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Subject 290-2-6 RULES AND REGULATIONS FOR CHILDREN'S TRANSITION CARE CENTERS

Rule 290-2-6-.01 Legal Authority

These rules are adopted and published pursuant to the Official Code of Georgia Annotated (O.C.G.A.) Sec. 49-5-1et seq.

Rule 290-2-6-.02 Title and Purposes

These rules shall be known as the Rules and Regulations for Children's Transition Care Centers. The purposes of these rules are to provide for the licensing and inspection of children's transition care centers within Georgia, and to establish foster care requirements applicable to those centers that provide such services.

Rule 290-2-6-.03 Definitions

In these rules, unless the context otherwise requires, the words, phrases and symbols set forth herein shall mean the following:

(a) "Abuse" means any unjustifiable intentional or grossly negligent act, exploitation or series of acts, or omission of acts which causes injury to a person, including but not limited to verbal abuse, assault or battery, failure to provide treatment or care, or sexual harassment.
(b) "Adult" means a person eighteen (18) years of age or older, who is not an individual under care of the center.
(c) "Activities of daily living" means bathing, brushing teeth, combing hair, toileting, dressing, eating, grooming, and transfers or ambulation.
(d) "Applicant" means the following:
1. When the center 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 center 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 center 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 center 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.
(e) "Behavior management" means those principles and techniques used by a center 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 comprehensive service plan, written policies and procedures governing service expectations, service plan goals, safety, security, and these rules and regulations.
(f) "Center" in these rules means a children's transition care center.
(g) "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 comprehensive service plan, to treat current symptoms of a medical or psychiatric condition.
(h) "Children's transition care center" means a center which provides a temporary, home-like environment for medically fragile children, technology dependent children, and children with special health care needs, up to 21 years of age, who are deemed clinically stable by a physician but are dependent on life-sustaining medications, treatments, and equipment, and who require assistance with activities of daily living to facilitate transitions from a hospital or other facility to a home or other appropriate setting.
(i) "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.
(j) "Commissioner" means the Commissioner of the Department of Human Resources.
(k) "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.
(l) "Department" means the Georgia Department of Human Resources.
(m) "Director" means the chief administrative or executive officer of the center.
(n) "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.
(o) "Emergency safety intervention plan" means the plan developed by the center 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.
(p) "Employee" means any person, other than a director, employed by a center to perform any duties at any of the center's facilities which involve personal contact between that person and any child being cared for at the center and also includes any adult person who resides at the center or who, with or without compensation, performs duties for the center which involve personal contact between that person and any child cared for by the center.
1. For purposes of these rules, an employee does not mean a child that resides at the center and performs duties for the center;
2. For purposes of criminal history background check determinations and if a center 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.
(q) "Exploitation" means the illegal or improper use of a person or that person's resources through undue influence, coercion, harassment, duress, deception, false representation, false pretense, or other similar means for another person's profit or advantage.
(r) "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.
(s) "Foster care" means supervised care in a substitute home or a children's transition care center on a 24 hour full-time basis for a temporary period of time.
(t) "Foster home" means a private home where the foster parent(s) live which has been approved by the center to provide 24 hour care, lodging, supervision and maintenance for no more than six children under the age of 19.
(u) "Foster parent" means an adult person approved by the center 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.
(v) "Human services professional" means the person(s) employed by the center 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 center's admission evaluation; the development of the service plans; case work services as provided in the resident's service plans; and monitoring of the resident's medical, social, and other needs.
(w) "Living unit" means the physical location where residents live within the center.
(x) "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.
(y) "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.
(z) "Medical day care" means specialized services provided to medically fragile children during daytime hours, without overnight stays.
(aa) "Medically fragile children" means children who are medically stable but require skilled nursing care and either specialized therapy or specialized medical equipment and supplies.
(bb) "Neglect" means the absence or omission of essential services to the degree that it harms or threatens with harm the physical or emotional health of a person.
(cc) "Nursing services" means those services that may only be provided by licensed professional nurses pursuant to the regulations established under Georgia law. O.C.G.A. 43-26-3et seq.
(dd) "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 center licensed as a children's transition care center and who:
1. Purports to or exercises the authority of the owner in a center;
2. Applies to operate or operates a center;
3. Enters into a contract to acquire ownership of a center.
(ee) "Placement" means any activity by any person that provides assistance to a parent or guardian in locating and affecting 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.
(ff) "Preliminary records check application" means an application for a preliminary records check determination on forms provided by the department.
(gg) "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.
(hh) "Professional services" means services provided by a licensed or certified professional such as an audiologist, clinical social worker, dentist, dietician, family therapist, licensed professional counselor, occupational therapist, nurse, optometrist, physical therapist, physician, podiatrist, psychologist, respiratory therapist, speech-language pathologist and others.
(ii) "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.
(jj) "Respite care" means the provision of intermittent and temporary substitute care or supervision to a medically fragile child on behalf of and in the absence of the caregiver, for the purpose of providing relief from stress or responsibilities associated with providing continuous care or supervision, to enable the caregiver to continue the provision of care in the home.
(kk) "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.
(ll) "Seclusion" means the unobserved, involuntary confinement of a child, 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.
(mm) "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.
(nn) "Time-out" means a behavior management technique that involves the brief separation of a child from the group or activity, not to exceed twenty (20) minutes, during which time the child is continually observed by a staff member. During "time-out" a child is not physically restricted to an enclosed room or area.
(oo) "Transfer agreement" means a written contract with other institutions providing for transfer of a child in care from the center to the other institution when the center cannot provide the level of care required by the child, and providing for the exchange of medical and other information at the time of the transfer.
(pp) "Unsatisfactory criminal history background check determination" means a written determination that a person for whom a records check was performed has a criminal record.
(qq) "Weekend camp" means a planned program for medically fragile children with special health care needs that consists typically of a short residential stay from Friday afternoon through Sunday evening.

