Rules & Regulations of the State of Tennessee
Title 0250 - Children's Services
Subtitle 0250-04 - Standards for Regulated Institutions
Chapter 0250-04-05 - Standards for Residential Child Caring Agencies
Section 0250-04-05-.07 - CARE OF THE CHILDREN

Universal Citation: TN Comp Rules and Regs 0250-04-05-.07

Current through September 24, 2024

(1) Staff-Child Ratio.

(a) In determining the ratio of staff to children in cottages, the professional and auxiliary staff on duty may be included, if on the premises.

(b) There must be at least one (1) staff member for every eight (8) children in care.

(2) Discipline: Agencies shall develop general Discipline Policy which identifies the type of children served, describes the anticipated behavioral problems of this population, sets forth acceptable methods of dealing with these behaviors, and details the required qualifications and training of staff working with the residents. All consequences of undesirable behavior shall be reasonable and consistent with the service plan for the resident.

(a) All discipline must be reasonable and responsible related to the child's understanding, need, and level of behavior. All discipline shall be limited to the least restrictive appropriate method and administered by appropriately trained staff.

(b) Encouragement and praise of good behavior is often more effective than punishment, and is a must in disciplining a child. The child's acceptance of discipline and his/her ability to profit by it depends largely upon his/her feeling that he/she is liked, accepted, and respected.

(c) Any discipline must be determined on an individual basis and be related to the undesirable behavior. Requiring children to accept the natural consequences of their acts may be a desirable experience provided consequences are not too drastic.

(d) The facility shall have written policies and procedures prohibiting punishment which may adversely affect a child's health, physical, or psychological well being. A copy must be given to all residents, families, staff, and, placing agencies. The following forms of punishment must not be used:
1. Cruel and unusual punishment.

2. Assignment of excessive or inappropriate work.

3. Denial of meals, daily needs and program provided by the individual service plan.

4. Verbal abuse, ridicule or humiliation.

5. Permitting a child to punish another child.

6. Chemical or mechanical restraints.

7. Denial of planned visits, telephone calls, or mail contacts with family.

(e) If corporal punishment is permitted under the Agency's policies, the Agency must have the written consent of the child's parent, guardian, or other legal custodian before administering such corporal punishment.

(3) Physical Control and Isolation.

(a) All agencies using physical control techniques must have written policies defining the method of control, identifying persons used in implementing these methods, and establishing the training required for such persons. These policies must require:
1. Use of two fully qualified staff.

2. Immediate notice to supervisor.

3. A written report to the administrator.

4. A review process for use of the facility's Executive Committee which must also be available to licensing staff.

(b) If isolation from others in a time out room is used as a control measure, written policies must set forth the parameters of this measure.
1. The facility must keep a record of each isolation incident, provide for direct supervision every 15 minutes and limit the time to a maximum of 30 minutes for children 7 to 11 years of age and a maximum of one hour for children over 12 years of age. Any additional times required shall be approved by the executive director, but in no event shall it exceed two hours. Time-out rooms must not be locked.

(4) Abuse of Children.

(a) All public and private agencies must have written policy which establishes internal controls for the prevention and detection of abuse or neglect of children.

(b) All public and private agencies must have written policies and procedures for reporting incidents of abuse or neglect of children. These policies should clearly set forth the roles and responsibilities of all parties involved in both the reporting and investigative process.

(5) Exploitation. Any agency must not engage in practices which exploit the rights of children. Children shall not be identified in connection with publicity for the agency unless a positive value accrues for the child.

(6) Health

(a) Physical Examinations
1. Children must have had a physical exam at least six (6) months prior to placement or within five (5) working days after placement.

2. Children must receive physical assessments at the following intervals:

(i) 5 to 6 yearsevery twelve months
(ii) Six years and aboveevery three years.

(b) Dental Care. The teeth of each child must be examined annually and any indicated correction of defects of the teeth and mouth be initiated. The same care applies to both permanent and temporary teeth.

(c) Immunizations
1. The following immunizations (unless there is a medical reason to the contrary, certified by the child's physician) shall be begun before admission and must be completed within six (6) months, Diphtheria, Whooping Cough, (for children under 7 years of age), Tetanus, Polio, Measles, Rubella, Mumps, others recommended by the physician.

2. The home must have a written record of the above information. (Refer to Emergency Shelter Care for exception).

(d) Illness
1. Doctor's orders must be observed during the course of an illness.

2. Regulation of visits, sanitation of dishes and utensils, and good personal hygiene must be observed as the nature of the illness warrants.

3. In case of death or life threatening illness or injury notify legal guardian and state licensing immediately.

(e) Medications
1. All medications including over the counter drugs, attitude manipulators, tranquilizers, legend pain killers, barbiturates, or amphetamines, must be safeguarded by a double entry medication system whereby each medication is recorded as it comes into the agency. Administration of all medications must be documented. Medications must be double-locked within the agency.

2. The agency must not have psychotrophic drugs as stock items. Such drugs must be individually prescribed and kept in the original containers with the name of the patient , drug, dosage, frequency of administration and prescription number unless filled directly by the physician.

3. Other prescribed medication may not be administered without a specific order or standing order from a licensed physician.

(f) First-Aid Supplies. First aid supplies must be kept on hand but secured out of reach of children.

(7) Education and Religion.

(a) All children in residence must be in compliance with Tennessee state law on compulsory school attendance.

(b) Certain handicapped children may require specialized training suitable to their needs. If so, this must be provided.

(c) If it is not possible on the part of the agency's program for the children to attend public school, the school within the institution must conform both as to program and physical set-up with standards set by the Tennessee Department of Education. This also applies to special education classes or remedial work provided by the home.

(d) The atmosphere prevailing in the home must be such as to foster the spiritual growth of the child in his daily living.

(8) Nutrition.

(a) Food of adequate quality and quantity must be served and meet the child's dietary allowances as recommended by USDA. (Refer to Appendix D for further requirements.)

(b) Three meals and snacks must be provided daily (Refer to Appendix D) with no more than a fourteen- hour span between a substantial evening meal and breakfast of the following day.

(c) All special diets must be prepared as prescribed by the physician or recommended by a dietician.

(d) Denial of a nutritionally adequate diet must not be used as punishment.

(e) Menus
1. Menus for the week must be prepared in advance. These menus must be followed and must be varied from week to week.

2. Menus must be kept on file for a period of one month.

(9) Recreation. There must be a planned program of recreation for all children in care.

(a) Outdoor activity areas:
1. Must protect small children from traffic hazards.

2. Must provide appropriate recreational materials and supplies.

Authority: T.C.A. §§ 4-5-226(b)(2);14-10-104, 37-1-603; 37-1-612; 37-5-101; 37-5-105; 37-5-106 and 37-5-112(a).

Disclaimer: These regulations may not be the most recent version. Tennessee 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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