Library: Policy

340:100-5-22.1. Community residential supports

Revised 9-15-17

(a) Applicability.Community residential supports are funded through contracts with the Oklahoma Department of Human Services DHS, Oklahoma Health Care Authority (OHCA), or both, and must meet standards per this Section.

(1) A service recipient is considered receiving community residential supports when the service recipient receives:

(A) daily living supports (DLS), per Oklahoma Administrative Code (OAC) 317:40-5-150;

(B) Prader-Willi Syndrome services;

(C) agency companion services (ACS), per Part 1 of OAC 317:40-5; or

(D) specialized foster care (SFC), per Part 5 of OAC 317:40-5.

(2) This Section does not apply to:

(A) group home services, per OAC 340:100-6; or

(B) services provided to service recipients who receive assisted living services, per OAC 340:100-5-22.2.

(b) General information.

(1) Services for children are provided in family settings unless approved by the Developmental Disabilities Services DDS Community Services Unit programs administrator or designee.

(2) In addition to OAC 340:100-5-50 through 340:100-5-58, the DDS case manager ensures each Personal Support Team (Team) assesses and addresses the service recipient's needs regarding:

(A) safety in the home, including:

(i) storage of toxic chemicals, cleaning supplies, and combustibles; and

(ii) use of a tempering valve or other anti-scald device or lowered, hot water tank temperature to control water temperature;

(B) financial issues in addition to OAC 340:100-3-4 , including:

(i) a household budget that provides adequate resources for housing, food, clothing, furnishings, personal supplies, and recreational opportunities; and

(ii) assistance needed by the service recipient in money management;

(C) selection, adaptation, and maintenance of a home;

(D) community inclusion and access to work, recreation, and therapies;

(E) transportation; and

(F) water safety.

(3) Each service recipient is responsible for his or her room and board expenses, including recreational activities, clothing, furnishings, food, and other expenses for services or supports not funded through DHS, except as:

(A) provided to members of the Homeward Bound class; or

(B) approved in emergency circumstances per OAC 340:100-3-33 or 340:100‑5‑3.

(c) Homes.Community residential supports are provided in the service recipient's home.The provider agency ensures:

(1) the home and yard are clean, well-maintained, safe, hazard free, and adapted to the service recipient's needs;

(2) the home has:

(A) utility service and adequate heating, cooling, and plumbing;

(B) safety items in operating condition located in strategic locations in the home, such as a:

(i) flashlight;

(ii) smoke detector;

(iii) carbon monoxide detector;

(iv) first aid kit;

(v) fire extinguisher; and

(vi) tempering valve or other anti-scald device, when determined by the Team necessary to ensure the service recipient's safety;

(C) phone service is available and accessible to the service recipient.Emergency numbers are available at each phone, including:

(i) the DDS toll-free number;

(ii) the fire, police, ambulance, hospital, and poison control, when not in a 911 area;

(iii) a physician name and number; and

(iv) a nursing agency number, when applicable;

(D) at least two means of exit;

(E) a bedroom of at least 80 square feet for each service recipient living in the home.When a service recipient shares a bedroom with another individual, the bedroom must have 120 square feet or more;

(F) adequate enclosed storage space available for personal items;

(G) laundry equipment, when in the home, located in a safe, well ventilated, and clean area, with dryers vented to the outside;

(H) an address clearly visible from the street;

(I) a bathroom that:

(i) includes a:

(I) flush toilet;

(II) fixed basin; and

(III) shower or bath tub that meets the service recipient's needs;

(ii) is in proper working order;

(iii) provides privacy;

(iv) is adapted when needed; and

(v) provides hot and cold running water; and

(J) a kitchen and equipment to store, prepare, and serve food in a sanitary manner;

(3) dangerous or deadly weapons are not permitted in the home, except as provided in OAC 317:40-5-40.  Provider agency staff is prohibited from assisting any service recipient to obtain or possess dangerous or deadly weapons.Dangerous or deadly weapons include, but are not limited to:

(A) guns, BB guns, air rifles, or other firearms;

(B) crossbows;

(C) paint guns;

(D) arrows;

(E) explosives;

(F) stun guns; and

(G) knives, except cooking and eating utensils; and

(4) illegal substances are not permitted in the home.

