[28 Pa.B. 953]
[Continued from previous Web Page] § 3800.89. Temperature.
(a) Indoor temperature shall be at least 65° F during awake hours when children are present in the facility.
(b) Indoor temperature may not be less than 58° F during sleeping hours.
(c) When indoor temperature exceeds 90° F, mechanical ventilation such as fans or air conditioning shall be used.
§ 3800.90. Communication system.
(a) The facility shall have a working, noncoin-operated, telephone with an outside line that is accessible to staff persons in emergencies.
(b) The facility shall have a communication system to allow staff persons to contact other staff persons in the facility for assistance in an emergency.
§ 3800.91. Emergency numbers.
Telephone numbers for the nearest hospital, police department, fire department, ambulance and poison control center shall be posted on or by each telephone with an outside line.
§ 3800.92. Screens.
Windows, including windows in doors, shall be securely screened when doors or windows are open.
§ 3800.93. Handrails and railings.
(a) Each ramp, interior stairway and outside steps exceeding two steps shall have a well secured handrail.
(b) Each porch that has over an 18 inch drop shall have a well secured railing.
§ 3800.94. Landings and stairs.
(a) There shall be a landing which is at least as wide as the doorway, beyond each interior and exterior door which opens directly into a stairway.
(b) Interior stairs shall have nonskid surfaces.
§ 3800.95. Furniture and equipment.
(a) Furniture and equipment shall be free of hazards.
(b) There shall be enough furniture to accommodate the largest group of children that may routinely congregate in a room an any given time.
(c) Power equipment shall be kept in safe condition.
(d) Power equipment, excluding normal household appliances, shall be stored in a place that is inaccessible to children.
(e) Power equipment excluding normal household appliances, may not be used by children except under supervision of a staff person.
§ 3800.96. First aid supplies.
The facility shall have a first aid manual, nonporous disposable gloves, antiseptic, adhesive bandages, gauze pads, thermometer, tape, scissors and syrup of Ipecac that are stored together.
§ 3800.97. Elevators.
Each elevator shall have a valid certificate of operation from the Department of Labor and Industry.
§ 3800.98. Indoor activity space.
The facility shall have separate indoor activity space for activities such as studying, recreation and group activities.
§ 3800.99. Recreation space.
The facility shall have regular access to outdoor or large indoor, recreation space and equipment.
§ 3800.100. Exterior conditions.
(a) The exterior of the building and the building grounds or yard shall be free of hazards.
(b) Outside walkways shall be free of ice, snow and obstruction.
§ 3800.101. Firearms and weapons.
Firearms, weapons and ammunition are not permitted in the facility or on the facility grounds, except for those carried by law enforcement personnel.
§ 3800.102. Child bedrooms.
(a) Each single bedroom shall have at least 70 square feet of floor space per child measured wall to wall, including space occupied by furniture.
(b) Each shared bedroom shall have at least 60 square feet of floor space per child measured wall to wall, including space occupied by furniture.
(c) No more than four children may share a bedroom.
(d) Ceiling height in each bedroom shall be at least an average of 7 1/2 feet.
(e) Each bedroom shall have a window with a source of natural light.
(f) Each child shall have the following in the bedroom:
(1) A bed with solid foundation and fire retardant mattress in good repair.
(2) A pillow and bedding appropriate for the temperature in the facility.
(3) A storage area for clothing.
(g) Cots or portable beds are not permitted. This prohibition does not apply for the first 30 days of a child's placement if a facility is given 7 days or less notice of the placement.
(h) Bunk beds shall allow enough space in between each bed and the ceiling to allow the child to sit up in bed.
(i) Bunk beds shall be equipped with securely attached ladders capable of supporting a staff person.
(j) The top bunk of bunk beds shall be equipped with a secure safety rail on each open side and open end of the bunk.
(k) A bedroom may not be used as a means of egress or access to another part of the facility.
§ 3800.103. Bathrooms.
(a) There shall be at least one flush toilet for every six children.
(b) There shall be at least one sink for every six children.
(c) There shall be at least one bathtub or shower for every six children.
(d) There shall be slip-resistant surfaces in all bathtubs and showers.
(e) Privacy shall be provided for toilets, showers and bathtubs by partitions or doors.
(f) There shall be at least one wall mirror for every six children.
(g) Individual towels and washcloths shall be provided for each child.
(h) Bar soap is not permitted unless there is a separate bar clearly labeled for each child.
(i) Toiletry items including toothbrush, hairbrush, comb, toothpaste, shampoo, deodorant and soap shall be provided for each child.
§ 3800.104. Kitchen areas.
(a) A facility shall have a kitchen area with a refrigerator, sink, cooking equipment and cabinets for storage.
(b) Utensils for eating, drinking and food serving and preparation shall be washed and rinsed after each use.
(c) Food shall be protected from contamination while being stored, prepared, transported and served.
(d) Uneaten food from a person's dish may not be served again or used in the preparation of other dishes.
(e) Cold food shall be kept at or below 40° F. Hot food shall be kept at or above 140° F. Frozen food shall be kept at or below 0° F.
§ 3800.105. Laundry.
Bed linens, towels, washcloths and clothing shall be laundered at least weekly.
§ 3800.106. Water areas.
(a) Aboveground pools, in-ground outdoor pools, ponds and lakes located on the premises, shall be fenced with a gate that is locked when the water area is not in use.
(b) Indoor pools shall be made inaccessible to children when not in use.
(c) A certified lifeguard shall be present with the children at all times children are using the water areas.
(d) The certified lifeguard specified in subsection (c) may not be counted in the staff person to child ratios specified in §§ 3800.54 and 3800.55 (relating to child care supervisor; and child care worker).
FIRE SAFETY § 3800.121. Unobstructed egress.
(a) Stairways, hallways, doorways, passageways and egress routes from rooms and from the building shall be unlocked and unobstructed, unless the firesafety approval specified in § 3800.14 (relating to firesafety approval) permits locking of certain means of egress.
(b) Doors used for egress routes from rooms and from the building may not be equipped with key-locking devices, electronic card operated systems or other devices which prevent immediate egress of children from the building.
§ 3800.122. Exits.
