Agencies | Governor
Virginia Regulatory Town Hall

Proposed Text

highlight

Action:
Periodic Review of Regulation Governing Juvenile Group Homes and ...
Stage: Proposed
 
6VAC35-41-10 Definitions

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Annual" means within 13 months of the previous event or occurrence.

"Aversive stimuli" means physical forces, such as sound, electricity, heat, cold, light, water, or noise, or substances, such as hot pepper, pepper sauce, or pepper spray, measurable in duration and intensity, that when applied to a resident are noxious or painful to the resident.

"Behavior management" means the principles and methods employed to help a resident achieve positive behavior and to address and correct a resident's inappropriate behavior in a constructive and safe manner in accordance with written procedures governing program expectations, treatment goals, and resident and employee safety and security.

"Board" means the Board of Juvenile Justice.

"Case record" or "record" means written or electronic information relating to one regarding a resident and the resident's family, if applicable. This information includes, but is not limited to, social, medical, psychiatric, and psychological records; reports; demographic information; agreements; all correspondence relating to care of the resident; individual service plans with periodic revisions; aftercare plans and discharge summary; and any other information related to the resident.

"Contraband" means any an item possessed by or accessible to a resident or found within a facility or on its premises that (i) that is prohibited by statute, regulation, or facility procedure, (ii) that is not acquired through approved channels or in prescribed amounts, or (iii) that may jeopardize the safety and security of the facility or individual residents.

"Contractor" means an individual who (i) has entered into a legal agreement with a juvenile residential facility to provide services directly to a resident, (ii) will work with the resident more than twice per month, and (iii) in the provision of the contractual services, will be alone with the resident.

"Department" or "DJJ" means the Department of Juvenile Justice.

"Direct care staff" means the staff whose primary job responsibilities are (i) maintaining the safety, care, and well-being of residents and (ii) implementing the structured program of care and behavior management program.

"Direct supervision" means that the act of staff may work working with residents while not in the presence of direct care staff. Staff members who provide direct supervision are responsible for maintaining the safety, care, and well-being of the residents in addition to providing services or performing the primary responsibilities of that position.

"Director" means the Director director of the Department of Juvenile Justice department.

"Emergency" means a sudden, generally unexpected occurrence or set of circumstances demanding immediate action, such as a fire, chemical release, loss of utilities, natural disaster, taking of hostages hostage situation, major disturbances disturbance, escape, and or bomb threats threat. Emergency does not include regularly scheduled employee time off or other situations that could be reasonably could be anticipated.

"Emergency admission" means the unplanned or unexpected admission of a resident in need of immediate care.

"Facility administrator" means the individual who has the responsibility is responsible for the on-site management and operation of the facility on a regular basis or that individual's designee.

"Family oriented "Family-oriented group home" means a private home in which residents may reside upon placement by a lawful placing agency.

"Grievance" means a written communication developed by a resident to report a real or imagined wrong or other cause for complaint or protest, particularly involving a claim of unfair treatment.

"Group home" means a juvenile residential facility that is a community based, home-like single dwelling, or its acceptable equivalent community-based dwelling, other than the private home of the operator, and that does not exceed the capacity approved by the regulatory authority. director. For the purpose of this chapter, a group home includes a halfway house that houses residents in transition from a commitment to the department., a shelter care facility, or an independent living facility.

"Health care record" means the complete record of medical screening and examination information and ongoing records of medical and ancillary service delivery, including all findings, diagnoses, treatments, dispositions, prescriptions, and their administration.

"Health care services" means preventive and therapeutic actions taken for the physical and mental well-being of a resident. Health care services include medical, dental, orthodontic, mental health, family planning, obstetrical, gynecological, health education, and other ancillary services.

"Health-trained personnel" means an individual who is trained by a licensed health care provider to perform specific duties, such as administering health care screenings, reviewing screening forms for necessary follow-up care, preparing residents and records for outside medical visits, and assisting in the implementation of certain medical orders.

"Human research" means a systematic investigation, including research development, testing, and evaluation utilizing human subjects that is designed to develop or contribute to generalized knowledge. Human research shall not be deemed to include research exempt from federal research regulation pursuant to 45 CFR 46.101(b).

"Independent living program" means a competency-based program specifically approved by the director to provide residents with the opportunity to develop the skills necessary to become independent decision makers and self-sufficient adults and to live successfully on their own following completion of the program.

"Individual service plan" or "service plan" means a written plan of action developed, revised as necessary, and reviewed at specified intervals to meet the needs of a resident. The individual service plan specifies (i) measurable short-term and long-term goals and (ii) the objectives, strategies, and time frames for reaching the goals.

"Juvenile residential facility" or "facility" means a publicly or privately operated facility or placement where 24-hour per day nonsecure residential program that is required to be certified and that provides 24-hour-per-day care is provided to residents who are separated from their parents or legal guardians and that is required to be certified. As used in this regulation, the term includes, but is not necessarily limited to, group homes, family-oriented group homes, and halfway houses independent living programs and excludes juvenile correctional centers and juvenile detention centers.

"Legally authorized representative" means, in the following specified order of priority, (i) the parent or parents having custody of a minor; (ii) the legal guardian of a minor; (iii) the spouse of a minor, except where a suit for divorce has been filed and the divorce decree is not yet final; or (iv) a person or judicial or other body authorized by law or regulation to provide consent on behalf of a minor, including an attorney in fact appointed under a durable power of attorney, provided the power grants the individual the authority to make such a decision.

"Legal mail" means written material that is sent to or received from a designated class of correspondents, as defined in written procedures, which shall include any court, legal counsel, administrator of the grievance system, or administrator of the department, facility, provider or governing authority.

"Living unit" means the space in which a particular group of residents in under the care of a juvenile residential facility resides. A living unit contains sleeping areas rooms, bath and toilet facilities, and a living room or its equivalent for use by the residents of the living unit. Depending upon its design, a building may contain one living unit or several separate living units.

"Medication incident" means an error made in administering a medication to a resident, including the following: (i) a resident is given incorrect medication, (ii) medication is administered to an incorrect resident, (iii) an incorrect dosage is administered, (iv) medication is administered at a wrong time or not at all, and (v) the medication is administered through an improper method. A medication incident shall not include (a) a resident's refusal of appropriately offered medication or (b) a facility's failure to administer medication due to repeated, unsuccessful attempts to obtain such medication.

"On duty" means the period of time an employee is responsible for the direct care or direct supervision of one or more residents.

"Parent" or "legal guardian" means (i) a biological or adoptive parent who has legal custody of an individual, including either parent if custody is shared under a joint decree or agreement; (ii) a biological or adoptive parent with whom the individual resident regularly resides; (iii) a person judicially appointed as a legal guardian of a resident; or (iv) a person who exercises the rights and responsibilities of legal custody by delegation from a biological or adoptive parent, upon provisional adoption, or otherwise by operation of law.

"Physical restraint" means the application of behavior intervention techniques involving a physical intervention to prevent an individual from moving all or part of that individual's body.

"Placement" means an activity by any person that provides the provision of assistance to a placing agency, parent, or legal guardian in locating and effecting the movement of a resident to a juvenile residential facility.

"Placing agency" means (i) any a person, group, court, court service unit, or agency licensed or authorized by law to place residents in a juvenile residential facility or (ii) a local board of social services authorized to place residents in a juvenile residential facility.

"Planned admission" means the admission of a resident following evaluation of an application for admission and execution of a written placement agreement.

"Premises" means the tracts of land on which any part of a facility is located and any buildings on such tracts of land.

"Provider" means the person, corporation, partnership, association, locality, commission, or public agency to whom a license or certificate to operate a juvenile residential facility is issued and who that is legally responsible for compliance with the regulatory and statutory requirements relating to the facility.

"Regulatory authority" means the board or the department as if designated by the board.

"Resident" means an individual who is legally placed in, formally placed in, or admitted to a juvenile residential facility for supervision, care, training, or treatment on a 24-hour per day 24-hour-per-day basis.

"Rest day" means a period of not less than 24 consecutive hours during which a staff person has no responsibility to perform duties related to supervision in a juvenile residential facility.

"Rules of conduct" means a listing list of a facility's rules or regulations that is maintained to inform residents and others of (i) the behavioral expectations of the behavior management program, about (ii) behaviors that are not permitted, and about (iii) the sanctions that may be applied when impermissible behaviors occur.

"Shelter care facility" means a nonsecure facility or an emergency shelter specifically approved to provide a range of services, as needed, on an individual basis not to exceed 90 days.

"Timeout" means a systematic behavior management technique program component designed to reduce or eliminate inappropriate or problematic behavior by having a staff require a resident to move to a specific location that is away from a source of reinforcement for a specific period of time or until the problem behavior has subsided.

"Tuberculosis risk assessment" means an assessment involving a series of questions designed to determine whether a person requires a tuberculosis screening.

"Tuberculosis screening" means the administration of a tuberculin skin test, chest x-ray, or interferon gamma release assay blood test to determine whether tuberculosis bacteria is present in an individual's body.

"Volunteer or intern" means an individual or group who voluntarily provides goods and services without competitive compensation.

"Vulnerable population" means a resident or group of residents who have been assessed as reasonably likely to be exposed to the possibility of being attacked or harmed, either physically or emotionally.

"Weapon" means (i) a pistol, revolver, or other weapon intended to propel a missile of any kind by action of an explosion; (ii) any dirk, bowie knife (except a pocket knife having a folding metal blade of less than three inches), switchblade knife, ballistic knife, machete, straight razor, slingshot, spring stick, metal knucks, or blackjack; (iii) nun chucks or other flailing instrument with two or more rigid parts that swing freely; and (iv) throwing star or oriental dart.

"Wilderness program" means a residential program that provides treatment and services to residents primarily through experiential wilderness expeditions.

"Written" means the required information is communicated in writing. Such writing may be available in either hard copy or in electronic form.

6VAC35-41-20 Applicability

This chapter applies to group homes, halfway houses, shelter care, and other applicable juvenile residential facilities regulated by the board as authorized by statute. Parts I (6VAC35-41-10 et seq.) through VI (6VAC35-41-710 et seq.), XII X (6VAC35-41-1150 et seq.), and XIII XI (6VAC35-41-1290 et seq.) of this chapter apply to all juvenile residential facilities, with the exception of family-oriented group homes, governed by this regulation unless specifically excluded. Parts VII (6VAC35-41-950) (6VAC35-41-960) through XI (6VAC35-41-1120 et seq.) IX (6VAC35-41-1080 et seq.) of this chapter apply only to the specific programs or facilities as indicated.

6VAC35-41-30 Previous regulations terminated.  (Repealed.)

This chapter replaces the Standards for the Interim Regulation of Children's Residential Facilities (6VAC35-51) and the Standards for Juvenile Residential Facilities (6VAC35-140) for the regulation of all juvenile residential facilities as defined herein. The Standards for the Interim Regulation of Children's Residential Facilities and the Standards for Juvenile Residential Facilities remain in effect for juvenile detention facilities and juvenile correctional centers, regulated by the board, until such time as the board adopts new regulations related thereto.

6VAC35-41-40 Certification

A. The provider shall comply with the provisions of the Regulations Governing the Monitoring, Approval, and Certification of Juvenile Justice Programs and Facilities (6VAC35-20). The provider shall:

1. Demonstrate compliance with this chapter, other applicable regulations issued by the board, and applicable statutes and regulations; and

2. Implement approved plans of action to correct findings of noncompliance; and

3. Ensure no noncompliance may pose any immediate and direct danger to residents.

B. The provider shall maintain the documentation necessary to demonstrate compliance with this chapter for a minimum of three years.

C. The current certificate shall be posted at all times in each facility in a place conspicuous to the public.

6VAC35-41-50 Age of residents

A. Facilities shall admit residents only in compliance with the age limitations approved by the board director in establishing the facility's certification capacity, except as provided in subsection B of this section.

B. A facility shall not admit a resident who is above the age approved for certification. A resident may remain in the facility above the age of certified capacity age only (i) to allow the resident to complete a program identified in the resident's individual service plan and (ii) if a discharge plan has been established. This subsection does not apply to shelter care programs.

6VAC35-41-60 Relationship to the regulatory authority

A. All reports and information as the regulatory authority may require to establish compliance with this chapter and other applicable regulations and statutes shall be submitted to or made available to the regulatory authority audit team leader.

B. A written report of any contemplated changes in operation that would affect the terms of the certificate or the continuing eligibility for certification shall be submitted to the regulatory authority. A change may not be implemented prior to approval by the regulatory authority.

6VAC35-41-70 Relationship with the department

A. The director or the director's designee shall be notified within five working days of any significant change in administrative structure or newly hired facility administrator.

B. Any of the following that may be related to the health, safety, or human rights of residents shall be reported to the director or designee within 10 days: (i) lawsuits against the facility or its governing authority and (ii) settlements with the facility or its governing authority.

6VAC35-41-80 Variances and waivers

A. Board action may be requested by the facility administrator A facility may request board action to relieve a facility from having to meet or develop a plan of action for the requirements of a specific section or subsection of this regulation chapter, provided the section or subsection is a noncritical regulatory requirement. The variance request may be granted either permanently or for a determined period of time, as provided in the Regulations Governing the Monitoring, Approval, and Certification of Juvenile Justice Programs and Facilities (6VAC35-20).

B. Any such A variance may not be implemented prior to approval of by the board.

C. When the facility administrator has submitted a variance request to the director or the director's designee concerning a noncritical regulatory requirement, and board action has been requested formally by the director or the director's designee, the director may, but is not required to, grant a waiver temporarily excusing the facility from meeting the requirements of a specific section or subsection of this chapter. The waiver shall be subject to the requirements in 6VAC35-20-93.

6VAC35-41-90 Serious incident reports

A. The following events shall be reported within 24 hours to: (i) the placing agency, (ii) the parent or legal guardian, or both, as applicable and appropriate, and (iii) the director or the director's designee:

1. Any A serious incident, accident, illness, or injury to the resident;

2. Any An overnight absence from the facility without permission;

3. Any A runaway;

4. Any A fire, hostage or situation, emergency situation, or natural disaster that jeopardizes may jeopardize the health, safety, and welfare of the residents; and

5. Any A suspected case of child abuse or neglect at the facility, on a facility event or excursion, or involving facility staff as provided in 6VAC35-41-100 (suspected child abuse or neglect).

The 24-hour reporting requirement may be extended provider may extend the 24-hour reporting requirement when the emergency situation or natural disaster has made such communication impossible (e.g., modes of communication are not functioning), such as when modes of communication are not functioning. In such these cases, notice shall be provided as soon as feasible thereafter.

B. The provider shall notify the director or the director's designee within 24 hours of any events detailed in subsection A of this section and all other situations required by the regulatory authority of which the facility has been notified.

C. Any incident Incidents involving the death of a resident shall be reported to the individuals specified in subsections subsection A and B of this section without undue delay. If an incident involving the death of a resident occurs at the facility, the facility shall notify the parents or legal guardians, as appropriate and applicable, of all residents in the facility provided such the notice does not violate any confidentiality requirements or jeopardize any law-enforcement or child protective services investigation or the prosecution of any criminal cases related to the incident.