Rule 290-2-6-.04 Governing Body

(1) Each center shall have a clearly identified governing body which shall be empowered and responsible for determining all policies and procedures and ensuring compliance with all applicable state and federal laws and regulations.
(2) 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 a center is individually owned, then the owner(s) will complete the statement of responsibility.
(3) If a center is governed by a board, there shall be policies and procedures for periodic rotation of members which include term limits.

Rule 290-2-6-.05 Criminal History Background Checks, Licenses and Exemptions

(1) Criminal History Background Checks for Owners Required. Prior to approving any license for a new center 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 any 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 children's transition care center 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 centers;
(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 children's transition care center license 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.
(a) An owner with a valid children's transition care center 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.
(b) 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.
(4) Criminal History Background Checks for Director and Employees Required. Prior to serving as a director of a licensed center, 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 children's transition care center 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 center, 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 center 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 children's transition care center if it is determined that such person has a criminal record involving any of the covered crimes outlined in Rule .05(2)(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.
(5) Criminal History Background Checks for Foster Parents Required. No center 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.
(6) 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.
(7) Licenses. No person, partnership, association, corporation or entity shall operate a children's transition care center in the state without first obtaining a license to operate the center by demonstrating compliance with the necessary requirements set forth in these rules.
(a) No licensed children's transition care center shall provide care to more than six (6) children per residence and no more than 16 children per campus.
(b) A licensed children's transition care center must provide transitional care as described in these rules for the facilitation of transition of children to a home or other appropriate setting and for the reunion of families.
(c) In addition to transition care services, a licensed center may provide respite care services, registered nursing or licensed practical nursing care, medical day care services, weekend camps and diagnostic studies typically done in the home setting.
(d) Centers 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 centers that request to be commissioned, and for the purposes of these rules, the term license shall have the same meaning as commission.
(e) A license may be issued, upon presentation of evidence satisfactory to the department, that the center 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.
(8) 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 center 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 a center complies with these rules but has not yet enrolled children; or
(b) If a center 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 children's transition care center 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 children's transition care center, 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 center 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.
(9) 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 a center 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 center.
(10) Qualifications Requirement. In order to obtain or retain a license, the director of the center and its employees must be qualified, as defined in these rules, to administer or work in a center. 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 a center.
(11) License is Nontransferable. A license to operate a center is not transferable in any way. Each license shall be returned to the department immediately upon the suspension, revocation or restriction of the license or upon the termination, sale or change in ownership of the center.
(12) Renewal of License. A license will be renewed upon a determination by the department that the center presents satisfactory evidence of meeting the requirements set forth in these rules.
(13) 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 centers 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.

Rule 290-2-6-.06 Applications

(1) An application for a license to operate a center 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 center.
(b) Records Check and Preliminary Records Check Applications. Accompanying any application for a new license for a center, 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 a center is proposed to operate even when all of the proposed centers are owned by the same person or entity.
(d) Amended License. If there is to be a change in the name of the center, changes in the ages of children to be served, or additions or changes in the uses of the buildings that will affect the center'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.
(2) 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, center, 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.
(3) A center shall not begin operation without departmental approval.

Rule 290-2-6-.07 Inspections and Investigations

(1) The department is authorized and empowered to conduct investigations and on-site inspections of any center 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 center to assess compliance with these rules.
(b) Consent to Entry. An application for a license or commission to operate a center 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 center staff, to enter the premises at any time during operating hours for the purpose of inspecting the center. 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 client and business records required by these rules. 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 center.
(c) Other Inspections. The department may conduct scheduled and unscheduled on-site inspections of a center 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 center, alleging child abuse, mistreatment, neglect, exploitation, or deprivation which occurred while the child was in the care of the center director or employees; or
3. Upon receiving information of alleged violations of these rules, including information provided by the center, 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 center's personnel.
(d) Failure to Allow Access. Failure to allow access of the department's representative to the center, its staff, or the children receiving care at the center 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.

Rule 290-2-6-.08 Children's Rights

(1) General. A child shall not be deprived of any rights, benefits, or privileges guaranteed by law based solely on his/her status as a resident of the center. Children's right include but are not limited to the following:
(a) The right to accept or refuse services as agreed or as mutually established and to know the consequences of such action.
(b) The right to voice grievances and complaints regarding treatment or care that is furnished without fear of retaliation, discrimination, coercion or reprisal.
(c) The right to confidential treatment of all information in the case record.
(2) Personal Property. A child shall be permitted to retain and use or wear his/her personal property in his/her immediate living quarters unless deemed medically inappropriate or socially disruptive by a physician and so documented in the case record.
(a) The center shall make reasonable efforts to prevent loss and theft of children's property.
(b) The center shall develop procedures for investigating complaints concerning theft of children's property and shall promptly investigate all such complaints.
(3) Religion. A child shall be permitted the free exercise of religion. Upon the child's or the child's representative's request, and if necessary at his/her expense, the center shall make arrangements for a child's attendance at religious services of the child's choice. However, no religious beliefs or practices, or attendance at religious services, may be imposed upon any child.
(4) Every child or child's representative shall be permitted to inspect and copy all of the child's clinical and other records concerning the child's care and maintenance kept by the center.
(5) Center staff may terminate visits or provide other accommodations for the visit if they are so requested by the child or the child's representative, or if the visitor is involved in behavior violating other children's rights.