If more than four children sleep above the ground floor, there shall be a minimum of two interior or exterior exits from each floor. If a fire escape is used as a means of egress, it shall be permanently installed.
§ 3800.123. Evacuation procedures.
There shall be written emergency evacuation procedures that include staff responsibilities, means of transportation and emergency location.
§ 3800.124. Notification of local fire officials.
The facility shall notify local fire officials in writing of the address of the facility, location of bedrooms and assistance needed to evacuate in an emergency. The notification shall be kept current.
§ 3800.125. Flammable and combustible materials.
(a) Combustible materials may not be located near heat sources.
(b) Flammable materials shall be used safely, stored away from heat sources and inaccessible to children.
§ 3800.126. Furnaces.
Furnaces shall be inspected and cleaned at least annually by a professional furnace cleaning company or trained maintenance staff persons. Documentation of the inspection and cleaning shall be kept.
§ 3800.127. Portable space heaters.
Portable space heaters, defined as heaters that are not permanently mounted or installed, are not permitted in the facility.
§ 3800.128. Wood and coal burning stoves.
The use of wood and coal burning stoves is not permitted.
§ 3800.129. Fireplaces.
The use of wood burning fireplaces is not permitted.
§ 3800.130. Smoke detectors and fire alarms.
(a) A facility shall have a minimum of one operable automatic smoke detector on each floor, including the basement and attic.
(b) There shall be an operable automatic smoke detector located within 15 feet of each bedroom door.
(c) The smoke detectors specified in subsections (a) and (b) shall be located in common areas or hallways.
(d) Smoke detectors and fire alarms shall be of a type approved by the Department of Labor and Industry or listed by Underwriters Laboratories.
(e) If the facility serves four or more children or if the facility has three or more stories including the basement and attic, there shall be at least one smoke detector on each floor interconnected and audible throughout the facility or an automatic fire alarm system that is audible throughout the facility.
(f) If one or more children or staff persons are not able to hear the smoke detector or fire alarm system, all smoke detectors and fire alarms shall be equipped so that each person with a hearing impairment will be alerted in the event of a fire.
(g) If a smoke detector or fire alarm is inoperative, repair shall be completed within 48 hours of the time the detector or alarm was found to be inoperative.
(h) There shall be a written procedure for firesafety monitoring in the event the smoke detector or fire alarm is inoperative.
§ 3800.131. Fire extinguishers.
(a) There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic.
(b) If the indoor floor area on a floor including the basement or attic is more than 3,000 square feet, there shall be an additional fire extinguisher with a minimum 2-A rating for each additional 3,000 square feet of indoor floor space.
(c) A fire extinguisher with a minimum 2A-10BC rating shall be located in each kitchen. The kitchen extinguisher meets the requirements for one floor as required in subsection (a).
(d) Fire extinguishers shall be listed by Underwriters Laboratories or approved by Factory Mutual Systems.
(e) Fire extinguishers shall be accessible to staff persons. Fire extinguishers may be kept locked if access to the extinguisher by a child may cause a safety risk for the child. If fire extinguishers are kept locked, each staff person shall be able to immediately unlock the fire extinguisher in the event of a fire emergency.
(f) Fire extinguishers shall be inspected and approved annually by a firesafety expert. The date of the inspection shall be on the extinguisher.
§ 3800.132. Fire drills.
(a) An unannounced fire drill shall be held at least once a month.
(b) Fire drills shall be held during normal staffing conditions and not when additional staff persons are present.
(c) A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, the number of children in the facility at the time of the drill, problems encountered and whether the fire alarm or smoke detector was operative.
(d) Children shall be able to evacuate the entire building or to a fire safe area designated in writing within the past year by a firesafety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a firesafety expert. The firesafety expert may not be an employe of the facility.
(e) A fire drill shall be held during sleeping hours at least every 6 months.
(f) Alternate exit routes shall be used during fire drills.
(g) Fire drills shall be held on different days of the week, at different times of the day and night and on different staffing shifts.
(h) Children shall evacuate to a designated meeting place outside the building or within the fire safe area during each fire drill.
(i) A fire alarm or smoke detector shall be set off during each fire drill.
CHILD HEALTH § 3800.141. Child health and safety assessment.
(a) A child shall have a written health and safety assessment within 24 hours of admission.
(b) The assessment shall be completed or coordinated, signed and dated by medical personnel or staff persons trained by medical personnel.
(c) The assessment shall include the following:
(1) Medical information and health concerns such as allergies; medications; immunization history; illnesses; injuries; dental, mental or emotional problems; body positioning and movement stimulation for children with disabilities, if applicable; and ongoing medical care needs.
(2) Known or suspected suicide or self-injury attempts or gestures and emotional history which may indicate a predisposition for self-injury or suicide.
(3) Known incidents of aggressive or violent behavior.
(4) Substance abuse history.
(5) Sexual history or behavior patterns that may place the child or other children at a health or safety risk.
(d) A copy of the assessment shall be kept in the child's record.
§ 3800.142. Health and safety plan.
If the health and safety assessment in § 3800.141 (relating to health and safety assessment) identifies a health or safety risk, a written plan to protect the child shall be developed and implemented within 24 hours after the assessment is completed.
§ 3800.143. Child physical examination.
(a) A child shall have a physical examination within 15 days after admission and thereafter in accordance with the periodicity schedule recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision,'' available from 141 Northwest Point Boulevard, Post Office Box 927, Elk Grove Village, Illinois, 60009-0927.
(b) If the child had a physical examination prior to admission that meets the requirements of subsection (e) within the periodicity schedule specified in subsection (a), an initial examination within 15 days after admission is not required. The next examination shall be required within the periodicity schedule specified in subsection (a).
(c) If the child will participate in a program that requires significant physical exertion, a physical examination shall be completed before the child participates in the physical exertion portion of the program.
(d) The physical examination shall be completed, signed and dated by a licensed physician, certified registered nurse practitioner or licensed physician's assistant.
(e) The physical examination shall include:
(1) A comprehensive health and developmental history.
(2) A complete, unclothed physical examination.
(3) Immunizations, screening tests and laboratory tests for children 17 years of age or younger, as recommended by the American Academy of Pediatrics, ''Guidelines for Health Supervision.''
(4) A gynecological examination including a breast examination and a Pap test if recommended by medical personnel.
