922 KAR 1:300. Standards for child-caring facilities

Link to law: http://www.lrc.ky.gov/kar/922/001/300.htm
Published: 2015

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      922 KAR 1:300. Standards for

child-caring facilities.

 

      RELATES TO: KRS 2.015, 17.165,

17.500(8), 189.125(3),

198B.050-198B.090, 199.011(2), (3), (4), (6), (7), (10), (11), 199.640,

199.650, 199.660, 199.670, 211.350-211.380, 214.034(5), Chapter 271B Subtitle 8,

273.161(7), 600.020(23), 605.080(3),

605.090(1),

610.110(6), 615.010, 615.030, 615.040, 620.020, 620.030, 620.090(2),

620.140(1), 620.230(3), 20 U.S.C. 7183, 42 U.S.C. 677(a)(1)-(6)

      STATUTORY AUTHORITY: KRS 194A.050(1), 199.640(5),

199.645, 605.150,

615.050

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires

the Secretary for the Cabinet for Health and Family Services to promulgate

administrative regulations necessary to operate programs and fulfill the

responsibilities vested in the cabinet. KRS 199.640(5) requires the secretary for the

cabinet to promulgate administrative regulations establishing basic standards

of care and service for child-caring facilities and child-placing agencies. KRS 605.150 authorizes the

cabinet to promulgate administrative regulations to implement the provisions of

KRS Chapter 605. This

administrative regulation establishes basic standards of care and service for

child-caring facilities,

 

      Section 1. Definitions. (1)

"Aftercare" means a service provided to a child after discharge from

a child-caring facility.

      (2) "Board of directors" is

defined at KRS 273.161(7).

      (3) "Cabinet" means the Cabinet

for Health and Family Services.

      (4) "Case" means an individual

child or family being provided services by a social worker or counselor.

      (5) "Chemical restraint" means

a drug used as a restraint that is a medication used to control behavior or to

restrict the patient's freedom of movement and is not a standard treatment for

the patient's medical or psychiatric condition.

      (6) "Child" is defined at KRS

199.011(4) and 600.020(8) and may include:

      (a) A person age eighteen (18) or older

whose commitment to the cabinet has been extended or reinstated by a court in

accordance with KRS 610.110(6) or 620.140(1)(d); or

      (b) A child who meets the exceptions to the age of

majority in accordance with KRS 2.015.

      (7) "Child-caring facility" is

defined at KRS 199.011(6).

      (8) "Child-placing agency" is

defined at KRS 199.011(7).

      (9) "Child-caring program"

means the method of delivering a child-caring service.

      (10) "College or university"

means:

      (a) An institution accredited by one (1)

of the eleven (11) regional accrediting organizations recognized by the U.S.

Department of Education, Office of Postsecondary Education;

      (b) For a Kentucky institution, one that

is licensed by the Kentucky Council on Postsecondary Education or the Kentucky

Board for Proprietary Education; and

      (c) For an out-of-state institution, one

that is licensed in its home state if licensure is required in that state.

      (11) "Community resource" means

a service or activity available in the community that supplements those

provided by the child-caring facility or child-placing agency in the care and

treatment of a child.

      (12) "Corporal physical

discipline" means reasonable physical discipline in accordance with KRS

199.640(6).

      (13) "Crisis intervention unit"

means a unit that serves a child in need of short-term intensive treatment, to

avoid risk of placement to a higher level of care.

      (14) "Direct child-care staff"

means an employee or volunteer providing face-to-face care and supervision of a

child.

      (15) "Discharge" means a

planned release of a child from a program.

      (16) "Emergency discharge"

means the release of a child from a program as a result of a circumstance that

presents a risk to the health or safety of a child.

      (17) "Emergency shelter child-caring

facility" means a child-caring facility that meets the requirements of 922

KAR 1:380.

      (18) "Executive director" means

the person employed by the board of directors to be responsible for the

administration and management of a child-caring facility.

      (19) "Group home" is defined at

KRS 199.011(10).

      (20) "Independent living services" means services provided to an

eligible child, as described in Section 8 of this administrative regulation, to

assist the child in the transition from dependency of childhood to living

independently.

      (21) "Individual treatment

plan" or "ITP" means a plan of action developed and implemented

to address the needs of a child.

      (22) "Indoor living area" means

an area in the child-caring facility that is separate from a hallway, bedroom,

kitchen, stairway, vestibule, bathroom, closet, unfinished basement, or attic.

      (23) "Institution" is defined

at KRS 199.011(11).

      (24) "Living unit" means a

building or part thereof in which a child resides, not exceeding sixteen (16)

beds.

      (25) "Permanence" is defined at

KRS 620.020(8).

      (26) "Physical management" means a

technique used by a specially-trained staff member for the purpose of

restricting a child's freedom of movement in order to maintain a safe environment

for the child and others.

      (27) "Residential child-caring facility"

means a child-caring facility that meets the standards established in 922 KAR

1:390.

      (28) "Residential treatment program"

means a residential child-caring facility that meets the treatment program

requirements of 922 KAR 1:390, Section 4.

      (29) "Sex crime" is defined at KRS

17.500(8).

      (30) "Social services" means a planned

program of assistance to help an individual move toward a mutual adjustment of

the individual and his social environment.

      (31) "Time-out" means a

treatment intervention utilized by child-caring staff to separate a child from

others in a nonsecure area for a time limited period, in order to permit the child

to regain control over his behavior.

      (32) "Treatment" means

individualized management and care of a child, utilizing professionally

credentialed and certified staff and a component of the treatment environment

to assist the child in resolving his emotional conflict or behavioral disorder.

      (33) "Treatment team" means a

representative group of people who provide services to the child and the

child's family.

      (34) "Unplanned discharge"

means the release of a child from the child-caring facility that is not in

accordance with the ITP.

      (35) "Youth wilderness camp"

means a specific program of a child-caring facility that is designed to provide

an outdoor experience consistent with a child’s ITP.

