3000 Division of Long Term Care Residents Protection
3310 Neighborhood Homes for Persons with Developmental Disabilities (Formerly Regulation No. 55)
1.0 Purpose
The following regulations are designed specifically for Neighborhood Homes, for five or fewer persons with developmental disabilities, which are licensed by the Division of Long Term Care Residents Protection. These homes are distinct from Rest (Family care) Homes where three or fewer persons live in a home with care and supervision provided by persons who also reside on the premises.
These regulations address the minimum acceptable level of living conditions and supports for persons in Neighborhood Homes. The purpose of these regulations is to provide a sequence of expectations for services rendered by the Neighborhood Home provider and a system for Neighborhood Home providers to be accountable to the Division of Long Term Care Residents Protection (DLTRCP) and the Division of Developmental Disabilities Services (DDDS).
2.0 Definitions
“Action Plan” The portion of the Essential Lifestyle Plan (ELP) that lists, and is used to track, those desired outcomes which are important to a person.
“Annual Conference” The yearly interdisciplinary team meeting held with the person served and his/her family to develop or update the ELP after a review of the various assessments done on the person and discussion with the individual as to his/her aspirations and desires. The annual conference must be held within 30 days of the initiation of DDDS funded residential services and be held no more than 365 days from the previous annual conference.
“Assessment” The process of gathering information to describe what has been learned about a person, and what others need to know or to do to support the person in attaining a healthy, safe and meaningful life.
“Behavior Support Plan” or “Mental Health Plan” A multi-dimensional, systematic, assessment-based plan that details how staff should implement the identified behavior and/or mental health supports.
“Behavior Support Review Committee” A committee assigned to review behavior intervention strategies and behavior support plans containing support procedures.
“Choice” The process by which people make selections from an array of options which are within the context of Division of Developmental Disabilities Services (DDDS) policies and all applicable state and federal laws and regulations intended to safeguard the person and the rights of others.
“Emergency Behavior Interventions” A set of DDDS sanctioned procedures available to manage an unanticipated event such as severe aggression or severe property destruction that places the individual or others in imminent danger of physical harm.
“Essential Lifestyle Plan (ELP)” The type of individualized support plan used by the Division of Developmental Disabilities Services. A result of a system of person-centered planning, the ELP outlines how a person wants to live, service-related issues which need to be addressed as well as a plan of action for achieving expressed lifestyle choices and adequately addressing service-related issues.
“Evaluation” An assessment process performed by professionals, according to standardized procedures, that incorporates the use, when possible, of standardized tests and measures in addition to informal and observational measures.
“Goals” Desired outcomes that provide the framework upon which service and support actions are based.
“Human Rights Committee (HRC)” A body of individuals composed of impartial members with no direct affiliation with the Division of Developmental Disabilities Services (DDDS), and whose role is to serve as a monitoring agent to safeguard the rights and personal dignity of persons served by DDDS.
“Incident” An occurrence or event, a record of which must be maintained in provider’s files, that results or might result in harm to a resident. Incident includes alleged abuse, neglect, mistreatment and financial exploitation; incidents of unknown source which might be attributable to abuse, neglect or mistreatment; all deaths; falls; and errors and omissions in medication/treatment. (Also see Reportable Incident)
“Individual Records” Those records pertaining to a person served which are essential for effective individual planning, plan implementation, establishing and maintaining a personal history of the person, and for protecting legal rights of the person, the agency and the agency staff.
“Interdisciplinary Team” Also known as “Treatment Team” or “Team,” this is a group consisting of those who are knowledgeable about the person served, whose participation is required to identify the supports the person wants and/or needs so as to help him/her achieve a healthy, safe and meaningful life.
“Intrusive” The unwanted or uninvited introduction of procedures or other people/staff into the lives or daily routines of persons served which is found bothersome by the person and which causes a perceived interference with the life and/or daily routines of the person.
“Least Restrictive” Descriptive of services and treatments that are delivered with a minimum of limitation, intrusion, disruption or departure from commonly accepted patterns of living in the community.
“Neighborhood Home” A single-unit house providing residential and support services to five or fewer people and licensed pursuant to 16 Del.C. §1101. This definition does not include ICF/MR programs.
“Neighborhood Home Provider” An individual or organization responsible for the operation of the Neighborhood Home.
“Outcomes” The major expectations and desired achievements for people’s lives. The accompanying supports that are developed should reflect what people expect from the services and assistance they receive in order to reach their desired outcomes.
“Person/People/Individual/Resident” Terms used throughout these regulations that identify someone receiving services and supports in a Neighborhood Home.
“Physical Environment” Those locations in which the individual lives, works, recreates or receives services.
“Physical Restraint” Approved manual methods that restrict the movement of the individual or the normal functioning of an individual’s body or portion of the body.
“Reportable Incident” An occurrence or event which must be reported at once to the Division of Developmental Disabilities Services (DDDS) and for which there is reasonable cause to believe that a resident has been abused, neglected, mistreated or subjected to financial exploitation. Reportable incident also includes an incident of unknown source which might be attributable to abuse, neglect or mistreatment; all deaths; falls with injuries; and significant errors or omissions in medication/treatment which cause the resident discomfort or jeopardize the resident’s health and safety. DDDS will forward the report to the Division of Long Term Care Residents Protection (DLTCRP). (Also see Incident.)