(5) Communicable disease detection if recommended by medical personnel based on the child's health status and with required written consent in accordance with applicable laws.
(6) Specific precautions to be taken if the child has a communicable disease, to prevent spread of the disease to other children.
(7) An assessment of the child's health maintenance needs, medication regimen and the need for blood work at recommended intervals.
(8) Special health or dietary needs of the child.
(9) Allergies or contraindicated medications.
(10) Medical information pertinent to diagnosis and treatment in case of an emergency.
(11) Physical or mental disabilities of the child, if any.
(12) Health education.
(f) Immunizations, screening tests and laboratory tests may be completed, signed and dated by a registered nurse or licensed practical nurse instead of a licensed physician, certified registered nurse practitioner or licensed physician's assistant.
§ 3800.144. Dental care.
(a) A child who is 3 years of age or older shall have a dental examination performed by a licensed dentist and teeth cleaning performed by a licensed dental technician, at least semiannually.
(b) A written record of the dental examination, including the date of the examination, the dentist's name, procedures completed and follow-up treatment recommended, shall be kept.
(c) Follow-up dental work indicated by the examination, such as treatment of cavities, shall be provided in accordance with recommendations by the licensed dentist.
§ 3800.145. Tobacco prohibited.
Use or possession of tobacco products by children and staff persons is prohibited in the facility, on the premises of the facility and during transportation provided by the facility.
§ 3800.146. Health services.
(a) The facility shall arrange for or provide medical treatment for acute and chronic conditions of a child.
(b) Medically necessary health services, such as medical, nursing, pharmaceutical, dental, dietary and psychological services that are planned or prescribed for the child shall be arranged for or provided.
§ 3800.147. Emergency medical plan.
The facility shall have a written emergency medical plan listing the following:
(1) The hospital or source of health care that will be used in an emergency.
(2) The method of transportation to be used.
(3) An emergency staffing plan.
STAFF HEALTH § 3800.151. Staff health statement.
A staff person or volunteer who comes into direct contact with the children or who prepares or serves food, shall have a statement signed and dated by a licensed physician, certified registered nurse practitioner or licensed physician's assistant, within 12 months prior to working with children or food service and every 2 years thereafter, stating the person is free of serious communicable disease that may be spread through casual contact or that the staff person has a serious communicable disease that may be spread through casual contact but is able to work in the facility if specific precautions are taken that will prevent the spread of the disease to children.
§ 3800.152. Serious communicable diseases.
(a) If a staff person or volunteer has a serious communicable disease that may be spread through casual contact, written authorization from a licensed physician, certified nurse practitioner or licensed physician's assistant is required for the person to be present at the facility.
(b) Written authorization from a licensed physician, certified nurse practitioner or licensed physician's assistant shall include a statement that the person will not pose a serious threat to the health of the children and specific instructions and precautions to be taken for the protection of the children.
(c) The written instructions and precautions specified in subsection (b) shall be followed.
NUTRITION § 3800.161. Three meals a day.
At least three meals and one snack a day shall be provided to the children.
§ 3800.162. Quantity of food.
(a) The quantity of food served shall meet minimum daily requirements as recommended by the United States Department of Agriculture, unless otherwise recommended in writing by a licensed physician for a specific child.
(b) Additional portions of snacks and meals shall be available for the children.
§ 3800.163. Food groups.
Each meal shall contain at least one item from the dairy, protein, fruits and vegetables and grain food groups, unless otherwise recommended in writing by a licensed physician for a specific child.
§ 3800.164. Withholding or forcing of food prohibited.
(a) A facility may not withhold food or drink, including snack and dessert, as punishment.
(b) A child may not be forced to eat food.
TRANSPORTATION § 3800.171. Safe transportation.
The following requirements apply whenever the facility, facility staff persons or facility volunteers provide transportation for the children. These requirements do not apply if transportation is provided by a source other than the facility.
(1) The child care worker ratios specified in § 3800.55 (relating to child care worker) apply.
(2) Each child shall be in an individual, age and size appropriate, safety restraint at all times the vehicle is in motion.
(3) The crisis intervention procedures specified in §§ 3800.201--3800.213 (relating to crisis intervention procedures) apply.
(4) The driver of a vehicle shall be 21 years of age or older.
MEDICATIONS § 3800.181. Storage of medications.
(a) Prescription and over-the-counter medications shall be kept in their original containers.
(b) Prescription and potentially poisonous over-the-counter medications shall be kept in an area or container that is locked.
(c) Prescription and potentially poisonous over-the-counter medications stored in a refrigerator shall be kept in a separate locked container.
(d) Oral and topical prescription and over-the-counter medications shall be stored separately.
(e) Prescription and over-the-counter medications shall be stored under proper conditions of sanitation, temperature, moisture and light.
(f) Discontinued and expired medications, and prescription medications for children who are no longer served at the facility, shall be disposed of in a safe manner.
§ 3800.182. Labeling of medications.
(a) The original container for prescription medications shall be labeled with a pharmaceutical label that includes the child's name, the name of the medication, the date the prescription was issued, the prescribed dosage and the name of the prescribing physician.
(b) Over-the-counter medications shall be labeled with the original label.
§ 3800.183. Use of prescription medications.
Prescription medications shall only be used by the child for whom the medication was prescribed.
§ 3800.184. Medication log.
(a) A medication log shall be kept to include the following for each child:
(1) A list of prescription medications.
(2) The prescribed dosage.
(3) Possible side effects.
(4) Contraindicated medications.
(5) Specific administration instructions, if applicable.
(6) The name of the prescribing physician.
(b) For each prescription and over-the-counter medication including insulin administered or self-administered, documentation in the log shall include the medication that was administered, dosage, date, time and name of person who administered or self-administered the medication.
(c) The information in subsection (b) shall be logged immediately after each dosage of medication is administered or self-administered.
§ 3800.185. Medication errors.
Documentation of medication errors and follow-up action taken to prevent future medication errors shall be kept.
§ 3800.186. Adverse reaction.
If a child has a suspected adverse reaction to a medication, the facility shall notify the prescribing physician immediately. Documentation of adverse reactions and the physician's response shall be kept.
§ 3800.187. Administration.
