Florida Administrative Code
65 - DEPARTMENT OF CHILDREN AND FAMILIES
65E - Mental Health Program
Chapter 65E-9 - LICENSURE OF RESIDENTIAL TREATMENT CENTERS
Section 65E-9.006 - Program Standards
Universal Citation: FL Admin Code R 65E-9.006
Current through Reg. 50, No. 187; September 24, 2024
(1) Additional standards for therapeutic group homes. The primary mission of the therapeutic group home is to provide treatment of serious emotional disturbance. Distinguishing features of a therapeutic group home include the following:
(a) Meets the requirements of a single-family
unit or community residential home as defined in chapter 419, F.S.; the home is
a non-secure or unlocked facility;
(b) The use of mechanical restraint or drugs
used as restraint is prohibited;
(c) If physical restraint is used, the
following conditions shall be met:
1. Physical
restraint must be applied only during potential emergency or crisis situations
for no more than 30 minutes;
2. If
the use of physical restraint is required during the child's stay, the
treatment team shall formally review the child's treatment plan, at least
monthly, and revise at the time of the review if determined necessary, to
actively address and eliminate its use. As part of its review, the treatment
team will determine whether implementation of an individual behavior plan is
necessary, considering such factors as the frequency and duration of the
physical restraint incidents and the age and cognitive ability of the child;
and
3. The guidelines in rule
65E-9.013, F.A.C., related to
physical restraint shall be met in addition to those listed
above.
(d) The use of
seclusion is prohibited. If time-out is used, the provider shall comply with
the procedures outlined in subsection
65E-9.013(11),
F.A.C.;
(e) Children or adolescents
must be medically stable;
(f)
Children or adolescents being served attend school in the community and engage
in community recreational and social activities;
(g) Treatment plan includes treatment and
support services, goals and objectives designed to enable children being served
to transition to a less restrictive level of care or be reunited with their
family; and
(h) Treatment and other
mental health services are provided in a family-like setting, and the provider
may employ professional parents to staff the home.
(2) Collocation.
(a) Upon written approval of the Department
and the Agency, a provider may collocate other programs with programs serving
children admitted under chapter 394 or section
39.407, F.S.
(b) The collocated programs may share
administration and facility services, such as housekeeping, food preparation,
and maintenance.
(c) Children
admitted to these other programs shall be separated from the other children by
staff supervision and shall not co-mingle or share a common space at the same
time.
(3) Treatment and services.
(a) Treatment shall be
individualized, child and family centered, culturally competent, and based on
the child's assessed strengths, needs, and presenting problems that
precipitated admission to the program.
(b) Treatment services shall be provided as
part of an individualized written treatment, plan that complies with rule
65E-9.009, F.A.C., of this
chapter.
(c) Treatment modalities
and services shall be in accordance with the child's psychiatric, behavioral,
emotional and social needs and be incorporated into their individualized
treatment plan and discharge plan.
(d) The provider shall ensure that all staff
caring for or providing treatment or services for the child:
1. Have current information about the child's
treatment plan and goals, including the child's permanency goals if admitted
pursuant to section 39.407, F.S.; and
2. Direct all aspects of the child's
treatment, services and daily activities toward meeting the child's specific
treatment goals.
(e) The
provider shall ensure that all staff providing a treatment modality to the
child are qualified to provide that treatment modality.
(f) Discussions are held on an on-going basis
with the individuals involved in implementing treatment.
(g) Treatment shall not be aversive,
coercive, or experimental.
(h)
Treatment provided, including behavior analysis services, shall be consistent
with nationally recognized standards.
(i) When multiple modalities of treatment are
provided, such as psychotherapy, behavior management, and medication, the
treatment shall be coordinated among the treatment professionals.
(j) Treatment progress shall be monitored on
a continuous basis and the treatment adjusted as needed to meet the child's
individual treatment goals.
(4) Activities.
(a) Basic routines shall be outlined in
writing and made available to staff and children on a continuing
basis.
(b) The daily program shall
be planned to provide a framework for daily living and periodically reviewed
and revised as the needs of the individual child or the living group
change.
(c) Daily routines shall be
adjusted as needed to meet special requirements of the child's treatment
plan.
(d) The facility shall have a
written plan for a range of age-appropriate indoor and outdoor recreational and
leisure activities provided for children, including activities for evenings and
weekends. Such activities shall be based on the group and individual interests
and developmental needs of the children in care.
(e) Books, magazines, newspapers, arts and
crafts materials, radios and televisions shall be available in accordance with
children's recreational, cultural and educational backgrounds and
needs.
