Okla. Admin. Code § 340:100-5-22.1 - Community residential supports
(a)
Applicability. Community residential supports are funded through
contracts with the Oklahoma Department of Human Services DHS, Oklahoma Health
Care Authority (OHCA), or both, and must meet standards per this Section.
(1) A service recipient is considered
receiving community residential supports when the service recipient receives:
(A) daily living supports (DLS), per Oklahoma
Administrative Code (OAC)
317:40-5-150;
(B) Prader-Willi Syndrome services;
(C) agency companion services (ACS), per Part
1 of OAC 317:40-5; or
(D)
specialized foster care (SFC), per Part 5 of OAC 317:40-5.
(2) This Section does not apply to:
(A) group home services, per OAC 340:100-6;
or
(B) services provided to service
recipients who receive assisted living services, per OAC
340:100-5-22.2.
(b)
General
information.
(1) Services for children
are provided in family settings unless approved by the Developmental
Disabilities Services DDS Community Services Unit programs administrator or
designee.
(2) In addition to OAC
340:100-5-50
through
340:100-5-58,
the DDS case manager ensures each Personal Support Team (Team) assesses and
addresses the service recipient's needs regarding:
(A) safety in the home, including:
(i) storage of toxic chemicals, cleaning
supplies, and combustibles; and
(ii) use of a tempering valve or other
anti-scald device or lowered, hot water tank temperature to control water
temperature;
(B)
financial issues in addition to OAC
340:100-3-4,
including:
(i) a household budget that
provides adequate resources for housing, food, clothing, furnishings, personal
supplies, and recreational opportunities; and
(ii) assistance needed by the service
recipient in money management;
(C) selection, adaptation, and maintenance of
a home;
(D) community inclusion and
access to work, recreation, and therapies;
(E) transportation; and
(F) water safety.
(3) Each service recipient is responsible for
his or her room and board expenses, including recreational activities,
clothing, furnishings, food, and other expenses for services or supports not
funded through DHS, except as:
(A) provided
to members of the Homeward Bound class; or
(c)
Homes.
Community residential supports are provided in the service recipient's home.
The provider agency ensures:
(1) the home and
yard are clean, well-maintained, safe, hazard free, and adapted to the service
recipient's needs;
(2) the home
has:
(A) utility service and adequate
heating, cooling, and plumbing;
(B)
safety items in operating condition located in strategic locations in the home,
such as a:
(i) flashlight;
(ii) smoke detector;
(iii) carbon monoxide detector;
(iv) first aid kit;
(v) fire extinguisher; and
(vi) tempering valve or other anti-scald
device, when determined by the Team necessary to ensure the service recipient's
safety;
(C) phone
service is available and accessible to the service recipient. Emergency numbers
are available at each phone, including:
(i)
the DDS toll-free number;
(ii) the
fire, police, ambulance, hospital, and poison control, when not in a 911
area;
(iii) a physician name and
number; and
(iv) a nursing agency
number, when applicable;
(D) at least two means of exit;
(E) a bedroom of at least 80 square feet for
each service recipient living in the home. When a service recipient shares a
bedroom with another individual, the bedroom must have 120 square feet or
more;
(F) adequate enclosed storage
space available for personal items;
(G) laundry equipment, when in the home,
located in a safe, well ventilated, and clean area, with dryers vented to the
outside;
(H) an address clearly
visible from the street;
(I) a
bathroom that:
(i) includes a:
(I) flush toilet;
(II) fixed basin; and
(III) shower or bath tub that meets the
service recipient's needs;
(ii) is in proper working order;
(iii) provides privacy;
(iv) is adapted when needed; and
(v) provides hot and cold running water;
and
(J) a kitchen and
equipment to store, prepare, and serve food in a sanitary manner;
(3) dangerous or deadly weapons
are not permitted in the home, except as provided in OAC
317:40-5-40.
Provider agency staff is prohibited from assisting any service recipient to
obtain or possess dangerous or deadly weapons. Dangerous or deadly weapons
include, but are not limited to:
(A) guns, BB
guns, air rifles, or other firearms;
(B) crossbows;
(C) paint guns;
(D) arrows;
(E) explosives;
(F) stun guns; and
(G) knives, except cooking and eating
utensils; and
(4)
illegal substances are not permitted in the home.
