[26 Pa.B. 867]
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BUILDING, FIRE PROTECTION, FURNISHINGS AND MAINTENANCE Section 5320.81. Building, physical plant and grounds.
31. Comment:
IRRC commented that a provider which had been licensed or approved to operate an LTSR with bed capacity in excess of 16 prior to January 1, 1993, is exempt from this subsection.
IRRC questioned the rationale for selecting January 1, 1993, as the exemption date. IRRC questioned how many LTSRs are in excess of 16 beds and how the Department will address staffing levels to ensure a safe and therapeutic environment in facilities which exceed 16 beds. IRRC strongly believed that staffing levels must be established based upon a reasonable resident/staff ratio to ensure a safe and therapeutic environment.
Response:
In response to these comments, the Department choose January 1, 1993, since it was the beginning of the year immediately preceding publication of the draft regulations. At that time, there was only one provider with bed capacity in excess of 16. There are no additional providers with bed capacity in excess of 16. LTSR regulations prohibit housing more than 16 residents. Staffing levels were established in § 5320.42.
32. Comment:
IRRC recommended that § 5320.81(b) be clarified to identify whether the purpose of this section is to allow for locks on common entrances or if the intent is to require the capacity to lock resident rooms.
Response:
The Department's intent is to allow for locks on common entrances, not to lock resident rooms. The language at § 5320.81 (relating to building, physical plant and grounds) has been revised to reflect the Department's intention.
WAIVER OF STANDARDS Section 5320.101. Waiver of standards.
33. Comment:
The Department proposes to limit the ability to apply for waivers to only one provision of the regulation, § 5320.41(3).
IRRC believed the Department should adopt a general waiver provision which allows an LTSR to submit a waiver request to the Department from any of the specific requirements included in the chapter. IRRC recommended using waiver language under § 2620.12 (relating to waivers).
This would provide an avenue for LTSRs currently operating under a different set of requirements to continue providing the same services yet have the ability to submit a waiver request for good cause.
Response:
In response to this comment, the Department has adopted the waiver of standards language as described in Chapter 2620 (relating to personal care home licensing).
SANCTIONS 34. Comment:
Under the prior proposed rulemaking, the Department established an entire subchapter incorporating the conditions for denial, nonrenewal and revocation of licenses as well as an appeal process. This rulemaking omits that entire subchapter. The Department staff indicated that it was eliminated because LTSRs are subject to the sanction provisions contained in Chapter 20. IRRC suggested the Department either incorporate those provisions in Chapter 20 or specifically include a statement in the regulation that failure to comply with Chapter 5320 may result in the imposition of sanctions found in Chapter 20.
Response:
In response to this comment, the Department has included at § 5320.12 (new section) the statement ''Failure to comply with this chapter may result in the imposition of sanctions found in Chapter 20 (relating to licensure or approval of facilities and agencies).''
APPENDIX A 35. Comment:
IRRC recommended the Department eliminate Appendix A, Community Support Principles from the rulemaking and incorporate the principles as a statement of policy.
Response:
In response to this recommendation, the Department has incorporated the Community Support Principles as a Statement of Policy as suggested by IRRC. See Subchapter L (relating to statement of policy) at 26 Pa.B. 915 (March 2, 1996).
Fiscal Impact
Public Sector
Commonwealth LTSRs may be established only in those counties affected by the closure or consolidation of a State mental hospital, or when a county/State mental hospital integrated project has been approved by the Department or where operations of LTSRs are included in an approved county plan. As part of a State hospital bed reduction, funds previously allocated to the State hospitals will be allocated under contract to county administrators to provide community-based services, including LTSRs, for persons who are eligible for hospitalization but can receive adequate care in an LTSR.
LTSRs are treatment facilities which provide a less expensive alternative to psychiatric inpatient care. In addition to State hospital patients, patients referred from private psychiatric hospitals and psychiatric units of general hospitals may also be admitted to an LTSR. The Department must license providers and provide periodic inspections.
Political Subdivisions The county administrator is the single point of accountability for program and financial decision making. The administrator must authorize and establish conditions for the provision of services. LTSR services are 100% State funded; however, funding needs will vary from LTSR to LTSR according to the services provided, the size of the program and the area served.