(a) Prescription medications and injections of any substance shall be administered by one of the following:
(1) A licensed physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic.
(2) A graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the facility.
(3) A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the facility.
(4) A staff person who meets the criteria in § 3800.188 (relating to medications administration training) for the administration of oral, topical and eye and ear drop prescriptions, insulin injections and epinephrine injections for insect bites.
(5) A child who meet the requirements in § 3800.189 (relating to self administration of medications).
(b) Prescription medications and injections shall be administered according to the directions specified by a licensed physician, certified registered nurse practitioner or licensed physician's assistant.
§ 3800.188. Medications administration training.
(a) A staff person who has completed and passed a Department approved medications administration course within the past 2 years is permitted to administer oral, topical and eye and ear drop prescription medications and epinephrine injections for insect bites.
(b) A staff person who has completed and passed a Department approved medications administration course and who has completed and passed a diabetes patient education program within the past 12 months that meets the National Standards for Diabetes Patient Education Programs of the National Diabetes Advisory Board, 7550 Wisconsin Avenue, Bethesda, Maryland 20205, is permitted to administer insulin injections.
(c) A record of the training shall be kept including person trained, date, source, name of trainer, content and length of training.
§ 3800.189. Self-administration of medications.
A child is permitted to self-administer medications, insulin injections and epinephrine injections for insect bites, if the following requirements are met:
(1) The child is 13 years of age or older.
(2) A person who meets the qualifications of § 3800.187(a)(1)--(4) (relating to administration) is physically present observing the administration and immediately records the administration in accordance with § 3800.184 (relating to medication log).
(3) The child recognizes and distinguishes the medication and knows the condition or illness for which the medication is prescribed, the correct dosage and when the medication is to be taken.
BEHAVIOR INTERVENTION PROCEDURES § 3800.201. Behavior intervention procedure.
A behavior intervention procedure includes chemical restraint, exclusion and manual restraint and for secure care mechanical restraint and seclusion.
§ 3800.202. Appropriate use of behavior intervention procedures.
(a) A behavior intervention procedure may not be used in a punitive manner or for the convenience of staff persons.
(b) A behavior intervention procedure, with the exception of exclusion as specified in § 3800.212 (relating to exclusion), may be used only to prevent a child from injuring himself.
(c) For each incident in which use of a behavior intervention procedure is considered:
(1) Every attempt shall be made to anticipate and de-escalate the behavior using methods of intervention less intrusive than behavior intervention procedures.
(2) A behavior intervention procedure may not be used unless less intrusive techniques and resources appropriate to the behavior have been tried but have failed.
(3) A behavior intervention procedure shall be discontinued when the child demonstrates he has regained self-control.
§ 3800.203. Behavior intervention procedure plan.
(a) For each child for whom behavior intervention procedures will be used beyond unanticipated use specified in § 3800.204 (relating to unanticipated use), a behavior intervention plan shall be written and included in the ISP specified in § 3800.223 (relating to content of the ISP), prior to use of behavior intervention procedures.
(b) The plan shall be developed and revised with the participation of the child, parent, guardian or custodian if available, child care staff persons, funding agency representative and other appropriate professionals.
(c) The plan shall be reviewed every 6 months and revised as needed.
(d) The plan shall be reviewed, approved, signed and dated by persons involved in the development and revision of the plan, prior to the use of a behavior intervention procedure, whenever the plan is revised and at least every 6 months.
(e) The plan shall include:
(1) The specific behavior to be addressed, observable signals that occur prior to the behavior and the suspected reason for the behavior.
(2) The single behavioral outcome desired stated in measurable terms.
(3) The methods for modifying or eliminating the behavior, such as changes in the child's physical and social environment, changes in the child's routine, improving communications, teaching skills and reinforcing appropriate behavior.
(4) The types of procedures that may be used and the circumstances under which the procedures may be used.
(5) The amount of time the procedure may be applied, not to exceed the maximum time periods specified in this chapter.
(6) Health conditions that may be affected by the use of specific procedures.
(7) The name of the staff person responsible for monitoring and documenting progress with the plan.
(f) The plan shall be implemented as written.
(g) Copies of the plan shall be kept in the child's record.
§ 3800.204. Unanticipated use.
If behavior intervention procedures are used on an unanticipated basis, § 3800.203 (relating to behavior intervention procedure plan) does not apply until after a behavior intervention procedure is used four times for the same child in any 3-month period.
§ 3800.205. Staff training.
(a) If behavior intervention procedures are used, each staff person who administers a behavior intervention procedure shall have completed and passed a Department approved training program within the past year in the use of behavior intervention procedures.
(b) Training shall include:
(1) The use of de-escalation techniques and alternative nonrestrictive strategies and addressing the child's feelings after use of a behavior intervention procedure.
(2) Child development principles appropriate for the age of the children served, to understand normal behavior reactions to stress at various ages.
(3) The proper use of the specific techniques or procedures that may be used.
(4) Techniques and procedures appropriate for the age and weight of the children served.
(5) Experience of use of the specific procedures directly on themselves and demonstration of use of the procedure.
(6) Health risks for the child associated with use of specific procedures.
(7) A testing process to demonstrate understanding of and ability to apply specific procedures.
(c) A record of the training including person trained, date, source, name of trainer and length of training shall be kept.
§ 3800.206. Seclusion.
Seclusion, defined as placing a child in a locked room, is prohibited. A locked room includes a room with any type of door locking device, such as a key lock, spring lock, bolt lock, foot pressure lock or physically holding the door shut.
§ 3800.207. Aversive conditioning.
The use of aversive conditioning, defined as the application of startling, painful or noxious stimuli, is prohibited.
§ 3800.208. Pressure points.
The application of pain through pressure point techniques or pain compliance is prohibited.
§ 3800.209. Chemical restraints.
(a) A chemical restraint is a drug used to control acute, episodic behavior that restricts the movement or function of a child. A drug ordered by a licensed physician as part of ongoing medical treatment is not a chemical restraint.
(b) Administration of a chemical restraint is prohibited except for the administration of drugs ordered by a licensed physician and administered by licensed/certified/registered medical personnel on an emergency basis.
