STATE OF CONNECTICUT
Department of Children and Families
SUBJECT MATTER OF REGULATION
Residential Child Care Facilities
Section 1. The Regulations of Connecticut State Agencies are amended by adding new sections 17a-145-161 to 17a-145-241, inclusive, as follows:
(NEW) Section 17a-145-161. Scope of Regulations
Sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies establish the standards and practices required of residential child care facilities. Reflected in these regulations is the philosophy that every aspect of a facility’s operation affects the residents in its care.
(NEW) Section 17a-145-162. Definitions
As used in sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies:
(1) “Applicant” means a person or entity that has completed, signed and submitted an application to the department to obtain or renew a residential child care facility license;
(2) “Chief administrative officer” means the person responsible for the day-to-day operation of a facility;
(3) “Commissioner” means the commissioner of the Department of Children and Families;
(4) “Corrective action plan” means a written plan that sets out steps that shall be taken by a facility to remediate deficiencies in, or noncompliance with, the standards set forth in the section 17a-145 of the general statutes and sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies, as identified by the department;
(5) “Department” means the Department of Children and Families;
(6) “Group home” means a facility that meets long-term community-based placement needs during which the facility attempts to transition the resident toward reunification with family, independent living or long-term foster care. Clinical and medical services are generally provided on an outpatient basis and educational services are provided by attendance in public or private school programs arranged by the resident’s school district;
(7) “Incident” means an atypical event or occurrence that may jeopardize the health, safety, treatment or care of residents, including but not limited to, the following: injury, illness, death, restraint, seclusion, harassment or any unauthorized absence;
(8) “License” means a document issued by the department to a person or entity that the department has determined to be in compliance with sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies authorizing such person or entity to operate a residential child care facility. A “Licensee” means the holder of a license;
(9) “Limitation” means an involuntary restriction to a license issued by the department. Restrictions include, but are not limited to: a reduction in the licensed bed capacity, a suspension of admissions, a change in the age range of the residents served by the facility, or a change in the population of residents appropriate for admission to the facility;
(10) “Provisional license” means a temporary permit to operate a facility that is not able to fully comply with the provisions of sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies but which will be able to achieve full compliance with minimal efforts;
(11) “Psychiatric residential treatment facility” means a facility that meets the requirements of sections 441.151 to 441.182, inclusive, of the Code of Federal Regulations;
(12) “Related party” means persons or organizations related to the facility or its principals through marriage; ability to control, directly or indirectly; ownership; family; or business association;
(13) “Resident” means any person in placement at a residential child care facility who is eighteen (18) years of age, or under twenty-one (21) years of age and in full-time attendance in a secondary school, a technical school, a college or a state-accredited job training program, and who is not related to the owner of the facility;
(14) “Residential child care facility” or “facility” means a congregate residential setting licensed by the Department of Children and Families for the out-of-home placement of children or youths under eighteen (18) years of age, or under twenty-one (21) years of age and in full-time attendance in a secondary school, a technical school, a college or state accredited job training program and who was placed in a congregate residential setting prior to such person's eighteenth (18th) birthday. Residential child care facilities include residential treatment centers, psychiatric residential treatment facilities, group homes, residential education facilities and temporary shelters;
(15) “Residential education facility” means a facility that provides for the long-term housing needs of students who are participating in a residential special education program. Educational services are provided on site in a program that is approved by the state Department of Education as a special education program. Limited medical services are provided by the facility by nursing and child care staff. Such facilities are designed to meet the long-term educational needs of the students;
(16) “Residential treatment center” means a facility that meets long-term placement needs and provides clinical treatment of psychiatric, behavioral and emotional disorders. Clinical treatment is provided on site in a therapeutic setting. Limited medical services are provided by the facility by nursing and child care staff. All other medical care is provided by hospitals or community- based medical professionals. Educational services are provided by the facility whenever required in accordance with procedures developed jointly by the department and the state Department of Education;
(17) “Suspension of admission” means a temporary restriction which prohibits the facility from admitting additional residents;
(18) “Summary suspension of a license” means the immediate cessation of the authority granted under a license pending proceedings for revocation or other licensure action;
(19) “Temporary shelter” means a facility that meets short-term placement needs during which the facility attempts to stabilize, assess and prepare the resident for a more permanent placement. Clinical and medical services are provided on an outpatient basis and educational services are provided by short-term in-house tutoring or attendance in public or private school programs arranged by the resident’s school district; and
(20) “Unplanned discharge” means the release of a resident from a facility on a date earlier than the date stated in the resident’s treatment plan.
(NEW) Section 17a-145-163. Length and Term of License
(a) No facility shall board or care for a resident without a license from the department.
(b) A license shall be issued for a period not to exceed twenty-four (24) months.
(c) In addition to the requirements of sections 17a-145-1 to 17a-145-241 of the Regulations of Connecticut State Agencies, residential child care facilities that are identified as psychiatric residential treatment facilities shall be reviewed every two (2) years for compliance with Code of Federal Regulations sections 441.151 through 441.182 inclusive.
(NEW) Section 17a-145-164. Achieving Compliance with Legal Requirements
(a) In the event that a facility is found to be in non-compliance with any applicable federal, state and local statutes, regulations and ordinances, the department shall identify in writing the non-compliance and the sections of the federal, state and local statutes, regulations and ordinances with which such facility is not in compliance.
(b) The facility shall be given no more than thirty (30) calendar days to either show compliance with the applicable federal, state and local statutes, regulations and ordinances or to submit a written corrective action plan for approval by the commissioner or designee, except as provided in subsections (d) and (e) of this section.
(c) If the facility fails or refuses to submit a corrective action plan within the time requested by the commissioner or designee, the facility license shall be revoked, limited, suspended or its renewal refused pursuant to subsection (b) of section 17a-145-174 of the Regulations of Connecticut State Agencies.
(d) The commissioner or designee shall not be required to request that a facility submit a corrective action plan if the non-compliance creates an imminent threat to the health, safety or well being of residents residing in the facility.
(e) The commissioner or designee shall not be required to request that a facility submit a corrective action plan if the nature or severity of the non-compliance is such that the commissioner or designee determine that compliance is not achievable within a reasonable time period or would require such involvement by the department that the relative cost/benefit would be fiscally imprudent on the part of the department. The department shall document such instances when the opportunity to submit a corrective action plan is not granted.
(f) If the department does not accept the submission of a corrective action plan pursuant to subsections (d) and (e) of this section, the department shall provide the facility with documentation of the nature of the non-compliance and the reasons for the department’s action. The department shall promptly institute proceedings for revocation or non-renewal of such license.
(NEW) Section 17a-145-165. Display of License
The facility to which a license has been granted by the commissioner for the care or board of residents shall publicly display the license on its premises and show it, upon request, to any person or organization seeking to place a prospective resident.
(NEW) Section 17a-145-166. Access of Commissioner or Designee to Premises
Each license shall be conditioned on the granting to the commissioner or designee unrestricted access to the premises described on the license, and all documentation, records and residents, at any reasonable time as deemed necessary by the commissioner or designee. In cases of suspected child abuse or neglect or emergency conditions affecting the health, safety or well being of any resident, the department shall have unrestricted access at any time without prior notice.
(NEW) Section 17a-145-167. Interstate Placement of Prospective Residents
Facilities shall comply with state statutes and regulations regarding the interstate placement of prospective residents prior to accepting placement of a prospective resident from out of state.
(NEW) Section 17a-145-168. Consultation with Licensee
Except as provided in section 17a-145-176 of the Regulations of Connecticut State Agencies, the department may provide technical consultation to the licensee to help achieve compliance with these regulations. Technical consultation may be requested by the applicant or licensee or offered by the department.
(NEW) Section 17a-145-169. Issuance of License; License Not transferable or Assignable
A license shall be issued only to the facility for which application is made and only for the address shown on the application and shall not be transferable or assignable.
(NEW) Section 17a-145-170. Waiver of Requirements
(a) A facility shall comply with all relevant regulations unless the commissioner or designee has granted a waiver for a specific requirement of a provision.
(b) A waiver shall be granted only when the commissioner or designee has determined that the waiver will not adversely affect the health or safety of the residents served by the facility and that the intent of the provision(s) to be waived will be satisfactorily achieved in a manner other than that prescribed by the provision(s).
(c) No waiver shall be granted for the requirements of sections 17a-145-173, 17a-145-175, 17a-145-191, 17a-145-216, 17a-145-220, 17a-145-239, 17a-145-240, or 17a-145-241 of the Regulations of Connecticut State Agencies..
(d) The applicant or licensee shall submit to the department a written request for a waiver, together with evidence supporting the request. This request shall specify the particular requirement(s) to be waived, the duration of the waiver, and the terms under which the waiver is requested.
(e) Within thirty (30) calendar days of receipt of a request for a waiver, the department shall notify the applicant or licensee, in writing, whether the request has been approved, approved with modifications or denied and, if approved, shall prepare a waiver agreement that contains the details of the waiver.
(f) If the facility fails to comply with the waiver agreement in any particular, the agreement shall be subject to immediate termination and licensing action if applicable.
