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CHAPTER 114LICENSING AND REGULATION OF ALLGROUP LIVING FOSTER CARE FACILITIES FOR CHILDREN[Prior to 7/1/83, Social Services[770] Ch 114][Prior to 2/11/87, Human Services[498]]441—114.1(237) Applicability. This chapter outlines the basic standards for all group living foster care facilities and contains the basic standards applicable to community residential facilities for children. Additional standards applicable to specific levels of group living are discussed in 441—Chapter 115, “Licensing and Regulation of Comprehensive Residential Facilities for Children,” and 441—Chapter 116, “Licensing and Regulation of Residential Facilities for Children with an Intellectual Disability.”This rule is intended to implement Iowa Code chapter 237.Related ARC(s): 3185C441—114.2(237) Definitions.
"Adequate lighting" means a light intensity of 20 foot-candles (approximately equivalent to a 60 watt bulb at a clear distance of 5 feet).
"Caseworker" means any staff of the facility who is primarily responsible for planning for individual children, a family, or groups, as well as coordination with referral sources and coordination of services to the individual.
"Casework supervisor" means any staff of the facility who provides supervision of the caseworker(s) by regularly scheduled face-to-face case specific discussions with the caseworker.
"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" means any staff of the facility whose primary responsibility is the direct care of children in the facility.
"Community residential facility" means a facility which provides care for children who are considered unable to live in a family situation due to social, emotional or physical disabilities but are capable of interacting in a community environment with a minimum amount of supervision. The facility provides 24-hour care including board and room. Community resources are used for education, recreation, medical, social and rehabilitation services. The facility is responsible for planning the daily activities of the children, discipline, guidance, peer relationships, and recreational programs.
"Control room" means a locked room used for treatment purposes in a comprehensive residential facility.
"Educational degrees" means formally approved certificates from accredited schools.
"Immediate family," for the purposes of this chapter, means persons who have a blood or legal relationship with the child.
"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.
"Physical restraint" means direct physical contact required on the part of a staff member to prevent a child from hurting self, others, or property.
"Private juvenile detention home" means a juvenile detention home as defined in Iowa Code section 232.2, which does not meet the requirements of being “county or multicounty” as defined in 441—subrule 105.1(2).
"Private juvenile shelter care home" means a juvenile shelter care home as defined in Iowa Code section 232.2, which does not meet the requirements of being “county or multicounty” as defined in 441—subrule 105.1(2).
"Prone restraint" means a physical restraint in which a child is held face down on the floor.
"Schedule II medications" means those controlled substances identified in Iowa Code chapter 124.
"Staff" means any person providing care or services to or on behalf of the residents whether the person is an employee of the facility, an independent contractor or any other person who contracts with the facility, an employee of an independent contractor or any other person who contracts with the facility, or a volunteer.
"Time out" means the temporary and short-term restriction of a resident for a period of time to a designated area from which the resident is not physically prevented from leaving, for the purpose of providing the resident an opportunity to regain self-control. Staff physically preventing the resident from leaving the time out area would be considered seclusion in control room conditions.
Related ARC(s): 9488B, 4793C441—114.3(237) Physical standards. Local building and zoning ordinances shall be met. 114.3(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. 114.3(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 ceiling surfaced with materials that are asbestos free. b. All sleeping rooms shall: (1) Provide a minimum of 60 square feet per child for multiple occupancy. (2) Provide a minimum of 80 square feet per child for single occupancy. (3) Not sleep more than four children per room. Facilities licensed prior to July 1, 1981, meeting current square footage requirements shall be allowed to house five children per room. (4) Be of finished construction.Facilities licensed prior to July 1, 1981, having a square foot area less than that required in subparagraphs (1) and (2) shall be considered to meet those standards. 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. 114.3(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 use, and a designated space for hanging clothing in proximity to the bedroom occupied by the child. d. No child over the age of five years shall occupy a bedroom with a member of the opposite sex. 114.3(4) Heating. a. The heating unit shall be located and operated 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 and water heaters involving the combustion of fuel, such as gas, oil or similar fuel, shall be vented to the outside atmosphere. c. Neither rubber nor plastic tubing shall be used as supply lines for gas heaters. d. The heating or cooling plant shall be checked at least annually and kept in safe working condition at all times.This rule is intended to implement Iowa Code section 237.3.441—114.4(237) Sanitation, water, and waste disposal. 114.4(1) 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 in dispensers, paper towels or functional hand dryers, soap, and other items required for personal hygiene. 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 wash basin 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 an enclosed solid door. 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. 114.4(2) 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 foods 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 below. f. The kitchen and food storage areas shall be kept clean and neat. Foods shall not be stored on the floor. g. The floor and walls shall be of smooth construction and in good repair. 114.4(3) Personnel handling food. Personnel who handle food shall: a. Be free of infection. b. Be clean and neatly groomed. c. Wear clean clothes. d. Not use tobacco in any form while preparing or serving food. 114.4(4) Dishwashing facilities. a. Manual dishwashing will be allowed in facilities that normally serve 15 or less people at one meal. b. Commercial dishwashers shall be used in facilities serving more than 15 people at one meal, and shall meet the following criteria: (1) When chemicals are added for sanitation purposes, they shall be automatically dispensed. (2) Machines using hot water for sanitizing must maintain 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. 114.4(5) 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. 