W. Va. Code R. § 78-3-14

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 78-3-14 - Service Delivery

14.1. Program Description.

The organization shall develop a written description of each service and program that is available to the public and potential consumers. The description shall include:

14.1.1. The goals of the program;

14.1.2. The expected outcomes of the program;

14.1.3. The services provided by the program;

14.1.4. The usual staffing of the program including ratios and overall credentialing;

14.1.5. Characteristics of children appropriately served by the program; and

14.1.6. Restrictions in access to the program, if any.

14.2. Involvement of Families and Guardians.

14.2.1. The organization shall document efforts to involve families of biological origin and foster and adoptive families in developing, modifying and reviewing plans of care unless contraindicated by the court or unless clinically contraindicated in writing in the child record, regardless of custody.

14.2.2. When residential or other out-of-home services cannot be provided close to a child's home, the organization shall document efforts to maintain family ties and involve the family in plan of care and delivery.

14.2.3. The organization is responsible for notifying parents and guardians of:

14.2.3.a. Interdisciplinary team meetings;

14.2.3.b. Changes in the plan of care; and

14.2.3.c. Critical incidents and significant changes in the child's condition.

14.2.4. The notification shall be completed within one working day after the event and documented.

14.2.5. If the organization cannot obtain guardian or parental participation and permission for treatment after documented efforts to do so, it shall not be held in violation of regulatory standards regarding permission and participation. However, the organization shall continue to document on-going efforts to include parents and guardians in the treatment process.

14.3. Behavioral and Therapeutic Interventions. An organization that uses therapeutic interventions shall:

14.3.1. Use positive approaches whenever possible to teach pro-social adaptive behavior and to modify behaviors that may be socially or personally maladaptive;

14.3.2. Identify antecedent conditions that may trigger inappropriate behavior and determine the most appropriate intervention;

14.3.3. Apply interventions in a caring and humane manner; and

14.3.4. Carefully describe and document interventions in the client record and in the plan of care.

14.4. Discipline.

14.4.1. The organization shall outline and follow its practices regarding discipline of persons served and this policy shall prohibit the following:

14.4.1.a. Corporal punishment (physical hitting or physical punishment inflicted in any manner upon the body);

14.4.1.b. Physical exercises such as running laps or pushups when used solely as a means of punishment;

14.4.1.c. Requiring or forcing the child to take an uncomfortable position for an extended period of time or forcing the child to repeat physical movements when used solely as a means of punishment;

14.4.1.d. The use of aversive conditioning such as electric shock devices, sound, heat, cold, light, water, noise, hot pepper, pepper sauce, pepper spray or ammonia;

14.4.1.e. Interventions that involve withholding nutrition, sleep, or hydration;

14.4.1.f. Punitive work assignments;

14.4.1.g. Sanctioning by peers, except as part of an organized therapeutic self-government program that is conducted in accordance with written policy and is supervised directly by employees;

14.4.1.h. Punishment of the group for an individual child's behavior except as it involves a brief delay to initiation of the next activity or to ensure safety of the employees and children or as part of a therapeutic program using logical and natural consequences as a means of discipline;

14.4.1.i. Punishment that subjects the child to verbal abuse, ridicule, or humiliation;

14.4.1.j. Excessive denial of on-grounds program services or denial of any essential program service solely for disciplinary purposes;

14.4.1.k. Denial of visiting or communication privileges with family solely as a means of punishment;

14.4.1.l. Enforced silence for long periods of time;

14.4.1.m. Exclusion of the child from entry to the residence;

14.4.1.n. Assignment of unduly physically strenuous or harsh work;

14.4.1.o. Use of physical restraint involving peers;

14.4.1.p. Use of physical restraint outside commonly accepted systematic methods of passive physical control applied in an appropriately de-escalating fashion; or

14.4.1.q. Use of any technique of manual or physical restraint as an ongoing intervention for inappropriate or undesired behavior except in situations involving significant risk of harm to self or others if the restraint is not used.

14.4.2. The organization shall discontinue use of any intervention if it:

14.4.2.a. Produces adverse side effects such as illness, physical damage, or injury; or

14.4.2.b. Is ineffectual or detrimental to meeting service goals and objectives.

14.5. Medication Control and Administration.

14.5.1. Medication shall be prescribed and monitored by a licensed physician, dentist, physician's assistant, or advanced practice registered nurse. The organization is responsible for physicians and other medical employees contracted for service just as it is responsible for physicians considered to be employees.