(NEW) Section 17a-145-171. Application and Renewal Procedures
(a) A facility shall submit an application for initial licensure to operate a facility and for renewal of a license. Applications shall be submitted on department-approved forms and with supportive documents attached which shall include, but not be limited to, the following:
(1) copies of articles of incorporation, and the most recently adopted corporate by-laws;
(2) a roster of the current governing board, including a listing of all officers, their terms of office and home or business addresses;
(3) a copy of the annual audit for the fiscal year ending prior to submitting application or renewal application;
(4) a copy of zoning approval for any new programs or changes in existing programs that affect zoning or evidence that such program is permitted under section 8-3e of the Connecticut General Statutes;
(5) a copy of local or state fire marshal approval;
(6) a copy of health and sanitation approval by the state or local departments of health;
(7) a copy of annual well water testing results for programs served by well water;
(8) a copy of the physical plant floor plan, describing the utilization of space, including square footage of bedrooms;
(9) a staff list with job titles and functions;
(10) on initial application, a copy of all policies required by §17a-145-183 of the Regulations of Connecticut State Agencies, or, if the application is for a renewal of a license, a copy of any changes to its policies; and
(11) a copy of the certification from the state Department of Education for any facility operating a special education school.
(b) The department may request any additional documentation deemed necessary to process a license application.
(c) An application for initial licensure shall include a current Certificate of Inspection or Use and Occupancy issued by the state or local building inspector.
(d) An applicant for initial licensure shall show proof of compliance with the relevant statutes and regulations related to the Department of Public Health's Office of HealthCare Access (OHCA).
(e) An applicant for initial licensure or renewal shall prepare and submit a budget which demonstrates the applicant’s ability to carry out the stated purpose of the facility. The applicant shall identify all sources of income, and demonstrate the ability to operate the facility as a going concern.
(f) An applicant for initial licensure or renewal shall attest that no employee is in violation of the requirements of subsections (b) or (c) of section 17a-145-175 of the Regulations of Connecticut State Agencies.
(g) Whenever a facility proposes to change the location, licensed bed capacity, age of residents served or the population served, or proposes to change any other term or condition of its license, the facility shall submit a new license application to the commissioner prior to instituting the proposed change. The commissioner shall notify the chief executive officer of the municipality in which the facility is located of such new license application prior to making a final decision, except that no confidential resident information shall be disclosed.
(h) Prior to initial licensure each facility shall be inspected and determined to be lead- and radon-safe. Such inspections shall be conducted by individuals certified by the state Department of Public Health, and shall follow state Department of Public Health guidelines.
(i)Health and sanitation approval by the state and local departments of health, safety approval by the state and local fire marshals, certificate of occupancy, and zoning approval are prerequisites to licensing upon initial application. State, or at the discretion of the commissioner, local fire marshal and health inspections and approvals shall be required for renewal of a license.
(j) The department, at its discretion, may issue a provisional license for a period not to exceed sixty (60) days to an applicant for a facility license that is not able to fully comply with the provisions of sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies, but which shall be able to achieve full compliance with minimal efforts. Provisional licenses shall be issued for additional periods of up to sixty (60) days if the applicant demonstrates substantial progress towards full compliance. However, in no event shall the total period of time an applicant operates a facility under provisional licenses be longer than one (1) year. A provisional license shall only be granted upon initial application or following a major change to a facility, such as new construction or a new location, and shall not be granted for a license renewal. Provisional licenses are part of the initial application process and if, after the issuance of a provisional license, the application is denied, the provisional license is void. There is no right to appeal the voiding of a provisional license.
(NEW) Section 17a-145-172. Expiration of License
Any license issued under the provisions of sections 17a-145-161 to 17a-145-241, inclusive, of the Regulations of Connecticut State Agencies shall expire on the date specified on the license. When a licensee has made timely and sufficient application for the renewal of a license, the existing license shall remain in effect until the department has made a final determination on the renewal application. If renewal is denied or the terms of a license limited or modified, the existing license shall not expire until the last day for seeking review of the department’s decision, or a later day fixed by order of a court of competent jurisdiction.
(NEW) Section 17a-145-173. Procedures for Exceeding Capacity; Expansion
(a) Licensees seeking to exceed their licensed bed capacity or to accept residents outside the age range stipulated on the license on a temporary basis shall do so only with written approval from the commissioner or designee. Any request for expansion of the licensed bed capacity or acceptance of residents outside the age range stipulated on the license shall be made by written application to the department.
(b) Any placements by the department which exceed the licensed bed capacity or of residents outside the age range stipulated on the license, approved pursuant to subsection (a) of this section, shall not be considered a violation of the provisions under which the license has been issued.
(c) No facility shall exceed or expand its bed capacity or the age range of the residents residing therein beyond those limits established by the local or state fire, health, building and zoning authorities.
(NEW) Section 17a-145-174. Causes for Denying, Revoking, Limiting, Suspending, Refusing to Renew a License
(a) An initial license application may be denied for any of the following causes whenever in the judgment of the commissioner or designee the applicant:
(1) fails to comply with the regulations prescribed by the commissioner;
(2) fails to comply with applicable state and local laws, regulations, ordinances and rules relating to building, health, fire protection, safety, sanitation, zoning and discrimination;
(3) furnishes or makes any false or misleading statements to the commissioner in order to obtain the license;
(4) refuses or fails to submit reports or make records available when requested by the commissioner or designee; or
(5) fails to comply with applicable federal, state and local statutes, regulations and ordinances governing the care and treatment of residents.
(b) A license may be revoked, limited, suspended or its renewal refused for any of the following causes whenever in the judgment of the commissioner or designee the facility:
(1) fails to comply with all applicable regulations prescribed by the commissioner;
(2) fails to comply with applicable state and local laws, regulations, ordinances and rules relating to building, health, fire protection, safety, sanitation and zoning;
(3) violates any of the provisions under which the license has been issued;
(4) furnishes or makes any false or misleading statements to the commissioner in order to obtain or retain the license;
(5) fails or refuses to submit reports or make records available when requested by the commissioner or designee;
(6) fails or refuses to admit the commissioner or designee at any reasonable time as deemed necessary by the commissioner or designee or at any time in cases of suspected child abuse or neglect or emergency conditions affecting the health, safety or well-being of any resident;
(7) fails to submit a corrective action plan when required to do so, or fails to comply with a corrective action plan approved by the department;
(8) fails to make reasonable efforts to prevent abuse or neglect of residents or to take reasonable precautions to prevent a recurrence of abuse or neglect;
(9) fails to comply with applicable federal, state and local statutes, regulations and ordinances governing the care and treatment of residents; or
(10) fails to provide proper care and attention to residents.
(NEW) Section 17a-145-175. Criminal History; Pending Criminal Actions; History of Child Abuse or Neglect
(a) An applicant for a residential child care facility license and all licensed child care facilities shall conduct a criminal history record check and a child protective services history check on all employees, volunteers and interns who have contact with, care for, or supervise residents at the time of their employment, at least once every two (2) years, or at any time requested by the department. Such persons shall sign waivers at the time of employment specifically permitting the facility to conduct such checks. Said criminal history checks shall be conducted in accordance with the procedure set forth in section 29-17a of the Connecticut General Statutes.
(b) A facility shall not knowingly permit an employee, volunteer or intern to have contact with, care for, or supervise residents if such person has been convicted of a crime involving:
(1) child abuse or neglect;
(2) a crime against a minor, including, but not limited to, injury or risk of injury to a minor, impairing the morals of a minor or child pornography;
(3) sexual assault or homicide, if such conviction was for a felony offense;
(4) other crimes against persons involving physical harm or the threat thereof, if such conviction occurred within the past five (5) years and was for a felony offense;
(5) the possession, use, or sale of controlled substances or any drug-related offense, if such conviction occurred within the past five (5) years and was for a felony offense; or
(6) the illegal use of a firearm or other dangerous weapon or other similar offenses, if such conviction occurred within the past five (5) years and was for a felony offense.
A facility's non-compliance with this regulation shall result in regulatory action against the facility.
(c) A facility shall not knowingly permit an employee, volunteer or intern to have contact with, care for, or supervise residents if such person has been convicted of a crime involving:
(1) has been convicted of any crime involving the illegal use of a firearm or other dangerous weapons or other similar offenses;
(2) has been convicted of a felony, excluding those crimes listed in subdivisions (1) through (6) of subsection (b) of these regulations, which conviction occurred more than five (5) years previously, or any non-felony involving: (A) a crime involving violence against a person; (B) physical assault or battery; (C) the possession, use, or sale of controlled substances or any drug-related offense; or (D) the illegal use of a firearm or other dangerous weapons or other similar offenses;
(3) has had an allegation of child abuse or neglect substantiated and whose named appears on the department's Child Abuse and Neglect Registry;
(4) has a current child abuse or neglect allegation pending;
(5) has had a minor removed from the person's care because of child abuse or neglect; or
(6) has been arrested, is awaiting trial, or is on trial, for charges as described in subdivisions (1) through (6) of subsection (b) of this section or subdivisions (1) or (2) of subsection (c) of this section.
Except as provided in subsection (d) of this regulation, a facility's non-compliance with this regulation may result in regulatory action against the facility.
(d) If a licensee hires a new employee or retains an existing employee who has a criminal or protective services history which includes any of those offenses described is subsection (c) (1) through (6) of this section, the licensee shall undertake and document an evaluation of the risk to residents posed by such employee. Such evaluation shall include but not be limited to: 1) the details of the offense(s), (2) the length of time passed since the offense(s) occurred, (3) remedial actions taken by the employee, and (4) the employee's acceptance of responsibility for the offense(s).
