CC - Item 6A - 8845 Domaine Street- Adult Residential Care FacilityMEMORANDUM
TO: BILL CROWE, CITY MANAGER
FROM: BRAD JOHNSON, PLANNING DIRECTOR
DATE: SEPTEMBER 4, 2002
SUBJECT: 8845 DOMAINE STREET -ADULT RESIDENTIAL CARE FACILITY
At their August 27` meeting, the City Council requested staff to report back on the above referenced
issue, which was raised during the Oral Communications portion of the meeting. A group of
concerned Domaine Street residents, led by their spokesperson Mi. Joe ,Vrnite (who resides in the
home directly adjacent to the subject house), addressed the City Council and conveyed their concurs
with the future use of a currently vacant house within their single family, cul -de -sac neighborhood.
Mr. White indicated that no notification had been provided neighbors about the proposed use of the
home as a care facility. City staff was even unaware of the proposed facility until Mr. White
informed us, and even then it took several inquires at the state level to determine an application was
in process. City Attorney Bob Kress clarified the City's position by explaining that State law
provides that a facility with six or less occupants must be treated by the City as a single - family
residential occupancy; and as such, the City has no licensing or zoning juri sdiction over this type of
facility.
While acknowledging that the proposed residential care facility is within the state's jurisdictional
realm, the Council nonetheless requested a more in -depth report on the matter. The following
information is provided regarding the subject property and proposed application.
Our records indicate that a Mr. Daniel Leech purchased this residence in September 2001 from
"Mclean WJ 1988 Trust ". According to the neighbors the house has not been occupied since that
time.
Over the last few weeks, staff has been informed that a Mr. John Williams has signed a lease with
the property owner to rent the house. Mr. Williams has indicated to staff that he has a current
application pending with the California Department of Social Services (CDSS) to operate an "Adult
Residential Care Facility" at the 8845 Domaine Street house. Mr. Williams anticipates that his
application will be approved by the State within the next few weeks.
COUNCIL AGENDA
SEP 10 2002
ITEM No.
City staff has confirmed with CDSS, Community Care Licensing Division that Mr. Williams does
have a pending application. A database provided by the State, indicates that Mr. Williams also
currently operates a similar adult residential care facility with the City of Rosemead. The current
residential facility is located at 8715 DeAdalena Street and is licensed for a maximum of four
residents that are "developmentally disabled." "Developmentally disabled adults include adults
ranging in age from eighteen to fifty -nine that have some level of mental retardation or other
disabilities including autism, or cerebral palsy that require a level of supervision and or medical care. 0000.
As you are aware, Section 1566.3 of the California Health and Safety Code (enclosed) preempts local
zoning ordinances with regard to regulating such uses if the maximum occupancy is for six or fewer
persons. Even if these facilities are operated by "for profit" entities, the City cannot define them as
businesses or anything else other than a "single family residential" use.
Councilman Taylor requested a copy of the Attorney General's opinion on the disclosure laws related
to these types of residential facilities. This is attached with a memo from the City Attorney. Other ;
attachments as listed below are included for informational purposes that outline operational
procedures for these types of facilities as well as details of the proposed facility.
Although the City does not and is not allowed to regulate these types of uses, staff is attempting to
facilitate a meeting with all of the interested parties. Clearly, inadequate public outreach by the state
and applicant has contributed to the current situation. We have requests in to the CDSS and State
Senator Romero's and Assemblywoman Chu's office, as well as with the facility operator to
schedule a meeting with all interested parties to address any concerns that the neighborhood may
have.
Attachments: California Health & Safety Code § 1566.3 (2002)
Attorney General Opinion on Real Estate Disclosure Obligations
State Policies & Procedures Manual for Adult Res.Care Facilities
Draft Program Plan for Williams Concord House — 8845 Domain St.
State Database list of Rosemead Residential Care Facilities, Licensed by Comm. Care Licensing Div.
Map of Existing Rosemead Residential Care Facilities Licensed by Comm.Care Licensing Div.
Council Memorandum, August 27, 2002
DEERING'S CALIFORNIA CODES ANNOTATED
Copyright 2002 LEXIS Law Publishing, a division of Reed Elsevier Inc.
All Rights Reserved.
* ** THIS SECTION IS CURRENT THROUGH THE 2002 SUPPLEMENT (2001 SESSION) * **
INCLUDING URGENCY LEGISLATION THROUGH 2002 REG. SESS. CH. 201, 7/22/02 AND2001 -2002 3RD
EXTRA SESS. CH. 4XXX, 5/06/02
HEALTH AND SAFETY CODE
DIVISION 2. Licensing Provisions
CHAPTER 3. California Community Care Facilities Act
ARTICLE 7. Local Regulation
Cal Health & Saf Code § 1566.3 (2002)
§ 1566.3. Residential facility as residential use of property; Exemption from local zoning ordinances
Whether or not unrelated persons are living together, a residential facility which serves six or fewer persons shall be
considered a residential use of property for the purposes of this article. In addition, the residents and operators of such a
facility shall be considered a family for the purposes of any law or zoning ordinance which relates to the residential use
of property pursuant to this article.
For the purpose of all local ordinances, a residential facility which serves six or fewer persons shall not be included
within the definition of a boarding house, rooming house, institution or home for the care of minors, the aged, or the
mentally infirm, foster care home, guest home, rest home, sanitarium, mental hygiene home, or other similar term which
implies that the residential facility is a business run for profit or differs in any other way from a family dwelling.
This section shall not be construed to forbid any city, county, or other local public entity from placing restrictions on
building heights, setback, lot dimensions, or placement of signs of a residential facility which serves six or fewer
persons as long as such restrictions are identical to those applied to other family dwellings of the same type in the same
zone.
This section shall not be construed to forbid the application to a residential care facility of any local ordinance which
deals with health and safety, building standards, environmental impact standards, or any other matter within the
jurisdiction of a local public entity if the ordinance does not distinguish residential care facilities which serve six or
fewer persons from other family dwellings of the same type in the same zone; and if the ordinance does not distinguish
residents of the residential care facilities from persons who reside in other family dwellings of the same type in the same
zone.
No conditional use permit, zoning variance, or other zoning clearance shall be required of a residential facility which
serves six or fewer persons which is not required of a family dwelling of the same type in the same zone.
Use of a family dwelling for purposes of a residential facility serving six or fewer persons shall not constitute a
change of occupancy for purposes of Part 1.5 (commencing with Section 17910) of Division 13 or local building codes.
However, nothing in this section is intended to supersede Section 13143 or 13 143.6, to the extent such sections are
applicable to residential facilities providing care for six or fewer residents.
For the purposes of this section, "family dwelling," includes, but is not limited to, single- family dwellings, units in
multifamily dwellings, including units in duplexes and units in apartment dwellings, mobilehomes, including
mobilehomes located in mobilehome parks, units in cooperatives, units in condominiums, units in townhouses, and
units in planned unit developments.
HISTORY:
Added Stats 1978 ch 891 § 3, effective September 19, 1978. Amended Stats 1987 ch 1092 § 2, effective September
24, 1987.
NOTES:
AMENDMENTS:
1987 Amendment:
(1) Substituted "family dwelling" for "single family residence" at the end of the second paragraph;; (2) amended the
third paragraph by (a) deleting "The provisions of at the beginning of the paragraph; and (b) substituting "family
dwellings of the same type in the same zone" for "single family residences"; (3) amended the fourth paragraph by (a)
deleting "The provisions of at the beginning of the paragraph; (b) adding "care" after "residential" wherever it appears;
(c) substituting "if the" for "; provided, that such" after "entity'; (d) substituting "family dwellings of the same type in
the same zone; and if the ordinance does not distinguish residents of the residential care facilities from persons who
reside in other family dwellings of the same type in the same zone" for "single family dwellings; and provided further,
that such ordinance does not distinguish residents of such residential facilities from persons who reside in other single
family dwellings" at the end of the paragraph; (4) substituted "family dwelling of the same type" for "single family
residence" in the fifth paragraph; (5) deleted "single" before "family" in the second to last paragraph; and (6) added the
last paragraph.
CROSS REFERENCES:
Fire and panic regulations: H & S C § 13143.
Minimum standards for protective social care institutions: H & S C § 13143.6.
Regulation of buildings for human habitation: H & S C §§ 179/0 et seq.
COLLATERAL REFERENCES:
Witkin Summary (9th ed) Constitutional Law § 852.
Sep 04 02 10:51a Robert L. Kress 909 593 3349 p.2
WALLIN, KRESS, REISMAN 6 KRANITZ
LAW 011ICES
x800 TWEP:TV.EIGHTL' STREET, SUITE 31S
SANTA MONICA, CALIFORNIA 90305
TEIEFI-IONE (SIOI n50 -a SSZ
`n CSIM1LE IDICI n3C -0506
TO: HONORABLE MAYOR AND CITY COUNCIL
PROM: CITY A 17ORNEYAZZ,�
RE: GROUP HOME (WILLIAMS CONCORD HOUSE)
DATE: SEPTEMBER 4, 2002
Enclosed is a copy of Health and Safety Code §§1566.3 which requires that the City treat
residential care facilities for six or fewer persons as a single family use.
Also enclosed is a copy of a California Attorney General's opinion regardvug the
disclosure obligations of real estate agents regarding such licensed care facilities.
Please ignore the pagination on the documents' the missing page 1 of each document is
just the transmittal sheet.
I believe that these documents are very clear, so 1 won't attempt to paraphrase or recap
them. Of course if you have any questions regarding these documents, please contact me at
(909) 593 -9638.
cc: City Manager
Assistant City Manager
Director of Administrative Services
Planning Director
Sep 04 02 10:52a Robert L. Kress 909 593 3349 p.4
who reside in other family dwellings of the same type in the same zone.
No conditional use permit, zoning variance, or other zoning clearance shall
be required of a residential facility which serves six or fewer persons which is
not required of a family dwelling of the same type in the same zone.
Use of a family dwelling for purposes of a residential facility serving six
or fewer persons shall not constitute a change of occupancy for purposes of Part
1.5 (commencing with Section 17910) of Division 13 or local building codes.
However, nothina in this section is intended to supersede Section 13143 or
13143.6, to the extent such sections are applicable to residential facilities
providing care for six or fewer residents.
. For the purposes of this section, "family dwelling," includes, but is not
limited to, single - family dwellings, units in multifamily dwellings, including
units in duplexes and units in apartment dwellings, mobilehcmes, including
mobilehomes located in mobilehome parks, units in cooperatives, units in
condominiums, units in townhouses, and unit's in ai'annedunit developments.
HISTORY:
Added Stats 1978 ch 891 @ c effective September 19, 1978. ?mended Stats 1987
ch 1052 @ 2, effective September 24, 1987.
NOTES:
AMENDMENTS:
1987 P.mendment:
(1) Substituted "family dwelling" for "single fami..1y residence" at the end of
the second paragraph ;; (2) amended the third paragraph by (a) deleting "The
provisions of" at the beginning of the paragraph; and (b) substituting "family
dwellings of the sane t in the sane zone" for "single family residences "; (3)
amended the fourth paragraph by (a) deleting "The provisions of" at the
beginning of Lre paragraph; (b) adding "care" after "residential" wherever it
appears; (c) substituting "if the" for "; provided, that such" after "entity ";
(d1 substituting ".family dwellings of the same type in the same zone; and if the
ordinance does not distinguish residents of the residential ca:e facilities from
persons who reside in other family dwellings of the same type in the same zone"
for "single family dwellings; and provided further, that such ordinance does not
distinguish residents of such residential facilities from persons who reside in
other single family dwellings" at the end of the paragraph; (4) substituted
"family dwelling of the same type" for "single family residence" in the fifth
paragraph; (5) deleted "single" before "family" in the second to last paragraph;
and (6) added the last paragraph.
CROSS REFERENCES:
Fire and panic regulations: H s S C @ 13143.
Minimum standards for protective social care institutions: H S S C @ 13143.6.
Regulation of buildings for human habitation: H 5 S C P.@ 17910 et sec.
COLLATERAL REFERENCES:
Witkin Summary f9ch ed) Constitutional Law @ 852.
Sep 04 02 10:52a Robert L. Kress 909 593 3349 p.5
1ST CASE of Level 1 printed in FULL format.
OFFICE OF THE ATTORNEY GENERAL OF THE STATE OF CALIFORNIA
Opinion No. 89 -902
1990 Cal. AG LEXIS 7; 73 Op. Atty Gen. Cal. 58
March 14, 1990
PAGE 3
CORE TERMS: national origin, religiun, color, sex, licensed, physical handicap,
handicap, care facility, disclosure, ancestry, real property, dwelling,
buyer, marital status, familial status, neighborhood, disclose, real estate
agent, appraisal, rental, broker, desirability, residential property,
financing, residents, regulation, residential real property, care facilities,
real estate, serving
REQCIESTBY :
1 11
JOHN K. VAN DE KAMP, Attorney General (Rodney 0. Lilvquist, Deputy)
OPINION:
Requested by: MEMBER OF THE CALIFORNIA STATE SENATE.
THE HONOR:BLF. MTT.TON MARFS, MEMBER OF THE CALIFORNIA STATE SENATE, has
requested an opinion on the following question:.
Is a licensed real estate acent required or permitted rn disclose the
location of a licensed care facility servino six or fewer people to prospects.ie
buyers of residential property?
CONCLUSION.
A licensed real estate agent is not required to disclose the location of a
licensed care facility serving six or fewer people tc prospective buyers of
residential property. Disclosure in response to an inquiry is permitted if it 1s
factual, not intended to aid discrimination against or segregation of licensed
care facilities within the community, and in fact does not have that effect.
ANALYSIS
The Legislature has enacted the California Community Care Facilities Act
(Health L Saf. Code, @@ 1500 - 1567.9) nl "to establish a coordinated and
coin prehensive statewide service system of quality community care for mentally
ill, developmentally and physically disabled, and children and adults who
require care or services. . . (@ 1501, subd. (a); see Barrett ( *2) V.
Lipscomb (1987) 194 Cal.App.3d 1524, 1529; McCaffrey v. Preston (1954) 154
Cal.App.3d 422, 42e -429; Welsch v. Goswick (1982) 130 Cal.App.3d 398, 406 -408.)
ni All references hereafter to the Health and Safety Code are by section
number only.
As part of this legislation, "each county and city shall permit and encourage
the development of .sufficient numbers and types of residential care facilities
as are commensurate with local need." (@ 1566.) If these residential facilities
are limited to serving six or fewer persons, they are to be considered as a
Sep 04 02 10:54a Robert L. Kress 909 593 3349 p.10
1990 Cal. AG LE: {IS 7, '14; 73 00. Atty Gen. Cal. SE
PAGE
the area in which real property is located which indicates any preference,
limitation or discrimination because of race, color, sea, religion, ancestry,
physical handicap, marital status or national origin.
"(y) Advising a person of the price or *value of real property` on the basis of
factors related to the race, color, sex, religion, ancestry, physical handicap,
marital status or national origin of residents of an area or of residents or
potential residents of the area in which the property is located.
Similarly, the California Fair Employment and Housing Act prohibits real
estate agents from practicing arbitrary discrimination in the sale, rental,
lease, or acquisition. Of housina accommodations. Government Code section 17948
provices: "It shall be an unl.awfirl practice under this part. for a person to deny
or to aid, incite, or conspire in the denial of the rights created by Section 51
or 51.7 of the Civil Code." Civil Code section 51 creates the rights of "full
and equal accommodations, advantages, facilities, privileges, or services in all
business establishments of every kind whatsoever," regardless of a person's
, '151 "sex, race, color, religion, ancestry, national origin, or blindness or
other physical disability." (Emphasis added.) Under this Civil Code provision,
read in conjunction with Government Code section 12946, a real estate agent is
prohibited from practicing any arbitrary discriuninat.ion in the services he or
she renders, including arbitrary discrimination with respect to a person having
a physical disability. (See Lee v. O'Hara (1962) 57 Ca1.2d 476, 478; 59
Ops.Cal.Atty.Gen. 223, 224 (1976); 58 Ops.Cal.Atty.Gen. 608, 609 -610 (1975); 58
Ops.Cal.Atty.Gen. 154, 155 (1975); 53 Ops.Cal.Atty.Gen. 196, 196 -197 (1970).)
Federal law also prohibits discriminatory practices in the real. estate
industry. The Fair Housing Act (42 U.S.C. @@ 3601 -3631) generally makes it
unlawful:
"To make, print, or publish, or cause to be made, printed, or published any
notice, statement, or advertisement, with respect to the sale or rental of a
dwelling that indicates anv preference, limitation, or discrimination based on
race, color, religion, sea, handicap, familial status, or national origin, or an
intention to make any such preference, limitation, or discrimination." (42
U.S.C. @ 3604 (c); [ 0 1.6] emphasis added.)
For purposes of the federal legislation, "handicap" is defined to include "a
physical or mental impairment which substantially limits one or more of such
person's major life activities." (42 U.S.C. @ 3602 (h)(1).
The express prohibition against_ discrimination based upon_handicap was added
to the federal law in 1988. The Secretary of Housing and Urban Development has
issued regulations implementing the recent federal statutory amendments,
lncludinq 24 Code of Federal Bequlations, section 100.70 (19891:
"(a) It shall be unlawful, because of race, color, reli.aion, sex, handicap,
familial status, or national origin, to restrict or attempt to restrict tine
choices of a person by word or conduct in connection with seeking, negotiating
for, buyi.nc o* renting a dwelling so as to perpetuate, or tend to perpetuate,
segregated housing patterns, or to discourage or obstruct choices in a
community, neighborhood or development.
"(c) Prohibited actions under paragraph (a) of this section, which are
generally referred to as unlawful steering practices, include, but are not
RUG 29 2002 14:12 FP, LRTC
323 986 4912 TO 16263079218 P.01i02
1 1
Date: ���� �O �— Fax number:
To:
From: rL� Co ` ;S 1
Message:
Total number of pages (including this cover sheet):
Telephone: (323) 980 -4934
Fax: (323) 980 -4912
If you do not receive all pages of this transmission, please call (323) 980 -4934
RUG 29 2002 14:12 FF LRTC
323 900 4912 TO 16263079216 P.02i02
PROGRAM: L1515A
DATE RUN: 07/01/02
O F SO
DEPARTMENT O CALIFORNVICES
COMMUNITY CARE LICENSING DIVISION
LICENSING INFORMATION SYSTEM
DIRECTORY REPORT PAGE: 55
DISTRICT OFFICE: LA TRI-COUNTY ADULT
COUNTY: LOS, ANGELES'
FACILITY NUMBER /NAME
FACILITY ADDRESS
LICENSEE NAME CAPACITY
FACILITY PHONE NO. ADMINISTRATOR
- -' - LICENSE COMMENTS -
CITY: POMONA
- -
.FACILITY TYPE: ADULT DAY CARE
-
191593695/CASA COLINA TLC /POST ACUTE BRAIN
'i NJURY SERVICES CASA COLINA CENTERS FOR REHABILITATION 24
250 E. HARRISON 91787
_ LICENSEE PREFERS TO SERVE ADULTS. ACES 18 AND ABOVE.
909 -590 -0955 URABE, BARBARA
.-
191500207/SOHOOL OF FASHION AND DESIGN-'
- - SCHOOL OF FASHION AND DESIGN 25
3530 W. POMONA BLVD. 17 91758
- ONLY HOURS OF OPERATION: 8 AM - A PM MONDAY
909. 595-3586 HIROTA, SYLVIA
`. THROUGH FRIDAY. LICENSEE CAN ONLY'SERVE DEVELOPMENTALLY DISABLED
_
-= .ADUL- TS-.AGES--18 THROUGH 59 YEARS.
19:592015 /SUNSHINE ACTIVITY CENTER
JOHNSON PEARLIE AN❑ ACOSTA GABRIEL 30
CONDITION RANDY JOHNSON
1931 SEVILLA PL 91767
909- 620 -93B6 JOHNSON, P 6 ACOSTA, G..
THIS LICENSE -IS ISSUED SUBJECT TO THE THAT C.
-NOT BE PRESENT IN THIS FACILITY AT ANY TIME . AMB. ONLY AGES 18 THNU
'65 YEARS, DEVELOPMENTALLY. DISABLED. -'
191592465 / SUNSHINE MANOR DEVELOPMENTAL
CENTER..I II 'PEARLE JOHNSON 6 GABRIEL ACOSTA 45
900 NORTH PARK AVE 91787
`v APPROVED FOR NON-AMBULATORY RESIDENTS 18 THRU '85 YEARS, DEVELDP-
909- 622 JOHNSON,PEARLIE
- .MENTALLY DISABLED. THIS LICENSE IS ISSUED SUBJECT TO THE CONDITION
THAT RANDY. O. JOHNSON NOT BE PRESENT IN THIS FACILITY AT ANY TIME."
----------------- _------------------------------------------------
CITY: RANCHO DOMINGUEZ
_ --------------------------- _----------------------------
..
FACILITY TYPE: ADULT RESIDENTIAL
191501287/C -H COMMUNITY LIVING RESIDENTIAL
FACILITY HARTWELL, JIMMY 6 HARTWELL, MAXINE 6
14708 FRAILLY 90221
AMBULATORY ONLY. ADULTS AGES 18.59, FACILITY IS APPROVED FOR AGE EACE
213. 637-4504 HARTWELL, JIMMY /MAXINE
PTION
FACILITY TYPE: ADULT DAY SUPPORT CENTER
191801085 /BRIGHTER OUTLOOK I
BEN BOLLINGER ENTERPRISES, INC. 75
2206 E. CLADWICK STREET_ '
. NON - AMBULATORY ADULTS, DEVELOPMENTALLY DISABLED, AGES 18 THRU 59 YRS.
213 -631 -2070 BABARA:SHAHWAN
-
_- •- -
1918010B3/5RIGHTER OUTLOOK 11
BEN BOLLINGER ENTERPRISES, INC. 75
2214 E. GLADWICK 90220
NON-AMBULATORY ONLY, DEVELOPMENTALLY DISABLED ADULTS, ACES
310 - 631.6380 5HAHWAN, BARBARA
- 10 THRU 59 YEARS,
CITY: REDONDO BEACH
FACILITY TYPE: ADULT RESIDENTIAL
19t001S59/ST MARY BOARD 8 CARE, INC
ST..MARY BOARD 6 CARE, INC. 22
2513 CARNEGIE LANE 90278
LICENSEE PREFERS TO SERVE ADULTS IB -59 YEARS OF AGE. 20 AMBULATORY,
310 - 318.2476 GUIRGES., RAEF 5. -
2 NON AMBULATORY.
FACILITY TYPE: ADULT DAY CAPE ° -'
198202445/CANYON VERDE
CANYON VERDE SCHOOL, INC. -
2761 190TH STREET 90276
_4
- LICENSEE'PREFERS TO SERVE ADULTS AGES .18 -59. 40 AMBULATORY AND
310. 371-7721 NANCY LANGDO ^_
8 NON - AMBULATORY,
191001361 /SOUTH BAY ADULT CARE CENTER,
INC, "- SOUTH BAY ADULT CARE CENTER, INC. 30
3007 VAIL AVENUE 90278
LICENSEE PREFERS TO SERVE ADULTS AGES 60 YEARS AND OVER.
310 - 214 -6963 PHILLIPS, KATHLEEN
-
_____________________________________________________
CITY RESEDA
:
___ ____ ________________________ ______________ __ ______ _____ ____
FACILITY TYPE: ADULT DAY CARE
-
197603521/TLC SUPPORT CENTER -
THERAPEUTIC LIVING CENTER FOR THE BLIND 30
7915 LINDLEY AVENUE '� -91335
_
't IGENSEE SERVES DEVELOPMENTALLY DISABLED ADULTS -ACE 18 -iDO YEARS,
818- 706-1740 FORD NEALE
20 AMBULATORY AND 10 NON-AMBULATORY.
_____________________________________________________
CST SEMEAD
___________ _______ _____ _______ -_._
_
FACILITY TYPE' ADULT RESIDENTIAL
- - -- - -
I97R00035 /HEGLIS CARE HOME
C_A.R.E. FOUNDATION 4
3218 HEGLIS AVE. 91770
LICENSEE TO SERVE DEVELOPMENTALLY DISABLED ADULTS 19 =_ 59 YEARS
826 -280 -0061 PINEDA, MILLET
OLD, 2 AMBULATORY AND 2 NON - AMBULATORY.
197602895/ROSEMEAD HOME _.
ORIENTAL CARELAND LLC B
3132 ROSEMEAD PLACE - 91770
APPROVED FOR DEVELOPMENTALLY DISABLED ADULTS IS THRU 59 YEARS OLD,
626-288-9348 GUI -GIN ZONG
3 NON - AMBULATORY ONLY,
197801709 /ROSEMEAD VILLA
'PASCASIO ENTERPRISES, INC. 22
-9025 GUESS ST ' 91770
LICENSEE PREFERS TO SERVE MENTALLY DISABLED CLIENTS. AMBULATORY ONLY,
625-280 -4375 PASCASID, ZONEL
AGES 16 THRU 59.
191592301 /SPRINGFIELD MANOR
VASGUEZ. OLIVER C 32
2525 N. NEW AVENUE 91770
APPROVED TO SERVE MENTALLY DISABLED ADULTS AGES 18.59 YEAR OLD.
B2B- 572 -4140 VASGUEZ, OLIVER
AMBULATORY ONLY, OPERATION IS SUBJECT TO THE STIPULATION AND
WAIVER AND ORDER #8200042001 EXPIRED ON 12/20/2003.
197803956 /WILLIAMS CONCORD HOUSE
JOHN 6 BETTY WILLIAMS 4
8715 OE ADALENA ST. 91770
LICENSED FOR FOUR AMBULATORY DEVELOPMENTALLY DISABLED CLIENTS
626 - 572.9207 BETTY WILLIAMS
AGE 18-59,
FACILITY TYPE: RESIDENTIAL - ELDERLY -
191501673 /CALIFORNIA CHRISTIAN HOME
CALIFORNIA CHRISTIAN HOME INC, THE 256
0417 MISSION DRIVE 91770
250 NON-AMBULATORY CLIENTS AGES 50 AND OVER, APPROVED DEMENTIA
626- 287 -0438 KITCHLL, BEVERLY
WAIVER FOR 12 CLIENTS, HOSPICE WAIVER.
197800894 /NEW FERN GUEST HOME
ALVIN 35
2506 N. NEW AVE- 91770
91
APPROVED FOR ELbERtY AGE 61 AND ABOVE. MAY ACCEPT 20 NON-AMBULATORY
818-280.8133 CHIN. ALVIN
OLIENT9, -
MAYOR:
ROBERT W. BRUESCH
MAYOR PRO TEM:
JOEVASOUEZ
COUNCILMEMBERS:
MARGARET CLARK
JAY T. IMPERIAL
GARY A. TAYLOR
R osesocad
8838 E. VALLEY BOULEVARD • P.O. BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218
MEMORANDUM
TO: BILL CROWE, CITY MANAGER
FROM: BRAD JOHNSON, PLANNING DIRECTOR" /
DATE: August 27, 2002
SUBJECT: 8845 DOMAINE STREET -ADULT RESIDENTIAL CARE FACILITY
Planning - Department staff has begun investigating a resident complaint regarding 8845 Domaine
Street. A resident has phoned City Hall with information that a residential care facility has proposed
to move into,their neighborhood. I have contacted the proposed operator (Williams Concord House)
and a Mr. John Williams informed me that he is processing an application for an "adult residential care
facility" at the Domaine address. Mr. Williams currently operates a similar facility within the City of
Rosemead that is licensed by the State Department of Social Services. Mr. Williams is licensed by the
State for a maximum of four clients at 8715 De Adalena Street. The application request for the
Domaine Street location al§o requesting an occupancy of four clients.
Williams Concord.House operates residential care -facilities for "developmentally disabled" adults.
These clients require. 24 -hour supervision and include services for providing health care to the
residents. . Mr: Williams has informed me that he has been in the application process with the State
for five months. He anticipates that he will have all of the approvals by mid September. The contact
person that is reviewing this application is William O'neil who works for the Department of Social
Services, Community Care Licensing, Mr. O'neil's phone number is (323) 981 -3981.
As you are aware, Section 1566.3 of the California Health and Safety Code preempts local zoning
ordinances with regard to regulating such uses if the maximum occupancy is for six or fewer persons.
Attached for your review is exerpts' from the Health and Safety Code as well as other pertinent
information related to Mr. Williams and his requested use at the subject site. I will keep you informed
as I. hear additional information - on this item. If you have any further questions please let me know.
