[54 Pa.B. 7156]
[Saturday, November 2, 2024]

[Continued from previous Web Page]

PART VII. MENTAL HEALTH MANUAL

Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES

 (Editor's Note: Chapter 5330 is proposed to be added and is printed in regular type to enhance readability.)

CHAPTER 5330. PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY

GENERAL PROVISIONS

Sec.

5330.1.	Purpose.
5330.2.	Scope.
5330.3.	Definitions.
5330.4.	Licensure and certificate of compliance.
5330.5.	Maximum capacity.
5330.6.	Fire safety approval.
5330.7.	Exemptions.

GENERAL REQUIREMENTS

5330.11.	Service description.
5330.12.	Coordination of services.
5330.13.	Abuse.
5330.14.	Reportable incidents.
5330.15.	Recordable incidents.
5330.16.	Child, youth or young adult funds.
5330.17.	Consent to treatment.
5330.18.	Confidentiality of records.
5330.19.	Emergency preparedness.
5330.20.	Visits.
5330.21.	Awake hours and sleeping hours.

RIGHTS

5330.31.	Rights.
5330.32.	Grievance procedures.
5330.33.	Nondiscrimination.
5330.34.	Searches.

STAFFING

5330.41.	Supervision of staff.
5330.42.	Staff requirements.
5330.43.	Medical director.
5330.44.	Treatment team leader.
5330.45.	Clinical director.
5330.46.	Program director.
5330.47.	Registered nurse.
5330.48.	Mental health professional.
5330.49.	Mental health worker.
5330.50.	Additional staff positions.
5330.51.	Initial staff training.
5330.52.	Annual staff training.
5330.53.	Criminal history checks and child abuse certifications.

PHYSICAL SITE

5330.61.	Applicable construction safety laws.
5330.62.	Physical accommodations and equipment.
5330.63.	Poisons.
5330.64.	Heat sources.
5330.65.	Sanitation.
5330.66.	Ventilation.
5330.67.	Lighting.
5330.68.	Surfaces.
5330.69.	Water.
5330.70.	Air temperature.
5330.71.	Communication system.
5330.72.	Emergency telephone numbers.
5330.73.	Handrails and railings.
5330.74.	Landings and stairs.
5330.75.	Furniture.
5330.76.	Equipment.
5330.77.	First aid supplies.
5330.78.	Elevators.
5330.79.	Activity space.
5330.80.	Exterior conditions.
5330.81.	Firearms and weapons.
5330.82.	Bedrooms.
5330.83.	Bathrooms.
5330.84.	Kitchen area.
5330.85.	Laundry.
5330.86.	Swimming.

FIRE SAFETY

5330.91.	Compliance with fire safety statutes, regulations and ordinances.
5330.92.	Unobstructed egress.
5330.93.	Exits.
5330.94.	Evacuation procedures.
5330.95.	Notification of local first responders.
5330.96.	Flammable and combustible materials.
5330.97.	Furnaces.
5330.98.	Portable space heaters.
5330.99.	Wood and coal burning stoves.
5330.100.	Fireplaces.
5330.101.	Detectors and alarms.
5330.102.	Fire extinguishers.
5330.103.	Fire drills.

HEALTH

5330.111.	Health and behavioral health services.
5330.112.	Initial medical assessment.
5330.113.	Health and safety plan.
5330.114.	Medical examination.
5330.115.	Dental care.
5330.116.	Vision care.
5330.117.	Hearing care.
5330.118.	Use of drugs, alcohol, tobacco and e-cigarettes.
5330.119.	Emergency plan.

STAFF HEALTH

5330.121.	Staff assessment.
5330.122.	Tuberculosis screening.
5330.123.	Serious communicable diseases or medical problem.

NUTRITION

5330.131.	Daily meals.
5330.132.	Quantity of food.
5330.133.	Withholding or forcing of food.

TREATMENT SERVICES

5330.141.	Treatment planning requirements.
5330.142.	Treatment plan.
5330.143.	Maintenance of treatment plan.
5330.144.	Copies of treatment plan.
5330.145.	Treatment services.
5330.146.	Education.
5330.147.	Discharge.
5330.148.	Level system.

TRANSPORTATION

5330.151.

Transportation.

MEDICATION

5330.161.	Storage of medication.
5330.162.	Labeling of medication.
5330.163.	Use of prescription medication.
5330.164.	Medication log.
5330.165.	Medication error.
5330.166.	Medication refusal.
5330.167.	Adverse reaction.
5330.168.	Medication administration.
5330.169.	Medication administration training.
5330.170.	Self-administration.

RESTRICTIVE PROCEDURES

5330.181.	Use of manual restraints.
5330.182.	Ordering a manual restraint.
5330.183.	Prohibited restrictive procedures.
5330.184.	Restrictive procedure plan.
5330.185.	Application of a manual restraint.
5330.186.	Injuries from a manual restraint.
5330.187.	Documentation of a manual restraint.
5330.188.	Debriefing.
5330.189.	Time out.
5330.190.	Attestation.

SECURE PRTF

5330.201.	Requirements for a secure PRTF.
5330.202.	Exceptions for a secure PRTF.

RECORDS

5330.211.	Emergency contact information.
5330.212.	Child, youth or young adult record.
5330.213.	PRTF record.
5330.214.	Record retention and disposal.

QUALITY ASSURANCE

5330.221.

Quality assurance requirements.

WAIVERS

5330.231.

Waivers.

GENERAL PROVISIONS

§ 5330.1. Purpose.

 The purpose of this chapter is to establish minimum requirements and service standards that shall be met for a facility to obtain a license as a PRTF.

§ 5330.2. Scope.

 This chapter applies to PRTFs that operate in this Commonwealth and serve children, youth or young adults with a behavioral health diagnosis. This chapter does not apply to providers that offer services for substance use disorder or provide services for a primary diagnosis of substance use disorder, which must be licensed by the Department of Drug and Alcohol Programs under 28 Pa. Code Part V (relating to Department of Drug and Alcohol Programs).

§ 5330.3. Definitions.

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

 AED—An automatic external defibrillator.

 APP—advanced practice professional—An individual who is licensed as a certified registered nurse practitioner or physician assistant.

 Aversive conditioning—The application of startling, painful or noxious stimuli.

 CMS—The Centers for Medicare & Medicaid Services.

 Caregiver—An individual with the primary responsibility for the care and supervision of a child, youth or young adult.

 Chemical restraint—The administration of a drug that has the temporary effect of restricting a child's, youth's or young adult's freedom of movement that is used to manage the child's, youth's or young adult's behavior and reduces risk to the safety of the child, youth, young adult or others and is not the standard service for the child's, youth's or young adult's behavioral health needs.

 Child—An individual under 14 years of age.

 Contraband—Property that poses a threat to a child's, youth's, young adult's or other's safety.

 Department—The Department of Human Services of the Commonwealth.

 Educational host district—The school district where a PRTF is physically located.

 Elopement—When a child, youth or young adult leaves the premises of a PRTF or a location without PRTF staff approval.

 Emergency safety situation—A sudden, unexpected occurrence or set of circumstances demanding immediate action.

 Exclusion—The removal of a child, youth or young adult from the child's, youth's or young adult's immediate environment and restricting the child, youth or young adult alone to a room or area that is not locked.

 Grievance—A written or verbal concern expressed by a child, youth, young adult, parent, legal guardian or caregiver about a PRTF.

 Intimate sexual contact—Vaginal and anal penetration, oral sex or direct skin-to-skin touching of sexual organs or the touching of intimate body parts.

 LPN—licensed practical nurse—The term includes an individual licensed under the laws of this Commonwealth to practice practical nursing or an individual who holds a privilege to practice as a practical nurse under the Nurse Licensure Compact Act (35 P.S. §§ 10291—10295).

 Manual restraint—A physical hands-on technique that restricts the movement or function of a child, youth or young adult or a portion of the child's, youth's or young adult's body. The term does not include the use of hands-on assistance needed to enable a child, youth or young adult to achieve a goal or objective identified in a treatment plan.

 Mechanical restraint—The use of a device attached or adjacent to a child's, youth's or young adult's body that restricts freedom of movement or normal access to the child's, youth's or young adult's body which cannot easily be removed by the child, youth or young adult.

 PRTF—psychiatric residential treatment facility—A residential facility that provides services to treat the behavioral health needs of children, youth or young adults under the direction of a psychiatrist.

 Parent—The biological or adoptive father or mother of a child, youth or young adult.

 RN—registered nurse—The term includes an individual licensed under the laws of this Commonwealth to practice professional nursing or an individual who holds a privilege to practice as a registered nurse under the Nurse Licensure Compact Act.

 Reportable illness—A life-threatening illness, involuntary emergency psychiatric admission or an illness that appears on the Department of Health's List of Reportable Diseases.

 Reportable injury—An injury for which a child, youth or young adult requires medical treatment more intensive than first aid. The term first aid includes assessing a condition, cleaning a wound, applying topical medications and applying simple bandages.

 Seclusion—Restricting a child, youth or young adult in a locked room, at any time, including sleeping hours. A locked room includes a room with a door locking device such as a key lock, spring lock, bolt lock or foot pressure lock or a room where the door is physically held closed and the child, youth or young adult is prevented from leaving the room. The term includes locking a child, youth or young adult in a bedroom during sleeping hours.

 Secure PRTF—A PRTF from which egress is prohibited.

 Serious injury—Bodily injury which creates a substantial risk of death, or which causes serious permanent disfigurement or protracted loss or impairment of function of any bodily member or organ.

 Staff—Individuals employed by a PRTF on a full-time or part-time basis. The term includes contracted staff, temporary staff, volunteers and interns.

 Supervisory staff—PRTF staff that meet the qualifications of a medical director, clinical director, program director, mental health professional or mental health worker supervisor.

 Time out—A voluntary behavioral approach that enables a child, youth or young adult to leave an immediate environment for a period of time to de-escalate and regain self-control.

 Trauma-informed care—A strengths-based approach to service delivery and organizational structure that:

 (i) Realizes the widespread impact of trauma, including historical trauma, and understands potential paths to recovery.

 (ii) Recognizes the signs and symptoms of trauma in children, youth, young adults, parents, legal guardians, caregivers, staff and others involved with the PRTF.

 (iii) Responds by fully integrating knowledge about trauma into policies, procedures and practices and seeks to actively prevent re-traumatization.

 Treatment plan—An individualized and detailed written plan of treatment services specifically tailored to address a child's, youth's or young adult's needs.

 Treatment team—A group of individuals who are led by a treatment team leader and includes the PRTF staff directly involved in the child's, youth's or young adult's treatment, and the child, youth or young adult. The treatment team may also include the child's, youth's or young adult's parent, legal guardian or caregiver; and any individuals chosen by the child, youth or young adult or the parent, legal guardian or caregiver.

 Treatment team leader—A board-certified or board-eligible psychiatrist who has the overall responsibility of directing the child's, youth's or young adult's treatment.

 Visit—When a child, youth or young adult is under the approved temporary supervision of an individual off the facility premises at the individual's residence or in the community and not under the supervision of PRTF staff.

 Young adult—An individual 18 years of age or older but under 21 years of age or an individual who is under 22 years of age but was admitted to the PRTF prior to turning 21 years of age.

 Youth—An individual 14 years of age or older but under 18 years of age.

§ 5330.4. Licensure and certificate of compliance.

 (a) A PRTF shall obtain a license from the Department prior to beginning operations.

 (b) A residential treatment facility licensed under Chapter 3800 (relating to child residential and day treatment facilities) that provides the services of a PRTF as of [insert the effective date of the final-form rulemaking] shall comply with this chapter by [insert date that is 12 months after the effective date of the final-form rulemaking].

 (c) To be licensed as a PRTF, a facility shall:

 (1) File an application for a certificate of compliance with the Department in accordance with the Department's application procedure.

 (2) Comply with the requirements of this chapter.

 (3) Comply with the requirements of Chapter 20 (relating to licensure or approval of facilities and agencies).

 (4) Comply with the requirements of Articles IX or X of the Human Services Code (62 P.S. §§ 901—1088) as applicable.

 (5) Comply with the requirements of 42 CFR Part 441, Subpart D (relating to inpatient psychiatric services for individuals under 21 years of age in psychiatric facilities or programs).

 (6) Be accredited by The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation or another accrediting body approved by the Department.

 (7) Obtain a certificate of compliance from the Department prior to beginning operations.

 (d) The Department will issue a new certificate of compliance for each physical location that qualifies for a certificate of compliance.

 (e) A PRTF shall post in a conspicuous and public place the current certificate of compliance and have a copy of this chapter readily available to be viewed.

§ 5330.5. Maximum capacity.

 (a) The maximum capacity specified on the certificate of compliance will be based on the available bedroom square footage and number of toilets and sinks in the PRTF.

 (b) The maximum capacity specified on the certificate of compliance may not be exceeded.

§ 5330.6. Fire safety approval.

 (a) A PRTF shall obtain a valid fire safety approval from the appropriate local building authority under the Pennsylvania Construction Code Act (35 P.S. §§ 7210.101—7210.1103) prior to applying for an initial certificate of compliance.

 (b) If a fire safety approval is withdrawn or restricted, the PRTF shall provide notification to the Department verbally within 24 hours and in writing within 48 hours of service of notice of the withdrawal or restriction. The notification shall include a plan to remedy the issue that led to the withdrawal or restriction of the fire safety approval or a plan for relocating the children, youth or young adults residing in the PRTF.

 (c) If a building is structurally renovated or altered after the initial fire safety approval is issued, the PRTF shall submit a new fire safety approval or written certification from the appropriate fire safety authority that a new fire safety approval is not required. The PRTF shall submit this documentation to the Department within 15 days of the completion of the renovation or alteration.

 (d) The Department will report fire safety concerns observed during an inspection to the fire safety authority that issued the fire safety approval.

§ 5330.7. Exemptions.

 (a) This chapter does not apply to community residences for persons with mental illness that provide care to both children, youth or young adults and adults in the same facility or community residential host homes for persons with mental illness that are licensed under Chapter 5310 (relating to community residential rehabilitation services for the mentally ill).

 (b) This chapter does not apply to residential facilities that serve children, youth or young adults that are licensed under Chapter 3800 (relating to child residential and day treatment facilities).

GENERAL REQUIREMENTS

§ 5330.11. Service description.

