[40 Pa.B. 4935]
[Saturday, August 28, 2010]
[Continued from previous Web Page]
Annex A
TITLE 55. PUBLIC WELFARE
PART IV. ADULT SERVICES MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 2380. ADULT TRAINING FACILITIES
GENERAL PROVISIONS § 2380.3. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Adult—A person 18 years of age or older.
Adult training facility or facility—A building or portion of a building in which services are provided to four or more individuals, who are 59 years of age or younger and who do not have a dementia-related disease as a primary diagnosis, for part of a 24-hour day, excluding care provided by relatives. Services include the provision of functional activities, assistance in meeting personal needs and assistance in performing basic daily activities.
Content discrepancy—A difference between what was determined at the ISP meeting by the plan team and what is documented in the written ISP.
Department—The Department of Public Welfare of the Commonwealth.
Direct service worker—A person whose primary job function is to provide services to an individual who attends the provider's facility.
Documentation—Written statements that accurately record details, substantiate a claim or provide evidence of an event.
Firesafety expert—A local fire department, fire protection engineer, State certified fire protection instructor, college instructor in fire science, county or State fire school, volunteer fire person trained by a county or State fire school or an insurance company loss control representative.
ISP—Individual Support Plan—The comprehensive document that identifies services and expected outcomes for an individual.
Individual—An adult with disabilities who receives care in an adult training facility and who has developmental needs which require assistance to meet personal needs and to perform basic daily activities. Examples of adults with disabilities include adults who exhibit one or more of the following:
(i) A physical disability such as blindness, visual impairment, deafness, hearing impairment, speech or language impairment or a physical handicap.
(ii) A mental illness.
(iii) A neurological disability such as cerebral palsy, autism or epilepsy.
(iv) Mental retardation.
(v) A traumatic brain injury.
Outcomes—Goals the individual and individual's plan team choose for the individual to acquire, maintain or improve.
Plan lead—The program specialist or family living specialist, as applicable, when the individual is not receiving services through an SCO.
Plan team—The group that develops the ISP.
Provider—An entity or person that enters into an agreement with the Department to deliver a service to an individual.
SC—Supports coordinator—An SCO employee whose primary job functions are to locate, coordinate and monitor services provided to an individual when the individual is receiving services from an SCO.
SCO—Supports coordination organization—A provider that delivers the services of locating, coordinating and monitoring services provided to an individual.
Services—Actions or assistance provided to the individual to support the achievement of an outcome.
STAFFING § 2380.33. Program specialist.
(a) At least one program specialist shall be assigned for every 30 individuals, regardless of whether they meet the definition of individual in § 2380.3 (relating to definitions).
(b) The program specialist shall be responsible for the following:
(1) Coordinating and completing assessments.
(2) Providing the assessment as required under § 2380.181(f) (relating to assessment).
(3) Participating in the development of the ISP, including annual updates and revisions of the ISP.
(4) Attending the ISP meetings.
(5) Fulfilling the role of plan lead, as applicable, under §§ 2380.182 and 2380.186(f) and (g) (relating to development, annual update and revision of the ISP; and ISP review and revision).
(6) Reviewing the ISP, annual updates and revisions under § 2380.186 (relating to ISP review and revision), for content accuracy.
(7) Reporting content discrepancy to the SC or plan lead, as applicable, and plan team members.
(8) Implementing the ISP as written.
(9) Supervising, monitoring and evaluating services provided to the individual.
(10) Reviewing, signing and dating the monthly documentation of an individual's participation and progress toward outcomes.
(11) Reporting a change related to the individual's needs to the SC or plan lead, as applicable, and plan team members.
(12) Reviewing the ISP with the individual as required under § 2380.186.
(13) Documenting the review of the ISP as required under § 2380.186.
(14) Providing the documentation of the ISP review to the SC or plan lead, as applicable, and plan team members as required under § 2380.186(d).
(15) Informing plan team members of the option to decline the ISP Review documentation as required under § 2380.186(e).
(16) Recommending a revision to a service or outcome in the ISP as provided under § 2380.186(c)(4).
(17) Coordinating the services provided to an individual.
(18) Coordinating the training of direct service workers in the content of health and safety needs relevant to each individual.
(19) Developing and implementing provider services as required under § 2380.188 (relating to provider services).
(c) A program specialist shall have one of the following groups of qualifications:
(1) A master's degree or above from an accredited college or university and 1 year of work experience working directly with persons with disabilities.
(2) A bachelor's degree from an accredited college or university and 2 years of work experience working directly with persons with disabilities.
(3) An associate's degree or 60 credit hours from an accredited college or university and 4 years of work experience working directly with persons with disabilities.
§ 2380.35. Staffing.
