R501-19A-13. Client Care, Safety, and Supervision

(1) The provider shall ensure: (a) a staff-to-client ratio of one direct care staff to every four clients is maintained, except: (i) to reduce the staff-to-client ratio during client sleeping hours to one direct care staff to every 16 clients; (ii) in an intermediate secure program, as specified in Subsection R501-19A-14(2); and (iii) as otherwise required by a department contract; (b) a ratio of one staff to one client during any transport only occurs when the provider has conducted a safety assessment that demonstrates client and staff safety is reasonably assured; (c) any direct care staff assigned to supervise a client one-on-one is not counted at the same time in the staffing ratio for any other client, except in an emergency situation; (d) at least two direct care staff are on-duty and immediately available; (e) direct care staff conduct and document line-of-sight check-ins at least every 15 minutes when the staff is outside the line of sight of any client; (f) direct care staff conduct and document sign-of-life check-ins during sleeping hours and when a client is in the medical bay; (g) continuous direct supervision of any client that meets supervision and ratio needs of the presenting population, including increasing the ratio for individual supervision as needed; (h) on-site video surveillance is only used to directly supervise a client in time-out or seclusion or as an enhancement to minimum supervision ratio requirements; (i) only direct care staff may perform direct supervision; (j) staff conduct and document physical check-ins every 15 minutes when a client is being monitored by video; (k) the staff-to-client ratio may only decrease during sleeping hours if: (i) a minimum of two direct care staff are on-duty; (ii) each client is appropriately supervised to ensure health and safety at the ratio; and (iii) each direct care staff remains awake while on-duty; (l) the staff-to-client ratio is increased as necessary to ensure the health and safety of the client population; (m) there are enough staff on-duty each shift to safely supervise the client population, including adding more staff than required by the usual staffing ratio as needed to manage behaviors, dynamics, and individual client treatment and supervision needs; (n) there is a phone accessible to each client, staff, or any other individual to place a direct call to the congregate care ombudsman: (i) at any time; (ii) without interference; (iii) with sufficient privacy to preclude another individual from hearing the conversation; and (iv) subject to the whistleblower protections in Section 26B-2-124.3; and (o) video surveillance is only used in a client bedroom if: (i) the provider monitors any camera footage or physically performs client checks in at intervals of at least every 15 minutes; (ii) there is a documented need; (iii) providing services to an individual served by DSPD, the video surveillance is compliant with Rule R539-3; and (iv) the client, or the client's parent or legal guardian, provides written permission. (2) The provider may not allow: (a) any client, non-direct care staff, or direct care staff who does not have current behavior management training, or anyone unfamiliar to the client, to use any form of restraint on a client; (b) any intervention that uses painful stimuli, unless as an individually justified and documented emergency safety measure; (c) the use of any physical work assignment or activity that inflicts pain as a behavior management technique; and (d) the use of restraints or seclusion as a convenience to staff, substitute for programming, or punishment. (3) The provider may allow a client to be separated from the area of any activity or any other client, including a client's bedroom, if on-duty staff: (a) provides direct line-of-sight supervision and monitors the client; (b) does not prevent the client from leaving the area; and (c) documents the separation, including the reason for the separation and the amount of time the client was separated from an activity or another client. (4) The provider may only use any: (a) body cavity search of a client in alignment with Subsection 26B-2-123(1)(a)(ii); and (b) strip search of a client in alignment with Subsection 26B-2-123(1)(a)(i). (5) For each critical incident, the provider shall: (a) document the details of the critical incident in each client and staff record; (b)(i) report to each involved client's parent or legal guardian no later than one business day after the incident; or (ii) when the critical incident involves any client meeting the definition of a child in crisis, report to the client's parent or legal guardian no later than five hours after the crisis began; and (c) report to OL no later than one business day after the incident. (6) During each shift, the provider shall: (a) document and share with staff from the next shift and the administration any client illness, injury, or critical incident; and (b) maintain and make available to OL upon request each staff shift list.