114.4(6) Milk supply. When fluid milk is used, it shall be pasteurized Grade A. 114.4(7) Public water supply. The water supply is approved when the water is obtained from a public water supply system. 114.4(8) Private water supplies. Any facility that serves at least 25 people for at least 60 days during the year and is supplied by its own well meets the definition of a public water supply and must be regulated by the department of natural resources. a. Maintenance and operation. Each privately operated water supply shall be maintained and operated in a manner that ensures safe drinking water. Each water supply used as part of a facility shall be annually inspected and evaluated for deficiencies that may allow contaminants access to the well interior. Items such as open or loose well caps, missing or defective well vents, poor drainage around the wells, and the nearby storage of potential contaminants shall be evaluated. All deficiencies shall be corrected within 30 days of discovery by a well contractor certified by the state. b. Evaluation and water testing. As part of the inspection and evaluation, water samples shall be collected and submitted by the local health sanitarian or a well contractor certified by the state to the state hygienic laboratory or other laboratory certified for drinking water analysis by the department of natural resources. The minimum yearly water analysis shall include coliform bacteria and nitrate (NO3-) content. Total arsenic testing shall be performed once every three years. The water shall be deemed safe when there are no detectible coliform bacteria, when nitrate levels are less than 10 mg/L as nitrogen, and when total arsenic levels are 10 μg/L or less. A copy of the laboratory analysis report shall be provided to the department within 72 hours of receipt by the water supply. c. Multiple wells supplying water. When the water supply obtains water from more than one well, each well connected to the water distribution system shall meet all of the requirements of these rules. d. Deficiencies. When no apparent deficiencies exist with the well or its operations and the water supply is proven safe by meeting the minimum sampling and analysis requirements, water safety requirements have been met. Wells with deficiencies that result in unsafe water analysis require corrective actions through the use of a well contractor certified by the state. e. When water is proven unsafe. When the water supply is proven unsafe by sampling and analysis, the facility shall immediately provide a known source of safe drinking water for all water users and hang notification at each point of water use disclosing the water is unsafe for drinking water uses. In addition, the facility shall provide a written statement to the department disclosing the unsafe result and detail a plan on how the water supply deficiencies will be corrected and the supply brought back into a safe and maintained condition. The statement shall be submitted to the department within ten days of the laboratory notice. All corrective work shall be performed and the water supply sampled and analyzed again within 45 days from any water test analysis report that indicates the water supply is unsafe for drinking water uses. f. Water obtained from another source through hauling and storage must meet the requirements of the department of natural resources. 114.4(9) 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. 114.4(10) 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. 114.4(11) 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.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 4793C441—114.5(237) Safety. 114.5(1) General. Facilities shall take sufficient measures to ensure the safety of the children in care in all of their programs. 114.5(2) Premises. a. 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. b. Radiators, registers, and steam and hot water pipes shall have protective covering or insulation. Electrical outlets and switches shall have wall plates. c. Fuse boxes and circuit breakers shall be inaccessible to children. d. Facilities shall have written procedures for the handling and storage of hazardous materials. e. Firearms and ammunition shall be kept under lock and key and inaccessible to children. When firearms are used, the facility shall have written policies regarding their purpose, use, and storage. f. 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. g. The facility shall have policies regarding fishing ponds, lakes, or any bodies of water located on or near the facility grounds and accessible to the children. 114.5(3) Emergency evacuation and safety procedures. Upon admission all children shall receive instruction regarding evacuation and safety procedures. All living units utilized by children shall have a posted plan for evacuation and safety procedures regarding severe weather events, fire or other natural or man-made disasters. Practice fire drills shall be held monthly, and severe weather drills shall be held twice annually. 114.5(4) Fire inspection. Each facility shall procure an annual fire inspection approved by the state fire marshal and shall meet the recommendations thereof. 114.5(5) Local codes. Each facility shall meet local building, zoning, sanitation and fire safety ordinances. Where no local standards exist, state standards shall be met. 114.5(6) Safety, protection, and well-being of children in care. Facilities shall develop and follow written policies and procedures that assure the safety, protection, and well-being of children in care. Policies shall address, but not be limited to, the following: a. Supportive leadership of the facility that promotes protecting each child from abuse or bullying from other children and staff. b. Defining the facility’s culture to reduce the use of unnecessary restraint. c. Clear definitions of unsafe behavior and the emergency situations when it is appropriate to use physical interventions. d. Staff training and development that give staff confidence they are supported by leadership with proper supervision and ongoing access to information about best practices and evidence-based approaches to care. e. Adequate supervision of children while the children are using any hazardous or dangerous objects or equipment and when children are using the Internet or other social media. f. The social, cultural, and developmental needs of children in care.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 2743C, 4793C441—114.6(237) Organization and administration. Any change in the name of the facility, the address of the facility, the executive, or the capacity shall be reported to the department. 114.6(1) Table of organization. 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. 114.6(2) Purpose of agency or facility. The purpose or function of the organization shall be clearly defined in writing and shall include a description of the children to be accepted for care and the services offered. 