(c) If a chemical restraint is administered as specified in subsection (b), the following apply:
(1) Immediately prior to each incidence of administering a drug on an emergency basis, a licensed physician shall have examined the child and given a written order to administer the drug.
(2) Immediately prior to each readministration of a drug on an emergency basis, a licensed physician shall have examined the child and ordered readministration of the drug.
(d) If a chemical restraint is administered as specified in subsection (c), the following apply:
(1) The child's vital signs shall be monitored at least once each hour.
(2) The physical needs of the child shall be met promptly.
(e) A Pro Re Nata (PRN) order for controlling acute, episodic behavior is prohibited.
(f) A drug ordered by a licensed physician as pretreatment prior to medical or dental examination or treatment is not a chemical restraint.
(g) Documentation of compliance with subsections (b)--(f) shall be kept.
§ 3800.210. Mechanical restraints.
(a) A mechanical restraint is a device that restricts the movement or function of a child or portion of a child's body. Examples of mechanical restraints include handcuffs, anklets, wristlets, camisoles, helmets with fasteners, muffs and mitts with fasteners, poseys, waist straps, head straps, restraining sheets and similar devices.
(b) The use of a mechanical restraint is prohibited.
(c) A device used to provide support for functional body position or proper balance and a device used for medical treatment, such as sand bags to limit movement after medical treatment, a wheelchair belt that is used for body positioning and support or a helmet for prevention of injury during seizure activity, are not considered mechanical restraints.
§ 3800.211. Manual restraints.
(a) A manual restraint is a physical hands-on technique that lasts more than 1 minute, that restricts the movement or function of a child or portion of a child's body. A manual restraint does not include a manual assist of any duration for a child during which the child does not physically resist or a therapeutic hold for a child who is 8 years of age or younger for less than 10 minutes during which the child does not physically resist.
(b) Manual restraints that apply pressure or weight on the child's respiratory system are prohibited.
(c) Prone position manual restraints are not permitted for girls who are pregnant.
(d) The position of the manual restraint or the staff person applying a manual restraint, shall be changed at least every 10-consecutive minutes of applying the manual restraint.
(e) A staff person who is not applying the restraint shall complete observation and documentation of the physical and emotional condition of the child, at least every 10 minutes the manual restraint is applied.
§ 3800.212. Exclusion.
(a) Exclusion is the removal of a child from the child's immediate environment and restricting the child alone to a room or area. If a staff person remains in the exclusion area with the child, it is not exclusion.
(b) Exclusion may not be used for more than 60 minutes, consecutive or otherwise, within a 2-hour period.
(c) Exclusion may not be used for a child more than 4 times within a 24-hour period.
(d) A staff person shall observe a child in exclusion at least every 5 minutes.
(e) A room or area used for exclusion shall have the following:
(1) At least 40 square feet of indoor floor space.
(2) A minimum ceiling height of 7 feet.
(3) An open door or a window for observation.
(4) Lighting and ventilation.
(5) Absence of any items that might injure a child.
§ 3800.213. Behavior intervention procedure records.
A record of each use of a behavior intervention procedure, including the emergency use of a behavior intervention procedure, shall be kept and shall include the following:
(1) The specific behavior addressed.
(2) The methods of intervention used to address the behavior less intrusive than the procedure used.
(3) The date and time the procedure was used.
(4) The specific procedure used.
(5) The staff person who used the procedure.
(6) The duration of the procedure.
(7) The staff person who observed the child.
(8) The child's condition following the removal of the procedure.
SERVICES § 3800.221. Development of ISP.
(a) An ISP shall be developed for each child within 30-calendar days of the child's admission.
(b) The ISP shall be developed by the child, parent, guardian or custodian if available, child care staff persons, funding agency representative and other appropriate professionals.
(c) Reasonable effort shall be made to involve the child and parent, guardian or custodian in the development of the plan ISP.
(d) Persons who participated in the development of the ISP shall sign and date the ISP.
§ 3800.222. Review, revision and rewrite of the ISP.
(a) A review of each child's progress on the ISP and a revision of the ISP, if necessary, shall be completed at least every 6 months.
(b) The ISP shall be revised in accordance with subsection (a) if there has been no progress on a goal, if a goal is no longer appropriate or if a goal needs to be added.
(c) Persons completing the revision shall sign and date the revised ISP.
§ 3800.223. Content of the ISP.
An ISP shall include:
(1) Goals and time-limited objectives for the child.
(2) Evaluation of the child's skill level for each goal.
(3) Services that meet the child's needs.
(4) A behavior intervention procedure plan, if appropriate.
(5) A component addressing family involvement.
(6) A plan to teach the child health and safety, if the child has a child living with them at the facility.
(7) The anticipated duration of stay at the facility.
(8) A discharge or transfer plan, if applicable.
(9) The name of the person responsible for coordinating the implementation of the ISP.
§ 3800.224. Implementation of the ISP.
An ISP shall be implemented as written.
§ 3800.225. Copies of the ISP.
(a) Copies of ISPs and revisions to the plan shall be provided to the parent, guardian or custodian if available, the funding agency and persons who participated in the development and revisions of the ISP.
(b) Copies of ISPs and revisions to the ISP shall be kept in the child's record.
§ 3800.226. Education.
Each child who is of compulsory school age shall participate in a Department of Education approved school program or an educational program under contract with the local public school district.
CHILD RECORDS § 3800.241. Emergency information.
(a) Emergency information for children shall be easily accessible at the facility.
(b) Emergency information for each child shall include the following:
(1) The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency.
(2) The name, address and telephone number of the child's physician or source of health care.
(3) The name, address and telephone number of the person able to give consent for emergency medical treatment, if applicable.
(4) A copy of the child's most recent annual physical examination.
§ 3800.242. Child records.
(a) A separate record shall be kept for each child.
(b) Entries in a child's record shall be legible, dated and signed by the person making the entry.
§ 3800.243. Content of records.
Each child's record shall include:
(1) Personal information including:
(i) Name, sex, admission date, birth date and Social Security Number.
(ii) Race, height, weight, color of hair, color of eyes and identifying marks.
(iii) Dated photograph of the child taken within the past year.
(iv) Language or means of communication spoken and understood by the child and the primary language used by the child's family, if other than English.
(v) Religious affiliation.