(NEW) Section 17a-145-176. Summary Suspension
If the department determines that public health, safety or welfare requires emergency action and incorporates a finding to that effect in its order, summary suspension of a license may be ordered pending proceedings for revocation or other licensing action in accordance sections 4-176e through 4-182, inclusive of the Connecticut General Statutes and the hearing procedures developed by the commissioner. These proceedings shall be promptly instituted and determined.
(NEW) Section 17a-145-177. Hearing on Revoking, Limiting, Suspending or Refusing to Renew a License
(a) An applicant for initial licensure shall, within fifteen (15) calendar days after receipt by certified mail of notice by the department to deny a license, request an administrative hearing thereon in accordance sections 4-176e through 4-182, inclusive of the general statutes and the hearing procedures developed by the commissioner. Such request shall be addressed in writing to the commissioner.
(b) Any facility shall, within fifteen (15) calendar days after receipt by certified mail of notice of intended revocation, limitation, summary suspension or refusal to renew a license, request an administrative hearing thereon in accordance sections 4-176e through 4-182, inclusive of the Connecticut General Statutes and the hearing procedures developed by the commissioner.
(c) Revocation, limitation or denial of renewal of a license shall be stayed until such hearing is held and a decision is rendered except as otherwise provided in the Connecticut General Statutes. In the absence of such request for a hearing during this time period, the license shall be revoked, limited or not renewed.
(d) A hearing on the summary suspension of a license as set forth in section 17a-145-176 of these regulations shall be deemed part of and may be consolidated with any other licensing action permitted under these regulations at the discretion of the commissioner or designee.
(e) A hearing shall not be granted for the denial of a request for a waiver or the approval of a waiver with modifications as provided by section 17a-145-170 of the Regulations Of Connecticut State Agencies.
(NEW) Section 17a-145-178. Return of License to the Commissioner
Upon discontinuance of the licensed facility or revocation of the license, the license shall be returned by the facility to the commissioner within fifteen (15) calendar days after receipt of such request.
(NEW) Section 17a-145-179. Governing Board
(a) Residential child care facilities shall have a governing board of no less than five (5) members. Such board shall be legally constituted and shall manage its affairs in accordance with applicable provisions of law, its certificate of incorporation and its duly adopted bylaws. The board shall meet at least four (4) times per year, with no two (2) meetings occurring less than forty-five (45) days of each other. Minutes of the board’s meetings shall be made part of the permanent record of the facility. Minutes of the discussion of those matters relating to the licensed facility’s operation shall be made available to the department upon request.
(b) The governing board shall make a good faith effort to ensure that, to the extent possible, the membership of the governing board is qualified and closely reflects the gender and racial diversity of the state and the client population served by the facility.
(NEW) Section 17a-145-180. Governing Board Responsibilities
The responsibilities of the governing board shall include, but shall not be limited to:
(a) establishing a written a plan which shall include setting a mission or statement of purpose for the facility, and providing for the strategic, operational, programmatic, and other plans and policies to achieve the mission or fulfill the statement of purpose;
(b) keeping informed about the operation of the facility;
(c) providing the organizational structure to carry out the purposes of the facility;
(d) reviewing and approving all existing and revised policies not less than once every year and insuring that they are consistent with current practices;
(e) appointing a chief administrative officer to manage the daily and overall operation and maintenance of the facility and to delegate responsibility for direct operations to such person, including the hiring of staff;
(f) approving, annually, a budget developed by the facility that is sufficient to adequately maintain the staff, physical plant, equipment, and program of the facility;
(g) ensuring the maintenance of current and complete records, which fully document the fiscal activities of the facility;
(h) informing the department in writing regarding any changes of chief administrative officer within seven (7) calendar days;
(i) ensuring that a quality assurance plan is established and implemented; and
(j) ensuring that the facility is operated in a way that protects the language, race, culture, religious beliefs, sexual orientation and gender identity of the residents.
(NEW) Section 17a-145-181. Chief Administrative Officer
(a) The facility shall have a chief administrative officer who shall be in charge of the overall management of the facility and its day-to-day operations and shall carry out the policies of the governing board. The chief administrative officer shall be appointed by, and shall have met the qualifications and standards established by, the governing board.
(b) The chief administrative officer’s responsibilities shall include, but not be limited to:
(1) the operation and ongoing maintenance of the facility;
(2) development and administration of policies and procedures to ensure clear definition of staff roles and responsibilities and lines of authority to ensure adequate care and treatment of residents;
(3) obtaining all background information, including criminal and child protective services check, on its employees, volunteers and interns who have contact with, care for, or supervise residents;
(4) reporting to the governing board on the operation of the facility;
(5) ensuring that the residents' personal money and property are properly safeguarded; and
(6) providing the staff and complementary services to address the physical, emotional and cultural well being and to ensure the safety of the residents.
(c) The chief administrative officer shall inform the department in writing within seven (7) calendar days of any changes in the management personnel of the facility, including but not limited to, clinical director, residential director, program director, chief operating officer, supervising nurse, medical director and psychiatrist, and functionally equivalent positions.
(NEW) Section 17a-145-182. Program Description
The facility shall have a written program description which specifies: the statement of purpose; a description of overall approach to treatment and family involvement; the types of services provided; the characteristics and ages of the residents to be served; service and program goals, outcome measures, and the characteristics and ages of those residents not appropriate for the program. Programmatic implementation shall employ "least restrictive environment" principles in assessments, treatment plans, and educational programs.
(NEW) Section 17a-145-183. Policies and Procedures
(a) The policies and operating procedures of the facility shall be in writing and shall include but not be limited to the following topics and subject matter:
(1) administrative services, including:
(B) mandated child abuse and neglect reporting responsibilities;
(C) personnel, including utilization of volunteers and interns, training and staff development;
(D) hiring or maintaining a staff person with a criminal history other than that described in section 17a-145-175 of the Regulations of Connecticut State Agencies;
(E) addressing the cultural, racial, ethnic and language needs of the residents and the protection of cultural, ethnic and sexual minorities;
(F) maintenance of the physical plant of the facility; and
(G) quality assurance;
(2) residential services. including:
(A) entry and orientation as provided in Section 17a-145-232 of the Regulations of Connecticut State Agencies;
(B) routine and emergency referral and admissions process;
(D) staffing including minimum direct care ratios and supervision of direct care staff;
(E) safety management, including searches of residents and personal belongings and the management and disposal of contraband;
(F) recreational opportunities;
(G) off campus activity including transportation, travel and supervision, and involvement with the local community;
(H) work opportunities;
(K) residents’ rights;
(L) protection of residents' money and personal belongings;
(M) daily routine;
(O) dietary services; and
(P) storage and replacement of resident clothing;
(3) clinical services, including:
(A) family involvement;
(B) clinical services, including resident to clinical staff ratios;
(C) treatment or service planning;
(D) discharge planning;
(E) behavior management including the use of physical restraint and seclusion; and,
(F) psychiatric emergencies, including, but not limited to, suicidal ideation, gesturing or other behavior which may present a risk of harm to self or others;
(4) medical services, including:
(A) well child care services;
(B) medical emergencies;
(C) administration of medications; and,
D) services as required in section 17a-145-238 of the Regulations of Connecticut State Agencies.
(b) Copies of all policies and procedures and any subsequent revisions thereto shall be made available to staff of the facility. Copies and any subsequent revisions shall be provided to the department upon request.
(c) In addition to the approval by the Governing Board required by subsection (4) of section 17a-145-180 of the Regulations of Connecticut State Agencies, the policies addressing the matters listed in Sections 17a-145-183(a) (3) (E) and (F) shall be reviewed, at least annually, by a mental health practitioner licensed to practice in this state.
(NEW) Section 17a-145-184. Finances
(a) The facility shall have sufficient income and resources to enable it to provide proper care for residents and to operate the facility.
(b) Financial records, including background documentation, showing the amount and source of all income and expenses and all assets and liabilities of the facility and any entity providing financial support to the facility shall be maintained for a period of at least three years and shall be available for inspection, audit and verification by the commissioner or designee.
(c) The facility shall disclose all related party transactions.
(d) There shall be an annual audit of all capital resources, assets, liabilities, receipts and expenditures, by a licensed public accountant not affiliated with the facility. For non-profit organizations the annual audit shall be in compliance with the state single audit requirements as set forth in section 4-230 to 4-236 of the Connecticut General Statutes. The annual audit shall provide information by functional classifications and shall conform to generally accepted accounting principles as defined in section 4-230(6) of the Connecticut General Statutes. A copy of each such audit shall be submitted to the department not more than six (6) months after the end of the facility’s fiscal year, or upon request, and shall be a part of the facility’s record.
(e) The department shall be permitted to conduct financial audits as may be necessary to ensure the quality and delivery of services, to determine if the facility is properly expending its funds and to determine if the facility is engaged in any activities prohibited by applicable laws and regulations.
(NEW) Section 17a-145-185. Fundraising
The facility shall not require or permit residents to solicit funds, nor shall the facility permit photographs of residents to be used in its fundraising material or in public relations, unless prior written permission is obtained from the guardian of each resident whose photograph is so used.
