Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org
317:40-5-40. Home profile process
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Revised 7-25-08


 (a) Applicability.  This Section sets forth procedures for the home profile process used for:

  • (1) agency companion services (ACS);
  • (2) specialized foster care (SFC) services;
  • (3) respite services delivered in the provider's home;
  • (4) approving a habilitation training specialist (HTS) or other provider to provide services overnight in the HTS's or other provider's home; and
  • (5) any other situation that requires a home profile.

(b) Pre-screening.  Designated Developmental Disabilities Services Division (DDSD) staff provides the applicant with program orientation and pre-screening information that includes, but is not limited to:

  • (1) facts, description, and guiding principles of the Home and Community-Based Services (HCBS) program;
  • (2) an explanation of:
    • (A) the home profile process;
    • (B) basic qualifications of the provider;
    • (C) health, safety, and environmental issues; and
    • (D) training required per OAC 340:100-3-38;
  • (3) the Oklahoma Department of Human Services (OKDHS) Form 06AC012E, Specialized Foster Care/Agency Companion Information Sheet;
  • (4) explanation of a background investigation conducted on the applicant and any adult or child living in the applicant's home.
    • (A) Background investigations are conducted at the time of application and include, but are not limited to:
      • (i) Oklahoma State Bureau of Investigation (OSBI) name and records criminal history search, including the Oklahoma Department of Public Safety and Sex Offenders Registry;
      • (ii) Federal Bureau of Investigation (FBI) national criminal history search, based on the fingerprints of the applicant and any adult members of the household;
      • (iii) search of any court involvement;
      • (iv) search of all OKDHS records, including Child Welfare records and Community Services Worker Registry; and
      • (v) search of Juvenile Justice Information System (JOLTS) records for any child older than 13 years of age in the applicant's household.
    • (B) An application is denied if the applicant:
      • (i) or any person residing in the applicant's home has a criminal conviction of:
        • (I) physical assault, battery, or a drug-related offense with the five year period preceding the application date;
        • (II) child abuse or neglect;
        • (III) domestic abuse;
        • (IV) a crime against a child, including, but not limited to, child pornography; or
        • (V) a crime involving violence, including, but not limited to, rape, sexual assault, or homicide, but excluding physical assault and battery.  Homicide includes manslaughter; and
      • (ii) does not meet the requirements of OAC 340:100-3-39;
  • (5) OKDHS Form 06AC015E, Agency Companion/Specialized Foster Care Employment Record;
  • (6) OKDHS Form 06AC016E, DDSD Reference Information Waiver;
  • (7) OKDHS Form 06AC029E, Employer Reference Letter; and
  • (8) OKDHS Form 06AC013E, Pre-Screening for Specialized Foster Care/Agency Companion Services.

(c) Home profile process.  If the applicant meets the requirements of the prescreening, the home profile process described in (1) through (8) of this subsection is initiated.

  • (1) The applicant completes the required forms and returns the forms to the DDSD address provided.  Required forms include OKDHS Forms:
    • (A) 06AC008E, Specialized Foster Care/Agency Companion Services Application;
    • (B) 06AC009E, Financial Assessment;
    • (C) 06AC011E, Family Health History;
    • (D) 06AC018E, Self Study Questionnaire;
    • (E) 06AC019E, Child's Questionnaire;
    • (F) 06AC010E, Medical Examination Report, if Form 06AC011E indicates conditions that may interfere with the provision of services;
    • (G) 06AC017E, Insurance Information; and
    • (H) 06AC020E, Evacuation/Escape Plan.
  • (2) If an incomplete form or other information is returned to DDSD, designated DDSD staff sends a letter to the provider or provider agency identifying information needed to complete the required forms.  The home profile is not completed until all required information is provided to DDSD.
  • (3) Designated DDSD staff completes the home profile when all required forms are completed and provided to DDSD.
  • (4) For each reference provided by the applicant, designated DDSD staff completes OKDHS Form 06AC058E, Reference Letter;
  • (5) Designated DDSD staff, through interviews, visits, and phone calls, gathers information required to complete OKDHS Form 06AC047E, Home Profile.
  • (6) OKDHS Form 06AC069E, Review of Policies and Areas of Responsibilities, is dated and signed by the applicant and designated DDSD staff.
  • (7) The DDSD area residential services programs manager sends to the applicant:
    • (A) a provider approval letter confirming the applicant is approved to serve as a provider; or
    • (B) a denial letter stating the application is denied.
  • (8) DDSD staff records the dates of completion of each part of the home profile process.