(a) A minimum of one direct service worker for every six individuals shall be physically present with the individuals at all times individuals are present at the facility, except while staff persons are attending meetings or training at the facility.
(b) While staff persons are attending meetings or training at the facility, a minimum of one staff person for every ten individuals shall be physically present with the individuals at all times individuals are present at the facility.
(c) A minimum of two staff persons shall be present with the individuals at all times.
(d) An individual may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the individual's assessment and is part of the individual's ISP, as an outcome which requires the achievement of a higher level of independence.
(e) The staff qualifications and staff ratio as specified in the ISP shall be implemented as written, including when the staff ratio is greater than required under subsections (a), (b) and (c).
(f) An individual may not be left unsupervised solely for the convenience of the facility or the direct service worker.
§§ 2380.101—2380.108. (Reserved).
MEDICATIONS § 2380.123. Use of prescription medications.
(a) Prescription medications shall only be used by the individual for whom the medication was prescribed.
(b) If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the ISP to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness.
RECORDS § 2380.173. Content of records.
Each individual's record must include the following information:
(1) Personal information including:
(i) The name, sex, admission date, birthdate and social security number.
(ii) The race, height, weight, color of hair, color of eyes and identifying marks.
(iii) The language or means of communication spoken or understood by the individual and the primary language used in the individual's natural home, if other than English.
(iv) Religious affiliation.
(v) A current, dated photograph.
(2) Unusual incident reports related to the individual.
(3) Physical examinations.
(4) Assessments as required under § 2380.181 (relating to assessment).
(5) A copy of the invitation to:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting.
(6) A copy of the signature sheet for:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting.
(7) A copy of the current ISP.
(8) Documentation of ISP reviews and revisions under § 2380.186 (relating to ISP review and revision), including the following:
(i) ISP review signature sheets.
(ii) Recommendations to revise the ISP.
(iii) ISP revisions.
(iv) Notices that the plan team member may decline the ISP review documentation.
(v) Requests from plan team members to not receive the ISP review documentation.
(9) Content discrepancies in the ISP, the annual update or revision under § 2380.186.
(10) Restrictive procedure protocols and records related to the individual.
(11) Copies of psychological evaluations, if applicable.
§ 2380.174. Record location.
(a) The record information required in § 2380.173(1) (relating to content of records) shall be kept at the facility.
(b) The most current copies of record information required in § 2380.173(2)—(11) shall be kept at the facility.
(c) The record information required in § 2380.173(2)—(11), that is not current shall be kept at the facility or at the facility's administrative office.
PROGRAM § 2380.181. Assessment.
(a) Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.
(b) If the program specialist is making a recommendation to revise a service or outcome in the ISP as provided under § 2380.186(c)(4) (relating to ISP review and revision), the individual shall have an assessment completed as required under this section.
(c) The assessment shall be based on assessment instruments, interviews, progress notes and observations.
(d) The program specialist shall sign and date the assessment.
(e) The assessment must include the following information:
(1) Functional strengths, needs and preferences of the individual.
(2) The likes, dislikes and interests of the individual, including vocational and employment interests.
(3) The individual's current level of performance and progress in the following areas:
(i) Acquisition of functional skills.
(ii) Communication.
(iii) Personal adjustment.
(iv) Personal needs with or without assistance from others.
(4) The individual's need for supervision.
(5) The individual's ability to self-administer medications.
(6) The individual's ability to safely use or avoid poisonous materials, when in the presence of poisonous materials.
(7) The individual's knowledge of the danger of heat sources and ability to sense and move away quickly from heat sources which exceed 120° F and are not insulated.
(8) The individual's ability to evacuate in the event of a fire.
(9) Documentation of the individual's disability, including functional and medical limitations.
(10) A lifetime medical history.
(11) Psychological evaluations, if applicable.
(12) Recommendations for specific areas of training, vocational programming and competitive community-integrated employment.
(13) The individual's progress over the last 365 calendar days and current level in the following areas:
(i) Health.
(ii) Motor and communication skills.
(iii) Personal adjustment.
(iv) Socialization.
(v) Recreation.
(vi) Community-integration.
(14) The individual's knowledge of water safety and ability to swim.
(f) The program specialist shall provide the assessment to the SC or plan lead, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development, annual update and revision of the ISP under §§ 2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP).
§ 2380.182. Development, annual update and revision of the ISP.
(a) An individual shall have one ISP.
(b) When an individual is not receiving services through an SCO and does not reside in a home licensed under Chapter 6400 or 6500 (relating to community homes for individuals with mental retardation; and family living homes), the adult training facility program specialist shall be the plan lead when one of the following applies:
(1) The individual attends a facility licensed under this chapter.
(2) The individual attends a facility licensed under this chapter and a facility licensed under Chapter 2390.
(c) The plan lead shall be responsible for developing and implementing the ISP, including annual updates and revisions.