Rule 290-2-6-.09 Administration and Organization

(1) Program Purpose. In accordance with these rules and regulations, a licensed children's transition care center 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 of the children it serves, including the referral sources. The policies and procedures for transition care services shall include that the services are limited to short term stays of one to fourteen (14) consecutive days and for long-term stays of up to ninety (90) consecutive days depending on the transition needs of the child. Stays of over ninety (90) consecutive days must be individually approved by the Department by waiver, and may not exceed 12 consecutive months.
(2) Program Description and Implementation. In accordance with these rules and regulations, a licensed children's transition care center shall develop, implement and comply with written policies and procedures that describe the range of services and the manner in which such services will be provided by the center. 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 center and what services are provided by other available community or contract resources. The program description must include which of the following services will be provided in addition to transition care services:
(a) Registered nursing and/or licensed practical nursing care;
(b) Medical day care;
(c) Diagnostic studies typically done in the home setting;
(d) Respite care; and/or
(e) Weekend camps.
(3) Director. The governing body of the center shall designate a director who shall be authorized to manage the center.
(a) The director shall possess at least one of the following qualifications:
1. A master's degree or higher from an accredited college or university in the area of nursing, social work or other health-related field plus at least two years of experience within the five years preceding the date of hire working with medically fragile children; or
2. A licensed registered nurse, physician, or other licensed health care professional with at least five years experience working with medically fragile children.
(b) The director 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 center at any time, there shall be a similarly qualified person designated to assume responsibility for the operation of the center.
(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 center, regardless of payor source. The schedule shall detail the basic cost of services and any additional costs for other services.
(5) Recordkeeping.
(a) Case Records. A center 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 center;
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;
7. Assessment plans;
8. Service plans and review and progress notes and collateral communications with physicians and others involved in the child's care;
9. Medical records, including the name, address, and phone numbers of doctors involved in the child's care, sufficient information to validate the child's medical diagnosis and to establish the basis on which treatment is provided, treatment and medication orders, health history, records of administration of medicines, immunization records, and orders for modified diets, and nurses notes;
10. Records of behavior management, emergency safety interventions, and written grievances, as described in Rule .18 and Rule .19;
11. Educational and vocational information such as report cards, progress reports, and related materials received during a child's residency in the center; and
12. Discharge plans required by Rule .13 .
(b) Retention of Case Records. Case records shall be retained in the center for at least five years 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. A center shall maintain the confidentiality of all children's case records. Employees of the center 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. A center 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, including explanations for any gaps in employment;
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, and documentation of such screening annually thereafter;
7. Date of employment;
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 .09(6)(g) 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 .18 and Rule .19 related to children in care and the employee.
(6) Staffing. There shall be sufficient staff members on duty at all times to assure each child proper care according to his or her needs. When children are present at the center, there shall be, at a minimum, one awake registered nurse (RN) on duty per residence at all times.
(a) In addition to the RN, staffing for child care shall be, at a minimum, no less than one awake qualified and trained staff member per three children.
(b) 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.
(c) Volunteers shall not be substituted for paid staff to meet the staffing requirements set forth in Rule .09(6)(a) and (b).
(d) 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 (g) 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 foster or adoptive 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.
(e) Human Services Professionals. The center shall have designated HSPs to provide services to children and their families. There shall be one human services professional employed for every separate residence. The center's director, if qualified by education, may perform the duties of a human services professional.
(f) Any HSP employed shall either 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; possess a master's degree from an accredited college or university in one of the above disciplines, or be a licensed LPN or registered nurse.
(g) Child Care Workers. The center shall have designated child care workers to supervise children, provide oversight for activities, provide for assistance with activities of daily living and be responsible for the areas where the children reside.
1. 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 relating to specific care techniques appropriate for the position and shall include cardiopulmonary resuscitation (CPR) and a triennial training program in first aid which have been offered by certified or licensed health care professionals.
2. Such training programs shall be completed within the first year of employment.
(h) Staff Training. Prior to working with children, all staff and volunteers, including the director, who work with children shall be oriented in accordance with these rules and shall thereafter receive annual additional training in accordance with these rules.
1. Orientation shall include instruction in:
(i) The center'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 and exploitation policies and procedures;
(v) Reporting requirements for suspected cases of child abuse and exploitation and notifiable diseases and serious injuries;
(vi) Policies and procedures for handling medical emergencies (life-threatening, limb-threatening, or function-threatening conditions), and managing use of medications by children in care;
(vii) Infection control policies and procedures; and
(viii) The center'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 center.
(i) There shall be, at a minimum, one awake RN or other staff member on duty at all times when children are present at the center who is trained in first aid and has a current CPR certificate.
(7) Reporting of Serious Occurrences or Incidents. Whenever the children's transition care center has reason to believe any of the occurrences or incidents listed below has occurred, the center shall make a report summarizing the occurrence or incident to the Department of Human Resources, Office of Regulatory Services, Residential Child Care Unit.
(a) The summary report shall be made via email or facsimile within 24 hours of the occurrence or incident or when the center first became aware of the occurrence or incident, and must contain all of the information required on the incident intake information form (ITF), as relevant.
(b) The report shall be made regarding any serious occurrences or incidents involving children in care, including but not limited to:
1. Accidents or injuries requiring medical treatment and/or hospitalization;
2. Death;
3. Suicide attempts;
4. Closure of the center or any part of the center due to disaster or emergency situations such as fire or severe weather;
5. Emergency safety interventions resulting in any injury that requires treatment beyond first aid; or
6. Any incident which results in any federal, state or private legal action by or against the center which affects any child or the conduct of the center. However, legal action involving the juvenile justice system is not required to be reported.
(c) A detailed investigative report which includes steps taken by the center 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 children's transition care center 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.

