Subject 290-2-5 RULES AND REGULATIONS FOR CHILD CARING INSTITUTIONS
These rules are adopted and published pursuant to the
Official Code of Georgia Annotated (O.C.G.A.) Sec.
49-5-1et
seq.
These rules shall be known as the Rules and Regulations for
Child Caring Institutions. The purposes of these rules are to provide for the
licensing and inspection of child caring institutions within Georgia, and to
establish foster care requirements applicable to those institutions that
provide such services.
In these rules, unless the context otherwise requires, the
words, phrases and symbols set forth herein shall mean the following:
| (a) |
"Adult" means a person eighteen (18)
years of age or older. |
| (b) |
"Applicant" means the following:
| 1. |
When the
institution is owned by a sole proprietorship, the individual proprietor shall
be the applicant for the license, complete the statement of responsibility and
serve as the licensee; |
| 2. |
When the
institution is owned by a partnership, the general partners shall be the
applicant for the license, complete the statement of responsibility and serve
as the licensee; |
| 3. |
When the
institution is owned by an association, the governing body of the association
shall authorize the application for the license and complete the statement of
responsibility and the association shall serve as the licensee; and |
| 4. |
When the institution is owned by a
corporation, the governing body of the corporation shall authorize the
application for the license and complete the statement of responsibility and
the corporation shall serve as the licensee. |
|
| (c) |
"Behavior management" means those
principles and techniques used by a facility to assist a resident in
facilitating self-control, addressing inappropriate behavior, and achieving
positive outcomes in a constructive and safe manner. Behavior management
principles and techniques shall be used in accordance with the individual
service plan, written policies and procedures governing service expectations,
service plan goals, safety, security, and these rules and
regulations. |
| (d) |
"Chemical
restraint" means drugs that are administered to manage a resident's behavior in
a way that reduces the safety risk to the resident or others; that have the
temporary effect of restricting the resident's freedom of movement; and that
are not being used as part of a standard regimen, as specified in the child's
service plan, to treat current symptoms of a medical or psychiatric
condition. |
| (e) |
"Child caring
institution" means a child-welfare agency that is any institution, society,
agency, or facility, whether incorporated or not, which either primarily or
incidentally provides full-time care for children through 18 years of age
outside of their own homes, subject to such exceptions as may be provided in
rules and regulations of the Board of Human Resources. This full-time care is
referred to as room, board and watchful oversight. For purposes of these rules,
a child caring institution means any institution, society, agency, or facility
that provides such care to six or more children |
| (f) |
"Criminal history background check" means
a search as required by law of the criminal records maintained by law
enforcement authorities to determine whether the applicant has a criminal
record as defined in these rules. |
| (g) |
"Commissioner" means the Commissioner of
the Department of Human Resources. |
| (h) |
"Criminal record" means:
| 1. |
Conviction of a crime; or |
| 2. |
Arrest, charge, and sentencing for a crime
where:
| (i) |
A plea of nolo contendere was
entered to the charge; or |
| (ii) |
First offender treatment without adjudication of guilt pursuant to the charge
was granted; or |
| (iii) |
Adjudication
or sentence was otherwise withheld or not entered on the charge; or |
| (iv) |
Arrest and being charged for a crime if
the charge is pending, unless the time for prosecuting such crime has expired
pursuant to O.C.G.A. Sec.
17-3-1et
seq. |
|
|
| (i) |
"Department" means the Georgia Department
of Human Resources. |
| (j) |
"Director"
means the chief administrative or executive officer of the
institution. |
| (k) |
"Emergency safety
interventions" mean those behavioral intervention techniques that are
authorized under an approved emergency safety intervention plan and are
utilized by properly trained staff in an urgent situation to prevent a child
from doing immediate harm to self or others. |
| (l) |
"Emergency safety intervention plan"
means the plan developed by the facility utilizing a nationally recognized,
evidence-based, training program for emergency safety intervention, approved by
the Department. The plan shall clearly identify the emergency safety
interventions staff may utilize and those that may never be used. |
| (m) |
"Employee" means any person, other than a
director, employed by an institution to perform any duties at any of the
institution's facilities which involve personal contact between that person and
any child being cared for at the institution and also includes any adult person
who resides at the institution or who, with or without compensation, performs
duties for the institution which involve personal contact between that person
and any child cared for by the institution.
| 1. |
For purposes of these rules, an employee does not mean a child that resides at
the facility and performs duties for the institution; |
| 2. |
For purposes of criminal history
background check determinations and if an institution provides foster care
services, an "employee" means any person employed by the foster home or any
adult person that resides at the home or who provides care to children placed
in the home. |
|
| (n) |
"Fingerprint records check determination" means a satisfactory or
unsatisfactory determination by the department based upon a records check
comparison of Georgia Crime Information Center (GCIC) information with
fingerprints and other information in a records check application. |
| (o) |
"Foster Care" means supervised care in a
substitute home or a child caring institution on a 24 hour full-time basis for
a temporary period of time. |
| (p) |
"Foster Home" means a private home where the foster parent(s) live which has
been approved by the institution/agency to provide 24 hour care, lodging,
supervision and maintenance for no more than six children under the age of
19. |
| (q) |
"Foster Parent" means an
adult person approved by the institution who has a satisfactory criminal
history background check determination and provides care, lodging, supervision,
and maintenance on a 24 hour basis for a child who must receive care out of his
own home. |
| (r) |
"Human Services
Professional" means the person(s) employed by the facility who is (are)
responsible for providing oversight of services to children and their families
in the home setting. The HSP is responsible for monitoring the residents' needs
and ensuring that appropriate services are being provided and arranged for in
order to meet those needs. Duties include, but are not limited to: the
coordination of the facility's admission evaluation; the development of the
service and Room, Board, Watchful Oversight plans; case work services as
provided in the resident's service plans; and monitoring of the resident's
educational and/or vocational needs. |
| (s) |
"Living unit" means the physical location
where residents live within the institution. |
| (t) |
"Manual hold" means the application of
physical force, without the use of any device, for the purpose of restricting
the free movement of a child's body and is considered a form of restraint. A
manual hold does not include briefly holding a child without undue force to
calm or comfort the child, holding a child by the hand or by the shoulders or
back to walk the child safely from one area to another where the child is not
forcefully resisting the assistance, or assisting the child in voluntarily
participating in activities of daily living. |
| (u) |
"Mechanical restraint" means a device
attached or adjacent to the child's body that is not a prescribed and approved
medical protection device and that he or she cannot easily remove that
restricts freedom of movement or normal access to his or her body. A mechanical
restraint does not include devices used to assist a child with appropriate
positioning or posture secondary to physical impairments or
disabilities. |
| (v) |
"Medicaid
Rehabilitation Option Provider (MRO)" means that category of behavioral health
services designed for the maximum reduction of impairments related to mental
illness or addiction and restoration of a Medicaid recipient to his/her best
possible functional level. |
| (w) |
"Owner" means any individual or any person affiliated with a corporation,
partnership, or association with 10 percent or greater ownership interest in
the business or agency licensed as a child caring institution and who:
| 1. |
Purports to or exercises authority of the
owner in a caring institution; |
| 2. |
Applies to operate or operates a child caring institution; |
| 3. |
Enters into a contract to acquire
ownership of a child caring institution. |
|
| (x) |
"Placement" means any activity by any
person that provides assistance to a parent or guardian in locating and
effecting the move of a child to a foster home or adoptive home, including
assessing suitability of homes for placement. Counseling with respect to
options available, legal services, or services as an agent for purposes of
notice or withdrawal of consent by the birth parent does not constitute
placement activity. |
| (y) |
"Preliminary records check application" means an application for a preliminary
records check determination on forms provided by the department. |
| (z) |
"Preliminary records check determination"
means a satisfactory or unsatisfactory determination by the department based
only upon a comparison of Georgia Crime Information Center (GCIC) information
with other than fingerprint information regarding the person upon whom the
records check is being performed. |
| (aa) |
"Records check application" means two
sets of classifiable fingerprints, a records search fee to be established by
the department by rule and regulation, payable in such form as the department
may direct to cover the cost of a fingerprint records check, and an affidavit
by the applicant disclosing the nature and date of any arrest, charge, or
conviction of the applicant for the violation of any law; except for motor
vehicle parking violations, whether or not the violation occurred in this
state, and such additional information as the department may require. |
| (bb) |
"Room, Board and Watchful Oversight"
means providing a safe, comfortable room, adequately nutritious meals and
oversight to ensure a child's basic safety needs are met. |
| (cc) |
"Satisfactory criminal history
background check determination" means a written determination that a person for
whom a records check was performed was found to have no criminal
record. |
| (dd) |
"Seclusion" means the
involuntary confinement of a child away from other children, due to imminent
risk of harm to self or others, in a room or an area from which the child is
physically prevented from leaving. |
| (ee) |
"Supervision" means the continued
responsibility of the licensee to take reasonable action to provide for the
health, safety, and well-being of a resident while under the supervision of the
licensee or the agent or employee of the licensee, including protection from
physical, emotional, social, moral, financial harm and personal exploitation
while in care. The licensee is responsible for providing the degree of
supervision indicated by a child's age, developmental level, physical,
emotional, and social needs. |
| (ff) |
"Time-out" means a behavior management technique that involves the brief
separation of a child from the group, not to exceed twenty (20) minutes,
designed to de-escalate the child. During "time-out" a child's freedom of
movement is not physically restricted. |
| (gg) |
"Unsatisfactory criminal history
background check determination" means a written determination that a person for
whom a records check was performed has a criminal record. |
Each institution shall have a clearly identified governing
body which shall be empowered and responsible for determining all policies and
procedures and ensuring compliance with these rules and regulations. The
chairperson or chief executive officer of the governing body shall complete a
statement of responsibility on behalf of the governing body acknowledging the
same in connection with any application for a license on a form provided by the
department. If an institution is individually owned, then the owner(s) will
complete the statement of responsibility. If an institution is governed by a
board, there shall be policies and procedures for periodic rotation of
members.
| (1) |
Criminal
History Background Checks for Owners Required. Prior to approving any license
for a new child caring institution and periodically as established by the
department by rule and regulation, the department shall require an owner to
submit a records check application so as to permit the department to obtain
criminal history background information on the owner.
| (a) |
An owner may not be required to submit a
records check application if it is determined that the owner does not do at
least one of the following:
| 1. |
Maintains an
office at the location where services are provided to children; |
| 2. |
Resides at a location where services are
provided to children; |
| 3. |
Has direct
access to residents receiving care; or |
| 4. |
Provides direct personal supervision of
personnel by being immediately available to provide assistance and direction
during the time services are being provided to children. |
|
| (b) |
In lieu of a records check application,
an owner may submit evidence, satisfactory to the department, that within the
immediately preceding 12 months the owner has received a satisfactory criminal
history background check determination. |
|
| (2) |
A child caring institution license shall
not be issued, and any license issued shall be revoked where it has been
determined that the owner has a criminal record involving any of the following
covered crimes, as outlined in O.C.G.A. Sec.