(d) The plan lead shall develop, update and revise the ISP according to the following:
(1) The ISP shall be initially developed, updated annually and revised based upon the individual's current assessment as required under §§ 2380.181, 2390.151, 6400.181 and 6500.151 (relating to assessment).
(2) The initial ISP shall be developed within 90 calendar days after the individual's admission date to the facility.
(3) The ISP, annual updates and revisions shall be documented on the Department-designated form located in the Home and Community Services Information System (HCSIS) and also on the Department's web site.
(4) An invitation shall be sent to plan team members at least 30 calendar days prior to an ISP meeting.
(5) Copies of the ISP, including annual updates and revisions under § 2380.186, shall be provided as required under § 2380.187 (relating to copies).
§ 2380.183. Content of the ISP.
The ISP, including annual updates and revisions under § 2380.186 (relating to ISP review and revision), must include the following:
(1) Services provided to the individual and expected outcomes chosen by the individual and individual's plan team.
(2) Services provided to the individual to increase community involvement, including work opportunities as required under § 2380.188 (relating to provider services).
(3) Current status in relation to an outcome and method of evaluation used to determine progress toward that expected outcome.
(4) A protocol and schedule outlining specified periods of time for the individual to be without direct supervision, if the individual's current assessment states the individual may be without direct supervision and if the individual's ISP includes an expected outcome which requires the achievement of a higher level of independence. The protocol must include the current level of independence and the method of evaluation used to determine progress toward the expected outcome to achieve the higher level of independence.
(5) A protocol to address the social, emotional and environmental needs of the individual, if medication has been prescribed to treat symptoms of a diagnosed psychiatric illness.
(6) A protocol to eliminate the use of restrictive procedures, if restrictive procedures are utilized, and to address the underlying causes of the behavior which led to the use of restrictive procedures including the following:
(i) An assessment to determine the causes or antecedents of the behavior.
(ii) A protocol for addressing the underlying causes or antecedents of the behavior.
(iii) The method and timeline for eliminating the use of restrictive procedures.
(iv) A protocol for intervention or redirection without utilizing restrictive procedures.
(7) Assessment of the individual's potential to advance in the following:
(i) Vocational programming.
(ii) Community involvement.
(iii) Competitive community-integrated employment.
§ 2380.184. Plan team participation.
(a) The plan team shall participate in the development of the ISP, including the annual updates and revisions under § 2380.186 (relating to ISP review and revision).
(1) A plan team must include as its members the following:
(i) The individual.
(ii) A program specialist or family living specialist, as applicable, from each provider delivering a service to the individual.
(iii) A direct service worker who works with the individual from each provider delivering a service to the individual.
(iv) Any other person the individual chooses to invite.
(2) If the following have a role in the individual's life, the plan team may also include as its members, as applicable, the following:
(i) Medical, nursing, behavior management, speech, occupational or physical therapy specialists.
(ii) Additional direct service workers who work with the individual from each provider delivering services to the individual.
(iii) The individual's parent, guardian or advocate.
(b) At least three plan team members, in addition to the individual, if the individual chooses to attend, shall be present for an ISP, annual update and ISP revision meeting.
(c) A plan team member who attends a meeting under subsection (b) shall sign and date the signature sheet.
§ 2380.185. Implementation of the ISP.
(a) The ISP shall be implemented by the ISP'S start date.
(B) The ISP shall be implemented as written.
§ 2380.186. ISP review and revision.
(a) The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the facility licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impact the services as specified in the current ISP.
(b) The program specialist and individual shall sign and date the ISP review signature sheet upon review of the ISP.
(c) The ISP review must include the following:
(1) A review of the monthly documentation of an individual's participation and progress during the prior 3 months toward ISP outcomes supported by services provided by the facility licensed under this chapter.
(2) A review of each section of the ISP specific to the facility licensed under this chapter.
(3) The program specialist shall document a change in the individual's needs, if applicable.
(4) The program specialist shall make a recommendation regarding the following, if applicable:
(i) The deletion of an outcome or service to support the achievement of an outcome which is no longer appropriate or has been completed.
(ii) The addition of an outcome or service to support the achievement of an outcome.
(iii) The modification of an outcome or service to support the achievement of an outcome in which no progress has been made.
(5) If making a recommendation to revise a service or outcome in the ISP, the program specialist shall complete a revised assessment as required under § 2380.181(b) (relating to assessment).
(d) The program specialist shall provide the ISP review documentation, including recommendations, if applicable, to the SC or plan lead, as applicable, and plan team members within 30 calendar days after the ISP review meeting.
(e) The program specialist shall notify the plan team members of the option to decline the ISP review documentation.
