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340:100-5-22.1. Community residential supports
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Revised 5-15-08
(a) Applicability. Community residential supports are funded through contracts with Oklahoma Department of Human Services (OKDHS), Oklahoma Health Care Authority (OHCA), or both, and must meet standards per OAC 340:100-5-22.1.
(b) General information.
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(1) Services for children are provided in family settings unless approved by the Developmental Disabilities Services Division (DDSD) Community Services Unit programs administrator or designee.
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(2) In addition to OAC 340:100-5-50 through 340:100-5-58, the DDSD case manager ensures each Personal Support Team (Team) assesses and addresses the service recipient's needs regarding:
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(A) safety in the home, including:
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(i) storage of toxic chemicals, cleaning supplies, and combustibles; and
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(ii) use of an anti-scald device or lowered hot water tank temperature to control water temperature;
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(i) a household budget that provides adequate resources for housing, food, clothing, furnishings, personal supplies, and recreational opportunities; and
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(ii) assistance needed by the service recipient in money management;
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(C) selection, adaptation, and maintenance of a home;
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(D) community inclusion and access to work, recreation, and therapies;
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(E) transportation; and
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(F) water safety.
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(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 OKDHS, except as:
(c) Homes. Community residential supports are provided in the service recipient's home. The provider agency ensures:
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(1) the home and yard are clean, well-maintained, safe, free from hazards, and adapted to the service recipient's needs;
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(2) the home has:
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(A) utility service and adequate heating, cooling, and plumbing;
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(B) safety items in operating condition located in strategic locations in the home, such as:
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(i) flashlight;
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(ii) smoke detector;
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(iii) carbon monoxide detector;
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(iv) first aid kit;
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(v) fire extinguisher; and
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(vi) an anti-scald device, when determined by the Team necessary to ensure the service recipient's safety;
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(C) phone service that is available and accessible to the service recipient. Emergency numbers are available at each phone, including:
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(i) DDSD toll-free number;
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(ii) fire, police, ambulance, hospital, and poison control, if not in a 911 area;
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(iii) physician name and number; and
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(iv) nursing agency number, if applicable;
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(D) at least two means of exit;
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(E) a bedroom of at least 80 square feet for each service recipient living in the home. If a service recipient shares a bedroom with another, the bedroom must have 120 square feet or more;
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(F) adequate enclosed storage space available for personal items;
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(G) laundry equipment, if in the home, located in a safe, well ventilated, and clean area, with dryers vented to the outside;
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(H) an address that is clearly visible from the street;
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(I) a bathroom that:
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(i) includes a:
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(ii) is in proper working order;
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(iii) provides privacy;
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(iv) is adapted if needed; and
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(v) provides hot and cold running water; and
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(J) a kitchen and equipment to store, prepare, and serve food in a sanitary manner;
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(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:
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(A) guns, BB guns, air rifles, or other firearms;
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(B) crossbows;
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(C) paint guns;
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(D) arrows;
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(E) explosives;
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(F) stun guns; and
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(G) knives, except cooking and eating utensils; and
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(4) illegal substances are not permitted in the home.
(d) Pre-service requirements. The DDSD case manager and service recipient, or, if applicable, legal guardian, complete and approve steps in (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.
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(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.
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(A) The back-up plan contains:
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(i) service recipient's name;
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(ii) description of living arrangement;
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(iii) name and phone number for back-up staff;
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(iv) back-up housing location;
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(v) written agreement by:
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(I) service recipient or legal guardian;
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(II) direct provider of service, if an ACS or SFC provider;
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(III) agency program coordination staff (PCS);
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(IV) provider agency administrative representative; and
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(V) DDSD case manager;
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(vi) dates for review of back-up plan, required quarterly and as changes occur; and
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(vii) review date by DDSD case manager.
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(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 OKDHS.
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(C) OKDHS 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 if the service recipient stays in the private home of a relative, per OAC 340:100‑5‑22.1(f)(4)(A).
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(D) The ACS or SFC provider is responsible for re-establishing a residence if his or her home becomes uninhabitable.
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(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.
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(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.
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(B) Upon request, the contract provider furnishes to the service recipient, service recipient's family, and legal guardian:
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(i) a record of all funds collected from the service recipient;
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(ii) documentation of how the money was used; and
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(iii) the amount of remaining money held by the provider.
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(C) Upon termination of residential supports from the contract provider, unused funds are returned to the service recipient within ten calendar days of service termination date.
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(3) Form 06CB034E, Residential Pre-Service Checklist, is completed, and all requirements of OAC 340:100-5-22.1 are satisfied.
(e) Service requirements.
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(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 two times annually. The dates, times, and outcomes of the drills are available in the home for review.
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(2) The provider:
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(A) ensures all requested financial information necessary for maintaining the service recipient's financial eligibility is provided to OKDHS in a timely manner;
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(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;
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(C) when a change of payee is necessary, cooperates to ensure the change is made in a timely manner;
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(D) establishes a written financial agreement with the service recipient or legal guardian that defines financial responsibilities of the agency and service recipient.