(NEW) Section 17a-145-186. Informed Consent for Research, Experimentation or Clinical Trials
(a)Policies shall be in place to protect the rights of residents and their families during any research, experimentation or clinical trials. All research, experimentation and clinical trials utilizing residents or their family members as subjects shall be approved by the department and the facility's institutional review board or other similar entity, if any, established to review and approve research involving human subjects. In addition, signed informed consent shall be secured for each subject including:
(1) a description of benefits to be expected;
(2) a description of the potential discomforts and risks;
(3) a description of alternative, non-experimental services that might also prove advantageous;
(4) a full explanation of all the procedures to be followed; and
(5) assurance of the subject's right to refuse to participate without compromising access to services.
(NEW) Section 17a-145-187. Confidentiality
(a) All case records are confidential and shall be maintained in locked files or in a locked area available only to duly authorized personnel as established in facility policy and procedure.
(b) The guardian of the resident shall receive, upon request, reports and information concerning the health, behavior and progress of the resident, and all other information about the resident permitted under state and federal law.
(c) The resident’s record shall be retained by the facility for seven (7) years from the date of discharge or until the resident reaches the age of twenty-one (21), whichever is later. The method of destruction of such records shall be incineration or shredding.
(d) If a facility ceases operation, all residents’ records shall be delivered to the department or, upon order, to a court of competent jurisdiction. In the event that a facility changes ownership, all resident and personnel records shall remain in the facility.
(e) The facility shall not disclose information pertaining to a resident or family to other persons without permission of the guardian, except in cases of suspected child abuse or neglect or emergency conditions affecting the health, safety or well being of the resident, or as otherwise permitted by federal or state law.
(NEW) Section 17a-145-188. Mandated Reporting
The facility shall ensure, and document, that each individual employee is aware of and knowledgeable about their responsibilities to report instances of suspected child abuse and neglect pursuant to Section 17a-101 et seq., as amended, of the Connecticut General Statutes.
(NEW) Section 17a-145-189. Unauthorized Absence of a Resident
(a) The facility shall notify the department and the guardian of the resident immediately upon determining that a resident is missing or absent from the facility without permission.
(b) The facility shall notify the local law enforcement authority within a reasonable amount of time upon determining that a resident is missing or absent from the facility without permission. The length of time for notification shall be determined by the age, developmental level, mental health status, and any other potential risk factors associated with the missing resident.
(c) The facility shall notify the local law enforcement authority immediately upon determining that a resident is missing or absent from the facility without permission if the resident is known to be a danger to himself or herself or others or may be in need of medical treatment.
(NEW) Section 17a-145-190. Property and Vehicle Insurance
(a) Every facility shall maintain insurance covering fire and liability. The facility shall submit to the department the amount of insurance and the name and the address of the insurance carrier.
(b) The facility shall ensure that any vehicle authorized for use in transporting residents and used by any of the facility’s staff shall be in proper working condition and have insurance which covers liability.
(NEW) Section 17a-145-191. Physical Environment and Safety Evacuation Drills
(a) The facility shall conduct unannounced evacuation drills in which all staff and residents shall participate at a frequency of one drill per shift for each quarter of the year. Documentation of drills held shall be maintained on a standardized form, which records the date, time, minutes taken to evacuate, number of participants, problems noted, follow up to problems and the nature of the drill.
(b) Evacuation diagrams shall be posted in accordance with the state or local fire marshal requirements.
(NEW) Section 17a-145-192. Safety Management
(a) The facility shall develop and implement written policy and procedures to address emergencies or other disasters which might endanger or require the removal of residents for reasons of health and safety, including procedures to ensure that emergency telephone numbers, including fire, police and poison control are conspicuously displayed adjacent to all facility telephones.
(b) The facility shall develop and implement written policy and procedures establishing an ongoing formal safety program that reviews safety issues for both residents and staff, including: (1) the evaluation of all incidents implicating the safety of residents or staff in order to make recommendations for prevention; and (2) a plan to review the physical facility in the context of suicide prevention of the population being served by the facility.
(c) The facility shall ensure that proper instruction regarding safety procedures, appropriate to each resident’s age and developmental level, are provided for the safe use of electrical or power equipment such as drills, saws and lawn mowers; and for the safe use of recreational equipment, including but not limited to, weight rooms, ROPES courses and treadmills. The instruction shall be documented. All use of such equipment shall be under the supervision of qualified staff or instructors.
(d) Accident and incident reports
(1) All accident or incident reports to the department shall be classified as either critical incidents or significant events.
(A) Critical incidents which shall be reported to the department's child abuse and neglect Hotline are those occurrences related to suspected abuse or neglect involving:
(i) the death of a resident;
(ii) a life-threatening condition;
(iii) broken bones in a resident under six (6) years of age;
(iv) serious injury, including lacerations, bone fractures, substantial hematoma (severe bruising), burns (rug/carpet burns are not considered serious injuries for purposes of critical incident reporting), and injuries to internal organs whether self-inflicted or inflicted by someone else;
(v) sexual assault of a resident by an adult or minor person;
(vi) all runaways under the age of thirteen (13), and any runaway over the age of thirteen (13) who presents an imminent danger to self or others; and
(vii) any other situation in which abuse or neglect of a resident is suspected.
(B) Significant events are those occurrences that are not considered to be critical incidents and do not arise from suspected abuse or neglect, but are serious enough in nature to require reporting to the department's Risk Management Unit, including, but not limited to, the following:
(i) abduction of a resident;
(ii) an incident involving one or more runaways;
(iii) a significant disturbance involving residents;
iv) allegation of a serious crime by an employee, volunteer or intern of the facility;
(v) a serious injury suffered by a facility employee, volunteer or intern in the course of the person's duties;
(vi) a serious threat to a facility employee, volunteer or intern in the course of the person's duties resulting in notification to law enforcement;
(vii) suicide or serious suicide attempt by a resident;
(viii) a serious injury to a resident occurring during restraint or seclusion;
(ix) deterioration of care or treatment of residents or other important facility function due to some disruption of the physical plant or environment (e.g., fire, natural disaster, failure of electronic equipment, other safety conditions);
(x) any call to 911;
(xi) any event that may affect the health, welfare or safety of the residents such as: strikes, major disturbances, public health issues, bomb threats; or
(xii) any event related to the facility that is likely to result in media coverage.
(2) The chief administrative officer or designee shall report any critical incident to the Hotline immediately, with a written report to follow within twenty-four (24) hours. The chief administrative officer or designee shall report any significant event to the department's Risk Management Unit by telephone as soon as practicable but in no event later than the end of the shift during which it occurred, with a written report to follow within seventy-two (72) hours.
(A) Each written report shall contain the following information:
(i) date of event and date of report;
(ii) facility licensing category;
(iii) identification of the individuals affected by the event, including, where available, resident identification, age, and status; name and position of employee, visitor or other person involved; nature of incident; action taken by the facility; and disposition.
(B) If the affected individual is or was at the time of the reported event a resident of the facility, the written report shall include:
(i) date of admission;
(ii) current diagnosis, if applicable;
(iii) physical and mental status prior to the event; and
(iv) physical and mental status after the event.
(C) The location, nature and brief description of the event.
(D) The name and time of notification of the physician or hospital consulted, if applicable.
(E) The name(s) of any witnesses to the event.
(F) Any other information deemed relevant by the reporting facility.
(G) The signature of the person who prepared the report and of the chief administrative officer.
3) Each report shall be identified on each page with the facility's child care license number, the last two digits of the calendar year and the sequential number of the report during the calendar year.
(4) The chief administrative officer or designee shall submit subsequent reports, if applicable, relevant to any accident or incident.
(NEW) Section 17a-145-193. Water Safety
(a) The facility shall develop safety procedures for the use of waterfronts, swimming areas and swimming pools and shall ensure that staff is adequately trained in such safety procedures.
(b) A certified individual shall be on duty when the residents are swimming. A certified individual is one who has a current water safety instructor’s certificate or senior lifesaving certificate from the Red Cross or its equivalent.
(c) The waterfront, swimming area or swimming pool shall be properly maintained and have all safety equipment required by law. The waterfront, swimming area or swimming pool shall comply with sections 19-13-B33b, 19-13-B34 and 19-13-B36, of the Regulations of Connecticut State Agencies.
(NEW) Section 17a-145-194. Water and Hot Water Temperature
(a) The water supply shall be safe and adequate to meet the needs of the facility.
(b) The hot water temperature for hand washing, bathing and/or showering shall not exceed 120° Fahrenheit in all buildings serving residents.
(NEW) Section 17a-145-195. Kitchens
(a) All kitchens shall be clean, well lighted, properly ventilated and provided with the equipment necessary for the preparation and serving of food.
(b) Cooking utensils, dishes and tableware shall be in good condition. Proper cleaning facilities for this equipment shall be provided. Non-disposable dishes and tableware shall be available for use by residents.
(c) Dishes, food preparation items and eating utensils shall be stored in a clean, dry place protected from insects, dust or other contamination and above the floor on shelves or other clean non-porous surfaces.
(NEW) Section 17a-145-196. Food Storage and Preparation
(a) Storage, refrigeration and freezer facilities shall be adequate for the number of persons to be served. All perishable foods shall be refrigerated at a temperature at or below 45° Fahrenheit, and shall be labeled and dated. Freezers and frozen food compartments shall be maintained at minus 10° to 0° Fahrenheit, with contents labeled and dated.
(b) Food preparation and serving areas shall be kept clean and well maintained. There shall be strict compliance with all health and sanitation requirements of the state and local departments of health.
(c) Proper food handling techniques and sanitation to minimize the possibility of the spread of food-borne diseases shall be maintained. Direct care staff who engage in food handling activities shall receive training in safe food handling through a department-approved training program.
