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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsApril 2017


Regulatory Flexibility Act Form

Authenticated PDF Version

16 DE Admin. Code 3310
3310 Neighborhood Homes for Persons with Developmental Disabilities
Advocate”- An advocate can be a guardian, legal representative, or knowledgeable person who seeks to promote the person’s best interest.
“Assessment” The process of gathering information as part of the Essential Lifestyle Planning process, including securing information about the individual’s strength’s, capacities, needs, preferences, and desired outcomes, health status and risk factors.
“Choice” The process by which people make selections from an array of options.
Co-mingling of funds”- Co-mingling of individual funds are funds that are blended into a “pool” of other program participants and/or contractual provider funds.
Essential Lifestyle Plan (ELP)” - A comprehensive document that specifies the individual’s desired outcomes, needs, and preferences, and identifies the strategies to address each. The ELP indicates who developed and participated in the process, the timing of the plan and how and when it is updated, including updates in response to changing circumstances and needs. The ELP includes information from assessments conducted prior to the planning meeting. The ELP indentifies how the individual/family/advocate is informed of services under the waiver and how the process ensures that the plan addresses the individual’s desired outcomes, needs, preferences and identified health/safety needs. The plan addresses the coordination of services and supports and assigns responsibility for the monitoring and oversight of all components of the individual’s plan.
“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.
Guardian– A legal relationship in which the person has been authorized to make decision for another person who has been determined by a court to incompetent to manage his/her affairs and/or property.
General Event– Any event involving an individual receiving services which causes or could cause injury which has serious impact on the individual or others. A reportable General Event could include, but is not limited to: potential violations of an individual’s rights; an explained or unexplained injury; accidents requiring non-routine first aid or outside medical attention; an individual’s unauthorized absence, the involvement or potential involvement of the legal system/law enforcement; actions of an individual which is generally viewed as unacceptable social behavior in a community setting; significant destruction of property, any situation which necessitates an emergency restrictive procedure; events which could have an adverse impact on the individual or services; any situation which necessitates the use of a medical restraint; any deviation from a physician’s plan of treatment; Errors related to the documentation of a physicians treatment plan; life-threatening or allergic reactions by an individual to medical treatment; the death of an individual regardless of cause.
General Event Report (GER)– The online incident reporting module which also includes the EMBIS (Emergency Medical and Behavioral Intervention Strategies) report, as required by the DDDS Behavior Support Policy.
Health Related Protection (HRP)” – Any material or mechanical device, or equipment used to restrict the normal movement of an individual so as to prevent a fall or injury. Examples of mechanical restraints, which may be used as a health related protection may include (but not be limited to): bed rails, seat belt, bed enclosure system, etc.
“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.
Individual”- Term used throughout these regulations that identifies someone receiving services and supports.
Individual Outcome and Support Assessment (IOSA)”- The DDDS assessment tool utilized to identify an individual’s preferences, needs for and satisfaction with services regarding: Living Options, Community Membership, Relationships/Social Network, Work, Health, Safety, and Organizational Support.
“Neighborhood Home” - A stand alone house within the community that serves up to 5 individuals with developmental disabilities in a single-family home setting. These homes are licensed by the Division of Long Term Care Residents Protection pursuant to 16 Del.C. §1101 and must meet minimum acceptable standards for living conditions and supports.
“Outcomes” - The results and/or goals of the services and supports that people receive. A major emphasis of outcome based service provision is the facilitation of individual choice in defining success and satisfaction.
Peer Review of Behavioral Intervention Strategies (PROBIS)”– The DDDS approved peer review committee charged with the review of Behavior and/or Mental Health Support Strategies, excluding positive behavior supports.
“Physical Environment” - Those locations in which the individual lives, works, recreates or receives services.
“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; significant errors or omissions in medication/treatment which cause the resident discomfort or jeopardize the resident’s health and safety; and incidents of physical altercations between 2 or more individuals in a residential or day program setting. 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.
“Service provider” - A person or organization under contract with the DDDS, which is responsible for the provision of specific selected services and supports for the individual.
“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.
4.1.1.1 The individual/family/advocate indicates that opportunities were given regarding choice of providers.
4.1.1.2 Documentation is present to indicate that the individual was informed of his/her right to choose among service providers.
4.1.1.3 If the individual expresses a need for a change in services, documentation is present that efforts are being made to support the individual in making an informed choice of a new service provider.