(f) If a recommendation for a revision to a service or outcome in the ISP is made, the plan lead as applicable, under §§ 2380.182(b) and (c), 2390.152(b) and (c), 6400.182(b) and (c), 6500.152(b) and (c) (relating to development, annual update and revision of the ISP), shall send an invitation for an ISP revision meeting to the plan team members within 30 calendar days of receipt of the recommendation.
(g) A revised service or outcome in the ISP shall be implemented by the start date in the ISP as written.
§ 2380.187. Copies.
A copy of the ISP, including the signature sheet, shall be provided to plan team members within 30 calendar days after the ISP annual update and ISP revision meetings.
§ 2380.188. Provider services.
(a) The facility shall provide services including assistance, training and support for the acquisition, maintenance or improvement of functional skills, personal needs, communication and personal adjustment.
(b) The facility shall provide opportunities and support to the individual for participation in community life, including work opportunities.
(c) The facility shall provide services to the individual as specified in the individual's ISP.
(d) The facility shall provide services that are age and functionally appropriate to the individual.
CHAPTER 2390. VOCATIONAL FACILITIES
GENERAL PROVISIONS § 2390.5. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Abusive act—An act or omission of an act that willfully deprives a client of rights or which may cause or causes actual physical injury or emotional harm to a client.
Certificate of compliance—A document issued to a legal entity permitting it to operate a vocational facility at a given location, for a specific period of time, according to appropriate regulations of the Commonwealth.
Chief executive officer—The staff person responsible for the general management of the facility. Other terms such as ''program director'' or ''administrator'' may be used as long as the qualifications specified in § 2390.32 (relating to chief executive officer) are met.
Client—A disabled adult receiving services in a vocational facility.
Competitive employment—A job in a regular work setting with an employee-employer relationship, in which a disabled adult is hired to do a job that other nondisabled employees also do.
Content discrepancy—A difference between what was determined at the ISP meeting by the plan team and what is documented in the written ISP.
Criminal abuse—Crimes against the person such as assault and crimes against the property of the client such as theft or embezzlement.
Department—The Department of Public Welfare of the Commonwealth.
Direct service worker—A person whose primary job function is to provide services to a client who attends the provider's facility.
Disabled adult—
(i) A person who because of a disability requires special help or special services on a regular basis in order to function vocationally.
(ii) The term includes persons who exhibit any of the following characteristics:
(A) A physical disability, such as visual impairment, hearing impairment, speech or language impairment or other physical handicap.
(B) Social or emotional maladjustment.
(C) A neurologically based condition such as cerebral palsy, autism or epilepsy.
(D) Mental retardation.
Documentation—Written statements that accurately record details, substantiate a claim or provide evidence of an event.
Handicapped employment—A vocational program in which the individual client does not require rehabilitation, habilitation or ongoing training in order to work at the facility.
ISP—Individual Support Plan—The comprehensive document that identifies services and expected outcomes for a client.
Individual written program plan—A plan that is developed for a client on the basis of assessment data that specifies specific objectives and program services for the clients.
Interdisciplinary team—A group of persons representing one or more service areas relevant to identifying a client's needs, including at a minimum the county casemanager if the client is funded through the county mental health and mental retardation program, the client and the program specialist.
Outcomes—Goals the client and client's plan team choose for the client to acquire, maintain or improve.
Plan lead—The program specialist or family living specialist, as applicable, when the client is not receiving services through an SCO.
Plan team—The group that develops the ISP.
Provider—An entity or person that enters into an agreement with the Department to deliver a service to a client.
Restrictive procedure—A practice that limits a client's movement, activity or function; interferes with a client's ability to acquire positive reinforcement; results in the loss of objects or activities that a client values; or requires a client to engage in a behavior that the client would not engage in given freedom of choice.
SC—Supports coordinator—An SCO employee whose primary job functions are to locate, coordinate and monitor services provided to a client when the client is receiving services from an SCO.
SCO—Supports coordination organization—A provider that delivers the services of locating, coordinating and monitoring services provided to a client.
Services—Actions or assistance provided to the client to support the achievement of an outcome.
Sheltered employment—A program designed to enable the client to move out of the vocational facility into competitive employment or into a higher level vocational program focusing on the development of competitive worker traits and using work as the primary training method.
Training—
(i) Occupational training that follows a specific curriculum and is designed to teach skills for a specific occupation in the competitive labor market.
(ii) The term also includes personal and work adjustment training that is designed to develop appropriate worker traits and teach an understanding of the expectations of a work environment to enable the client to progress into a higher level rehabilitation program or into competitive employment.
Vocational evaluation—The use of planned activities, systematic observation and testing to accomplish a formal assessment of a client, including an identification of program needs, potential for employment and identification of employment objectives.
Vocational facility (facility)—A premise in which rehabilitative, habilitative or handicapped employment or employment training is provided to one or more disabled clients for part of a 24-hour day.