 

      Section 2. Operations and Services. (1)

This administrative regulation establishes standards for the following

child-caring facilities:

      (a) An emergency shelter child-caring

facility, also governed by 922 KAR 1:380;

      (b) An emergency shelter child-caring

facility with treatment, also governed by 922 KAR 1:380, Section 3;

      (c) A residential child-caring facility,

also governed by 922 KAR 1:390, including:

      1. A group home; and

      2. An institution.

      (d) A residential treatment program, also

governed by 922 KAR 1:390, Section 4, including:

      1. A crisis intervention unit, also

governed by 922 KAR 1:390, Section 5;

      2. A group home, also governed by 922 KAR

1:390, Section 6;

      3. An institution; and

      (e) A youth wilderness camp program, also

governed by 922 KAR 1:460.

      (2) Except for a child-caring facility

maintaining a license prior to October 16, 2000, a child-caring facility shall

not be located or operated on the grounds of a psychiatric hospital.

 

      Section 3. Administration and Operation.

(1) The licensing procedure for a child-caring facility shall:

      (a) Be administered as established in 922

KAR 1:305; and

      (b) Based upon the services provided,

meet the requirements of this administrative regulation and 922 KAR 1:380, 922

KAR 1:390, or 922 KAR 1:460.

      (2) Board of directors.

      (a) The child-caring facility shall have a

board of directors in accordance with KRS Chapter 271B, Subtitle 8.

      (b) The board of directors shall:

      1. Consist of at least seven (7) members;

      2. Meet at least quarterly;

      3. Cause minutes of each meeting to be

taken and kept in written form;

      4. Have the authority and responsibility

to ensure continuing compliance with this administrative regulation and other

relevant federal, state, and local law;

      5. Have procedures in place to insure

that its staff receives ongoing training as defined in subsection (6)(o) of

this section;

      6. Obtain a criminal records check of

prior convictions of the executive director prior to employment; and

      7. Approve a mission statement delineating:

      a. The purpose;

      b. Objective; and

      c. Scope of service to be provided.

      (3) Executive director.

      (a) Duties of the executive director

shall be determined by the board of directors.

      (b) The executive director shall be

responsible for the child-caring facility and its affiliates in accordance with

the child-caring facility's written policy.

      (c) If the executive director is not on

the premises, a designated staff person shall be responsible for the day-to-day

operation of the child-caring program.

      (d) The executive director shall oversee

and report to the board on a quarterly basis, providing an evaluation of

program services addressing measurable goals, staff training, and incident

reports.

      (e) The criteria and process of the

quarterly evaluation shall be approved by the board.

      (4) Staff qualifications.

      (a) A person employed as an executive

director after the effective date of this administrative regulation shall

possess the following qualifications:

      1. A master's degree in business

administration or a human services field from a college or university,

supplemented by two (2) years of work experience in or management of a human services

program related to working with families and children; or

      2. A bachelor's degree in a human

services field from a college or university, supplemented by four (4) years

work experience in management of a human services program related to working

with families and children.

      (b) A treatment director or person

employed by the child-caring facility in a position responsible for

supervising, evaluating, or monitoring social work and related activities shall:

      1. Hold at least a master’s degree in a

human service discipline; and

      2. Within two (2) years of October 17,

2007, have at least five (5) years experience in mental health treatment of

children with emotional or behavioral disabilities and their families and be responsible

for the:

      a. Supervision;

      b. Evaluation; and

      c. Monitoring of the:

      (i) Treatment program;

      (ii) Social work; and

      (iii) Other treatment staff.

      (c) A residential child-caring facility

providing a treatment service for more than thirty (30) children shall employ a

separate treatment director other than the executive director.

      (d) A residential child-caring facility

providing a treatment service for thirty (30) or fewer children may utilize the

executive director in a dual role as treatment director, if at least fifty (50)

percent of his duties are spent supervising the treatment program. If an

employee serves as both executive director and treatment director, the higher

staff qualification requirements shall apply.

      (e) An employee responsible for social

work, counseling, or planning and coordinating these services for a child shall

have at least a bachelor's degree in a human services field from a college or

university.

      (f) A person employed in a position

responsible for supervising, evaluating, or monitoring the daily work of direct

child-care staff shall possess at least:

      1. Two (2) years of education from a

college or university and two (2) years of work experience in a child-caring

facility; or

      2. A high school diploma, or an

equivalence certificate, and at least five (5) years work experience in a

child-caring facility.

      (g) A person employed in a position

responsible for the daily direct care or supervision of a child shall possess

at least a high school diploma or equivalency certificate.

      (h) If an employee is responsible for

varied job responsibilities and falls within more than one (1) of the

categories specified, the employee shall meet the more rigorous qualifications.

      (i) A child-caring facility contracting

for the services of a social worker or treatment director not on the staff of

the child-caring facility shall document that the social worker or treatment

director meets the qualifications established in paragraphs (b) and (e) of this

subsection. An agreement for provision of service shall be on file at the

child-caring facility, and shall specify the qualifications of the social

worker or social services professional.

      (5) Staffing requirements.

      (a) The child-caring facility shall have:

      1. A written policy describing a

child-to-direct-child-care-staff ratio that is consistent with the

staff-to-child ratios required in paragraph (b) of this subsection; and

      2. An explanation of the assignment of

staff in order to:

      a. Ensure the health and safety of a

child; and

      b. Implement the child-caring program.

      (b) Staff-to-child ratios for each type

of facility shall be as follows:

      1. An emergency shelter child-caring

facility: one (1) staff member to ten (10) children at all times.

      2. An emergency shelter child-caring

facility with treatment: one (1) staff member to six (6) children at all times.

      3. A residential child-caring facility:

      a. One (1) staff member to ten (10)

children age six (6) and over; and

      b. One (1) staff member to five (5)

children under age six (6).

      4. A residential child-caring facility

with treatment:

      a. One (1) staff member to six (6)

children; and

      b. One (1) staff member to twelve (12)

children during sleeping hours.

      5. A crisis intervention unit:

      a. One (1) staff member to four (4)

children; and

      b. One (1) staff member to six (6)

children during sleeping hours.

      6. A group home:

      a. One (1) staff member to four (4)

children; and

      b. One (1) staff member to accompany a

child while away from the home.

      7. An institution: one (1) staff member

to ten (10) children.

