ML20247H117

Intervenor Exhibit I-MAG-90,consisting of 102CMR3.00, Regulations for Licensure or Approval of Group Care Facilities for Children

ML20247H117
Person / Time
Site:	Seabrook
Issue date:	05/17/1989
From:	AFFILIATION NOT ASSIGNED
To:
References
OL-I-MAG-090, OL-I-MAG-90, NUDOCS 8905310160
Download: ML20247H117 (38)

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102 CMR 3.00: REGULATIONS FOR LICENSURE OR APPROVAL OF GROUP CAR 89 ;iAY 23 P 6 :13 FACILITIES FOR CHILDREN Section OU n a uR, DOCKET %

2)s u, 3.01: Introduction MAgg 3.02: General Administrative Procedures 3.03: Administration of the Facility 3.04: Programs and Services 3.05: Care of Children 3.06: Physical Plant and Equipment 3.07: Applicability of the Regulation <

3.01: Introduction 102 CMR 3.00 is adopted in accordance with M.G.L. c. 28A, particularly ss. 9 - 13, which stresses the commitment of state government to assure eveiy child "a fair and full opportunity,to reach his/her full potential." In fulfilling its mandate as the agency responsible for licensing group care facilities, the Office has developed specific standards to be met by a group care facility in order to provide this opportunity to the children it serves.

The nature and scope of these regulations are based on the b:, lief that every aspect of a group care facility's operation affects the children in its care. The facility's philosophy, administrative policies, staff, physical facility and its clinical recreational, and educational services all contribute to a child's everyday living environment, and should maintain a level of quality that promotes healthy development. These licensing regulations identify, to the fullest extent possible, the standards and practices necessary to fulfilling the following general goals:

(a) A group care facility that is administratively and fiscally sound and whose policies and practices are clearly conceived can provide continuity of care for the children it serves.

(b) A group care facility's goal is to provide children with ser ices and an environment which meet the special needs their families are unable to fulfill (c) A group care facility must meet each child's needs relating to health, nutrition, individuality, and interaction with peers and adults, before it can begin to satisfy the child's more complex needs.

(d) While protecting children from fire, health, and accident hazards, a group care facility must also provide an environment that meets each child's need for space, comfort, privacy and com:nunity, 3.02: General Adminjst,r,ative Procedures (1) Definitions. As used in 102 CMR 3.00, the following words shall have the following meanings unless the context otherwise requires:

(a) Abuse. The non-accidental commissen of any act upon e cLild which causes, or creates a rutxtantial risk of, serious physical or serious emotional injury, or constitutes a sexual offena. under tha laws of the Commonwealth.

Ib) Applicant. The individual, designated by the person applying for group care licensure or approval, who is responsible for the adrninistration of such facility and who is designated as tlw chief r. administrative perran and is a duly authorized agent of the person applying for licensure or cpproval.

I (c) Approval. A certification in writiry Ather reguler or provisi)nal, issued by the Office to a departrrem cy, or institution of th6 Commonwealth or any political subdivism tr.

if which authorires it to operate a group care facility.

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(d) Ch.ld. Any person under the age of sixteen.

(e) QL,ldren with special needs. Children who, because of temporary or permanent disabilities arising from intellectual, sensory, emotional, physical 1

or environmental factors or other specific learning disabilities are or would be unable to progress ef fectively in a regular school program.

This may include, but not be limited to, children with special needs as determined by an evaluation conducted pursuant to M.G.L. c. 718, s. 3.

(f) Director. Director of Office for Children.

, (g) Group Care Facility. Any facility which provides care and custody for 8905310160 890517 s one or more children under sixteen years of age, on a regular, twenty-four PDR ADOCK 05000443 4 I

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102 CMR: OFFICE FOR CHILDREN 3.02: continued hour a day, residential basis by anyone other than a relative by blood, marriage, or adoption, notwithstanding the fact that such care may include educational in.>truction; provided, private schools shall be considered group care facilities only if such schools provide special services to children with special needs. Group care facility shall not mean family foster care, a hospital, ward or comprehensive center licensed under the provisions of M.G.L. c.19, s. 29, a hospital, ward or comprehensive center operated by the Commonwealth, or any subdivision thereof, a hospital, institution for unwed mothers, convalescent or nursing home, rest home or infirmary licensed under the provisions of M.G.L. c.111. or any facility licensed under the provisions of M.G.L. c.111. or any facility licensed under the provision of M.G.L. c.111E, s. 7 unless such facility admits children other than drug dependent children or children in need of immediate assistance due to the use.of a dependency related drug, or unless the facility wishes to apply for a license from the Office. Group care facility shall not be limited to a facility defined as 'a group residence in M.G.L. c.143, s.1. Group care facility shall not mean a summer camp.

(h) License. Any certification in writing, whether regular or provisional, issued by the Office to any person other than a department, agency, or institution of the Commonwealth or any political subdivision thereof, which authorizes such person to operate a group care facility, A provisional license is valid for a period not to exceed six months and may be renewed once for no more than six months consecutively. A regular license is valid for a two year period. A probationary license is issued to a facility operating under a consent decree entered into with the Office and is valid for a period not to exceed six '.nonths and may be renewed only once for a period not to exceed six months.

(i) Licensee. Any person holding a license or approvalissued by the Office.

(j) Neglect. The failure, either deliberately or through negligence or inability, to take those actions necessary to provide a child with minimally adequate food, clothing, shelter, education, medical care, supervision, emotional stability and growth, or other essential care.

(k) Office. The Office for Children.

(1) Parent. A lawful fath tr or mother of a person.

(m) person.

Any individual, partnership, corporation, association, j

organization or trust or any public agency.

Q (n) placement agency. A department, agency or institution of the Commonwealth, or any pclitical subdivision thereof, or any organization g

incorporated under chapter one hundred and eighty, one of whose principal

%W purposes is providing custodial care and social services to children, which k

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receives by agreement with a parent or guardian, by contract with a state dh, 3

f\\g agency or as a result of referral by a court of competent jurisdiction, any o

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child under sixteen years of age, for placement in family foster care or a

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group care facility, or for adoption.

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(u) Referral source. A parent, guardian, Massachusetts or out-of-state i

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g, public or private agency responsible for the placement and/or funding of the c

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placement of a child.

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!s (2) Procedure for issuing and Renewing Licenses and Apppvals and Crarting o

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(a) An initial request for a provisional license or approval shall follow the dN d ;(,a process determined by the Office.

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1. An applicant who wishes to establish and maintain a caoup care facility shall file an application M writing with the Office in a manner ah t

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and on a form prescribed by it.

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2. The completed application form shall be signed by the applicant.

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shall submit to the Office an application form together with the written

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3. An applicant filing an application for a provisional license or approval

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d ~d 3 1-hE%a materials required in 102 CMR 3.02(4)(a)1. through 15., inclusive.

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(b) A license or approval renewal application shall be processed in the

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1. Sixty day provide the h,s prior to the expiration of the ti, cense the Office shall censee with a " Request for Renewal form.

9/4/87 102 CMR - 12 w_-

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2. No less than thirty days prior to' the date of expiration 'of the license, the licensee shell file with the Office in hand or by certified mail retum receipt requested a " Request for Renewal" form. For licenses with an expiration.date which has already passed, the licensee shall file a

" Request for Renewal" form within sixty (60) days of the effective date of 102 CMR 3.00. Such request shall be filed with the Office in hand or j

. by certified mail return receipt requested.

3. Failure to submit a " Request for Renewal" form in accordance with 102 CMR 3.02(2)(b) shall void the license.

4. After receipt of the " Request for Renewal," the Office shall provide the Licensee with an application packet to be completed in a manner and on a form (s) prescribed by the Office. The application packet shall be returned to the Office within a time deadline prescribed by the Office which shall be at least thirty days from the date of receipt by the Licensee.

5. The applicant for renewal of a provisional or regular license shall be responsible for completing the renewal appl 3 cation form (s) and for completing materials required.in 102 CMR 3.02(3)(a)1i through 15..

. inclusive, for. provisional license renewals and 102 CMR 3.02(4)(b)1.

through 26. for regular license renewals.

(c) Upon receipt of the written application, the Office shall notify the applicant as to whether or not the application was complete. Such notification shall occur within thirty (30) days of receipt of the application.

No licensing study shall occur until the Office has received a written application from the facility. Upon receipt 'and review of the written application, the Office shall conduct a licensing study which shallinclude, at a minimum, site visit (s); record review, if applicable; staff interviews and review of written application and accompanying documents. The Office

. shall provide technical assistance to the appilcant related to licensing standards. Within sixty (60) days of completion of the licensing study the Ofhce shallissue a written report of the study, including violations of these regulations, if any. This report will be sent to the Chairperson of the Board of Directors and the chief administrative officer (applicant). Subsequent to the correction of all violations, the Office shall issue or renew a license or approval.

(d) Unless earlier revoked, suspended or made probationary, a regular license or approval shall remain in effect for two years from the date of issuance and a provisional license or approval shall remain in effect for six months from the date of issuance. A regular or provisional license or

' approval shall remain in effect beyond the term of the license until the next licensing study is completed and ~a determins90n made by the Office on the status of the license, if the licensee has filu with the Office a " Request for Renewal" form in acco dance with 102 CMR 3.02(2)(b)2. and in accordance with M.G.L. c. 30A, s.13.

(e) The Office in its discretion may upon written request grant a variance of any regulation contained. in 102 CMR 3.03 through 3.06, with the exception of provisional requirements.

1. Any applicant wishing to request a vanance shallsubmit a request for such in a manner and on a form prescribed by the Office. The variance l

I request shall be accompanied by expert opinion, if applicable, written documents, and any c'her pertinent infor. nation the applicant wishes the r

Office to concider in reviewing the request. Any variance request must

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provide clear evidence to the satisfaction of the Office that the j

applicant's pmcedure complies with the intent of the spedfic regulation and the intent of the regulations taken as a whole as cet forth in 102 CMR 3.01.

2. The Office shall act upon a request for variance within thirty (30) days of receipt of the request or within sixty (60) days of completion of the licensing study and shall notify the applicant or licenseo of its decision. In its written notification, the Office shallstate the reason for refusing or granting a variance request. A grant or denial of a variance

'i request shall be considered a final agency decision.

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3.02: continued

3. A variance shall remain in effect for the duration of the license unless the Office receives or finds evidence that the terms of the variance have been violated or the intent of 102 CMR 3.00 has not been met.

(3) Provisional Licenses.

fa) If the applicant seeks to operate a facility which the applicant has not previously operated, the applicant may apply for a provisional license, following the procedures cited in 102 CMR 3.02(2). The Office must determine that the care to be given in the facility will protect the health and safety of the children. The applicant shall have a background which in j

the judgement of the Office is free of conduct which bears adversely on the applicant's ability to provide or the safety and well being of children. Such r

application must be accompanied by the following documents.

1. A statement of the ownership of the facility, including the names and addresses of all owners, or, in the case of corporations, the officers as required by 102 CMR 3.03(2)(a).

2. A statement of purpose as required by 102 CMR 3.03(1).

3. A projected one year operating budget, and documentation of sufficient funds for at least three (3) months. For an operating agency, a current financial report, appropste fiscal portions of contracts if any, and a statement of the current rate of payment, as set by the Rate Setting Commission, if applicable.

4. A description of the intended staffing of the facility on a twenty-four (24) hour per day, seven day per week basis including availability of emergency on-call staff.

5. A plan for staff orientation as required by 102 CMR 3.03(4)(i) and a plan for staff training as required by 102 CMR 3.03(4)(l).

6. personnel policies, as required by 102 CMR 3.03(4)(b)1. through 3.,

inclusive.

7. A plan for meeting the emergency medical needs of children and evidence of access to emergency mental health services for children, as required by 102 CMR 3.04(6)(b) and 3.04(7)(a).

8. Evidence of access to schools for the provision of any necessary educational services.

9. A written report form from the appropriate health inspector documenting that the facility is in compliance with Chapter 11 of the State Sanitary Code as required by 102 CMR 3.06(1)(d).

