Code of Massachusetts Regulations
606 CMR - DEPARTMENT OF EARLY EDUCATION AND CARE
Title 606 CMR 3.00 - Standards for the Licensure or Approval of Residential Programs Servicing Children and Teen Parents
Section 3.07 - Care of Residents
Universal Citation: 606 MA Code of Regs 606.3
Current through Register 1531, September 27, 2024
(1) Role of Child Care Staff. The licensee shall employ child care staff to implement individual service plans on a daily basis. Child care staff shall assist each resident with all activities of daily living, in accordance with her or his developmental level or mental age. The licensee, program employees and all members of the child care staff shall supervise residents in a manner that protects each resident from any form of abuse and neglect. No program employee, member of the child care staff nor any other person with unsupervised access to residents shall inflict any form of physical, emotional or sexual abuse, or neglect upon a resident while in the program's care and custody. Child care staff shall assist each resident in the development of self help and social skills; positive human relationships, including promoting in each resident a sense of security, belonging, and self-worth; and shall provide emotional support and guidance to residents as appropriate. Programs serving teen parents shall prepare a teen parent for the physical, social, and emotional responsibilities of pregnancy, childbirth, parenthood, and, when appropriate, care and protection of the child.
(2) Staff-child Ratios.
(a) The licensee shall
establish a written description of the staffing of the facility on a 24 hour
per day, seven day per week basis. The staffing plan shall include the
availability of administrative and/or clinical staff on an on-call basis for
those hours when these staff are not present at the facility. The staffing
pattern shall be gender-appropriate. The staffing description must include
provisions for the periods of time when assigned staff are absent due to
illness or vacation.
(b) The
licensee must submit a current staffing schedule.
(c) The licensee shall assure that at all
times a staff person certified in C.P.R. and First Aid is available in the
facility.
(d) The licensee shall
assure a staff-child ratio appropriate to the age, capabilities, needs and
service plans of the residents in the facility, and sufficient to carry out the
requirements of 606 CMR 3.00. Volunteers shall not be included in the
staff-child ratio.
(e) In programs
serving teen parents the licensee shall assure that staffing patterns are
adequate to meet the needs of teen parents who may need assistance and
supervision in learning to care for newborns. The teen parent should be
responsible for providing most of the care of his or her child and staff should
be available as a resource and support.
(f) In transition to independent living
programs and programs serving teen parents, there may be times when it is
appropriate for residents to be in the facility without staff present. The
licensee shall evaluate each resident to determine his or her readiness to be
unsupervised. The licensee shall have a written plan defining the periods of
time residents may be left unsupervised, and the emergency assistance available
when staff are not physically present.
(3) Room Assignment and Programming.
(a) The licensee
shall assure that all room assignments are appropriate, taking into
consideration the ages and needs of residents.
(b) The licensee shall assure that
appropriate programming is provided for each age group served.
(4) Clothing. The licensee shall assure that each resident has adequate, clean, and seasonable clothing as required for health, comfort, and physical well-being and appropriate to age, sex, and individual needs.
(a) The licensee shall not require any
resident to wear a uniform which identifies him or her as a resident of a
particular facility.
(b) Each
resident shall have his or her own clothing for his or her own use. Any
identification on the clothing shall be inconspicuous.
(c) The licensee shall provide residents the
opportunity to participate in selecting their own clothing.
(d) The licensee shall permit each resident
to take his or her clothing upon discharge from the facility.
(e) In programs serving teen parents, the
licensee may lend newborn clothing, provided that it makes clear to teen
parents that the clothing must be returned upon discharge. The licensee shall
assure that both the teen parent and his or her child have adequate clothing
upon discharge.
(5) Grooming and Hygiene.
(a) The licensee shall provide each resident
with grooming and hygiene articles necessary to meet his or her needs. In
programs serving teen parents and in transition to independent living programs,
the licensee may encourage a resident to provide his or her own grooming and
hygiene articles. However, if the resident cannot provide his or her own
grooming and hygiene articles the licensee shall provide the necessary
articles.