14.5.2. Organizations that administer medication using approved medication assistive personnel shall comply with the Department's rule, "Delegation of Medication Administration and Health Maintenance Tasks to Approved Medication Assistive Personnel," 64CSR60.

14.5.3. A child entering a facility with properly bottled and labeled medications may continue on those medications with appropriate consents, until such time as the organization can obtain current physician's orders, either from the organization's physician or the child's physician, to continue the medications will be in accordance with the medical licensing requirements and standards.

14.5.4. When medication is prescribed or administered, the organization shall:

14.5.4.a. Obtain the written consent of the parent or legal guardian and the child over age 12 unless the child is incapable of supplying informed consent or there are compelling and documented clinical or legal reasons to overlook the child's lack of consent.

14.5.4.a.1. When the medication is a psychotropic, except for medications the child is prescribed and taking prior to entering the program, the following information shall be provided to the parent or guardian, or both:

14.5.4.a.1.A. Specification of conditions the medication is to address, such as mood swings, irritability, etc.;

14.5.4.a.1.B. Efforts to address condition without medication;

14.5.4.a.1.C. The expected length of time on medication;

14.5.4.a.1.D. Necessary medical testing needed to determine proper usage of the medication; and,

14.5.4.a.1.E. How often symptoms will be evaluated to determine effectiveness of the medication.

14.5.4.b. Fully explain the benefits and possible side effects of the proposed medication (except in cases of routine refill, changes within a class of medications or dosage changes); and

14.5.4.c. Obtain approval from the parent or legal guardian in advance to dispense medication unless there is documented inability to reach the guardian within a reasonable period of time relative to the urgency of the need for the medication, which shall be documented. In the case of all other prescribed medication, the guardian will be notified, within one next business day, of the medication prescribed, the reason, and the date the medication began.

14.5.5. The organization shall have a written procedure directing the administration and storage of prescribed and over-the-counter medications to include:

14.5.5.a. An individual record for those children who receive medications to include:

14.5.5.a.1. Medications administered;

14.5.5.a.2. The date medications were administered;

14.5.5.a.3. The time of administration (medications are to be administered within one hour of the prescribed time unless otherwise allowed by physician's order); and

14.5.5.a.4. The individual administering the medication;

14.5.5.b. A record of all appointments for medication management including unscheduled or canceled visits;

14.5.5.c. A record of missed medications and the reason;

14.5.5.d. Protocols for the administration of over-the-counter medications that includes individualized approval by a physician or qualified medical practitioner; and

14.5.5.e. Prescription medications shall be properly labeled and packaged and include:

14.5.5.e.1. The name of the person served;

14.5.5.e.2. The dosage and the name of the medication;

14.5.5.e.3. The name of the prescribing physician; and

14.5.5.e.4. An expiration date.

14.5.6. The organization shall have written procedures that govern:

14.5.6.a. The safe disposal of discontinued, out-of-date, or unused medications, syringes, medical waste, or medication; and

14.5.6.b. Provision for locked, supervised storage of medications with access limited to authorized employees.

14.5.6.c. Medication errors as described under subsection 3.46 of this rule.

14.5.7. Only licensed nursing employees may accept verbal orders for changes in medication regimens. These shall be signed by the prescribing physician within one week.

14.5.8. Organizations shall have, at a minimum, a consulting registered nurse whose responsibilities shall include as necessary:

14.5.8.a. Generating and reviewing monthly Medication Administration Records;

14.5.8.b. Matching physician's orders to the medication administration records;

14.5.8.c. Observing employees supervising self-administration of medications at least quarterly;

14.5.8.d. Assisting interdisciplinary teams to develop educational goals for children taking regularly prescribed medications and participating in a supervised self-administration protocol;

14.5.8.e. Instructing employees in dietary or medication administration issues as necessary;

14.5.8.f. Responding to emergency calls from employees on medical issues, and;

14.5.8.g. Conducting ongoing assessments of each child's health needs to include existing medical conditions, dietary issues, and medications.

14.5.9. The nursing employees of the organization shall assess each child or youth for the ability to self-medicate with supervision if the organization allows such administration before the youth is admitted into the program. Children not capable of participating in a plan shall have medications administered by licensed nursing employees or approved medication assistive employees as set forth in the Department's rule, "Delegation of Medication Administration and Health Maintenance Tasks to Approved Medication Assistive Personnel," 64CSR60. This requirement does not apply to organizations that operate shelters with a no refusal policy.