      8. A youth wilderness camp program to

include:

      a. A base camp:

      (i) One (1) staff member to four (4)

children age eleven (11) and (12) years old; and

      (ii) One (1) staff member to six (6)

children age thirteen (13) and above; and

      b. A field program, for which two (2)

staff members shall be on location at all times:

      (i) One (1) staff to three (3) children

age eleven (11) and (12) years old;

      (ii) One (1) staff to four (4) children

age thirteen (13) and above;

      (iii) Group size, including staff, shall

not exceed more than twelve (12) at one (1) time;

      (iv) In a mixed gender group, one (1)

woman and one (1) man, with one (1) staff member remaining awake during

sleeping hours;

      (v) A staff-to-child ratio shall be based

on the age of the youngest child; and

      (vi) A volunteer shall not be included in

the staff-to-child ratio.

      (c) There shall be at least one (1) staff

member present in each child-caring facility building if a child is present.

      (d) At least one (1) staff member

certified in first aid and cardiopulmonary resuscitation shall be on the

premises, if a child is present.

      (e) The child-caring facility shall have

a written work schedule and a policy that provides for utilization of relief

staff.

      (f) The child-caring facility shall

employ an individual who is responsible for the overall planning and

coordinating of social services for a family and child.

      (g) Social services staff shall not carry

a caseload of more than fifteen (15) children and their families.

      (6) Personnel policy.

      (a) A child-caring facility shall have

and comply with a written personnel policy and procedure.

      (b) An employee of the child-caring

facility shall be at least eighteen (18) years of age.

      (c) The

employment of an individual shall be governed by KRS 17.165, with regard to a

criminal record check.

      (d) A new criminal record

check shall be completed at least every two (2) years on each employee or

volunteer.

      (e) An employee under indictment or

legally charged with a violent or sex crime as defined in KRS 17.165 shall be

immediately removed from contact with a child within the child-caring facility

until the employee is cleared of the charge.

      (f) Each

employee or volunteer shall submit to a check of the central registry described

by 922 KAR 1:470. An individual listed on the central registry shall not be a

volunteer at or be employed by a child-caring facility.

      (g) Each licensee shall

report to the cabinet and each child-caring facility employee or volunteer

shall report to the licensee or facility’s director, an incident that occurs

subsequent to the most recent central registry check, if the employee or

volunteer:

      1. Is the subject of a

cabinet child abuse or neglect investigation;

      2. Has been found by the

cabinet or a court to have abused or neglected a child; or

      3. Has been indicted for or

charged with a violent or sex crime as defined in KRS 17.165.

      (h) An individual shall not

be left alone in the presence of a child if a central registry check has not

been completed.

      (i) Determination by the cabinet of risk

of potential harm by an employee to a child in a child-caring facility shall

result in:

      1. Investigation of the employee for

evidence of child abuse or neglect; and

      2. The removal of the employee from

direct contact with a child:

      a. For the duration of the investigation;

and

      b. Pending completion of the

administrative appeal process in accordance with 922 KAR 1:320.

      (j) A current personnel record shall be

maintained for each employee, that includes the following:

      1. Name, address, Social Security number,

date of employment, and date of birth;

      2. Evidence of a current registration,

certification, licensure, and college credentials, if required by the position;

      3. Record of ongoing participation in an

agency staff development program as specified in paragraphs (n) and (o) of this

subsection;

      4. Record of performance evaluation;

      5. Criminal records check as established

in paragraph (c) of this subsection;

      6. Documentation of a central registry

check completed every two (2) years in accordance with 922 KAR 1:470;

      7. Personnel action; and

      8. Application for employment, resume, or

contract.

      (k) A child-caring facility shall retain

an employee personnel record for at least five (5) years after termination of

employment.

      (l) An employee shall document compliance

with a requirement for meeting state or national professional standards, as set

forth in the job description.

      (m) The child-caring facility shall have

a record of participation and successful completion of an ongoing staff and volunteer

development program.

      (n) The staff development program shall

be under the supervision of a designated staff member; and

      (o) Full-time direct child care staff

shall have at least forty (40) hours, and part-time direct child care staff

shall have at least twenty-four (24) hours, of training specific to the tasks to

be performed and of annual training in the following:

      1. Emergency and safety procedure;

      2. Principle and practice of child

residential care;

      3. Behavior management, including

de-escalation training;

      4. Physical management for a child-caring

facility using the technique;

      5. First aid; and

      6. Personnel orientation.

      (p) A volunteer who functions as a

professional or direct staff member without compensation shall meet the same

general requirements and qualifications.

      (q) A child-caring facility using

physical management shall:

      1. Develop and maintain clearly-written

policy and procedure governing the use of physical management of a child,

including a requirement for a de-escalation plan, in accordance with 922 KAR

1:390, Section 4;

      2. Require a staff member who conducts physical

management, to complete at least sixteen (16) hours of annual training in

approved methods of de-escalation and physical management from a

nationally-recognized accreditation organization approved by the cabinet, as

part of the annual training established in paragraph (o) of this subsection, to

include:

      a. Assessing physical and mental status,

including signs of physical distress;

      b. Assessing nutritional and hydration

needs;

      c. Assessing readiness to discontinue use

of the intervention; and

      d. Recognizing when medical or other

emergency personnel are needed.

      (r) The program director shall review and

analyze instances of physical management in order to:

      1. Assure compliance with Section 5(2)(f)

through (h) of this administrative regulation and the child-caring facility

policy;

      2. Provide documentation of a plan of

action to prevent injury to a child or staff as a result of the use of physical

management; and

      3. Review each incident no later than one

(1) working day after its use.

      (s) A child-caring facility shall develop

and maintain clearly written policies and procedures governing professional

boundaries for an employee or volunteer working with children.

      (t) A child-caring facility shall develop

and maintain clearly written policies and procedures governing smoking

prohibitions, in accordance with 20 U.S.C. 7183 and 922 KAR 2:110, Section 3(9).

      (7) Interstate placement.

      (a) Before accepting a child from another

state or placing a child in another state, the child-caring facility shall be

in compliance with:

      1. Applicable provisions of the

Interstate Compact on Placement of Children, KRS 615.030, and 615.040; and

      2. The Interstate Compact on Juveniles,

KRS 615.010.

      (b) If a child committed to the cabinet

makes a brief visit out of state, not accompanied by child-caring facility

personnel, the child-caring facility shall obtain prior consent from the

cabinet staff member responsible for the case.

      (c) If an emergency placement of a child

into a licensed child-caring facility is made, the placement source shall be

responsible for compliance with KRS 615.030 to 615.040. If the receiving

child-caring facility is aware of noncompliance by the placement source, the

child-care facility shall notify the cabinet's interstate compact coordinator.