Digital Map Central
Page I of I
Property Detail
APN: 5389 - 014 -037
8845 DOMAINE ST
Assessed Value: $ 47036.0 Absentee Own: Y
SALES DATA
Land Value:
$ 22800.0
Census Tract:
432200310 Impr. Value:
$ 24236.0
TBM Page:
596 -H5 Prop Tax:
$ 612.61
Phone Number:
LAST '
PRIOR SALE
Owner Name:
LEECH DANIEL
Sold:
Mailing Address:
427 N BARRANCA AVE GLENDORA CA 91741
Units:
SALES DATA
IMPROVEMENTS
LAST '
PRIOR SALE
Living Area:
1748
Sold:
09/1212001
Units:
1
Recorded:
1012612001'
Stories:
1.0
-
Year Built:
1958
Sale Price:
$ 244500.0,
$
Total Rooms:
7
Sale Code:'
'F` :. _ -
Bedrooms:
3
Document:
' -
Baths:
Doc YeaF: ` "' "
.2001 . , -
" '
Fireplaces:
1 st TD:' ' ` " "
" "$ 1 195600-0 "
Pool:
— ..:•.:.._
_ _ >. - : .- ...
Bsmt Area:
- .
Construction:
Lender: _
INDYMACIBK FSEI
Building:
Seller:
MCLEAN "W J'1988 TRUST
Exterior Walls:
STU
....... —
Garage:
A00
Flooring:
SITE DATA
A /C:
Heat:
CLO
Lot Area`.
7357 -. - -
Lot Frontage:
62
Lot Depth:
119
Zoning:
RMR1YY
Lot Number:
9
Legal Description: TRACT # 20839
http: // maps .digitalmapcentral.com /silver_ server /servlet/FileReaderServlet ?FILE NAME=forms 8/27/02
STATE OF CALIFORNIA - HEALTH AND HUMAN SE,...JES AGENCY
GRAY DAVIS, Governor
DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
1000 Corporate Center Drive, Suite 200A, Monterey Park, CA 91754
Rosemead City Planning
8838 East Valley Blvd.
Rosemead: CA 91770
Dear Community Development Director:
Date:
09/11/01 -
RE: Applicant Name:
John 8 Betty Williams _
Facility Name:
R'illiams Concord House
Facility Address:
8715 De Adalena St.
Rosemead, CA 91770
Facility Type:
Adult Residential Facility
Facility Number:
197803956 • -_- __
Requested
0004
This office has received an application for a license to operate a residential care.facility referenced by Health and Safety Code,,.
Section 1520.5.
This code section sets forth the State's policy and requirements reprdmcF-the ov erconcentration'of residential care facilities.'
It defines overconcentration as "facilities which are separated byta distance of 300 feet or less'.as measired from anypomt '
upon the outside walls of the structures housing such facilities." The law r.eg °tl e`Director'of.the' Department of Social. : 1
Services to deny an application for license if the proposed facility is 300 feet or less ffoin another residential facility unless'
approval is obtained from the city or county in which the facility v✓ill be located:' The law also requires the Department of .
Social Services to notify the local agency 45 days in advance of appro ing an application for license. The,local agency may _
. .
request denial based upon overconcentration
We have determined that the proposed facility is more than 300 feet m fro any other licensed residential home as.
defined by the Health and Safety Code. Therefore should the referenced appllcant'meetother requirements for
licensure, we will approve the application. Should your'agency'S tee determine that the proposed facility is 300
feet or less from another residential facility, please notify us within 45 days:`` - = -
'e have determined that the proposed facility is 300 feet or less from an existing facility: We remind you of your
'Ale
9Dt:On to approve an e "emptinn from the exist P' regUirrrpentrh i p n , lo N n ed5�a7`d' C -0 ^.d:n nn S. ]f VO!1 d0
not approve this exemption within 45 days,,we will den} the application Wittioutftirtliei review.
Please include the above facility identifying information in any correspondence regarding this subject_
Thank you for your attention to this matter.
Sincerely,
Donald Lopez
Licensing Prograha Analyst
CC: Applicant
LIC 166 (4/82) (Public)
Aug 27 02 11:48a Executive Office
—._. vv itfY ...l � rW l.. � .���_rn��. — ♦r��u.J VrJJ ip
MENTAL HEALTH ADVOCACY SERVICES, INC.
A NON PROFIT ORGANIZATION PROVIDING LEGAL SERVICES To PEOPLE WITH MENTAL AND DEVEL
1336 WILSHIRE BOULEVARD, SUITE 102
LOS ANGELES, CA 90017
A�SYYYb u�l4. .v
NANCY M. SHEA
ci Mcm.y
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'au[811on $bi0¢Ea
SHERRIU MA571N
Bm61116 SmIallm
PAMELA MARY
stall Mbmoy
SpA A alY
Kim $$WAG[
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MARY V.\VCB..^ ER
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MAGGIE BRANDOW
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Goorch R. Nmya
Peter M. Moanun
eKiy Nortlm :e
HL ^al Ppeba!
MAX IL Rbllt
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April 8, 2002
Ms. Barbara O'Hearn
Legal Division
Department of Social Services
744 P. Street
Mail Station 4 -161
Sacramento, California 95814
Re: Homes for Life Foundation -
7
PHONE (213) 48- .1528+
FAX (213) 484 -2907•
Via Facsimile and First Class Mai
„�
Foster Care System with Disabilities Located in the City o f San Gnbnel
Dear Ms. &Hearn: _
Thank you for contirming your receipt of Homes for Life Foundations (HFLF)
documents concerning its home for six emancipated - young adults_with<mentaLdisabilities
in the Citv of San Gabriel. The documents were sent in response io.ihe
inquiry as to whether licensure under the Community Care'Facthtles Act ISrequ red fot-
this home. This letter is provided as a follow -up to thosc,documenfsdn ah:efforrio ens i *e
that the Department has a full and accurate understandzng oftfie f PLF homes PulposEt -
and function for transitioning young adults, why licensure,of ttie'honlc is <iio ;mandatrd,
and to assure The State that there is substantial oversight of fie progiapi opera
z'� uont'by
the County of Los Angeles.
We understand that the Department was contacted due to the opposzuon of a
group of San Gabriel residents who object to a home,for indi"duals with - mental : -
disabilities in their neighborhood and have asserted to the Cou` - ty' wittioit subsiant at on.
that the home requires a license. Despite_ that suspect motivation, we understand the
Department's responsibility for evaluating the borne accordii g to the licensing statute
and regulations and HFLF_ fully intends to cooperate with you in the resolution of dtis
matter.
The Homes For Life Foundation Trans itional -A ee -Youth Program Will Have Substa
Oversight by the County of Los An eie .
The HFLF residential progr In, referred to as HFL Athena Homes Transitional -
Age -Youth (TAY) Program, is a collaborative effort on the part of v`tree County of Los
Angeles Departments including Nfental Health, Children and Family Services and the
213 - 890 -8584 F.1
Aug 27 02 11:48a Executive Office 213- 890 -8584
�•" �_^ -- u.::Jl I`IHfY�_ f LnW I J HabUL 1H I t7 _ 1,i�.J.r7Ub5 !C
Ms, Barbara O'Heam
April 8, 2002
Page 2
p.2
10. 6
C,
Community Development Commission. As described more fully below, the program
assists emancipated young adults with disabilities leavine the foster care system in
making a successful transition to independent living. The San Gabriel home will provide
a supportive family -like environment for up to two years to six carefully. screened art 'd
selected young adults, 18 to 21 years old, who are capable of pursuing educational,
vocational and employment goals with guidance and assistance.
There will be substantial oversight of the HFLF home by the three County
departments involved in the prograrn to ensure that it is successful both in terms Of
compatibility in a con•,munity setting and its effectiveness in smoothly transit onin�
vounn adults to independent living. Each of these departments will have a role in seeing
that the residential program is well run, has an appropriate and effective scree=.uing -
selection process (two of the agencies will actually participate in the screen ng of young .
adults for the program) and that all contractual obligations are met. HFLF tdll.report'o . the. Department of Mental Health `s Quality and Assurance Divisior. and Ho rzless =
_ - Housing Division on operation of the.program, including matters perta runes tp, _ ,,
assessment, placement, supportive services, follow -up services, and fiscal manaeemeni =
The home will also be a Medi -Cal certified site and client files and records will be
maintained in accordance with requirements of the Department of Mental Health. The' '
Community Develu Drama Commission/Housing Authori ty of thc.County of. Los .Ang t Its
will perform annual inspections of the home to assure that the home is well niain amed.'�. - y
In essence, the State can be assured that without the necessity of a license the.Ca ,m'v has' ,
_-,substantial oversight as well as a vested interest in the.program'ssuccess f
The HFLF H Does Not Require Licensure Because It DOe s'Ndt - PION I e Caie and w
Supervision To The Young Adults Nor Are These Residents In N eed of.This "I: i'nd't)f
Assistance
As you know, the purpose of licensing under the Community Care, Facilities, Act
into ensure that individuals with mental disabilities residing.in.a:gioup home setting
receive the necessary level of care, supervision and assistance to live slfccessftllht
community setting. Those facilities or homes requiring licensure under tteAct sere
individuals who in many instances are unable to function in a community settine.without
substantial and continuous supervision and assistance with basic activities:of daily living.
The San Gabriel HFLF home is not a residential program requiring licensing because the
young adults entering the program will not need the care, supervision and mistmt:6
contemplated by the licensure mandate nor will the home provide "care and supervision"
as enumerated by the controlling regulations. Health & Safety Code § 1 >U2(a)!1); 22
CCR 80001(c)(2). Understanding the home environment fnr this TAY program. which
focuses on strengthening and further developing independent living skills, is the key to
distinguishing the HFLF home firm tnos: community case facilities that require state
licensing.
Rug 27 02 11:49a Executive Office
1 --+. - lo: U1 NHN+ ) l=Wl= riSSU'.,:Hlti " 16 1=r! tjn,b
Ms. Barbara O'Hearn
April 8, 2002
Page 3
213 - 890 -8584
p.3
r1 U. 523 !a
The young adults selected to participate in the TAY program and reside in the San
Gabriel home are those that have been determined by a cormninee of experienced mental
health professionals from the Department cf ivlental Health the Department of Children
and Family Services and HFLF as having the capacity to pursue educational, vocational
and employment goals in an increasingly independent manner and within a two yea*
period successfully transition to self - sufficiency and independent living. The rigid
selection criteria in place will identify those 18 to 21 year olds whose medical, family and .
foster care placement history and sobriety substantiate am ability to live in a supportive
family like setting in the community while pursing educational., vocational and
employment goals. The young adults selected for the program come to the home capable
of casinn for their personal hygiene and they are self- sufficient their "activities of daily
living." From their family foster care experience, these young adults will have already
exhibited a level of independence including, for example, traveling to and from school
and social and recreational activities on their own. The Community Care Facilities Ac;
does not require licensing where the young adults with mental disabilities have he
capability set forth above.
_... - .:.._...men -.... f
Thr, presence of staff at the home and their efforts in working with the young
adults is distinctly distinguishable from the "care and supervision" provided in
community care facilities requiring licensure. The staff role is to provide guidance to the
young adults as they formulate their goals for independence lid undertake
accomplish their goals be it an academic, vocational or employrnent path. W'lule staff is
well aware of the young adults' schedules and comings and goings to and from the home they do 'manage the residents nor exercise control ovei their daily actrvlues. ' i ha _
- young adults' acceptance into the program and successful stay at the home require Lh t 4.
they choose and are accountable for their daily schedule and activities while staff present' t "_
be available for guidance and advice. The manner in which this home will function is in
sharp contrast to those licensed facilities that provide essentially constant supervision of
residents, exercise control over residents' daily schedules and activities and make
decisions for them.
In an effort to more precisely address why the HFLF San Gabriel home, does net'
require licensure, we arc providing the following analysis of each element of the "Care
and supervision" activities enum- crated in 22 CCR 80001(c)('2) .
" e Assistance in dress, ng, oomin barhing and other personal hygiene. "
Staff at the home will not provide personal hygiene assistance and there is no
need for this type of care for the young adults, Each and every young adult who resides
in the home is fully capable of caring for his or her personal hvgienc needs. The selection
criteria and evaluation process for participation in the TAY program will substantiate that
the yotmg adults have been attending to their personal hygiene prior to coming to the
home and will rontinuc to do so whilcaesiding at the home.
Rug 27 02 11:49a Executive Office 213 - 890 -8584
.,., �� �c io: tic ntirai_, mew :o tioou_�:;ito - loe�o�U5ovo
Ms. Barbara O'Hearn
April 8, 2002
Page 4
"(B) Assistance with taking medications ...
p.4
NO. Lie_
Gk_J
Any ,young adult.resident that lives at the home who takes medication(s) will be
both self - medicating and responsible for storing his or her medications. The program
will not provide assistance to those residents who do take medications while residing at
the home, nor will the program take responsibility for storing any medications used b
the young adults.
*'(C) Central storing and'or distribution of medications. "
As indicated above, the HFLF will not maintain a central storage nor will it storc
or distribute any medications used by the young adults.
:. "(D) Arrangement of and assistance with medical and dental care. "
Each young adult resident will make his or her own medical and dental
appointmcnts as necessary and comes to the program having already. had such
eYperiencc. HFLF will neither arrange nor assist with medical care as -1iis is an important
independent living skill.. ..
YE) Maintenance_ofhouse rules for the protection of clients. "
_.._
The San Gabriel HFLF home will have program rules that address allowable
— behzi :grand day -to -day operations of the residence for the purpose of effectively
ensuring that each member of the household is a good neighbor, both in the home, and ir.
'- the community. The HFLF-home's program rules will be similar to those rules
commonly used for residential dwellings to address each resident's right to quiet
enjoyment of his or her premises. Similar provisions are often provided as addendums to
leases for multi- family residential dwellings. HFLF program rules are developed for the
- foregoing reasons and not for the protection of the residents.
"(F) Supervision of'client schedules and activities
As indicated earlier, the young adults participating in the TAY program will
receive from staff guidance in developing their educational, vocational and/or -
employment goals and the path to achieving those goals. Through this collaborative
effort and oversight, the young adult residents will then take the necessary day -to -day
steps to accomplishing their goals whether it is attending school or vocational training
programs and/or gaining employment. The staff is present to provide the residents with
guidance and support as they strengthen existing and develop new independent living
skills, The residents will not be supervised in the manner contemplated by the
regulations.
Aug 27 02 11:49a Executive Office 213-890 -8584 p -5
In:Ue nnra - I-W 1� :m n0 uU lH�em L= CiCt+ ✓JCb'(n
� - li i. oc_ Vby
Ms. Barbara O'Hearn
April 8, 2002
Page 5
"(G) Maintenance and /or supervision of client cash resources or property. "
The residents will have no money.when they move to the home nor will they pay
.anything to live at the home. It is possible that the program will give the young adults a
small monthly allowance to spend on incidentals as they so choose. If an allowance is
provided to the residents. HFLF will neither onto nor supervise this small amount of
money. As pan of the strengthening of independent living skills the young adults xvill be
fully responsible for what they do with the money. Residents will have had exposure to
basic money management concepts but will be taught how to balance a checking account,
all of which leads to successful independent living.
`(H) Monitoring jbod intake or special diets. "
The HFLF residents in the•.San,Gabnel home will participate in the shopping and
meal preparation for.the household. This activity will be an integral pan of their
pa ttcroatitiri tc'the'TAY progfam-as it'wih'strengdien inde living skills. Unlik - e a
facility - requiring liccnsin; under the Community Care Facilities Act where the provider
prepares and serves meals, monitors intake and special diets of its residents, at the HFLF
home it is the residents themselves who will-takt responsibility, in an increasingly
_- independentmatmer, for providing meals at the home,
_ _ '(I) Providing basic services as defined in section 80001(6)(2). "
As lndlcated above; HFLF wtll. "notimcdical care and supervision" on
— - �4 -hotii pei day basis, which is the defusing requirement of a licensed community care
facility; - The'distinction between a facility providing this type of care and supervision
and the program is that the 1 young adults themselves are responsible for
dally activities traditionally handled by the housing provider or staff in a licensed facility. -
;The young adults participating in the TAY will complete grocery shopping and meal
preparation for the household, clean and maintain the home, schedule their own medical
appointfnents, do their own laundry, and manage their own monev. While these young
�addlts will have staff guidance, they will not be "taken care of by the staff. The
iesidems will be participating in a program purposefully designed to strengthen their
skills for independent living in the community,'
Based on the foregoing analysis, HFLF does not require licensing under the
Community Care Facilities Act. flrhile HFLF understands that there is concern b_v some
as to the location of this home for young adults with mental disabilities, this does not
warrant licensing of a program that will function effectively under the guidelines of the
TAY program and the oversight of the County of Los Angeles. Hodes for Life
Foundation has developed and run a variety of programs for individuals with mental
Rug 27 02 11:50a Executive Office 213- 890 -8584 p.6
10: vWJ NHINL I LCW 1 O YOJ�JI. 1 N Cb 14d6t.M19N7 /b
I b lJ 1E'
Ms. Barbara O'Heam
April 8, 2002
page b
disabilities in the Los Angeles a! , all of which are of the highest quality and excellence.
11FLF's San Gabriel home will continue to uphold this fine reputation.
If you ar e in need of any additional information, ple.ase.do not hesitate to contact
me.
Sincerely,
Kim Savage
senior Attorney
KS:rc .
cc Rich lvlason
I:athryn Bar=er, Chtef Deputy; Fifth Supervlsonal Distr ct
Resse Roman, Deput)' Fifth Snpervisorial D'strict„
Carlos Jackson, Executive Director, Community Development Commissron,
_.County of Los Angeles '- p t of Mental Health
T Dr. Marvin Southard, Director, Los Angeles:County' p
Barbara-Wall3cc, Chief, Homeless cg Housing Division, Los Angeles County
Department of MeatatHealth -
_ Ain Bo , Director; Los Angeles County Dept ofChildren &Family Ser��ces
Muh�al Qlemck Cliicr, Emancipation Se ices Division, -Los Angeles County
Dept of Children & Family Services .
Conroe Fanos, Manaeer °Children Rcsidenual policy, Community Care Licensing
Division, California Department of Social Services
- tionorable Gloria Romero, State Senator, 24` Senatorial District
Honorable.Judy _Chu, State Assemblymember, 49 Assembly Disuict
Carol Liess,- Executive Director, Homes For Life Foundation
Nancy Lewis, Nancy Lewis Associates, Inc.
Aug 27 02 11:50a Executive Office 213 -890 -8584 p.7
MENTAL HEALTH ADVOCACY SERVICES, INC.
A NON PROFIT ORGANIZATION PROVIDING LEGAL SERVICES TO PEOPLE WITH MENTAL AND DEVELOPMENTAL DISABILITIES
1336 WILSHIRE BOULEVARD,
SUITE 102 PHONE (213) 484 -1628
LCS ANGELES, CA
80017
FAX (213) 484•2407
AME -° PACIS
urcul�. Oira ^.Iw
CjiRO
May 9, 2002 -
NANCY M. shF
s. , Jr AR°m"
Ms. Barbara O'Heana ...
LO'S'A 'NEINEERQ. on.C.
Legal Division
Ea,o,un, S�eIIe1
_
SrIERRILL -AR H
Department of Social Services .
S,�Z. s aamlcl
744 P. Street
SrW x
Mail Station 4 - 161
SONIAI- RARRANTES
Sacramento, California 95814
SIB Ae.��N
Re: Homes For Life Foundation Located in the Citv of San Gabriel
MARY V. WEBy rER
Sar A°.°cMe
_
Dear Ms. O'Heam: ....5 .. .. -
MAGGIE SRA 0
_ .. .. .
s aa° ^ F &-
Homes For Life Fotindauon requests that the Departzn6bt of Social Services defer
MONL COELHG
64x1' A
making a fival decision concerning.licensure.of its. San Gabriel home for six young adults
..*
MARL E ANGELUCUI
with disabilities emancipated from the foster care system. As I explained to you, Homes
stall A " Only
For Life Foundation and the County of Los Angcles;'whicb provides funding for the
S' m;, B E"
home, are currentiv'discussing t1i'e riew cer[incation- procedure available to transinonal
RE NEf COOK
housing programs under Health. Safeij §1,559.110(e).
Dlraaorm Anrlicmrat'Im,
!— ._. -
We appreciate your contiiidine courtesy ando
- coperation in this'tn °tier;. Please d6
OAPHNE APOSTLE
any questis a't thisaim
not hesitate to contact ine 1f you have on
I.
AIhNTatr3lnv AaJatBn!
;. .. - ..
Sincerely,
Pn4AO cnIS FrTaac_
- _
_ .- .
J
"Dal>
Kim Savage
LameE.FOe
-
Senior Attorney
Polar Ga�um
aver M. N°rlmu'.
kS:rc
Eery NoRmna
-
namet Pcsner
M..A S. R=
cc: Rich Mason, County Counsel
AnGraw A'Jnln
Flyt Ss�
Kathryn Barger, Chief Deputy; Fifth Supervisorial District Le
6 ma roan
Resse Roman, Deputy, Fifth Supervisorial District
M,enn we r,Meln
Carlos Jackson, Executive Director, CDC
Dr. Marvin Southard, Director, LACDMH
Barbara Wallace, Chief, Homeless & Housing Division. LACDMH
Anita Bock, Director, DCFS
Micheal Olenick Chief, Emancipation' Services Division, DCFS
Count Fauos, Manager, Children Residential Policy, Cununuaity Car- Liceusing
-
Division, DSS
Carol Liess, Executive Director, Homes For Life Foundation
Nancy Lewis, Nancy Lewis Associates, Inc.
VU
Manual of Policies and Procedures
COMMUNITY CARE LICENSING DIVISION
ADULT RESIDENTIAL
FACILITIES
Title 22
Division 6
Chapter 6
STATE OF CALIFORNIA
Gray Davis, Governor
HEALTH AND HUMAN SERVICES AGENCY
Grantland Johnson, Secretary
DEPARTMENT OF SOCIAL SERVICES
Rita Saenz, Director
Distributed Under the Library Distribution Act
November 2001
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES
TABLE OF CONTENTS
TITLE 22, DIVISION 6
CHAPTER 6 ADULT RESIDENTIAL FACILITIES
Article 1. General Requirements and Definitions
Section
General............................................................................................................. ............................... 85000
Definitions....................................................................................................... ............................... 85001
56 - -- - Fo has
Defi nitions rms .......................................................................................... ............................... 85002
Article 2. Licensing
Postingof License ............................................................................................ ............................... 85009
Article 3. Application Procedures
Applicationfor License .................................................................................... ............................... 85018
Plan Operation ............................................................................................. ............................... 85022
Article 4. Administrative Actions (Reserved)
Article 5. Enforcement Provisions
SeriousDeficiencies ......................................................................................... ............................... 85051
Article 6. Continuing Requirements
BasicServices ................................................................................................. ...............................
ReportingRequirements ................................................................................. ...............................
Administrator Qualifications and Duties ........................................................ ...............................
Admm�' trator Certification Requiremems ................................. ........:...................... .....
Adcnincs$al ' r * Recerificalion Re4uiiernens ................ .
n of
Denial or Revocatio a Ce�rtificatc ............................. ..................... ............................... .
., a ti r, r✓——
Forfeitoie'of: a= Cemficate ............:.................................................................. ...............................
Personnel Requirements .................................................................................. ...............................
DayStaff - Client Ratio .................................................................................... ...............................
NightSupervision ........................................................................................... ...............................
PersonnelRecords ........................................................................................... ...............................
Admission Agreements ................................................................................... ...............................
AdmissionProcedures .................................................................................... ...............................
85060
85061
85064
85064.2
850fi4'.3
85064.4
85064.5
85065
85065.5
85065.6
85066
85068
85068.1
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 115/01
Page 1
ADULT RESIDENTIAL FACILITIES Regulations
TABLE OF CONTENTS (Continued)
Article 6 (Continued)
Section
Needsand Services Plan .................................................................................. ...............................
85068.2
Modifications to Needs and Services Plan ....................................................... ...............................
85068.3
Acceptance and Retention Limitations ............................................................ ...............................
85068.4
Repealed by Manual Letter No. CCL- 97 -05, effective 2/ I/ 97 ......................... ...............................
85068.5
Mental Health Intake Assessment .................................................................... ...............................
85069.3
ClientRecords .................................................................................................. ...............................
85070
PersonalRights ................................................................................................ ...............................
85072
Health- Related Services ................................................................................... ...............................
85075
Observation of the Client ................................................................................. ...............................
85075.3
FoodService .................................................................................................... ...............................
85076
PersonalServices ............................................................................................. ...............................
85077
Responsibility for Providing Care and Supervision ......................................... ...............................
85078
Activities .......................................................................................................... ...............................
85079
ResidentCouncils .................................................................... ...............................
85080
Req uirements for Etner ServicesrPlacements ................ ............................850871
Article 7. Physical Environment
Buildingsand Grounds ....................................................................................
............................... 85087
OutdoorActivity Space ....................................................................................
............................... 85087.2
IndoorActivity Space ......................................................................................
............................... 85087.3
Fixtures, Furniture, Equipment and Supplies ...................................................
............................... 85088
Article 8. (Reserved)
Article 9. Administrator Certification Training Programs
Initial Certification Training Program Approval Requirements ..................... ...............................
85090
Denial of Request for Approval of an Initial Certification Training Program ...............................
85090.1
Revocation of an Initial Certification Training Program ................................ ...............................
85090.2
Continuing Education Training Program Vendor Requirements .................... ...............................
85091
Continuing Education Training Program Course Approval Requirements .... ...............................
85091.1
Administrative Review of Denial or Revocation of a Continuing Education Course ...................
85091.2
Denial of a Request for Approval of a Continuing Education Training Program g .........................
Revocation of a Continuing Education Training Program .............................. ...............................
85091.3
85091.4
CALIFORNIA -DS S- MANUAL -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 2
ADULT RESIDENTIAL FACILITIES
This Users' Manual is issued as an operational tool.
This Manual contains:
a) Regulations adopted by the California Department of Social Services (CDSS) for the governance
of its agents, licensees, and/or beneficiaries
b) Regulations adopted by other State Departments affecting CDSS programs
c) Statutes from appropriate Codes which govern CDSS programs; and
i
d) Court decisions
e) Operational standards by which CDSS staff will evaluate performance within CDSS programs.
Regulations of CDSS are printed in gothic type as is this sentence
Handbook material, which includes reprinted statutory material, other department's regulations and examples,
is separated from the regulations by double lines and the phrases "HANDBOOK BEGINS HERE ",
"HANDBOOK CONTINUES ", and "HANDBOOK ENDS HERE" in bold print. Please note that both
other department's regulations and statutes are mandatory, not optional.
In addition, please note that as a result of the changes to a new computer system revised language in this
manual letter and subsequent community care licensing manual letters will now be identified by grap tchtch
r
screen.
Questions relative to this Users' Manual should be directed to your usual program policy office
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -89 -09 Issued 7/1/89
Page 3
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85001 (Co
Article 1. GENERAL REQUIREMENTS AND DEFINITIONS
85000 GENERAL 85000
(a) Adult residential facilities, as defined in Section 80001a.(5), shall be governed by the provisions
specified in this chapter and in Chapter I, General Requirements.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1502, 1530 and
1531, Health and Safety Code.
85001 DEFINITIONS 85001
In addition to Section 80001, the following shall apply.
a. (1)
HANDBOOK BEGINS HERE
( 1 ?)
b. (Reserved)
C. (1) "Certificate holder" means a person who has a current administrator's certificate issued by the
Department regardless of whether the person is employed as an administrator in an adult
residential facility.
(2) "Certified administrator" means a person who has been issued an Administrator Certification by
the Department and whose certification is current.
(3) "Classroom Hour" means sixty (60) minutes of classroom instruction with or without a break.
It is recommended that no more than twenty (20) minutes of break time be included every four
(4) hours of instruction. No credit is given for meal breaks.
(4) "Co- locate" means that a vendor applicant is approved for more than one program type, i.e., ARF,
RCFE, GH, and has received approval to teach specific continuing education courses at the same
time and at the same location. Co- location is allowed for Continuing Education Training
Program vendors only.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -21
Effective 10/25/01
Page 4
85001 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85001 DEFINITIONS (Continued) 85001
(5) "Complete Request' means the vendor applicant has submitted and the Department has received
all required information and materials necessary to approve or deny the request for certification
program and/or course approval.
(6) "Continuing Education Training Program Vendor" means a vendor approved by the Department
to provide Continuing Education training courses to adult residential facility administrators and
certificate holders to qualify them for renewal of their adult residential facility administrator
certificate.
