Human Services, Administration, Administrative Services, Licensing

Rule R501-15

Therapeutic Schools

Notice of Proposed Rule

(New Rule)

DAR File No.: 34140
Filed: 10/06/2010 09:55:44 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule needs to be re-established and continued in order to establish basic health standards for therapeutic schools. (DAR NOTE: The rule expired on 10/06/2010; see the expiration notice under DAR No. 34139 is this issue, November 1, 2010, of the Bulletin.)

Summary of the rule or change:

This rule establishes basic health and safety standards for therapeutic schools; procedures and standards for permitting a therapeutic school to provide services to an adult in the same facility and under the same conditions as a child; and minimum administration and financial requirements.

State statutory or constitutional authorization for this rule:

• Section 62-A-101
• Section 62-A-106

Anticipated cost or savings to:

the state budget:

This rule clarifies practice but it will not increase the workload already being done.

local governments:

There will be no increase or savings to local government. This rule clarifies practice on work already being done.

small businesses:

There will be no increase or savings to small businesses because they will not be affected by this rule.

persons other than small businesses, businesses, or local governmental entities:

There will be no cost or savings to any persons or entities. This rule clarifies practice on work already being done.

Compliance costs for affected persons:

Affected persons have no cost associated with implementing this rule.

Comments by the department head on the fiscal impact the rule may have on businesses:

There will be no cost or savings associated with implementing this rule.

Palmer DePaulis, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Administration, Administrative Services, Licensing
195 N 1950 W
FIRST FLOOR
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Vilma Mosier at the above address, by phone at 801-538-4041, by FAX at 801-538-4553, or by Internet E-mail at vmosier@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/01/2010

This rule may become effective on:

12/08/2010

Authorized by:

Ken Stettler, Director

R501. Human Services, Administration, Administrative Services, Licensing.

R501-15. Therapeutic Schools.

R501-15-1. Authority and Purpose.

1. This rule is authorized under Section 62A-2-106.

2. This rule establishes:

a. basic health and safety standards for therapeutic schools;

b. procedures and standards for permitting a therapeutic school to provide services to an adult in the same facility and under the same conditions as a child; and

c. minimum administration and financial requirements.

 

R501-15-2. Definitions.

1. "Academic professional" means an educator with a "level 2 license" or "level 3 license," issued in accordance with Section 53A-6-101 et seq.

2. "Adult" means a person 18 years of age or older.

3. "Background screening clearance" means written verification that the Office of Licensing has approved an applicant's criminal, abuse, neglect, and exploitation background screenings.

4. "Child" is defined in Section 62A-2-101.

5. "Client" is defined in Section 62A-2-101.

6. "Dangerous weapon" is defined in Section 76-10-501.

7. "Dietician" means an individual certified in accordance with Utah Code Ann. Title 58 Chapter 49.

8. "Direct access" is defined in Section 62A-2-101.

9. "Direct care staff" means an individual who provides educational, therapeutic services, supervision or care directly to a client, and does not include support staff who do not supervise clients and who only provide support services such as maintenance, office or kitchen duties.

10. "Directly supervised" is defined in Section 62A-2-120.

11. "Explosive, chemical, or incendiary device" is defined in Section 76-10-306.

12. "Facility" means the physical area where program activities take place, and includes the buildings and grounds that are owned or leased by the therapeutic school or its governing body.

13. "Firearm or antique firearm" are defined in Section 76-10-501.

14. "Incident report" means a written description of any notable event, including but not limited to any crime, discipline, injury or illness, or unauthorized absence, and how that event was addressed.

15. "Medical practitioner" means an individual licensed by the State of Utah under Utah Code Ann. Title 58 as a physician, dentist, physician's assistant, practical nurse, or registered nurse.

16. "Mental health therapist" is defined in Section 58-60-102.

17. "Mental illness" is defined in Section 62A-15-602.

18. "Mental retardation" means having significantly below average intellectual functioning, and at the same time needing help with two or more basic life skills.

19. "On call" means immediately available to staff by telephone, and able to be present on site within one hour after a staff telephone call for assistance.