(d) Pre-service requirements.The DDS case manager and service recipient, or, when applicable, legal guardian, complete and approve steps (1) through (3) when community residential supports are initiated, when the service recipient changes provider agencies, and before the service recipient moves to a new home.The documentation of such is maintained in the home record and the case manager record.

(1) Prior to service delivery, the provider completes an emergency housing back-up plan for review and approval by the service recipient's Team per OAC 340:100-5-52.

(A) The back-up plan contains the:

(i) service recipient's name;

(ii) description of the living arrangement;

(iii) name and phone number for back-up staff;

(iv) back-up housing location;

(v) written agreement by the:

(I) service recipient or legal guardian;

(II) direct provider of service, when an ACS or SFC provider;

(III) agency program coordination staff (PCS), as applicable;

(IV) provider agency administrative representative, as applicable; and

(V) DDS case manager;

(vi) dates for provider review of back-up plan, required quarterly and as changes occur; and

(vii) review date by the DDS case manager.

(B) When the location for the back-up plan is a hotel or motel, the provider agency is responsible for including a plan to pay the cost without additional reimbursement from DHS.

(C) DHS must complete a home profile on a private home prior to the Team's identification of the home in the back-up plan or use of the home to provide back-up services to the service recipient.A home profile is not required when the service recipient stays in the private home of a relative, per (f)(4)(A) of this Section.

(D) The ACS or SFC provider is responsible for re-establishing a residence when his or her home becomes uninhabitable.

(2) The provider agency cooperates with the service recipient and Team to establish and maintain a household budget based on the service recipient's earned and unearned income.

(A) Expenses associated with supporting the household are maintained in an auditable fashion sufficient to track the use of money collected from the service recipient by the contract provider.

(B) Upon request, the contract provider furnishes to the service recipient, service recipient's family, and legal guardian:

(i) a record of all funds collected from the service recipient;

(ii) documentation of how the money was used; and

(iii) the amount of remaining money held by the provider.

(C) Upon termination of residential supports from the contract provider, unused funds are returned to the service recipient within 10-calendar days of service termination date.

(3) Form 06CB034E, Residential Pre-Service Checklist, is completed and this Section's requirements are satisfied.

(e) Service requirements.

(1) Unless the service recipient demonstrates the ability under varying conditions to independently and appropriately respond to emergency situations, the provider agency assists in conducting fire drills at least quarterly and weather emergency drills twice a year.The dates, times, and outcomes of the drills are available in the home for review.

(2) The provider:

(A) ensures all financial information necessary for maintaining the service recipient's financial eligibility is provided to DHS in a timely manner;

(B) when serving as payee, ensures the service recipient maintains financial eligibility for benefits and services by notifying appropriate authorities of a change in the service recipient's income;

(C) when a change of payee is necessary, cooperates to ensure the change is made in a timely manner;

(D) establishes a written financial agreement with the service recipient or legal guardian that defines financial responsibilities of the provider's and service recipient's financial responsibilities.The financial agreement:

(i) accurately reflects the ongoing financial arrangement between the provider and service recipient;

(ii) clearly defines who purchases personal items;

(iii) is renewed annually and when changes occur; and

(iv) is available to the service recipient, legal guardian, Office of Client Advocacy advocate, and DDS case manager;

(E) as a member of the service recipient's Team, assists in determining safeguards necessary to protect the service recipient's assets;

(F) allows service recipients to select stores for the purchase of food, clothing, and personal items;

(G) implements the service recipient's Individual Plan (Plan);

(H) provides necessary assistance, including staff support for each service recipient's active participation in community life;