(f) Provisions shall be made
for each child to have daily time for privacy and pursuit of individual
interests.
(g) The facility shall
have a written policy addressing the involvement of children in community
activities and services, which includes how the appropriate level of community
involvement is determined for each child.
(5) Education. The provider shall arrange for or provide an educational program for children, that complies with the State Board of Education, rule 6A-6.0361, F.A.C., effective date 2-18-93, hereby incorporated by reference.
(6) Food and nutrition.
(a) If the provider serves meals to staff
members, they shall serve staff and children substantially the same food,
except when age or special dietary requirements dictate differences.
(b) The provider shall serve three
well-balanced meals a day in the morning, noon, and evening and provide snacks.
If a child is admitted between meals, snacks will be provided. When children
are attending school or are not present in the facility during mealtime, the
provider shall make arrangements for the children's meals.
(c) The provider shall retain menus, with
substitutions, for a 12-month period, which shall be available for review.
Menus shall be posted 24 hours before serving of the meal. Any change shall be
noted. Menus shall be evaluated by a consultant dietitian for nutritional
adequacy at least annually. The provider shall maintain records of the
dietician's reviews.
(d) The
provider shall plan and prepare special diets as needed (e.g., diabetic, bland,
high calorie). No more than fourteen hours shall elapse between the end of the
evening meal and the beginning of the morning meal where a protein is served.
Meals shall meet general requirements for nutrition published by the department
or currently found in the Recommended Daily Diet Allowances, Food and Nutrition
Board; or by the Florida Dietetic Association.
(7) Health, medical, and emergency medical and psychiatric services.
(a) The provider
shall develop and implement on an ongoing basis written procedures for health,
medical, and emergency medical and psychiatric services describing how the
provider obtains or provides general and specialized medical, psychiatric,
nursing, pharmaceutical and dental services.
(b) The procedure shall clearly specify which
staff are available and authorized to provide necessary emergency psychiatric
or medical care, or to arrange for referral or transfer to another facility
including ambulance arrangements, when necessary. The procedure shall include:
1. Handling and reporting of emergencies.
Such procedures shall be reviewed at least yearly by all staff and updated as
needed;
2. Obtaining emergency
diagnoses and treatment of dental problems;
3. Facilitating emergency hospitalization in
a licensed medical facility;
4.
Providing emergency medical and psychiatric care; and
5. Notifying and obtaining consent from the
parent or legal guardian in emergency situations. This procedure shall be
discussed with the child's parent or guardian upon admission. The discussion
shall be documented in the child's file.
(c) The provider shall have a staff member on
duty at all times, when children are present in the facility, who is trained
and currently certified to administer first aid and CPR.
(d) The provider shall immediately notify the
child's parent or guardian and the placing organization or the department of
any serious illness, any incident involving serious bodily injury, or any
severe psychiatric episode requiring the hospitalization of a child.
(e) The provider shall have available, either
within the provider organization or by written agreement with health care
providers, a full range of services for treatment of illnesses and maintenance
of general health. Agreements shall include provisions for on-site visits,
office visits, and hospitalization.
(f) Children who are physically ill shall be
cared for in surroundings familiar to them, if medically feasible, as
determined by a physician. If medical isolation is necessary, it shall be
provided. There shall be a sufficient number of qualified staff available to
give care and attention within a setting designed for such care.
(g) A complete physical examination shall be
provided for each child in the provider's care every 12 months and more
frequently, if indicated.
(h)
Immunization of all children shall be kept current in accordance with the
American Academy of Pediatrics guidelines.
(i) Each staff member shall be required to
report to the program's physician and note in the child's record any illnesses
or marked physical dysfunction of the child.
(j) All staff shall have training in the
handling of emergency medical situations.
(k) Emergency medical services shall be
available within 45 minutes, 24 hours a day, seven days a week.
(l) The program physician's name and
telephone number shall be clearly posted in areas accessible by staff and
others within the facility.
(m)
There shall be a first aid kit available to staff for each unit or building for
facilities with multiple units or buildings and one per facility for single
unit or building facilities. Contents of the first-aid kits shall be selected
by the medical staff.
(n) The
provider shall have a written agreement with a licensed hospital verifying that
routine and emergency hospitalization will be available.
(8) Administration of medication.
(a) Pharmaceutical services, if provided,
shall be maintained and delivered as described in the applicable sections of
chapters 465 and 893, F.S., and the Board of Pharmacy rules.
(b) All medicines and drugs shall be kept in
a double locked location. Prescription medications shall be prescribed only by
a duly licensed physician or an ARNP or physician's assistant working under the
direction of a licensed physician.
