[46 Pa.B. 7061]
[Saturday, November 5, 2016]
[Continued from previous Web Page]
MEDICATIONS § 6500.131. [Storage of medications.] Self-administration.
[(a) Prescription and nonprescription medications of individuals shall be kept in their original containers, except for medications of individuals who self-administer medications and keep their medications in personal daily or weekly dispensing containers.
(b) Prescription and potentially toxic nonprescription medications shall be kept in an area or container that is locked or made inaccessible to the individuals, unless it is documented in each individual's assessment that each individual in the home can safely use or avoid toxic materials.
(c) Prescription and potentially toxic nonprescription medications stored in a refrigerator shall be kept in a separate locked container or made inaccessible to the individuals, unless it is documented in each individual's assessment that each individual in the home can safely use or avoid toxic materials.
(d) Prescription and nonprescription medications of individuals shall be stored under proper conditions of sanitation, temperature, moisture and light.
(e) Discontinued prescription medications of individuals shall be disposed of in a safe manner.]
(a) An agency shall provide an individual who has a prescribed medication with assistance, as needed, for the individual's self-administration of the medication.
(b) Assistance in the self-administration of medication includes helping the individual to remember the schedule for taking the medication, offering the individual the medication at the prescribed times, opening a medication container and storing the medication in a secure place.
(c) The agency shall provide or arrange for assistive technology to support the individual's self-administration of medications.
(d) The PSP must identify if the individual is unable to self-administer medications.
(e) To be considered able to self-administer medications, an individual shall do all of the following:
(1) Recognize and distinguish his medication.
(2) Know how much medication is to be taken.
(3) Know when the medication is to be taken. This knowledge may include reminders of the schedule and offering the medication at the prescribed times as specified in subsection (b).
(4) Take or apply the individual's own medication with or without the use of assistive technology.
§ 6500.132. [Labeling of medications.] Medication administration.
[(a) The original container for prescription medications of individuals shall be labeled with a pharmaceutical label that includes the individual's name, the name of the medication, the date the prescription was issued, the prescribed dose and the name of the prescribing physician.
(b) Nonprescription medications used by individuals shall be labeled with the original label.]
(a) An agency whose staff persons or others are qualified to administer medications as specified in subsection (b) may provide medication administration for an individual who is unable to self-administer the individual's prescribed medication.
(b) A prescription medication that is not self-administered shall be administered by one of the following:
(1) A licensed physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic.
(2) A person who has completed the medication administration training as specified in § 6500.139 (relating to medication administration training) for the medication administration of the following:
(i) Oral medications.
(ii) Topical medications.
(iii) Eye, nose and ear drop medications.
(iv) Insulin injections.
(v) Epinephrine injections for insect bites or other allergies.
(c) Medication administration includes the following activities, based on the needs of the individual:
(1) Identify the correct individual.
(2) Remove the medication from the original container.
(3) Crush or split the medication as ordered by the prescriber.
(4) Place the medication in a medication cup or other appropriate container, or in the individual's hand, mouth or other route as ordered by the prescriber.
(5) If indicated by the prescriber's order, measure vital signs and administer medications according to the prescriber's order.
(6) Injection of insulin or epinephrine in accordance with this chapter.
§ 6500.133. [Use of prescription] Storage and disposal of medications.
[(a) A prescription medication 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.]
(a) Prescription and nonprescription medications shall be kept in their original labeled containers.
(b) A prescription medication may not be removed from its original labeled container more than 2 hours in advance of the scheduled administration.
(c) If insulin or epinephrine is not packaged in an individual dose container, assistance with or the administration of the injection shall be provided immediately upon removal of the medication from its original labeled container.
(d) Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.
(e) Epinephrine and epinephrine auto-injectors shall be stored safely and kept easily accessible at all times. The epinephrine and epinephrine auto-injectors shall be easily accessible to the individual if the epinephrine is self-administered or to the staff person who is with the individual if a staff person will administer the epinephrine.
(f) Prescription medications stored in a refrigerator shall be kept in an area or container that is locked.