Rule 290-2-6-.10 Quality Assurance

(1) The center shall have an on-going comprehensive, integrated, self-assessment quality improvement process which provides assurance that care is provided at all times in compliance with accepted standards of professional practice.
(2) The center shall have written plans, policies and procedures addressing quality assurance which include:
(a) Goals and objectives;
(b) The identity of the person responsible for the program;
(c) A system to ensure systematic, objective regular reports are prepared and distributed to the governing body and any other committees as directed by the governing body;
(d) The method for evaluating the quality and the appropriateness of care;
(e) A method for resolving identified problems; and
(f) A method for implementing practices to improve the quality of patient care.
(g) The plan shall be reviewed at least annually and revised as appropriate by the governing body.
(3) Quality assessment and improvement activities shall be based on the systematic collection, review, and evaluation of data which, at a minimum, includes:
(a) Services provided by professional and volunteer staff;
(b) Audits of patient charts;
(c) Satisfaction surveys from staff, volunteers, and clients about services;
(d) Concerns or suggestions for improvement in services;
(e) Organizational review of the center's programs;
(f) Patient/family evaluations of care; and
(g) High-risk, high volume and problem-prone activities.
(4) When problems are identified in the provision of care, there shall be evidence of corrective actions, including ongoing monitoring, revisions of policies and procedures, educational intervention and changes in the provision of services.
(a) The effectiveness of actions taken to improve services or correct identified problems shall be evaluated.
(b) The center shall monitor and evaluate its resource allocation regularly to identify and resolve problems with the utilization of its services, facilities and personnel.

Rule 290-2-6-.11 Admission for Transition Care Services

(1) A center shall only admit medically fragile children whose known health care or medical support needs can be met by the center in accordance with its program purpose and program description.
(a) Admission agreements with any public or private agencies that place children in the center shall be in writing and shall include the following provisions and requirements.
(b) All relevant information required for admission to the center shall be reviewed, if available, in preplacement assessment and planning for the needs of the child.
1. All children shall have current immunizations as outlined in the 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. Prior to admission each child must have a current medical history and physical assessment sufficient for the provision of appropriate care and treatment to meet the child's needs while at the center.
3. A physician must provide orders for the skilled nursing services and other treatments provided to meet the child's health care or medical support needs while at the center.
4. Each child admitted to the center shall be under the continuing care of a physician, prior to and during the entire admission. The child shall be seen by the physician in accordance with the comprehensive service plan required in Rule .12(2).
(c) When 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.
(2) Prior to admission, the center shall:
(a) Provide information to the child's parent, guardian, or custodian about the services, environment, age ranges and characteristics of the other children in placement.
(b) Maintain signed documentation from the custodian that they have received and considered the information provided in Rule .11(2)(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.
(3) The center shall comply with the Interstate Compact on the Placement of Children when admitting children from another state.
(4) Written admission policies and procedures shall be established and implemented and shall include the following requirements:
(a) Completion of an intake referral form that includes a social, health, educational, family, behavioral and personal developmental history to determine the placement needs (services, supports, setting, etc.) of each child and whether that placement is appropriate.
(b) Completion of a written placement agreement developed with the involvement of the child, and the parent(s) or guardian(s), or placing agency representative and signed by all parties, with such agreement including the following:
1. Written authorization to care for the child;
2. Written authorization to obtain medical care for the child;
3. Written summary of discussions among the child and the parent(s) or guardian(s), or placing agency, and the center's Human Service Professional regarding basic care, any specialized services and/or treatments to be provided; the expectations of the involvement of the parent(s) or guardian(s), or the placing agency in service planning.
(5) Upon admission, a written description of the center shall be provided to the child, the parent(s) or guardian(s),or placing agency and shall include:
(a) The center's program purpose and program description;
(b) The description of service planning and normal daily routines of children;
(c) The description of health support services to be provided, including how the center handles illnesses, injuries, and medical emergencies (life-threatening, limb-threatening, and function-threatening conditions);
(d) The center's policies and procedures for behavior management and grievances;
(e) Policies and procedures for visiting hours and communications with persons outside the center;
(f) The names and telephone numbers of the child's designated HSP, nurse and primary Child Care Worker; and
(g) Schedule of fees if placement is not done under a Purchase of Service Agreement.