20. "On duty" means awake, within visual and auditory proximity of clients, and immediately available to clients.

21. "Recreational therapist" means an individual licensed to practice recreational therapy in accordance with Utah Code Ann. Title 58 Chapter 40.

22. "Regular business hours" is defined in Section 62A-2-101.

23. "Residential treatment" is defined in Section 62A-2-101.

24. "Service plan" means a written description of the educational, therapeutic, and other services an individual client requires, as determined and updated after periodic assessments by a mental health therapist or an academic professional.

25. "Sick" means to have a fever, an illness that may be contagious, or to be experiencing diarrhea or vomiting.

26. "Staff" means therapeutic school directors, supervisors, faculty, employees, agents, interns or volunteers who provide any therapeutic school services.

27. "Supervisor designee" means a direct care staff who currently meets all qualifications described in R501-15-6.C and is assigned by the program Director to act as a supervisor for a specified limited period of time.

28. "Therapeutic school" is defined in Section 62A-2-101.

 

R501-15-3. Legal Requirements.

1. A therapeutic school shall comply with this R501-15 and:

a. R495-876, Provider Code of Conduct;

b. R501-2, Core Standards;

c. R501-14, Background Screening;

d. R710-4, Buildings Under the Jurisdiction of the State Fire Prevention Board;

e. R710-9, Rules Pursuant to the Utah Fire Prevention Law; and

f. all applicable local, state, and federal laws.

2.a. A therapeutic school shall comply with R501-19 and obtain a residential treatment license prior to offering any residential treatment services.

b. A therapeutic school shall comply with R501-16 and obtain an intermediate secure treatment license prior to offering any intermediate secure treatment services.

 

R501-15-4. Administration Requirements.

1. A current policy and procedure manual will be maintained, and shall include:

a. admission criteria and procedures, which shall include:

i. A student may not attend a therapeutic school unless there is presented to the school a certificate of immunization from a licensed physician or authorized representative of the state or local health department stating that the student has received immunization against communicable diseases as required by Utah Administrative Rule R396-100, unless exempted as provided in Section 53A-11-302; and

ii. client admission, exclusion, and expulsion criteria described in Subection 501-15-4.B.1.

b. quarterly client needs evaluation and assessment procedures;

c. behavior management training requirements;

d. methods for compliance with each section of this R501-15;

e. an emergency transportation plan, describing how the therapeutic school shall safely transport each client to the client's legal guardian within 48 hours;

f. an emergency response plan, describing how the therapeutic school shall safely care for each client in the event of severe weather, a fire, natural disaster, significant criminal activity, major medical incident, prolonged power outage, or other emergency; and

g. methods for compliance with each legal requirement.

2. A current client manual will be provided to each client and each client's legal guardian before the therapeutic school accepts any payment or processes any application to provide services. The manual shall include detailed descriptions of:

a. client admission, exclusion, and expulsion criteria and procedures, including but not limited to:

i. A therapeutic school shall not admit or provide services to an individual who:

A. has a recent history (within the past 2 years) of attempting suicide or making serious self-harm gestures (requiring medical or therapeutic treatment),

B. has a psychosis, schizophrenia, severe depression, mental retardation, or a severe mental illness (requiring medical or therapeutic treatment),

C. is violent, highly combative, or physically or sexually aggressive,

D. presents substantial security risks,

E. requires medical detoxification,

F. lacks the ability to engage in a rational decision-making process or exhibits severely impaired judgment, or

G. has a history of repeated runaway attempts or incidents;

ii. A therapeutic school shall expel a client who exhibits high risk behavior or conditions, including but not limited to a client who:

A. attempts suicide or makes serious self-harm gestures (requiring medical or therapeutic treatment),

B. has a psychosis, schizophrenia, severe depression, mental retardation, or a severe mental illness (requiring medical or therapeutic treatment),