Work activities center—A program focusing on working and behavioral/therapeutic techniques to enable clients to attain sufficient vocational, personal, social and independent living skills to progress to higher level vocational programs.
Work performance review—An assessment of the client's skill level.
STAFFING § 2390.33. Program specialist.
(a) A minimum of one program specialist for every 45 clients shall be available when clients are present at the facility.
(b) The program specialist shall be responsible for the following:
(1) Coordinating and completing assessments.
(2) Providing the assessment as required under § 2390.151(f) (relating to assessment).
(3) Participating in the development of the ISP, including annual updates and revisions of the ISP.
(4) Attending the ISP meetings.
(5) Fulfilling the role of plan lead, as applicable, under §§ 2390.152 and 2390.156(f) and (g) (relating to development, annual update and revision to the ISP; and ISP review and revision).
(6) Reviewing the ISP, annual updates and revisions for content accuracy.
(7) Reporting content discrepancy to the SC or plan lead, as applicable, and plan team members.
(8) Implementing the ISP as written.
(9) Supervising, monitoring and evaluating services provided to the client.
(10) Reviewing, signing and dating the monthly documentation of a client's participation and progress toward outcomes.
(11) Reporting a change related to the client's needs to the SC or plan lead, as applicable, and plan team members.
(12) Reviewing the ISP with the client as required under § 2390.156.
(13) Documenting the review of the ISP as required under § 2390.156.
(14) Providing documentation of the ISP review to the SC or plan lead, as applicable, and plan team members as required under § 2390.156(d).
(15) Informing plan team members of the option to decline the ISP review documentation as required under § 2390.156(e).
(16) Recommending a revision to a service or outcome in the ISP as provided under § 2390.156(c)(4).
(17) Coordinating the services provided to a client.
(18) Coordinating the training of direct service workers in the content of health and safety needs relevant to each client.
(19) Developing and implementing provider services as required under § 2390.158 (relating to provider services).
(c) A program specialist shall meet one of the following groups of qualifications:
(1) Possess a master's degree or above from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field.
(2) Possess a bachelor's degree from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field; and 1 year experience working directly with disabled persons.
(3) Possess an associate's degree or completion of a 2 year program from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field; and 3 years experience working directly with disabled persons.
(4) Possess a license or certification by the State Board of Nurse Examiners, the State Board of Physical Therapists Examiners, or the Committee on Rehabilitation Counselor Certification or be a licensed psychologist or registered occupational therapist; and 1 year experience working directly with disabled persons.
§ 2390.39. Staffing.
(a) A minimum of two staff shall be present at the facility when 10 or more clients are present at the facility.
(b) A minimum of one staff shall be present at the facility when fewer than 10 clients are present at the facility.
(c) If 20 or more clients are present at the facility, there shall be at least one staff present at the facility who meets the qualifications of program specialist.
(d) A client may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the client's assessment and is part of the client's ISP, as an outcome which requires the achievement of a higher level of independence.
(e) The staff qualifications and staff ratio as specified in the ISP shall be implemented as written, including when the staff ratio is greater than required under subsections (a), (b) and (c).
(f) A client may not be left unsupervised solely for the convenience of the facility or the direct service worker.
§§ 2390.91—2390.100. (Reserved).
CLIENT RECORDS § 2390.124. Content of records.
Each client's record must include the following information:
(1) The name, sex, admission date, birthdate and place, social security number and dates of entry, transfer and discharge.
(2) The name, address and telephone number of parents, legal guardian and a designated person to be contacted in case of an emergency.
(3) The name and telephone number of a physician or source of health care.
(4) Written consent from the client, parent or guardian for emergency medical treatment.
(5) Physical examinations.
(6) Assessments as required under § 2390.151 (relating to assessment).
(7) A copy of the vocational evaluations, if applicable.
(8) A copy of the invitation to:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting.
(9) A copy of the signature sheet for:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting.
(10) A copy of the current ISP.
(11) Documentation of ISP reviews and ISP revisions under § 2390.156 (relating to ISP review and revision), including the following:
(i) ISP Review signature sheets.
(ii) Recommendations to revise the ISP.
(iii) ISP revisions.
(iv) Notices that the plan team member may decline the ISP review documentation.
(v) Requests from plan team members to not receive the ISP review documentation.
(12) Content discrepancy in the ISP, the annual update or revision under § 2390.156.
(13) Restrictive procedure protocols and records related to the client.
(14) Unusual incident reports related to the client.
(15) Copies of psychological evaluations, if applicable.
(16) Vocational evaluations as required under § 2390.159.
PROGRAM § 2390.151. Assessment.
(a) Each client shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.
(b) If the program specialist is making a recommendation to revise a service or outcome in the ISP as provided under § 2390.156(c)(4) (relating to ISP review and revision), the client shall have an assessment completed as required under this section.