D. The facility shall (i) prepare and maintain a written report of the events listed in subsections A and B of this section and (ii) submit a copy of the written report to the director or the director's designee. The report shall contain the following information:

1. The date and time the incident occurred;

2. A brief description of the incident;

3. The action taken as a result of the incident;

4. The name of the person who completed the report;

5. The name or identifying information of the person who made the report to who, in accordance with subsection A of this section, notified the placing agency and to either the parent or legal guardian, as appropriate and applicable, and the manner in which the information was communicated; and

6. The name of or identifying information provided by the person to whom the report was made, including any law enforcement or child protective service personnel.

E. The resident's record shall contain a written reference (i) that an incident occurred and (ii) of all applicable reporting.

F. In addition to the requirements of this section, any serious incident incidents involving an allegation of child abuse or neglect at the facility, at a facility sponsored facility-sponsored event, or involving facility staff shall be governed by 6VAC35-41-100 (suspected child abuse or neglect).

6VAC35-41-100 Suspected child abuse or neglect

A. When there is a reason to suspect that a child is an abused or neglected child, the matter shall be reported immediately to the local department of social services, or to the state Department of Social Services toll-free child abuse and neglect hotline as required by § 63.2-1509 of the Code of Virginia and in accordance with the written procedures.

B. Written procedures shall be distributed to all staff members and shall at a minimum provide for the following:

1. Handling accusations against staff;

2. Reporting and documenting suspected cases of child abuse and neglect;

3. Cooperating during any an investigation; and

4. Measures to be taken to ensure the safety of the resident and the staff.

C. Any case Cases of suspected child abuse or neglect against a resident shall be reported and documented as required in 6VAC35-41-90 (serious incident reports). The resident's record shall contain a written reference that a report was made.

6VAC35-41-105 Reporting criminal activity

A. Staff shall be required to report to the facility administrator for appropriate action all known criminal activity suspected to have occurred at the facility or at a facility-sponsored activity by residents or staff, including but not limited to any physical abuse, sexual abuse, or sexual harassment, to the facility administrator for appropriate action.

B. The facility administrator, in accordance with written procedures, shall notify the appropriate persons or agencies, including law enforcement, child protective services, if applicable and appropriate, and the department as appropriate and applicable, of suspected criminal violations by residents or staff. Suspected criminal violations relating to the health and safety or human rights of residents shall be reported to the director or designee.

C. The facility shall assist and cooperate with the investigation of any such complaints and allegations as necessary subject to restrictions in federal or state law.

6VAC35-41-110 Grievance procedure

A. Written procedure procedures shall provide require that residents are oriented to and have continuing access to a grievance procedure that provides for:

1. Resident participation in the grievance process with assistance from staff upon request;

2. Investigation of the grievance by an objective employee who is not the subject of the grievance;

3. Documented, timely responses to all grievances with the reasons for the decision, in accordance with facility procedures;

4. At least one level of appeal;

5. Administrative review of grievances;

6. Protection from retaliation or threat of retaliation for filing a grievance; and

7. Hearing of an emergency grievance Action within eight hours on grievances that pose an immediate risk of hardship or harm to a resident.

B. Each resident Residents shall be oriented to the grievance procedure in an age or and developmentally appropriate manner.

C. The grievance procedure shall be (i) be written in clear and simple language; (ii) provide the express definition of grievance as set out in 6VAC35-41-10; and (ii) (iii) be posted in an area easily accessible to residents and their parents and legal guardians.

D. Staff shall assist and work cooperatively with other employees in facilitating the grievance process.

6VAC35-41-120 Responsibilities of the provider or governing authority

A. The provider shall clearly identify clearly and in writing the corporation, association, partnership, individual, or public agency that is the holder of the certificate (governing authority) and that serves as the facility's governing authority. Any change in the identity or corporate status of the governing authority or provider shall be reported to the director or the director's designee.

B. The governing authority shall appoint a facility administrator to whom it delegates the authority and responsibility for administrative direction of the facility.

C. A written decision-making plan shall be developed and implemented and shall provide for a staff person with the qualifications of a facility administrator to be designated to assume the temporary responsibility for the operation of the facility. Each in the absence of the facility administrator. The plan shall include an organizational chart.

D. The provider shall have a written statement of its (i) purpose, (ii) population served, and (iii) available services for each facility subject to this regulation.

E. Written procedures shall be developed and implemented to monitor and evaluate quality assurance in each facility. Improvements shall be implemented when indicated.

6VAC35-41-140 Participation of residents in human research

A. The provider shall have procedures, approved by its governing authority, to govern the review, approval, and monitoring of human research. Human research means any systematic investigation, including research development, testing, and evaluating, involving human subjects, including but not limited to a resident or his parents, guardians, or family members, that is designed to develop or contribute to generalized knowledge. Human research does not include statistical analysis of information readily available on the subject that does not contain any identifying information or research exempted by federal research regulations pursuant to 45 CFR 46.101(b). Providers that allow residents to participate in human research shall comply with the provisions of the Regulation Governing Juvenile Data Requests and Research Involving Human Subjects (6VAC35-170) and Chapter 5.1 (§ 32.1-162.16 et seq.) of Title 32.1 of the Code of Virginia. The testing of medicines or drugs for implementation or research is prohibited.

B. Information on residents shall be maintained as provided in 6VAC35-41-330 (maintenance of records), and all records and information related to the human research shall be kept confidential in accordance with § 16.1-300 of the Code of Virginia, 6VAC35-170, and other applicable laws and regulations.

C. The provider may require periodic progress reports of any research project and a formal final report of all completed research projects.

6VAC35-41-145 Operational procedures

Current operational procedures shall be readily accessible to all staff.

6VAC35-41-150 Job descriptions

A. There shall be a written job description for each position that, at a minimum, includes the:

1. Job title or position;

2. Duties and responsibilities of the incumbent;

3. Job title or identification of the immediate supervisor; and

4. Minimum education, experience, knowledge, skills, and abilities required for entry-level performance of the job.

B. A copy of the job description shall be given to each person assigned to a position prior to assuming that position's duties.

6VAC35-41-160 Qualifications

A. Facilities subject to (i) the rules and regulations of a governing authority or (ii) the rules and regulations of a local government personnel office shall develop written minimum entry-level qualifications in accord accordance with the rules and regulations of the supervising personnel authority. Facilities not subject to rules and regulations of the governing authority or a local government personnel office shall follow the minimum entry-level qualifications of the Virginia Department of Human Resource Management.

B. When services or consultations are obtained on a contractual basis, they shall be provided by professionally qualified personnel.

C. Each facility shall provide documentation of contractual agreements or staff that verifies every contractor's or employee's expertise to provide educational services, counseling services, psychological services, medical services, or any other the services needed to serve assist the residents in accordance with the facility's program description as defined by the facility's criteria of admission, required by 6VAC35-41-730 B (application for admission).

6VAC35-41-165 Employee tuberculosis screening and follow-up

A. On or before the an employee's start date at the facility each, the employee shall submit evidence of freedom from have received a tuberculosis in a communicable form that is no older than 30 days risk assessment, as evidenced by completion of an assessment form containing the elements found on the current assessment form published by the Virginia Department of Health. The documentation shall indicate the screening results as to whether there is an absence of tuberculosis in a communicable form risk assessment shall be no older than 30 days and may be administered by health-trained personnel in a juvenile residential facility, provided the results of the assessment are interpreted by a physician, physician assistant, nurse practitioner, or registered nurse.

B. Each In addition to the initial tuberculosis risk assessment required in subsection A of this section, each employee shall submit evidence of an annual evaluation of freedom from risk assessment indicating the individual's risk of being exposed to tuberculosis in a communicable form.

C. Employees shall undergo a subsequent tuberculosis screening or evaluation, as applicable, in the following circumstances: if indicated based on the results of the initial or annual tuberculosis risk assessment.

1. The employee comes into contact with a known case of infectious tuberculosis; or

2. The employee develops chronic respiratory symptoms of three weeks duration.

D. If an employee comes into contact with a known case of infectious tuberculosis or develops chronic respiratory symptoms of three weeks' duration, the employee shall consult the employee's local health department or other medical professional for additional screening.

E. Employees suspected of having tuberculosis in a communicable form shall not be permitted to return to work or have contact with staff or residents until a physician has determined that the individual does not have tuberculosis in a communicable form.

E. F. Any active case of tuberculosis developed contracted by an employee or a resident shall be reported to the local health department in accordance with the requirements of the Commonwealth of Virginia State Board of Health Regulations for Disease Reporting and Control (12VAC5-90).

F. G. Documentation of any the screening results shall be retained in a manner that maintains the confidentiality of information.

G. H. The detection, diagnosis, prophylaxis, and treatment of pulmonary tuberculosis shall be performed consistent with the current requirements of the Virginia Department of Health's Division of Tuberculosis Prevention and Control and the federal Department of Health and Human Services Centers for Disease Control and Prevention.

6VAC35-41-180 Employee and volunteer background checks

A. Except as provided in subsection B of this section, all persons who (i) accept a position of employment at, (ii) volunteer on a regular basis and will be alone with a resident in the performance of their duties, or (iii) (ii) provide contractual services directly to a resident on a regular basis and will be alone with a resident in the performance of their duties in a juvenile residential facility shall undergo the following background checks, in accordance with § 63.2-1726 of the Code of Virginia, to ascertain whether there are criminal acts or other circumstances that would be detrimental to the safety of residents in the facility:

1. A reference check;

2. A criminal history check;

3. A fingerprint check with the Virginia State Police and Federal Bureau of Investigation (FBI);

4. A central registry check with Child Protective Services; and

5. A driving record check if applicable to the individual's job duties.

B. To minimize vacancy time when the fingerprint checks required by subdivision A 3 of this section have been requested, employees may be hired, pending the results of the fingerprint checks, provided:

1. All of the other applicable components of subsection A of this section have been completed;

2. The applicant is given written notice that continued employment is contingent on the fingerprint check results as required by subdivision A 3 of this section; and

3. Employees hired under this exception shall not be allowed to be alone work directly with residents and may work with residents only when under the direct supervision of staff whose background checks have been completed, until such time as all background checks are completed.

C. Documentation of compliance with this section shall be retained in the individual's personnel record as provided in 6VAC35-41-310 (personnel records).

D. Written procedures shall provide for the supervision of nonemployee persons, who are not subject to the provisions of subsection A of this section and who have contact with residents.

E. No juvenile residential facility regulated by the department shall hire for employment or contract services or allow a person to volunteer who has been convicted of any barrier crimes listed in § 19.2-392.02 of the Code of Virginia, subject to the exceptions permitted under § 63.2-1726 of the Code of Virginia.

6VAC35-41-190 Required initial orientation

A. Before the expiration of the employee's seventh work day at the facility, each employee shall be provided with a basic orientation on the following:

1. The facility;

2. The population served;

3. The basic objectives of the program;

4. The facility's organizational structure;

5. Security, population control, emergency preparedness, and evacuation procedures in accordance with 6VAC35-41-490 (emergency and evacuation procedures);

6. Emergency preparedness and evacuation procedures in accordance with 6VAC35-41-490;

7. The practices of confidentiality;

7. 8. The residents' rights; and

8. 9. The basic requirements of and competencies necessary to perform in the positions.

B. Prior to working with residents while not under the direct supervision of staff who have completed all applicable orientations and training, each direct care staff shall receive a basic orientation on the following:

1. The facility's program philosophy and services;

2. The facility's behavior management program;

3. The facility's behavior intervention procedures and techniques, including the use of least restrictive interventions and physical restraint;

4. The residents' rules of conduct and responsibilities;

5. The residents' disciplinary and grievance procedures;

6. Child abuse and neglect and mandatory reporting;

7. Standard precautions; and

8. Documentation requirements as applicable to the position's duties.

C. Volunteers shall be oriented in accordance with 6VAC35-41-300 (orientation and training for volunteers or interns).

6VAC35-41-200 Required initial training

A. Each full-time and part-time employee and relief staff shall complete initial, comprehensive training that is specific to the individual's occupational class, is based on the needs of the population served, and ensures that the individual has the competencies to perform in the position.

1. Direct care staff shall receive at least 40 hours of training, inclusive of all training required by this section, in their first year of employment.

2. Contractors shall receive training required to perform their position responsibilities in a juvenile residential facility.

B. Within 30 days following the employee's start date at the facility or before the employee is responsible for the direct supervision of a resident, all direct care staff and staff who provide direct supervision of the residents while delivering services, with the exception of workers employed by contract to provide behavioral health or health care services, shall complete training in the following areas:

1. Emergency preparedness and response;

2. First aid and cardiopulmonary resuscitation, unless the individual is currently certified, with certification required as applicable to their duties;

3. The facility's behavior management program;

4. The residents' rules of conduct and the rationale for the rules;

5. The facility's behavior intervention procedures, with physical and mechanical restraint training required as applicable to their duties;

6. Child abuse and neglect;

7. Mandatory reporting;

8. Maintaining appropriate professional relationships;

9. Interaction among staff and residents;

10. Suicide prevention;

11. Residents' rights, including but not limited to the prohibited actions provided for in 6VAC35-41-560 (prohibited actions);

12. Standard precautions; and

13. Procedures applicable to the employees' position positions and consistent with their work profiles.

C. Employees who administer medication shall have, have completed successfully, prior to such administration, successfully completed a medication training program approved by the Board of Nursing or be licensed by the Commonwealth of Virginia to administer medication.

D. Training shall be required by and provided as appropriate to the individual's job duties and in accordance with the provider's training plan.

E. D. When an individual is employed by contract to provide services for which licensure by a professional organization is required, documentation of current licensure shall constitute compliance with this section.

F. E. Volunteers and interns shall be trained in accordance with 6VAC35-41-300 (orientation and training for volunteers or interns).

6VAC35-41-210 Required retraining

A. Each employee, relief staff, and contractor shall complete retraining that is specific to the individual's occupational class and the position's job description and addresses any professional development needs.

B. All staff shall complete an annual training refresher on the facility's emergency preparedness and response plan and procedures.

C. All direct care staff and staff who provide direct supervision of the residents while delivering services, with the exception of workers who are employed by contract to provide behavioral health or health care services, shall complete at least 40 hours of training annually that shall include training annual refresher training in the following areas:

1. Suicide prevention;

2. Child abuse and neglect;

3. Mandatory reporting;

4. Residents' rights, including but not limited to the prohibited actions provided for in 6VAC35-41-560 (prohibited actions);

5. Standard precautions; and

6. Behavior intervention procedures.

D. Staff required by their position to have whose positions require certification in cardiopulmonary resuscitation and first aid shall receive training sufficient to maintain current certifications.

E. Employees who administer medication shall complete an annual refresher training on the administration of medication. The refresher training shall include a review of the components required in 6VAC35-41-1280.