      (8) Record retention.

      (a) The child-caring facility shall

retain all records, books, and reports related to financial conditions and

status for auditing purposes for a minimum of five (5) years.

      (b) Make available all books, records,

and financial information for review, inspection, auditing, and photocopying by

the cabinet or cabinet designee, authorized federal and state agency reviewers

and auditors.

      (9) A residential child-caring facility

shall become accredited by a nationally recognized accreditation organization

within two (2) years of initial licensure.

 

      Section 4. Physical Plant. (1) A

child-caring facility shall comply with applicable state and local law relating

to:

      (a) Construction;

      (b) Sanitation; and

      (c) Building maintenance.

      (2) The child-caring facility shall

conform to the Kentucky Standards of Safety in accordance with 815 KAR 10:060.

      (3) A climate control system shall be

provided as follows:

      (a) A minimum temperature of sixty-five

(65) degrees Fahrenheit maintained in occupied areas in cold weather

conditions;

      (b) In warm weather conditions and

periods of extreme heat, an occupied area shall be properly ventilated;

      (c) If not air-conditioned and the

temperature in an occupied area exceeds eighty-five (85) degrees Fahrenheit,

the child-caring facility director shall assure that the following occurs:

      1. A fan is utilized to circulate air;

      2. The child-caring facility is properly

ventilated to outside air;

      3. Ice water is readily available and

served to residents; and

      4. Staff frequently monitor residents for

a sign or symptom of a heat-related illness.

      (4) The water supply shall be from an

approved source and easily available from the following:

      (a) Drinking fountain;

      (b) Refrigerator; or

      (c) Cold water tap.

      (5) The plumbing and waste disposal

systems shall comply with applicable provisions of the Uniform State Building

Code, KRS 198B.050, and with laws regarding on-site sewage disposal, KRS

211.350 to 211.380, if applicable.

      (6) Housekeeping and maintenance service.

      (a) The building and its content shall be

maintained in a clean and safe condition and in good repair.

      (b) A maintenance plan shall be

implemented.

      (c) The child-caring facility shall

ensure that the grounds and outdoor equipment are well kept and the exterior of

the building is in good repair.

      (d) The interior of the building and its

contents shall be in good repair.

      (e) Garbage and trash shall be:

      1. Stored in an area separate from those

used for the preparation and storage of food;

      2. Removed from the premises regularly;

and

      3. Placed in a container that is cleaned

regularly.

      (f) Insecticides, pesticides, and

chemical poisons shall be plainly labeled and stored in a secure, locked area.

Access shall be given to:

      1. The facility's maintenance personnel;

and

      2. A pest control company with which the

facility has a contract.

      (7) Bedroom.

      (a) A bedroom shall be:

      1. Of adequate size to permit at least

three (3) linear feet between each bed or set of bunk beds; and

      2. Constructed to allow no more than four

(4) residents per room.

      (b) A bedroom for a child above age three

(3) shall be equipped with an individual bed for each child that shall be:

      1. Long and wide enough to accommodate

the child's size;

      2. Developmentally appropriate for the

child; and

      3. Equipped with a support mechanism and

a clean mattress.

      (c) A bed occupied by a child shall be

placed so that the child shall not experience discomfort because of:

      1. Proximity to a radiator or heat

outlet; or

      2. Exposure to drafts.

      (d) Except for a sibling indicated in an

ITP, there shall be separate sleeping quarters for boys and girls over the age

of five (5).

      (e) Storage space shall be provided for

each child to accommodate his or her personal belongings in a:

      1. Closet and drawers; or

      2. Closet for the child’s exclusive use

and shelves within the closet.

      (f) A child shall not be housed in a

room, detached building, or enclosure that has not previously been inspected

and approved for resident use.

      (g) A child shall be provided with clean

bed linens, laundered at least once a week, and a waterproof mattress covering.

      (8) Indoor living area. An indoor living

area shall have:

      (a) At least thirty-five (35) square feet

per child; and

      (b) Comfortable furnishings adequate for

the number of children served.

      (9) Bathroom.

      (a) For every six (6) children residing

in the living unit, a living unit shall have a minimum of:

      1. One (1) wash basin with hot and cold

water;

      2. One (1) flush toilet; and

      3. One (1) bath or shower with hot and

cold water.

      (b) A child shall be provided with access

to:

      1. Toilet paper;

      2. Towels;

      3. Soap; and

      4. A wastebasket.

      (c) Each bathtub and shower shall have an

enclosure or screen for individual privacy. If more than one (1) toilet is

located in the same bathroom, each toilet shall:

      1. Be partitioned; and

      2. Include a door capable of remaining

closed.

      (d) A bathroom shall contain at least one

(1) nondistorting mirror secured to the wall at a convenient height.

 

      Section 5. Health, Safety, and

Nutritional Requirements. (1) Health.

      (a) A child-caring facility shall have

written policy and procedure for health and medical care, to include provisions

for:

      1. The care and disposition of an ill

child; and

      2. Emergency care.

      (b) The service of a physician shall be

made available to a child. If the service of a licensed physician is not

available in the community, the child-caring facility shall request the

assistance of the:

      1. County health department; or

      2. The Department for Public Health,

Division of Adult and Child Health Improvement.

      (c) Staff shall follow licensed physician

orders for:

      1. Medicine;

      2. Prescription; and

      3. Medical care.

      (d) Except for a weekend or holiday,

within forty-eight (48) hours of admission to a child-caring facility, a child

shall have:

      1. An initial health screening for

illness, injury, and communicable disease or other immediate needs, by a nurse

or trained child-care staff;

      2. After the initial health screening, a

physical examination by a licensed physician or a qualified person under the

supervision of a licensed physician, within two (2) weeks of admission, unless

it has been documented that the child has received an examination during the

past twelve (12) months; and

      3. The examining professional shall

report, in writing, observations and findings including:

      a. Developmental history of the child,

illnesses, operations, and immunizations if available to the physician;

      b. A limitation the child may have that

may prevent participation in an activity scheduled by the child-caring

facility;

      c. Visual and auditory examination

results;

      d. Recommendation and order for future

care, treatment, and examinations;

      e. TB skin test results, unless contraindicated

by a qualified person under the supervision of a licensed physician; and

      f. Other tests for communicable disease

as indicated by the medical and social history of the child.