(c) The assessment shall be based on assessment instruments, interviews, progress notes and observations.
(d) The program specialist shall sign and date the assessment.
(e) The assessment must include the following information:
(1) Functional strengths, needs and preferences of the client.
(2) The likes, dislikes and interest of client, including vocational and employment interests of the client.
(3) The client's current level of performance and progress in the following areas:
(i) Acquisition of vocational functioning skills.
(ii) Communication; ability to receive, retain and carry out instructions.
(iii) Personal adjustment.
(iv) Personal needs with or without assistance from others.
(4) The client's need for supervision.
(5) The client's ability to self-administer medications.
(6) The client's ability to safely use or avoid poisonous materials, when in the presence of poisonous materials.
(7) The client's knowledge of the danger of heat sources and ability to sense and move away quickly from heat sources which exceed 120° F and are not insulated.
(8) The client's ability to evacuate in the event of a fire.
(9) Documentation of the client's disability, including functional and medical limitations.
(10) A lifetime medical history.
(11) Psychological evaluations, if applicable.
(12) Recommendations for specific areas of vocational training or placement and competitive community-integrated employment.
(13) The individual's progress over the last 365 calendar days and current level in the following areas:
(i) Health.
(ii) Motor and communication skills.
(iii) Personal adjustment.
(iv) Socialization.
(v) Vocational skills.
(f) The program specialist shall provide the assessment to the SC or plan lead, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development, annual update and revision of the ISP under §§ 2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP).
§ 2390.152. Development, annual update and revision of the ISP.
(a) A client shall have one ISP.
(b) When a client is not receiving services through an SCO and is not receiving services in a facility or home licensed under Chapters 2380, 6400 or 6500 (relating to adult training facilities; community homes for individuals with mental retardation; and family living homes), the vocational facility program specialist shall be the plan lead.
(c) The plan lead shall be responsible for developing and implementing the ISP, including annual updates and revisions.
(d) The plan lead shall develop, update and revise the ISP according to the following:
(1) The ISP shall be initially developed, updated annually and revised based upon the client's current assessment as required under §§ 2380.181, 2390.151, 6400.181 and 6500.151 (relating to assessment).
(2) The initial ISP shall be developed within 90 calendar days after the client's admission date to the facility.
(3) The ISP, annual updates and revisions shall be documented on the Department-designated form located in the Home and Community Services Information System (HCSIS) And also on the Department's web site.
(4) An invitation shall be sent to plan team members at least 30 calendar days prior to an ISP meeting.
(5) Copies of the ISP, including annual updates and revisions under § 2390.156, shall be provided as required under § 2390.157 (relating to copies).
§ 2390.153. Content of the ISP.
The ISP, including annual updates and revisions under § 2390.156 (relating to ISP review and revision) must include the following:
(1) Services provided to the client and expected outcomes chosen by the client and client's plan team.
(2) Services provided to the client to develop the skills necessary for promotion into a higher level of vocational programming or into competitive community-integrated employment as required under § 2390.158 (relating to provider services).
(3) Current status in relation to an outcome and method of evaluation used to determine progress toward that expected outcome.
(4) A protocol and schedule outlining specified periods of time for the client to be without direct supervision, if the client's current assessment states the client may be without direct supervision and if the client's ISP includes an expected outcome which requires the achievement of a higher level of independence. The protocol must include the current level of independence and the method of evaluation used to determine progress toward the expected outcome to achieve a higher level of independence.
(5) A protocol to address the social, emotional and environmental needs of the client, if medication has been prescribed to treat symptoms of a diagnosed psychiatric illness.
(6) A protocol to eliminate the use of restrictive procedures, if restrictive procedures are utilized, and to address the underlying causes of the behavior which led to the use of restrictive procedures including the following:
(i) An assessment to determine the causes or antecedents of the behavior.
(ii) A protocol for addressing the underlying causes or antecedents of the behavior.
(iii) The method and timeline for eliminating the use of restrictive procedures.
(iv) A protocol for intervention or redirection without utilizing restrictive procedures.
(7) Assessment of the client's potential to advance in the following:
(i) Vocational programming.
(ii) Competitive community-integrated employment.
§ 2390.154. Plan team participation.
(a) The plan team shall participate in the development of the ISP, including the annual updates and revisions under § 2390.156 (relating to ISP review and revision).
(1) A plan team must include as its members the following:
(i) The client.
(ii) A program specialist or family living specialist, as applicable, from each provider delivering a service to the client.
(iii) A direct service worker who works with the client from each provider delivering a service to the client.
(iv) Any other person the client chooses to invite.
(2) If the following have a role in the client's life, the plan team may also include as its members, as applicable, the following:
(i) Medical, nursing, behavior management, speech, occupational or physical therapy specialists.