10. A valid Certificate of Inspection by the Department of Public Safety or the local balding inspector, as required by 102 CMR 3.06(1)(a) through (c), inclusive. In the case of an apartment program a Certificate of Use and Occupancy is acceptable.

11. Documentation that the facility has had a fire inspection from the local fire department, as required by 102 CMR 3.06(1)(e).

12. Evidence of ability to comply with 102 CMR 3.04(1)(g), lachiding a copy of the advanced dagree persc.n's resume,

13. A written plan detailing procedures for meeting potential emergencies as required by 102 CMR 3.00(2)(a),

14. Evidence of compliance with chapter 233 of the Acts of 1983 Revenus Enforcement and Protection Program (REAP) on a form provided by the Office with the initial application.

15. The applicant's completec CORI affidavit.

(b) Upon receipt and review of the written sun.maty of findings, the applicant shali sign and retum to the Office an agreement to work toward svhstantial compliance with all reo,mrements of 102 CMR 3.00.

(c) A provisional license is valid for a period not to exceed six months and may be renewed once for no more than six additional months. Following a period of regular licensure, a provis!onal license may be issued as the restdt

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of a renewal study.

(4) Restular License.

(a) A person seeking to apply for or to renew a regular license, following the procedures outlined in 102 CMR 3.02(2), shall submit an application for 9/4/87 102 CMR - 14

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102 CMR: OFFICE FOR CHILDREN I

3.02: continued licensure. The applicant shall have a background which in the judgment of the Office is free of conduct which bears adversely on the applicant's ability to provide for the safety and well being of children.

(b) The applicant shallinclude the following written documents:

1. All documents required for provisional license,102 CMR 3.02(3)1.

through 15., inclusive.

2. Organizational table, as required by 102 CMR 3.03(2)(c).

3. Job descriptions, as required by 102 CMR 3.03(4)(d).

4. Salary ranges, as required by 102 CMR 3.03(4)(e).

S. Plan for staff orientatlun, as required by 102 CMR 3.03(4)(1).

6. Plan for staff training, as required by 102 CMR 3.03(4)(j).

. Rate, administrative adjustment applications, audited financial report, Rate Setting Commission Cost Report forms schedules 1, 2 and 3 as required by 102 CMR 3.03(5). If needed, current contracts will be made available for review at the program.

8. Plan for family services, as required by 102 CMR 3.04(4).

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9. Plan for follow-up services, as required by 102 CMR 3.04(5).

10. Plan for social, psychological and psychiatric services, as required by 102 CMR 3.04(6).

11. Plan for medical services, as required by 102 CMR 3.04(7).

12. Plan for administration of medication, as required by 102 CMR 3.04(7)(h).

13. Plan for educational services, as required by 102 CMR 3.04(8).

14. Plan for vocational services, as required by 102 CMR 3.04(9).

l'i. Plan for recreational services, as required by 102 CMR 3.04(10).

16. Description of staffing, as required by 102 CMR 3.05(1).

17. Plan for nutritional services, as required by 102 CMR 3.05(5).

18. Description of rules for behavior management, as required by 102 CMR 3.05(6)(a).

19. Allowance policy, as required by 102 CMR 3.05(7)(b).

20. Visiting, mail and telephone policies, as required by 102 CMR 3.05(8)(a) and including procedures required by 102 CMR 3.C3(8)(f)1. and 2.

21. Runaway procedures, as required by 102 CMR 3.05(9).

22. Plan for using volunteers, as required by 102 CMR 3.03(4)(k).

23. Plan for transportation, as required by 102 CMR 3.05(11), including documentation of insurance coverage, as required by 102 CMR 3.05(11)(d).

24. Written documentation of lead-free paint inspection if applicable, on the approved form as required by 102 CMR 3.06(4)(b).

25. Written plan for monito.ing student safety around swimming areas, if applicable, as required by 102 CMR 3.06(5)(a)7.

26. Written policy and procedure for internal investigation of child abuse and naglect es required by 102 CMR 3.03(3)(d).

V! sits 1,y the Of!1ce. b accordrnco with M.G.I., c. 20A, s 10(d), any (5) Toyee of the' Office authorized by the Directar may, at any reasonable time, emp vurit erni inspect any facilliy operated by a person who is subject to licen=um or t.pproval by the Office, in order to determine whether such facility is being operated in compliance with law and with the regulations established by the Office. Thu visit may !nclude, but not be limited to, a tour of the facility, staff and child interviews and record review.

(6) Qpm_rjamt irr4estitatiqrts. An er..plc>ee of the Off4 e. at.thorize1 by the Director rosy ristt 4nd irnoect any fecility upon receipt of s complaint aad i

allegatior s regarding compliance with ti,ese repdations. Such vir.its wi.'l be l

conducted at any reasonable time in order to determine whether any cht!d is in

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ieonardy and/or whether such facility is being operated in accordance with l

102 CMR 3.00 (et s g.).

A person duly authorized by the Director may be e y accompanied by an employee of any department, agency or institution of the Commonwealth during the Office's investigation process if the Office and said department, agency or institution of the Commonwealth have agreed to conduct a joint investigation.

9/4/87 102 CMR - 15 n_ ___ _

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e 102 CMR: OFFICE FOR CHILDREN 3.02: continued (7) Enforcement procedures. Whenever a duly authorized employee of the Office finds upon inspection or through information in its possession that a facility licensed or subject to licensure pursuant to 102 CMR 3.00 is not in compliance with these regulations the Office may take any of the following actions:

(a) Inform the licensee in writing c' '

observations made, the method for compliance, the time frame for con nce and the regulation (s) that is in violation.

(b) Require the person to correct any violations as specified in the correction order. The correction order shall include a statement of observations; the regulations which are determined to be in violation; the method of compliance with the regulations; and the time period prescribed far correction, which shall be reasonable, depending on the nature of violations cited and the time required for corrections, and shall not exceed sixty (60) days.

1. Within seven days of receipt of a correction order, the licensee may file with the Director a written. request for administrative i

reconsideration. The request shall clearly state the reason why the i

correction order should be rescinded, or modified and the approximate time for the licensee to take corrective measures if any. A request for administrative reconsideration, shall not alter the time required for compliance with the correction order.

2. Within seven (7) working days gfter receipt of request for reconsideration, the Director shall grant, deny or otherwise act on such request.

3. Upon the expiration of the time frame (s) prescribed in a correction order, a duly authorized employee of the Office will reinspect the group care facility and/or the documents required by the correction order to determine compliance with the correction order and these regulations.

If upon reinspection, a determination of non-compliance with the correction order is made, the Office may issue a second correction order or a notice of action, in accordance with M.G.L. c. 28A. s.16, 4

(c) Issue a notice of action based on evidence of substantial non-compliance with applicable regulations. The notice of action shall be issued in accordance with 102 CMR 3 02(7) and (8).

(8) Probation Suspension. Revocation. and Refusal to issue or Renew Licenses and Approvals. Subject to the rec,uirements of M.G.L. c. 30A, the Office mey make probationary, revoke, suspend, refuse to issue or refuse to renew a license or approvalif it finds any of the following:

(a) The applicant or licensee failed to comply with any applicable regulation or any entrection order or terms of probation.

(b) Ths opticant or liceitsee furnished or made any misleadin or false statemet..e or report required under 102 CMR 3.00.

(c) The applicant or licensee refused to submit any report or make available any records tequired under 102 CMR 3.00.

i (d! The applicant er licensee retused to admit at a reasonable time any employee of the Office authorized by the Director, for purposes of investigation or inspection in accordance with 102 CMR 3.02.

(9) flearing.

(a) An applicant to whom the Office has refused to issue an approval or a l

licen:;e may request a hearing by filing a notice of claim for a hearing and l

answer within twenty-one (21) days of the receipt of notice of ection from J

the Office.

l (b) A licensee whose approval or license the Office proposes to maice l

probationary, revoke, suspend or refuse to renew, may request a hearing by I

filing a notice of claim for a hearing and answer within twenty-one (21) days of rece2pt of t!'e Office's notice.

I (c) Prior to or during the hearing, the Office and the licensee or applicant I

may agree to enter into a consent decree. The consent decree may mclude j

but not be limited to a specific plan and time schedule for the lic-r:,ee or i

applicant to reach compliance with the regulations and provisloc-r.rding breach of the consent decree. A facility operating under a cons. decree i

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e 102 CMR: OFFICE FOR CHILDREN 3.02 continued may be issued a probationary license. A consent decree shall be posted in the facility next to the license.

(d) The hearing officer shall issue a recommended decision. Final agency decisions shall be issued by the Director or his/her designee. Unless otherwise provided in 102 CMR 3.00, hearings shall be in accordance with the provisions of 801 CMR 1.01 and 1.03. Failure to request a hearing and file timely answers may be deemed a waiver of such right and a final agency decision may enter without further notice.

(10) Suwension in Emergencies.

(a) The Office may suspend or refuse to issue any license or approval without a hearing if failure of the licensee to comply with any applicable regulation results in an emergency situation which endangers the life, health, or safety of children or staff residing in a group care facility.

Children may not continue to reside in the facility following an emergency suspension. The licensee shall be notified of any such suspension of a license or approval by a written notice, hand delivered or mailed to the licensee via first class certifiedc return receipt requested. If a written request for a hearing is delivered in hand or mailed to the Office within five (5) business days of the suspension of any license, a hearing shall be held within ten (10) business days of the delivery of such request. The suspension shall remain in effect pending such a hearing.

(b) The sole issue at this hearing shall be whether there is reasonable cause to believe that an emergency situation exists.

(11) Return of 1.icense. In the event of revocation or suspension, the licensee shall promptly return t'he license or approval to the Office.

(12) Notification of Notice of Action. The Office shall notify in a timely j

manner all appropriate referral sources and the Department of Education when applicable of a notice of action. Such notice shall include a request for the I

referral source to find alternative placemer. s for the children, if the suspended license is restored, the referral sources shall be similarly notified of these events.

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(13) Posting of License or Approval. Every licensee shall post in a prominent place any current license or approvalissued to the agency by the Office.

(14) License or Approyal Required. No person shall operate or purport to l

operate a facility unless said person holds and acts consistently with the terms i

and conditions of a currently valid license issued by the Office.

(15) Information Required by the Office.

(a) Notwithstanding 102 CMR 3.03(6)id), upon request of the Office, each j

facility shall make available to the Office ary lufotmetion required to be j

key and rnalntained under thne regulations and any otaer information resonaMy related to :.he evaluation of the facility.

(b) pnor to any substantin! changes in the program or physical plant, the licensee shall give written notification of intent to change to the Office.

Notice shallbe given so as to allow the Office sufficient time to determine whether any enange in licensing status is necessary. Substantial changes include any reductions of services or staff, building changes thr.t effect he care of children, major changes in the population to be served, change ;n quota and/or significant revision of the policies and procedures required by 102 CMR 3.00.

(16) Change of Nams Ownership or Location.

(a) A license or approval shall not be transferrable from ona bcensee to another, or from one location to another.

(b) The licensee shall provide prior notification in writing to the Office of any change in ownership of the facility.

(c) The licensee shall provide notification in writing to the Office upon any change in the chief administrative person of the facility or any change in the person who functions as the program's advanced degree person as 9/4/87 102 CMR - 17 i

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A 102 CMR: OFFICE FOR CHILDREN 3.02: continued required by 102 CMR 3.04(1)(g). Such notification shall occur within two weeks af ter such a change occurs.

(d) Any change in location shall necessitate a new application and may require a licensing re-study end subsequent issuance of an amended or new license, after receipt of all necessary information and documentation of compliance with all applicable regulations.

(17) Licenses issued Under Previous Regulations. Any license or approval in effect immediately prior to the effective date of 102 CMR 3.00 shall, notwithstanding its expiration date, remain in effect, unless suspended or revoked, until a new license or approval is issued or expressly refused or revoked under 102 CMR 3.00.

