212 R.I. Code R. 212-RICR-10-10-1.5

Current through December 3, 2024

Section 212-RICR-10-10-1.5 - Rights of Persons Served in Residential Programs

A. Programs that provide twenty-four (24) hour care shall develop and implement policies and procedures that address the rights of the persons served as described in §§1.5.1 and 1.5.4 of this Part below.

B. No resident admitted to any community residence shall be deprived of any constitutional, civil or legal right solely by reason of admission pursuant to R.I. Gen. Laws § 40.1-24.5-5. In addition to the rights of persons served noted in §1.5.3 of this Part below, each resident is entitled to the following rights without limitation:

1. To privacy and dignity;

2. To communicate by sealed mail or otherwise with persons of the resident's choosing;

3. To be visited privately at all reasonable times by his or her personal physician, attorney or clergy;

4. To vote and participate in political activity with, as needed, reasonable assistance in registering and voting;

5. To be employed at a gainful occupation insofar as the resident's condition permits;

a. No resident shall be required to perform labor that involves the essential operation and maintenance of the community residence or program or the regular care and supervision of other residents. Residents may be required to perform labor involving normal housekeeping and home maintenance functions as documented in their person-centered plan or as delineated in the community residents' Rules and Regulations.

6. To attend or not attend religious services; and

7. Residents have the right to access the Mental Health Advocate and to have assistance, when desired and necessary, to implement this right. R.I. Gen. Laws § 40.1-5-22.

C. Except to the extent that the residential program director determines that a limitation or a denial of any of the following rights would be in the resident's best interests and, further, unless the director documents the good cause reasons for the denial or limitations in the resident's person-centered plan, the resident shall be entitled to the following:

1. To keep and use one's own personal possessions;

2. To have reasonable access to a telephone to make and receive private calls;

3. To keep and be allowed to spend a reasonable sum of one's own money for consumer purchases;

4. To have opportunities for physical exercise and outdoor recreation;

5. To have reasonable, prompt access to current newspapers, magazines and radio and television programming; and

6. To receive visitors of one's own choosing at reasonable times. Posted reasonable visiting hours must be maintained in each community residence.

D. The following shall apply when any of the rights listed in § 1.5(C) of this Part above are restricted:

1. Reasons for the restriction must be explained to the resident;

2. The resident's person-centered plan shall address ways for the resident to gain or regain the restricted right(s);

3. Restrictions shall be as limited as possible and should not occur if there is an alternative, less restrictive way for the individual to participate in the program and attain his or her treatment goals;

4. All restrictions shall be reviewed by the treatment team and the program administrators within thirty (30) days of implementation and at least quarterly thereafter; and

5. At the resident's request, information about such restrictions shall be forwarded to family members.

E. Every effort shall be made by the organization to give a prospective resident an opportunity to visit the BHO's residential program prior to admission. The prospective resident shall participate in making the decision regarding his or her admission.

F. Individuals served in a twenty-four (24) hour setting who want spiritual support or services shall have reasonable access to them. Access to spiritual support or services shall not infringe on the rights of other residents.

1.5.1Protection of Rights: Human Rights Officers

A. Each organization shall designate and empower at least one (1) person employed by or affiliated with the organization to serve as a Human Rights Officer (HRO). The HRO must, to the extent possible, have no duties that may conflict with his or her responsibilities as an HRO and the organization must ensure that the HRO is given the time and resources to perform his or her human rights responsibilities. The name of the HRO and the method for contacting her or him shall be given to all persons served and shall be posted in a conspicuous place, such as waiting rooms and/or other common/public places, at all sites where services are provided by the organization.

1. Individuals selected to fulfill the responsibilities of an HRO must have satisfactorily completed a HRO training program approved by the Department and, at a minimum, must meet the following qualifications:

a. Ability to serve as an advocate for all persons served while working cooperatively and effectively with staff;

b. Knowledge and skills to conduct investigations; and

c. Capacity to perform responsibilities in an impartial manner.

2. The responsibilities of the HRO include the following:

a. Ensuring that persons served are informed of their rights and given opportunities to receive education regarding their rights;

b. Providing ways for persons served to have an opportunity to discuss and ask questions about their rights;

c. Training all staff, during orientation, regarding the rights of persons served, as defined in these Regulations;

d. Assisting persons served to exercise their rights;

e. Monitoring the implementation of human rights Regulations throughout the organization; and

f. Fulfilling all HRO responsibilities specified in the Grievance Procedure.

3. The above responsibilities shall be included in the HRO's position description and his or her performance relative to these responsibilities shall be evaluated at least annually.

1.5.2Confidentiality

All persons served have the right to have their records kept confidential pursuant to the applicable Federal and State laws and Regulations.