 (a) As part of the initial certificate of compliance application, a facility shall submit to the Department for review and approval a written service description that includes all of the following:

 (1) The PRTF's mission and vision for supporting and maximizing the behavioral health of a child, youth or young adult.

 (2) Address, phone number, web site and accreditation agency of the PRTF.

 (3) An overview of the PRTF to include a description of specialized services and modalities the PRTF offers.

 (4) The average length of treatment.

 (5) Identification of the target population served by the PRTF, including age range, gender and total number of children, youth or young adults that will be served.

 (6) The bed capacity of the PRTF.

 (7) Description of the criteria used for exclusion.

 (8) Goals, objectives and expected outcomes of the PRTF.

 (9) Description of the overall theoretical design and clinical approaches to services.

 (10) Description of how the PRTF implements and utilizes trauma-informed care practices.

 (11) Description of the level system as specified in § 5330.148 (relating to level system), if applicable.

 (12) Description of the expectations that will be used to encourage active involvement in the treatment process by the parent, legal guardian or caregiver.

 (13) Identification of the specific restrictive procedures utilized by a PRTF.

 (14) Description of educational providers that will be utilized by a child, youth or young adult while at the PRTF.

 (15) Identification of the school district within which the PRTF is located.

 (16) Description of the discharge planning process of the PRTF.

 (17) An organizational chart of the PRTF according to position titles.

 (b) A PRTF's updated service description must be approved by the Department prior to a change in services specified in subsection (a).

§ 5330.12. Coordination of services.

 (a) A PRTF shall have written agreements to coordinate services with other service providers, including the following:

 (1) A psychiatric inpatient hospital.

 (2) A local community hospital.

 (3) Peer support providers.

 (4) Mental health and intellectual or developmental disability case management programs.

 (5) Drug and alcohol programs.

 (6) Educational providers.

 (b) A PRTF shall update the written agreements with the other service providers annually or when the PRTF becomes aware that the agreements are no longer accurate.

 (c) A PRTF shall have an affiliation or a written transfer agreement with at least one hospital that participates in the Medical Assistance Program. The affiliation or transfer agreement must reasonably ensure all of the following:

 (1) A child, youth or young adult will be transferred from a PRTF to a hospital and admitted in a timely manner when a transfer is medically necessary for medical care or acute psychiatric care.

 (2) Medical and other information needed for the child's, youth's or young adult's care will be exchanged between the PRTF and the hospital in accordance with Federal and State medical privacy laws and regulations, including any information needed to determine whether the appropriate care can be provided in a less restrictive setting.

 (3) Services are available to each child, youth or young adult at all times.

§ 5330.13. Abuse.

 (a) A PRTF shall have a written policy and procedure on the identification of abuse, reporting abuse, plan of supervision for any PRTF staff implicated in abuse and plan for the protection of the child, youth or young adult who was subject to abuse.

 (b) A PRTF shall comply with 23 Pa.C.S. §§ 6301—6388 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services).

 (c) A PRTF shall comply with the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704).

§ 5330.14. Reportable incidents.

 (a) A PRTF shall develop a written policy and procedure on the reporting, investigation and management of reportable incidents.

 (b) A PRTF shall call the Department and complete an incident report through the Department's information management system within 12 hours after any of the following reportable incidents are known to the PRTF:

 (1) Fire requiring the children, youth or young adults of a PRTF to shelter in place or relocate.

 (2) Death of a child, youth or young adult.

 (3) Serious injury to a child, youth or young adult.

 (4) Disruption to water, heat, power or cooling at a PRTF.

 (c) A PRTF shall complete an incident report through the Department's information management system within 12 hours after any of the following reportable incidents are known to a PRTF:

 (1) Use of a prohibited restrictive procedure specified in § 5330.183 (relating to prohibited restrictive procedures).

 (2) An incident where a child, youth or young adult requires hospitalization or outpatient treatment at a hospital or other medical facility.

 (3) Physical act by a child, youth or young adult to attempt suicide.

 (4) Child's, youth's or young adult's elopement from a PRTF.

 (5) Incidents of physical assault involving a child, youth, young adult or PRTF staff.

 (6) Violation of a child's, youth's or young adult's civil rights.

 (7) Intimate sexual contact involving a child, youth or young adult.

 (8) An outbreak of a serious communicable disease as defined by the Department of Health.

 (9) Suspected abuse or abuse of a child, youth or young adult.

 (10) An event that results in notification of emergency services, such as the fire department, law enforcement or emergency medical services.

 (11) Activation of a PRTF emergency preparedness plan.

 (12) Misuse of a child's, youth's or young adult's funds.

 (13) A medication error as specified in § 5330.165 (relating to medication error).

 (d) A PRTF shall call the parent, legal guardian or caregiver and inform the parent, legal guardian or caregiver of the reportable incidents identified in subsections (b) and (c) no later than 12 hours after the reportable incident is known to the PRTF.

 (e) A PRTF shall report the following reportable incidents to the State-designated protection and advocacy system no later than close of business the next business day after the reportable incident is known to a PRTF:

 (1) Death of a child, youth or young adult.

 (2) Physical act by a child, youth or young adult to attempt suicide.

 (3) Serious injury to a child, youth or young adult.

 (f) If a PRTF reports a reportable incident to the State-designated protection and advocacy system, it shall include all of the following information:

 (1) Name of the child, youth or young adult involved in the reportable incident.

 (2) Description of the reportable incident.

 (3) Name, street address and telephone number of the PRTF.

 (g) A PRTF shall document in the child's, youth's or young adult's record the date and time a report was made to the State-designated protection and advocacy system and the name and title of the individual from the State-designated protection and advocacy system that received the report.

 (h) A PRTF shall report the death of a child, youth or young adult to the appropriate CMS regional office no later than close of business the next business day after the child's, youth's or young adult's death is known to the PRTF and document in the child's, youth's or young adult's record that the child's, youth's or young adult's death was reported to the appropriate CMS regional office.

 (i) A PRTF shall document in the child's, youth's or young adult's record the date and time the Department was called about a reportable incident identified in subsection (b) and the name and title of the individual from the Department who was notified of the reportable incident.

 (j) A PRTF shall document in the child's, youth's or young adult's record the date and time the parent, legal guardian or caregiver was called about a reportable incident identified in subsections (b) and (c) and the name of the parent, legal guardian or caregiver who was notified of the reportable incident.

 (k) A copy of all incident reports in subsections (b) and (c) shall be maintained in the child's, youth's or young adult's record.

§ 5330.15. Recordable incidents.

 (a) A PRTF shall maintain a record of the following recordable incidents:

 (1) Medical seizure that requires medical attention.

 (2) Suicidal gesture or verbal threat of suicide or harm to self or others.

 (3) Property damage of more than $500.

 (4) Search of a child, youth or young adult or the child's, youth's or young adult's property.

 (5) A reportable injury or reportable illness while the child, youth or young adult is on a visit.

 (b) A PRTF shall notify a child's, youth's or young adult's parent, legal guardian or caregiver of a recordable incident specified in subsection (a)(1)—(5) no later than 12 hours after a recordable incident occurs. The notification shall be documented in the child's, youth's or young adult's record.

§ 5330.16. Child, youth or young adult funds.

 (a) A PRTF shall have a written policy and procedure on the management and disbursement of a child's, youth's or young adult's funds.

 (b) Money earned or received by a child, youth or young adult is the child's, youth's or young adult's personal property.

 (c) If a PRTF maintains funds for a child, youth or young adult, the PRTF shall maintain a separate accounting system for the child's, youth's or young adult's funds, including the dates and amounts of deposits and withdrawals. Combining a child's, youth's or young adult's funds with PRTF funds is prohibited.

 (d) If a PRTF maintains funds for a child, youth or young adult, the child, youth or young adult shall be provided with an accounting of their funds at least once a month and upon request.

 (e) A PRTF may not use or borrow a child's, youth's or young adult's funds.

 (f) A PRTF shall release the youth's or young adult's funds to the youth or young adult upon discharge and upon request.

 (g) A PRTF shall release a child's funds to the child's parent, legal guardian or caregiver upon discharge and upon request.

§ 5330.17. Consent to treatment.

 (a) Consent to treatment must be obtained in accordance with Federal and State laws, regulations and Department policies regarding consent to treatment.

 (b) Prior to the initiation of services provided by a PRTF, the PRTF shall obtain consent from either a youth or young adult, or the child's, youth's or young adult's parent, legal guardian or caregiver for the child, youth or young adult to receive services.

 (c) Consent for emergency physical health treatment is not required for life-threatening conditions when an attempt to obtain consent would result in a delay of services and the delay would increase the risk of harm to the child's, youth's or young adult's life or health.

 (d) Consent and attempts to obtain consent shall be documented in the child's, youth's or young adult's record. Documentation of consent, refusal to consent and attempts to obtain consent shall include all of the following:

 (1) Name of the person contacted to provide consent.

 (2) Relationship of the person contacted to provide consent for the treatment to the child, youth or young adult.

 (3) Name and title of the PRTF staff person who sought consent.

§ 5330.18. Confidentiality of records.

 (a) A PRTF shall comply with all of the following statutes and regulations relating to confidentiality of records, to the extent applicable:

 (1) Chapter 63 of 23 Pa.C.S. (relating to Child Protective Services Law).

 (2) Part III of 23 Pa.C.S. (relating to Adoption Act).

 (3) The Mental Health Procedures Act (50 P.S. §§ 7101—7503).

 (4) Section 602(d) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4602(d)).

 (5) The Confidentiality of HIV-Related Information Act (35 P.S. §§ 7601—7612).

 (6) Sections 5100.31—5100.39 of 55 Pa. Code (relating to confidentiality of mental health records).

 (7) Sections 3490.91—3490.95 of 55 Pa. Code (relating to confidentiality).

 (8) Section 444 of the General Education Provisions Act (20 U.S.C. § 1232g).

 (9) Part 99 of 34 CFR (relating to family educational rights and privacy).

 (10) The Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191).

 (11) Other applicable statutes and regulations.

 (b) Information relating to a child, youth or young adult may only be shared if a signed authorization of release is obtained from the youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver.

 (c) Information relating to the parent, legal guardian or caregiver of a child, youth or young adult may not be shared without an authorization of release of information from the child's, youth's or young adult's parent, legal guardian or caregiver.

 (d) A PRTF shall have a written policy and procedure on protecting the confidentiality and privacy of a child's, youth's or young adult's information that includes all of the following:

 (1) The process to obtain permission to release a photograph of a child, youth or young adult.

 (2) The use of photographs of children, youth or young adults.

 (3) How the PRTF will ensure that children's, youth's or young adult's and PRTF staff's social media activity does not contain identifying information about a child, youth or young adult served by the PRTF.

§ 5330.19. Emergency preparedness.

 A PRTF shall comply with the requirements of 42 CFR 441.184 (relating to emergency preparedness).

§ 5330.20. Visits.

 (a) A PRTF shall have a written policy and procedure on visits.

 (b) A PRTF may not deny a child, youth or young adult a visit as a means of punishment or coercion.

 (c) A PRTF shall develop a visit plan for a child, youth or young adult when the child, youth or young adult is not under the supervision of PRTF staff that includes both of the following:

 (1) Identified coping skills for the child, youth or young adult.

 (2) Telephone numbers for local crisis intervention services and for the PRTF.

 (d) A PRTF shall give the visit plan for a child, youth or young adult to the individual who will be supervising the child, youth or young adult during the visit.

 (e) Prior to a visit that occurs at the parent's, legal guardian's or caregiver's residence or in the community, a PRTF shall require that the child's, youth's or young adult's parent, legal guardian or caregiver sign an acknowledgement that the parent, legal guardian or caregiver will receive, secure, administer and return prescribed medication not taken by the child, youth or young adult during the visit.

 (f) The visit plan and signed acknowledgment shall be included in the child's, youth's or young adult's record.

 (g) A PRTF shall contact the child's, youth's or young adult's parent, legal guardian or caregiver at least once every 24 hours if a visit lasts more than 24 hours to check on the safety, health and well-being of the child, youth or young adult.

§ 5330.21. Awake hours and sleeping hours.

 A PRTF shall have a written policy and procedure that designates the PRTF's awake hours and sleeping hours.

RIGHTS

§ 5330.31. Rights.

 (a) A PRTF shall have a written policy and procedure on the rights of children, youth or young adults.

 (b) A child, youth or young adult has the right to all of the following:

 (1) To be informed of the policies and procedures of the PRTF.

 (2) To appropriate medical, behavioral health and dental treatment.

 (3) To receive services in the PRTF in the least restrictive setting necessary to accomplish the treatment objectives.

 (4) To participate in the development and review of the child's, youth's or young adult's treatment plan.

 (5) To clean and seasonal clothing that is age and gender appropriate.

 (6) To be free from excessive medication.

 (7) To be free from abuse, mistreatment, threats, harassment, corporal punishment and unusual treatment.

 (8) To not be subjected to unusual or extreme methods of discipline which may cause psychological or physical harm to the child, youth or young adult.

 (9) To be protected from unreasonable search and seizure. A PRTF may conduct searches of a child, youth or young adult or the child's, youth's or young adult's personal property in accordance with § 5330.34 (relating to searches).

 (10) To communicate with PRTF staff in a language that the child, youth or young adult understands, including American Sign Language, and when necessary, through interpreters or translators.

 (11) To be treated with dignity and respect.

 (12) To be assisted by an advocate of the child's, youth's or young adult's choice in the assertion of rights and to communicate with a lawyer in private.

 (13) All civil rights unless prohibited by court order.

 (14) To practice the child's, youth's or young adult's religion of choice or abstain from religious practices.

 (15) To communicate with a clergy person in private.

 (16) To file a grievance without retaliation and to receive a prompt response to the grievance.

 (17) To communicate privately with an individual unless the communication is prohibited by court order or the child's, youth's or young adult's treatment team has determined that communication with an individual would negatively impact the child's, youth's or young adult's treatment, safety or well-being.

 (18) To visit with the child's, youth's or young adult's parent, legal guardian or caregiver at reasonable hours at least once each week, at a time and location convenient for the parent, legal guardian or caregiver, the child, youth or young adult and the PRTF, unless the parent, legal guardian or caregiver is prohibited from visiting by court order or the child's, youth's or young adult's treatment team has determined that the visit with the parent, legal guardian or caregiver would negatively impact the child's, youth's or young adult's treatment, safety or well-being.