(d) All food storage and preparation, the personal cleanliness of food handlers, and care of the food storage and preparation areas shall meet all applicable health standards.
(e) All food shall be stored in a clean, dry place protected from insects, dust or other contamination and above the floor on shelves or other clean non-porous surfaces.
(NEW) Section 17a-145-197. Food and Nutrition
(a) Food served shall be nutritious and of sufficient quantity. Residents shall be offered reasonable choices at meals. The diets of residents under twelve (12) months of age shall be approved by a physician. The diets of residents over twelve (12) months of age shall be based upon a menu, which includes meals and snacks, approved by a registered dietitian.
(b) No non-pasteurized milk products shall be provided by, or with the approval or knowledge of, the facility to any resident.
(c) The facility shall meet the special religious or medical dietary needs of its residents.
(d) Residents shall receive reasonable additional portions of food at meals when requested. Any dietary restrictions shall be based on a medical evaluation by a physician or nurse practitioner.
(e) Food shall not be used as a part of the facility’s behavioral management system except that food may be used as special treats, or in celebrations or group activities.
(NEW) Section 17a-145-198. Dining
(a) Dining areas shall be kept clean, well lighted, properly ventilated and be large enough to accommodate the residents and the staff responsible for their supervision. The dining room equipment for residents shall be clean and in good repair, and of appropriate size and height for the residents' use.
(b) Staff supervision at meals shall be adequate to ensure a safe and comfortable atmosphere for eating. Whenever possible, staff shall participate with the residents during meals and engage the residents.
(NEW) Section 17a-145-199. Bathrooms
(a) The facility shall provide bathrooms and toilets which shall allow for individual privacy, including window coverings for bathroom windows. Staff supervision shall be adequate to ensure safety.
(b) At least one toilet and sink shall be provided near recreation areas and dining rooms and shall have adequate hot and cold running water, equipment and supplies. Adequate bath facilities, including toilet, sink and shower/bath shall be in the same building(s) as, and accessible from, bedrooms. Bathrooms shall be kept clean, adequately ventilated, and free from odors. The bathroom equipment for residents shall be of appropriate size and height for the residents' use.
(c) Each resident shall be provided with an adequate supply of individual hygiene products and towels and washcloths.
(NEW) Section 17a-145-200. Bedrooms
(a) Bedrooms for each resident shall have adequate area, spacing and equipment in accordance with the resident’s age and needs. Bedrooms shall contain a window even when there is a 24-hour ventilation system. When windows are utilized for ventilation they shall be screened and function properly. Bedroom windows shall be equipped with sufficient window coverings to afford privacy for residents. Bedrooms shall have doors in order to provide privacy. Heating facilities shall be sufficient to maintain a room temperature consistent with state Department of Public Health guidelines.
(b) Separate bedrooms shall be provided for unrelated residents of the opposite sex three (3) years of age or over, unless prior approval is obtained from the department.
(c) Bedrooms for residents under twelve (12) years of age shall have a minimum of three hundred (300) cubic feet of air space per resident, or a minimum of seventy (70) square feet of floor space per resident. Bedrooms for residents twelve (12) years of age or older shall have a minimum of five hundred (500) cubic feet of air space per resident, or a minimum of seventy (70) square feet of floor space per resident.
(NEW) Section 17a-145-201. Furniture and Bedding
(a) The facility shall provide bedroom furniture for each resident that shall include, but not be limited to: a bed, including a frame, a clean comfortable mattress and pillow, and a private dresser or similar storage unit for personal belongings which is readily accessible to the resident. A chair and writing surface appropriate for schoolwork shall be provided in the resident’s room or in another suitable location.
(b) Regularly cleaned linens shall be provided for each resident that shall include, but not be limited to: sheets, pillowcases and blankets appropriate in number and type for the season and the individual resident’s comfort.
(NEW) Section 17a-145-202. Nursery
Nursery areas for residents up to three years of age shall be separate from living quarters for residents over three years of age except that siblings may be placed together outside of such nursery area. Staff supervision for the nursery area shall be adequate to ensure the physical and emotional safety and health of the residents.
(NEW) Section 17a-145-203. Staff Quarters
Living quarters and bathroom facilities of staff shall be separate from those of residents, afford privacy, and be suitable according to job duties and employment arrangements.
(NEW) Section 17a-145-204. Living Room and Environment
The facility shall provide a living room or lounge in each unit sufficient in size and equipment for the use of the residents. Each living room or lounge shall be attractively furnished, well heated, lighted, ventilated, clean and decorated in an age appropriate manner, with furnishings in good repair, and suitable for use by residents.
(NEW) Section 17a-145-205. Visitation
(a) Residents shall have a place to receive visitors at the facility in private. Each resident shall be permitted to receive visitors subject to reasonable restrictions consistent with the resident’s treatment plan.
(b) Off-ite visitation shall be in accordance with the resident’s treatment plan. The facility shall document the following:
(1) the name, address and telephone number of the person responsible for transporting or supervising the resident while absent from the facility;
(2) the duration of the visit; and
(3) any significant observed behaviors during the departure and return.
(NEW) Section 17a-145-206. Recreation
(a) Indoor and outdoor recreational facilities, supplies and equipment shall be provided for and used by the residents. Appropriate safety measures, instructions and supervision shall be provided to protect the residents from bodily harm.
(b) The facility shall develop a written plan for recreation services including gross and fine motor activities. The plan shall include specific individual and group recreational activities appropriate to the age, interests and needs of each resident.
(c) The facility shall provide or arrange for individual and group recreational activities appropriate to the age, interests and needs of each resident, and shall ensure adequate staff supervision during activities and transportation to and from activities.
(NEW) Section 17a-145-207. Office Space
Office space shall be available for administrative and counseling staff. There shall also be space available that is large enough to accommodate family counseling or group therapy in a comfortable and confidential setting.
(NEW) Section 17a-145-208. Laundry
Residents’ clothing and linens, towels and other items supplied by the facility shall be washed regularly. Provisions shall be made for the repair or replacement of residents’ clothing as needed. The facility shall provide supplies, instruction and supervision for youth developmentally capable of accomplishing these tasks.
(NEW) Section 17a-145-209. Lighting
The facility shall provide ample natural or artificial lighting in all areas used by residents. All light bulbs shall be enclosed in protective covers if so designed. Light fixtures shall be maintained as designed, and shall take into consideration the safety needs of the residents.
(NEW) Section 17a-145-210. Ventilation and Heat
(a) Comfortable heating and sufficient ventilation shall be provided in all areas used by residents.
(b) All windows and doors used for ventilation shall be screened.
(NEW) Section 17a-145-211. Maintenance
(a) The facility shall develop and implement written policy and procedure to ensure the ongoing maintenance of and emergency repairs to the facility and its vehicles. Such policy and procedure shall address the safety of residents during maintenance, construction or repairs.
(b) Adequate and safe sewage and garbage facilities shall be maintained, and the facility shall be free from rodents and other vermin. Good housekeeping shall be observed in all areas at all times.
(c) Housekeeping equipment and supplies shall not be accessible to residents unless an individual determination is made concerning a resident's ability to safely use them or the use is under staff supervision. Such materials shall be maintained in a safe, protected space. All materials shall be properly labeled.
(NEW) Section 17a-145-212. Security
The facility shall provide internal and external security necessary to ensure the safety of residents.
(NEW) Section 17a-145-213. Accessibility of Facility
(a) Staff shall be available to respond to telephones, doorbells or other signaling devices so that 24-hour accessibility is maintained when any resident is present.
(b) When no resident or staff is present at the facility, the facility shall provide the department with a means to contact on-duty staff at any time.
(NEW) Section 17a-145-214. Animals
All animals at the facility shall be kept in a safe and sanitary manner and receive generally accepted veterinary care. The facility shall be in compliance with all applicable federal, state and local statutes, regulations and ordinances regarding vaccinations and treatment of animals. The facility shall document the veterinary care of its animals. The facility shall develop written policy and procedures to ensure the proper care of the animals and to ensure the safety of residents.
(NEW) Section 17a-145-215. Construction
The plans and designs for all new construction, additions to or substantial modifications of buildings, or parts of buildings used or to be used in the operation of the facility, shall be submitted to the commissioner for review. The proposed plans shall be in compliance with required health, fire, safety and zoning laws, regulations and ordinances.
(NEW) Section 17a-145-216. Water Quality
Water supply shall be adequate and safe. If the facility is not served by a public water supply, the water shall be analyzed and approved by the state Department of Public Health, local department of health, or a private water-testing laboratory approved by the state Department of Public Health prior to the granting of a license and on an annual basis thereafter. Readily available drinking water shall be accessible to residents at all times.
(NEW) Section 17a-145-217. Personnel Policies
Personnel policies and operating procedures regarding facility employment and personnel practices shall be in writing, and made available to the department. A copy shall be made available to each employee, volunteer and intern. Personnel policies shall be non-discriminatory and in compliance with federal and state laws.
