TITLE XII
LICENSING AND APPROVED STANDARDS
CHAPTER 105
COUNTY AND MULTICOUNTY JUVENILE DETENTION HOMES AND COUNTY
AND MULTICOUNTY JUVENILE SHELTER CARE HOMES
[Prior to 7/1/83, Social Services[770] Ch 105]
[Prior to 2/11/87, Human Services[498]]
441—105.1(232) Definitions.
“Chemical restraint” means the use of chemical agents including psychotropic drugs as a form of restraint. The therapeutic use of psychotropic medications as a component of a service plan for a particular child is not considered chemical restraint.
“Child care worker or house parent” shall mean an individual employed by a facility whose primary responsibility is the direct care of the children in the facility.
“Coed facility” shall mean a facility which has both sexes in residence.
“Control room” shall mean a locked room in a juvenile detention home, used for the purpose of isolation or seclusion of a child. A control room shall not be allowed in a juvenile shelter care home.
“County or multicounty” shall mean that the governing body is a county board of supervisors or a combination of representatives from county boards of supervisors.
“Facility” shall mean a county or multicounty “juvenile detention home” or county or multicounty “juvenile shelter care home” as those terms are defined in Iowa Code section 232.2.
“Family shelter home” means a family home providing temporary care for a child in a physically unrestricting home at any time between the child’s initial contact with the juvenile authorities and the disposition of the case.
“Mechanical restraint” means restriction by the use of a mechanical device of a child’s mobility or ability to use the hands, arms or legs.
“Prime programming time” is any period of the day when special attention or supervision is necessary, for example, upon awakening in the morning, during meals, later afternoon play, transitions between activities, evenings, and bedtime, weekends and holidays, in order to maintain continuity of programs and care. Prime programming time shall be defined by the facility and approved by the department of human services.
441—105.2(232) Buildings and grounds.
	105.2(1)  Grounds.
	a. 	An outdoor play area of 75 square feet per child shall be provided.
	b. 	The play area shall be identified and kept free from hazards that could cause injury to a child.
	c. 	Rubbish and trash shall be kept separated from the play area.
	d. 	The grounds shall be adequately drained.
	105.2(2) Buildings.
	a. 	All living areas shall:
	(1)	Have screens on windows used for ventilation.
	(2)	Be maintained in clean, sanitary conditions, free from vermin, rodents, dampness, noxious gases, and objectionable odors.
	(3)	Be in safe repair.
	(4)	Provide for adequate lighting when natural sunlight is inadequate.
	(5)	Have heating and storage areas separated from sleeping or play areas.
	(6)	Have walls and ceilings surfaced with materials that are asbestos free.
	b. 	All sleeping rooms shall be of finished construction and provide a minimum of 60 square feet per child for multiple occupancy, 80 square feet per child for single occupancy, and not sleep more than four children per room.
	(1)	Facilities licensed prior to July 1, 1981, having a square foot area less than that required shall be considered to meet these standards.
	(2)	There shall be not more than four youths per room in shelter and two youths per room in detention. Sleeping areas shall be assigned on the basis of the individual child’s needs for privacy and independence of group support. For detention facilities built prior to July 1, 1979, four youths per room in detention may be allowed provided the minimum square feet per child requirement is met. When a detention facility licensed prior to July 1, 1979, remodels or makes an addition after July 1, 1979, only two youths per room shall be allowed.
	c. 	All rooms aboveground shall:
	(1)	Have a ceiling height of at least 7 feet, 6 inches.
	(2)	Have a window area of at least 8 percent of the floor area unless mechanical ventilation is provided that is capable of removing dampness and odors.
	d. 	All rooms belowground shall:
	(1)	Have a ceiling height of at least 6 feet, 8 inches.
	(2)	Have a window area of at least 2 percent of the floor area unless mechanical ventilation is provided that is capable of removing dampness and odors.
	(3)	Have floor and walls constructed of concrete or other materials with an impervious finish and free from groundwater leakage.
	105.2(3) Bedrooms.
	a. 	Each child in care shall have a solidly constructed bed.
	b. 	Sheets, pillowcases and blankets shall be provided for each child and shall be kept clean and in good repair.
	c. 	Each child in care shall have adequate storage space for private belongings.
	d. 	No child over the age of five years shall occupy a bedroom with a member of the opposite sex.
	105.2(4) Heating.
	a. 	The heating unit shall be so located and operated as to maintain the temperature in the living quarters at a minimum of 65 degrees Fahrenheit during the day and 55 degrees Fahrenheit during the night. Variances may be made in case of health problems. Temperature is measured at 24 inches above the floor in the middle of the room.
	b. 	All space heaters involving the combustion of fuel, such as gas, oil or similar fuel, shall be properly vented to the outside atmosphere.
	c. 	Neither rubber nor plastic tubing shall be used as supply lines for gas or oil heaters.
	d. 	The heating and cooling plant shall be checked yearly and kept in a safe working condition at all times.
	105.2(5) Bathroom facilities.
	a. 	Bathrooms shall have an adequate supply of hot and cold running water.
	b. 	Each bathroom shall be properly equipped with toilet tissue, towels, soap, and other items required for personal hygiene unless children are individually given such items. Paper towels, when used, and toilet tissue shall be in dispensers. Detention facilities shall provide items required for personal hygiene but shall not be required to keep items in the bathrooms.
	c. 	Toilets and baths or showers shall provide for individual privacy.
	d. 	There shall be a shower or tub for each ten children or portion thereof.
	e. 	Tubs and showers shall have slip-proof surfaces.
	f. 	At least one toilet and one lavatory shall be provided for each six children or portion thereof.
	g. 	Toilet facilities shall be provided with natural or artificial ventilation capable of removing odors and moisture.
	h. 	Toilet facilities adjacent to a food preparation area shall be separated completely by a windowless door that completely fills the doorframe.
	i. 	All toilet facilities shall be kept clean.
	j. 	When more than one stool is used in one bathroom, partitions providing privacy shall be used.
	k. 	Toilets, wash basins, and other plumbing or sanitary facilities shall be maintained in good operating condition.