114.6(3) Governing bodies or individuals. All group living foster care facilities shall: a. Have a governing board or individuals who are accountable for and have authority over the policies and activities of the organization. In the case of an organization owned by a proprietor or partnership, the proprietor or partner shall be regarded as the governing body. b. Provide the department with a list of names, addresses, telephone numbers and titles of the members of the governing body. c. Have adequate insurance covering fire and liability as a protection to children in care. d. For organizations with the home base located outside Iowa, have duly authorized representatives with decision-making abilities designated within the state of Iowa. 114.6(4) Executive director. The governing body or proprietor or partner(s) shall select and appoint an executive director with full administrative responsibility and qualifications for carrying out the policies, procedures and programs established by the governing body. 114.6(5) Financial solvency of facilities. Profit and nonprofit institutions shall maintain financial solvency to ensure adequate care of children and youth for whom responsibility is assumed. It shall have sufficient financial resources, predictable income, or both, and not be totally dependent upon current fees, for a three-month operating period. The facility shall have written policies and procedures describing the program of the facility and specifying how it will be carried out.This rule is intended to implement Iowa Code section 237.2.Related ARC(s): 4793C441—114.7(237) Policies and record-keeping requirements. 114.7(1) Policies in writing. The following current personnel policies and practices of the agency and relating to the 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 evaluations. 114.7(2) Health of staff. Each staff person who has direct client contact or is involved in food preparation shall be tested for tuberculosis and have a physical examination within six months prior to hiring, unless the staff can produce valid documentation of the physical and tuberculosis test from within the previous three years. Physical examinations shall be completed every three years thereafter. Evidence of these examinations or tests shall be included in each personnel file. The examinations or tests shall be completed by one of the following: a. A physician as defined in Iowa Code section 135.1(4); b. An advanced registered nurse practitioner who is registered with and certified by the Iowa board of nursing to practice nursing in an advanced role; or c. A physician assistant licensed under Iowa Code chapter 148C. 114.7(3) Staff records. a. The facility shall maintain the following information with respect to each staff person: (1) Name and current address of each staff person. (2) At least two written references or documentation of oral references. In case of unfavorable references, there shall be documentation of further checking to ensure that the person will be reliable. (3) Documentation of all record checks and evaluations as required in subrule 114.24(1). (4) A written, signed and dated statement furnished by the staff person prior to providing any care or services to or on behalf of the facility which discloses any founded reports of child abuse on the person that may exist. (5) Reserved. (6) Records of a physical examination or a record of a health report, as required in subrule 114.7(2), plus a written record of subsequent health services rendered to staff necessary to ensure that each individual is physically able to perform the job duties or functions. (7) Reserved. (8) Records of training sessions attended, including dates and content of the training. (9) When otherwise required in situations that apply, a certified copy of a school transcript, diploma, or written statement from the school or supervising agency for positions having educational requirements. b. In addition, with respect to staff who are employed by the facility, the facility shall maintain the following records: (1) Social security number of each employee. (2) A job application containing sufficient information to justify the initial and current employment. (3) A certified copy of a school transcript, diploma, or written statement from the school or supervising agency before permanent employment of applicants for positions having educational requirements. (4) Written verification of licensure before permanent employment of applicants for positions requiring licenses. Evidence of renewal of licenses as required by the licensing agency. (5) Current information relative to work performance evaluation. (6) Information on written reprimands or commendations. (7) Information on position in the agency and date of employment. (8) If the applicant, probationary or temporary employee has completed and submitted Form 470-2310, Record Check Evaluation, to the agency, a copy shall be kept in the staff record.Related ARC(s): 9488B, 4793C441—114.8(237) Staff. 114.8(1) Qualifications of staff. a. A caseworker shall have a bachelor of arts or bachelor of science degree in social work, psychology or a related behavioral science, plus two years of supervised experience; or a bachelor’s degree in social work with one year of supervised experience; or six years of supervised child welfare experience in residential care or a combination of advanced education in the behavioral sciences and experience equal to six years. b. A casework supervisor shall have either a master’s degree in social work with one year of supervised experience after the master’s degree or a master’s degree in psychology or counseling with two years of experience beyond the master’s degree, one of which was under supervision. The experience shall be in the area of child welfare services. c. Child care workers shall be at least 18 years of age. d. Any licensed facility having persons in employment in positions for which present rules require higher qualifications will be considered to meet rules with the present staff. New staff will need to meet the requirements of these rules. e. A person who has a record of a criminal conviction or founded child abuse report shall not be employed, unless an evaluation of the crime or founded child abuse has been made by the department which concludes that the crime or founded child abuse does not merit prohibition of employment. If a record of criminal conviction or founded child abuse exists, the person shall be offered the opportunity to complete and submit Form 470-2310, “Record Check Evaluation.” In its evaluation, the department shall consider the nature and seriousness of the crime or founded abuse in relation to the position sought, the time elapsed since the commission of the crime or founded abuse, the circumstances under which the crime or founded abuse was committed, the degree of rehabilitation, and the number of crimes or founded abuses committed by the person involved. 