3.03: Administration of the Facility (1) Statement of Purpose. Each licensee 'shall keep and maintain a written statement of purpose identifying the program s philosophy, goals and objectives and the characteristics of the children served, intake procedures and serviul The statement shall make clear which services are provided directly by the facility and which will be provided in cooperation with community resovrces. If the licensee administers several programs at different sites, appropriate resources shall be identified for each site. The statement shall be kept current and shall be available.

(a) The licensee shall identify goals and objectives of the facilik and shall include generally and specifically, both short term and long term aims; provided, however, that the primary purpose of each group care facility shall be to foster the optimal growth and individual development of the children in its care. Each facility shall wherever possible work towards reintegration of the children into the families or communities from which they came or into new families or communities when required.

(b) The licensee shall identify the characteristics of children to be served, as reflected in the faciuty's eligibility criteria, and shall include identification where applicable, by:

1. age range;

2. sex;

3. residency;

4. intellectual ability or grade level;

5. physical development or health:

6. social behavior and clinical profile;

7. custody or guardianship status:

8. family involvement.

(c) The licensee shall provide evidence thu it has completed its own annual written evaluatien of its overall prograrn which shall include general facility effectiveness in relation to stated goals and delivery of services.

(2) M Each Uceases shall have aucumentary evidenco of its sources of OrjanizatioJ1

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authority t, operate the fac!Dty.

1. A faculty operateri by the Commonwealth or any pelitical subdivision thereo! shall keep and maintain documents that identify the statutory basis of its existence, and the administrative framework of the govemmental departments in which it operates.

2. A private facility shall keep and maintain documents that completely idertify its ownership. Corporations, partnerships, or associations or sole p:nprietsships shall identify their current officers and board members, if any, Where applicable, documents shall include but not be

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limited to copies of all papers filed with the Secretary of State of the

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Comrronwealth and/or any political subdivision of the Commonwealth.

(b) Each Ucensee shall designate one person who is responsible for administrative supervision and is duly authorized to act as an agent for the licensee and to oversee the operation of the facility.

(c) Each licenses shall keep and maintain an organizational table showing l

the administrative structure of the facility, including the lines of authority, l

responsibility, and staff assignment. Each licensee shall familiarize children L

with the organization of the facility whenever that may be appropriate.

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102 CMR: OFFICE FOR CHILDREN 3.03: continued (d) Each group care facility shall have an advisory board of at least 4 persons. Such board shall include at least three (3) penons who are not in the employ or family members of the licensee; and who are familiar with children's needs, group care facilities and the altematives to group care. If the facility's board of directors meets the requirements of this regulatiun then the board may function as the facility's advisory board.

1. The advisory board shall make recommer.dations on the facility's policy regarding program structure, program evaluation, personnel and human rights, focusing on the quality of resident life. The program shall document the reason for any differences between these recommendations and program activities.

2. The advisory board shall meet at least annually or more often if necessary to meet the above purpose.

3. Copies of the minutes of the advisory board meeting (s) shall be kept and maintained.

(3) Administration.

(a) The chief administrative person or designee shall be on the premises of the group care facility at all times while it is in operation. All employees on duty shall know who is responsible for administrative supervision of the facility at any given time, i

(b) Each licensee shall establish a system of business management and staffing to assure that the facility maintains complete and accurate accounts, books and records, including required financial, personnel and children's records.

(c) Separate financial accounts shall be established for funds belonging to children and complete and accurate records shall be kept of all transactions regarding these funds.

1. These funds shall be used solely for the benefit of the child to whom the funds belong. The child, parent, representative, payee, etc., shall be provided an accounting of all expenditures from her/his own funds upon request.

2. These funds shall accompany a child when he/she is discharged or transferred to another facility.

(d) The licensee shall develop and follow procedures for conducting intemal investigations within the facility. Such procedures are to be used for any suspected incidents of child abuse and neglect including but not limited to the incidents within the facility reported to the Department of Social Services pursuant to M.G.L c.119, s. 51A and shall be implemented upon request of the Office for any serious incident involving the health or safety i

of children within the facility, The procedures shallinclude:

1. time lines for conducting and completing the investigations.

2. the written format for the investigation report.

j

3. provisions for reporting suspected child abuse and neglect to the chief 1

administrative person and to the Department of Social Services in accordance with M.C.L c.119, s. 51A, and following the procedure d

required by 102 CMR 3.03(3)(f) regarding reporting to the Office j

4. the process for designating pe:snns responsibts forimplementing cach j

step of these procedures including conducting the investigations.

q

5. a description of the process for reviewing the imestigation report and i

for taking corrective action if necensery.

(e) The licensee shall have a written plar. for utaff to file a report of abuse or neglect Cth the Departmertt of Social Services, pursuant to M.C.L c.110,s.51A i

(f) The licensee shall have a written plan whereby the licensee's chief administrative person or his or her designee shell notify the Office as well as any other state agency or eeferra) source which requires sue.h notifiestion i

immediately after teaming that a 51A report has been filed alleging abuse j

or neglect of a child at the facility or during a program activity.

(g) The licensee shall implement a proctdure for documenting unusual and/or serious incidents such as behavioral incidents, runaways, serious injuries or accidents, property destruction, medical and other emergencies.

The procedure for documenting these incidents shall include a review of the report by the chief administrative person or his/her designee.

9/4/87 102 CMR - 19 j

h

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4 i,.t..

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t 102 CMR: ~ OFFICE FOR CillLDREN.

i;,

3.03: ~ continued

. (h) Within ten days of receipt of notice of the initiation nf civil, crimn,al.

or administrative action against the licensee or any person employed by the licensee regarding the licensee's care of children in its facility or which

' could affect the continued operation of the facility, the licensee shalinotify' the Office in writing.

(i) The licensee. shall have a. written procedure reqarding the receipt of, s

consideration of, and decision on complaints and grievances from staff, parents and children regarding care of children. The procedure must include.

a mechanism to inform the complainant of the results of the decision.-

1, The licensee shall distribute this written grievance procedure to children and parents prior to admission' and' to staff during initial orientation period.

+

2. The license ~ uall maintain written records of all decisions resulting from the griev : e procedure,

- (J) The licensee

'l provide a ' telephone number and a system' of emergency assistan.. to children and their parents while children are away from the facility. Th.; system shall be in place on a 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> per day seven day per week basis (4) Personnel Each person employed by the

.(a) Employment Background Information.

licensee,' who has unmonitored contact with children, shall have a

' background free of conduct which, in the judgment of. the licensee,: bears adversely upon his or her ability to provide for the safety and well-being of a child (ren). = The licensee shall determine whether an employee's or potential employee's conduct, criminal or otherwise, shall disqualify the.

person from employment in the program. in making this determination the licensee shall consider at least the following conduct:

1.

Engaging in.' or having engaged in conduct which results in his/her child being adjudicated to be in need of care and protection.

2.. Use of alcohol or drugs to-an extent or in a manner that is t,

determined by the licenses to impair his/her ability to care for children

~

properly.

3.

Having engaged in conduct which results in.a criminal conviction included in a relevant CORI (Criminal Offender Record Information) report. Engaging in, or having engaged in, any other conduct, criminal or otherwise, determined by the licensee, to impair the employee's ability to care for children.

a.

A relevant CORI will consist of those convictions which the Office for Children determines may affect the individual's ability to have contact with children in a licensed faciltiy or agency.

(i) A relevant CORI report may consist of convictions for any offense involving saxual or physical abuse, any offense involving children, and certain violent or drug related crimes.

'(ii) ne Ecensee shall request a relevant CORI report for only thoso etapkyees who still have unmonitored contact with a chdd(ren). Unmonitored contact shall be defined as being alone with one or more childrer, for longer than five minutea tri a licensed ptogram with no other Maff member or volunteer in the immediate area within sight or within hearing distance; or removal of a child (ren) from the licensed premises by an individual without the presence of anothen staff mamber or volunteer in the immediate area.

1 t

4.

Procedures to obtain and review relevant CORI repott:

a.

The licenace shall obtain f:om those employees identified in 1

102 CMR 3.03(4)(a)3a(li) a corr.pleted CORI affidavit.

j b.

Each licensee shall submit to the Office the names of employees in 102.CMR 3.03(4)(a)4a with their completed affidavits, c.

The Office shall provide the relevant CORI Report to the employee and shall notify the licenses that such report exists. Within five (5) business days of receipt of notification, the employee and the licensee must review the report in order for the licensee to determine whether the conviction (s) disqualifies the employee from 9/4/87 102 CMR - 20 l

'.h '

102 CMR: OFFICE FOR CHILDREN i

w 3.03: continued having unmonitored contact with children. After the review of the report, the licensee shall return to the Office both its notification and the e.nployee's report.

d. If the employee does not' provide his/her CORI report to the licensee, the licensee must return its notification to Office for Children within fiv e (5) working days af ter receipt.

e Each licensee shall ensure that employees shall not have unmonitored contact with a child (ren) until the licensee determines that the requirements of 102 CMR 3.03(4)(a) are met.

(b) Each licensee shall describe in writing the facility's current personnel

.1 policies and practices and shall make them available to all employees. Such i

personnel policies shall include a description of:

1

1. Criteria and procedures for hiring, assignment, promotion, probation, and suspension or flismissal of an employee;

2. The procedure for handling staff complaints;

3. provisions for vacations, holidays, and leaves.

(c). A copy of the personnel policies shall be given to each new employee or they shall be informed tf at a copy is available upon their request.

(d) The licensee shall make available written job descriptions for all positions, including consultants, part-time employees, interns, volunteers and per diem workers.

j (e). The licensee shall establish and describe in writing a salary range

~

including benefits covering all positions and shall provide each employee with information regarding the salary range for his/her position or the psucedure for determining his/her salary.

(f) The licensee shall obtain evidence that personnel are currently certified, licensed, or registered where applicable laws require certification, -

i

' licensure, or registration.

(g) The licensee shall maintain a personnel record for each employee which.

. shall include but not be limited to:

1. employee's resume or job application.

- 2. copies of licenses or certification held.

3. documentation ' of employment - history and reference checks by telephone.

-4. documentation of a completed CORI evaluation as required by 102 CMR 3.03(4)(a)4 a-d.

5. annual evaluations as required by 102 CMR 3.03(4)(h) and 3.04(2)(bla.

through 3. inclusive if applicable.

6. documentation of any disciplinary actions or investigations.

(h) The licensee shall conduct at least an annual evaluation of the performance of all personnel Such written evaluations shall be kept and maintained in the staff's personnel record.

(i) The licensee stall provide orientation for all new employees to acquaint them with the facility's philosophy, organization, program, practices and goels. Each licensee shall desctibe 'in writing the facility's plan for staff orientation which shall include at a mirdmum b.st not be limited to the facility's ' policies on emergency and' evacuation procedens, behavior -

management policies, treatment. philosopny, rnedication policies and first aid trendrg.

1. No new employee shall be solely responsible for children in care until he/she has received the minimum orientation described above.

(j) The licensee chall provide on-going staff training pxr, rams appropriate to the size and nature of the f'icility and staff invcived. Each licensee shall describe in writing the facility's plan for siaff training.

1. Full-time child care, professional and super" iso y staff shall be required to attend a minimum of 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> of training per calender year.

2. Part-time and weeker.d staff shall be required to attend a minimum of 12 hours1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br /> af training per calendar year.

(k) If voluntee s are used. the licensee shall describe in writing its plan for using volunteer services. Volunteers shall be chosen for their ability to meet the needs of the children. Each volunteer who has unmonitored contact with children must have a background which is free of conduct which, in the judgment of the licensee, bears adversely upon his or her ability to provide for the safety and well being of children. The licensee 9/4/87 102 CMR - 21

4 102 CMR: OFFICE FOR CHILDREN 3.03: continued i

shall have evidence of each volunteer's compliance with 102 CMR l

3.03(4)(a), at least one reference check shall be conducted on each volunteer.