 (19) To receive visitors of the child's, youth's or young adult's choice at reasonable hours unless the visitor is prohibited from visiting by court order or the child's, youth's or young adult's treatment team has determined that the visitor would negatively impact the child's, youth's or young adult's treatment, safety or well-being.

 (20) To receive and send unopened letters and to have outgoing letters stamped and mailed unless prohibited by court order and to be allowed to read and write letters in private. Incoming and outgoing mail may be inspected for contraband when there is reasonable suspicion that the contents of the mail may negatively impact the child's, youth's or young adult's treatment, safety or well-being. The inspection shall be done in the presence of the child, youth or young adult.

 (21) To have access to a telephone designated for use by children, youth or young adults.

 (22) To keep and use personal property, unless it is determined that a specific item is contraband in accordance with the PRTF's policy and procedure. The reasons for imposing a limitation on personal property and its scope shall be clearly defined, documented and explained to the child, youth or young adult.

 (23) To be paid in compliance with the Fair Labor Standards Act of 1938 (29 U.S.C. §§ 201—219) and the Child Labor Act (43 P.S. §§ 40.1—40.14) for any work the child, youth or young adult does for the PRTF.

 (24) To peacefully assemble and to join with other children, youth or young adults to organize a body of or participate in government of the PRTF, when it has been determined feasible by the PRTF.

 (25) To be discharged from the PRTF as soon as the child, youth or young adult no longer needs services.

 (c) A child's, youth's or young adult's rights may not be used as a reward or sanction.

 (d) A child's, youth's or young adult's parent, legal guardian or caregiver has all of the following rights:

 (1) To communicate with PRTF staff in a language that the parent, legal guardian or caregiver understands, including American Sign Language, and when necessary, through interpreters or translators.

 (2) To have ongoing contact with their child, youth or young adult unless prohibited by court order or determined by the child's, youth's or young adult's treatment team that the contact would negatively impact the child's, youth's or young adult's treatment, safety or well-being.

 (3) To actively participate in the development, implementation and monitoring of their child's, youth's or young adult's treatment unless prohibited by court order or determined by the child's, youth's or young adult's treatment team that the active participation would negatively impact the child's, youth's or young adult's treatment, safety or well-being.

 (e) A PRTF shall obtain a written acknowledgement from a youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver that the policy on the rights of children, youth and young adults was received and reviewed within 7 days of the child's, youth's or young adult's admission to the PRTF. The signed acknowledgement shall be maintained in the child's, youth's or young adult's record.

 (f) A copy of a child's, youth's or young adult's rights specified in subsection (b) shall be posted in a conspicuous and public location in the PRTF.

§ 5330.32. Grievance procedures.

 (a) A child, youth or young adult and the child's, youth's or young adult's parent, legal guardian or caregiver has the right to file a grievance with a PRTF.

 (b) A PRTF shall have a written policy and procedure on grievances that assures the investigation and resolution of grievances and includes both of the following:

 (1) A process to document written and verbal grievances.

 (2) A process that assures that written and verbal grievances are submitted in a secure manner and without fear of retaliation.

 (c) A copy of the PRTF grievance policy and procedure shall be posted in a conspicuous and public place in the PRTF.

 (d) A copy of the grievance policy and procedure shall be provided to the child, youth or young adult and the child's, youth's or young adult's parent, legal guardian or caregiver on the day of admission to the PRTF.

 (e) A PRTF shall obtain a written acknowledgement from a youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver that the grievance policy was received and reviewed within 7 days of the child's, youth's or young adult's admission to the PRTF. The signed acknowledgement shall be filed in the child's, youth's or young adult's record.

§ 5330.33. Nondiscrimination.

 A PRTF may not discriminate based on race, color, creed, disability, religious affiliation, ancestry, gender, gender identity or expression, sexual orientation, national origin or age and shall comply with applicable Federal and State laws and regulations.

§ 5330.34. Searches.

 (a) A PRTF shall have a written policy and procedure on searches of a child, youth or young adult or the child's, youth's or young adult's personal property.

 (b) A PRTF may conduct searches of a child, youth or young adult or the child's, youth's or young adult's property and bedroom when a search is necessary to protect the child, youth, young adult or others.

 (c) Unclothed body searches of a child, youth or young adult are prohibited.

STAFFING

§ 5330.41. Supervision of staff.

 (a) A PRTF shall have a written policy and procedure on the supervision of PRTF staff that includes all of the following:

 (1) A medical director shall provide the following supervision to an RN, clinical director or APP:

 (i) One hour of face-to-face supervision every month.

 (ii) Thirty minutes of direct observation of the provision of services every 6 months.

 (2) A clinical director or medical director shall provide the following supervision to a mental health professional:

 (i) Two hours of supervision each month. Of the 2 hours of supervision, 1 hour shall be face-to-face.

 (ii) One hour of direct observation of the provision of services every 6 months. Each occurrence of direct observation of services shall be for at least 30 minutes.

 (3) A clinical director, medical director or mental health professional shall provide the following supervision to a mental health worker supervisor:

 (i) Two hours of supervision each month. Of the 2 hours of supervision, 1 hour shall be face-to-face.

 (ii) One hour of direct observation of the provision of services every 6 months. Each occurrence of direct observation of services shall be for at least 30 minutes.

 (4) A clinical director, medical director, mental health professional or mental health worker supervisor shall provide the following supervision to a mental health worker:

 (i) Two hours of supervision each month. Of the 2 hours of supervision, 1 hour shall be face-to-face.

 (ii) One hour of direct observation of the provision of services every 6 months. Each occurrence of direct observation of services shall be for at least 30 minutes.

 (5) If a PRTF utilizes a mental health worker supervisor, the mental health worker supervisor shall supervise the mental health worker.

 (6) An RN shall provide the following supervision to an LPN:

 (i) One hour of face-to-face supervision every month.

 (ii) Thirty minutes of direct observation of the provision of services every 6 months.

 (b) A PRTF shall maintain documentation about each supervision session in the supervised PRTF staff person's personnel file that includes the following:

 (1) The date and type of supervision session or date of direct observation.

 (2) The location of the supervision session or location of direct observation.

 (3) The start and end time of the supervision session or direct observation.

 (4) Summary of the purpose and content of the supervision session or direct observation.

 (5) Signature and date of signature for both the supervisee and the supervisor.

 (c) Face-to-face supervision may be delivered through secure, real-time, two-way audio and video transmission that meets technology and privacy standards required by the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191).

§ 5330.42. Staff requirements.

 (a) Staff working in a PRTF shall be 21 years of age or older.

 (b) At least two PRTF staff persons who are trained in the use of manual restraints shall be present and available at the PRTF at all times.

 (c) During the PRTF's awake hours, the following requirements must be met:

 (1) At least one mental health worker or a PRTF staff person who meets the qualifications of a mental health worker shall provide supervision to every six children, youth or young adults.

 (2) PRTF staff providing supervision shall always be within auditory and visual range of children, youth or young adults.

 (3) A mental health professional shall be present at the PRTF.

 (d) During sleeping hours, the following requirements must be met:

 (1) At least one mental health worker or a PRTF staff person who meets the qualifications of a mental health worker shall provide supervision to every 12 children, youth or young adults.

 (2) PRTF staff providing supervision to children, youth or young adults shall remain within auditory range of the children, youth or young adults being supervised.

 (3) PRTF staff supervising children, youth or young adults shall conduct visual observations of each child, youth or young adult at least every 15 minutes.

 (e) PRTF staff shall be supervised as follows:

 (1) When there are less than 12 children, youth or young adults physically present at a PRTF, at least one PRTF supervisory staff person shall be physically present at the PRTF or on call to consult with PRTF staff.

 (2) When 12 or more children, youth or young adults are physically present at a PRTF, at least one PRTF supervisory staff person shall be physically present at the PRTF for every 12 children, youth or young adults.

§ 5330.43. Medical director.

 (a) A PRTF shall have a medical director.

 (b) The medical director shall be responsible for both of the following:

 (1) Overseeing the delivery of psychiatric services and programming to children, youth or young adults in a PRTF.

 (2) Coordination and supervision of PRTF staff on clinical and medical matters, including the prescribing and monitoring of psychotropic medication.

 (c) The medical director shall be licensed in this Commonwealth as a physician practicing psychiatry and be a board-certified or board-eligible psychiatrist.

 (d) The medical director may also serve as a treatment team leader.

§ 5330.44. Treatment team leader.

 (a) A PRTF shall identify a treatment team leader for each child, youth or young adult.

 (b) The treatment team leader shall be responsible for all of the following:

 (1) Direction of each child's, youth's or young adult's treatment team.

 (2) Leading monthly treatment plan meetings for each child, youth or young adult.

 (3) Development and implementation of the child's, youth's or young adult's individualized treatment plan.

 (4) Overseeing the update of each child's, youth's or young adult's treatment plan by the treatment team at least every 30 days.

 (5) Development of a discharge plan for each child, youth or young adult.

 (6) Completing a comprehensive psychiatric evaluation that includes an examination of the medical, psychological, social, behavioral and developmental aspects of the child, youth or young adult and reflects the need for a PRTF level of care. The comprehensive psychiatric evaluation shall be completed within 7 days of a child's, youth's or young adult's admission to the PRTF.

 (7) Determining if a PRTF level of care remains medically necessary for the child, youth or young adult every 30 days.

 (c) The treatment team leader shall meet the qualifications of a medical director specified in § 5330.43(c) (relating to medical director).

§ 5330.45. Clinical director.

 (a) A PRTF shall have a clinical director.

 (b) The clinical director shall be responsible for all of the following:

 (1) Oversight of treatment assessments, services, therapeutic activities and program schedules.

 (2) Review and response to emergency safety situations that occur at a PRTF.

 (3) Oversight of the training curricula to ensure the requirements of §§ 5330.51 and 5330.52 (relating to initial staff training; and annual staff training) are met.

 (c) The clinical director shall have at least 2 years of experience in the delivery of behavioral health services to children, youth or young adults with a mental illness or behavioral health disorder and meet one of the following:

 (1) Be licensed in this Commonwealth as a physician.

 (2) Be licensed in this Commonwealth as a psychologist.

 (3) Be licensed in this Commonwealth as a marriage and family therapist.

 (4) Be licensed in this Commonwealth as a professional counselor.

 (5) Be licensed in this Commonwealth as a clinical social worker.

 (6) Be licensed in this Commonwealth as a social worker and have completed a clinical practicum.

 (d) A medical director may also serve as a clinical director.

§ 5330.46. Program director.

 (a) A PRTF shall have a program director.

 (b) The program director shall be responsible for all of the following:

 (1) Administration and management of a PRTF.

 (2) Implementation of the PRTF's policies and procedures.

 (3) Compliance with this chapter.

 (4) Overseeing the general safety and protection of children, youth and young adults.

 (5) Developing and maintaining a program schedule of daily activities, which includes designated awake and sleeping times.

 (c) The program director shall have one of the following:

 (1) At least 1 year of experience in human service administration or direct care of children, youth or young adults with behavioral health needs and a graduate degree in psychology, sociology, social work, counseling, education, human services, public administration, business administration or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (2) At least 2 years of experience in human service administration or direct care of children, youth or young adults with behavioral health needs and a bachelor's degree in psychology, sociology, social work, counseling, education, human services, public administration, business administration or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (3) At least 3 years of experience in human service administration or direct care of children, youth or young adults with behavioral health needs and an associate's degree in psychology, sociology, social work, counseling, education, human services, public administration, business administration or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency. One of the 3 years of experience must be in a supervisory or managerial role.

 (4) At least 5 years of experience in direct care of children, youth or young adults with behavioral health needs and a high school diploma or the equivalent of a high school diploma. Two of the 5 years of experience must be in a supervisory or managerial role.

§ 5330.47. Registered nurse.

 (a) A PRTF shall have an RN who is either onsite or available at all times when not onsite.

 (b) The RN shall be responsible for all of the following:

 (1) Overseeing the nursing care for children, youth or young adults in a PRTF.

 (2) Assessing the health conditions of children, youth or young adults and determining appropriate nursing care needs.

 (3) Participating in monthly treatment plan meetings.

 (c) The RN shall have at least 1 year of experience in treating children, youth or young adults with behavioral health needs.

§ 5330.48. Mental health professional.

 (a) A PRTF shall have a mental health professional.

 (b) Children, youth or young adults in a PRTF shall be assigned to a mental health professional.

 (c) The mental health professional shall be responsible for all of the following:

 (1) Developing of the child's, youth's or young adult's individualized treatment plan.

 (2) Participating in monthly treatment plan meetings for all assigned children, youth or young adults.

 (3) Implementing treatment services and therapeutic activities for a child, youth or young adult in accordance with the child's, youth's or young adult's treatment plan.

 (4) Providing individual, group or family therapy in accordance with the child's, youth's or young adult's treatment plan.

 (5) Coordinating with the treatment team under the direction of the treatment team leader to address the goals, objectives, needs and strengths of assigned children, youth or young adults.

 (d) The mental health professional's assigned caseload may not exceed eight children, youth or young adults.

 (e) The mental health professional shall meet one of the following:

 (1) Be licensed in this Commonwealth as a physician, psychologist, marriage and family therapist, professional counselor or clinical social worker.

 (2) Be licensed in this Commonwealth as a social worker or behavior specialist and have a graduate degree that required a clinical or mental health direct service practicum from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (3) Have at least 1 year of experience in providing mental health direct services to children, youth or young adults and a graduate degree with at least nine credits specific to clinical practice in psychology, sociology, social work or counseling from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (4) Completed a clinical or mental health direct service practicum and have a graduate degree with a least nine credits specific to clinical practice in psychology, sociology, social work, education, counseling or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or have an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

§ 5330.49. Mental health worker.

 (a) A PRTF shall have a mental health worker.

 (b) The mental health worker shall be responsible for all of the following:

 (1) Implementing therapeutic interventions.

 (2) Providing direct and active supervision to children, youth or young adults.

 (3) Supporting the strengths and needs of children, youth or young adults.

 (4) Sharing pertinent information with the child's, youth's or young adult's treatment team. This may include general observations, progress with service goals and areas of concern.

 (5) Facilitating psychoeducational groups.

 (c) The mental health worker shall have a high school diploma or the equivalent of a high school diploma and at least 1 year of experience working with children, youth or young adults.