(d) Home standards.  In order to qualify and remain in compliance, the provider's home must meet the provisions in (1) through (11) of this subsection.

  • (1) General conditions.
    • (A) The home, buildings, and furnishings must be comfortable, clean, and in good repair and grounds must be maintained.  There must be no accumulation of garbage, debris, or rubbish or offensive odors.
    • (B) The home must:
      • (i) be accessible to school, employment, church, day programming, recreational activities, health facilities, and other community resources as needed;
      • (ii) have adequate heating, cooling and plumbing; and
      • (iii) provide space for the member's personal possessions and privacy and allow adequate space for the recreational and socialization needs of the occupants.
    • (C) Provisions for the member's safety must be present, as needed, including:
      • (i) guards and rails on stairways;
      • (ii) wheelchair ramps;
      • (iii) widened doorways;
      • (iv) grab bars;
      • (v) adequate lighting;
      • (vi) anti-scald devices; and
      • (vii) heat and air conditioning equipment guarded and installed in accordance with manufacturer requirements.  Home modifications and equipment may be provided through HCBS Waivers operated by DDSD.
    • (D) Providers must not permit members to access or use swimming or other pools, hot tubs, saunas, ponds, or spas on the premises without supervision.  Swimming pools, hot tubs, saunas, ponds, or spas must be equipped with sufficient safety barriers or devices designed to prevent accidental injury or unsupervised access.
    • (E) The household must be covered by homeowner's or renter's insurance including personal liability.
  • (2) Sanitation.
    • (A) Sanitary facilities must be adequate and safe, including toilet and bathing facilities, water supply, and garbage and sewer disposal.
    • (B) If a septic tank or other non-municipal sewage disposal system is used, it must be in good working order.
    • (C) Garbage and refuse must be stored in readily cleanable containers, pending weekly removal.
    • (D) Sanitation for household pets and other domestic animals must be adequate to prevent health hazards.
      • (i) Proof of rabies or other vaccinations as required by a licensed veterinarian must be maintained on the premises for household pets.
      • (ii) Pets not confined in enclosures must be under control and not present a danger to members or guests.
    • (E) There must be adequate control of insects and rodents, including screens in good repair on doors and windows used for ventilation.
    • (F) Universal precautions for infection control must be followed in care to the member.  Hands and other skin surfaces must be washed immediately and thoroughly if contaminated with blood or other body fluids.
    • (G) Laundry equipment, if in the home, must be located in a safe, well-ventilated, and clean area, with the dryer vented to the outside.
  • (3) Bathrooms.  A bathroom must:
    • (A) provide for individual privacy and have a finished interior;
    • (B) be clean and free of objectionable odors; and
    • (C) have a bathtub or shower, flush toilet, and sink in good repair, and hot and cold water in sufficient supply to meet the member's hygiene needs.
      • (i) A sink must be located near each toilet.
      • (ii) A toilet and sink must be provided on each floor where rooms of members who are non-ambulatory or with limited mobility are located.
      • (iii) There must be at least one toilet, one sink, and one bathtub or shower for every six household occupants, including the provider and family.
  • (4) Bedrooms.  A bedroom must:
    • (A) have been constructed as such when the home was built or remodeled under permit;
    • (B) be provided for each member.
      • (i) Minor members must not share bedrooms with adults in the household.
      • (ii) No more than two members may share a bedroom.
      • (iii) Exceptions to allow members to share a bedroom may be made by the DDSD area residential programs manager, when DDSD determines sharing a bedroom is in the best interest of the members;
    • (C) have a minimum of 80 square feet of usable floor space for each member or 120 square feet for two members and two means of exit.  The provider, family members, or other occupants of the home must not sleep in areas designated as common use living areas, nor share bedrooms with members;
    • (D) be finished with walls or partitions of standard construction that go from floor to ceiling;
    • (E) be adequately ventilated, heated, cooled, and lighted;
    • (F) include an individual bed for each member consisting of a frame, box springs, and mattress at least 36 inches wide, unless a specialized bed is required to meet identified needs.  Cots, rollaways, couches, futons, and folding beds must not be used for members.