4.1.2.1 The individual is supported to make choices in all areas of his/her life.
4.1.2.2 Individual/family/advocate reports that the plan reflects what is important to the individual.
4.2.1.1 The individual is treated in a respectful and dignified manner.
4.2.1.2 If the individual/family/advocate has a complaint, the service provider addresses the concern in a timely manner.
4.2.1.3 The individual decides when and with whom to share personal information.
4.2.1.4 The individual is free from unnecessary restraints/restrictions. Surveillance cameras/monitors are prohibited in private areas such as bedrooms and bathrooms unless the individual has extraordinary circumstances that deem constant monitoring. The use of cameras needs approval by PROBIS and HRC with final approval by the DDDS director/designee.
4.2.1.5 The individual has access to all areas of his/her environment.
4.2.2.1 The individual’s incidents and accidents are reported and followed up as appropriate.
4.2.2.2 The Policy Memorandum 46 (PM46) policy for reporting abuse, assault, attempted suicide, mistreatment, neglect, financial exploitation and significant injury is followed.
4.2.3.1 The individual’s rights and responsibilities are reviewed with the individual/guardian, legal representative or advocate at least annually.
4.2.3.2 If the individual has a rights restriction, DDDS policy and procedures are followed.
4.2.3.3 The Individual Rights Complaint Policy is posted within the residence and the individual/family/advocate has access to the Individual Rights Complaint form.
4.2.3.4 The Patient’s Bill of Rights (Title 16) is posted in a conspicuous location within the residence to ensure easy access by individuals served.
4.2.4.1 Peer Review of Behavior Intervention Strategies (PROBIS), Human Rights Committee (HRC), and Health Related Protection (HRP) reviews are completed per policy.
4.2.4.2 Consents are obtained annually, as otherwise specified, or whenever a change occurs.
4.2.4.3 The Individual’s Rights Restriction form is completed and reviewed at least annually by HRC or whenever additional rights are restricted.
4.2.5.1 The individual has access to his/her funds.
4.2.5.2 The individual is supported to manage his/her funds to the greatest extent possible.
4.2.5.3 The individual’s Personal Spending Record (PSR) is reviewed as outlined by DDDS policy to ensure that the individual’s money is safeguarded.
4.2.5.4 Authorizations for expenditures are present as required by policy.
4.2.5.5 Documentation is present for expenditures as required by policy.
4.2.5.6 Discrepancies in the individual’s funds are addressed in a timely manner.
4.2.5.7 The individual’s funds are not co-mingled.
4.2.5.8 The individual’s funds are kept in a secure manner.
4.2.5.9 Resource and personal spending issues effecting eligibility for services are handled immediately.
4.3.1.1 Lab work is completed in a timely manner: as ordered or within 5 working days of receipt of order.
4.3.1.2 Necessary screenings/appointments are scheduled within 5 working days of receipt of order or per doctor’s order.
4.3.1.3 The service provider advocates for any other screenings when indicated by the individual’s needs.
4.3.1.4 The individual receives all required medical and mental health care.
4.3.1.5 If the individual is not receiving needed health care services, documentation is present that indicates what is being done by the service provider(s) to address the specific issue.
4.3.2.1 Documentation is present to indicate that the individual’s current health and immunization history is updated on a continuous basis.
4.3.3.1 Service Providers shall have on file the results of tuberculin testing performed on all individuals at the beginning of his/her service by DDDS (referenced as newly placed individuals) and following the discovery by the service provider of a new case.
4.3.3.2 All newly placed individuals shall have a baseline two-step tuberculin skin test (TST) or single Interferon Gamma Release Assay (IGRA) or TB blood test such as Quanti FERON. The service provider shall provide employee documentation of their baseline test.
4.3.3.3 For newly placed individuals with a negative TST or IGRA no annual evaluation is required unless the category of risk changes as determined by the Division of Public Health. Any required subsequent testing according to risk category shall be in accordance with the recommendations of the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.
4.3.3.4 If any of the baseline tests listed above are positive, the newly placed individual shall receive one chest x-ray to rule out active disease, be offered treatment for latent TB (LTBI) infection and shall be evaluated annually for signs and symptoms of active TB if they cannot provide documentation of completion of treatment for LTBI.
4.3.3.5 Service Providers shall establish policies for TB risk assessment for any individual having a positive skin test but negative x-ray. The service provider has available an annual statement from a licensed health care professional that indicates the individual has exhibited no signs or symptoms of active TB.
