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COMMONWEALTH OF PENNSYLVANIA

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PA Bulletin, Doc. No. 99-1045d

[29 Pa.B. 3295]

[Continued from previous Web Page]

   (2)  A restrictive procedure may not be used unless less intrusive techniques and resources appropriate to the behavior have been tried but have failed.

   (3)  A restrictive procedure shall be discontinued when the child demonstrates he has regained self-control.

§ 3800.203.  Restrictive procedure plan.

   (a)  For each child for whom restrictive procedures will be used beyond unanticipated use specified in § 3800.204 (relating to unanticipated use), a restrictive procedure plan shall be written and included in the ISP specified in § 3800.226 (relating to content of the ISP), prior to use of restrictive procedures.

   (b)  The plan shall be developed and revised with the participation of the child, the child's parent and, if applicable, the child's guardian or custodian, if available, any person invited by the child and the child's parent, guardian or custodian, child care staff persons, contracting 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 restrictive procedure, whenever the plan is revised and at least every 6 months. The child, the child's parent and, if applicable, the child's guardian or custodian shall be given the opportunity to sign the plan.

   (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 behavioral outcomes 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 restrictive procedures that may be used and the circumstances under which the restrictive procedures may be used.

   (5)  The length of time the restrictive 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 restrictive 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 restrictive procedures are used on an unanticipated basis, § 3800.203 (relating to restrictive procedure plan) does not apply until after any type of restrictive procedure is used four times for the same child in any 3-month period.

§ 3800.205.  Staff training.

   (a)  If restrictive procedures are used, each staff person who administers a restrictive procedure shall have completed training within the past year in the use of restrictive procedures.

   (b)  Training shall include:

   (1)  Using de-escalation techniques and alternative nonrestrictive strategies and addressing the child's feelings after use of a restrictive 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 each staff person and demonstration of use of the procedure by each staff person.

   (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 the person trained, the 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.

   (a)  Pressure point techniques, defined as the application of pain for the purpose of achieving compliance, are prohibited, except as provided in subsection (b).

   (b)  The use of a pressure point technique that applies pressure at the child's jaw point for the purpose of bite release, is permitted.

§ 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, or as pretreatment prior to a medical or dental examination or 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 to be 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 and in accordance with the frequency and duration recommended and documented by the prescribing physician.

   (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)  Documentation of compliance with subsections (b)-- (e) shall be kept in the child's record.

§ 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, papoose boards, restraining sheets and similar devices.

   (b)  The use of a mechanical restraint is prohibited.

   (c)  Devices 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 used 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 observe and document 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.  Restrictive procedure records.

   A record of each use of a restrictive procedure, including the emergency use of a restrictive 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.  Description of services.

   The facility shall have a written description of services that the facility provides to include the following:

   (1)  The scope and general description of the services provided by the facility.

   (2)  The ages, needs and any special characteristics of the children the facility serves.

   (3)  Specific activities and programs provided by the facility.

§ 3800.222.  Admission.

   Prior to admission, a determination shall be made and documented in writing, that the age, needs and any special characteristics of the child can be appropriately met by the services, activities and programs provided by the facility.

§ 3800.223.  Placement process.

   The facility shall have a placement process that assesses, and documents the following for each child, prior to or upon admission:

   (1)  The service needs of the child.

   (2)  The child's legal status.

   (3)  Circumstances that make placement of the child necessary.

   (4)  How the activities and services provided by the facility will meet the needs of the child.

§ 3800.224.  Development of the 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, the child's parent and, if applicable, the child's guardian or custodian, if available, any person invited by the child and the child's parent, guardian or custodian, child care staff persons, a contracting agency representative and other appropriate professionals.

   (c)  Reasonable effort shall be made to involve the child and the child's parent and, if applicable, a guardian or custodian, in the development of the ISP at a time and location convenient for the child, the child's parent, the child's guardian or custodian, if applicable, and the facility.

   (d)  Documentation of reasonable efforts made to involve the child's parent and, if applicable, guardian or custodian, shall be kept.

   (e)  Persons who participated in the development of the ISP shall sign and date the ISP, with the exception of the child, the child's parent and, if applicable, the child's guardian or custodian, who shall be given the opportunity to sign the ISP.

§ 3800.225.  Review and revision 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)   A review and revision of the ISP shall be completed in accordance with § 3800.224 (b)--(e) (relating to development of the ISP).

§ 3800.226.  Content of the ISP.

   An ISP shall include:

   (1)  Measurable and individualized goals and time-limited objectives for the child.