Private Sector
Payment rates will be cost-based and negotiated between providers and the CAO. Providers will be required to establish written policies for providing services, compile and maintain personnel records, service contracts with consultants, if needed, and letters of agreement with other community resources.
General Public
LTSR residents are the major group within the general public who will benefit from being in small residential treatment facilities with a home-like environment rather than large State institutions. There are the customary indirect costs to the general public when services are provided in an efficient and effective manner to persons with serious mental illness.
Paperwork Requirements
Providers will be required to establish written policies for guiding the operation of the LTSR. They will be required to maintain comprehensive individual resident records, and a schedule of fees and charges. Prior to, or upon admission, a written agreement meeting specified minimum requirements must be signed by the provider and the resident. A written policy must be established for in-service orientation and training for all staff. If the provider manages residents' funds, the provider must document deposits, receipt of funds, dispersal of funds and the current balance. Paperwork requirements will vary according to the service provided, the size of the program and the area served.
Cross References
These regulations reference Chapters 20, 4215 and 5100. The 1990 Americans with Disabilities Act (42 U.S.C.A. §§ 12101--122213), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 794) and the Protection and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C.A. §§ 10801--10851) are also referenced.
Effective Date
The regulations will become effective upon publication as final regulations in the Pennsylvania Bulletin.
Sunset Date
There is no sunset date for these regulations. The effectiveness of these regulations will be evaluated as part of the Department's annual licensing inspections of programs.
In addition to the annual licensing inspections conducted by the Department, LTSRs will be monitored by the county on an ongoing basis. Section 305(7) of the Mental Health and Mental Retardation Act of 1966 (50 P. S. § 4305(7)), requires county mental health/mental retardation administrators to review and evaluate facilities and to cooperate with the Department in the maintenance of established standards.
Data obtained through annual licensing inspections, together with county reviews, will be used by the Department to evaluate the effectiveness of these regulations.
Contact Person
Questions on these regulations should be directed to Barbara Dean-Johnson, Bureau of Adult Services, Office of Mental Health, Room 502, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-7666.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Department submitted a copy of the notice of proposed rulemaking, published at 23 Pa.B. 5806 (December 11, 1993), to IRRC and the Chairpersons of the House Committee on Health and Welfare and the Senate Committee on Public Health and Welfare for review and comment. In compliance with section 5(b.1) of the Regulatory Review Act, the Department also provided IRRC and the Committees with copies of comments received, as well as other documentation.
In preparing these final-form regulations, the Department has considered comments received from IRRC, the Committees and the public.
In accordance with section 5(c) of the Regulatory Review Act, these final-form regulations were deemed approved by the Committees on November 16, 1995, and were disapproved by IRRC on November 16, 1995.
On November 27, 1995, the Department notified the Chairpersons of the Committees and IRRC of its intention to proceed under section 7(c) of the Regulatory Review Act (71 P. S. § 745.7(c)). On December 27, 1995, under section 7(c) of the Regulatory Review Act, the Department submitted its report to the designated Committees and IRRC.
These amendments were deemed approved by the Committees on January 8, 1996; and were approved by IRRC on January 18, 1996.
Findings
The Department finds that:
(1) Public notice of intention to adopt the administrative regulations adopted by this order has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) The adoption of these regulations in the manner provided in this order is necessary and appropriate for the administration and enforcement of the Public Welfare Code.
Order
The Department, acting under the Public Welfare Code, orders that:
(a) The regulations of the Department, 55 Pa. Code, are amended by adding §§ 5320.1--5320.3, 5320.11, 5320.12, 5320.21--5320.26, 5320.31--5320.33, 5320.41--5320.46, 5320.51--5320.54, 5320.61--5320.65, 5320.71--5320.74, 5320.81--5320.86, 5320.91 and 5320.101 to read as set forth in Annex A.
(Editor's Note: Sections 5320.12, 5320.45 and 5230.46 were not included in the proposal at 23 Pa.B. 5806 (December 11, 1993).)
(Editor's Note: For a statement of policy dealing with this rulemaking see 26 Pa.B. 915 (March 2, 1996).)