C. is violent, highly combative, or physically or sexually aggressive,

D. presents substantial security risks,

E. requires medical detoxification,

F. lacks the ability to engage in a rational decision-making process or exhibits severely impaired judgment,

G. runs away or attempts to runaway more than two times,

H. uses or attempts to use illegal substances (including but not limited to drugs or alcohol) more than two times, or

I. exhibits any other behavioral or emotional conditions that require more intense supervision and treatment than that permitted in a therapeutic school;

b. academic accreditation, or disclosure that the school is not accredited;

c. curriculum;

d. criteria for awarding course credit, and whether credits are transferable;

e. grades, progress assessment, and testing;

f. academic and career counseling;

g. academic activities and methods;

h. graduation requirements;

i. post-graduation planning services;

j. methods of providing specialized structure and supervision of clients on-site;

k. methods of providing specialized structure and supervision of clients off-site;

l. services or treatment related to a client's disability, emotional development, behavioral development, familial development, or social development;

m. behavior management practices;

n. individual, group, or family counseling services;

o. therapeutic school rules, including but not limited to rules regarding discipline, searches, visitation, correspondence, and personal possessions;

p. food service and weekly menus;

q. physical education and recreational activities;

r. client rights statement;

s. permitted and prohibited weapons;

t. a client grievance policy, including an appeal process; and

u. name and contact information for the Office of Licensing.

3. All staff and client files, manuals, and records shall be maintained in an on-site office. The on duty supervisor or supervisor designee shall have access to all locked files, including computer files, and make them available upon request to the Office of Licensing.

 

R501-15-5. Financial Requirements.

1. A therapeutic school shall provide a written disclosure of all fees and expenses a client may incur, and identify which fees may be non-refundable, before accepting any payment, processing any application, or entering any contract to provide client services.

2. A therapeutic school shall provide an itemized accounting of actual expenditures made on behalf of each client before requiring reimbursement from the client's guardian.

3. A therapeutic school shall maintain an accurate log of all funds deposited and all withdrawals made for the personal use of each client. Receipts for purchases of over $20.00 shall be signed by the client and staff, and maintained with the log.

 

R501-15-6. Staff Requirements.

1. Each owner and board member of a therapeutic school shall successfully complete a minimum of 8 hours of annual training relating to therapeutic school services.

2. A therapeutic school shall employ a director who is responsible for daily client supervision and operation of the program.

a. A director shall be on duty or on call at all times.

b. The director shall:

i. be at least 25 years of age;

ii. have a BS or BS social services degree, or a minimum of three years of documented training or experience in providing therapeutic school or residential treatment services;

iii. have a minimum of two years of therapeutic school or residential treatment program supervisory experience; and

iv. demonstrate a comprehensive knowledge of this R501-15, R495-876, R501-1, R501-2, R501-3, R710-4, R710-9, and all applicable local, state, and federal laws.

c. The governing body of a therapeutic school may appoint an acting director to fulfill the responsibilities of the Director.

i. An acting director shall satisfy all requirements of Subsection R501-15-6.B.2 at the time of appointment.

3. A therapeutic school shall have a minimum of one supervisor or supervisor designee on duty at all times.

a. A supervisor or supervisor designee shall have:

i. a demonstrated, documented competency and proficiency in providing services to children in out-of-home placements;

ii. qualifications, including education, experience, licensing or certification requirements, and current annual continuing education and training, directly related to providing:

A. specialized structure and supervision of clients; or

B. services or treatment related to a client's disability, emotional development, behavioral development, familial development, or social development;

iii. current certification in standard first aid;

iv. current certification in CPR;

v. current certification in passive restraint techniques; and

vi. current background screening clearance.

4. A therapeutic school shall maintain a staff manual, which shall include specific:

a. job descriptions for each staff position;

b. qualifications, including education, experience, and licensing or certification requirements, for each staff position;

c. competency and proficiency requirements for each staff position; and

d. continuing education and training requirements for each staff position.