1. The provision of such articles
shall not be contingent upon behavior and may not be part of a level or
privilege system.
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 provide each resident
with the opportunity to have a daily shower or tub bath, with due regard for
privacy. The licensee shall give residents assistance or supervision in bathing
when they are unable to perform this function by themselves.
(c) The licensee shall encourage each
resident to brush his/her teeth and provide assistance where needed
(d) The licensee shall assist each resident
in learning grooming practices.
(e)
For each child in care more than 72 hours, the licensee shall make arrangements
for hair cutting in accordance with the wishes of the resident and consistent
with good health.
(f) The licensee
shall bathe or clean children upon soiling, and shall change soiled clothing.
As necessary, the licensee shall conduct a toilet training program for each
child in care more than 72 hours.
(g) In programs serving teen parents, the
licensee shall assist the teen parent with a toilet training program for his or
her child. The teen parent shall be responsible for bathing or cleaning his or
her own child upon soiling and shall change soiled clothing.
(6) Nutrition. Except as provided in 606 CMR 3.07(6)(j):
(a) The licensee shall provide a nourishing
well-balanced diet to all residents. 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 and at times appropriate to the nutritional needs
of each resident, including special dietary needs.
(b) No resident 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
606 CMR
3.06(4)(h).
(c) The licensee shall encourage residents to
eat a well-balanced diet, but no resident shall be force-fed or otherwise
coerced to eat against his or her will except where medically
prescribed.
(d) The licensee shall
serve to residents meals which are substantially the same as those served to
staff unless special dietary needs require differences in diet.
(e) The licensee shall prepare tasteful meals
and shall serve meals appetizingly.
(f) The licensee shall allow residents to eat
at a reasonable, leisurely rate, and shall encourage normal conversation during
meals.
(g) Staff shall be present
and shall assure that each resident receives adequate amounts and variety of
food.
(h) 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.
(i) 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.
(j) In programs serving teen parents and in
transition to independent living programs, the resident may be responsible for
nutritional services. If so, the licensee shall submit a written plan which
describes training provided to residents regarding nutrition, budgeting, menu
planning, shopping, meal preparation, and food storage. Staff shall provide
adequate monitoring and supervision regarding nutrition.
(7) Behavior Support.
(a) Each licensee shall
maintain a written statement defining rules, policies and procedures for
behavior support, which shall include goals for reducing or eliminating the use
of all physical restraint. This statement shall provide for and include a
description of the safeguards for the emotional, physical and psychological
well-being of the population served. This statement shall include measures for
positive responses to appropriate behavior and shall define and explain the use
of behavior support procedures used in the facility including, where
applicable:
1. procedures for measuring a
resident's progress in the program;
2. the type and range of restrictions a staff
member can authorize for misbehavior of residents;
3. the form of physical restraint used, the
range of interventions used as alternatives to restraint (e.g. behavioral,
sensory, recreational, role of family, etc.), including de-escalation
techniques and non-confrontational approaches to angry or aggressive residents,
and controls on misuse and abuse of such restraints;
4. the circumstances under which the program
would restrain a resident;
5. the
name of the restraint coordinator;
6. the procedure for regular review of
restraint data by a restraint safety committee. At a minimum, each licensee
shall analyze restraint data and implementation of corrective measures on a
quarterly basis;
7. the names and
positions of the restraint safety committee;
8. the use of the practice of separating a
resident from a group or program activity;
9. any denial or restrictions of on-grounds
program services.
(b) In
programs serving teen parents, the licensee's policies and procedures for
behavior support shall include acceptable behavior support strategies for a
teen parent to use with his or her child, and shall include:
1. a process for educating teen parents about
behavior support practices;
2.
statements and training prohibiting the practices stated in
606 CMR
3.07(7)(g); and
3. rules outlining the expected behavior of
teen parents.