      • (i) Each bed must have clean bedding in good condition consisting of a mattress pad, bedspread, two sheets, pillow, pillowcase, and blankets adequate for the weather.
      • (ii) Sheets and pillowcases must be laundered at least weekly and more often if necessary.
      • (iii) Waterproof mattress covers must be used for members who are incontinent;
    • (G) have sufficient space for each member's clothing and personal effects, including hygiene and grooming supplies.
      • (i) Members must be allowed to keep and use reasonable amounts of personal belongings and have private, secure storage space.
      • (ii) The provider assists the member in furnishing and decorating the member's bedroom.
      • (iii) Window coverings must be in good condition and allow privacy for members;
    • (H) be on ground level for members with impaired mobility or who are non-ambulatory; and
    • (I) be in close enough proximity to the provider to alert the provider to nighttime needs or emergencies, or be equipped with a call bell or intercom.
  • (5) Food.
    • (A) Adequate storage must be available to maintain food at proper temperature, including a properly working refrigerator.  Food storage must be such that food is protected from dirt and contamination and maintained at proper temperatures to prevent spoilage.
    • (B) Utensils, dishes, glassware, and food supplies must not be stored in bedrooms, bathrooms, or living areas.
    • (C) Utensils, dishes, and glassware must be washed and stored to prevent contamination.
    • (D) Food storage and preparation areas and equipment must be clean, free of offensive odors, and in good repair.
  • (6) Phone.
    • (A) A working phone must be provided in the home that is available and accessible for the member's use for incoming and outgoing calls.
    • (B) Phone numbers to the home and providers must be kept current and provided to DDSD and, if applicable, the provider agency.
  • (7) Safety.
    • (A) Buildings must meet all applicable state building, mechanical, and housing codes.
    • (B) Heating, in accordance with manufacturer's specifications, and electrical equipment, including wood stoves, must be installed in accordance with all applicable fire and life safety codes.  Such equipment must be used and maintained properly and in good repair.
      • (i) Protective glass screens or metal mesh curtains attached at top and bottom are required on fireplaces.
      • (ii) Unvented portable oil, gas, or kerosene heaters are prohibited.
    • (C) Extension cord wiring must not be used in place of permanent wiring.
    • (D) Hardware for all exit and interior doors must have an obvious method of operation that cannot be locked against exit.
  • (8) Emergencies.
    • (A) Working smoke detectors must be provided in each bedroom, adjacent hallways, and in two story homes at the top of each stairway.  Alarms must be equipped with a device that warns of low battery condition, when battery operated.
    • (B) At least one working fire extinguisher must be in a readily accessible location.
    • (C) A working flashlight must be available for emergency lighting on each floor of the home.
    • (D) The provider:
      • (i) maintains a working carbon monoxide detector in the home;
      • (ii) maintains a written evacuation plan for the home and conducts training for evacuation with the member;
      • (iii) conducts fire drills quarterly and severe weather drills twice per year and maintains and makes available fire drill and severe weather drill documentation for review by DDSD;
      • (iv) has a written back-up plan for temporary housing in the event of an emergency; and
      • (v) is responsible to re-establish a residence, if the home becomes uninhabitable.
    • (E) A first aid kit must be available in the home.
    • (F) The address of the home must be clearly visible from the street.
  • (9) Special hazards.
    • (A) Firearms and other dangerous weapons must be stored in a locked permanent enclosure.  Ammunition must be stored in a separate locked location.  Providers are prohibited from assisting members to obtain, possess, or use dangerous or deadly weapons per OAC 340:100-5-22.1.
    • (B) Flammable and combustible liquids and hazardous materials must be safely and properly stored in original, properly labeled containers.
    • (C) Cleaning supplies, medical sharps containers, poisons, and insecticides must be properly stored in original, properly labeled containers in a safe area away from food, food preparation areas, dining areas, and medications.
    • (D) Illegal substances are not permitted on the premises.
  • (10) Vehicles.
    • (A) All vehicles used to transport members must meet local and state requirements for licensing, inspection, insurance, and capacity.
    • (B) Drivers of vehicles must have valid and appropriate driver licenses.
  • (11) Medication.  Medication for the member is stored in accordance with OAC 340:100-5-32.