“Rights Restriction” The limitation, disruption or constraint of a person’s freedom to engage in activities generally allowed to others in society. Such is permissible only on a case-by-case basis and when there has been due process, official approval received and the need for such documented.
“Safety” The absence of recognizable hazards in the design, construction and maintenance of any component of the physical environment including equipment and the establishment of procedures to evaluate and to reduce risks of physical harm.
“Sanitation” The promotion of hygiene and prevention of disease by the maintenance of uncontaminated conditions.
“Screening” The initial part of the assessment process which is of limited scope and intensity and is designed to determine whether further evaluation or other intervention is indicated.
“Self-Limiting Behavior” Any behavior that significantly interferes with a person’s ability to acquire meaningful life skills, form and maintain interpersonal relationships, and/or successfully live in his/her community. A behavior in and of itself is not self-limiting; rather, it may be viewed contextually relative to the impact it has on the quality of life of both the person who is displaying the behavior and on others in the environment who are affected by the behavior.
“Supplemental Plans” Detailed instructions or preparations needed to support an outcome or opportunity. Types of such plans include learning, motivating, achieving a personal goal and gaining a new opportunity. Supplemental plans are used to outline a course of action in an effort to accomplish an outcome or provide an opportunity which has been identified in the action plan.
“Support” A broad term used to refer to those methods designed to help an individual achieve a meaningful life and to function to his/her fullest capacity.
“Support Coordinator” The staff person responsible for monitoring and coordinating all activities in implementing the person’s plan.
“Transfer” Movement of a person from one program, service or residence to another within DDDS.
3.0 Licensing and General Requirements
3.1 When a Neighborhood Home pursuant to these regulations plans any structural alteration, one copy of properly prepared plans and specifications for the entire home shall be submitted to the Division of Long Term Care Residents Protection (DLTCRP). The Neighborhood Home shall receive written approval of the plans before any work is begun.
3.2 Separate licenses are required for separate homes, regardless of their proximity, even though operated by the same Neighborhood Home provider.
A license shall not be transferred from one provider to another or from one location to another.
3.3 The license shall be conspicuously posted in the Neighborhood Home.
3.4 All applications for renewal of licenses shall be filed with DLTCRP at least thirty days prior to expiration. Licenses shall be issued by DLTCRP for a period not to exceed one year (12 months) from the date they are issued.
3.5 All required records maintained by the Neighborhood Home shall be open to inspection by the authorized representatives of DLTCRP and DDDS.
3.6 The term “Neighborhood Home” shall not be used as part of the name of any program in this State unless the home is licensed under these regulations.
3.7 No Neighborhood Home provider shall adopt rules that conflict with these regulations.
3.8 DLTCRP shall be notified in writing of any changes in the ownership or management of a Neighborhood Home.
3.9 Each Neighborhood Home provider shall provide with the admission agreement, to all persons or their family member/guardian, a complete statement enumerating all charges for services, materials and equipment which shall, or may be, furnished to the person during the period of residency.
3.10 Each Neighborhood Home provider shall make known, in writing, the refund and prepayment policy at the time of admission, and in the case of third-party payment, an exact statement of responsibility in the event of retroactive denial.
4.0 Neighborhood Home Provider Performance Standards
4.1 The Neighborhood Home provider shall have a written statement of its mission, values and goals which defines the agency’s proactive commitment to helping people live the lifestyle they choose and fosters the least restrictive alternatives of supports and services.
4.2 The Neighborhood Home provider shall have written policies and procedures that delineate how the civil rights of the people served are to be ensured.
4.3 The Neighborhood Home provider shall have a written procedure to handle appeals of decisions made by the provider from people receiving services, their advocates, legal guardians and families. The procedures shall include the use of the Appeal to DDDS Decisions policy.
4.4 The Neighborhood Home provider shall have a written policy that defines and prohibits abuse, neglect, mistreatment, misappropriation of property and significant injury of persons served and a procedure for initiating intervention in all such cases whether the alleged incident occurred within or outside of the Neighborhood Home. The provider shall comply with the provisions of Department of Health and Social Services (DHSS) Policy Memorandum #46 by reporting all instances of abuse, neglect, mistreatment, misappropriation of property or significant injury and the requirements for other reportable incidents. (See Reportable Incident)
4.5 The Neighborhood Home provider shall have a written policy and procedures for protecting the financial interests of people served.
4.6 The Neighborhood Home provider shall review its written policies and procedures at least annually to ensure that they are in compliance with the requirements of the applicable laws and regulations. Copies of all relevant policies and procedures shall be made available to persons served or their families at any time and be available to any party upon request.
4.7 The Neighborhood Home provider shall maintain a current table of organization identifying its operational elements and programs and administrative personnel and illustrating lines of authority, responsibility and communication. This document shall be shared with provider staff.
4.8 The Neighborhood Home provider’s chief executive officer shall designate an employee to assume management responsibility during his or her absence. All employees shall be informed of who has such responsibility at any given time and who is to be contacted in the event of an emergency.
4.9 The Neighborhood Home provider shall comply with the policies of the Department of Health and Social Services (DHSS) Human Subjects Review Board with regard to conducting research involving people served.
4.10 In all provider activities and references, including name, language of staff, internal documents and communication to the public, the language used shall reflect the Neighborhood Home provider’s program, its purposes and promote respect and a positive image of the people served and the staff who support them.
