902 KAR 20:078 - Operations and services; group homes
RELATES TO: KRS 216B.010, 216B.015, 216B.040, 216B.042, 216B.045-216B.055, 216B.075, 216B.105-216B.131, 216B.990, 311.560(4), 314.011(8), 320.210(2)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Kentucky Cabinet for Health Services to regulate health facilities and health services. This administrative regulation establishes licensure requirements for group homes.
Section 1. Definitions.
(1) "Developmental disability" means a severe
chronic disability which is attributable to a mental or physical impairment or
combination of mental and physical impairments manifested before the person
attains the age of twenty-two (22) and is likely to continue indefinitely. This
disability results in substantial limitations in areas of major life activity
including self-care, receptive and expressive language, learning, mobility,
capacity for independent living and economic sufficiency and requires
individually planned and coordinated services of a lifelong or extended
duration.
(2) "Mental retardation"
means a significantly subaverage general intellectual functioning existing
concurrently with deficiencies in adaptive behavior which is first manifested
during the developmental period.
(3) "Normalization principle" means the
utilization of means which are as culturally normative as possible in order to
establish and maintain personal behavior and characteristics which are as
culturally normative as possible.
(4) "Qualified mental retardation or
developmental disability professional" means:
(a) A physician with specialized training or
one (1) year of experience in treating persons with mental retardation or
developmental disabilities;
(b) A
psychologist with a doctoral or master's degree from an accredited program with
specialized training or one (1) year of experience in treating persons with
mental retardation or developmental disabilities;
(c) An educator with at least a bachelor's
degree in education and with specialized training or one (1) year of experience
in working with persons with mental retardation or developmental
disabilities;
(d) A social worker
with at least a bachelor's degree from an accredited program and with
specialized training or one (1) year of experience working with persons having
mental retardation or developmental disabilities, or a field other than social
work and at least three (3) years of social work experience under the
supervision of a qualified social worker;
(e) A licensed physical therapist or an
occupational therapist who is a graduate of a program of physical or
occupational therapy approved by the Council on Medical Education of the
American Medical Association and who has specialized training or one (1) year
of experience in treating persons with mental retardation or developmental
disabilities;
(f) A speech
pathologist or audiologist who has been granted a certificate of clinical
competence by the American Speech and Hearing Association or who has completed
the equivalent educational and experimental requirements for such a certificate
and has specialized training or one (1) year of experience in training persons
with mental retardation or developmental disabilities;
(g) A registered nurse who has specialized
training or one (1) year of experience in treating persons with mental
retardation or developmental disabilities;
(h) A therapeutic recreation specialist who
is a graduate of an accredited program and licensed or registered by the state
if required; or
(i) A
rehabilitation counselor who is certified by the commission on Rehabilitation
Counselor Certification.
Section 2. Scope of Operations. A group home
shall provide a homelike environment and specialized services in accordance
with individualized habilitation plans to not less than four (4) nor more than
eight (8) persons with mental retardation or developmental disabilities, at a
location not adjacent to or part of a mental health or mental retardation
institution.
Section 3.
Administration and Operations.
(1) Licensee.
The licensee shall be legally responsible for the group home and for compliance
with federal, state and local laws and regulations pertaining to the operation
of the home.
(2) Manager. The group
home shall have a manager who is responsible for the full-time operation of the
home and for implementing programs as delineated. The manager shall be at least
twenty-one (21) years of age and a high school graduate or
equivalent.
(3) In the absence of
the manager, responsibility shall be delegated to a similarly qualified staff
person, to be on site when a resident is present.
(4) Advisory board. Each group home shall
have a specific group of individuals, organized as an advisory board, who shall
establish policies concerning the operation of the group home and the welfare
of the individuals residing in the home. The advisory board shall meet at least
quarterly. The advisory board shall be composed of at least three (3) members
and shall include representatives from each of the following groups:
(a) Mental retardation or developmental
disability representative from regional mental health and mental retardation
board;
(b) A parent or guardian of
an individual with mental retardation or developmental disability or a consumer
advocate knowledgeable of the needs of group home residents; and
(c) A qualified mental retardation or
developmental disability professional.
