C.M.R. 14, 193, ch. 6, RESIDENTIAL SERVICE STANDARDS
These standards, in addition to the core standards, are applied to agencies providing residential services.
Access
RS.1 The agency has policies and procedures governing the establishment of a waiting list, that minimally includes the following: prioritizing clients, selecting clients from the waiting HA, and referring clients to other providers.
RS. 1. A. Policies and procedures governing the establishment of waiting lists and the selection of clients will be in compliance with the Fair Housing Amendments Act.
Assessment
RS.2 A comprehensive assessment is conducted by an individual chosen or agreed to by the client or legally responsible party, with the client's participation, within 20 working days of the client's admission.
RS. 2. A.. The comprehensive assessment minimally addresses the following:
RS. 2. A..1 the client's strengths and weaknesses;
RS. 2. A..2 the client's perception of his or her needs;
RS. 2. A..3 the family/guardian's input and perception of the client's needs when appropriate, and with the client's consent;
RS. 2. A..4 a personal, family, and social history;
RS. 2. A..5 the client's emotional, psychiatric and psychological strengths and needs;
RS. 2. A..6 a physical health status and history, including current prescription and over-the-counter medication use;
RS. 2. A..7 past and current drug/alcohol use;
RS. 2. A..8 a developmental history;
RS. 2. A.9 possible sources of assistance and support in meeting the needs expressed by the client or legally responsible party, including state and federal entitlement programs;
RS. 2. A.10 physical and environmental barriers that may impede the client and family's ability to obtain services;
RS. 2. A..11 history of physical and/or sexual abuse;
RS. 2. A..12 the vocational, educational, social, living, leisure/recreation and medical domains;
RS. 2. A..13 potential need for Crisis Intervention Services;
RS.2. A.14 housing and financial needs;
RS. 2. A..15 status of the Individualized Support Plan; and
RS.2. A..16 the signature of the person who performed the assessment.
Interpretive Guideline for RS.2.A.1 thru RS.2.A.13
The Division of Licensing recognizes that in some cases not all of the information requested in these standards will be able to be obtained. The Division also recognizes that the level of detail required will vary given a variety of factors (the client's level of cooperation, the integrity of the information sources, the length of services or treatment, the condition being addressed, the practitioner's training, etc.). Although the Division will attempt to be sensitive to these factors and flexible in surveying this area, the agency should assure that assessments that do not address all these standards have accompanying documentation that justifies abbreviated or absent information.
RS. 2. B. The agency will establish policies and procedures establishing criteria for the performance of the following assessments:
RS. 2. B.1 a nutritional assessment;
RS. 2. B.2 a cognitive functioning assessment;
RS. 2. B.3 an assessment of the client's capacity to make reasoned
decisions;
RS. 2. B.4 a neurological assessment.
Interpretive Guideline for RS.2.B.2
The client's cognitive functioning assessment should include assessment of the following functions: problem solving, decision making, organization, self-direction, system negotiation skills, concentration, and abstract reasoning. For individuals over 60 years of age, this assessment should also include memory, language, orientation, and visuo-spatial abilities.
Interpretive Guideline for RS.2.B thru RS.2.B.4
These assessments do not necessarily have to be performed in the agency or by agency staff. the intent of these standards are to assure that the agency has mechanisms by which to evaluate the need for these assessments and to perform or refer for assessment those clients whose symptomatology suggests such need.
RS. 2. C The assessment(s) shall be obtained from the client, legally responsible party, community service agencies, and to the extent possible, from other individuals in the community as authorized by the client or legally responsible party.
RS. 2. C.1. In instances in which the client receives community support services and/or has an Individualized Support Plan, the agency will, subject to the client's consent, attempt to coordinate the assessment and subsequent service planning with the community support provider.
RS. 2. C.1.a. Services provided to these clients will be consistent with the targets and objectives of the Individualized Support Plan.
RS. 2. C.1.b. Services provided to these clients will be delivered pursuant to a service agreement negotiated with the community support worker.
RS. 2. D The client record contains a summary evaluation of the data collected in the comprehensive assessment.
RS.3 The agency has a documented policy and procedure on updating assessments that assures that assessments are current and in no case exceed annual updates.
Service Planning
RS.4 An initial service plan is developed within 72 hours following admission and is based on preliminary assessment findings.