§ 5330.50. Additional staff positions.

 The following PRTF staff positions, if utilized, shall meet all of the following requirements:

 (1) If within the scope of the APP's practice, an APP may do the following:

 (i) Evaluate the physical or psychological condition of a child, youth or young adult who takes a prescribed medication.

 (ii) Review, update, sign and date the child's, youth's or young adult's treatment plan.

 (iii) Perform initial or routine specific screenings and assessments to assess the physical or psychological condition of a child, youth or young adult.

 (2) The APP shall be licensed in this Commonwealth and have at least 1 year of experience working with children, youth or young adults.

 (3) If within the scope of the LPN's practice, an LPN may do the following:

 (i) Accept verbal orders for a manual restraint.

 (ii) Participate in the planning, implementation and evaluation of nursing care provided to a child, youth or young adult.

 (4) The LPN shall be onsite at a PRTF whenever an RN is not onsite at the PRTF.

 (5) The LPN shall have at least 1 year of experience working with children, youth or young adults.

 (6) A mental health worker supervisor may provide the following:

 (i) Supervision to a mental health worker.

 (ii) Direct and active supervision to children, youth or young adults.

 (7) The mental health worker supervisor shall have one of the following:

 (i) At least 1 year of experience in the delivery of behavioral health services to children, youth or young adults and a bachelor's degree in psychology, sociology, social work, counseling, education, human services, public administration, business administration or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (ii) At least 2 years of experience in the delivery of behavioral health services to children, youth or young adults and an associate's degree in psychology, sociology, social work, counseling, education, human services, public administration, business administration or a related field from a college or university accredited by an agency recognized by the United States Department of Education or the Council for Higher Education Accreditation or an equivalent degree from a foreign college or university that has been evaluated by the Association of International Credential Evaluators, Inc. or the National Association of Credential Evaluation Services. The Department will accept a general equivalency report from the listed evaluator agencies to verify a foreign degree or its equivalency.

 (iii) At least 3 years of experience in the delivery of behavioral health services to children, youth or young adults and a high school diploma or the equivalent of a high school diploma.

§ 5330.51. Initial staff training.

 (a) A PRTF shall have a written policy and procedure on the monitoring of initial PRTF staff training.

 (b) PRTF staff shall complete an orientation that includes the individual's specific duties and responsibilities and information on the PRTF's policies and procedures.

 (c) Except as required under subsection (d), PRTF staff shall complete at least 30 hours of training in the following areas within 120 days of their date of hire:

 (1) The requirements of this chapter.

 (2) The requirements of 23 Pa.C.S. §§ 6301—6388 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services).

 (3) The requirements of the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704).

 (4) Fire safety by a fire safety expert. The following apply:

 (i) Training may be through a video recording if the video recording is prepared by a fire safety expert and is administered onsite by a PRTF staff person who is trained by a fire safety expert.

 (ii) If the facility serves 20 or fewer children, youth or young adults, the training may be conducted by a PRTF staff person trained by a fire safety expert.

 (5) First aid, opioid overdose reversal medication, Heimlich techniques, cardiopulmonary resuscitation, use of an AED, universal precautions and blood-borne pathogen training facilitated by an individual qualified as a trainer by a hospital or other recognized health care organization.

 (6) The use of manual restraints that is consistent with 42 CFR 483.376 (relating to education and training) and provided by an individual who meets the qualifications in 42 CFR 483.376(c).

 (7) Verbal de-escalation, crisis prevention and suicide prevention.

 (8) Professional ethics and conduct, professional boundaries and confidentiality.

 (9) Cultural competency and equity training that increases awareness of cultural norms and provides skills and knowledge regarding the value of diversity.

 (10) Trauma-informed care principles and practical applications.

 (11) Mental health diagnoses, conditions, needs and effective service interventions for children, youth or young adults.

 (12) Principles of child development.

 (13) Recognizing and responding to emergency safety situations.

 (d) The medical director, treatment team leader, clinical director, program director, RN, mental health professional, mental health worker, and if utilized, an APP, an LPN and a mental health worker supervisor shall complete the training required under subsection (c) prior to working directly with children, youth or young adults.

 (e) A PRTF shall keep documentation of completion of initial training requirements, which includes all of the following:

 (1) Name of the PRTF staff trained.

 (2) Training date.

 (3) Training source.

 (4) Name and qualifications of the trainer.

 (5) Length of training.

§ 5330.52. Annual staff training.

 (a) A PRTF shall have a written policy and procedure on the monitoring of annual PRTF staff training.

 (b) PRTF staff shall have at least 30 hours of annual training in the areas specified in § 5330.51(c) (relating to initial staff training).

 (c) In addition to the requirements in subsection (b), the medical director, treatment team leader, clinical director, program director, RN, mental health professional, mental health worker, and if utilized, an APP, an LPN and a mental health worker supervisor shall complete an additional 10 hours of annual training in the following areas:

 (1) Best practices, including evidenced-based practices to address the unique characteristics of the children, youth or young adults served.

 (2) Types, uses and side effects of psychotropic medications prescribed to children, youth or young adults.

 (3) Effective and transferable discharge and reintegration planning.

 (4) Documentation skills and requirements.

 (5) Mental health conditions, emotional disturbances or behavior disorders in children, youth or young adults as they relate to their biopsychosocial needs.

 (d) A PRTF shall keep documentation of completion of annual training requirements, which includes all of the following:

 (1) Name of the PRTF staff trained.

 (2) Training date.

 (3) Training source.

 (4) Name and qualifications of the trainer.

 (5) Length of training.

§ 5330.53. Criminal history checks and child abuse certifications.

 (a) Criminal history checks and child abuse certifications must be completed for all PRTF staff in accordance with 23 Pa.C.S. §§ 6301—6388 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services).

 (b) A PRTF shall have a written policy and procedure to ensure that PRTF staff having contact with children, youth or young adults comply with 23 Pa.C.S. §§ 6301—6388 and Chapter 3490, including mandated reporting and training requirements.

PHYSICAL SITE

§ 5330.61. Applicable construction safety laws.

 A PRTF shall comply with the requirements of 34 Pa. Code Part XIV (relating to uniform construction code).

§ 5330.62. Physical accommodations and equipment.

 A PRTF shall provide or arrange for physical site accommodations and equipment needed to meet the health and safety needs of a child, youth or young adult served, including special accommodations as a result of a child's, youth's or young adult's disability.

§ 5330.63. Poisons.

 (a) Poisonous materials, including cleaning and other toxic materials, must be kept locked and inaccessible to a child, youth or young adult.

 (b) Poisonous materials, including cleaning and other toxic materials, must be clearly labeled and stored in a container that meets the requirements for safe storage of that material.

 (c) Poisonous materials, including cleaning and other toxic materials, must be kept separate from food, food preparation surfaces and dining surfaces.

§ 5330.64. Heat sources.

 Heat sources, such as hot water pipes, fixed space heaters, hot water heaters and radiators exceeding 120°F that are accessible to a child, youth or young adult must be equipped with protective guards or insulation to prevent a child, youth or young adult from making physical contact with the heat source.

§ 5330.65. Sanitation.

 (a) Sanitary conditions must be maintained.

 (b) A PRTF shall take steps to prevent and address infestation of insects or rodents.

 (c) Trash must be removed from the property at least once a week.

 (d) Trash inside and outside of a PRTF must be kept in covered trash receptacles that prevent insect and rodent penetration.

§ 5330.66. Ventilation.

 (a) Living areas, recreation areas, dining areas, bathrooms, bedrooms and kitchens must be ventilated by at least one operable window or mechanical ventilation.

 (b) Windows, including windows in doors, must be securely screened when open.

§ 5330.67. Lighting.

 Rooms, bedrooms, hallways, interior stairs, outside steps, outside doorways, porches, ramps and fire escapes must be properly lighted to avoid accidents.

§ 5330.68. Surfaces.

 Indoor and outdoor floors, walls, ceilings, windows, doors and other surfaces must be free of damage or hazards.

§ 5330.69. Water.

 (a) A PRTF shall have hot and cold water.

 (b) Hot water temperature in areas accessible to a child, youth or young adult may not exceed 120°F.

 (c) A PRTF that is not connected to a public water or sewer system shall meet all Federal and State statutes, regulations and standards regarding private water and sewage systems.

 (d) A PRTF that is not connected to a public water system shall have a coliform water test performed at least every 3 months by the Department of Environmental Protection.

§ 5330.70. Air temperature.

 (a) The indoor temperature shall be at least 65°F during awake hours when a child, youth or young adult is present in a PRTF.

 (b) The indoor temperature may not be less than 62°F during sleeping hours.

 (c) When the indoor temperature exceeds 85°F, a PRTF shall use mechanical ventilation, such as fans or air conditioning.

§ 5330.71. Communication system.

 (a) A PRTF shall have a working telephone that is accessible to PRTF staff at all times.

 (b) A PRTF shall have communication equipment, such as a hand-held two-way radio, to allow PRTF staff to contact other PRTF staff for assistance in an emergency safety situation.

§ 5330.72. Emergency telephone numbers.

 The PRTF's physical address and telephone numbers for the nearest hospital, police department, fire department, ambulance and poison control center must be posted on or by all working telephones accessible to PRTF staff.

§ 5330.73. Handrails and railings.

 (a) Ramps, interior stairways and outside steps exceeding two steps must have a well-secured handrail.

 (b) Porches that have over an 18-inch drop must have a well-secured railing.

§ 5330.74. Landings and stairs.

 (a) Stairs must have a landing which is at least as wide as the doorway, beyond each interior and exterior door that opens directly into a stairway.

 (b) Interior stairs must have nonskid surfaces.

§ 5330.75. Furniture.

 (a) Furniture must be free of hazards.

 (b) A PRTF shall have enough furniture to accommodate seating for the largest group of children, youth or young adults that may routinely congregate so that no child, youth or young adult is required to stand or sit on the floor.

§ 5330.76. Equipment.

 (a) Equipment must be kept clean and maintained in good repair.

 (b) Equipment that poses a hazard to children, youth or young adults must be stored in an area that is inaccessible to children, youth or young adults.

 (c) A PRTF shall have a written policy and procedure to ensure that hazardous equipment is used in a safe and appropriate manner.

§ 5330.77. First aid supplies.

 (a) A PRTF shall have a first aid kit available to PRTF staff on every floor of the PRTF.

 (b) PRTF staff shall confirm that a first aid kit is present if an activity is being conducted outside on the grounds of the PRTF or away from the PRTF.

 (c) A first aid kit shall contain all of the following items:

 (1) A first aid manual.

 (2) Nonporous disposable gloves.

 (3) Antiseptic.

 (4) Assorted adhesive bandages.

 (5) Gauze pads.

 (6) Thermometer.

 (7) Tape.

 (8) Tweezers.

 (9) Scissors.

 (10) Opioid overdose reversal medication.

 (d) A first aid kit may not be accessible to children, youth or young adults.

 (e) A PRTF shall have an AED that is accessible to PRTF staff.

 (f) An AED may not be accessible to children, youth or young adults.

§ 5330.78. Elevators.

 An elevator must have a valid certificate of operation from the Department of Labor and Industry.

§ 5330.79. Activity space.

 A PRTF shall have indoor space for activities such as recreation, studying and group activities and outdoor space for activities such as recreation and group activities.

§ 5330.80. Exterior conditions.

 (a) The exterior of structures and grounds or yard of a PRTF must be free of hazards.

 (b) Outside walkways must be free of ice, snow and any type of obstruction.

§ 5330.81. Firearms and weapons.

 A PRTF shall have a written policy regarding possession of firearms, weapons and ammunition on the premise of a PRTF. A PRTF is not required to permit firearms, weapons and ammunition. The policy shall be in accordance with Federal and State law.

§ 5330.82. Bedrooms.

 (a) A single bedroom must have at least 70 square feet of floor space per child, youth or young adult measured wall to wall, including space occupied by furniture.

 (b) A shared bedroom must have at least 60 square feet of floor space per child, youth or young adult measured wall to wall, including space occupied by furniture.

 (c) No more than four children, youth or young adults may share a bedroom.

 (d) The ceiling height in a bedroom must be at least 7 1/2 feet.

 (e) A bedroom must have a window with a source of natural light.

 (f) A child, youth or young adult shall be provided with all of the following:

 (1) A bed with a solid foundation and fire-retardant mattress in good condition.

 (2) A pillow and bedding, in good condition, appropriate for the temperature in the PRTF.

 (3) A storage area for clothing.

 (g) Cots or portable beds are not permitted.

 (h) Bunk beds must allow enough space between each bed and the ceiling to allow a child, youth or young adult to sit up in bed.

 (i) Bunk beds must be equipped with securely attached ladders capable of supporting a child, youth or young adult.

 (j) The top bunk of bunk beds must be equipped with a secure safety rail on each open side and open end of the bunk.

 (k) A bedroom may not be used as a means of egress or as a means to access another part of a PRTF.

§ 5330.83. Bathrooms.

 (a) A PRTF shall have at least one functional toilet for every six children, youth or young adults.

 (b) A PRTF shall have at least one functional sink for every six children, youth or young adults.

 (c) A PRTF shall have at least one functional bathtub or shower for every six children, youth or young adults.

 (d) A PRTF shall have slip-resistant surfaces in bathtubs and showers.

 (e) Privacy must be provided for toilets, showers and bathtubs by partitions or doors.

 (f) A PRTF shall have at least one wall mirror for every six children, youth or young adults.

 (g) All of the following toiletry items must be provided for each child, youth or young adult:

 (1) Towels and washcloths.

 (2) Toothpaste.

 (3) Toothbrush.

 (4) Comb or hairbrush.

 (5) Shampoo.

 (6) Soap.

 (7) Feminine hygiene products, if needed.

 (8) Toilet paper.

 (9) Deodorant, if needed.

 (10) Body lotion, if needed.

 (h) Bar soap is not permitted unless there is a separate bar clearly labeled for each child, youth or young adult.

§ 5330.84. Kitchen area.

 (a) A PRTF shall have a kitchen area with an operable refrigerator, sink, cooking equipment and cabinets for storage.

 (b) Utensils for eating, drinking, serving food and preparing food must be washed and rinsed after each use.

 (c) Food must be protected from contamination while being stored, prepared, transported and served.

 (d) Uneaten food from a child's, youth's or young adult's dish may not be served again or used in the preparation of future meals.