(5) Policies. The licensee shall develop,
with the input of the advisory board:
(a) A
written outline of the objectives and goals it is striving to achieve. The
outline shall be available for public distribution; and
(b) A written policy to include description
of procedures for:
1. Current routine
operations;
2. Protection of
resident rights;
3. Protection of
resident financial interests; and
4. Reporting of cases of abuse, neglect or
exploitation of an adult or child pursuant to KRS Chapters 209 and
620.
(6) The
licensee shall incorporate the normalization principle into its objectives and
shall implement programs consistent with this principle.
(7) The licensee shall establish a job
description for group home personnel and shall delegate necessary authority for
the daily management of the group home program.
(8) The licensee shall conduct an annual
program evaluation.
(9) The way
residents are represented to the public shall be appropriate to the purposes
and programs of the group home and shall not emphasize mental retardation or
deviancy.
(10) The advisory board
shall appoint a services committee which shall be responsible for:
(a) Decisions pertaining to resident
admissions, transfers and discharges.
(b) Assuring that a comprehensive
habilitation plan is established for each resident on an individual
basis.
(11) The services
committee shall:
(a) Be composed of the
manager and two (2) other persons, both of whom shall be qualified mental
retardation and developmental disability professionals.
(b) Determine eligibility for admission based
on areas of comparable need for programming. If the chronological age span of
the program participants exceeds five (5) years for individuals twelve (12)
years or younger, ten (10) years for individuals aged thirteen (13) to eighteen
(18), and twenty (20) years for individuals eighteen (18) years and older,
written justification demonstrating the appropriateness of the program shall be
a part of the individual habilitation plan.
(12) Upon admission a resident shall be free
from communicable disease which is reportable to the health department, except
a noninfectious tuberculosis patient under continuing medical supervision for
tuberculosis. Thirty (30) days prior to or within fourteen (14) days after
admission, a resident shall have a physical examination.
(13) The services committee shall assure that
the following information is a part of each resident's record:
(a) Persons to contact in case of
emergency;
(b) Next of
kin;
(c) Legal competency status
and presence or absence of committee; and
(d) Financial resources.
Section 4. Personnel.
(1) The group home shall employ an adequate
number of supervisory and direct care personnel and establish an on-call
procedure to assure that the home has staff present when a resident is
present.
(2) Volunteers may be
utilized but not substituted for the employment of full- or part-time
staff.
(3) The group home shall
provide an employee orientation program to include:
(a) History of retardation;
(b) Normalization principle;
(c) Habilitation planning techniques;
and
(d) Basic first aid.
(4) A regular in-service program
for the entire staff shall be conducted at least four (4) times a year.
Volunteers may participate in the program.
Section 5. Services.
(1) Within thirty (30) days after admission
to the facility the services committee shall establish a comprehensive
habilitation plan for each resident. The resident's habilitation plan shall be
reviewed at least every ninety (90) days. In all cases, whether children or
adults, the resident or resident's representatives shall participate in the
development of the comprehensive habilitation plan.
(a) The plan shall address the following:
1. Sensorimotor needs;
2. Communicative needs;
3. Social needs;
4. Emotional needs;
5. Educational needs; and
6. Vocational training needs.
(b) The individual habilitation
plan shall outline the responsible parties for meeting each of the above listed
needs.
(c) Each resident's
habilitation plan shall be maintained as an integral part of the resident's
records.
(2) Availability
of services. The licensee shall assure that a comprehensive array of services
is available as needed by each resident of the group home. These services shall
be obtained from agencies through a written agreement. The following components
shall be available:
(a) Medical services,
including emergency medical services and an annual physical examination. For
women this examination shall include gynecological services.
(b) Dental services to include at least two
(2) visits annually.
(c)
Psychological and psychiatric services, to be available as needed according to
the resident's habilitation plan.
(d) Physical therapy.
(e) Social services, to include individual,
group and family counseling as appropriate, according to individual
needs.
(f) Occupational
rehabilitative services, to include vocational counseling, planning and
training as appropriate, according to individual needs.
(g) Speech therapy and audiology services, as
needed.
(h) Public education for
school age persons in accordance with
20 USC
1400.