4.11 Services shall be provided to people who are otherwise eligible without regard to disability, gender, age, sexual orientation, race, religion, marital status or ability to pay.
4.12 The Neighborhood Home provider shall not employ individuals under the age of 18.
4.13 The Neighborhood Home provider shall obtain the results of each employment applicant’s drug screening for the following drugs:
4.13.1 Marijuana/cannabis
4.13.2 Cocaine
4.13.3 Opiates including heroin
4.13.4 Phencyclidine (PCP)
4.13.5 Amphetamines
4.13.6 Barbiturates
4.13.7 Benzodiazepene
4.13.8 Methadone
4.13.9 Methaqualone
4.13.10 Propoxyphene
4.14 The Neighborhood Home provider shall complete a state and federal criminal background check for each employment applicant through DLTCRP.
4.15 The Neighborhood Home provider shall ensure that each employee is thoroughly familiar with assigned duties and responsibilities. Job descriptions with employees’ individual responsibilities and duties shall be made available on site.
4.16 Orientation and training shall be provided to all employees in accordance with the training policy of DDDS and shall be documented, continuously updated and made available for review upon request.
4.17 The Neighborhood Home provider shall ensure that staff training is relevant to the support needs of the people served and shall continuously evaluate training effectiveness by assessing employees’ demonstrated competencies and by modifying training programs accordingly.
4.18 The Neighborhood Home provider shall provide each person with an oral and written summary of his/her rights and an explanation of how to exercise those rights in easily understandable language. This review shall be documented in the person’s record and shall occur at least annually. The rights of a person shall not be restricted without due process; any restrictions, including the need for guardianship, shall be reviewed at least annually. All investigation into alleged violations of individuals’ rights and the actions taken to intervene in such situations shall be documented.
4.19 Each Neighborhood Home provider shall have its own human right committee or shall participate in a system-wide human rights committee. Each human rights committee shall be responsible for assuring that people’s rights are supported and shall be approved by the Division of Developmental Disabilities Services. Human rights committees shall comply with DDDS minimum standards of operations of such committees, and their decisions concerning persons served by DDDS shall be subject to the review and approval of the DDDS human rights committee.
4.20 Each human rights committee member shall be provided with a written explanation and training in the committee’s duties and responsibilities. Any member who has been involved in the development, review or approval of a matter before the committee shall be excluded from decision-making related to that matter.
4.21 The Neighborhood Home provider shall safeguard and maintain records regarding the funds of people receiving services and support their efforts towards independence/self-management of those funds. Requests to the contrary, other than from the person’s legal guardian (of property), shall require a recommendation of the Interdisciplinary Team, accompanied by substitute safeguards, with approval from the Director of the DDDS Community Services or Special Populations program. Such actions shall be documented in the person’s record. The financial records shall be available on request to the person, his/her legal guardian (of property) or other individuals or entities authorized by DDDS.
4.22 Funds for one person shall not be commingled with the funds of another person. People shall have community bank accounts in their own names unless otherwise indicated by them or their legal guardian of property.
5.0 Persons’ Services and Supports
5.1 The Neighborhood Home provider shall comply with the Patient’s Bill of Rights set forth in 16 Del.C. §1121. A copy of the Patient’s Bill of Rights shall be conspicuously posted within the home.
5.2 To the greatest extent possible, the person chooses where and with whom he/she shall live.
5.3 With due regard to each individual’s right to privacy and safety and as agreed upon by the person served, the person’s family, guardian, advocates, spouse and friends shall be encouraged to visit the person in his/her Neighborhood Home. Visits shall occur at reasonable times and may be without prior notice.
5.4 The Neighborhood Home provider shall facilitate frequent informal visits by persons to the homes of their families and friends in accordance with each party’s desire. 5.5 People shall be provided with opportunities and supports to develop and maintain social relationships, to perform different social roles and to participate in the life of their community, including attending and participating in religious activities of their choice. Wherever possible, supports shall be adapted to the cultural background, language and ethnic origin of the person.
5.6 People shall receive support and instruction as appropriate to exercise the rights and responsibilities of citizens such as voting, employment, consumer affairs, law enforcement, paying taxes or consulting an attorney.
5.7 People shall be supported in receiving advocacy and/or legal services as needed.
5.8 People shall receive support and instruction in recognizing and respecting the rights of others as reciprocal to their own.
5.9 If a person is represented by a legal guardian or a substitute decision maker (as defined in the DDDS Consent Policy), such shall be documented in the individual plan; and efforts shall be made to ensure that the person receives continued education, instruction and support to exercise his/her rights and make informed decisions.
5.10 People shall decide when and with whom they wish to share personal information. Prior to the release of information, including the person’s name or photo, a written consent shall be signed by the person (unless legally adjudicated to need a guardian), a parent (if the person is a minor), or by a substitute decision maker in accordance with DDDS policy on confidentiality and release of information. The consent shall minimally include:
5.10.1 The designation of time limit with a maximum of 365 days;
5.10.2 The person to whom the information is to be released;
5.10.3 The exact information to be released;
5.10.4 The stipulation that consent may be rescinded at any time.
5.11 People shall be supported to exercise choice, including but not limited to choice in the following:
5.11.1 Clothing and personal possessions;
5.11.2 Telephone use with privacy available;
5.11.3 Time, space and opportunity for privacy;
5.11.4 Opening mail addressed to them unless other arrangements are expressly made;
5.11.5 Deciding when and where to go unless otherwise indicated in their plan;
5.11.6 Deciding who will assist them with personal hygiene;
5.11.7 Participation in household responsibilities.
5.12 People shall be supported to bathe with the maximum independence and privacy.
5.13 People who are incontinent shall be bathed or cleansed immediately upon voiding or soiling. All soiled items shall be changed immediately.