(NEW) Section 17a-145-218. Personnel Records
All personnel records for employees, volunteers and interns shall be maintained by the facility and be available to authorized representatives from the department. Each record shall include, where applicable, but not be limited to:
(a) a job description;
(b) individual application;
(c) resume, if used as part of the hiring process;
(d) references, if used as part of the hiring process;
(e) licenses or certifications required by job description;
(f) criminal background check conducted by the Connecticut State Police;
(g) child abuse and neglect background check conducted by the department;
(h) date of hire;
(i) date employee assumed duties;
(j) documentation of employee orientation;
(k) documentation of awareness of laws regarding confidentiality of the records of residents;
(l) documentation of knowledge of responsibilities regarding mandated child abuse and neglect reporting as required by section 17a-101a of the Connecticut General Statutes;
(m) documentation of any training, specialized training or certification received;
(n) documentation of cardiopulmonary resuscitation (CPR) training;
(o) documentation of blood-borne pathogen (universal precautions) training;
(p) documentation of crisis management and behavioral interventions training in compliance with sections 46a-150 through 46a-154 of the Connecticut General Statutes, if applicable; and
(q) documentation of completion of physical exam and tuberculosis test.
(NEW) Section 17a-145-219. Job Descriptions
The facility shall maintain written job descriptions outlining the general requirements for each position, any license or certification required, duties of the job, and supervision to be provided. A copy shall be given to each employee.
(NEW) Section 17a-145-220. Health Screenings
(a) The health of facility staff, volunteers and interns shall not present a hazard to the residents.
(b) Facility staff, volunteers and interns shall be physically, mentally and intellectually able to perform their job functions.
(c) All new facility staff, volunteers and interns having contact with residents shall have a physical examination, including a test for tuberculosis, with results documented, no more than six (6) months prior to assuming their assigned duties.
(NEW) Section 17a-145-221. Orientation or Training
(a) The facility shall maintain personnel policies for the training and education of employees, volunteers and interns that include but are not limited to: introductory orientation; ongoing training and development; supervision; and annual evaluations. A plan for ongoing training shall be developed which includes a written curriculum and a minimum number of hours of annual training.
(b) Any person who has direct supervision of residents in a facility shall, prior to being assigned sole supervision of a resident, be trained in:
(1) cardiopulmonary resuscitation;
(2) child or adolescent development , whichever is applicable;
(3) a behavior management program approved by the department, including de-escalation techniques pursuant to sections 46a-150 through 46a-154, inclusive, of the Connecticut General Statutes;
(4) the safety management policies and procedures of the facility, including searches of person(s) and personal belongings;
(5) working with culturally diverse populations, including sexual minority youth;
(6) residents' rights;
(7) mandated child abuse and neglect reporting responsibilities;
(8) suicidal ideation, gesturing or other behavior, which may present a risk of harm to self or others;
(9) emergency response procedures; and
(10) policies and procedures related to safe food handling.
(NEW) Section 17a-145-222. Resident Supervision and Staffing Levels
(a) The facility shall have a sufficient number of staff qualified by virtue of education and training to meet the needs and maintain the safety of the residents and the programs and services the facility delivers.
(b) At least one (1) fully trained person shall be on site at all times when one or more residents are present on the facility’s premises. No resident shall be responsible for direct supervision of other residents.
(c) The facility shall know the whereabouts or intended whereabouts of each resident at all times.
(d) The facility shall employ sufficient child care staff to implement individual treatment plans on a daily basis. Staffing ratios shall not include the use of volunteers and interns. A gender- appropriate staffing pattern shall be established to assist each resident with the intimate activities of daily living, in accordance with each resident’s treatment plan, developmental level or mental age.
(NEW) Section 17a-145-223. Volunteers, Interns and Temporary Workers
The facility may use volunteers, interns and temporary workers within its programs, provided that any volunteer, intern, or temporary worker shall have clearly defined duties and responsibilities and shall be supervised by a trained employee of the facility. All such persons shall submit to criminal and child protective services background checks pursuant to section 17a-175-145 of these Regulations, and shall execute waivers to permit such checks at the time of employment and, subsequently, at the discretion of the facility.
(NEW) Section 17a-145-224. External Contracted Services
External service providers including, but not limited to, psychiatrists, psychologists, physicians, nurses and dentists shall be licensed or certified as required by law.
(NEW) Section 17a-145-225. Non-Discrimination, Affirmative Action and Hiring
(a) The facility shall not discriminate against staff or residents on the basis of race, color, religion, national origin, sex, sexual orientation, gender identification, age, marital status or disability.
(b) The facility shall actively recruit qualified personnel representative of the racial, ethnic and linguistic groups it serves.
(c) The facility shall establish a policy and process to recruit and hire culturally competent staff.
(NEW) Section 17a-145-226. Daily Routine
(a) The facility shall establish basic daily routines for residents. Daily routines shall be established for mealtimes, waking transition periods and bedtimes. The facility shall schedule and make available to residents appropriate recreational and leisure-time activities that afford opportunities for regular exercise and relaxation.
(b) Notwithstanding the foregoing, daily routines shall not supersede the terms of an individual resident's treatment plan.
(c) Residents shall not be removed from school for the purpose of individual counseling, unless the resident’s behavior in the classroom so warrants or as permitted by the resident’s treatment plan or as required by the resident’s individualized education plan.
(NEW) Section 17a-145-227. Chores
Chores shall provide constructive experiences in accordance with the age and ability of the resident and shall not substitute for the work of staff. All chores shall be scheduled so as not to conflict with other essential activities.
(NEW) Section 17a-145-228. Resident Employment
(a) Residents may be encouraged to work or participate in work-study programs. The facility shall ensure that the resident’s work experience has a constructive value for the resident’s training and development. Work assignments shall be made in accordance with the age and ability of the resident and applicable laws and regulations.
(b) Paid or voluntary work assignments outside of the facility shall be approved by the chief administrative officer of the facility or designee, and be in accordance with the resident’s treatment plan.
(NEW) Section 17a-145-229. Hygiene
(a) The facility shall provide the program, facilities and training necessary for the residents’ daily health needs and the development of sound habits and practices of personal hygiene (including toilet training) and appearance, appropriate to age, gender, race and culture of the resident.
(b) There shall be supervision by staff to provide for proper grooming and personal hygiene of the residents.
(c) Elective cosmetic procedures such as tattoos and piercing shall only be performed with the written consent of the guardian and by licensed or certified practitioners, as applicable.
(d) The facility shall ensure that each resident is provided with the necessary and appropriate grooming and hygiene articles to meet the resident’s needs, including but not limited to, clean, individual towels and washcloths, a toothbrush, toothpaste, a comb, and shampoo.
(e) Community use of grooming and hygiene articles such as towels, toothbrushes, soap and deodorants is prohibited. The provision of grooming and hygiene articles shall not be contingent upon behavior and shall not be part of a level or privilege system.
(NEW) Section 17a-145-230. Personal Belongings
(a) The facility shall allow each resident to bring the resident's personal belongings, as defined by the facility policy, to the facility and to acquire new belongings in accordance with the resident’s treatment plan. The facility shall, as necessary, limit or supervise the use of these items while the resident is in care. Where extraordinary limitations are imposed, the resident shall be informed of the reasons in a language or manner of communication the resident can understand. The decision and reasons shall be recorded in the resident’s case record. Provisions shall be made for the protection of the resident’s property.
(b) The facility shall ensure that each resident has adequate, clean, proper-fitting, and seasonal clothing as required for health, comfort and physical well-being, and as appropriate to age, gender, individual needs, culture and religion:
(1) each resident’s clothing shall be distinguished from that owned by other residents in accordance with the facility’s policies;
(2) each resident’s clothing shall be kept clean and in good repair. The resident shall be involved, as appropriate, in the care and maintenance of the clothing. As appropriate, laundering, ironing and sewing equipment and supplies shall be accessible to the resident;
(3) the wardrobe for each resident shall go with him or her at time of discharge; and
(4) if a resident’s belongings are left at a facility after discharge, whether planned or unplanned, the facility shall safely store those belongings for a minimum of thirty (30) days after written notification to the resident's legal guardian.
(NEW) Section 17a-145-231. Referral and Admission Criteria
(a) The facility shall consider for admission all referrals appropriate to the program, regardless of race, color, religion, national origin, ancestry, language, sex, sexual orientation, gender identification, age, marital status or disability. Admissions shall be in keeping with the capacity of the facility’s staff, program and equipment to meet the needs of the prospective resident as well as the needs of residents already in residence. The facility shall provide written notification to the appropriate parties of its decision on admission no more than nine (9) business days from the date of receipt of the referral.
(b) Referral information pertaining to residents not accepted for admission shall be safeguarded for confidentiality or be properly destroyed.
(c) A comprehensive psychological, behavioral, clinical, medical, educational, substance abuse and legal history shall be obtained prior to admission to the facility to the extent possible. Residential child care facilities providing emergency placement services shall obtain all available relevant information about each resident so placed at the time of the placement.
(d) Prior to acceptance of a prospective resident who will attend a facility-operated special education program, a facility staff member with expertise in special education shall review educational information regarding the prospective resident, including the prospective resident’s individual education program (IEP), if any, to determine if the prospective resident is eligible for special education services. The staff member shall also review the prospective resident's 504 accommodation plan, if any. The facility shall not accept the prospective resident for admission unless the facility ascertains that the prospective resident’s IEP can and may be implemented fully upon placement in the facility, or that the prospective resident is ineligible for special education services, and that the facility can implement the resident's 504 accommodation plan, if any.