(e) Evaluating the applicant and home.  • 1 The home profile includes, but is not limited to:

  • (1) evaluating the applicant's:
    • (A) interest and motivation;
    • (B) life skills;
    • (C) children in the home;
    • (D) methods of behavior support and discipline;
    • (E) marital status and background, household composition, and children;
    • (F) income and money management; and
    • (G) teamwork and supervision, back-up plan, and use of relief; and
  • (2) assessment and recommendation.  • 2 DDSD staff:
    • (A) evaluates the ability of the applicant to provide services ;
    • (B) approves only applicants who can fulfill the expectations of the role of service provider;
    • (C) if the applicant does not meet standards per OAC 317:40-5-40, ensures the final recommendation includes:
      • (i) basis for the denial decision; and
      • (ii) effective date for determining the applicant as not meeting standards.  Reasons for denying a profile may include, but are not limited to:
        • (I) lack of stable, adequate income to meet the applicant's own or total family needs or poor management of available income;
        • (II) a physical facility that is inadequate to accommodate the addition of a member to the home or presents health or safety concerns;
        • (III) the age, health, or any other condition of the applicant that impedes the applicant's ability to provide appropriate care for a member;
        • (IV) relationships in the applicant's household are unstable and unsatisfactory;
        • (V) the mental health of the applicant or other family or household member impedes the applicant's ability to provide appropriate care for a member;
        • (VI) references are guarded or have reservations in recommending the applicant;
        • (VII) the applicant fails to complete the application, required training, or verifications in a timely manner as requested or provides information that is incomplete, inconsistent, or untruthful; or
        • (VIII) the home is determined unsuitable for the member requiring placement;
    • (D) notifies the applicant in writing of the final recommendation; and
    • (E) if an application is canceled or withdrawn prior to completion of the profile, completes a final written assessment that includes:
      • (i) reason the application was canceled or withdrawn;
      • (ii) DDSD staff's impression of the applicant based on information obtained; and
      • (iii) effective date of cancellation or withdrawal.  Written notice is sent to the applicant to confirm cancellation or withdrawal of the application, a copy is included in local and State Office records.

(f) Annual evaluation.  The annual evaluation is a comprehensive review of the provider's continued ability to meet standards.

    • (1) The annual evaluation consists of information specifically related to the provider's home and is documented on OKDHS Form 06AC024E, Annual Review.
    • (2) OKDHS FORM 06AC010E must be completed a minimum of every three years following the initial approval, unless medical circumstances warrant more frequent completion.
    • (3) Input from the DDSD case manager, Child Welfare worker, Adult Protective Services staff, Office of Client Advocacy staff, and provider agency program coordinator is included in the evaluation, if applicable.
    • (4) The background investigation per OAC 317:40-5-40(b) is repeated every year, except the FBI national criminal history search.
    • (5) Providers are notified in writing of the continued recommendation of the use of the home.
    • (6) Copies of OKDHS Forms 06AC024E and, if applicable, 06AC010E, are included in local and State Office records.

