Standards for administration

1. Administrator. In order to develop an adequate program of treatment and care it is essential that there be an administrator of maturity and experience to equip the administrator for the task. It is highly recommended that the administrator shall have had at least two years of previous professional work with the mentally retarded or administrative experience of similar duration with adequate programs of residential care. Professional preparation and experience in medicine, social work, or psychology are especially desirable. 2. Finances. A sound financial plan must be demonstrated. Adequate records must be kept of all income received and expended. An audit shall be performed annually and a copy of the audit report shall be submitted to the division of mental health and retardation of the state department of health. Financial records may be inspected by the division at any time. Financial records must be kept for a period of fifteen years. 3. Insurance. Adequate insurance, including liability insurance, must be maintained. 4. Health clearance. The residential care center shall secure a written report from a licensed physician or health department that all personnel at the time of employment and annually thereafter are free of communicable and infectious diseases, including tuberculosis. Persons with infectious and communicable diseases shall not be on duty in any center. 5. Reports. Licensees shall furnish to the division of mental health and retardation such reports as may be required. a. Injury and incident reports. A written report shall be submitted to the division within three days concerning any serious injury or unusual incident involving a resident including name, age, sex, date of admission, diagnosis, date of incident or death, nature of incident, medical findings and treatment, name of attending physician, and final disposition. b. Death reports. Reports of all deaths from unnatural causes, including those reported to the coroner, shall be submitted to the division either as a special report or by copy of the death certificate within thirty days of occurrence. c. Special reports. Any occurrences such as epidemic outbreaks, poisonings, reportable diseases, or other unusual occurrences which threaten the welfare, safety, or health of any resident admitted to any institution shall be immediately reported by telephone or telegram to the local health officer. The residential care center shall furnish such other pertinent information as the local or state department of health may require. The residential care center shall immediately submit an identical report to the division. 6. Fire safety. All residential care centers shall conform to the requirements established by the state fire marshal. An annual inspection shall be made by the state fire marshal, or the fire marshal's designee. A copy of the latest fire inspection clearance shall be on the premises. 7. Disaster program. All residential care centers shall adopt and maintain a written disaster program which shall provide plans for disasters occurring within and on the grounds of the center. a. The written disaster program shall include: (1) Administrative procedures. (2) Plans for evacuation and continued care of residents. b. The current plan shall be available on the premises and personnel shall be instructed in its implementation. 8. Telephones. All residential care centers shall have telephone service, including a telephone accessible to visitors. Each building housing residents shall have telephones or intercommunicating equipment. 9. Waiting and visiting space and public toilets. All residential care centers shall have ample waiting and visiting room space. Toilet facilities for the public shall include separate facilities for males and females. 10. Admission policies. All residential care centers shall have admission policies which are in writing and available to the public. No individual whose needs cannot be met by the facility shall be admitted to it. All admissions shall be in accordance with the facility's screening team's written policies. 11. Personnel policies and practices. All residential care centers shall have written policies and maintain accurate employee records. 12. Records. Records shall be kept on all residents admitted and shall be maintained after discharge or after a minor has reached eighteen years of age until such time as the statute of limitations no longer applies. a. Maintenance of resident's records. The residential center shall maintain a separate clinical record for each resident admitted with all entries kept current, dated and signed. The record shall include: (1) Identification and summary sheets including resident's name, social security number, marital status, age, sex, home address and religion; names, addresses and telephone numbers of referral agency, personal physician, dentist and next of kin or other responsible person; admitting diagnosis, final diagnosis, conditions on discharge, and disposition. (2) Initial medical evaluation including medical history, physical examination, diagnosis. (3) The physician will make progress notes at each visit and the professional staff at the center shall write progress notes describing significant changes in the resident's behavior or at least monthly. (4) Physician's orders, including all medication, treatment, diet, restorative, and special medical procedures required for the safety and well-being of the resident. (5) Medication and treatment record including all medications, treatments, and special procedures performed for the safety and well-being of the resident. (6) Laboratory and X-ray reports. (7) Consultation reports. (8) Dental reports. (9) Social service notes. (10) Resident care referral reports. b. Confidentiality of records. All information contained in the clinical records shall be treated as confidential and may be disclosed only to authorized persons. c. Staff responsibility for records. The center shall assign one staff member to be responsible for assuring that records are maintained, completed, and preserved. 13. Restraints. a. Restraints or seclusion should be used only when all reasonable methods have failed and then should be used only for as brief a period as reasonably possible. b. Restraints may be applied only by written order of the attending physician. In case of an emergency a verbal order may be accepted, but must be placed in writing on the resident's record within twelve hours. c. When restraints or seclusion is used, a record shall be kept which will show: (1) Name, age, and sex of resident. (2) Type of procedure and device. (3) Justification. (4) Name of authorizing doctor. (5) Date and hour placed in restraint or seclusion. (6) Date and hour removed from restraint or seclusion.