114.8(2) Number of staff. a. Children shall be provided with 24-hour awake supervision. There shall be at least one awake and readily accessible staff person on duty for each currently occupied living unit. The staff person shall make regular visual checks at least every hour throughout the night. A log shall be kept of all checks, including the time of the check and any significant observations. Policies for nighttime checks shall be in writing. b. Each facility shall have the services of a casework supervisor and a caseworker adequate to fulfill the staff duties. c. There shall be an on-call system operational 24 hours a day to provide supervisory consultation. There shall be a written plan documenting this system. d. The number and qualifications of the staff will vary depending on the needs of the children. There shall be at least a one to eight staff to client ratio during all times children are awake and present in the facility and during supervised outings. 114.8(3) Staff duties. a. The casework supervisor shall provide in-person case specific supervision at the site of the facility for one hour per month per caseworker and be available for consultation in case of emergency. b. Caseworkers shall: (1) Develop a service plan for each child containing goals and objectives with projected dates of accomplishment and shall involve the client, referral agency, and family whenever possible. (2) Develop a specific plan relating to the involvement of the child’s parents unless documented by the caseworker that their involvement would be counterproductive. c. The facility staff shall be responsible for the following: (1) Documenting case reassessments quarterly, involving the same personnel as previously involved in service plan development. (2) Documenting the implementation of the service plan. (3) Providing for scheduled in-person conferences with each resident. (4) Providing a supportive atmosphere for the child. (5) Providing for coordination of internal and external activities of the child. (6) Providing for liaison with the referring agency. (7) Providing leadership and guidance to the children. (8) Providing a mechanism for dealing with day-to-day program operations. (9) Being responsible for overseeing and maintaining general health and well-being of children. (10) Supervising the living activities of the children. (11) Monitoring and recording behavior on a daily basis. (12) At all times, knowing where the children are and where they are supposed to be to assure ongoing safety. 114.8(4) Staff development. Staff development shall be appropriate to the size and nature of the facility. There shall be a written format 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 for all staff members to improve their competency. This may be accomplished 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 information and evidence-based practices relevant to the facility’s services. d. An individual designated responsible for staff development and training, who will complete a written staff development plan which shall be updated annually. 114.8(5) Volunteers. A facility that utilizes volunteers to work directly with a particular child or group of children shall have a written plan for using volunteers. This plan shall be given to all volunteers. The plan shall indicate that all volunteers shall: a. Be directly supervised by a paid staff member. b. Be oriented and trained in the philosophy of the facility and the needs of children in care, and methods of meeting those needs. c. Be subject to character, reference, and record check requirements described in subrule 114.24(1).This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 9488B, 4793C441—114.9(237) Intake procedures. 114.9(1) Intake policies. The agency shall have written intake policies specific to the licensed facility. 114.9(2) Basis of acceptance. Children shall be accepted for care only after the following criteria have been met: a. An assessment of the child’s need for service and supervision has been agreed upon by the staff of the facility and the referring agency worker. The child, the child’s family, and any other significant people shall be invited to participate in this process to the fullest extent possible. b. The assessment indicates that the child requires the care offered by this type of facility and is likely to benefit from the program the facility offers. 114.9(3) Referral information. The following information shall be made available prior to any decision being made regarding the acceptance of a child. The following information shall be requested by the facility if not yet received. a. A current social history. b. A copy of the child’s physical assessment including immunization history completed within one year prior to application, when available. c. Where indicated, or when available, psychological testing completed no more than one year prior to referral. d. Current educational data. e. When indicated or available, psychiatric report completed no more than one year prior to referral. f. Referring agency’s case plan which includes goals and objectives to be achieved during placement with a time frame for the achievement of these goals and objectives. g. Documentation of the legal status of the child which includes any court orders or statements of custody and guardianship. 114.9(4) Admission requirements. a. The following items shall be secured upon admission of the child to the facility. (1) A placement agreement for the child signed by the person having legal responsibility for the child and the agency where the child is being placed. When this is not available at the time of placement, it shall be furnished within 48 hours of placement in the facility. (2) Emergency medical authorization from the court, the parents, the guardian, or custodian. b. The following items shall be provided to the child, the child’s family or guardian, and the referring worker at the time of placement: (1) A description of the services provided. (2) Written policies regarding children’s rights as in 114.13(2). (3) Written policies regarding religion, work or vocational experiences, family involvement, grievance procedures and discipline as in 441—114.13(237) to 114.18(237) and 114.20(237). 114.9(5) Personal assessment. At the time of intake, individual needs will be identified by staff based on written and verbal information from referral sources, observable behavior at intake and the initial interview with youth or family, school contacts, physical examinations, and other relevant material. The individual assessment shall provide the basis for development of a service plan for each child. 114.9(6) Educational assessment. An educational assessment shall be developed by the staff and the referring worker. Involvement of the parents or guardian, area education agency, and public schools may be appropriate. 114.9(7) Person responsible. Each agency shall designate a person or persons who have the authority to do intake. 114.9(8) Intake sheet. An intake sheet shall be completed on each child containing at least the information specified in 114.11(2).This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 4793C441—114.10(237) Program services. 