 (e) Food must be kept at the following temperatures:

 (1) Cold food must be kept at or below 40°F.

 (2) Hot food must be kept at or above 140°F.

 (3) Frozen food must be kept at or below 0°F.

§ 5330.85. Laundry.

 Bed linens, towels, washcloths and clothing must be laundered at least once a week.

§ 5330.86. Swimming.

 (a) The perimeter of swimming pools must be surrounded by a fence that meets local codes and a gate that is locked when the pool is not in use.

 (b) Swimming pools must be inaccessible to children, youth or young adults when not in use.

 (c) A certified lifeguard shall supervise children, youth or young adults at all times while swimming. A certified lifeguard may not be counted towards the supervision ratio specified in § 5330.42 (relating to staff requirements).

FIRE SAFETY

§ 5330.91. Compliance with fire safety statutes, regulations and ordinances.

 A PRTF shall comply with applicable Federal and State laws, regulations and local ordinances regarding fire safety.

§ 5330.92. Unobstructed egress.

 (a) Stairways, hallways, doorways, passageways and egress routes from rooms and from a PRTF must be unlocked and unobstructed unless the fire safety approval specified in § 5330.6 (relating to fire safety approval) permits locking of certain means of egress. If a fire safety approval is not required in accordance with § 5330.6, means of egress may not be locked.

 (b) Doors used for egress routes from rooms and from a PRTF may not be equipped with key-locking devices, electronic card-operated systems or other PRTF staff-controlled devices that prevent immediate egress by a child, youth or young adult from the PRTF.

 (c) Doors with delayed egress must be equipped with a mechanism that unlocks after no more than a 15-second delay and must meet the requirements of section 1008.1.9.7 of the International Building Code, regarding delayed egress locks.

§ 5330.93. Exits.

 (a) If more than four children, youth or young adults sleep above the ground floor of a PRTF, there must be at least two interior or exterior exits from each floor.

 (b) If a fire escape is used as a means of egress, it must be permanently installed.

§ 5330.94. Evacuation procedures.

 (a) A PRTF shall have written emergency evacuation procedures that include PRTF staff responsibilities, means of transportation and designated meeting areas.

 (b) A PRTF shall have emergency evacuation procedures that contain a detailed diagram of exit paths, exit doors and fire extinguishers for each floor posted in a conspicuous and public place on each floor of the PRTF.

 (c) An elevator may not be used during a fire drill or an emergency evacuation procedure.

§ 5330.95. Notification of local first responders.

 (a) A PRTF shall notify local first responders in writing of all of the following:

 (1) Maximum number of children, youth, young adults and PRTF staff that could be present at the PRTF.

 (2) Physical address of physical structures.

 (3) Specific location of bedrooms.

 (4) Assistance needed to evacuate children, youth or young adults in an emergency.

 (b) Notification to local first responders must be reviewed and updated annually or within 5 days of when there is a change in the physical address of a physical structure, location of bedrooms or assistance needed to evacuate.

§ 5330.96. Flammable and combustible materials.

 Flammable and combustible materials must be used safely, stored away from heat sources and inaccessible to children, youth or young adults.

§ 5330.97. Furnaces.

 (a) Furnaces must be inspected and cleaned annually by a professional furnace cleaning company or properly trained PRTF maintenance staff.

 (b) A PRTF shall maintain documentation of the annual inspection and cleaning of a furnace.

§ 5330.98. Portable space heaters.

 Portable space heaters or heaters that are not permanently mounted or installed are not permitted.

§ 5330.99. Wood and coal burning stoves.

 The use of wood and coal burning stoves is not permitted.

 

§ 5330.100. Fireplaces.

 (a) Fireplaces must be securely screened or equipped with protective guards while in use.

 (b) PRTF staff shall be present with a child, youth or young adult while a fireplace is in use.

 (c) A fireplace chimney and flue must be cleaned and inspected annually by a professional cleaning company or properly trained PRTF maintenance staff.

 (d) A PRTF shall maintain documentation of the cleaning and inspection of the fireplace chimney and flue.

 (e) Inoperable fireplaces must be inaccessible.

§ 5330.101. Detectors and alarms.

 (a) A PRTF shall have an operable smoke detector located within 15 feet of each bedroom door.

 (b) A PRTF shall have at least one operable smoke detector on each floor, including a basement and an attic.

 (c) Smoke detectors and fire alarms must be a type approved by the Department of Labor and Industry or listed by Underwriters Laboratories.

 (d) If a PRTF serves four or more children, youth or young adults or if the PRTF has three or more floors including a basement and an attic, there must be at least one smoke detector on each floor that is interconnected and audible throughout the PRTF or a fire alarm system that is audible throughout the PRTF.

 (e) Smoke detectors and fire alarms must be equipped with a visual aid so that an individual with a hearing impairment can be alerted in the event of a fire.

 (f) If a smoke detector or fire alarm becomes inoperable, repair or replacement shall be completed within 24 hours of the time the detector or alarm was found to be inoperable.

 (g) An approved carbon monoxide alarm must be installed in a PRTF no more than 15 feet from any fossil fuel-burning device or appliance.

 (h) Carbon monoxide detectors and alarm systems must be tested and replaced in accordance with the manufacturer's guidelines.

 (i) A PRTF shall have a written procedure for fire safety monitoring if a smoke detector, fire alarm or carbon monoxide detector becomes inoperative.

§ 5330.102. Fire extinguishers.

 (a) Fire extinguishers must be inspected and approved annually by a fire safety expert who is not an employee of the PRTF. The date of the inspection must be documented on the fire extinguisher.

 (b) Fire extinguishers must be listed by Underwriters Laboratories or approved by Factory Mutual Systems.

 (c) There must be at least one approved fire extinguisher with a minimum 2-A rating for each floor, including a basement and an attic.

 (d) If an indoor floor area including a basement or an attic is more than 3,000 square feet, there must be an additional approved fire extinguisher with a minimum 2-A rating for each additional 3,000 square feet of indoor floor space.

 (e) An approved fire extinguisher with a minimum 2A-10BC rating must be in a kitchen. The kitchen fire extinguisher meets the requirements for one approved fire extinguisher for each floor as required in subsection (c).

 (f) Fire extinguishers must be accessible to all PRTF staff. A fire extinguisher must be secured if access to the extinguisher by a child, youth or young adult may cause a safety risk to the child, youth or young adult. If fire extinguishers are secured, PRTF staff shall have the means to immediately gain access to the fire extinguisher in the event of a fire emergency.

§ 5330.103. Fire drills.

 (a) An unannounced fire drill must be held at least once a month.

 (b) Fire drills must be held during normal staffing conditions and not when additional PRTF staff are present.

 (c) The evacuation routes must allow children, youth or young adults to evacuate the entire physical structure into a public thoroughfare or to a fire-safe area designated in writing within the past year by a fire safety expert. The public thoroughfare or to a fire-safe area must be within 2 1/2 minutes or within the period specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employee of the PRTF.

 (d) A fire drill must be held during sleeping hours at least once every 6 months.

 (e) Alternate exit routes must be used during fire drills at least once every 3 months.

 (f) Fire drills must be held on different days of the week, at different times and during different staffing shifts.

 (g) A fire alarm or smoke detector must be activated during each fire drill.

 (h) A PRTF shall have a written fire drill record that contains all of the following:

 (1) Address and name of the physical structure where the fire drill occurred.

 (2) Date the fire drill occurred.

 (3) Time the fire drill occurred.

 (4) Amount of time for all individuals to evacuate the PRTF.

 (5) The exit route that was utilized during the fire drill.

 (6) The number of children, youth or young adults in the location at the time of the fire drill.

 (7) Documentation of any issues encountered during the fire drill.

 (8) Documentation of whether fire alarms or smoke detectors were operable.

HEALTH

§ 5330.111. Health and behavioral health services.

 (a) A PRTF shall identify acute and chronic conditions of a child, youth or young adult and shall arrange for or provide appropriate medical treatment.

 (b) Medically necessary physical and behavioral health treatment, diagnostic services, follow-up examinations and services, such as medical, nursing, pharmaceutical, dental, dietary, hearing, vision, blood lead level, psychiatric and psychological services that are planned or prescribed for the child, youth or young adult, shall be arranged for or provided.

§ 5330.112. Initial medical assessment.

 (a) A PRTF shall have a written policy and procedure on inclusion of the assessment of health or safety risks in the initial medical assessment of children, youth or young adults.

 (b) An initial medical assessment must include all of the following:

 (1) Vital signs, such as blood pressure, pulse, temperature and breathing rate.

 (2) Allergies.

 (3) Medication history.

 (4) Immunization history.

 (5) Substance use history.

 (6) Prior or current injuries or illnesses.

 (7) Prior hospitalizations.

 (8) Medical diagnoses.

 (9) Parents' medical history, if known.

 (10) Vision screening.

 (11) Hearing screening.

 (c) A child, youth or young adult shall have an initial medical assessment completed by a physician, APP or RN within 24 hours of admission to a PRTF.

 (d) An initial medical assessment must be signed and dated by the physician, APP or RN who completed the initial medical assessment.

 (e) If a physician did not complete the initial medical assessment, a physician shall review and sign the initial medical assessment within 3 days from the date the initial medical assessment was completed.

 (f) A copy of the initial medical assessment shall be kept in a child's, youth's or young adult's record.

§ 5330.113. Health and safety plan.

 (a) If an initial medical assessment specified in § 5330.112 (relating to initial medical assessment) identifies a health or safety risk to a child, youth, young adult or others, a written health and safety plan to protect the child, youth, young adult or others must be developed and implemented within 24 hours after the initial medical assessment is completed.

 (b) The health and safety plan to protect the child, youth, young adult or others must be communicated to and made available to PRTF staff and must be filed in the child's, youth's or young adult's record.

 (c) A written health and safety plan must be developed and implemented within 24 hours of the PRTF medical staff or treatment staff being notified of a health or safety risk to the child, youth or young adult.

 (d) Written health and safety plans must be updated based on the health and safety risks of the child, youth or young adult.

§ 5330.114. Medical examination.

 (a) If a child, youth or young adult did not have a medical examination, or there is no documentation of a medical examination 12 months prior to admission to a PRTF that meets the requirements of the State Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Periodicity Schedule, a medical examination by a physician or APP shall be completed within 15 days of the child's, youth's or young adult's admission to a PRTF.

 (b) An initial medical examination must include all of the following:

 (1) Review of the assessments specified in § 5330.112 (relating to initial medical assessment).

 (2) Review of the health history and medical information pertinent to the child, youth or young adult to inform medical care, diagnosis and services needed in an emergency safety situation.

 (3) Review of required immunizations, screening tests and laboratory tests, including the ordering of any immunizations, screening tests and laboratory tests that are indicated.

 (4) Communicable disease detection, if recommended by a physician or APP based on the child's, youth's or young adult's health condition and with appropriate consent from the youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver.

 (5) Recommendations for follow-up physical or behavioral health treatment, examinations or services.

 (c) A child, youth or young adult shall have a medical examination completed annually by a physician or APP that meets the requirements of the State EPSDT Program Periodicity Schedule.

 (d) A medical examination must be signed and dated by the physician or APP who completed the medical examination.

 (e) Written verification of completion of the medical examination must be kept in the child's, youth's or young adult's record specifying all of the following:

 (1) Date of the examination.

 (2) Results of the examination.

 (3) Name, address and contact information of the examining physician or APP.

 (4) Follow-up recommendations.

§ 5330.115. Dental care.

 (a) A child, youth or young adult shall have a dental examination performed by a licensed dentist and teeth cleaning performed by a licensed dentist or dental technician at least semiannually.

 (b) A child, youth or young adult shall receive a dental examination and teeth cleaning within 30 days after admission to a PRTF.

 (c) If the child, youth or young adult had a dental examination and teeth cleaning prior to admission to the PRTF that meets the requirements of subsection (a), an initial examination and teeth cleaning within 30 days after admission is not required.

 (d) Follow-up dental work indicated by the examination, such as treatment of cavities and application of protective sealants, must be provided as recommended by the licensed dentist.

 (e) A written record of completion of each dental examination and teeth cleaning, including the preadmission dental examination and teeth cleaning permitted in subsection (c), specifying the date of the examination and teeth cleaning, the licensed dentist's name and address, results of the examination, follow-up recommendations made and the dates and provision of follow-up services and treatment, must be kept in the child's, youth's or young adult's record.

§ 5330.116. Vision care.

 (a) A child, youth or young adult shall receive vision screening and treatment to include diagnosis and services including eyeglasses, for defects in vision.

 (b) A child, youth or young adult shall receive a vision screening within 30 days after admission to a PRTF in accordance with the periodicity schedule recommended by the American Academy of Pediatrics.

 (c) If the child, youth or young adult had a vision screening prior to admission to the PRTF that meets the requirements of subsection (a) within the periodicity schedule specified in subsection (b), an initial examination within 30 days after admission is not required. The next screening shall be required within the periodicity schedule specified in subsection (b).

 (d) Follow-up treatment, such as provision of eyeglasses, must be provided as recommended by the treating practitioner.

 (e) A written record of completion of each vision screening, including the preadmission screening permitted in subsection (c), specifying the date of the screening, the treating practitioner's name and address, results of the screening, follow-up recommendations made, and the dates and provision of follow-up services and treatment, must be kept in the child's, youth's or young adult's record.

§ 5330.117. Hearing care.

 (a) A child, youth or young adult shall receive a hearing screening and treatment to include diagnosis and services, including hearing aids, for defects in hearing.

 (b) Each child, youth or young adult shall receive a hearing screening within 30 days after admission in accordance with the periodicity schedule recommended by the American Academy of Pediatrics.

 (c) If the child, youth or young adult had a hearing screening prior to admission to the PRTF that meets the requirements of subsection (a) within the periodicity schedule specified in subsection (b), an initial examination within 30 days after admission is not required. The next screening shall be required within the periodicity schedule specified in subsection (b).

 (d) Follow-up treatment, such as provision of hearing aids, must be provided as recommended by the treating practitioner.

 (e) A written record of completion of each hearing screening, including the preadmission screening permitted in subsection (c), specifying the date of the screening, the treating practitioner's name and address, the results of the screening, follow-up recommendations made and the dates and provision of follow-up services and treatment, must be kept in the child's, youth's or young adult's record.