(b) The Secretary of the Department shall submit this order and Annex A to the Office of Attorney General and the Office of General Counsel for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin.
FEATHER O. HOUSTOUN,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 26 Pa.B. 548 (February 3, 1996).)
Fiscal Note: 14-412. (1) General fund;
(2) Estimate for: (DOLLAR AMOUNTS IN THOUSANDS)
[1] [2] [3] Implementing year 1991-92 is $ 425 $7,446 $ 0 (3) 1st succeeding year 1992-93 is $1,451 $7,446 $ 0 2nd succeeding year 1993-94 is $ 0 $ 0 $ 9,479 3rd succeeding year 1994-95 is $ 0 $ 0 $13,964 4th succeeding year 1995-96 is $ 0 $ 0 $14,243 5th succeeding year 1996-97 is $ 0 $ 0 $14,243 (4) Three year history of program costs: (DOLLAR AMOUNTS IN THOUSANDS)
[1] [2] [3] FY 1993-94 0 0 $386,922 FY 1992-93 $316,217 $42,940 new approp. 93-94 FY 1991-92 $303,247 $44,497 new approp. 93-94 (7) Appropriation Title: Department of Public Welfare--State Mental Hospitals (SMH) [1], Closing of Philadelphia State Hospital [2] and Mental Health Services [3]; (8) recommends adoption. Funds are included in the 1995-96 Community Hospital Integrated Projects Programs (CHIPPS) portion of the Mental Health Services appropriation to cover this cost.
Annex A
TITLE 55. PUBLIC WELFARE
PART VII. MENTAL HEALTH MANUAL
CHAPTER 5320. REQUIREMENTS FOR LONG-TERM STRUCTURED RESIDENCE LICENSURE Subch.
A. GENERAL PROVISIONS B. GENERAL REQUIREMENTS C. PROVISION OF SERVICES D. ADMISSION AND RESIDENT/PROVIDER CONTRACT E. REQUIREMENTS FOR DIRECT-CARE AND SUPPORT STAFF F. THERAPEUTIC PROGRAM G. PERSONAL CARE SERVICES/RESIDENT RECORDS H. QUALITY IMPROVEMENT/SERVICE UTILIZATION I. BUILDING, FIRE PROTECTION, FURNISHINGS AND MAINTENANCE J. FOOD SERVICE K. WAIVER OF STANDARDS
Subchapter A. GENERAL PROVISIONS Sec.
5320.1. Scope. 5320.2. Policy. 5320.3. Definitions. § 5320.1. Scope.
This chapter establishes minimum standards for the operation of LTSRs for individuals with serious mental illness. See §§ 5320.31 and 5320.32(1)(2) (relating to admission criteria; and admission authorization) for information pertaining to admission criteria and authorization. This chapter is applicable only to counties affected by the closure or consolidation of a State mental hospital, or where a county/State hospital integrated project has been approved by the Department or where operation of LTSRs are included in an approved county plan.
§ 5320.2. Policy.
An LTSR is a highly structured therapeutic residential mental health treatment facility designed to serve persons 18 years of age or older and over who are eligible for hospitalization but who can receive adequate care in an LTSR. Admission is limited to individuals who require the services described in this chapter. Admission may occur voluntarily under section 201 of the act (50 P. S. § 7201) or involuntarily under section 304, 305 or 306 of the act (50 P. S. §§ 7304--7306).
§ 5320.3. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act--The Mental Health Procedures Act (50 P. S. §§ 7101--7503).
CPR--Cardio-Pulmonary Resuscitation.
County administrator--The person appointed or designated to carry out the duties specified in section 305 of the Mental Health and Mental Retardation Act of 1966 (50 P. S. § 4305).
Department--The Department of Public Welfare of the Commonwealth.
Designated person--A person chosen by the resident and documented in the resident's record to act, on behalf of the resident or be notified in case of emergency, termination of service, LTSR closure or other situations as indicated by the resident or as required by this chapter. The designated person could be the resident's family, next-of-kin, legal or personal guardian, executor, appropriate other person or agency.
