Tenn. Comp. R. & Regs. 0250-04-02-.07

Current through January 8, 2025

Section 0250-04-02-.07 - CARE OF THE CHILDREN

(1) STAFF-CHILD RATIO:

(a) In determining the ratio of staff to children, the professional, relief, auxiliary, and clerical staff may be included while on the premises.

(b) There must be no more than twelve (12) children in a group care home who are not related to the provider.

(c) A group care home caring for nine (9) or more children, including the providers own children, must have at least two (2) child-care workers on duty when children are present and awake. If any child is under three (3), or severely handicapped, and nine (9) or more children are present, an additional child-care worker is required.

(d) With three (3) infants under two (2) years of age in care and other children present, there must be an additional adult on duty.

(e) If group care home enrollment drops to six (6) children or below, the family boarding home ratio must be met.

(2) NUMBER AND AGES OF CHILDREN IN CARE (FAMILY BOARDING HOMES ONLY):

(a) With three infants (under two years of age) in care, there must not be other children in the home unless a second adult is on duty when children are present and awake.

(b) There must be no more than six (6) children in a family boarding home who are not related to the provider.

(c) If more than nine (9) children are in the home, including the child-care provider's own children, a second adult must be present.

(3) DISCIPLINE: Agencies shall develop general Discipline Policy which identifies the type of children served, describes the anticipated behavioral problems of this population, sets forth acceptable methods of dealing with these behaviors, and details-the required qualifications and training of staff working with the residents. All consequences of undesirable behavior shall be reasonable and consistent with the service plan for the resident.

(a) All discipline must be reasonable and responsibly related to the child's understanding, need, and level of behavior. All discipline shall be limited to the least restrictive appropriate method and administered by appropriately trained staff.

(b) Encouragement and praise of good behavior is often more effective than punishment, and is a must in disciplining a child. The child's acceptance of discipline and his/her ability to profit by it depends largely upon his/her feeling that he/she is liked, accepted, and respected.

(c) Any discipline must be determined on an Individual basis and be related to the undesirable behavior. Requiring children to accept the natural consequences of their acts may be a desirable experience provided consequences am not too drastic.

(d) The facility shall have written policies and procedures prohibiting

(e) punishment which may adversely affect a child's health, physical, or psychological well being. A copy must be given to residents, families. staff, and placing agencies. The following forms of punishment must not be used;

1. Cruel and unusual punishment;

2. Assignment of excessive or inappropriate work;

3. Denial of meals, daily needs, and program provided by the individual service plan;

4. Verbal abuse, ridicule, or humiliation;

5. Permitting a child to punish another child;

6. Chemical or mechanical restraints;

7. Denial of planned visits, telephone calls, or mail contacts with family; or

8. Corporal punishment.

(4) PHYSICAL CONTROL AND ISOLATION:

(a) All agencies using physical control techniques must have written policies defining the method of control, identifying persons used in implementing these methods. and establishing the training required for such persons. These policies must require:

1. Use of two (2) fully qualified staff-

2. Immediate notice to supervisor;

3. A written report to the administrator; and

4. A review process for use of the facility's Executive Committee which must also be available to licensing staff.

(b) If isolation from others in a time-out room is used as a control measure, written policies must set forth the parameters of this measure. The facility must keep a record of each incident, provide for direct supervision every fifteen (15) minutes, and limit the time to a maximum of thirty (30) minutes for children seven (7) to eleven (11) years of age and a maximum of one (1) hour for children over twelve (12) years of age. Any additional times required shall be approved by the executive director, but in no event shall it exceed two (2) hours. Time-out rooms must not be locked.

(5) ABUSE OF CHILDREN.

(a) All public and private agencies must have written policy which establishes internal controls for the prevention and detection of abuse or neglect of children.

(b) The Agency must have an instructional program in child sexual abuse prevention for all residents. The curriculum must include information on such pertinent subjects as: personal ownership of the child's body, inappropriate touching, and how to report abuse within the agency. Appropriate treatment must be provided for those who have been victims of sexual abuse. Such treatment must be provided either by the qualified person within the Agency, or by a person outside the Agency qualified to provide such treatment.

(c) All public and private agencies must have Department approved written policies and procedures for reporting incidents of abuse or neglect of children. These policies should clearly set forth the roles and responsibilities of all parties involved in both the reporting and investigative process.