1. Volunteers shall possess qualifications in accordance with the services they provide.

2. The lic see shall utilize volunteers only in conjunction with appropriate ongoing scheduled supervision and training.

(5) Financy. The applicant or licensee shall demonstrate financial capability to carry out its program for the licensing period; facilities which have not previously operated shall demonstrate such capacity for at least a three month l

period.

(a) The licensee shall keep and maintain an accurate record of receipts and expenditures which shall be audited annually.

(b) The licensee shall keep on file an annual budget for the operation of the facility.

(c) An applicant for a regular two year license shall, if subject to the rules of the Massachusetts Rate Setting Commission, submit copies of its rate, current cost report forms schedules 1. 2, 3 for the licensed progiam and administrative adjustment application, if any, upon request of the Office.

(6) Records and Confidentiality.

(a) The licensee shall maintain a written record for each child which includes:

1. A face sheet which identifies the child by the following information, where available:

a. the name, date of admission, date of birth, place of birth, citizenship, and primary language of the child, if other than English;

b. father's name, mother's name and parent's marital status;

c. name and address of parents, legal guardian, or closest relative available in case of emergency, and telephone number;

d. sex, race, height, weight, color of hair, color of eyes, and identifying marks; e medical condition significant to the child's well being, including allergies;

f. description of the child's ability for self-preservation;

g. referring agency, narr.e of social worker and telephone number;

h. custody, guardianship and/or commitment status;

i. date of discharge and child's location after discharge;

j. Individual responsible for follow-up contact with the child.

' 2. Copy of complete evaluations as required by 102 CMR 3.04(1)(b)1.&2.

3. Written assessment of needs and the individual service plan as required by 102 CMR 3.04(1)(g).

4. Written reports of periodic reviews as required by 102 CMR 3.04(1)(h).

5. Written report of the discharge conference and summary as required by 102 CMR 3.04(1)(i).

6. Written summary of any follow-up services provided, as required by 102 CMR 3.04(5).

7. Heslth records may be in:luded in the case record or maintained at a designated health location, such as a curse's office, provided that cocedination of records occurs. Herith records indicating child's health while t. resident shallinc?ude:

a. documentation of physical examininations as required by 102 CMR 3.04(7)(c) through (g), inclusive;

b. a record of prescribed medications administered to the child.

8. All necessary authorizations and consents, including the placement agreement required by 102 CMR 3.04(1)(f), all consents required for the medical care of the child and Interstate Compact Documents, where applicable.

9. Copies or originals of all correspondence relating to the placement, treatment, progress and discharge of the child.

10. Copies of allincident reports as required by these regulations.

(b) The licensee shall maintain records which shall be legible, dated and signed by the individual making the entry. The licensee shall continually update allinformation in the child's record.

9/4/87 102 CMR - 22

1 I

102 CMR: OFFICE FOR CHILDREN 3.03: continued (c) The maintenance, retention, dissemination, duplication, storage and periodic destruction of children's records shall accord with the following:

1. If a licensed group care facility is subject to approval by the Massachusetts Department of Education, the licensee shall maintain, retain, disseminate, duplicate, store and destroy all children's records in a manner which complies.with the Massachusetts Student Records Regulations (MSRR),102 CMR 3.03(6)(c)2. notwithstanding.

2. If a licensed group care facility is not subject to MSRR, the Licensee shall maintain its children's records in the following manner:

a. Information contained in a child's record is privileged and confidential.

b. Such information may be distributed or released as necessary to persons directly related to implementing the child's service plan without written consents.

c. Such information may not be distributed or released to persons not directly related to implementing the child's service plan unless appropriate consents are obtained.

(d) Children's records shall be the property of the licensee who shall have written procedures which provide for:

1. accer. sing a child's records by a child (taking into account the child's capacity to understand), parent (s), person other than the parent or a person not directly related to the service plan.

2. identifying person (s), if any, whose consent (s) is required before information in a child's records may be released.

3. duplicating and costs for duplicating, if any.

4. releasing information contained in a child's record.

5. making available summaries of progress reports in lieu of the entire case records.

{

6. securing the information contained in a child's record against loss.

defacement, tampering or unauthorized use.

7. storing and preserving a child's record for a period of at least seven years.

(e) If a group care facility intends to cease operation, it shall submit to the Office a written plan for the storage and preservation of children's records at least 120 days before ceasing operation.

(f) Each licensee shall maintain a log or record system to assure communication among staff and continuity of service. The log shall be in writing and kept on a daily basis unless the size or staffing pattem require another frequency.

3.04: Programs and Services j

(1) Planning for Admissions through Discharge.

(a) Eligibidtv for Admission.

1. Eacilicensee shall establish written eligibility criteria for admission, 3

as required in 102 CMR 3.03(1)(b) and shall make such criteria available upon request.

2. The facility shall only admit a child whose needs it believes can be 1

met by the program.

l

3. The facility shall admit children only upon the written consent of the l

parent having custody of the child, a legd guardian, upon court order, or i

upon written agreement with a placement agency.

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9/4/87 102 CMR - 22.2

.s 102 CMR: OFFICE FOR CHILDREN f

i 3.04: continued '

4. The licensee shall not permit more than the licensed maximum number of children as specified on the license to reside in a facility at any one time.

l-(b) Procedures for Admission. The licensee shall conduct a pre-admission review of the child's ref erral to assure compliance with the following:

1. Whenever possible, the licensee shall not admit a child to a facility without evidence in the child's referral that group care facility placement is the most appropriate plan for the child. The licensee shall seek information from the referral source which includes evidence of attempts to provide preventive services and an examination of possible -

attematives to group care placement. or a statement by the referring agency as to why group care placement is warranted without such

. attempts being made.

2. The licensee shall admit only those children who have had an evaluation by qualified professionals covering physical, emotional, social and intellectual factors relevant to the child's situation.

(c) Information for parents. Prior to admission of a child, the licensee shall provide the following wntten materials to the child's parents or to a person other than a parent who has custody of the child. Items 3-8 below shall be provided to the child, consistent with the child's capacity to understand.

1. Statement of purpose.102 CMR 3.03(1)(a).

2. Eligibility critena,102 CMR 3.03((1)(b).

3. Description of program of unusual or extraordinary treatment, if applicable.102 CMR 3.04(14).

4. Emergency assistance system.102 CMR 3.03(3)(e).

5. Agency grievance procedure.102 CMR 3.03(3)(f).

6.' Name of child's case manager.102 CMR 3.04(3).

7. Rules for behavior management.102 CMR 3.05(6)(a).

8. Visiting, mail and telephone policies.102 CMR 3.05(8).

(d) Placement Preparations.

1. Prior to admission, the licensee shall provide the child and his/her parents or guardian an opportunity to visit the facility and the living unit in which the child is likely to be placed.

2. The licensee shall establish procedures to prepare the staff and children in the living unit for the new child's arrival and shall provide staff with appropriate information to receive the new child and assist in the child's adjustment. This information shall include at a minimum, reason for placement, medical condition and behavior problems and specific instructions related to the individual needs of the child.

3. Upon admission, the licensee shall designate and prepare sleeping quarters for the child and space for the admitted child's personal belongings.

4. The licensee shall assign at least one adult to help orient a newl' admitted child to the facility and to the services an't p;ograms available to the child.

5. The licensee shall assign at least one adult to help orient the, child's family members to the facility, consistent with 107 CMR 3.04(1)(c).

(e) Emergency Admissions. For emergency admtssions or admissions for purposes of evaluation, the hcensen shall make appropriate ar/ adequate provisions to meet the requirements of 3.04(1)(b)1. ud 2. as soon as possible after admission, provided that the licensee shall initiate admissions evaluation within one (1) week af ter admission.

(f) Anreement with placement Agency and Purchaser of Service. The licensee shall include in the child's record a wntten agreement with the placement agency referring the child, the purchaser of services and the parent or guardian regarding the following responsibilities:

1. The terms and methods for paying the child's board as well as other specific items such as personal articles or medically recommended devices outlined in 102 CMR 3.04(7)(g);

2. Pmvision of direct services including social, medical, psychological and psychiatric and/or individual counseling to the child and his/her family;

3. Arrangements for the child's special training or education; 12/31/86 102 CMR - 23

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i 102 CMR: OFFICE FOR CHILDREN 3.04: continued I

4. Arrangements for contacts between the facility and other persons and between the child and other persons:

5. Arrangements for family visits and other contacts between the child and friends, including specific information on any restrictions:

6. Responsibility for seeking judicial approval if required for adminstration of antipsychotics medication as required by 102 CMR 3.04(7)(h)3.e.:

7. Responsibility for counseling the child's family;

8. Responsibility for transportation of the child:

9. Responsibility for after-care services:

10. Circumstances under which child may be discharged.

(g) Individual Service Plan for Services and Treatment. Within six weeks of admission, the licensee shall assess the needs of the child and prepare an individual goal oriented service plan for services and treatment for the child. If a child has an Individual Education Plan (IEp) developed as a result of a Chapter 766 Team Evaluation, the IEP may be used to meet the requirements of part, but not necessarily all of the child's service plan.

1. The individual service plan shall be developed by a team which includes those personnel of the facility responsible for implementing the service plan on a daily basis. At least one member of the team shall have an advanced degree from an accredited school in social work, psychology, or psychiatry or be. a certified Massachusetts school psychologist and experienced in providing direct treatment services to children. 'Ihe team shall include at least one child care worker who will be implementing the plan with the child, the child's case mana person who har knowledge of the child's educational program. ger and a The team shall request a representative from the referral source to participate in the development of the service plan and document notification of such meetings. Consistent with any court order and requirements of the referral source,' parents shall be invited to attend service planning meet.ngs. If parents are not invited, the reasons shall be documented.

2. The team shall assess the needs of the child in the areas of education:

health, including medical, dental and ancillary services; social services.

l including family work: psychological and psychiatric services, including individual and group counseling; and behavior management, recreation, life skills and vocational training.

3. The team shall consult with the child in developing the child's service plan, consistent with the child's capacity to understand.

4. The team shall insure that the written service plan includes the following components:

a. findings of the assessment

b. statement of goals for the child and family. Coals shall be stated for each assessment area, except those areas specifically addressed in the !EP. If no goals are stated for an assessment area, the reasons shall be documented in the service plan:

c. strategies for fostering positive family relationships or for developing a permanent home for the child, including a planned schedule for frequency of family visits or family resource visits; I

i

d. identification of all services to be provided by staff, consultants and outside resources, to meet the stated goals and the schedule of those services;

e. identification of the persons providing the individual services.

5. The licensee shall explain a child's individual service plan to all child care personnel responsible for implementing the service plan on a daily basis, and as appropriate to the child's family or guardian. A copy of the Individual service plan shall be forwarded to the referral source.

f..

6. The licensee shall explain the individual service plan to the child in a manner consistent with the child's maturity and capacity to understand.

(h) Periodic Review. As necessary, but no later than every six months, the I

licensee shall review the progress, needs and service plan for each child.

1. The periodic review shall be conducted by a team which includes team members as required by 102 CMR 3.04(1)(g)1.

2. The team shall evaluate the child's progress and shall reassess the child's needs in the areas required in 102 CMR 3.04(1)(g)2.

1

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12/31/86 102 CMR - 24

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'102 CMR: OFFICE FOR CHILDREN h

3.04:. continueo -

3.

The team shall review the service plan for services and treatment i-and shall revise the service plan to meet the needs of the child. The l'

'i=

l.~

guardianship. 'if any,. and shall make ~ recommendations regarding team shall specifically consider the child's, legal status and need for

, appropriate allematives to group care placement.

l 3/31/89 102 CMR - 24.1 l

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102 CMR: OFFICE FOR Cli!LDREN

'i NON-TEXT PAGE f

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3/31/89 102 CMR - 24.7

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4

~f 102 CMR:. OFFICE FOR CHil.DREN -

. 3.04: continued 4.

The licensee shall explain tho findings of the-periodic review and reAsed service plan-to all child care personnel responsible for -

implementing the service plan on a daily basis, and as appropriate to the child's family or guardian. A copy of the periodic review and revised service plan shall be forwarded to the referral source.