(g) Prescription medications shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions.
(h) Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to the Department of Environmental Protection and applicable Federal and State regulations.
(i) Subsections (a)—(d) and (f) do not apply for an individual who self-administers medication and stores the medication in the individual's private bedroom.
§ 6500.134. [Medication log.] Labeling of medications.
[(a) A medication log listing the medications prescribed, dosage, time and date that prescription medications, including insulin, were administered, and the name of the person who administered the prescription medication or insulin shall be kept for each individual who does not self-administer medication.
(b) The information specified in subsection (a) shall be logged immediately after each individual's dose of medication.
(c) A list of prescription medications, the prescribed dosage and the name of the prescribing physician shall be kept for each individual who self-administers medication.]
The original container for prescription medications must be labeled with a pharmacy label that includes the following:
(1) The individual's name.
(2) The name of the medication.
(3) The date the prescription was issued.
(4) The prescribed dosage and instructions for administration.
(5) The name and title of the prescriber.
§ 6500.135. [Medication errors.] Prescription medications.
[Documentation of medication errors and follow-up action taken shall be kept.]
(a) A prescription medication shall be prescribed in writing by an authorized prescriber.
(b) A prescription order shall be kept current.
(c) A prescription medication shall be administered as prescribed.
(d) A prescription medication shall be used only by the individual for whom the prescription was prescribed.
(e) Changes in medication may only be made in writing by the prescriber or, in the case of an emergency, an alternate prescriber, except for circumstances in which oral orders may be accepted by a registered nurse in accordance with regulations of the Department of State. The individual's medication record shall be updated as soon as a written notice of the change is received.
§ 6500.136. [Adverse reaction.] Medication record.
[If an individual has a suspected adverse reaction to a medication, the family shall notify the prescribing physician immediately. Documentation of adverse reactions shall be kept in the individual's record.]
(a) A medication record shall be kept, including the following for each individual for whom a prescription medication is administered:
(1) Individual's name.
(2) Name and title of the prescriber.
(3) Drug allergies.
(4) Name of medication.
(5) Strength of medication.
(6) Dosage form.
(7) Dose of medication.
(8) Route of administration.
(9) Frequency of administration.
(10) Administration times.
(11) Diagnosis or purpose for the medication, including pro re nata.
(12) Date and time of medication administration.
(13) Name and initials of the person administering the medication.
(14) Duration of treatment, if applicable.
(15) Special precautions, if applicable.
(16) Side effects of the medication, if applicable.
(b) The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.
(c) If an individual refuses to take a prescribed medication, the refusal shall be documented on the medication record. The refusal shall be reported to the prescriber within 24 hours, unless otherwise instructed by the prescriber. Subsequent refusals to take a prescribed medication shall be reported as required by the prescriber.
(d) The directions of the prescriber shall be followed.
§ 6500.137. [Administration of prescription medications and insulin injections.] Medication errors.
[(a) Prescription medications and insulin injections shall be administered according to the directions specified by a licensed physician, certified nurse practitioner or licensed physician's assistant.
(b) An insulin injection administered by an individual or another person shall be premeasured by the individual or licensed medical personnel.]
(a) Medication errors include the following:
(1) Failure to administer a medication.
(2) Administration of the wrong medication.
(3) Administration of the wrong amount of medication.
(4) Failure to administer a medication at the prescribed time, which exceeds more than 1 hour before or after the prescribed time.
(5) Administration to the wrong person.
(6) Administration through the wrong route.
(b) Documentation of medication errors, follow- up action taken and the prescriber's response shall be kept in the individual's record.
§ 6500.138. [Medications training.] Adverse reaction.
[(a) Family members who administer prescription medications or insulin injections to individuals shall receive training by the individual's source of health care about the administration, side effects and contraindications of the specific medication or insulin.
(b) Family members who administer insulin injections to individuals shall have completed and passed a diabetes patient education program that meets the National Standards for Diabetes Patient Education Programs of the National Diabetes Advisory Board, 7550 Wisconsin Avenue, Bethesda, Maryland 20205.