4.3.4.1 Annual/current orders are present for all medications.
4.3.4.2 Non-routine medications are obtained immediately upon receipt of Physician’s order.
4.3.4.3 Medication labels and Medication Administration Records match the Physician’s Orders for the medication.
4.3.4.4 A three-day supply of medications is available at all times.
4.3.4.5 PRN medications have protocols for how/when the medication should be given.
4.3.4.6 A supply of over-the-counter medication (SMOs) shall be stocked at each home. However, the use of such medications must be authorized by the individual’s physician in writing, and their use documented in the medication record and in the individual’s active file.
4.3.7.1 Individuals receiving medication shall be instructed in self-administration to the limit of their understanding. The service provider shall also include instruction in the purpose, dosage and possible side effects of the prescribed medication to the limit of the individual's understanding.
4.3.7.2 Assessments for self-medication are completed at least annually or more often, if needed, for individuals who desire to self-medicate.
4.3.8.6 Records of food served are maintained by the service provider for three months.
8.4 Multi-bed bedrooms shall provide at least 75 square feet per individual. Neighborhood homes licensed subsequent to the implementation of these regulations shall provide at least 80 square feet per person.
9.1 There shall be private toilet facilities with a shower or tub in good repair in each home. These facilities shall be accessible to the individual according to his/her needs and shall facilitate maximum independence.
10.1 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.
"Abuse" means the term as defined in 16 Del.C. Ch. 11.
"Authorized Representative" means the person, on behalf of an individual without decision-making capacity, who has the highest priority to act for the individual under law, and who has the authority to make decisions on behalf of the individual. The individual's authorized representative could be a person designated by an individual under an advance health-care directive, an agent under a medical durable power of attorney for health-care decisions or financial decisions, a guardian of the person appointed pursuant to 12 Del.C. Chs. 39 and 39A, in accordance with the authority granted by the appointing court, a surrogate appointed under 16 Del.C. Ch. 25, a person designated by an individual pursuant to 16 Del.C. Ch. 94A, or an individual who is otherwise authorized under applicable law to make the decisions on the individual's behalf, if the individual lacks decision-making capacity.
"Aversive Interventions" means those interventions intended to inflict pain, discomfort and/or social humiliation or any intervention as perceived by the individual to inflict pain, discomfort or social humiliation in order to reduce behavior. Examples of aversive interventions include, but are not limited to, electric skin shock, liquid spray to one's face and strong, non-preferred taste applied to the mouth. (National Association of State Directors of Developmental Disabilities Services (NASDDDS) Research Committee-11/11/2014)
"Choice" means the process by which people make selections from an array of options.
"DDDS" means the Division of Developmental Disabilities Services.
"Department" means the Department of Health and Social Services.
"DLTCRP" means the Division of Long Term Care Residents Protection.
"Financial Exploitation" means the term as defined in 16 Del.C. Chapter 11.
"Incident" means an unexpected and usually unpleasant occurrence that interrupts normal procedure or functioning.
"Individual" means a person living in a neighborhood home in the community who receives authorized services and/or supports through the DDDS.
"Mistreatment" means the term as defined in 16 Del.C. Chapter 11.
"Neglect" means the term as defined in 16 Del.C. Chapter 11.
"Neighborhood Home" means a residence for no more than five (5) individuals that is fully integrated in the community, not on the grounds of an institution, has shared common living areas and is where the individual chooses to live. These homes offer 24 hour supports to individuals with intellectual and/or developmental disabilities.
"Person Centered Plan" means the Life Span Plan or other plan approved by DDDS. This plan includes the following elements: people chosen by the individual; reflects cultural considerations; uses plain language; strategies for solving disagreements; offers informed choice to the individual regarding services and supports that the individual receives and from whom; and provides a method to request updates.
"Provider" means an entity that has been authorized and approved in accordance with the standards of DDDS to provide services to meet the specialized needs of individuals' with intellectual and developmental disabilities.
"Reportable Incident" means an occurrence, event or suspicion of same which must be reported immediately to the DDDS and within 8 hours to the DLTCRP.
"Rights Complaint" means an allegation that an individual's rights have been violated.
"Safety" means 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" means the promotion of hygiene and prevention of disease by the maintenance of uncontaminated conditions.
"Support" means those methods designed to help an individual achieve a meaningful life and to function to his/her fullest capacity.
6.8.1 Abuse as defined in 16 Del.C. §1131, or reasonable suspicion of same.
6.8.2 Neglect, mistreatment or financial exploitation as defined in 16 Del.C. §1131, or reasonable suspicion of same.
Neighborhood homes must comply with 16 Del.C. Ch.11, Subchapter II, regarding the rights of the individuals residing in the neighborhood homes.
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.
Last Updated: December 31 1969 19:00:00.
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