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(E) as a member of the service recipient's Team, assists in determining safeguards necessary to protect the service recipient's assets;
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(F) allows service recipients to select stores for the purchase of food, clothing, and personal items;
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(G) implements the service recipient's Individual Plan (Plan);
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(H) provides necessary assistance, including staff support for each service recipient's active participation in community life;
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(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;
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(J) promotes the service recipient's health and welfare, including providing meals that meet the service recipient's nutritional needs;
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(K) promotes visitation and contact with each service recipient's natural family, legal guardian, and friends, according to the service recipient's desires;
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(L) promotes friendships with neighbors, co-workers, and peers, according to the service recipient's desires;
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(M) when the service recipient, legal guardian, or provider wishes 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;
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(N) while providing services, ensures staff is engaged at all times in purposeful activity that directly or indirectly benefits the service recipient;
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(O) ensures the service recipient attends scheduled medical and therapy appointments.
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(i) Transportation to the appointment is provided.
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(ii) Adequate records, needed materials, and equipment accompany the service recipient to the appointment.
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(iii) If the service recipient requires support in describing illness, issues, or concerns to the practitioner, knowledgeable staff accompanies the service recipient;
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(P) ensures the service recipient's prescriptions are filled and administered as prescribed, per OAC 340:100-5-32; -
(Q) ensures the Plan addresses in a positive manner any issues related to maintaining the home per OAC 340:100-5-22.1(c); and
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(R) ensures the service recipient has transportation to programs and services.
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(i) Transportation is provided to and from:
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(I) medical or therapy appointments;
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(II) personal shopping;
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(III) leisure or recreational activities;
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(IV) vocational or employment activities;
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(V) religious or cultural activities;
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(VI) Team meetings;
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(VII) appointments necessary to secure or maintain needed services; and
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(VIII) voting.
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(ii) All vehicles used to transport the service recipient meet local and state requirements for licensing, inspection, insurance, and capacity.
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(iii) A vehicle used to transport a service recipient with physical disabilities is adapted to meet the service recipient's needs.
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(iv) Drivers of vehicles have valid and appropriate driver licenses.
(f) Provider agency policies, practices, and procedures. The provider agency develops and maintains written policies and procedures that are consistent with OKDHS rules and govern all aspects of service provision.
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(1) Provider agency policies are made available to each service recipient, service recipient's parent(s), legal guardian, or advocate, provider agency staff, and OKDHS.
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(2) Provider agency policies and procedures include, but are not limited to:
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(A) service recipient rights protection;
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(B) services provided;
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(C) admission and discharge criteria;
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(D) grievance procedures;
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(E) prevention and reporting of abuse, neglect, and exploitation;
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(F) confidentiality;
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(G) emergency management;
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(H) fees paid by service recipient;
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(I) health and safety precautions; and
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(J) safeguarding service recipient funds.
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(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.
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(4) The provider agency is responsible for recruitment, screening, training, and supervision of staff or volunteers providing direct services, ensuring direct support staff:
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(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;
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(B) who provides back-up services is available and has received training per OAC 340:100-3-38; -
(C) is at least 18 years of age;
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(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;
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(E) is physically able and mentally alert to carry out the duties of the job;
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(F) implements and follows the service recipient's Plan; and
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(G) does not take the service recipient to visit staff's home unless the Team has provided prior written approval.
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(5) The provider agency ensures the PCS supervises, guides, and oversees all aspects of programming associated with receipt of community residential supports.
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(A) The PCS must:
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(i) get to know the service recipient and his or her needs;
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(ii) make announced and unannounced visits to the service recipient's home. The PCS makes a minimum of three unannounced monitoring visits per month, based on the needs of the service recipient and the need for supervision of staff. Of the unannounced visits:
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(iii) provide support and assistance to any service recipient who is experiencing an emotional, behavioral, or medical crisis;
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(iv) be accessible to direct service staff 24 hours per day and available to respond, in person if necessary, to an emergency;
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(v) supervise direct contact staff to promote achievement of outcomes in the Plan;
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(vi) ensure staffing levels meet the requirements of the service recipient's Plan, with staff trained in accordance with OAC 340:100-3-38; -
(vii) ensure records are maintained according to DDSD community records per OAC 340:100-3-40; -
(viii) ensure basic household requirements are always in place, including:
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(I) utilities and phone service;
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(II) furniture;
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(III) food supplies that meet the service recipient's nutritional needs;
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(IV) linens;
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(V) personal items;
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(VI) adaptive equipment; and
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(VII) prescription medications;
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(ix) assist the DDSD 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; -
(x) ensure applicable OKDHS and OHCA rules are followed;
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(xii) have a minimum of four years of any combination of college level education or full-time equivalent experience in serving persons with disabilities, unless this requirement is waived in writing by the DDSD director or designee.
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(B) Provider agencies ensure the caseload of each PCS numbers no more than 15 service recipients when the PCS serves service recipients receiving community residential supports.
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(C) Provider agencies providing community residential supports for less than one year ensure the caseload of each PCS numbers no more than ten service recipients when the PCS serves service recipients receiving community residential supports.
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(D) The DDSD director may grant a written exception to the PCS ratios per OAC 340:100-5-22.1 upon written request and adequate justification from the provider.
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(E) Provider agencies who fail to meet program coordination requirements per OAC 340:100-5-22.1(f) may be required to provide a reduced PCS ratio in accordance with sanctions per OAC 340:100-3-27.
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(6) Staff, who assist a service recipient with bathing or showering, must ensure the water temperature is safe and comfortable for the service recipient. Even when an anti-scald device is used, staff:
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(A) tests the water temperature by touch 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;
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(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
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(C) does not leave a service recipient who is unable to attend to safety considerations alone in the bath or shower.
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