(c) Documentation of the training specified in subsections (a) and (b) shall be kept.]
(a) If an individual has a suspected adverse reaction to a medication, the home shall immediately consult a health care practitioner or seek emergency medical treatment.
(b) An adverse reaction to a medication, the health care practitioner's response to the adverse reaction and the action taken shall be documented.
(Editor's Note: The following section is new and printed in regular type to enhance readability.)
§ 6500.139. Medication administration training.
(a) A person who has successfully completed a Department-approved medications administration course, including the course renewal requirements, may administer the following:
(1) Oral medications.
(2) Topical medications.
(3) Eye, nose and ear drop medications.
(b) A person may administer insulin injections following successful completion of both:
(1) The course specified in subsection (a).
(2) A Department-approved diabetes patient education program within the past 12 months.
(c) A person may administer an epinephrine injection by means of an auto-injection device in response to anaphylaxis or another serious allergic reaction following successful completion of both:
(1) The course specified in subsection (a).
(2) Training relating to the use of an auto-injection epinephrine injection device provided by a licensed, registered or certified health care professional within the past 12 months.
(d) A record of the training shall be kept including the person trained, the date, source, name of trainer and documentation that the course was successfully completed.
PROGRAM § 6500.151. Assessment.
(a) Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the [family living] home and an updated assessment annually thereafter. The initial assessment must include an assessment of adaptive behavior and level of skills completed within 6 months prior to admission to the [family living] home.
(b) If the [program] life sharing specialist is making a recommendation to revise a service or outcome in the [ISP as required under § 6500.156(c)(4) (relating to ISP review and revision)] PSP, 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 [family living] life sharing specialist shall sign and date the assessment.
* * * * * (f) The [program] life sharing specialist shall provide the assessment to the SC, as applicable, and [plan] PSP team members at least 30 calendar days prior to [an ISP meeting for the development of the ISP, the 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)] a PSP meeting.
§ 6500.152. Development[, annual update and revision of the ISP] of the PSP.
[(a) An individual shall have one ISP.
(b) When an individual is not receiving services through an SCO, the family living program specialist shall be the plan lead when one of the following applies:
(1) The individual resides at a family living home licensed under this chapter.
(2) The individual resides at a family living home licensed under this chapter and attends a facility licensed under Chapter 2380 or 2390 (relating to adult training facilities; and vocational facilities).
(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 assessments 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 family living home.
(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 § 6500.156 (relating to ISP review and revision), Shall be sent as required under § 6500.157 (relating to copies).]
(a) An individual shall have one approved and authorized PSP at a given time.
(b) An individual's service implementation plan must be consistent with the PSP in subsection (a).
(c) The support coordinator, targeted support manager or life sharing specialist shall coordinate the development of the PSP, including revisions, in cooperation with the individual and the individual's PSP team.
(d) The initial PSP shall be developed based on the individual assessment within 60 days of the individual's date of admission to the home.
(e) The PSP shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment.
(f) The individual and persons designated by the individual shall be involved in and supported in the development and revisions of the PSP.
(g) The PSP, including revisions, shall be documented on a form specified by the Department.
§ 6500.153. [Content of the ISP.] The PSP team.
[The ISP, including annual updates and revisions under § 6500.156 (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 volunteer or civic-minded opportunities and membership in National or local organizations as required under § 6500.158 (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 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 time line 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) Residential independence.
(ii) Community involvement.
(iii) Vocational programming.
(iv) Competitive community-integrated employment.]
(a) The PSP shall be developed by an interdisciplinary team including the following:
(1) The individual.
(2) Persons designated by the individual.
(3) The individual's direct care staff persons.
(4) The program specialist.
(5) The support coordinator, targeted support manager or a program representative from the funding source, if applicable.
(6) The program specialist for the individual's day program, if applicable.
(7) Other specialists such as health care, behavior management, speech, occupational and physical therapy as appropriate for the individual needs.
(b) At least three members of the PSP team, in addition to the individual and persons designated by the individual, shall be present at a PSP meeting at which the PSP is developed or revised.