49-2-14.1et
seq.:
| (a) |
A violation of Code
Section
16-5-1,
relating to murder and felony murder; |
| (b) |
A violation of Code Section
16-5-21,
relating to aggravated assault; |
| (c) |
A violation of Code Section
16-5-24,
relating to aggravated battery; |
| (d) |
A violation of Code Section
16-5-70,
relating to cruelty to children; |
| (e) |
A violation of Code Section
16-5-100,
relating to cruelty to a person 65 years of age or older; |
| (f) |
A violation of Code Section
16-6-1, relating
to rape; |
| (g) |
A violation of Code
Section
16-6-2,
relating to aggravated sodomy; |
| (h) |
A violation of Code Section
16-6-4,
relating to child molestation; |
| (i) |
A violation of Code Section
16-6-5,
relating to enticing a child for indecent purposes; |
| (j) |
A violation of Code Section
16-6-5.1,
relating to sexual assault against persons in custody, detained persons, or
patients in hospitals or other institutions; |
| (k) |
A violation of Code Section
16-6-22.2,
relating to aggravated sexual battery; |
| (l) |
A violation of Code Section
16-8-41,
relating to armed robbery; |
| (m) |
A
violation of Code Section
30-5-8,
relating to abuse, neglect, or exploitation of a disabled adult or elder
person; or |
| (n) |
Any other offense
committed in another jurisdiction that, if committed in this state, would be
deemed to be a crime listed in this paragraph without regard to its designation
elsewhere. |
|
| (3) |
An owner
with a valid child caring institution license issued on or before June 30, 2007
shall be required to obtain a criminal records check determination no later
than December 31, 2008.
| (a) |
An owner with a
valid child caring institution license issued on or before June 30, 2007 who is
determined to have a criminal record for any of the crimes listed in Rule
.05(2)(a)-(n)
above, shall not have the license revoked prior to a hearing being held before
a hearing officer pursuant to Chapter 13 of Title 50, the "Georgia
Administrative Procedure Act." |
| (b) |
An owner with a valid child caring institution license who acquires a criminal
record as defined in Rule
.05(2)(a)-(n) above
subsequent to the effective date of these rules shall disclose the criminal
record to the department. |
|
| (4) |
If at any time the department has reason
to believe an owner holding a valid license has a criminal record for any of
the crimes listed in Rule
.05(2)(a)-(n)
above, the department shall require the owner to submit a records check
application immediately for determination of whether a revocation action is
necessary. Prior to the revocation of the license becoming final, the owner is
entitled to an administrative hearing unless the owner has not begun providing
services under the license. Where services are not currently being provided
under the license, the decision of the administrative hearing officer must
precede the initiation of services. |
| (5) |
Criminal History Background Checks for
Director and Employees Required. Prior to serving as a director of a licensed
institution, a person shall submit a records check application and receive a
satisfactory determination.
| (a) |
A person with
an unsatisfactory criminal history background check determination may not serve
as a director of a licensed child caring institution if it is determined that
such person has a criminal record involving any of the following covered
crimes:
| 1. |
Any felony under Georgia
law; |
| 2. |
A violation of Code Section
O.C.G.A. Sec.
16-4-1, relating
to criminal attempt when the crime attempted is any of the crimes specified by
this paragraph; |
| 3. |
A violation of
Code Section O.C.G.A. Sec.
16-5-23, relating
to simple battery; where the victim is a minor; |
| 4. |
A violation of Code Section O.C.G.A. Sec.
16-6-1et
seq., relating to sexual offenses, excluding the offenses of bigamy or
marrying a bigamist; |
| 5. |
A violation
of Code Section O.C.G.A. Sec. 16-21-1, relating to contributing to the
delinquency of a minor; |
| 6. |
Any
other offense committed in another jurisdiction that, if committed in this
state, would be deemed to be a crime listed in this paragraph without regard to
its designation elsewhere. |
|
| (b) |
Prior to serving as an employee other
than a director of a licensed institution, a person must submit a preliminary
record check application and receive a satisfactory determination. Provided
however, should there be an unsatisfactory determination, the person must
submit to a fingerprint record check and get a satisfactory determination or be
determined eligible to be employed by the institution as a result of an
administrative hearing. |
| (c) |
A
person with an unsatisfactory background check determination may not serve as
an employee of a licensed child caring institution if it is determined that
such person has a criminal record involving any of the covered crimes outlined
in Rule
.05(5)(a)1. -6.
above. |
| (d) |
In lieu of a records
check application, a director or employee may submit evidence, satisfactory to
the department, that within the immediately preceding 12 months the above
personnel have received a satisfactory records check determination or a
satisfactory preliminary records check determination. |
|
| (6) |
Criminal History Background Checks for
Foster Parents Required. No facility that provides care in foster homes shall
place a child in a foster home unless the foster parent(s) of the home and
other adult persons that reside in the home or provide care to children placed
in the home have obtained criminal records checks as required by law. |
| (7) |
No child shall continue to be placed in
such foster care home unless the foster parent(s) also subsequently receive a
satisfactory fingerprint records check determination. |
| (8) |
Licenses. No person, partnership,
association, corporation or entity shall operate a child caring institution in
the state without first obtaining a license to operate the institution by
demonstrating compliance with the necessary requirements set forth in these
rules. No licensed child-caring institution first licensed after the effective
date of these rules shall provide room, board and watchful oversight to more
than 16 children on its premises.
| (a) |
Institutions operated as a part of a local church ministry or religious
nonprofit school or a nonprofit religious charitable organization may request
to be commissioned in lieu of licensed. All provisions of these rules shall
apply to institutions that request to be commissioned, and for the purposes of
these rules, the term license shall have the same meaning as
commission. |
| (b) |
A license may be
issued, upon presentation of evidence satisfactory to the department, that the
facility is in compliance with applicable statutes and these rules. The license
is valid for the period of time specified by the department, unless voluntarily
surrendered by the holder, reduced to a restricted or temporary license or
suspended or revoked by the department. |
|
| (9) |
Temporary License. The department may in
its discretion issue a temporary license if the health and safety of the
children to be served by the institution will not be endangered. A temporary
license will be valid for a specified period not to exceed one (1) year and may
be issued in the following instances:
| (a) |
If
an institution complies with these rules but has not yet enrolled children;
or |
| (b) |
If an institution is not in
full compliance with these rules but has demonstrated satisfactory evidence
that it is making progress toward meeting these rules and has submitted an
acceptable plan of correction. |
| (c) |
If the department finds that any child caring institution applicant does not
meet rules and regulations prescribed by the department but is attempting to
meet such rules and regulations, the department may, in its discretion, issue a
temporary license or commission to such child caring institution, but such
temporary license or commission shall not be issued for more than a one-year
period.
| 1. |
Upon presentation of satisfactory
evidence that such institution is making progress toward meeting prescribed
rules and regulations of the department, the department may, in its discretion,
reissue such temporary license or commission for one additional period not to
exceed one year. |
| 2. |
As an
alternative to a temporary license or commission, the department, in its
discretion, may issue a restricted license or commission which states the
restrictions on its face. |
|
|
| (10) |
Restricted License. The department may
in its discretion issue a restricted license in lieu of a temporary or regular
license. The restricted license may be granted either in connection with the
initial application process for a license or as a result of a subsequent
determination made by the department concerning compliance with these rules.
The restriction shall appear on the face of the license and shall restrict an
institution from providing care or services which are beyond the capability of
the licensee to provide. The restriction may include but is not limited to the
number and/or age of the children served by the institution. |
| (11) |
Qualifications Requirement. In order to
obtain or retain a license, the director of the institution and its employees
must be qualified, as defined in these rules, to administer or work in a
institution. The department may presume that the director and employees are
qualified, subject to satisfactory determinations on the criminal history
background checks. However, the department may require additional reasonable
verification of the qualifications of the director and employees either at the
time of application for a license or at any time during the license period
whenever the department has reason to believe that a director or employee is
not qualified under these rules to administer or work in an
institution. |
| (12) |
License is
Nontransferable. A license to operate an institution is not transferable in any
way. Each license shall be returned to the department immediately upon the
suspension, revocation, restriction of the license or termination of the
operation. |
| (13) |
Renewal of License.
A license will be renewed upon a determination by the department that the
institution presents satisfactory evidence of meeting the requirements set
forth in these rules. |
| (14) |
Exemptions. Anyone operating or desiring to provide a service believed to be
exempt from licensure shall apply to the department for exemption. The
exemptions granted by the department are exemptions from licensure, and do not
affect the authority of local, regional or state health department officials,
the state fire marshal or local fire prevention officials to inspect
facilities. These rules shall not apply to the following kinds of programs
providing care to children:
| (a) |
Child welfare
agencies and other facilities and institutions wherein children and youths are
detained which are operated by any department or agency of state, county, or
municipal government. |
| (b) |
Any bona
fide boarding school whose primary purpose of admission is education, provided
that such facility in order to claim exemption shall operate under a published
academic educational curriculum which meets the requirements of the State
Department of Education, shall have classroom facilities which are not used for
residential living and shall not have been granted nor have assumed legal
custody of children attending the facility. |
| (c) |
Facilities owned and operated by the
state or federal government. |
| (d) |
Temporary recreational facilities and programs which limit residency to no more
than three months, such as summer camps. |
|
| (1) |
An application
for a license to operate an institution shall be submitted to the department on
the forms provided by the department.
| (a) |
Time
for Filing. An application for a license shall be submitted at least thirty
(30) days prior to the proposed opening date of the new institution. |
| (b) |
Records Check and Preliminary Records
Check Applications. Accompanying any application for a new license for an
institution, the applicant shall furnish to the department a records check
application for the owner and director and a preliminary records check
application for each employee and any foster parents, if applicable as defined
in these rules. |
| (c) |
Separate
Licenses or Commissions. A separate license or commission application is
required for each geographical location which an institution is proposed to
operate even when all of the proposed institutions are owned by the same person
or entity. |
| (d) |
Amended License. If
there is to be a change in the name of the institution, change in ownership,
changes in the ages of children to be served, or additions or changes in the
uses of the buildings that will affect the facility's licensed capacity, an
application for an amended license shall be submitted at least thirty (30) days
prior to the changes or additions, except in cases of emergencies. In such
cases of emergencies, which make it impossible to submit an application within
thirty (30) days, the governing body or director shall notify the department by
telephone and shall submit an application for the amended license as soon as
the governing body or the director becomes aware of the change or
addition. |
| (e) |
Notice of Denial. If
the department determines that the applicant does not comply with these rules
and determines that the issuance of a temporary or restricted license is not
appropriate, the department will provide a written notice of the denial of
licensure and the opportunity for a hearing to the applicant. |
| (f) |
False or Misleading Information. The
application for a license including the application for a criminal history
background check must be truthfully and fully completed. In the event that the
department has reason to believe that any required application has not been
completed truthfully, the department may require additional verification of the
facts alleged. The department may refuse to issue a license where false
statements have been made in connection with the application or any other
documents required by the department. |
| (g) |
The department may deny a license or
otherwise restrict a license for any applicant who has had a license denied,
revoked, or suspended within one year of the date of the application or who has
transferred ownership or governing authority of an agency, facility,
institution, or entity subject to regulations by the department within one year
of the date of a new application when such transfer was made in order to avert
denial, revocation, or suspension of a license. |
| (h) |
An institution shall not begin operation
without departmental approval. |
|
The department is authorized and empowered to conduct
investigations and on-site inspections of any institution required by these
rules to be licensed. The proposed and current licensee and staff shall
cooperate with any inspection or investigation by responding truthfully to any
legitimate departmental inquiry.