	105.2(6) Food preparation and storage.
	a. 	Cracked dishes and utensils shall not be used in the preparation, serving, or storage of food.
	b. 	Storage areas for perishable foods shall be kept at 45 degrees Fahrenheit or below.
	c. 	Storage areas for frozen food shall be kept at zero degrees Fahrenheit or below.
	d. 	Food that is to be served hot shall be maintained at 140 degrees Fahrenheit or above.
	e. 	Food that is to be served cold shall be maintained at 45 degrees Fahrenheit or less.
	f. 	The kitchen and food storage areas shall be kept clean and neat. Food shall not be stored on the floor.
	g. 	The floor and walls shall be of smooth construction and in good repair.
	105.2(7) Personnel handling food.
	a. 	Shall be free of infection that might be transferred while preparing or handling food.
	b. 	Shall be clean and neatly groomed.
	c. 	Shall wear clean clothes.
	d. 	Shall not use tobacco in any form while preparing or serving food.
	105.2(8) Dishwashing facilities.
	a. 	Manual dishwashing will be allowed in facilities that normally serve 15 or less people at one meal.
	b. 	Automatic or commercial dishwashers shall be used in facilities normally serving more than 15 people at one meal, as long as the following conditions are met:
	(1)	When chemicals are added for sanitation purposes, they shall be automatically dispensed.
	(2)	Machines using hot water for sanitizing must maintain the wash water at least 150 degrees Fahrenheit and rinse water at a temperature of at least 180 degrees Fahrenheit or a single temperature machine at 165 degrees Fahrenheit for both wash and rinse.
	(3)	All machines shall be thoroughly cleaned and sanitized at least once each day or more often if necessary to maintain satisfactory operating condition.
	c. 	Soiled and clean dish table areas shall be of adequate size to accommodate the dishes for one meal.
	d. 	All hand-held food preparation and serving equipment shall be cleaned and sanitized following each meal. Dispensers, urns and similar equipment shall be cleaned and sanitized daily.
	105.2(9) Foods not prepared at site of serving.
	a. 	The place where food is prepared for off-site serving shall conform with all requirements for on-site food preparation.
	b. 	Food shall be transported in covered containers or completely wrapped or packaged so as to be protected from contamination.
	c. 	During transportation, and until served, hot foods shall be maintained at 140 degrees Fahrenheit or above and cold food maintained at 45 degrees Fahrenheit or below.
	105.2(10) Milk supply. When fluid milk is used, it shall be pasteurized Grade “A.”
	105.2(11) Public water supply. The water supply is approved when the water is obtained from a public water supply system.
	105.2(12) Private water supplies.
	a. 	Each privately operated water supply shall be annually checked and evaluated for obvious deficiencies such as open or loose well tops or platforms and poor drainage around the wells.
	b. 	As part of the evaluation, water samples must be collected and submitted by the department of human services worker or local health sanitarian to the state hygienic laboratory or other laboratory certified by the hygienic laboratory and analyzed for coliform bacteria and nitrate (NO3) content.
	c. 	When the water supply is obtained from more than one well, proof of the quality of the water from each well is required.
	d. 	When no apparent deficiencies exist in the well and the water sample is approved, water safety requirements have been met.
	e. 	When the water sample is not approved, the facility shall provide a written statement as to how the water supply will be upgraded.
	f. 	A facility with unsafe water can meet water safety requirements by utilizing an alternative safe water source for foster children until the facility’s own water supply is tested as safe. The Unsafe Water Sample Approval Form, SS-2208 must be completed and approved by the department.
	105.2(13) Heating or storage of hot water. Each tank used for the heating or storage of hot water shall be provided with a pressure and temperature relief valve.
	105.2(14) Sewage treatment.
	a. 	Facilities shall be connected to public sewer systems where available.
	b. 	Private disposal systems shall be designed, constructed, and maintained so that no unsanitary or nuisance conditions exist, such as surface discharge of raw or partially treated sewage or failure of the sewer lines to convey sewage properly.
	105.2(15) Garbage storage and disposal.
	a. 	A sufficient number of garbage and rubbish containers shall be provided to properly store all material between collections.
	b. 	Containers shall be fly-tight, leakproof, and rodent proof and shall be maintained in a sanitary condition.
	105.2(16) General.
	a. 	Facilities shall take sufficient measures to ensure the safety of the children in care.
	b. 	Stairways, halls and aisles shall be of substantial nonslippery material, shall be maintained in a good state of repair, shall be adequately lighted and shall be kept free from obstructions at all times. All stairways shall have handrails.
	c. 	Radiators, registers and steam and hot water pipes shall have protective covering or insulation. Electrical outlets and switches shall have wall plates.
	d. 	Fuse boxes shall be inaccessible to children.
	e. 	Facilities shall have written procedures for the handling and storage of hazardous materials.
	f. 	Firearms are prohibited in shelter care and detention facilities.
	g. 	All swimming pools shall conform to state and local health and safety regulations. Adult supervision shall be provided at all times when children are using the pool.
	h. 	The facility shall have policies regarding fishing ponds, lakes or any bodies of water located on or near the institution grounds and accessible to the children.
	105.2(17) Emergency evacuation. All living units utilized by children shall have a posted plan for evacuation in case of fire or disaster with practice drills held at least every six months.