   (2)  Evaluation of the child's skill level for each goal.

   (3)  Monthly documentation of the child's progress on each goal.

   (4)  Services and training that meet the child's needs, including the child's needs for safety, competency development and permanency.

   (5)  A restrictive procedure plan, if appropriate.

   (6)  A component addressing family involvement.

   (7)  A plan to teach the child health and safety, if the child has a child living with him at the facility.

   (8)  A component addressing how the child's educational needs will be met in accordance with applicable Federal and State laws and regulations.

   (9)  The anticipated duration of stay at the facility.

   (10)  A discharge or transfer plan.

   (11)  Methods to be used to measure progress on the ISP, including who is to measure progress and the objective criteria.

   (12)  The name of the person responsible for coordinating the implementation of the ISP.

§ 3800.227.  Implementation of the ISP.

   An ISP shall be implemented as written.

§ 3800.228.  Copies of the ISP.

   (a)  Copies of the ISPs, revisions to the ISP and monthly documentation of progress shall be provided to the child if the child is over 14 years of age, the parent, the child's guardian or custodian, if applicable, the contracting agency and persons who participated in the development and revisions to the ISP.

   (b)  Copies of ISPs, revisions to the ISP and monthly documentation of progress shall be kept in the child's record.

§ 3800.229.  Education.

   Under 22 Pa. Code Chapters 11, 14 and 15 (relating to pupil attendance; special education services and programs; and protected handicapped students), 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.

§ 3800.230.  Transfer or discharge.

   Prior to the transfer or discharge of a child, the facility shall inform, and when possible discuss with, the child's parent and, if applicable, the child's guardian or custodian, the recommended transfer or discharge. Documentation of the discussion or transmission of the information shall be kept.

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 and health insurance information.

   (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 health 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)  The name, sex, admission date, birth date and Social Security Number.

   (ii)  The race, height, weight, color of hair, color of eyes and identifying marks.

   (iii)  The 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)  The name, address and telephone number of the person to be contacted in the event of an emergency.

   (2)  Health records.

   (3)  Dental, vision and hearing records.

   (4)  Health and safety assessments.

   (5)  ISPs.

   (6)  Restrictive procedure plans.

   (7)  Restrictive procedure records relating to the child.

   (8)  Reports of reportable incidents.

   (9)  Consent to treatment, as specified in § 3800.19 (relating to consent to treatment).

   (10)   Court order, if applicable.

   (11)  Admission and placement information specified in §§ 3800.222 and 3800.223 (relating to description of services; and admission).

   (12)  Signed notification of rights, grievance procedures and applicable consent to treatment protections specified in § 3800.31 (relating to notification of rights).

   (13)  Service records of the contracting agency.

   (14)  Education records.

§ 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 in a locked location when unattended.

FACILITIES SERVING NINE OR MORE CHILDREN

§ 3800.251.  Additional requirements.

   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)  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 alleged delinquent, or adjudicated delinquent and court ordered to a secure facility.

§ 3800.272.  Admission to secure care.

   Prior to accepting a child in secure care, the facility shall request the following documents from the committing court:

   (1)  A description of the offenses and circumstances that make secure care necessary.

   (2)  The child's needs to be addressed during placement.

   (3)  The court order committing the child to a secure care facility.

§ 3800.273.  Exceptions for secure care.

   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 3800.57(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(b) (relating to mechanical restraints).

§ 3800.274.  Additional requirements.

   The following additional requirements apply to facilities in which secure care is provided:

   (1)  The facility shall have a valid fire safety occupancy approval appropriate for locked facilities from the appropriate authority, listing the type of occupancy, prior to receiving a certificate of compliance under this chapter.

   (2)  A reportable incident as specified in § 3800.16(a) (relating to reportable incidents) includes a child's absence from the premises for any period of time, an assault on a staff person by a child that requires medical treatment for the staff person, the use of handcuffs or leg restraints beyond 2 hours, and the use of seclusion beyond 4 hours.

   (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)  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.

   (13)  Glass mirrors are not permitted.

   (14)  Furnishings or other items such as drapery cords, electrical outlets, shower curtains, shoe strings, razors and noncollapsing clothing hooks, that may create a risk for self-injury or suicide may not be accessible to a child whose health and safety assessment specified in § 3800.141 (relating to child health and safety assessment) indicates known or suspected suicide or self-injury attempts or gestures or an emotional history which may indicate a predisposition to self-injury or suicide, except during specific activities while these items are in use and the child is under direct supervision by staff persons.