(NEW) Section 17a-145-232. Entry and Orientation
(a) The facility shall obtain from the resident’s guardian, at the time of admission, written permission:
(1) to place the resident in the facility;
(2) to provide facility programming to the resident;
(3) to provide routine medical care, except that the legal guardian shall provide informed consent for each occurrence of routine medical care; and
(4) to provide emergency treatment when the parent or guardian is unavailable, except that the facility shall, if possible, make reasonable efforts to notify the legal guardian prior to seeking emergency treatment.
(b) Each newly admitted resident and the resident's parent or guardian shall receive:
(1) a tour of the facility and instruction on evacuation procedures, routes and exits;
(2) a copy of the rules of the facility;
3) an explanation of the behavior management procedures, including limits, restrictions, the type of discipline used in the facility, and consequences for certain behaviors; and
(4) an explanation of the residents' rights and residents' grievance procedures.
(c) The orientation process shall be documented in the resident’s record.
(NEW) Section 17a-145-233. Assessments
(a) Within thirty (30) calendar days of admitting a resident, the facility shall complete a comprehensive assessment of the resident. The facility shall assess the needs and strengths of the resident which shall include but not be limited to the following areas:
(1) medical and dental care, including a health history of the resident and relevant family health history;
(2) mental and psychological health;
(3) personal and social development;
(4) family and community relationships;
(5) vocational training, as appropriate;
(7) life skills development;
(8) independent living skills, as appropriate;
(9) legal status and history;
(10) treatment or placement history;
(11) alcohol or substance abuse history;
(12) abuse or neglect history;
(13) risk of injury to self and or others; and
(14) risk of runaway.
(b) If the facility concludes from the assessment conducted in subsection (a) of this section that a formal evaluation of the resident in regard to one or more areas assessed is warranted, the facility shall insure that such evaluation is requested within fourteen (14 days) of such conclusion. Informed consent from the guardian shall be required for all formal evaluations.
(c) All direct evaluations of the resident shall be conducted in the resident’s dominant language or mode of communication, including augmented or facilitated communication, if necessary, and shall take into consideration the resident’s age, disability, sexual orientation, gender identity and cultural and religious background.
(d) If the evaluation process requires the services of a specialist, such as a psychiatrist, psychologist, speech therapist, occupational therapist, or physical therapist, the specialist shall be currently certified or licensed according to state law.
(NEW) Section 17a-145-234. Treatment Plans and Care Plans
(a) The facility shall ensure that there is a preliminary written treatment plan for each resident at the time of admission, except as provided in subdivision (o) of this subsection.
(b) The facility shall develop a written individualized comprehensive treatment plan for each resident within thirty (30) calendar days of the resident’s admission into the facility.
(c) The treatment plan shall include provisions for the resident's contact, treatment and visitation with family members as appropriate to the best interests of the residents.
(d) The treatment plan shall specify measurable and time-bounded goals and objectives to be achieved by the resident and family in order to establish or re-establish emotional or physical health.
(e) The facility shall ensure that the treatment plan specifies the least restrictive environment for education and other life activities, as appropriate, and that supplementary aids and services are provided to enable the least restrictive environment.
(f) The plan shall specify any specialized services or treatment to be provided as well as identify the person responsible for implementing or coordinating the implementation of the plan. The plan shall include referrals for relevant services that the facility does not provide directly.
(g) The treatment plan shall delineate the specific criteria to be met for termination of treatment or services. Such criteria shall be part of the initial treatment plan and all subsequent plans.
h) The treatment plan shall include an aftercare plan that shall include the anticipated discharge date, the supports and resources that may be required for discharge and a plan to prepare the resident for discharge.
(i) The frequency and duration of contacts shall be specified for the delivery of treatment services.
(j) The facility shall document that the treatment plan and any subsequent revisions have been explained to the resident and the resident's guardian, in language understandable to these persons. Copies shall be made available to the resident, the guardian and other authorized persons if requested.
(k) The plan shall be signed by the chief administrative officer or designee, the clinician and the resident’s guardian.
(l) The facility shall review each treatment plan at intervals not to exceed ninety (90) calendar days after the completion and approval of the most recent treatment plan, as well as when a significant change in diagnosis or condition occurs. This review shall document and evaluate the progress or lack thereof toward the established goals and objectives.
(m) The facility shall ensure that the resident, and all involved individuals, have the opportunity to actively participate in the planning process.
(n) In the case of residents placed in the facility by the department, the facility's treatment plan shall be consistent the department’s case and discharge plans.
(o) In the case of residential education facilities or facilities which primarily provide medical treatment, a detailed care plan consistent with the resident's needs and strengths may be developed in lieu of a treatment plan.
(NEW) Section 17a-145-235. Case Records
(a) The facility shall maintain a current confidential case record for each resident. The case record shall include: pre-admission data; the reason for admission; results of all diagnostic assessments and testing performed; a summary of admission information; the individual treatment plan; a record of all care and services, including medical services provided while in the facility; all progress notes reflective of the goals and objectives identified on the resident’s plan; notes regarding all visitations; reviews of the plan; the plan for discharge and aftercare; a discharge summary; and all other documents received or required for the treatment of or services provided to the resident.
(b) The case record shall contain only information pertaining to a particular resident and no identifying information regarding other residents.
(c) The case record shall include summaries of significant collateral contacts. These summaries shall be printed, legibly written in ink or typed.
(d) The case record shall include copies of all special behavior contracts, where appropriate.
(e) A summary of all incident and accident reports in which the resident was involved and the impact, if any, on treatment.
(f) The guardian or other authorized representative of the resident shall be entitled to receive, upon request, reports and information concerning the resident.
(g) In accordance with the treatment plan, each record shall contain notes which document services provided and progress made toward goals and objectives. Each note shall be entered by a qualified staff member or consultant, and shall be dated, printed, legibly written in ink or typed, signed by the person making the entry, and include the person’s title.
(NEW) Section 17a-145-236. Discharge Planning, Discharge and Aftercare
(a) The facility shall establish criteria for discharge, including administrative and emergency discharges.
(b) The facility shall complete a written discharge summary within thirty (30) calendar days following the date of discharge.
(c) The discharge summary shall include the facility’s name, address and telephone number; the resident’s presenting problems; significant findings from all assessments and evaluations; the reason for discharge, including the date of discharge; the resident’s placement or location immediately after discharge including name, address, telephone number and relationship to the resident of the individual(s) responsible for the resident’s care; the name and relationship of the person to whom the resident was discharged; whether or not the placement is consistent with the resident’s treatment plan; a summary of services provided during placement; a summary of growth and accomplishments during placement; the assessed needs which remain to be met and alternate service possibilities which might meet those needs; and recommendations as appropriate for an aftercare plan and the identification of the persons responsible for aftercare services.
(d) When the discharge date is not in accordance with the resident’s treatment plan, the following items shall be added to the summary: the circumstances leading to the unplanned discharge, the actions taken by the facility to avoid the discharge, and the reason for these actions. In the event of an unplanned discharge, the facility shall provide treatment information and recommendations to the resident’s next placement or guardian, as appropriate.
(e) All discharge documentation shall be maintained in the resident’s record.
(f) Discharge of a resident from the care of the facility shall only be to the person, persons or facility having legal custody of the resident, or on the written authorization of the resident's legal guardian.
(g) An aftercare plan approved by the department for residents placed by the department shall be ready for implementation prior to any resident’s planned discharge. The plan shall specify the nature, frequency and duration of aftercare services and the persons responsible for service delivery.
(h) An aftercare program shall be developed and communicated to the person responsible for the resident’s care at least thirty (30) days prior to the resident’s discharge.
(NEW) Section 17a-145-237. Health Care and Medical Administration
(a) Facilities whose programs administer medication to residents shall follow all of the provisions of sections 17a-6(g)-12 to 17a-6(g)-16 of the Regulations of Connecticut State Agencies.
(b) There shall be written policies and procedures, reviewed by a physician or Advanced Practice Registered Nurse (APRN) at least annually, for the administration of first aid care of residents with minor illnesses, injuries or special conditions; and for the facility’s medication administration program.
(c) The facility shall provide or arrange for appropriate medical, dental and nursing care for residents, including use of community health services. The health program for the residents shall include preventive and remedial medical, dental and optical services, and psychiatric and psychological services as needed.
(d) The facility shall have written policy and procedures governing the prescribing of medications. Such policy shall include provisions that there shall be informed consent, signed by the guardian, acknowledging that the guardian has been provided with a written description of the medication including possible side effects and contraindications.
(e) The facility shall provide for the health and medical treatment needs of residents by having written procedures which specify the arrangements for the provision of preventive, routine, elective and emergency medical care. Such procedures shall be reviewed by a physician or Advanced Practice Registered Nurse (APRN). The facility shall provide or arrange for qualified medical services for residents, including medical emergency treatment, on a 24-hour, 7-day-a-week basis.
(f) The facility shall only permit prescription and non-prescription medication to be administered to a resident upon the written order of a licensed practitioner who has examined the resident in a manner appropriate for the condition and its treatment. Orders for prescription medication shall be reviewed at intervals appropriate for that resident and the resident's treatment, as specified in writing by the practitioner, but no less than quarterly.
(g) The facility shall only permit the administration of medication or treatment by staff licensed by the state or staff certified by the department pursuant to the department’s medication administration guidelines.
(h) A written record shall be kept of the administration of all prescription and non-prescription medication to residents, identifying the resident, medication and dosage, time of administration, method of administration, and the name of the person who administered the medication.