5. Each staff with direct access to a client shall be directly supervised by a supervisor or supervisor designee until the staff:

a. achieves the qualifications, competency and proficiency requirements, and training requirements of the applicable job description;

b. receives current certification in standard first aid;

c. receives current certification in CPR;

d. receives current certification in passive restraint techniques;

e. successfully completes annual training in working with clients who have a history of failing to function at home or in school;

f. receives current background screening clearance; and

g. demonstrates a working knowledge of:

A. R495-876, Provider Code of Conduct;

B. R501-2, Core Standards;

C. R501-15, Therapeutic Schools;

D. the current therapeutic school policy and procedure manual;

E. the current therapeutic school client manual and

F. all applicable local, state, and federal laws.

6. A therapeutic school shall have a policy, subject to the approval of the Office of Licensing, which clearly defines the minimum levels of supervision of clients by direct care staff.

a. A therapeutic school shall submit a proposed minimum direct care staff-to-client ratio with its license application and each time the activities or the client population of the therapeutic school are modified.

b. A therapeutic school shall identify the minimum direct care staff-to-client ratio for each type of activity its clients engage in, including but not limited to various types of on-site and off-site activities, specific low risk and high risk activities, individual and group activities, and waking and sleeping hours.

c. A therapeutic school shall consider factors particular to its client population, including but not limited to clients' presenting problems, risk to the community, age, maturity, behavior, and daily schedule, in determining its minimum direct care staff-to-client ratio.

d. A minimum of 2 staff shall be on duty at all times.

e. A minimum of one male staff shall be on duty when a male client is present, and a minimum of one female staff shall be on duty when a female client is present.

f. A client who has earned the privilege of unsupervised time off site shall be required to engage in two-way communication with on duty direct care staff once every 4 hours.

i. A therapeutic school shall develop and adhere to a policy that specifies what measures shall be taken if a client fails to check-in with staff when scheduled.

g. A therapeutic school's approved minimum direct care staff-to-client ratio shall be visibly posted.

h. A therapeutic school shall comply with approved minimum direct care staff-to-client ratios.

i. Support staff shall not be counted when ascertaining compliance with the approved minimum direct care staff-to-client ratios.

7. A therapeutic school shall be required to justify, to the satisfaction of the Office of Licensing, basic low risk, on-site "waking hours" direct care staff-to-client ratio that does not meet or exceed:

a. two direct care staff on duty for 1-8 clients;

b. three direct care staff on duty for 9-24 clients;

c. four direct care staff on duty for 25-48 clients;

d. five direct care staff on duty for 49-96 clients;

e. 1:20 direct care staff-to-client ratio for 97 or more clients, and never any less than six direct care staff on duty.

8. A therapeutic school shall be required to justify, to the satisfaction of the Office of Licensing, any "sleeping hours" direct care staff-to-client ratio that does not meet or exceed:

a. two direct care staff on duty for 1-48 clients;

b. a 1:40 direct care staff-to-client ratio for 49 or more clients, and never any less than three direct care staff on duty.

 

R501-15-7. Documentation.

1. A therapeutic school shall maintain a current roster of all clients, including the name, date of birth, sex, and emergency contact information.

2. A therapeutic school shall maintain staff files, which shall include:

a. application and resume;

b. qualifications for the staff position held;

c. written competency evaluations, which shall be completed six months after the date of hire and a minimum of once annually;

d. continuing education, training, and certifications; and

e. background screening approval verification.

3. A therapeutic school shall maintain client files, which shall include:

a. application forms and contracts signed by client's legal guardian;

b. acknowledgment of client rights signed by client and client's legal guardian;

c. academic records, including quarterly progress reports and all records of standardized testing, grades, credits earned, and diplomas awarded;

d. medical records, including medication log and medical treatment records;

e. counseling notes, signed by the counselor;

f. incident reports, signed by supervisor or supervisor designee on duty; and

g. daily shift report, signed by supervisor or supervisor designee on duty.

 

R501-15-8. Client Services.

1. A service plan, to include specific educational and therapeutic goals, shall be developed within thirty days after admission.

a. A service plan shall be reviewed, updated, and signed by the client and a supervisor no less than quarterly.

i. the service plan shall include a quarterly reassessment of the suitability of the therapeutic school in providing for the client's needs.

b. A copy of the service plan shall be provided to the client's legal guardian within two weeks after it is developed and within two weeks after it is updated.