(ii) Additional direct service workers who work with the client from each provider delivering services to the client.
(iii) The client's parent, guardian or advocate.
(b) At least three plan team members, in addition to the client, if the client chooses to attend, shall be present for the ISP, annual update and ISP revision meetings.
(c) A plan team member who attends an ISP meeting under subsection (b) shall sign and date the signature sheet.
§ 2390.155. Implementation of the ISP.
(a) The ISP shall be implemented by the ISP's start date.
(b) The ISP shall be implemented as written.
§ 2390.156. ISP review and revision.
(a) The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the facility licensed under this chapter with the client every 3 months or more frequently if the client's needs change which impacts the services as specified in the current ISP.
(b) The program specialist and client shall sign and date the ISP review signature sheet upon review of the ISP.
(c) The ISP review must include the following:
(1) A review of the monthly documentation of a client's participation and progress during the prior 3 months toward ISP outcomes supported by services provide by the facility licensed under this chapter.
(2) A review of each section of the ISP specific to the facility licensed under this chapter.
(3) The program specialist shall document a change in the client's needs, if applicable.
(4) The program specialist shall make a recommendation regarding the following, if applicable:
(i) The deletion of an outcome or service to support the achievement of an outcome which is no longer appropriate or has been completed.
(ii) The addition of an outcome or service to support the achievement of an outcome.
(iii) The modification of an outcome or service to support the achievement of an outcome in which no progress has been made.
(5) If making a recommendation to revise a service or outcome in the ISP, the program specialist shall complete a revised assessment as required under § 2390.151(b) (relating to assessment).
(d) The program specialist shall provide the ISP review documentation, including recommendations if applicable, to the SC or plan lead, as applicable, and plan team members within 30 calendar days after the ISP review meeting.
(e) The program specialist shall notify the plan team members of the option to decline the ISP review documentation.
(f) If a recommendation for a revision to a service or outcome in the ISP is made, the plan lead, as applicable, under §§ 2380.182(b) and (c), 2390.152(b) and (c), 6400.182(b) and (c), 6500.152(b) and (c) (relating to development, annual update and revision of the ISP), shall send an invitation for an ISP revision meeting to the plan team members within 30 calendar days of receipt of the recommendation.
(g) A revised service or outcome in the ISP shall be implemented by the start date in the ISP as written.
§ 2390.157. Copies.
A copy of the ISP, ISP annual update and ISP revision, including the signature sheet, shall be provided to plan team members within 30 calendar days after the ISP, ISP annual update and ISP revision meetings.
§ 2390.158. Provider services.
(a) The facility shall provide services including work experience and other developmentally oriented, vocational training designed to develop the skills necessary for promotion into a higher level of vocational programming or competitive community-integrated employment.
(b) The facility shall provide opportunities and support to the client for participation in community life, including competitive community-integrated employment.
(c) The facility shall provide services to the client as specified in the client's ISP.
(d) The facility shall provide services that are age and functionally appropriate to the client.
§ 2390.159. Vocational evaluation.
If the facility provides vocational evaluation, the following apply:
(1) The vocational evaluator shall perform the evaluations.
(2) A copy of the written evaluation shall be kept in the client's record.
(3) The written evaluation must include the following information:
(i) The client's current level of vocational functioning.
(ii) The employment objectives for the client.
(iii) The vocational interests of the client.
(iv) The client's level of personal and social adjustment.
(v) The client's work attitude.
(vi) The client's fatigue levels.
(vii) The client's ability to receive, retain and carry out instructions.
(viii) Recommendations for specific areas of training or placement.
(4) The facility shall ensure the client and the client's parent, guardian or advocate, as applicable, are informed of the results of the evaluation.
(i) The client and the client's parent, guardian or advocate, as applicable, shall sign a statement acknowledging receipt of the evaluation results.
(ii) The signed statement acknowledging receipt of the evaluation results shall be kept in the client's record.
PART VIII. MENTAL RETARDATION MANUAL
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
ARTICLE I. LICENSING/APPROVAL
CHAPTER 6400. COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION
GENERAL PROVISIONS § 6400.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Agency—A person or legally constituted organization operating one or more community homes for people with mental retardation serving eight or fewer individuals.
Community home for people with mental retardation home—A building or separate dwelling unit in which residential care is provided to one or more individuals with mental retardation, except as provided in § 6400.3(f) (relating to applicability). Each apartment unit within an apartment building is considered a separate home. Each part of a duplex, if there is physical separation between the living areas, is considered a separate home.
Content discrepancy—A difference between what was determined at the ISP meeting by the plan team and what is documented in the written ISP.
Department—The Department of Public Welfare of the Commonwealth.
