16 Del. Admin. Code § 3305-III-7.0

Current through Register Vol. 28, No. 3, September 1, 2024

Section 3305-III-7.0 - Care, Treatment and Quality Assurance

7.1 The service provider shall operate the group home in a manner such that residents will be able to maximize their quality of life as a result of the following:

7.1.1 Involvement and choice in all aspects of their care, rehabilitation and support;

7.1.2 Development and maintenance of supportive social networks;

7.1.3 Access to services, programs, and activities in the most integrated setting; and

7.1.4 Access to rehabilitative support during the course of day to day activities.

7.2 The following requirements represent minimum guidelines to implement these principles:

7.2.1 The service provider shall maintain the following staffing pattern:

7.2.1.1 Between the hours of 8 AM and 10 PM:

7.2.1.1.1 A minimum of one (1) clinician or associate clinician shall be on duty and on site for every one (1) to five (5) residents present in the home.

7.2.1.1.2 A minimum of two (2) staff members, at least one (1) of whom shall be a clinician or associate clinician, shall be on duty and on site whenever six (6) or more residents are present in the home.

7.2.1.2 At all other times, a minimum of one (1) clinician or associate clinician shall be on duty and on site whenever any residents are present in the home.

7.2.1.3 At all times, at least one (1) clinician, associate clinician, or residential service assistant shall be available on call. When a staff member is on duty and on site alone, the on-call person must be a clinician or associate clinician.

7.2.1.4 The Department may require a modified staffing pattern based on extenuating circumstances or resident need.

7.2.2 The service provider shall develop procedures for facility and resident emergencies/crises and shall train all staff to implement such procedures prior to their assumption of an in-home resident support role. Emergency procedures shall include prompt methods for acquiring assistance of the following: facility on-call and other appropriate staff; 911 personnel; and medical/psychiatric personnel, including the area's crisis intervention service and local hospital/medical aid unit's emergency room. Psychiatric on-call coverage must be available at all times.

7.2.3 Each resident shall have his/her progress and continuing treatment needs thoroughly reassessed at least once every six (6) months. The reassessment will be conducted by a the resident's treatment team, which shall include a psychiatrist.

7.2.4 A service provider shall employ, or have under contract, a psychiatrist who shall participate in staff support and training, resident intake evaluation, emergency responses, and staff performance plans and reviews in each group home. This psychiatrist may be a physician other than the primary treating physician for one or all of the patients. The psychiatrist shall visit the group home at least once a week and spend a minimum of one-half hour per resident per month providing direct services to residents on site, participating in the assessment of residents' needs, planning service provision, and providing supervision/consultation to other program staff.

7.2.5 The service provider shall offer a full range of rehabilitation, treatment and support services for each resident including, but not limited to, the following:

7.2.5.1 Three hundred sixty-five (365) day per year services, with on-site staff available to make face-to-face contact on a twenty-four (24) hour basis;

7.2.5.2 Psychiatric treatment and linkage to community support programs or day hospital programs;

7.2.5.3 Clinical liaison during periods of psychiatric hospitalization;

7.2.5.4 Outreach and crisis response;

7.2.5.5 Social networking in an effort to promote a stable social network for the resident;

7.2.5.6 Support to ensure educational and vocational training opportunities and help residents to get and keep a job;

7.2.5.7 Teaching and counseling on-site to improve interpersonal skills and to assist residents to control psychiatric symptoms;

7.2.5.8 Support and assistance in on-site activities of daily living such as personal hygiene, care and grooming, and training in community living;

7.2.5.9 Support and assistance in the receipt of entitlements and social services;

7.2.5.10 Provision and encouragement of participation in activities outside of the home, to the maximum extent possible. In addition, providers shall create incentives for residents to become involved in the activities of their choice;

7.2.5.11 Transportation of residents to community activities; and

7.2.5.12 Support and encouragement to promote resident participation in mutual support and self-advocacy groups.

7.3 The service provider shall designate a clinician or associate clinician to be the primary clinician for each resident who shall:

7.3.1 Maintain the clinical file for the resident;

7.3.2 Conduct and participate in treatment planning and case conferences with other staff of the group home, and other appropriate agencies;

7.3.3 Maintain a therapeutic alliance with the resident;

7.3.4 Refer and link the resident to all needed services provided outside the program;

7.3.5 Follow up to ensure that all needed services provided outside of the group home are received and monitor the resident's benefit from those services;

7.3.6 Coordinate the provision of emergency services and hospital liaison services when a resident is in crisis;

7.3.7 Coordinate overall independent living assistance services and work with community agencies to develop needed resources including housing, employment options and income assistance; and

7.3.8 Support and consult with the resident's family.

7.4 The duties of the service coordinator notwithstanding, all staff of the program shall share responsibility for resident care to the extent they are credentialed to provide such care.

7.5 Within thirty (30) days of the resident's admission, the individualized treatment plan shall be revised and updated by the resident and the resident's treatment team.

7.6 The treatment plan shall include both short-range and long-range goals, stated in measurable terms and including criteria for revision of goals. It shall include the specific treatment, rehabilitation and support interventions, and their frequency, planned to achieve treatment goals.

7.7 The resident's participation in the development of treatment goals shall be documented. With the permission of the resident, the resident's treatment team shall engage the involvement of other service providers and members of the resident's social network in formulating treatment plans.

7.8 The treatment plan shall be prepared on forms which are subject to Departmental approval. It shall be signed by members of the resident's treatment team and the resident.

7.9 The treatment plan shall be reviewed in full at least every six (6) months by the resident and the resident's treatment team. The date, results of the review, and any changes in the treatment plan shall be recorded.

7.10 The service provider shall develop, implement, and adhere to a documented, ongoing, quality assurance program that includes an internal monitoring process that tracks performance and measures resident satisfaction.

16 Del. Admin. Code § 3305-III-7.0