14.5.10. Medications may be self-administered under supervision of employees under the following conditions:

14.5.10.a. As part of the child's plan of care, he or she is taught to identify his or her medications, recognize possible side effects, describe the purpose for the medication and indicate the time of day and frequency of which he or she is to take the medications;

14.5.10.b. The child is assessed by nursing staff as being cognitively capable of learning these skills.

14.5.10.c. Medication is kept in a secure location with limited access to employees only except at dosage times;

14.5.10.d. Employees are fully trained as to the purpose, most common side effects and dangers of each medication prescribed for children in the facility, and can identify each medication on sight;

14.5.10.e. Employees are trained in emergency procedures for overdose or abreactions;

14.5.11. The organization shall assess the effect of medication on the child at regular intervals and base its assessment on:

14.5.11.a. Documentation by clinical employees of the person's behavior in the case record;

14.5.11.b. The observations of the child, employees, and significant others; and

14.5.11.c. Any commonly recommended medical tests necessary to determine the impact and safety of the medication on the persons served (e.g., blood levels, etc.).

14.5.12. Organizations with a length of stay longer than one year shall document attempts to titrate psychotropic medications to the lowest possible level while still achieving symptom control prior to discharge.

14.6. Medication as Chemical Restraint.

An organization shall not use chemical restraints unless permitted otherwise by its specific rules.

14.7. Case Records.

14.7.1. The organization shall maintain a case record for each child served that shall be retained for a minimum of 5 years following the child's 18th birthday.

14.7.2. Case records are confidential and access to case records is limited to:

14.7.2.a. The child and as appropriate, his or her parent, guardian, or attorney, unless legally contraindicated;

14.7.2.b. Employees authorized to see specific information on a "need-to-know" basis; and

14.7.2.c. Others outside the organization whose access to the information contained in case records is permitted by law.

14.7.3. When not being used by authorized employees, case files should be returned to a secure area.

14.7.4. The case record shall comply with all legal requirements and contain, at a minimum:

14.7.4.a. Biographical or other identifying information;

14.7.4.b. Copies of custody and guardianship papers and court orders if appropriate and possible within the time frame of the program;

14.7.4.c. Reasons for referral and admission date;

14.7.4.d. Assessment information;

14.7.4.e. A master plan of care including goals and objectives of service;

14.7.4.f. Behavior support plans or therapy plans, or both, if any;

14.7.4.g. Reviews of the master plan of care as appropriate;

14.7.4.h. Reports from outside or contracted providers of service to the child;

14.7.4.i. Copies of all signed, written consent forms;

14.7.4.j. Routine documentation of ongoing services;

14.7.4.k. Documentation of incidents or investigations or reference to a separate incident file for each incident or investigation;

14.7.4.l. Documentation of any therapeutic physical restraints used by the organization with the child in question;

14.7.4.m. Documentation of medication administration for prior months;

14.7.4.n. Educational records, such as report cards, individual education plans, and class schedules, as available considering average program length;

14.7.4.o. Recommendations for ongoing or future service needs and assignment of aftercare or follow-up responsibility if needed and appropriate will be outlined in the discharge summary; and

14.7.4.p. A discharge summary will be entered within 30 days of termination or discharge.

14.7.5. The organization shall document a reasonable effort to obtain required materials.

14.7.6. When necessary and appropriate, the case record shall also include:

14.7.6.a. Legal evidence of custody;

14.7.6.b. Court ordered restrictions on the rights of persons served;

14.7.6.c. Psychological, medical, toxicological, diagnostic, or psychosocial evaluations;

14.7.6.d. Copies of all written orders for medications or special treatment procedures such as diet and physical therapy;

14.7.6.e. Regular reports from contracted service providers serving the child or family; and

14.7.6.f. Other information essential for delivering service to the child.

14.7.7. Only authorized employees may make entries into case records and all entries shall be:

14.7.7.a. Specific, factual, and pertinent to the nature of the service and the needs of the persons served; and

14.7.7.b. Completed, signed, or electronically identified and dated by the person who provided the service.

14.7.8. Case records shall be clearly legible, kept up-to-date from intake through termination and contact entries shall be made within one working day, unless the group is away from the main facility, in which case entries shall be made within one working day, of return to the main facility or program site.

14.8. Termination or Discharge.

14.8.1. Discharge plan shall be developed with the creation of the plan of care.

14.8.2. Termination or discharge shall occur when:

14.8.2.a. The child achieves the goals of his or her plan of care or is no longer in need of out-of-home care;

14.8.2.b. The child has reached maximum benefit or cannot benefit further from services provided by the organization;

14.8.2.c. The guardian terminates treatment;

14.8.2.d. The child no longer meets eligibility criteria;

14.8.2.e. The child refuses to meet program standards or requirements; or

14.8.2.f. The child completes court-ordered treatment.