(6) REPORTING OF BRUTALITY, ABUSE, NEGLECT, OR CHILD SEXUAL ABUSE:

(a) Any person, including but not limited to any:

1. Physician, osteopath, medical examiner, chiropractor, nurse, or hospital personnel engaged in the admission, examination, care, or treatment of persons;

2. Health or mental health professional other than one listed in subdivision (a)(1);

3. Practitioner who relies solely on spiritual means for heating;

4. School teacher or other school official or personnel;

5. Judges of all courts of the state;

6. Social worker, day care center worker, or other professional child care, foster care, residential, or institutional worker;

7. Law enforcement officer; or

8. Neighbor, relative, friend, or any other person who knows or has reasonable cause to suspect, that a child has been sexually abused or having knowledge of or called upon to render aid to any child who is suffering from or has sustained any wound, injury, disability, or physical or mental condition which is of such a nature as to reasonably indicate that it has been caused by brutality, abuse or neglect, or which on the basis of available information reasonably appears to have been caused by brutality, abuse or neglect, shall report such harm immediately by telephone or otherwise to the judge having juvenile jurisdiction or to the county office of the Department of Children's Services, or to the office of the sheriff or the chief law enforcement official of the municipality where the child resides. Any person, including judges of all courts of this state, who knows or has reasonable cause to suspect that a child has been sexually abused shall report such information in accordance with Public Acts of 1985, Chapter 478, relative to the sexual abuse of children, regardless of whether such person knows or believes that the child has sustained any apparent injury as a result of such abuse.

(b) If a hospital, clinic, school, or any other organization responsible for the care of children has a specific procedure approved by the director of the county office of the Department, for the protection of children who are victims of brutality, abuse, or neglect, any members of its staff whose duty to report under the preceding sentence arises from the performance of his services as a member of the staff of the organization may, at his option, fulfill that duty by reporting instead to the person in charge of the organization or his designee who shall make the report in accordance with the preceding sentence.

(c) The report shall include, to the extent known by the reporter, the name, address, and age of the child, the name and address of the person responsible for the care of the child, and the facts requiring the report. The report may include any other pertinent information.

(d) If a law enforcement official or judge becomes aware of known or suspected child abuse through personal knowledge, receipt of a report or otherwise, such information shall be reported to the Department immediately, and where appropriate, the child protective team shall be notified to investigate the report for the protection of the child in accordance with the provisions of this part. Further criminal investigation by such official shall be appropriately conducted in coordination with the team or Department to the maximum extent possible.

(e) Any person required to report or investigate cases of suspected child abuse who has reasonable cause to suspect that a child died as a result of child abuse shall report his suspicion to the appropriate medical examiner. The medical examiner shall accept the report for investigation and shall report his findings, in writing, to the local law enforcement agency, the appropriate district attorney, and the Department Autopsy reports maintained by the medical examiner shall not be subject to the confidentiality requirements provided for in T.C.A. § 37-1-409.

(f) Reports involving known or suspected institutional child sexual abuse shall be made and received in the same manner as all other reports made pursuant to the Public Acts of 1985, Chapter 478 relative to the sexual abuse of children. Investigations of institutional child sexual abuse shall be conducted in accordance with the provisions of T.C.A. § 37-1-606.

(g) Every physician or other person who makes a diagnosis of, or treats, or prescribes for any venereal disease set out in T.C.A. § 68-10-101, or venereal herpes and chlamydia, in children thirteen (13) years or younger, and every superintendent or manager of a clinic, dispensary, charitable, or penal institution, in which there is a case of any of the diseases, as set out in this subsection, in children thirteen (13) years of age or younger shall report the case immediately, in writing on a form supplied by the Department of Health and Environment to that Department. If the reported cases arc confirmed and if sexual abuse is suspected, the Department of Health and Environment will report the case to the Department of Children's Services. The Department of Children's Services will be responsible for any necessary follow-up.

(7) VIOLATIONS PENALTIES:

(a) Any person required to report known or suspected child sexual abuse who knowingly and willfully fails to do so, or who knowingly and willfully prevents another person from doing so, is guilty of a misdemeanor.

(b) Any person who knowingly and willfully makes public or discloses any confidential information contained in the abuse registry or in the records of any child sexual abuse case, except as provided in the "Public Acts of 1985", Chapter 478, Section 16, is guilty of a misdemeanor.

(c) Failure to make the reports concerning child abuse as required shall, standing alone, be grounds for denial or revocation of the agency's license.

(8) EXPLOITATION: An agency shall not engage in practices which exploit the rights of residents. Residents shall not be identified in connection with fund raising activities for the agency. Residents shall not be identified in connection with publicity for the agency unless a positive value accrues for the child.

