Code of Massachusetts Regulations
603 CMR - DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION
Title 603 CMR 18.00 - Program and safety standards for approved public or private day and residential special education school programs
Section 18.03 - Requirements for Daily Care

Universal Citation: 603 MA Code of Regs 603.18

Current through Register 1531, September 27, 2024

(1) Supervision of Students.

(a) The school shall at all times provide appropriate supervision of students while they are engaged in any school related activity on or off school grounds.

(b) Each program shall develop and implement a written staffing plan for the employment of childcare workers. This plan shall include but not be limited to:
1. A rationale describing the need for such childcare workers;

2. A detailed description of the duties and responsibilities of such childcare workers;

3. A detailed work schedule for childcare workers, including days and hours worked and the students for whom they will be responsible;

4. A detailed description of how the school will provide childcare services in the absence of childcare workers due to illness, position, vacancy, emergencies, or other unexpected circumstances;

5. A detailed justification of the childcare worker to student ratio requested by the school, including the ages, capabilities, behavioral and educational needs of the students, and other information as may be required due to the respective goals of individual students and/or programs.

(2) Childcare Worker to Student Ratio. The Department may approve a student to childcare worker ratio not lower than 4:1 nor greater than 6:1 during non school day waking hours and not lower than 6:1 nor greater than 8:1 during sleeping hours or an alternative ratio justified by the special education school. The Department shall make the final decision on alternative ratios. In rendering such decisions, the Department will consider but not be limited to the following factors in priority order:

(a) The requirements of IEPs;

(b) The recommendations of the state agency responsible for licensing programs providing residential childcare;

(c) The current approval status of the school;

(d) The most current monitoring data available.

(3) Childcare Worker Staff Development and Training. Each program shall develop and implement with staff input a detailed written plan for staff development and inservice training of all childcare workers. This training plan shall be ongoing in nature and provide for a minimum of two hours of formal training per month and shall include but not be limited to the following:

(a) Procedures for orienting new childcare workers to the role and purpose of the school;

(b) Information and discussion on the nature and needs of the students enrolled in the school;

(c) The role of the childcare worker in the growth and development of students, and the relationship of this work to the IEPs of students;

(d) Procedures to be followed in the event of an emergency;

(e) Basic first aid and emergency training;

(f) Techniques for dealing with disruptive and violent behavior, including skill training on the proper use of non-violent restraint; and

(g) Other topics that may be relevant to the operation of the school or the student population served.

(4) Supervision of Childcare Workers. Each program shall provide ongoing and regular supervision of all childcare workers by a professional staff person who has supervisory and administrative responsibility within the school. Such responsibilities shall include, but are not necessarily limited to:

(a) Regularly scheduled conferences between childcare workers and supervisors to plan and share information relative to the needs of individual students;

(b) Regularly scheduled conferences between teachers, childcare workers and other educational personnel to ensure that there is coordination among all components of an individual student's program;

(c) Regular review and discussion of ongoing case logs.

(5) Clothing, Grooming, and Hygiene.

(a) Clothing. The school shall make provisions with parents or, where appropriate, state agencies to assure that students in the school are provided with adequate, clean, appropriate, fashionable, and seasonable clothing, as required for health and comfort subject to the following conditions:
1. No student shall be required to wear a uniform that identifies the student as a resident of a particular school.

2. Each student shall have his/her clothing identified for personal use, and such identification shall be inconspicuous.

3. For students whose clothing is provided by a state agency, the school shall provide such students the opportunity to participate in the selection of their own clothing.

(b) Grooming and Hygiene. The school shall provide each student with the personal grooming and hygiene articles and materials necessary to meet his/her individual needs. The provision of such articles shall not be contingent upon behavior and may not be part of a level or privilege system.
1. The school shall instruct and assist each student in developing good grooming habits.

2. The school shall provide students with the opportunity to brush their teeth after meals.

3. The school shall conduct a toilet training program for all students who are not toilet trained, unless otherwise indicated in the student's IEP.

4. In addition to the above, residential schools shall:
a. Ensure that the right to personal privacy for each child is protected at all times.

b. Ensure that each student bathes or showers in a private bath or shower frequently enough to maintain proper hygiene. The school shall provide students with assistance and/or supervision in bathing if they are unable to perform this function by themselves.

c. The school shall ensure that each student has his or her own articles necessary for personal grooming and hygiene.

d. The school shall assist each student in learning good grooming practices.

e. The school shall encourage each student to brush his or her teeth at least twice daily.

f. The school shall make arrangements for hair cutting and styling, in accordance with the wishes of the student and parents and consistent with good health practices.

(6) Religious Services. Residential schools shall make available opportunities for students to voluntarily participate in religious services, in accordance with individual preferences.

(7) Food and Nutrition.

(a) The school shall, provide a nourishing well- balanced diet to all students.

(b) Residential schools shall provide at least three meals daily, at reasonably appropriate times, which constitute a nutritionally adequate diet.
1. The school shall prepare and serve meals in a manner and amount appropriate to the nutritional needs of each student, including special dietary needs, consistent with applicable state and federal regulations.

2. No student shall be denied, nor unreasonably delayed, a meal for any reason other than medical prescriptions. Meals shall not be withheld as a form of punishment under any circumstances.