5.

The licensee shall explain the revised service plan to the child in a manner consistent with the child's maturity and capacity to understand.

(i) Discharse from Care. Thirty (30) working Pys prior to any child's discharge, except in the case of an emergency, the, licensee shall prepare a discharge plan for the child.

1.

The discharge planning shall be conducted by a team which includes team members as required in 102 CMR 3.04(1)(g)1.

2.

The team shall assess the child's needs and develop a discharge plan to meet these needs, including provisions for follow-up services in the.

child's new environment, as required in 102 CMR 3.04(5).

3.

The licensee shall explain the discharge plan to the child, the child's t

parents, the person other than a parent who has custody of the child and the referral source.

4.

Except in an emergency, the licensee shall permit transfer of a child -

to another facility only with the consent of the parent or the person other than a parent who has legal custody of the child..

- 5.

In the case of unplanned discharge, the licensee shall,in conjunction with the referral source, prepare a discharge summary which explains the circumstances of the unplanned discharge.

6.

The licensee shall identify in the child's record the child's location immediately after discharge including the name, address, telephone number and relationship of the persons responsible for the child's care.

(j) Illness: Accident: Death.

1.

In the event of serious illness the licensee shall notify as soon as reasonably possible the child's parent or person other than a parent who has legal custody of the child,'the referral source, and the Department of Education, when applicable.

2.

In the event of serious accident or death, the licensee shall

. immediately notify the child's parent or person other than the parent who has legal custody. the referral source, the Office, and the Department of Education, when applicable. The licensee shall cooperate in arrangements made for examination, autopsy and burial.

3.

In the event of unexpected death, the licensee shall also notify the local police.

4.

In the event of a serious injury to a child resulting in hospitalization, an incident involving firearms or dangerous weapons which results in a report to law enforcement officials, an incident involving fire which results in a response by fire officials, or an incident involving an escape

'i from secure facilities the licensee shall notify the Office within twenty-four (24) hours of the injury or incident. The licensee, !4 requested by the Office, shall prepare and submit to the Office a written report regarding the injury or incident.

(2) Child Care Workers.

(a) Responsibility of Child Care Staff. The licensco shall employ child care staff to irnplement the individual service plan on a daily basis.

1.

A gender-appropriate staffing pattern shall be established to assist children with the intimate activities of daily living, in accordance with a child's developmental level or mental age.

-(b) Supervision. The licensee shall make child care staff directly responsible to a staff. person who has supervisory or administrative responsibility and who has experience suitable to the goals of the program.

The licensee shall require child care staff 'to have reguist, scheduled conferences with the child care supervisor regarding children's needs and methods of meeting those needs.

1..The child care supervisor (s) shall conduct evaluations at least yearly, of all child care staff.

2.

Evaluations shall consider the individual's job performance, attendance at trainings and ability to implement children's service plans.

3.

Copies of evaluations shall be maintained in a staff's personnel record and shall be available to him/her upon request.

3/31/89 102 CMR - 25 t

j s

102 CMit- (WFICE FOR CHILDRl:N

.~.04: continued (c) Role of Child Care Staff.

1. Child care stnff shall assist in developing and implementing the children's service plans.

2 Child care staff shall assist residents in the activities of daily living, in the development of self help and social skills, and in the development of positive human relationships, including promoting in each resident a sense of security. belonging. and self-worth; providing emotional support and guidance to residents as appropriate.

i (3) Case Management. The licensee shall assign each child a staff person who shalI~be responsible for coordinating the implementation of the child's service plan and other services provided to that child. The licensee shall insure continuity of case management responsibilities in the absence of the case manager for an extended period of time such as vacation or leave. The case man #ger shath (a) attend and participate in the child's service planning, periodic review, and discharge conference required in 102 CMR 3.04(t)(g), (h) and (i);

(b) work with child care staff and other persons involved in the child's care d

to assure that the treatment plan is adhered to in the child's daily living:

l (c) collaborate with other agencies who share responsibilities for the child's welfare, and utilize appropriate community resources in providing needed services to the child; (d) assure that the child's record is maintained in compliance with f

102 CMR 3.03(6).

(e) carry a reasonable caseload which allows for an effective and timely j

performance of the above tasks.

l (4) Family Work.

i (a) The licensee shall establish and have in writing a plan for establishing a i

professional relationship with each child's family and for maintaining i

regular contact with the family for the purposes of:

1. assisting the family to adjust to the child's placement and separation:

2. developing a visiting plan and encouraging the family's continued interaction with their child in accordance with the child's service plan:

3. informing the family of their child's progress:

4. mobilizing parent (s) strengths and resources to help parents participate in planning for their child's return home or to another 1

community environment.

i (b) The licensee may provide family work services through staff employed l

directly, or through agreement with another agency, l

(5) Follow-up Services.

l (a) The licensee shall establish and have in writing a plan for insuring that I

follow-up services are provided. The licensee shall, where possible.

l maintain contact with each child for at least six months after discharge.

l unless the child was referred to the licensee by a placement agency or 1

purchaser of service which has legal care or custody or is responsible for the j

child.

(b) The licensee shall, where possible, arrange for on-going services as necessary to facilitate the child's adjustment to his/her new environment, except where the child was referred by a placement agency or purchaser of service which is responsible for the child.

l (c) The licensee shall identify the parties responsible for providing follow-up services in the child's record and discharge plan, consistent with the requirements of 102 CMR 3.04(1)(i)2.

(6) Social, Psychological and Psychiatric Services.

l (a) The licensee shall establish and describe in writing a plan for providing social, psychological and psychiatric services. The plan for providing social, psychological and psychiatric services shall be such that each child's needs for such services shall be met and the purpose of the facility accomplished.

(b) The licensee shall provide evidence of access to emergency mental het.ith services on a twenty-four hour per day, seven day per week basis.

This evidence may be provided through an agreement with the Department l

12/31/86 102 CMR - 26

(

6-h 103 CM!1: OFFICE FOR ClllLDREN l

l 3.04: continued of Mental Health for evaluation, crisis intervention and facilitation of admission to an inpatient facility; an agreement with a private psychiatrist who can provide crisis intervention and facilitate inpatient admission if necessary; an agreement with an inpatient mental health facility; or an agreement with a hospital having an inpatient psychiatric unit.

(c) As appropriate to the needs of the children, the licensee shall provide or facilitate the provision of a range of social, psychological and psychiatric services which shall include:

1. evaluation and assessment;

2. therapy and/or counseling for individuals and groups;

3. clinical consultation with children, parents or guardians and staff;

4. staff development services including specific training geared to address the needs of children in the program.

(7) Health Services.

(a) The licensee shall have a written plan for meetings the health needs of the children served and which details the availability of qualified medical care to the facility, including medical emergencies on a twenty-four hour per day, seven day per week basis.

(b) The licensee shall provide or arrange for children in the facility a range of health services including:

1. evaluation and diagnosis;

2. treatment;

3. consultation;

4. preventive health services.

(c) The licensee shall insure that at the time of placement each child has had a medical examination thirty days prior to admission where possible or within two weeks af ter admission. If however a child is admitted directly from another licensed facility or placement agency, the licensee must have documentation that the previous medical examination was conducted according to the project Good Health (PGH) Medical Protocol and Periodicity Schedule and insure provision of health services identified at that time. If the pCH Periodicity Schedule is amended, the licensee shall be required to follow the arnended schedule.

(d) The licensee shallinsure that for all children under the age of six years, but not less than two years of age, the medical examination shall include a statement signed by a physician or an employee of a health care agency stating that the child has been screened for lead poisoning.

(e) At the time of placement, children shall be provided with emergency medical / dental / mental health care if needed.

(f) The licensee shall provide or arrange for preventive health services for children, including but not limited to:

1. Routine medical and dental examinations which shall occur according

{

to the PGH Periodicity Schedule as follows l

PGH PERIODICITY SCHEDULE FOR ROUTINE MEDICAL A

OR DENTAL EXAMINATIONS.

Routine medical examinations should occur at the following intervals:

2 - 6 weeks of age 8 -10 weeks of age 4 months of age 6 months of age 9 months of age 1 year of age 15 months of age l

l 20 months of age 2 years of age 30 months of age 3 years of age Af ter age 3, annually Routiae dental examinations should occur at the following intervals:

Starting at age 3, routine dental examinations should be scheduled

annually,

s. Medical examinations may be conducted by a licensed physir:ian, a certified nurse practitioner or a physician's assistant.

3/31/89 102 CMR - 27

4

'l 102 CMR: OITICF. mR CHILDREN 3.04: continued

b. Special studies are to be carried out at the direction of a physician in accordance with the child's needs and the periodicity Schedule, c.

the routine medical examination required at two years of age shall include a screening for lead poisoning and a statement signed by a physician or an employee of a health care agency stating that the child has been screened.

2. Immunizations and TB testing as required by the Department of public Health.

3. Reporting of communicable diseases and infections to the local Board of Health as required by M.G.L. c. lit, s.111<

4. Family Planning information, and upon request of the child (with any required consent of parent or guardian or placement agency), piovision of or referral for family planning devices, medication and services. Any licensee whose conscience prohibits the prosision of such family planning devices, medication or services, shall notify the child, parents or referral source that the facility will not provide such services.

(g) The licensee shall insure that medically recommended glasses, heaf ng i

aids, prosthetic devices, corrective physical or dental devices or any equipment recommended by the examining physician are provided to the child, consistent with the terms of the agreement with the placement agency end purchaser of service,102 CMR 3.04(1)(f).

(h) The licensee shall have written policies and procedures regarding the prescription and administration of all medication. These policies and procedures shallinclude the following:

1. Administration Procedures. The licensee shall identify on a written-list all persons authorized by law. regulation and the licensee to prescribe and/or administer medication to a child.' The licensee shall also develop procedures to:

a. document the prescription and/or administration of medication;

b. provide notification to attending physicians of significant changes in behavior or in a child's health that may result from medication;

c. record significant side effects of medication.

2. Staff Training. All staff shall be provided with copies of the licensee's policies and procedures regarding administration of medication. Staff providing care to a child receiving medication shall be instructed about the nature of the medication. potential sido effects, and any special precautions or requirements that may need to be observed.

Only trained staff shall administer medications.

3. Antipsychotics Medication. Antipsychotics medication shall mean drugs which are used in treating psychoses and alleviating psychotic states.

The licensee shall not administer or arrange for the administration of antipsychotics medication except as follows:

a. Any antipsychotics medication shall be prescribed by a licensed physician for the diagnosis, treatment and care of the child, and only after review of the child's medical record and actual observation of the child.

b. If antipsychotics medication is prescribed, the prescribing physician shall submit a written report to the licensee detailing the necessity for the medication: the staff monitoring requirements, if at:y potential side effects that may or may not require medical attention; and the next scheduled clinical meeting or series of meetings with the child.

c. No antipsychotics prescription shall be administered for a period longer than is medically necessary as determined by the prescribing physician af ter meeting with the chile rev: ewing the child's progress; and examining the child for poiential side effects. All subsequent meetings with the child after the initial meeting shall be on a schedule determined by the physician, as sufficient to monitor the child while on antipsychotics medication.

d. Staff providing care to a child receiving antipsychotics medication shall be instructed regarding the nature of the medication, potential side effects that may or may not require medical attention and required monitoring or special precautions, if any.

e. Except in an emergency, as enfined in 1G2 CMR 3.05(6)(h)1.b or 102 CMR 3.04(7)(h)3.g.; the licenses shall not administer or arrange 3/31/89 102 CMR - 28

3

.}l

102 CMRh OFFICE FOR CHILDREN

,s L

3.04: ' continued

. for prescription and administration of antipsychotics medication unless informed written cansent is obtained. Informed written consent shall be obtained in the following manner: If a child is in the custody of' his/her parent (s), parental consent (in writing or in a witnessed ie conversation) is required. Parental consent pursuant to this subparagraph may be revoked at any time unless subject to any court order. If the parent does not consent or is not available to give consent the referral source shall be not.fied and judicial approval

'shall be sought, if a child is in the custody of a person other than the parent, a placement agency or an cut-of-state public or private agency, the referral source shall be notified and judicial approval shall be sought,

f. The licensee shall inform a child twelve years of age and older, consistent with the child's capacity to understand, about the treatment, risks and any potential side effects of such medication.