(i) Recreational opportunities to provide the
resident with adequate physical fitness and constructive leisure time
activities.
Section
6. Physical Standards. The ultimate aim of the environment and
design for a group home shall be to foster those skills necessary for maximum
independence of the resident and enhance the resident's ability to cope with
his or her environment. To this end the following shall be required:
(1) Location.
(a) Group homes may be located in urban,
suburban or rural settings, but shall not be isolated from the mainstream of
their community, and shall be in an area zoned for residential use where
applicable. The residence shall have the style and appearance of neighborhood
houses.
(b) The group home shall be
located within thirty (30) minutes driving time of resident's day program
locations, medical and other professional services; and the usual array of
essential merchants: groceries, clothing stores, drug stores, etc. The home
shall be located within sixty (60) minutes driving time of a
hospital.
(c) Group homes shall not
be located in house trailers or motor homes.
(2) Resident accommodations.
(a) The residence shall house no less than
four (4) nor more than eight (8) residents.
(b) Other than residents, a person other than
the residence's staff and the staff's immediate family shall not reside in the
home.
(c) A bedroom shall contain
no more than two (2) beds with a minimum of sixty (60) square feet in single
rooms and eighty (80) square feet in multiple rooms. A bed shall be no less
than thirty-three (33) inches wide and six (6) feet long. Bunk beds shall not
be used.
(d) A bed occupied by a
resident shall be placed so that the resident shall not experience discomfort
because of proximity to a radiator, heat outlet, or exposure to drafts. Each
resident shall have his or her own bed equipped with substantial springs, a
clean comfortable mattress, two (2) sheets and a pillow, and bed covering as
required for the resident's health and comfort.
(e) Closet space and drawer space shall be
provided for personal belongings.
(f) A resident shall not be housed in a room,
a detached building or other enclosure which has not been previously inspected
and approved for resident use, or in a basement not constructed for sleeping
quarters. An approved basement shall have an outside door.
(g) Appropriate sanitary toilet and bathing
facilities shall be conveniently available for resident use with one (1)
toilet, lavatory and shower or tub for each six (6) persons residing in the
home, including residents and staff.
(h) Adequate ventilation in resident use
areas shall be maintained. Each resident bedroom shall have an exterior
screened window, which can be opened.
(i) If a private source of water is used, the
group home shall annually obtain written certification from an appropriate
agency that the supply is safe and sanitary. An ample supply of hot and cold
running water shall be available at all times.
(j) The group home shall have adequate
lighting by natural or artificial means in each hall, stairway, entryway,
vestibule, resident area, kitchen, and bathroom.
(k) A heating system which can maintain an
even temperature of seventy-two (72) degrees Fahrenheit in resident used areas
shall be provided.
(l) Adequate
common living areas shall be provided in the group home. This shall include
separate living, recreational and eating areas, each large enough to
accommodate residents and their visitors.
(m) Adequate laundry facilities shall be
available in the home or a conveniently located laundromat may be
used.
(n) Telephone service shall
be provided to the residents. This service shall be accessible to the residents
and shall afford a degree of privacy.
(o) Resident staff living quarters. Resident
staff living quarters shall provide privacy. Resident staff includes
managers.
(3) General
requirements.
(a) The facility shall conform
to the National Fire Protection Association 101, Life Safety Code adopted by
the Kentucky Department of Housing, Buildings and Construction relative to
group homes.
(b) The group home
shall conform to requirements for plumbing pursuant to
815 KAR 20:010 to
815 KAR 20:191, as amended.
(c) The group home shall conform to
requirements for making buildings and facilities accessible to and usable by
persons with disabilities.
(d) The
group home shall comply with applicable state and local laws relating to
sanitation, including insect and rodent control.
Section 7. Resident Care and Safety.
(1) Dietary.
(a) The group home shall provide at least
three (3) meals per day with not more than a fifteen (15) hour span between the
substantial evening meal and breakfast. One (1) or more of these meals may be
provided outside the group home depending upon the resident's habilitation
plan, but all meals are the financial responsibility of the group
home.
(b) Nutrition needs shall be
met in accordance with the current recommended dietary allowances of the Food
and Nutrition Board of the National Research Council and in accordance with
resident dietary restrictions.