RS.5 There is documented evidence that the service planning and revision process involves the client, legally responsible party, and other representatives and professionals whom the client identifies.
Interpretive Guideline for RS.5
The client and legally designated guardian shall be fully and actively involved in the development or revision of the service plan, if possible. It the client consents, the client's designated representative e, family members or significant others shall be included in the development and revision of the service plan, unless contraindicated. When these individuals do not attend, their absence is noted. Each agency shall document good faith efforts, including at least 24 hour notice of any service planning meeting, to involve guardians, representatives or legally responsible parents.
RS.6 A comprehensive service plan is developed for each client, with the client's consent, and within 20 working days of admission.
RS. 6. A. The comprehensive service plan minimally contains the following:
RS. 6. A.1 problem statements;
RS. 6. A.2 short- and long-range goals based upon client needs with a projection of when such goals will be attained;
RS. 6. A.3 objectives stated in terms which allow objective measurement of progress;
RS. 6. A.4 multidisciplinary input and specification of treatment responsibilities;
RS. 6. A.5 client input and signature;
RS. 6. A.6 signatures of all people participating;
RS. 6. A.7 the methods and frequency of treatment, rehabilitation, support;
RS. 6. A.8 a description of any physical handicap and any accommodations necessary to provide the same or equal services and benefits as those afforded non-disabled individuals; and
RS. 6. A.9 criteria for discharge or release to a less restrictive setting.
RS. 6. B Justification for not addressing problems identified in the assessments is documented in the client record.
Interpretive Guideline for RS.6.B
The intent of this standard is to assure that the clinical staff considers all of the client's identified problems in formulating the service plan. problems that are not reflected on the service plan should have accompanying documentation identifying the rationale for not addressing the problems at this time. This documentation can take many forms including progress notes service plan narratives, etc.
RS.7 The service plan is designed so that the client's progress towards service plan goals can be monitored and evaluated.
Interpretive Guideline for RS.7
Service plans should have measurable goals and some means for reflecting when, or to what degree, a goal has been attained. The organization should also have mechanisms that document monitoring and evaluation of client goals, e.g., quality assessment, treatment plan review documents.
RS.8 The service plan is reviewed at major decision points in each client's treatment course, upon client request, and no less frequently than every 90 days.
Interpretive Guideline for RS.8
Major decision points may include, but are not necessarily limited to the following: when there is a change in the client's condition, when a service appears not to benefit the client, when the client is under- or over- utilizing services.
RS.9 Unmet service needs are documented in the service plan.
Interpretive Guideline for RS.9
If at the time of the service planning meeting, team members know on the basis of reliable information that the needed services are unavailable, they shall note them as "unmet service needs" on the service plan and develop an interim plan based upon available services that meet, as nearly as possible, the actual needs of the client. The organization should also document notification of the organization's leadership and the Commissioner regarding the unavailability of service that is causing the unmet service need.
RS.10 The agency has a policy and procedure for providing clients with a copy of their service plan within one week following its formulation, review or revision and notification of client recourse should they disagree with any aspect of the plan.
RS. 10. A. The agency will not fail to provide a copy of the client's service plan and/or notify them of recourse should they disagree.
Discharge Planning
RS.11 Each client record contains documentation of current discharge or termination planning, if appropriate.
RS. 11. A. Planning for discharge to another setting or service will be contingent upon the client's consent to the establishment of such a discharge as a goal.
RS.12 A discharge summary is entered in the client record within 15 days of discharge and includes the client's course of treatment and ongoing needs at discharge.
RS. 12. A. Each discharge summary minimally addresses, but need not be limited to the following:
RS. 12. A.1 the reasons for termination of service;
RS. 12. A.2 the final assessment, including the general observations and significant findings of the client's condition initially, while services were being provided and at discharge;
RS. 12. A..3 the course and progress of the client with regard to each identified problem; and
RS. 12. A.4 the recommendations and arrangements for further continued service needs.
RS.13 The agency has policies and procedures that specify under what conditions services may be discontinued or interrupted which minimally include how and when the client is notified.
RS. 13. A. For agencies serving DMHMR class members, the agency shall first obtain prior written approval for discontinuing or interrupting services from the Department.