| (a) |
Initial Inspection. Following receipt and review of a complete application
package, the department may conduct an on-site inspection of the institution to
assess compliance with these rules. |
| (b) |
Consent to Entry. An application for a
license or commission to operate an institution or the issuance of a license by
the department constitutes consent by the applicant, the proposed holder of the
license and the owner of the premises for the department's representative,
after displaying picture identification to any institution staff, to enter the
premises at any time during operating hours for the purpose of inspecting the
facility. This includes both scheduled and unscheduled inspections and includes
consent for meaningful access to all staff, parts of the premises, all children
present, and all records required by these rules. To the degree possible,
inspections of records normally maintained in the institution's business
office, such as financial records, will be conducted during normal business
hours, e.g., 8:00 a.m. to 6:00 p.m. on Mondays through Fridays. The department
shall have the authority to require the production of any books, records,
papers, or other information related to the initial or continued licensing of
any institution. |
| (c) |
Other
Inspections. The department may conduct scheduled and unscheduled on-site
inspections of an institution in the following instances:
| 1. |
Annually or at other regular intervals as
the department may determine or at the expiration of the current license;
or |
| 2. |
Upon receiving a report,
including a report submitted by the institution, alleging child abuse, neglect,
sexual exploitation, or deprivation which occurred while the child was in the
care of the institution director or employees; or |
| 3. |
Upon receiving information of alleged
violations of these rules, including information provided by the institution,
which, if true, could endanger the health, safety or welfare of the children in
care; or |
| 4. |
Upon receipt and review
of a request for an amended license, where the department determines that an
on-site inspection is advisable; or |
| 5. |
Upon the department or its duly authorized
representative being made aware of any flagrant abuses, derelictions or
deficiencies during the course of the department's inspection or at any other
time. The department shall immediately investigate such matters and may make an
on-site inspection so as to take such actions as conditions may require;
or |
| 6. |
Subsequent to the receipt of
a plan of correction, as determined necessary by the department, to monitor
whether the plan of correction is being complied with by the institution's
personnel. |
|
| (d) |
Failure
to Allow Access. Failure to allow access of the department's representative to
the institution, its staff, or the children receiving care at the institution
or the books, records, papers, or other information related to initial or
continued licensing, or failure to cooperate with a departmental inspection or
investigation shall constitute good cause for the denial, restriction,
revocation or suspension of a license, or other penalty as provided by
law. |
| (e) |
False or Misleading
Statements. No licensee shall make or condone any employee making false or
misleading statements to the department in connection with any authorized
investigation or inspection being conducted by the department. |
| (1) |
Program Purpose. In accordance with these
rules and regulations, a licensed child caring institution shall develop,
implement and comply with written policies and procedures that specify its
philosophy, purpose, and program orientation. Such policies and procedures
shall identify the characteristics and ages of the children it serves,
including the referral sources. |
| (2) |
Program Description and Implementation. In accordance with these rules and
regulations, a licensed child caring institution shall develop, implement and
comply with written policies and procedures that describe the range of services
including room, board and watchful oversight and the manner in which such
services will be provided by the facility. Such policies and procedures shall
describe how identified services will be provided, the specific emergency
safety intervention plan, including the emergency safety interventions, that
will be used, and how such services will be assessed and evaluated. A program
description must show what services are provided directly by the facility and
how it will coordinate its services with those provided by any Medicaid
rehabilitation option provider or other available community or contract
resources. |
| (3) |
Director. The
governing body of the institution shall designate a director who shall be
authorized to manage the institution.
| (a) |
Any
director employed on or after the effective date of these rules shall possess
at least one of the following qualifications:
| 1. |
A master's degree from an accredited
college or university in the area of social sciences, social work, childhood
education, or business or public administration or a related field plus two
years of experience in the field of child care; |
| 2. |
A bachelor's degree from an accredited
college or university in the area of social sciences, social work, childhood
education, or business or public administration or a related field plus four
years of experience in the field of child care; |
| 3. |
A licensed registered nurse, doctor or
other health care professional where the child-caring institution chooses to
serve primarily children with special medical needs. |
|
| (b) |
Any director employed on or after the
effective date of these rules must meet the following additional minimum
qualifications.
| 1. |
Never have been shown by
credible evidence (e.g. a court or jury, a department investigation, or other
reliable evidence) to have abused, neglected, sexually exploited, or deprived a
child or adult or to have subjected any person to serious injury as a result of
intentional or grossly negligent misconduct as evidenced by an oral or written
statement to this effect obtained at the time of application and evidence of
having made efforts to obtain and evaluate references from previous
employers; |
| 2. |
Participate in the
orientation and training required by these rules; and |
| 3. |
Not have made any material false
statements concerning qualifications requirements either to the department or
the proposed licensee. |
|
| (c) |
When the director is absent from the
institution at any time, there shall be an officially designated person to
assume responsibility for the operation of the institution. |
|
| (4) |
Finances. The governing body
shall provide for the preparation of an annual budget and approve such budget.
Copies of the current year's budget and expenditure records shall be maintained
for examination and review by the department.
| (a) |
The director and all persons authorized
to receive or disburse operating funds shall be bonded or insured. |
| (b) |
A schedule of fees shall be established
and implemented and made available to a parent(s) or guardian(s), or
representative(s) of children considered for admission to the institution. The
schedule shall detail the basic cost of services and any additional costs for
other services. |
|
| (5) |
Recordkeeping.
| (a) |
Case Records. An
institution shall maintain a written record for each child which shall include
the following:
| 1. |
Identifying information
including name, sex, and birth date or age; |
| 2. |
Date of admission and source of referral
including all documents related to the referral and admission of the child to
the institution; |
| 3. |
Name, address,
and telephone numbers of the parent(s) or guardian(s) or
representative(s); |
| 4. |
Name and
telephone number of placing agency and agency's contact, if
applicable; |
| 5. |
Documentation of
current custody if not placed by natural or adoptive parents; |
| 6. |
A copy of the child's birth certificate,
or an appropriate record of birth; |
| 8. |
Service plans and review and progress
notes and collateral communications with MRO and/or other service
providers; |
| 9. |
Records of behavior
management, emergency safety interventions, and written grievances, as
described in Rule
.14
and Rule
.15; |
| 10. |
Documentation of health history; as
required at admission; |
| 11. |
Medical
records, including documentation of visits to physicians and dentists, records
of prescriptions and administration of medicines, immunization records, and
orders for modified diets; |
| 12. |
Educational and vocational information such as report cards, progress reports,
and related materials received during a child's residency in the institution;
and |
| 13. |
Discharge plans required by
Rule
.11, if applicable, |
|
| (b) |
Retention of Case Records.
Case records shall be retained in the institution for at least one year
following discharge of residents. |
| (c) |
Confidentiality of Case Records.
| 1. |
Written policies and procedures shall be
established and implemented for the maintenance and security of case records
specifying who shall supervise the maintenance of records, who shall have
custody of records, and to whom records may be released and for what
purposes. |
| 2. |
An institution shall
maintain the confidentiality of all children's case records. Employees of the
institution shall not disclose or knowingly permit the disclosure of any
information in a case record except to appropriate direct care staff, the
parent(s) or guardian(s), their respective legal counsel, a court of legal
jurisdiction, licensing staff, and other authorized public officials in the
performance of their mandated duties, or the child's placing agency. |
|
| (d) |
Personnel Records. An
institution shall maintain written records for each employee and the director.
Such records shall include the following:
| 1. |
Identifying information such as name, address, telephone number, and emergency
contact person(s); |
| 2. |
A 10-year
employment history or a complete employment history if the person has not
worked 10 years; |
| 3. |
Records of
educational qualifications; |
| 4. |
Documentation of at least two professional, educational, or personal references
that attest to the person's capabilities of performing the duties for which
they are employed and to the person's suitability of working with or around
children; |
| 5. |
Satisfactory
preliminary criminal history background check determination and a satisfactory
fingerprint records check determination as required by law for the director and
foster parents, and a satisfactory determination on a preliminary records check
and fingerprint records check for employees as required by law; |
| 6. |
Documentation from a licensed physician or
other licensed healthcare professional of a health screening examination within
thirty (30) days of hiring sufficient in scope to identify conditions that may
place the children at risk of infection, injury or improper care; |
| 8. |
The person's job description or statements
of the person's duties and responsibilities; |
| 9. |
Documentation of orientation and training,
including dates of all such training, as required by Rule
.08(6)(d) of these
rules; and |
| 10. |
Any documentation of
the individual's performance, including all records of employee discipline
arising from the inappropriate use of behavior management techniques and
emergency safety interventions and grievance reports described in Rule
.14
and Rule
.15 related to children in care and
the employee. |
|
|
| (6) |
Staffing. The institution shall have
sufficient numbers of qualified and trained staff as required by these rules to
provide for the needs, care, protection, supervision and room, board and
watchful oversight of children. All staff and volunteers shall be supervised to
ensure that assigned duties are performed adequately and to protect the health,
safety and well-being of the children in care.
| (a) |
All staff employed on or after the
effective date of these rules must meet the following minimum qualifications:
| 1. |
Never have been shown by credible evidence
(such as a decision of a court or jury, or a department investigation or other
reliable evidence) to have abused, neglected, sexually exploited, or deprived a
child or adult or to have subjected any person to serious injury as a result of
intentional or grossly serious injury as a result of intentional or grossly
negligent misconduct as evidenced by an oral or written statement to this
effect obtained at the time of application; |
| 2. |
Participate in the orientation and
training as stated in subparagraph (d) of this Rule; and |
| 3. |
Not have made any material false
statements concerning qualifications requirements either to the department or
the proposed licensee. |
| 4. |
All
prospective foster parents, adoptive parents or any adult living in the home
must be checked against the child abuse and neglect registry for information,
and must provide information from any other state in which any such prospective
parent or other adult has resided in the previous 5 years to check any child
abuse and neglect registry maintained by that state. Providers will need to
comply with these requirements before they approve prospective homes when such
information is available. |
|
| (b) |
Human Services Professionals. The
institution shall have designated human service professionals to provide
oversight of services to children and their families in the home setting.
Within six months of the effective date of these rules, there shall be one
human services professional employed for every 16 children in care or fraction
thereof for those institutions first licensed after the effective date of these
rules. For those institutions licensed prior to the effective date of these
rules, there shall be one human service professional employed for every 30
children in care or fraction thereof. However, a human services professional
assigned referral and intake duties and responsibilities shall provide
oversight of services to not more than 16 children. The institution's director,
if qualified by education, may perform the duties of a human services
professional.
| 1. |
Any human services
professional employed on or after the effective date of these rules shall
either:
| (i) |
Possess a bachelor's degree from
an accredited college or university in social work, psychology, childhood
education, education counseling and psychology, or a related field and either
have two years experience in the field of child care or be supervised by
another human service professional with a master's degree in one of the above
disciplines; or |
| (ii) |
Possess a
master's degree from an accredited college or university in one of the above
disciplines. |
|
|
| (c) |
Child Care Workers. The institution shall
have designated child care workers to supervise children and be responsible for
living units where the children reside.
| 1. |
No
institution shall admit or retain children whose needs for room, board and
watchful oversight cannot be met. The institution shall have sufficient numbers
of qualified and trained staff to provide for the room, board and watchful
oversight of children pursuant to Rule
.08(6). |
| 2. |
Any child care worker shall be at least 21
years of age and possess a high school diploma or general education diploma
(GED) and have current evidence of successful completion of a biennial training
program in cardiopulmonary resuscitation (CPR) and a triennial training program
in first aid which have been offered by certified or licensed health care
professionals. Such training programs shall be completed within the first year
of employment. |
|
| (d) |
Staff
Training. Prior to working with children, all staff, including the director,
who work with children and are hired after the effective date of these rules
shall be oriented in accordance with these rules and shall thereafter
periodically receive additional training in accordance with these rules.
| 1. |
Orientation shall include instruction in:
| (i) |
The institution's purpose and description
of services and its policies and procedures; |
| (ii) |
The employee's assigned duties and
responsibilities; |
| (iii) |
Grievance
policies and procedures; |
| (iv) |
Child
abuse policies and procedures; |
| (v) |
Reporting requirements for suspected cases of child abuse and sexual
exploitation and notifiable diseases and serious injuries; |
| (vi) |
The institution's policies and
procedures for handling medical emergencies (life-threatening,
limb-threatening, or function-threatening conditions), and managing use of
medications by children in care; and |
| (vii) |
The institution's policies and
procedures regarding appropriate behavior management and emergency safety
interventions. |
|
| 2. |
Additional training shall include twenty-four (24) clock hours of formal,
annual training or instruction in child care issues related to the employee's
job assignment and to the types of services provided by the
institution. |
|
| (e) |
All
direct care staff shall have at least one full day (24 hours) off each week and
shall also have at least one weekend off each month. |
|
| (7) |
Reporting. Detailed written summary
reports shall be made to the Department of Human Resources, Office of
Regulatory Services, Residential Child Care Unit via email or fax on the
required incident intake information form (IIIF) within 24 hours. This report
shall be made regarding serious occurrences involving children in care,
including but not limited to:
| (a) |
Accidents or
injuries requiring medical treatment and/or hospitalization; |
| (d) |
Closure of the living unit due to
disaster or emergency situations such as fires or severe weather; |
| (e) |
Emergency safety interventions resulting
in any injury; or |
| (f) |
Any incident
which results in any federal, state or private legal action by or against the
institution which affects any child or the conduct of the institution. However,
legal action involving the juvenile justice system is not required to be
reported. |
| (g) |
A detailed
investigative report which includes steps taken by the facility to prevent
further incidents of a similar nature from occurring shall follow in five work
days if not provided initially. |
|
| (8) |
Child Abuse Reports. Whenever the child
caring institution has reason to believe that a child in care has been
subjected to child abuse it shall cause a report of such abuse to be made to
the child welfare agency of the county of occurrence providing protective
services as designated by the Department of Human Resources (Division of Family
and Children Services) or in the absence of such an agency to an appropriate
police authority or district attorney in accordance with the requirements of
O.C.G.A. Sec.