	105.2(18) Fire inspection. Each facility shall procure an annual fire inspection approved by the state fire marshal and shall meet the recommendations thereof.
	105.2(19) Local codes. Each facility shall meet local building, zoning, sanitation and fire safety ordinances. Where no local standards exist, state standards shall be met.
441—105.3(232) Personnel policies.
	105.3(1) Policies in writing. The following personnel policies and practices of the agency relating to a specific facility shall be described in writing and accessible to staff upon request:
	a. 	Affirmative action and equal employment opportunity policies and procedures covering the hiring, assignment and promotion of employees.
	b. 	Job descriptions for all positions.
	c. 	Provisions for vacations, holidays and sick leave.
	d. 	Effective, time-limited grievance procedures allowing the aggrieved party to bring the grievance to at least one level above that party’s supervisor.
	e. 	Authorized procedures, consistent with due process for the suspension and dismissal of an employee for just cause.
	f. 	Written procedures for annual employee evaluation shall be in place for each facility and available to all staff upon request.
	105.3(2) Health of employees. Staff who have direct client contact or are involved in food preparation shall be medically determined to be free of serious infectious communicable diseases and able to perform their duties. A statement by a physician (as defined in Iowa Code section 135.1) attesting to these facts shall be secured at the time of employment and whenever necessary thereafter and filed in the personnel records of that staff. A new statement shall be secured at least every three years.
	105.3(3) Personnel records. A record shall be maintained by the facility which contains at least the following:
	a. 	Name, address, and social security number of employee.
	b. 	A job application containing sufficient information to justify the initial and current employment.
	c. 	Education and experience requirements. Applicants for positions having educational requirements shall be permanently employed only after the facility has obtained a certified copy of the transcript, diploma, or verification from the school or supervising agency. Applicants for positions having experience requirements shall be permanently employed only after the facility has obtained verification from the agency supervising the experience.
	d. 	License requirements. Applicants for positions requiring licenses shall be permanently employed only after the facility has obtained written verification of their licenses. Evidence of renewal of licenses as required by the licensing agency shall be maintained in the personnel record.
	e. 	References. At least two written references or documentation of oral references shall be contained in the employee’s personnel record. In case of unfavorable references, there shall be documentation of further checking to ensure that the person will be a reliable employee.
	f. 	After July 1, 1983, a written, signed and dated statement which discloses any substantiated instances of child abuse, neglect or sexual abuse committed by the applicant is required.
	g. 	Documentation of the submission of Form SS-1606-0, Request for Child Abuse Information, to the registry and the registry response. The request may be submitted after probationary employment but the response must be received before permanent employment is ensured.
	h. 	A written, signed and dated statement furnished by the new applicant for employment which discloses any convictions of crimes involving the mistreatment or exploitation of a child.
	i. 	Documentation of a check with the Iowa department of public safety on all new applicants for employment asking only whether the applicant has been convicted of a crime involving the mistreatment or exploitation of a child prior to permanently employing the individual. Department Form SS-2203, “Department of Public Safety Check,” shall be used.
Any individual convicted of a crime involving the mistreatment or exploitation of a child shall not be employed by the facility.
	j. 	Documentation of any checks with the Iowa department of public safety for persons hired prior to July 1, 1983, for whom the agency has reason to suspect a criminal record and asking only whether the employee has been convicted of a crime involving the mistreatment or exploitation of a child. Department Form SS-2203, “Department of Public Safety Check,” shall be used.
	k. 	Current information relative to work performance evaluation.
	l. 	Records of preemployment health examination or a record of a health report as required in 105.3(2) as well as a written record of subsequent health services rendered to an employee as necessary to ensure that all facility employees are physically able to perform their duties.
	m. 	Information on written current reprimands or commendations.
	n. 	Position in the agency, and date of employment.
	o. 	Information covered in paragraphs “g,” “i,” “j,” is confidential and may not be redisseminated to that particular applicant or employee.
441—105.4(232) Procedures manual. The facility shall have written policies and procedures specifying the manner in which the program of the facility is to be carried out.
441—105.5(232) Staff.
	105.5(1) Number of staff.
	a. 	Generally. A sufficient number of child care or house parent staff shall be on duty at all times so as to provide adequate coverage. The number of staff required will vary depending on the size and complexity of the program. All facilities shall have at least one staff person on duty. Facilities having six or more residents shall have at least two staff persons on duty at all times that children are usually awake and present in the facility. Coed facilities having more than five residents should have both male and female staff on duty at all times. All child care or house parent staff shall be at least 18 years of age.
	b. 	On-call system. There shall be an on-call system for coed facilities to provide that staff of the same sex as the resident shall perform the following:
	(1)	All personal body searches.
	(2)	Supervision of personal care.
	c. 	Prime programming time. A minimum staff-child ratio of one child care worker or house parent to five children shall be maintained during prime programming times.
	d. 	Night hours. At night, there shall be a staff person awake in each living unit and making regular visual checks throughout the night. The visual checks shall be made at least every hour in shelter care and every half hour in detention. A log shall be kept of all checks, including the time of the check and any significant observations. There shall be an on-call system which allows backup within minutes for both child care staff and casework personnel.
	105.5(2) Staff composition. The composition of the program staff shall be determined by the facility, based on an assessment of the needs of the children being served, the facility’s goals, the programs provided, and all applicable federal, state and local laws and regulations.