F. Retraining shall (i) be required by and provided as appropriate to the individual's job duties, and (ii) address any needs identified by the individual and the supervisor, if applicable, and (iii) be in accordance with the provider's training plan. In addition to the training hours required in subsection C of this section, facilities shall ensure that staff receive at least 15 hours of additional training.

G. When an individual is employed by contract to provide services for which licensure by a professional organization is required, documentation of current licensure shall constitute compliance with this section.

H. Staff who have not timely completed required retraining shall not be allowed to have direct care responsibilities pending completion of the retraining requirements.

6VAC35-41-220 Written personnel procedures

The provider shall have and implement provider approved provider-approved written personnel procedures and make these readily accessible to each staff member.

6VAC35-41-250 Notification of change in driver's license status

Staff whose job responsibilities may involve transporting residents shall (i) maintain a valid driver's license and (ii) report to the facility administrator or designee any change in their driver's license status, including but not limited to suspensions, restrictions, and revocations.

6VAC35-41-260 Physical or mental health of personnel

When an individual poses a direct threat significant risk of substantial harm to the health and safety of a resident, others at the facility, or the public or is unable to perform essential job-related functions, that individual shall be removed immediately from all duties involved in the direct care or direct supervision of residents. The facility may require a medical or mental health evaluation to determine the individual's fitness for duty prior to returning to duties involving the direct care or direct supervision of residents. The results of any medical information or documentation of any disability related disability-related inquiries shall be maintained separately from the employee's personnel records maintained in accordance with 6VAC35-41-310 (personnel records). For the purpose of this section a direct threat means a significant risk of substantial harm.

6VAC35-41-270 Definition of volunteers or interns.  (Repealed.)

For the purpose of this chapter, volunteer or intern means any individual or group who of their own free will provides goods and services without competitive compensation.

6VAC35-41-280 Selection and duties of volunteers or interns

A. Any A facility that uses volunteers or interns shall develop and implement written procedures governing their selection and use. Such The procedures shall provide for the objective evaluation of persons and organizations in the community who wish to associate with the residents.

B. Volunteers and interns shall have qualifications appropriate for the services provided.

C. The responsibilities of interns and individuals who volunteer on a regular basis shall be clearly defined in writing.

D. Volunteers and interns shall neither be responsible neither for the duties of direct care staff nor for the direct supervision of the residents.

6VAC35-41-290 Background checks for volunteers or interns

A. Any individual who (i) volunteers on a regular basis or is an intern and (ii) will be alone with a resident in the performance of that position's duties shall be subject to the background check requirements provided for applicable to employees in 6VAC35-41-180 A (employee and volunteer background checks).

B. Documentation of compliance with the background check requirements shall be maintained for each intern and each volunteer for whom a background check is required. Such records shall be kept in accordance with 6VAC35-41-310 (personnel records).

C. A facility that uses volunteers or interns shall have procedures for supervising volunteers or interns, on whom background checks are not required or whose background checks have not been completed, and who have contact with residents.

D. No juvenile residential facility regulated by the department shall allow a person to volunteer on a regular basis and be alone with a resident in the performance of that position's duties if the person has been convicted of a barrier crime listed in § 19.2-392.02 of the Code of Virginia, subject to the exceptions permitted under § 63.2-1726 of the Code of Virginia.

6VAC35-41-300 Orientation and training for volunteers or interns

A. Volunteers and interns shall be provided with a basic orientation on the following:

1. The facility;

2. The population served;

3. The basic objectives of the facility;

4. The facility's organizational structure;

5. Security, population control, emergency, emergency preparedness, and evacuation procedures;

6. Emergency, emergency preparedness, and evacuation procedures;

7. The practices of confidentiality;

7. 8. The residents' rights, including but not limited to the prohibited actions provided for in 6VAC35-41-560 (prohibited actions); and

8. 9. The basic requirements of and competencies necessary to perform their duties and responsibilities.

B. Volunteers and interns shall be trained within 30 days from their start date at the facility in the following:

1. Any procedures that are applicable to their duties and responsibilities; and

2. 1. Their duties and responsibilities in the event of a facility evacuation; and

2. Procedures applicable to their duties and responsibilities.

6VAC35-41-310 Personnel records

A. Separate up-to-date written or automated personnel records shall be maintained on each (i) employee and, (ii) volunteer or intern, and (iii) contractor on whom a background check is required.

B. The records of each employee shall include:

1. A completed employment application form or other written material providing the individual's name, address, phone number, and social security number or other unique identifier;

2. Educational background and employment history;

3. Documentation of required reference check;

4. Annual performance evaluations;

5. 4. Date of employment for each position held and date of separation;

6. 5. Documentation of compliance with requirements of Virginia law regarding child protective services and criminal history background investigations;

7. 6. Documentation of the verification of any educational requirements and of professional certification or licensure if required by the position;

8. 7. Documentation of all training required by this chapter and any other training received by individual staff; and

9. 8. A current job description.

C. If applicable, health care records, including reports of any required health examinations, shall be maintained separately from the other records required by this section.

D. The personnel records of volunteers or interns and contractual service providers contractors may be limited to documentation of compliance with the background checks as required by 6VAC35-41-180 (employee and volunteer background checks).

E. The personnel records required in subsection A of this section shall be maintained in a secure location and shall remain confidential from unauthorized access.

6VAC35-41-330 Maintenance of resident's records

A. A separate written or automated case record shall be maintained for each resident that shall include all correspondence and documents received by the facility relating to the care of that resident and documentation of all case management services provided.

B. A separate health care record may shall be kept maintained on each resident. The resident's active health care records shall be readily accessible in case of emergency and shall be made available to authorized staff consistent with applicable state and federal statutes and regulations.

C. Each case record and health care record shall be kept (i) up to date, (ii) in a uniform manner, and (ii) (iii) confidential from unauthorized access.

D. Written procedures shall provide for the management of all records, written and automated, written records and shall describe confidentiality, accessibility, security, and retention of records pertaining to residents, including:

1. Access, duplication, dissemination, and acquisition of information only to persons legally authorized according to federal and state laws;

2. Facilities For facilities using automated records shall address procedures that include, the manner in which such records will be: (i) protected from unauthorized access, including unauthorized Internet access; (ii) protected from loss; (iii) protected from unauthorized alteration; and (iv) backed up.

a. How records are protected from unauthorized access;

b. How records are protected from unauthorized Internet access;

c. How records are protected from loss;

d. How records are protected from unauthorized alteration; and

e. How records are backed up;

3. Security measures to protect records (i) from loss, unauthorized alteration, inadvertent or unauthorized access, or disclosure of information; and (ii) during transportation of records between service sites;

4. Designation of the person responsible for records management; and

5. Disposition of records in the event if the facility ceases to operate operations.

E. Written procedure shall specify what information is available to the resident.

F. Active and closed written records shall be kept in secure locations or compartments that are accessible to authorized staff and shall be protected from unauthorized access, fire, and flood.

G. All case records shall be retained as governed by The Library of Virginia.

6VAC35-41-360 Equipment and systems inspections and maintenance

A. All safety Safety, emergency, and communications equipment and systems, as identified by the facility administrator, shall be inspected, tested, and maintained by designated staff in accordance with the manufacturer's recommendations or instruction manuals or, absent such requirements, in accordance with a schedule that is approved by the facility administrator. Testing of such equipment and systems shall, at a minimum, be conducted at least quarterly. The facility administrator shall develop written procedures for the development, maintenance, and review of safety, emergency, and communications equipment and systems that the facility administrator identifies as critical, as well as the testing intervals for such equipment and systems.

B. Whenever safety, emergency, and communications equipment or a system is found to be systems are determined defective, corrective action shall be taken to rectify the situation and to repair, remove, or replace the defective equipment or systems.

6VAC35-41-370 Heating and cooling systems and ventilation

A. Heat shall be distributed in all rooms occupied by the residents such that a temperature no less than 68°F is maintained, unless otherwise mandated by state or federal authorities.

B. Air conditioning or mechanical ventilating systems, such as electric fans, shall be provided in all rooms occupied by residents when the temperature in those rooms exceeds 80°F unless otherwise mandated by state or federal authorities.

6VAC35-41-380 Lighting

A. Sleeping rooms and activity areas in the facility shall provide natural lighting.

B. All areas within buildings shall be lighted for safety, and the lighting shall be sufficient for the activities being performed.

C. There shall be night lighting sufficient to observe residents.

D. Each facility shall have a plan for providing alternative lighting in case of emergencies.

E. Outside entrances and parking areas shall be lighted.

6VAC35-41-390 Plumbing and water supply; temperature

A. Plumbing shall be maintained in operational condition, as designed.

B. An adequate supply of hot and cold running water shall be available at all times.

C. Precautions shall be taken to prevent scalding from running water. Water Hot water temperatures should shall be maintained at 100°F to 120°F.

6VAC35-41-400 Toilet facilities

A. There shall be at least one bathtub or bathtub alternative in each facility.

B. There shall be at least one toilet, one hand basin, and one shower or tub for every eight residents for facilities certified before July 1, 1981.

C. There shall be one toilet, one hand basin, and one shower or tub for every four residents in any building constructed or structurally modified after July 1, 1981. Facilities certified after December 28, 2007, shall comply with the one-to-four ratio.

D. The maximum number of staff members on duty in the living unit shall be counted in determining the required number of toilets and hand basins when if a separate bathroom is not provided for staff.

E. There shall be at least one mirror securely fastened to the wall at a height appropriate for use in each room where hand basins are located.

F. When bathrooms are not If a facility has a bathroom that is not designated for individual use:

1. Each toilet Toilets shall be enclosed for privacy, and

2. Bathtubs and showers shall provide visual privacy for bathing by through the use of enclosures, curtains, or other appropriate means.

G. Windows in bathrooms and dressing areas shall provide allow for privacy.

6VAC35-41-410 Sleeping areas rooms

A. Males and females shall have separate sleeping areas rooms.

B. No more than four residents shall share a bedroom or sleeping area room.

C. Beds shall be at least three feet apart at the head, foot, and sides; and double-decker bunk beds shall be at least five feet apart at the head, foot, and sides.

D. Sleeping quarters rooms in facilities established, constructed, or structurally modified after July 1, 1981, shall have:

1. At least 80 square feet of floor area in a bedroom accommodating one person;

2. At least 60 square feet of floor area per person in rooms accommodating two or more persons; and

3. Ceilings with a primary height at least 7-1/2 feet in height exclusive of protrusions, duct work, or dormers.

E. Mattresses shall be fire retardant as evidenced by documentation from the manufacturer except in buildings equipped with an automated sprinkler system as required by the Virginia Uniform Statewide Building Code (13VAC5-63).

F. Each resident shall be assigned drawer space and closet space, or their equivalent, that is storage space for storage of clothing and personal belongings. The storage space shall be accessible to from the sleeping area for storage of clothing and personal belongings room.

G. Windows in sleeping areas rooms and dressing areas shall provide allow for privacy.

H. Every sleeping area Sleeping rooms shall have a door that may be closed for privacy or quiet and this door shall that may be opened readily opened in case of a fire or other emergency.

6VAC35-41-440 Smoking prohibitions

Smoking shall be prohibited in living areas and in areas where residents participate in programs. Residents shall be prohibited from possessing, purchasing, using, or distributing tobacco products or nicotine vapor products. Tobacco products, including cigarettes, cigars, smokeless tobacco, pipe tobacco, bidis, and wrappings and vapor products, such as electronic cigarettes, electronic cigars, electronic cigarillos, electronic pipes, or similar products or devices shall not be used by staff, contractors, volunteers, interns, or visitors in any areas of the facility or its premises.

6VAC35-41-450 Space utilization

A. Each facility shall provide for the following:

1. A living room;

2. An indoor recreation area with appropriate recreation materials;

3. An outdoor recreation area;

4. A dining area, where meals are served, that is equipped with tables and benches or chairs;

5. A visitation area that permits informal communication between residents and visitors, including the opportunity for physical contact, in accordance with written procedures;

6. Kitchen facilities and equipment for the preparation and service of meals with any walk-in refrigerators or freezers equipped to permit emergency exits;

7. Space and equipment for laundry, if laundry is done at the facility;

8. Space for the storage of items such as first aid equipment, household supplies, recreational equipment, luggage, out-of-season clothing, and other materials; and

9. Space for administrative activities including, as appropriate to the program, confidential conversations and the storage of records and materials.

B. Spaces or areas may be interchangeably utilized for multiple purposes but shall be in functional condition for the designated purposes.

6VAC35-41-460 Maintenance of the buildings and grounds

A. The interior and exterior of all buildings and grounds shall be safe, maintained, and reasonably free of clutter and rubbish. This includes, but is not limited to, requirement applies to all areas of the facility and to items within the facility, including (i) required locks, mechanical devices, indoor and outdoor equipment, and furnishings; and (ii) all areas where residents, staff, and visitors may reasonably may be expected to have access.

B. All buildings shall be reasonably free of stale, musty, or foul odors.

C. Buildings shall be kept reasonably free of flies, roaches, rats, and other vermin.

6VAC35-41-470 Animals on the premises

A. Animals maintained on the premises shall be housed at a reasonable distance from sleeping, living, eating, and food preparation areas, as well as a safe distance from water supplies. be:

1. Housed a reasonable distance from eating and food preparation areas, as well as a safe distance from water supplies;

2. Tested, inoculated, and licensed as required by law; and

3. Provided with clean sleeping areas and adequate food and water.

B. Animals maintained on the premises shall be tested, inoculated, and licensed as required by law.

C. The premises shall be kept reasonably free of stray domestic animals.

D. Pets shall be provided with clean sleeping areas and adequate food and water.

6VAC35-41-490 Emergency and evacuation procedures

A. The provider shall develop a written emergency preparedness and response plan for each facility. The plan shall address:

1. Documentation of contact with the local emergency coordinator to determine (i) local disaster risks, (ii) communitywide plans to address different disasters and emergency situations, and (iii) assistance, if any, that the local emergency management office will provide to the facility in an emergency;

2. Analysis of the provider's capabilities and potential hazards, including natural disasters, severe weather, fire, flooding, work place violence or terrorism, missing persons, severe injuries, or other emergencies that would disrupt the normal course of service delivery;

3. Written emergency management procedures outlining specific responsibilities for provision of administrative direction and management of response activities; coordination of logistics during the emergency; communications; life safety of employees, contractors, interns, volunteers, visitors and residents; property protection; community outreach; and recovery and restoration;

4. Written emergency response procedures for assessing the situation; protecting residents, employees, contractors, interns, volunteers, visitors, equipment and vital records; and restoring services. Emergency procedures shall address:

a. Communicating with employees, contractors, and community responders;

b. Warning and notification of notifying residents;

c. Providing emergency access to secure areas and opening locked doors;

d. Conducting evacuations to emergency shelters or alternative sites and accounting for all residents;

e. Relocating residents, if necessary;

f. Notifying parents and legal guardians, as applicable and appropriate;

g. Alerting emergency personnel and sounding alarms;

h. Locating and shutting off utilities when necessary; and

i. Providing for a planned, personalized means of effective egress evacuation for residents who use wheelchairs, crutches, canes, or other mechanical devices for assistance in walking individuals with disabilities or who require special accommodations, such as vision-impaired, hearing-impaired, or nonambulatory individuals.