19-7-5.
A copy of such report shall also be filed with the Office of Regulatory
Services. |
| (1) |
Referrals. An institution
shall only accept referrals for children whose known needs can be met by the
institution in accordance with its program purpose and program description.
| (a) |
Referral agreements with any public or
private agencies that place children in the institution shall be in writing and
shall include the following provisions and requirements.
| 1. |
Preplacement assessment and planning with
the placing agency regarding the institution's abilities to meet the needs of
the child shall be done. To the degree possible, all relevant information
required for admission to the facility shall be reviewed in preplacement
assessment and planning. |
| 2. |
To the
degree possible, there shall be a preplacement visit by the child, and the
parent(s) or guardian(s), or placing agency representative if there is a
reasonable likelihood that the child will be admitted. |
|
| (b) |
Referrals from any persons other than
placing agencies (such as a parent or guardian) shall be handled in the same
manner as described above for referrals from placing agencies. |
|
| (2) |
Admissions. An
institution shall only admit children whose known needs can be met by the
institution based on preplacement assessment, planning and room, board and
watchful oversight capacity.
| (a) |
A child under
the age of six (6) shall not be admitted to an institution, unless the child is
a member of a sibling group with at least one of the siblings being 6 years of
age or older who will reside in the institution, or the mother who is under the
age of 19 and her child are placed in the home together. Where a child under
the age of six (6) is admitted, the child-caring institution shall provide
developmentally-appropriate sleeping facilities, diapering facilities and daily
child-care arrangements. |
| (b) |
Prior
to admission, the facility shall:
| 1. |
Provide
information to the custodian about the services, environment, age ranges and
behavioral characteristics of the other children in placement. |
| 2. |
Maintain signed documentation from the
custodian that they have received and considered the information provided in
Rule
.09(1)(a)1. above
and have determined that the placement environment is appropriate and does not
represent an undue risk to the health and safety of the child or children being
placed. |
|
| (c) |
The facility
shall comply with the Interstate Compact on Placement when admitting children
from another state. |
| (d) |
Written
admission policies and procedures shall be established and implemented and
shall include the following provisions or requirements.
| 1. |
An intake referral form that includes a
social, health, educational, family, behavioral and personal developmental
history, shall be done to determine the placement and room, board and watchful
oversight needs (services, supports, setting, etc.) of each child and whether
that placement is appropriate. |
| 2. |
A
completed written placement agreement shall be developed with the involvement
of the child, and the parent(s) or guardian(s), or placing agency
representative and signed by all parties; such agreement shall include the
following:
| (i) |
Written authorization to care
for the child; |
| (ii) |
Written
authorization to obtain medical care for the child; |
| (iii) |
Written summary of discussions among
the child and the parent(s) or guardian(s), or placing agency, and the
institution's Human Service Professional regarding basic care, any specialized
services to be provided, room, board and watchful oversight, the description of
the institution as outlined in Rule
.09(2)(b); and
involvement of the parent(s) or guardian(s), or the placing agency in service
planning. |
|
|
| (e) |
A written description of the institution shall be provided to the child, the
parent(s) or guardian(s), or placing agency and shall include:
| 1. |
The institution's program purpose and
program description; |
| 2. |
The
description of service planning and normal daily routines of
children; |
| 3. |
The description of
health services including how the institution handles illnesses, injuries, and
medical emergencies (life-threatening, limb-threatening, and
function-threatening conditions); |
| 4. |
The institution's policies and procedures
for behavior management and grievances; |
| 5. |
Policies and procedures for visiting hours
and communications with persons outside the institutions; |
| 6. |
The names and telephone numbers of the
child's designated Human Services Professional and primary Child Care Worker;
and |
| 7. |
Schedule of fees if
placement is not done under a Purchase of Service Agreement. |
|
| (f) |
Emergency Admissions. In
situations that require emergency admission to an institution and when
completion of the intake referral form, as described in Rule
.09(1)(a)1., and
intake evaluation and placement agreements, as described in Rules
.09(2)(a)1. and 2.
are not possible, the institution shall obtain as much information as possible
about the child to be admitted, and as much information as possible about the
circumstances requiring admission. Such information shall be obtained from the
referring person(s) or entity(ies) within 72 hours. When all the information to
complete the intake referral form is not available, a health assessment shall
be scheduled within 24 hours of emergency admission. |
|
| (1) |
An institution shall complete a full
written assessment of each child admitted for care and of each child's family
within thirty days of admission and develop an individual written service plan
for each child based on the assessments within thirty days of admission. If an
assessment is not completed within thirty days, the reasons for the delay shall
be documented in the child's case record and such documentation shall include
statements indicating when the assessment is expected to be completed.
| (a) |
The facility's admission evaluation shall
be coordinated by the child's designated Human Services Professional. The
facility shall assess the needs of the child in the areas of health care, room,
board and watchful oversight, education, family relationships, personal, social
and vocational development, and any behavioral issues that require monitoring.
| 1. |
This assessment is intended to expand upon
the initial intake evaluation required by Rule
.09(2)(a)1.; |
| 2. |
The institution shall obtain the child's
school records from the last school attended in order to complete the education
needs component of the assessment. |
|
| (b) |
A service and room, board and watchful
oversight plan shall be developed by the child's Human Services Professional in
concert with the child's primary Child Care Worker, meaning the worker who has
responsibility for supervision of the child in the living unit where the child
resides. The plan shall contain the following data:
| 1. |
The results of the assessment and
identified needs; |
| 2. |
Statements of
time-limited goals and objectives for the child and family and methods of
achieving them and evaluating them; |
| 3. |
Statements of activities to be followed by
the child and staff members in pursuit of the stated goals and
objectives; |
| 4. |
Statements of any
special care and services that will be arranged for or provided
directly; |
| 5. |
Statements of goals
and preliminary plans for discharge; |
| 6. |
Statements about the types of discipline
that should be employed when necessary; and |
| 7. |
Statements about any restrictions of
communications or visitations with any persons; such statements shall clearly
show that the health, safety, and welfare of the child would be adversely
affected by such communications or visits. |
|
| (c) |
The child, and the parent(s) or
guardian(s), or child placing agency representative shall be involved in the
development of the service and room, board and watchful oversight plans, and
its periodic updates as described below. |
| (d) |
The service and room, board and watchful
oversight plan shall be updated by the Human Services Professional at a minimum
of every six months and pertinent progress notes and data shall be incorporated
in the plan to measure attainment of stated goals and objectives.
| 1. |
The child's primary Child Care Worker
shall participate in updating the service and room, board and watchful
oversight plan. |
| 2. |
The facility
shall be responsible for implementing the service and room, board and watchful
oversight plan. |
|
|
| (1) |
During a child's placement in an
institution, the preliminary plans for discharge required by Rule
.10(b)5. shall be
adjusted according to the child's circumstances. At least three months prior to
planned discharge, except in cases of emergency discharges, an institution
shall formulate an aftercare plan that identifies the supports, room, board and
watchful oversight summary and resources that the child and child's family are
expected to need following discharge. When a child is being discharged for
placement in another institution or similar program, the receiving institution
or program, except in cases of emergency discharges, shall be given at least
thirty days notice of the proposed date of placement. |
| (2) |
Emergency discharges are authorized when
the health, safety and room, board and watchful oversight needs of the child or
other children in residence might be endangered by the child's further
placement in the institution. At least 72 hours of prior notice of discharge
shall be provided to the parent(s) or guardian(s), or placement agency. If such
notice is not possible, the reasons shall be documented in the child's case
record. |
| (3) |
When a child is
discharged, an institution shall compile a complete written discharge summary
within thirty days of the discharge. Such summary shall include:
| (a) |
The name, address, telephone number and
relationship of the person or entity to whom the child was discharged, or the
name of the placing agency if discharged to a placement agency; |
| (b) |
A summary of all the services and room,
board and watchful oversight activities provided for the child to meet assessed
needs while the child was in the institution; |
| (c) |
A summary of the child's and the family's
goals and objectives and accomplishments during care; |
| (d) |
A summary of any problems encountered by
the child and the family during care; and |
| (e) |
A summary of assessed needs which were
not met during care, and a summary of the reasons why they were not
met. |
|
| (4) |
A copy of the
completed discharge summary shall be made available to the child's parent(s) or
guardian(s), or placement agency representative when it is completed. |
| (1) |
Casework Services. All children in care
and families of children in care shall receive case work services as provided
in their service plan from their assigned Human Services Professional or other
appropriate professionals (internal and external of facility) who shall meet
with and counsel with the children. The results of such counseling shall be
recorded in the children's case records. The purposes of such services are to
identify and monitor the children's and families' progress relative to the
needs, goals and objectives identified in child care assessments and service
plans and to discuss any problems being encountered by or with the children in
care. |
| (2) |
Educational and
Vocational Services. An institution shall not admit a child unless an
educational program commensurate with the specific educational and vocational
needs of the child can be provided.
| (a) |
Provisions shall be made for mandatory education of all children in care in
accordance with O.C.G.A.
20-2-690et
seq. or its successor statute. For purposes of these rules, an
on-campus school is defined as a private school, and must be in compliance with
the above law. |
| (b) |
A child's
assigned Human Services Professional shall monitor the child's educational or
vocational progress in the course of providing case work services and planning.
Progress reports, such as report cards, and other records or documentation of a
child's educational or vocational performance while residing in the institution
shall be maintained in the child's case record. |
| (c) |
Children attending public schools who
wish to participate in extracurricular activities shall be provided such
reasonable opportunities by the institution in accordance with the child's
service plan. |
| (d) |
Children's daily
activities as stated in their service plans shall provide for study time during
the periods the children are attending school. |
|
| (3) |
Health Services. The facility shall
provide for a comprehensive program of preventive, routine, and emergency
medical and dental care for all children.
| (a) |
Within thirty days of admission, an assessment of the children's medical and
dental health shall be completed by the designated intake Human Services
Professional.
| 1. |
A general physical
examination of the child shall be provided within 72 hours (excluding weekends
and holidays) of admission unless such an examination has been completed within
one year prior to admission.
| (i) |
Such
examination shall be done by a medical doctor, physician's assistant, or public
health department and shall include basic diagnostic laboratory work, including
but not limited to a Complete Blood Count (CBC) and basic urinanalysis;
required immunizations; and vision and hearing tests. |
| (ii) |
Required Immunization. All children
shall have current immunizations as outlined in Rules and Regulations of the
Department of Human Resources for Immunization of Children as a Prerequisite to
Admission to School or Other Facilities, Chapter 290-5-4. |
|
| 2. |
A general dental examination of the child
shall be provided for unless such an examination has been completed within six
months prior to admission. Such examinations shall be done by either a dentist
or a dental hygienist that is employed by the department and County Boards of
Health to screen school pupils. |
|
| (b) |
An institution shall ensure that children
receive timely, qualified medical and dental care when they are ill and that
they continue to receive necessary follow-up medical care. The child-caring
institution shall take appropriate safety and sanitary precautions to ensure
that underlying medical conditions are not exacerbated or infections not
transmitted to others where required by the medical condition of the child.