(7) "Course" means either, (1) a quarter -or- semester -long structured sequence of classroom
instruction covering a specific subject, or (2) a one -time seminar, workshop or lecture of varying
duration.
d. (Reserved)
C. (Reserved)
f (Reserved)
g. (Reserved)
h. (Reserved)
i. (1) "Initial Certification Training Program Vendor" means a vendor approved by the Department
to provide the initial thirty -five (35) hour certification training program to persons who do not
possess a valid adult residential facility administrator certification.
(2) "Initial Vendor Application" means the application form, LIC 9141, used to request approval
from the Department to become a vendor for the first time.
(Reserved)
k. (Reserved)
(1) "Licensed Mental Health Professional" means a licensed clinical psychologist; a psychiatrist; a
licensed clinical social worker; or a licensed marriage, family and child counselor.
M. (Reserved)
n. (1) "Needs and Services Plan" means a written plan that identifies the specific needs of an individual
client, including those items specified in Sections 80068.2 and 85068.2, and delineates those
services necessary to meet the client's identified needs.
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 4.1
Regulations ADULT RESIDENTIAL FACILITIES 8 5001
85001 DEFINITIONS (Continued) 85001
o. (Reserved)
p. (Reserved)
q. (Reserved)
r. (1) "Renewal Vendor Application" means the application form, LIC 9141, used to request approval
from the Department to continue another two (2) years as an approved vendor.
S. (Reserved)
t. (Reserved)
U. (Reserved)
V. (1) "Vendor" means a Department- approved institution, association, individual(s), or other entity
that assumes full responsibility or control over a Department- approved Initial Certification
Training Program and/or a Continuing Education Training Program.
(2) "Vendor Applicant' means any institution, association, individual(s) or other entity that submits
a request for approval of an Initial Certification Training Program and/or a Continuing Education
Training Program.
W. (Reserved)
X. (Reserved)
y. (Reserved)
Z. (Reserved)
NOTE: Authority cited: Sections 1530 and 1562.3(i), Health and Safety Code. Reference: Sections 1501,
1502.2, 1507, 1530, 1531, and 1562.3, Health and Safety Code ar i1Sac tio�n L561013, +: _Ifafe;ana
Institutions Code
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 5
85002 ADULT RESIDENTIAL FACILITIES Regulations
85002 DEFINITIONS - FORMS 85002
The following forms, which are incorporated by reference, apply to the regulations in Title 22, Division 6,
Chapter 6 (Adult Residential Facilities).
(a) LIC 9139 2( %011) - Renewal of Continuing Education Course Approval, Administrator Certification
Program.
(b) LIC 9140 6101) - Request for Course Approval, Administrator Certification Program.
(c) LIC 9141 (•5101) - Vendor Application /Renewal, Administrator Certification Program.
(d) LIC 9142a 2( 0) - Roster of Participants - For Vendor Use Only - 35/40 Hour Initial Or CEU Courses,
Administrator Certification Program.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1530 and 1562.3,
Health and Safety Code; and Section 15376, Government Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -23 Effective 11/8/01
Page 5.1
Regulations ADULT RESIDENTIAL FACILITIES 85009
Article 2. LICENSING
85009 POSTING OF LICENSE 85009
(a) In facilities with a licensed capacity of seven or more, the license shall be posted in a prominent,
publicly accessible location in the facility.
(b) In facilities with a licensed capacity of six or fewer, the license shall be retained in the facility and be
available for review upon request.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code.
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -89 -09 Issued 7/1/89
Page 6
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85022
Article 3. APPLICATION PROCEDURES
85018 APPLICATION FOR LICENSE 85018
(a) In addition to Section 80018, the following shall apply.
(b) Each applicant shall submit a financial plan of operation on forms provided or approved by the
department.
(l) Start-up funds shall be available which shall include funds for the first three months of operation.
(c)
(j)
NOTE: Authority cited: Sections 1530 and'f� 5623 (1), Health and Safety Code. Reference: Sections 1501,
1528, 1531, 1562.3, and 1562.4, Health and Safety Code.
85022 PLAN OF OPERATION 85022
(a) In addition to Section 80022, the following shall apply.
(b) The plan of operation shall contain written evidence of arrangements for any consultants and
community resources which are to be utilized to meet regulatory requirements or requirements of the
facility's plan of operation.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1528 and 1531,
Health and Safety Code.
CALIFORNIA -DSS .MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 7
The licensing agency shall have the authority to require written verification of the availability of the
funds required in (b)(1) above.
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85051
Article 4. ADMINISTRATIVE ACTIONS (Reserved)
Article 5. ENFORCEMENT PROVISIONS
85051 SERIOUS DEFICIENCIES 85051
HANDBOOK BEGINS HERE
(a) In addition to Section 80051, the following are examples of regulations which, if not complied with,
nearly always result in a serious deficiency.
(1) Sections 85068.4(a)(1), (2), and (5) and 85075.3(d) relating to persons with communicable
diseases and persons requiring inpatient health or acute psychiatric care.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1530 and 1534, Health
and Safety Code.
CA LI FORN IA -DSS- MAN UAL -CCL
MANUAL LETTER NO. CCL -89 -09 Issued 7/1189
Page 8
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85060
Article 6. CONTINUING REQUIREMENTS
85060 BASIC:SERVICES 85060
(a)
HANDBOOK BEGINS HERE
(A')
(2)
)
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -96 -05 Effective 4/19/96
Page 9
This page is intentionally left blank.
Regulation - ADULT RESIDENTIAL FACILITIES 85064 (Cont.
85061 REPORTING REQUIREMENTS 85061
(a) In addition to Section 80061, the following shall apply.
(b) The licensee shall notify the Depaitnen1, in writing, within tht� irty (30) days of a change of
administrator. Thd notification shall include the following:
(1) Name, and residence and mailing addresses of the new administrator.
(2) Date he /she assumed his /her position.
(3) Description of his /her background and qualifications, including documentation of required
education and adniiiisfratoi certification.
(A) A photocopy of the documentation shall be permitted.
NOTE: Authority cited: Sections 1530 arTd`� 6 3 (i), Health and Safety Code. Reference: Sections 1501,
1531, 1562.3, and 1562:4 Health and Safety Code.
85064 ADMINISTRATOR QUALIFICATIONS AND DUTIES 85064
(a) In addition to Section 80064, the following shall apply.
(b) All adult residential facilities shall have a d administrator.
(c) Thei'adiimisttator sha IIL& at least 21 years of age.
(d) Have a high school diploma or pass a general educational development test (GED).
(1) Administrators employed prior to July 1, 1996 are exempt from this requirement.
(e) The administrator shall be on the premises the number of hours necessary to manage and administer
the facility in compliance with applicable law and regulation.
(f) When the administrator is absent from the facility there shall be coverage by a designated substitute,
who meets the qualifications of Section 80065, who shall be capable of, and responsible and
accountable for, management and administration of the facility in compliance with applicable law and
regulation.
(g) The administrator of a facility for seven to 15 clients shall have one year of work experience in
residential care.
(h) The administrator of a facility for 16 to 49 clients shall have graduated from high school, or possess
a GED, and shall have one of the following prior to employment:
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 10
85064 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85064 ADMINISTRATOR QUALIFICATIONS AND DUTIES (Continued) 85064
(1) Completion, with a passing grade, of 15 college or continuing education semester or equivalent
quarter units, three of which shall be in nutrition, human behavior, administration, or staff
relations.
(2) One year of work experience in residential care.
(i) The administrator of a facility for 50 or more clients shall have graduated from high school, or possess
a GED, and shall have one of the following prior to employment.
(1) Completion, with a passing grade, of 60 college or continuing education semester or equivalent
quarter units, six of which shall be in administration or staff relations.
(2) Three years work experience in residential care, one year of which shall have been providing
direct care to clients or assisting in facility administration.
(j) The administrator shall perform the following duties:
(1) Where applicable, advise the licensee on the operation of the facility and advise the licensee on
developments in the field of care and supervision.
(2) Development of an administrative plan and procedures to define lines of responsibility,
workloads, and staff supervision.
(3) Recruitment, employment and training of qualified staff, and termination of staff.
(4) Provision of, or insurance of the provision of, services to the clients, required by applicable law
and regulation, including those services identified in the client's individual needs and services
plans.
(A) The licensing agency shall have authority to approve the use of a centralized service
facility to provide any required services to two or more licensed facilities. Prior
approval shall be obtained in writing.
HANDBOOK BEGINS HERE
(B) Examples of such centralized service facilities are a centralized laundry, dining room or
kitchen serving two or more facilities.
(5) Arrangement for special provisions for the care and supervision and safety and guidance of
clients with disabilities including visual or auditory deficiencies.
CALI FORN IA -DSS- MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 11
Regulations ADULT RESIDENTIAL FACILITIES 85064 (Cont.)
85064 ADMINISTRATOR QUALIFICATIONS AND DUTIES (Continued) 85064
1
HANDBOOK BEGINS HERE
(A) Such provisions may include additional staff, safety and emergency information printed
in braille, and lights to alert the deaf to emergency sounds.
(6) Arrangement for the clients to attend available community programs, when clients have needs,
identified in the needs and services plan, which cannot be met by the facility but can be met by
community programs.
(k)
HANDBOOK BEGINS HERE
(1) Administrators employed prior to July 1,''1996 shall be;ezeri p i;from the cc q uiienicnts,of Sections
85064( 0),;,` nd'(i)rabove provided that they have no break in employment as an adult residential
facility administrator exceeding three M consecutive years.
(m)
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 12
(A) Such arrangements shall include, but not be limited to, arranging for transportation.
Health!and —SSafety SectionJ562�- 5(4)'readsjin pertinegtp .
85064 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85064 ADMINISTRATOR QUALIFICATIONS AND DUTIES (Continued) 85064
(n)
(o)
NOTE: Authority cited: Sections 1530 and l` — 5_62 :3 (1), Health and Safety Code, Reference: Sections 1501,
1531, 1562, !1562.3; a dd 1 5, Health and Safety Code.
85064.2
L) An mdivMal ' shall a`oeitificaterholder p rionto;bein g`employ ed as ewA'dn7inistratoi.
(b) Td'rece h ts l er certificate an a uyshall:
(1) ,S uccessfull y pomplefe a D`epart�ment approved ,In itial!Certificat oniTra ningrProgiam,
(2) Pas:
Trait.
O Sub
(B)
(C)
(D)
(c)
(d)
85064.2
CALIFORNIA -DSS- MANUAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13
Fik 6n e`bundred dollar ($100) - p occcssin
Regulations ADULT RESIDENTIAL FACILITIES 85064.3 (Cont.)
85064`:2 A'1)MINIST - teCERTIFICATION' :RE (Continued) 85064:2
O Gtf
hol
Ff Ge
inil
(s)
85064:3
(a)
FT
85064:3
HANDBOOK BEGINS HERE
( ) Examples of a ccredifed''educational' msht ti mmumty and!State ctilleges.
NA)
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.1
1 Go` rses rovided'b vendors'a rov'edb a'r'tmerit or
(_) P Y pp Y p >_
85064.3 (Cont.)
ADULT RESIDENTIAL FACILITIES
Regu lations
(Continued)
85064:3
AD VI[ NISTR ATOR •RECERTIFICATIONREQUIREMENTS
8506 3
in
L)
(D)
M)
FA)
FB)
(5)
(lid Goi
hol
z1)
(c) �To
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -03
Effective 1/5/01
Page 13.2
HANDBOOK BEGINS HERE
Reg ulations ADULT RESIDENTIAL eoLma 85064.3
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MA NUAL LETTER NO. mom,* Effective 1/5/01
Pag
85064.4 ADULT RESIDENTIAL FACILITIES Regu lati o ns
85064:4 DENLAL ORrRE VOCATI ON OF'A'CE RTIFIGATE 85 6
(a)
(f) The °certificate tiol tler; p rocureil7a�certificate :b rp esen tation.
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(B)
(4) The
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(b) Any
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(c)
CA LIFO RN I A- D S S -M AN UAL-CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.4
Regulations ADULT RESIDENTIAL FACILITIES 85064.4
850 4 DENIAti'OR REVOCATION OF A CERTIFICATE (Continued) 85064A
HANDBOOK BEGINS HERE
CALIFORNIA -DSS- MANUAL -CCL -
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.5
This page is intentionally left blank.
85064.5 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
850 FORFEITURE ° OF =A "CERTIFICATE (Continued) 85064.5
HANDBOOK BEGINS HERE
A
review
that the applicant was
1558; 1568.092 c
Lnlessdhe excluded indivi
by the depardrienv
c'or special permit indicat
tthe applicanthad previo
'from,.a
led fora Itcense,under any c
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 • Effective 1/5/01
Page 13.7
Regulations ADULT RESIDENTIAL FACILITIES 85064.5 (Cont.)
8506445 FORFEI CERTIFICATE (Continued) 85064 5
HANDBOOK CONTINUES
CA LIFO RNIA -DSS -MAN UA L -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 115101
Page 13.8
Health and;S Code Section 1 538(h)(I)('A) rcads'in - p ct inent part
Health `and Safet Code S'ectidn`133 8(I(a)(I)`re'ads irpq_ nt'part
85064.5 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
8506405 FORFEI OF "A " ERTIEICATE (Continued) 85064.5
HANDBOOK CONTINUES
IN
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.9
Regulations ADULT RESIDENTIAL FACILITIES 85065 (Cont)
85065 PERSONNEL REQUIREMENTS 85065
(a) In addition to Section 80065, the following shall apply.
(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client
needs.
(c) The licensee shall employ support staff as necessary to perform office work, cooking, house cleaning,
laundering, and maintenance of buildings, equipment and grounds.
(d) The licensee shall ensure that the following personnel requirements are met in the provision of planned
activities:
(1) In facilities with a licensed capacity of 16 to 49 clients, one employee shall be designated by the
administrator to have primary responsibility for the organization, conduct and evaluation of
planned activities.
(A) The designated employee shall possess at least six months of experience in organizing
and providing planned group activities.
(2) In facilities with a licensed capacity of 50 or more clients, one employee shall have full -time
responsibility for the organization, conduct and evaluation of planned activities, and shall be
given assistance as necessary in order to ensure that all clients participate in accordance with
their interests and abilities.
(A) The designated employee shall possess at least one year of experience in organizing and
providing planned group activities, and shall be knowledgeable in the evaluation of
client needs, the supervision of other employees, and the training of volunteers.
(3) Participation of volunteers in planned activities shall be encouraged.
(A) Such volunteers shall be under the direction and supervision of the employee designated
as responsible for the activity program.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.10
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85065 (Co nt.)
85065 PERSONNEL REQUIREMENTS (Continued)
85065
HANDBOOK BEGINS HERE
(4) Where the facility can demonstrate that its clients are self - directed to the extent that they are able
to plan, organize and conduct the facility's activity program themselves, the licensing agency
shall be permitted to waive these requirements.
(c) The licensee shall ensure that the following personnel requirements are met in the provision of food
service:
(1) Employment, training and scheduling of food service personnel shall ensure that client's food
service needs are met by the facility.
(2) In facilities with a licensed capacity of 16 or more clients an employee shall be designated to
have primary responsibility for food planning, preparation and service.
(A) The designated employee shall receive on- the -job training or shall have related
experience as evidenced by safe and effective job performance.
(3) In facilities with a licensed capacity of 50 or more clients, and which provide three meals per day,
an employee shall be designated to have full -time responsibility for the operation of the food
service program and shall possess either:
(A) One year of experience in food preparation and service accommodating 50 or more
persons.
(B) Two years of experience in food preparation and service accommodating 16 to 49
persons.
(4) If the employee designated in a facility for 50 or more clients is not a nutritionist, dietitian, or
a home economist, provision shall be made for regular consultation from a person so qualified.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09
Effective 10/1/98
Page 14
85065 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85065 PERSONNEL REQUIREMENTS (Continued) 85065
(A) Such consultation shall be during at least one meal preparation and service, on the day
of the consultation, and shall include review and approval of the facility's food planning,
preparation and service procedures.
(B) A written record of the frequency, nature and duration of the consultant's visits shall be
secured from the consultant and maintained in the facility.
(C) The licensing agency shall have authority to require more frequent consultation than the
licensee is having, when the licensing agency determines and documents the need for
such additional consultation.
(f) The licensee shall ensure that all direct services to clients requiring specialized skills are performed by
personnel who are licensed or certified to perform the service.
(1) Where no license or certification is available for a particular skill, prior approval of the licensing
agency shall be obtained for the provision of the service by an unlicensed or uncertified person.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1531 and 1562,
Health and Safety Code.
85065:5
O W1
fol
(I)
(2)
85065:5
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 15
Regulations ADULT RESIDENTIAL FACILITIES 85065.6
85065.6 NIGHT SUPERVISION . 85065.6
(a) Night supervisory staff shall meet the personnel requirements specified in Section 80065, and the
requirements below.
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f)
below, shall be available to assist in the care and supervision of clients in the event of an emergency,
and shall have received training in the following:
(1) The facility's planned emergency procedures.
(2) First aid, as specified in Section 80075.
(c) In facilities providing care and supervision for 15 or fewer clients, there shall be at least one person on
call on the premises.
(d) In facilities providirig care and supervision for 16 to 100 clients, there shall be at least one person on
duty, on the premises and awake. Another person shall be on call and capable of responding within
30 minutes.
(c) In facilities providing care and supervision for 101 to 200 clients, at least one person shall be on call,
on the premises; another qualified person shall be on duty, on the premises and awake; and another
person shall be on call and capable of responding within 30 minutes.
(D
(1)
(j For every additional 100 clients, or fraction thereof, for whom care and supervision is being provided,
there shall be one additional person on duty, on the premises and awake.
(i) In facilities required to have a signal system, as specified in Section 85088, at least one staff person
shall be responsible for responding to the signal system.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501,1507 and 1531,
Health and Safety Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 16
85066 ADULT RESIDENTIAL FACILITIES Regulations
85066 PERSONNEL RECORDS 85066
(a) In addition to Section 80066, the following shall apply.
(b) A dated employee time schedule shall be developed at least monthly, shall be displayed conveniently
for employee reference and shall contain the following information for each employee:
(1)
Name.
(2)
Job title.
(3)
Hours of work.
(4)
Days off.
(c)
NOTE Authority cited: Sections 1530 and1� O, Health and Safety Code. Reference: Sections 1501,
1562 a nd` 1562:4 Health and Safety Code,
85068 ADMISSION AGREEMENTS
(a) In addition to Section 80068, the following shall apply.
(b) The admission agreement must specify the following:
(1) Payment provisions, including the client's funding source.
(A) Such disclosure shall be at the client's discretion.
(2) General facility policies which are intended to ensure that no client, in the exercise of his /her
personal rights, infringes upon the personal rights of any other client.
(3) The current arrangement with the client regarding the provision of food service.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1507, and 1531,
Health and Safety Code.
85068
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 17
Regulations ADULT RESIDENTIAL FACILITIES 85068.2 (Cont.)
85068.1 ADMISSION PROCEDURES
85068.1
(a) The licensee shall develop, maintain, and implement admission procedures which shall meet the
requirements specified in this section.
(b) No client ay, be admitted prior to a determination of the facility's ability to meet the needs of the
client, which must include an appraisal of his /her individual service needs as specified in Sections
80068.2 a nd,8 " � 8 506 8 - :2.
(c) Prior to accepting a client for care and supervision, the person responsible for admissions shall:
(1) Interview the prospective client, and his /her authorized representative, if any.
(A) The interview shall provide the prospective client with information about the facility,
including the information contained in the Admission Agreement and any additional
policies and procedures, house rules, and activities.
(2) Develop a Needs and Services Plan as specified in Sections 80068.2 and 8 r �50 68.2.
(d) The facility shall obtain the medical assessment, performed as specified in Section 80069.
(c) If admission is agreed to, the facility shall obtain the signature of the client, or his /her authorized
representative, if any, on the Admission Agreement.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1507, 1530 and
1531, Health and Safety Code.
85068.2 NE
(a) Pr'i6n4o;ac
chentsse
(b If the c 6
SCrvc' es�I
(1) ThE
reps
85068:2
CA LIFORN IA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 18
85068.2 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85068:2
(Continued)
(B) Sp ecific "sefvke needs if ariyl
TO The writteniinedical assessments Secti n 80069
(D) Mental and:emotionaP,f
85068.2
O The'written'mental l calt}i i ntake asse ssmenf;'if�any, °sp ecified in Section 85069.3.
(F) T wrttten wfunctional; capa specified!inSechon�800692.
(2j Facility_p for p rovidin g seivicesYO meet the individu identified above.
(c)
(d) {flic licensee sl3all iolve p ers
nv he.followin m tfie develo r rof the Needsiand`Services�Plan;
-r es c6t
(d:) �hechent �or�hts /hei�aiithorized
7�) Any :relative participating imtheip lacement.
(3) TheThe pla e n feiral age
yl
(4) Ti hc' . ersori �cs for faoilif
85068:3
(a)
ger
(1)
85068:3
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 19
Regulations ADULT RESIDENTIAL FACILITIES 85068.4
85068.3 MODII IC ATIONS`�TO � `NEEDS -AND SERVICCS�P.LAN 850683
(Continued0
(2)
(B)
(C)
{D)
()
(A)
85068.4 ACCEPTANCE AND RETENTION LIMITATIONS 85068.4
(a) The licensee shall not accept or retain the following:
(1) Persons with prohibited health conditions specified in Section 80091.
(2) Persons who require inpatient care in a health facility.
(3) Persons who have needs which are in conflict with other clients or the program of services
offered.
(4) Persons who require more care and supervision than is provided by the facility.
(5) Any person whose primary need is acute psychiatric care due to a mental disorder.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1507, and 1531,
Health and Safety Code.
CALI FORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 20
A Oti ec� tives tiw hm a time framee that relate'to -the client's pioblems'�and/or� eedss,
85068.5 ADULT RESIDENTIAL FACILITIES Regulations
85068.5 EVICTION PROCEDURES 85068.5
Repealed by Manual Letter No. CCL- 97 -05, effective 2/1/97.
85069:3 MENTAL HEALTH INTAKE ASSESSMENT 85069.3
(a) In order to determine his/her ability to provide the services needed by a client with mental illness, the
liceh e of = shall ensure that a written intake assessment is prepared as required by Health and
Safety Code Section 1562.6(a).
HANDBOOK BEGINS HERE
(1) Health and Safety Code Section 1562.6(a)
The administrator of an adult residential care facility that provides services for residents who
have mental illness shall ensure that a written intake assessment is prepared by a licensed mental
health professional prior to acceptance of the client. This assessment may be provided by a
student intem if the work is supervised by a properly licensed mental health professional.
Facility administrators may utilize placement agencies, including, but not limited to, county
clinics for referrals and assessments.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1502, 1507,
1530, 1531 and 1562.6, Health and Safety Code.
85070 CLIENT RECORDS 85070
(a) In addition to Section 801070 66a h client record t u t contain the following information:
(1) Last known address.
(2) Religious preference, and name and address of clergyman or religious advisor, if any.
(3) Needs and Services P lan and any modifications thereto, as specified in Sections 80068.20
80068.3, �850� 68T2wand?85068.3.
(4) Mental Health Intake Assessm 'spcci6cd�in7 Section;85069 3.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1531, 1533,
1534 and 1538, Health and Safety Code.
CALI FORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 1011/98
Page 21
Regulations ADULT RESIDENTIAL FACILITIES 85072 (Cont.)
85072 PERSONAL RIGHTS 85072
(a) In addition to Section 80072, the following shall apply.
(b) The licensee shall insure that each client is accorded the following personal rights.
(1) To visit the facility with his /her relatives or authorized representative prior to admission.
(2) To have the facility inform his /her relatives and authorized representative, if any, of activities
related to his /her care and supervision, including but not limited to notification of any
modifications to the needs and services plan.
(3) To have communications to the facility from his /her relatives or authorized representative
answered promptly and completely.
(4) To have visitors, including advocacy representatives, visit privately during waking hours,
provided that such visitations do not infringe upon the rights of other clients.
(5) To wear his /her own clothes.
(6) To possess and use his /her own personal items, including his/her own toilet articles.
(7) To possess and control his /her own cash resources.
(8) To have access to individual storage space for his /her private use.
(9) To have access to telephones in order to make and receive confidential calls, provided that such
calls do not infringe upon the rights of other clients and do not restrict availability of the
telephone during emergencies.
(A) The licensee shall be permitted to require reimbursement from the client or his /her
authorized representative for long distance calls.
(B) The licensee shall be permitted to prohibit the making of long distance calls upon
documentation that requested reimbursement for previous calls has not been received.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 22
85072 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85072 PERSONAL RIGHTS (Continued) 85072
(10) To mail and receive unopened correspondence.
(11) To receive assistance in exercising the right to vote.
(12) To move from the facility in accordance with the terms of the Admission Agreement.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code.
85075 HEALTH - RELATED SERVICES
(a) In addition to Section 80075, the following shall apply.
85075
(b) The facility shall develop and implement a plan which ensures that assistance is provided to the clients
in meeting their medical and dental needs.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code.
85075.3 OBSERVATION OF THE CLIENT 85075.3
(a) The licensee shall regularly observe each client for changes in physical, mental, emotional and social
functioning.
HANDBOOK BEGINS HERE
(1) Documentation of such observation shall not be required.
(b) The licensee shall provide assistance when observation reveals needs which might require a change in
the existing level of service, or possible discharge or transfer to another type of facility.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 23
Regulations ADULT RESIDENTIAL FACILITIES 85076 (Coat.)
85075.3 OBSERVATION-OF THE CLIENT (Continued) 85075.3
(c) The licensee shall bring observed changes, including but not limited to unusual weight gains or losses,
or deterioration of health condition, to the attention of the client's physician and authorized
representative, if any.
(d) A client suspected of having a contagious or infectious disease shall be isolated and a physician
contacted to determine suitability of the client's retention in the facility.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1507, 1521 and
1531, Health and Safety Code.
85076 FOOD SERVICE 85076
(a) In addition to Section 80076, the following shall apply.
(b) The licensee shall meet the food service personnel requirements, specified in Section 85065(c).
(c) The following requirements shall be met when serving food:
(1) Meals served on the premises shall be served in one or more dining rooms or similar areas in
which the furniture, fixtures and equipment necessary for meal service are provided.
(A) Such dining areas shall be located near the kitchen so that food may be served quickly
and easily.
(2) Tray service shall be provided in case of temporary need.
(d) The licensee shall meet the following food supply and storage requirements:
(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods
for a minimum of two days shall be maintained on the premises.
(2) Freezers shall be large enough to accommodate required perishables and shall be maintained at
a temperature of zero degrees F (17.7 degrees Q.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective I0 /1/98
Page 24
85076 (Cont.) I ADULT RESIDENTIAL FACILITIES Regulations
85076 FOOD SERVICE (Continued) 85076
(3) Refrigerators shall be large enough to accommodate required perishables and shall maintain a
maximum temperature of 45 degrees F (7.2 degrees Q.
(4) Freezers and refrigerators shall be kept clean, and food storage shall permit the air circulation
necessary to maintain the temperatures specified in (2) and (3) above.
(c) Clients shall be encouraged to have meals with other clients
(f) Clients who do not elect to have all meals provided by the facility as specified in Section 80076(a)(3),
but whose conditions subsequently change so that self - purchase of foods and self - preparation of meals
is no longer a viable alternative, shall receive full meal service.
NOTE: Authority cited: Sections 1501 and 1531, Health and Safety Code. Reference: Sections 1501 and
1531, Health and Safety Code.
85077 PERSONAL SERVICES 85077
(a) Licensees shall provide necessary personal assistance and care, as indicated in the needs and services
plan, with activities of daily living including but not limited to dressing, eating, and bathing.
(b) Licensees shall provide basic laundry services, including washing and drying of clients' personal
clothing.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code,
85078 RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION 85078
(a) In addition to Section 80078, the following shall apply:
(1) The licensee shall provide those services identified in the client's needs and services plan as
necessary to meet the client's needs.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1527, 1530 and 1531,
Health and Safety Code.
CALI FORMA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 25
Regulations ADULT RESIDENTIAL FACILITIES 85079
85079 ACTIVITIES 85079
(a) The licensee shall ensure that planned recreational activities, which include the following, are provided
for the clients:
(1) Activities that require group interaction.
(2) Physical activities including but not limited to games, sports and exercise.
(b) Each client who is capable shall be given the opportunity to participate in the planning, preparation,
conduct, clean -up and critique of the activities.
