SECTION 340:110-3-168. Requirements for residential treatment facilities

(a)   Residential treatment facilities. A residential treatment program cares for children under 24-hour medical care with emotional, psychological, or mental disorders.

(b)   Requirements. The program complies with the rules in Oklahoma Administrative Code (OAC) 340:110-3-145 through 340:110-3-165.1, except as otherwise provided in this Section.

(c)   Personnel. The program:

(1)   complies with the rules regarding personnel, per OAC 340:110-3-153.1; and

(2)   employs a psychiatrist and adequate medical personnel to meet the residents' medical needs.

(d)   Supervision of residents. The program is exempt from the rules, per OAC 340:110-3-153.2 regarding residents' supervision.

(1)   The program employs a sufficient number of personnel as child care workers to adequately supervise and meet residents' needs. Staff members are awake and accessible at all times.

(2)   The program maintains a ratio of one personnel for:

(A)   six residents (1:6) during awake hours; and

(B)   eight residents (1:8) during sleeping hours.

(3)   When psychiatric residential treatment admission is ordered by a medical doctor, the doors may be locked.

(e)   Admission. Within 24-hours of admission, a health care professional reviews and approves the admission assessment.

(f)   Service planning. The program is exempt from the rules, per OAC 340:110-3-154(b)(1) and (2) regarding service plans.

(1)   The program meets the requirements in:

(A)   (1) and (2) of this subsection; and

(B)   OAC 340:110-3-154(b)(1)(A) and (B) and (b)(2)(B) and (C).

(2)   A written service plan for each resident is:

(A)   developed and documented within seven-program business days after admission; and

(B)   reviewed at least every 30-calendar days thereafter unless required by other licensing or contracted entities.

(g)   Portable pools. The program is exempt from the rules, per OAC 340:110-3-163(14)(B). Therapeutic water activities are permitted when prescribed by an attending licensed physician, included in a treatment plan, and provisions are made to ensure hygienic practices. When portable pools are used as a therapeutic activity children are directly supervised at all times. Portable pools are:

(1)   no larger than six feet in diameter; and

(2)   contain no more than six inches water depth.

(h)   Discharge procedures. The program meets the rules, per OAC 340:110-3-154(d) regarding discharge procedures. The program:

(1)   supplies the resident with two weeks' worth of prescribed medication, when appropriate, on discharge; and

(2)   documents in the resident's file at least one scheduled outpatient follow-up contact within two weeks of discharge.

(i)   Visitation. The program is exempt from the rules, per OAC 340:110-3-154.1(b)(2) regarding visitation restriction reviews. Visitation restrictions are:

(1)   explained to the resident and parents;

(2)   documented in the resident's records; and

(3)   reviewed every seven-calendar days.

(j)   Behavior management. The program is exempt from the rules, per OAC 340:110-3-154.2(b)(7) and (10), regarding seclusion and restraint. If the program uses seclusion and chemical restraint, it meets the requirements in (1) through (5) of this subsection.

(1)   Seclusion. Seclusion is only used when less-restrictive interventions, per program policy, were attempted or when an immediate intervention is required to protect the resident, staff member, or others. The resident is released from seclusion when he or she is no longer deemed a risk to self or others. A written incident report is completed within 24-hours following each use of seclusion.

(A)   Seclusion is used only with specific verbal authorization of a health care professional. The authorization is written and signed by a health care professional within 24 hours.

(B)   While in seclusion, a staff member continuously monitors the resident, either by direct contact or with audiovisual equipment, and directly checks the resident's well-being at least every 15 minutes. The resident receives appropriate medical and psychological services.

(C)   The resident has reasonable access to toilet facilities and all scheduled meals while in seclusion.

(D)   As soon as the resident sufficiently gains control and is no longer a serious and immediate danger, the resident is released from seclusion.

(i)   Residents 10 years of age and older do not remain in seclusion longer than two hours or a total of six non-consecutive hours within a 24-hour period.

(ii)   Residents 9 years of age and younger do not remain in seclusion longer than one hour within a 24-hour period.

(2)   Seclusion room. A room used for seclusion includes:

(A)   at least 60 square feet and a seven foot, six inch ceiling height;

(B)   a safety glass window, mirror, or camera allowing for seclusion room full-observation;

(C)   no hardware or furnishings obstructing child observation at all times;

(D)   no hardware, equipment, or furnishings presenting a physical hazard or suicide risk;

(E)   natural or mechanical ventilation;

(F)   a temperature between 65 and 85 degrees Fahrenheit;

(G)   lighting for all room areas; and

(H)   an automatic fire suppression system.

(3)   Mechanical restraint. Mechanical restraint is not used on children 18 years of age and younger, per OAC 317:30-5-95.39.

(4)   Chemical restraint. Chemical restraint is only used when less restrictive interventions, per program policy, were attempted or when an immediate intervention is required to protect the resident, personnel, or others. A written incident report is completed within 24-hours following each chemical restraint use.

(A)   Chemical restraint is used only with a health care professional's verbal authorization prior to administration. The verbal authorization must be written and signed by the health care professional within 24-hours.

(B)   Chemical restraint is administered in a humane manner.

(C)   A staff member continuously monitors the resident, either by direct contact or with audiovisual equipment, and personally checks the resident's well-being every 15 minutes.

(D)   The resident receives appropriate medical and psychological services.

(5)   Seclusion and restraint log. A seclusion and restraint log is maintained, and a report containing all log information is part of the resident's record. The log includes the:

(A)   date and time of placement in seclusion or in restraint;

(B)   health care professional's name, who is authorizing the restraint or seclusion;

(C)   reason for restraint or seclusion and other behavior management techniques attempted;

(D)   observation times, including a description of the resident's activity at each observation, and the signature of the person observing the resident; and

(E)   time the resident is released from seclusion or restraint.

[Source: Added at 18 Ok Reg 3331, eff 10-1-01 (emergency); Added at 19 Ok Reg 1171, eff 5-13-02; Amended at 22 Ok Reg 1304, eff 6-1-05; Amended at 26 Ok Reg 2239, eff 7-1-09; Amended at 27 Ok Reg 48, eff 10-1-09 (emergency); Amended at 27 Ok Reg 1869, eff 7-1-10; Amended at 31 Ok Reg 154, eff 11-1-13 (emergency); Amended at 31 Ok Reg 1854, eff 9-15-14; Amended at 37 Ok Reg 1858, eff 11-1-20]