	105.5(3) Staff development. Staff development shall be appropriate to the size and nature of the facility. There shall be a written plan for staff training that includes:
	a. 	Orientation for all new employees, to acquaint them with the philosophy, organization, program practices, and goals of the facility.
	b. 	Training of new employees in areas related to their job assignments.
	c. 	Provisions in writing for all staff members to improve their competency through such means as:
	(1)	Attending staff meetings;
	(2)	Attending seminars, conferences, workshops, and institutes;
	(3)	Visiting other facilities;
	(4)	Access to consultants;
	(5)	Access to current literature, including books, monographs, and journals relevant to the facility’s services.
	d. 	There shall be an individual designated responsible for staff development and training, who will complete a written staff development plan which shall be updated annually.
	105.5(4) Organization and administration. Whenever there is a change in the name of the facility, the address of the facility, the executive, or the capacity, the information shall be reported to the licensing manager. A table of organization including the identification of lines of responsibility and authority from policymaking to service to clients shall be available to the licensing staff. An executive director shall have full administrative responsibility for carrying out the policies, procedures and programs.
This rule is intended to implement Iowa Code section 232.142.
441—105.6(232) Intake procedures.
	105.6(1) Admissions. Admission to shelter care or detention shall be in accordance with Iowa Code sections 232.20, 232.21 and 232.22. In no case shall a youth be admitted to detention or shelter care when the resulting admission would exceed the facility’s approved client capacity. The facility and referring agency shall agree upon service responsibilities at the time of admission.
	105.6(2) Agency or court order placement. Each agency or court placing a child in a facility shall make available to the facility the following:
	a. 	A placement agreement should accompany the child.
When this is not possible, a copy of the placement agreement shall be provided the facility within 24 hours.
	b. 	For court-ordered placements, a copy of the court order authorizing placement shall be provided to the facility within 48 hours.
	c. 	When the child is in the facility more than four days, the following information shall be made available to the facility.
	(1)	All available psychological and psychiatric tests and reports concerning the child.
	(2)	Any available family social history.
	(3)	Any available school information.
	105.6(3) Self-referrals. Any child admitting self to a facility shall be provided appropriate services. The facility shall notify the child’s parents, guardian or the juvenile court as soon as possible concerning the child’s admission to the facility but in any event the notification shall take place within 48 hours after the child’s admission. Self-referrals shall not be accepted for placement in detention.
	105.6(4) Person responsible. Each agency shall designate who has the authority to do intake. This may include anyone trained in intake procedures and who is designated to do intake.
	105.6(5) Intake sheet. An intake sheet shall be completed on each child containing at least the information specified in 105.17(2).
441—105.7(232) Assessments.
	105.7(1) Personal. At the time of intake and throughout a child’s stay, individual needs will be identified by staff. The initial and ongoing determination of each child’s needs will be based on written and verbal information from referral sources, observable behavior at intake, initial interview with the youth or family, school contacts, physical examination, and other relevant materials. The individual assessment shall provide the basis for development of a care plan for each youth.
	105.7(2) Educational. An educational assessment shall be developed by the staff and referring worker for each child. When appropriate, other agencies such as the public schools and the area education agency shall be involved.
441—105.8(232) Program services.
	105.8(1) Care plan. There shall be a written care plan developed for each resident remaining in the facility over four days. The care plan will be based on individual needs determined through the assessment of each youth. The care plan shall be developed in consultation with child care services, probation services, social services and educational, medical, psychiatric and psychological personnel as appropriate. The plan shall include:
	a. 	Identification of specific needs;
	b. 	Description of planned service;
	c. 	Which staff person(s) will be responsible for each element of the plan;
	d. 	Where services are to occur;
	e. 	Frequency of activities or services.
	105.8(2) Educational programs. All children currently enrolled in a school shall continue in that school when possible, or in an appropriate alternative. Where educational assessments indicate an educational need for a child not currently enrolled in public schools, an alternative shall be developed in cooperation with public schools, area education agency, and the referring worker. When an educational program is established within the facility it shall meet the educational and teaching standards established by the state department of public instruction. A child should be compelled to participate in an educational program only in compliance with the compulsory education law, Iowa Code chapter 299.
	105.8(3) Daily program. The daily program shall be planned to provide a consistent, well structured, yet flexible framework for daily living, and shall be periodically reviewed and revised as the needs of the individual child or the living group change.
Attention shall be given to the special nature of the facility population and its resulting stresses, for example, rapid turnover in population and minimal screening at intake.
	105.8(4) Optional services. When a facility provides services in addition to those required by these rules, they shall be clearly defined in writing.
	105.8(5) Recreation program. The facility shall provide adequately designed and maintained indoor and outdoor activity areas, equipment, and equipment storage facilities appropriate for the age group which it serves. There shall be a variety of activity areas and equipment so that all children can be active participants in different types of individual and group sports and other motor activity.
	a. 	Games, toys, equipment, and arts and crafts materials shall be selected according to age, number of children, and with consideration of the needs of children to engage in both active and quiet play. All materials shall be of a quality to ensure safety and shall be of a type which allows imaginative play and creativeness.
	b. 	The facility shall plan and carry out efforts to establish and maintain workable relationships with the community recreational resources. The facility staff shall enlist the support of these resources to provide opportunities for children to participate in community recreational activities.
	105.8(6) Health care.
	a. 	There shall be 24-hour emergency and routine medical and dental services available and provided as necessary. Provisions for these services shall be documented.
	b. 	A facility shall not require medical treatment when the parent(s) or guardian of the child or the child objects to the treatment on the grounds that it conflicts with the tenets and practices of a recognized church or religious denomination of which the parent(s), guardian or child is an adherent. When imminent danger to the child’s life or health exists, the facility shall refer the child’s care to appropriate medical and legal authorities.
	c. 	A facility shall have written procedures for staff members to follow in case of medical emergency.
	105.8(7) Counseling program. Counseling services shall be related to the immediate problem, daily living skills, peer relationships, educational opportunities, vocational opportunities, future planning and preparation for placement, family counseling, and any other factors identified in the individual care plan. Counseling shall be done by appropriate staff personnel.