(c) The licensee shall ensure that clients are given the opportunity to attend and participate in community
activities including but not limited to the following:
(l) Worship services and activities of the client's choice.
(2) Community Service activities.
(3) Community events, including but not limited to concerts, tours, dances, plays, and celebrations
of special events.
(4) Self -help organizations.
(5) Senior citizen groups, sports leagues and service clubs.
(d) In facilities with a licensed capacity of seven or more clients, notices of planned activities shall be
posted in a central facility location readily accessible to clients, relatives, and representatives of
placement and referral agencies.
(1) Copies of such notices shall be retained in facility files for at least six months.
(c) In facilities with a licensed capacity of 50 or more clients, a current, written program of activities shall
be planned in advance and made available to all clients.
(f) Activities shall be encouraged through provision of the space, equipment and supplies specified in
Sections 85087.2, 85087.3, and 85088(8).
NOTE: Authority cited: Section 1530, Health and Safety Coda Reference: Sections 1501 and 1531, Health
and Safety Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 26
85080 ADULT RESIDENTIAL FACILITIES Regulations
85080 RESIDENT COUNCILS 85080
(a) Each facility, at the request of a majority of its residents, shall assist its residents in establishing and
maintaining a resident - oriented facility council:
(1) The licensee shall provide space and post notice for meetings, and shall provide assistance in
attending council meetings for those residents who request it.
(A) If residents are unable to read the posted notice because of a physical or functional
disability, the licensee shall notify the residents in a manner appropriate to that disability
including but not limited to verbal announcements.
(2) The licensee shall document notice of meetings, meeting times, and recommendations from
council meetings.
(3) In order to permit a free exchange of ideas, at least part of each meeting shall be conducted
without the presence of any facility personnel.
(4) Residents shall be encouraged, but shall not be compelled to attend council meetings.
(b) The licensee shall ensure that in providing for resident councils the requirements of Section 1520.2 of
the Health and Safety Code arc observed.
HANDBOOK BEGINS HERE
Health and Safety Code Section 1520.2 reads in pertinent part
The council shall be composed of residents of the facility and may include family members of residents
of the facility. The council may, among other things, make recommendations to the facility
administrators to improve the quality of daily living in the facility and may negotiate to protect
residents' rights with facility administrators.
A violation of this section shall not be subject to the provisions of Health and Safety Code Section 1540
(misdemeanors), but shall be subject to the provisions of Health and Safety Code Section 1534 (civil
penalties).
This section shall not apply to facilities licensed for six (6) or fewer individuals
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Section 1520.2, Health and
Safety Code.
CA LIFO RN IA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 27
Regulations ADULT RESIDENTIAL FACILITIES 85081
808' REQUIREMENTS FOR EMERGENCY AD
PR 8 8
OTECTIVE SERVIC PLACEMENTS
1
(a)
(I)
F
PI-
U)
f
7
9
CALIFORNIA -DSS -MAN UA L -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 27.1
The licensee sh all „ provide atp nvate 'room £or .tt e Ghent until' a an
mdrvilual program plan 'or -a Needs and Services Plan liar' been
completed „spe cified in Sections_ 80068:2 an 85068':2
85081 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
8508(1 REQUIREMENTS, FOR ENIERGENCY AD ULTi V54 8R
PROTEC TIdE$ERYICES:PLACEMENTS (Continued)
TO
PH
a
(b)
(c)
FID
C2)
d The censee shall not'acce t ttie followin crsoiis das APS `emer enc lace rents
P B.P
(1) E divtduals hw o use metered =dose and dr y�powden tnh ers [
(3) IndMdila ce o xygen [ Seciion ]80075 (h)].
( Individual's A6 rel to p erform'all actiViti of dail Iivit g;[ Secuon 80077:2
m m.�
(4) Individuals whotlack Hazard awarcne'ss or: un .controL
(5) Individuals who'havc contractuics [ Sectios80077:5 ]_
(6) I ndividu als who,havcp a&tli�co_ndmoiis [Section;800911i].
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 27.2
Regulations ADULT RESIDENTIAL FACILITIES 85081 (Cont.)
K507 REQUIREMENTS FORJEMERGENCY'ADULT 85081"
o PROTECTIVE'SERVICES PliACEMENTS { (Continued)
[( Individuals' who have restncted health- conditions [ Saction. 80092]a
8 Inds iduals who re ui a tri atiei t 6a c in Wh6lth facilit Section'85068 4 a 2
(0
(10) Individual's who are rcceivin
() fTri�
fac
Ff Psi
M
TO
(2) Client's`ambul'ator status.
(3, Names) and tele number' §) of the client's physician(§);
(`7)
(5)
(b)
ass
(h) IW
info
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 27.3
85081 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
8 O81 RE FOR §EMERGENCY,ADULT 8 8
PROTECTIUE'SERVTCES PLACEMENT (Continucd)
T)
(Z)
(A)
(k)
(D
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -21 Effective 10/25/01
Page 27.4
Regulations ADULT RESIDENTIAL FACILITIES 85087 (Cont.)
Article 7. PHYSICAL ENVIRONMENT
85087 BUILDINGS AND GROUNDS 85087
(a) In addition to Section 80,.087 be in5omsmiusf meet, at a minimum, the following requirements:
(1) Not more than two clients shall sleep in a bedroom.
(2) Bedrooms must be large enough to allow for easy passage and comfortable use of anyreequired
clientlassistive devices, including but not limited to wheelchairs9 walkers, dr xyo g n
between beds and other items of furniture specified in Section 85088(c).
(3) No room commonly used for other purposes shall be used as a bedroom for any person.
(A) Such rooms shall include but not be limited to halls, stairways, unfinished attics or
basements, garages, storage areas, and sheds, or similar detached buildings.
(4) No client bedroom shall be used as a public or general passageway to another room, bath or
toilet.
(b) Stairways, inclines, ramps, open porches, and areas of potential hazard to clients whose balance or
eyesight is poor shall not be used by clients unless such areas are well lighted and equipped with sturdy
hand railings.
(c) Facilities shall meet the following requirements in laundry areas:
(1) Space and equipment for washing, ironing and mending of personal clothing.
(2) Space used for soiled linen and clothing shall be separated from the clean linen and clothing
storage and handling area.
(3) In facilities with a licensed capacity of 16 or more clients, space used to do the laundry shall not
be part of an area used for storage of any item other than items necessary for laundry activities.
(d) Facilities with a licensed capacity of 16 or more clients shall meet the following requirements:
(1) There shall be space available in the facility to serve as an office for business, administration and
admission activities.
(2) There shall be a private office in which the administrator may conduct private interviews.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 28
85087 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85087 BUILDINGS AND GROUNDS (Continued) 85087
(3) There shall be a reception area and a restroom facility designated for use by visitors.
(c) Dining rooms or similar areas for food service shall be provided as specified in Section 85076.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, (P507, and 1531,
Health and Safety Code.
85087.2 OUTDOOR ACTIVITY SPACE 85087.2
(a) Outdoor activity areas shall be provided which are easily accessible to clients and protected from
traffic.
(b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for
outdoor use.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code.
85087.3 INDOOR ACTIVITY SPACE
85087.3
(a) As a condition of licensure, there shall be common rooms, including a living room, dining room, den
or other recreation/activity room, which provide the necessary space and/or separation to promote and
facilitate the program of planned activities specified in Section 85079, and to prevent such activities
from interfering with other functions.
(1) At least one such room shall be available to clients for relaxation and visitation with friends
and/or relatives.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501 and 1531, Health
and Safety Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 29
Regulations ADULT RESIDENTIAL FACILITIES 85088 (Cont.)
85088 FIXTURE, FURNITURE, EQUIPMENT, AND SUPPLIES 85088
(a) In addition to Section 80088, as a condition of licensure, the following shall apply.
(b) Toilet, washbasin, bath and shower fixtures shall at a minimum meet the following requirements:
(1) At least one toilet and washbasin shall be maintained for each six persons residing in the facility,
including clients, family and personnel.
(2) At least one bathtub or shower shall be maintained for each ten persons residing in the facility.
(3) Toilets and bathrooms shall be located near client bedrooms.
(4) Individual privacy shall be provided in all toilet, bath and shower areas.
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies
necessary for personal care and maintenance of personal hygiene.
(1) An individual bed, except that couples shall be allowed to share one double or larger sized bed,
maintained in good repair, and equipped with good bed springs, a clean mattress and pillow(s).
(A) Fillings and covers for mattresses and pillows shall be flame retardant.
(B) No adult residential facility shall have more beds for client use than required for the
maximum capacity approved by the licensing agency.
This requirement shall not apply to beds made available for illness or separation
of others in the isolation room or area as required by Section 80075.
(2) Bedroom furniture including, in addition to (c)(1) above, for each client, a chair, a night stand,
and a lamp or lights necessary for reading.
(A) Two clients sharing a bedroom shall be permitted to share one night stand.
(3) Portable or permanent closets and drawer space in each bedroom to accommodate the client's
clothing and personal belongings.
(A) A minimum of two drawers or eight cubic feet (.2264 cubic meters) of drawer space,
whichever is greater, shall be provided for each client.
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 30
85088 (Cunt.) ADULT RESIDENTIAL FACILITIES Regulations
85088 FIXTURE, FURNITURE, EQUIPMENT, AND SUPPLIES (Continued) 85088
(4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom
bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath
towels, hand towels and washcloths.
(A) The quantity of linen provided shall permit changing the linen at least once each week
or more often when necessary to ensure that clean linen is in use by clients at all times.
(B) The use of common towels and washcloths shall be prohibited.
(5) Feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.
(d) If the facility operates its own laundry, necessary supplies shall be available and equipment shall be
maintained in good repair.
(1) Clients who are able, and who so desire, shall be allowed to use at least one washing machine
and iron for their personal laundry, provided that the equipment is of a type and in a location
which can be safely used by the clients.
(A) If that washing machine is coin operated, clients on SSI/SSP shall be provided with coins
or tokens and laundry supplies.
(B) The licensee shall be permitted to designate a safe location or locations, and/or times in
which clients shall be permitted to iron.
(e) Emergency lighting, which shall include at a minimum working flashlights or other battery- powered
lighting, shall be maintained and readily available in areas accessible to clients and staff.
(1) An open -flame type of light shall not be used.
(2) Night lights shall be maintained in hallways and passages to nonprivate bathrooms.
(f) Facilities shall meet the following signal system requirements:
(1) In all facilities with a licensed capacity of 16 or more clients, and all facilities having separate
floors or separate buildings without full -time staff there shall be a signal system which has the
ability to meet the following requirements:
(A) Operation from each client's living unit.
(B) Transmission of a visual and/or auditory signal to a central location, or production of an
auditory signal at the client's living unit which is loud enough to summon staff.
CA LIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 31
Regulations ADULT RESIDENTIAL FACILITIES 85064.5 (Cont.
8506 55 FORF A CERTIFICATE' £ 3506415
O Uni ^ ` ess otl
[he *follom
(1) TsF
issL
(2)
(B)
(ti)
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 13.6
(A) The certifiea[ holder did — not at pp eal the"exclisio de or
Regulations ADULT RESIDENTIAL FACILITIES 85088
85088 FIXTURE, FURNITURE, EQUIPMENT, AND SUPPLIES (Continued) 85088
(C) Identification of the specific client's living unit from which the signal originates.
(2) Facilities having more than one wing, floor or building shall be allowed to have a separate signal
system in each component provided that each such system meets the criteria specified in (1)(A)
through (C) above.
(g) The licensee shall provide and maintain the equipment and supplies necessary to meet the requirements
of the planned activity program.
(1) Such supplies shall include daily newspapers, current magazines and a variety of reading
materials.
(2) Special equipment and supplies necessary to accommodate physically handicapped persons or
other persons with special needs shall be provided to meet the needs of the handicapped clients.
(3) When not in use, recreational equipment and supplies shall be stored where they do not create
a hazard to clients.
NOTE: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1501, 1530 and 1531,
Health and Safety Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -98 -09 Effective 10/1/98
Page 32
This page is intentionally left blank.
Regulations ADULT RESIDENTIAL FACILITIES 85090 (Cont.
Article 97ADMINISTRATOR CERTIFICATION
85090 INITIA CERTIFICATION TRAINING PROGRAM 85090
APP RO' AL RE
(a) Initial Certification Training Programs shall be approved by the Department prior to being offered to
applicants see g ce tilication
rm- -
(b) Any vendor a pplicant seeking app roval of a n'Initial Certification Training Program shall submit a
written request to the Department using form LIC 9 140 an
d_L 914 ; orr a replicd. The request shall
be's 2ned under nerialty ofp'er un%'and contain the following:'
(1) Name, address and phone number of the venndoi requesting approval and the name of
the person in charge of the program.
(2) Subject title, classroom hours, prt p ed dates, duration, time, location and proposed instructor
of each c moc ponent.
(3) Writteaiiescrt and educational objectives for each component.
(4) Qualifications of;cacH lii p osed instructor as specified in Section 8:
(5) Geographic areas in which the Trainin gProgi m will be offered.
(6) Types of records to be maintained, as___requtred by Section 850 90(i)(4 }below.
C)
(g)
(9)
(d 0
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 33
85090 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85090 INI� TIAL CERTIFICATION TRAINING PROGRAM 85090
APPROVAL R (Continued)
(c) Initial Certification Tit a g Program approval shall expire two (2) years from the date the program
is approved.
(d) A written request for renewal of the,lnitia Certif ication)Trainirig Prog 'shalt be submitted to the
Dep artment using forms LIC 9140 and`LIC'9141 or a re
reph and shall contain the information and
p cessin se pecified in Section 85090(b) above.
(e)
sl) The request is deficient, describing what documents are outstanding and/or inadequate, and
informing the vendo a pplicant that the information must be submitted within th(rtJ30) days
of the date of notice.
(f) If the vcndor� applicant does not submit the requested information within ihirfy (305 a� ys `the request
for appr to avr itcnewal shall be deemed withdrawn provided that the Department has not denied or
taken action to deny the request.
(g) Witham th ( days of receipt of ca omp "Iete request for an app' L Va the Deparfin of shall notify
the vm� dor`a)iphcant in writing whether the request has been approved or denied.
(h) The Initial Certification TC nima g Program shall consist of the following components:
(1) A minimum of thirty -five (35) classroom hours on a uniform Core of Knowledge with the
. follo g basic curriculum:
(A) Six( §) hours of instruction in laws, including residents' personal rights, regulations,
policies, and procedural standards that impact the operations of adult residential
facilities.
(B) Three (3) hours of instruction in business operations.
(C) Three (3) hours of instruction in management and supervision of staff.
(D) �drk (,4 hours of instruction in the psychosocial needs of the facility residents.
(E) Three (3) hours of instruction in the use of community and support services to meet
residents' needs.
(F) Four (4) hours of instruction in the physical needs of facility residents.
CALIFORNIA -DSS- MANUAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 33.1
Regulations ADULT RESIDENTIAL FACILITIES 85090 (Cont.)
85090 INITIA CERTIFICATION TR AINING PROGRAM 85090
APPROVAL RE (Continued)
.
(G) Fbur;(4� hours of instruction in the a "8niinistrati r- �
on storage, use p revention of misuse and
interaction of drugs commonly used by facility residents.
(H) Four (4) hours of instruction on admission, retention, and assessment procedures.
HANDBOOK BEGINS HERE
(7j)
(K)
(2) A standardized test administered by the Department.
(A) Individuals completing ari Ina` iti�crtiffication Tj rain ing Program must pass the test with
a minimum score of seventy percent Q0 %) /o).
(9)
(i) Initial Certification Trtg Program vendors shall:
(1) Offer all thirty -frye , 35) of the classroom hours required for certification.
(A)
10
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 115101
Page 34
85090 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85090 INITTA CERTIFICATION TR AINING PROGRAM 85090
1 AP ; PROVAL RE (Continued)
(2) Establish a procedure to allow participants to make up any component necessary to complete the
program.
(3)
(4) Maintain and ensure thafwritten records as a available for review by Deep [merit representatives.
Records shall be maintained for (3) three years. The records shall include the following
information:
(A) Cou sr e schedules,I�ates and descriptions.
(B) List of in structors and docume ^ - ntation of qualifications of each, as specified in Section
85090(1)(6) below.
(C) Names of registered participants and documentation of completion of the program.
D E al tau tons b aitict ants of coarse`s and`insiri(ctors;
(5) Ensure that all classes are open to i ionito d inspection by Department representatives.
(6) Have i sEucto i who have knowledge and/or experience in the subject area to be taught and who
1 ' k -
meet atrleast �oneof the following criteria:
(A) Possession of a four (4) year college degree and ".two (2)y relevant to the
coursc(s) to be taught, or
(B) Four (4);yea�s exp erience rele to the cou rses) to'be;tau ,Or
(C) Be ' a. p ida related field with a v, ulid ` � aiceti c to practice in California, or
(D) Have at least four O years experience in California as an administrator of an adult
residential facility, within the last eight (4) years, and with a record of administering
facilities in substantial compliance, as defined in Section 80001s.(6).
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 35
Regulations ADULT RESIDENTIAL FACILITIES 85090.1 (Coot.
85090 INITIAL CERTIFICATION TRAINING PROGRAM 85090
AEPROVAL RE (Continued)
7)
TO
(�)
NOTE: Authority cited: Sections 1530 and r 562:6(1), Health and Safety Code; and Section 15376,
Government Code. Reference: Section 1551. and 1562.3, Health and Safety Code.
85090:1' DE NIAL OF R Q FOR APB F =AN INITIA 850901
CERTIFICATION'TRA►NING PROGRAM
(a)
accordance with Section 1562.3(h of the Health and Safety Code.
ihe�app , with a written notice of. -the denia
in
HANDBOOK BEGINS HERE
Section X1562 3 h 1 `r ac ds in er'tin n art:
The Department may deny vendor approval to any agency or person in any of the following
circumstances:
(A) The applicant has not provided the Department with evidence satisfactory to the Department of the
ability of the applicant to satisfy the requirements of vendorization set out in the regulations ad pteo d
by;th�e dep artrrtent p ursuanYfo'subdivision , O.
(B) The applicant person or agency has a conflict of interest in that the person or agency places its
clients in adult residential facilities.
(C) The applicant public or private agency has a conflict of interest in that the agency is mandated to
place clients in adult residential facilities and to pay directly for the services. The Department may
deny vendorization to this type of agency only as long as there are other vendor programs available to
conduct the certification training programs and conduct education courses.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 36
85090.1 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
85090 1 D ENIA L OF R Q FOR APPROVA ' OF AN INITIAL 850900-1'
C P.ROCRAM; (Continued)
(0
(c)
HANDBOOK BEGINS HERE
NOTE: A uthority cited: Section "s_ 1530 and 51 6 i3 (i), Health and Safety Code. Reference: Sections E 31
LI_55I, -and 1562.3, Health and Safety Code.
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 36.1
Hcalt Sa fety C „ ode j Sechon ,!1520:3 ,(b) reads?in perttnegUparr
Regulations ADULT RESIDENTIAL FACILITIES 85090.2
85090 2 REVOCAT OF A INITIAL CERTIFICATION 85090,02
TRAINING PROGRAM
(a) The De ma y revoke an 021 Certification ramigg Program approval val iimfiemove the.vendor
fr oircth P list of a oved.veiidors if the vendor doesnot p rovide tramin consistent with Section 85090
r
or
(I) Is unable to provide training due to lack of staff, funds or resources, or
(2) Misrepresents or makes false claims regarding the training provided r
(3) Demonstrates conduct in the administration of the program that is illegal, inappropriate, or
inconsistent with the intent or req iiemr of the program,`or r�
(4j Misrep resents or makes false st5tements'm he vend ora
I4f+►i
(c}
HANDBOOK BEGINS HERE
A
NOTE: Authority cited: Sections 1530 and' l 623 (i), Health and Safety Code. Reference: Sections 1520.3,
1531';'and 1562.3, Health and Safety Code.
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37
85091 ADULT RESIDENTIAL FACILITIES Regulations
88509 CONTINUING .EDUCATION TRAINI PROGRAM 85091'
VENDOR RE
(a) n
ob1
(b)
(1)
(2)
(3)
(4)
(5)
(c) Cq
vet
(d)
(e) f
De
(1)
(f)
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 115101
Page 37.1
Regulations ADULT RESIDENTIAL FACILITIES 85091 (Cont.)
8 OS 91 CONTINUING EDUCATION TRAIN PR OGRAM 85091
VENDOR- RE (Continued)
($)
(h) Continuin Educatioti;Trairiin Prog Jendors sfiall:
Fj) Mamta�na id ensurettfiat written records,are at% a
A Course,sctiedules; descri ptions.
(A) List of msiru`ctors'at d documen of t
(C) Names'of re particip documentation''a
(D) Evaluationsj partic p ants ofcourses=and instructors.
(2)
(A)
(B)
(C)
(p)
(i) Co
liol
f'=
�)
' ge l
(k) Co
Fou (4).y ex relevant to the courseit bcitau or
CALIFORNIA -DSS -MAN UAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.2
55091 (Cont.) ADULT RESIDENTIAL FACILITIES Regulations
8585 91 CONTINUING EDUCATION 'TRAINING'PROGRAM 8509!
VEIVDOR`RE (Continued)
(1)
(in)
(n)
8509 1 CONTINUING EDUCATION•TRAINING PROGRANI 850 1 19
COURSE *APPROYAI
- RE Q UIREMENTS
(a)
offi
, FD
(b)
7D
(?)
713)
4 T es`'ofrecords to;be maintained as e' aired l Sectfon'8509 t tl
(5)
CA LIFO RNIA -DSS -M ANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.3
Regulations ADULT RESIDENTIAL FACILITIES 85091.1
85091.1'
()
(�)
(9) Coi
Pro
(/)
(d) If'a
Hie
(L)
(e)
(f) �Wii
sha
(g)
(h) C
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.4
CONTINUINGEDUCATION'TRAININGTRO M 85091x1'
COURSE "APPROUAL•RE (Continued)
85091.2 ADULT RESIDENTIAL FACILITIES Regulations
„. —�
85091:2 ADMINISTRATIVE`REVIEW OF DEN[ACiORI 8509.1:2
(� A'svendor may 'seek-administrative ? eviewbf the denial:or'}evocation.ofcourse a as follows:
(1) The
the'
() F he
den
TO
(A)
�4) The decision of tfichi s oii`sliall Gefinal'
850 DENIAti OF'A =REQIIEST FOR 'ATPROVAL OF (A 85091''.3
CONTINUING EDUCATION TRAININGyPROGRAM
(a)
HANDBOOK BEGINS HERE
Health andLS fety Code injpetincnt - party
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.5
Regulations ADULT RESIDENTIAL FACILITIES 85091.3
85091:3 DENIAL' :OEj, REQUEST FOR APPRQ,VAL { OF' 85091'.3 .1 1 CON TINUINGIDUCATION`TRAINING PROGRAM (Continued)
.: ►1111, ►1 . I
(5)
(5)
HANDBOOK BEGINS HERE
CALIFORNIA -DSS -MAN UAL -CC L
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.6
HANDBOOK CONTINUES
85091.4 ADULT RESIDENTIAL FACILITIES Regulations
85091A REVOCATIONOVA� C ONTINUING EDUCATION 85091.4
TRAINING PROGRAM
(a)
(2)
(3)
C)
(b)
(c)
HANDBOOK BEGINS HERE
CALIFORNIA -DSS- MANUAL -CCL
MANUAL LETTER NO. CCL -01 -03 Effective 1/5/01
Page 37.7
(1) Is uiiab1e °fo. traihiu "e toaaelF`of.staff ; f nds or 2esouices or
The vendor ma y_appe al Ifie'revocation' n accordance with Health and Safet Code:Section'.f55111
Health °and Safet reads in p etinenY pait:
WILLIAMS CONCORD HOUSE
Organizational Chart
Licensee /Administrator -
John Williams
Program Consultants:
Ronald Barazani, Ph.D.
,Physical
Therapis
Direct Care Staff:
House Manager:
The direct care staff and
house manager will work with
the Program Consultant on a
regular basis for training on
a group and one to one basis
and to provide input on how
consumers are progressing.
The Administrator will meet
monthly with the Program
Consultant to discuss each
(consumer, changes that will
elp the program and prepare
1�pports. ,
Housekeeping
Landscaping
l
WILLIAMS CONCORD HOUSE, INC.
8845 Domain Street
Rosemead, California
(626) 286 -6694
STATEMENT OF PURPOSE
The program is designed to allow for individuality in a small residential setting.
Consumers will be involved in the operation of the facility and the consumers
will, as much as possible, be involved in providing input into the day to day
decision making of the facility.
Each consumer living in the facility will be encouraged to work towards goals and
objectives of their own choosing while learning acceptable alternatives to
maladaptive behaviors that have caused on -going problems in the community.
2
The program is designed to provide services to consumers who have severe
behavior problems, deficits in social skills and personal care, along with the
deficits in communication skills and interpersonal relationships.
The program will be a level 4I facility for four male and female consumers.
There will be four ambulatory beds in the facility.
PHILOSOPHY
The program will provide a caring and structured environment in which
individuality and self -worth are stressed in an effort to enable each consumer to
grow and develop to their fullest potential. The program will teach consumers
about their living options and social and community opportunities available to
them.
By providing our consumers with many of the advantages we hope to instill a
sense of self -worth, value and pride while implementing a behavior management
program directed not only at the intervention but prevention as well. We will do
this by recognizing and dealing with type of behavior patterns exhibited by the
consumers in residence. Individualized service plans (ISP) will be devised to
meet the needs and future wishes of the consumer. A circle of support will be
formed and maintained. Strategies will be implemented for meet future plans
2
3
and training provided to meet these plans. In this way we hope to provide a
comprehensive and systemic approach to the treatment of our consumers.
FACILM FUNTIONS
The objectives of the program will be achieved through step -by -step plans of
action, which includes measurable, time - limited and achievable objectives to
reach goals.
The approach to be utilized will be consistent with both the philosophy and goals
of the Developmental Disabilities System and will include both intensive
treatment models in the home and community. A monthly schedule of activities
will be developed each month that state the activity and where it will be
performed each day. This activity plan will be developed during consumer
council meetings.
Consumers will be encouraged to participate in pre - vocation, vocation or activity
programs during the day 5 out of 7 days a week.
The program will possess a valid Community Care Facility license, be vendorized
by the East Los Angeles Regional Center, have supervision and special services
pursuant to the regulations stated in Title 17 and provide services in accordance
3
4
with, and to meet the requirements of, the approved program design pursuant to
Section 56005 and the consumer's IPP objectives.
There will be a staffing level of no less than one direct support staff person at all
times when consumers at the facility. This staff level shall be the total direct
supervision and special services hours required in Title 17 Section 56004 (2) (d).
PROGRAM GOALS
The program will provide individual service plans that will allow the consumer to
develop adult daily living skills while eliminating inappropriate behaviors that
might, in the future, keep them from successfully entering the living situation of
their choice.
Our objective will be:
1. To evaluate consumer's needs and develop an individual service plan to reach
stated goals and choices.
2. To assist consumers to better understand themselves and their environment.
3. To help consumers learn more acceptable ways of communicating their
wants, needs and feelings to others and to be able to seek assistance with
4
E
problems and concerns from peers, staff and non - handicapped members of
the community.
4. To teach consumers appropriate alternative ways of dealing with frustration
and annoyances in daily living situations to replace inappropriate behaviors.
5. To instruct consumers in appropriate modes of interacting with others at
home and in the community.
6. To prepare consumers for entrance into the living situation of their choice
within the community.
7. Enhance self -help skills for the consumer with personal care and daily living
skill deficits.
CONSUMERS TO BE SERVED
The program is to serve those consumers who are age of eighteen to
fifty-nine years of age and need to or wish to live in an adult residential facility.
The program is designed to be a small family group where each consumer has
direct input into all areas of daily living in a community environment. Consumers
5
6
will have a role in meal planning and other important areas of daily living
through the consumer council. Consumer council will meet monthly or more
frequently if needed, to discuss issues of interest to the consumer that they can
then review with the Administrator to make changes of importance to them.
Each consumer will have the opportunity to make decisions about activities and
house rules and each consumer will be encouraged to develop skills to meet their
future plans.
Consumers will be selected by review of records provided by Regional Center and
information provided by their current placement. The Administrator and House
Manager will conduct an in- person interview at the consumer's current
placement. After this interview, if it is felt that the consumer is appropriate for
our program a pre - placement visit with the prospective resident and the current
facility residents will be scheduled. Input from Regional Center staff, family and
other involved parties, as decided by consumer choice, will also be considered in
the decision making process.