(I) assists the service recipient in maintaining an adequate supply of seasonal clothing that fits appropriately, personal grooming materials, and linens.All items are maintained in good condition;

(J) promotes the service recipient's health and welfare, including providing meals that meet the service recipient's nutritional needs;

(K) promotes visitation and contact with each service recipient's natural family, legal guardian, and friends, according to the service recipient's desires;

(L) promotes friendships with neighbors, co-workers, and peers, according to the service recipient's desires;

(M) when the service recipient, legal guardian, or provider wants to discontinue services, cooperates in securing alternative services and continues to serve the service recipient until the Team confirms all essential services are in place;

(N) while providing services, ensures staff is engaged at all times in purposeful activity that directly or indirectly benefits the service recipient;

(O) ensures the service recipient attends scheduled medical and therapy appointments.

(i) Transportation to the appointment is provided.

(ii) Adequate records, needed materials, and equipment accompany the service recipient to the appointment.

(iii) When the service recipient requires support in describing illness, issues, or concerns to the health care provider, knowledgeable staff accompanies the service recipient;

(P) ensures the service recipient's prescriptions are filled and administered as prescribed, per OAC 340:100-5-32;

(Q) ensures the Plan in a positive manner addresses issues related to maintaining the home per (c) of this Section;

(R) ensures the service recipient has transportation to programs and services.

(i) Transportation is provided to and from:

(I) medical or therapy appointments;

(II) personal shopping;

(III) leisure or recreational activities;

(IV) vocational or employment activities;

(V) religious or cultural activities;

(VI) Team meetings;

(VII) appointments necessary to secure or maintain needed services; and

(VIII) voting.

(ii) All vehicles used to transport the service recipient meet local and state licensing, inspection, insurance, and capacity requirements.

(iii) A vehicle used to transport a service recipient with physical disabilities is adapted to meet the service recipient's needs.

(iv) Drivers of vehicles have valid and appropriate driver licenses.

(S) ensures the hot water temperature for the home is set to no more than 120 degrees Fahrenheit.The provider tests the hot water temperature of the home at least annually, after any servicing of the home's water system, and any time the water temperature is believed to have increased above 120 degrees Fahrenheit.The provider maintains test documentation and the documentation at minimum includes the test date and the home's hot water temperature.The documentation is maintained in the home and available for inspection.The provisions within this paragraph will henceforth be known as the Julie Teenor Anti-Scald Protocol; and

(T) ensures reasonable precautions are employed for safety with hot food, cooking oils, and other hot liquids.

(f) Provider agency policies, practices, and procedures.The provider agency develops and maintains written policies and procedures that are consistent with DHS rules and govern all aspects of service provision.

(1) Provider agency policies are made available to each service recipient, the service recipient's parent(s), legal guardian, or advocate, provider agency staff, and DHS.

(2) Provider agency policies and procedures include, but are not limited to:

(A) service recipient rights protection;

(B) services provided;

(C) admission and discharge criteria;

(D) grievance procedures;

(E) prevention and reporting of abuse, neglect, and/or exploitation;

(F) confidentiality;

(G) emergency management;

(H) fees paid by service recipient;

(I) health and safety precautions; and

(J) safeguarding service recipient funds.

(3) The provider agency designates one person who, in the absence of the agency administrator, is responsible for the administration of the agency and is empowered to act on behalf of the provider agency.

(4) The provider agency is responsible for recruitment, screening, training, and supervision of staff or volunteers providing direct services, ensuring direct support staff:

(A) is not supervised by a relative or person living in the staff's home.A relative includes wife, husband, children, parents, stepparents, parents-in-law, grandchildren, grandparents, brothers, sisters, stepchildren, brothers-in-law, sisters-in-law, sons-in-law, daughters-in-law, aunts, uncles, nieces, nephews, first cousins or any such person with whom the employee shares a foster relationship;

(B) who provides back-up services is available and has received training per OAC 340:100-3-40;

(C) is at least 18 years of age;

(D) is present in sufficient numbers to ensure the service recipient's health and welfare, as authorized by the service recipient's Plan of Care;

(E) is physically able and mentally alert to carry out the job duties;

(F) implements and follows the service recipient's Plan;

(G) does not take the service recipient to visit staff's home unless the Team has provided prior written approval; and

(H) must meet requirements of OAC 317:40-5-40 when overnight visits are going to occur.