5. Supporting documents that would be needed in an emergency, including emergency call lists, building and site maps necessary to shut off utilities, designated escape routes, and list lists of major resources such as local emergency shelters; and

6. Schedule for testing the implementation of the plan and conducting emergency preparedness drills.

B. The provider shall develop emergency preparedness and response training for all employees to ensure they are prepared to implement the emergency preparedness plan in the event of an emergency. Such The training shall include the employees' responsibilities for:

1. Alerting emergency personnel and sounding alarms;

2. Implementing evacuation procedures, including evacuation of residents with special needs (i.e., deaf, blind, nonambulatory); or who require special accommodations;

3. Using, maintaining, and operating emergency equipment;

4. Accessing emergency information for residents including medical information; and

5. Utilizing community support services.

C. Contractors and, volunteers, and interns shall be oriented in their responsibilities in implementing the emergency preparedness plan in the event of an emergency.

D. The provider shall review and document the review of the emergency preparedness plan annually and make necessary revisions. Such The revisions shall be communicated to employees, contractors, interns, and volunteers and incorporated into training for employees, contractors, interns, and volunteers and orientation of residents to services.

E. In the event of If a disaster, fire, emergency, or any other condition that may jeopardize the health, safety, and welfare of residents, occurs, the provider shall take appropriate action to protect the health, safety, and welfare of the residents and to remedy the conditions condition as soon as possible. The provider first shall respond and stabilize the disaster or emergency. After the disaster or emergency is stabilized, the provider shall report the disaster or emergency in accordance with 6VAC35-41-90.

F. In the event of a disaster, fire, emergency, or any other condition that may jeopardize the health, safety, and welfare of residents, the provider should first respond and stabilize the disaster or emergency. After the disaster or emergency is stabilized, the provider shall report the disaster or emergency in accordance with 6VAC35-41-90 (serious incident reports).

G. F. Floor plans showing primary and secondary means of emergency exiting exits shall be posted on each floor in locations where they can be seen are easily by visible to staff and residents.

H. G. The responsibilities of the residents in implementing the emergency procedures shall be communicated to all residents within seven days following admission or a substantive change in the procedures.

I. At H. The facility shall conduct at least one evacuation drill (the simulation of the facility's emergency procedures) shall be conducted in which its emergency and evacuation procedures are simulated each month in each building occupied by residents. During any three consecutive calendar months, at least one evacuation drill shall be conducted during each shift.

J. I. Evacuation drills shall include, at a minimum:

1. Sounding of emergency alarms;

2. Practice in evacuating buildings;

3. Practice in alerting emergency authorities;

4. Simulated use of emergency equipment; and

5. Practice in accessing resident emergency information.

K. J. A record shall be maintained for each evacuation drill and shall include the following:

1. Buildings in which the drill was conducted;

2. Date and time of the drill;

3. Amount of time taken to evacuate the buildings;

4. Specific problems encountered;

5. Staff tasks completed including:

a. Head count, and

b. Practice in notifying emergency authorities; and

6. The name of the staff members responsible for conducting and documenting the drill and preparing the record.

L. K. The facility shall assign one staff member who shall ensure that all requirements regarding the emergency preparedness and response plan and the evacuation drill program are met.

6VAC35-41-510 Searches of residents

A. Each facility that conducts searches shall have procedures that provide that all searches shall be subject to the following:

1. Searches of residents' persons shall be conducted only for the purposes of maintaining facility security and controlling contraband while protecting, and only in a manner that protects the dignity of the resident.

2. Searches are shall be conducted only by personnel who are trained and authorized to conduct such searches.; and

3. The resident shall not be touched any more than is necessary to conduct the search.

B. Facilities that do not conduct searches of residents shall have a procedure prohibiting them.

C. Patdown Pat-down and frisk searches shall be conducted by trained personnel of the same sex as the resident being searched, except in emergencies.

D. Strip searches and visual inspections of the vagina and anal cavity areas shall only be permitted (i) if ordered by a court; (ii) if conducted by law-enforcement personnel acting in his official capacity; or (iii) if the facility obtains the approval of the regulatory authority to conduct such searches. A facility that conducts such searches shall have a procedure that provides that the searches shall be subject to the following:

1. The search shall be performed by personnel of the same sex as the resident being searched;

2. The search shall be conducted in an area that ensures privacy; and

3. Any witness to the search shall be of the same sex as the resident.

E. Manual and D. Strip searches and visual, manual, or instrumental searches of the anal cavity or vagina shall be prohibited unless court ordered prohibited.

6VAC35-41-520 Telephone access and emergency numbers

A. There shall be at least one continuously operable, nonpay telephone accessible to staff in each building in which residents sleep or participate in programs.

B. There shall be an emergency telephone number where a staff person may be immediately contacted immediately, 24 hours a day and seven days per week.

C. An emergency telephone number shall be provided to residents and the adults responsible for their care when a resident is away from the facility and not under the supervision of direct care staff or law-enforcement officials.

6VAC35-41-540 Weapons

A. The possession, use, and storage of weapons in facilities or on the premises where residents are reasonably expected to have access are prohibited except when specifically authorized by statutes or regulations or provided in subsection B of this section. For the purpose of this section, weapons shall include but will not be limited to (i) any pistol, revolver, or other weapon intended to propel a missile of any kind by action of an explosion; (ii) any dirk, bowie knife, except a pocket knife having a folding metal blade of less than three inches, switchblade knife, ballistic knife, machete, straight razor, slingshot, spring stick, metal knucks, or blackjack; (iii) nunchucks or other flailing instrument with two or more rigid parts that swing freely; and (iv) throwing star or oriental dart.

B. Weapons shall be permitted if they are in the possession of a licensed security personnel or law-enforcement officer while in the course of his duties.

6VAC35-41-550 Transportation

A. It The facility shall be the responsibility of the facility to have responsible for having transportation available or to make making the necessary arrangements for routine and emergency transportation.

B. There shall be The facility shall have written safety rules for transportation of residents and, if applicable, for the use and maintenance of vehicles.

C. If a person or entity other than the juvenile residential facility assumes custody of the resident for purposes of transportation, and the facility has flagged the resident for additional monitoring due to (i) a recent suicide attempt, (ii) recent suicidal ideations, or (iii) special medical needs, the facility shall:

1. Provide the person or entity responsible for transporting the resident, except the resident's parent or guardian, with a department-approved form that identifies pertinent information known to the juvenile residential facility concerning the need for additional monitoring, provided the information reasonably could be considered necessary for the resident's safe transportation and supervision, and

2. Notify the transporting party that such information must remain confidential in accordance with applicable laws, rules, and regulations regarding confidentiality of juvenile records.

D. The facility shall be excused from meeting the requirements of subsection C of this section if an emergency renders completion of the form impracticable or infeasible.

C. E. The facility shall have a procedure for the verification of appropriate licensure for staff whose duties involve transporting residents.

6VAC35-41-560 Prohibited actions

The following actions are prohibited:

1. Discrimination in violation of the Constitution of the United States, the Constitution of the Commonwealth of Virginia, and state and federal statutes and regulations;

2. Deprivation of drinking water or food necessary to meet a resident's daily nutritional needs, except as ordered by a licensed physician for a legitimate medical purpose and documented in the resident's record;

3. Denial of contacts and visits with the resident's attorney, a probation officer, the department, the regulatory authority, a supervising agency representative, or representatives of other agencies or groups as required by applicable statutes or regulations;

4. Bans on contacts and visits with family or legal guardians, except as permitted by other applicable state regulations or by order of a court of competent jurisdiction;

5. Any action that is Actions that are humiliating, degrading, or abusive, including but not limited to physical abuse, sexual abuse, and sexual harassment;

6. Corporal punishment, which is administered through the intentional inflicting infliction of pain or discomfort to the body through actions, such as, but not limited to (i) striking or hitting with any part of the body or with an implement; (ii) pinching, pulling, or shaking; or (iii) any similar action actions that normally inflicts inflict pain or discomfort;

7. Subjection to unsanitary living conditions;

8. Denial of opportunities for bathing or access to toilet facilities, except as ordered by a licensed physician for a legitimate medical purpose and documented in the resident's record;

9. Denial of health care;

10. Deprivation of appropriate services and treatment;

11. Application of aversive stimuli, except as permitted pursuant to other applicable state regulations Aversive stimuli means any physical forces (e.g., sound, electricity, heat, cold, light, water, or noise) or substances (e.g., hot pepper, pepper sauce, or pepper spray) measurable in duration and intensity that when applied to a resident are noxious or painful to the individual;

12. Administration of laxatives, enemas, or emetics, except as ordered by a licensed physician or poison control center for a legitimate medical purpose and documented in the resident's record;

13. Deprivation of opportunities for sleep or rest, except as ordered by a licensed physician for a legitimate medical purpose and documented in the resident's record;

14. Placement of a resident alone in a locked room or a secured area where the resident is prevented from leaving;

15. Use of mechanical restraints (e.g., handcuffs, waist chains, leg irons, disposable plastic cuffs, leather restraints, or a restraint chair) chairs;

16. Use of pharmacological restraints; and

17. Other constitutionally prohibited actions.

6VAC35-41-565 Vulnerable population

A. The Immediately upon a resident's admission, the facility shall implement a procedure for assessing determining whether a resident is a member of a vulnerable population. Factors including the resident's height and size, English proficiency, sexual orientation, history of being bullied, or history of self-injurious behavior may be considered in determining whether a resident is a member of a vulnerable population. The resident's own views with respect to the resident's safety shall be considered.

B. If the assessment facility determines a resident is a member of a vulnerable population, the facility shall implement any identified additional precautions such as heightened need for supervision, additional safety precautions, or separation from certain other residents. The facility shall consider on a case-by-case basis whether a placement would ensure the resident's health and safety and whether the placement would present management or security problems.

C. For the purposes of this section, vulnerable population means a resident or group of residents who have been assessed to be reasonably likely to be exposed to the possibility of being attacked or harmed, either physically or emotionally (e.g., very young residents; residents who are small in stature; residents who have limited English proficiency; residents who are gay, lesbian, bi-sexual, transgender, or intersex; residents with a history of being bullied or of self-injurious behavior).

6VAC35-41-570 Residents' mail

A. A resident's incoming or outgoing mail may be delayed or withheld only in accordance with this section or as permitted by other applicable regulations or by order of a court.

B. In accordance with written procedures, staff may open and inspect residents' incoming and outgoing nonlegal mail, including electronic nonlegal mail, for contraband. When based on legitimate facility interests of order and security, nonlegal mail, including electronic nonlegal mail, may be read, censored, or rejected. In accordance with written procedures, the resident shall be notified, as appropriate, when incoming or outgoing letters, including electronic letters, are withheld in part or in full redacted.

C. In the presence of the resident recipient and in accordance with written procedures, staff may open to inspect for contraband, but shall not read, legal mail. Legal mail shall mean any written material that is sent to or received from a designated class of correspondents, as defined in procedures, which shall include any court, legal counsel, administrators of the grievance system, or administrators of the department, facility, provider, or governing authority.

D. Staff shall not read mail, including electronic mail, addressed to parents, immediate family members, legal guardian, guardian guardians, guardians ad litem, counsel, courts, officials of the committing authority, public official officials, or grievance administrators unless permission has been obtained from a court or the facility administrator has determined that there is a reasonable belief that the security of a facility is threatened. When so authorized, staff may read such mail only in the presence of a witness and in accordance with written procedures.

E. Except as otherwise provided, incoming and outgoing letters shall be held for no more than 24 hours and packages for no more than 48 hours, excluding weekends and holidays.

F. Cash, stamps, and other specified items specified in written procedures may be held for the resident.

G. Upon request, each resident shall be given postage and writing materials for all legal correspondence mail and at least two other letters per week.

H. Residents shall be permitted to correspond at their own expense with any person or organization, provided such the correspondence does not pose a threat to facility order and security and is not being used to violate or to conspire to violate the law.

I. First class letters and packages received for residents who have been transferred or released shall be forwarded. to the resident's last known address or forwarding address or returned to sender.

J. Written procedure governing correspondence of residents shall be made available to all staff and residents and shall be, reviewed annually, and updated as needed.

6VAC35-41-590 Visitation

A. Residents shall be permitted to given reasonable visiting privileges, consistent with written procedures, that take into account (i) the need for security and order, (ii) the behavior of individual residents and visitors, (iii) the importance of helping the resident maintain strong family and community ties, and (iv) the welfare of the resident, and (v) whenever. Whenever possible, the facility shall provide flexible visiting hours.

B. Copies of the written visitation procedures shall be made available to the parents, or legal guardians, when appropriate, legal guardians, appropriate, and the resident, and other interested persons important to the resident no later than the time of admission except that when. When parents or legal guardians do not participate in the admission process, however, visitation procedures shall be mailed, to them, either electronically or via first class mail, to them by the close of the next business day after admission, unless a copy has already been provided to the individual.

6VAC35-41-600 Contact with attorneys, courts, and law enforcement

A. Residents shall have uncensored, confidential contact with their legal representative in writing, as provided for writing subject to the exceptions provided in 6VAC35-41-570 (residents' mail), by telephone, or in person.

B. Residents shall not be denied access to the courts.

C. Residents shall not be required to submit to questioning by law enforcement, law-enforcement, though they may do so voluntarily.

1. Residents' consent shall be obtained prior to any contact with law enforcement.

2. No employee may coerce a resident's decision to consent to have contact with law enforcement.

3. Each facility shall have procedures for establishing a resident's consent to any such contact questioning by law-enforcement and for documenting the resident's decision. The procedures may provide for require (i) notification of the parent or legal guardian, as appropriate and applicable, prior to the commencement of questioning; and (ii) opportunity, at the resident's request, to confer with an attorney, parent or guardian, or other person in making the decision deciding whether to consent to questioning.

6VAC35-41-610 Personal necessities and hygiene

A. At admission, each resident shall be provided the following:

1. An adequate supply of personal necessities for hygiene and grooming;

2. A separate bed equipped with a mattress, a pillow, blankets, bed linens, and, if needed, a waterproof mattress cover; and

3. Individual washcloths and towels.

B. At the time of issuance, all items shall be clean and in good repair.

C. Personal necessities shall be replenished as needed.

D. The washcloths, towels, and bed linens shall be cleaned or changed, at a minimum, once every seven days and more often, often if needed. Bleach or another sanitizing agent approved by the federal Environmental Protection Agency to destroy bacteria shall be used in the laundering of such linens and table bed linens.

E. Staff shall promote good personal hygiene of residents by monitoring and supervising hygiene practices each day and by providing instruction when needed.