(c) When
feasible and appropriate, residents shall participate in the establishment of
rules, policies and procedures for behavior support.
(d) Except in cases of emergency admission,
the licensee shall provide residents, 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. In the case of an emergency admission, the
written statement shall be provided to the parents or guardians as soon as
possible after admission.
(e) For
children admitted in emergency circumstances who remain in care more than 72
hours, the licensee shall provide to the child's parents or persons other than
a parent with custody, a copy of the program's written behavior support
statement.
(f) The licensee shall
inform parents, persons other than a parent with custody of the child and
residents of any significant changes in behavior support procedures.
(g) No resident 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 resident to take
an uncomfortable position such as squatting or bending or requiring or forcing
the resident to repeat physical movements, when used as punishment;
3. punishments which subject the resident to
verbal abuse, ridicule or humiliation;
4. denial of visitation or communication
privileges with family, when used as punishment;
5. deni al of suffi ci ent si eep;
6. denial of shelter, bedding, food or
bathroom facilities;
7. extensive
separation from the group.
(h) The licensee shall direct behavior
support to the goal of maximizing the growth and development of the residents
and protecting the group and individuals within it.
(i) The licensee shall directly relate
consequences to the specific misbehavior and shall apply such consequences
without prolonged delay.
(j) Use
of medication restraint and seclusion is prohibited in programs licensed by the
Department. The use of mechanical restraint is prohibited, except in Department
of Youth Services operated and contracted facilities, as it relates to the use
of handcuffs. Prone restraint shall not be used unless the licensee, on an
individual child basis, obtains and maintains documentation in accordance with
606 CMR
3.07(7)(j)15. or in
circumstances where the use of prone restraint is required in an emergency
situation to prevent serious injury to the resident, other residents, and/or
staff.
1. Prior to implementing any
restraint, residents shall be screened for any medical or psychological
contraindications.
a. Physical restraint shall
be considered an emergency procedure of last resort and shall be prohibited in
residential programs except when a resident's behavior poses a threat of
imminent, serious, physical harm to self or others and the resident is not
responsive to verbal directives or other lawful and less intrusive behavior
interventions, or such interventions are deemed to be inappropriate under the
circumstances.
b. If any physical
restraint is deemed necessary, the resident shall be placed in a position that
allows airway access and does not compromise respiration.
2. No resident shall be restrained for
purposes of punishment or for the convenience of others.
3. No resident may be restrained solely for
non-compliance with a program rule, staff directive or expectation.
4. Only staff trained in physical restraint
shall participate in restraining a child.
5. The administrative designee on the
premises shall be notified immediately whenever a physical restraint is
initiated. The designee shall have oversight responsibility of every physical
restraint at the program.
6. Steps
must be initiated to contact the on-call administrative or clinical staff as
soon as possible, but no later than five minutes after the restraint is
initiated.
7. A licensee shall
assure that the form of restraint used is the least intrusive means necessary
to protect the resident, other residents and staff. Any restraint procedure
which includes choke holds, headlocks, full nelsons, half-nelsons, hog-tying or
the use of pressure points to inflict pain is prohibited.
8. If a resident is restrained for a period
longer than 20 minutes, the approval of the chief administrative person or his
or her designee shall be obtained. Such approval shall be based upon the
resident's continued behavior justifying the need for continued
restraint.
9. The physical
condition of a resident who is being restrained shall be constantly monitored,
as defined in
606 CMR 3.02
10. The licensee shall immediately
release a resident who exhibits any sign of significant physical distress
during restraint and shall immediately provide the resident with any needed
medical assistance.
11. A
restrained resident shall be released at the first indication that it is safe
to do so.
12. Within 48 hours,
following the release of a resident from a restraint, the program shall
implement its processing and follow-up procedures.