(c) Members of the PSP team who attend the meeting shall sign and date the PSP.
§ 6500.154. [Plan team participation.] The PSP process.
[(a) The plan team shall participate in the development of the ISP, including the annual updates and revision under § 6500.156 (relating to ISP review and revision).
(1) A plan team shall 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 services 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 a service 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 the ISP, annual update and ISP revision meeting.
(c) Plan team members who attend a meeting under subsection (b) shall sign and date the signature sheet.]
The PSP process shall:
(1) Provide necessary information and support to ensure that the individual directs the PSP process to the maximum extent possible.
(2) Enable the individual to make informed choices and decisions.
(3) Be conducted to reflect what is important to the individual to ensure that supports are delivered in a manner reflecting individual preferences and ensuring the individual's health, safety and well-being.
(4) Be timely in relation to the individual's needs and occur at intervals, times and locations of choice and convenience to the individual and to persons designated by the individual.
(5) Be communicated in clear and understandable language.
(6) Reflect cultural considerations of the individual
(7) Include guidelines for solving disagreements among the PSP team members.
(8) Include a method for the individual to request updates to the PSP.
§ 6500.155. [Implementation of the ISP.] Content of the PSP.
[(a) The ISP shall be implemented by the ISP's start date.
(b) The ISP shall be implemented as written.]
The PSP, including revisions, must include the following:
(1) The individual's strengths and functional abilities.
(2) The individual's individualized clinical and support needs.
(3) The individual's goals and preferences related to relationships, community participation, employment, income and savings, health care, wellness and education.
(4) Individually identified, person-centered desired outcomes.
(5) Supports to assist the individual to achieve desired outcomes.
(6) The type, amount, duration and frequency for the support specified in a manner that reflects the assessed needs and choices of the individual. The schedule of support delivery shall be determined by the PSP team.
(7) Communication mode, abilities and needs.
(8) Opportunities for new or continued community participation.
(9) Risk factors, dangerous behaviors and risk mitigation strategies, if applicable.
(10) Modification of individual rights as necessary to mitigate risks, if applicable.
(11) Health care information, including a health care history.
(12) Financial information including how the individual chooses to use personal funds.
(13) The person responsible for monitoring the implementation of the PSP.
§ 6500.156. [ISP review and revision.] Implementation of the PSP.
[(a) The family living specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the family living home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change, which impacts the services as specified in the current ISP.
(b) The family living 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 family living home licensed under this chapter.
(2) A review of each section of the ISP specific to the family living home licensed under this chapter.
(3) The family living specialist shall document a change in the individual's needs, if applicable.
(4) The family living 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 family living specialist shall complete a revised assessment as required under § 6500.151(b) (relating to assessment).
(d) The family living specialist shall provide the ISP review documentation, including recommendations if applicable, to the SC, as applicable, and plan team members within 30 calendar days after the ISP review meeting.
(e) The family living 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.]
The home and the agency shall implement the PSP including revisions.
§ 6500.157. [Copies.] (Reserved).
[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.]
§ 6500.158. [Provider services.] (Reserved).
[(a) The family living home 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 family living home shall provide opportunities to the individual for participation in community life, including volunteer or civic-minded opportunities and membership in National or local organizations.
(c) The family living home shall provide services to the individual as specified in the individual's ISP.
(d) The family living home shall provide services that are age and functionally appropriate to the individual.]
§ 6500.159. Day services.
(a) Day services such as employment, education, training, volunteer, civic-minded and other meaningful opportunities shall be provided to the individual.
(b) Day services and activities shall be provided at a location other than the [family living] home where the individual lives, unless one of the following exists:
(1) There is written annual documentation by a licensed physician that it is medically necessary for the individual to complete day services at the [family living] home.
(2) There is written annual documentation by the plan team that it is in the best interest of the individual to complete day services at the [family living] home.
§ 6500.160. Recreational and social activities.
(a) The [family living] home shall provide recreational and social activities, including volunteer or civic-minded opportunities and membership in National or local organizations at the following locations:
(1) The [family living] home.