Only after all of these steps have been made would a decision be made as to
whether the consumer will be accepted into the program.
6
7
ENTRANCE CRITERIA
The program will be designed to provide programming for individuals with
developmental disabilities between the age of 18 and 59 who are placed or
approved by Eastern Los Angeles Regional Center. The facility will be for male
and female consumers. The program is designed for consumers functioning in
the mild to moderate range of retardation. Preference will be given to those
consumers with dual diagnosis and severe behavior problems and ADL/self -help
skills deficits. Consumers must be ambulatory.
The program is designed to serve consumers that have serious /severe behavior
problems that require a highly structured behavior modification program as well
as socialization, communication arid daily living skills training. Each consumer
will be considered on an individual basis.
Consumers need to be able to feed themselves with only minimal assistance
from staff. They may need special diets or have dietary needs. They do not
have to have any personal care skills and may be totally dependent on staff for
all personal care needs, including toileting.
Consumers with diabetes would be considered for the program, if medication and
diet controlled their condition. If a consumer needs or progress to the point that
7
8
they need to take daily insulin injections they would be considered on an
individual basis depending on their ability to learn to care for their own medical
needs for continued placement. Likewise consumers with'hypertension, seizure
disorders controlled by medication, and other chronic illnesses that do not
require oxygen, or injectable medication would be eligible for the program.
Level of behavior /deficits consumer may display to be considered for the
program are:
The consumer may need total physical assistance with personal hygiene tasks
or is resistiveness to having the task performed for them.
The consumer needs to be able to move independently in familiar settings
and be able to leave the facility in case of an emergency with verbal assistance
from staff.
The consumer does not have to have any skills related to public transportation
and may require close supervision while being transported in the community.
The consumer does not have to participate in any social or group activities
in the community on a regular basis.
n
The consumer may have socially unacceptable behaviors that prevent social
participation seven out of seven days.
Incidents of aggression may be occurring on a daily basis. These incidents can
not cause more than minor injury to others.
Self- injurious behavior may occur at least daily and may require prevention
measures to prevent injury. (Head banging, biting self, picking sores or
scratching self).
Consumer may cause serious property destruction on a daily basis.
Consumers may have temper tantrums on a daily basis.
Consumer may smear feces on a regular basis.
Consumer may have AWOL problems, leaving the facility at least once per day
without notifying staff.
Consumer may become verbally aggressive or hostile in one or more daily
situations.
9
io
Consumer may be resistive in one or more situations but need to be compliant
with medication and house procedures during emergencies.
Consumer can totally undress inside the facility and community without one on
one supervision.
Consumer attention span can prevent them from focusing on a single activity for
more than five minutes due to behavior problems or lack of attention.
Consumer does not need to have any safety skills and may endanger self unless
closely supervised both at home and in the community.
Consumer can be non - verbal without a formal means of making their wants and
needs being known.
In addition to these considerations consumers must:
Consumers may have deficits in hearing or vision but can not be blind or totally
deaf without special previsions being agreed upon between the facility and the
Regional Center prior to acceptance. -
10
Other exclusions to the program will be consumers with uncontrolled medical
problems that require skilled nursing. This would include but not be limited to,
consumers who require insulin injections given by staff, oxygen or breathing
assistance equipment, wheelchairs or equipment to assist with ambulation.
Prior to admission Regional Center will submit current psychological and social
assessment, IPP, CDER, IEP, ambulatory statement and dangerous behavior
statement. A current medical and mental assessment and 1B clearance. In
addition the facility will require a functional capabilities report. Psychological
evaluation, behavior assessment and information. This information will be
received by the facility prior to placement.
All consumers will be interviewed at their present placement by the team,
composed of Administrator and House Manager. The program consultant would
be included if needed, to be sure that the facility can meet the consumer's
special behavioral needs.
Only after these requirements have been met will a decision be made as to
whether a consumer is appropriate for the program.
12
INTAKE PROCEDURE
The facility Administrator and House Manager, with input from the program
consultant, will review all placement packets to determine whether the consumer
would be appropriate to our program.
Consumer will be accepted into the program if it is decided that they have needs
that can be met by our program. The decision will be made by reviewing the
packet provided by the Regional Center and conducting an interview with the
consumer, their family, staff from their current placement, Regional Center
Service Coordinator and the facility liaison.
Even though a consumer may meet the general admittance criteria, we will
select consumers who integrate harmoniously into the existing consumer
population.
When a consumer appears appropriate they will be invited to make a pre -
placement visit so that they can meet the consumers already in placement and
see our facility and program. Only after all of these items have been completed
will a decision be made as to whether a consumer will be accepted.
12
13
Once a consumer has been accepted the Administrator and Service Coordinator
will decide on a date for placement into the facility.
ADMISSION AGREEMENT
Since no consumer will be considered for placement at the Program unless they
are placed by Regional Center the facility will have no admission agreement
other than the one entered into by the consumer, facility and Regional Center.
The agreement states the basic and specific services that will be provided by the
facility. If the consumer were to need additional services such as speech
therapy, generic funding would be used, with approval from the Regional Center
Service Coordinator.
The agreement specifies the eviction procedure, facility visiting policy, notice of
change in rates, refund policy and monthly rate.
This agreement will be signed and dated by the consumer or their legal
representative, the licensee or their representative and the Regional Center
making the placement. It will be then become a part of the consumer's records.
13
14
No consumer from a Regional Center other than East Los Angeles Regional
Center would be accepted into the program without prior approval from Eastern
Los Angeles Regional Center.
EXIT CRITERIA
The ISP will be designed with the outcome and living plans of the consumer
identified.. A plan, specific to each individual, will be developed to reach the
appropriate level of competence needed to be successful in that setting. The IPP
will set goals for the consumer on an individual basis to determine when they are
ready, or wish to leave the program. The consumer will be ready to leave the
facility when they have reached one of the following:
The consumer will be ready to leave the facility when he has met all
objectives and goals set forth in the IPP that are relevant to transition to
another setting..
The consumer has made it known to the facility, their legal representative,
Service Coordinator or family that they no longer want to remain at the
facility and an alternative placement has been located.
14
15
A consumer might be asked to find another placement under the following
circumstances:
1. If their health deteriorates to the point that they require more than routine
medical treatment. (i.e. diabetes requiring insulin, seizures that can not be
controlled on medication, a change in ambulatory status, etc.).
2. The consumer's mental health condition deteriorates to the point where
repeated hospitalization or 5150 are required and continued placement
might endanger their health or safety or the health and safety of others.
3. If the consumer reaches the age of 59 and is no longer appropriate for the
facility and /or an age waiver can not be obtained from CCL.
4. Consumer has begun to engage in behaviors that present a real and
immediate threat to the health and safety of themselves or others.
(fire setting, involvement with the police or criminal activities, etc.)
5. The consumers aggression has escalated in level of violence to the point that
these incidents result in immediate danger to the other residents of the
facility. This would occur only after all efforts to change behavior treatment
plan has failed to result in any progress. The facility in conjunction to the
Regional Center are unable to find additional resources that would allow the
15
16
consumer to remain in the facility without being extreme danger to other
consumers.
Before a consumer is asked to leave the facility a meeting that includes the
Regional Center Service Coordinator, involved family members or others in the
consumer's circle of support, the Administrator, House Manager and other
interested parties will be required. At the request of the Regional Center Service
Coordinator the program consultant will attend this meeting.
All aspects of the problem will be discussed and any changes or adjustments will
be made to assist the consumer to stay in the program, if it is the wish of the
consumer and his circle of support, to do so. New plans will be developed if it is
decided that this might allow the consumer to remain in the program. Any
changes to the ISP will be approved in advance by the Regional Center.
However, if it is decided that a re- placement is necessary a 30 -day notice will be
given and the program staff will assist with arrangements for re- placement. A
consumer would not be required to leave the facility until such time as a new
placement that is appropriate has been found.
The length of time a consumer remains in the program will be determined on an
individual basis by the facility and Regional Center interdisciplinary team and the
16
17
consumer. No specific time frame can be established, as each consumer will
respond to the program differently.
TYPES OF SERVICES TO BE PROVIDED:
The program will .provide the following services:
1. Individual Program Plan and Individual Service Plan — The ISP will be
consistent with the IPP and will specify in detail the goals, objectives and
approaches to be utilized for each individual, including reinforcement
schedules and projected outcomes. The IPP will contain the goals and
objectives for the services provided to the consumer, service review
schedule, referrals to be made to provide maximum benefit to the consumer
in all areas of daily living, and initiate the discharge and continuing care plan.
The Regional Center Service Coordinator with will develop the IPP with
input from the consumer, facility/conservator and significant others asked to
participate by the consumer. The consumer and all other parties involved in
development of the IPP will sign the IPP signature page and the IPP will
become the guide for the development of the ISP.
2. The facility interdisciplinary team, the program consultant, with input
17
P
18
from the consumer, will develop the ISP. Prior to this the program consultant
and the program manager will gather information that includes consumer's
developmental, psychiatric, social, behavior, physical and recreational needs
determined by the IPP and data collected by the staff during the first thirty
days of residence. The ISP will be written by the program consultant and
approved by the Regional Center.
a. Short term objectives, including quantifiable, observable and prioritized
behavior and personal care objectives, which are taken from the data,
collected during the first thirty days of residence in the program.
In some case historical problematic data found on the CDER might be
used in planning goals meant to maintain current acceptable levels of
behavior problems that have occurred in the past. These would
be behaviors or other deficits that are not compatible with the consumer's
long range goals.
b. Strategies to accomplish each objective including the specific intervention
or training procedures to be employed, the type and amount of
reinforcement to be provided, when it is to be provided, and the staff
member primarily responsible for the implementation of the strategy.
c. The house manager will supervise the staffs implementation of the ISP
18
19
and review the data collected on a daily basis. The administrator will then
use this information to compile quarterly progress reports for the facility,
Regional Center Service Coordinator and consumer's authorized
representative, when applicable to insure progress and continuity of care.
The services to be provided pursuant to the ISP will be designed to enhance the
capabilities of consumers including those with deficits in daily living skills,
maladaptive behaviors and poor socialization and communication skills. The ISP
is written by the program consultant with input from the facility interdisciplinary
team and implemented after receiving approval from the Regional Center. The
approval of the ISP would be received from the Regional Center Service
Coordinator at the 30 -day review meeting, which would include the consumer,
Regional Center Service Coordinator, facility Administrator and other members of
the consumer's circle of support requested to be in attendance by the consumer.
At the request of the Service Coordinator or the Administrator the program
consultant would also attend this meeting.
3. Skills Assessment:
a. Skill assessment in all areas of personal hygiene, grooming and daily living
will be performed on all consumers in the program. This methodology will
19
20
be utilized to systematically evaluate the consumer's deficits, if any, in
these areas.
b. This evaluation will describe the degree of prompting or assistance by
staff needed for successful completion of the task. This information will
then be reviewed and target objectives decided upon during the 30-day
meeting that will include the consumer, facility staff and Regional Center
Service Coordinator and others invited by the consumer.
c. Once targeted objectives are identified a task analysis will be developed to
break down each deficit skills task into easy, achievable steps. This task
analysis will then be used by staff as a guide for teaching the consumer
the task, as well being used to record and track progress towards
reaching the objective. The task analysis and service plan assessment
will be written by the program consultant.
d. Staff will provide verbal and physical assistance along with modeling and
teaching techniques that will enable the consumer to learn to perform
each step of the task. The training process will start with maximum
assistance and be faded to minimal assistance as the consumer's skills
improve.
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e. The direct care staff will each day record the level of assistance
required for each step of a targeted task on the Data Collection Form.
f. This progress will be reviewed daily by the house manager and a
consumer will be considered to have mastered a step of the task when
they are able to complete that step independently 20 consecutive days.
This procedure will be followed until the consumer is able to do the entire
targeted task independently.
g. This data will be used to report progress on meeting these skills
objectives on the quarterly report made by the administrator.
h. All data will be reviewed by the program consultant on a monthly
basis.
4. Program Activities:
Programmatic activities will be structured and designed to provide training
and skills development in areas of interest to the individual consumer.
Consumers will be encouraged to learn skills that would allow them to
become more independent, but no consumer will be required to perform
household chores if they elect not to be involved and this would be
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documented in the consumer ID notes.
Staff will assist the consumers in planning individual activities with family and
friends outside of the facility on a regular basis.
Activities in the community will be planned with consumer input through the
consumer council and will be designed as an opportunity for training in social
skills, integration and community awareness. Leisure activities will also be
planned and consumers will be encouraged to become involved in the
community at large, advocacy and other groups that will lead to increased
self- esteem and self- reliance. Staff will encourage consumers to invite
friends and family to share in these activities and celebrations.
5. Behavior Program Plan:
An integral part of the program activities is the implementation of behavior
treatment plans which will be implemented across all areas of training and
activities. When dealing with behaviors in natural settings the least aversive
and most unobtrusive methods will be used to extinguish inappropriate
behaviors while reinforcing those behaviors that we wish to increase or add
to the consumer's repertoire. The behavior plan will be developed utilizing
the following procedures:
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a. Identification of the maladaptive behavior to be addressed
b. Collection of baseline data on the frequency of the maladaptive behavior
prior to intervention. This will be done during the first 30 -days in
placement or thirty days after the behavior has started to occur.
c. Identification of the antecedent events related to the occurrence of the
behavior.
d. Identification of the consequences of the behavior with particular
attention to the reinforcements those consequences may provide.
e. Identification of the potential reinforcers to be utilized.
f. Description of the intervention strategies.
g. Plans to reduce the restrictiveness of the program.
h. Identification of treatment priorities, including as identification of a
treatment hierarchy which specifies the behavior warranting the most
immediate attention.
Each behavior program plan will include the following standards
a. prevention plan
b. intervention plan
c. the environment in which the intervention procedures are to be employed
is designed to avoid stigma, and to reinforce adaptive behaviors
d. the intervention procedures have been chosen from various procedures
available, based upon relative effectiveness
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e. undesirability
f. long -term or short-term effects which may be associated with the
procedures used
g. an identification of the conditions under which the intervention procedures
are contra - indicated
h. identification of the expected social behavior and status benefits of the
program
i. a statement that the rights of the consumer are and were protected in
accordance with Sections 4503 and 4505 of the Welfare and Institutions
Code
j. A statement that the plan meets all legal and regulatory requirements.
6. Intervention/Training Techniques:
The behavioral intervention program will use the least restrictive and least
intrusive treatment strategies with the intention of developing appropriate, pro-
social and self - sufficient behaviors in the participants, as well as decreasing the
maladaptive behaviors that they may exhibit.
The types of behaviorally oriented therapeutic activities, which will be provided
as part of the residential treatment program, include:
a. Social skills: The shaping and development of adaptive pro - social behavior,
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including tantrums, outburst of aggressiveness, both physical and
verbal and restiveness.
b. Communicative Development Skills: Involving the development of
expressive and receptive communication skills. This includes instruction in
cues for availability of conversations, personal space. Alternative methods
of making wants and needs known without verbal speech such as
sign language, communication books, pictures, gestures or the use
of substitute items when requesting a desired object.
c. Money Recognition and Management: Learning to exchange money for
desired purchases. Giving money to clerks when ordering meals or
making purchases in the community. Money recognition and coin
identification.
d. Dressing /Clothing: Dressing and putting clothing on correctly. Learning
how to tell clean clothing from dirty. How to put dirty clothing in the
hamper. Choice of clothes to wear and color and style preferences.
e. Pedestrian Safety: Introduction to community safety. Learning to cross
walks, watching for traffic. How to watch for cars when walking in
neighborhood or parking lots, watching for cars backing from driveways
or parking spaces. Simple safety sign recognition.
f. Leisure planning: Home activities, N, radio, stereo, arts and crafts, pets
and their care, entertaining friends. Community activities, adult
educational facilities, public recreational facilities, movies, sports, party,
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eating out, motels /hotels. Introduction to new activities and self- advocacy.
Friendship formation and maintenance.
7. Psychotropic Medications:
Medication therapy will be utilized primarily for individuals experiencing severe
depressive and psychotic symptoms or those with extreme hyperactivity.
Utilization of medication will be closely monitored and used appropriately in
accordance with the consumer's symptoms rather than the needs of staff and the
caregivers. Each consumer, who is receiving psychotropic medications, will be
involved in a medication review at least once per month and more often if
necessary, by the facility psychiatrist. Psychotropic medication will not be
utilized for-purposes of behavioral control or restraint. Prior to the use of
psychotropic medications, the interdisciplinary team, including the program
consultant, with the psychiatrist will determine the most effective treatment plan
for the symptoms and behaviors being modified. The purpose of the medication
will be discussed, along with why it is being used for the specific consumer. The
psychiatrist will also explain to the staff the side effects they need to be aware of
and watch for. Medication therapy, if needed will be conducted by a psychiatrist.
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8. Recreational and Socialization Activities:
Another aspect of the program is the assist the consumers in their normalized
use of leisure time. This will include peer interaction in recreational, non- stress-
related activities and in activities promoting socialization skills. These activities
will be conducted during the early evening hours and will include Program
residents, family members and /or community members.
On weekends, these programs will be continued and will incorporate outings,
field trips and community activities to aid the consumers in establishing more
appropriate social relations with other members of the community. Family will
be encouraged to participate in activities as often as is possible for them, if the
consumer chooses to include them in their lives.
9. Medical and dental services will be insured by annual checkups and on as
needed basis. These services will occur in the community.
10. Consumers will be referred to other community agencies for developing
their vocational, educational and socialization skills. The Administrator
and House Manager will work with the Service Coordinator and consumer to
utilize appropriate community agencies in their skill development. All
consumers will be strongly encouraged to participate in a program outside
the facility Monday through Friday. Failure to participate in a day program for a
short period of time will not be considered a reason to ask a consumer to leave
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the facility. But the facility staff would do everything they could to assist the
consumer in trying different types of activities, vocational, educational and
recreational, that are available to them in the community.
11. Behavior Assessments
After the interdisciplinary meeting where targeted behaviors have been identified
a behavioral assessment will be completed on each behavior. The assessment
will be completed by the Program Consultant and describe the behavior, list the
precursors and antecedents, the consequences reinforcers that the behavior..
generates, what the consumer is trying to tell us by the behavior and what
occurs after the behavior stops. This information will then be used to develop a
behavior plan designed to extinguish the behavior while teaching the consumer
alternative behaviors that are socially acceptable and result in the consumer
getting the same reinforcers. Once this is completed it will be reviewed with the
consumer and Regional Center Service Coordinator, for their approval and then
implemented by facility staff. The behavior plans will be approved at the
meeting held at the end of the consumer's first 30 -days in the facility.
The behavior plan will identify the behavior and give a step by step plan to be
followed by all staff members when the targeted behavior occurs.
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Data collection sheets will be given to staff so that they can collect data for
tracking progress towards meeting behavioral goals. The data sheet will again
describe the behavior in a manner that makes it easily identifiable to anyone who
sees it. It will tell when and how to count occurrences. Progress notes will then
be completed to correspond with data to explain to Administrator and consultant
what is occurring. Data will be kept in a daily working file for each consumer
and reviewed daily by the House Manager each night. Data will be maintained in
consumer's file for Regional Center review.
The program consultant will determine the frequency of data collection and each
consumer may have more than one method of data collection. The time frame
for data collection will be daily and the method used to count incidents will be
clearly stated in the behavior assessment and on the ISP /data collection sheet.
The areas and methods of data collection to be used will be identified at the 30-
day IPP meeting.
The program consultant will review data monthly, discuss the consumer progress
with the facility interdisciplinary staff and make adjustments as needed to the
behavior treatment plans. The Administrator will then review the purposed
changes with the Service Coordinator prior to implementation of these changes.
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PROGRAM DESCRIPTION
The program is designed to serve adults who need this enriched level of care and
wish to remain a family group or as a positive alternative for their current
placement. The house is designed to promote improved daily Irving skills,
development of appropriate social behaviors and ready access to activities and -
services available in the community. This skill training will be completed while
addressing maladaptive behaviors that are interfering with the consumer's ability
to integrate into the community in social settings.
The program is designed for the consumer to learn and develop skills needed to
allow them to move into the living option of their choice.
The facility is designed so that each consumer has a semi- private room.
Consumes will share a bath with other consumers. All others areas of the facility
will be available to all consumers.
Although the primary focus of the house will be to modify maladaptive behaviors
that have interfered with the consumer's ability to live successfully in the
community. The house will be designed to allow for training in skill building in
ADL chores, housekeeping and practice of individual choices and decision making
in varying situations.
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The house will be a four -bed facility that is operated by staff at a staffing hours
as required in Title 17. There will be an awake staff on duty at all times that
consumers are awake and in the facility. The house will be staff operated and it
will have a live -in House Manager.
Consumers will be introduced to the community and taught choices and options
available to them by allowing them to work within a structured program that still
allows them to be a part of the decision making process as described in the
Types of Services section of this program. Consumers -will engage in community
outings with integration with no handicapped people in the community on a daily
basis.
Each consumer will have the opportunity to learn to do household chores and
cooking activities of interest to them. Each consumer will have the opportunity
to plan activities and outings for the group as well as on an individual basis and a
strong emphasis will be placed on developing and improving communication and
social skills.
All consumers will be encouraged to engage in some sort of day /vocational
program. The facility staff will, along with Regional Center Service Coordinator,
assist the consumer in identifying and enrolling in the program of their choice.
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Arrangements will be made for the consumers to practice religious activities of
their choice. This will be a personal preference and plans will be made so that
everyone can participate if they wish, but no consumer would be required to
participate if they indicated they did not wish to be involved.
The facility staff will encourage consumers and their family /friends to introduce
their ethnic celebrations to the facility, and to develop an interest in their
heritage and cultural differences. Consumers and their families will be invited to
introduce their special observances to their peers, including the introduction of
foods and customs.
The program will be very interactive and all consumers will be encouraged to
participate on a regular basis to an extent that allows them to benefit from the
program as it is designed for them. Consumers are expected to respect the
beliefs and interests of their peers and learn to allow others to at times make
choices that effect what they do, as their choices will affect others in the
program.
Consumers will be encouraged to become involved in the dynamics of the facility
and the community and practice all their personal rights in influencing the issues
that affect them. This will be accomplished by consumer council, which will meet
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one time per month. Areas to be discussed will included, but not be limited to,
meals and menus, daily activities, house rules and other issues of importance to
the consumer. The consumers will conduct this meet with assistance of staff.
Staff will work with the program consultant on ways of assisting consumers who
are non - verbal to make their wants and needs known. Topics decided on by
these meetings will be presented to the Administrator the next day for discussion
and implementation when possible.
Transportation will be provided to consumers for group and individual activities.
All consumers will also receive exposure and training, when appropriate, in how
to use public transportation. The facility will have a vehicle available for
consumers' use for outings and appointments at all times.
Family members will be encouraged to participate in activities and celebrations
on a regular basis if the consumer wishes to include them. The consumer will be
assisted in notifying family members and friends that they would like to have
attend and participate in planned activities. The facility staff will also stay in
contact with the family members as often as requested by them and agreed
upon by the consumer. Family members and friends will be welcome at the
facility at times when they don't conflict with the program and when the time has
been agreed upon by the consumer.
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A telephone will be available for calls by consumers of the facility. Consumers
will be expected to pay for their personal long distance calls if they are not
related to case management.
Although normally activities will be planned on a one on one basis if or
when a group activity has been scheduled and a consumer decides at the last
minute that they do not wish to participate, or if their behavior is such that they
would disruptive to the group as a whole, one staff member will remain with the
consumer at the facility during the activity. If the incident is behavior generated
the behavior plan for that speck behavior will be implemented.. If the .
consumer has stayed home because he does not feel like participating staff will
interact with the consumer in activities at the facility of his choice, when
possible. Consumers will not be taken into the community when they are
displaying disruptive or inappropriate behavior prior to the scheduled outing or
activity. `
The program will have staff employed that is fluent in the languages of the
facility consumers on a daily basis. If a consumer is considered for placement in
the facility and that consumer uses a specific type of alternative communication
the facility would assure that staff was fluent in the use of this device prior to the
time that they accept the consumer. The local community will have services
available in English, Spanish, and numerous Asian languages. As part of the
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program preparation staff will explore services in the community to assure that
the need language is available to the facility consumers.
A trust account will be established for consumer Personal and Incidental monies.
A book will be kept in the facility office area showing each deposit and
withdrawal that the consumer makes along with the consumers signatures.
Receipts will be kept for expenditures.
A surety bond will be purchased to insure the safety of the consumers' money.
EXPECTED SERVICE OUTCOMES FOR CONSUMERS
The length of the facility placement will be decided on an individual basis. The
facility interdisciplinary team, including the program consultant and the Regional
Center will establish the timeframe. By the time that a consumer leaves the
program they should have met the following:
1. The consumer will be able to communicate, verbally or through other non-
verbal methods, their feelings to others'in three different settings 10 out of
10 times.
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2. The consumer will be able to successfully participate in three leisure activities
with staff involvement 4 out of 4 weeks.
3. The consumer will be able to care for clothing and personal property with
staff assistance 4 out of 4 weeks.
4. The consumer will have met behavior objectives 10 out of 10 times and have
required no outside intervention such as the PET team or psychiatric
hospitalization.
5. The consumer will have explored and participated, at least part time, in a
school, day program /vocational program of their choice.
6. The consumer will be able to complete personal hygiene tasks with only
minimal assistance 7 out of 7 days.
7. Consumers should have acquired the skills necessary to move into living
situations of their choice.
8. Consumers will improve their capabilities and deficits to a level appropriate
for the entrance criteria to the next step in their desired living option.
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PROGRAM PREPARATION
The facility will allow the Administrator or his designee up to 7 hours per week,
per consumer, for program preparation functions.
These functions will include gathering information about activities and advocacy
activities that are available to the consumers in the program. Collecting specific
information about activities and subjects of interest to individual consumers.
Writing ID notes and participating. in interdisciplinary meetings. Meeting with the
program consultant to review behavior and ISP plans and participating in staff
meetings held by the Administrator designed to improve the overall functions of
the facility.
At times staff may be asked to use this time to purchase specific supplies needed
for an activity or training that they are planning with the consumers assigned to
them.
PROGRAM IMPLEMENTATION AND TECHNIQUES TO BE USED:
An individual service plan will be developed for each consumer. Behavioral
excesses and deficits that have interfered with the consumer's entrance into
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his /her choices of activities will be targeted. The program is designed to provide
ample opportunities to learn and practice alternative behaviors that are socially
acceptable.
Program staff will discuss and explore appropriate options that the consumer can
use to express and assert themselves to others. A group of alternatives that
could be substituted for current maladaptive behaviors will be explored;
reinforcers will be identified with the consumer and delivered by staff after the
occurrence of appropriate behaviors.
Consumers will be encouraged to participate in all aspects of their program plan
and to review and discuss the data collected by the staff on a weekly basis. At
that time, adjustments can be made in areas where the consumer or staff feels
are necessary. A meeting may be requested when major change is required so
that the Service Coordinator can provide input and give their approval.
Whenever possible reinforcers identified for use in extinguishing an inappropriate
behavior will be natural and self- occurring, but tangible reinforcers will be used
when needed. When primary reinforcers are used a schedule of reinforcement
will be implemented and a secondary, more appropriate, reinforcer will
accompany it and fading of the primary reinforcer will begin as soon as possible.
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TYPES OF REINFORCERS TO BE USED:
Primary in conjunction with secondary reinforcer
Simple token economies
Activities and special individual outings
Each behavior plan will state specifically the type of reinforcer to be used, how
and when it is to be delivered and by whom
A primary reinforcer would be an edible or other tangible reward that is given
immediately after the occurrence of a behavior that is positive and that staff
wants to see reoccur. A secondary reinforcer will always accompany primary
reinforcers.
Secondary reinforcers would be praise, a handshake, verbal acknowledgement of
a job well done, etc. If it has been established that a secondary reinforcer alone _...
is not sufficient to get wanted results a secondary reinforcer should be given
with the primary so that it begins to become more reinforcing and can in time
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replace the need for an immediate, tangible reward to illicit the appropriate
behavior.
TECHNIQUESf TO BE EMPLOYED:
SAME MODALITY SENSORY FEEDBACK: Substituting other activities for the
targeted behavior, which competes with the sensory stimulation, obtained
through the target behavior. (e.g.; body rocking replaced by rocking in a rocking
chair.)
DIFFERENTIAL REINFORCEMENT OF INCOMPATABLE BEHAVIOR: Representing
reinforcement for appropriate behavior that is incompatible with undesired
behavior.