13. The chief administrator/executive
director, or designee, shall conduct a weekly review of restraint data to
identify any resident that has been restrained multiple times. Any resident who
has been restrained multiple times during the previous week must receive a
review of his or her clinical and behavioral needs by his or her case manager
or clinician. Parents or guardians shall be invited to this review. Changes
made as a result of this review require parental consent and must be documented
in the resident's service plan, as required by
606 CMR
3.05(4) and (5).
14. The licensee shall document all
restraints, including any required administrative approval, and its processing
and follow-up procedures in a physical restraint incident report and keep such
reports in the resident's record.
15. Use of prone restraint shall not be
permitted on any resident, unless the licensee documents and maintains the
following:
a. The license obtained consent, as
defined in
606 CMR
3.02(1), to use prone
restraint, which has been approved in writing by the agency's chief
administrator/ executive director;
b. There is psychological or behavioral
justification for the use of prone restraint with no contraindications, as
documented by a licensed mental health professional;
c. There are no medical contraindications, as
documented by a licensed physician;
d. The resident has a documented history of
repeatedly causing serious self-injuries and/or injuries to other residents or
staff; and
e. All other forms of
physical restraint have failed to ensure the safety of the resident and/or
safety of others.
(k) Any behavior support policy which results
in a resident being separated from the group or program activities shall
include, but not be limited to the following:
1. guidelines for staff in the utilization of
such procedures;
2. persons
responsible for implementing such procedures;
3. the duration of such procedures including
provisions for approval by the chief administrative person or his or her
designee for a period longer than 30 minutes;
4. a requirement that residents shall be
observable at all times and that staff shall be in close proximity at all
times;
5. a procedure for staff to
directly observe the resident at least every 15 minutes;
6. a means of documenting the use of such
procedures if used for a period longer than 30 minutes including, at a minimum,
length of time, reasons for this intervention, who approved the procedure and
who directly observed the resident at least every 15 minutes;
7. a provision that the resident shall be
returned to the group and to regular program activities as soon as his or her
behavior indicates that it is safe to do so.
(l) Any room or space used for the practice
of separation shall not be locked, except as outlined in
606 CMR
3.07(7)(n).
(m) Any room or space used for the practice
of separation must be physically safe, free of hazard and appropriate to the
population served by the facility.
(n) A Department of Youth Services operated
and contracted facility is permitted to use separation or involuntary room
confinement. If the licensee operates a locked secure detention or treatment
program, 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, alternative 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 procedure for
documenting use of the room. Such plan must be submitted to the Department for
approval prior to use of a locked room.
a. A
locked room utilized for the practice of separation or involuntary room
confinement may be used only when necessary to protect the resident, other
residents, or staff from immediate danger of physical harm for population
control, during shift changes and during investigations. Locked rooms must meet
all applicable state and federal regulations.
b. Use of the locked room shall not exceed 15
minutes without consultation with and approval from the chief administrative
person or his or her designee. Such approval shall be necessary for each
following 60 minute period. A staff person shall be in close proximity to the
locked room at all times while a resident is in a locked room, and shall
directly observe the resident at least every 15 minutes, and shall take
appropriate measures to assure the safety of the resident.
(8) Money.
(a) The
licensee shall provide opportunities for residents in care more than 45 days to
develop a sense of the value of money through earning, spending, giving and
saving.
(b) The licensee shall have
a written policy regarding allowances.
(9) Visiting, Mail and Telephones.
(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 resident's growth and development, and protecting the residents,
staff and program from unreasonable and unsafe intrusions.
2. Such policies shall be distributed to
staff and residents, persons other than a parent with custody of the child, and
parents prior to admission, when possible, or within 72 hours after
admission.
(b) The
licensee shall provide opportunities and encourage residents to visit and
otherwise communicate with family and other persons. The licensee shall insure
that visits offer reasonable privacy.
(c) No resident shall be restricted in his or
her opportunities to visit with 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 resident's individual service plan
for therapeutic reasons only.