Rule 290-2-6-.12 Assessment and Planning for Transition Care Services

(1) Health Service Plan. A written assessment and health service plan shall be developed by a RN on the day of admission and must include preliminary discharge plans for the child, including the anticipated date of discharge.
(a) The health service plan throughout the child's stay at the center shall also include but not be limited to:
1. Identification of each child's current, priority health care issues relating to medical, physical, intellectual, emotional/behavioral, psychosocial/developmental, and spiritual needs;
2. The short term and long term outcomes, interventions, and resources engaged to promote outcome achievement;
3. Daily progress notes reflecting the child's progression towards the achievement of each specific outcome;
4. The input and participation of involved health care team members (child's pediatrician, specialty physicians, therapists, HSP, counselors, care givers, and family members); and
5. Documentation of updates and monthly reviews.
(b) Arrangements shall be made with at least one physician and one dentist or a health care agency that provides physician or dental services in order to meet the health and medical support needs of children in care.
1. A general physical examination of the child shall be provided by a by a medical doctor, physician's assistant, or public health department within 72 hours (excluding weekends and holidays) of admission unless such an examination has been completed within one year prior to admission.
2. The general physical examination 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.
(c) Within ten days of admission, an assessment of the children's medical and dental health shall be completed by the designated intake HSP.
(d) 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;
(e) Children shall receive annual medical check-ups and semiannual dental check-ups;
(2) Comprehensive Service Plan. The center shall complete a full written assessment of each child admitted for care and of each child's family and develop an individual written comprehensive service plan for each child based on the assessments within ten (10) days of admission. If an assessment is not completed within ten (10) 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 assessment shall be coordinated by a registered nurse, and shall assess the needs of the child in the areas of health care, education, family relationships, personal social needs, and any behavioral issues that require monitoring.
(b) A comprehensive service plan to address the transition needs of the child, the child's family or prospective family other than the medical and nursing needs addressed by the health services plan shall be developed by a RN or other assigned HSP in concert with the RN who has responsibility for supervision of the child in the area where the child resides. The plan shall contain the following data:
1. The results of the assessment and identified needs other than those medical and nursing 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 daily activities to be followed by the child, the child's family or prospective family and staff members in pursuit of the stated goals and objectives;
4. Statements of any special care and educational services that will be arranged for or provided directly;
5. Statements of goals and preliminary plans for discharge, including referrals for appropriate community support services;
6. Statements about the plan for behavior management 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 comprehensive service plan, and its periodic updates as described below.
(d) The comprehensive service plan shall be updated by the HSP at a minimum of every thirty days, or whenever the child experiences a significant change in condition, and pertinent progress notes and data shall be incorporated in the plan to measure attainment of stated goals and objectives.
1. The review shall consider input from the care team providing services directly to the child.
2. The center shall be responsible for implementing the comprehensive service plan.

Rule 290-2-6-.13 Discharge and Aftercare for Transition Care Services

(1) During a child's placement in a center, the preliminary plans for discharge required by Rule .12(1) shall be adjusted according to the child's circumstances. At the time of admission, a center shall initiate an aftercare plan that identifies the supports and resources that the child and child's family are expected to need following discharge.
(2) Emergency discharges are authorized when the health and safety of the child or other children in residence might be endangered by the child's further placement in the center. At least 72 hours of prior notice of discharge shall be provided in writing 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, a center shall compile a complete written discharge summary within fourteen 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 provided for the child to meet assessed needs while the child was in the center;
(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 provided to the child's parent(s) or guardian(s), or placement agency representative when it is completed. The center shall keep a record of the discharge summary in the center's files.

Rule 290-2-6-.14 Services for Transition Care

(1) Casework Services. All children in care and families of children in care shall receive case work services as provided in their comprehensive service plan from their assigned HSP or other appropriate professionals (internal and external of the center) 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) Health Services. The center shall provide for a comprehensive program of services to meet the health care needs and medical support needs for the child, as well as preventive, routine, and emergency medical and dental care for all children.
(a) Medications. The center 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. The center shall designate appropriate staff to dispense non prescription medications. No child shall be given a non-prescription medication by staff members of the center 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 at the center by an RN, parent, guardian, custodian or person standing in loco parentis as ordered in the child's prescription. A center 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. A center 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.
4. 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.
5. All expired medications shall be discarded and not handed out for use.
(b) Infection Control. The center shall employ appropriate universal precautions and isolation techniques to ensure that underlying medical conditions are not exacerbated or infections not transmitted to others where required by the medical condition of the child.
(c) First Aid Supplies. Each living unit shall have at a minimum 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.
(d) Equipment.
1. All specialized equipment and supplies necessary to meet the needs of the children shall be available at the center and maintained in clean and working order with all inspections and repairs documented.
2. The center must have an operable emergency generator appropriate to meet the needs of children in care.
(3) Educational and Vocational Services. A center 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 HSP 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 center 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 center in accordance with the child's comprehensive 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.
(4) Recreation and Leisure. The center 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. A center 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 center shall make arrangements to provide all children with 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 considered substitutes for employed staff and shall not be held responsible for the accomplishments of any work activity of the center such as food preparation, laundering, housekeeping, or center maintenance beyond that which is identified as a learning need in the comprehensive service plan.
(d) Children shall not be used for the purposes of soliciting funds for the center, 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.