(vi) Name, address and telephone number of the relative or person to be contacted in the event of an emergency.
(2) Physical examinations.
(3) Dental examinations.
(4) Health and safety assessments.
(5) ISPs.
(6) Behavior intervention procedure plans.
(7) Behavior intervention procedure records relating to the child.
(8) Reports of unusual incidents.
(9) Consent for treatment.
(10) Court order, if applicable.
§ 3800.244. Record retention.
(a) Information in the child's record shall be kept for at least 4 years or until any audit or litigation is resolved.
(b) A child's record shall be kept for at least 4 years following the child's departure or until any audit or litigation is resolved.
§ 3800.245. Locked records.
A child's record shall be kept locked when unattended.
FACILITIES SERVING NINE OR MORE CHILDREN § 3800.251. Additional requirements for facilities serving nine or more children.
This section and §§ 3800.252--3800.257 apply to facilities serving nine or more children. These provisions are in addition to the other provisions of this chapter.
§ 3800.252. Sewage system approval.
A facility that is not connected to a public sewer system shall have a written sanitation approval for its sewage system by the sewage enforcement official of the municipality in which the facility is located.
§ 3800.253. Evacuation procedures.
Written emergency evacuation procedures and an evacuation diagram specifying directions for egress in the event of an emergency, shall be posted in a conspicuous place.
§ 3800.254. Exit signs.
(a) Signs bearing the word ''EXIT'' in plain legible letters shall be placed at exits.
(b) If the exit or way to reach the exit is not immediately visible, access to exits shall be marked with readily visible signs indicating the direction of travel.
(c) Exit sign letters shall be at least 6 inches in height with the principal strokes of letters at least 3/4 inch wide.
§ 3800.255. Laundry.
(a) There shall be a laundry area which is separate from kitchen, dining and other living areas.
(b) The laundry area shall have an entrance that does not require transportation of soiled linen through food preparation and food storage areas or soiled linen shall be covered while being transported through food preparation and food storage areas.
§ 3800.256. Dishwashing.
(a) Utensils used for eating, drinking, preparation and serving of food or drink shall be washed, rinsed and sanitized after each use by a mechanical dishwasher or by a method approved by the Department of Agriculture.
(b) A mechanical dishwasher shall use hot water temperatures exceeding 140°F in the wash cycle and 180°F in the final rinse cycle or shall be of a chemical sanitizing type approved by the National Sanitation Foundation.
(c) A mechanical dishwasher shall be operated in accordance with the manufacturer's instructions.
§ 3800.257. Bedrooms.
A child's bedroom may not be more than 200 feet from a bathtub or shower and a toilet.
SECURE CARE § 3800.271. Criteria.
Secure care is permitted only for children who are court ordered to a secure facility.
§ 3800.272. Exceptions.
The following requirements do not apply to facilities in which secure care is provided:
(1) Section 3800.55 (a)--(d) (relating to child care worker).
(2) Section 3800.56 (d) (relating to supervision).
(3) Section 3800.102 (c) (relating child bedrooms).
(4) Section 3800.103 (f) (relating to bathrooms).
(5) Section 3800.171(1) (relating to safe transportation).
(6) Section 3800.206 (relating to seclusion).
(7) Section 3800.210 (relating to mechanical restraints).
§ 3800.273. Additional requirements.
The following additional requirements apply to facilities in which secure care is provided:
(1) The facility shall have a valid C-5 firesafety occupancy approval from the Department of Labor and Industry or a firesafety occupancy approval appropriate for locked facilities from the Department of Licensing and Inspection of the city of Philadelphia, the Department of Public Safety of the city of Pittsburgh or the Department of Community Development of the city of Scranton.
(2) An unusual incident as specified in § 3800.16(a) (relating to unusual incidents) includes a child who is absent without leave for any period of time.
(3) Children shall be directly supervised at all times during awake hours.
(4) A minimum of two child care workers shall be present in the facility at all times.
(5) There shall be one child care worker present with the children for every six children during awake hours.
(6) There shall be one child care worker present with the children for every 12 children during sleeping hours.
(7) Children shall be supervised by conducting observational checks of each child within 15 minute intervals during sleeping hours.
(8) Observational checks of children during sleeping hours shall include actual viewing of each child.
(9) Observational checks of children during sleeping hours shall be recorded in writing noting the date, time, person making the check and any unusual circumstances observed.
(10) The driver and at least one additional staff person shall be present in the vehicle at all times one or more children are being transported. There shall be one child care worker present with the children for every three children during transportation of children either by the facility or another transportation source. The driver of the vehicle may not be counted in the staffing ratio.
(11) No more than two children may share a bedroom.
(12) The following physical site requirements apply:
(i) Glass windows, windows in doors, shower doors and light fixtures and other glass surfaces shall be protected with a secure, nonbreakable covering or composed of shatterproof glass.
(ii) Glass mirrors are not permitted.
(iii) Furnishings or other items such as drapery cords, electrical outlets, shower curtains, shoe strings and noncollapsing clothing hooks, that may create a risk for self-injury or suicide may not be accessible to the children.
(13) The following requirements apply to the use of mechanical restraints:
(i) Handcuffs behind the back, leg restraints and locking transportation waist belts with handcuffs in front of the child used during transportation, are the only types of mechanical restraints that are permitted.
(ii) A child may not be handcuffed to an object or another person.
(iii) Oral or written authorization by supervisory staff is required prior to each use of a mechanical restraint, except for those restraints used during transportation.
(iv) The use of handcuffs and leg restraints, except for those used during transportation, may not exceed 6 hours, unless a licensed physician, licensed physician's assistant or registered nurse examines the child and gives written orders to continue the use of the restraint. Reexamination and new written orders are required for each 6-hour period the restraint is continued. If a restraint is removed for any purpose other than for movement and reused within 24 hours after the initial use of the restraint, it is considered continuation of the initial restraint.
(v) The restraint shall be checked for proper fit by a staff person at least every 15 minutes.
(vi) The physical needs of the child shall be met promptly.
(vii) Handcuffs and leg restraints, except for those used during transportation, shall be removed completely for at least 10 minutes during every 2 hours the restraint is used.