2. A therapeutic school shall have written policies and procedures describing how medical services will be promptly provided.

a. A therapeutic school that must travel more than thirty miles to an emergency room or 24-hour urgent care facility shall retain the on-call services of a medical practitioner and a licensed mental health therapist.

b. Upon admission, each client shall be informed of the right to consult with a medical practitioner or a licensed mental health therapist.

3. A client who has a serious illness, who sustains a serious injury, or who requests the services of a medical practitioner, shall receive an immediate assessment by a certified wilderness first responder, certified EMT, or a medical practitioner.

a. The therapeutic school shall attach the written assessment to an incident report.

b. The therapeutic school shall comply with the recommendations of the certified wilderness first responder, certified EMT, or medical practitioner.

4. A monthly schedule of activities shall be posted in the common area and the office. Monthly schedules of activities shall be filed and retained for a minimum of one year.

5. A therapeutic school's academic curriculum shall be accredited by an accrediting entity recognized by the Utah State Board of Education, or it shall present an educational service plan and educational funding plan in accordance with Section 62A-2-108.1.

a. The therapeutic school curriculum shall be provided to each client and the client's legal guardian prior to accepting any payment or processing any application to provide services.

b. The therapeutic school curriculum shall be reviewed and updated annually.

c. Modifications to the curriculum shall be provided to each client and the client's legal guardian within two weeks of any curriculum change.

6. The therapeutic school shall monitor and document each client's academic progress, and communicate this information to the client's legal guardian monthly.

 

R501-15-9. Physical Environment.

1. A therapeutic school shall provide written verification of compliance with:

a. local zoning ordinances;

b. local business license requirements;

c. local building codes, as evidenced by the local governmental entity's building inspector;

d. state fire prevention laws and rules; and

e. state and local health codes and rules regarding sanitation and infectious disease control.

2. The building and grounds shall be maintained in a safe and sanitary manner.

3. A therapeutic school shall have on-site offices.

a. Staff and client records shall be stored in locked file cabinets when not in active use.

b. A private office shall be available for individual counseling sessions.

4. A therapeutic school shall provide indoor common areas, such as gymnasiums, recreation areas, cafeterias, classrooms, libraries, and lounges, for group activities.

a. The total common area space in a therapeutic school shall be a minimum of thirty square feet per client.

5.a. A therapeutic school shall maintain a minimum of 3 feet between beds and 2 feet at the end of each bed.

b. Bedroom ceilings shall be a minimum of 7 feet in height.

c. A minimum of fifty square feet per client shall be provided in a multiple occupant bedroom.

i. Storage space shall not be counted when calculating square footage requirements.

d. A minimum eighty square feet per client shall be provided in a single occupant bedroom.

i. Storage space shall not be counted when calculating square footage requirements.

e. Each client shall have a minimum of thirty cubic feet of private storage space.

f. Sleeping areas shall have a source of natural light, and shall be ventilated by mechanical means or equipped with a screened window that opens.

g. Each bed shall be solidly constructed.

h. Bed mattresses shall be in a clean and safe condition.

i. Each client shall be provided with clean linens upon arrival, when soiled, and a minimum of once per week.

j. Sleeping quarters serving male and female clients shall be structurally separated.

6. A therapeutic school shall provide a minimum of one toilet, one sink, one mirror, and one bathtub or shower, for each six clients.

a. Each bathroom shall be designated for males only or for females only.

b. A bathroom with multiple toilets, showers, or bathtubs shall be subdivided to preserve each client's privacy.

c. Each bathroom shall be maintained in good operating order and in a clean and safe condition.

d. Each bathroom shall be equipped with personal hygiene supplies, including but not limited to toilet paper, clean towels, trashcans, and soap.

e. Bathrooms shall be well lighted and ventilated by mechanical means or equipped with a screened window that opens.