 

INSTRUCTIONS TO STAFF

 

1.     Evaluating the applicant and home.

(1) Interest and motivation.  Explore the applicant's interest and motivation for providing services by asking questions in (A) through (H).

(A) How did the applicant learn about the applicable Home and community-Based Services (HCBS) program?

(B) Is there an existing relationship between the applicant and a specific member for placement?  If so, explain the relationship.

(C) Why does the applicant wish to expand the applicant's family?

(D) Has the applicant ever had a home profile completed?  If so, when, where, and what were the results?

(E) Is assuming the care of a member, in part, an attempt to work through a loss or to repeat or replace a major relationship?

(F) What expectations does the applicant have for the member?

(G) Is extended family supportive of the decision to participate in the applicable HCBS program?

(H) Has the applicant had experience with an individual with developmental disabilities?  If not, the applicant is made aware of the physical and emotional requirements of a person for whom the applicant may provide care.

(2) Applicant and any other adult in the home.  Knowledge of past experience and influences is vital in understanding the applicant's and other adult's current functioning.  Significant areas of study include:

(A) life skills and general attitudes of the applicant;

(B) childhood relationships with parents, siblings, relatives, or other meaningful persons, asking what each adult's childhood was like;

(C) experiences, such as death, illness, divorce, or poverty, which had an impact on each person's attitudes, feelings, and expectations;

(D) whether the applicant has ever known anyone who was sexually or physically abused.  If so, the applicant's experience is explored in depth and information included in Oklahoma Department of Human Services (OKDHS) Form 06AC047E, Home Profile;

(E) concepts of appropriate behavior support and discipline and the manner in which behavior supports must be administered, especially as applied to persons with developmental disabilities;

(F) the meaning of education and training to the applicant;

(G) general physical and emotional health of household members.

(i) Adult family members must complete OKDHS Form 06AC011E, Family Health History.

(ii) If a household member has a physical disability, does the disability affect the ability to function as a provider of services in giving adequate care and supervision?  If so, in what manner?

(iii) Do any household members experience a medical or emotional condition?  Is any household member under professional care for any condition that requires the use of prescribed drugs or narcotics?  If any household member uses prescribed drugs or narcotics, explore the extent of the use;

(H) emotional ability of family members to provide services.

(i) If any household member previously received psychiatric or psychological counseling, the circumstances and results must be explored in depth.

(ii) A release of information is obtained allowing contact with the person who provided the counseling;

(I) physical description of the applicant;

(J) employment record regarding stability of work and satisfaction derived from employment;

(K) social relationships with members of the community, including hobbies, skills, talents, and special interests;

(L) religious influences, affiliations, and activities.

(i) Does the applicant have any specific religious beliefs that may affect a member in areas such as dress code, holiday observances, medical care, daily living, or social activities?

(ii) Will the applicant ensure the member is able to attend the place of worship of the member's choice as often as desired and practice his or her faith as desired;

(M) reaction to stressful situations;

(N) current relationships within the family, including marital and parent-child relationships;

(O) relationship with children, adult and minor, living outside the home.  Adult children must be interviewed by DDSD staff in writing, by phone, or in person;

(P) special training, ability, or experience in working with or caring for a person with physical disabilities, mental retardation, behavior problems, emotional disturbances, or other special needs;

(Q) explanation of any arrests or convictions, including status of parole or probation, from information obtained from the required background investigation per OAC 317:40-5-40(b); and

(R) explanation of any allegations of abuse, neglect, or exploitation of child, adult, or animal. 

(i) If there are no findings on the required searches, the absence of findings is stated as such on OKDHS Form 06ACO47E.

(ii) A copy of background investigation searches and findings is included in local and State Office records.