6VAC35-41-620 Showers

Residents shall have the opportunity to shower daily, except when a declaration of a state of emergency due to drought conditions has been issued by the Governor or water restrictions have been issued by the locality. Under these exceptional circumstances showers shall be restricted as determined by the facility administrator after consultation with local health officials. The alternate schedule implemented under these exceptional circumstances shall account for cases of medical necessity related to health concerns and shall be in effect only until such time as the water restrictions are lifted there is a documented emergency.

6VAC35-41-630 Clothing

A. Provision shall be made for each resident to have an adequate supply of clean and size-appropriate clothing and shoes for indoor and outdoor wear.

B. Clothes and shoes shall be similar in style to those generally worn by individuals of the same age in the community who are engaged in similar activities.

C. Residents shall have the opportunity to participate in the selection of their clothing.

D. Residents shall be allowed to take personal clothing when leaving the facility.

6VAC35-41-650 Nutrition

A. Each resident, except as provided in subsection B of this section, shall be provided a daily diet that (i) consists of at least three nutritionally balanced meals and an evening snack, (ii) includes an adequate variety and quantity of food for the age of the resident, and (iii) meets any applicable federal nutritional requirements.

B. Special diets or alternative dietary schedules, as applicable, shall be provided in the following circumstances: (i) when prescribed by a physician or (ii) when necessary to observe the established religious dietary practices of the resident. In such circumstances, the meals shall meet t any applicable federal nutritional requirements.

C. Menus of actual meals served shall be kept on file for at least six months. in accordance with applicable federal requirements.

D. Staff who eat in the presence of the residents shall be served the same meals as the residents unless a special diet has been prescribed by a physician for the staff or residents or the staff or residents are observing established religious dietary practices.

E. There shall not be more than 15 hours between the evening meal and breakfast the following day, except when the facility administrator approves an extension of time between meals on weekends and holidays. When an extension is granted on a weekend or holiday, there shall never be more than 17 hours between the evening meal and breakfast.

F. Providers shall assure ensure that food is available to residents who for documented medical or religious reasons need to eat breakfast before the 15 or 17 hours have expired.

G. The provisions of this section shall not apply to independent living programs, which shall be subject to the provisions applicable to nutrition in 6VAC35-41-1000.

6VAC35-41-660 School enrollment and study time

A. The facility shall make all reasonable efforts to enroll each resident of compulsory school attendance age in an appropriate educational program within five school business days after admission and in accordance with § 22.1-254 of the Code of Virginia and Regulations Governing the Reenrollment of Students Committed to the Department of Juvenile Justice (8VAC20-660), if applicable. Documentation of the enrollment and any attempt to enroll the resident shall be maintained in the resident's record.

B. Each provider Providers shall develop and implement written procedures to ensure that each resident has adequate study time.

6VAC35-41-680 Recreation

A. The provider shall have a written description of its recreation program that describes activities that are consistent with the facility's total program and with the ages, developmental levels, interests, and needs of the residents that includes. The recreation program shall include:

1. Opportunities for individual and group activities, both structured and unstructured;

2. Use of available community recreational resources and facilities;

3. Scheduling of activities so that they do not conflict with meals, religious services, educational programs, or other regular events; and

4. Regularly scheduled indoor and outdoor recreational activities that are structured to develop skills and attitudes. pro-social attitudes; and

5. Appropriate recreational materials for indoor and outdoor use.

B. The provider shall develop and implement written procedures to ensure protect the safety of residents participating in recreational activities that include by ensuring that:

1. How activities will be Activities are directed and supervised by individuals knowledgeable in the safeguards required for the activities;

2. How residents Residents are assessed for suitability for an activity and the supervision provided; and appropriately supervised;

3. How safeguards Safeguards for water related water-related activities will be are provided, including ensuring that a certified life guard lifeguard supervises all swimming activities and that the provider attempts to determine the resident's swimming ability by consulting the swimmer's parent or legal guardian; and

4. All participants are equipped and clothed appropriately and wearing safety gear appropriate for the activity in which the resident is engaging.

C. For all overnight recreational trips away from the facility, the provider shall document trip planning to include:

1. A supervision plan for the entire duration of the activity including awake and sleeping hours that meets the specific staffing ratio requirements set out in 6VAC35-41-930;

2. A plan for safekeeping and distribution of medication;

3. An overall emergency, safety, and communication plan for the activity, including resident accountability, prompt evacuation, and identification of emergency numbers of for facility administration administrators and outside emergency services;

4. Staff training and experience requirements for each activity;

5. Resident preparation for each activity;

6. A plan to ensure that all the necessary equipment for the and gear that will be used in connection with the specified activity is certified, if required; in good repair; in operable condition; and age, body-size, and otherwise appropriate for the activity;

7. A trip schedule giving addresses and phone numbers of locations to be visited and how the location was chosen and evaluated;

8. A plan to evaluate residents' physical health throughout the activity and to ensure that the activity is conducted within the boundaries of the resident's capabilities, dignity, and respect for self-determination;

9. A plan to ensure that a certified life guard lifeguard supervises all swimming activities in which residents participate; and

10. Documentation of any variations from trip plans and reason for the variation.

D. All For overnight recreational trips away from the facility, the facility administrator shall ensure that:

1. A telephone is located in each area where residents sleep or participate in programs;

2. First-aid kits are accessible at all times and contain supplies that are appropriate for the activity;

3. A separate bed, bunk, cot, or sleeping bag is available for each resident and staff member attending the overnight trip; and

4. Bedding is clean, dry, sanitary, and in good repair.

E. The facility shall obtain written permission from each resident's parent or legal guardian for all overnight out-of-state or out-of-country recreational trips require written permission from each resident's legal guardian. trips. Documentation of the written permission shall be kept maintained in the resident's case record.

F. The provisions of this section shall not apply to wilderness programs, which shall be subject to the provisions of 6VAC35-41-1010 through 6VAC35-41-1070.

6VAC35-41-690 Residents' funds

A. The provider shall implement written procedures for safekeeping and for recordkeeping of any money that belongs or is provided to residents, including allowances, if applicable.

B. A resident's personal funds, including any allowance or earnings, shall be used for the resident's benefit, for payments ordered by a court, or to pay restitution for damaged property or personal injury as determined by disciplinary procedures.

6VAC35-41-700 Fundraising

The provider shall not use residents in its fundraising activities without the written permission of both the parent or legal guardian, as appropriate and applicable, and the consent of residents.

6VAC35-41-710 Placement pursuant to a court order

A. When a resident is placed in a facility pursuant to a court order, the requirements of the following requirements shall be met by maintaining a copy of a court order in the resident's case record provisions of this chapter do not apply:

1. 6VAC35-41-730 (application for admission).

2. 6VAC35-41-740 (admission procedures).

3. 6VAC35-41-750 (written placement agreement).

4. 6VAC35-41-780 (emergency admissions).

5. 6VAC35-41-810 (discharge procedures).

B. The facility shall maintain a copy of the court order in the resident's case records instead of the documentation required by the regulatory sections enumerated in subsection A of this section.

6VAC35-41-720 Readmission to a shelter care program

A. When a resident is readmitted to a shelter care facility within 30 days from discharge, the requirements of the following requirements shall provisions of this chapter do not apply:

1. 6VAC35-41-730 (application for admission).

2. 6VAC35-41-740 (admission procedures).

B. When a resident is readmitted to a shelter care facility within 30 days from discharge, the facility shall:

1. Review and update all information on the face sheet as provided in 6VAC35-41-340 (face sheet);

2. Complete a health screening in accordance with 6VAC35-41-1200 (health screening at admission);

3. Complete the required admission and orientation process as provided in 6VAC35-41-760 (admission); and

4. Update in the case record any other information regarding the resident that has changed since discharge.

6VAC35-41-730 Application for admission

A. Except for placements pursuant to a court order or resulting from a transfer between residential facilities located in Virginia and operated by the same governing authority, all admissions shall be based on evaluation of an application for admission.

B. Providers shall develop and fully complete, an application for admission and ensure that the referral source has fully completed the application prior to a resident's acceptance for care, an application for admission that is designed to compile information necessary to determine:. The provider shall ensure that the completed application for each admitted resident is placed in the resident's case record.

C. The application for admission shall consist of information necessary to determine:

1. The suitability of the prospective resident's admission;

2. The educational needs of the prospective resident;

2. 3. The mental health, emotional, and psychological needs of the prospective resident;

3. 4. The physical health needs, including the immunization needs, of the prospective resident;

4. 5. The protection needs of the prospective resident;

5. The suitability of the prospective resident's admission;

6. The behavior support needs of the prospective resident; and

7. Information necessary to develop a service plan and a behavior support plan.

C. Each facility D. Providers shall develop and implement written procedures to assess each prospective resident as part of the application process to ensure that:

1. The needs of the prospective resident can be addressed by the facility's services;

2. The facility's staff are trained to meet the prospective resident's needs; and

3. The admission of the prospective resident would not pose any a significant risk to (i) the prospective resident or (ii) the facility's residents or staff.

6VAC35-41-740 Admission procedures

A. Except for placements pursuant to a court order, the facility shall admit only those residents who are determined to be compatible with the services provided through the facility.

B. The facility's written criteria for admission shall include the following:

1. A description of the population to be served;

2. A description of the types of services offered;

3. Intake and admission procedures;

4. Exclusion criteria to define those that identify behaviors or problems that for which the facility does not have the lacks the experienced or trained staff with experience or training necessary to manage the behaviors; and

5. Description of how educational services will be provided to the population being served.

6VAC35-41-750 Written placement agreement

A. Except for placements pursuant to a court order or when a resident admits himself to a shelter care facility, each resident's case record shall contain, prior to a routine planned admission, a completed placement agreement signed by a facility representative and the parent, legal guardian, or placing agency. Routine admission means the admittance of a resident following evaluation of an application for admission and execution of a written placement agreement.

B. The written placement agreements agreement shall:

1. Authorize the resident's placement;

2. Address acquisition of and consent for any medical treatment needed by the resident;

3. Address the rights and responsibilities of each party involved;

4. 3. Address financial responsibility for the placement;

5. 4. Address visitation with the resident; and

6. 5. Address the education plan for the resident and the responsibilities of all parties. regarding the plan; and

6. Address the rights and all other responsibilities of each party involved.

6VAC35-41-760 Admission

A. Written procedure governing the admission and orientation of residents to the facility shall provide for:

1. Verification of legal authority for placement;

2. Search of the resident and the resident's possessions, including inventory and storage or disposition of property, as appropriate;

3. Health screening;

4. Notification of parents and legal guardians, as applicable and appropriate, including of (i) the resident’s admission, (ii) information on visitation, and (iii) general information, including how the resident's parent or legal guardian may request information and register concerns and complaints with the facility. The facility shall ask the parent or legal guardian regarding whether the resident has any immediate medical concerns or conditions;

5. Interview with the resident to answer questions and obtain information;

6. Explanation to the resident of program services and schedules;

7. An orientation on the residents' rights, including but not limited to the prohibited actions provided for in 6VAC35-41-560 (prohibited actions); and

8. Assignment of the resident to a housing unit or room.

B. When a resident is readmitted to a shelter care facility within 30 days from discharge, the facility shall administer all searches and screenings, provide all notifications, and update the all information required in subsection A of this section.

6VAC35-41-770 Orientation to facility rules and disciplinary procedures

A. During the orientation to the facility, residents shall be given written information describing facility rules, the sanctions for rule violations, and the facility's disciplinary process. These The written information shall be explained to the resident and documented by the dated signature of the resident and staff.

B. Where a language or literacy problem exists that can lead to a resident misunderstanding the facility rules and regulations, staff or a qualified person under the supervision of staff shall assist the resident.

6VAC35-41-780 Emergency admissions

Providers accepting emergency admissions, which are the unplanned or unexpected admission of a resident in need of immediate care excluding self-admittance to a shelter care facility or a court ordered placement, shall:

1. Develop and implement written procedures governing such admissions that shall include procedures require the provider to make and document prompt efforts to obtain (i) a written placement agreement signed by the parent or legal guardian or (ii) the order of a court order;

2. Place in each resident's record the order of a court, court order, a written request for care or documentation of an oral request for care, and justification of for why the resident is to be being admitted on an emergency basis; and

3. Except for placements pursuant to court orders, clearly document clearly in the written assessment information gathered for the emergency admission that the individual meets the facility's criteria for admission.

6VAC35-41-790 Resident transfer between residential facilities located in Virginia and operated by the same governing authority

A. Except for transfers pursuant to a court order, when a resident is transferred from one facility to another facility operated by the same provider or governing authority, the sending facility shall provide the receiving facility, at the time of transfer, a written summary of (i) the resident's progress while at the sending facility; (ii) the justification for the transfer; (iii) the resident's current strengths and needs; and (iv) any medical needs, medications, and restrictions and, if necessary, instructions for meeting these needs.

B. Except for transfers pursuant to a court order, when a resident is transferred from one facility to another facility operated by the same provider or governing authority, the receiving facility shall document at the time of transfer:

1. Preparation measures accomplished through sharing information with the resident, the family, and the placing agency about the receiving facility, the staff, the population served, activities, and criteria for admission;

2. Notification to the family, if as applicable and appropriate;, the resident, the placement agency, and the legal guardian; and

3. Receipt of the written summary from the sending facility required by subsection A of this section.

6VAC35-41-800 Placement of residents outside the facility.  (Repealed.)

A resident shall not be placed outside the facility prior to the facility obtaining a placing agency license from the Department of Social Services, except as permitted by statute or by order of a court of competent jurisdiction.

6VAC35-41-810 Discharge procedures

A. The provider shall have written criteria for discharge that shall include:

1. Criteria for a resident's completing the program that are consistent with the facility's programs and services;

2. Conditions under which a resident may be discharged before completing the program; and

3. Procedures for assisting placing agencies in placing the residents should the facility cease operation.

B. The provider's criteria for discharge shall be accessible to prospective residents, parents or legal guardians, and placing agencies.

C. Residents younger than 18 years of age shall be discharged only to the parent or legal guardian, legally authorized representative, or foster parent with the written authorization of a representative of the legal guardian. Residents over the age of 17 18 years of age or older or who have been emancipated may assume responsibility for their own discharge.

D. As appropriate and applicable, information concerning current medications, need for continuing therapeutic interventions, educational status, and other items important to the resident's continuing care shall be provided to the parent or legal guardian or legally authorized representative, as appropriate.

E. Residents shall be permitted to take personal clothing when discharged from the facility.

6VAC35-41-820 Discharge documentation

A. Except for residents discharged pursuant to a court order, the case record of a discharged resident shall contain the following:

1. Documentation that discharge planning occurred prior to the planned discharge date;

2. Documentation that discussions with the parent or legal guardian, placing agency, and resident regarding discharge planning occurred prior to the planned discharge date;

3. A written discharge plan developed prior to the planned discharge date; and

4. As soon as possible, but no later than 30 days after discharge, a comprehensive discharge summary placed in the resident's record and, which also shall be sent to the placing agency. The discharge summary shall review the following:

a. Services The services provided to the resident;

b. The resident's progress toward meeting service plan objectives;

c. The resident's continuing needs and recommendations, if any, for further services and care, if any;

d. Reasons The reasons for discharge and names of persons to whom the resident was discharged;

e. Dates The dates of admission and discharge; and

f. Date The date the discharge summary was prepared and the signature of the person preparing who prepared it.