(d)
Pre-service requirements.
The DDS case manager and service recipient, or, when applicable, legal
guardian, complete and approve steps (1) through (3) when community residential
supports are initiated, when the service recipient changes provider agencies,
and before the service recipient moves to a new home. The documentation of such
is maintained in the home record and the case manager record.
(1) Prior to service delivery, the provider
completes an emergency housing back-up plan for review and approval by the
service recipient's Team per OAC
340:100-5-52.
(A) The back-up plan contains the:
(i) service recipient's name;
(ii) description of the living
arrangement;
(iii) name and phone
number for back-up staff;
(iv)
back-up housing location;
(v)
written agreement by the:
(I) service
recipient or legal guardian;
(II)
direct provider of service, when an ACS or SFC provider;
(III) agency program coordination staff
(PCS), as applicable;
(IV) provider
agency administrative representative, as applicable; and
(V) DDS case manager;
(vi) dates for provider review of back-up
plan, required quarterly and as changes occur; and
(vii) review date by the DDS case
manager.
(B) When the
location for the back-up plan is a hotel or motel, the provider agency is
responsible for including a plan to pay the cost without additional
reimbursement from DHS.
(C) DHS
must complete a home profile on a private home prior to the Team's
identification of the home in the back-up plan or use of the home to provide
back-up services to the service recipient. A home profile is not required when
the service recipient stays in the private home of a relative, per (f)(4)(A) of
this Section.
(D) The ACS or SFC
provider is responsible for re-establishing a residence when his or her home
becomes uninhabitable.
(2) The provider agency cooperates with the
service recipient and Team to establish and maintain a household budget based
on the service recipient's earned and unearned income.
(A) Expenses associated with supporting the
household are maintained in an auditable fashion sufficient to track the use of
money collected from the service recipient by the contract provider.
(B) Upon request, the contract provider
furnishes to the service recipient, service recipient's family, and legal
guardian:
(i) a record of all funds collected
from the service recipient;
(ii)
documentation of how the money was used; and
(iii) the amount of remaining money held by
the provider.
(C) Upon
termination of residential supports from the contract provider, unused funds
are returned to the service recipient within 10- calendar days of service
termination date.
(3)
Form 06CB034E, Residential Pre-Service Checklist, is completed and this
Section's requirements are satisfied.
(e)
Service requirements.
(1) Unless the service recipient demonstrates
the ability under varying conditions to independently and appropriately respond
to emergency situations, the provider agency assists in conducting fire drills
at least quarterly and weather emergency drills twice a year. The dates, times,
and outcomes of the drills are available in the home for review.
(2) The provider:
(A) ensures all financial information
necessary for maintaining the service recipient's financial eligibility is
provided to DHS in a timely manner;
(B) when serving as payee, ensures the
service recipient maintains financial eligibility for benefits and services by
notifying appropriate authorities of a change in the service recipient's
income;
(C) when a change of payee
is necessary, cooperates to ensure the change is made in a timely
manner;
(D) establishes a written
financial agreement with the service recipient or legal guardian that defines
financial responsibilities of the provider's and service recipient's financial
responsibilities. The financial agreement:
(i)
accurately reflects the ongoing financial arrangement between the provider and
service recipient;
(ii) clearly
defines who purchases personal items;
(iii) is renewed annually and when changes
occur; and
(iv) is available to the
service recipient, legal guardian, Office of Client Advocacy advocate, and DDS
case manager;
(E) as a
member of the service recipient's Team, assists in determining safeguards
necessary to protect the service recipient's assets;
(F) allows service recipients to select
stores for the purchase of food, clothing, and personal items;
(G) implements the service recipient's
Individual Plan (Plan);
(H)
provides necessary assistance, including staff support for each service
recipient's active participation in community life;
(I) assists the service recipient in
maintaining an adequate supply of seasonal clothing that fits appropriately,
personal grooming materials, and linens. All items are maintained in good
condition;
(J) promotes the service
recipient's health and welfare, including providing meals that meet the service
recipient's nutritional needs;
(K)
promotes visitation and contact with each service recipient's natural family,
legal guardian, and friends, according to the service recipient's
desires;
(L) promotes friendships
with neighbors, co-workers, and peers, according to the service recipient's
desires;
(M) when the service
recipient, legal guardian, or provider wants to discontinue services,
cooperates in securing alternative services and continues to serve the service
recipient until the Team confirms all essential services are in
place;
(N) while providing
services, ensures staff is engaged at all times in purposeful activity that
directly or indirectly benefits the service recipient;
(O) ensures the service recipient attends
scheduled medical and therapy appointments.