      (e) An annual physical examination shall

be scheduled and documented as established in paragraph (d)3 of this

subsection.

      (f) Upon admission, the child-caring

facility shall consult with a physician if there is evidence that the child may

require medical attention.

      (g) The child-caring facility shall

develop a procedure for a child requiring a specific provision for an

infectious medical condition.

      (h) A separate health record shall be

maintained for each child, kept on the premises, and be made available to a:

      1. Physician;

      2. Nurse; or

      3. Designated staff member.

      (i) The health record shall contain the

following:

      1. Copy of each physical examination,

including any recommendations for treatment;

      2. Previous and continuing health and

medical history, if available;

      3. Record or report of each test,

immunization, periodic reexamination, and physician order and instruction;

      4. Report and date of each dental

examination and treatment;

      5. Authorization for regular and

emergency medical, dental, and surgical care, signed at admission by the legal

custodian;

      6. Documentation of medication

administered to the child; and

      7. Documentation of a special provision

made for the child in accordance with a physician's order.

      (j) A child's medical need shall be

provided for as recommended by a licensed physician.

      (k) The facility shall keep an

immunization certificate on file for each child, in accordance with KRS

214.034(5).

      (l) If a child dies while in the care of

a child-caring facility or in a home operated or supervised by the child-caring

facility:

      1. The child-caring facility shall

immediately notify the:

      a. County coroner;

      b. Child's parent;

      c. Guardian or custodian; and

      d. Cabinet staff;

      2. A verbal report of the death shall be

made immediately to the Commissioner of the Department for Community-Based Services;

      3. A written comprehensive report from

the executive director outlining the incident shall be forwarded to the Office

of the Commissioner, Department for Community-Based Services, on the next working

day following the verbal report; and

      4. If a child's death occurred as a

result of alleged abuse or neglect, the executive director of the child-caring

facility shall make verbal and written reports as required by KRS 620.030(1)

and (2).

      (m) Upon discharge, medical information

shall follow the child if a release form has been obtained.

      (n) Unless a dental examination has been

performed in the six (6) months preceding admission, the child-caring facility,

within one (1) week after a child's admission, shall schedule an appointment

for a dental examination. The facility shall ensure the treatment of emergency

dental needs by a licensed dentist as they arise.

      (o) A child age two (2) years and above

shall be examined at least annually by a licensed dentist.

      (p) The child-caring facility shall:

      1. Document the information required by

this subsection; and

      2. Assure the confidentiality of the

information.

      (q) The child-caring facility shall

maintain a continuous program of personal hygiene.

      (2) Safety.

      (a) A child shall be instructed in fire

prevention, safety, and fire emergency procedures.

      1. The child-caring facility shall

maintain and post a current, written emergency fire evacuation plan and diagram

to include:

      a. An evacuation route and procedure; and

      b. The location of fire extinguishers.

      2. Emergency drills shall be preformed

quarterly and documented for each of the following emergency events;

      a. Fire;

      b. Tornado or severe thunderstorm

warning; and

      c. Flash flood, if applicable.

      3. An emergency plan shall designate a

suitable shelter in the event of an emergency.

      (b) A child-caring facility with a

swimming pool shall be staffed with a certified lifeguard in accordance with

902 KAR 10:120, Section 13.

      (c) Donated home processed foods shall be

prohibited.

      (d) Transportation.

      1. If transportation is provided

directly, contracted for, or arranged, a child-caring facility shall require:

      a. Compliance with state laws pertaining

to vehicles, drivers, and insurance;

      b. A seat for each child and that the

child remain seated while the vehicle is in motion;

      c. A seat belt be used to secure the

child;

      d. A vehicle used to transport a child

off campus to provide a seat for each passenger as manufactured standard

equipment;

      e. That a child never be left unattended

in a vehicle; and

      f. Compliance with KRS 605.080(3)

pertaining to court-ordered transportation.

      2. The maximum number of children a

driver shall supervise alone is four (4).

      3. A child under forty (40) inches tall

or forty (40) pounds in weight shall not be transported unless restrained in a

safety seat approved in accordance with KRS 189.125(3).

      4. A vehicle shall not pick up and

deliver a child under the age of six (6) to a location that requires the child

to cross a street or highway unless the child is accompanied by an adult.

      5. If transportation is provided by a

means other than licensed public transportation:

      a. The vehicle shall be maintained in a

safe mechanical and operable condition;

      b. A thorough inspection of the vehicle

shall be made and documented by a qualified mechanic at least annually; and

      c. If the driver is not in his seat, the

motor shall be turned off, keys removed, and brake set.

      (e) A child with a history of aggressive

behavior or sexual acting-out shall be assessed by the treatment team to ensure

the safety of the child and other children in the facility, including sleeping

arrangements, with the appropriate safety measures included in the child’s ITP.

      (f) If a child-caring facility accepts

for placement a child who has been committed to the Department of Juvenile

Justice for the commission of a sex crime, the child-caring facility shall have

written policies and procedures for the segregation of the child from a child

committed to the cabinet in accordance with KRS 605.090(1), 620.090(2), and

620.230(3).

      1. Segregation shall include sight and

sound separation of a child committed to the Department of Juvenile Justice

from a child committed to the cabinet for the following functions within the

facility or activities supervised by the facility:

      a. Sleeping;

      b. Personal hygiene; and

      c. Toiletry.

      2. During other functions within the

facility or activities supervised by the facility, segregation shall include

separation of a child committed to the Department of Juvenile Justice from a child

committed to the cabinet to prohibit any physical contact and verbal communication

between the children.

      (g) Physical management shall be used in

an emergency or a crisis situation only:

      1. After attempts to de-escalate the

situation have been made;

      2. By trained staff; and

      3. To prevent:

      a. A child from injury to self or others;

or

      b. Serious property damage or disruption

of the child-caring facility's program.

      (h) Physical management shall not be used

as:

      1. Punishment;

      2. Discipline; or

      3. For the convenience of staff.

      (i) Physical management shall be

discontinued if a child displays adverse side effects including:

      1. Illness;

      2. Severe emotional or physical stress;

or

      3. Physical damage.

      (3) Nutritional requirements.