3. The school shall encourage students to eat a well balanced diet, but no student shall be force fed or otherwise coerced to eat against his/her will except where medically prescribed.

4. The school shall serve meals to students which are substantially the same as those served staff, unless age differences or special dietary needs require differences in diet.

5. The school shall allow students to eat at a reasonable, leisurely rate.

6. Staff shall be present to assure that each student receives adequate amounts and variety of food.

(c) Schools that serve meals to students shall prepare written menus for each week and shall maintain copies of menu plans for typical weeks. Staff possessing an understanding of the nutritional needs of students shall develop menus.

(d) Schools shall provide or arrange for nutritional mid-morning snacks for students, where appropriate.

(e) Nutritional Requirements.
1. Schools that serve meals and snacks to students shall provide for one-third to one- half of the daily nutritional needs of children in accordance with the "Food and Nutrition Board, National Academy of Sciences National Research Council Recommended Dietary Allowances" in one regular meal and one or more snacks.

2. Schools shall provide to parents, when appropriate, a written list of nutritional items which should be included in a snack or lunch when parents are required to provide meals and snacks. The school shall have a method for providing a nutritious meal and snack in accordance with this section to a student who should arrive without one or whose parent has provided an inappropriate meal or snack.

(f) Written Plan and Designated Person. The school shall have a written plan which describes the methods for purchase, storage, preparation and serving of food and identifies one person responsible for the food program.

(g) Requirements for Food Preparation, Storage and Services.
1. The school shall store, prepare, and serve all food so that it is clean, wholesome, free from spoilage and safe for human consumption.

2. The school shall provide refrigeration and storage for food at not more than forty-five (45) degrees Fahrenheit for food requiring refrigeration.

3. The school shall store all food in clean, covered containers.

4. The school shall properly wash and sanitize all bottles, utensils, and dishes.

5. The school shall dispose of food, milk or formula unfinished by a student.

6. The school shall prepare tasteful meals and serve them in a manner which makes them appetizing.

(8) Toileting Procedures for Day and Residential Schools.

(a) Written Plan. Schools that enroll students who are incontinent shall have a written plan describing procedures for:
1. Regular toileting and diapering of students;

2. Disposal or laundering of soiled clothing or diapers; and

3. Protecting the personal privacy of all such students.

(b) Toilet Training. The school shall toilet train students requiring such training in accordance with the plan requested by the parents or the IEP for the student and in accordance with the student's physical and emotional abilities.

(c) Diapering Requirements. The school shall change the diapers of students when soiled or wet and wash and dry each student with individual materials during each diaper change.
1. The school shall maintain a supply of clean, dry diapers adequate to meet the needs of the students.

2. The school shall use either a disposable covering on the changing surface which shall be changed after each use, or a surface which can be disinfected properly.

(d) Clothing Requirements. Schools that enroll students who are incontinent shall keep extra clean, dry indoor clothing to change a student's clothing which becomes soiled or wet. The school shall store clothing or diapers which are a potential health hazard in a covered waterproof container unless they can be sanitized immediately after removal from the student.

(9) Visiting, Mail, and Telephones.

(a) Visiting Policy. The school shall have a written policy pertaining to visiting and other forms of communication with family, friends, and others.
1. Such policy shall be developed with the goal of encouraging healthy family relationships, maximizing the individual student's growth and development, and protecting the students, staff, and programs from unreasonable intrusions.

2. Such policy shall be available to students, staff and parents.

3. The school shall provide opportunities and encourage students to visit with parents or siblings unless such visits have been limited by court order or by the student's IEP.

4. The school shall provide opportunities for visits with relatives and friends on the premises, with reasonable privacy, in accordance with the student's IEP.

5. The school shall establish visiting hours which meet the needs of the students and parents.

6. The school shall formulate procedures for students visiting outside the facility, including:
a. A method for recording the student's location, the duration of the visit, and the name and address of the person responsible for the student while absent from the school;

b. A method for recording the student's return, and a procedure for action if a student fails to return.

(b) Mail and Telephone. Written and telephone communication shall not be prohibited. It shall be each student's right to open and send his/her own mail unread by staff, except in accordance with the following circumstances:
1. Such restrictions or censorship must be limited to that which is necessary to achieve the therapeutic purpose outlined in the student's IEP.

2. Mail that is restricted or censored must be returned to the sender with reasons therefore.

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

4. The school shall make available a telephone (pay or free) to students.

5. Telephone communication may not be restricted or monitored unless there are specific therapeutic reasons justifying such limitations.
a. Such therapeutic reasons must be clearly stated in the student's IEP and must be no greater than necessary to achieve the therapeutic purpose.

b. If phone conversations are monitored, the parties to the conversation must be informed.

c. There must be no restrictions or monitoring of conversations between a student and his/her attorney, social worker or clergy person.

(10) Runaways: The school shall have a written policy, including a definition of runaways, appropriate for the school population and location, as well as procedures for handling situations involving students who have run away. These policies must be approved by the Department. All personnel in the school shall be familiar with the procedures for handling these situations and the persons or agencies to be notified. The school shall notify the Department, and the parents or Department of Social Services as appropriate, immediately whenever any student runs away.

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