Direct-care staff--A mental health professional or mental health worker employed by the LTSR provider either directly or under contract, who through education and experience is qualified to oversee or directly provide mental and social services to adults under this chapter. The term does not include support staff such as clerical, dietary, maintenance or fiscal personnel.
Immobile resident--An individual who is unable to move from one location to another or has difficulty in understanding and carrying out instructions without the continual and full assistance of other persons, or is incapable of independently operating a device, such as a wheelchair, prosthesis, walker or cane to exit a building.
LTSR--long-term structured residence--A highly structured therapeutic residential mental health treatment facility for adults.
License--A certificate of compliance issued under Chapter 20 (relating to licensure or approval of facilities and agencies).
Provider--The legal entity to which the license is issued.
Referring entity--The individual or organization referring a person for admission to an LTSR. Referrals can come from self, family, friends, emergency rooms, other residential facilities, psychiatric hospitals, physicians, mental health centers, and the like.
Support staff--A nonmental health professional or mental health worker employed by the LTSR provider either directly or under contract, who does not oversee or directly provide mental and social services to adults under this chapter. The term includes staff such as clerical, dietary, maintenance or fiscal personnel.
Therapeutic environment--A treatment milieu designed to facilitate the acquisition of behaviors necessary for the resident to function with as much self-determination and independence as possible and to prevent or decelerate regression or loss of optimal functioning.
Subchapter B. GENERAL REQUIREMENTS Sec.
5320.11. Prerequisites to licensure. 5320.12. Sanctions. § 5320.11. Prerequisites to licensure.
To obtain licensure to operate an LTSR, a provider shall:
(1) Comply with Chapter 20 (relating to licensure or approval of facilities and agencies).
(2) Be identified in the approved county plan or its amendments as specified in Chapter 4215 (relating to annual plan and estimates of expenditures).
(3) Have a letter of agreement between the provider and the county administrator's office. The agreement will include:
(i) Admission and discharge authority and procedure.
(ii) Charges for care, including room and board, treatment and rehabilitation services, personal hygiene and laundry services and other personal care services.
(iii) Charges for residents' care may not exceed the resident's current monthly income reduced by a minimum personal allowance of at least $60.
(iv) Charges for residents' care may not exceed the actual documented costs of services.
(v) Payment mechanisms for LTSR services, including charges for which the resident may be directly billed.
(vi) A dispute resolution mechanism.
§ 5320.12. Sanctions.
Failure to comply with this chapter may result in the imposition of sanctions found in Chapter 20 (relating to licensure or approval of facilities and agencies).
Subchapter C. PROVISION OF SERVICES Sec.
5320.21. Contracted services. 5320.22. Governing body. 5320.23. Access. 5320.24. Access by Pennsylvania Protection and Advocacy. 5320.25. Provider records. 5320.26. Confidentiality. § 5320.21. Contracted services.
To meet the needs of residents, some services are provided under agreements with outside sources. The provider shall have a written agreement with each outside source to furnish the necessary services as stipulated by the County Administrator/Provider Letter of Agreement. The provider is responsible for upholding service stipulations contained in the Letter of Agreement between the county administrator and the provider, even if the provider subcontracts for that service. The LTSR provider agreement with outside providers shall do the following:
(1) Set forth the responsibilities, functions, objectives, scope, cost and nature of the service and other terms agreed to by both parties.
(2) Contain a statement that the LTSR recognizes that it is responsible for ensuring that the contracted services meet the standards specified in this chapter.
§ 5320.22. Governing body.
An LTSR shall be operated by either a nonprofit corporation established under 15 Pa.C.S. Part I, Subpart C (relating to nonprofit corporations) or a for-profit corporation established under 15 Pa.C.S. Part I, Subpart B (relating to business corporations). The corporation's governing body has legal responsibility for the operation of the facility. The governing body shall:
(1) Adopt written policies for its own operation which include:
(i) Criteria for the qualifications and methods of selection for governing body membership.
(ii) Frequency of meetings.
(iii) Procedures for conducting business.
(iv) Provisions for disclosure by members of conditions that may create a conflict of interest and procedures for dealing with conflict of interest situations.
(2) Select a program director qualified under § 5320.42 (relating to staffing levels) who shall supervise the LTSR in accordance with the policies of the governing body and be officially responsible to the governing body.