(viii) Handcuffs and leg restraints, except those used during transportation, shall be checked and observed by a supervisory staff person who is not administering the restraint, at least every 2 hours the restraint is used.
(14) The following requirements apply to the use of seclusion:
(i) Oral or written authorization by supervisory staff is required prior to each use of seclusion.
(ii) The use of seclusion may not exceed 6 hours, unless a licensed physician, licensed physician's assistant or registered nurse examines the child and gives written orders to continue the use of seclusion. Reexamination and new written orders are required for each 6-hour period the seclusion is continued. If seclusion is interrupted for any purpose and reused within 24 hours after the initial use of seclusion, it is considered continuation of the initial seclusion period.
(iii) A staff person shall observe a child in seclusion at least every 5 minutes.
(iv) The physical needs of the child shall be met promptly.
(v) A child in seclusion shall be checked and observed by a supervisory staff person who is not continually observing the child as required in subparagraph (iii), at least every 2 hours the seclusion is used.
(vi) The use of seclusion may not exceed 12 hours in any 48-hour period without a written court order.
(15) Documentation of compliance with paragraphs (6) and (7) shall be kept.
SECURE DETENTION § 3800.281. Requirements for secure detention.
The requirements and exceptions for secure care apply for secure detention.
§ 3800.282. Exception for secure detention.
The following requirements do not apply for secure detention:
(1) Section 3800.143(b) (relating to child physical examination).
(2) Sections 3800.221--3800.225.
§ 3800.283. Additional requirements.
The following additional requirements apply to facilities in which secure detention is provided:
(1) No more than one child may occupy a bedroom.
(2) No more than 12 children may be in a group at any one time.
(3) No more than 12 children may occupy a sleeping unit or area.
(4) The child health and safety assessment required in § 3800.141 (relating to child health and safety assessment) shall be completed within 1 hour of admission.
(5) The child physical examination as required in § 3800.143 (relating to child physical examination) shall be completed within 96 hours after admission.
TRANSITIONAL LIVING § 3800.291. Criteria.
A child shall complete a Department-approved training program and demonstrate competency in the following areas to be eligible for transitional living:
(1) Health, general safety and firesafety practices.
(2) Money management.
(3) Transportation skills.
(4) Child health and safety, child development and parenting skills, if the child has a child living with them at the residence.
§ 3800.292. Exceptions for transitional living.
The following requirements do not apply for transitional living:
(1) Section 3800.2(d) (relating to applicability). Each building in which transitional living is provided shall be inspected at least once a year. Annual inspection of each individual transitional living residence is not required.
(2) An incident specified in § 3800.17 (relating to incident records) does not include a child who leaves the premises of the facility for any period of time without the approval of staff persons, but does include a child whose whereabouts is unknown for more than 24 hours.
(3) Sections 3800.55 and 3800.56 (relating to child care worker; and supervision).
(4) Sections 3800.82, 3800.83 and 3800.88(b) (relating to poisons; heat sources; and water), unless infants or toddlers live at the residence.
(5) Section 3800.90 (relating to communication systems).
(6) Sections 3800.98 and 3800.99 (relating to space; and recreation space).
§ 3800.293. Additional requirements.
(a) There shall be one child care worker present on the premises for every 12 children during awake hours. A child's own children present at the residence shall be counted in the staffing ratio.
(b) There shall be one child care worker present on the premises for every 24 children during sleeping hours. A child's own children present at the residence shall be counted in the staffing ratio.
(c) If there are 8 or fewer children present on the premises at any one time, one child care worker may be available by telephone instead of physically present on the premises.
OUTDOOR AND MOBILE PROGRAMS § 3800.301. Applicability.
The exceptions for outdoor and mobile programs specified in §§ 3800.302 and 3800.303 (relating to exceptions for outdoor and mobile programs; and additional requirements for outdoor and mobile programs) apply during the time in which children receive services in outdoor or mobile settings.
§ 3800.302. Exceptions for outdoor and mobile programs.
(a) The following requirements do not apply for mobile and outdoor programs that operate from nonstationary settings.
(1) Section 3800.13(a) (relating to maximum capacity).
(2) Section 3800.14 (relating to firesafety approval).
(3) Section 3800.56 (relating to supervision), for outdoor programs.
(4) Section 3800.83 (relating to heat sources).
(5) Sections 3800.84(b)--(e) (relating to sanitation).
(6) Section 3800.84--3800.88.
(7) Section 3800.90(a) (relating to communication system).
(8) Sections 3800.91--3800.93 (relating to emergency numbers; screens; and handrails and railings) physical site).
(9) Sections 3800.96--3800.99.
(10) Sections 3800.101--3800.105.
(11) Section 3800.124 (relating to notification of local fire officials).
(12) Section 3800.130 (relating to smoke detectors and fire alarms).
(13) Section 3800.131 (relating to fire extinguishers) for outdoor programs.
(14) Section 3800.132 (relating to fire drills).
(15) Sections 3800.251--3800.257 (relating to facilities serving nine or more children).
(b) The following requirements do not apply for mobile and outdoor programs that operate from stationary settings such as tepees and cabins:
(1) Section 3800.13(a).
(2) Section 3800.56 for outdoor programs.
(3) Section 3800.84(b) (relating to sanitation).
(4) Section 3800.84--3800.86 (relating to sanitation; ventilation and lighting)
(5) Sections 3800.88 and 3800.89 (relating to water; and temperature).
(6) Section 3800.90(a).
(7) Sections 3800.91--3800.94.
(8) Sections 3800.97--3800.100.
(9) Sections 3800.101--3800.106.
(10) Section 3800.124.
(11) Sections 3800.251--3800.257.
§ 3800.303. Additional requirements for outdoor and mobile programs.
(a) The following additional requirements apply for outdoor and mobile programs:
(1) There shall be a supply of food and water for drinking, cleaning and bathing for the number of days until the program will reach the next supply of water and food.
(2) Potable drinking water shall be available to children at all times.
(3) There shall be an opportunity for children to bathe at least once a week and wash their hands and brush their teeth once a day.
(4) There shall be a communication system such as a CB radio to communicate with public emergency sources in the event of a medical, police, fire or other emergency.
(5) There shall be a source for routine weather information for advance warning of severe or dangerous weather conditions.