DIFFERENTIAL REINFORCEMENT OF LOW RATE OF BEHAVIOR: Reinforcing a
response only if a specific period of time has passed during which the targeted
response has not occurred. The first response to occur after the time period will
be reinforced but not again until a second period has elapsed without responses,
and so on.
DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR: The delivery of
reinforcement after a specified or preset period in which the undesired behavior
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is absent. Reinforcement will be given regardless of what other behaviors might
occur during the same period.
GROUP CONTINGENT CONSEQUENCES: Making reinforcement for the group
contingent on the behavior of an individual.
INSTRUCTIONAL CONTROL (VERBAL/GESTURAL): Verbal or gestural instruction
to stop an inappropriate behavior immediately following the occurrence of that
behavior. This is normally the first procedure used by staff to manage a person's
behavior.
INSTRUCTIONAL CONTROL (PHYICAL PROMPT): Physical (hand on hand)
instruction to stop an inappropriate behavior following the occurrence of that
behavior or to physically assist the consumer when teaching a new skill.
WITHDRAWAL OF SOCIAL CONTACT: Termination of interaction immediately
(e.g.; walking a short distance away), after the consumer demonstrates an
inappropriate behavior, typically, the instruction resumes shortly after the person
ceases the inappropriate behavior.
EXTINCTION: Withholding all reinforcement for an undesirable behavior.
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TOKEN ECONOMY: The consumer will be required to earn favorite privileges
that they now receive regardless of their behavior. These reinforcers will be
made available to them contingent upon the designated target behavior. Tokens
(i.e.; points) will be awarded immediately for the occurrence of the target
behavior and then may be exchanged after a designated period of time.
In addition to these formal methods of training the staff will work with the
consumer in the group to teach specific skills. This training will take place both
in the group and individual sessions. Group activities will include:
GROUP DISCUSSION AND TRAINING IN HYGIENE AND APPEARANCE: Group
discussion activities will be scheduled weekly with the group to talk about and
discuss clothing and what is and is not appropriate for any given activity.
Magazines, catalogs and television will be used as aids to show appropriate
clothing for different types of activities. Also in this group hygiene and health
issues will be discussed. Future activities will be used as learning experiences to
plan clothing that is appropriate to place, occasion and weather conditions. Staff
will encourage consumers to develop their own style of dressing, incorporating
their favorite colors and materials into their wardrobes.
EXPLORATION OF LEISURE /ACTIVITY PLANNING: Group discussions will be
scheduled monthly to plan activities and outings that the facility consumers
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would like to do together or individually. When appropriate visual aids will be
used to assist consumers in making choices of activities. The staff with the
assistance of the consumers, will research where activities are to be held, times,
costs, means of transportation available and any items that they might need to
take with them. The staff will direct discussion in such a manner that all
consumers get the opportunity to choose activities for the group to do each
week. Also, at these meetings staff will make available material about activities
taking place in the local community, training and advocacy'sessions being held in
the area and other information that might be of interest to the group as a whole
or an individual consumer with interest.in.a.particular activity.
COMMUNICATION SIQLLS: During activities both at the facility and in the
community staff will encourage consumers to communicate their wants and
opinions to others. They will be provided with opportunities to interact with
community members in diverse settings. When appropriate at the facility where
situations are role played by consumers and staff. These sessions will be
critiqued and discussions held on other appropriate responses that could be used
to resolve conflicts. This procedure will be continued until the consumer feels
that they have found an approach to given situations that conveys their feelings
in an appropriate way that can be easily understood by others. These methods .
of communication do not need to be verbal and staff will develop alternative
methods when needed. If the facility interdisciplinary team and the Regional
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Center Service Coordinator feel it is appropriate a speech therapist would be
contacted for an evaluation and /or therapy sessions.
There will be time set aside daily for consumers to engage in activities and
outings on an individual basis. In these cases staff will provide one on one
assistance as needed. Staff will encourage consumers to make plans with
friends and others outside the facility so that they can develop a wide range of
friends and begin to establish a strong circle of support.
Facility activities will include researching and learning about all living options
available to each consumer. They will be able to use this information to make
informed decision regarding those skills they need or want to learn in order to
meet their future living goals. This information will then be able to be utilized by
the consumer when developing their IPP.
METHODOLOGY TO'BE USED IN RECORDKEEPING, ASSESSMENT AND DATA
COLLECTION:
Immediately upon the admission of a consumer into the program staff will begin
to collect-data. daily, with intervention, with behaviors and information about the
consumer. They will track consumer's strengths, deficit areas, and behavior
problems including antecedents and consequences and identify reinforcers. Staff
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observations will include the duration, severity and frequency of behaviors that
are considered undesirable.
The data collected in the first month will be used as the basis for the IPP /ISP
objectives.
At the end of the first thirty days a meeting will be held with the consumer and
the facility interdisciplinary team to review the information gathered. The
consumer will be encouraged to provide input into their feelings and desires in
regards to what they-wish to accomplish while in our program. Together goals
and objectives will be decided upon and the process for designing an ISP will be
explained to the consumer.
After this meeting the facility interdisciplinary team will meet with the program
consultant and a behavioral assessment and ISP will be completed for each
targeted behavior by the program consultant. After the ISP has been completed,
a behavior plan will be designed, by the program consultant and approved by the
Regional Center Service Coordinator prior to implementation. This approval will
occur at the 30 -day review meeting held with the Service Coordinator,
Administrator, consumer and house manager, day program (if applicable) and
any other interested parties that the consumer or Service Coordinator requests
to be present. At that meeting the IPP will be developed and ISP presented for
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approval. Also at that time changes can be made so that all parties feel
comfortable with the behavior modification plans to be used. Once all parties
have agreed to the plans the staff will implement them.
Data will be collected as specified on the ISP. This may be to count each
occurrence, to count only at specific times, etc. The Administrator and Program
Consultant will go over how and when to collect the data for each targeted
behavior at the time that the ISP is implemented. Service objective data will be
collected daily. The data will be reviewed daily by the House Manager, the
Administrator at least weekly and the program consultant monthly.
A permanent file will be made for the consumer that includes emergency
information, a picture of the consumer along with a narrative physical
description, placement agreement, authorization for services, signed consent for
release of information, a signed copy of house rules, grievance procedure and
consumers rights including the name and telephone number of the Consumer
Rights Advocate and Community Care Licensing Program Analyst, an inventory of
consumer's personal property, a statement of ambulatory status and a Regional
Center statement of dangerous behaviors, a current physical examination
including a TB test, inoculation records, when available, a record of allergies and
a list of current medication, there use and side effects, a copy of the current IPP,
the facility ISP, quarterly reports, from the facility, progress notes and data
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keeping records, special incident reports, psychological evaluation and psychiatric
notes, social assessment and history provided by Regional Center.
These files will be available daily for consumer to review alone or with the House
Manager upon request. Files will never be left out in an unlocked area when
unsupervised. File information, progress notes and changes in the program will
be updated on a regular basis. (Pictures and descriptions will be updated one
time a year.)
A staff meeting, including the program consultant, will be held to review and
discuss the ISP for each new consumer. The data collection system will be
reviewed and the staff responsible for collection identified. All staff will sign and
acknowledge that they understand the method and time intervals to be used to
collect data. Staff will also be responsible for writing daily progress notes and
observations and Special Incident Reports as needed.
The Administrator will give a written quarterly progress report to the Regional
Center Service Coordinator on each consumer in the program. The report will
address each objective on the IPP stating progress or lack of progress made and
recommendations for changes if needed._ The quarterly report will also include
barriers to progress and actions the facility will take to overcome these barriers.
This report will also include ID notes from the program consultant. The
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Administrator will also meet in person with the Service Coordinator to review
quarterly progress and share information and get their input into changes as
they feel they are needed.
Any changes would be approved by Regional Center- prior to implementation.
This would occur at the quarterly meeting.
The Administrator will complete semi - annual reviews and a face to face meeting
arranged with the Service Coordinator and consumer to review the IPP; progress
made and recommends changes as needed.
Annual meetings will be held at the facility and the Administrator will be sure that
family members, day programs, and others involved or interested parties are
notified. The consumer will be encouraged to invite those people that they wish
to be there for the meeting. At the request of the service coordinator the
program consultant will also attend this meeting.
The Administrator will keep in close contact with the consumer, family and
Service Coordinator to share information and assure that adjustment to plans are
made as needed to insure maximum. benefit. to our consumers...
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written progress reports will be given to Regional Center and retained in the
consumer's file quarterly. Face to face meetings will be held with the Service
Coordinator for quarterly, semi- annual review that includes the Administrator,
House Manager and the consumer. The Administrator along with the Service
Coordinator will schedule, and encourage the consumer to invite the people they
consider their circle of support, to meet annually to review progress and whether
the program as designed is still appropriate and able to meet their needs for the
next year.
TRAINING
Continuing education subjects will be decided based on subjects offered by
Regional Center the local development c enters and other agencies in the local
area. In addition training subjects will be based on the needs of the consumers
in the home. The Administrator will make the decision with input from the
program consultant, Regional Center liaison and quality assurance unit of the
Regional Center and Community Care Licensing Program Analyst.
CONSULTANT QUALIFICATIONS AND HOURS
Consultant hours will be provided to all residents at the.facility. Each consumer
will receive at least 12 cumulative hours of individual services each consecutive
six -month period after the effective date of admission.
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Part of the program consultant hours will be used to meet with staff to review
data, progress and effectiveness of the plans. In addition, the program
consultant will provide training in behavior modification techniques as they feel is
needed to improve the effectiveness of the facility.
The program consultant will meet at least one time per month with the
Administrator to report findings and make suggestions that they feel are needed
to improve the program.
If the Program Consultant and Administrator agreed that a change in an
individual consumer treatment plan is needed at the monthly meeting the
Administrator will notify the Service Coordinator of the change and a meeting will
be scheduled to discuss the need for these changes. The Program Consultant
will have prepared the new plan in time for it to be presented at that time and
agreed to be the facility, the service coordinator and the consumer.
The program consultant will make notes of each visit they make to the facility
and the purpose of the meeting, including the consumers seen, each time they
come to-the facility.. This information will be kept in a consultant logbook, and
be available for review at all times.
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Consultants shall be individuals or groups eligible for vendorization in accordance
with Title 17, California Code of Regulations, Chapter 3, and subchapter 2.
STAFFING
The facility will operate 24 hours per day, 7 days per week. Required staffing
hours will be scheduled per Section 56004 of Title 17. (See sample staff
schedules). Staff may leave the facility to provide recreational activities, provide
community experience to the consumers or to transport them to necessary
appointments. At least one staff member will be on the premises whenever a
consumer is in the facility. There will be an on -call staff person responsible for
overnight coverage to insure the safety and well being of the consumers. The
Administrator will be on call during nighttime hours in case it is necessary for
staff to leave the facility in order to fulfill their duties to the consumers.
Intake evaluations will be scheduled only during the daytime hours to insure an
adequate evaluation and involvement of Regional Center and other interested
parties.
Staffing for program will meet requirements for Level 4I residential programs
and will include highly qualified professional and paraprofessional staff. All staff
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will be under the direction of professional staff who have the experience and
skills required for these programs.
A psychiatrist and psychologist or licensed mental health professional working for
the psychologist will be part of the treatment team. Both of these professionals
will have experience with both individuals who have emotional- problems and
developmental disabilities. The psychiatrist will closely monitor the medications
provided to the participants and the side effects of the medication. This
individual will be highly trained in psychopharmacology, especially as it related to
individuals who may be unable to adequately express the affects (positive or
negative) of the medications they are taking. The activities of the psychiatrist,
psychologist will be coordinated to insure that the services they provide are
consistent and not duplicative.
The Direct Service Staff will provide general supervision for the consumers, and
administer and implement the ISP. They will have experience and training in
residential care for persons with developmentally disabled. All staff providing
direct care services to facility consumers will have the Direct Support Professional
certification.
Following are job descriptions for the positions discussed above:
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JOB DESCRIPTION
PROGRAM CONSULTANT
DUTIES
1. Responsible for preparing behavior assessments and behavior plans.
Design and prepare data collection system and task analysis for each
consumer in the program.
2. Will provide training and technical support to the facility staff.
3. Will provide one on one counseling to all facility consumers.
4. Will act as a member of crisis team, as needed, to insure that the current
plan being used to work with the consumer is working. Reevaluate
effectiveness of behavior plans and assessments and provide input into
changes to be made.
5. Will meet monthly with the Facility Administrator to assure that he is aware of
on -going plans and make suggestions of changes in the program that would
enhance the consumers progress and integration into the community.
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QUALIFICATIONS
Education: A Ph.D. in psychology. A California license in good standing.
Experience: Must have experience working developmentally disabled individuals
with severe behavior problems, communication deficits. Must have the ability to
work with agencies associated with consumer services, such as day programs
and Regional Center.
The psychologist /program consultant will be approved by the East.Los Angeles
Regional Center.
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JOB DESCRIPTION
ADMINISTRATOR
The facility Administrator shall be responsible for all aspects of daily operation of
the facility and oversee consumer programming. The Administrator shall report
directly to the Licensee.
DUTIES:
1. Develop and maintain facility policies and procedures.
2. Insure non - discrimination in the delivery of facility services and procedures.
3. Assure that the facility is operated and maintained in accordance with the
Department of Social Services, Department of Developmental Disabilities and
the Department of Labor standards.
4. Develop and monitor budget on an on -going basis, supervise maintenance of
financial and all other records.
5. Interview, screen, hire and discharge professional and consultant staff.
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6. Responsible for recruitment, training and supervision of all direct care staff.
7. Assure that all necessary equipment and supplies are procured.
8. Have knowledge of consumers' IPP /ISP and oversee their implementations.
9. Serve or appoint liaison with day care programs, community groups, provide
information to the community as required.
10. Participate in the screening process when admitting consumers to the
facility.
11. Report unusual occurrences to the proper agencies.
12. Review consumers and staff's incident and accident reports and take
appropriate action in a timely manner.
13. Responsible for proper administration of resident's money and valuables.
14. Knowledge of consumer's and employee's rights and ability to communicate
and discuss these with them.
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15. Work closely with the direct care staff to assure a coordinated effort in
maximizing the development of consumer skills.
16. Assist staff in preparing progress notes and data collection, reviewing them
weekly for accuracy.
17. Oversee the practice of consistent behavior management principles.
18. Know each consumer's medical condition and history.
19. Work directly with the doctor and other specialists.
20. Responsible overseeing the correct procedures are in use for medical
documentation, storage and administration.
21. Assess facility needs and evaluate staff members on a daily basis.
22. Act as head of the interdisciplinary team and give accurate input on residents
performance and progress.
24. Understand behavior modification techniques and their implementation.
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25. Insure open lines of communication with staff, consumers, families and
agencies.
26. Prepare annual and quarterly reports for the Regional Center and insure
appointments are made to have a face to face meeting with the consumer at
least one time per quarter.
QUALIFICATIONS
1) Have a minimum of 12 months prior. experience providing direct supervision
and special services to persons with developmental disabilities
2) Complete a minimum of 12 hours of continuing education in the areas, on
related to the administration and management of residential services for
persons with developmental disabilities;
a. Consumer services as described in the program design
b. Promotion of consumer rights, health, safety and social and physical
integration; and
c. The ID team process, including development and implementation
of the IPP.
3) Complete CPI training and /or have a current certificate of completion of
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this training.
4) If the Administrator is used for any direct care hours they must also have
Passed the Direct Support Professional challenge tests or attend the DSP
classes and pass the test.
The Administrator must have a current Administrator certificate and keep it
current.
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JOB DESCRIPTION
HOUSE MANAGER
The facility House Manager shall be responsible for implementation of daily
operation of the facility and oversee consumer programming. The House
Manager reports directly to Administrator.
DUTIES
1. Responsible for the physical plant and operations.
2. Insure the upkeep of the home.
3. Responsible for the purchasing of food and supplies for the home.
4. Insure proper maintenance of the facility vehicle.
5. Responsible for insuring that the facility is managed in a prudent and
organized manner.
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6. Schedule group activities, plan for special occasions and outings and arrange
for transportation.
7. Update employee's records.
8. File and review all incident reports.
9. Attend staff meetings and conduct staff in- service training.
10. In absence of the Administrator they will be responsible for the duties of the
Administrator.
11. Handle tours of the facility and hold interviews as needed.
12. Work closely with the direct care staff to assure a coordinated effort in
maximizing the development of consumer skills.
13. Instruct consumers as necessary in acceptable behavior and other areas of
training.
14. Assist staff in preparing progress notes and data collection, reviewing them
daily for accuracy.
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15. Know individual consumer's program and oversee their implementation.
16. Oversee the practice of consistent behavior management principles are
practiced.
17. Assign specific staff duties.
18. Know each consumer's medical conditions and history.
19. Work directly with doctor and other specialists.
20. Responsible for medical documentation, storage and administration.
21. Document and. report to the Administrator all incidents when they occur.
22. Implement behavior programs for all consumers.
23. Work with the Administrator to implement training staff and provide in-
service training.
24. Provide orientation, training and evaluation of all staff members.
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25. Communicate, discuss all incidents with the Administrator.
26. Act as a member of interdisciplinary team and give accurate input on
consumers performance and progress.
27. Perform basic medical treatment as prescribed. (Creams and lotions)
28. Insure open lines of communication with staff, consumers, families
and agencies.
29. Understand behavior modification techniques and their implementation.
30. Complete SIRS and complete abuse reporting as required by regulations.
31.Other duties as assigned.
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QUALIFICATIONS
1) Have a minimum of six months experience providing direct supervision and
special services; or
2) Within six months of beginning to provide direct care services in the facility,
complete 12 hours additional training of continuing education in
implementing program services, promoting consumers' rights, health, safety
and social and physical integration, and the ID process, including
development and implementation of IPP.
3) Complete a minimum of 12 hours continuing education which meets the
requirements specified consumer services as described in program design;
promotion of consumer's rights, health, safety and social and physical
integration; and the ID process, including development and implementation
of the IPP. (as specified in section 56037(a))
4) Have current First Aid and CPR certification.
5) Complete 40 hours of in -house training and orientation on:
a. Facility Program Design
b. Consumer IPPs
c. Consumer rights
d. Medication
e. Health and emergency procedures
f. Identifying and reporting SIRS
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g. Identifying and reporting abuse
h. IPP /ISP implementation
6) Criminal records clearance, TB screening and physical exam
7) Complete Personnel file, including application, criminal record clearance.
8) Have completed CPI training.
9) Must have completed Direct Support _ProfessionaI training /and or passed the
challenge test.
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JOB DESCRIPTION
DIRECT CARE STAFF
The direct care staff will work directly with the consumers assigned to them.
Direct Care Staff will report directly to the House Manager.
DUTIES
1. Will be thoroughly familiar with the program plans for each consumer in
the facility.
2. Will fully understand behavior modification techniques and how to correctly
implement them.
3. Will document incidents that occur.
4. Will implement behavior program for each consumer.
5. Will maintain current progress notes and data frequency count on each
consumer assigned to them.
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6. Will attend staff meetings and in- service training.
7. Will be able to instill acceptable behaviors in others.
8. Will aid in orientation and training of new staff members.
9. Will act as a member of the interdisciplinary team and provide input into
consumer progress and overall condition.
10. Will assist consumer in all areas of grooming and personal hygiene skills.-
11. Will perform basic medical treatment (creams and lotions) as prescribed and
pass medication as directed.
12. Will insure open lines of communication with other staff members.
13. Will assist in supervision of meal preparation and housekeeping chores as
assigned.
14. Have the ability to exercise mature judgment and relate to consumers in a - -.
warm, caring and non - expletive means.
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15. Insure that the facility is maintained in a clean, safe and home like manner.
16. Reports observations or evidence or violation of any consumers rights as
specified in Section 80072.
QUALIFICATIONS
1) Have a minimum of six months prior experience providing direct supervision
and special services; or
2) Within six months of beginning to provide direct care services in the facility,
complete twelve additional hours continuing education in implementing
program services, promoting consumers' rights, health, safety and social and
physical integration; and the ID process, including development and
implementation of the IPP.
3) Complete a minimum of 12 hours continuing education which meets the
requirements specified in consumer services as described in program design;
promotion of consumer's rights, health, safety and social and physical
integration; and the ID process, including development and implementation
of the IPP. (as specified in Section 56037(a))
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4) Have current First Aid and CPR certificate.
5) Complete 20 hours of in -house training and orientation on:
Facility Program Design Medication
Consumer IPPs Health and emergency procedures
Consumer rights. Identifying and reporting SIRS
Identiying and reporting abuse
IPP /ISP implementation
5) Complete 20 hours of on the floor training.
6) Complete an employment application, have a TB and health screening, a
criminal record clearance.
7) Must pass the test for Direct Support Professional or take the training and
pass the test within six months of employment.
8) Must have completed CPI training.
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Staff Training:
On -Site Orientation
The Williams Concord facility shall assure the development, implementation, and
maintenance of a written facility staff training plan.
All new staff members will receive 40 hours of initial on -site orientation training
within the first 40 hours of employment.
Training will consist of staff reading the facility program design. At the
completion of reading the design the Administrator will review each section with
the staff member and discuss the staff persons understanding of what they have
read. Areas to be covered will be:
** *Philosophy of the facility, the purpose of the program and its overall goals
and an objective as it effects all consumers in the program.
** *Role of each staff member at the facility and how they interact with each
other and the consumers.
** *Behavior modification policies and procedures will be discussed and the
procedure for use with an aggressive consumer. demonstrated... _..
* **Type of consumer that the program accepts and explanation and overview
of each consumer currently in residence at the facility.
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** *Recreational responsibilities will be discussed and staff will learn the
procedure for planning activities and outings. The procedure for signing
out and the rules they are expected to follow each time that they take a
consumer into the community. A resource list will be reviewed along with
how staff members may change the schedule if they feel that it would
benefit the consumer.
** *Consumer rights and the responsibility of the program and its staff to ensure
that each consumer's rights are not violated. Emphasis will be placed on the
responsibility of each staff member to report any violations that they see,
regardless of the consequences to the facility or its staff members.
** *Introduction into the purpose and reason for an Individual Program Plan.
How it is used and the responsibilities of staff to direct services and activities
to meet the consumer's individual goals.
** *Health and emergency procedures to follow in case of the onset of an illness
or injury to a consumer. Fire and natural disaster procedures to be followed.
Training provided by administrator
Estimated time: 12 hours.
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Tit /e 17 and Title 22
Staff will be provided with a copy of current Title 22 and Title 17 regulations for
their review. Staff will be asked to keep these regulations for their regular
review and reference.
The administrator will review key areas of Title 22 and Title 17 regulations with
the new staff member. This will be an overview of the regulations and the
responsibility of the facility and each staff member to be sure that the facility is
in compliance with these regulations at all times.
Special emphasis will be given to the reporting of special incidents and suspect
abuse. The administrator will read over all the sections that pertain to these
reports in the regulations. The staff member will be given a copy of the facility
policy and procedure on abuse reporting, including the names, addresses and
telephone numbers of the agency that abuse must be reported to and the time
schedule in which these reports must be made.
The administrator will introduce the staff to the SIR forms and they will write
sample reports, completing them thoroughly and discussing what steps occur
once the report has been written. They will also be given a written copy of the
policy and procedure for writing SIRs, the reporting system and their role in
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reporting to the needed agencies. The administrator will also explain to the staff
member the facility procedure for reporting abuse, or suspected abuse to the
emergency numbers, including pager and cellular phone numbers so they can
reach the administrator or licensee at any time. Staff will be asked at the end of
this training to sign a statement that they have received this training, understand
their role in reporting special incidents or suspected abuse. This form will also
state that failure to report an incident in a timely fashion will result in
termination.
Trainer: Administrator
Time: 8 hours
The new staff member will be provided with a copy of employee policies that
includes all policy and procedures to be used at the facility. Employee rules and
regulations, policies for hiring, evaluations, write -ups and terminations.
The administrator will review this information with the employee and explain the
importance of receiving positive evaluations. Write up and termination
procedures and discuss those areas of misconduct or failure to perform assigned
job duties that would result in immediate termination.
The administrator will explain the need to work together with the other facility
staff to form a well- coordinator team that assures the safety and well being of
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each consumer in the facility care. The administrator will encourage new staff
members to seek assistance or request further training in any area of the
program or its implementation that they do not fully understand. The
administrator will also encourage new staff members to provide input in those
areas that they feel could be changed or modified to improve the overall
implementation of the program.
At the completion of this twenty hours of training the new staff member will be
given a copy of the job description for their position. The Administrator will
discuss these duties and the -staff member will be familiarized with the
expectations of the program for them as an employee.
The organizational chart will be discussed and the staff will be taught whom they
report to and how each job fits together to implement the program and
treatment plan for each individual consumer in the facility.
Once this training has been completed the new staff member will be assigned to
work for 20 hours with the house manager or their designee. The house
manager /designee will shadow the employee through the shifts while the
consumers are in the facility.-
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During these hours the new staff member will work along side the house
manager /designee as they work with the consumer on implementation of the
ISP.
House Manager will demonstrate personal care training and observe the new
staff member as they implement the plan, providing verbal cue and modeling
techniques as needed to have the new employee complete these tasks correctly.
The house manager will then assist staff in completing data collection sheets and
ID notes on this training.
House manager will familiarize staff with the location of:
First Aid supplies
Emergency supplies
Community Resource List
Facility file
Program Design
Title 17 and 22 regulations
Consumer Files
SIR forms, data collection sheets and id note forms
Cleaning supplies (including the need for them to be kept in a lock cabinet at all
times.)
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House manager will take the new staff member through the steps for practicing
universal precautions to use when providing personal care to consumers. The
methods to use to insure safe sanitary methods when preparing meals or
cleaning after meals. The proper storage of meat and fresh foods before and
after they are prepared. How they are to save food in the refrigerator, including .
packaging and labeling.. Review the housekeeping. chores that they are expected
to complete, and the use and safe storage of household cleaning supplies.
The house manager will also give the staff member an overview of the
medication procedure used at the facility. But no.staff member will be allowed to
pass medication until they have received an additional 2 hours of training by the
facility pharmacist or a registered nurse contracted by the facility to provide this
training.
The house manager will show the new staff member where and how to find out
information about the medication each consumer is taking and its side.effects.
They will also review the procedure that the staff member is to follow if they
observe a consumer having any signs of side effects from medication.
House manager will acquaint new.staff member-with the existing staff member_.
with whom they will work. The consumers who they will be assigned to care for
and the duties that they will be expected to complete each day.
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Only after these hours of training have been completed will a new staff member
be placed on the facility schedule as a regular employee.
The administrator and house manager will document and sign the training that
they performed and the time of the actual training in each area presented. The
new staff member will also be asked to sign this training and understand their
job duties and functions.
After 90 days of employment the administrator and house manager will complete
an evaluation /assessment. It recommends any further training that they feel the
staff member needs before they are able to continue on the staff schedule.
If the new employee is found to have a positive assessment they will be
continued on the facility schedule as a permanent employee. If however, the
assessment finds that the staff needs further training in one or more areas, staff
will be given the opportunity to bring these skills up to the need level of
competence.
The administrator will - determine on-an individual basis when they.feel.that.a-
staff member is not able to learn the needed skills to perform the assigned job to
the facility standard. When this occurs the employee will be terminated.
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If an employee is able to obtain a positive evaluation, with or without additional
training, they will be scheduled as a permanent staff member on the facility
schedule.
IN ADDITION TO THIS EIGHT HOURS OF TRAINING a staff member who is
designated as a house manager must complete an additional hour of training on
the following topics:
Interaction with Agencies including investigative role: Training in how to
identify and request identification from people coming to the facility from outside
agencies. What these agencies inspection and investigation authority consists of
and how they are to assist them when they come to the facility. When and how
to notify the administrator when an agency is at the facility.
Neighborhood compliant procedure - how to interact with the community law
enforcement Regional Centers day oroorams and families
Training in how to deal with neighbors who have complaints about the facility or
its consumers. Train staff on the neighborhood complaint form and notifying the .
administrator promptly to resolve the problem. How to provide information to
law enforcement officers, if it is necessary for them to come to the facility for
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reports or investigations. The role of Regional Center and their policy regarding
unannounced visits as well as the house manager's role in the IPP process. How
to relate and assist family members with their concerns or questions regarding
their adults. How to know who has the right to information about the consumer.
What to do when someone asks for information and the house manager is not
sure what to provide or whether they can provide the requested information.
How to contact the administrator when a problem arises and they are not sure
what to do.