Arrangements shall be made with at least one physician and one dentist or a
health care agency that provides physician and dental services for the medical
care of the children. Children shall receive annual medical check-ups and
semiannual dental check-ups. |
| (c) |
An
institution shall ensure that children receive timely, qualified medical care
in cases of medical emergencies (life-threatening, limb-threatening, or
function-threatening conditions). Policies shall be in place for the emergency
medical care of children with a local hospital or other health care facility
that provides emergency services or with a local physician. |
| (d) |
Medications. The institutions shall
develop and implement policies and procedures for the use and management of all
types of medications. All direct care staff shall receive orientation on the
policies and procedures. Such policies and procedures shall include the
following:
| 1. |
Non-prescription medications. No
child shall be given a non-prescription medication by staff members of the
institution unless the child exhibits symptoms that the medication is designed
to relieve. |
| 2. |
Prescription
medications. No child shall be given a prescription medication unless the
medication is prescribed for the child by an authorized health care
professional.
| (i) |
Prescription medications
shall only be given to a child as ordered in the child's prescription. An
institution shall not permit such medications prescribed for one child to be
given to any other child. |
| (ii) |
A
child's attending physician shall be notified in cases of dosage errors, drug
reactions, or if the prescription medication does not appear to be
effective. |
|
| 3. |
Psychotropic medications. No child shall be given psychotropic medications
unless use is in accordance with the goals and objectives of the child's
service plan developed by an external physician and/or MRO provider.
| (i) |
Psychotropic medications must be
prescribed by an external physician or MRO provider who has responsibility for
the diagnosis and treatment of the child's conditions that necessitate such
medication. Continued use of psychotropic medications shall be reviewed by the
external prescribing Physician and/or MRO provider every sixty days. |
| (ii) |
Psychotropic medication shall only be
given to a child as ordered in the child's prescription. An institution shall
not permit such medications prescribed for one child to be given to another
child. |
| (iii) |
The external
prescribing physician and/or MRO provider shall be notified in cases of dosage
errors, drug reactions, or if the psychotropic medication does not appear to be
effective. |
|
| 4. |
An
institution shall designate and authorize classes of staff, such as Child Care
Workers, to hand out medications and supervise the taking of medications. Only
designated and authorized staff shall hand out and supervise the taking of
medication. |
| 5. |
An institution shall
maintain a record of all medications handed out by authorized staff and taken
by children to include: name of child taking medication, name of prescribing
physician and date of prescription (if the medication is prescription or
psychotropic), required dosage, date and time taken, dosage taken, and name and
signature of staff member that handed out and supervised the taking of the
medication. |
| 6. |
All prescription and
non-prescription medications shall be kept in a locked storage cabinet or
container which is not accessible to the children and stored separate from
cleaning chemicals and supplies or poisons. The keys to the locked cabinets or
containers shall not be accessible to residents. |
| 7. |
All expired medications shall be discarded
and not handed out for use. |
|
| (e) |
First Aid Supplies. Each living unit
shall have a first aid kit and instruction manual; such kit shall contain
scissors, tweezers, gauze pads, adhesive tape, thermometer, assorted band-aids,
antiseptic cleaning solution, and bandages. |
|
| (4) |
Recreation and Leisure. The institution
shall provide for a program of indoor and outdoor recreational and leisure
activities. When providing these activities, it shall utilize the community's
cultural, social, and recreational resources whenever possible and appropriate.
Children's activities as stated in their service plans shall provide for
leisure and recreational time. An institution shall procure and maintain a
variety of recreational and leisure equipment and supplies such as games,
sporting equipment, reading materials, and art supplies. |
| (5) |
Other Services.
| (a) |
The institution shall ensure that all
children have adequate, properly fitting, seasonable clothing as required for
health, comfort and physical well-being. Clothes shall be appropriate to age,
gender, and individual needs. |
| (b) |
Daily routines of children shall provide for appropriate personal care,
hygiene, and grooming commensurate with age, gender, and cultural heritage. All
necessary toiletry items and supplies, such as soap, shampoo, hair brushes,
tooth brushes and paste, deodorant, and bath towels, shall be
provided. |
| (c) |
Children shall not be
held solely responsible for the accomplishments of any work activity of the
institution such as food preparation, laundering, housekeeping, or facility
maintenance. Children shall not be considered substitutes for employed
staff. |
| (d) |
Children shall not be
used for the purposes of soliciting funds for the institution, nor shall
children be used in connection with any advertisement or publicity without the
consent of the child and the parent(s) or guardian(s). |
| (e) |
Children shall be permitted to
participate in religious and cultural activities in accordance with their
cultural and ethnic heritage. |
|
| (1) |
An institution shall not engage in
temporary placement activities in Georgia unless licensed as a child caring
institution and approved by the department to provide care and room, board and
watchful oversight in foster homes. |
| (2) |
Foster care shall be considered only
after it has been established that it is necessary for the physical and/or
emotional well-being of the child. |
| (3) |
No more than 6 children under the age of
19 may reside in a foster home unless it is an intact sibling group and it is
in the best interests of each of the children to be placed in the same foster
home. |
| (4) |
Orientation Prior to
Foster Care Application. The Agency shall provide orientation information in
person or in written form to prospective foster parent(s) to assist them in
making an informed decision about applying to become a foster parent. The
format of the orientation must be documented in the applicant's file. The
orientation information must include at least the following:
| (a) |
The Agency's purpose and a listing of
services provided; |
| (b) |
A
description of the approval process for foster parenting; |
| (c) |
The minimum requirements for foster
parenting including the limits to the number of children in the home; |
| (d) |
The roles and responsibilities of foster
parent(s); |
| (e) |
A description of
children served by the Agency; |
| (f) |
Support services available for foster parent(s); |
| (g) |
General information regarding financial
reimbursement for expenses in foster care; and |
| (h) |
Policies and procedures regarding
appropriate behavior management and emergency safety interventions. |
|
| (5) |
Training for Prospective
Foster Parent(s). Once an application to become a foster parent has been
submitted, and prior to the approval of an applicant for placement of a child
in foster care, the agency shall provide and document training for the
applicant in at least the following topics:
| (a) |
The Agency's grievance policies and
procedures; |
| (b) |
The annual training
requirements for foster parent(s), including the requirement of at least
fifteen (15) hours of training relevant to the type of child placed or to be
placed in the foster home if the child is more than 12 months old. For
parent(s) providing foster care for children under 12 months of age, the foster
parent shall have at least eight (8) hours of training; |
| (c) |
The Agency's policies and procedures for
behavior management techniques and emergency safety interventions for children
in foster care; |
| (d) |
Child abuse
recognition, reporting, and investigation procedures; |
| (e) |
Characteristics of children served and
their developmental needs, including special needs when applicable; |
| (f) |
The Agency's policies and procedures for
handling medical emergencies (conditions or situations which threaten life,
limb, or continued functioning), and managing use of medications by children in
care. |
|
| (6) |
Minimum
Requirements for Prospective Foster Families. Home Study. The Agency shall make
a thorough evaluation of each prospective foster family and document this
evaluation in a foster home study report which shall be updated as changes in
the required home study information occur and include at least the following:
| 1. |
The names of family members, the family
address and telephone number, drivers' license numbers, and proof of automobile
insurance as applicable; |
| 2. |
The
motivation for foster parenting, including but not limited to attitude toward
childlessness; |
| 3. |
A description of
family members, including:
| (i) |
Date and place
of birth; |
| (ii) |
Physical
description; |
| (iii) |
Family
background and history; |
| (iv) |
Current relationships with immediate and extended family members; |
| (vi) |
Social involvements; |
| (vii) |
Personal characteristics:
| (II) |
Interests and hobbies; and |
| (III) |
Emotional stability. |
|
|
| 4. |
Evaluation of
marriages and family life:
| (i) |
Verified date
and place of marriage, if applicable; |
| (ii) |
Assessment of marital
relationship; |
| (iii) |
Family
interaction patterns; and |
|
| 5. |
Evaluation of parenting practices:
| (i) |
Description of parenting knowledge, attitudes and skills; |
| (ii) |
Current behavior management practices;
and |
| (iii) |
Current child-rearing
practices. |
|
| 6. |
Physical
and mental health:
| (i) |
Health history and
condition of family members; |
| (ii) |
Documentation of a physical examination of the foster parent applicants
completed by a licensed physician, physician's assistant, or a registered nurse
with advanced training working under the direction of a physician, or the
public health department, within 12 months prior to the completion of the home
study; |
| (iii) |
A statement from a
licensed physician, physician's assistant, or public health department
regarding the general health status of other members of the prospective
adoptive family, obtained within the 12 months prior to the completion of the
home study; |
| (iv) |
Evaluation of
emotional and mental health status of each member of the prospective foster
family; and |
| (v) |
Screening for
tuberculosis and venereal disease for prospective foster parent(s) and children
16 years of age and older living in the prospective foster home. |
|
| 7. |
Understanding of and adjustment
to foster parenting:
| (i) |
Understanding of the
role of a foster parent and the issues in caring for foster children; |
| (ii) |
Foster family's attitude toward the
parent(s) of the foster children including parental visits in their
home; |
| (iii) |
Expectations of the
foster child, including intellectual and physical achievement; |
| (iv) |
Anticipated adjustment of each foster
family member to a foster child; |
| (v) |
Willingness to cooperate with the
placement agency; and |
| (vi) |
Support
network in place for the foster family, including support systems for single
parent families, if applicable. |
|
| 8. |
Finances and occupations of family
members:
| (i) |
Employment history, including
whether the home is a registered family day care home or operating any other
business or service out of the home that might have an impact on health and
safety of the children in care; |
| (ii) |
Financial stability of the family;
and |
| (iii) |
Possible financial impact
of the addition of a foster child to the home. |
|
| 9. |
A description of the home and community:
| (i) |
Description of the
neighborhood; |
| (ii) |
Physical
standards of the home, including space, and water supply and sewage disposal
systems which, if other than public systems, have been approved by appropriate
authorities; |
| (iii) |
A statement to
verify that any domestic pets owned or residing with the family have been
inoculated against rabies as required by law; |
| (iv) |
A statement verifying that all firearms
owned and in the home are locked away from children; |
| (v) |
A statement verifying that if a swimming
pool is present at the home, it is fenced with a locked gate to prevent
unsupervised access and that it meets all applicable community
ordinances; |
| (vi) |
A statement that
smoke alarms are present and functioning on each level in the home; |
| (vii) |
Verification that gas heaters are
vented to avoid fire and health hazards, with any unvented fuel-fired heaters
equipped with oxygen depletion safety shut-off systems; and |
| (viii) |
Assessment of community resources,
including accessibility of schools, religious institutions, recreation, and
medical facilities. |
|
| 11. |
Results of the
criminal history background check for family members as required by Georgia
law; |
| 12. |
Pre-service training the
prospective foster parent and/or family may have received; |
| 13. |
A minimum of three (3) character
references:
| (i) |
At least one reference shall
be from an extended family member not residing with the prospective foster
family, and |
| (ii) |
If the prospective
foster parent has either served previously as a foster parent for another
agency, and/or been employed within the past five (5) years in a job involving
the care of children, at least one reference must be from the former agency or
employer; |
|
| 14. |
A
description of the type of child desired by the prospective foster
family; |
| 15. |
The date the study is
completed and the name and signature of the person completing the study.
| (i) |
Notification of Approval. Potential
foster parent(s) shall be notified in writing as to whether or not their
application has been approved. |
| (ii) |
Location of Foster Homes. Foster homes used by the Agency shall be located
within a reasonable travel distance from the Agency so as to be accessible for
regular visits by family and Agency staff. |
|
|
| (7) |
Services Prior to Foster Care Placement.
| (a) |
The selection of a foster home for a
particular child shall be based on an assessment of the child's total needs and
how well a particular home can meet the child's needs. |
| (b) |
Children of the same family shall be kept
together when possible unless it has been determined through casework services
that this is not desirable. |
| (c) |
Placement considerations shall include the potential for children's
participation in religious and cultural activities in accordance with their
cultural ethnic heritage. |
| (d) |
The
Agency shall discuss the prospective foster placement with the foster family
and shall prepare the foster family for the placement of a particular child by
anticipating the adjustments and problems that may arise during placement and
any specialized services to be provided. This discussion shall be documented in
the case record. |
| (e) |
Pre-placement
activities between child and foster family shall be documented in the case
record of the child and family. |
| (f) |
Complete written placement agreement(s) shall be developed with the involvement
of the child, the foster parent(s), the parent(s) or guardian(s), and the
placing agency representative and signed by all adult parties; such
agreement(s) shall include the following:
| 1. |
Written authorization to care for the child; |
| 2. |
Written authorization to obtain medical
care for the child; |
|
|
| (8) |
Home visits shall be conducted by the
Agency at least monthly in order to verify that the foster parent(s) are
delivering care in a safe and healthy environment to the children, in
accordance with these rules and regulations and agency policies and procedures.