(9) HEALTH:

(a) An agency shall provide a complete health program for the children including:

1.Screening for Admission:

(i) The agency shall obtain a report of a physical examination for each child. The examination shall be completed no more than six (6) months prior to placement and no later than two (2) weeks after placement.

(ii) The following immunizations (unless there is a medical reason to the contrary, certified by the child's physician) shall be begun before admission and must be completed within six (6) months; Diptheria, Whooping Cough (for children under seven (7) years of age), Tetanus, Polio, Measles, Rubella, Mumps, and others recommended by the physician.

(iii) The home must have a written record of the above information. (Refer to Emergency Shelter Care for Exception.)

2.Ongoing Medical Care

(i) Every child over three (3) years of age shall have a dental examination every year and treatment as indicated.

(ii) Children in an agency's care shall be given physical examinations at the following intervals.

(I) Birth to six (6) months every six (6) weeks;

(II) Six (6) months to one (1) year every three (3) months;

(III) One (1) year to six (6) years every twelve (12) months; and

(IV) Six (6) years and above every three (3) years.

(iii) Children shall receive treatment from a physician when the need is indicated; and

(iv) Children shall receive psychiatric or psychological services when a need is indicated.

3.Illness.

(i) Doctor's orders must be observed during the course of an illness; and

(ii) Regulation of visits, sanitation of dishes and utensils, and good personal hygiene must be observed as the nature of the illness warrants.

4. Medications:

(i) All medications, including over the counter drugs, attitude manipulators, tranquilizers, legend pain killers, barbiturates, or amphetamines must be safeguarded by a double-entry medication system whereby each medication is recorded as it comes into the agency. Administration of all medications must be documented.

(ii) Medications must be double-locked within the agency. Any refrigerated medication should be kept in a single locked leak proof box.

(iii) The agency must not have psychotrophic drugs as stock items. Such drugs must be individually prescribed and kept in the original containers with the name of the patient, drug, dosage, frequency of administration and prescription number unless filled directly by the physician.

(iv) Other prescribed medication may not be administered without a specific order or standing order from a licensed physician.

5. First aid supplies must be kept on-hand but secured out of reach of children.

(10) EDUCATION AND RELIGION:

(a) All children in residence must be in compliance with Tennessee State law on compulsory school attendance

(b) Certain handicapped children may require specialized training suitable to their needs. If so, this must be provided.

(c) If it is not possible or a part of the agency's program for the children to attend public school, the school within the institution must conform both as to program and physical set-up with standards set by the Tennessee Department of Education. This also applies to special education classes or remedial work provided by the home.

(d) The atmosphere prevailing in the home must be such as to foster the spiritual growth of the child in his daily living.

(11) NUTRITION:

(a) Food of adequate quality and quantity must be served and meet the child's daily dietary allowances as recommended by USDA.

(b) Three (3) meals and snacks must be provided daily with no more than a fourteen (14) hour span between a substantial evening meal and breakfast of the following day.

(c) All special diets must be prepared as prescribed by the physician or recommended by a dietician.

(d) Denial of a nutritionally adequate diet must not be used as punishment.

(e) Menus:

1. Menus for the week must be prepared in advance. These menus must be followed and must be varied from week-to-week. (Refer to 0250-4-2-.11E mergency Shelter Care for Exception.)

2. Menus must be kept on rile for a period of one (1) month. (Refer to 0250-4-2 11 Emergency Shelter Care for Exception.)

(f) Agencies not monitored by USDA must seek annual consultation with a licensed nutritionist.

(12) RECREATION: Regular opportunities for recreation must be provided.

(a) Outdoor activity areas must be safe

(b) Appropriate recreational materials and supplies must be provided.

Tenn. Comp. R. & Regs. 0250-04-02-.07

Original rule certified June 10, 1974. Repeal and new rule filed July 27, 1978; effective September 11, 1978. Repeal and new rule filed January 20, 1984; effective February 19, 1984. Repeal and new rule filed February 26, 1991, effective April 12, 1991. Rule assigned new control number, removed and renumbered from 1240-4-2-.07 filed and effective March 25, 1999.

Authority: T.C.A. §§ 4-5-226(b)(2);37-1-401 et seq., 37-1-601 et seq., 37-5-101; 37-5-105; 37-5-106; 37-5-112(a);71-1-105(12) and 71-3-501 et seq.