RS. 13. B For agencies serving DMHMR class members, the agency shall give thirty days advance written notice to the client and the client's guardian. If the client poses a threat of imminent harm to persons employed or served by the agency, the agency shall give notice that is reasonable under the circumstances.
RS. 13. C For agencies serving DMHMR class members, the agency shall give such notice as may be required by law or regulation.
RS. 13. D For agencies serving DMHMR class members, the agency shall assist the client in obtaining the services from another agency.
RS. 13. E For agencies serving DMHMR class members, the agency shall provide documented evidence in the client record of compliance with these standards, through letters, progress notes, phone logs, and/or facsimile.
RS.14 The agency will have a discharge protocol that protects the client from summary discharge and allows the agency to maintain program integrity.
RS. 14. A. The agency has a policy and procedure for discharging clients that include the terms upon which a client may be discharged (e.g., disciplinary reasons, under-utilization of the program).
RS. 14. B. Except in emergency cases, clients shall be given 30 days notice before discharge.
RS. 14. C. The agency will not summarily discharge clients. All substantiated complaints will be assessed for the seriousness of the violation and actions taken to achieve compliance.
RS.15 The agency documents the client's stated preference for living situation in the discharge plan.
Interpretive Guideline for RS.15
When the client's preference for living situation cannot be accommodated, the reasons are documented.
RS.16 Applicants who are not eligible for services will be referred to appropriate services, if required, available and desired.
RS. 16. A. The agency has a policy and procedure on referral and/or transfers of individuals deemed inappropriate for services offered by the agency that minimally includes communicating the rationale for the referral/transfer to the applicant and providing them with a list of alternative service providers and advocacy services.
RS. 16. B. The agency provides and documents other assistance as required to assist the individual to obtain access the services to which they are referring him/her.
Health
RS.17 If food services are provided, the facilities for the preparation and serving of food shall be inspected and approved by the Department of Human Services.
RS. 17. A If food is either prepared or served at the facility, then the agency shall either a DHS Eating Establishment license or show written evidence from DHS indicating that they need no such license.
RS. 17. B. When the agency requires a DHS license, the agency's Eating Establishment license is current.
RS.18 The agency shall have methods for obtaining on- or off-site medical services for all clients.
RS. 18.A. The agency defines in policy and procedure those medical services delivered on-site. For those medical services not provided on-site, letters of agreement and/or procedures for accessing medical service provider(s) are in effect.
Physical Plant
RS.19 A secure and readily accessible storage area of adequate size is available to accommodate client belongings.
RS. 19. A. The agency has a policy and procedure related to what personal belongings may be brought to the agency.
Residential Services
RS.20 Residential service agencies provide or arrange for comprehensive treatment, training and support of clients.
RS. 20. A. Residential service agencies provide or arrange for support and training in the following areas:
RS. 20. A.1 housekeeping and home maintenance skills;
RS. 20. A.2 mobility and community transportation skills;
RS. 20. A.3 interpersonal relationships, including spouse, family and friends;
RS. 20. A.4 health maintenance, including personal hygiene, exercise and fitness, nutrition and diet management, and use of medical services and medicine;
RS. 20. A.5 safety practices, including dealing with injuries and life threatening emergencies;
RS. 20. A.6 financial management, including techniques of client purchasing, banking, taxes, budgeting and repaying debts;
RS. 20. A.7 basic academic skills;
RS. 20. A.8 management of personal and legal affairs;
RS. 20. A.9 contingency planning, problem-solving, decision-making;
RS. 20. A.10 self-advocacy and assertiveness training;
RS. 20. A.11 utilization of community services and resources, including laundromats, library, post office, client affairs offices, etc.
RS. 20. A.12 recreational and leisure time activities;
RS. 20. A.13 work attitude and skills exploration;
RS. 20. A.14 menu planning and meal preparation;
RS. 20. A.15 use of the telephone;
RS. 20. A.16 human sexuality; and
RS. 20. A.17 client affairs and rights, including familiarity with warranties, policies and procedures of governmental and community service agencies.
Interpretive Guideline for RS.20.A through RS.20.A.17.
For providers of children's residential services, these topics will be addressed as applicable on an age appropriate basis.
C.M.R. 14, 193, ch. 6, RESIDENTIAL SERVICE STANDARDS