(3) Conduct an annual review and evaluation of the LTSR's program activities, policies, procedures and program goals. This annual review and evaluation shall be documented.
(4) Adopt written program goals and objectives, including measurable anticipated outcomes.
(5) Develop and document the organizational structure.
(6) Administer funds needed to meet the written program goals and objectives.
(7) Develop, review and approve the annual budget and its modifications. These activities shall be documented.
(8) Develop and maintain written personnel policies for all staff.
(9) Develop written policies prohibiting discrimination against residents, prospective residents and all staff on the basis of age, race, sex, religion, handicap or disability, ancestry and ethnic origin, economic status or sexual preference, subject to applicable State and Federal statutes, including Chapter 5100 (relating to mental health procedures), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 794) and the Americans with Disabilities Act of 1990 (42 U.S.C.A. §§ 12101--12213).
(10) Develop written policies to maintain a clean, healthful and therapeutic environment.
(11) Document provisions made to meet the laundry, food service, housekeeping and maintenance requirements of this chapter.
(12) Oversee the provision of services specified in this chapter.
(13) Adopt written policies for the operation of the LTSR which shall include:
(i) The protection of residents' rights as set forth in §§ 5100.51--5100.56 (relating to patient rights).
(ii) A resident grievance procedure guaranteeing a written response to the resident by the program director when informal methods of resolving complaints are unsuccessful.
(iii) Site specific policies and schedules for fire and emergency evacuation drills.
(iv) Medication policies consistent with § 5320.53 (relating to medication).
(v) Policies covering the investigation and reporting of allegations of resident abuse.
(14) Develop written policies regarding the resident/provider contract as specified in § 5320.33 (relating to resident/provider contract; information on resident rights).
(15) Review and document reported allegations of violations of resident rights in the LTSR and report the results of the review to the county administrator.
(16) Maintain copies of policies applicable to the LTSR onsite, and make them readily available to residents, family members and visitors.
(17) Comply with § 5100.11(a) (relating to adequate treatment), which requires compliance with other relevant statutes, regulations and professional standards.
(18) Comply with this chapter when there is a conflict or inconsistency with the provision of any other regulation.
§ 5320.23. Access.
The provider shall permit community legal services, advocacy groups, mental health consumer and family organizations and authorized Federal, State or local government agents reasonable access to the facility and its residents. The provider shall review requests by generic community service organizations to access the facility on a case-by-case basis.
§ 5320.24. Access by Pennsylvania Protection and Advocacy.
The provider shall permit access by employes and legal counsel of Pennsylvania Protection and Advocacy (PPA) to the facility and its records, residents and staff under the Protection and Advocacy for Mentally Ill Individuals Amendments Act of 1988 (42 U.S.C.A. §§ 10801--10851).
§ 5320.25. Provider records.
Provider records shall, at a minimum, contain copies of the following:
(1) Required inspection reports, certifications or licenses by State and local agencies.
(2) Contracts with outside service providers.
(3) Affirmative action and nondiscrimination policies.
(4) Policies and procedures required by this chapter.
(5) Preemployment and biennial physical examinations and screening results for direct-care and dietary support staff. These shall be kept in a separate confidential file.
(6) Job descriptions for all staff.
(7) Credentials or qualifications of direct-care staff as required by this chapter and evidence of verification of credentials.
(8) Records of all staff orientation and training as required under § 5320.45 (relating to staff orientation and training).
(9) Staff work schedules, including payroll records and time sheets.
(10) Provider/resident contracts as described in § 5320.33 (relating to resident/provider contract; information on resident rights).
(11) The LTSR's ''house'' rules.
(12) A schedule of allowable resident fees or charges signed, as approved, by the county administrator or a designee. The County Administrator/Provider Letter of Agreement shall include a definition of the service items included in the per diem cost of care, including room and board, treatment, rehabilitation and personal care services, personal hygiene items and laundry services. See § 5320.11(3) (relating to prerequisites to licensure).
(13) Resident activity schedules. Current schedules shall be posted in a resident accessible area and outdated schedules shall be kept in provider records for 1 year.
(14) Other records mandated by Federal, State and local statutes and regulations.