Rule 290-2-6-.15 Respite Care Services and Weekend Camps

(1) Respite Care General Requirements. A center may provide a comprehensive program of respite care services to medically fragile children, whose known health care or medical support needs can be met by the center in accordance with its program purpose and program description.
(a) Respite care services are limited to short term stays of no more than 14 consecutive days and no more than four weeks total (28 days), within any six month period.
(b) The maximum number of children for whom a center may provide respite care along with other allowable care shall not exceed the center's capacity requirements set forth in Rule .05(7).
(c) The center shall develop, implement and comply with written policies and procedures that describe the range of respite care services and the manner in which such services will be provided by the center.
(2) Admission for Respite Services. Licensed children's transition care centers may receive medically fragile children for respite care services from their caregiver, parents, guardians, custodians, or persons serving in loco parentis.
(a) Eachchild admitted for respite care services shall either arrive at the center with a health services plan or have a health services plan developed upon admission as detailed in Rule .12(1).
(b) The child's health services plan shall be updated by the RN whenever the child experiences a significant change in condition.
(3) Respite Care Health Services. The center shall provide for a comprehensive program of services to meet the health care needs and medical support needs of children admitted for respite care. Children admitted for respite care shall be provided services in accordance with all the requirements in rules 290-2-6-.01 through 290-2-6-.10, 290-2-6-.15 and Rules 290-2-6-.18 through 290-2-6-.27, respectively.
(a) Children admitted for respite care shall receive timely, qualified health services as needed or in the same manner normally received when living in their usual environment or place of residence.
(b) A general physical examination of the child shall be provided by a medical doctor, physician's assistant, or public health department within 72 hours (excluding weekends and holidays) of admission for respite care services, unless such an examination has been completed within one year prior to admission and the center has documentation of the examination.
(c) The general physical examination shall include the basic diagnostic laboratory work indicated in Rule .12(1)(b)2.
(d) The center shall document written orders for the skilled nursing services, medications and other treatments provided to children during respite care services.
(4) Case Record. Each child admitted for respite care shall have a case record that includes, at a minimum, the following information:
(a) Identifying information for the child such as name, sex, and birth date or age;
(b) Local emergency contact information for the primary caregiver, parent(s), guardian(s), custodians(s), or person(s) serving in loco parentis such as name, address and phone number(s);
(c) Name, address and phone number of the primary physician involved in the child's care;
(d) Current medical history with sufficient information to document the child's medical diagnosis and to establish a basis upon which treatment is provided;
(e) Records of behavior management, emergency safety interventions and written grievances as outlined in Rule .18 and .19.; and
(5) During a child's residency at a center for respite services, the center shall make arrangements to ensure that the child's educational needs are met.
(6) Discharge from Respite Care. At the time of admission, a child's HSP shall develop preliminary discharge plans for the child, which identifies the child's anticipated date of discharge.
(a) Emergency discharges are authorized when the health and safety of the child or other children at the center might be endangered by the child's further placement in the center.
(b) Prior notice of an emergency discharge from respite care shall be provided to the primary caregiver, parents, guardians, custodians, or persons serving in loco parentis. If such notice is not possible, the reasons shall be documented in the child's case record. The child's case record shall include:
1. The name, address, telephone number and relationship of the person or entity to whom the child was discharged;
2. A summary of all the services provided for the child to meet assessed needs during respite care;
3. A summary of any problems encountered by the child and the family during respite care; and
4. A summary of assessed needs which were not met during respite care, and a summary of the reasons why they were not met.
(7) Weekend Camps. Medically fragile children may be admitted to the center for the purpose of attending a weekend camp. Admission, service, and discharge requirements for weekend camps shall be the same as those required for respite services and described in Rules .15(1) through (6).

Rule 290-2-6-.16 Medical Day Care Services

(1) General Requirements. A licensed center may provide a comprehensive program of medical day care services for medically fragile children whose known health or medical support needs can be met by the center in accordance with its program purpose and program description.
(a) Children admitted to a center for the purpose of receiving medical day care services shall be provided services in accordance with all the requirements in Rules 290-2-6-.01 through 290-2-6-.10, Rule 290-2-6-.16 and Rules 290-2-6-.18 through 290-2-6-.27, respectively.
(b) The center shall develop, implement and comply with written policies and procedures that describe the range of medical day care services and the manner in which such services will be provided.
1. Medical day care services are to be limited to no more than twelve consecutive hours per day, per child.
2. The maximum number of children for whom a center may provide medical day care services together with those receiving transition care and respite care services shall not exceed the center's capacity requirements set forth in Rule .05(7).
(c) During a child's residency at a center for medical day care services, the center shall make arrangements to ensure that the child's educational needs are met.
(d) The request for admission to a center for medical day care services may be made by a medically fragile child's caregiver, parents, guardians, custodians, or persons serving in loco parentis.
(e) Emergency discharges are authorized when the health and safety of the child or other children at the center might be endangered by the child's further placement in the center.
(2) Medical Day Care Health Services. Children admitted for medical day care services shall receive timely, qualified health services as needed or in the same manner normally received when living in their usual environment or place of residence.
(a) The center shall document written orders for the skilled nursing services, medications and other treatments provided to children while at the center to receive medical day care services.
(b) Eachchild admitted for medical day care services shall either arrive at the center with a health service plan or have a health service plan developed upon admission as detailed in Rule .12(1).
(c) The child's plan shall be updated by the RN whenever the child experiences a significant change in condition.
(d) Upon admission to a center for medical day care services, a general physical examination of the child shall be provided by a medical doctor, physician's assistant, or public health department, unless the child had such examination within one year prior to admission and the center has documentation of the examination.
(e) The general physical examination shall include the basic diagnostic laboratory work indicated in Rule .12(1)(b)2.
(3) Case Records. Each child admitted for medical day care shall have a case record that includes, at a minimum, the following information:
(a) Identifying information for the child such as name, sex, and birth date or age;
(b) Local emergency contact information for the primary caregivers, parents, guardians, custodians, or persons serving in loco parentis such as name, address and phone number(s);
(c) Name, address and phone number of the primary physician involved in the child's care;
(d) Current medical history with sufficient information to document the child's medical diagnosis and to establish a basis upon which treatment is provided; and
(e) Records of behavior management, emergency safety interventions and written grievances as outlined in Rules .19 and .20.