(c) An accurate log shall be kept of the
administration of all medication including the following:
1. Name of the child for whom it is
prescribed;
2. Physician's name,
and reason for medication;
3.
Quantity of medication in container when received;
4. Method of administration of medication
(i.e., orally, topically, or injected);
5. Amount and dosage of medication
administered;
6. Time of day and
date medication is to be administered or self-administered and time of day and
date medication was taken by the child; and
7. Signature of staff member who administered
or supervised self-administration of the medication.
(d) The provider shall not permit medication
prescribed for one child to be given to another child.
(e) Children capable of self-medication shall
be supervised by a staff person who has been trained in medication
supervision.
(f) For children not
capable of self-medication, only a licensed nurse or unlicensed staff who has
received training as required by this rule shall administer
medications.
(9) Religious and ethnic heritage. The provider shall offer opportunities for children to participate in religious services and other religious and ethnic activities within the framework of their individual and family interests, treatment modality and provider setting. The option to celebrate holidays in the child's traditional manner shall be provided and encouraged.
(10) Interpreters, translators and language options. The provider shall establish procedures for identifying and assessing the language needs of each child and providing:
(a) A range of oral and written language
assistance options, including American Sign Language;
(b) Written materials in languages that are
spoken by the child other than English; and
(c) Oral language interpretation for children
identified with limited English proficiency.
(11) Clothing and personal needs.
(a) The provider shall complete a written
inventory of personal belongings of each child upon admission and account for
all personal belongings upon discharge. This written inventory shall be
maintained in the child's case file and a copy given to the parent or guardian
at admission and discharge.
(b) The
provider shall ensure each child has individual personal hygiene and grooming
items readily available and has training in personal care, hygiene, and
grooming appropriate to the child's age, gender, race, culture and
development.
(c) The provider shall
involve the child in the selection, care and maintenance of personal clothing
as appropriate to the child's age and ability. Clothing shall be maintained in
good repair, sized to fit the child and suited to the climate and
season.
(d) The provider shall
allow a child to possess personal belongings. The provider may limit or
supervise the use of these items while the child is in care.
(e) When needed, protection from the weather
or insects shall be provided, such as rain gear and insect repellent.
(f) The provider shall return all of the
child's personal clothing and belongings to the parent or guardian when the
child is discharged from the facility.
(12) Child's record.
(a) The provider shall have written
procedures regarding children's records, including provisions to ensure that
clinical records are maintained in accordance with section
394.4615, F.S.
(b) The provider shall develop an
individualized record for each child. The form and detail of the records may
vary but shall, at a minimum, include:
1.
Identification and contact information, including the child's name, date of
birth, Social Security number, gender, race, school and grade, date of
admission, and the parent or guardian's name, address, home and work telephone
numbers;
2. Source of
referral;
3. Reason for referral to
residential treatment, e.g., chief complaint, presenting problem(s);
4. Record of the complete
assessment;
5. DSM
diagnosis;
6. Treatment
plan;
7. Medication
history;
8. Record of medication
administered by program staff, including type of medication, dosages, frequency
of administration, persons who administered each dose, and method of
administration;
9. Documentation of
course of treatment and all evaluations and examinations, including those from
other facilities, such as emergency rooms or general hospitals;
10. Progress notes;
11. Treatment summaries;
12. Consultation reports;
13. Informed consent forms;
14. A chronological listing of previous
placements, including the dates of admission and discharge, and dependency and
delinquency actions affecting the minor's legal status;
15. Written individual education plan for the
child, when applicable;
16. The
discharge summary, which shall include the initial diagnosis, clinical summary,
treatment outcomes, assessment of child's treatment needs at discharge, the
name, address and phone number of the person to whom the child was discharged
and follow-up plans. In the event of death, a summary shall be added to the
record and shall include circumstances leading to the death. All discharge
summaries shall be signed by the clinical or medical director;
17. For out of state children, copies of
completed interstate compact ICPC 100A and ICPC 100B forms (February 2002) and
a copy of each Interstate Compact Transmittal Memorandum and any attachments
thereto that were sent to the Residential Treatment Center by the department's
Interstate Compact on the Placement of Children Office;
18. Documentation of any use of restraint,
seclusion or time out;
19. A copy
of each incident report that includes a clear description of each incident; the
time, place, and names of individuals involved; witnesses; nature of injuries,
if any; cause, if known; action(s) taken; a description of medical services
provided, if any; by whom such services were provided; and any steps taken to
prevent a recurrence. Incident reports shall be completed by the individual
having first hand knowledge of the incident, including paid and volunteer
staff, emergency or temporary staff, and student interns; and
20. Documentation that all of the various
notices and copies required by these rules were properly
given.