   (15)  Items such as knives, razors, matches and tools, that may create an opportunity for use as a weapon or tool in an assault or other violent behavior may not be accessible to a child whose health and safety assessment specified in § 3800.141 indicates known incidents of aggressive or violent behavior, except during specific activities while these items are in use and the child is under direct supervision by staff persons.

   (16)  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 or leg restraints, except for those used during transportation, may not exceed 2 hours, unless a licensed physician, a 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 2-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, except for those used during transportation.

   (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 1 hour the restraint is used.

   (ix)  The use of handcuffs and leg restraints for any child, except those used during transportation, may not exceed 4 hours in any 48-hour period without a written court order.

   (17)  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 4 hours, unless a licensed physician, a 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 4-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 for any child may not exceed 8 hours in any 48-hour period without a written court order.

   (vii)  A room used for seclusion shall meet the conditions as specified in § 3800.212(e) (relating to exclusion).

   (18)  Mechanical restraints and seclusion may not be used simultaneously for any child.

   (19)  The use of any combination of mechanical restraints and seclusion for any child may not exceed 6 hours in any 48-hour period without a written court order.

SECURE DETENTION

§ 3800.281.  Requirements for secure detention.

   The requirements and exceptions for secure care apply for secure detention.

§ 3800.282.  Exceptions for secure detention.

   The following requirements do not apply for secure detention:

   (1)  Section 3800.55(g) (relating to child care worker).

   (2)  Section 3800.143(b) (relating to child health examination).

   (3)  Sections 3800.221--3800.228.

§ 3800.283.  Additional requirements.

   The following additional requirements apply to facilities in which secure detention is provided:

   (1)  The child care worker shall have an associate's degree or 60 credit hours from an accredited college or university.

   (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 health examination as required in § 3800.143 (relating to child health examination) shall be completed within 96 hours after admission.

   (6)  The facility shall comply with 42 Pa.C.S. §§ 6301--6365 (relating to the Juvenile Act) related to detention.

   (7)  A child may not be admitted to a secure detention facility who is 9 years of age or younger, or who is 18 years of age or older, unless the child is a juvenile as defined in the Juvenile Act.

   (8)  A child may not remain in the facility longer than is absolutely necessary.

   (9)  Staff persons shall have visual or auditory contact with children at all times.

   (10)  Children may not share space or have contact with adult offenders.

   (11)  The facility shall submit a written quarterly report to the appropriate regional office of the Department with the following information, for every child detained in a secure detention facility for more than 35 days:

   (i)  The child's name and birth date.

   (ii)  The committing court and probation officer.

   (iii)  The date the petition was filed.

   (iv)  The reason the child is still in the facility.

   (12)  The placement of each child shall be reviewed by a staff person designated by the director or the court at least weekly to assess whether the child could be served in a less restrictive setting. If a recommendation is made for a less restrictive setting, written documentation shall be included in the child's record and sent to the court.

TRANSITIONAL LIVING

§ 3800.291.  Criteria.

   A child shall complete a training program and demonstrate competency in the following areas to be eligible for transitional living:

   (1)  Health, general safety and fire safety 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 him at the residence.

§ 3800.292.  Exceptions for transitional living.

   The following requirements do not apply for transitional living:

   (1)  Section 3800.4 (relating to inspections and certificates of compliance).

   (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 are unknown for more than 24 hours.

   (3)  Sections 3800.55 and 3800.57 (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 system).

   (6)  Sections 3800.98 and 3800.99 (relating to indoor activity space; and recreation space).

§ 3800.293.  Additional requirements.

   (a)  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.

   (b)  If there are 11 or fewer children present on the premises at any one time, one child care worker shall be available onsite or by telephone. A child's own children present at the residence shall be counted in the staffing ratio.

   (c)  If there are 12 or more children present on the premises at any one time, there shall be one child care worker present on the premises for every 12 children. A child's own children present at the residence shall be counted in the staffing ratio.

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 fire safety approval).

   (3)  Section 3800.57 (relating to supervision), for outdoor programs.

   (4)  Section 3800.83 (relating to heat sources).

   (5)  Sections 3800.84(b)--(e) (relating to sanitation).

   (6)  Sections 3800.85--3800.88.

   (7)  Section 3800.90(a) (relating to communication system).

   (8)  Sections 3800.91--3800.93 (relating to emergency telephone numbers; screens; and handrails and railings).

   (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) (relating to maximum capacity).

   (2)  Section 3800.57, for outdoor programs.