Rule 290-2-6-.17 Foster Home Placement

(1) A center shall not engage in temporary placement activities in Georgia unless licensed as a children's transition care center and approved by the department to provide for care 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 center 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 center'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 center;
(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 center shall provide and document training for the applicant in at least the following topics:
(a) The center's grievance policies and procedures and the Georgia Foster Parent's Bill of Rights;
(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 less than 12 months of age, the foster parent shall have at least eight (8) hours of training.
(c) The center'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 center'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;
(g) All prospective foster parents shall be trained regarding the child's known health care needs. This training shall be documented in the child's case records.
(6) Minimum Requirements for Prospective Foster Families. Home Study. The center 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:
(a) The names of family members, the family address and telephone number, drivers' license numbers, and proof of automobile insurance as applicable;
(b) The motivation for foster parenting, including but not limited to attitude toward childlessness;
1. 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;
(v) Education;
(vi) Social involvements;
(vii) Personal characteristics;
(viii) Personality;
(ix) Interests and hobbies; and
(x) Emotional stability.
2. 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
(iv) Previous marriages.
3. Evaluation of parenting practices:
(i) Description of parenting knowledge, attitudes and skills;
(ii) Current behavior management practices; and
(iii) Current child-rearing practices.
4. 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 foster 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.
5. 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.
6. 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.
7. 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 centers, recreation, and medical facilities.
8. Religion;
9. Results of the criminal history background check for family members as required by Georgia law;
10. Pre-service training the prospective foster parent and/or family may have received;
11. 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;
12. A description of the type of child desired by the prospective foster family;
13. 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 center shall be located within a reasonable travel distance from the center so as to be accessible for regular visits by family and center 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 center 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 center 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 center 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:
(a) Adjustment of the child to the foster family and vice versa;
(b) Progress made on treatment plan goals;
(c) Any new problems that have arisen and the actions taken toward a solution of those problems;
(d) Contacts and issues with other resources serving the child;
(e) Center 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 center policies and procedures.
(f) 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 center 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:
1. The application;
2. Home study;
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;
5. References;
6. The annual evaluations of the foster home, family, and placements;
7. Documentation of required annual training hours as required in Rule .09(6)(g);
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 and county of custody.
(c) Foster home records shall be maintained for at least 3 years following the center's last placement in said foster home.
(d) The center 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 center 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 center shall maintain records and submit on a timely basis reports required by the Department.
(b) Each center 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 center shall submit on a timely basis such financial, statistical reports, and Board minutes and other information as may be required by the Department.

Rule 290-2-6-.18 Behavior Management and Emergency Safety Interventions

(1) Behavior Management.
(a) Every center shall develop and implement policies and procedures on behavior management. Such policies and procedures shall set forth the types of children served and the center's 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 comprehensive service plan and written policies and procedures governing service expectations, service plan goals, safety, security, and these rules and regulations.
2. Acceptable behavior management methods shall be limited to the least restrictive appropriate method, as described in the child's comprehensive service plan pursuant to Rule .12(2) 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 beyond that which is identified as a learning need in the comprehensive service plan;
2. Denial of meals and hydration;
3. Denial of sleep;
4. Denial of shelter, clothing, or essential personal needs;
5. Denial of essential program services;
6. Verbal abuse, ridicule, or humiliation;
7. Chemical or mechanical 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 .12(2);
9. Corporal punishment;
(d) When there is a need for a chemical restraint, there shall be a verbal doctor's order authorizing the chemical restraint followed by a written doctor's order within one (1) business day thereafter.
1. The child's care must be monitored by a doctor for as long as the chemical restraint is ongoing.
2. There shall be no standing orders for chemical restraints.
(e) Restraints for positioning during physical therapy shall not be used as a form of behavior management.
(f) Time out. A child may be placed in a separate room or area, from which egress is prevented only if the following conditions are met:
1. If the room in which the child is to be placed has a door, the door must remain open at all times; and
2. The child is under the direct constant supervision of a designated staff member.
(g) 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.
(h) Centers 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.
(i) 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.
(j) A positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize a child during medical, dental, diagnostic, or surgical procedures is permissible if ordered by a physician and removed upon the completion of the procedure.
(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 mechanical 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. All emergency safety interventions which employ the use of chemical restraints shall be implemented in accordance with the requirements set forth in Rule .18(1)(d).
(c) The center 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 a physician's assessment 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) Beginning and ending time of the intervention;
(viii) Outcome of the intervention;
(ix) Detailed description of any injury arising from the incident or intervention; and
(x) 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 comprehensive service plan.
(e) Center 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. Center 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;
16. Documentation;
17. Investigation of injuries and complaints;
18. Monitoring physical signs of distress and obtaining medical assistance; and
19. Legal issues.
(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 who has responsibility for the diagnosis and treatment of the child's behavior.
(k) Centers 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 a center utilizes emergency safety interventions three or more times in one month with the same child and/or whenever the center utilizes more than 10 emergency safety interventions for all children in care within a 30-day period.
(l) Centers 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 center, utilizing a master 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 center identifies opportunities for improvement as a result of such reviews or otherwise, the center shall implement these changes through an effective quality improvement plan.
(n) All direct care staff who may be involved in the use of emergency safety interventions, shall have evidence of having satisfactorily completed a 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. Centers shall check the Department's website for a list of approved training programs.
(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 mechanical 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 center director or his or her designee, who possesses at least the qualifications of the director and has been fully trained in the center'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.
8. A positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize a child during medical, dental, diagnostic, or surgical procedures is not considered a manual hold.

Rule 290-2-6-.19 Grievances

(1) The center shall develop and implement policies and procedures for children and families or guardians 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 as well as a separate grievance or complaint log showing the grievance, description or method of explanation or resolution, and involved staff.

Rule 290-2-6-.20 Child Abuse and Sexual Exploitation

(1) The center 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 center;
2. Provisions for conducting internal investigations of such incidents (however, such provisions shall not relieve the center of the requirement to submit reports as required by Rule .16(a)1. 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 center's abuse policies and procedures and reporting requirements.