(i) Transportation to the appointment is
provided.
(ii) Adequate records,
needed materials, and equipment accompany the service recipient to the
appointment.
(iii) When the service
recipient requires support in describing illness, issues, or concerns to the
health care provider, knowledgeable staff accompanies the service
recipient;
(P) ensures
the service recipient's prescriptions are filled and administered as
prescribed, per OAC
340:100-5-32;
(Q) ensures the Plan in a positive manner
addresses issues related to maintaining the home per (c) of this
Section;
(R) ensures the service
recipient has transportation to programs and services.
(i) Transportation is provided to and from:
(I) medical or therapy
appointments;
(II) personal
shopping;
(III) leisure or
recreational activities;
(IV)
vocational or employment activities;
(V) religious or cultural
activities;
(VI) Team
meetings;
(VII) appointments
necessary to secure or maintain needed services; and
(VIII) voting.
(ii) All vehicles used to transport the
service recipient meet local and state licensing, inspection, insurance, and
capacity requirements.
(iii) A
vehicle used to transport a service recipient with physical disabilities is
adapted to meet the service recipient's needs.
(iv) Drivers of vehicles have valid and
appropriate driver licenses.
(S) ensures the hot water temperature for the
home is set to no more than 120 degrees Fahrenheit. The provider tests the hot
water temperature of the home at least annually, after any servicing of the
home's water system, and any time the water temperature is believed to have
increased above 120 degrees Fahrenheit. The provider maintains test
documentation and the documentation at minimum includes the test date and the
home's hot water temperature. The documentation is maintained in the home and
available for inspection. The provisions within this paragraph will henceforth
be known as the Julie Teenor Anti-Scald Protocol; and
(T) ensures reasonable precautions are
employed for safety with hot food, cooking oils, and other hot
liquids.
(f)
Provider agency policies, practices, and procedures. The provider
agency develops and maintains written policies and procedures that are
consistent with DHS rules and govern all aspects of service provision.
(1) Provider agency policies are made
available to each service recipient, the service recipient's parent(s), legal
guardian, or advocate, provider agency staff, and DHS.
(2) Provider agency policies and procedures
include, but are not limited to:
(A) service
recipient rights protection;
(B)
services provided;
(C) admission
and discharge criteria;
(D)
grievance procedures;
(E)
prevention and reporting of abuse, neglect, and /or exploitation;
(F) confidentiality;
(G) emergency management;
(H) fees paid by service recipient;
(I) health and safety precautions;
and
(J) safeguarding service
recipient funds.
(3) The
provider agency designates one person who, in the absence of the agency
administrator, is responsible for the administration of the agency and is
empowered to act on behalf of the provider agency.
(4) The provider agency is responsible for
recruitment, screening, training, and supervision of staff or volunteers
providing direct services, ensuring direct support staff:
(A) is not supervised by a relative or person
living in the staff's home. A relative includes wife, husband, children,
parents, stepparents, parents-in-law, grandchildren, grandparents, brothers,
sisters, stepchildren, brothers-in-law, sisters-in-law, sons-in-law,
daughters-in-law, aunts, uncles, nieces, nephews, first cousins or any such
person with whom the employee shares a foster relationship;
(B) who provides back-up services is
available and has received training per OAC
340:100-3-38;
(C) is at least 18 years of age;
(D) is present in sufficient numbers to
ensure the service recipient's health and welfare, as authorized by the service
recipient's Plan of Care;
(E) is
physically able and mentally alert to carry out the job duties;
(F) implements and follows the service
recipient's Plan;
(G) does not take
the service recipient to visit staff's home unless the Team has provided prior
written approval; and
(H) must meet
requirements of OAC
317:40-5-40
when overnight visits are going to occur.