Such visits shall include observation of the foster child with at least one of
the foster parent(s). |
| (9) |
The
Agency shall provide an annual evaluation of the strengths and needs of the
foster family and assessment of the best way to maximize the foster care
experience for the foster family and the children placed with them. This
evaluation shall be shared with the foster family as evidenced by the signature
of the foster parent(s) on the evaluation. Documentation of supervision of the
placement by the agency shall include:
| (i) |
Adjustment of the child to the foster family and vice versa; |
| (ii) |
Progress made on treatment plan
goals; |
| (iii) |
Any new problems that
have arisen and the actions taken toward a solution of those
problems; |
| (iv) |
Contacts and issues
with other resources serving the child; |
| (v) |
Agency updates reassessing the
appropriateness of the foster care placement whenever a significant change
occurs in the home, to ensure that care continues to be delivered in a safe and
healthy environment in accordance with these rules and regulations and agency
policies and procedures. |
| (vi) |
Documentation that the foster parent(s) have received the required clock hours
of training annually following the initial foster placement, with the training
being relevant to the type(s) of children placed in the foster home. |
|
| (10) |
Maintenance of Foster Care
Records.
| (a) |
The Agency shall maintain
separate records for each foster home. The record shall be started at the time
of application and shall be kept current. |
| (b) |
The foster home record shall contain:
| 3. |
Medical reports for each member of the
foster family; |
| 4. |
Summary narrative
containing the dates as well as the content material from the caseworker's
contacts; |
| 6. |
The annual evaluations of the foster home,
family, and placements; |
| 7. |
Documentation of required annual training hours per .13(5)(b); |
| 8. |
Placement history of the foster home,
children placed, date(s) admitted, date(s) discharged and reason for
discharge; |
| 9. |
Documentation of
satisfactory criminal history background checks in accordance with Georgia
law. |
| 10. |
Phone numbers of foster
parent(s) including day, cell & evening phone numbers and the days of the
week and times of day the foster parent is likely to be accessible at the
foster home. |
| 11. |
Foster children
currently in the foster home including the child's name & county of
custody. |
|
| (c) |
Foster home
records shall be maintained for at least 3 years following the Agency's last
placement in said foster home. |
| (d) |
The Agency shall maintain separate records for each child placed in foster
care. The record for each child shall include:
| 1. |
Name, sex, race, birth date and birthplace
of child; |
| 2. |
Name, address,
telephone number and marital status of parent or guardian of the
child; |
| 3. |
Name, address, telephone
number of the foster parent with whom the child is currently placed; |
| 4. |
Legal documents including verified birth
record, court status, agreements, consents, etc.; |
| 5. |
Social history of the family and parent
background; |
| 6. |
Medical history and
cumulative health record, psychological and psychiatric reports; |
| 7. |
Education records and reports; |
| 8. |
Plan of care pursuant to these
rules; |
| 9. |
Summary of each 6 month
case review conference which reflects the contacts with and the status of all
family members in relation to the placement plan as well as the achievements or
changes in the goals or services; |
| 10. |
Summary of child's contacts with the
family, the quality of the relationships and the child's progress in
coping; |
|
| (e) |
Upon
termination of placement of the child, the following shall be placed in the
record of the child and the foster home:
| 1. |
Date of termination, reason for termination, the name, telephone number,
address, and relationship of the person or Agency assuming responsibility for
the child. |
| 2. |
A termination summary
describing the services provided during care, growth and accomplishments, and
assessed needs which remain to be met with the service possibilities which
might meet those needs. |
| 3. |
Aftercare plans that determine the responsibility for follow through. |
|
| (f) |
Family/child records shall be
maintained for at least 3 years following completion of service. |
|
| (11) |
Agency Records and Reports.
| (a) |
Each Agency shall maintain records and
submit on a timely basis reports required by the Department. |
| (b) |
Each Agency shall maintain a permanent
listing with identifying information of all children accepted for service or
placement. |
| (c) |
Records shall be
confidential and protected from unauthorized use, fire, damage or theft.
Records and files shall be kept current and be available for review by the
Department. |
| (d) |
The Agency shall
submit on a timely basis such financial, statistical reports, and Board minutes
and other information as may be required by the Department. |
|
| (1) |
Behavior Management.
| (a) |
Every institution shall develop and
implement policies and procedures on behavior management. Such policies and
procedures shall set forth the types of children served and room, board and
watchful oversight capacities in accordance with its program purpose, the
anticipated behavioral problems of the children, and acceptable methods of
managing such problems. |
| (b) |
Such
Behavior management policies and procedures shall incorporate the following
minimum requirements:
| 1. |
Behavior management
principles and techniques shall be used in accordance with the individual
service plan and written policies and procedures governing service
expectations, service plan goals, safety, security, and these rules and
regulations. |
| 2. |
Behavior management
shall be limited to the least restrictive appropriate method, as described in
the child's service plan pursuant to Rule .10(b)6. and in accordance with the
prohibitions as specified in these rules and regulations. |
|
| (c) |
The following forms of behavior
management shall not be used:
| 1. |
Assignment of
excessive or unreasonable work tasks; |
| 2. |
Denial of meals and hydration; |
| 4. |
Denial of shelter, clothing, or essential
personal needs; |
| 5. |
Denial of
essential program services; |
| 6. |
Verbal abuse, ridicule, or humiliation; |
| 7. |
Chemical restraint, manual holds, and
seclusion used as a means of coercion, discipline, convenience, or
retaliation; |
| 8. |
Denial of
communication and visits unless restricted in accordance with Rule
.10(b)7.; |
| 9. |
Corporal punishment;
and |
| 10. |
Seclusion not used
appropriately as an emergency safety intervention. |
|
| (d) |
Residents shall not be permitted to
participate in the behavior management of other residents or to discipline
other residents, except as part of an organized therapeutic self-governing
program in accordance with accepted standards of practice that is conducted in
accordance with written policy and is supervised directly by designated
staff. |
| (e) |
Institutions shall
submit to the Department electronically or by facsimile a report within 24
hours whenever an unusual incident occurs regarding behavior management,
including any injury requiring medical treatment beyond first aid that is
received by a child as a result of any behavior management. |
| (f) |
All forms of behavior management used by
direct care staff shall also be documented in case records in order to ensure
that such records reflect behavior management problems. |
|
| (2) |
Emergency Safety Interventions.
| (a) |
Emergency safety interventions may be
used only by staff trained in the proper use of such interventions when a child
exhibits a dangerous behavior reasonably expected to lead to immediate physical
harm to the child or others and less restrictive means of dealing with the
injurious behavior have not proven successful or may subject the child or
others to greater risk of injury. |
| (b) |
Emergency safety interventions shall not
include the use of any physical or chemical restraint or manual hold that would
potentially impair the child's ability to breathe or has been determined to be
inappropriate for use on a particular child due to a documented medical or
behavioral condition. |
| (c) |
The
institution shall have written policies and procedures for the use of emergency
safety interventions, a copy of which shall be provided to and discussed with
each child and the child's parents and/or legal guardians prior to or at the
time of admission. Emergency safety interventions policies and procedures shall
include:
| 1. |
Provisions for the documentation
of assessments (which will include social, emotional, behavioral and room,
board and watchful oversight needs) at admission and at each annual exam by the
child's physician, a physician's assistant, or a registered nurse with advanced
training working under the direction of a physician, or a public health clinic
that states there are no medical issues that would be incompatible with the
appropriate use of emergency safety interventions on that child. Such
assessments and documentation must be re-evaluated following any significant
change in the child's medical condition; and |
| 2. |
Provisions for the documentation of each
use of an emergency safety intervention including:
| (i) |
Date and description of the precipitating
incident; |
| (ii) |
Description of the
de-escalation techniques used prior to the emergency safety intervention, if
applicable; |
| (iii) |
Environmental
considerations; |
| (iv) |
Names of staff
participating in the emergency safety intervention; |
| (v) |
Any witnesses to the precipitating
incident and subsequent intervention; |
| (vi) |
Exact emergency safety intervention
used; |
| (vii) |
Documentation of the 15
minute interval visual monitoring of a child in seclusion; |
| (viii) |
Beginning and ending time of the
intervention; |
| (ix) |
Outcome of the
intervention; |
| (x) |
Detailed
description of any injury arising from the incident or intervention;
and |
| (xi) |
Summary of any medical
care provided. |
|
| 3. |
Provisions for prohibiting manual hold use by any employee not trained in
prevention and use of emergency safety interventions. |
|
| (d) |
Emergency safety interventions or the use
of physical or chemical restraints may be used to prevent runaways only when
the child presents an imminent threat of physical harm to self or others, or as
specified in the individual service and room, board and watchful oversight
plan. |
| (e) |
Facility staff shall be
aware of each child's medical and behavioral conditions, as evidenced by
written acknowledgement of such awareness, to ensure that the emergency safety
intervention that is utilized does not pose any undue danger to the health and
well-being of the child. |
| (f) |
Residents shall not be allowed to participate in the emergency safety
intervention of another resident. |
| (g) |
Immediately following the conclusion of
the emergency safety intervention and hourly thereafter for a period of at
least four hours where the child is with a staff member, the child's behavior
will be assessed, monitored, and documented to ensure that the child does not
appear to be exhibiting symptoms that would be associated with an
injury. |
| (h) |
At a minimum, the
emergency safety intervention program that is utilized shall include the
following:
| 1. |
Techniques for de-escalating
problem behavior including child and staff debriefings; |
| 2. |
Appropriate use of emergency safety
interventions; |
| 3. |
Recognizing
aggressive behavior that may be related to a medical condition; |
| 4. |
Awareness of physiological impact of a
restraint on the child; |
| 5. |
Recognizing signs and symptoms of positional and compression asphyxia and
restraint associated cardiac arrest; |
| 6. |
Instructions as to how to monitor the
breathing, verbal responsiveness, and motor control of a child who is the
subject of an emergency safety intervention; |
| 7. |
Appropriate self-protection
techniques; |
| 8. |
Policies and
procedures relating to using manual holds, including the prohibition of any
technique that would potentially impair a child's ability to breathe; |
| 9. |
Agency policies and reporting
requirements; |
| 10. |
Alternatives to
restraint; |
| 11. |
Avoiding power
struggles; |
| 12. |
Escape and evasion
techniques; |
| 13. |
Time limits for the
use of restraint and seclusion; |
| 14. |
Process for obtaining approval for continual restraints and
seclusion; |
| 15. |
Procedures to
address problematic restraints; |
| 17. |
Investigation of
injuries and complaints; |
| 18. |
Monitoring physical signs of distress and obtaining medical assistance;
and |
|
| (i) |
Emergency safety intervention
training shall be in addition to the annual training required in Rule
.08(6)(d)2. and shall be documented in the staff member's personnel
record. |
| (j) |
All actions taken that
involve utilizing an emergency safety intervention shall be recorded in the
child's case record showing the cause for the emergency safety intervention,
the emergency safety intervention used, and, if needed, approval by the
director, the staff member in charge of casework services, and the external
physician and/or MRO provider who has responsibility for the diagnosis and
treatment of the child's behavior. |
| (k) |
Institutions shall submit to the
Department electronically or by facsimile a report, in a format acceptable to
the Department, within 24 hours whenever an unusual incident occurs regarding
emergency safety interventions, including:
| 1. |
Any injury requiring medical treatment beyond first aid that is received by a
child as a result of any e mergency safety intervention; |
| 2. |
Whenever an institution utilizes emergency
safety interventions three or more times in one month with the same child
and/or whenever the institution utilizes more than 10 emergency safety
interventions for all children in care within a 30-day period. |
|
| (l) |
Institutions shall submit a
written report to the program's director on the use of any emergency safety
intervention immediately after the conclusion of the intervention and shall
further notify the child's parents or legal guardians regarding the use of the
intervention. A copy of such report shall be maintained in the child's
file. |
| (m) |
At least once per
quarter, the institution, utilizing a master agency restraint log and the
child's case record, shall review the use of all emergency safety interventions
for each child and staff member, including the type of intervention used and
the length of time of each use, to determine whether there was an appropriate
basis for the intervention, whether the use of the emergency safety
intervention was warranted, whether any alternatives were considered or
employed, the effectiveness of the intervention or alternative, and the need
for additional training. Written documentation of all such reviews shall be
maintained. Where the institution identifies opportunities for improvement as a
result of such reviews or otherwise, the institution shall implement these
changes through an effective quality improvement plan. |
| (n) |
No later than January 1, 2007 and ongoing
thereafter, all direct care staff who may be involved in the use of emergency
safety interventions, shall have evidence of having satisfactorily completed a
nationally recognized training program for emergency safety interventions to
protect residents and others from injury, which has been approved by the
Department and taught by an appropriately certified trainer in such
program. |
| (o) |
Manual Holds.
| 1. |
Emergency safety interventions utilizing
manual holds require at least one trained staff member to carry out the hold.