114.10(1) Evaluation services. a. When evaluation services are provided by staff of the facility, the services shall be clearly defined so that referral sources are clear about the components of the service. b. Evaluations shall be based on behavioral observations, social history, educational assessments and shall include an assessment of vocational needs, recreational skills, and physical therapy, speech, language, vision and hearing needs to assist in planning and placement for the child. The need for providing all of these evaluative services will be determined on the basis of the specific child being referred. 114.10(2) Service plan. There shall be a written service plan for each child. The service plan shall be based on the individual needs determined through the assessment of each resident, provide for consultation with the family, and shall include the following: a. Identification of special needs. b. Description of planned services including measurable goals and objectives which indicate which staff person will be responsible for the specific services in the plan. c. Indication of where the services are to occur and note the frequency of activities or services. d. A discharge summary. 114.10(3) Daily routine. Each facility shall provide a daily routine for the children in residence which is directed toward developing healthful habits in eating, sleeping, exercising, personal care, hygiene, and grooming according to the needs of the individual child and the living group. 114.10(4) Daily log. The facility shall maintain a daily log to generally record noteworthy occurrences regarding the children in care. Problem areas or unusual behavior for specific children shall be recorded in individual children’s records. 114.10(5) Educational services. An educational program shall be available for each child in accordance with abilities and needs. The educational and teaching standards established by the state department of education shall be met when an educational program is provided within an institution. 114.10(6) Health care. a. There shall be 24-hour emergency and routine medical and dental services available and provided when prescribed. Provisions for these services shall be documented. b. The facility shall arrange a physical assessment including vision and hearing tests for each child in care within one week of admission unless the child has received an examination within the past year and the results of this examination are available to the facility. c. A facility shall not require medical treatment when the parent(s) or guardian of the child or the child objects to 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. In potentially life-threatening situations, the facility shall refer the child’s care to appropriate medical and legal authorities. d. A facility shall have and staff shall follow written procedures in case of medical emergency. e. A facility shall schedule a dental examination for each child within 14 days of admission unless the child has been examined within six months prior to admission and the facility has the results of that examination. 114.10(7) Dietary program. The facility shall provide properly planned, nutritious and inviting food and take into consideration the dietary and health needs of children. The facility shall follow all dietary recommendations prescribed by medical personnel or a dietitian licensed in the state of Iowa. 114.10(8) Recreation and leisure programs. a. The facility shall provide adequately designed and maintained indoor and outdoor activity areas, equipment, and equipment storage facilities appropriate for the residents 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 activities. b. Games, toys, equipment, and arts and crafts material shall be selected according to the ages and number of children with consideration to the needs of the children to engage in active and quiet play. c. The facility shall plan and carry out efforts to establish and maintain workable relationships with community recreational resources so these resources may provide opportunities for children to participate in community recreational activities. 114.10(9) Casework services. A facility shall provide or obtain casework services in the form of counseling in accordance with the needs of each child’s individual service plan. Casework services include crisis intervention, daily living skills, interpersonal relationships, future planning and preparation for placement as required by the child. 114.10(10) Psychiatric and psychological services—(Optional service). a. When the diagnostic evaluation of a child indicates need for care by a psychiatrist and under psychiatric guidance, the specialized treatment or consultation shall be provided or arranged by the facility. b. Psychologists, whose services are used in behalf of children, shall be licensed as a psychologist in the state of Iowa, or be certified by the department of education. 114.10(11) Volunteers—(Optional service). Rescinded IAB 12/4/19, effective 1/8/20. 114.10(12) Liability. Licensed group living foster care facilities that apply the reasonable and prudent parent standard reasonably and in good faith in regard to a child in foster care shall have immunity from civil or criminal liability which might otherwise be incurred or imposed. This subrule shall not remove or limit any existing liability protection afforded under any other law.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 2743C, 4793C441—114.11(237) Case files. 114.11(1) Generally. All facilities shall establish and maintain case files on each child. The case files shall include the following: 114.11(2) Face sheet. The face sheet shall contain the following information: a. Full name, birth place and date of birth. b. Parents’ full name. c. Parents’ address and telephone number. d. Religious preference of parents and child. e. Statement of who has legal custody and guardianship. f. Name of the referring worker and agency making the referral. g. Telephone number and address of the agency or court making the referral and contact information of the child’s attorney or guardian ad litem. 114.11(3) Referral packet. All of the information required in the referral packet shall be contained in the case record including a social history on the child, a copy of the child’s physical assessment and immunization history, psychological testing, when available, current educational information, psychiatric report, when available, and the referring agency’s case plan. 114.11(4) Legal documents. a. Placement agreement signed by parent(s) or custodian of the child. b. Petitions and orders of the court regarding adjudication, custody, or guardianship. 114.11(5) Psychiatric and psychological. Psychiatric and psychological reports, when available. 114.11(6) Correspondence. Correspondence regarding the child. 114.11(7) Medical. a. Medical and surgical authorizations signed by the parent(s), guardian, or contained in the court order. b. Record of medical care received while in the facility. c. Information on past medical history. 114.11(8) School. a. Name of school currently attended. b. Grade placement. c. Any specific educational problem. d. Remedial action recommended. 