(i) All drugs, medications and medical instruments shall be kept in a locked cabinet accessible only to designated staff members. External and internal medications shall be stored separately. Residents shall keep and administer prescribed medications themselves only with the written approval of a physician and the guardian and the agreement of designated staff that this practice will not be a risk to other residents.
(j) The facility shall ensure that residents, in the event of sickness, have an area which is comfortable, safe and allows appropriate privacy.
(k) A telephone with prominently posted emergency medical and poison control numbers shall be available in all health care and living areas.
(NEW) Section 17a-145-238. Education
The facility shall ensure that every resident attends either an education program within a local public school or within another setting located outside the facility as arranged by the resident’s school district, or an education program that has been determined appropriate for the resident in accordance with procedures developed jointly by the department and the state Department of Education.
(NEW) Section 17a-145-239. Residents' Rights
(a) The facility shall ensure the rights of residents as provided for in sections 17a-16-6 to 17a-16-13, inclusive, of the Regulations of Connecticut State Agencies regarding the Rights of Children and Youth Under the Supervision of the Commissioner of Children and families.
(b) Each resident shall have equal access to programs and services.
(c) Residents who speak a language other than, or in addition to, English shall be allowed to communicate in that language without restriction. Residents shall be provided with adequate opportunities to participate in cultural, religious and educational activities while in their placement setting and in their ethnic community.
(d) Residents shall have the right to be present during a search of is or her personal possessions.
(NEW) Section 17a-145-240. Behavior Management
(a) The facility shall comply with the provisions of sections 46a-150 to 46a-154, inclusive, as amended, of the Connecticut General Statutes regarding the use of restraints and seclusion.
(b) The facility shall prohibit abusive, corporal, humiliating or frightening punishment, treatment or action as well as physical interventions not appropriate to the circumstances, particularly in the area of toileting, feeding or sleeping practices.
(c) Control, supervision and discipline of residents shall be an adult responsibility appropriate to the residents' ages and levels of development and shall not be prescribed or administered by the residents.
(d) No physical restraint that uses any mechanical device or object shall be used on a resident except with prior written approval from the commissioner or designee.
(e) No facility shall use involuntary physical restraint on a resident except:
(1)as an emergency intervention to prevent immediate or imminent injury to the resident or to others, provided the restraint is not used for discipline or convenience and is not used as a substitute for a less restrictive alternative; or
(2) as necessary and appropriate, as determined in advance on an individual basis by the resident's treatment team and documented in the resident’s treatment plan, to prevent the resident from leaving the facility without permission, in order to prevent immediate or imminent injury to the resident or to others.
(f) In order to determination whether such involuntary physical restraint is necessary and appropriate as set forth in section 17a-145-240(e)(2) of the Regulations of Connecticut State Agencies, the resident's treatment team shall consider the following, which shall be documented in the treatment plan and reviewed by the treatment team and the resident's guardian at least monthly:
(1) the resident’s age;
(2) the resident’s physical and mental health;
(3) the nature and extent of the resident’s current risk of harm to self or others, including, but not limited to, any history of violent, dangerous, at-risk or self-injurious behavior;
(4) if the resident has engaged in criminal behavior, how such criminal behavior represents a risk to self or others;
(5) the reason for the resident’s presence in the facility; and
(6) the less restrictive alternatives to physical restraint that shall be used before the use of physical restraint.
(g) Unless emergency circumstances dictate otherwise, the use of seclusion and restraint shall only be used after less restrictive intervention strategies have been exhausted. The use of seclusion or restraint shall not be considered treatment. Any use of seclusion or restraint shall take into consideration the individual treatment plan, gender, developmental level, age, weight, existing health conditions, medications, and history of victimization of the resident subjected to the intervention.
(h) The resident shall be removed from seclusion or restraint at the earliest possible time that it can be determined that use of the safety intervention is no longer necessary to prevent injury to the resident or others.
(i) The decision to continue seclusion or restraint and the rationale for the decision shall be documented in the resident’s record.
(j) All uses of physical restraint or seclusion shall be monitored constantly by staff. The resident shall be assessed regularly and periodically during the physical restraint or seclusion to ensure safety and to identify medical problems, indications of stress injury and the appropriate time for release. The facility shall develop standards to ensure the individual comfort of the resident, e.g. bathroom breaks and covering areas of the body exposed during a restraint or seclusion.
(k) Monitoring shall be conducted by an individual trained in the use of seclusion and restraint, cardiopulmonary resuscitation and first aid. Within fifteen (15) minutes of the initiation of a restraint, an individual trained in restraint, CPR and first aid shall conduct a face-to-face assessment of the physical and psychological well being of the resident. Successive assessments shall continue at least every fifteen (15) minutes until the restraint is completed. A final assessment shall be conducted immediately following the completion of the restraint.
(l) Every assessment shall include, but not be limited to:
(1) any signs of physical injury, e.g., bleeding, swelling, physical distress, difficulty breathing;
(2) the resident's behavior and emotional condition;
(3) the appropriateness of the intervention;
(4) any complications resulting from the intervention; and
(5) the continuing need for the emergency intervention/restraint.
(m) No staff member shall use life-threatening physical restraint on a resident. No restraint or seclusion shall:
(1) include any restraint or hold in which the resident experiences chest or back compression;
(2) include any restraint or hold in which the resident is held face down, with or without chest or back compression;
(3) include the use of a latex glove or any other device or material to cover the resident's mouth or include any technique which may restrict the resident's ability to speak or breathe;
(4) include any pressure to, or gripping of, the resident's throat or neck;
(5) be used for punishment, discipline or as a punitive measure;
(6) be used for the convenience of the facility or staff;
(7) be used for the intentional infliction of pain or discomfort; or
(8) be inconsistent with the resident's treatment plan, individualized education plan, 504 accommodation plan or physician's orders.
(n) For each incident of serious injury to or death of a client that occurs during a restraint, the facility shall:
(1) immediately notify the department's Hotline;
(2) within forty-eight (48) hours, send a completed DCF Form 136, "Report of Suspected Child Abuse/Neglect," to the department's Hotline;
(3) file a report concerning the death or serious injury with the department on a form provided by the department for that purpose; and
(4) provide copies of incident reports and medical reports regarding the incident and a description of the medical follow-up to the department.
(o) All facility staff shall be trained in appropriate restraint models as well as in prevention, trauma-informed care and the uses of restraint. All staff shall be assessed at least annually to ensure continued competency in the use of restraint. Policy and procedures shall be established for the utilization of staff that have been determined to be incapable of or unable to authorize, initiate, or participate in restraints or seclusions.
(p) The facility shall have a written plan for staff training and staff development, which shall include, but is not limited to:
(1) the use of restraint and seclusion;
(2) verbal de-escalation;
(3) prevention strategies;
(4) types of safety interventions;
(5) the differences between physical restraint, pain compliance techniques and permissible physical restraints;
(6) monitoring procedures;
(7) recording and reporting procedures;
(8) maintenance of personal safety for the resident and the staff;
(9) medical and physical restrictions to be considered;
(10) self protection, including escape and evasion;
(11) the continuum of least-to-most restrictive interventions;
(12) approved techniques;
(13) prohibited techniques;
(14) debriefing and post-intervention activities;
(15) safe escort and transport;
(16) stages of crisis;
(17) verbal limit setting;
(18) understanding personal space, body language, and non-verbal communication; and
(19) consideration of child and adolescent development and cultural issues.
(q) No facility shall place a resident in seclusion without the resident's consent except:
(1) as an emergency intervention to prevent immediate or imminent injury to the resident or to others, provided the seclusion is not used for discipline or convenience and is not used as a substitute for a less restrictive alternative; or
(2) as specifically provided for in the resident's individual education plan developed pursuant to section 10-76d of the Connecticut General Statutes.
(r) No facility shall use a psychopharmacologic agent on a resident without the consent of the resident or the resident's guardian except:
(1) as an emergency intervention to prevent immediate or imminent injury to the resident or to others; or
(2) as otherwise permitted by a court of competent jurisdiction.
(s) The use of psychopharmacologic agents, alone or in combination, shall be used only in doses that are therapeutically appropriate and not as a substitute for other appropriate treatment. The administration of a psychopharmacologic agent shall only be done by persons licensed to do so by the state Department of Public Health. All such uses of pharmacological agents shall be immediately reported to the department and to the resident’s guardian.
(t) All facilities shall report, on a schedule authorized by the department, aggregate data concerning the use of seclusion and restraint on forms developed by the commissioner.
(u) All facilities which permit the use of restraint and/or seclusion pursuant to the provisions of this regulation shall present to the commissioner, on an annual basis, a plan for the reduction of said uses of restraint and seclusion in the forthcoming year.
(v) In those facilities which maintain a restraint-free policy, a plan for monitoring the safety of children or youth who pose a risk of injury to self or others shall be required, and all staff shall be trained on it.
(NEW) Section 17a-145-241. Appeal of Regulatory Violation Dispute
(a) A facility wishing to dispute the issuance by the department of a citation for a regulatory violation shall do so in writing addressed to the bureau chief or division director directly responsible for the enforcement of child care facility licensing regulations. The decision of the bureau chief or division director shall be final.
(b) Nothing in this section shall supersede the right of a facility to challenge a licensing action taken by the department pursuant to section 17a-145-177 of these regulations.
Statement of Purpose: To provide the criteria for licensing and management of residential child care facilities.
Section: 2. Sections 17a-145-48 to 17a-145-98, inclusive, of the Regulations of Connecticut State Agencies are repealed.