(2) Away from the [family living] home.
(b) Time away from the [family living] home may not be limited to time in school, work or vocational, developmental and volunteer facilities.
(c) Documentation of recreational and social activities shall be kept in the individual's record.
[RESTRICTIVE PROCEDURES] POSITIVE INTERVENTION § 6500.161. [Definition of restrictive procedures.] Use of a positive intervention.
[A restrictive procedure is a practice that limits an individual's movement, activity of function; interferes with an individual's ability to acquire positive reinforcement; results in the loss of objects or activities that an individual values; or requires an individual to engage in a behavior that the individual would not engage in given freedom of choice.]
(a) A positive intervention shall be used to prevent, modify and eliminate a dangerous behavior when the behavior is anticipated or occurring.
(b) The least intrusive method shall be applied when addressing a dangerous behavior. For each incidence of a dangerous behavior, every attempt shall be made to modify and eliminate the behavior.
(c) As used in this section, the following words and terms have the following meanings, unless the context clearly indicates otherwise:
Dangerous behavior—An action with a high likelihood of resulting in harm to the individual or others.
Positive intervention—An action or activity intended to prevent, modify and eliminate a dangerous behavior. This includes improved communications, reinforcing appropriate behavior, an environmental change, recognizing and treating physical and behavioral health symptoms, voluntary physical exercise and other wellness practices, redirection, praise, modeling, conflict resolution and de-escalation.
§ 6500.162. [Written policy.] PSP.
[A written policy that defines the prohibition or use of specific types of restrictive procedures, describes the circumstances in which restrictive procedures may be used, the persons who may authorize the use of restrictive procedures, a mechanism to monitor and control the use of restrictive procedures, and a process for the individual and family to review the use of restrictive procedures shall be kept.]
If the individual has a dangerous behavior as identified in the PSP, the PSP must include the following:
(1) The specific dangerous behavior to be addressed.
(2) A functional analysis of the dangerous behavior and the plan to address the reason for the behavior.
(3) The outcome desired.
(4) A description of the positive intervention aimed at preventing, modifying or eliminating the dangerous behavior and the circumstances under which the intervention is to be used.
(5) A target date to achieve the outcome.
(6) Health conditions that require special attention.
§ 6500.163. [Appropriate use of restrictive procedures.] Prohibition of restraints.
[(a) A restrictive procedure may not be used as retribution, for the convenience of the family, as a substitute for the program or in a way that interferes with the individual's developmental program.
(b) For each incident requiring restrictive procedures:
(1) Every attempt shall be made to anticipate and de-escalate the behavior using methods of intervention less intrusive than restrictive procedures.
(2) A restrictive procedure may not be used unless less restrictive techniques and resources appropriate to the behavior have been tried but have failed.]
The following procedures are prohibited:
(1) Seclusion, defined as involuntary confinement of an individual in a room or area from which the individual is physically prevented or verbally directed from leaving.
(2) Aversive conditioning, defined as the application of startling, painful or noxious stimuli.
(3) Pressure point techniques, defined as the application of pain for the purpose of achieving compliance.
(4) A chemical restraint, defined as use of drugs or chemicals for the specific and exclusive purpose of controlling acute or episodic aggressive behavior. A chemical restraint does not include a drug ordered by a health care practitioner or dentist to treat the symptoms of a specific mental, emotional or behavioral condition, or as pretreatment prior to a medical or dental examination or treatment.
(5) A mechanical restraint, defined as a device that restricts the movement or function of an individual or portion of an individual's body. Mechanical restraints include a geriatric chair, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, restraint vest, waist strap, head strap, papoose board, restraining sheet, chest restraint and other locked restraints.
(i) The term does not include a device prescribed by a health care practitioner that is used to provide post-surgical care, proper balance or support for the achievement of functional body position.
(ii) The term does not include a device prescribed by a health care practitioner to protect the individual in the event of a seizure, as long as the individual can easily remove the device.