	105.8(8) Dietary program. The facility shall provide properly planned, nutritious and inviting food and take into consideration the special food needs and tastes of children.
441—105.9(232) Drug utilization and control. The agency shall have written policies and procedures governing the methods of handling prescription drugs and over-the-counter drugs within the facility. No prescription or narcotic drugs are to be allowed in the facility without the authorization of a licensed physician.
	105.9(1) Approved drugs. Only drugs which have been approved by the federal Food and Drug Administration for use in the United States may be used.
	105.9(2) Prescribed by physician. Drugs shall be prescribed by a physician licensed to practice in the state of Iowa or the state in which the physician is currently practicing.
	105.9(3) Dispensed from a licensed pharmacy. Drugs provided to residents shall be dispensed only from a licensed pharmacy in the state of Iowa in accordance with the pharmacy laws in the Code of Iowa or from a licensed pharmacy in another state according to the laws of that state or by a licensed physician.
	105.9(4)  Locked cabinet. All drugs shall be maintained in a locked cabinet. Controlled substances shall be maintained in a locked box within the locked cabinet. The cabinet key shall be in the possession of a staff person. A bathroom shall not be used for drug storage. A documented exception can be made by a physician for self-administered drugs as discussed in 105.9(17).
	105.9(5) Medications requiring refrigeration. Medications requiring refrigeration shall be kept in a locked box in the refrigerator and separated from food and other items.
	105.9(6) Poisonous or caustic drugs. All potent poisonous or caustic drugs shall be stored separately from other drugs and shall be plainly labeled and stored in a specific well-illuminated cabinet, closet or storeroom and made accessible only to authorized persons.
	105.9(7)  Prescribed medications. All prescribed medications shall be clearly labeled indicating the resident’s full name, physician’s name, prescription number, name and strength of the drug, dosage, directions for use, date of issue and name and address and telephone number of the pharmacy or physician issuing the drug. Medications shall be packaged and labeled according to state and federal guidelines.
	105.9(8)  Medication containers. Medication containers having soiled, damaged, illegible or makeshift labels shall be returned to the issuing pharmacist.
	105.9(9) Medication for discharged residents. When a resident is discharged or leaves the facility, medication currently being administered shall be sent, in the original container, with the resident or with a responsible agent, and with the approval of the physician.
	105.9(10) Unused prescription drugs. Unused controlled prescription drugs prescribed for residents shall be returned to the issuing pharmacist or physician for credit or destruction according to state law. Other unused prescription drugs shall be destroyed by facility staff in the presence of a witness and this destruction shall be documented.
	105.9(11) Refills. Prescriptions shall be refilled only with the permission of the attending physician.
	105.9(12) Use of medications. No prescription medications prescribed for one resident may be administered to or allowed in the possession of another resident.
	105.9(13) Order of physician. No prescription medication may be administered to a resident without the order of a licensed physician.
	105.9(14) Patient reaction. Any unusual patient reaction to a drug shall be reported to the attending physician immediately.
	105.9(15) Dilution or reconstitution of drugs. Dilution or reconstitution of drugs and their labeling shall be done only by a licensed pharmacist.
	105.9(16) Administration of drugs. Medications shall be administered only in accordance with the instructions of the attending physician. Controlled substances shall be administered only by qualified personnel. The type and amount of the medication, the time and date and the staff member administering the medication shall be documented in the child’s record. (See 657—subrule 10.16(1).)
	105.9(17) Self-administration of drugs. There shall be written policy and procedures relative to self-administration of prescription medications by residents and only under these circumstances:
	a. 	Medications shall be prescribed by a physician.
	b. 	The physician, the referring worker, and the facility staff agree that the patient can self-administer the drug.
	c. 	What is being taken and when shall be documented in the record of the child.
441—105.10(232) Control room—juvenile detention home only.
	105.10(1) Written policies. When a juvenile detention facility uses a control room as part of its service, the facility shall have written policies regarding its use and the facility director shall complete Form SS-2209-3, Evaluation and Recommendation to Operate a Control Room. The policy shall:
	a. 	Specify the behaviors resulting in control room placement.
	b. 	Delineate the staff members who may authorize its use as well as procedures for notification of supervisory personnel.
	c. 	Document in writing behaviors leading to control room placement and the nature of the agreement reached with the child that will allow the child to return to the living unit.
	105.10(2) Physical requirements. The control room shall be designed to ensure a physically safe environment that:
	a. 	Has all switches controlling lights and ventilation outside of the room.
	b. 	Allows for total observation of the child at all times.
	c. 	Has protected recessed ceiling light.
	d. 	Has no electrical outlets in the room.
	e. 	Is properly heated, cooled and ventilated.
	f. 	Has all doors, ceilings and walls constructed of strength and materials as to prevent damage to the extent that no harm could come to the child.
	g. 	When a window is present, it is secured and protected in such a manner as to prevent harm to the child.
	h. 	Is a minimum of 6 feet by 9 feet in size with at least a 7½-foot ceiling.