5.14 Each person shall have an Essential Lifestyle Plan written in terms that are understandable to all, where the person’s goals, dreams and aspirations are stated and defined. The person, with the support of the team, shall determine when and how to measure success and attainment of his/her desired outcomes; and such criteria shall be defined in the Essential Lifestyle Plan, as applicable.
5.15 The person’s plan shall include financial planning which takes into account the person’s resources, assets and benefits in conjunction with his/her personal goals.
5.16 For each person, an interdisciplinary team including the support coordinator and specific people responsible for obtaining services and implementing the support plan, shall be clearly defined. Staff of all Neighborhood Home providers providing any component of service or support shall take an active role in assuring effective communication and overall support coordination.
5.17 The support coordinator shall monitor, review, analyze, observe the implementation and document all components of a person’s plan at least monthly.
5.18 If the monthly review determines the need for any action, such action shall be taken in a timely manner by the appropriate team member.
5.19 The support coordinator shall assist the person in locating and obtaining those services and supports identified by the team and shall assist the person in assuming management of those activities for which the person has demonstrated management capacity and/or expressed an interest.
5.20 The support coordinator shall elicit the person’s preferences and respect those preferences when they are consistent with the rights and well-being of the person and of others.
5.21 The support coordinator shall facilitate the transfer of the person to another service, service location or service provider when the person desires such a transfer and such is consistent with the person’s plan.
5.22 The initial plan and subsequent plans are developed, at the discretion of the person and/or the guardian, with the active participation of the following:
5.22.1 The person;
5.22.2 Support staff who know and care about the person;
5.22.3 Professionals and others with the expertise to design and review elements of the plan, including those who provide supports or treatment.
5.22.4 The person’s family, guardian, advocate or friends.
5.23 The person’s plan shall be reviewed by his/her team as often as the person decides, but at least yearly (365 days) in conjunction with the person’s annual conference or when significant changes occur, to determine the need to continue, revise or terminate services and supports. Any applicable information, including previous plans, shall be reviewed for possible inclusion in the current plan.
5.24 Plans shall be implemented within 30 days of the development of an initial plan and within 30 days of each subsequent annual conference. The initial plan shall be revised within 60 days of initiation of Neighborhood Home services.
5.25 Supplemental plans shall be in place as required by the person’s action plan, and shall be based on the person’s learning styles.
5.26 Reassessments for those persons receiving services, including direct or indirect clinical services, shall be completed annually in preparation for the annual conference or when there is an indication of need. Reassessments shall be available in preparation for the person’s annual conference.
5.27 Meetings concerning the person shall be scheduled at a date, time and location suitable for all team members, especially the person and his/her parents, guardian and/or advocate.
5.28 The Neighborhood Home provider’s policies and practices relative to behavior supports, as evidenced in writing and in ongoing activities, shall be congruent with the policies and practices of DDDS and emphasize positive approaches and behavior interventions.
5.29 The Neighborhood Home provider shall have its own, or use the DDDS behavior support committee which shall include:
5.29.1 Persons qualified to evaluate published behavior support research studies and the technical adequacy of proposed behavior support interventions;
5.29.2 Medical and other professionals qualified to evaluate proposals for the use of interventions to manage behavior.
5.30 Prior to the use of behavior intervention strategies, and absent a crisis situation or psychiatric emergency requiring an immediate response, the following activities shall take place:
5.30.1 The physical and social environments shall be analyzed to determine their role in contributing to the self-limiting behavior;
5.30.2 The necessary modifications shall be made to the environment based on that analysis;
5.30.3 Medical treatment shall be obtained for any possible physiological cause of the behavior; and
5.30.4 The treatment team shall discuss and document the risk/benefits of the proposed procedure.
5.31 Prior to the use of behavior intervention strategies, persons who will implement behavior support procedures shall have been trained in the procedures specified in the person’s plan.
5.32 People receiving services shall not discipline other people receiving services.
5.33 When food is used in a behavior support plan, good health and nutritionally adequate dietary practices shall be followed.
5.34 The behavior support plan shall be designed to replace self-limiting behaviors by understanding their purpose or function and by subsequently teaching functionally equivalent behaviors and promoting existing adaptive behaviors to serve the same function.
5.35 Procedures for altering behaviors shall not be implemented in the absence of self-limiting behaviors, in retribution, for the convenience of the staff, as a consequence of insufficient staff or in the absence of positive behavior support.
5.36 Emergency behavior interventions, in accordance with Division of Developmental Disabilities Services policies, shall only be used as a last resort to manage an unanticipated and already occurring event which is placing an individual or others in imminent danger of physical or emotional harm.
5.37 Prior to the implementation of a written behavior support plan incorporating the use of a restrictive or intrusive technique:
5.37.1 The Neighborhood Home provider shall document that acceptable informed consent has been obtained;
5.37.2 The behavior support plan has been reviewed and approved by a behavior support committee; and
5.37.3 The behavior support plan has been reviewed and approved by a human rights committee.
5.38 Restraint procedures shall be designed to use the minimum amount of restraint necessary to safely manage the person's behavior in order to avoid physical injury to a person and to minimize any possible physical or psychological discomfort.