§ 5320.26. Confidentiality.
Providers of LTSR services shall be responsible for ensuring that confidentiality of individual mental health records is maintained in accordance with §§ 5100.31--5100.39 (relating to confidentiality of mental health records).
Subchapter D. ADMISSION AND RESIDENT/PROVIDER CONTRACT Sec.
5320.31. Admission criteria. 5320.32. Admission authorization. 5320.33. Resident/provider contract; information on resident rights. § 5320.31. Admission criteria.
To be eligible for admission to an LTSR, a prospective resident shall:
(1) Be 18 years of age or older.
(2) Have had a physical examination and psychiatric evaluation not more than 6 months prior to application.
(3) Qualify for voluntary treatment under section 201 of the act (50 P. S. § 7201), or involuntary treatment under section 304, 305 or 306 of the act (50 P. S. §§ 7304-- 7306).
(4) Have a physician's certification that the applicant does not require hospitalization, nursing facility care or a level of care more restrictive than an LTSR, written within 30 days before admission.
(5) Evidence a severe psychosocial disability as a result of serious mental illness that indicates a less restrictive level of care as inappropriate.
§ 5320.32. Admission authorization.
A person will not be admitted without an assessment and admission authorization. The provider shall ensure that the written assessment and admission authorization includes:
(1) Approval by the county administrator.
(2) An assessment of the prospective resident's needs by the referring entity prior to admission. The assessment will include, at a minimum, the mental, physical and social needs of the prospective resident.
§ 5320.33. Resident/provider contract; information on resident rights.
(a) Within 24 hours of a resident's admission, the provider shall develop a written contract with the resident that meets the minimum requirements listed in subsection (b). The provider shall explain the contents of the contract to the resident and designated person, if any. The provider shall sign the contract and shall request the resident's signature. If the resident refuses to sign, the provider shall document the attempts made to secure the resident's signature. The provider shall ensure that the resident's refusal to sign has no bearing on the treatment or services subsequently provided.
(b) The resident/provider contract shall include, at a minimum, the following:
(1) The actual amount of allowable resident charges for each service or item.
(2) The party responsible for payment.
(3) The method for payment of long distance or collect charges for telephone calls.
(4) The conditions under which refunds will be made.
(5) The financial arrangements if assistance with financial management is to be provided.
(6) Limits on access to personal funds.
(7) The LTSR ''house rules.''
(8) The conditions under which the contract may be terminated, including cessation of operation of the LTSR.
(9) A statement that the resident is entitled to at least 30 days' advance notice, in writing, of the provider's intent to change the contract.
(c) Residents may be responsible for the cost of services or items not included in the per diem cost of care if these items are furnished at the request of the resident.
(d) In conjunction with explaining the contract, the provider shall give, and explain to, the resident written information on the resident's rights, on grievance procedures and on access to advocates, as specified at § 5100.52 (relating to statement of principle).
Subchapter E. REQUIREMENTS FOR DIRECT-CARE AND SUPPORT STAFF Sec.
5320.41. Physical examinations. 5320.42. Staffing levels. 5320.43. Program director and direct-care staff qualifications. 5320.44. Staff supervision. 5320.45. Staff orientation and training. 5320.46. Interdisciplinary treatment team. § 5320.41. Physical examinations.
The provider shall require and document preemployment and biennial physical examinations for direct-care and support staff to include screening for:
(1) Tuberculosis
(2) Hepatitis
§ 5320.42. Staffing levels.
The provider of LTSR services shall:
(1) Retain staff having an appropriate combination of education, work experience and training to meet the special needs of the population being served so that the service and program standards of this chapter are maintained.
(2) Retain full-time staffing levels sufficient to provide active treatment, psychosocial rehabilitation and 24-hour supervision on weekdays, weekends and holidays.
(3) Have a minimum of two direct-care staff persons awake and on duty within the LTSR whenever 10 to 16 residents inclusive are on the premises. A third direct-care staff person shall be either onsite or available to respond onsite within 30 minutes.
(4) Have a minimum of two direct-care staff, awake and on duty within the LTSR whenever fewer than 10 residents are on the premises.
