Statutes, codes, and regulations
Delaware Administrative Code
Title 16 - Health and SafetyDepartment of Health and Social ServicesDivision of Health Care Quality
Intensive Behavioral Support and Educational Residence
Section 3320-8.0 - Resident Services

16 Del. Admin. Code § 3320-8.0

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Current through Register Vol. 28, No. 5, November 1, 2024
Section 3320-8.0 - Resident Services
8.1 The SBS Plan:
8.1.1 Must be developed by the resident, or the authorized representative, and the BMC within 5 days of admission to the IBSER.
8.1.1.1 The BMC must include:
8.1.1.1.1 A properly credentialed professional with documented training and experience in behavioral treatment of severe behavior disorders, and
8.1.1.1.2 A licensed independent practitioner.
8.1.2 Must conform to current best practices and ethical standards pertaining to the behavioral treatment of severe problem behavior.
8.1.3 Must be reviewed by the HRC to ensure that itconforms to current best practices and to ethical standards.
8.1.4 Must be adjusted as needed based on frequent review by the treatment team of data representing objectively measured occurrences of the problem behavior, and the impact of the intervention procedures.
8.1.5 Must be reviewed at least monthly for the first 90 days and then at least quarterly thereafter.
8.1.6 Must include informed consent rendered voluntarily and in writing by the resident or authorized representative after they have been provided with complete, accurate, and understandable information about all aspects of the intervention techniques that may be utilized with the resident.
8.1.7 Must include safeguards to minimize risks of harm and insure the resident's safety at all times, including during physical interventions.
8.2 Healthcare
8.2.1 The provider shall ensure that residents receive needed medical, dental, visual and behavioral care.
8.2.2 The provider shall ensure that necessary screenings/appointments are scheduled within five (5) business days of receipt of an order.
8.2.3 Providers shall assist individuals to the carry out all health related orders as determined by the health care professionals.
8.2.4 Each resident shall have a physical/medical examination annually or more frequently as required by a licensed independent practitioner or the affiliated social agency/program.
8.2.5 The provider shall provide or assist to arrange for transportation for a resident's appointments.
8.3 Medications
8.3.1 Storing and controlling medications.
8.3.1.1 Storage must be in a locked container, cabinet, refrigerator or area that is only accessible to authorized personnel. A bathroom or laundry room may not be used for medication storage.
8.3.1.2 Medications must be attended at all times; may not be left unattended and may not be accessible to unauthorized personnel.
8.3.1.3 Medications must be stored in the original labeled container.
8.3.1.4 Medications requiring refrigeration shall be kept locked in a separate box within the refrigerator.
8.3.1.5 Medications must be stored at room temperature (59-86F), unless otherwise indicated by the labeling, in a manner that protects the product itself from deterioration or container breakage.
8.3.2 Medications shall be self-administered (as approved by the BMC based on an assessment of the resident's capabilities) or distributed directly to the resident from the prescription container in strict accordance with the prescription directions.
8.3.3 Administration of medications must be in accordance with the requirements in 24 Del.C. § 1932.
8.3.3.1 LLAM trained personnel must have documentation on file that they have completed LLAM training as required by 24 Del.C. Ch. 19.
8.3.3.2 LLAM trained personnel must complete annual competencies and have documentation of same as required by 24 Del.C. Ch. 19.
8.3.3.3 Each IBSER must complete an annual LLAM report on the form provided by the Board of Nursing. The report must be submitted pursuant to 24 Del.C. Ch. 19.
8.3.4 The authorized provider shall ensure that prescription medication is not used by other than the resident for whom the medication was prescribed.
8.3.5 Topical (external) medications must be stored separately from oral (internal) medications.
8.3.6 Controlled substances must be under a double lock whether stored in a cupboard or refrigerator. A lock on an outside access door can be considered the first lock.
8.3.7 Medication must be stored at room temperature (59-86F) unless otherwise indicated by the labeling in a manner that protects the product itself from deterioration or container breakage.
8.3.8 Employees must observe for any changes in resident behavior or cognition and report same per policy requirements.
8.3.9 Documentation of medication administration.
8.3.9.1 A separate medication log must be maintained for each resident.
8.3.9.2 Each medication administered by a licensed or LLAM trained staff member must be documented.
8.3.9.3 The log must clearly document whether the medication was self-administered or administered by staff.
8.3.9.4 Staff members administering medications must legibly document their name and initials on the log.
8.3.9.5 Refused medication or resident unavailability must be documented.
8.3.10 Medications must be disposed of according to policy.
8.3.11 Psychotropic medications
8.3.11.1 Are prohibited for disciplinary purposes, for the convenience of staff or as a substitute for appropriate treatment service.