5.39 Physical restraint shall be used only until the individual is no longer dangerous to him/herself or others and shall be ended immediately if a person begins to exhibit signs of medical distress.
5.40 Only devices specified in the written behavior intervention strategy shall be used to restrain the individual; and mechanical restraint devices shall be inspected before and after each use to ensure that they are clean and in good repair.
5.41 The monitoring requirement for the restraint procedure shall be specified in behavior support plan. The record shall document the time of the institution of the mechanical restraint, the time of release and the time interval that the person was in restraints, as indicated in the individual plan.
5.42 Each behavior support plan utilizing an intrusive intervention or drugs to manage behavior shall:
5.42.1 Include a risk/benefit analysis, in non-technical terms, which identifies the risks associated with not providing the intervention, the risks associated with providing the intervention, and the benefits of the proposed intervention;
5.42.2 Include a detailed plan of action the team intends to follow to reduce or eliminate the need for the intrusive intervention/drugs;
5.42.3 Specify provisions for at least a quarterly reevaluation for the need for continuation of the intervention/drugs;
5.42.4 Include alternative supports; and
5.42.5 Be discussed with the person/guardian relative to the rationale for such treatment and the risks/benefits involved.
5.43 Each mental health plan utilizing psychotropic medications for the treatment of a diagnosed psychiatric illness shall:
5.43.1 Include a risk/benefit analysis, in non-technical terms, which identifies the risks associated with not providing the intervention, the risks associated with providing the intervention, and the benefits of the proposed intervention;
5.43.2 Specify provisions for ongoing reevaluation of the need for continuing the use of medication;
5.43.3 Include alternative supports, as appropriate; and
5.43.4 Be discussed with the person/guardian relative to the rationale for such treatment and the risks/benefits involved.
6.0 Environment
6.1 Neighborhood Home providers shall ensure a home-like environment for each licensed home. Functional arrangement of rooms, furnishings, and decor shall be compatible with the need for accessibility.
6.2 Furniture and furnishings shall be safe, comfortable, and in good repair and shall resemble those in homes in the local community, to the extent compatible with persons’ choice and the physical needs of the people living in the home. To the extent possible, personal furniture shall be chosen by individuals.
6.3 Heating apparatus shall not constitute a burn, smoke or carbon monoxide hazard to persons served or their support staff.
6.4 Temperature, humidity, ventilation, and light in all living and sleeping quarters shall be maintained to provide a comfortable atmosphere.
6.5 Homes serving persons with physical challenges shall be accessible to those persons with physical challenges according to the appropriate American National Standards Institute (ANSI) Standards and all other federal and state standards.
6.6 Protective or security features such as fences and security windows may be used only when justified on the basis of the needs of persons served and shall preserve as normal an appearance as possible.
6.7 Use of security or observational devices shall constitute a restrictive procedure and require consent and review by the human rights committee. The need for such devices shall be documented in the person’s behavior support plan.
6.8 Homes shall be sanitary, free of offensive odors, insects and uncontrolled pests. Exterminator services shall be required upon evidence of any infestation.
6.9 Waste and garbage shall be stored, transferred, and disposed of in a manner that does not create a nuisance, or permit the transmission of disease. Litter shall not be permitted to accumulate on the premises.
6.10 Stairways, ramps, walkways and open-sided porches shall have adequate lighting and handrails for safety. Non-skid surfaces shall be used when slippery surfaces present a hazard.
6.11 All stairways, hallways, doorways and walkways shall be kept free and clear of obstructions at all times.
6.12 Mirrors shall be furnished in bedrooms and bathrooms, including mirrors that are accessible by persons who use wheelchairs.
6.13 Each home shall provide storage space for both in season and out of season clothing and storage space for personal items to include, minimally, closet space and four drawers in a chest of drawers.
6.14 Each home shall contain a clothes washer and dryer that are accessible to people unless people use commercial laundromats or are being supported to do so.
6.15 Basement space may be used for activities for people in the home if there is a minimum of two (2) fire exits.
6.16 If a bedroom is below grade level, it must have a window that
6.16.1 Is usable as a second means of escape by the person(s) occupying the room; and
6.16.2 Is no more than 36 inches (measured to the window sill) above the floor as required under the Health Care Occupancy Chapter of the Life Safety Code.
7.0 Mealtimes
7.1 The home’s meal and menu planning shall be supervised by a registered dietitian or nutritionist or by anexperienced person who consults a registered dietitian or nutritionist as needed. Therapeutic diet orders, meal and menu planning shall be reviewed, monitored and updated as recommended by the nutritionist/dietitian with a minimum of an annual evaluation. Therapeutic diets shall require a physician’s order.
7.2 Nutritional intake of persons receiving a medically prescribed modified diet shall be followed, reviewed and monitored by a nurse, dietitian or other medical personnel as appropriate, as determined by the dietitian or physician.
7.3 Persons shall be offered opportunities for choices in food selection and are actively involved in menu planning and food preparation as part of the daily meal routine.
7.4 Menus and records of foods actually served shall be retained for a period of three months.
7.5 Foods shall be provided in sufficient amounts for meals and snacks and in sufficient variety on a daily, weekly, monthly, and seasonal basis.
7.6 The daily diet for each person shall include a minimum of three balanced meals a day with food from the four basic food groups.