Rule 290-2-6-.21 Food Service

(1) A center 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 or as prescribed by the child's physician.
(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 a center 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 center provides food services in a centralized kitchen area. Such a center must obtain a valid food service permit. Centers 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 center 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.

Rule 290-2-6-.22 Infection Control, Physical Plant and Safety

(1) Infection Control. Each center shall have procedures for infection control. Policies and procedures shall be written, assembled and available to all staff to reduce the risk of infections originating, occurring, or acquired in the center. Such policies and procedures shall be included in an on-going prevention training program.
(a) Procedures to isolate children to prevent the spread of infections as deemed appropriate;
(b) Procedures for handling and disposing of hazardous waste products and soiled linens and diapers;
(c) Procedures for hand washing and hand antisepsis;
(d) Procedures to ensure that any person whose duties include direct child care, handling food, or handling clean linens, and who has an acute illness or readily contagious condition, shall not be allowed to work until no longer contagious;
(e) Procedures for reporting communicable diseases as required by the rules and regulations for notification of disease which have been promulgated by the Department.
(2) Physical Plant and Safety. Each center shall be physically separate and apart from any other facility licensed by the Department under O.C.G.A. 49-5-12.
(3) Required Approvals.
(a) A center 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) A center 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 center shall have functioning fire extinguishers and smoke detectors.
(d) All buildings and grounds shall be constructed and maintained in accordance with these rules. Centers 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.
(4) Accessibility. All centers serving a child or children dependent on a wheelchair or other device for mobility shall have:
(a) At least two exits from the center, remote from each other, that are accessible to the child in the wheelchair and with easily negotiable ramps;
(b) All doorways and halls leading to exits, bedrooms, bathrooms, and social areas shall accommodate wheelchair access;
(c) At least one bathroom of sufficient size to accommodate a wheelchair and an assisting staff member.
(5) Sleeping Areas.
(a) The center 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. Beds shall be arranged to provide for at least three feet of space between the heads, foot, and sides of each bed. 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. Waterproof mattresses shall be provided as needed as required by the child's assessment and comprehensive 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.
(6) Lavatory and Bathing Facilities.
(a) There shall be lavatory (water basin and toilet) and bathing facilities for children that shall be located near the sleeping areas. Such facilities shall not be used routinely by staff or boys and girls simultaneously.
(b) There shall be at least one lavatory equipped with hot and cold water and mirror for every six 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. Each toilet shall have grab bars firmly installed and convenient to use.
(c) There shall be at least one shower or bathtub with hot and cold water for every six residents or fraction thereof. Bathtubs and shower stalls shall be equipped with nonslip surfaces and have grab bars firmly installed and convenient to use.
(d) Lavatory areas shall be ventilated with either an open screened window or functioning exhaust fan.
(7) Living Room. For centers licensed on or after the effective date of these rules, the center 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.
(8) Dining Area. The center shall maintain a dining area that is furnished to permit children, staff, and guests to eat together in a small group or groups.
(9) Climate Control. The center 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.
(10) Ceilings and Walls. All ceilings shall be at least seven (7) feet in height. Ceiling and walls shall be of good repair.
(11) 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.
(12) The center shall be kept clean and free of hazards to health and safety and of debris and pests.
(a) Firearms or ammunition shall not be allowed on the center's premises.
(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.
(13) Exterior Grounds. Exterior grounds of the center 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 a center 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.
(14) Transportation.
(a) Vehicles used by a center 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, a center'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 a center authorizes residents to drive, it shall establish and implement policies and procedures relative to the use of center 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.
(15) 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.

Rule 290-2-6-.23 Enforcement and Penalties

(1) Plans of Correction. If the Department determines that either a center or a facility applying to become licensed as a center does not comply with the rules, the Department shall provide written notice specifying the rule(s) violated and setting a time for the center 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 center or facility applying to become licensed that the plan of correction is not acceptable. The Department may permit the center to submit a revised plan of correction.
(a) The center shall comply with an accepted plan of correction.
(b) Where the Department determines that either the center or the facility applying to become licensed as a center 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 Children's Transition Care Centers 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 center 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 center'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 center to each current and prospective child's parents and/or legal guardians.
(b) The center shall ensure the posting of the official notice at the center in an area that is visible to each child's parents and/or legal guardians.
(c) The center 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 center 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 center 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 center.
(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.

Rule 290-2-6-.24 Emergency Orders

(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 a center 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 center 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 a center when residents are in imminent and substantial danger and the center 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 center 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 center to determine if there is a potential for greater adverse effects on children in care as a result of the emergency order.

Rule 290-2-6-.25 Diaster Preparedness

(1) The center 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 center or within a local or widespread area;
4. Loss of heat or air conditioning;
5. Fire, explosion, or other physical damage to the center; and
6. Pandemics or other situations where the community's need for services exceeds the availability of beds and services regularly offered by the center.
(b) There shall be plans to ensure sufficient staffing and supplies during the emergency situation.
(c) There shall be plans for the emergency transport or relocation of all 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 center's children in these situations.
(d) The center shall document participation of all areas of the center in quarterly fire drills.
(e) In addition to fire drills, the center 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 center 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 center's plan for the management of external disasters.
(h) The center'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.

Rule 290-2-6-.26 Waivers and Variances

(1) The department may, in its discretion, grant waivers and variances of specific rules upon application or petition being filed by a center. The department may establish conditions which must be met by the center in order to operate under the waiver or variance granted. Waivers and variances may be granted in accordance with the following considerations:
(2) 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.
(3) 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.
(4) 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.

Rule 290-2-6-.27 Severability

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.