§ 5330.118. Use of drugs, alcohol, tobacco and e-cigarettes.

 (a) A PRTF shall have a written policy and procedure on the use of drugs, alcohol, tobacco and e-cigarettes.

 (b) Use or possession of drugs, alcohol, tobacco and e-cigarette products by a child, youth or young adult is prohibited.

 (c) Use or possession of drugs, alcohol, tobacco and e-cigarettes products by a PRTF staff person is prohibited in the PRTF and during transportation of a child, youth or young adult.

 (d) If PRTF staff are permitted to use tobacco and e-cigarette products on the grounds of the PRTF, the following apply:

 (1) The PRTF shall designate areas of the PRTF grounds where it is permissible to use tobacco or e-cigarettes.

 (2) The PRTF shall have a written fire safety procedure in the areas where it is permissible to use tobacco and e-cigarettes. Procedures must include extinguishing procedures and requirements that use of tobacco and e-cigarette products shall occur a safe distance from flammable or combustible materials and physical structures.

 (3) Use of tobacco and e-cigarette products must be out of the sight of a child, youth or young adult.

§ 5330.119. Emergency plan.

 (a) A PRTF shall have a written medical emergency plan for children, youth, young adults and PRTF staff. The plan must include all of the following:

 (1) A hospital or health care provider that will provide services in an emergency.

 (2) A transportation method to be used during an emergency.

 (3) An emergency staffing plan.

 (4) Medical and behavioral health needs or situations for which emergency medical care and services are warranted.

 (b) A child, youth or young adult and the child's, youth's or young adult's parent, legal guardian or caregiver shall be given a copy of the medical emergency plan upon the child's, youth's or young adult's admission to the PRTF.

 (c) A child's, youth's or young adult's parent, legal guardian or caregiver shall be notified within 12 hours from the time the medical emergency plan is implemented for their child, youth or young adult.

STAFF HEALTH

§ 5330.121. Staff assessment.

 (a) PRTF staff who have direct contact with children, youth or young adults or who work in food preparation shall have a health assessment completed within 12 months prior to being hired by the PRTF and shall have a health assessment completed within 24 months of their last health assessment thereafter.

 (b) A physician or APP shall complete the health assessment.

 (c) The health assessment must include all of the following:

 (1) A physical examination.

 (2) Tuberculosis screening consistent with § 5330.122 (relating to tuberculosis screening).

 (3) Examination for communicable diseases.

 (4) Examination of medical problems which might threaten the health of a child, youth or young adult or prevent a PRTF staff person from providing adequate care to children, youth or young adults.

 (d) The physician or APP who completed the assessment shall complete a report of the assessment that includes all of the following:

 (1) The signature and professional title of the physician or APP who completed the assessment.

 (2) Results of the examination for communicable disease.

 (3) The physician's or APP's assessment of the PRTF staff person's suitability to provide care to a child, youth or young adult.

 (e) A copy of the report of the current health assessment must be included in the PRTF staff person's record.

§ 5330.122. Tuberculosis screening.

 (a) A PRTF staff person shall have a tuberculosis screening completed at initial employment.

 (b) A PRTF staff person shall have a subsequent tuberculosis screening completed if directed by a physician, an APP, the Department of Health or a local health department.

 (c) A PRTF staff person who has had a positive tuberculin skin test and a negative chest X-ray is not required to have further tuberculosis testing, unless one of the following occurs:

 (1) The PRTF staff person is exposed to an active case of tuberculosis.

 (2) The PRTF staff person develops a productive cough that does not respond to medical treatment within 14 days of the onset of the cough.

 (d) A copy of a positive tuberculin test shall be included in the PRTF staff person's record along with the results of a chest X-ray and evaluation for chemoprophylaxis.

§ 5330.123. Serious communicable diseases or medical problem.

 (a) If a PRTF staff person has a serious communicable disease as defined by the Department of Health, written authorization from a physician or APP is required for the PRTF staff person to be present at the PRTF.

 (b) The written authorization from a physician or APP shall include a statement that the PRTF staff person will not pose a serious threat to the health of the children, youth or young adults and specific instructions and precautions to be taken for the protection of the children, youth or young adults while the PRTF staff person has a communicable disease.

 (c) A PRTF shall follow the written instructions and precautions specified in the written authorization from a physician or APP.

NUTRITION

§ 5330.131. Daily meals.

 (a) A PRTF shall provide at least three meals and one snack a day to children, youth or young adults.

 (b) There may be no more than 15 hours between an evening meal and a morning meal.

 (c) If a child, youth or young adult misses a meal, a PRTF shall provide the child, youth or young adult with a meal as soon as possible.

 (d) If a child, youth or young adult refuses to eat a meal, the refusal shall be documented in the child's, youth's or young adult's record and reported to the child's, youth's or young adult's treatment team.

 (e) If a child, youth or young adult requests a meal after initially refusing a meal, a PRTF shall provide the meal to the child, youth or young adult when requested.

§ 5330.132. Quantity of food.

 (a) The quantity of food for each meal served must meet the minimum daily requirements as recommended by the United States Department of Agriculture, unless otherwise recommended in writing by a physician or an APP for a specific child, youth or young adult.

 (b) Dietary alternatives must be available for a child, youth or young adult who has food allergies, special health needs or religious beliefs regarding dietary restrictions or dietary preferences.

 (c) Additional portions of meals must be available for a child, youth or young adult upon request, unless a physician or an APP has directed in writing that additional portions must not be available for the child, youth or young adult.

 (d) Water must be available to a child, youth or young adult at all times.

§ 5330.133. Withholding or forcing of food.

 (a) A PRTF may not withhold food or drink as a means for punishment or coercion.

 (b) A child, youth or young adult may not be forced to consume food or drink.

TREATMENT SERVICES

§ 5330.141. Treatment planning requirements.

 (a) A treatment team shall meet the requirements of 42 CFR 441.156 (relating to team developing individual plan of care).

 (b) A treatment team leader shall ensure that only PRTF staff who are trained and experienced in the use of the modalities proposed in the treatment plan participate in its development, implementation and review.

 (c) A treatment team leader shall actively involve the child's, youth's or young adult's treatment team in the treatment planning process.

 (d) PRTF staff shall maintain a communication log for each child, youth or young adult that includes daily notes about the child's, youth's or young adult's behaviors and observations about the child, youth or young adult that can be used by the treatment team in the treatment planning process.

§ 5330.142. Treatment plan.

 (a) The following requirements must be met prior to the development of a child's, youth's or young adult's treatment plan:

 (1) A multi-disciplinary assessment and screening must be completed within 48 hours of a child's, youth's or young adult's admission to the PRTF.

 (2) A psychiatric evaluation must be completed that includes an examination of the medical, psychological, social, behavioral and developmental aspects of the child, youth or young adult and reflects the need for a PRTF level of care. The psychiatric evaluation must be completed within 7 days of a child's, youth's or young adult's admission to the PRTF.

 (b) The multi-disciplinary assessment and psychiatric evaluation must address all of the following:

 (1) Specific service recommendations that address the reasons the child, youth or young adult was admitted to the PRTF.

 (2) The child's, youth's or young adult's trauma history.

 (3) The parent's, legal guardian's or caregiver's trauma history, if known.

 (4) Identification of the child's, youth's or young adult's strengths.

 (5) The child's, youth's or young adult's educational history and needs.

 (6) Prior evaluations, assessments and screenings.

 (7) Prior treatment services and their effectiveness.

 (c) A child's, youth's or young adult's treatment team shall utilize the multi-disciplinary assessment, psychiatric evaluation and PRTF staff observations to formulate an individualized treatment plan for the child, youth or young adult.

 (d) A child's, youth's or young adult's treatment plan shall be developed and implemented no later than 14 days after the child's, youth's or young adult's admission to the PRTF.

 (e) A treatment plan must:

 (1) Be designed to result in the child's, youth's or young adult's discharge at the earliest possible time from the PRTF.

 (2) Identify objectives and interventions aimed at treating and eliminating behavior that may lead to the use of a manual restraint.

 (3) Reflect the need for a PRTF level of care.

 (4) State individualized and measurable treatment objectives.

 (5) Monitor the progress of each individualized treatment objective.

 (6) Identify the child's, youth's or young adult's strengths.

 (7) Include the child's, youth's or young adult's plan for discharge.

 (8) Document the child's, youth or young adult's achievements since the last treatment plan.

 (9) Prescribe an integrated program of therapies and experiences designed to meet the child's, youth's or young adult's treatment needs.

 (10) Address the impact of the child's, youth's or young adult's medical and trauma history.

 (f) A PRTF shall document in the child's, youth's or young adult's record the participation of treatment team members in the development of the child's, youth's or young adult's treatment plan.

 (g) Treatment team members shall sign and date the treatment plan. Objections to the treatment plan or refusal to sign the treatment plan must be documented in the child's, youth's or young adult's record.

§ 5330.143. Maintenance of treatment plan.

 (a) A child's, youth's or young adult's treatment plan must be revised at least every 30 days in accordance with 42 CFR 441.155(c) (relating to individual plan of care).

 (b) A child's, youth's or young adult's treatment plan must be revised when changes to service objectives and goals are identified.

 (c) A PRTF shall notify the child's, youth's or young adult's parent, legal guardian or caregiver at least 14 days prior to the date of a regularly scheduled treatment plan meeting. The PRTF shall document the notification, including the method of notification.

 (d) A PRTF shall implement a treatment plan in accordance with the objectives, therapies and activities that have been determined by the treatment team.

§ 5330.144. Copies of treatment plan.

 A copy of the child's, youth's or young adult's treatment plan and revisions to the child's, youth's or young adult's treatment plan must be provided to all of the following:

 (1) The child, youth or young adult.

 (2) The child's, youth's or young adult's parent, legal guardian or caregiver with authorized release of information.

 (3) An individual who participated in the development of or revision to the treatment plan with authorized release of information.

§ 5330.145. Treatment services.

 (a) A PRTF shall ensure the physical and psychological well-being of a child, youth or young adult are being met in accordance with age, presenting behaviors and other vulnerabilities.

 (b) A PRTF shall provide therapy that addresses a child's, youth's or young adult's psychological, social, behavioral, medical, recreational, developmental needs and traumatic experiences.

 (c) All of the following must be provided in accordance with the child's, youth's or young adult's treatment objectives:

 (1) Individual therapy with the child's, youth's or young adult's treatment team leader must be provided for at least 1 hour each month.

 (2) Individual therapy with the child's, youth's or young adult's mental health professional must be provided for at least 2 hours each week.

 (3) Group therapy must be provided for at least 3 hours each week. PRTF staff that meet the qualifications of a mental health professional, clinical director or treatment team leader shall facilitate group therapy.

 (4) Family therapy as follows:

 (i) Family therapy must be provided by PRTF staff that meet the minimum qualifications of a mental health professional, clinical director or treatment team leader.

 (ii) Family therapy must be scheduled at a time that is convenient for the child's, youth's or young adult's parents, legal guardians or caregivers.

 (iii) Family therapy must be provided for at least 1 hour each week.

 (5) Psychoeducation group therapy must be provided at least 3 hours each week. PRTF staff that meet the minimum qualifications of a mental health worker shall facilitate psychoeducation groups.

 (d) If a child, youth or young adult or parent, legal guardian or caregiver refuses to receive a treatment service, the refusal to receive the service must be documented in the child's, youth's or young adult's record.

 (e) Individual and group therapy and psychoeducation groups must be in person and may not be provided through two-way audio and video transmission.

 (f) Family therapy may be provided in person or through secure, real-time, two-way audio and video transmission that meets technology and privacy standards required by the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191).

 (g) Services received by a child, youth or young adult or parent, legal guardian or caregiver, including efforts to conduct services, must be documented in the child's, youth's or young adult's record.

§ 5330.146. Education.

 (a) Under 22 Pa. Code Chapters 11, 14 and 15 (relating to student attendance; special education services and programs; and protected handicapped students), a child, youth or young adult who is of compulsory school age shall participate in a school program provided by an entity that is licensed by the Department of Education.

 (b) A child's, youth's or young adult's educational needs may not be a prerequisite for admission to a PRTF.

 (c) Decisions regarding the education of the child, youth or young adult shall be made by the educational host district, on an individualized basis utilizing the most integrated setting appropriate, with input from the treatment team, home school district, the educational decision maker and court, if applicable.

 (d) A child, youth or young adult shall have the right to an appropriate education consistent with State laws, including the opportunity to participate in extracurricular, cultural, vocational and personal enrichment activities that are reasonably available and consistent with the child's, youth's or young adult's age, developmental level and treatment plan.

§ 5330.147. Discharge.

 (a) A plan for the child's, youth's or young adult's discharge shall begin on the day of admission to the PRTF and remain an active part in the child's, youth's or young adult's treatment plan.

 (b) A PRTF shall provide no less than 30 days advance written notice of the pending discharge of a child, youth or young adult to all of the following:

 (1) The child's, youth's or young adult's treatment team.

 (2) Identified community providers, with authorized release of information.

 (3) The child's, youth's or young adult's educational host district and receiving district, if known, with authorized release of information.

 (c) Prior to discharging a child, youth or young adult, the treatment team shall meet to complete a plan for discharge that must be child, youth or young adult centered and include all of the following:

 (1) The child's, youth's or young adult's strengths and needs.

 (2) Specific and transferrable short-term and long-term objectives for the child, youth or young adult.

 (3) A summary of the treatment provided, including the goals, objectives and services used.

 (4) If the child, youth or young adult receives psychotropic medications, the rationale for the psychotropic medications, the dosage taken by the child, youth or young adult and the effectiveness of the psychotropic medications.

 (5) The name and contact information of identified community providers.

 (d) The treatment team meeting specified in subsection (c) must be documented in the child's, youth's or young adult's record.

 (e) The mental health professional, in coordination with the child's, youth's or young adult's parent, legal guardian or caregiver, shall contact the community providers identified in the plan for discharge to schedule an appointment.

 (f) Documentation of the contact specified in subsection (e) and date of appointment must be included in the child's, youth's or young adult's record.

 (g) At least a 30-day supply of prescribed medications must be provided upon discharge to the young adult or the person to whom the child, youth or young adult is being discharged.

§ 5330.148. Level system.

 The following requirements must be met if a PRTF utilizes a level system:

 (1) A PRTF shall develop a written policy and procedure which utilizes trauma-informed care principles to provide incentives, structure, limit setting, encouragement and support to a child, youth or young adult.

