certification agency may waive in existing building, for such periods as deemed appropriate, any of these standards which, if rigidly enforced, would result in unreasonable hardship upon the facility, but only if such waiver will not affect the health and safety of the persons cared for. I.There shall be records that document strict compliance with the sanitation, health, and environmental safety codes of the state or local authorities having primary jurisdiction over the facility. Written reports of inspections by state or local authorities and records of action taken on their recommendations, shall be kept on file at the facility. J.The facility shall have an appropriate and written preventive maintenance program. There shall be sufficient personnel to accomplish the required engineering and maintenance functions, either directly or through arrangements. The following standards must be met in addition to the general standards by all facilities caring primarily for mentally retarded persons. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5547.Records A.A complete record shall be maintained for each individual that is adequate for: 1.planning and continuous evaluation of the individual's habilitation and educational program; 2.furnishing documentary evidence of the individual's progress and of this response to his habilitation programs; and 3.protecting the legal rights of the individual facility, and staff. B.All entries in the individual's records shall be legible, dated, and authenticated by the signature and identification of the person making the entry. C.Symbols and abbreviations are to be used in record entries only if a legend is provided to explain them. D.The following information shall be entered in the individual's record at the time of admission to the facility: 1.identification data on the individual; including name, date and place of birth, date of admission, citizenship status, Social Security number, legal status, sex, race, height, weight, color of hair, color of eyes, identifying marks, and a recent photograph; 2.the individual's family history; including the parents' names, their birthdates and birth places, their marital status, their educational backgrounds, religious affiliations, and their employment records; 3.the individual's medical history, both physical and mental, including any prior institutionalization; 4.the type and legal status of the individual's admission to the facility and his legal competency statusl 5.the sources of the individual's support, including Social Security, veterans' benefits, other forms of governmental assistance or insurance; 6.reports on the pre-admission evaluation and any other histories, evaluations, and examinations; 7.the immunization record. If immunization records are not complete, a statement from a physician with reasons for incomplete immunization; 8.written authorizations for field trips, photos, emergency medical assistance, inclusion in research projects, etc. E.Other information which shall be included in the individual's record is as follows: 1.his grievances, if any; 2.any inventory of his life skills; 3.records of subsequent physical or mental examinations; 4.a copy of his plan and any modifications thereto and an appropriate summary to guide the facility's staff in implementing his program; 5.a monthly summary of his response to his program, prepared by qualified professionals involved in the treatment, including an analysis of the successes and failures of the plan and a recommendation for any modification deemed necessary. A summary of the person's response to his program shall be forwarded at least quarterly to the funding agency; 6.a copy of the plan for the individual which will take effect when he leaves the facility and a summary of the steps that have been taken to implement that program; 7.the history and present status with respect to medication and a record of any seizures, illnesses, treatments thereof, and immunizations; 8.a signed order by the appropriate qualified professional for any physical restraints and a record of all periods of justification and authorization for each; 9.a summary of family visits and contracts, as well as attendance and leaves, from the facility; 10.a description of any extraordinary incident or accident in the facility involving the individual to be entered by a staff member noting his personal knowledge of the incident or accident or other source of information, including any reports of investigations or mistreatment of the individual, as required elsewhere in these standards. F.At the time of discharge or transfer from the facility, a discharge summary shall be prepared and shall be available to the parents or the funding agency. With the permission of the parent, the discharge summary shall also be forwarded to any facility which the student attends subsequently. G.The records for each individual shall be readily available to the appropriate qualified professionals and staff members who are directly involved with the particular individual. H.The parent, tutor, or guardian of the child shall also be permitted access to these records. I.All information contained in an individual's record shall be considered privileged and confidential. J.The record is the property of the facility, whose responsibility it is to secure the record against loss, defacement, tampering, or use by unauthorized persons. K.There shall be written policies governing access to duplication of and dissemination of information from the record. L.Written consent of the individual, if competent and of the age of majority, or his guardian shall be required for the release of information to persons not otherwise authorized to receive it. M.The individual's records shall be maintained in an organized manner appropriate to the needs of the facility and the individual served. N.Records shall be retained for a period consistent with the statute of limitations, of the Department of Health, Education, and Welfare regulations. O.There shall be available sufficient, appropriately qualified staff and necessary supporting personnel to facilitate the accurate processing, checking, indexing, filing, and prompt retrieval of records and record data. The following standards must be met in addition to the general standards by all facilities caring primarily for mentally ill. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5549.Staff Composition and Organization A.The psychiatric facility shall be responsible for evaluating and ensuring that the fundamental needs of the persons in care are provided for. To meet this responsibility, the facility shall have available the services of a sufficient number of appropriately qualified mental health professionals. These shall include but are not limited to qualified psychiatrists, qualified psychologists, and qualified social workers. When these qualified professionals are not available on a full-time basis, arrangements shall be made to obtain their services on at least a continuing consulting basis. Their authority and participation shall be such that they are able to assume professional responsibility for supervising and reviewing the needs of the individuals and the services being provided. B.In addition, there shall be a sufficient number of other qualified mental health professionals and paraprofessionals as necessary to carry out the particular clinical programs provided by the facility and to provide quality clinical services. They include but are not limited to other physicians; child psychiatric nurses; child care workers; educators; speech, hearing, and language specialists; activity therapists, recreational therapists; and vocational counselors. There shall be an adequate number of administrative personnel to provide the necessary support for the administrative and clinical programs. C.The composition of the staff shall be determined by the facility, based on an assessment of the needs of the persons being served, the facility's goals, the programs provided, and all applicable federal, state, and local laws and regulations. Factors to be considered in determining appropriate staff composition include (1) number of persons in care, (2) type and severity of handicap, (3) amount of time the persons are in the care of the facility, and (4) the type of program offered by the facility. Many identical or similar services or functions may be rendered competently by individuals of various professionals. D.The facility shall develop a staffing pattern which shall provide for adequate staff coverage at all times. Special attention shall be paid to the time of day when additional attention or supervision is required, e.g., upon awakening in the morning, during meals, late afternoon play, transitions between activities and bedtime. Staffing on nights, weekends, and holidays shall be adequate to maintain continuity of programs and care. The ratio of direct-care staff shall not, however, be less than that set out in the general standards. E.There shall be at least one direct care staff person on duty in any area of the facility where persons are present or are expected to be present. F.The qualified professional staff shall have the responsibility for determining which staff members shall be assigned specific treatment responsibilities. Those individuals, whether professional or paraprofessional, who are assigned specific treatment responsibilities shall have training or experience and demonstrated competence, or they shall be supervised by a professional who is qualified by experience to supervise such specific treatment. Before any member of the staff is assigned responsibility for carrying out any individual or group treatment services, the qualified professional responsible for the person(s) shall develop and implement policies which will ensure adequate supervision where indicated. G.The residential psychiatric facility shall have coverage by qualified child psychiatrists, psychiatrists or other physicians on a 24 hour basis each day of the week that the facility is in operation. The on-call physician(s) shall be readily available by phone or page. Medical care shall be available to any resident within 30 minutes. Each physician providing coverage shall have had training or experience in caring for those with mental or emotional disorders and shall be familiar with the programs of the facility and the persons residing there. H.The facility's written staff organization plan shall delineate all clinical staff members who are assigned responsibility, on any shift, for supervision of other staff involved in direct care. I.The facility shall have an organizational chart which specifies the relationships among the governing body, the director, the administrative staff, the clinical staff, and supporting services; their respective areas of responsibility; the lines of authority involved; and the types of formal liaison between the administrative and clinical staff. The organizational chart shall also reflect medical responsibility for the care of all individuals. J.The administrative and clinical staff shall be organized to carry out effectively the policies and programs of the facility. K.The organizational chart shall reflect relationships with affiliate agencies which provide services by these standards. L.The organizational plan shall be reviewed at least annually. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5551.Records A.Records shall be written and maintained in order to: 1.serve as a basis for planning for the individual in care; 2.provide a means of communication among all appropriate staff who are involved in the treatment; 3.justify and substantiate the adequacy of the evaluation and to form the basis for the ongoing development of the treatment plan; 4.facilitate continuity of treatment and enable the staff to determine, at a future date, what the individual's condition was at a specific time and what procedures were used; 5.furnish documentary evidence of ordered and supervised treatments, observations of the person's behavior, and responses to treatment; 6.serve as a basis for review, study, and evaluation of the treatment rendered; 7.protect the legal rights of the person, the facility, and staff; 8.provide data, when appropriate, for use in research and education. B.Where parents or other family members are involved in the treatment program, appropriate documentation shall exist for them although there may not have to be a separate record for each family member involved. C.While form and detail of the record may vary, all records shall contain all pertinent information and each person's record shall contain at least: 1.identification data and consent forms; when these are unobtainable, reasons shall be noted; 2.source of referral; 3.reason for referral, e.g., chief complaint, presenting problem; 4.record of the complete evaluation; 5.initial formulation and diagnosis based upon the evaluation; 6.written treatment plan. The treatment plan should include: a.a diagnostic statement including psychiatric