B. When a resident is discharged pursuant to a court order, the case record shall contain a copy of the court order.

6VAC35-41-840 Structured programming

A. Each facility shall implement a comprehensive, planned, and structured daily routine, including appropriate supervision designed to:

1. Meet the residents' physical and emotional needs;

2. Provide protection, guidance, and appropriate supervision;

3. Ensure the delivery of program services; and

4. Meet the objectives of any individual service plan, if applicable.

B. Each facility shall have goals, objectives, and strategies consistent with the facility's mission and program objectives utilized when working with all residents until the residents' individualized individual service plans are developed. These goals, objectives, and strategies shall be provided to the residents in writing during orientation to the facility.

C. Residents shall be allowed to participate in the facility's programs, as applicable, upon admission.

6VAC35-41-850 Daily log

A. A daily communication log shall be, in accordance with facility procedures, maintained, in accordance with facility procedures, to inform staff of significant happenings or problems experienced by residents.

B. The date and time of the entry and the identity of the individual making each entry shall be recorded.

C. If the facility records log book-type information its log on a computer, all entries shall post the date, time, and identity of the person making an entry. The computer program shall prevent previous entries from being overwritten.

6VAC35-41-860 Individual service plan

A. An individual service plan shall be developed and placed in the resident's record within 30 days following admission and implemented immediately thereafter. The initial individual service plan shall be distributed to the resident; the resident's family, legal guardian, or legally authorized representative; the placing agency; and appropriate facility staff.

B. Individual service plans shall describe in measurable terms the:

1. Strengths and needs of the resident;

2. Resident's current level of functioning;

3. Goals, objectives, and strategies established for the resident including a behavior support plan, if appropriate;

4. Projected family involvement;

5. Projected date for accomplishing each objective; and

6. Status of the projected discharge plan and estimated length of stay, except that this requirement shall not apply to a facility that discharges only upon receipt of the order of a court of competent jurisdiction.

C. Each individual service plan shall include the date it was developed and the signature of the person who developed it.

D. The individual service plan shall be reviewed within 60 days of the development of the plan and within each 90-day period thereafter. The individual service plan shall be revised as necessary. Any changes to the plan shall be made in writing. All participants shall receive copies of the revised plan.

E. The resident and facility staff shall participate in the development of the individual service plan.

F. The (i) supervising agency and (ii) resident's parents, legal guardian, or legally authorized representative, if appropriate and applicable, shall be given the opportunity to participate in the development of the resident's individual service plan.

G. Copies of the individual service plan shall be provided to the (i) resident; (ii) parents or legal guardians, as appropriate and applicable, and (iii) the placing agency.

6VAC35-41-870 Quarterly reports

A. Except when a resident is placed in a shelter care program, the resident's progress toward meeting his individual service plan goals shall be reviewed and a progress report shall be prepared within 60 days of the development of the plan and within each 90-day period thereafter and. The progress report shall review the status of the following:

1. Resident's The resident's progress toward meeting the plan's objectives;

2. Family's The family's involvement;

3. Continuing The continuing needs of the resident;

4. Resident's The resident's progress towards toward discharge; and

5. Status The status of discharge planning.

B. Each quarterly progress report shall include the date it was developed and the signature of the person who developed it.

C. All quarterly progress reports shall be distributed to the resident; the resident's family, parent, legal guardian, or legally authorized representative; the placing agency; and appropriate facility staff.

6VAC35-41-880 Therapy

Therapy, if provided, shall be provided by an individual Individuals providing therapy shall be: (i) licensed as a therapist therapists by the Department of Health Professions or (ii) who is licensure eligible for licensure and working under the supervision of a licensed therapist unless exempted from these requirements under the Code of Virginia.

6VAC35-41-890 Community relationships

A. Opportunities shall be provided Facilities shall provide opportunities for the residents to participate in activities and to utilize resources in the community.

B. In addition to the requirements of 6VAC35-41-290 (background checks for volunteers or interns), written procedures shall govern how the facility will determine if participation in such community activities or programs would be in the residents' best interest.

C. Each facility shall have a staff community liaison who shall be responsible for facilitating cooperative relationships with neighbors, the school system, local law enforcement, local government officials, and the community at large.

D. Each provider Providers shall develop and implement written procedures for promoting positive relationships with the neighbors that shall be approved by the department their neighbors.

6VAC35-41-900 Resident visitation at the homes of staff

Resident visitation at Residents shall be prohibited from visiting the homes of staff is prohibited unless written permission from the (i) resident's parent or legal guardian, as applicable and appropriate, (ii) the facility administrator, and (iii) the placing agency is obtained before the visitation occurs. The written permission shall be kept in the resident's record.

6VAC35-41-905 Work and employment

A. Paid and unpaid work assignments, including chores, are assigned by or carried out at the facility shall be in accordance with the developmental level, health, and ability of the resident.

B. Chores shall not interfere with school programs, study periods, meals, or sleep.

C. Work assignments or employment outside the facility, including reasonable rates of pay, shall be approved by the facility administrator, upon collaboration with the referring agency and the parent or legal guardian.

D. In both work assignments and employment, the facility administrator shall evaluate the appropriateness of the work and fairness of the pay.

6VAC35-41-910 Additional assignments of direct care staff. (Repealed.)

If direct care staff assume nondirect care responsibilities, such responsibilities shall not interfere with the staff's direct care duties.

6VAC35-41-920 Staff supervision of residents

A. No member of the direct care staff shall be on duty and responsible for the direct care of residents more than six consecutive days without a rest day, except in an emergency. For the purpose of this section, a rest day shall mean a period of not less than 24 consecutive hours during which a staff person has no responsibility to perform duties related to the operation of the facility.

B. Direct care staff shall have an average of at least two rest days per week in any four-week period.

C. Direct care staff shall not be on duty more than 16 consecutive hours, except in an emergency.

D. There Except as provided in subsection G of this section, there shall be at least one trained direct care staff member who has satisfied the requirements in 6VAC35-41-200 and, if applicable, 6VAC35-41-210 on duty and actively supervising residents at all times that one or more residents are present.

E. Whenever residents are being supervised by staff, there shall be at least one staff person present with a current basic certification in standard first aid and a current certificate in cardiopulmonary resuscitation issued by a recognized authority.

F. The provider shall develop and implement written procedures that address staff supervision of residents including contingency plans for resident illnesses, emergencies, and off-campus activities, and resident preferences. These procedures shall be based on the:

1. Needs of the population served;

2. Types of services offered;

3. Qualifications of staff on duty; and

4. Number of residents served.

G. Notwithstanding the requirements in subsection D of this section, the trained direct care staff member who is present, on duty, and actively supervising residents in an independent living program shall be authorized, in emergency situations, to leave the facility for no longer than one hour to attend to a resident who is away from the facility and is in need of immediate assistance. Facilities that elect to exercise this option must observe the following rules:

1. The direct care staff must provide notice to the facility administrator or other supervisor before leaving the facility;

2. Residents who remain at the facility shall be provided with an emergency telephone number or other means of immediately communicating with a staff member; and

3. The facility shall have written procedures governing this exception.

6VAC35-41-930 Staffing pattern

A. During the hours that residents are scheduled to be awake, there shall be at least one direct care staff member awake, on duty, and responsible for supervision of every 10 eight residents, or portion thereof, on the premises or participating in off-campus, facility sponsored activities, except that independent living programs shall have at least one direct care staff member awake, on duty, and responsible for supervision of every 15 residents on the premises or participating in off-campus, facility sponsored activities.

B. During the hours that residents are scheduled to sleep, there shall be no less fewer than one direct care staff member on duty and responsible for supervision of every 16 residents, or portion thereof, on the premises.

C. There shall be at least one direct care staff member on duty and responsible for the supervision of residents in each building where residents are sleeping. This requirement does not apply to approved independent living programs.

D. On each floor where residents are sleeping, there shall be at least one direct care staff member awake and on duty for every 30 residents or portion thereof.

D. The facility administrator shall have the discretion to determine the appropriate staffing ratios when residents are participating in off-campus, facility-sponsored activities or events after taking into account the residents who are participating, the nature of the event, and any other factors important in establishing the appropriate ratio. There shall never be fewer than one direct care staff member present for every eight residents or portion thereof while attending off-campus, facility-sponsored activities.

E. The provisions of this section shall not apply to independent living programs. Staffing for independent living programs shall be provided in accordance with 6VAC35-41-1005.

6VAC35-41-935 Periodic monitoring of residents

A. Whenever residents are present in the facility, staff shall conduct periodic checks on each resident in the facility at least once every 30 minutes and more often if justified by the circumstances. Each check shall be documented in accordance with written procedures.

B. The requirement provided in subsection A of this section shall not apply to independent living programs.

6VAC35-41-950 Work and employment. (Repealed.)

A. Assignment of chores that are paid or unpaid work assignments shall be in accordance with the age, health, ability, and service plan of the resident.

B. Chores shall not interfere with school programs, study periods, meals, or sleep.

C. Work assignments or employment outside the facility, including reasonable rates of pay, shall be approved by the facility administrator with the knowledge and consent of the parent or legal guardian, as appropriate and applicable.

D. In both work assignments and employment the facility administrator shall evaluate the appropriateness of the work and the fairness of the pay.

6VAC35-41-960 Independent living programs. (Repealed.)

A. Independent living programs shall be a competency based program, specifically approved by the board to provide the opportunity for the residents to develop the skills necessary to become independent decision makers, to become self-sufficient adults, and to live successfully on their own following completion of the program.

B. Independent living programs shall have a written description of the curriculum and methods used to teach living skills, which shall include finding and keeping a job, managing personal finances, household budgeting, hygiene, nutrition, and other life skills.

6VAC35-41-970 Independent living programs curriculum; curricula and assessment

A. Each An independent living program must shall demonstrate that use of a structured program using that incorporates materials and curriculum curricula approved by the board is being used facility administrator to teach independent living skills. The curriculum must curricula shall include information regarding each of the areas listed in subsection B C of this section.

B. An independent living program shall have a written description of the curricula and methods used to teach living skills.

C. Within 14 days of placement, the provider must complete an assessment, including strengths and needs, of the resident's life living skills using an independent living assessment tool approved by the department. The assessment must cover covering the following areas:

1. Money management and consumer awareness;

2. Food management;

3. Personal Hygiene and personal appearance;

4. Social skills;

5. Health and sexuality Physical and mental health;

6. Housekeeping;

7. Transportation;

8. Educational planning and career planning;

9. Job seeking skills;

10. Job maintenance skills;

11. Emergency and safety skills;

12. Knowledge of community resources;

13. Interpersonal skills and social relationships;

14. Legal skills matters;

15. Leisure activities; and

16. Housing.

C. The resident's individualized service plan shall include, in addition to the requirements found in 6VAC35-41-860 (individual service plan), goals, objectives, and strategies addressing each of the areas listed in subsection B of this section, as applicable.

D. The independent living program shall document each resident's progress toward developing independent living skills.

6VAC35-41-980 Employee training in independent living programs

Each An independent living program shall develop and implement procedures to train that require training of all direct care staff within 14 days of employment before the expiration of the staff's 14th work day on the content of the independent living curriculum, curricula, the use of the independent living materials, the application of the assessment tool, and the documentation methods used. Documentation of the training shall be kept maintained in the employee's staff personnel record.

6VAC35-41-990 Medication management in independent living programs

If an independent living program allows residents age 18 years or older are to share in the responsibility for administering their own medication with the provider, the independent living program shall develop and implement written procedures that include:

1. Training for the resident Resident training in self administration self-administration and recognition of side effects;

2. Method The method for storage and safekeeping of medication;

3. Method The method for obtaining approval for the resident to self administer self-administer medication from a person authorized by law to prescribe medication; and

4. Method The method for documenting the administration of medication.

6VAC35-41-1000 Nutrition procedure in independent living programs

Each independent Independent living program programs shall develop and implement written procedures that ensure that each resident is receiving adequate nutrition as required in 6VAC35-41-650 A, and B, and C (nutrition).

6VAC35-41-1005 Staffing in independent living programs

During all hours, regardless of whether residents are scheduled to be awake or asleep, an independent living program shall have at least one direct care staff member awake, on duty, and responsible for supervision of every 16 residents on the premises; however, in accordance with subsection G of 6VAC35-41-920, the direct care staff member shall be authorized in emergency situations to leave the facility for no longer than one hour to attend to a resident who is away from the facility and is in need of immediate assistance.

6VAC35-41-1010 Wilderness program Requirements for wilderness programs

A. The provider must shall obtain approval by from the board prior to director before operating a primitive camping wilderness program.

B. Any A wilderness program must meet the following conditions: (i) maintain a nonpunitive environment; (ii) have an experience a written curriculum; and (iii) accept only residents only who are nine years of age or older who cannot presently function at home, in school, or in the community.

C. Any A wilderness work program or wilderness work camp program shall have a written program description covering:

1. Its The program's intended resident population;

2. How work assignments, education, vocational training, and treatment will be interrelated;

3. The length of the program;

4. The type and duration of treatment and supervision to be provided upon release or discharge; and

5. The program's behavioral expectations, incentives, and sanctions.

6VAC35-41-1020 Wilderness Procedures for wilderness programs or adventure activities; training

A. All wilderness programs and providers that take residents on wilderness or adventure activities shall develop and implement written procedures that include:

1. Staff and resident training and experience requirements for each activity;

2. Resident training and experience requirements for each activity;

3. 2. Specific staff to resident staff-to-resident ratio and supervision plan that is appropriate for each activity, including sleeping arrangements and supervision during night time hours. The ratio and supervision plan shall meet the requirements set out in 6VAC35-41-930;

4. 3. Plans to evaluate and document each participant's physical health throughout the activity;

5. 4. Preparation and planning needed for each activity and time frames;

6. 5. Arrangement, maintenance, and inspection of activity areas;

7. 6. A plan to ensure that any equipment and gear that is to be used in connection with a specified wilderness or adventure activity is appropriate to the activity, certified if required, in good repair, in operable condition, and age and body size appropriate;

8. 7. Plans to ensure that all ropes and paraphernalia used in connection with rope rock climbing, rappelling, high and low ropes courses, or other adventure activities in which ropes are used are approved annually by an appropriate certifying organization and have been inspected by staff responsible for supervising the adventure activity before engaging residents in the activity;

9. 8. Plans to ensure that all participants are appropriately equipped, clothed, and wearing safety gear, such as a helmet, goggles, safety belt, life jacket, or a flotation device, that is appropriate to the adventure activity in which the resident is engaged;

10. 9. Plans for food and water supplies and management of these resources;

11. 10. Plans for the safekeeping and distribution of medication;

12. 11. Guidelines to ensure that resident participation is conducted falls within the boundaries of the resident's capabilities, dignity, and respect for self-determination;

13. 12. Overall emergency, safety, and communication plans for each activity including rescue procedures, frequency of drills, resident accountability, prompt evacuation, and notification of outside emergency services; and

14. 13. Review of trip plans by the trip coordinator.