(5) Have sufficient psychiatric time available to meet the psychiatric needs of the resident. At least 1/2 hour of psychiatric time per resident per week is required.
(6) Employ the program director on a full-time basis.
(7) Employ a mental health professional as provided in § 5320.43(b) (relating to program director and direct-care staff qualifications) onsite for at least 8 out of every 24 hours. This requirement may be met by the presence of the program director.
(8) Employ substitute staff with equivalent qualifications when staff are absent so that minimum direct-care staffing requirements are always met.
(9) Have direct-care staff certified in CPR and first aid on duty 24 hours a day.
§ 5320.43. Program director and direct-care staff qualifications.
(a) The program director shall:
(1) Have a Master's degree in a generally recognized clinical discipline and 2 years of mental health clinical experience.
(2) Be registered, licensed or certified to practice his profession, if that profession is governed by a registration, licensing or certification board in this Commonwealth.
(b) A mental health professional shall:
(1) Have a Master's degree or higher in a generally recognized clinical discipline and 1 year of mental health clinical experience.
(2) Be registered, licensed or certified to practice in his profession, if that profession is governed by a licensing board in this Commonwealth.
(c) A mental health worker shall be a person who has completed 12 semester hours of college training in a mental health related field or has at least a high school diploma or equivalency and 6 months of formal training in mental health or a related field.
§ 5320.44. Staff supervision.
The program director shall oversee supervision of the staff, including:
(1) Maintenance and review of resident care records.
(2) Annual evaluations of job performance.
(3) Orientation and training programs.
§ 5320.45. Staff orientation and training.
The program director shall oversee orientation and training of the staff, including:
(1) In-service and out-service training relevant to the needs of the population being served by the facility.
(2) A written policy for orientation and training of direct care and support staff according to the following criteria:
(i) Full-time staff, defined as working 30 hours per week or more, shall receive a minimum amount of orientation as follows:
(A) Direct care staff--20 hours.
(B) Support staff--4 hours.
(ii) Regularly scheduled part-time staff, defined as working less than 30 hours per week, shall receive a minimum amount of orientation as follows:
(A) Part-time direct care staff--10 hours.
(B) Part-time support staff--2 hours.
(3) Written documentation that an orientation program includes the following topics:
(i) Program philosophy, mission statement, goals and objectives.
(ii) Review and update of all policies and procedures.
(iii) Infection control including universal precautions, risk reduction and HIV education.
(iv) Confidentiality.
(v) Safety, fire safety and evacuation procedures.
(vi) Resident rights as specified at §§ 5100.51--5100.56 (relating to patient rights).
(vii) Conflict resolution (direct-care staff only).
(viii) Crisis prevention, management and reporting.
(ix) Abuse prevention and reporting.
(x) An overview of the main effects and side effects of medication (direct-care staff only).
(xi) Interdisciplinary treatment process and treatment planning (direct-care staff only).
(xii) Quality improvement and service utilization (direct-care staff only).
(xiii) Documentation and reporting mechanisms (direct-care staff only).
(4) Written documentation that ongoing training includes review and update of all policies and procedures including those listed under topics for orientation.
(5) Orientation shall be completed before the direct-care staff has independent, unsupervised, interaction with residents.
§ 5320.46. Interdisciplinary treatment team.
(a) The interdisciplinary treatment team shall be comprised of at least three mental health professionals who are appointed by the program director and who are involved in the resident's treatment. At least one member of the treatment team shall be a physician. The other members shall represent different clinical disciplines.
(b) The director of the interdisciplinary treatment team shall be appointed by the program director and be a physician or a licensed psychologist with a clinical background. The program director may serve as one of the three members of the treatment team. The director of the interdisciplinary treatment team shall be responsible for:
(1) Assuring that the resident, and the resident's family if the resident consents, is involved in the treatment planning process. The director shall document efforts to maintain this involvement and the results of these efforts.
(2) Implementing and reviewing the treatment plan and coordinating treatment service delivery with service providers.
(3) Utilizing external specialty consultants when needed.
(4) Assuring that direct-care staff and consulting professionals participate in the development, implementation and review of the treatment plan and that they have credentials in the use of the modalities proposed in the plan.
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