Emergency safety interventions utilizing prone restraints require at least two
trained staff members to carry out the hold. |
| 2. |
Emergency safety interventions shall not
include the use of any chemical or physical restraint or manual hold that would
potentially impair the child's ability to breathe or has been determined to be
inappropriate for use on a particular child due to a documented medical or
behavioral condition. |
| 3. |
When a
manual hold is used upon any child whose primary mode of communication is sign
language, the child shall be permitted to have his or her hands free from
restraint for brief periods during the intervention, except when such freedom
may result in physical harm to the child or others. |
| 4. |
If the use of a manual hold exceeds 15
consecutive minutes, the facility director or his or her designee, who
possesses at least the qualifications of the director and has been fully
trained in the facility's emergency safety intervention plan, shall be
contacted by a two-way communications device or in person and determine that
the continuation of the manual hold is appropriate under the circumstances.
Documentation of any consultations and outcomes shall be maintained for each
application of a manual hold that exceeds 15 minutes. Manual holds shall not be
permitted to continue if the restraint is determined to pose an undue risk to
the child's health given the child's physical or mental condition. |
| 5. |
A manual hold may not continue for more
than 30 minutes at any one time without the consultation as specified in
subparagraph (2) of this subparagraph, and under no circumstances may a manual
hold be used for more than one hour total within a 24-hour period. |
| 6. |
If the use of a manual hold on a child
reaches a total of one hour within a 24-hour period, the staff shall reconsider
alternative strategies, document same, and consider notifying the authorities
or transporting the child to a hospital or other appropriate facility for
evaluation. |
| 7. |
The child's
breathing, verbal responsiveness, and motor control shall be continuously
monitored during any manual hold. Written summaries of the monitoring by a
trained staff member not currently directly involved in the manual hold shall
be recorded every 15 minutes during the duration of the restraint. If only one
trained staff member is involved in the restraint and no other staff member is
available, written summaries of the monitoring of the manual hold shall be
recorded as soon as is practicable, but no later than one hour after the
conclusion of the restraint. |
|
| (p) |
Seclusion.
| 1. |
If used, seclusion procedures in excess of
thirty (30) minutes must be approved by the director or designee. No child
shall be placed in a seclusion room in excess of one (1) hour within any
twenty-four (24) hour period without obtaining authorization for continuing
such seclusion from the child's external physician and/or MRO provider and
documenting such authorization in the child's record. |
| 2. |
A seclusion room shall only be used if a
child is in danger of harming himself or herself or others. |
| 3. |
A child placed in a seclusion room shall
be visually monitored at least every fifteen (15) minutes. |
| 4. |
A room used for the purposes of seclusion
must meet the following criteria:
| (i) |
The room
shall be constructed and used in such ways that the risk of harm to the child
is minimized; |
| (ii) |
The room shall
be equipped with a viewing window on the door so that staff can monitor the
child; |
| (iii) |
The room shall be
lighted and well-ventilated; |
| (iv) |
The room shall be a minimum fifty (50) square feet in area; and |
| (v) |
The room must be free of any item that
may be used by the child to cause physical harm to himself/herself or
others. |
|
| 5. |
No more than
one child shall be placed in the seclusion room at a time. |
| 6. |
A seclusion room monitoring log shall be
maintained and used to record the following information:
| (i) |
Name of the secluded child; |
| (ii) |
Reason for child's seclusion; |
| (iii) |
Time of child's placement in the
seclusion room; |
| (iv) |
Name and
signature of the staff member that conducted visual monitoring; |
| (v) |
Signed observation notes; and |
| (vi) |
Time of the child's removal from the
seclusion room. |
|
|
|
| (1) |
The institution
shall develop and implement policies and procedures for children to voice
grievances and to submit written grievances without fear of
retaliation. |
| (2) |
All written
grievances submitted by a child shall be recorded in the case record showing
the grievance, description or method of explanation or resolution, and involved
staff. |
| (1) |
The institution shall develop and
implement policies and procedures that prohibit child abuse and sexual
exploitation of children in care. Such policies and procedures shall
incorporate requirements for the reporting of child abuse and sexual
exploitation in accordance with state law. |
| (2) |
All reports of alleged child abuse and
sexual exploitation of children in care shall also be reported immediately to
the Child Care Licensing Section of the department.
| (a) |
Such policies and procedures shall also
include the following:
| 1. |
Provisions for the
immediate reporting by any staff member of any suspected incident of abuse or
sexual exploitation of a child to the director of the institution; |
| 2. |
Provisions for conducting internal
investigations of such incidents (however, such provisions shall not relieve
the institution of the requirement to submit reports as required by Rule .16
above); |
| 3. |
Provisions for
preventing the recurrence of an alleged incident pending
investigation; |
| 4. |
Provisions for
evaluating the continued use, pending investigation, of any staff member
alleged to be involved in a reported incident of abuse or sexual exploitation;
and |
|
| (b) |
As required in
Rule .08(6)(d), all employees shall receive orientation and training on the
institution's abuse policies and procedures and reporting
requirements. |
|
| (1) |
An institution shall provide each child
with meals and snacks of serving sizes dependent upon the age of the child
based upon nutrition guidelines as established by the United States Department
of Agriculture Child Care Food Program.
| (a) |
Meals and snacks shall be varied daily. |
| (b) |
Additional serving of food shall be
offered to children over and above the required daily minimum if not
contraindicated by modified diets. |
| (c) |
Modified diets based on medical or
religious reasons shall be served to children as needed. Modifications due to
medical reasons shall be based on the written order of a physician and the
order shall be placed in the child's case record. |
|
| (2) |
Food services of an institution licensed
to care for thirteen or more children are subject to the provisions of the
Rules and Regulations of the Department of Human Resources for Food Service,
Chapter 290-5-14, if the institution provides food services in a centralized
kitchen area. Such an institution must obtain a valid food service permit.
Institutions licensed to care for twelve or less children, or not required to
obtain a food Service permit shall meet the following requirements:
| (a) |
Food shall be stored, prepared, and
served in a safe and sanitary manner commensurate with generally accepted and
recognized food service standards. |
| (b) |
Each institution shall have designated
space for food preparation and storage areas separate from rooms used by
children. |
| (c) |
All perishable and
potentially hazardous foods shall be refrigerated at a temperature of
forty-five (45) degrees Fahrenheit or below and served promptly after cooking.
Freezer temperature shall be maintained at zero (0) degrees Fahrenheit or
below. |
| (d) |
Food shall be in sound
condition, free from spoilage and contamination and shall be safe for human
consumption. |
| (e) |
All raw fruits and
vegetables shall be washed thoroughly before being cooked or served. Food not
subject to further washing or cooking before serving shall be stored in such a
manner as to be protected against contamination. |
| (f) |
Containers for food storage other than
the original containers or packages in which the food was obtained shall be
impervious and nonabsorbent and have tight fitting lids or covers. |
| (g) |
Eggs, pork, pork products, poultry, and
fish, shall be thoroughly cooked. |
| (h) |
Meats, poultry, fish, dairy products,
bakery products and processed foods shall have been inspected under an official
regulatory program. |
| (i) |
Food
service equipment and preparation areas shall be kept clean and free of
accumulations of dust, dirt, food particles and grease deposits. |
| (j) |
Non-disposable dishes, glasses and
silverware shall be properly cleaned by pre-rinsing and scraping, washing,
sanitizing and drying. |
|
| (1) |
Required Approvals.
| (a) |
An institution shall be in compliance
with all applicable zoning laws, ordinances, or rules and regulations which
apply to its operation. |
| (b) |
All
water and sewage disposal systems, if other than approved city and county
systems, shall be approved by the proper authorities having
jurisdiction. |
| (c) |
An institution
shall submit proof of compliance with applicable laws and regulations issued by
the State Fire Marshal, the proper local fire marshal, or state inspector,
including a certificate of occupancy if required. The premises of the
institution shall have functioning fire extinguishers and smoke
detectors. |
| (d) |
All buildings and
grounds shall be constructed and maintained in accordance with these rules.
Institutions that initially apply for a license or current licensees that plan
to renovate buildings for housing residents shall submit building blueprints or
similar schematic drawings or diagrams for review and approval by the
department. |
|
| (2) |
Sleeping
Areas.
| (a) |
The institution shall have separate
sleeping areas which contain not less than 63 square feet of usable floor space
per resident. Single bedrooms shall contain at least 75 square feet of usable
floor space. Usable floor space does not include built-in closet space. The
preceding requirements on usable floor space shall apply to any institution
licensed after the effective date of these rules and to any licensed
institution that renovates its current sleeping areas or increases its capacity
by adding new buildings or areas to the institution. Beds shall be arranged to
provide for at least three feet of space between the heads, foot, and sides of
each bed. If bunk bed units are used, they shall be arranged to provide for at
least five feet of space between the ends, foot and sides of each bunk bed
unit. Boys and girls shall sleep in separate sleeping areas. |
| (b) |
Each child shall be provided with his or
her own personal space and furnishings for storage of clothes and personal
belongings. |
| (c) |
Each child shall be
provided his or her own personal bed and mattress that is no shorter than the
child's height and at least thirty inches wide. Clean sheets, pillows and
pillow cases, blankets or bed covering shall be provided and sheets and pillow
cases shall be changed or cleaned at least weekly. Water proof mattresses shall
be provided as needed as required by the child's assessment and service
plan. |
| (d) |
Bedrooms shall be
provided with outside ventilation by means of windows, air conditioners, or
mechanical ventilation. |
| (e) |
No
staff member shall sleep in children's bedrooms. Separate sleeping quarters and
lavatory for staff shall be provided in the living units. |
|
| (3) |
Lavatory and Bathing Facilities.
| (a) |
There shall be separate lavatory (water
basin and toilet) and bathing facilities for boys and girls that shall be
located near the sleeping areas. Such facilities shall not be used routinely by
staff. |
| (b) |
There shall be at least
one lavatory equipped with hot and cold water and mirror for every eight
residents or fraction thereof. Rooms that contain more than one toilet shall
contain stalls for individual privacy. Each lavatory shall be supplied with
toilet paper and holders, and individual hand towels, or disposable towels, or
mechanical hand drying equipment. |
| (c) |
There shall be at least one shower or
bathtub with hot and cold water for every ten residents or fraction thereof.