 (2) The level system must be individualized according to a child's, youth's or young adult's age and stage of development.

 (3) The level system must be consistent with the child's, youth's or young adult's treatment objectives.

 (4) The level system must be age and developmentally appropriate for the child, youth or young adult.

 (5) The level system may not be punitive in nature.

TRANSPORTATION

§ 5330.151. Transportation.

 (a) PRTF staff who provide transportation for children, youth or young adults shall comply with all applicable Federal and State laws and regulations regarding vehicles and properly transporting children, youth or young adults according to age, size, disability and other needs.

 (b) A driver of a vehicle may not be counted towards the supervision ratio requirements specified in subsection (d).

 (c) A driver of a vehicle and at least one PRTF staff person shall be present in the vehicle when a child, youth or young adult is being transported.

 (d) There shall be at least one PRTF staff person present for every three children, youth or young adults being transported.

 (e) A manual restraint may not be utilized on a child, youth or young adult during transport.

MEDICATION

§ 5330.161. Storage of medication.

 (a) Prescription and nonprescription medication must be kept in an area or container that is locked and not accessible to children, youth or young adults.

 (b) Prescription and nonprescription medication stored in a refrigerator must be kept in a locked container.

 (c) Prescription and nonprescription medication must be stored under proper sanitary, temperature, moisture and light conditions.

 (d) A PRTF shall have a written policy and procedure that meets Federal and State laws and regulations regarding the handling of discontinued and expired medication.

§ 5330.162. Labeling of medication.

 (a) Prescription medication must be kept in its original container and labeled with a pharmacy label that includes all of the following:

 (1) The child's, youth's or young adult's name.

 (2) Name of the medication.

 (3) Prescription number.

 (4) Date the prescription was issued.

 (5) Prescribed dosage.

 (6) Name of the prescribing physician.

 (b) Nonprescription medication must be stored in its original container with the original label.

§ 5330.163. Use of prescription medication.

 (a) Prescription medication must be used only by the child, youth or young adult for whom the medication was prescribed.

 (b) The use of pro re nata medication to control a child's, youth's or young adult's acute, episodic behavior is prohibited.

§ 5330.164. Medication log.

 (a) A prescription and nonprescription medication log must be kept for each child, youth or young adult.

 (b) The prescription and nonprescription medication log must be available to the treatment team upon request.

 (c) A child's, youth's or young adult's medication log must include all of the following:

 (1) Known allergies of the child, youth or young adult.

 (2) For each prescription and nonprescription medication taken by the child, youth or young adult, all of the following:

 (i) Name of the medication, including brand name and generic name.

 (ii) If a prescription medication, name of the prescribing physician or APP.

 (iii) If a prescription medication, prescribed dosage of the medication.

 (iv) Method of administration.

 (v) Time medication must be administered.

 (vi) Other specific administration instructions, as applicable.

 (vii) Possible side effects.

 (viii) Contraindicated medications.

 (ix) Name of the qualified PRTF staff specified in § 5330.168 (relating to medication administration) who distributed, administered or observed the child's, youth's or young adult's self-administration of the medication, if applicable.

 (x) Time medication was administered.

§ 5330.165. Medication error.

 (a) A medication error includes the following, regardless of whether the medication error resulted in an adverse reaction:

 (1) Failure to administer the prescribed medication.

 (2) Utilizing the incorrect method to administer the medication.

 (3) Administering the incorrect medication.

 (4) Administering the correct medication in an incorrect dosage.

 (5) Administering the correct medication at the incorrect time.

 (b) Documentation of a medication error that includes detailed information about the medication error must be recorded in the child's, youth's or young adult's medication log.

§ 5330.166. Medication refusal.

 (a) A child, youth or young adult and the child's, youth's or young adult's parent, legal guardian or caregiver has the right to refuse a prescription or nonprescription medication in accordance with applicable Federal and State laws and regulations.

 (b) If a child, youth or young adult refuses to take a prescription or nonprescription medication, the refusal must be documented in the child's, youth's or young adult's medication log.

 (c) A PRTF shall inform the child's, youth's or young adult's treatment team leader of the refusal to take prescription medication as soon as possible, but no later than 1 hour after the refusal.

§ 5330.167. Adverse reaction.

 (a) If a child, youth or young adult experiences an adverse reaction to a prescription or nonprescription medication requiring immediate medical attention, a PRTF shall notify the parent, legal guardian or caregiver and treatment team leader prior to the next scheduled dosage, but no later than 1 hour after the adverse reaction.

 (b) If a child, youth or young adult experiences an adverse reaction from a prescription or nonprescription medication not requiring immediate medical attention, a PRTF shall notify the parent, legal guardian or caregiver and treatment team leader prior to the next scheduled dosage, but no later than 12 hours after the adverse reaction.

 (c) Documentation of an adverse reaction from a prescription or nonprescription medication must be included in the child's, youth's or young adult's medication log.

 (d) The treatment team leader shall review the adverse reaction and document a change to a medication in the child's, youth's or young adult's medication log.

§ 5330.168. Medication administration.

 (a) Prescription and nonprescription medication, including injections, shall only be administered by the following:

 (1) Physician.

 (2) Physician assistant.

 (3) Certified registered nurse practitioner.

 (4) RN.

 (5) LPN.

 (6) PRTF staff who meet the requirements of § 5330.169 (relating to medication administration training).

 (7) A child, youth or young adult who meets the requirements of § 5330.170 (relating to self-administration).

 (b) Prescription and nonprescription medication must be administered in accordance with the instructions for the medication.

§ 5330.169. Medication administration training.

 (a) PRTF staff who have completed and passed a Department-approved medication administration course within the past 2 years are permitted to administer oral, inhaled, topical, eye and ear drop medications, diabetes medications and epinephrine injections for insect bites or other allergic reactions.

 (b) PRTF staff who have completed and passed a Department-approved medication administration course and have completed and passed a diabetes patient education program within the past 12 months that meets the Standards for Diabetes Patient Education Programs of the Department of Health are permitted to administer insulin injections.

 (c) PRTF staff medication administration training must be documented and must include the name of PRTF staff trained, training date, training source, name of qualified trainer and length of training.

§ 5330.170. Self-administration.

 (a) The following requirements must be met for a child, youth or young adult to self-administer oral, inhaled, topical, eye and ear drop medications, diabetes medications and epinephrine injections for insect bites or other allergic reactions:

 (1) Documented approval from a prescribing physician stating that a child, youth or young adult has the knowledge, skills and abilities to self-administer the medication.

 (2) The child, youth or young adult recognizes the prescription or nonprescription medication and knows the condition or illness for which the prescription or nonprescription medication is being taken, the correct dosage and when to take the prescription or nonprescription medication.

 (3) A PRTF staff person who meets the qualifications of § 5330.168(a)(1)—(6) (relating to medication administration) is physically present throughout the self-administration and immediately records the administration in the child's, youth's or young adult's medication log.

RESTRICTIVE PROCEDURES

§ 5330.181. Use of manual restraints.

 (a) A manual restraint is the only restrictive procedure permitted in a PRTF.

 (b) A manual restraint may only be used if a child, youth or young adult poses an imminent threat to physically harm themselves or others.

 (c) Children, youth or young adults have the right to be free from a manual restraint used as a means of coercion, discipline, convenience or retaliation.

 (d) A PRTF staff person shall only use a manual restraint if the PRTF staff person has completed training in the use of manual restraints that is consistent with 42 CFR 483.376 (relating to education and training) and is provided by an individual who meets the qualifications in 42 CFR 483.376(c).

 (e) A PRTF shall develop a written policy and procedure for the use of manual restraints that includes all of the following:

 (1) The requirements of subsections (a)—(d).

 (2) Therapeutic approaches, such as goal planning, which are aimed at de-escalating, redirecting and releasing aggression through healthy channels, counseling and removing a child, youth or young adult from an overstimulating environment.

 (3) A performance improvement process that must be reviewed every 30 days to monitor and reduce the use of manual restraints.

 (4) Contact information, including the phone number and mailing address, for the appropriate State protection and advocacy organization.

 (f) On the day of admission, a PRTF shall do all of the following:

 (1) Provide a copy of the restrictive procedure policy to the child, youth or young adult and the parent, legal guardian or caregiver.

 (2) Inform the child, youth or young adult and the parent, legal guardian or caregiver of the PRTF's restrictive procedure policy.

 (3) Obtain a signed acknowledgment from a youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver that the restrictive procedure policy was received and reviewed. The signed acknowledgment must be filed in the child's, youth's or young adult's record.

§ 5330.182. Ordering a manual restraint.

 (a) The ordered manual restraint must be the least restrictive manual restraint.

 (b) An order for a manual restraint must align with all of the following conditions relating to the child, youth or young adult:

 (1) The results of the assessment, screening and evaluation specified in § 5330.142 (relating to treatment plan).

 (2) Chronological and developmental age.

 (3) Size.

 (4) Gender.

 (5) Physical condition.

 (6) Psychiatric condition.

 (7) Personal trauma history.

 (8) Personal abuse history.

 (c) A manual restraint may be ordered only when a child, youth or young adult poses an imminent threat to physically harm themselves or others and both of the following have occurred:

 (1) Every attempt has been made to de-escalate the child's, youth's or young adult's behavior.

 (2) Less intrusive techniques and resources appropriate to address the behavior have been tried and failed.

 (d) A manual restraint may not be ordered as a standing order or on an as-needed basis.

 (e) If a child's, youth's or young adult's treatment team leader is available to the PRTF staff and certified in the use of manual restraints, the treatment team leader is the only PRTF staff person that may order a manual restraint.

 (f) If the treatment team leader is not available to PRTF staff or if the treatment team leader is available but not certified in the use of manual restraints, PRTF staff who meet the qualifications specified in §§ 5330.43 or 5330.45 (relating to medical director; and clinical director) or an APP may order a manual restraint provided the ordering PRTF staff are certified in the use of manual restraints.

 (g) An order for a manual restraint must be received by an RN or LPN while the manual restraint is being used by PRTF staff or immediately after the manual restraint ends.

 (h) A child's, youth's or young adult's treatment team leader shall be contacted and informed about the use of a manual restraint within 48 hours of its use, unless the manual restraint was ordered by the treatment team leader.

 (i) An order for a manual restraint and the application of a manual restraint may not exceed 30 minutes.

 (j) An order for a manual restraint must include all of the following and be documented in the child's, youth's or young adult's record:

 (1) The name of the qualified PRTF staff person who ordered the manual restraint.

 (2) The date and time a manual restraint was ordered.

 (3) The type of manual restraint that was ordered.

 (4) The length of time for which a manual restraint was ordered.

 (5) The start time and end time the manual restraint was applied.

 (k) An order for a manual restraint expires once the manual restraint of the child, youth or young adult ends and a new order must be obtained prior to the initiation of a new manual restraint.

 (l) The qualified PRTF staff who ordered a manual restraint shall be available in person or by telephone for consultation with PRTF staff administering and observing the manual restraint throughout the duration of a manual restraint.

§ 5330.183. Prohibited restrictive procedures.

 (a) The following restrictive procedures are prohibited:

 (1) Seclusion.

 (2) Exclusion.

 (3) Chemical restraint.

 (4) Mechanical restraint.

 (5) A manual restraint that places a child, youth or young adult in a prone position or applies pressure or weight on the child's, youth's or young adult's respiratory system.

 (6) Aversive conditioning.

 (7) A restrictive procedure that limits a child's, youth's or young adult's food, drink or access to a toilet.

 (b) Seclusion and exclusion do not include the use of a time out as defined in this chapter.

 (c) Exclusion does not occur if a PRTF staff person remains in the exclusion area with the child, youth or young adult.

§ 5330.184. Restrictive procedure plan.

 (a) A restrictive procedure plan must be written within 24 hours of a child's, youth's or young adult's admission to a PRTF and prior to the use of a manual restraint.

 (b) A restrictive procedure plan must be developed and revised with the participation of the treatment team.

 (c) A restrictive procedure plan must be reviewed, approved, signed and dated by treatment team members at least every 30 days.

 (d) A restrictive procedure plan must include all of the following:

 (1) Known observable signals that occur prior to any behaviors that put a child, youth or young adult at risk for a manual restraint and the suspected reason for the behavior.

 (2) Desired behavioral outcomes, documented in measurable terms.

 (3) Interventions to be used to modify or eliminate behaviors that put a child, youth or young adult at risk for a manual restraint.

 (4) Physical or behavioral health needs or past trauma that may contraindicate the use of a specific manual restraint.

 (e) A restrictive procedure plan must be implemented as written.

 (f) Copies of a restrictive procedure plan must be kept in a child's, youth's or young adult's record.

§ 5330.185. Application of a manual restraint.

 (a) A PRTF shall have at least two PRTF staff persons present during the application of a manual restraint.

 (b) At least one PRTF staff person who is medically trained to provide emergency first aid and cardiopulmonary resuscitation shall be present throughout the use of a manual restraint.

 (c) At least one PRTF staff person who has completed the required manual restraint training and who is not involved in applying a manual restraint shall be physically present throughout the use of a manual restraint to continually assess the physical and psychological well-being of the child, youth or young adult and to oversee that the manual restraint is being applied correctly.

 (d) The child's, youth's or young adult's physical and psychological condition must be documented in the child's, youth's or young adult's medical record at least every 10 minutes during a manual restraint.

 (e) Both of the following must occur at 10-minute increments during the application of a manual restraint:

 (1) The manual restraint is released.

 (2) The child, youth or young adult is transitioned to another approved manual restraint technique.

 (f) PRTF staff who are directly or indirectly involved in a manual restraint shall reduce or eliminate influences that may impede the child, youth or young adult from de-escalating.

 (g) During a manual restraint, a child's, youth's or young adult's basic needs and rights must continue to be met.

 (h) A manual restraint must end when the earliest of the following occurs:

 (1) The order for a manual restraint expires.

 (2) The manual restraint has been applied for 30 minutes.

 (3) When the child, youth or young adult no longer poses an imminent danger of physical harm to self or others.

 (i) Within 30 minutes of initiation of a manual restraint or immediately after a manual restraint is removed, a treatment team leader, physician, APP or RN, who is certified in the use of manual restraints, shall conduct a face-to-face assessment of all of the following:

 (1) The child's, youth's or young adult's physical and psychological condition.