(c) Records of
discharged children shall be completed within 15 business days following
discharge.
(d) Recording. Entries
in the child's record shall be made by staff having pertinent information
regarding the child. Staff shall legibly sign and date each entry. Symbols and
abbreviations shall be used only when there is an explanatory notation. Final
diagnosis, both psychiatric and physical, shall be recorded in full without the
use of symbols or abbreviations.
(e) Maintenance of records.
1. Each provider shall maintain a master
filing system, including a comprehensive record of each child's involvement in
the program.
2. Records for
children currently receiving services shall be kept in the unit where the child
is being treated or be directly and readily accessible to the clinical staff
caring for the child.
3. The
program shall maintain a system of identification and coding to facilitate
prompt location and ongoing updating of the child's clinical records.
4. Records may be removed from the program's
jurisdiction and safekeeping only as required by law or rule.
5. The provider shall establish procedures
regarding the storage, disposal, or destruction of clinical records, which are
compatible with the protection of rights.
6. Records for each child shall be kept for
at least five years after discharge.
7. The provider shall maintain a permanent
admission and discharge register of all children served, including name of the
child, the child's parent or guardian, address, date of admission and
discharge, child''s date of birth, custody status, person to which the child
was discharged, and address to which discharged.
(13) Quality assurance program. The provider shall develop and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its performance, ensuring compliance with standards, and disseminating results. The quality assurance program shall address and include:
(a) Appropriateness of service assignment,
intensity and duration, appropriateness of resources utilized, and adequacy and
clinical soundness of care and treatment given;
(b) Utilization review;
(c) Identification of current and potential
problems in service delivery and strategies for addressing the
problems;
(d) A written system for
quality improvement, approved by the provider's governing board that includes:
1. A written delineation of responsibilities
for key staff;
2. A policy for peer
reviews;
3. A confidentiality
policy complying with all statutory confidentiality requirements, state and
federal; and
4. Written, measurable
criteria and norms assessing, evaluating, and monitoring quality of care and
treatment.
(e) A
description of the methods used for identifying and analyzing problems,
determining priorities for investigation, resolving problems, and monitoring to
assure desired results are achieved and sustained;
(f) A systematic process to collect and
analyze data from reports, including, but not limited to, incident reports,
grievance reports, department and agency monitoring or inspection reports and
self-inspection reports;
(g) A
systematic process to collect and analyze data on process outcomes, client
outcomes, priority issues chosen for improvement, and satisfaction of
clients;
(h) A process to establish
the level of performance, priorities for improvement, and actions to improve
performance;
(i) A process to
incorporate quality assurance activities in existing programs, processes and
procedures;
(j) A process for
collecting and analyzing data on the use of restraint and seclusion to monitor
and improve performance in preventing situations that involve risks to children
and staff. The provider shall:
1. Collect and
regularly analyze, at least quarterly, restraint and seclusion data to
ascertain that restraint and seclusion are used only as emergency
interventions, to identify opportunities for reducing the rate and improving
the safety of restraint and seclusion use, and to identify any need to redesign
procedures;
2. Aggregate quarterly
restraint and seclusion data by all settings, units or locations, including:
a. Shift;
b. Staff who initiated the
procedure;
c. Details of the
interactions prior to the event;
d.
Details of the interactions during the event;
e. The duration of each episode;
f. Details of the interactions immediately
following the event;
g. Date and
time each episode was initiated and concluded;
h. Day of the week each episode was
initiated;
i. The type of restraint
used;
j. Whether injuries were
sustained by the child or staff; and
k. Age and gender of each child for which
emergency safety interventions had been found necessary.
3. Prepare and submit a report quarterly to
the district/region mental health program office, including the aggregate data
and:
a. Number and duration of each instance
of restraint or seclusion experienced by a child within a 12-hour
timeframe;
b. The number of
instances of restraint or seclusion experienced by each child; and
c. Use of psychoactive medications as an
alternative for or to enable discontinuation of restraint or
seclusion.
(k)
Analysis of the use of time-out shall be conducted quarterly by the treatment
team and shall include:
1. Patterns and
trends, for example, by shift, staff present, or day of the week;
2. Multiple instances of time-out within a
12-hour timeframe;
3. Number of
episodes per child; and
4.
Instances of extending time-out beyond 30
minutes.
Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS.
New 7-25-06, Amended 9-24-08.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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