      (a) A child shall be served meals that:

      1. Meet the nutritional guidelines of the

U.S. Department of Agriculture that include foods from the five (5) basic food

groups; and

      2. Satisfy the quantity required to meet

the needs of each child as to age, activity, and prescribed diet or ITP.

      (b) A child shall be encouraged to eat

the food served, but shall not be subjected to coercion.

      (c) An order for a modified diet from a

licensed physician shall be followed by the child-caring facility.

      (d) A menu shall be planned at least one

(1) week in advance, dated, posted, and kept on file for one (1) year.

      (e) With the exception of a child

receiving a meal at school, three (3) meals a day shall be provided at regular

intervals and, except for weekends and holidays, no more than fourteen (14)

hours shall lapse between the evening meal and morning meal.

      1. A nourishing snack shall be provided

and:

      a. May be part of the daily food needs;

      b. Shall not replace a regular meal; and

      c. Shall be recorded on the menu.

      2. A meal shall be scheduled at set times

each day so that at least one (1) hot meal a day is not hurried, allowing time

for conversation.

      3. Food, or withholding of food, shall

not be used as a punishment.

      4. Only pasteurized milk and milk

products, and U.S. government inspected meat shall be served to a child.

      5. Food shall be prepared to preserve

nutritive value and heighten flavor and appearance.

      6. The same food shall be served to

children under care and to staff members, unless a food is not suitable for a

person because of:

      a. The person's age;

      b. A dietary restriction; or

      c. A religious preference.

      (f) Table service shall be provided for a

child capable of eating at a table.

      1. Tables and chairs shall be:

      a. Of a height that corresponds to the

size of the child served; and

      b. Constructed of material that can be

easily sanitized.

      2. A child who has not had an opportunity

to learn how to handle food with the usual table service shall be managed in a

way that he shall not be embarrassed or subjected to ridicule.

      (g) A written report of a food inspection

by municipal, county, or federal authorities shall:

      1. Be kept on file at the child-caring

facility; and

      2. Meet local, state, and federal

regulations.

      (h) If a child-caring facility

subcontracts a food service, applicable federal and state administrative

regulations shall apply.

 

      Section 6. General Requirements. (1) An

incident of suspected child abuse or neglect shall be reported as required by

KRS 620.030.

      (2)(a) The facility shall, with regard to

suspected child abuse or neglect by an employee:

      1. Document each incident;

      2. Keep each incident document on file;

and

      3. Make the files accessible to the

cabinet.

      (b) A child shall not be exploited for

promotional purposes, or in a manner that shall cause the child or family to

suffer discomfort or embarrassment.

      (c) Except as indicated in paragraph (d)

of this subsection, a child shall not be used personally for a fund-raising

purpose for the child-caring facility.

      (d) If a picture, slide, recording, or

other private, personal effect of a child is used in fund-raising or

promotional effort of a child-caring facility, written permission shall be

obtained from:

      1. A parent or guardian; or

      2. An authorized:

      a. Representative of the cabinet;

      b. Representative of the Department of Juvenile

Justice; or

      c. Legal representative.

      (3) For an activity conducted away from a

child-caring facility, the facility shall:

      (a) Safeguard the health and safety of

the children during the activity;

      (b) Have a written policy and procedures

governing the activity;

      (c) Maintain staff-to-child ratios in

accordance with Section 3 of this administrative regulation; and

      (d) Provide transportation in a manner

that complies with Section 5(2)(d) of this administrative regulation.

      (4) Clothing and personal possessions.

      (a) Through agreement with the child's

legal custodian, the child-caring facility shall provide a child with clothing

and footwear that is clean, well-fitting, and seasonal.

      (b) A child shall be provided individual

articles of personal hygiene.

      (c) The child-caring facility shall allow

a child to have personal belongings and property consistent with this

administrative regulation and child-caring facility policy.

      (5) A child's money.

      (a) The child-caring facility shall have

written policy and procedure relating to money belonging to a child.

      (b) A child shall have access to

information regarding the balance of the child's fund.

      (c) Within thirty (30) days of discharge,

funds belonging to a child shall be transferred with or returned to the child.

      (6) Visitation and communication shall

include:

      (a) Written policy on visitation and

communication;

      (b) An arrangement for visitation that is

not in conflict with the ITP;

      (c) Documentation of each visit in the

case record; and

      (d) Access to a telephone to make and

receive a telephone call consistent with the child's ITP, current court orders,

and the facility's child-caring policy.

      (e) Allowing a child to contact cabinet

staff by telephone within twenty-four (24) hours of the request of the child.

      (7) Religion, culture, and ethnic origin.

      (a) Facility policy shall demonstrate

consideration for and sensitivity to:

      1. The racial, cultural, ethnic, and

religious background of a child in care; and

      2. Availability of activities appropriate

to the child's cultural or ethnic origin.

      (b) With the exception of a religious

practice that is destructive or places a child in physical danger, an

opportunity shall be provided for a child to:

      1. Practice the religious belief and

faith of the child's individual or family preference; and

      2. Participate in a religious activity

without coercion.

      (8) Education.

      (a) If a child-caring facility operates

its own school program, it shall have written policy and procedure regarding

the development and implementation of the educational program. The policy and

procedure shall include:

      1. School attendance;

      2. Teaching staff;

      3. School records;

      4. Educational supplies and equipment;

      5. Individual educational plans; and

      6. Use of a community school.

      (b) A child-caring facility shall ensure

that a child attends an accredited educational program the number of days

required by law.

      (c) A child shall be enrolled in an

accredited educational program within one (1) week of admission.

      (d) A school-age child ineligible or

unable to attend an accredited school shall have an educational program

specific to the individualized need of the child that may include a General

Education Diploma or vocational training.

      (e) If a child-care facility operates an

educational program, maintenance of school records shall comply with state law

and administrative regulations of the educational body having jurisdiction.

      (f) The child-caring facility shall

provide a quiet area and designated time for study.

      (9) Work and chore assignment.

      (a) An assigned chore or work assignment

shall not place the child in physical danger.

      (b) A chore assignment shall be posted

within the child's living quarters.

      (c) A child may be given a job in

compliance with child labor laws for which he receives payment that shall be

clearly differentiated from a chore expected of him to be completed in relation

to the routine of daily living.