(6) There shall be a written emergency transportation and staffing plan and equipment such as a litter to transport a child in a medical emergency.
(7) There shall be a written plan for conducting a search for a missing child and requesting assistance from local authorities.
(8) Each staff person shall have a map of the area.
(9) Each staff person shall have a written anticipated schedule of the dates, times and estimated locations for the next 7 days.
(10) Each child shall wear footwear, that is well-constructed, in good condition and appropriate for the activity being conducted.
(b) The following additional requirements apply for outdoor programs:
(1) Each child shall have personal hygiene supplies, shelter such as a fire retardant tent or tarpaulin, a fire retardant sleeping bag or other sleeping equipment, bedding appropriate to the temperature and at least one change of clothing.
(2) While the child is engaged in an activity away from a stationary site, each child shall have a daily water supply and a whistle for use in emergencies.
(3) Safe and well-maintained equipment shall be provided for activities.
(4) Staff persons responsible for teaching children high-risk activities such as boating, biking, horseback riding, swimming and climbing shall be trained by an appropriate, recognized source in safe practices regarding these activities. Documentation of the training shall be kept.
(5) At least one staff person shall be present with the children at all times who has current certification from a hospital or other recognized health care organization in first aid, Heimlich techniques and cardiopulmonary resuscitation
(c) The following additional requirement applies for mobile and outdoor programs that operate from stationary settings such as tepees and cabins: The maximum capacity specified on the certificate of compliance shall be based on 30 square feet per child, including measurement of all floor space.
DAY TREATMENT § 3800.311. Exceptions for day treatment.
The following requirements do not apply for child day treatment centers:
(1) Section 3800.13(a) (relating to maximum capacity).
(2) Section 3800.14(a) (relating to fire safety approval).
(3) Section 3800.32(f), (g) and (i) (relating to specific rights).
(4) Section 3800.54(a) and (b) (relating to child care supervisor).
(5) Section 3800.56 (relating to supervision).
(6) Section 3800.98 (relating to indoor activity space).
(7) Section 3800.102 (relating to child bedrooms).
(8) Sections 3800.103(a)--(e), (g), (h) and (j) (relating to bathrooms).
(9) Section 3800.104(a) (relating to kitchen areas).
(10) Section 3800.105 (relating to laundry).
(11) Section 3800.124 (relating to notification of local fire officials).
(12) Section 3800.130(b) and (e) (relating to smoke detectors and fire alarms).
(13) Section 3800.144 (relating to dental care).
(14) Section 3800.161 (relating to three meals a day).
(15) Section 3800.171(1) (relating to safe transportation).
(16) Section 3800.255 (relating to laundry).
(17) Section 3800.257 (relating to bedrooms).
§ 3800.312. Additional requirements.
The following additional requirements apply for child day treatment centers:
(1) The maximum capacity specified on the certificate of compliance shall be based on the available indoor square footage and the number of sinks and toilets.
(2) If the facility is located outside Philadelphia, Pittsburgh and Scranton, the facility shall have a valid firesafety approval listing the type of occupancy from the Department of Labor and Industry.
(3) There shall be one child care supervisor present at the facility for every 36 children, whenever children are present at the facility.
(4) Children shall be directly supervised at all times.
(5) The facility shall have at least 50 square feet of indoor activity space per child, measured wall to wall including space occupied by furniture. Indoor activity space includes areas accessible to children such as dining areas, recreation areas and other general living areas. Indoor activity space does not include kitchens, bathrooms, counseling rooms, offices or hallways.
(6) There shall be at least one flush toilet for every 18 children
(7) There shall be at least one sink for every 24 children.
(8) A meal shall be provided to the children at least every 5 hours they are at the facility.
(9) An evening snack shall be provided to children who are at the facility more than 3 hours beyond the evening meal.
(10) Certified teachers may be substituted for a child care supervisor to meet the requirements of paragraph (3).
CHAPTER 3810. (Reserved) (Editor's Note: The Department proposes to delete Chapter 3810, pages 3810-1 to 3810-31, serial pages (109569) to (109572), (168981) to (168982), (109575) to (109598) and (168983).)
CHAPTER 5310. COMMUNITY RESIDENTIAL REHABILITATION SERVICES FOR THE MENTALLY ILL
Subchapter A. GENERAL PROVISIONS § 5310.3. Applicability.
(a) This chapter applies to providers of full-care or partial-care community residential rehabilitation services, or both, as defined in § 5310.6 (relating to definitions).
(b) This chapter does not apply to child residential facilities which serve exclusively children, with the exception of host homes, governed by Chapter 3800 (relating to child residential and day treatment facilities).
§ 5310.6. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.
* * * * * [Group home for children--A single dwelling or apartment in the community, which is staffed by the provider and owned, held, leased or controlled by the provider or a provider-affiliate. Each group home cares for one group of four to eight children.]
* * * * *
Subchapter C. CHILDREN SERVICES
GENERAL PROVISIONS § 5310.92. Applicability.
(a) This subchapter applies to all community residential rehabilitation services (CRRS) that provide full-care for children in host home settings. Persons under 18 years of age, with the exception of emancipated minors, may not be cared for in partial-care CRRS nor in a CRRS site in which adults are served.
* * * * *
PHYSICAL FACILITY STANDARDS § 5310.161. [Group homes] (Reserved).
[The requirements of §§ 5310.71--5310.73 (relating to physical facilities standards) apply to community residential rehabilitation service (CRRS) group homes for children. The following also applies:
(1) Space must be provided for the care of ill children who require separation from the group.
(2) All electrical equipment must be in good repair. Equipment such as washers and garbage disposals must have protective safety devices which prevent use when open. All electric power tools must be locked in a cabinet, closet or storage room when not in use and must be used only by staff. Electrical kitchen equipment may be operated by children only when under direct supervision of staff.]
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
ARTICLE I. LICENSING/APPROVAL
CHAPTER 6400. COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION § 6400.3. Applicability.
* * * * * (f) This chapter does not apply to the following:
* * * * * (8) Child residential facilities which serve exclusively children, regulated under Chapter 3800 (relating to child residential and day treatment facilities).
* * * * *
[Pa.B. Doc. No. 98-289. Filed for public inspection February 13, 1998, 9:00 a.m.]
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