1. "Group home or community residential service" means a congregate service providing 24-hour direct awake supervision in a community-based home having eight or fewer residents. Services include supervision, supports, counseling, and training in activities of daily living for individuals whose individualized services plan identifies the need for the specific types of services available in this setting. AND Group home services includes 24-hour direct awake supervision in a  community-based home having eight or fewer residents. Services include supervision, supports, counseling, and training in activities of daily living.

Comment: This does not allow for least restrictive environment. Providers have operated for many years with staff that sleep. There are measures in place to ensure the individuals are cared for should the need arise. This doesn’t consider electronic supports that have allowed for greater independence. This will also force smaller group homes to increase the capacity of home to cover the costs of bringing in awake staff. This takes away from services being individualized based on the needs of the people in the home.

2. A. In the event that an individual has been placed on a waitlist prior to receiving services a secondary screening shall be performed prior to admission to the service. The provider shall document:

Comment: According to 12VAC30-122-120, providers cannot have a waitlist as they are expected to be able to serve within 30 calendar days of the referral. Is this regulation contradictory or are we misinterpreting 12VAC30-122-120?

3. 2. After each training, providers shall test the employee’s or contractor’s knowledge, competency or both, and retain documentation of the test of the employee’s or contractor’s knowledge, competency or both within the employee or contractor’s personnel file.

Comment: this places an undue burden on the provider to show competency and is a duplication of effort. This will cause a significant amount of time to create ISP specific tests. We already document our training on ISP’s and ensure understanding of the needs of the person.

4. Reassessments shall be completed at least annually and any time there is a need based on changes in the medical, psychiatric, behavioral, or other status of the individual. Reassessments shall include documented justification that the individual’s needs continue to require a provider operated residential setting.

Comment: Does the provider or the Support Coordinator complete the reassessment? Is this a team effort?

5. Group homes shall meet the following staffing requirements:

Comment: Ratio’s shall be determined based on needs of the people residing in the home rather than a fixed ratio dictated by DBHDS. If everyone in the home sleeps through the night and doesn’t require intervention, it should be at the providers discretion to allow staff to sleep if safety measures are in place should the need arise. Management will continue to evaluate the need for staff changes based on the needs of the individuals.

6. Sponsored residential homes shall meet the following staffing requirements:

Comment: Sponsored residential is an individualized service that serves a max of two people in one home with one sponsor. It is up to the sponsor to have designated staff that are available to provide supports when needed.

7. B. The provider shall have menus. Menus shall:

Comment: Please exclude Sponsored Residential from being required to have menus. Requiring menus in Sponsored takes away from this being a home like environment and makes it institutional. If the person residing in the sponsored home has a specialized diet, the sponsor will follow those dietary guidelines.

8. D. An individual with a communicable disease shall not be admitted unless a licensed physician certifies that: 1. The facility is capable of providing care to the individual without jeopardizing individuals and staff; and 2. The facility is aware of the required treatment for the individual and the procedures to protect individuals and staff.

Comment: Physicians are rarely involved in private provider operations; it is doubtful they would be willing to sign off on these items. This also opens the door to discriminate against someone with a communicable disease. Perhaps a better regulation would be to ensure the provider puts plans in place to serve the person based on their needs while protecting the well-being of others served in the same program or residence.

9. I. The provider shall develop and implement written policies and procedures that include use of standard precautions and address communicable and contagious medical conditions. These policies and procedures shall be approved by a medical professional.

Comment: Would an agency RN count as a medical professional according to this regulation? If not, it would be very challenging to find a medical professional willing to approve other agencies policies and procedures. Please also consider the many providers who do not have any medical professionals on staff.

10. The provider shall secure all cleaning products and other household chemicals by:

Comment: Some program participants have the capacity to manage their own environments and should be permitted to maintain that level of independence. Please allow for a competency assessment to be completed, and if met, household chemicals would not need to be secured.

11. C. The provider shall specify and provide staffing arrangements in all sponsored residential homes, including on-call and substitute care arrangements.

Comment: Please remove “and provide” from this regulation. The sponsored residential contractor is expected to maintain their own staffing arrangements.