7.7 Meals shall be served so that they are flavorful, attractive in appearance, at appropriate serving temperature, and have preserved their nutritional value.
7.8 Meals should be provided in locations which provide the opportunity for socialization, choice, sanitation, and also support the person’s preference.
7.9 Persons shall eat in an upright position or in a position that is medically indicated.
7.10 There shall be at least one refrigerator and one freezing unit, in proper working order and capable of maintaining frozen foods in the frozen state and refrigerated foods at 41 degrees F. or below.
7.11 Dry or staple food items shall be stored at least four inches above the floor in a ventilated room that is not subject to waste water back flow or to contamination by condensation or leakage.
7.12 There shall be at least one four-burner range and one oven (or combination thereof), which is in proper working order.
7.13 There shall be a dishwasher or facilities for performing dishwashing.
7.14 There shall be at least one operable window or exhaust system for removal of smoke, odors, and fumes in the cooking area.
7.15 There shall be three days supply of food in each home at all times as posted on the menus. Opened foods that are to be stored shall immediately be dated with the date that the foods were opened.
8.0 Medical and Health Care
8.1 Each person shall have a primary care physician and a dentist and shall receive an annual physical and dental examination unless otherwise recommended by the appropriate professional. Routine screening and laboratory examinations shall be obtained when such are determined warranted by the physician.
8.2 Within 30 days after services are initiated by the agency, the following screenings shall be scheduled if the need for such is identified by the physician, person, advocate, guardian or team:
8.2.1 Nutritional;
8.2.2 Visual;
8.2.3 Auditory;
8.2.4 Speech and language;
8.2.5 Occupational therapy;
8.2.6 Physical therapy;
8.2.7 Assistive technology;
8.2.8 Other screenings as identified.
8.3 When requested by the person, advocate, guardian or team or when indicated by the screening results, the person shall receive a comprehensive evaluation in the area(s) within 90 days.
8.4 Each person shall have his/her own toothbrush which is used regularly and stored antiseptically.
8.5 Persons shall be supported, to the extent possible, to attend to their own health care needs by making medical and dental appointments, cooperating in receiving medical and dental treatment and in self-administering their medications.
8.6 The Neighborhood Home provider shall have policies and procedures for infection control as it pertains to persons, staff, and visitors. Upon confirmation of reportable disease, the appropriate County Health Officer of the Division of Public Health shall be notified.
8.7 The Neighborhood Home provider shall have on file results of tuberculin tests:
8.7.1 Performed annually for all employees and volunteers, and
8.7.2 Performed on all newly admitted persons. The tuberculin test to be used is the Mantoux test containing 5 TU-PPD stabilized with Tween, injected intradermally, using a needle and syringe, usually on the volar surface of the forearm. Persons found to have a significant reaction (defined as 10 mm of induration or greater) to tests shall be reported to the Division of Public Health and managed according to recommended medical practice. A tuberculin test as specified, done within the twelve months prior to employment or admission, or a chest x-ray showing no evidence of active tuberculosis shall satisfy this requirement.
8.8 Each person’s health and immunization history shall be updated continuously.
8.9 Persons who require adaptations of the environment or who use adaptive, corrective, mobility, orthotic, prosthetic, communication or other assistive devices or supports shall receive instruction in their proper use and shall receive professional assessments annually, or as otherwise prescribed, to ascertain the continued applicability and fitness of those devices or supports.
8.10 Adaptive, corrective, mobility, orthotic and prosthetic equipment shall be available, kept clean and in good repair and used as appropriate.
8.11 If any of the above supports are needed or used, the person’s plan shall specify:
8.11.1 the reason for each support;
8.11.2 the situations in which each is to be applied; and
8.11.3 a schedule for the use of each support.
9.0 Medications
9.1 Individuals receiving medication shall be instructed in self-administration to the limit of their understanding. The Neighborhood Home Provider shall also include instruction in the purpose, dosage and possible side effects of the prescribed medication to the limit of the person’s understanding.
9.2 Individuals who administer their own medication shall:
9.2.1 Understand the purpose of the medication, dosage times and possible side effects;
9.2.2 Know what to do if a dosage is missed, extra medication is taken or an adverse reaction is experienced;
9.2.3 Be educated in the maintenance of his/her own medication history and in the recording of information needed by the physician to determine medication and dosage effectiveness.
9.3 Medications shall be used only by the person for whom they were prescribed.
9.4 Injectable medication shall only be administered by licensed practical nurses, registered nurses or other licensed medical professionals.
9.5 Providers who have successfully completed a Board of Nursing approved Assistance with Self-Administration of Medication (AWSAM) training program may assist persons in the taking of medication, provided that the medication is in the original container and properly labeled. The medication shall be taken exactly as indicated on the label.
9.6 A medication record shall be maintained for each person. The record shall show the name and strength of each medication being taken by the person. Each dose administered shall be recorded by date, time and initials of person or persons assisting. Effectiveness shall be monitored by clinical support staff.
9.7 The Neighborhood Home Provider shall assist the person in reporting side effects to the physician who prescribed the medication. Suspected drug reactions shall be noted in the medication record and documented in the active file of the person.
9.8 All medication errors and corrective actions shall be documented and reported in accordance with provider written policy.
9.9 Serious medication errors and reactions to medication shall be reported immediately to the physician and to the Neighborhood Home provider’s chief executive officer or to a person designated by written policy.