(5) The provider agency ensures the Program Coordinator Staff (PCS) supervises, guides, and oversees all aspects of programming associated with receipt of community residential supports.

(A) The PCS must:

(i) get to know the service recipient and his or her needs;

(ii) make announced and unannounced visits to the service recipient's home.The PCS makes a minimum of three face-to-face visits per month, to monitor the service recipient's needs and for staff supervision.Agency administration staff meeting (f)(5)(A)(xii) requirements of this Section, may complete these visits in addition to program coordination staff.At least two of the three visits must be unannounced.Of the unannounced visits:

(I) at least one visit each month must occur on Saturday or Sunday; or

(II) between 8:00 p.m. and 7:00 a.m. on a weekday;

(iii) Monthly visits may be reduced to one unannounced face-to-face visit to the service recipient's home when the home:

(I) has fully trained staff;

(II) has had no turn-over for the past year;

(III) does not require restrictive or intrusive procedures; and

(IV) has had no medication errors during the previous calendar year.

(iv) provide support and assistance to any service recipient who is experiencing an emotional, behavioral, or medical crisis;

(v) be accessible to direct service staff 24 hours per day and available to respond, in person when necessary, to an emergency;

(vi) supervise direct contact staff to promote achievement of outcomes in the Plan;

(vii) ensure staffing levels meet the requirements of the service recipient's Plan, with staff trained per OAC 340:100-3-38;

(viii) ensure records are maintained according to DDS community records per OAC 340:100-3-40;

(ix) ensure basic household requirements are always in place, including:

(I) utilities and phone service;

(II) furniture;

(III) food supplies that meet the service recipient's nutritional needs;

(IV) linens;

(V) personal items;

(VI) adaptive equipment; and

(VII) prescription medications;

(x) assist the DDS case manager as requested to prepare for and implement the Plan and its revisions per OAC 340:100-5-50 through 340:100-5-58;

(xi) ensure applicable DHS and OHCA rules are followed;

(xii) complete necessary training per  OAC 340:100-3-38; and

(xiii) have a minimum of four years of any combination of college level education or full-time equivalent experience in serving persons with disabilities, or full-time equivalent experience in a supervisory position, unless this requirement is waived in writing by the DDS director or designee.

(B) Provider agencies ensure that residential PCS caseloads do not exceed 27 with the following calculations:

(i) calculate one for persons receiving community residential supports and group home services; and

(ii) calculate one for every five persons receiving In-home Supports Waiver services, assisted living services, or any other non-residential service on the PCS caseload.

(C) Provider agencies providing community residential supports for less than one calendar year ensure the caseload of each PCS numbers no more than 15 service recipients when the PCS serves service recipients receiving community residential supports.

(D) The DDS director may grant a written exception to the PCS ratios per this Section upon written request and adequate justification from the provider.

(E) Provider agencies who fail to meet program coordination requirements per this subsection may be required to provide a reduced PCS ratio in accordance with sanctions per OAC 340:100-3-27.

(6) Staff, who assist a service recipient with bathing or showering, must ensure the water temperature is safe and comfortable for the service recipient. The requirements of this paragraph are enforced even when an anti-scald device is used.Staff:

(A) tests the water temperature by touch or with a thermometer designed to test hot liquids, before the service recipient enters the water.The water must be determined safe and comfortable for the service recipient, not merely comfortable for the staff;

(B) is trained by his or her employer in the unique needs of each service recipient including tolerance to water temperature and bathing or showering needs; and

(C) does not leave a service recipient who is unable to attend to safety considerations alone in the bath or shower.