1.5.3Grievance Procedure

A. Every BHO shall establish an accessible grievance procedure.

B. The grievance procedure shall be presented to every person served in a manner consistent with the person's learning style and be conspicuously posted in the BHO. The notice of grievance procedure shall include the name and contact information for organizations that provide free legal assistance.

C. The person served shall be entitled to initiate a grievance. It shall be the duty of the BHO to encourage and assist the person in exercising his or her rights.

D. The person served shall initiate the grievance by filing for a grievance with the director of the BHO. The director shall forthwith forward a copy of the grievance form to the HRO.

E. The director of the BHO, or his or her designee, with the assistance of the HRO, or his or her designee, shall investigate the grievance and issue a written decision to the person within ten (10) business days of receipt of the grievance. The written decision shall include a copy of the grievance, a list of persons interviewed in the investigation, the steps taken to resolve the grievance, and the conclusion of the BHO director or his or her designee.

F. The HRO, or his or her designee, shall, if necessary, assist the person in requesting a review.

G. If the person is not satisfied with the outcome of the grievance proceedings, the person may file for an administrative hearing in accordance with the Appeals Process and Procedures for EOHHS Agencies and Programs, 210-RICR- 10-05-2.

1.5.4Behavioral Management

A. Aversive techniques are prohibited in all BHOs.

B. Behavioral management procedures require the written consent of the person served as identified in the person-centered treatment plan.

1. Persons served and, as appropriate, their families, shall participate in selecting behavior management interventions.

C. The organization shall develop and implement written policies and procedures that describe the use and the monitoring of behavioral management interventions. These policies and procedures must be consistent with applicable Federal and State Regulations and incorporate the following standards:

1. The organization shall require a positive approach to behavior management;

2. The least restrictive alternative shall be used in selecting a behavior management intervention;

3. Behavioral management goals and objectives must be integrated with the individual's other goals and objectives and be in accordance with written policies and procedures that govern service expectations, treatment goals, safety and security;

4. When the organization serves as representative payee for the person served, the person's benefits may not be used as reinforcers or restrictions in a behavioral management agreement;

5. A behavioral management agreement that is part of the person-centered plan shall document:

a. The behaviors that are the target of the plan;

b. The methods to teach appropriate expression of the targeted behavior or alternative adaptive behavior;

c. The procedures to be used;

d. How often, under what circumstances, and by whom the plan will be implemented; and

e. The intended result of the behavioral management interventions.

6. Other individuals served by the organization shall not be requested or assigned to carry out any element of the person's behavioral management plan;

7. Prohibited interventions include, but are not limited to, the following:

a. Corporal punishment;

b. Fear-eliciting procedures;

c. Denial of any basic need such as shelter, essential clothing, and an adequate, nutritional diet; and

d. Denial of the person's legal rights.

D. All behavioral management plans shall be developed, implemented, and monitored by employees or contractors trained in behavioral management.

E. The person served has the right to withdraw, at any time, his or her agreement to an element, or to all elements, in a behavioral management agreement or plan and to be advised of the potential risks and impact on his or her treatment process.

F. The organization shall identify, educate, and approve those staff who will be responsible for the development and implementation of behavioral treatment plans.

G. Policies and procedures shall specify the mechanism for monitoring the use of behavioral management.

H. Policies and procedures related to behavioral management shall be available to persons served, and as appropriate, to their families, guardians, and advocates.

1.5.5Seclusion and Restraint

A. Seclusion, chemical restraint, and mechanical restraint, as defined in this Part, are prohibited in all BHOs.

B. Physical restraint as defined in this Part may be used only when there is an imminent risk of danger to an individual or others and no other safe and effective intervention is possible. Nonphysical interventions are the first choice as an intervention, unless safety issues demand an immediate physical response.

1. When physical restraint is used, it shall be applied in a manner that minimizes the possibility of physical injury or mental distress to the individual.

a. Only approved physical restraining procedures that have been developed by a nationally recognized organization shall be used.

b. The individual served shall not be placed in a prone restraint, as prohibited by R.I. Gen. Laws § 42-158-4.

c. The individual shall be removed from restraint as soon as the threat of harm has been safely minimized.

C. The individual and, if appropriate, the individual's family shall participate with staff who were involved in the episode in a debriefing about each episode of restraint.

D. The use of physical restraint must be recorded in the individual's treatment record by a staff member who was present at the time of the restraint.

E. Every use of restraint shall be recorded and reported as an adverse event to the Department's Office of Quality Assurance.

1. The organization shall collect data on the use of restraint in order to monitor and improve its performance and report it to the Department's Office of Quality Assurance.

212 R.I. Code R. 212-RICR-10-10-1.5

Adopted effective 1/7/2019
Amended effective 12/27/2022
Amended effective 2/13/2023
Amended effective 1/1/2024