B. Direct care workers staff hired by wilderness campsite programs and providers that take residents on wilderness or adventure activities shall be trained in a wilderness first aid course.

6VAC35-41-1030 Initial physical for wilderness programs or adventure activities

Initial physical forms used by wilderness campsite programs and providers that take residents on wilderness or adventure activities shall include:

1. A statement notifying the doctor of the types of activities the resident will be participating in; and

2. A statement signed by the doctor stating that the individual's health does not prevent him from participating in the described activities.

6VAC35-41-1040 Physical environment of wilderness programs or adventure activities

A. Each resident shall have adequate personal storage area.

B. Fire A. If combustion-type heating devices, campfires, or other sources of combustion are present, fire extinguishers of a 2A 10BC rating shall be maintained so that it is never necessary to travel more than or available within 75 feet to a fire extinguisher from combustion-type heating devices, campfires, or other of the source of combustion.

C. B. Artificial lighting shall be provided in a safe manner.

D. C. All areas of the campsite shall be lighted for safety when occupied by residents.

E. D. A telephone or other means of communication is required at shall be accessible in each area where residents sleep or participate in programs.

F. E. First aid kits used by wilderness campsite programs and providers that take residents on adventure activities shall be appropriate for the activity appropriate and shall be accessible at all times.

6VAC35-41-1050 Sleeping areas of wilderness programs or adventure activities

If a wilderness program requires outdoor, off-campus, or alternative overnight sleeping arrangements, the following provisions shall apply:

A. In lieu 1. Instead of or in addition to dormitories, cabins, or barracks for housing residents, primitive campsites may be used.

B. Sleeping areas 2. Areas in which residents sleep shall be protected by screening or other means to prevent admittance of flies and mosquitoes.

C. 3. A separate bed, bunk, or cot, or sleeping bag, if applicable, shall be made available for each person.

D. 4. A mattress cover shall be provided for each mattress, as applicable.

E. Bedding 5. Bedding, if used, shall be clean, dry, sanitary, and in good repair.

F. Bedding 6. Bedding, if used, shall be adequate to ensure protection and comfort in cold weather.

G. 7. Sleeping bags, if used, shall be fiberfill and rated for 0°F.

H. 8. Linens shall be changed as often as required for cleanliness and sanitation but not less frequently than once a week every seven days.

I. 9. Staff shall be of the same sex may as each resident in a tent or sleeping room in order to share a the tent or sleeping area room with the residents.

6VAC35-41-1060 Personal necessities in wilderness programs or adventure activities

A. Each resident Residents participating in wilderness programs shall be provided with an adequate supply of clean clothing and footwear that is sturdy, suitable for outdoor living the activity planned, and is appropriate to the geographic location and season.

B. Sturdy, water resistant, outdoor footwear shall be provided for each resident.

6VAC35-41-1070 Trip or activity coordination for wilderness programs or adventure activities

A. All wilderness Wilderness programs and facilities that take residents on wilderness or adventure activities must shall designate one staff person to be the trip coordinator who will be responsible for all facility wilderness or adventure trips.

1. This person must The trip coordinator shall have experience in and knowledge regarding wilderness activities and be trained in a wilderness first aid course. The individual must trip coordinator also shall have at least one year experience at the facility and be familiar with the facility facility's procedures, staff, and residents.

2. Documentation regarding this knowledge and experience shall be found placed in the individual's staff personnel record.

3. The trip coordinator will shall review all trip plans and procedures and will shall ensure that staff and residents meet the requirements as outlined in the facility's procedure regarding each wilderness or adventure activity to take place during planned as part of the trip.

4. The trip coordinator will review all trip plans and procedures and will ensure that staff and residents meet the requirements as outlined in the facility's procedure regarding each wilderness or adventure activity to take place during the trip.

B. The trip coordinator shall conduct a post trip debriefing within 72 hours of the group's return to base to evaluate individual and group goals as well as the trip as a whole.

C. The trip coordinator will shall be responsible for (i) writing a summary of the debriefing session and shall be responsible for; and (ii) ensuring that procedures are updated to reflect improvements needed.

D. A trip folder will shall be developed for each wilderness or adventure activity conducted away from the facility and shall include:

1. Medical release forms including pertinent medical information on the trip participants;

2. Phone numbers for administrative staff and emergency personnel;

3. Daily trip logs;

4. Incident reports;

5. Swimming A swimming proficiency list if the trip is near water;

6. Daily logs;

7. Maps of the area covered by the trip; and

8. Daily plans.

E. The provider shall ensure that before engaging Before allowing participants to engage in any aquatic activity, each resident shall be classified by the trip coordinator or his designee shall develop a list that classifies residents according to swimming ability in one of two classifications: swimmer and nonswimmer. This ability. The list shall be placed in the trip folder as required in subsection D of this section, and the resident's classification shall be documented in the resident's record and in the trip folder.

F. The provider trip coordinator shall ensure that lifesaving equipment is provided for all aquatic activities and is placed so that it is immediately available in case of an emergency. At a minimum, the The equipment shall include:

1. A whistle or other audible signal device; and

2. A lifesaving throwing device.

G. The trip coordinator shall ensure that all aquatic activity is supervised by a certified lifeguard.

6VAC35-41-1080 Requirements of family oriented group home systems

Family oriented Family-oriented group home systems shall have written procedures for:

1. Setting the number of residents to be housed in each home and room of the home and prohibiting individuals less younger than 18 years of age from sharing sleeping rooms with and individuals older than 17 who are 18 years of age from sharing sleeping rooms or older without specific approval from the facility administrator;

2. Providing supervision of and guidance for the family oriented family-oriented group home parents and relief staff;

3. Admitting and orienting residents;

4. Preparing a treatment an individual service plan for each resident within 30 days of admission or 72 hours in the case of a shelter care facility, and reviewing the plan quarterly;

5. Providing appropriate programs and services from intake through release;

6. Providing residents with spending money;

7. Managing resident records and releasing information;

8. Providing medical and dental care to residents;

9. Notifying parents and guardians, as appropriate and applicable, the placing agency, and the department of any serious incident as specified in written procedures;

10. Making a program supervisor or designated staff person available to residents and house parents 24 hours a day; and

11. 10. Ensuring the secure control of any firearms and ammunition in the home that firearms and ammunition are secured in a manner so as to prevent unauthorized access by juvenile residents in the home.

6VAC35-41-1090 Examination by physician

Each resident admitted to a family oriented family-oriented group home shall have a physical examination including tuberculosis screening within 30 days of admission unless the resident was examined within six months prior to admission to the program.

6VAC35-41-1100 Requirements of family oriented group homes

Each family oriented family-oriented group home shall have:

1. A fire extinguisher, inspected annually;

2. Smoke alarm devices in working condition according to inspections conducted at least monthly and documented by facility staff;

3. Alternative methods of escape from second story;

4. Modern sanitation facilities;

5. 4. Freedom from physical hazards;

6. 5. A written emergency plan that is communicated to all new residents at orientation;

7. 6. An up-to-date listing of medical and other emergency resources in the community;

8. 7. A separate bed for each resident, with clean sheets equipped with a mattress, pillow, blankets, bed linens, and if needed, a waterproof mattress cover. The blankets and linens weekly; shall be cleaned at least once every seven days and more often, if needed. Bleach or another sanitizing agent approved by the federal Environmental Protection Agency to destroy bacteria shall be used in the laundering of bed linens;

9. 8. A bedroom that is well illuminated and ventilated; is in reasonably good repair; is not a hallway, unfinished basement or attic; and provides conditions allows for privacy;

10. 9. A place to store residents' clothing and personal items;

11. Sanitary 10. Modern sanitary toilet and bath facilities that are adequate for the number of residents;

12. 11. A safe and clean place for indoor and outdoor recreation;

13. 12. Adequate furniture;

14. 13. Adequate laundry facilities or laundry services;

15. 14. A clean and pleasant dining area;

16. 15. Adequate and nutritionally balanced meals; and

17. 16. Daily provision of clean size-appropriate clothing and shoes for indoor and outdoor wear and articles necessary for maintaining proper personal hygiene. All such items shall be clean and in good repair.

6VAC35-41-1110 Other applicable regulations

Each In addition to the requirements listed in 6VAC35-41-1080 through 6VAC35-41-1100, each family oriented group home also shall also be subject to and comply with the requirements of the following provisions of this chapter:

1. 6VAC35-41-180 (employee and volunteer background checks) 1. 6VAC35-41-90;

2. 6VAC35-41-190 (required initial orientation) 2. 6VAC35-41-180;

3. 6VAC35-41-200 (required initial training); and

4. VAC35-41-210 (required retraining).

3. 6VAC35-41-190;

4. 6VAC35-41-200;

5. 6VAC35-41-210;

6. 6VAC35-41-560;

7. 6VAC35-41-565;

8. 6VAC35-41-570;

9. 6VAC35-41-580;

10. 6VAC35-41-590;

11. 6VAC35-41-600;

12. 6VAC35-41-620;

13. 6VAC35-41-640;

14. 6VAC35-41-660;

15. 6VAC35-41-670;

16. 6VAC35-41-690; and

17. 6VAC35-41-700.

6VAC35-41-1120 Definition of respite care.  (Repealed.)

Respite care facility shall mean a facility that is specifically approved to provide short-term, periodic residential care to residents accepted into its program in order to give the parents or legal guardians temporary relief from responsibility for their direct care.

6VAC35-41-1130 Admission and discharge from respite care.  (Repealed.)

A. Acceptance of an individual as eligible for respite care by a respite care facility is considered admission to the facility. Each individual period of respite care is not considered a separate admission.

B. A respite care facility shall discharge a resident when the legal guardian no longer intends to use the facility's services.

6VAC35-41-1140 Updating health records in respite care.  (Repealed.)

Respite care facilities shall update the information required by 6VAC35-41-1170 B (health care procedures) at the time of each stay at the facility.

6VAC35-41-1150 Definitions applicable to health care services.  (Repealed.)

"Health authority" means the individual, government authority, or health care contractor responsible for organizing, planning, and monitoring the timely provision of appropriate health care services, including arrangements for all levels of health care and the ensuring of quality and accessibility of all health services, consistent with applicable statutes and regulations, prevailing community standards, and medical ethics.

"Health care record" means the complete record of medical screening and examination information and ongoing records of medical and ancillary service delivery including, but not limited to, all findings, diagnoses, treatments, dispositions, prescriptions, and their administration.

"Health care services" means those actions, preventative and therapeutic, taken for the physical and mental well-being of a resident. Health care services include medical, dental, orthodontic, mental health, family planning, obstetrical, gynecological, health education, and other ancillary services.

"Health trained personnel" means an individual who is trained by a licensed health care provider to perform specific duties such as administering health care screenings, reviewing screening forms for necessary follow-up care, preparing residents and records for sick call, and assisting in the implementation of certain medical orders.

6VAC35-41-1160 Provision of health care services

Treatment by nursing Nursing personnel shall be performed provide treatment pursuant to the laws and regulations governing the practice of nursing within the Commonwealth. Other health trained health-trained personnel shall provide care within their level of training and certification.

6VAC35-41-1170 Health care procedures

A. The provider shall have and implement written procedures for promptly:

1. Arranging for the provision of medical and dental services for health problems identified at admission;

2. Arranging for the provision of routine ongoing and follow-up medical and dental services after admission;

3. Arranging for emergency medical and mental health care services, as appropriate and applicable, for each resident as provided by statute or by the agreement with the resident's parent or legal guardian;

4. Arranging for emergency medical and mental health care services, as appropriate and applicable, for any resident experiencing or showing signs of suicidal or homicidal thoughts, symptoms of mood or thought disorders, or other mental health problems; and

5. Ensuring that the required information in subsection B of this section is accessible and up to date.

B. The following written information concerning each resident shall be readily accessible to staff who may have to respond to a medical or dental emergency:

1. Name, address, and telephone number of the physician and dentist to be notified;

2. Name, address, and telephone number of a relative or other person to be notified;

3. Medical insurance company name and policy number or Medicaid number;

4. Information concerning:

a. Use of medication;

b. All allergies, including medication allergies;

c. Substance abuse and use;

d. Significant past and present medical problems; and

5. Written permission for emergency medical care, dental care, and obtaining immunizations or a procedure and contacts for obtaining consent.

C. Facilities approved to provide respite care shall update the information required by subsection B of this section at the time of each stay at the facility.

6VAC35-41-1180 Health trained Health-trained personnel

A. Health trained Health-trained personnel shall provide care as appropriate to their level of training and certification and shall not administer health care services for which they are not qualified or specifically trained.

B. The facility shall retain documentation of the training received by health trained health-trained personnel necessary to perform any designated health care services. Documentation of applicable, current licensure or certification shall constitute compliance with this section.

6VAC35-41-1190 Consent to and refusal of health care services

A. The knowing and voluntary agreement, without undue inducement or any element of force, fraud, deceit, duress, or other form of constraint or coercion, of a person who is capable of exercising free choice (informed consent) to health care shall be obtained from the resident, parent, guardian, or legal custodian as required by law. Consent to health care services shall be provided in accordance with § 54.1-2969 of the Code of Virginia. The juvenile residential facility shall obtain consent from the resident or parent or legal custodian as required by law before providing health care services to a resident. The consent shall be knowing and voluntary, without undue inducement or any element of force, fraud, deceit, duress, or other form of constraint or coercion.

B. The resident, parent, guardian, or legal custodian, as applicable, shall be advised by an appropriately trained medical professional of (i) the material facts regarding the nature, consequences, and risks of the proposed treatment, examination, or procedure and (ii) the alternatives to it.

C. Residents may refuse in writing medical treatment and care. This subsection does not apply to medication refusals that are governed by 6VAC35-41-1280 (medication).

D. When health care is rendered against the resident's will, it shall be in accordance with applicable laws and regulations.

6VAC35-41-1200 Health screening at admission

The juvenile residential facility shall require that:

1. To prevent newly arrived residents who pose a health or safety threat to themselves or others from being admitted to the general population jeopardizing the health of other residents, all residents shall immediately upon admission shall undergo a preliminary health screening consisting of a structured interview and observation by health care personnel or health trained staff health-trained personnel. As necessary to maintain confidentiality, all or a portion of the interview shall be conducted with the resident without outside the presence of the parent or guardian.

2. Residents admitted to the facility who pose are identified during the screening required in subsection A of this section as posing a health or safety threat to themselves or others shall not be admitted to the facility's general population but provision shall be made for them to receive comparable services. be separated from all other residents in the facility until they are no longer a risk. During the period of separation, provision shall be made for the residents to receive comparable services.