	105.10(3) Use. A control room shall be used only when a less restrictive alternative to quiet or allow the child to gain control has failed. Utilization of the control room shall be in accordance with the following policies:
	a. 	No more than one child shall be in the control room at any time.
	b. 	There shall be provision for visual observation of the child at all times, regardless of the child’s position in the room.
	c. 	The control room should be checked thoroughly for safety and the absence of contraband prior to placing a child in the room.
	d. 	The child shall be thoroughly checked before placement in the control room and all potentially injurious objects removed from such child including shoes, belts, pocket items, and similar items. The staff member placing the child in the control room shall document such check.
	e. 	In no case shall all clothing or underwear be removed and the child shall be provided sufficient clothing to meet seasonal needs.
	f. 	A staff member shall always be within hearing distance of the control room and the child shall be visually checked by the staff at least every 15 minutes and each check shall be recorded.
	g. 	The child shall not remain in the control room longer than 1 hour except in consultation with and approval from the supervisor. Documentation in the child’s case record shall include the time in the control room, the reasons for the control, and the reasons for the extension of time. Use of the control room for a total of more than 12 hours in any 24-hour period shall occur only in consultation with the referring agency or court. In no case shall a child be in a control room for a period longer than 24 hours.
	h. 	The child’s parents, referring worker, and the child’s attorney shall be notified when the control room is used for more than a total of 30 minutes in any 24-hour period.
441—105.11(232) Clothing. All children shall have clothing that is suited to existing climate and seasonal conditions and is clean, dry and in good repair.
441—105.12(232) Staffings. The staff shall be available to participate in staffings or upon request to provide a written summary of the child’s progress and behavior while in the facility program. Written recommendations regarding future planning and placement shall be provided to the referring agency or court upon request. Staff shall be available to discuss recommendations with the child’s parent or guardian.
441—105.13(232) Child abuse. Written policies shall prohibit mistreatment, neglect or abuse of children and specify reporting and enforcement procedures for the facility. Alleged violations shall be reported immediately to the director of the facility and appropriate department of human services personnel. Any employee for whom there is a substantiated instance of child abuse or failure to report child abuse shall be subject to the agency’s policies concerning dismissal.
441—105.14(232) Daily log. The facility shall maintain a daily log. The log shall be used to note general progress in regard to the care plan and any problem areas or unusual behavior for each child.
441—105.15(232) Children’s rights.
	105.15(1) Policies in writing. All policies and procedures covered in this rule shall be in writing and provided to the child upon admission and made available to the child’s parent or guardian upon request. If the child remains in care over four days, the policies and procedures shall be provided to the parent or guardian. The rationale and circumstances of any deviation from these policies shall be discussed with the child’s parents or guardian and the referring worker, documented, and placed in the child’s case record.
	105.15(2) Confidentiality. Information regarding children and their families shall be kept confidential and released only with proper written authorization.
	105.15(3) Communication.
	a. 	Unless specifically regulated by the court, visitation shall be allowed with members of the child’s immediate family.
	b. 	Family visits shall be monitored only to the extent necessary to ensure the child’s safety and facility security. Rationale for monitoring shall be documented in the child’s record.
	c. 	The child shall be permitted to communicate privately with legal counsel and the referring worker.
	d. 	The child shall be allowed to conduct telephone conversations with family members. Telephone calls shall be monitored only to the extent necessary to ensure the child’s well-being and facility security. Rationale for monitoring a child’s conversation shall be documented in the child’s record. Incoming calls may be screened by staff to verify the identity of the caller before approval is given.
	e. 	The staff shall not open or read residents’ mail. The child shall be allowed to send and receive mail. The facility may require the child to open incoming mail in the presence of a staff member when the mail is suspected to contain contraband articles, or to contain money that should be receipted and deposited.
	f. 	When limitations on visitation or other communications are indicated, they shall be determined with the participation or knowledge of the child, family or guardian, and the referring worker. All restrictions shall have specific bases which shall be made explicit to the child and family and documented in the child’s case record.
	105.15(4) Privacy. Reasonable provisions shall be made for the privacy of residents.
441—105.16(232) Discipline.
	105.16(1) Generally. A facility shall have written policies regarding methods used for control and discipline of children which shall be available to all staff and to the child’s family. Discipline shall not include withholding of basic necessities such as food, clothing, or sleep. Agency staff shall be in control of and responsible for discipline at all times.
	105.16(2) Corporal punishment prohibited. The facility shall have a policy that clearly prohibits staff or the children from utilizing corporal punishment as a method of disciplining or correcting children. This policy shall be communicated in writing to all staff of the facility.
	105.16(3) Physical restraint. The use of physical restraint shall be employed only to prevent the child from injury to self, to others, or to property. The rationale and authorization for the use of physical restraint, and staff action and procedures carried out to protect the children’s rights and to ensure their safety, shall be clearly set forth in the child’s record by the responsible staff.
	105.16(4) Room confinement. Facilities shall provide sufficient programming and staff coverage to enable children to be involved in group activities during the day and evening hours. A child shall only be confined to the child’s room for illness, at the child’s own request, or for disciplinary reasons. A juvenile detention home may confine a child to the child’s room during normal sleeping hours if the facility has written policies and procedures which are approved by the department regarding this confinement.
	105.16(5) Written policies. The facility shall provide to the child written policies specifying inappropriate behaviors, reasonable consequences for misconduct, and due process procedures available to the child. Upon request, the above information shall be provided to the child’s parent or guardian and referring worker.
441—105.17(232) Case files.
	105.17(1) Generally. For the purpose of promoting a uniformity of program for all facilities and as an aid to the department of human services in determining its approval of a facility all facilities shall establish and maintain for inspection case files on each child.
	105.17(2) Face sheet. For all children, a face sheet containing the following information shall be completed.
	a. 	Full name, current address, and date of birth.
	b. 	Parent’s(s’) full name(s).
	c. 	Parent’s(s’) address and telephone number.
	d. 	Religious preference of the child and also parent, if available.
	e. 	Statement of who has legal custody and guardianship.
	f. 	Name of referring worker and agency making the referral.
	g. 	Telephone number and address of referring agency or court.
	h. 	Name, address, and telephone number of the child’s attorney.
	105.17(3) Written summary. When a written summary has been requested under 441—105.12(232), a copy shall be placed in the child’s record.