The licensee shall have procedures to follow if the child refuses to consent to administration of the medication.

g. In an emergency situation antipsychotics medication may

• be administered for treatment purposes without parental consent or prior judicial. approval if an unic oseen combination of circumstances or the resulting state calls for immediate action and there is no less

. Intrusive alternative to the medication. The treating physician must determine in his/her professional judgment that medication is necessary to prevent the immediate substantial 'and irreversible

deterioration of a serious mental illness. If the treating physician determines that nedication should continue informed consent or judicial approval must be obtained as required by 102 CMR 3.04(7)(h)3.e.

(i) Thb licensee shall train au child care staff in first aid procedures.

1 The training shall include, but not be limited to, information on:

Feeding, bruises, choking, falls, poisorQng, objects in the eye, animal and inect bites, and convulsions,

2. Such training shall occur within one month of a new employee's berinning work unless he/she can show evidence of current first aid tra ning.

3i The licensee shall insure that at all times a child care worker trained in fhst aid procedures is available in the facility.

(j) The lcensee shall maintain standard first aid kits that are accessible to each mvjor activity area of the facility, (k) The licensee shall store medical equipn.ent and medications under proper conditiva for sanitation, preservation, and security.

(1) Tht licensee shall not require any child to receive medical treatment or screening when the parent or guardian of such child objects thereto on the grounds that it conflicts with the tenets and practices of a recognized church or religious denomination of which the parent or child is an adherent or member. However, the facility may seek a court order for medical treatment or screening of a child if it believes such medical treatment or screening is in the child's best interest, (m) The licensee shall make provisions for isolating children in cases of illnesses requiring such isolation.

(8) Educational Services. The licensee shall describe in writing its plan for meeting the educational needs of the children served. The licensee shall arrange for the education of each child in care, in compliance with federal, state and loca) laws, as appropriate to the needs of each child and consistent l

with the child's 1.E.P.

II i

(9) Vocational Preparation Services. The licensee shall describe in writing its plan for meeting the vocational preparation needs of the children served.

(a) The licensee shall provide, arrange, or facilitate the provision of services according to each child's needs and ability.

(b) As appropriate to the needs of the child. the licensee shall provide, arrange or facilitate vocalional services wiven 1: clude:

1. vocational evaluation;

2. formulation of vocational goals for the chhd; 3/31/89 102 CMR - 29 N

L -___-_

4' 102 CMR: OfflCC IDR CillLDREN 3

3.04; continued

3. formulation of a plan to ach; eve vocational goals;

4. ' implementation of a vocational plan, in':luding vocational counseling, instruction, and training. and vocational placernent or referral to L

appropriate services-(c) The child shall be fully involved in his/her vocational evaluation and formulation of vocational plan.

L (10) Recreational Services. The licensee shall describe in writing its plan for meeting the recreational needs of the children served, including the use of

- community recreational resources where appropriate.

(a) The licensee shall provide or arrange. for individual and group recreational programs appropriate to the age, interests and needs of ea*:h child.

(b) The licensee shall provide a recreational program which provides for free, unplanned time for children to pursue individual interests, with supervision as required for the protection of each child.

(c) The licensee shall assign responsibility for the recreation program to.a designated staff person or persons.-

(11) Reliaious Services. The licensee shall make religious oppc'tunities available to children upon request and shall respect the religious preference of each child.

(12) Attendance at Legal Proceedings. The licensee shall' insure that no child attends a judicial or administrative hearing without a representative of the licensee or the referral source.

(13) Researrh. Fund Raising, ce Publicity. The licensee shall not authorize any activities unrelated to the service plan of the child or to any agreements with the parent or a person other than the parent with custody of the child without the written consent of the parents or a person other than the parent with custody of' the child and the child if over fourteen (14) years of age.

" Activities" shall mean, but not be limited to, the following examples:

- (a) research and experimentation which involves the child; (b) fund raisir g; (c) publicity, including photographs ant'/or mass media communications.

(14) Unusual or Extraordinary Treatmert. ' No licensee shall conduct unusual or extraordinary treatment except in accot 1nce with this subsection.

(a) Unusual or extraordinary treatmmt shallinclude:

1. Any experimental or extraordinary behavior modification treatment or behavior management program.

2. Treatment or conditioning that poses known or unknown risks or involves the infliction of physical or mental' pain, discomfort, or j

deprivation.

3. A treatment program for a specific child, a specific group of children or for all children in the facility using a particular extraordinary b

treatment model, for example aversive treatment or survival training.

L (b) Any licensee which seeks to implement a program utilizing unusual or

)

extraordinary treatment must s',bmit a written variance request prior to

['~

implementation as required by 102 CMR 3.02(2)(f)1. through 3., inclusive, l

and this subsection. Such request shall provide a clear and precise statement describing the proposed treatment. Such statements shall describe:

1

1. the rationale for the treatment, including a statement of medical ar.d l

clinical consideration and a description of previous use of other, non-extraordinary treatments and their results;

2. the members of and the procedures followed by the interdisciplinary team that authorizes the treatment program;

3. a description of the process and person (s) responsible for orienting and training staff to administer the treatment procedures;

4. person (s) responsible for administering and munitorin;' the i

implementation of the treatment procedures;

5. any assessment and identification of procedures which require a witness; h

o E

12/31/86 102 CMR - 30

q _[

_y y

f) j-C j.

0 102 CMR: OFFICE FOR CHILDREN 3.04: continued

6. when and bow the treatment will be administered.

7. how long sne treatment program will be utilized and the duration of

)

individual treatmentst j

8. the anticipated benefits and all possible risks associated with the j

treatment;

9. procedures and the person (s) responsible for monitoring, documenting and evaluating the pmgram.

(c) No child shall be subjected to a program of unusual or extraordinary f

. treatment unless such program is approved by the Office for Children and such treatment is specifically consented to in writing by the child's

. parent (s), person other than a parent with custody of the child or judicial approval.

(d) No program of unusual or extraordinary treatment may involve procedures which violate any regulations contained in 102 CMR 3.05.

(e) A licensee implementing a program using unusual or extraordinary treatment approved by the Office shall record the following information in the child's record:

1. Clinical and medical review, where appropriate, supporting the need -

for the program. In cases utilizing aversive treatments, baseline data must be collected prior to implementation.

2. The date, time and duration of each treament.

3.. The name of the person administering tne treatment and the name of any staff observer,

4. required consents.

(f) In addition to approval from the Office. all pmgrams utilizing unusual or extraordinary treatment shall organize a Human Rights Committee to oversee the u*e of approved treatments.

3.05: Care of Children (1) Staff-Child Ratios.

(a) The licensee shall establish a written description of the staffing of the facility on a 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> per day, seven day per week basis, including ovemight and weekends. The staffing description must include provisions for the periods of time when assigned staff are absent due to illness or on vacation.

(b) The licensee must submit a current staffing schedule.

t ) The licensee shall assure a staff-child ratio appropriate to the age, capabilities, needs and service plans of the children in the facility, and sufficient to carry out the requirements of these regulations. Volunteers shall not be included in the staff-child ratio.'

(2) Mixing of Children and Adults.

(a) The licensee shall not permit children under sge sixteen (16) to share bedmoms with residents over age twenty-two (22).

(b) In facilities which serve residents over age twenty-two (22) and twelve (12) or more of the residents are under sixteen (16) years of age, the licensee shall provide separate programming.

(3) Clothing. The licensee shall assure that each child has adequate, clean, fashionable and seasonable clothing as required for health, comfort, and i

physical well being and appropriate to age, sex, and individual needs.

(a) The licensee shall not require any child to wear a uniform which identifies the child as a resident of a particular facility.

(b) Each child shall have his/her own clothing for his/her own use. Any identification on the clothing shall be inconspicuous.

(c) The licensee shall provide children the opportunity to participate in selecting their own clothing.

(d) The licensee shall permit each child to, take his/her clothing upon discharge imm the facility.

(4) Cmoming and Hvriene.

(a) The licensee shall provide each child with grooming and hygiene articles necessary to meet his/her needs.

1. The provision of such articles shall not be contingent upon behavior and may not be part of a level or privilege system.

12/31/86 102 CMR - 31 9

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4 D_

102 CMR: OFFICE FOR CHILDREN

~

c 3.05: continued '

2. Such articles may not be sold to residents.

3. Community use of grooming and hygiene articles such as towels, tooth brushes, soap and deodorants is prohibited.'

(b) The licensee shall assist each child in learning grooming practices.

(c) The licensee shall provide each child with the opportunity to have a daily shower or tub bath, with due regard for privacy. The licensee shall give children assistance or supervision in bathing when they are unable to perform this function by themselves.

.k

- (d) The licensee shall encourage each child to brush his/her teeth at least i M

twice daily and provide assistance where needed.

.(e) The licensee shall make arrangements for hair cutting and styling. in L

accordance with the wishes of the child and consistent with good health.

(f) The licensee shall conduct a toilet training program for those children who need toilet training. The licensee shall bathe or clean children upon soiling, and shall change soiled clothing, p

(5) Nutrition.

(a) The licensee shall provide a nourishing well-balanced diet. to all l>

children. The licensee shall have a written. plan for nutritional services including purchase, storage, preparation and serving of food. The plan must identify one person who is responsible for the food program.

1. The licensee shall provide at least three meals daily constituting a nutritionally adequate diet.

2. The licensee shall prepare and serve meals in a manner and in an amount appropriate to the nutritional needs of each child, including -

special dietary needs.

(b) No child shall be denied a meal for any reason other than medical prescription. Such prescription shall be in writing and shall be carried out, as required by 102 CMR 3.04(7)(h).

(c) The licensee shall encourage children to eat a well-balanced diet, but no

~

child shall be force-fed or otherwise coerced to eat against his/her' will except where medically prescribed.

(d) The licensee shall serve to children meals which are substantially the those served to staff unless special dietary needs-require same as differences in diet.

(e) The licensee shall prepare tasteful meals and shal' serve meals 1

appetizingly.

(f) The licensee shall allow children to eat at a reasonable, leisurely rate.

(g) Normal conversation during meals shall be encouraged.

(h) Staff shall be present and shall assure that each child receives adequate amounts and variety of food, (i) The licensee shall prepare menus and shall maintain copies of the menus used. Menus shall be prepared or reviewed by a person who has had training in the nutritional needs of children and the U.S.D.A. requirements for a nutritionally adequate diet.

()) The licensee shall store, prepare, and serve all food in a manner as to be clean, wholesome, free from spoilage, and safe for human consumption.

(S) Behavioc Management.

(a) Each licensee shall provide a written statement defining rules, policies and procedures for the behavior management of children. This statement shall pmvide for and include a description of the safeguards for the emotional, physical and psychological well-being of the population served.

This statement shallinclude measures for positive responses to appropriate

{

behavior and shall define and explain the use of behavior management procedures used in the facility including where applicable:

1. level / point systems of privileges, including procedures for the child's progress in the pmgram.

2. the type and range of restrictions a staff member can authorize for misbehavior of children.

3. the form of restraint used in an emergency, the behavioral interventions used as altematives to restraint and contmis on abuse of such restraints:

4. the use of the practice of separating a child fmm a group or program activity; 12/31/86 102 CMR - 32 1

c in i

(

102 CMR: OFFICE FOR CHILDREN 3.05: continued

5. any denial or restrictions of on-grounds program services.

- (b) When feasible and appropriate, children shall participate in the establishment of such rules, policies and procedures.

(c) The licensee shall provide children, and parents or persons other than a parent with custody of the child with a copy of the facility's written statement prior to admission.'