(6) A manual restraint, defined as a hands-on physical method that restricts, immobilizes or reduces an individual's ability to move his arms, legs, head or other body parts freely, on a nonemergency basis, or for more than 15 minutes within a 2-hour period. A manual restraint does not include physically prompting, escorting or guiding an individual to provide a support as specified in the individual's PSP.
(7) A prone position manual restraint.
(8) A manual restraint that inhibits digestion or respiration, inflicts pain, causes embarrassment or humiliation, causes hyperextension of joints, applies pressure on the chest or joints, or allows for a free fall to the floor.
§ 6500.164. [Restrictive procedure review committee.] Permitted interventions.
[(a) If restrictive procedures are used, there shall be a restrictive procedure review committee.
(b) The restrictive procedure review committee shall include a majority of persons who do not provide direct services to the individual.
(c) The restrictive procedure review committee shall establish a time frame for review and revision of the restrictive procedure plan, not to exceed 6 months between reviews.
(d) A written record of the meetings and activities of the restrictive procedure review committee shall be kept.]
(a) Voluntary exclusion, defined as an individual voluntarily removing himself from his immediate environment and placing himself alone to a room or area, is permitted in accordance with the individual's PSP.
(b) A physical protective restraint may be used only in accordance with § 6500.163(6)—(8) (relating to prohibition of restraints).
(c) A physical protective restraint may not be used until §§ 6500.48(b)(5) and 6500.155(9) (relating to annual training; and content of the PSP) are met.
(d) A physical protective restraint may only be used in the case of an emergency to prevent an individual from injuring the individual's self or others.
(e) A physical protective restraint may not be used as a behavioral intervention, consequence, retribution, punishment, for the convenience of staff persons or as a substitution for individual support.
(f) A physical protective restraint may not be used for more than 15 minutes within a 2-hour period.
(g) A physical protective restraint may only be used by a staff person who is trained as specified in § 6500.48.
(h) As used in this section, a ''physical protective restraint'' is a hands-on hold of an individual.
§ 6500.165. [Restrictive procedure plan.] Access to or the use of an individual's personal property.
[(a) For each individual for whom restrictive procedures may be used, a restrictive procedure plan shall be written prior to the use of restrictive procedures.
(b) The restrictive procedure plan shall be developed and revised with the participation of the family living specialist, the family, the interdisciplinary team as appropriate and other professionals as appropriate.
(c) The restrictive procedure plan shall be reviewed, and revised if necessary, according to the time frame established by the restrictive procedure review committee, not to exceed 6 months.
(d) The restrictive procedure plan shall be reviewed, approved, signed and dated by the chairperson of the restrictive procedure review committee and the family living specialist, prior to the use of a restrictive procedure, whenever the restrictive procedure plan is revised and at least every 6 months.
(e) The restrictive procedure plan shall include:
(1) The specific behavior to be addressed and the suspected antecedent or reason for the behavior.
(2) The single behavioral outcome desired stated in measurable terms.
(3) Methods for modifying or eliminating the behavior, such as changes in the individual's physical and social environment, changes in the individual's routine, improving communications, teaching skills and reinforcing appropriate behavior.
(4) Types of restrictive procedures that may be used and the circumstances under which the procedures may be used.
(5) A target date for achieving the outcome.
(6) The amount of time the restrictive procedure may be applied, not to exceed the maximum time periods specified in this chapter.
(7) Physical problems that require special attention during the use of restrictive procedures.
(8) The name of the person responsible for monitoring and documenting progress with the plan.
(f) The restrictive procedure plan shall be implemented as written.
(g) Copies of the restrictive procedure plan shall be kept in the individual's record.]
(a) Access to or the use of an individual's personal funds or property may not be used as a reward or punishment.
(b) An individual's personal funds or property may not be used as payment for damages unless the individual consents to make restitution for the damages as follows:
(1) A separate written consent is required for each incidence of restitution.
(2) Consent shall be obtained in the presence of the individual, a person designated by the individual and in the presence of and with the support of the support coordinator or targeted support manager.
(3) There may not be coercion in obtaining the consent of an individual.