Trainer: Facility Administrator and Technical Support Person from Community
Care Licensing.
An overview of the facility's right to appeal as citation from Community Care
Licensing or Regional Center. The procedure for correcting deficiencies and
making needed changes to bring the facility into compliance.
Each year, after the first year, of employment -staff is required to receive 12
hours of continuing education.
Continuing Education
Administrator Training:
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1. Complete a minimum of 12 hours of continuing education within each
12 month period.
2. Consumer services as described in the program design.
3. Promotion of consumer's rights, health, safety and social and physical (e.i.,
consumer rights, health, safety and social and physical development.
4. The interdisciplinary team,..ID process, including development and
implementation of the IPP.
5. Receive Training in the areas of administration and management of a
residential facility.
House Manager and Direct Care Staff Training:
1. Complete a minimum of 12 hours of continuing education within each
12 month period
2. Consumer Services as described in the program design.
3. Promotion of consumer's rights, health, safety and social and physical
development of the consumer.
4. Receive training in the areas of areas of planning and implementation of
residential services, behavior modification, and introduction to alternative
living arrangements.-
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This is in relation to planning and implementation of residential services for the
developmentally disabled.
The following are community resources which we will use to provide continuing
education opportunities to our staff and which we project to continue to utilize:
1. East Los Angeles Regional Center
2. Lanternman Development Center Training
3. Community Care Licensing
4. Rio Hondo Junior College
5. Fullerton Community College
6. San Gabriel /Pomona Valley Regional Center
7. Hospitals
9. Private agencies such as CARCH
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Continuing Education Training Schedule for Staff and Administrators
Training Schedule of 2001
January Reporting Issues, when, how and to whom
(2 hours) Training coordinator — CCL Monterey Park
Training site: Facility
February Consumer Recreation /Leisure Activity Planning
(3 hours) Training unit, Lanternman Development Center.
Training site: Lanternman Development Center.
March Communicative Function of Behaviors
(3 hours) Ronald Barazani, Ph.D.
Training site: Facility
April Documentation and Data - Recording -
(2 hours) Ronald Barazani, Ph.D.
Training site: Facility
May Person - Centered Planning -
(1 hour) Regional Center approved Trainer
Training site: Facility
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July Special Needs Of the Developmentally Disabled
with communication deficits.
(2 hours) Ronald Barazani, Ph.D.
Training site: Facility
September Living Options and Community Services
Regional Center Approved Trainer
(3 hours) Training site: Facility
Subjects will be chosen for continuing education training based on changes in
current regulations and requirements, needs of the consumers in residence, the
recommendations of the program consultant, Service Coordinator or the Quality
Assurance unit of the Regional Center. Community Care Licensing changes in
regulations and requirements that effect our consumes and the
recommendations of training needs given by the facility Licensing Program
Analyst.
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In addition, the facility administrator will evaluate the performance of all staff
employed by the facility on an annual basis. The Administrator will then use this
evaluation to determine areas of additional or further training that is needed.
The Administrator will then schedule training in this area, either - for -the entire
staff or on an individual staff member basis as determined necessary.
Any and all changes made to this program design will be approved prior to
implementation by the East Los Angeles Regional Center.-
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SPECIAL INCIDENT REQUIRMENTS
The facility will furnish Regional center and the licensing agency with special
incident report whenever a reportable incident occurs at the facility.
The Administrator of the facility or their designee shall make a report to Regional
Center and Licensing within the first working day during normal business hours
by telephone. The report must be given to either the service coordinator for the
involved consumer(s), their supervisor or the on -duty worker. Regional Center
has an on -duty supervisor at night and on weekends to take report on incidents
that are of a serious nature such as hospitalization, serious injury or police
involvement.
In addition, a written report containing the required information will be sent to
the Regional Center within the forty -eight hours and to Community Care
Licensing within seven days following the occurrence of the incident.
Special incident reports will be written and reported for the following:
• Death of any consumer from any cause
• Any injury to any consumer which requires medical treatment
• Any unusual incidents or consumer absence which threatens the physical or
emotional health or safety of any consumer.
• Any suspected physical or psychological abuse of any consumer
• Epidemic outbreaks
• Poisonings
• Catastrophes, will also be reported to the local fire authority immediately
• Fires or explosions which occur in or on the premises
Information to be provided in the report is:
• Consumer's name, age, sex and date of admission
• Date and nature of the event
• Attending physician's name, findings, and treatment, if any
• Disposition of the case
The items below shall be reported to the licensing agency within 10 working days
following the occurrence.
• Organizational changes specified in Section 80034(a)(2)
• Any change in the licensee's or applicant mailing address.. .
• Any change of the chief executive officer of a corporation or association.
• In these cases such notification shall include the name and address
• Fingerprint card shall be submitted as specified in Title 22, 80019(c)(1)
• Any changes in the plan of operation which affect the services to the
consumers.
In addition to the above the facility shall also report to the local health officer
when appropriate, according to Title 17,section 2500,2502 and 2503.
For outbreak reporting and the reporting of occurrence of unusual and rare
disease see Title 22, 2502 and 2503
Amebiasis
Anthrax
Botulism
Brucellosis (Undulant Fever)
Chancroid
Cholera
Coccidioidomycosis
Conjunctivitis, Acute Infection
Dengue
Diphtheria
Disorders Characterized by Lapses of Consciusness
Dynsentery, Bacillary (see Shigella infections)
Encephalitis, viral
Food poisoning (other than Botulism)
German Measles (Rubella)
Gonococca I Infections
Gramuloma Inguinale
Hepatitis, Infectious (A)
Hepatitis, Serum (B)
Hepatitis, unspecified
Hepatitis, Non -A, Non -B
Leprosy (Hansen's Disease)
Leptospirosis (including Weil's Disease)
Lymphogranuloma Venereum
Malaria
Measles (Rubella)
Men ingococcal Infection
Mumps
Paratyphoid Fever, A, B, and C
Petussis (Whooping Cough)
Plague
Poliomyelitis, Paralytic
Psittacosis
Q Fever
Rabies, Human or Animal
Relasping Fever
Pheumatic Fever, Acute
Rocky Mountain Spotted Fever
Salmonella, Infectious (exclusive of Typhoid Fever)
Scarlet Fever
Shigella Infections
Smallpox (Variola)
Streptococcal Infections, hemolytic
Syphilis
Tetanus
Trachoma
Trichinosis
Tuberculosis
Tularemia
Typhoid fever, cases and carriers
Typhus Fever
Yellow Fever
The facility would also report any knowledge of outbreak or undue prevalence of
infectious or parasitic disease or infestation whether it is listed or not in Section
2500, promptly to local health officer, who shall investigate the circumstances
and if he finds that an epidemic or undue prevalence does not in fact exist, he
shall report the outbreak to the Director of the State Department of Health
Services. The following are examples of diseases, outbreaks of which are to be
so reported:
Epidemic Gastroenteritis (other than food poisoning)
Epidemic Derotoconjunctivitis
Fevers of unknown etiology
Infectious Mononucleosis
Influenza, Epidemic
Pneumonia, Infectious
Ringworm
Staphylococcus Infection.
Knowledge of any case of an unusual disease not listed in Section 2500 shall
promptly convey the facts to the local health officer. Examples are: glanders,
herpangina, histoplasmosis, toxoplasmosiss, echinoccoccosis, listeriosis, cat
scratch fever and rickettsialpox shall also be reported to local health officer.
Licensees shall send copies of all substantiated complaints to parents, legal
guardians, conservators client - rights advocates or placement agencies, as-
designated in each client's placement agreement in accordance with Health and
Safety Code Section 1538.5.
DEPENDENT ADULT ABUSE REPORTING PROCEDURE
This is the policy to be followed if abuse occurs or is suspected:
1. It needs to be immediately reported by the person who saw the abuse occur
or feels abuse may have occurred, whether it is support staff or the house manager.
2. If an injury or crime has occurred call 911.
3. Contact the on -call administrator who will then immediately begin an internal
investigation and report the incident to the proper authorities.
As a care giver you are responsible to see that all cases of abuse are
reported, therefore if you have told someone and have seen no signs of
action you must continue to report until some resolution is achieved.
Reporting abuse will not result in a type of retaliation or
harassment
Numbers that can assist with abuse are:
Matt Pope, Consumer Rights Advocate
1000 South Fremont Avenue Room 1088
Alhambra, Ca. 91802
(626) 576 -4407
Ombudsman: Dorothy Park (909) 868 -4819
2040 West Holt Avenue
Pomona, Ca. 91768
On Duty: Licensing Program Analyst
Community Care Licensing
1000 Corporate Center Drive
Suite 500
Monterey Park, Ca. 91754
(323) 981 -4934
I have read and understand my responsibility to report any case of
suspected abuse.
Signature/Date
FUNCTIONAL ANALYSIS OF BEHAVIOR
WHAT DOES THE BEHAVIOR LOOK LIKE:
WHAT DOES THE BEHAVIOR LOOK LIKE WHEN IT BEGINS:
WHAT DOES THE BEHAVIOR.LOOK LIKE IN THE MIDDLE:
WHAT DOES THE BEHAVIOR LOOK LIKE WHEN IT IS OVER:
WHAT IS HAPPENING JUST BEFORE THE BEHAVIOR BEGINS:
WHAT IS THE TIME AND WEATHER CONDITIONS WHEN THE BEHAVIOR
OCCURS:
WHAT DOES THE CONSUMER SEEM TO BE GETTING FROM ENGAGING
IN THIS BEHAVIOR:
WHAT IS THE CONSUMER AVOIDING BY ENGAGING IN THIS
BEHAVIOR:
HOW DO OTHERS REACT TO THE CONSUMER'S BEHAVOIOR:
STAFF:
OTHER CONSUMERS:
PEOPLE IN THE COMMUNITY: -.
WHAT IS REINFORCING THIS BEHAVIOR FROM THE CONSUMER'S
POINT OF VIEW:
WHAT IS THE LONG TERM HISTORY OF THE BEHAVIOR:
WHAT IS THE SHORT TERM HISTORY OF THE BEHAVIOR:
HOW LONG DOES THE BEHAVIOR LAST:
WHAT IS THE SEVERITY OF THE BEHAVIOR:
WAS OUTSIDE INTERVENTION REQUIRED:
Completed by Ronald Barazani, Ph.D. Date:
signature
SIQLLS ASSESSMENT
Please complete all of the following skill assessments. If consumer is not able to
do the entire task independently fill out the space provide to explain steps they
can do independently, level of assistance needed to complete the task correctly
and any other information that will assist in preparing service plans.
Bathes
[ ] Completes the entire task independently. .
Describe assistance
Washes Hair
[ ] Completes the entire task independently.
Describe assistance needed:
Picks out appropriate clothing
[ ] Completes the entire task independently.
Describe assistance needed:
Dress self
[ ] Completes the entire task independently.
Describe assistance needed:
Brushes Teeth
[ ] Completes the entire task independently.
Describe assistance needed:
Combs /styles Hair
[ ] Completes the entire task independently.
Describe assistance needed:
Washes Hands before meals /after toileting
[ ] Completes the entire task independently.
Describe assistance needed:
Toileting
[ ] Completes the entire task independently.
Describe assistance needed:
Care for Menstrual Hygiene
[ ] Completes the entire task independently.
Describe assistance needed:
Shaves
[ ] Completes the entire task independently.
Describe assistance
Eats Appropriately
[ ] Completes the entire task independently.
Describe assistance needed:
Laundry/Clothing Care
[ ] Completes the entire task independently.
Describe assistance needed:
Cleans room /living space
[ ] Completes the entire task independently.
Describe assistance needed:
Makes Bed
[ ] Completes the entire task independently.
Describe assistance needed:
Prepares Meals
[ ] Completes the entire task independently.
Describe assistance needed:
Uses Money
[ ] Completes the entire task independently.
Describe assistance needed:
Community Safety/Traffic Skills
[ ] Able to use the community independently.
Describe assistance needed:
Staff completing the report Date:
Reviewed by: Ronald Barazani, Ph.D. Date:
CONSUMER RIGHTS
On the day that a consumer is admitted to the program the Administrator will
read and explain to them their consumer rights, house rules and facility
grievance procedure. They will have them sign the rights form as well as
complete the Assessment of Consumer Verbal Skills and Methods of Advising
Consumer of Rights, Rules and Grievance Procedure form. (See example in
Appendix 6)
Once this has been completed a copy of the forms will be given to the consumer
to keep for their own information. A second copy of all forms will become part of
the consumer's permanent record.
In addition, a copy of the consumer rights forms from Regional Center and
Community Care Licensing, including the names and addresses of the contact
person will be posted in the facility in a place where they are readily available to
consumers, family and visitors to review. Also posted will be house rules, facility
grievance procedure, neighborhood complaint procedure and abuse reporting
requirements.
HOUSE RULES
i ' understand that the following rules have
been adopted to make it possible for all consumers to live together in a
comfortable and harmonious environment. I agree to abide by said rules and
understand that failure to do so may be considered valid reason for eviction.
I agree for
1. Refrain from damaging or destroying the property of peers or the facility.
2. Refrain from harming or harassing other consumers, visitors, staff, etc.
3. Keep radios and television volumes low so they cannot be heard from another
room.
4. Consumers are urged to return to the facility no later than 10:00pm. If the
consumer is going to be back to the facility later than 10:00pm they are
requested to call and notify staff.
5. Smoking is to be done in the backyard only. There is no smoking allowed in
the house.
6. Refrain from gathering in the front yard.
7. Request permission to enter another consumer's room.
8. Inform staff and sign out before leaving the facility.
9. Make arrangements with staff before introducing pets into the facility.
10. Pay for long distance telephone calls made by me.
11. Wear appropriate attire while in the common areas of the facility or when in
the community.
12. No overnight - visitors are allowed at the facility.
Failure to comply with these house rules will result in the following disciplinary
actions.
The first time that I fail to follow house rules I will have a meeting with the
house manager to review the rules and talk about ways that we can work
together to find an acceptable method for me to be able to work with staff to
comply with the rules.
The second time that I fail to follow the same house rule I will have a formal
meeting with the Administrator and it will document that I was counseled on the
need to follow the rules and that my failure to comply with house rules may
result in my being asked to move from the facility.
A third incident of failing to follow the same house rule will require a meeting
with the facility Administrator, my Regional Center Service Coordinator and any
representatives that I request to attend this meeting. This meeting will review
my failure to comply with house rules, the steps taken by the facility to assist me
in complying with the house rules and state that another failure on my part to
comply with house rules will result in a 30 -day notice to leave the facility. This
meeting will be documented and signed by my Service Coordinator, and myself,
the Administrator of the facility.
I understand that, if after this meeting, I again fail to follow the house rules I will
be asked to leave the facility.
Consumer Signature Date
ADDITIONAL COMMUNITY RESOURCES
Palm Park
5703 Palm Ave.'
Whittier, Ca.
(562) 908 -3666
Whittier Public Library
7344 Washington Ave.
Whiiter, Ca.
(562) 464 -3450
Getty Center
1200 Getty Center Dr.
Los Angeles
(310) 440 -7300
WEEKLY STAFF SCHEDULE ' I DATE:
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CONSUMER 30 -DAY PROGRESS REPORT
DATE: 4/1/02
CONSUMER: Daniel
CPC: Carmen Castro
FACILITY:
FACILITY MANAGER:
DOB: 1/12/87
P & I BALANCE: $ 0 WEIGHT: 172 lbs. HEIGHT: 5'2
MEDICATION:
Seroquel 200mg 1 tab am and 2 tabs at bedtime for behavior control
Celexa 40mg 1 /2 tab at bedtime for depression
. . . . . . . . . . . . . . . . . . ....•...•.•.,.•...•.
CURRENT PROGRESS AND GROWTH
I.P.P. OBJECTIVES:
Obj. #1 Placement
Daniel is beginning to adjust to the new facility. He has severe behaviors and is
appropriately placed at this level of service.
Obj. #2 Health
Daniel is in good medical health. He had his most recent physical examination
on 3/1/02 by Dr. The Dental Group of La Mirada completed a dental
exam and cleaning on 3/5/02. We have attempted to have an eye exam and lab
work completed but his MediCal is showing not active at this time. Podiatry care
completed by Dr. on.3/25/02.
Obj. #3 Mental Health
Daniel is followed for mental health by Dr. E. White of ALMA Family Services and
was seen by him on 3/21/02. There were no medication changes at that time.
Obj. #4 School
Daniel is attending the program. They report that he
is doing well academically but continues to have behavior problems on a regular
basis.
Obj. #5 Social /Recreational Skills
Daniel is going into the community for activities and training on a daily basis. He
is going to the YMCA 3x a week to workout and swim, which he very much
enjoys. He has also gone to the beach, park, malls, movies and arcade. Daniel
has fairly good safety skills but needs reminders to watch for cars when he is
intent on going to an outing.
Obj. #6 Personal Care and Hygiene Skills
Daniel has all the skills to perform all personal hygiene skills independently. He
can fully dress himself, shower and brush his teeth with verbal prompts. He
needs some verbal prompts to complete these tasks completely. He can tie
shoes, button, and snap and zip clothing without assistance. He does not like to
make his bed or straighten up his room and does this only with verbal prompts
and staff assistance. He is able to do his laundry with one on one verbal
prompts and modeling through the entire task.
Obj. #7 Behaviors or
Verbal Aggression — which is defined as using profanity when talk to people
mumbling profanity under his breath as he walks away from someone. This
behavior has occurred 249x in the month that he has been at the facility.
Property Destruction — which is defined as hitting walls and furniture when mad.
This behavior has occurred. 43x in the month he has been in placement.
Making up stories with the intent of getting them in trouble — defined as telling
stories that he knows are untrue. These are things like going to school and
telling them that he is allowed to smoke "weed" at the facility. Then tell the
facility staff that he is able to smoke "weed" when visiting his family. This
behavior has occurred 41x in the month that he has been at the facility.
Resistiveness — defined as refusing to follow directives /instructions or walking
away and pretending that he did not hear what was asked of him. This behavior
has occurred 58x since he came to the facility.
These behaviors will be addressed on the ISP submitted at this meeting.
Barriers to Progress — Daniel has a negative attitude towards authority
and tends to ignore or verbally assault these people as a way of fee ling
in charge and demanding respect Staff will work wish him on learning
that he can assert himself in appropriate ways that will bring him the
respect that he wants.
--------------- - - --
CARE PROVIDER CPC
CONSUMER SEMI- ANNUAL PROGRESS REPORT
DATE:
CONSUMER: David
CPC:
P & I BALANCE: $ 65.58
FACILITY:
FACILITY MANAGER:
WEIGHT: 282lbs HEIGHT: 5 "10"
MEDICATION:
Risperdal 1mg lx a day for agitation
Glochopage 850mg 2x a day for control of sugar
Lopid 600mg lx a day for high blood pressure
Potassium Chlorate 8mg 3x a day low potassuim
Lithium Carb 300mg lx a day for depression
Motrin 600mg 2x a day for pain
Lasix 40mg ix a day for diuretic
Prozac 20mg lx a day for depression
CURRENT PROGRESS AND GROWTH����� .. � .•....•.•......•
I.P.P. OBJECTIVES:
Obj. #1 Placement: David continues to have behaviors that require this level
of care. He is content in program and doing well.
Obj. #2 Day Program: David continues to attend
5 days a week. He is doing well there and likes the program. There have
been no reports of problems.this quarter..
Obj. #3 Health: David's general health is stable. He had an annual physical
completed by Dr. >n 10/6/00. Lab work completed at Whittier Medical
Center 2/1//01. Dr. i saw him on 2/7/01 for routine review of medical
conditions. Dr. provided podiatry services on 2/12/01.
Obj. #4 Mental Health: Psychiatric review is completed monthly by Dr.!
2/18/01. He is very stable at this-time.
Obj. #5 Behavior Modification Services: David continues to see Dr. Ron
Barazani on a regularly basis (16 hours
He
is seen mon th s ) a f o r reeva
needed
behavior plans and to check prog
basis.
Obj. #6 Social/ Recreational Activities: David enjoys, participating in
community activities for short periods after day program only if he is given time
to rest and be alone first. He enjoys going to the park to relax and walk, but he
has to be able to set his own pace or he will become agitated. He is currently
going out for at least one hour 7 days per week.
Obj. # 6 Self -Help Skills
Washing hands after toiieting. David continues to need verbal prompts to
complete toileting and wash his hands after each attempt. He still has difficulty
wiping himself. There has been no significant progress in this area.
Bathing: continues to need verbal prompts and modeling cues to wash his
whole body daily, this is no change from last quarter.
Brushing Teeth: David continues to need verbal prompts and modeling cues
through the entire task. No significant progress this quarter.
Obj. #7 Inappropriate Behaviors
Aggression defined as pushing and shoving other consumers or running into
them with the full force of his body. This behavior has occurred 4x in December,
8x in January and 8x in February for a monthly average of 6x per month. This is
a very slight increase from last quarter.
Temper Tanbums defined as using obscene language. David will frequently
make obscene remarks under his breath. This behavior has occurred 15x in
December, 12x in January and 15x in February for a monthly average of 14x a
month. This is a decrease from last quarter.
Resistiveness defined as refusing to comply with staff request after it has been
made for the second time. David will occasionally say no or pull away from staff
that has made the request. This behavior has occurred 18x in December, 18x in
January and 17x in February for a monthly average of 17x a month. This is a
minor decrease from last quarter.
E/oAement as leaving the house or group, or attempting to do so,
without notifying the staff and using the proper sign out procedure. This
behavior has occurred 2x in December, Ox in January and Ox in February for a
monthly average of .3x per month for this quarter. This is an increase from last
quarter.
Obj. #8- Summer.Camp -.
David continues to talk about wanting to attend Camp again soon.
Barriers to Progress: It is difficult for David to maintain stability in his eating
habits as food remains of utmost importance to him. Staff will continue to work
with him on his diet and provide other types of reinforcement when his behavior
is appropriate. Short attention span and poor retention skills make it difficult for
David to learn new tasks. Staff will continue to introduce all tasks in short
simple, achievable steps that allow David to be successful.
Care provide Signature Administrator Signature Service Coordinator Signature
CONSUMER ANNUAL PROGRESS REPORT
DATE: 7/31/01
CONSUMER: David
CPC:
P & I BALANCE: $ 18.37
FACILITY:
FACILITY MANAGER:
OI•:
WEIGHT: 149 lbs. HEIGHT: 4'11"
MEDICATION:
Levoxyl 0.75mg 1x a day for treatment of thyroid disorder
Glipizide 5mg 2 '/z tabs lx a day for treatment diabetes
Trazodone 50mg ix a day for anti - depression
Prolixin 10mg ix a day at bedtime for behavior control
Prolixin 5mg 2x a day for behavior control
Spectazole 1% cream apply between toes daily until healed
Tobradex 1 drop in both eyes 2x a day for infection
Polysporin cream 2x a day to external ear for infection
Trileptal 600mg 2x a day for seizure control
I.P.P. 083ECfIVES:
Obj. #1 Placement: David is doing well at His is appropriately
placed and continues to need this level of service. David remains in close
contact with his sister and she visits and has him come to visit her regularly.
She works closely with the facility and has contributed greatly to David's
successful placement.
Obj #2 — Day Program: David attends They
report that he is doing well. He has made accusations to them about facility
staff abusing him and reports about them to the facility that they were abusing
him but the programs have worked together to investigate and not reinforce
these false accusations. He is doing well and should continue for the present
time in this program.
Obj #3 - Health: David's health stable. Dr. ! ; completed his last annual
physical on 10/21/00. David's blood sugar remains under good control. He
was seen for a general follow up with Dr. on 7/10/01 and at that time
he was treated for an eye and ear infection. Dr. . from Dental Group of La
Mirada saw him for follow up with is dentures on 2/7/01. His current weight is
149 pounds and this is a four -pound weight loss for the year. Weight loss was
due to more strict control of his diet and is reflected in lower blood sugar levels.
Obj. #4 — Neurological: David is being seen for for neurological
follow up and was last seen on 7/20/01 and there was a medication change from
Dilantin to Trileptal 600mg 2x a day. David has had no seizures in the last year.
He has had incidents of falling for no reason both at the facility and day program
and this was the reason for the medication change as the doctor felt that this
might be a side effect of the Dilantin.
Obj. #5 — Psychiatric: David's mental health is fairly stable. There has been
the start of a new behavior where he is making up statements and making
accusations that are unfounded and some increase in AWOL behavior over the
last few months but there have been no medication changes. He is experiencing
no side effects from medication. He is seen monthly for medication review and
follow up by Dr. and was last seen on 7/8/01.
Obj. #6 — Dietary/Nutritional Supplements: David is on a special diet for
his diabetes and is using substitutes for sugar -in all foods. - Low intake of fruits
and sodas and high fat foods. He is able to follow this diet with a good deal of
supervision from staff. He will still drink soda at every opportunity and his
preferred meals out are still fast food, especially Taco Bell and McDonalds.
Obj. #7 — Adaptive Equipment /Therapy Services: David is doing well in
this area and blood sugar is so controlled that he is only having blood test done
one time a month to monitor sugar level. Levels are being taken at the Whittier
Medical Center Hospital in Whittier. Dr. is reviewing all diabetic results
at that time. He also remains on medication for his condition and he is very
stable at this time.
Obj #8 Inappropriate Behaviors
Attempts to AWOL - defined as David leaving or attempting to leave the facility
without staff knowledge. This behavior occurred 4x in May, 3x in June and 3x in
July. Quarterly average is 3x per month. This is some progress from last
quarter. David did not meet his goal for the year but did making good progress
in this area. We will continue to address this objective on the new IPP.
Resistive - defined as being resistive to getting up in the morning and doing.. .
personal hygiene or other ADL tasks that he does not enjoy. Behavior occurred
4x in May, 3x in June and 3x in July. Monthly average was 3x per month. This
is good progress from last quarter. David has meet his objective for the year in
this area but needs to continue to work on this area for the new year. David is
resistive less often but often is not completing the task when resistive even after
numerous attempts by staff to get him to comply.
Makes Fa /se Accusations: defined as making up stories about staff at facility and
day program, peers and his family, saying that he is being mistreated. Behavior
has occurred 7x in May, 6x in June and 5x in July. This is a monthly average of
6x per month.. This is a decrease we started to track this behavior in April.
We need to continue to address this behavior on the new IPP.
Obj #9 — Self -help skills:
Bathin - David continues to need verbal prompts to complete each step of this
task daily. David is still resistive to starting this task and continues to need
numerous prompts to begin but is now able to do the steps with only one verbal
prompt with each attempt. We will continue to address this area on the new
ISP.
Brushes Teeth - David continues to need 1 -2 verbal prompts to complete each
step of the task to complete the task completely daily. He is no longer needing
hand on hand assistance and is making good progress for the quarter and year. -
We will continue to address this area on the new ISP.
Shavin - David is now able to attempt to complete shaving with an electric
razor and verbal and modeling cues with each step on each attempt. This is
excellent progress for the quarter and year. We will continue to address this
behavior on the new ISP.
Obj #10 — .Social /Recreational Activities: David is going into the community
for social activities 7 out of 7 days. He enjoys all types of activities and
especially likes going out for meals with staff and peers. He is looking forward to
camp again this year. He is also going regularly to visit with his sister at her
home.
Obj #11— Community Health and Safety Issues: David needs close
supervision in all settings as he is not safe with traffic rules and will step into
traffic, hide under cars or cross against lights at street corners. He needs to be
observed closely to be sure that he does not AWOL during outings. David has
made no real progress in this area because when he is out he is so focused on
where he is going and what he is going to do when he gets there that he forgets
the traffic rules he knows when asked by staff at home. We need to continue to
work on this area, as David will also attempt to be in the community alone and
needs to be able to follow simple safety rules consistently.
Barriers to progress:
David has poor communication skills and is unable to express his wants and
needs satisfactorily. Staff will continue to work with David to learn ways that he
can let others know when he. needs or wants something in appropriate manner.
David enjoys being in the community to eat those things that he is not allowed
to have on his special diet and to visit people on his own schedule. Staff will
continue to teach him the importance of remaining on his special diet to control
his diabetes as well as the need to make arrangements to visit family and friends
so he can be sure that they will be home. David is generally safe crossing
streets in the day time but this is not the case at night, and when hiding from
staff, when he knows they are searching for him, he often endangers himself by
hiding in the yards of people he does not know, under cars or in trash bins.
Staff will continue to teach him good community safety rules for both day and
nighttime hours.