   (3)  Sections 3800.85 and 3800.86 (relating to ventilation; and lighting).

   (4)  Sections 3800.88(a) and 3800.89 (relating to water; and temperature).

   (5)  Section 3800.90(a).

   (6)  Sections 3800.91--3800.94.

   (7)  Sections 3800.97--3800.100.

   (8)  Sections 3800.101--3800.106.

   (9)  Section 3800.124.

   (10)  Sections 3800.251--3800.257.

§ 3800.303.  Additional requirements.

   (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 food and water.

   (2)  Potable drinking water shall be available to children at all times.

   (3)  There shall be an opportunity for children to bathe once a week, brush their teeth once a day and wash their hands before each meal.

   (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)  For mobile programs and outdoor programs whenever children are away from the stationary outdoor site, each staff person shall have a map of the area.

   (9)  For mobile programs and outdoor programs whenever children are away from the stationary outdoor site, 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 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)  Sections 3800.16(a) (relating to reportable incidents), as it applies to a child absence from the premises without the approval of staff persons.

   (3)  Section 3800.18 (relating to child funds).

   (4)  Section 3800.32(f), (g) and (k) (relating to specific rights).

   (5)  Section 3800.54(a) and (b) (relating to child care supervisor).

   (6)  Section 3800.57(d) (relating to supervision).

   (7)  Section 3800.98 (relating to indoor activity space).

   (8)  Section 3800.102 (relating to child bedrooms).

   (9)  Sections 3800.103(a)--(d) and (f)--(h) (relating to bathrooms).

   (10)  Section 3800.104(a) (relating to kitchen areas).

   (11)  Section 3800.105 (relating to laundry).

   (12)  Section 3800.124 (relating to notification of local fire officials).

   (13)  Section 3800.130(b) and (e) (relating to smoke detectors and fire alarms).

   (14)  Section 3800.132(e) (relating to fire drills).

   (15)  Sections 3800.144--3800.146 (relating to dental care; vision care; and hearing care).

   (16)  Section 3800.161 (relating to three meals a day).

   (17)  Sections 3800.162 and 3800.163 (relating to quantity of food; and food groups and alternative diets) if the facility does not provide meals.

   (18)  Section 3800.171(1) (relating to safe transportation).

   (19)  Section 3800.255 (relating to laundry).

   (20)  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 a child is absent from the premises without approval of staff persons, the facility shall orally notify the child's parent and, if applicable, the child's guardian or custodian, immediately.

   (3)  For facilities serving 32 or more children, whenever 32 or more children are present at the facility, there shall be at least one child care supervisor present at the facility.

   (4)  The facility shall have at least 15 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.

   (5)  There shall be at least one flush toilet for every 18 children.

   (6)  There shall be at least one sink for every 24 children.

   (7)  If the child had a health examination that was completed in accordance with Article XIV of the Public School Code of 1949 (24 P. S. §§ 14-1401--14-1422) and 28 Pa. Code § 23.2 (relating to medical examinations), for content and periodicity of the examination, an initial health examination within 15 days after admission is not required. The next examination shall be required within the periodicity schedule by the public school. The health examination completed in accordance with the public school requirements shall be accepted for day treatment service. A copy of the health examination shall be on file at the facility within 30 days after admission.

   (8)  A meal break 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)

§§ 3810.1--3810.5.  (Reserved).

§ 3810.10.  (Reserved).

§ 3810.11.  (Reserved).

§§ 3810.21--3810.25.  (Reserved).

§§ 3810.31--3810.41.  (Reserved).

§§ 3810.51--3810.56.  (Reserved).

§§ 3810.61--3810.68.  (Reserved).

§ 3810.81.  (Reserved).

§ 3810.82.  (Reserved).

§§ 3810.91--3810.94.  (Reserved).

§§ 3810.101--3810.103.  (Reserved).

PART VII.  MENTAL HEALTH MANUAL

Subpart E.  RESIDENTIAL AGENCIES FACILITIES/SERVICES

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, which are governed by Chapter 3800 (relating to child residential and day treatment facilities).

   (c)  This chapter applies to host homes serving one or more children.

§ 5310.6.  Definitions.

   The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   CRRS--Community residential rehabilitation services--Transitional residential programs in community settings for persons with chronic psychiatric disability. CRRS's provide housing, personal assistance and psychosocial rehabilitation to clients in nonmedical settings. There are two levels of care, full or partial, which are distinguished by the level of functioning of the clients served and the intensity of rehabilitation and training services provided by CRRS staff to the clients. In both levels of care, the provider acts as landlord to the client. Except host homes for children, every site used by a CRRS to house clients is owned, held, leased or controlled by the provider or a provider-affiliate.