(4) The agency shall keep a copy of the individual's written consent.
§ 6500.166. [Training.] Rights team.
[(a) If a restrictive procedure is used, there shall be at least one person available when restrictive procedures are used who has completed training within the past 12 months in the use of and ethics of using restrictive procedures including the use of alternate positive approaches.
(b) Persons responsible for developing, implementing or managing a restrictive procedure plan shall be trained in the use of the specific techniques or procedures that are used.
(c) If manual restraint or exclusion is used, persons responsible for developing, implementing or managing a restrictive procedure plan shall have experienced the use of the specific techniques or procedures directly on themselves.
(d) Documentation of the training program provided, including the persons trained, dates of training, description of training and training source shall be kept.]
(a) The agency shall have a rights team. The agency may use a county mental health and intellectual disability program rights team that meets the requirements of this section.
(b) The role of the rights team is to:
(1) Review each incident, alleged incident and suspected incident of a violation of individual rights as specified in §§ 6500.31—6500.34 (relating to individual rights).
(2) Review each incidence of the use of a restraint as specified in §§ 6500.161—6500.164 to:
(i) Analyze systemic concerns.
(ii) Design positive supports as an alternative to the use of a restraint.
(iii) Discover and resolve the reason for an individual's behavior.
(c) Members of the rights team shall include the affected individual, persons designated by the individual, a family member or an advocate if the individual is unable to speak for himself, the individual's support coordinator, a representative from the funding agency and an agency representative.
(d) Members of the rights team shall be comprised of a majority who do not provide direct support to the individual.
(e) If a restraint was used, the individual's health care practitioner shall be consulted.
(f) The rights team shall meet at least once every 3 months.
(g) The rights team shall report its recommendations to the individual's PSP team.
(h) The agency shall keep documentation of the rights team meetings and the decisions made at the meetings.
(Editor's Note: As part of this proposed rulemaking, the Department is proposing to rescind §§ 6500.167—6500.176 which appear in 55 Pa. Code pages 6500-43—6500-46, serial pages (382045)—(382048).)
§§ 6500.167—6500.176. (Reserved).
INDIVIDUALS RECORDS § 6500.182. Content of records.
(a) A separate record shall be kept for each individual.
(b) Entries in an individual's record must be legible, dated and signed by the person making the entry.
(c) 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) The religious affiliation.
(v) The next of kin.
(vi) A current, dated photograph.
(2) Unusual incident reports relating to the individual.
(3) Physical examinations.
(4) Dental examinations.
(5) Assessments as required under § 6500.151 (relating to assessment).
[(6) A copy of the invitation to:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting.
(7) A copy of the signature sheet for:
(i) The initial ISP meeting.
(ii) The annual update meeting.
(iii) The ISP revision meeting
(8) A copy of the current ISP.
(9) Documentation of ISP reviews and revisions under § 6500.156 (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.
(10) Content discrepancy in the ISP, the annual updates or revisions under § 6500.156.]
(6) SP documents as required by this chapter.
[(11) Restrictive procedure protocols] (7) Positive intervention records related to the individual.
[(12) Restrictive procedure records related to the individual.
(13)] (8) Recreational and social activities provided to the individual.
[(14)] (9) Copies of psychological evaluations and assessments of adaptive behavior, as necessary.
§ 6500.183. Record location.
Copies of the most current record information required in [§ 6500.182(c)(1)—(14)] § 6500.182(c)(1)—(9) (relating to [individual] content of records) shall be kept in the [family living] home.
§ 6500.185. Access.
The individual, and the individual's parent, guardian or advocate, shall have access to the records and to information in the records. If the [family living] life sharing specialist documents, in writing, that disclosure of specific information constitutes a substantial detriment to the individual or that disclosure of specific information will reveal the identity of another individual or breach the confidentiality of persons who have provided information upon an agreement to maintain their confidentiality, that specific information identified may be withheld.
[Pa.B. Doc. No. 16-1934. Filed for public inspection November 4, 2016, 9:00 a.m.]
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