 (2) The child's, youth's or young adult's behavior.

 (3) Appropriateness of the intervention measures.

 (4) Complications caused by the use of the manual restraint.

 (j) The face-to-face assessment specified in subsection (i) must be in person and may not occur through secure, real-time, two-way audio and video transmission.

 (k) A PRTF shall notify the child's, youth's or young adult's parent, legal guardian or caregiver of the manual restraint within 1 hour after the manual restraint has ended.

§ 5330.186. Injuries from a manual restraint.

 (a) A PRTF shall immediately obtain medical treatment from qualified medical personnel for a child, youth or young adult injured as a result of a manual restraint.

 (b) Injuries that occur as a result of a manual restraint, including injuries to PRTF staff, must be documented in the child's, youth's or young adult's record.

§ 5330.187. Documentation of a manual restraint.

 (a) The PRTF staff shall document the use of a manual restraint in the child's, youth's or young adult's record by the end of the shift in which the manual restraint was concluded.

 (b) Documentation of the use of a manual restraint must include all of the following:

 (1) The requirements of § 5330.182(j) (relating to ordering a manual restraint).

 (2) The requirements of § 5330.185(d) (relating to application of a manual restraint).

 (3) The time and results of the face-to-face assessment specified in § 5330.185(i).

 (4) The name of the qualified medical personnel that completed the child's, youth's or young adult's face-to-face physical and psychological assessment during and after the manual restraint.

 (5) Description of the emergency safety situation that created the need for the manual restraint.

 (6) Description of the attempts made to de-escalate the child's, youth's or young adult's behavior.

 (7) Description of the less intrusive techniques and resources that are appropriate to address the child's, youth's or young adult's behavior that were tried and failed.

 (8) The name and title of PRTF staff involved in the ordering, application and observation of the manual restraint.

 (9) The date and time the treatment team leader was consulted if the treatment team leader did not order the manual restraint.

 (10) Written statements from PRTF staff describing the events prior to, during and following the manual restraint from each PRTF staff person who was directly involved or who observed the manual restraint.

 (11) The date, time and method the PRTF used to contact the child's, youth's or young adult's parent, legal guardian or caregiver regarding the use of the manual restraint and the name of the PRTF staff person that contacted the child's, youth's or young adult's parent, legal guardian or caregiver.

 (c) A verbal order for a manual restraint must be verified in writing by the qualified PRTF staff person who ordered the manual restraint and documented in the child's, youth's or young adult's record within 48 hours of the verbal order.

§ 5330.188. Debriefing.

 (a) A PRTF shall have a written policy and procedure on debriefing after the use of a manual restraint.

 (b) Within 24 hours after the use of a manual restraint, a face-to-face discussion with the child, youth or young adult must occur and include all of the following:

 (1) PRTF staff involved in the manual restraint, except when the presence of a particular PRTF staff person may jeopardize the well-being of the child, youth or young adult.

 (2) Representatives from the child's, youth's or young adult's treatment team.

 (3) The child's, youth's or young adult's parent, legal guardian or caregiver, if available.

 (c) The discussion specified in subsection (b) must provide the child, youth or young adult; parent, legal guardian or caregiver; and PRTF staff the opportunity to discuss the circumstances resulting in the use of a manual restraint and strategies to be used by PRTF staff, the child, youth, young adult or others that may prevent the future use of a manual restraint.

 (d) Within 24 hours after the use of a manual restraint, the PRTF staff involved in the manual restraint, supervisory and administrative staff shall conduct a debriefing that includes, at a minimum, a review and discussion of all of the following:

 (1) The circumstances that led to the use of the manual restraint, including a discussion of the precipitating factors.

 (2) Alternative techniques that may have prevented the use of a manual restraint.

 (3) The procedures, if any, that PRTF staff are to implement to prevent a recurrence of the use of a manual restraint.

 (4) The outcome of the manual restraint, including any physical or emotional injuries resulting from the use of the manual restraint.

 (e) PRTF staff involved in a manual restraint that results in an injury to a child, youth or young adult or PRTF staff shall meet with PRTF supervisory staff within 24 hours of the manual restraint and evaluate the circumstances that caused the injury and develop a plan to prevent future injuries.

 (f) PRTF staff shall document in the child's, youth's or young adult's record the discussions required by subsections (b), (d) and (e), including the names of the PRTF staff who were present, the names of PRTF staff that were excused and any changes to the child's, youth's or young adult's treatment plan as a result of the discussion.

§ 5330.189. Time out.

 (a) A child, youth or young adult in a time out may not be physically prevented from leaving the time out area.

 (b) Time outs may take place in areas away from other children, youth or young adults or in areas where other children, youth or young adults are having activities.

 (c) PRTF staff shall directly supervise the child, youth or young adult while in a time out.

 (d) A time out may not be used in a punitive manner or to exclude or seclude a child, youth or young adult from activities.

§ 5330.190. Attestation.

 (a) A PRTF shall attest, in writing, in accordance with 42 CFR 483.374 (relating to facility reporting) that the PRTF is complying with CMS's standards on the use of restrictive procedures and this chapter's requirements on the use of restrictive procedures.

 (b) The attestation shall include the signature of the PRTF program director.

 (c) A PRTF shall provide an attestation to the Department annually.

 (d) A PRTF enrolling in the Medical Assistance Program shall provide the attestation required by subsection (a) when it executes a provider agreement with the Department.

 (e) Within 5 days of receiving notification from the Department of Health that it has determined that the PRTF is out of compliance with 42 CFR Part 483, Subpart G (relating to condition of participation for the use of restraint or seclusion in psychiatric residential treatment facilities providing inpatient psychiatric services for individuals under age 21) and must close, the PRTF shall provide the Department with the PRTF's plans for the orderly transfer of children, youth or young adults.

SECURE PRTF

§ 5330.201. Requirements for a secure PRTF.

 (a) A PRTF must be designated as a secure PRTF when egress from the PRTF, or a portion of the PRTF, is prohibited through one of the following mechanisms:

 (1) Internal locks within the building or exterior locks.

 (2) Secure fencing around the perimeter of the PRTF.

 (b) A secure PRTF shall have a written fire safety approval that is appropriate for a secure setting from the Department of Labor and Industry, the Department of Health or the appropriate local building authority under the Pennsylvania Construction Code Act (35 P.S. §§ 7210.101—7210.1103) prior to applying for an initial certificate of compliance.

 (c) A secure PRTF shall meet all of the following staffing requirements:

 (1) During awake hours, at least one mental health worker or PRTF staff person who meets the qualifications of a mental health worker shall provide supervision to every four children, youth or young adults.

 (2) During sleeping hours, at least one mental health worker or PRTF staff person who meets the qualifications of a mental health worker shall provide supervision to every eight children, youth or young adults.

 (d) No more than two children, youth or young adults may share a bedroom in a secure PRTF.

 (e) A fence that surrounds the secure PRTF may not have razor ribbon or barbed wire attached to it.

 (f) A secure PRTF may not have security bars attached to doors and windows.

§ 5330.202. Exceptions for a secure PRTF.

 A secure PRTF shall comply with the requirements of this chapter, except for the following:

 (1) Section 5330.42(d)(1) (relating to staff requirements).

 (2) Section 5330.42(e)(1).

 (3) Section 5330.82(c) (relating to bedrooms).

 (4) Section 5330.92 (relating to unobstructed egress).

RECORDS

§ 5330.211. Emergency contact information.

 (a) Emergency contact information for a child, youth or young adult must be documented in a child's, youth's or young adult's record and accessible to PRTF staff.

 (b) Emergency contact information for a child, youth or young adult must include all of the following:

 (1) The name, address and telephone number of a parent, legal guardian or caregiver to be contacted in case of an emergency.

 (2) The name, address and telephone number of a child's, youth's or young adult's physician and health insurance.

 (3) The name, address and telephone number of the parent, legal guardian or caregiver permitted to give consent for medical treatment.

 (c) The emergency contact information for each child, youth or young adult shall accompany the child, youth or young adult when the child, youth or young adult is not at the PRTF.

§ 5330.212. Child, youth or young adult record.

 (a) A PRTF shall store child, youth or young adult records in a secure location.

 (b) A PRTF shall maintain a record for each child, youth or young adult it serves that includes all of the following:

 (1) Identifying information as follows:

 (i) The child's, youth's or young adult's name, gender, gender identity, admission date, birth date and social security number.

 (ii) The child's, youth's or young adult's race and ethnicity, height, weight, hair color, eye color and identifying marks.

 (iii) Dated photograph of the child, youth or young adult taken within the past year.

 (iv) The language spoken and understood by the child, youth or young adult and the primary language used by the child's, youth's or young adult's parent, legal guardian or caregiver if other than English or other means of communication used by the child, youth or young adult or the child's, youth's or young adult's parent, legal guardian or caregiver.

 (v) The child's, youth's or young adult's religious affiliation.

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

 (2) Independent certification of need for PRTF services.

 (3) Medical and behavioral records, including medication logs, assessments, screenings and treatment updates.

 (4) A psychiatric evaluation and updates to the psychiatric evaluation.

 (5) A treatment plan and updates to the treatment plan.

 (6) Documentation of efforts to coordinate care with other services and community supports.

 (7) Documentation of each service provided, including all of the following:

 (i) Date and time a service is provided, duration of service and setting where the service is provided.

 (ii) Identification of the service provided to address a goal in the treatment plan.

 (iii) Description of the outcome of the service provided.

 (iv) Signature of the PRTF staff providing the service.

 (8) Documentation of the reason why a service was not provided in accordance with the treatment plan.

 (9) Consent to treatment and authorized release of information forms.

 (10) Plan for discharge in accordance with § 5330.147 (relating to discharge).

 (11) Documentation of the use of manual restraints as required by § 5330.187 (relating to documentation of a manual restraint).

 (12) Applicable court orders.

 (13) Educational records.

 (14) Reportable incidents as specified in § 5330.14 (relating to reportable incidents).

 (15) Documentation of psychotropic medication reviews, including the clinical rationale for the psychotropic medication.

 (16) Signed notification of rights and grievance procedures specified in §§ 5330.31 and 5330.32 (relating to rights; and grievance procedures).

 (17) Signed notice of confidentiality in accordance with the Health Insurance Portability and Accountability Act of 1996 (Pub.L. No. 104-191).

 (c) A child's, youth's or young adult's record must be:

 (1) Legible.

 (2) Signed and dated by the PRTF staff writing in the record.

 (3) Reviewed for quality by the program director, clinical director or designated quality assurance staff within 6 months of the initial entry. After the initial review, subsequent reviews may be limited to new additions to the record and must occur at least annually.

 (d) A child's, youth's or young adult's record must be kept for at least 4 years following the child's, youth's or young adult's discharge from the PRTF or until any audit or litigation is resolved, whichever is later.

§ 5330.213. PRTF record.

 (a) A PRTF shall store its records in a secure location.

 (b) A PRTF shall maintain records that contain all of the following for at least 4 years:

 (1) Inspection reports, certifications or licenses issued by Federal, State and local agencies.

 (2) A detailed service description in accordance with § 5330.11 (relating to service description) and all updates to the service description.

 (3) A copy of the emergency preparedness plan specified in § 5330.19 (relating to emergency preparedness).

 (4) Human resources policies and procedures.

 (5) Written agreements to coordinate services in accordance with § 5330.12 (relating to coordination of services) that must be maintained by a PRTF and updated annually.

 (6) Daily schedules for services and activities.

 (7) If the PRTF is not connected to a public water system, results of water tests performed by the Department of Environmental Protection.

 (8) Quality assurance plans in accordance with § 5330.221 (relating to quality assurance requirements).

 (c) A PRTF shall maintain PRTF staff personnel records that include all of the following for at least 4 years after the PRTF staff is no longer employed by the agency:

 (1) Job descriptions.

 (2) Work schedules and time sheets.

 (3) Criminal history checks and child abuse certifications required by 23 Pa.C.S. §§ 6301—6388 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services).

 (4) Documentation of PRTF staff credentials and qualifications.

 (5) Documentation of required trainings, including completion of continuing education credits required for professionally licensed PRTF staff in accordance with the applicable professional regulations.

 (6) Documentation of PRTF staff health assessments.

§ 5330.214. Record retention and disposal.

 A PRTF shall secure, maintain and dispose of records, both written and electronic, that contain protected health information in accordance with applicable Federal and State privacy and confidentiality laws and regulations.

QUALITY ASSURANCE

§ 5330.221. Quality assurance requirements.

 (a) A PRTF shall establish and implement a written quality assurance plan that meets all of the following:

 (1) Identifies the methodology for PRTF and individual record reviews, including all of the following:

 (i) Method for establishing sample size of PRTF and individual records for review.

 (ii) Frequency of individual records review to prepare for the annual report.

 (iii) Qualifications of PRTF staff who perform the review of records.

 (2) Provides an annual report of services provided by the PRTF that includes all of the following:

 (i) Review of individual records for compliance with this chapter.

 (ii) Review of individual and parent, legal guardian or caregiver satisfaction information.

 (iii) Assessment of delivered services outcomes and if treatment plan goals have been completed.

 (iv) Evaluation of compliance with the PRTF's approved service description.

 (v) Analysis of manual restraint usage.

 (b) A PRTF shall make annual reports available to the public upon request.

 (c) A PRTF shall provide written notification that a copy of the annual report may be requested at any time by a child, youth, young adult, parent, legal guardian or caregiver upon the child's, youth's or young adult's admission to the PRTF.

WAIVERS

§ 5330.231. Waivers.

 (a) A PRTF may submit a written request to the Department for a waiver of a specific regulation in this chapter.

 (b) The Department may grant a waiver unconditionally or subject to conditions that must be met. The Department may revoke a waiver if conditions required by the waiver are not met.

 (c) A waiver request will be granted only in exceptional circumstances and if all of the following are met:

 (1) The waiver does not jeopardize the health and safety of the children, youth or young adults.

 (2) The waiver will not adversely affect the quality of services.

 (3) The intent of the requirement to be waived will still be met.

 (4) Children, youth or young adults will benefit from the waiver of the requirement.

 (5) The waiver does not violate a Federal or State statute or regulation or local ordinance.

 (d) The scope, definitions and purpose of this chapter may not be waived.

[Pa.B. Doc. No. 24-1575. Filed for public inspection November 1, 2024, 9:00 a.m.]

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