Direct service worker—A person whose primary job function is to provide services to an individual who resides in the provider's residential home.
Documentation—Written statements that accurately record details, substantiate a claim or provide evidence of an event.
Fire safety expert—A local fire department, fire protection engineer, State certified fire protection instructor, college instructor in fire science, county or State fire school, volunteer fire person trained by a county or State fire school or an insurance company loss control representative.
ISP—Individual Support Plan—The comprehensive document that identifies services and expected outcomes for an individual.
Individual—A person with mental retardation who resides, or receives residential respite care, in a home and who is not a relative of the owner of the home.
Mental retardation—Subaverage general intellectual functioning which originates during the developmental period and is associated with impairment of one or more of the following:
(i) Maturation.
(ii) Learning.
(iii) Social adjustment.
Normalization—A principle designed to ensure for every person with mental retardation and the person's family the right to live a life as close as possible to that which is typical for the general population.
Outcomes—Goals the individual and individual's plan team choose for the individual to acquire, maintain or improve.
Plan lead—The program specialist, when the individual is not receiving services through an SCO.
Plan team—The group that develops the ISP.
Provider—An entity or person that enters into an agreement with the Department to deliver a service to an individual.
Relative—A parent, child, stepparent, stepchild, grandparent, grandchild, brother, sister, half brother, half sister, aunt, uncle, niece or nephew.
SC—Supports coordinator—An SCO employee whose primary job functions are to locate, coordinate and monitor services provided to an individual when the individual is receiving services from an SCO.
SCO—Supports coordination organization—A provider that delivers the services of locating, coordinating and monitoring services provided to an individual.
Services—Actions or assistance provided to the individual to support the achievement of an outcome.
STAFF § 6400.44. Program specialist.
(a) A minimum of one program specialist shall be assigned for every 30 individuals. A program specialist shall be responsible for a maximum of 30 people, including people served in other types of services.
(b) The program specialist shall be responsible for the following:
(1) Coordinating and completing assessments.
(2) Providing the assessment as required under § 6400.181(f) (relating to assessment).
(3) Participating in the development of the ISP, ISP annual update and ISP revision.
(4) Attending the ISP meetings.
(5) Fulfilling the role of plan lead, as applicable, under §§ 6400.182 and 6400.186(f) and (g) (relating to development, annual update and revision of the ISP; and ISP review and revision).
(6) Reviewing the ISP, annual updates and revisions under § 6400.186 (relating to ISP review and revision) for content accuracy.
(7) Reporting content discrepancy to the SC, as applicable, and plan team members.
(8) Implementing the ISP as written.
(9) Supervising, monitoring and evaluating services provided to the individual.
(10) Reviewing, signing and dating the monthly documentation of an individual's participation and progress toward outcomes.
(11) Reporting a change related to the individual's needs to the SC, as applicable, and plan team members.
(12) Reviewing the ISP with the individual as required under § 6400.186.
(13) Documenting the review of the ISP as required under § 6400.186.
(14) Providing the documentation of the ISP review to the SC, as applicable, and plan team members as required under § 6400.186(d).
(15) Informing plan team members of the option to decline the ISP review documentation as required under § 6400.186(e).
(16) Recommending a revision to a service or outcome in the ISP as provided under § 6400.186(c)(4).
(17) Coordinating the services provided to an individual.
(18) Coordinating the training of direct service workers in the content of health and safety needs relevant to each individual.
(19) Developing and implementing provider services as required under § 6400.188 (relating to provider services).
(c) A program specialist shall have one of the following groups of qualifications:
(1) A master's degree or above from an accredited college or university and 1 year work experience working directly with persons with mental retardation.
(2) A bachelor's degree from an accredited college or university and 2 years work experience working directly with persons with mental retardation.
(3) An associate's degree or 60 credit hours from an accredited college or university and 4 years work experience working directly with persons with mental retardation.
§ 6400.45. Staffing.
(a) A minimum of one staff person for every eight individuals shall be awake and physically present at the home when individuals are awake at the home.
(b) A minimum of one staff person for every 16 individuals shall be physically present at the home when individuals are sleeping at the home.
(c) An individual may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the individual's assessment and is part of the individual's ISP, as an outcome which requires the achievement of a higher level of independence.
(d) The staff qualifications and staff ratio as specified in the ISP shall be implemented as written, including when the staff ratio is greater than required under subsections (a), (b) and (c).
(e) An individual may not be left unsupervised solely for the convenience of the residential home or the direct service worker.
§§ 6400.121—6400.130. (Reserved).
MEDICATIONS § 6400.163. Use of prescription medications.
(a) Prescription medications shall only be used by the individual for whom the medication was prescribed.
(b) If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the ISP to address the social, emotional and environmental needs of the individual related to the symptoms of the diagnosed psychiatric illness.
(c) If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.
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