14.8.3. The organization and interdisciplinary team, guardian, placement organization (such as the court), multidisciplinary team, and the person or family shall jointly plan for termination or discharge. Prior to discharge, the team shall meet to review and document the child's progress in treatment, describe continuing problems and issues and develop specific recommendations for aftercare and follow-up. The aftercare and follow-up plans or recommendations shall be provided to the child and his or her parent and guardian upon discharge.

14.8.4. The organization shall enter a discharge summary into the case record upon termination of service within 10 days of termination or discharge that:

14.8.4.a. Includes recommendations for any needed future services; and

14.8.4.b. Provides a summary of services received while in care and an assessment of service effectiveness.

14.9. Educational Services.

14.9.1. The organization shall access an educational program for each school-age child in care.

14.9.2. All children in residential child care shall be enrolled in an educational or vocational program (depending on age and the child's expressed desire) and provided with an educational or vocational plan, as appropriate, that is integrated into his or her plan of care and complies with the requirements set forth by the State Department of Education.

14.9.3. When appropriate and unless clinically, programmatically, or educationally contraindicated, children and transitioning adults shall be enrolled in the public school system. Organization employees shall maintain regular contact with school employees at a frequency appropriate for the severity and type of each child's problems and service needs. The organization shall have a practice describing the method and frequency of contact.

14.9.4. The organization shall collaborate with the public or private school so that information can be exchanged freely, and problem behaviors addressed consistently across all environments.

14.10. On-Ground Schools.

14.10.1. On-ground schools shall be operated by the State Department of Education or a county board of education. Outdoor therapeutic educational programs are exempt from this requirement and shall comply with the requirements set forth in section 22 of this rule.

14.10.2. Therapeutic support plans developed in the residential setting shall be continued in the on-ground educational setting and vice versa. The educational program and the residential program shall communicate on a regular basis to ensure that this occurs and shall exchange data and information regularly. The organization shall have a practice and an interorganizational or interoffice agreement specifying how the organizations or offices will interact and the frequency of that interaction.

14.11. Groups and Groupings.

14.11.1. The organization shall ensure that therapeutic activities and groups shall be of an appropriate size to promote the success of the activity. Living areas are limited to no more than 12 children.

14.11.2. Children shall have the right to be housed with children of the same approximate ages, developmental levels, and social needs. This separation shall be a matter of organizational practice.

14.11.2.a. The organization shall not admit a child under six years of age without prior written approval from the Secretary.

14.11.2.b. No child over the age of five years shall occupy a bedroom with a member of the opposite sex.

14.12. Employment Opportunities.

The organization may involve the child in voluntary maintenance of the facility so long as those work programs do not replace the organization's need for housekeeping and maintenance employees. Household "chores" may be required as a condition of participation in the program or as a method of moving to a more privileged level of programming. Descriptions of the employment opportunities should be included in the organization's descriptions. All employment opportunities shall be evaluated for their therapeutic or habilitative value. The organization shall pay the child for an activity at a level required by state or federal law if there is no therapeutic or rehabilitative value in the activity. Money earned in an employment opportunities belongs to the child, although the organization may maintain control of the money until the child's discharge, using an accurate and on-going method of tracking disbursements and deposits, made available to the child or guardian upon request. Employment opportunities other than household "chores" shall be evaluated and approved by the interdisciplinary team.

14.13. Daily Schedules.

14.13.1. The interdisciplinary team shall provide each child with a written daily schedule of activities designed to help him or her develop positive personal and interpersonal skills and behaviors by providing activities that are individualized, as needed to meet treatment needs:

14.13.1.a. Appropriate to the age, behavioral level, emotional needs, strengths, and interests of the child;

14.13.1.b. Specialized to meet the child's identified strengths and needs as described in the assessment and plan of care;

14.13.1.c. Normalizing and integrated into the community to the maximum extent possible given the child's clinical needs and behavioral functioning;

14.13.1.d. Available at all times to the employees and child; and

14.13.1.e. Comprehensive of all waking hours while allowing a reasonable amount of recreational, study and quiet time.