	105.17(4) Documentation. The following information shall be documented in each child’s rec-~~~ord:
	a. 	Appropriate notes on all significant contacts by staff with parents, referral person and other collateral contacts.
	b. 	A summary related to discharge including name, address, and relationship of person to whom discharged.
	105.17(5) Other information. The following information shall be requested when the child remains in the facility more than four days and, when available, placed in the child’s record.
	a. 	Current family history or social history.
	b. 	Case plans submitted by the referring agency or orders of the court.
	c. 	Psychological and psychiatric records; copies of all available testing performed plus notes and records of contact with the child.
	d. 	Medical.
	(1)	A record of all illnesses, immunizations, communicable diseases and follow-up treatment.
	(2)	Medical and surgical authorization signed by the parent, guardian, custodian or court.
	(3)	A record of all medical and dental examinations including findings.
	(4)	Date of last physical examination prior to placement.
	e. 	School.
	(1)	Name and address of school attended.
	(2)	Grade placement.
	(3)	Current school in which child is enrolled.
	(4)	Specific educational problems.
	(5)	Remedial action.
	f. 	Placement agreement, court order, releases.
	(1)	Agreement shall authorize the facility to accept the child.
	(2)	The agreement shall set forth the terms of payment for care.
	(3)	Medical release authorizing emergency medical and surgical treatment, including the administration of anesthesia.
	(4)	All releases and authorizations shall be signed by the parent or legal guardian.
	(5)	All court orders affecting the custody or guardianship of the child.
441—105.18(232) Discharge.
	105.18(1) Children in shelter care shall be discharged to a permanent placement at the earliest possible time, and in any event within 30 days from the date of admission. Extension requests shall be made, substantiated, and approved by both the referral agency and the shelter care agency by the twenty-fifth day of care. Maximum length of stay should not exceed 45 days. Maximum length of stay in detention should not exceed 21 days.
	105.18(2) A summary of any significant medical or dental services that were provided while the child was at the facility shall be supplied to the next placement.
441—105.19(232) Approval. The department will issue a Certificate of Approval, SS-1205-0 annually without cost to any juvenile detention homes or juvenile shelter care home which meets the standards. The department may offer consultation to assist homes in meeting the standards.
	105.19(1) Applications. An application shall be submitted on forms provided by the department, SS-3105-0, Application for License or Certificate of Approval. It shall be signed by the operator of the home, chairman of the county board of supervisors, or chairman of the multicounty board of directors and shall indicate the type of home for which the application is made.
	a. 	The withdrawal of an application shall be reported promptly to the department.
	b. 	Each application will be evaluated by the department to ensure that all standards are met.
	c. 	Reports and information shall be furnished to the department as requested.
	105.19(2) Rejection.
	a. 	Applications will be rejected when the minimum standards set forth in the rules in this chapter are not met.
	b. 	Fraudulent applications will be rejected. A fraudulent application is one which contains false statements knowingly made by the applicant or one in which the applicant knowingly conceals information.
	c. 	Applications will be rejected when the director of the facility has been convicted of a crime indicating an inability to operate a children’s facility or care for children.
	d. 	Applications will be rejected for just cause.
	105.19(3) Approval. Approvals will be given for one year.
	105.19(4) Notification. Homes should be notified of approval or rejection within 120 days of application unless the applicant requests and is granted an extension by the department. Form SS-3307, Notification of Action, will be used to inform applicants of approval and a restricted certified letter will be used to inform applicants of rejection.
	105.19(5) Renewals.
	a. 	Applications for renewal shall be made on forms provided by the department and shall be made at least 30 days, but no more than 90 days, prior to expiration of the approval.
	b. 	Each application for renewal will be evaluated by the department to ensure that standards continue to be met.
	c. 	The application for renewal will be rejected or approved in the same manner as an application.
	d. 	Decisions on renewals should be made within 60 days from the application for renewal. Notification of renewal decisions shall be the same as for new applications.
	105.19(6) Revocations.
	a. 	Approval shall be revoked by the state director for the following reasons:
	(1)	When the facility violates laws governing the provision of services or rules contained in this chapter.
	(2)	When the facility is misusing funds furnished by the department.
	(3)	When the facility is operating without due regard to the health, sanitation, hygiene, comfort, or well-being of the children in the facility.
	(4)	When the director has been convicted of a crime indicating an inability to operate a children’s facility or care for children.
	b. 	The following may be causes for revocation:
	(1)	Substantiated child abuse.
	(2)	When the facility staff has been convicted of a crime indicating an inability to operate a children’s facility or care for children.
	105.19(7) Certificate of approval. Upon approval, the home will be issued a certificate of approval containing the name of the home, address, capacity, and the date of expiration. Renewals will be shown by a seal bearing the new date of expiration, unless a change requires a new certificate to be issued.
441—105.20(232) Provisional approval.
	105.20(1) Required conditions. A provisional approval may be issued at the time of application or reapplication for approval or as a result of a complaint investigation when all of the following conditions exist:
	a. 	The shelter care or detention facility fails to meet the approval requirements.
	b. 	A provisional approval has not previously been issued to the facility for the same deficiencies during the past year.
	c. 	The deficiencies do not present an immediate danger to the child’s physical or mental health.
	d. 	The director of the facility, chairman of the county board of supervisors, or chairman of the multicounty board of directors provides the department with the following:
	(1)	A plan for correcting the deficiencies.
	(2)	The date by which the standards will be met.
If conditions “b,” “c,” or “d” are not met, then the application for approval shall be rejected or the approval revoked.
	105.20(2) Time limited. Provisional approvals shall not be issued for longer than one year.