(c)
A written record shall be kept of foods served.
(d) Food shall be stored off the floor in
such a manner as to be protected from dust, insects, rodents, birds, or other
forms of contamination. Food showing evidence of spoilage or infestation shall
be disposed of immediately upon detection.
(e) Each refrigerator shall have a complete
seal, be clean, free of odor, and kept at a temperature of forty-five (45)
degrees Fahrenheit or below. A thermometer that is easily readable shall be
placed in each refrigerator and freezer.
(2) Housekeeping and sanitation.
(a) The facility shall be kept in good
repair, clean, uncluttered and sanitary at all times. Floors, walls, ceilings,
lighting fixtures, storage areas and equipment shall be kept clean and in good
repair. Windows and doors shall be screened.
(b) The facility shall collect and dispose of
all garbage, refuse, trash, and litter in compliance with applicable state and
local laws and administrative regulations. Garbage containers shall be made of
metal or other impervious material, approved by the fire marshal, that will not
emit harmful vapors upon exposure to extreme heat, and shall be water tight and
rodent proof and shall have tight-fitting lids.
(3) Emergency procedures.
(a) Each group home shall have a fire control
and evacuation plan to be practiced at least quarterly with all staff and
residents participating.
(b) An
on-duty staff member shall be designated to be in charge of evacuation of
residents in the event of a fire or other natural disaster.
(c) Phone numbers of a hospital, an ambulance
service, the fire department, and a physician for emergencies shall be posted
by each telephone in large legible print.
(d) A report on an accident requiring medical
treatment of a resident shall be written and one (1) copy kept on file and made
available to the advisory board within seven (7) days of the incident. The
original shall be sent to the Cabinet for Health Services, Division for
Licensing and Regulation, 275 East Main Street, Frankfort, Kentucky.
(e) An incident report for a minor accident
shall be written, kept on file and made available upon request.
(4) Medications.
(a) A prescription medication administered to
a resident shall be noted in writing, with the date, time and dosage, and
signed by the person administering the medication. A medication shall be
plainly labeled with the patient's name, the name of the drug, strength, name
of pharmacy, prescription number, date, physician name, caution statement and
directions for use.
(b) Medication
shall not be administered to a resident except on the written order of a
physician or other practitioner acting within his statutory scope of practice.
If medication requires administration by a licensed person, an arrangement
shall be made to procure the services of a person licensed to administer
medication.
(c) A medication in the
home shall be kept in a locked cabinet. A controlled substance shall be kept
under double lock (e.g., in a locked box in a locked cabinet). There shall be a
controlled substance record in which is recorded the name of the patient; the
date, time, kind, dosage, balance remaining and method of administration of a
controlled substance; the name of the physician who prescribed the medication;
and the name of the nurse who administered it, or staff who supervised the
self-administration.
(d)
Self-administration of prescription medication shall be allowed only upon the
written instruction of the attending physician or other practitioner acting
within his statutory scope of practice.
(e) Each resident who requires prescription
medication shall receive regular evaluation of his response to the medication,
including appropriate monitoring and laboratory assessment.
(f) The group home shall comply with federal
and state law and regulation relating to the procurement, storage, dispensing,
administration and disposal of drugs.
(5) Restraints. Physical or chemical
restraint shall not be used.
Section
8. Resident Rights.
(1) Staff
shall recognize a resident's rights for:
(a)
Treatment which preserves his feelings of self-worth and dignity;
(b) Visitation;
(c) Privacy; and
(d) Freedom of worship.
(2) Staff shall not open resident
correspondence, except as authorized by the resident or his legal guardian or
committee.
(3) A resident shall be:
(a) Free from physical punishment;
(b) Appropriately dressed;
(c) Supplied with:
1. Clean washcloth and towel;
2. Toothbrush;
3. Hair brush and comb;
4. Other toilet articles; and
5. Bureau or cupboard for storage of personal
belongings.
(d) Allowed
rest periods in his own bed;
(e)
Allowed free movement within the group home, with access to all common areas;
and
(f) Allowed access to the
community at large.
Notes
STATUTORY AUTHORITY: KRS 216B.010, 216B.040, 216B.042
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.