114.11(9) Service plan. Individual child service plan, quarterly update, and revisions of the service plan. The service plan shall be updated quarterly or any time upon receipt of a new case permanency plan or juvenile court services plan or as otherwise needed to address the changing needs of the child. Discharge summary completing the service plan information shall be completed upon a child’s discharge from placement. 114.11(10) Documentation. The following information shall be documented in each child’s record. a. Appropriate notes, all significant contacts with parents, referring worker and other collateral contracts, as well as staff counseling with child and notations on behavior. b. A summary related to discharge including: (1) The name, address and relationship of the person or agency to whom the child was released. (2) The discharge summary (as included in the service plan). (3) Final disposition of a child’s medications as applicable. (4) Identification of who transported the child and destination postdischarge. 114.11(11) Electronic records. An authorized representative of the department shall be provided unrestricted access to electronic records pertaining to the care provided to the residents, who are served as a result of a contract with the department, of the facility. a. If access to an electronic record is requested by the authorized representative of the department, the facility may provide a tutorial on how to use its particular electronic system or may designate an individual who will, when requested, access the system, respond to any questions or assist the authorized representative as needed in accessing electronic information in a timely fashion. b. The facility shall provide a terminal where the authorized representative may access records. c. If the facility is unable to provide direct print capability to the authorized representative, the facility shall make available a printout of any record or part of a record on request in a time frame that does not intentionally prevent or interfere with the department’s survey or investigation.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 4793C441—114.12(237) Drug utilization and control. The agency shall have and follow 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 or authorized prescriber. 114.12(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. No experimental drugs may be used. 114.12(2) Prescribed by physician or other authorized prescriber. 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, or by an advanced registered nurse practitioner or physician assistant as permitted by Iowa law, and may be prescribed only for use in accordance with dosage ranges and indications approved by the federal Food and Drug Administration. 114.12(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. 114.12(4) Locked cabinet. All drugs shall be maintained in a locked cabinet. Schedule II medications 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 persons identified in these rules who may allow self-administered drugs as discussed in subrule 114.12(17). 114.12(5) Medications requiring refrigeration. Medications requiring refrigeration shall be kept in a locked box in the refrigerator and separated from food and other items. 114.12(6) Poisonous or caustic drugs. All potent poisonous or caustic drugs shall be plainly labeled, stored separately from other drugs in a specific well-illuminated cabinet, closet, or storeroom, and made accessible only to authorized persons. 114.12(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 and, date of issuing the drug. Medications shall be packaged and labeled according to state and federal guidelines. 114.12(8) Medication containers. Medication containers having soiled, damaged, illegible or makeshift labels shall be returned to the issuing pharmacist. 114.12(9) Medication for discharged residents. When a resident is discharged or leaves the facility, the facility shall turn over to a responsible agent Schedule II medications and prescription medications currently being administered. The facility may send nonprescription medications with the child as needed. The facility shall document in the child’s file: a. The name, strength, dosage form, and quantity of each medication. b. The signature of the facility staff person who turned over the medications to the responsible agent. c. The signature of the responsible agent receiving the medications. 114.12(10) Unused prescription drugs. Unused prescription drugs prescribed for residents may not be kept at the facility for more 15 days after the resident has left the facility. The unused prescription drugs shall be destroyed by the facility executive director or the executive director’s designee in the presence of at least one witness. Outdated, discontinued, or unusable nonprescription medications shall also be destroyed in a similar manner. The person destroying the medication shall document: a. The resident’s name. b. The name, strength, dosage form, and quantity of each medication. c. The date the medication was destroyed. d. The names and signatures of the witness and staff person who destroyed the medication. 114.12(11) Refills. Prescriptions shall be refilled only with the permission of the prescriber authorized under Iowa law. 114.12(12) Use of medications. No prescription medications prescribed for one resident may be administered to or allowed in the possession of another resident. 114.12(13) Order of authorized prescriber. No prescription medication may be administered to a resident without the order of an authorized prescriber. 114.12(14) Patient reaction. Any unusual patient reaction to a drug shall be reported to the attending physician or prescriber immediately. 114.12(15) Dilution or reconstitution of drugs. Dilution or reconstitution of drugs and their labeling shall be done only by a licensed pharmacist. 114.12(16) Administration of drugs. Medications shall be administered only in accordance with the instructions of the attending physician or authorized prescriber. Medications shall be administered only by staff who have completed a medication management course. 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. 114.12(17) Self-administration of drugs. There shall be written policy and procedures relative to self-administration of prescription medications by residents and only when: a. Medications are prescribed by a physician or other authorized prescriber. b. The physician or authorized prescriber provides written approval that the patient is capable of participating and can self-administer the drug. c. What is taken and when is documented in the record of the child. 