(3) Children in the home.  Provide a description of children in the home regarding:

(A) age and physical appearance;

(B) personality, interests, and skills;

(C) strengths and problems in parent-child relationships, school adjustment, behavior, and health;

(D) ability to get along with other persons, especially persons with developmental disabilities;

(E) physical or developmental disabilities and health, including current immunizations;

(F) attitude toward having a relationship with a person who has developmental disabilities; and

(G) depending on age, attitude toward persons receiving services.

(4) Behavior support and discipline.  Applicants are advised on discipline and behavior management, per OAC 340:110-5-62, and individual planning and protective intervention, per OAC 340:100-5-50 through 340:100-5-57.

(A) DDSD staff discusses with the applicant how he or she disciplines his or her natural children.

(i) If there is a divergence between OKDHS policy and the methods used to discipline natural children, DDSD staff explores how the applicant will deal with any problems that may result from this difference.

(ii) DDSD staff discusses with the applicant how the applicant was disciplined as a child and any effects it has on the applicant's attitude toward discipline.

(iii) From information obtained through training and discussion with the applicant, DDSD staff documents the applicant's understanding and acceptance of applicable Oklahoma Health Care Authority (OHCA) or OKDHS policy on OKDHS Form 06AC047E.  This information is considered in the final recommendation.

(iv) DDSD staff determines whether there is agreement among all adults in the household on methods of discipline.

(v) Any applicant who does not agree to abide by applicable OHCA or OKDHS policy is not approved to provide services.

(B) Members may require behavior supports.  An Individual Plan (IP) is developed by the Personal Support Team (Team) that includes the service provider.

(C) Prohibited procedures, per OAC 340:100-5-58, must be upheld in the home.

(5) Marital status and background, household composition, and children.  DDSD staff documents aspects of the applicant's marital status.

(A) Current marriage, if applicable.  DDSD staff describes the applicant's marriage regarding:

(i) length of present marriage;

(ii) stability of marriage;

(iii) method of resolution of marital problems; and

(iv) whether the decision to become a provider is a joint decision.

(B) Previous marriage, if applicable.  DDSD staff describes previous marriage regarding:

(i) number and length of previous marriages;

(ii) reason marriages ended, if applicable; and

(iii) children involved, visitation, and child support arrangements, if applicable.

(C) Single or never married.  If the applicant is not married, DDSD staff discusses:

(i) best and most difficult aspects of being single;

(ii) the applicant's source of support; and

(iii) significant adult relationships in the applicant's life.

(6) Income and money management.  Verification of income and expenses is required.

(A) OKDHS Form 06AC009E, Financial Assessment, must be completed.

(B) Any financial problem areas are discussed and included in OKDHS Form 06AC047E.

(C) The applicant, and family if applicable, shows financial stability by being able to pay their bills and to live within their financial means.

(7) Teamwork and supervision, back-up plan, and use of relief.  OKDHS Form 06AC047E includes a brief description of:

(A) fundamental responsibility of OKDHS to meet the member's physical, emotional, and medical needs;

(B) responsibility of the provider for the member's daily care so all areas of need are met;

(C) primary responsibility of Child Welfare staff and the DDSD case manager as liaisons in all planning with the member, natural family, provider, Team, provider agency, and court, where applicable;

(D) situations necessitating placement;

(E) varying lengths of time for which members requre services;

(F) characteristics of members requiring services;

(G) differences between service provision and adoption;

(H) importance of teamwork in:

(i) working toward reunification of the member with his or her biological family, if appropriate; or

(ii) if reunification is not possible, developing an alternative permanent plan for the member; and

(I) OHCA and OKDHS policies and procedures regarding:

(i) payment of room and board;

(ii) provision of clothing;

(iii) medical care;

(iv) behavior support;

(v) confidentiality;

(vi) education; and

(vii) religious training.

 

2.     Consultation.  Consultation may be obtained from the DDSD area residential programs manager, area manager, or State Office residential programs manager in the assessment and recommendation process.