9.10 A three-day supply of medication shall be available at all times. All medication shall be stored in its original container either from the pharmacy, physician or manufacturer with the proper label and specific directions for assistance.
9.11 Medications to be applied externally shall be distinguishable from medications to be taken internally by means of packaging, labeling and segregation within storage areas.
9.12 Medication shall be stored and locked under proper conditions of temperature, light, humidity and ventilation. Room temperature acceptable for medication storage is between 59 and 86 degrees Fahrenheit.
9.13 Medications requiring refrigeration shall be kept in a separate locked box within the refrigerator. A temperature monitoring device shall be used and the temperature shall be maintained between 36 and 42 degrees Fahrenheit.
9.14 A supply of over-the-counter medication shall be stocked at each home. However, the use of such medications must be authorized by the person’s physician in writing, and their use documented in the medication record and in the person’s active file.
9.15 Discontinued and outdated medications and containers with illegible or missing labels shall be promptly disposed of in a safe manner.
10.0 Persons’ Records
10.1 A cumulative record containing all information and documents related to supporting and providing services to the person shall be maintained chronologically for each person
10.2 The record shall be readily accessible to those who require such access in order to provide services as described in the person’s support plan.
10.3 All information concerning a person served, including information contained in an automated data bank, is confidential; and access shall be limited to staff who need to see the record, or to persons specifically authorized by the person or legally qualified representatives.
10.4 Entries in a person’s record referring to actions with another person shall be coded in such a way as to protect the confidentiality of the persons served.
10.5 The provider shall be responsible for the safekeeping of each person’s record and for securing it against loss, destruction, or use by unauthorized persons as evidenced by policies and practices.
10.6 Incident reports, with adequate documentation, shall be complete dfor each incident. Adequate documentation shall consist of the name of the resident(s) involved; the date, time and place of the incident; a description of the incident; a list of other parties involved, including witnesses; the nature of any injuries; resident outcome; and follow-up action, including notification of the resident’s family or guardian, attending physician and DDDS or law enforcement authorities when appropriate. Incident reports shall be kept on file by the provider. Reportable incidents shall be communicated immediately to the Division of Developmental Disabilities Services.
11.0 Transportation
11.1 The transportation system operated by, or under contract to, the home shall meet local and state licensing, inspection, insurance, and capacity requirements.
11.2 Vehicles used to transport persons shall be equipped with a seat belt for each person and a means of communication. Vehicles used to transport persons with physical impairments shall be adapted to their needs.
11.3 Drivers of vehicles shall have valid and appropriate driver’s licenses.
11.4 Emergency transportation shall be available on a 24-hour basis.
11.5 The provider shall provide or arrange transportation for a person’s routine medical and dental care.
12.0 Safety and Sanitation
12.1 The Neighborhood Home’s program shall comply with all applicable provisions of federal, state and local laws, regulations and codes pertaining to health, safety, sanitation and plumbing.
12.2 The provider shall maintain records and reports of periodic fire safety, health, sanitation, and environmental inspections required by local and state laws and regulations. The provider shall document actions taken to correct deficiencies noted in these reports.
12.3 The provider shall prepare written policies that outline maintenance (including electrical maintenance) and cleaning procedures, storage of cleaning materials and/or pesticides and other toxic materials.
12.4 Hot water at shower, bathing and handwashing facilities shall not exceed 115 degrees F.
12.5 There shall be adequate, safe and separate areas of storage of:
12.5.1 Food items;
12.5.2 Cleaning agents, disinfectants and polishes;
12.5.3 Poisons, chemicals and pesticides;
12.5.4 Eating, serving and cooking utensils;
12.5.5 Clean and dirty linen.
12.6 Firearms shall be prohibited on the premises of the Neighborhood Home.
12.7 Active attention shall be directed to avoiding hazards to the people supported, such as dangerous substances, sharp objects, unprotected electrical outlets, slippery floors or stairs, exposed heating devices, scalding water or broken glass. However, people shall be prepared for and progressively exposed to routine risks that are likely to be encountered in normal environments.
13.0 Bedrooms
13.1 Rooms or other areas of the Neighborhood Home that are not ordinarily sleeping rooms may not be used for sleeping purposes.
13.2 Sleeping rooms shall have an outside window and must provide for quiet and privacy. Adequate electrical outlets shall be conveniently located in each room with at least one (1) light fixture switch at the entrance to the bedroom.
13.3 Bedrooms shall have walls that extend from floor to ceiling, and shall accommodate no more than two persons.
13.4 Multi-bed bedrooms shall provide at least 75 square feet per person.
13.5 Single-bed bedrooms shall contain at least 100 square feet.
13.6 Bedrooms shall contain space, as needed, for bedside assistance and to accommodate the use and storage of mobility devices and prosthetic equipment.
13.7 Each person shall have a bed suitable for his or her physical statute and condition.
13.8 Mattresses, bedding and pillows shall be clean and provide comfort and sufficient support and warmth.
13.9 The use of hospital-type beds, plastic or other materials to keep beds and pillows dry, flat pillows or the absence of pillows or other departures from normalcy shall be justified in each case in the person’s record and reviewed at least annually.