	105.20(3) Completed corrective action. When the corrective action is completed on or before the date specified on the provisional approval, a full approval shall be issued for the remainder of the year.
	105.20(4) Uncompleted corrective action. When the corrective action is not completed by the date specified on a provisional approval, the department shall not grant a full approval and has the option of rejecting or extending the provisional approval. An extension of a provisional approval shall not cause the effective period of a provisional approval to exceed 18 months. If the corrective action plan is not completed within 18 months, the approval shall be rejected.
441—105.21(232) Mechanical restraint—juvenile detention only. When a juvenile detention facility uses mechanical restraints as part of its program, the facility shall have written policies regarding their use. These policies shall be approved by the department prior to their use. The policies shall be available to clients, parents or guardians, and referral sources at the time of admission. Policies shall also be available to staff. The executive director of the detention home shall sign the commitment contained in Form SS-2212-3, “Evaluation and Recommendation for Approval to Use Mechanical Restraint,” before the facility shall be approved to use mechanical restraint.
	105.21(1) Restrictions on mechanical restraints.
	a. 	Mechanical restraints shall not inflict physical injury.
	b. 	Each use of mechanical restraint shall be authorized by the executive director of the facility, as discussed in 105.5(4), or other staff designated by the executive director if those staff meet one of the following requirements:
	(1)	Have a bachelor’s degree in social work, psychology or a related behavioral science and one year of supervised experience in a juvenile shelter care, detention or foster group care facility.
	(2)	Have five years of supervised experience in a juvenile shelter care, detention or foster group care facility.
	(3)	Have some combination of advanced education in related behavioral sciences and supervised experience in a juvenile shelter care, detention or foster group care facility equal to five years. The facility shall have a written listing of all staff designated and qualified to authorize the use of mechanical restraint.
	c. 	When immediate restraint is necessary to protect the safety of the child, other residents of the facility, staff or others, mechanical restraint may be utilized without prior authorization but in each case a person designated to provide authorization shall be contacted as soon as the child is restrained. The designated person shall visit the resident before determining if continued use of the mechanical restraint is necessary. If not viewed as necessary, the child shall be immediately released from restraint.
	d. 	Each authorization of mechanical restraint shall not exceed one hour in duration without a visit by and written authorization from a licensed psychologist, psychiatrist or physician or psychologist employed by a local mental health center.
	e. 	No child shall be kept in mechanical restraint for more than 1 hour in a 12-hour period without a visit by and written authorization from a licensed psychologist, psychiatrist or physician or psychologist employed by a local mental health center.
	f. 	Anytime that a child is placed in mechanical restraint, a staff person shall be assigned to monitor the child with no duties other than to ensure that the child’s physical needs are properly met. The staff person shall remain in continuous auditory and visual contact with the child.
	g. 	Each child shall be released from mechanical restraint as soon as the restraints are no longer needed.
	105.21(2) Documentation.
	a. 	Each use of mechanical restraints shall be documented in the client’s record and shall include at least the following:
	(1)	The date and time the child was placed in mechanical restraint.
	(2)	The type of mechanical restraint utilized.
	(3)	The reason for the restraint.
	(4)	The signature of the person authorizing the restraint and the time of authorization.
	(5)	The signature of the person placing the child in restraint.
	(6)	The signature of the person providing the continuous auditory and visual contact with the child.
	(7)	The signature of the person releasing the child and the time of release.
	b. 	Each use of mechanical restraint shall be documented in a separate file which is used only for the recording of uses of mechanical restraints and shall contain the name of the child restrained and the information discussed in 105.21(2)“a.”
	c. 	Each facility authorized to use mechanical restraint shall submit a quarterly report to the bureau of adult, children and family services of the department which shall include all the information required in 105.21(2)“b.”
	105.21(3) Continued use of mechanical restraints. When a child requires mechanical restraint on more than four occasions during any 30-day period, the facility shall hold an immediate emergency meeting within 3 days of the fifth incident and shall have a licensed psychologist or psychiatrist or psychologist employed by a local mental health center present at the staffing to discuss the appropriateness of the child’s continued placement at the facility.
	105.21(4) In transporting children. Notwithstanding 105.21(1)“d,” mechanical restraint of a child by the staff of a juvenile detention facility while that child is being transported to a point outside the facility is permitted when there is a serious risk of the child exiting the vehicle while the vehicle is in motion. The facility shall place a written report on each use in the child’s case record and the mechanical restraint file. This report shall document the necessity for the use of restraint.
Seat belts are not considered mechanical restraints. Agency policies should encourage the use of seat belts while transporting children.
441—105.22(232) Chemical restraint. Chemical restraint shall not be utilized in juvenile shelter care or detention facilities. Each juvenile shelter care or detention facility shall have written policies which clearly prohibit the use of chemical restraints.
These rules are intended to implement Iowa Code section 232.142.
[Filed December 19, 1962; amended December 20, 1962]
[Filed 6/25/76, Notice 5/17/76—published 7/12/76, effective 8/16/76]
[Filed 1/23/80, Notice 5/30/79—published 2/20/80, effective 3/26/80]
[Filed 6/4/80, Notice 4/2/80—published 6/25/80, effective 7/30/80]
[Filed 10/23/80, Notice 7/23/80—published 11/12/80, effective 12/17/80]
[Filed 12/19/80, Notice 10/15/80—published 1/7/81, effective 2/11/81]
[Filed 2/26/82, Notice 10/28/81—published 3/17/82, effective 5/1/82]
[Filed 7/29/83, Notice 5/25/83—published 8/17/83, effective 10/1/83]
[Filed 1/22/86, Notice 12/4/85—published 2/12/86, effective 4/1/86]
[Filed emergency 1/15/87—published 2/11/87, effective 1/15/87]