3. Immediate health care is provided to residents who need it.

6VAC35-41-1210 Tuberculosis screening

A. Within seven days of placement arrival at a facility, each resident shall have had a screening risk assessment for tuberculosis. as evidenced by documentation by a medical professional or the completion of an assessment form containing the elements found on the current assessment form published by the Virginia Department of Health. The screening risk assessment can shall be no older than 30 days. The risk assessment may be administered by health-trained personnel; however, results of the assessment shall be interpreted by a physician, physician assistant, nurse practitioner, or registered nurse.

B. A screening In addition to the initial risk assessment required in subsection A of this section, a risk assessment for tuberculosis shall be completed annually on each resident., as evidenced by documentation by a medical professional or the completion of a form containing the elements of the assessment form published by the Virginia Department of Health.

C. If the physician, physician assistant, nurse practitioner, or registered nurse, having interpreted the results of the risk assessment, determines a tuberculosis screening is necessary, the facility shall refer the resident to the local health department or a medical professional for additional screening.

D. The facility's assessment and screening practices shall be performed consistent with any current recommendations of the Virginia Department of Health, Division of Tuberculosis Prevention and Control and the federal Department of Health and Human Services Centers for Disease Control and Prevention for the detection, diagnosis, prophylaxis, and treatment of pulmonary tuberculosis.

E. For any residents determined to have tuberculosis in a communicable form, the facility shall observe the requirements in 6VAC35-41-1230.

F. Active cases of tuberculosis contracted by a resident shall be reported to the local health department in accordance with the requirements of the Commonwealth of Virginia State Board of Health Regulations for Disease Reporting and Control (12VAC5-90).

G. The provider shall retain documentation of the assessment and screening results in a manner that maintains the confidentiality of information.

6VAC35-41-1220 Medical examinations and treatment

A. Except for residents placed in a shelter care facility, each A resident accepted for care who has been accepted into a juvenile residential facility as a planned admission shall have a physical examination performed by or under the direction of a licensed physician no earlier than 90 days prior to admission to the facility or no later than seven days following admission, except (i) the report of an examination within the preceding 12 months shall be acceptable if a resident transfers from one facility licensed or certified by a state agency to another and (ii) a physical examination shall be conducted within 30 days following an emergency admission if a report of physical examination is not available. A resident placed in a facility pursuant to an emergency admission process shall have a physical within 90 days following the emergency admission.

B. Each resident shall have an annual physical examination by or under the direction of a licensed physician and an annual dental examination by a licensed dentist.

6VAC35-41-1230 Infectious or communicable diseases

A. A resident with a communicable disease shall not be admitted unless a licensed physician certifies that:

1. The facility is capable of providing care to the resident without jeopardizing residents and staff; and

2. The facility is aware of the required treatment for the resident and the procedures to protect residents and staff.

The requirements of this subsection shall not apply to shelter care facilities.

B. The facility shall implement written procedures approved by a medical professional that:

1. Address staff (i) interactions with residents with infectious, communicable, or contagious medical conditions; and (ii) use of standard precautions;

2. Require staff training in standard precautions, initially and annually thereafter; in accordance with 6VAC35-41-200 and 6VAC35-41-210; and

3. Require staff to follow procedures for dealing with residents who have infectious or communicable diseases.

6VAC35-41-1240 Suicide prevention

Written procedure procedures shall provide (i) for a suicide prevention and intervention program, developed in consultation with a qualified medical or mental health professional, and (ii) for all direct care staff to be trained in the implementation of the program in accordance with 6VAC35-41-200 and 6VAC35-41-210.

6VAC35-41-1250 Residents' health care records

A. Each resident's health care record shall include written documentation of (i) the initial physical examination, (ii) an annual physical examination by or under the direction of a licensed physician including any recommendation for follow-up care, and (iii) documentation of the provision of follow-up medical care recommended by the physician or as indicated by the needs of the resident.

B. The resident's active health care records (i) shall be (i) kept confidential and inaccessible from unauthorized persons, (ii) shall be readily accessible in case of emergency, and (iii) shall be made available to authorized staff consistent with applicable state and federal statutes and regulations.

C. Each physical examination report shall include:

1. Information necessary to determine the health and immunization needs of the resident, including:

a. Immunizations administered at the time of the exam;

b. Vision exam;

c. Hearing exam;

d. General physical condition including documentation of apparent freedom from communicable disease, including tuberculosis;

e. Allergies, chronic conditions, and handicaps disabilities, if any;

f. Nutritional requirements including special diets, if any;

g. Restrictions on physical activities, if any; and

h. Recommendations for further treatment, immunizations, and other examinations indicated;

2. Date of the physical examination; and

3. Signature of a licensed physician, the physician's designee, or an official of a local health department.

D. Each A resident's health care record shall include written documentation of (i) an annual examination by a licensed dentist and (ii) documentation of follow-up dental care recommended by the dentist or as indicated by the needs of the resident. This requirement does not apply to shelter care facilities and respite care facilities.

E. Each resident's health care record shall include notations of health and dental complaints and injuries and shall summarize symptoms and treatment given.

F. Each resident's health care record shall include or document the facility's efforts to obtain treatment summaries of ongoing psychiatric or other mental health treatment and reports, if applicable.

6VAC35-41-1260 First aid kits

A. A well-stocked first aid kit shall be maintained, within the facility, as well as in facility vehicles used to transport residents, together with an inventory of its contents, and readily accessible for dealing with minor injuries and medical emergencies.

B. First aid kits should shall be monitored in accordance with established facility written procedures to ensure kits are maintained, stocked, and ready for use.

6VAC35-41-1270 Hospitalization and other outside medical treatment of residents

A. When a resident needs hospital care or other medical treatment outside the facility:

1. The resident shall be transported safely; and

2. A The facility shall ensure that a parent or legal guardian, a staff member, or a law-enforcement officer, as appropriate, shall accompany accompanies the resident and stay at least during admission. remains with the resident until the resident is admitted. If sending a staff member would result in inadequate coverage at the juvenile residential facility, the provider shall deploy a staff member to the hospital or outside medical facility as soon as reasonably possible.

2. If a law-enforcement officer conducts the transport, the provider shall comply with the provisions of subsection C of 6VAC35-41-550 unless exempted under subsection D of 6VAC35-41-550.

B. If a parent or legal guardian does not accompany the resident to the hospital or other off-site medical treatment outside the facility, the parent or legal guardian provider shall be informed inform the parent or legal guardian as soon as practicable that the resident was taken outside the facility off-site for medical attention as soon as is practicable.

6VAC35-41-1280 Medication

A. All medication shall be properly labeled consistent with the requirements of the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia). Medication prescribed for individual use shall be so labeled.

B. All medication shall be securely locked, unless otherwise ordered by a physician on an individual basis for keep-on-person or equivalent use.

C. All staff responsible for medication administration who do not hold a license issued by the Virginia Department of Health Professions authorizing the administration of medications shall have successfully completed a medication training program approved by the Board of Nursing or be licensed by the Commonwealth of Virginia to administer medications before they can may administer medication. All staff who administer medication shall complete an annual refresher medication training.

D. Staff authorized to administer medication shall be informed of any known side effects of the medication and the symptoms of the effects.

E. A program of medication, including procedures regarding the use of over-the-counter medication pursuant to written or verbal orders signed by personnel authorized by law to give such orders, shall be initiated for a resident only when prescribed in writing by a person authorized by law to prescribe medication. This includes over-the-counter medication administered pursuant to a written or verbal order that is issued by personnel authorized by law to give such orders.

F. All medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the requirements of § 54.2-2408 § 54.1-3408 of the Code of Virginia and the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia).

G. A medication administration record shall be maintained of that identifies all medicines received by each resident and shall include that includes:

1. Date The date the medication was prescribed or most recently refilled;

2. Drug The drug name;

3. Schedule The schedule for administration;

4. Strength The strength;

5. Route The route;

6. Identity The identity of the individual who administered the medication; and

7. Dates The dates on which the medication was discontinued or changed.

H. In the event of If a medication incident or an adverse drug reaction, occurs, first aid shall be administered if indicated. Staff shall promptly contact a poison control center, pharmacist, nurse, or physician and shall take actions as directed. If the situation is not addressed in standing orders, the attending physician shall be notified as soon as possible and the actions taken by staff shall be documented. A medical incident shall mean an error made in administering a medication to a resident including the following: (i) a resident is given incorrect medication; (ii) medication is administered to an incorrect resident; (iii) an incorrect dosage is administered; (iv) medication is administered at a wrong time or not at all; and (v) the medication is administered through an improper method. A medication error does not include a resident's refusal of appropriately offered medication.

I. Written procedures shall provide for require (i) the documentation of medication incidents, (ii) the review of medication incidents and reactions and making any implementation of necessary improvements, (iii) the storage of controlled substances, and (iv) the distribution of medication off campus. The procedures must be shall be approved by a health care professional. Documentation of this approval shall be retained.

J. Medication refusals shall be documented including action taken by staff. The facility shall follow procedures for managing such refusals that shall address:

1. Manner The manner by which medication refusals are documented, and

2. Physician follow-up, as appropriate.

K. Disposal and storage of unused, expired, and discontinued medications and medical implements shall be in accordance with applicable laws and regulations.

L. The telephone number of a regional poison control center and other emergency numbers shall be posted on or next to each nonpay telephone that has access to an outside line in each building in which residents sleep or participate in programs.

M. Syringes and other medical implements used for injecting or cutting skin shall be locked and inventoried in accordance with facility procedures.

6VAC35-41-1290 Behavior management

A. Each facility shall implement a behavior management program. Behavior management shall mean those principles and methods employed to help a resident achieve positive behavior and to address and correct a resident's inappropriate behavior in a constructive and safe manner in accordance with written procedures governing program expectations, treatment goals, and residents' and employees' safety and security.

B. Written procedures governing this program shall provide the following:

1. A description of the rules of conduct and behavioral expectations for the resident;

2. Orientation of residents as provided in 6VAC35-41-770 (orientation to facility rules and disciplinary procedures);

3. A description of a system of privileges and sanctions that is used and available for use.;

4. Specification of the staff members who may authorize the use of privileges and sanctions; and

5. Documentation requirements when sanctions are imposed.

C. Written information concerning the procedures of the provider's behavior management program shall be provided prior to before admission to prospective residents, parents or legal guardians, and placing agencies. For court-ordered and emergency admissions, this information shall be provided to: according to the following timelines:

1. Residents shall receive the information within 12 hours following admission;

2. Placing agencies shall receive the information within 72 hours following the resident's admission; and

3. Legal Parents or legal guardians shall receive the information within 72 hours following the resident's admission.

D. When substantive revisions are made to procedures governing the provider's behavior management of resident behavior program, written information concerning the revisions shall be provided before implementation to:

1. Residents prior to implementation Residents; and

2. Legal Parents or legal guardians and placing agencies prior to implementation.

E. The facility administrator or designee shall review the behavior management program and procedures at least annually to determine appropriateness for the population served.

F. Any time residents are present, staff must who have completed required trainings in behavior management shall be present who have completed all trainings in behavior management.

6VAC35-41-1300 Behavior support

A. Each A facility shall have a procedure regarding written procedures governing behavior support plans for use with residents who need supports in addition to those provided in the facility's behavior management program that addresses. The procedures shall address the circumstances under which such the plans shall be utilized.

Such B. The behavior support plans shall support the resident's self-management of his own the resident's behavior and shall include:

1. Identification of positive and problem behavior;

2. Identification of triggers for behaviors;

3. Identification of successful intervention strategies for problem behavior;

4. Techniques for managing anger and anxiety; and

5. Identification of interventions that may escalate inappropriate behaviors.

B. C. Individualized behavior support plans shall be developed in consultation with the:

1. Resident;

2. Legal guardian, if applicable;

3. Resident's parents, if applicable;

4. Program director;

5. Placing agency staff; and

6. Other applicable individuals.

C. Prior to working alone with an assigned resident, each D. Each staff member shall review and be prepared to implement the assigned resident's behavior support plan.

6VAC35-41-1310 Timeout

A. A facility may use a systematic behavior management technique program component designed to reduce or eliminate inappropriate or problematic behavior by having a staff require a resident to move to a specific location that is away from a source of reinforcement for a specific period of time or until the problem behavior has subsided (timeout) timeout under the following conditions:

1. The provider shall develop and implement written procedures governing the conditions under which a resident may be placed in timeout and the maximum period of timeout.

2. The conditions and maximum period of timeout shall be based on the resident's chronological and developmental level.

3. The area in which a resident is placed shall not be locked nor the door secured in a manner that prevents the resident from opening it.

4. 3. A resident in timeout shall be able to communicate with staff.

5. 4. Staff shall check on monitor the resident in the timeout area at least every 15 minutes and more often depending on the nature of the resident's disability, condition, and behavior the circumstances. During each check on the resident, staff shall evaluate and document whether the resident is prepared to be released from timeout.

B. Use of timeout and staff checks on the residents shall be documented.

6VAC35-41-1320 Physical restraint

A. Physical restraint shall be used as a last resort only after less restrictive interventions have failed or to control residents whose behavior poses a risk to the safety of the resident, others, staff, or the public others.

1. Staff shall use the least force deemed reasonable to be reasonably necessary to eliminate the risk or to maintain security and order and shall never use physical restraint as punishment or with the intent to inflict injury.

2. Staff may physically restrain a resident only after less restrictive behavior interventions have failed or when failure to restrain would result in harm to the resident or others.

3. Physical restraint shall be implemented, monitored, and discontinued only by staff who have been trained in the proper and safe use of restraint.

4. Physical restraint shall mean the application of behavior intervention techniques involving a physical intervention to prevent an individual from moving all or part of that individual's body.

B. Written The facility shall have written procedures governing the use of physical restraint shall that include:

1. The staff position who will write responsible for writing the report and the timeframe; for completing the report;

2. The staff position who will review responsible for reviewing the report and timeframe; the timeframe for reviewing the report; and

3. Methods to be followed should physical restraint, less intrusive interventions, or measures permitted by other applicable state regulations prove unsuccessful in calming and moderating the resident's behavior.

C. All Each application of physical restraints restraint shall be reviewed and evaluated in order to plan for provide continued staff development for and performance improvement.

D. Each application of physical restraint shall be fully documented in the resident's record including:

1. Date The date and time of the incident;

2. Staff involved The staff involved in the restraint;

3. Justification The justification for the restraint;

4. Less restrictive behavior interventions that were unsuccessfully attempted prior to using physical restraint;

5. Duration The duration of the restraint;

6. Description A description of the method or methods of physical restraint techniques used;

7. Signature The signature of the person completing the report and date; and

8. Reviewer's The reviewer's signature and date.

6VAC35-41-9998 FORMS (6VAC35-41)

Virginia Department of Health TB Risk Assessment Form, TB512 (eff. 11/2016)

6VAC35-41-9999 Documents Incorporated by Reference (6VAC35-41)

Compliance Manual - Group Homes and Halfway Houses, effective January 1, 2014, Virginia Department of Juvenile Justice