      (d) A work assignment outside of a daily

routine chore at the child-caring facility shall not be used as a form of

punishment. An additional chore assignment beyond what is regularly assigned to

a child may be:

      1. Performed as restitution for

intentional property damage made by the child; or

      2. Given to a child for violation of a

child-caring facility rule upon mutual agreement between the child and

supervisory child-caring staff without the child being coerced to enter into an

agreement.

      (e) A child shall be given a rest period

of at least ten (10) minutes during each hour worked.

      (f) Use of a child to perform a chore or

work assignment shall not negate the child-caring facility's ultimate

responsibility for the maintenance of the child-caring facility nor the

employment of staff sufficient to maintain the child-caring facility.

      (10) Discipline.

      (a) A child-caring facility shall have

written policy and procedure governing disciplinary action.

      (b) Discipline shall be:

      1. Utilized as an educational tool and be

related to the child's actions initiating the disciplinary process; and

      2. Consistent with the child's ITP and in

response to the child's lack of control or misbehavior.

      (c) A group of children shall not be

punished due to the misbehavior of one (1) or more individual group members.

      (d) The following practices shall not be

allowed:

      1. Cursing;

      2. Screaming;

      3. Name calling;

      4. Threatening of physical harm;

      5. Intimidation;

      6. Humiliation;

      7. Denial of food or sleep;

      8. Corporal physical discipline, except

in accordance with KRS 199.640(6);

      9. Hitting;

      10. Unnecessarily rough handling;

      11. Other physical punishment; or

      12. Denial of visitation with family or

custody holder as punishment.

      (e) With the exception of a parent

disciplining a child, a child shall not directly discipline another child.

      (f) Handcuffs, weapons, mechanical

restraints, chemical restraints, or other restraint devices shall not be used.

      (g) A child placed in a time-out area

shall be:

      1. In sight or hearing of staff; and

      2. Checked by staff at least every five

(5) minutes until it is determined the child is ready to continue normal

activity.

 

      Section 7. Child-caring Program Services.

(1) Admissions and intake.

      (a) The child-caring facility shall have

clearly defined written policy and procedure for an admission that identifies

the age, sex, and detailed description of the type of child served.

      (b) Acceptance of a referral shall be

based on the assessment that the child's need is one that:

      1. The service of the child-caring

facility is designed to address; and

      2. Cannot be met in a less restrictive

setting.

      (c) The child-caring facility shall not

accept into care a child for whom a service cannot be provided based on the

child-caring program's mission statement and its available resources.

      (d) The child-caring facility shall have

a written placement agreement with the child's custodian.

      (e) The child-caring facility shall

conduct a:

      1. Preadmission interview with the child;

or

      2. Screening of the child's available

information, if a preadmission interview is not possible due to an emergency

placement.

      (f) The following information regarding

the child shall be obtained by the child-caring facility from the child's

custodian during intake, or it shall be documented that the information was

requested and not available:

      1. Commitment order or signed voluntary

admission form;

      2. Verification of birth;

      3. Immunization record; and

      4. Social history and needs assessment

that includes medical, educational, developmental, and family history.

      (g) A written consent pertaining to the

child's care shall be obtained from the child's custodian for:

      1. Photograph, video, and audio tape;

      2. Emergency and routine medical care;

and

      3. Release of case record information.

      (h) Before admission, the child and

custodian shall be informed in writing of their rights and the child-caring

facility's responsibilities, including policy pertaining to services offered to

the child.

      (i) A child shall be informed upon

admission of the right to file a grievance.

      (j) Upon admission, the child shall be

oriented to life at the child-caring facility, including rules and consequences

for violation of the rules.

      (2) Casework planning.

      (a) The child-caring facility shall have

written policy and procedure for the ITP process including:

      1. Assessment;

      2. Assignment;

      3. Designation of a case coordinator; and

      4. Development, implementation, and

evaluation of the ITP and family involvement.

      (b) An initial assessment shall be

completed by designated staff within twenty-four (24) hours of admission to

include:

      1. Identifying information;

      2. Presenting problem;

      3. History (developmental, social,

emotional health, education); and

      4. Current level of functioning including

strengths and weakness.

      (c) An initial ITP shall be developed by

designated staff and implemented within twenty-four (24) hours of admission.

      (3) Comprehensive assessment and

treatment plan.

      (a) A comprehensive emotional and

behavioral assessment of a child shall be completed by the treatment team and

entered in the case record within twenty-one (21) days of admission, including

the following:

      1. A history of previous emotional,

behavioral, and substance abuse problems and treatment;

      2. The child's current emotional,

behavioral, and developmental functioning, including strengths and weakness;

      3. A psychiatric or psychological

evaluation if recommended by the treatment team;

      4. Other functional evaluation of

language, self-care, social effectiveness, and visual-motor functioning, if

recommended by the treatment team;

      5. Social assessment that includes:

      a. Environment and home;

      b. Religion;

      c. Ethnic group;

      d. Developmental history;

      e. Family dynamics and composition; and

      f. Education; and

      6. Recommendation for provision of treatment.

      (b) A coordinated treatment team approach

shall be utilized in the development, implementation, and evaluation of a comprehensive

ITP.

      (c) A comprehensive ITP shall be

developed and implemented, in accordance with KRS 199.640(5)(a)4, to improve

child functioning based upon the individual need of the child, and the child's

family if appropriate, and shall include at least the following components:

      1. Goals and objectives for permanence;

      2. Time frame projected for completion of

each goal and objective;

      3. Method for accomplishing each goal and

objective, including utilization of community providers;

      4. Person responsible for completion of

each goal and objective; and

      5. Projected discharge date and placement

plan.

      (d) The comprehensive ITP shall be

developed within twenty-one (21) days of admission.

      1. A treatment team review of the child's

and family's progress toward meeting each treatment goal shall occur at least

monthly.

      2. Every effort shall be made to involve

the child and his family in the monthly treatment team review.

      3. Treatment team evaluation of the

comprehensive ITP shall occur at least quarterly.

      4. An additional assessment shall be

completed upon the recommendation of the treatment team.

      5. Evaluation and assessment information

shall be documented and maintained in the child's record.

      (e) The child shall be offered the

opportunity to sign an ITP and ITP review, signifying understanding of the ITP.

      1. If the child refuses to sign or is

developmentally unable to understand the circumstance, this shall be documented

in the record.

      2. The child and his family or custodian

shall receive a copy of the ITP.