7. Live-in staff shall have a separate bedroom with a private bathroom.

8. Clients who are sick shall have a bedroom and bathroom separate from clients who are not sick.

9. All furniture and equipment shall be maintained in a clean and safe condition.

10. School desks or tables, lights, and chairs shall be provided for each client.

11. A therapeutic school shall contract with a laundry service or shall provide laundry appliances and supplies for washing, drying, and ironing.

a. Each client shall have a dirty laundry hamper for personal linens and clothing;

b. all personal linens and clothing shall be laundered weekly;

c. clients who launder their own linens or clothing shall have weekly access to laundry appliances and supplies for washing, drying, and ironing;

d. a common laundry hamper shall be provided for linens owned by the therapeutic school;

i. dirty linens shall be laundered within 72 hours; and

e. laundry appliances shall be maintained in a clean and safe operating condition.

12.a. Firearms, antique firearms, ammunition, and explosive, chemical, or incendiary devices, shall not be permitted on site.

b. Dangerous weapons, including but not limited to tools, knives (including kitchen knives), scissors, matches, lighters, clubs, bats, and arrows, shall be inaccessible to clients, except as specifically authorized in the client manual.

i. A therapeutic school's client manual shall describe which dangerous weapons are permitted and which dangerous weapons are prohibited on site.

A. he determination of permitted and prohibited dangerous weapons shall be made in accordance with the age and behavioral characteristics of the client population to be served.

ii. A therapeutic school's client manual shall describe how dangerous weapons shall be stored, and the circumstances under which they may be accessible to clients.

13.a. Animals and pets shall be free from disease and cared for in a safe and clean manner.

b. A therapeutic school shall maintain a file documenting the health of each pet or domestic animal on site. The file shall include written verification of each animal's current rabies vaccinations, species-specific vaccinations, health care, and health history.

 

R501-15-10. Food Service.

1. A therapeutic school shall contract with or employ a dietitian to plan nutritious, appetizing, snacks and meals.

a. a current weekly menu shall be posted in the kitchen and the office.

2. A therapeutic school shall provide snacks and three daily meals in accordance with the dietitian's menu.

3. A therapeutic school shall maintain a current log of each client's food allergies and other individual dietary needs, and comply with the instructions of the client's physician or dietician.

4. A therapeutic school shall establish and post kitchen safety and sanitation rules.

5. A therapeutic school kitchen shall have clean, safe, and operational equipment and supplies for the preparation, storage, serving, and clean up of food.

6. A dining area shall be provided, with tables and chairs for each client.

7. The dining area shall be maintained in a clean and safe condition.

8. No staff or client shall prepare food without first obtaining Utah Department of Health food handler certification.

 

R501-15-11. Hazardous Chemicals and Materials.

1. A therapeutic school shall place all hazardous chemicals and materials, including but not limited to poisonous substances, explosive or flammable substances, laundry detergent and cleaning supplies, in locked storage when not in active use.

a. a client shall have no access to any hazardous chemicals or materials unless the client is directly supervised by staff.

2. A therapeutic school shall place all medications in locked storage when not in active use.

a. Non-prescription medications shall be stored in their original manufacturer's packaging together with manufacturer's directions and warnings.

b. Prescription medications shall be stored in their original pharmacy packaging together with the pharmacy label, directions and warnings.

3. A therapeutic school supervisor or supervisor designee shall:

a. administer or oversee the self-administration of prescription medications only as prescribed by a licensed physician;

b. administer or oversee the self-administration of non-prescription medications only as directed by the manufacturer;

c. observe the client consume any medication;

d. maintain an individual client medication log, which shall include the medication, time and dosage dispensed, and the effects of the medication.

4. Each client medication log shall be maintained together with the medication in locked storage while the client is actively enrolled in the therapeutic school, and transferred to the client's file when the client leaves the therapeutic school.

5. Unused medications shall be destroyed by two staff; and the destruction shall be documented.

 

KEY: human services, therapeutic schools

Date of Enactment or Last Substantive Amendment: 2010

Authorizing, and Implemented or Interpreted Law: 62A-2-106