13.10 There shall be a sturdy bedside stand, chair, a desk or table, and reading light for the person.
13.11 Each bedroom window shall have a window treatment that closes for privacy.
13.12 People shall be encouraged, and assisted as needed, to decorate their bedrooms as they choose.
14.0 Bathrooms
14.1 There shall be private toilet facilities with a shower or tub in good repair in each home. These facilities shall be accessible to the person according to his/her needs and shall facilitate maximum independence.
14.2 Traffic to and from any room shall not be through a bedroom or bathroom except where a bathroom opens directly off the room it serves.
14.3 There shall be at least one (1) window or mechanical ventilation to the outside of the bathroom.
14.4 Toilets, bathing and toileting appliances shall be equipped for use by physically handicapped persons, as dictated by such persons’ needs.
14.5 There shall be at least one (1) toilet of appropriate size for each four (4) persons. Each toilet shall be equipped with a toilet seat and toilet tissue.
14.6 There shall be at least one (1) wash basin for each four (4) persons.
14.7 There shall be at least one (1) tub or shower for each four (4) persons.
14.8 Wash basins shall be available in or immediately adjacent to bathrooms and/or toilet rooms.
14.9 Shower and tub areas shall be equipped with substantial hand-grip bars and slip-resistant floor surfaces.
15.0 Emergencies and Disasters
15.1 Fire safety in Neighborhood Homes shall comply with the rules and regulations of the State Fire Prevention Commission or the appropriate local jurisdiction. All applications for a license or renewal of a license shall include a letter certifying compliance by the Fire Marshal with jurisdiction. Notification of non-compliance with the applicable rules and regulations shall be grounds for revocation of a license.
15.2 The home shall have a minimum of two means of egress.
15.3 The home shall have an adequate number of UL approved smoke detectors in working order.
15.3.1 In a single level home, a minimum of one smoke detector shall be placed between the bedroom area and the remainder of the home.
15.3.2 In a multi-story home, a minimum of one smoke detector shall be on each level. On levels which have bedrooms, the detector shall be placed between the bedroom area and the remainder of the home.
15.4 There shall be at least one functional two and one-half to five pound ABC fire extinguisher on each floor of living space in the home that is readily accessible, visible and mounted on the wall. Inspections shall be completed by the service company or as regulated by the Fire Marshal. Each extinguisher shall be checked annually.
15.5 The provider shall have written procedures for meeting all emergencies and disasters such as fire, severe weather, and missing persons; and such procedures shall be communicated to all staff.
15.6 The procedures shall assign specific personnel to specific tasks and responsibilities.
15.7 The procedures shall contain instructions related to the use of alarm and signal systems. Provisions shall be made to alert persons living in the home according to their abilities, and these provisions shall be included in the procedures.
15.8 Evacuation routes and the location of fire-fighting equipment shall be posted in areas used by the public as required by the applicable fire safety regulations. The number and placement of postings are otherwise dictated by building use and configuration and by the needs of persons and staff.
15.9 The provider shall maintain an adequate communication system to ensure that on and off-duty personnel and local fire and safety authorities are notified promptly in the event of an emergency or disaster.
15.10 The telephone numbers of the nearest poison control center and the nearest source of emergency medical services shall be posted.
15.11 Provisions shall be made for emergency auxiliary heat and lighting by means of alternate sources of electric power, alternate fuels, and stand-by equipment, or arrangements with neighbors, other agencies or community resources.
16.0 Evacuation Drills
16.1 Drills shall be held quarterly for each shift with one drill per calendar month. Evacuation drills shall be held on different days, at different times, including times when people are asleep.
16.2 The location of egress during these evacuation drills shall be varied, with window evacuation procedures discussed as an alternative, if not practiced.
16.3 During drills, persons shall be evacuated with staff assistance to the designated safe area outside of the home.
16.4 As evidenced by evacuation drill reports that are maintained by the Neighborhood Home, drills shall assure that all persons and staff are familiar with the evacuation requirements and procedures. Any problems persons have evacuating a building during a drill shall result in a written plan of specific corrective action(s) to be taken.
16.5 Persons who are unable to achieve the exit schedule prescribed by the Life/Safety Code with available assistance shall be either relocated or provided with additional assistance.
17.0 Waivers of Standards
17.1 Specific standards may be waived by the Division of Long Term Care Residents Protection provided that each of the following conditions is met:
17.1.1 Strict enforcement of the standard would result in unreasonable hardship on the provider.
17.1.2 The waiver is in accordance with the particular needs of the person.
17.1.3 A waiver must not adversely affect the health, safety, welfare, or rights of any person.
17.1.4 Residents may be informed of the waiver request and asked for input, as appropriate.
17.2 The request for a waiver must be made to the Division of Long Term Care Residents Protection in writing by the provider with substantial detail justifying the request. The Division of Long Term Care Residents Protection will inform the provider of its decision within 30 days of receipt of the written request.
17.3 A waiver granted by the Division of Long Term Care Residents Protection is not transferable to another Neighborhood Home provider in the event of a change in ownership.
17.4 A waiver shall be granted for a period up to the term of the license.
18.0 Severability
18.1 Should any section, sentence, clause or phrase of these regulations be legally declared unconstitutional or invalid for any reason, the remainder of said regulations shall not be affected thereby.
7 DE Reg. 505 (10/1/03)
Please note: The DHSS regulations on this website are not as yet complete. In conjunction with the Delaware Registrar of Regulations, DHSS is in process of compiling regulations relating to Title 16, as part of the continuing project to develop the Delaware Administrative Code.