(5) The provider agency ensures the Program
Coordinator Staff (PCS) supervises, guides, and oversees all aspects of
programming associated with receipt of community residential supports.
(A) The PCS must:
(i) get to know the service recipient and his
or her needs;
(ii) make announced
and unannounced visits to the service recipient's home. The PCS makes a minimum
of three face-to-face visits per month, to monitor the service recipient's
needs and for staff supervision. Agency administration staff meeting
(f)(5)(A)(xii) requirements of this Section, may complete these visits in
addition to program coordination staff. At least two of the three visits must
be unannounced. Of the unannounced visits:
(I) at least one visit each month must occur
on Saturday or Sunday; or
(II)
between 8:00 p.m. and 7:00 a.m. on a weekday;
(iii) Monthly visits may be reduced to one
unannounced face-to-face visit to the service recipient's home when the home:
(I) has fully trained staff;
(II) has had no turn-over for the past
year;
(III) does not require
restrictive or intrusive procedures; and
(IV) has had no medication errors during the
previous calendar year.
(iv) provide support and assistance to any
service recipient who is experiencing an emotional, behavioral, or medical
crisis;
(v) be accessible to direct
service staff 24 hours per day and available to respond, in person when
necessary, to an emergency;
(vi)
supervise direct contact staff to promote achievement of outcomes in the
Plan;
(vii) ensure staffing levels
meet the requirements of the service recipient's Plan, with staff trained per
OAC
340:100-3-38;
(viii) ensure records are maintained
according to DDS community records per OAC
340:100-3-40;
(ix) ensure basic household requirements are
always in place, including:
(I) utilities and
phone service;
(II)
furniture;
(III) food supplies that
meet the service recipient's nutritional needs;
(IV) linens;
(V) personal items;
(VI) adaptive equipment; and
(VII) prescription medications;
(x) assist the DDS case manager as
requested to prepare for and implement the Plan and its revisions per OAC
340:100-5-50
through
340:100-5-58;
(xi) ensure applicable DHS and OHCA rules are
followed;
(xii) complete necessary
training per OAC
340:100-3-38;
and
(xiii) have a minimum of four
years of any combination of college level education or full-time equivalent
experience in serving persons with disabilities, or full-time equivalent
experience in a supervisory position, unless this requirement is waived in
writing by the DDS director or designee.
(B) Provider agencies ensure that residential
PCS caseloads do not exceed 27 with the following calculations:
(i) calculate one for persons receiving
community residential supports and group home services; and
(ii) calculate one for every five persons
receiving In-home Supports Waiver services, assisted living services, or any
other non-residential service on the PCS caseload.
(C) Provider agencies providing community
residential supports for less than one calendar year ensure the caseload of
each PCS numbers no more than 15 service recipients when the PCS serves service
recipients receiving community residential supports.
(D) The DDS director may grant a written
exception to the PCS ratios per this Section upon written request and adequate
justification from the provider.
(E) Provider agencies who fail to meet
program coordination requirements per this subsection may be required to
provide a reduced PCS ratio in accordance with sanctions per OAC
340:100-3-27.
(6) Staff, who assist a service
recipient with bathing or showering, must ensure the water temperature is safe
and comfortable for the service recipient. The requirements of this paragraph
are enforced even when an anti-scald device is used. Staff:
(A) tests the water temperature by touch or
with a thermometer designed to test hot liquids, before the service recipient
enters the water. The water must be determined safe and comfortable for the
service recipient, not merely comfortable for the staff;
(B) is trained by his or her employer in the
unique needs of each service recipient including tolerance to water temperature
and bathing or showering needs; and
(C) does not leave a service recipient who is
unable to attend to safety considerations alone in the bath or
shower.
Notes
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