diagnosis as well as pertinent social and medical diagnostic information; b.a statement of identified problems; c.long and short-term treatment goes related to the problems; d.treatment modalities to be utilized; e.identification of persons assigned to carry out treatment; f.signatures of the physician authorizing the treatment plan: i.the treatment plan shall be modified as frequently as patient assessment indicates the need for change. It shall be reviewed at least every three months. The treatment plan shall reflect appropriate multi-disciplinary input by the staff, and shall reflect evidence of participation in the planning and approval of the plan by a qualified psychiatrist. Procedures that place the patient at physical risk or cause pain shall require special justification. Rationale for their use shall be specified in the treatment plan and shall be specifically reviewed and approved by a qualified psychiatrist; 7.history and record of all medications prescribed; 8.record of all medications administered by facility staff, including type of medication, dosages, frequency of administration, and person who administered each dose; 9.specific signed physician's authorization for any treatment which may place the individual at physical risk or cause pain (including physical restraint or seclusion) and detailed record of the cause of such treatment; 10.immunization record, record of adverse reactions and sensitivities to specific drugs; 11.documentation of course of treatment and all evaluations and examinations through progress notes; 12.a monthly summary of the person's response to his program prepared by qualified professionals involved in the treatment, including an analysis of the successes and failures of the plan and a recommendation for any modifications deemed necessary; 13.a summary of family visits and contacts as well as attendance and leaves from the facility and all consultations with the family; 14.all other appropriate information obtained from outside sources pertaining to the patient and reports of all extraordinary incidents or accidents; 15.discharge summary; and 16.plan for follow-up and documentation of its implementation. D.Identification data and consent forms shall include the individual's name, address, home telephone number, date of birth, sex, Social Security number, race, height, color of hair and eyes, identifying marks, next of kin, school and grade or employment information, date initial contact and/or admission to the facility, legal status and legal documents, and other identifying data as indicated. E.Identifying data on person's family shall include parents' names, their birthdate, their marital status, educational background, religious affiliations, and employment records. Additionally, the names, birthdates, educational and employment records of siblings shall be included where possible. F.If the child or adolescent is in legal custody of individuals other than his parents, information on his guardian shall be included identical to that on the parent. G.A recent photograph of the patient shall be included in the record. H.Other information which shall be included in the individual's record is as follows: 1.the individual's medical history, both physical and mental, including any prior evaluations, examinations, and institutionalizations; 2.the sources of the individual's support, including Social Security, veteran's benefits, other forms of governmental assistance or insurance; 3.written authorization for field trips, photos, emergency medical assistance, inclusion in research projects, etc.; 4.the individual's grievances, if any; 5.an inventory of the individual's life skills. I.Progress notes shall include regular notations by staff members, consultation reports and signed entries by authorized, identified staff. Notes and entries should contain all pertinent and meaningful observations and information. Progress notes by the clinical staff shall: 1.document a chronological picture of the patient's clinical course; 2.document all treatment rendered to the patient; 3.document the implementation of the treatment plan; 4.describe each change of the individual's conditions, responses of the person and his family to any significant events. J.The discharge summary shall reflect the general observations and understanding of the individual's condition initially, during treatment, and at the time of discharge, and shall include a final appraisal of his fundamental needs. All relevant discharge diagnosis shall be recorded and coded in the standard nomenclature of the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. K.Entries in the person's records shall be made by all staff having pertinent information regarding the individual. Authors shall clearly sign and date each entry. Signature shall include position title. When mental health trainees are involved in the person's care, documented evidence shall be in the clinical record to substantiate the active participation of supervisory clinical staff. Symbols and abbreviations shall be used only when they have been approved by the clinical staff and when there is an explanatory legend. Final diagnosis―psychiatric, physical, and social―shall be recorded in full, and without the use of either symbols or abbreviations. L.A facility shall have written policies and procedures regarding records which shall provide that: 1.all records shall be confidential, current, and accurate; 2.all records are the property of the facility and are maintained for the benefit of the person in care, the staff, and the facility; 3.the facility is responsible for safeguarding the information in the record against loss, defacement, tampering, or use by unauthorized persons; 4.the facility shall protect the confidentiality of information and communications among staff members and those in care; 5.except as required by law, the written consent of the individual, family or other legally responsible parties is required for the release of information; 6.records may be removed from the facility only according to the policies of the facility or as required by law and with authorization for release, appropriate records should be made available to any facility which the person subsequently attends as well as to his parents or legal guardians and to state agencies having responsibility for the care of the person. M.There shall be evidence that all staff have received training, as part of new staff orientation and with periodic update, regarding the effective maintenance of confidentiality. This refers to discussions regarding patients inside and outside the facility as well as to records. Verbal confidentiality shall be discussed as part of employee training. N.Appropriate records shall be directly and readily accessible to the staff caring for the person. The facility shall maintain a system of identification and filing to facilitate the prompt location of records. O.There shall be written policies regarding the permanent storage, disposal/and/or destruction of records. P.Records shall be retained for a period consistent with the prescriptive period of the state of Louisiana and consistent with the statute of limitations, of the Department of Health, Education, and Welfare regulations. The following standards must be met in addition to the general standards by all facilities caring primarily for learning disabled persons. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980. HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987). §5553.Records A.A complete record shall be maintained for each individual that is adequate for: 1.planning and continuous evaluation of the individual's habilitation and educational program; 2.furnishing documentary evidence of the individual's progress and of his response to his habilitation program; and 3.protecting the legal rights of the individual facility, and staff. B.All entries in the individual's record shall be legible, dated, and authenticated by the signature and identification of the person making the entry. C.Symbols and abbreviations are to be used in record entries only if a legend is provided to explain them. D.The following information shall be entered in the individual's record at the time of admission to the facility: 1.identification data on the individual, including name, date, and place of birth, date of admission, citizenship status, Social Security number, legal status, sex, race, height, weight, color of hair, color of eyes, identifying marks and a recent photograph; 2.the individual's family history, including the parents' names, their birthdates and birthplaces, their marital status, their educational backgrounds, religious affiliations, and their employment records; 3.the individual's medical history, both physical and mental, including any prior institutionalization; 4.the type and legal status of the individual's admission to the facility and his legal competency status; 5.the sources of the individual's support, including Social Security, veteran's benefits, other forms of governmental assistance or insurance; 6.reports on the pre-admission evaluation and any other histories, evaluations, and examinations; 7.the immunization record. If immunization records are not complete, a statement from a physician with reasons for incomplete immunization; 8.written authorizations for field trips, photos, emergency medical assistance, inclusion in research projects, etc. E.Other information which shall be included in the individual's record is as follows: 1.his grievance, if any; 2.any inventory of his life skills; 3.records of subsequent physical or mental examinations; 4.a copy of his plan and any modifications thereto and an appropriate summary to guide the facility's staff in implementing his program; 5.a monthly summary of his response to this program, prepared by qualified professionals involved in the treatment, including an analysis of the successes and failures of the plan and a recommendation for any modifications deemed necessary. A summary of the person's response to his program shall be forwarded at least quarterly to the funding agency; 6.a copy of the plan for the individual which will take effect when he leaves the facility and a summary of the steps that have been taken to implement that program; 7.the history and present status with respect to medication and a record of any seizures, illnesses, treatments thereof, and immunizations; 8.a signed order by the appropriate qualified professional for any physical restraints and a record of all periods of justification and authorization for each; 9.a summary of family visits and contacts, as well as attendance and leaves, from the facility; 10.a description of any extraordinary incident or accident in the facility involving the individual to be entered by a staff member noting his personal knowledge of the incident or accident or other source of information, including any reports of investigations of mistreatment of the individual, as required elsewhere in these standards. 11.periodic updating of the information recorded at the time of admission. F.At the time of discharge or transfer from the facility, a discharge summary shall be prepared and shall be available to the parents or the funding agency. With the permission of the parent, the discharge summary shall also be forwarded to any facility which the student attends subsequently. G.The records for each individual shall be readily available to the appropriate qualified professionals and staff members who are directly involved with the particular individual. H.The parent, tutor, or guardian of the child shall also be permitted access to these records. I.All information contained in an individual's record shall be considered privileged and confidential. J.The record is the property of the facility, whose responsibility it is to secure the record against loss, defacement, tampering, or use by unauthorized persons. K.There shall be written policies governing access to duplication of and dissemination of information from the record. L.Written consent of the individual, if competent and of the age of majority, or his guardian shall be required for the release of information to persons not otherwise authorized to receive it. M.The individual's words shall be maintained in an organized manner appropriate to the needs of the facility and the individual served. N.Records shall be retained for a period consistent with the prescriptive period of the state of Louisiana and consistent with the statute of limitations, of the Department of Health, Education, and Welfare regulations. O.There shall be available sufficient appropriately qualified staff and necessary supporting personnel to facilitate the accurate processing checking, indexing, filing and prompt retrieval of records and record data. AUTHORITY NOTE:Promulgated in accordance with R.S. 46:1971 through 1980 HISTORICAL NOTE:Promulgated by the Department of Health and Human Resources, Office of the Secretary, Division of Licensing and Certification, LR 13:246 (April 1987).