Bathtubs and shower stalls shall be equipped with nonslip surfaces. |
| (d) |
Lavatory areas shall be ventilated with
either an open screened window or functioning exhaust fan. |
|
| (4) |
Living Room. For institutions licensed on
or after the effective date of these rules, the institution shall maintain a
living room or den for the children residing in a living unit. Such space shall
be equipped with comfortable furnishings suitable for relaxation and social
interaction. |
| (5) |
Dining Area. The
institution shall maintain a dining area that is furnished to permit children,
staff, and guests to eat together in a small group or groups. |
| (6) |
Climate Control. The institution shall be
maintained at a temperature range of sixty-five (65) degrees Fahrenheit to
eighty-two (82) degrees Fahrenheit, depending upon the season of the
year. |
| (7) |
Ceilings and Walls. All
ceilings shall be at least seven (7) feet in height. Ceiling and walls shall be
of good repair. |
| (8) |
Windows. All
windows that can be opened and that are used for ventilation shall have insect
window screens. Windows and screens must be in good repair. |
| (9) |
The institution shall be kept clean and
free of hazards to health and safety and of debris and pests.
| (a) |
Any firearms or ammunition on the
institution's premises shall not be allowed within any living units and shall
be stored in locked cabinets or similar storage containers which are not
accessible to children and which are in areas that are not accessible to
children. |
| (b) |
An effective pest
control system shall be implemented. Pesticides, disinfectants, chemicals, and
cleaning supplies, with hazardous labels, shall be stored in designated areas
away from children and if used by children, such use shall be supervised by
staff. |
|
| (10) |
Exterior
Grounds. Exterior grounds of the institution shall be free of hazards to health
and safety.
| (a) |
Garbage which is stored
outside shall be stored in covered containers and shall be emptied at least
weekly. Garbage storage areas and containers shall be cleaned periodically to
eliminate buildup of dirt and grime that attracts pests and rodents. |
| (b) |
Playgrounds and recreation areas used by
children shall be kept clean and free from litter and hazards to health and
safety. |
| (c) |
Swimming Pools. If an
institution has a swimming pool on its grounds, such pool shall be enclosed
with protective fencing and be free of contamination. A certified lifeguard
shall be in attendance at all times that a swimming pool is in use by any
resident. |
|
| (11) |
Transportation.
| (a) |
Vehicles used by an
institution to transport children shall be insured and shall have a
satisfactory annual safety inspection of brakes, exhaust system, headlights,
steering, stop lights, suspension, tail lights, tires, turn signals, and
windows and windshield wipers. Such inspection shall be documented on a GDHR
Annual Transportation Vehicle Safety Inspection Certification (Form 699) or its
equivalent. |
| (b) |
When transporting
children, an institution's vehicle shall only be operated by a staff member or
an authorized resident who possesses a valid driver's license as required for
the class of the vehicle operated. If an institution authorizes residents to
drive, it shall establish and implement policies and procedures relative to the
use of agency vehicles by such residents. |
| (c) |
No vehicle shall be used to transport
more children than the manufacturer's rated seating capacity for the
vehicle. |
| (d) |
All vehicles used to
transport children shall be equipped with safety equipment as required by
federal and state laws. |
|
| (12) |
Accessibility. Where children are
dependent upon a wheelchair or other mechanical device for mobility, the
child-caring institution shall have:
| (a) |
At
least two exits from the child caring institution, remote from each other that
are accessible to the child and with easily negotiable ramps; |
| (b) |
All doorways and hallways leading to
exits, as well as bathrooms, must accommodate wheelchair access; and |
| (c) |
The bathroom shall be sufficient to
accommodate a wheelchair and a staff person and appropriate accessibility
devices installed. |
|
| (13) |
Children shall not be required to sleep in areas of the premises that are not
routinely used as or specifically designated as bedrooms such as doorways,
hallways, bathrooms, closets, crawl spaces, fire escapes, kitchens, communal
living areas, etc. |
| (1) |
Plans of Correction. If the
Department determines that either a child-caring institution or a facility
applying to become licensed as a child-caring institution does not comply with
the rules, the Department shall provide written notice specifying the rule(s)
violated and setting a time for the institution not to exceed ten (10) working
days within which to file an acceptable written plan of correction where the
Department has determined that an opportunity to correct is permissible. If
such plan of correction is determined not acceptable to the Department because
it does not adequately correct the identified violation, the Department will
advise the child-caring institution or facility applying to become licensed
that the plan of correction is not acceptable. The Department may permit the
institution to submit a revised plan of correction.
| (a) |
The institution shall comply with an
accepted plan of correction. |
| (b) |
Where the Department determines that either the child-caring institution or the
facility applying to become licensed as a child-caring institution has not
filed an acceptable plan of correction or has not complied with the accepted
plan of correction, the Department may initiate an adverse action to enforce
these rules. |
|
| (2) |
All
adverse actions to enforce the Rules and Regulations for Child-Caring
Institutions shall be initiated in accordance with the Rules and Regulations
for Enforcement of Licensing Requirements, Chapter 290-1-6, and O.C.G.A.
§§ 49-5-12
and
49-5-12.1,
Penalties for Violation of Child Welfare Agency Laws and Regulations and § 49-5-60et
seq. and the requirements set forth herein. |
| (3) |
Required Notifications for
Revocations and Suspensions. The institution shall notify each child's
parents and/or legal guardians of the Department's actions to revoke the
license or seek an emergency suspension of the institution's license to
operate.
| (a) |
The official notice of the
revocation or emergency suspension action and any final resolution, together
with the Department's complaint intake phone number and website address, shall
be provided by the institution to each current and prospective child's parents
and/or legal guardians. |
| (b) |
The
institution shall ensure the posting of the official notice at the institution
in an area that is visible to each child's parents and/or legal
guardians. |
| (c) |
The institution
shall ensure that the official notice continues to be visible to each child's
parents and/or legal guardians throughout the pendency of the revocation and
emergency suspension actions, including any appeals. |
| (d) |
The institution shall have posted in an
area that is readily visible to each child's parents and/or legal guardians any
inspection reports that are prepared by the Department during the pendency of
any revocation or emergency suspension action. |
| (e) |
It shall be a violation of these rules
for the institution to permit the removal or obliteration of any posted notices
of revocation, emergency suspension action, resolution, or inspection survey
during the pendency of any revocation or emergency suspension action. |
| (f) |
The Department may post an official
notice of the revocation or emergency suspension action on its website or share
the notice of the revocation or emergency suspension action and any information
pertaining thereto with any other agencies that may have an interest in the
welfare of the children in care at the institution. |
| (g) |
The Department may suspend any
requirements of these rules and the enforcement of any rules where the Governor
of the State of Georgia has declared a public health emergency. |
|
| (1) |
In accordance with O.C.G.A.
49-5-90et
seq., notwithstanding other remedies available to the department which
may be pursued at the same time, the commissioner or his designee may issue
emergency orders. Such orders may include the following:
| (a) |
Emergency relocation of residents when it
is determined that the residents are subject to an imminent and substantial
danger. |
| (b) |
Emergency placement of
a monitor or monitors in an institution upon a finding that the department's
rules and regulations are being violated which threaten the health, safety, or
welfare of children in care and when one or more of the following conditions
are present:
| 1. |
The institution is operating
without a license; or |
| 2. |
The
department has denied the application for the license or has initiated action
to revoke the existing license; or |
| 3. |
Children are suspected of being subjected
to injury or life-threatening situations or the health or safety of a child or
children is in danger. |
|
| (c) |
Emergency prohibition of admissions to an
institution when residents are in imminent and substantial danger and the
institution has failed to correct a violation of rules and regulations within a
reasonable time, as specified by the department. Such violation giving rise to
the prohibition could jeopardize the health and safety of the residents if
allowed to remain uncorrected or is a repeat violation over a twelve month
period. |
|
| (2) |
An emergency
order shall contain the following:
| (a) |
The
scope of the order; |
| (b) |
The reasons
for the issuance of the order; |
| (c) |
The effective date of the order if other than the date the order is
issued; |
| (d) |
The person to whom
questions regarding the order are to be addressed; and |
| (e) |
Notice of the right to a preliminary
hearing. |
|
| (3) |
Unless
otherwise provided in the order, an emergency order shall become effective upon
its service to the owner, the director, or any other agent, employee, or person
in charge of the institution at the time of the service of the order. |
| (4) |
Prior to issuing an emergency order, the
commissioner or his designee may consult with persons knowledgeable in the
field of child care and a representative of the institution to determine if
there is a potential for greater adverse effects on children in care as a
result of the emergency order. |
The facility shall prepare for potential emergency situations
that may affect the care of children by the development of an effective
disaster preparedness plan that identifies emergency situations and outlines an
appropriate course of action. The plan must be reviewed and revised annually,
as appropriate, including any related written agreements.
| (a) |
The disaster preparedness plan shall
include at a minimum plans for the following emergency situations:
| 1. |
Local and widespread weather emergencies
or natural disasters, such as tornadoes, hurricanes, earthquakes, ice or snow
storms, or floods; |
| 2. |
Manmade
disasters such as acts of terrorism and hazardous materials spills; |
| 3. |
Unanticipated interruption of service of
utilities, including water, gas, or electricity, either within the facility or
within a local or widespread area; |
| 4. |
Loss of heat or air
conditioning; |
| 5. |
Fire, explosion,
or other physical damage to the facility; and |
| 6. |
Pandemics or other situations where the
community's need for services exceeds the availability of beds and services
regularly offered by the facility. |
|
| (b) |
There shall be plans to ensure sufficient
staffing and supplies to provide room, board and watchful oversight during the
emergency situation. |
| (c) |
There
shall be plans for the emergency transport or relocation of all the facility
children, should it be necessary, in vehicles appropriate to the children's
needs. Additionally there shall be written agreements with any facilities which
have agreed to receive the facility's children in these situations. |
| (d) |
The facility shall document participation
of all areas of the facility in quarterly fire drills. |
| (e) |
In addition to fire drills, the facility
shall have its staff rehearse portions of the disaster preparedness plan, with
a minimum of two rehearsals each calendar year either in response to an
emergency or through planned drills, with coordination of the drills with the
local Emergency Management Agency (EMA) whenever possible. |
| (f) |
The plan shall include the notification
to the department of the emergency situation as required by these rules and
notification of the lawful custodians of the children's whereabouts and
condition. |
| (g) |
The facility shall
provide a copy of the internal disaster preparedness plan to the local
Emergency Management Agency (EMA) and shall include the local EMA in
development of the facility's plan for the management of external
disasters. |
| (h) |
The facility's
disaster preparedness plan shall be made available to the department for
inspection upon request. |
| (i) |
The
department may suspend any requirements of these rules and the enforcement of
any rules where the Governor of the State of Georgia has declared a public
health emergency. |
| (1) |
The department may, in its discretion,
grant waivers and variances of specific rules upon application or petition
being filed by an institution. The department may establish conditions which
must be met by the institution in order to operate under the waiver or variance
granted. Waivers and variances may be granted in accordance with the following
considerations:
| (a) |
Variance. A variance may
be granted by the department upon a showing by the applicant or petitioner that
the particular rule or regulation that is the subject of the variance request
should not be applied as written because strict application of the rule would
cause undue hardship. The applicant or petitioner must also show that adequate
standards affording protection for the health, safety and care of the children
exist and will be met in lieu of the exact requirements of the rule or
regulations in question. |
| (b) |
Waiver. The department may dispense entirely with the enforcement of a rule or
regulation upon a showing by the applicant or petitioner that the purpose of
the rule or regulation is met through equivalent standards affording equivalent
protection for the health, safety and care of the children. |
| (c) |
Experimental Variance or Waiver. The
department may grant waivers and variances to allow experimentation and
demonstration of new and innovative approaches to delivery of services upon a
showing by the applicant or petitioner that the intended protections afforded
by the rule or regulation which is the subject of the request are met and that
the innovative approach has the potential to improve service
delivery. |
|
In the event that any rule, sentence, clause or phrase of any
of these rules and regulations may be construed by any court of competent
jurisdiction to be invalid, illegal, unconstitutional, or otherwise
unenforceable, such determination or adjudication shall in no manner affect the
remaining rules or portions thereof. The remaining rules or portions thereof
shall remain in full force and effect, as if such rule or portions thereof so
determined, declared or adjudged invalid or unconstitutional were not
originally a part of these rules.