8.3.11.2 An informed, written consent of the resident or authorized representative must be secured and maintained in the resident's file prior to the administration of any psychotropic medication.
8.3.11.3 Residents admitted or placed on a psychotropic medication must be seen and evaluated on a regular basis by a licensed independent practitioner with expertise in mental health treatment.
8.3.11.4 Documentation of such evaluations must be maintained in the resident record.
8.3.12 Residents admitted or placed on medication for chronic illness must be seen and evaluated on a regular basis by a licensed independent practitioner.
8.3.12.1 Documentation of such evaluations should be maintained in the resident record.
8.3.13 No person other than a licensed healthcare professional approved by the Division of Professional Regulation may administer medication by injection.
8.4 Communicable disease
8.4.1 A resident with an active communicable disease must receive prompt medical treatment and supervision.
8.4.2 The provider shall assume responsibility for seeing that necessary precautions are taken and that there is a minimum danger of transmission of a communicable disease to any occupant of the home.
8.4.3 Minimum requirements for tuberculosis (TB) testing require all residents to have a base line two step tuberculin skin test prior to admission.
8.4.4 All IBSERs shall have on file evidence of an annual vaccination against influenza for all residents unless refused or medically contraindicated.
8.4.4.1 The provider must document and keep on file each resident's acceptance or refusal of the flu vaccine.
8.5 Food service
8.5.1 A minimum of three (3) meals shall be available and/or served in each 24 hour period.
8.5.2 There shall not be more than a 14 hour span between the evening and breakfast meals unless suitable nourishment is provided in the interim.
8.5.3 Individuals shall have access to food at all times.
8.5.4 The food served shall be suitably prepared and of sufficient quantity and quality to meet the nutritional needs of the residents.
8.5.5 Special diets shall be served on the written prescription of the resident's licensed independent practitioner.
8.5.6 There shall be three day supply of food and water in each home at all times as posted on the menus.
8.6 Physical Intervention
8.6.1 Physical intervention utilized must be from a training program approved by the Department.
8.6.2 All staff must be trained in the use of physical intervention techniques.
8.6.2.1 Implementation must be by personnel with documented training and experience in behavioral treatment of severe behavior disorders to insure that it is done competently, safely and ethically.
8.6.3 Physical intervention may be employed only when:
8.6.3.1 The resident is exhibiting a problem behavior that is so severe that it poses an imminent risk of serious bodily injury to self or others.
8.6.3.2 It is part of a SBS Plan that incorporates all of the elements cited below:
8.6.3.2.1 An initial medical evaluation to assess and address medical conditions that may be contributing to the problem behavior;
8.6.3.2.2 A licensed independent practitioner has determined that there are no contraindications to the use of the intervention;
8.6.3.2.3 It has been determined that less-restrictive alternative interventions are not safe, feasible or effective; and
8.6.3.2.4 A functional behavioral assessment has been conducted to identify the situations and conditions that trigger and/or maintain the severe problem behavior and means have been taken to address and correct those conditions.
8.6.4 Upon initiation of the physical intervention the following must occur:
8.6.4.1 Notification of the on-site supervisor.
8.6.4.2 Continuous monitoring of the resident during the physical intervention.
8.6.4.2.1 If the resident is observed to be in medical distress, e.g., exhibiting labored breathing, or there is evidence of physical injury, the resident must immediately be released from the physical intervention, and medical attention provided.
8.6.5 The physical intervention must be terminated when there is no imminent risk to either the resident or others.
8.6.6 At the termination of the intervention the resident must be observed by both the staff terminating the procedure and a second staff person to evaluate the resident's medical and emotional condition.
8.6.7 If any signs of medical or emotional distress are observed, a medical and/or behavioral clinical professional must be contacted and decisions made about the next steps to resolve the situation.
8.6.8 Following the conclusion of each incident of physical intervention, the resident, staff, and any witnesses, shall participate in debriefing(s).
8.6.8.1 Debriefing for the resident shall occur as soon as possible, or within 24 hours of the incident unless the resident is unavailable or there is a documented clinical contraindication.
8.6.8.2 Staff should also debrief as soon as possible, or within 24 hours to conduct a thorough review and analysis of each incident in an effort to use the knowledge gained from the debriefing to inform policy, procedures and practices to avoid repeated use in the future, and to improve treatment outcomes.