      (4) Treatment environment. The daily

child-caring program shall be planned in the following manner in order to

create an atmosphere conducive to treatment:

      (a) The child-caring facility shall have

written policy and procedure describing its daily routine, rules, activity, and

child and staff interaction.

      (b) The daily child-caring program shall

be:

      1. Planned to provide a framework for

daily living; and

      2. Reviewed and revised as the needs of

the individual child or living group change.

      (c) The daily routine shall be written

and available to each child.

      (d) Each rule shall be clearly stated in

language that a child can understand.

      (e) Staff shall interact with a child in

a warm, supportive, constructive, and confidential manner and shall treat the

child with respect.

      (f) Counseling and interviewing a child

and the child's family shall be conducted in a private area.

      (g) A daily recreational activity shall

be available to promote mastery of:

      1. Developmental tasks;

      2. Development of relationships; and

      3. Increase in self-esteem, in accordance

with the child's ITP.

      (h) The child-caring facility shall

provide recreational equipment, maintained in usable and safe condition, to

implement the recreational program.

      (5) The child-caring facility shall make

available a quality program for substance abuse prevention and treatment in

compliance with KRS 199.640(5)(a)7.

      (6) Discharge and aftercare.

      (a) The child-caring facility shall have

written policy and procedure that describe the condition under which a child

may be discharged, including criteria for an unplanned or emergency discharge

and a discharge inconsistent with the ITP.

      (b) The approval of the program director

shall be required for an unplanned or emergency discharge.

      (c) Discharge planning shall begin with

the development of the ITP and shall continue throughout subsequent ITP

reviews. The treatment team shall consider the following matters related to

discharge planning:

      1. Identification of placement;

      2. Community resources to provide support

for youth; and

      3. Family services.

      (d) When a child is leaving a facility as

a planned discharge, a predischarge conference shall be held to ensure that the

child and family are prepared for successful transition into placement. The parent,

guardian or custodian, the child, and the treatment team shall attend this

conference.

      (e) The child shall have at least one (1)

preplacement visit prior to the planned discharge, or the facility shall

document unsuccessful efforts to arrange a visit.

      (f) The child-caring facility shall

prepare a written discharge summary within fourteen (14) days following the

date of discharge. A copy shall be provided to the custody holder. The summary

shall include:

      1. Information related to progress toward

completion of each ITP goal;

      2. Each barrier to treatment;

      3. Each treatment method used in working

with the child;

      4. Date of discharge;

      5. Reason for discharge; and

      6. Name, telephone number, and address of

person or child-caring facility to whom the child was discharged.

      (g) An aftercare service shall be

provided to a child where no other agency has responsibility for the child's

transition or adjustment to a new environment. Upon discharge, the following

needs of the child shall be assessed and a referral made for needed aftercare

service:

      1. Educational;

      2. Medical;

      3. Vocational;

      4. Psychological;

      5. Legal; and

      6. Social.

      (7) Case record. The child-caring

facility shall:

      (a) Maintain, in a confidential and

secure manner, a current case record on each child, including:

      1. Identifying information on the child

to include:

      a. Name, ethnic origin and gender;

      b. Date of birth and Social Security

number;

      c. Former residence;

      d. Name, address, and occupation of each

parent, if available;

      e. Date of admission; and

      f. Type of commitment;

      2. Commitment order or custodian's

consent form for admission;

      3. Birth and immunization certificates;

      4. Education;

      5. Medical and dental records that may be

maintained separately from the case record;

      6. Assessment data or social history;

      7. ITP and each review;

      8. Each incident report, with a paper or

electronic copy maintained in a centralized location within the licensed

facility;

      9. Chronological recording;

      10. Correspondence with court, family,

and custody holder;

      11. Discharge summary; and

      12. Written consent;

      (b) Document, at least weekly, progress

made by the child and his family toward meeting the treatment goal;

      (c) Record the aftercare service it

provides until the service is terminated;

      (d) Have a written policy regarding

maintenance, security, and disposal of a case record maintained by, or in

possession of, the child-caring facility;

      (e) Not disclose information concerning a

child or his family to a person not directly involved in the case, without the

written consent of the custodian of the child;

      (f) Forward, within twenty-four (24)

hours, a request made by an individual or an agency to review the case record

of a committed child, to the:

      1. Commissioner, Department for Community

Based Services, if the child is committed to the cabinet; or

      2. Other legal custodian, if the child is

not committed to the cabinet;

      (g) With the exception of a sealed

adoptive record, release identifying or personal information including a Social

Security card, birth certificate, or driver's license to the child at

discharge;

      (h) After the discharge of a child:

      1. Maintain the case record at the

child-caring facility for at least three (3) years; and

      2. After three (3) years, the

child-caring facility may archive the case record and have it transferred to

one (1) of the cabinet's designated record centers; or

      3. Maintain the case record permanently

at the child-caring facility;

      (i) If the child-caring facility ceases

to operate, transfer the case record to the Cabinet for Health and Family

Services;

      (8) The cabinet shall maintain a file on

each record transferred to one (1) of its record centers. The file shall

include the following information:

      (a) The child's name, case number, date

of birth; and

      (b) Date the case record was sent to the

cabinet.

      (9) All records maintained by the

child-caring facility shall be made available to the cabinet or designee upon

request.

 

      Section 8.Independent Living Services. A

child-caring facility shall:

      (1) Provide independent living services:

      (a) To a child:

      1. In the custody of a state agency; and

      2. Twelve (12) to twenty-one (21) years

of age;

      (b) As prescribed in the child’s ITP; and

      (c) In accordance with 42 U.S.C. 677(a);

and

      (2) Teach independent living:

      (a) To a child:

      1. In the custody of a state agency; and

      2. Sixteen (16) years of age and older;

and

      (b) Developed in accordance with 922 KAR

1:310, Section 17(1)(e). (17 Ky.R. 2339;

eff. 3-12-91; 20 Ky.R. 2414; eff. 3-23-94; Recodified from 905 KAR 1:300,

10-30-98; 26 Ky.R. 2068; 27 Ky.R. 557; 994; eff. 10-16-2000; 28 Ky.R. 1708;

2221; 2601; eff. 6-14-2002; 33 Ky.R. 3543; 34 Ky.R. 307; 569; eff. 10-17-2007;

TAm. eff. 8-24-2010.)