114.12(18) Obtaining nonprescription medications. Facilities shall maintain a supply of standard nonprescription medications for use for children residing at the facility. Examples of standard nonprescription medications include cough drops and cough syrups, aspirin substitutes and other pain control medication, poison antidote, and diarrhea control medication. a. All nonprescription medications kept on the premises for the use of residents shall be preapproved annually by a licensed pharmacist or an authorized prescriber. b. Facilities shall maintain a list of all preapproved nonprescription medications. The list shall indicate standard uses, standard dosages, contraindications, side effects, and common drug interaction warnings. The facility administrator or the administrator’s designee shall be responsible for determining the scope of the list and brands and types of medications included. c. Only nonprescription medications on the preapproved list shall be available for use. However, the facility administrator or the administrator’s designee, in consultation with an authorized prescriber or licensed pharmacist, may approve use of a nonprescription medication that is not on the preapproved list for a specific child.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 4793C441—114.13(237) Children’s rights. 114.13(1) Policies in writing. All policies and procedures covered in this rule shall be in writing and provided to the child and parents or guardian upon the child’s admission to the facility. 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. 114.13(2) Confidentiality. Information regarding children and their families shall be kept confidential and released only with proper written authority. 114.13(3) Communication. a. Visitation shall be allowed with members of the child’s immediate family unless otherwise regulated by the court. b. Visits shall be allowed with other significant persons. c. Consideration shall be given to privacy for family visits. d. The child shall be permitted to communicate with legal counsel and the referring worker. e. The child shall be allowed to conduct private telephone conversations with family members. Incoming calls may be screened by staff to verify the identity of the caller before approval is given. f. The child shall be allowed to send and receive mail unopened unless contraindicated. Contraindications, except those listed below, should be documented in the child’s file. The facility may require the child to open incoming mail in the presence of a staff member when it is suspected to contain contraband articles, or when there is money that should be receipted and deposited. g. When limitations on visitation, calls 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. 114.13(4) Privacy. Reasonable provisions shall be made for the privacy of residents.This rule is intended to implement Iowa Code section 237.2.Related ARC(s): 4793C441—114.14(237) Personal possessions. 114.14(1) Belongings. A facility shall allow a child in care to bring personal belongings and to acquire belongings in accordance with the child’s service plan. However, the facility shall, as necessary, limit or supervise the use of these items while the child is in care. 114.14(2) Clothing. A facility shall ensure that each child in care has adequate, clean, well-fitting, attractive, and seasonable clothing as required for health, comfort, and physical well-being. The clothes should be appropriate to age, sex and individual needs.This rule is intended to implement Iowa Code section 237.2.441—114.15(237) Religion—culture. 114.15(1) Facility orientation. A facility shall have a written description of its religious orientation, particular religious practices that are observed, and any religious restrictions. This description shall be provided to the child, the parent(s) or guardian, and the placing agency at the time of admission. 114.15(2) Child participation. When a facility accepts a child, the child shall have the opportunity to participate in religious activities and services in accordance with the child’s own faith or that of the child’s parent(s) or guardian. The facility shall, when necessary and reasonable, arrange transportation for religious activities. Wherever feasible, the child shall be permitted to attend religious activities and services in the community.This rule is intended to implement Iowa Code section 237.2.441—114.16(237) Work or vocational experiences. 114.16(1) Written description. The facility shall have a written statement of any work and vocational experiences available to children. 114.16(2) Program component. Work as part of the program shall be identified in the child’s case plan. 114.16(3) Self-care. Ordinary self-care and self-sufficiency tasks are not considered work. 114.16(4) Purpose. Work shall be in the child’s interest, within the child’s ability, with payment where appropriate, and never solely in the interest of the facility’s goals or needs.This rule is intended to implement Iowa Code section 237.2.441—114.17(237) Family involvement. There shall be written policies and procedures for family involvement that shall encourage continued involvement of the family with the child.This rule is intended to implement Iowa Code section 237.2.441—114.18(237) Children’s money. 114.18(1) Treatment of funds. Money earned, received as a gift, or as an allowance by a child in care shall be deemed to be that child’s personal property. 114.18(2) Limitations. The facility shall have a written policy on limitations on the child’s use of funds. 114.18(3) Records. The facility shall maintain a separate accounting system for children’s money.This rule is intended to implement Iowa Code section 237.2.441—114.19(237) 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 found to be in violation of Iowa Code chapter 232, division III, part 2, as substantiated by the department of human services’ investigation shall be subject to the agency’s policies concerning dismissal.This rule is intended to implement Iowa Code section 237.2.441—114.20(237) Discipline. 114.20(1) Generally. The 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. Agency staff shall be in control of and responsible for discipline at all times. Discipline shall not include the withholding of basic necessities such as food, clothing, or sleep. Discipline shall not be used for anyone other than a child whose actions resulted in consequences. Group discipline shall not be used because of actions of an individual child or other children. 114.20(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 is to be communicated, in writing, to all staff of the facility. 114.20(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. Physical restraint must be conducted with the child in a standing position whenever possible. Each child has the right to be free from restraint and seclusion, of any form, used as a means of coercion, discipline, convenience, or retaliation. a. No staff person shall use any restraint that obstructs the airway of a child. b. Prone restraint is prohibited. Staff persons who find themselves involved in the use of a prone restraint when responding to an emergency must take immediate steps to end the prone restraint. c. If a staff person physically restrains a child who uses sign language or an augmentative mode of communication as the child’s primary mode of communication, the child shall be permitted to have the child’s hands free of restraint for brief periods unless the staff person determines that such freedom appears likely to result in harm to the child, others, or property. d. The rationale and authorization for the use of physical restraint and staff action and procedures carried out to protect the child’s rights and to ensure safety shall be clearly documented in the child’s record by the responsible staff persons no later than the end of the shift in which the restraint was used. e. Documentation of restraint use shall include, but need not be limited to, the following: (1) Each use of restraint or control room. (2) The time the intervention began and ended. (3) The reason that required the resident to be restrained or put in a control room. (4) The name of staff involved in the intervention. 