(d) The licensee shall inforrn parents, persons other than a parent with custody of. the child and children of any significant changes in behavior management procedures.

(e) No child shall be subjected to abuse or neglect, cruel, unusual, severe or corporal punishment including the following practices:

1. any type of physical hitting inflicted in any manner upon the body; 2 ' requiring or forcing the child to take an uncomfortable position such as squatting or bending or requiring or forcing the child to repeat physical movements, when used as punishment;

3. punishments which subject the child to verbal abuse, ridicule or humiliation;

4. denial of visitation or communication privileges with family:

5. denialof sufficient sleep;

6. denial of shelter bedding. food or bathroom facilities.

(f) The licensee shall direct behavior management to the goal of maximizing the growth and development of the childrer. and for protecting the group and individuals within it.

' (g) The licensee shall directly relate consequences to the specific misbehavior and shall apply such consequences without prolonged delay.

(h) The licensee shall not use any form of restraint except as described below. For the purposes of 102 CMR 3.00 the word restraint shall refer to the use of any physical mechanical or chemical means to temporarily control behavior.

1. Restraint of children may be used only in cases of emergency where there is the occurrence of, or serious threat of, violence to self, others, or property. Restraint is defined as follows:

a. passive physical restraint means the least amount of force required on the part of staff to prevent a child from harming him/herself or others.

(i) Passive physical restraint shall not continue for a period

!=

longer than needed to pmtect the health and safety of the child or others. If a child needs to be restrained for a period longer than thirty minutes, the approval of the chief administrative person or his/her designee shall be obtained.

b. Chemical restraint means the administration of medication for the purpose of restraint.

(i) An emergency for purposes of administering medication is an-unforeseen combination of circumstances or the resulting state that calls forimmediate action. Predictable crises are not within the definition of emergency.

(ii) Medication may be administered without parental consent or L

prior judicial approval only in an emergency situation:

1. where there is the occurrence or serious threat of extreme i

violence. personal injury, or attempted suicide; and l

11. only if there is no less intrusive altemative to medication.

(iii) If a child is medicated and the treating physician determines that the medication should centinue, then the licensee shall immediately seek, as set forth in 102 CMR 3.04(7)(h)3:

1. the consent of the parent (s) of a child, where the parents have custody of their child, or

11. judicial approval for medicating children who are in the custody of a person other than the parent, a placement agency or an out-of-state public or private agency, if a child is administered medication in an emergency situation, the licensee shall notify the parents of the child or the person other than parent who has custody of the child, the placement agency or out-of-state public or private agency as soon after the emergency as possible.

l'

[

12/31/se 102 CMR - 33

102 CMR: OFFICE FOR CHILDREN 3.05: continued

c. Mechanical restraint means the restriction by mechanical means of a child's mobility and/or ability to use his/her arms or legs.

(i) Mechanical restraint (s) may be used only to protect the child, other children and staff. Mechanical restraint (s) may not be attached to any fixed object.

(ii) If a child needs to be mechanically restrained for a period longer than fifteen minutes, the. approval of the chief administrative person or his/her designee shall be obtained.

Mechanical restraint may not be used for more than one hour without medical or clinical consultation.

2. No child shall be restrained for purposes of punishment or for the convenience of others.

3. The use of any form of restraint other than passive physical restraint by the licensee must have the prior written approval of the Office. The person who placed the child shall be provided a copy of the licensee's restraint plan as approved by the Office.

4. A licensee shall assure that the form of restraint used is the least intrusive means neccssary to protect the child, other children and staff.

5. A licensee shall not use chemical restraint of children unless the licensee submits to the Office for its approval a written plan for the use of such restraints and complies with the applicable requirements of 102 CMR 3.04(7)(h)3. and 3.05(6)(h)1.b.

6. The licensee shall not use mechanical restraints unless the licensee submits to the Office for its approval a written plan for the use of such restraints and complies with the applicable requirements of 102 CMR 3.05(6)(h)1.c.

7. The plans required by 102 CMR 3.05(6)(h)5. and 6., shall include but not be limited to the following:

i a, the type and nature of restraint (s) to be used:

i

b. mechanism for approval for use of such restraint from the chief administrative person or his/her designee:

c. the conditions under which the restraint (s) will be used:

d. risks associated with using the restraint and risks likely to occur if restraints are not used;

e. alternatives to the use of restraint which.will be used prior to such restraints;

f. provisions for staff supervision of the child during the restraint:

g. plan for obtaining medical and/or clinical consultation for those situations in which the use of mechanical restraint may exceed one hour duration:

h. a procedure for documenting the use of restraint including:

(i) name of child; (ii) date and time restraint (s) were applied and by whom:

(iii) description of incident, alternative interventions considered and reasons restraint (s) were required; (iv) persons notified, when and from whom approval was obtained (v) steff member assigned to directly superQe and involvement of any additional staff; (vi) date and time restraints were removed or discontinued.

1. A plan for training staff in the appropriate use of restraints.

l. Any supporting documentation submitted by the licensee.

B. The licensee shall document all restraints in an incident report and keep such reports in the child's record.

9. A licensee subject to M.G.L. c.123 sball perform restraints on a child in a manner which conforms with M.C.L. c.123. s. 21,104 CMR 3.12, 15.03,20.02, and 20.08 and any other applicable Department of Mental i

Health (DMH) regulations.

(i) Any behavior management policy which results in a child being separated in a room apart from the group or program activities shall include, but not be limited to the following:

1. guidelines for staff in the utilization of such an area:

2. persons responsible for implementing such pmcedures:

3. the duration of such procedures including provisions for approval by the chief administrative person or his/her designee for a period longer than thirty minutes:

12/31/86 102 CMR - 34

g-l

~

"<'y a?

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= 102 CMR: OFFICE FOR CHILDREN l

r.J

s,.

' 3.05: continued

4. a requirement that children shall be observable at all times and in all

. parts of the room and that staff shall be in close proximity at all times;

' 5. a procedure 'for staff to directly observe the child at least every

'lp',

~

fif teen minutes;. _

6,- a means of documenting the use of such area if used for a period longer than thirty (30) minutes including, at a minimuma length of time, 4

. reasons for this intervention, wi.o approved the procedure and who y

directly observed the child at least every fifteen minutes.

?

, (j) A time out room.shall not be locked, except as outlined in 102 CMR '

3.05(6)(1)1. through 3.

(k) Any room. or space.. used for the practice of separation must be -

physically safe and appropriate to the population served by the facility.

4

> (1) If the licensee operates a locked secure treatment program for children committed to the Department of Youth Services (DYS) or a program

. determined by the Office to be subject to the requirements of this regulation, a clear and precise description of the program must be submitted which includes:

1. A description of. the facility's security system including _ any automatic locks or safety devices on doors or windows;

2. If individual bedroom doors are locked at any time, a statement of the hours the doors will be locked, an explanation of any time doors may be locked other than during : sleeping hours, a description of the procedures to insure that locks are released in the event of fire, power failure or any situation which may necessitate evacuation of the room,

floor or building.

. 3. A plan which specifies a description of the' population indicating the need for a locked room, altemative interventions to be used prior to a

locked room, a physical description of the room, the method for direct -

observation of the child by staff and the pmcedure for documenting use of the room. Such plan must be submitted to the Office for approval prior to use of a locked room,

a. ' A locked time out room may be used'only when necessary to protect the child, ot'her children, or staff imm immediate danger of physical harm.- Locked rooms must-meet all applicable state and federal regulations.

b. Use of the locked room shall not exceed fifteen minutes without 4

-consultation with and approval from the chief admimstrative person or his/her designee. 9uch approval shall be necessary' for each following. sixty-minute period... A staff person shall be in close proximity to the locked rooO at all times while a child is in a locked room, and shall' directly oberve the child at least every fifteen minutes, and shall take appropriate measures to assure the safety of the child.

licensee shall provide opportunities for children to develop a sense of the value of money through eamings, spendmg, giving and saving.

(b) The licensee shall have a written policy regantiing allowances.

. (8) Visitina. Mail and Teleohones.

(a) The licensee shall have written policies which encourage and support family visits, mail, telephone calls, and other forms of communication with family, friends, or other persons.

1. Such policies shall be developed with the goal of encouraging healthy family relationships, maximizing the individual child's growth and development, and protecting the children, staff and pmgram from l.1 l-unreasonable intrusions.

2. Such policies shall he distributed to staff and children, persons other than a parent with cuudy of the child, and parents prior to admission.

a (b) The licensee shall provide opportunities and encourage children to visit i

and otherwise communicate with family and other persons. The licensee l

shallinsure that visits provided pursuant to this subsection at the facility offer reasonable privacy.

l 12/31/86 102 CMR - 35

= _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

i p

4 I-s 102 CMR:. OFFICE FOR CHILDREN 3.05: continued

. (c) No child shall be restricted in his or her opportunities to visit with i

family and other persons unless such opportunities are restricted as follows:

1. by court order and in such case only to the extent of the court order:

2. by the child's individual service plan for therapeutic reasons only.

Such restrictions or denial must be no greater than necessary to echieve the therapeutic purpose. Those persons whose visitation is restricted or denied should receive an explanation from the facility as to the reasons therefore.

(d) Communication with a child's social worker, attomey, or clergy person l

may not be pmhibited, curtailed or restricted.

(e) The licensee shall establish visiting hours which meet the needs of the L.

children and their parents.

(f) The licensee shall formulate procedures for children visiting outside the :

facility including:

1. A method for recording the child's locetion, the duration of the visit, and the name, address and telephone number of the person responsible for the child while absent fmm the facility;

2. A method for recording the child's retum and a procedure for actmn.

if a child fails to retum.

(g) Written and telephone communications shall not be prohibited.

(h) It shall be each child's right to open and send his/her mail unread by staff except in accordance with the following circumstances:

1. Such restrictions or censorship must be no greater than necessary to achieve the therapeutic purpose described in the individual service plan.

2. Mall restricted or censored must be retumed to the sender with reasons therefore.

3. Staff may open and inspect resident's mail for contraband only in the presence of the child.

(i) Telephone communications may not be restricted or monitored unless there are specific therapeutic reasor.s justifying such limitations.

1. Such. therapeutic reasons must be developed in the child's individual service plan and must be no greater than necessary to achieve the therapeutic purpose.

2. If phone conversations are monitored, the parties to the conversations must be informedi

3. There must be no restrictions or monitoring of conversations between a child and his or her attomey, social worker or clergy person.

(9) Runaways. The licensee shall have a written policy for handling runaways and missing children. The policy shall be readily available and include:

(a) pmcedures for making staff aware of children with a history of runnmg or who show potential for being runaways; (b) preventive procedures; 1

(c) a procedure requiring the staff to inform'the chief administrative person i

or his/her designee immediately upon discovering a child missing from the program; (d) A procedure requiring the program to notify the child's parent, person other than a parent with custody of the child, referral source and the Department of Education, when applicable, and the local police.

(10) T~Tae licensee shall describe in writing its arrangements for transpor!

Transportation of Children.

(a children and provide evidence of required insurance.

1. Each child shall be provided with the transportation necessary for t

implementing his/her service plan.

2. Appmpriate supervision with adequate staff-child ratio for transportation must be maintained,

3. Each facility shall have available means of transporting children in cases of emergency.

4. The licensee shall describe its policy on the use of seat belts for l

children and staff.

(b) The operator of any vehicle shall be licensed in accordance with state laws.

(c) Any vehicle used for transporting children shall be registered, inspected and operated in accordance with state laws.

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.1-a 102 CMR: OFFICE FOR CHILDREN 3.05: continued

1. Vehicles shall be maintained in a safe operating condition and shall be equipped with a standard first aid kit.

2. The licensee shall not allow the number of children riding in a vehicle r

at any time to exceed the number of seats therein, nor shall such vehicle be in motion until all the children are seated.

3. Children under five years of age shall be restrained in a child passenger restraint or a safety belt, according to M.G.L. c. 90, s. 7AA.