Such restrictions or denial must be no greater than necessary to achieve the therapeutic purpose. Those persons whose visitation is restricted or denied should receive an explanation from the program as to the reasons therefore.
3. due
to a documented safety risk to residents or staff.
(d) In programs serving teen parents, the
licensee may not prohibit the other parent of a child from visiting unless
there is a court order prohibiting contact, his or her behavior within the
program is disruptive and/or inappropriate, or the resident teen parent does
not wish to have contact with him or her.
(e) The licensee shall establish visiting
hours which meet the needs of the residents and their parents.
(f) The licensee shall formulate procedures
for residents visiting outside the facility, when appropriate, including:
1. A method for recording the location, the
duration of the visit, and the name, address and telephone number of the person
responsible for the resident while absent from the facility;
2. A method for recording the resident's
return and a procedure for action if he or she fails to return.
(g) It shall be each resident's
right to open and send mail unread by staff except in accordance with the
following circumstances:
1. Any restrictions
or censorship must be no greater than necessary to achieve the therapeutic
purpose described in the individual service plan.
2. Mail restricted or censored must be
returned to the sender with reasons therefore.
3. Staff may open and inspect a resident's
mail for contraband only in his or her presence.
(h) Telephone communications may not be
monitored or unreasonably restricted unless there are specific therapeutic
reasons justifying such limitations.
1. Such
therapeutic reasons must be developed in the child and/or teen parent'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
informed.
(i)
Communication with a resident's social worker, attorney, or clergy person may
not be prohibited, restricted or censored.
(10) Runaways. The licensee shall have a written policy for handling runaways and missing residents. The policy shall include:
(a)
procedures for making staff and shelter home parents aware of residents with a
history of running or who show potential for being runaways;
(b) preventive procedures, including
interventions used to prevent or retrieve a resident from running; what dangers
a resident would be exposed to if he or she ran or what danger the resident may
pose to others if he or she ran. The program shall describe how staff would
determine if a danger exists which is sufficient to justify using physical
restraint to prevent the resident from running.
(c) procedures for staff and shelter home
parents to follow in the event that a resident is missing including immediately
informing the chief administrative person or his or her designee;
(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 Elementary and Secondary
Education, when applicable, and the local police.
(11) Search.
(a) If the licensee has a practice of
searching the resident and/or the resident's personal belongings, the licensee
shall maintain a written statement defining the policies, procedures and
circumstances for the search of residents and their personal
belongings.
(b) The licensee shall
provide children a copy of the written search policy within 24 hours of their
admission to the program.
(c) The
licensee shall provide parents or persons other than a parent with custody of
the child, a copy of the written search policy within 72 hours of the child's
admission.
(12) Transportation of Residents. The licensee shall describe in writing its arrangements for transporting residents. Each resident shall be provided with the transportation necessary for implementing his or her service plan. Each program shall have available means of transporting residents in cases of emergency. Whenever the licensee uses agency owned, leased or contracted vehicles or staff vehicles to transport residents, the following regulations shall apply:
(a) Appropriate
supervision with adequate staff-child ratio for transportation must be
maintained.
(b) The operator of any
vehicle shall be licensed in accordance with state laws.
(c) Any vehicle used for transporting
residents shall be registered, inspected and operated in accordance with state
laws.
(d) Vehicles shall be
maintained in a safe operating condition and shall be equipped with a standard
first aid kit.
(e) The licensee
shall not allow the number of residents riding in a vehicle at any time to
exceed the number of seats therein, nor shall such vehicle be in motion until
all the passengers are seated.
(f)
Residents being transported in vehicles other than buses shall be restrained in
appropriate child passenger restraints or safety belts.
(g) No vehicle shall be used to transport
residents 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 |
(h)
The licensee shall ascertain the nature of any need or problem of a resident
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 transport
vehicle.
(i) 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.
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