8.6.9 Documentation of physical intervention utilization must include:
8.6.9.1 Date and time;
8.6.9.2 Staff involved;
8.6.9.3 Location;
8.6.9.4 Activity;
8.6.9.5 Antecedent conditions;
8.6.9.6 Specific behaviors observed;
8.6.9.7 Interventions implemented;
8.6.9.8 Duration of intervention;
8.6.9.9 Well-being checks;
8.6.9.10 Clinical review and approval by the Director or designee for interventions longer than 15 minutes;
8.6.9.11 Physical examination for possible injury after the termination of the intervention utilization;
8.6.9.12 Treatment provided;
8.6.9.13 Supervisor signature; and
8.6.9.14 Review by the Director or designee within one business day of an intervention when a physical intervention utilization event is less than 15 minutes.
8.6.10 A report of all episodes of physical intervention utilization must be provided to the Department on the fifth day of each month for the previous month in a manner prescribed by the Department.
8.6.11 Individual and aggregate clinical data on physical interventions for each resident must be provided to the BMC and the HRC.
8.6.12 If a resident experiences the use of a physical intervention six or more times in a 30 day period, that resident's SBS Plan must be reviewed and, if necessary, modified.
8.6.13 Any physical intervention not in the approved physical intervention procedure and training manual is prohibited.
8.6.14 The use of any physical intervention technique that is medically contraindicated for a resident is prohibited.
8.6.15 The use of involuntary seclusion is prohibited.
8.7 Human Rights Committee (HRC)
8.7.1 Membership:
8.7.1.1 At least five licensed professionals (social worker, psychologist, registered nurse, licensed independent practitioner), two of whom must be professionally knowledgeable or experienced in the theory and ethical application of various treatment techniques used to address behavioral problems.
8.7.1.2 One member from the community or parent of a resident.
8.7.1.3 One member a licensed mental health professional (a licensed independent practitioner, a licensed clinical psychologist, or a clinical social worker).
8.7.2 A majority of Committee members must be external to the licensee or its parent organization.
8.7.3 The Committee must meet at least bi-monthly.
8.7.4 The Human Rights Committee is responsible for:
8.7.4.1 Determining that residents are receiving humane and proper treatment;
8.7.4.2 Reviewing and making recommendations regarding the policies and procedures governing the use of physical intervention;
8.7.4.3 Reviewing the physical intervention records, and reviewing incident reports required by these regulations related to the use of physical intervention; ensuring that the appropriate intervention was utilized for the documented behavior according to the approved manual and the resident's SBS; and, advising the Director accordingly;
8.7.4.4 Recording and maintaining on file written minutes of all of its meetings, and providing the Director with a copy of these minutes;
8.7.4.5 Making inquiries into any allegations of abusive techniques or the misuse of physical intervention procedures. A report of the inquiry must be provided by the Committee to the Director and sent to the Department;
8.7.4.6 Monitoring the qualifications and training of employees who have been given responsibility for administering physical intervention procedures and to make recommendations to the Director accordingly; and
8.7.4.7 Reviewing and making recommendations on all SBS Plans.
8.8 Behavior Management Committee (BMC)
8.8.1 The BMC is also known as the professional interdisciplinary treatment team.
8.8.2 In conjunction with the resident or authorized representative, the BMC establishes and reviews the SBS Plan.
8.8.3 The development and review of the SBS must include:
8.8.3.1 The clinical efficacy and ethical acceptability of the plan;
8.8.3.2 A description of the results of the most recent functional assessment to identify environmental factors that correlate with the occurrence of dangerous target behaviors;
8.8.3.3 A description of the resident and his or her clinical/educational/vocational progress;
8.8.3.4 A description of positive reinforcement components that are designed to teach and strengthen appropriate behaviors;
8.8.3.5 A description of the most recent mental health review and recent changes in medication or other psychiatric interventions;
8.8.3.6 A description of any medical conditions that might be expected to impact on the occurrence of dangerous behaviors;
8.8.3.7 A description of any familial or other emotional variables that might be expected to impact on the occurrence of dangerous behaviors;
8.8.3.8 A summary of the risk benefit analysis for each proposed intervention; and
8.8.3.9 A summary statement as to the general effectiveness of the SBS Plan and a recommendation for future use.
8.8.4 Following approval by the BMC, the HRC must review the SBS Plan at their next meeting.

16 Del. Admin. Code § 3320-8.0

23 DE Reg. 43( 7/1/2019) (final)