(d) No vehicle. whether agency owned, leased or contracted and no staff member's vehicle shall be used to transport children unless the licensee has assured that the following minimum amounts of liability insurance are provided:

injury per person -

$100,000 injury per accident -

300,000 property damage -

5.000 (e) The licensee shall ascertain the nature and any need or problem of a child which may cause difficulties during transportation, such as seizures, a tendency towards motion sickness, and disabilities. The licensee shall communicate such information to the operator of any vehicle transporting children.

(f) The operator of a vehicle transporting children shall discharge a child only to a person known to the operator as authorized by the licensee to receive the child.

L 3.06: physical Plant and Equipment (1) Required Inspections.

(a) The licensee shall have a certificate of inspection from the Department of Public Safety or the appropriate local building inspector. The licensee shall provide a copy of such certificate to the Office.

Ib) Each facility defined as a " group residence" pursuant to the State Du'ilding Code shall meet the building code applicable to " group residences."

(c) Each facility not defined as a " group residence" under the State Building Code shall meet the building codes applicable to the facility.

(d) The licensee shall obtain a written report from the local health inspector or from the Department of Public Health certifying that the facility is in compliance with Chapter il of th; State Sanitary Code including the following categories: kitchen areas, bathroom areas, water supply, hot water operations, heating operations, lighting and electrical operations, metering of electricity and gas, installation and inaintenance of the physical plant, asbestos material used as insulation or covering, smoke detectors, exits maintenance of structural elements, control of insects, rodents and skunks, garbago and rubbish storage and disposal and security.

(e) The licensee shall obtain a written report of an annual fire inspection from the local fire department. The licensee shall request fire inspections on a quarterly basis and maintain copies of such requests andinspections at the facility.

(2) Safety Program.

(i) The licensee shall establish a written plan detailing procedures for meeting potential emergencies, such as fire, power outage, severe weather conditions and staffing problems. The procedures shallinclude:

1. plans for the assignment of personnel to specific tasks and responsibilities in emergency situations;

2. Instructions relating to the use of alarm systems and signals;

3. systems for notification of appropriate persons;

4. specification of evacuation routes and procedures, with clearly marked diagrams.

(b) One person shall be assigned responsibility for coordination of the planning and procedures for meeting potential emergencies.

(c) In cases of fire or other emergencies which have required the evacuation of the facility and seeking other shelter the Office and the Department of Education when applicable, must be notified within twenty-four (24) hours, j.

(d) The licensee shall post the plans and procedures at suitable locations throughout the facility, and insure that staff are familiar with the procedures.

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' 3.06: continued (e) The licensee shall cond'uct training on procedures quarterly in order to:

t'. assure that all personnel on all shif ts are trained to perform assigned tasks;

2. assure that 'all personnel on all shif ts are familiar with the use of the fire-fighting equipment in the facility; L

3. evaluate the effectiveness of emergency plans and procedures.

(f) The licensee shall prepare children for and conduct evacuation drills on each shift twice a year under varied conditions.

1. The licensee shall make special provisions for the evacuation of any physically handicapped children in the facility.

2. The licensee shall take special care to help emotionally disturhed or perceptually handicapped children understand the nature of such drills.

=3. The licenses shall maintain a written. log documenting each evacuation drill including the date and time elapsed for the drill.

(g) The licensee shall maintain an active safety program allowing for

. ongoing assessment of the facility's emergency and safety procedures.

(h) The facility shall be equipped with at least one working smoke detector on each floor and at least one additional smoke detector for each separate sleeping area not connected by a common hallway.

(i) Each area for cooking and any other areas used for electrical, gas, or other heating equipment shall be equipped with a fire extinguisher in good working order.

(3) Toxic Substances.

(a) The licensee shall store poisonous cleaning substances or other toxic substances in areas where they are' securely protected from possible ingestion by staff or children.

(b) The licensee shall assure that toxic substances and medications are not stored together.

(c) The licensee shall assure that all toxic substances are labeled as to the contents and antidote.

'(d) The poison control center number shall be posted conspicuously next to all telephones in the facility.

(4) Paint. The licensee shall use only lead-free paint in any and all parts of the facility.

- (a) The licensen shall remove or make inaccessible to children paint or plaster containing lead.

(b) All buildings, residential or other e, utilized by children age six years-and under or with a mental age of s.

4 ears and under shall be free of lead paint violations in accordance with 105 CMR. 460.000 (Massachusetts Department of Public Health Prevention and control of Lead Poisoning regulations). Certification shall be obtained from the Massachusetts Department of Public Health or local board of health or private inspector utilizing an inspection form approved by the Childhood Lead Poisoning Prevention Program of the Massachusetts Department of Public Health.

(c) A licensee that obtained a letter of compliance from the Massachusetts Department of Public Health, local board of health or private inspector prior to July 1.1988. will not be required to comply with additional deleading requirements unless so ordered by the local-board of health or the Massachusetts Department of Public Health to remain in compliance with t.

L.

105 CMR 460.000, or when expanding to space not previously approved by the Office.

(5) Buildings and Grounds.

(a) The facility and its grounds shall be maintained in a sanitary, comfortable and safe condition.

1. The facility and grounds shall be maintained free from rodent or insect infestation by qualified persons.

2. Porches, elevated walkways and elevated play or recreation areas shall have barriers to prevent falls. Class barriers shall not be used.

Such barriers shall be at least 3e* in height if the elevated area is 1.

greater than 30" off the ground.

3. All exits, exit accesses and exit discharge areas shall be maintained continuously free from all obstructions or impediments to immediate use.

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3/31/89 102 CMR - 38

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3.06: continued

4. Outdoor recreation areas and, equipment. shall be safe. ~ Equipment.

shall be maintained in. good repair,' of safe design without sharp protrusions and shall be securely anchored to the ground.

. a. The outdoor recreation area shall be free from hazards (e.g., lead paint, unprotected pools, wells, cesspools. - etc.) and dangerous machinery.

I 3/31/89 102 CMR - 38.1 I'

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b. The outside recreation area shall be fenced,if appropriate, for the age and needs of the population served..

5. Power tools and equipment shall be stored in a locked area and only used by children under the instruction and appropriate supervision of a staff member,

6. Outdoor and indoor swimming areas shall be tested for water quality and be secured from inappropriate entry, _

7. ~Ihe 11censee shall have a plan for monitoring and insurms student safety amund swimming areas.

3 1

8. Any private well or water source shall be inspected and appmved by the local board of health or health department.

(6) Physical Facility /Archit wtural Barriers.'.

The licensee shall

. (a) Requirements for Cu dren with Limited Mobility.

assure that children with imited mobility have access, free from barriers to their mobility, to those areas of thel facility and smunds to which such access is necessary.

(b) Buildina Entrances.-- A facility which enmils children requiring wheel

- chairs shall have at least one entrance without steps and wide enough for a wheel chair, for each building utill ed by children.

(7) Livins Units.

~ (a) ne licensee shall design the living units to simulate the functional arrangements of a home and to encourage a personalized atmosphere for.

small groups of. children, unless it has been demonstrated that another estrangement is more effective in maximizing the human qualities of the specific children served. Living units shall be safe, clean and in good repair.

in all living areas; for example, bedrooms, g and maintenance routines

1. There shall be evidence of regular cleam'n oathrooms, kitchens, livmg rooms, dining moms, hallways, studies, etc. of the facility.

' 2. All rooms shall be kept safe from fire hasards.-

3. Hallways to bedrooms shall be illuminated at night.

(b) The licensee shall pmvide fumiture and fumishings which are safe, appropriate, comfortable, and home-like.

1 Bmken furniture and ripped upholstery is to be repaired or discarded.

~2. Furniture and furmahings provided to children shall be substantially the same as those provided to staff.

(c) All windows shall have operable screens in good repair.

(d) All incandescent or fluorescent light fixtures to which children have access shall be protected with shadas or covers.

-(e) h licensee shall provide bedrooms which have:

1. direct outside ventilation:

2. At least one operable window;

3. at least 70 square feet of space for single bedrooms, at least 50 square feet per person in bedmoms for two or more children.

(f) De licensee shall provide a means for children to mount pictures on bedmom walls, for example, by means of peg-board or cork strips, and to have other decorations.

(3) h licensee shau make provisions for safe keeping of each child's money or valuables.

1 (h) N licenses shall provide each child with appspriate individual furniture, and an individual closet or a designated section of a closet with clothes rocks and shelves.

(i) N licenses shall provide accessible. storage areas for personal possessions, such as toys, teoks, prosthetic equipment, pictures, games, radios, arts and-crafts materials, toiletries, jewelry, letters and other articles and equipment.

(j) N licensee shall provide each child with his/her own bed which shall be of sufficient size to accommodate the child comfortably. No cots or portable beds shall be used.

1. Each bed shall have a clean, comfortable, non-toxic and fire retardant mattress.

2. Sheets, pillows, pillow cases and blankets shall be provided for each

. bed.

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3. Sheets and pillow cases shall be changed weekly or more frequently if indicated.

(k) Living moms for the children's use shall be provided in each facility.

The living area (s) shall have adequate space per resident exclusive of hallways, bathrooms, kitchens, dining areas, closets. offices, storage areas or areas regularly used for other purposes.

(8) Bathing and Toilet Facilities.

(a) Bathing and toilet facilities shall be maintained in good repair and in a clean condition.

(b) The licensee shall locate and equip toilet areas so as to facilitate maximum self-help by children.

(c) The licensee shall provide toilets, which allow for individual privacy-(with partitions and doors), unless inconsistent with a toilet training program.

(d) The licensee shall provide bathing and toileting fixtures which are specially equipped, if used by the physically handicapped.

(e) The licensee shall pmvide at least one toilet for each six children easily accessible to children's sleeping quarters.

(f) The licensee shall provide at least one wash basin for each six children.

(g) The licensee shall provide at least one tub or shower for each six chil-dren. All tubs and showers shall be equipped with a non-slip surface or mat.

(h) The licensee shall have available hot and cold mnmng water for all wash basins, tubs and showers.

(i) The licensee shall pmvide mirrors at convenient heights for use by children.

(j) The licensee shall provide a place for toiletries and for hanging towels and washcloths.

(9) Kitchens and Dinimt Facilities.

(a) Kitchens shall be provided with all necessary equipment for the preparation, storage, serving and clean-up of all meals for all of the l

children and staff regularly served by the facility. All equipment shall be i

maintained in a clean and safe working order.

(b) The licensee shall provide dining areas which are sufficiently large to accommodate in an uncrowded manner tables and chairs for all persons eating.

(c) The licensee sha.1 provide dining areas which are clean, well lighted and ventilated, and attractively furnished.

(d) The licensee shall provide tables and chairs of the type, size and design i

appmpriate to the ages and needs of the children.

(e) The licensee shall provide dining utensils and dishes appropriate to the age and needs of the children.

1. Disposable dinnerware shall not be used on a regular basis unless the 1

facility documents that such dinnerware is necessary to protect the I

health and safety of the children in care.

2. Defective or damaged dishes or utensils shall not be used.

3.07: Applicability of the Regulations (1) 102 CMR 3.00 reflects basic standards for the operation of gmup care facilities. Office for Children licensure shall not relieve facilities of their obligation to comply with any other applicable state or federal statutory or regulatory requirements or requirements set forth in their contracts with the referral sources. Whenever possible, these other statutory regulatory and contractual requirements shall be construed in a manner that is consistent with 102 CMR 3.00.

(2) If any provision contained in 102 CMR 3,00 or the application thereof is held invalid to any person or circumstances the remainder of these regulations and the application of the provision in question to other persons not similarly situmd, or to other circumstances, shall not be affected thereby.

(3) The agency, its corporation, board members and its principal officers and employees shall operate a group care far:ility in a manner which complies with these regulations and their intent.

12/31/86 102 CMR - 40

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102 CMR: OFFICE FOR CHILDREN 3.07: continued REGULATORY AUTHORITY 102 CMR 3.00: M.G.L. c. 28A, s.10.

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