114.20(4) Other restraints and control room. Only comprehensive residential facilities may use a control room, locked cottages, or mechanical restraints. 114.20(5) Behavior expectations. The facility shall make available to the child and the child’s parents or guardian written policies regarding the following areas: a. The general expectation of behavior including the facility’s rules and practices. b. The range of reasonable consequences that may be used to deal with inappropriate behavior. 114.20(6) Time out. a. A resident in time out must never be physically prevented from leaving the time out area. b. Time out may take place away from the area of activity or from other residents, such as in the resident’s room, or in the area of activity of other residents. c. Staff must monitor the resident while the resident is in time out.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 9488B, 4793C441—114.21(237) Illness, accident, death, or unauthorized absence from the facility. 114.21(1) Notification of illness. A facility shall notify the child’s parent(s), guardian and responsible agency of any serious illness, incident involving serious bodily injury, circumstances causing removal of the child from the facility, or elopement. 114.21(2) Notification of death. In the event of the death of a child, a facility shall notify immediately the physician, the child’s parent(s) or guardian, the placing agency, and the appropriate state authority. The agency shall cooperate in arrangements made for examination, autopsy, and burial.This rule is intended to implement Iowa Code section 237.2.Related ARC(s): 4793C441—114.22(237) Records. In the event of closure of a facility, children’s records shall be sent to the department of human services for retention according to the department’s records retention policy or the period defined in the department’s contract for services, whichever is longer.This rule is intended to implement Iowa Code section 237.2.Related ARC(s): 4793C441—114.23(237) Unannounced visits. 114.23(1) Frequency. a. Time. At least one annual unannounced visit shall occur during periods of the day when the child would normally be in the facility and awake. b. Activities. The visit shall include an assessment of, but not be limited to, the following areas: (1) Interaction between the staff and child. (2) Interaction between the children. (3) Discussion with the child about experiences in the facility. (4) A check on any previously cited deficiencies. (5) Overall impression of the facility. (6) Staff record checks. c. Recommendation. The licensing staff shall recommend follow-up when needed. 114.23(2) Visits at other times may occur as a result of a self-reported incident or specific complaint.This rule is intended to implement Iowa Code section 237.7.Related ARC(s): 4793C441—114.24(237) Record check information. Record checks are required for any entity being considered for licensure or employment by a licensee on a facility campus where children reside to determine whether any founded child abuse reports or criminal convictions exist or whether the entity has been placed on a sex offender registry. The facility shall not employ any person who has been convicted of a crime involving the mistreatment or exploitation of a child. The facility shall not employ any person who has a record of a criminal conviction or founded child abuse report unless the department has evaluated the crime or abuse and determined that the crime or abuse does not merit prohibition of licensure, volunteering or employment. 114.24(1) Procedure. Each entity being considered for licensure or employment shall be checked for all of the following: a. Records with the Iowa central abuse registry, using the request for child and dependent adult abuse information form; b. Records with the Iowa division of criminal investigation, using the department’s criminal history record check form; c. Records with the Iowa sex offender registry; d. Records with the child abuse registry of any state where the person has lived during the past five years; and e. Fingerprints provided to the department of public safety for submission through the state criminal history repository to the United States Department of Justice, Federal Bureau of Investigation, for a national criminal history check. Fingerprinting, for the purpose of a national criminal history check, is required for all entities considered for licensure or employment by a licensee on a facility campus where children reside. 114.24(2) Evaluation of record. If an entity for which a background check is required has a record of founded child or dependent adult abuse, a criminal conviction, or placement on a sex offender registry, the department shall prohibit licensure or employment unless an evaluation determines that the abuse, criminal conviction, or placement on a sex offender registry does not warrant prohibition. a. Scope. The evaluation shall consider the nature and seriousness of the founded child or dependent adult abuse or criminal conviction report in relation to: (1) The position sought or held, (2) The time elapsed since the abuse or crime was committed, (3) The degree of rehabilitation, (4) The likelihood that the person will commit the abuse or crime again, and (5) The number of abuses or crimes committed by the person. b. Evaluation form. The person with the founded child or dependent adult abuse or criminal conviction report shall complete and return the department’s record check evaluation form within ten calendar days of the date of receipt to be used to assist in the evaluation. 114.24(3) Evaluation decision. The department shall conduct the evaluation and make the decision of whether or not the founded child or dependent adult abuse or criminal conviction warrants prohibition of licensure or employment by a licensee. The department shall issue a notice of decision in writing to the requesting entity. The requesting entity is responsible for providing a copy of the notice to the prospective employee. Record check evaluations are valid for 30 days from the date the notice of decision is issued.This rule is intended to implement Iowa Code section 237.7 and 2019 Iowa Acts, House File 644.Related ARC(s): 4793C441—114.25(237) Standards for private juvenile shelter care and detention homes. The standards of 441—Chapter 105 shall be used as the basis for licensing private juvenile shelter care and detention homes. These homes are not required to meet other standards of 441—Chapter 114.This rule is intended to implement Iowa Code section 237.3.Related ARC(s): 4793CRelated ARC(s): 9488B, 2743C, 3185C, 4793C