14.13.2. The daily schedules are not required to be archived in the child's file.

14.14. Employee Supervision.

14.14.1. At all times, the organization shall have sufficient employees to allow the number of children being served to be adequately supervised, taking into consideration the complexity of the needs of the children. The organization shall consider appointments requiring employee supervision, employee leave, possible illness of children and any other relevant factor when scheduling employee and child activities.

14.14.2. Except as otherwise provided by this rule, children shall be supervised at all times. Short breaks in direct supervision shall be therapeutically indicated or necessary for the child to gain independence. The supervision of each child shall be determined in relation to normalcy and the reasonable and prudent parent standard. The supervision level must be documented in the child's treatment plan that shall detail specific activities geared to support the youth's treatment needs. Generic treatment plans will not meet the intent of this regulation.

14.14.3. Youth actively working toward independence shall be permitted short breaks in supervision to pursue recreation, employment or educational opportunities that complement his or her plan of care.

14.14.4. The organization shall have a procedure regarding employee supervision that ensures the safety, supervision and security of children who are acutely disturbed or suicidal, or both.

14.14.5. The organization shall have a procedure regarding supervision of children in off grounds activities that shall maximize the supervision and safety of children participating in the activities.

14.14.6. The organization shall ensure that when children leave a facility for overnight visits, there is a procedure for signing or being checked in and out of the program. The checklist or sign-in sheet shall be dated and shall include time in and out, the person responsible for the child, as appropriate, and the location at which the child may be contacted if necessary.

14.15. Special Services and Populations.

14.15.1. If an organization provides specialized services to a unique population (e.g., children with issues of substance abuse, children with developmental disabilities, sexually reactive children) the organization shall ensure that:

14.15.1.a. The service and clinical model reflects knowledge and use of the best practices available in the field;

14.15.1.b. Clinical and professional employee are appropriately trained and when possible certified or licensed in the area of service provided;

14.15.1.c. Direct care employees are specially trained to understand issues in clinical treatment of the population and able to use suitable intervention techniques when necessary and appropriate;

14.15.1.d. The environment and milieu of the treatment location is clinically, structurally, and developmentally appropriate for the population served; and

14.15.1.e. The facility is suitably secure and employee ratios suitably high to ensure the supervision and safety of children served during a crisis.

14.15.2. If an organization accepts into service a child with unusual clinical or programmatic needs, or both, the organization is responsible for adapting its routine practices to meet the needs of the child in care to the greatest extent possible. If it becomes evident that the child cannot benefit from the program, even with the adaptations the organization is able to make, the organization is responsible for assisting the department in identifying a more suitable placement at the earliest opportunity in conjunction with the guardian or multidisciplinary team, or both.

14.15.3. A residential program that specializes in serving children and transitioning adults with developmental disabilities or intellectual disabilities shall ensure that employees are trained to properly provide habilitation services and supervision in the following areas as appropriate for the population served:

14.15.3.a. Feeding;

14.15.3.b. Communication with nonverbal individuals;

14.15.3.c. Use of community recreation options;

14.15.3.d. Management of self-abusive and aggressive behavior;

14.15.3.e. Adaptive living skills;

14.15.3.f. Person first language and attitudes;

14.15.3.g. Therapeutic behavioral supports; and

14.15.3.h. Implementation of normalcy.

14.15.4. When serving individuals with developmental disabilities for more than 30 days, the program shall provide supportive services to help them fully interact with the community and achieve maximum independence. If the organization provides or contracts for the provision of therapeutic services such as individual therapy, it shall ensure that therapeutic interventions are adapted for the developmental functioning of the child.

14.15.5. An organization that provides services to children with developmental disabilities shall adhere to and implement normalcy and adapt the organization's therapeutic facilities to meet the developmental needs of the child.

14.15.6. The organization shall provide children with co-occurring presenting issues with specialized services to meet their needs as identified in the comprehensive assessment. The organization shall arrange for detoxification and inpatient services to meet any emergency needs of children.

14.15.7. The organization shall ensure that children are provided with therapeutic and didactic interventions that directly address his or her substance abuse and any deficits in adaptive functioning relating to or concurrent with the abuse of substances.

14.15.8. If the organization specializes in co-occurring presenting issues, employee training shall comprehensively address the latest information, theories, and techniques in:

14.15.8.a. Identification, diagnosis and treatment of alcohol and drug abuse;

14.15.8.b. The concept of chemical dependency as a disease; and

14.15.8.c. Prevention activities that address both primary and relapse prevention.

