Section 87896 - Resident Individual Services Plan/Team(a) The licensee shall ensure that there is an Individual Services Plan for each resident, developed by the Individual Services Team, as specified in Subsection (b). (1) The licensee shall ensure that there shall be a Registered Nurse Case Manager who is responsible for the coordination and/or the provisions of the services specified in the Individual Services Plan.(b) In addition to the Registered Nurse Case Manager, the following persons shall constitute the Individual Services Team and shall be involved in the development and updating of the resident's Individual Services Plan. (1) The resident and/or his/her authorized representative.(2) The resident's physician.(3) Facility administrator/designee.(4) Facility house manager.(5) Direct care personnel.(6) Social worker/placement worker.(7) Pharmacist, if needed.(8) For each unemancipated minor, the child's parent or guardian and the person who will assume legal custody and control of the child upon the hospitalization, incapacitation, or death of the parent or guardian.(9) Others, as deemed necessary.(c) The plan shall include, but not be limited to:(1) Current health status.(2) Current mental status.(3) Current functional limitations.(5) Medical treatment/therapy.(6) Specific services needed.(7) Intermittent home health care required.(8) Agencies or persons assigned to carry out services.(9) "DO NOT Resuscitate Order", if applicable.(10) For each unemancipated minor, the specific legal means of ensuring continuous care and custody when the parent or guardian is hospitalized, relocates, becomes unable to meet the child's needs, or dies. (A) The interdisciplinary team shall develop a relocation plan for each unemancipated minor in anticipation of one or more of the events in Section 87896(c)(10).(B) The interdisciplinary team shall immediately initiate the relocation plan following one or more of the events in Section 87896(c)(10).(C) No unemancipated minor shall remain in the facility more than 24 hours after one or more of the events in Section 87896(c)(10).(D) An immediate referral shall be made to a local child welfare services agency for case management services, if an unemancipated minor cannot be relocated with 24 hours of one or more of the events in Section 87896(c)(10) or if no person has been appointed to take legal custody and control of the child.(d) The plan shall be updated every three months or more frequently as the resident's condition warrants.(e) The Registered Nurse Case Manager shall document all contacts made with the Individual Services Team members pertaining to a resident. (1) This documentation shall be maintained in the resident file and shall be made available to the Department upon request.Cal. Code Regs. Tit. 22, § 87896
1. New section filed 6-7-91 as an emergency; operative 6-7-91 (Register 91, No. 38). A Certificate of Compliance must be transmitted to OAL by 10-7-91 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 12-3-91 as an emergency; operative 12-3-91 (Register 92, No. 9). A Certificate of Compliance must be transmitted to OAL 4-1-92 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 12-3-91 order including adoption of subsection (c)(7) and renumbering and amendment of subsections (c)(9) and (e) transmitted to OAL 4-1-92 and filed 5-13-92 (Register 92, No. 23).
4. New subsections (b)(8), subsection renumbering, and new subsections (c)(10)-(c)(10)(D) filed 11-4-96; operative 12-4-96 (Register 96, No. 45).
5. Editorial correction of subsection (a) (Register 2002, No. 14). Note: Authority cited: Section 1568.072, Health and Safety Code. Reference: Sections 1568.02, 1568.072 and 1568.08, Health and Safety Code.
1. New section filed 6-7-91 as an emergency; operative 6-7-91 (Register 91, No. 38). A Certificate of Compliance must be transmitted to OAL by 10-7-91 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 12-3-91 as an emergency; operative 12-3-91 (Register 92, No. 9). A Certificate of Compliance must be transmitted to OAL 4-1-92 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 12-3-91 order including adoption of subsection (c)(7) and renumbering and amendment of subsections (c)(9) and (e) transmitted to OAL 4-1-92 and filed 5-13-92 (Register 92, No. 23).
4. New subsections (b)(8), subsection renumbering, and new subsections (c)(10)-(c)(10)(D) filed 11-4-96; operative 12-4-96 (Register 96, No. 45).
5. Editorial correction of subsection (a) (Register 2002, No. 14).