   Child--A person who is under 18 years of age and who is not an emancipated minor.

   Full-care CRRS for adults--A program that provides living accommodations for the client with staff onsite whenever a client is there and a full range of personal assistance and psychosocial rehabilitation for psychiatrically disabled adults who display severe community adjustment problems and who require an intensive, structured living situation.

   Full-care CRRS for children--A program providing living accommodations with maximum supervision, personal assistance and a full range of psycho-social rehabilitation services for psychiatrically disabled children who display severe interpersonal adjustment problems and who require an intensive, structured living situation.

   Host home for children--A private residence of a family, other than the home of the child's parents, with whom the CRRS contracts to provide a structured living arrangement for one to three children.

   Mental disorder--Conditions classified as mental disorders by the International Classification of Diseases (TCD-9-CM) excluding mental retardation and drug/alcohol conditions.

   Mental health professional--A person trained in a generally recognized clinical discipline, including, but not limited to, psychiatry, social work, psychology, nursing, rehabilitation, special education or activity therapies who has a graduate degree and clinical experience.

   Mobile ambulatory--Able to walk without assistance.

   Mobile nonambulatory--The ability to move from place to place with the use of devices such as walkers, crutches, wheelchairs, wheeled platforms, and the like, by a person who is otherwise unable to walk independently.

   Parent--The mother or father by birth or adoption or the legal guardian of the child.

   Partial-care CRRS--A program that provides living accommodations for the client. Staff is at the site on a regularly scheduled basis including evenings and weekends. A limited range of personal assistance and psychosocial services are provided for psychiatrically disabled adults who display community adjustment problems and require a living situation which includes rehabilitation and training services.

Subchapter C.  CHILDREN SERVICES

GENERAL PROVISIONS

§ 5310.92.  Applicability.

   (a)  This subchapter applies to all 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 a partial-care CRRS nor in a CRRS site in which adults are served.

   (b)  When a CRRS accepts a child who is in the legal custody of the county children and youth agency or a public or private social service agency for placement in CRRS group home or host home, the requirements of Chapter 3800 (relating to child residential and day treatment facilities) apply. These requirements are additional to the requirements in this chapter.

PHYSICAL FACILITY STANDARDS

§ 5310.161.  (Reserved).

Subpart E.  RESIDENTIAL AGENCIES/FACILITIES/SERVICES

ARTICLE I.  LICENSING/APPROVAL

CHAPTER 6400.  COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION

§ 6400.3.  Applicability.

   (a)  This chapter applies to community homes for people with mental retardation, except as provided in subsection (f).

   (b)  This chapter contains the minimum requirements that shall be met to obtian a certificate of compliance. A certificate of compliance shall be obtained prior to operation of a community home for people with mental retardation.

   (c)  This chapter applies to profit, nonprofit, publicly funded and privately funded homes.

   (d)  Each home serving nine or more individuals shall be inspected by the Department each year and shall have an individual certificate of compliance specific for each building.

   (e)  Each agency operating one or more homes serving eight or fewer individuals shall have at least a sample of its homes inspected by the Department each year. The certificate of compliance issued to an agency shall specify the location and maximum capacity of each home the agency is permitted to operate.

   (f)  This chapter does not apply to the following:

   (1)  Private homes of persons providing care to a relative with mental retardation.

   (2)  Residential facilities operated by the Department.

   (3)  Intermediate care facilities for the mentally retarded licensed by the Department in accordance with Chapter 6600 (relating to intermediate care facilities for the mentally retarded).

   (4)  Foster family care homes licensed by the Office of Children, Youth and Families of the Department that serve only foster care children.

   (5)  Summer camps.

   (6)  Facilities serving exclusively personal care home, drug and alcohol, mental health or domiciliary care residents.

   (7)  Residential homes for three or fewer people with mental retardation who are 18 years of age or older and who need a yearly average of 30 hours or less direct staff contact per week per home.

   (8)  Child residential facilities which serve exclusively children, which are regulated under Chapter 3800 (relating to child residential and day treatment facilities).

   (g)  This chapter does not measure or assure compliance with other applicable Federal, State and local statutes, regulations, codes and ordinances. It is the responsibility of the home to comply with other applicable laws, regulations, codes and ordinances.

[Pa.B. Doc. No. 99-1045. Filed for public inspection June 25, 1999, 9:00 a.m.]



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