14.15.9. When the initial assessment indicates the presence of a sexually sensitive history (either as offender or victim) the organization shall:

14.15.9.a. Obtain either directly or by contract or referral information a thorough assessment of the sexual history and functioning of the child, attending in particular to episodes of victimization or offense;

14.15.9.b. Obtain either directly or by contract or referral specialized treatment interventions or services as appropriate; and

14.15.9.c. Consider the child's history when making determination regarding housing and supervision in order to ensure the safety of all the children.

14.15.10. If the organization specializes in the treatment of children with sexualized behaviors:

14.15.10.a. The milieu shall be organized and maintained in such a way as to maximize the safety and supervision of the children at all times; and

14.15.10.b. Employees shall be specially trained in the supervision and treatment of sexualized behaviors in children; and

14.15.10.c. Professional employees shall be trained and certified as appropriate in the treatment of sexualized behaviors in children or shall be in the process of obtaining certification and properly supervised by certified employees.

14.15.11. If the organization discovers that a child is pregnant and it is not a Maternity and Parenting Program, it shall provide or make referral for the following health services, at a minimum, until other arrangements are made;

14.15.11.a. Fetal alcohol syndrome screening;

14.15.11.b. Prenatal care;

14.15.11.c. Well-baby care; and

14.15.11.d. Parenting skills instruction.

14.16. Health Services.

14.16.1. The organization shall have a procedure in place to ensure emergency medical care for all its children on a 24-hour basis.

14.16.2. Each child shall have upon admission or receive within 72 hours of admission a current medical screening by a qualified medical practitioner (EPSDT). The screening shall document:

14.16.2.a. A general history of the child's and family's health;

14.16.2.b. The patient's current medications;

14.16.2.c. Allergies;

14.16.2.d. Pertinent medical problems requiring nursing attention;

14.16.2.e. Current risk and safety factors;

14.16.2.f. Nutritional status;

14.16.2.g. Immunization status, and

14.16.2.h. Sleep patterns.

14.16.3. In facilities with stays of longer than 30 days duration, appropriate dental assessments shall be conducted at least annually to include provision of any routine dental care as recommended by the evaluating dentist.

14.16.4. Health services shall also include, in facilities with stays of longer than 30 days duration, age appropriate instruction regarding:

14.16.4.a. Pregnancy prevention,

14.16.4.b. AIDS/HIV and STD prevention,

14.16.4.c. Nutrition;

14.16.4.d. Laboratory or other diagnostic work as prescribed by a physician; and,

14.16.4.e. Other general information about the prevention and treatment of disease.

14.16.5. Educational services shall also be provided regarding psychotropic medications and mental health as age appropriate and necessary. When possible, the family of origin or expected family of projected placement shall be educated as well.

14.17. Clothing.

14.17.1. The organization shall ensure that each child in care has adequate, clean, well fitting, attractive, and seasonable clothing as required for health, comfort, and physical well-being and as appropriate to age, sex and individual needs. The child shall be encouraged to participate in the selection of clothing.

14.17.2. A child's clothing shall not be shared in common.

14.17.3. Clothing shall be kept clean and in good repair. The child shall be involved in the care and maintenance of his or her clothing. As appropriate, laundering, ironing, and sewing equipment shall be accessible to the child.

14.17.4. When uniforms are required, the child and parents or guardians shall be advised of this requirement prior to admission.

14.17.5. The organization shall ensure that discharge plans make provisions for clothing needs at the time of discharge. All personal clothing shall go with a child when he or she is discharged, or arrangements shall be made if the child was not able to leave with his or her personal belongings.

14.18. Personal Belongings.

The organization shall allow a child to bring personal belongings to the program and to acquire belongings. However, the organization shall, as necessary, limit or supervise the use of these items. Provisions shall be made for the protection of a child's property. The organization shall provide a list of items that are not appropriate for the child to have at the program upon intake.

14.19. Personal Hygiene.

14.19.1. Procedures to ensure that children receive assistance and education in personal care, hygiene and grooming appropriate to their age, gender identity, race and culture shall be established.

14.19.2. The organization shall ensure that children are provided with all necessary toiletry items.

14.19.3. A child shall be permitted a reasonable degree of freedom in selecting a style of wearing his or her hair and clothing.

14.20. Religion and Culture.

14.20.1. Children shall have the opportunity to participate in religious activities and services in accordance with their own faith. The organization, when necessary, shall arrange transportation.

14.20.2. Children may not be coerced or required to attend religious activities.

14.20.3. The organization shall involve children in cultural or ethnic activities, appropriate to their own cultural or ethnic background.

W. Va. Code R. § 78-3-14