Care Provider Administrator Service Coordinator
CONSUMER SEMI- ANNUAL PROGRESS REPORT
DATE: 2/12/01
CONSUMER:
CPC: Jessica Montesinos
P & I BALANCE: $ 42.44
FACILITY:
FACILITY MANAGER:
F•:
WEIGHT: 154lbs. HEIGHT: 4'11"
MEDICATION:
Levoxyl 0.75mg 1x a day for treatment of thyroid disorder
Phenytoin Extended 100mg 3x a day for seizure disorder
Glipizide 5mg 2 '/2 tabs 1x a day for treatment diabetes
Benztropine 1mg 1x a day for side effects of psychotropic medication
Trazodone 50mg lx a day for anti - depression
Prolixin 10mg lx a day at bedtime for behavior control
Prolixin 5mg 2x a day for behavior control
I.P.P. OBJECTIVES:
Obj. #1 Placement: David is doing well at His is appropriately
placed and he wishes to remain at the facility.
Obj #2 - Health: David's health stable. David's blood sugar is currently under
good control. He was seen for a general follow up with Dr. on 1/27/01.
Dr. saw him for follow up with seizure disorder on 1/28/01. Dr.
reviews David's psychotropic medication on a monthly basis and last saw him on
1/20/01.
Obj #3 — Day Program: David attends : Center. They
report that he is doing well.
Obj #4 — Social/ Recreational Activities: David is going into the community
for social activities 7 out of 7 days. He enjoys all types of activities and .
especially likes going out for meals with staff and peers. He is also going to
parties, dances, shopping, sporting events and amusement parks. He needs
close supervision in all settings.
Obj #5 — Self -help skills:
Bathin4 - David continues to need 3 —4 verbal prompts to complete each step of
this task daily. David is still resistive to starting this task and continues to need
numerous prompts to begin. No progress in this area this quarter.
Brushes Teeth - David continues to need 3 -4 verbal prompts to complete each
step of the task and hand on hand assistance to complete the task completely
daily. No progress this quarter.
Shavin - David hand on hand assistance to shave daily. He needs hand on
hand assistance to complete this task daily. No progress from last quarter.
Obj #6 Inappropriate Behaviors
Attempts to AWOL - defined as David leaving or attempting to leave the facility
without staff knowledge. This behavior occurred 4x in February, lx in March and
7x in April. Quarterly average is 4x per month. This is good progress from last
quarter.
Resistive - defined as being resistive to getting up in the morning and doing
personal hygiene or other ADL tasks that he does not enjoy. Behavior occurred
4x in February, 8x in March and 7x in April. Monthly average was 6x per month.
This is a slight increase from last quarter.
Makes False Accusations: defined as making up stories about staff at facility and
day program, peers and his family, saying that he is being mistreated. Behavior
has occurred 12x a month that continues to be an increase since baseline was
taken last month. ,
Barriers to progress:
David has poor communication skills and is unable to express his wants and
needs satisfactorily. Staff will continue to work with David to team ways that he
can let others know when he needs or wants something in appropriate manner.
David enjoys being in the community to eat those things that he is not allowed
to have on his special diet and to visit people on his own schedule. Staff will
continue to teach him the importance of remaining on his special diet to control
his diabetes as well as the need to make arrangements to visit family and friends
so he can be sure that they will be home. David is generally safe crossing
streets in the day time but this is not the case at night, and when hiding from
staff, when he knows they are searching for him, he often endangers himself by
hiding in the yards of people he does not know, under cars or in trash bins.
Staff will continue to teach him good community safety rules for both day and
nighttime hours.
Care Provider Administrator Service Coordinator
CONSUMER QUARTERLY PROGRESS REPORT
DATE:
FACILITY:
CONSUMER: David Hernandez
CPC:
P & I BALANCE: $ 3.06
FACILITY MANAGER:
WEIGHT: 150 lbs.. HEIGHT: 4'11"
MEDICATION:
Levoxyl 0.75mg 1x a day for treatment of thyroid disorder
Phenytoin Extended 100mg 3x a day for seizure disorder
Glipizide 5mg 2 '/z tabs ix a day for treatment diabetes
Benztropine 1mg lx a day for side effects of psychotropic medication
Trazodone 50mg ix a day for anti- depression
Prolixin 10mg lx a day at bedtime for behavior control
Prolixin 5mg 2x a day for behavior control
Spectazole 1% cream apply between toes daily until healed
I.P.P. OBJECTIVES:
Obj. #1 Placement: David is doing well at His is appropriately
placed and continues to need this level of service.
Obj #2 - Health: David's health stable. David's blood sugar remains under
good control. He was seen for a general follow up with o
4/9/01.[ y from Dental Group of La Mirada saw him for follow up with is
dentures on 2/7/01. Dr. aviews David's psychotropic medication on•a
monthly basis and last saw him on 4/21/01.
Obj #3 — Day Program: David attends ' - enter. They
report that he is doing well and there have been no incidents this quarter.
Obj #4 — Social/ Recreational Activities: David is going into the community
for social activities 7 out of 7 days. He enjoys all types of activities and
especially likes going out for meals with staff and peers.. He.needs.close
supervision in all settings.
Obj #5 - Self -help skills:
Bathing - David continues to need 3 -4 verbal prompts to complete each step of
this task daily. David is still resistive to starting this task and needs 3 or more
prompts to begin. No progress in this area this quarter.
Brushes Teeth - David continues.to need 3 -4 verbal prompts to complete each
step of the task and hand on hand assistance to complete the task completely
daily. No progress this quarter.
Shaving - David hand on hand assistance to shave daily. He needs hand on
hand assistance to complete this task daily. No progress from last quarter.
Obj #6 Inappropriate Behaviors
Attemats to AWOL - defined as David leaving or attempting to leave the facility
without staff knowledge. This behavior occurred 3x in November, 5x in
December and 6x in January. Quarterly average is 7x per month. This is no
significant progress from last quarter.
Resistive - defined as being resistive to getting up in the morning and doing
personal hygiene or other ADL tasks that he does not enjoy. Behavior occurred
5x in November, 4x in December and 6x in January. Monthly average was 5x
per month. This is excellent progress from last quarter.
Barriers to progress:
David has poor communication skills and is unable to express his wants and
needs satisfactorily. Staff will continue to work with David to learn ways that he
can let others know when he needs or wants something in appropriate manner.
David enjoys being in the community to eat those things that he is not allowed
to have on his special diet and to visit people on his own schedule. Staff will
continue to teach him the importance of remaining on his special diet to control
his diabetes as well as the need to make arrangements to visit family and friends
so he can be sure that they will be home. David is generally safe crossing
streets in the day time but this is not the case at night, and when hiding from
staff, when he knows they are searching for him, he often endangers himself by
hiding in the yards of people he does not know, under cars or in trash bins.
Staff will continue to teach him good community safety rules for both day and
nighttime hours.
Care Provider Administrator Service Coordinator
Ronald Barazani, Ph.D.
Licensed Psychologist PL 4549
2230 San Marcos Drive
Los Angeles, California 90068
(323) 461 -1321 Fax(323)462 -1157
Name: Daniel
DOB:
Date of the Report: 4/1/02
Age:
Psychologist: Ron Barazani, Ph. D. .
BACKGR INFORMATION
This is the initial 30-day behavior assessment for Daniel -year old
Hispanic male who is now living at the P
lcility in
He was admitted to the facility on 3/1/02. Daniel has a diagnosis of
Mild level of retardation and Attention Deficit Hyperactive Disorder. These
diagnoses make him eligible for services from East Los Angeles Regional Center.
His service coordinator is
MEDICAL
Daniel is in stable health. He had his most recent physical examination on
3/1/02 at Dr. ( ; office. The Dental Group of La Mirada for a cleaning and
exam saw him on 3/9/02. He needed no further work at this time. He has had
no other medical exams or lab work, as his MediCal is now not active. Dr.
White, psychiatrist, at ALMA Family Services, sees him. There have been no
medication changes since. admission. Daniel is 57 tall and weighs 172'/2
pounds.
Current Medication:
Seroquel 200mg 1 tab am and 2 tabs at bedtime for behavior control
Celexa 40mg 1 /2 tab at bedtime for depression
DAILY LMNG SKILLS
Personal Hyoiene and Groomino:
Daniel has the skills to do all of his own personal care tasks. He can shower
completely. Dress matching colors and clothing to weather conditions and tie his
shoes. He can brush his teeth correctly and is fully continent of bowel and
bladder. He does need verbal prompts to start these tasks and periodically
through the task for him to complete.
Meals
Daniel can feed himself completely using appropriate manners and utensils and
napkin. He can order food in the community. He can get from the kitchen
snacks that he wants but can not prepare food for himself.
Handlino Monev:
Daniel can use money to make purchases. He knows that five dollars is more
than one and he can make change to the nearest dollar. He does not
understand budget or money management. He is constantly asking people for
money but has no concept of repayment of loans.
Recreational.•
Daniel enjoys all types of typical teenage activities. He likes going to movies,
shopping, parties and amusement parks. Daniel attends the YMCA 3x a week
and enjoys both working out there and swimming.. He goes into the community
on a daily basis.
Education:
Daniel is attending _ _ Center in ive days per
week.
Communication Skills:
Daniel is able to carry on a complex conversation and strangers easily
understand his speech. He generally attempts to make people think that he is a
"tough guy" and is not appropriate.when. talking to others.
Ambulatory Status:
Daniel is fully ambulatory.
BEHAVIORS
Daniel has a number of serious behavior. issues that.need to be addressed. The
behaviors that have been targeted for treatment are: (1) Verba/Aggression, (2)
property Destruction, (3) Lying about others and (4) Resistiveness.
1. Verba /Aggression
Description of the Behavior:
Verbal aggression is defined as using profanity when addressing others or
mumbling profanity under his breath when someone asked him to do something.
Count as one incident when there is verbal aggression followed by 10 minutes
when Daniel does not display any of the target behavior.
Antecedents of the Behavior
Daniel will have asked for something that he wants and be denied, or is told that
he has to do something he does not want to do. He will start to use profanity
directed at the person or walk away from them mumbling profanity. This
behavior often chains with property destruction.
Communicative Function of the Behavior:
Daniel has poor impulse control and is telling staff that he is no longer able to
control is anger. The primary purpose of this behavior is to let staff know that
he is mad and attempt to engage them in dialog that allows him to escalate
further.
Baseline of the Behavior.
This behavior has occurred 249x per month since admission to the facility. This
figure will be used as the baseline for the behavior.
Behavior Goal.
Daniel's goal will be to reduce incidents of verbal aggression or from 249x per
month to 200x per month by 7/02.
Behavior Plan:
Prevention P /an
1. The facility will work with the Service Coordinator to find an anger
management class that Daniel can attend a regular- basis.
2. Staff will provide transportation to and from this class so that Daniel can learn
some techniques that he can use when he becomes upset.
3. Staff will talk to Daniel when he is calm about the appropriate way to talk to
others when he is upset.
4. Staff will provide him with a variety of opportunities to practice these
techniques and provide verbal praise and a plan to get things that he wants
when he engages in appropriate alternative behaviors.
Intervention Plan
1. When Daniel starts to use profanity or mumble as he walks away staff will
prompt one time in a calm voice to stop and use his anger management
techniques.
2. If he does not immediately respond to this directive staff will move other
consumers out of the area for their welfare and to prevent them from
becoming involved in the acting out.
3. Staff will work as a team to closely monitor Daniel without any interaction or
intervention until he shows signs that he is calming down. This would mean
that the verbal aggression has stopped.
4. He will then be offered an opportunity to discuss the problem calmly. If he
refuses he will be asked if he would like to go to his room until he is ready to
rejoin scheduled activities.
5. Staff will continue to closely monitor him and immediately reinforce him when
he begins to engage in appropriate activity/behavior.
Z Property DeS&UC•t%On
Description of the Behavior.
Property destruction is defined as hitting walls and furniture when he is mad.
He has caused some minor damage to facility while engaging in this behavior.
Count each time the behavior occurs followed by 10 minutes with no destruction
as one incident.
Antecedents of (fie Behavior.
Daniel has already engaged in verbal aggression without desired results.
Communicative Function of the Behavior:
Daniel uses this behavior to let others know that he is mad. Again Daniel does
use this behavior primarily in an attempt to control and manipulate others into
giving in to his wishes.
Baseline of the Behavior.
Daniel has displayed this behavior 43x in the month that he has been at-the
facility. This will be used as the baseline for this behavior.
Behavior Goal.
Daniel's goal will be to reduce incidents of property destruction from 43x per
month to 35x per month by 7/02.
Behavior Plans.
Prevention P /an
1. Staff will use the same prevention plan as for verbal aggression to teach
Daniel more appropriate ways of dealing with his anger.
2. Staff needs to give positive reinforcement for all appropriate behavior each
time that it is displayed.
Intervention Plan
1. If behavior occurs staff will calmly prompted Daniel one time to stop.
2. If he does not immediately respond staff will remove all other consumers out
of the area for their safety.
3. Staff will then monitor Daniel without intervention, unless he endangers
himself or others, until he is again calm.
4. When Daniel is calm staff will ask him to assist with cleaning up the mess he
made. If he refuses he will be ignored and asked to return to his regularly
scheduled activities.
5. If he does assist with cleaning up he will then be given time to discuss his
problem and given alternative ways that he can get the things that he wants.
6. As soon as Daniel is again engaged in appropriate behavior staff will give him
positive reinforcement for this behavior.
3. Makes up sfvries about olfiers
Description of the Behavior.
This behavior is defined as making up stories about staff and peers with the
intention of getting them in trouble. He has told the staff at his school that he is
smoking "weed" at the facility and tells the facility he-is allowed to smoke "weed"
when at home.
Count each time that behavior occurs as one incident.
Antecedents of the Behavior.
Daniel is mad at someone and wants to get him or her in trouble. There are
times when he seems to engage in this behavior with no specific reason.
Communicative Function of the Behavior.
Daniel seems to enjoy the reaction he gets to these stories. He may also be
trying to impress the other children in school with the stories of his misbehavior.
Baseline of the Behavior.
Daniel has engaged in this behavior 41x per month during the month that he has
been in placement. This will be the baseline figure for this behavior.
Behavior Goal.
Daniel's goal will be to reduce incidents of lying from 41x per month -to 35x per .
month by 7/02.
Behavior P /ans:
Prevention P /an
1. Staff will work with and explain to Daniel about the dangers of making false
accusations against others when he is not engaging in this behavior. _This.... .
should be to explain that people would not know when to listen to him. and
know that he is in need of real help or assistance. Do not mention that his
behavior could get them in trouble as Daniel is already aware of this and it
could increase the likelihood of target behavior occurring.
2. Staff l
actions w without Daniel each
to that he
on responsibility for his
another person.
intervention
1. When Daniel starts to blame others for his action or make up untrue stories
staff will tell him to stop and that they will not talk to him until he is ready to
talk about the situation without making things up.
2. If staff is not sure whether a story is true or false they will investigate the
facts without asking for more than minimal details. if the investigation
provides that the story is not true they will tell Daniel they know what
happened and he was not telling the truth.
3. Once staff has told Daniel this they will be ignored him if he continues to talk
about this subject.
4. Only after Daniel is again engaged in an appropriate activity will staff involve
Daniel in conversation. When the subject matter is appropriate staff will
provide positive reinforcement.
4. Resistiveness
Descdotion of the Behavio
Resistive behavior is defined as Daniel ignoring directives or instructions or
refusing to do things that are asked of him. oes
Count each not occur as' behavior s e
one incident. incident. If Danielrefus s he task entire for the en day county his
as one incident.
Antecedents of the Behavior:
He is asked to do something that he dos not want to do.
Communicative Function of the Behavior:
Daniel appears to enjoy having the staff have to ask him many times to do
something. He uses this behavior to manipulate staff and to avoid things he
does not want to do.
Baseline of the Behavior:
Daniel has engaged in this behavior 58x in the month that he has been in
placement. This will be the baseline data for the behavior.
Behavior
Daniel will reduce incidents of resistiveness from 58x per month to 48x per
month by 7/02.
Behavior P /ans
Prevention Plan:
1. Staff will make eye contact with Daniel and give one set of simple instruction
of what he is to do.
2. If Daniel,does not understand the directive staff will model for him what he
needs to do. Staff should establish that he understands by having him tell
them back what he is to do.
3. Any time that he responds to this by following the directive /instructions he
will receive verbal praise.
Intervention Plan:
If he does not respond by starting the task staff will prompt him one more
time that he needs to complete the assigned task/instruction.
2. If Daniel still does not follow the directive /instruction he will be ignored and
reminded that more preferred activities will be contingent on completion of
the task.
3. If Daniel does not do the task it should be rescheduled when possible to be
just prior to an outing or favored activity so that he will be more inclined to
comply to get the activity he enjoys.
Ban7ers to progress: Daniel has a negative attitude towards authorrty
and tends to ignore or verbally assault these people as a way of feeling
in charge. Staff will work with him on learning that he can asset
himself in appropriate ways that will bring him the respect
wants.
Ronald Barazani, Ph.D.
Licensed Psychologist PL 4549
2230 San Marcos Drive
Los Angeles. California 90068
(323) 461 -1321 Fax(323)462 -1157
Name: Daniel
DOB:
Date of Report: 4/1/02
Age:
Psychologist: Ronald Barazani, Ph.D.
BACKGROUND INFORMATION
This is the review of service plans for Daniel - year -old ' who
lives at the facility. He has lived here since
3/1/02. Daniel is diagnosed with (1) Mild level of retardation and (2) Attention
Deficit Hyperactive Disorder. This diagnoses makes him eligible for services from
the Eastern Los Angeles Regional Center. His service coordinator is
Daniel is working on the following personal care and
Making his bed, and (3) completing his own laundry .
will review Daniel's progress monthly. New plans wil
needed.
1, Bathes Daily
Current Status
ADL skills. (1) Bathing (2)
The facility psychologist
I be written annually or as
Daniel has all the skills needed to complete this task independently. He does not
follow the schedule without verbal prompt to start and occasional prompt
through the task to complete thoroughly.
Obiective
Daniel will bathe at the time of his choice on a daily basis with-only verbal
prompt.
Task Ana /vsis:
1. Staff should prompt Daniel that he needs to bathe. They should prompt him,
that he needs to complete this task before he goes out in the morning or
before bed.
2. Staff should provide the verbal prompts required to have Daniel complete the
task thoroughly and completely.
3. Staff should provide the least amount of verbal assistance needed to have
Daniel complete the task.
4. Staff should praise all progress towards meeting the goal.
5. Staff should record all progress on data collection sheet.
6. Staff should provide this training every day.
2. Makes his bed neatly and completely
Current Status
Daniel has the skills to do this task thoroughly and completely but requires verbal
prompts to start the task and complete it thoroughly.
Obiective
Daniel will make his bed neatly and completely with one verbal reminder to start
Task Ana /vsis
1. Staff should prompt Daniel in the morning that he needs to make his bed.
2. They should provide him with the minimal verbal and physical assistance
needed to complete the task thoroughly.
3. Staff should praise all progress towards this goal. They should gradually fade
level and frequency of prompts as skills improve.
4. Staff will record all progress on data collection sheet.
5. Staff should provide this training every day.
3. Compietes his own Laundry
. Current Status
Daniel has the skills to do his own laundry with some verbal assistance from
staff. He needs verbal instructions to sort clothing, put in soap and set the
machine timer. He can transfer clothing from washer to dryer and fold clothing
correctly.
Objective
Daniel will complete his laundry with only minimal verbal prompting from staff
one time per week.
Task Analysis
1. Staff will prompt Daniel when it is time to do his laundry. They should
remind him that he needs to assist with this task.
2. Staff should provide verbal prompts and modeling needed to have Daniel
complete each step of the task.
3. Staff should praise all progress towards goal. They should gradually fade
level and frequency of prompts as skills improve.
4. Staff should record all progress on data collection sheet.
5. Staff should provide this training on time per week.
Notes:
Staff should use the following symbols when recording Daniel's
progress toward meeting these objectives.
Independent (I) - Daniel is able to complete the entire task
Independently
Verbal Prompt (V) - Daniel is able to complete the task when verbally
prompted by staff.
Gesture Prompts (G) - Daniel is able to complete the task when
shown by the staff.
Physical Assistance (P) - Daniel requires physical assistance from
staff to complete the task.
Hand over Hand Assistance (H) - Staff needs to complete the entire
task for Daniel.
Refusal (R) - Daniel refuses to complete the task even when
prompted twice.
Staff should always pro vide the lowest level prompt needed for Daniel
to complete the task. For instance, they should not provide physical
assistance before gesture prompts
_ ISP /DATA
CONSUMER NAME: DAVID
Description of Behavior:
Leaving the facility without notifying staff is defined as going out the front door or through the
back gate and walidng down the street without signing out first
David will reduce incidents of AWOL from 5x a month to Dc per month
Code: 5.
Situational /Environmental Antecedents: tie mad about something ne warm. A peer tells
him that they should leave bemuse staff can't stop them.
Behavioral Antecedents: He can't have something that he wants or is told no.
Data Collection: count each incident as a separate occurrence
Is MEDICATION part of the plan? YES_X NO_ If YES what is the criteria for reducing
use of medication as a intervention? Facility psychiatrist will have a specific plan to decrease or
discontinue medication as behavior improves.
Identify Reinforcers to be Used: verbal praise, time with staff, going out for small treat
SEVERITY CODE - Level of interference with tie Regular Programming
0 - Does not occur at any time
1 -Does not in[efeae w /pogramming: Does occur during non-structured time.
2 - Mild - occurs during riogramming, does not require irteivartlon
3 - Moderate - intem4Z /Postpones regular pogramming
4 - Severe - requires 1 to 1 intervention
5 - Extreme - danger to self /others. Requires at least 1:1 intervention
-;W
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Objective written:
Signed: Date:
. ISP /DATA
CONSUMER NAME: DAVID
Description of Behavior:
Property destruction is defined as hitting walls and pounding on doors.
Objective:
David will reduce incidents of property destruction from 20x a month to 15x per month
C ode: 4
Situational /Environmertal Antecedents: He is engaged in screaming, yelling ano being
verbally aggressive.
Behavioral Antecedents: He can't have something that he wants or is told no.
Data collection: count as one incident followed by 15 minutes when he is not
engaged in this behavior
Is MEDICATION part of the plan? YES_X_ NO_ If YES what is the criteria for reducing
use of medication as a intervention? Facility psychiatrist will have a specific plan to decrease or
discontinue medication as behavior improves.
Identify Reintbrcers to be Used: verbal praise, time with staff, going out for small treat
SEvERrrY CODE — Level of interference with the Regular Programming
0 — Does not omir at arty time
1 — Does not interfere w /Programming:. Does ooarr during nonsbumurm time
2 — Mild — ooaus dining Programming, does rat require intervention
3 — Moderate — inter�pou{pnes regular programming
4 — Severe — requires 1 to 1 intervention
5 — Extreme— danger to self /others Requires at least 1:1 intervention
u •ICI Tmu:►iiy -r
obriective written:
Signed: Date:
ISP /DATA
CONSUMER NAME: DAVIDr
Description of Behavior:
Verbal aggression is defined as causing, yelling and standing in a threatening posture that
indicates that he could become physically aggressive.
Objective:
David will reduce incidents of verbal aggression from 132x a month to 100x per month
Code: 4
Situational /Environmental Antecedents: He mad about something he wants or ne is
denied a request
Behavioral Antecedents: He can't have something that he wants or is hold no.
Data Collection: count as one incident when the behavior occurs followed by 15
minutes when there is no target behavior.
Is MEDICATION part of the plan? YES _X_ NO_ If YES what is the criteria for reducing
use of medication as a intervention? Facility psychiatrist will have a specific plan to decrease or
discontinue medication as behavior improves.
Identify Reinforcers to be Used: verbal praise, time with staff, going out for small treat
SEVERr ry CODE — Level of interference with the Regular Programming
0 — Does rot occur at any time
i — Does not interfere w /programming: Does occur during non- stuctured time
2 - Mild - occurs during programming, does riot require invention
3 — Moderate — internots/postpone5 regular Programnung
4 — Severe — requires 1 to 1 intervention
5 — Extreme — danger to sdf /others. Requires at least 1:1 intervention
MONTH /YEAR
Objective vmtten:
Date:
ISP /DATA
CONSUMER NAME: DAVID
Description of Behavior:
Making up stories is defined as telling stories about staff punishing him, consumers hitting him,
staff not taking him into the community or staff refusing to assist him when other consumers are
picking on him. This is done to attempt to get others in trouble.
Objective:
David will reduce incidents of making up stories _ from 65x a month to 60x per month
Code: 5
Situational /Environmental Antecedents: He mac and wants to get others In avuDle or
defuse attention from his behavior.
Behavioral Antecedents: He wants to get others in trouble.
Data Collection: count as one incident when the behavior occurs followed by 15
minutes when there is no target behavior.
Is MEDICATION part of the plan? YES—X— NO_ If YES what is the criteria for redudng
use of medication as a intervention? Facility psychiatrist will have a spedfic plan to decrease or
discontinue medication as behavior improves.
Identify Reinforcers to be Used: verbal praise, time with staff, going out for small treat
SEVERITY CODE — Level of interference with the Regular Rvcyamming
0 — Does not owes at any time
1 — Does not interfere w /programming: Does occur during non-structured time
2 — Mild — occurs during programming, does not require intervention
3 — Moderate — int wupts/postpones regular programming
4 — Severe — requires 1 to 1 intervention
3 — Extreme — danger to self /others. Requires at least 1:1 intervention
MONTH/YEA
Objective written:
Signed; Date:
Consumer Name:—DAVID
Data for the Month Of
H HAND ON HAND
R - REFUSAL -
I - INDEPENDENT
V - VERBAL PROMPT
M - MODELING
P - PHYSICAL PROMPT
Consumer Name:--DAVID
Data for the Month of:
- -... �n wTn .-
I — INDEPENDENT
V — VERBAL PROMPT
M — MODELING
P - PHYSICAL PROMPT
H — HAND ON HAND
R - REFUSAL
Consumer Name:—DAVID
Data for the Month of:
I – INDEPENDENT
V – VERBAL PROMPT
M – MODELING
p - PHYSICAL PROMPT
H – HAND ON HAND
R - REFUSAL
Ronald Barazani, Ph.D.
Licensed Psychologist PL 4549
2230 San Marcos Drive
Los Angeles, California 90068
(213) 462 -1157 Fax(213)462 -1157
Name: David'
DOB:
Date of the Assessment: 3/25/02
Age: 46 years, 6 months
Psychologist: Ronald Barazani, Ph.D.
BACKGROUND INFORMATION
This is the semi - annual behavioral assessment for David 1 46 year old
African - American male who currently resides at the board and care
facility in . David has a diagnoses of (1) Intermittent Explosive Disorder,
(2) Moderate Mental Retardation. These diagnoses make him eligible for service
through the East Los Angeles Regional Center. His service coordinator is
MEDICAL
David is in stable medical and dental health. He weighs 269 pounds and is 5'10"
tall. Dr. I gave him his most recent physical on 10/3/01. The latest
dental was done on 12/11/01 with Dental Group of La Mirada.., Dr. sees
him for mental health and he was last seen on 2/23/02.
David takes the following medication:
Motrin 600mg 2x a day for pain
Risperdal lmg lx a day -for behavior control
Potassium Chloride 8mg 3x a day as a supplement
Lithium Carb 300mg lx a day for mood stabilizer
Glucophage 850mg 2x a day for diabetes
Lopid 600mg 2x a day for stomach discomfort
Lasix 40mg 1x a day for hypertension
Prozac 20mg 1x a day for depression
Glucometer Elite and lancets to check blood sugar daily
BEHAVIORS
David has five inappropriate behaviors that require behavior modification plans.
These are: (1) Aggression, (2) Temper tantrums, (3) Resistive and (4)
Elopement.
1. Aggression
Description of the Behavior.
Aggression, is defined as pushing and shoving other consumers or running into
others with the full force of his body. This behavior has not caused any injury.
Count each time that the behavior occurs, followed by 10 minutes when the
behavior does not occur as one incident.
Antecedents of the Behavior.
David comes home tired from being out in the community and then comes in
close proximity to others who he feels are bothering him. If David is not allowed
adequate time to himself to relax and rest.
Communication Function of the Behavior
David appears to be showing his displeasure with others for making him do
things that he does not want to do. He may also be trying to tell staff that he
needs time alone to relax.
Base line of the Behavior
David has exhibited the following number of episodes of this behavior since his
last report..
September - 6x
October - 5x
November - 5x
First Quarter Total -16x
Monthly Average - 5x per month
December - 6x
January - 5x
February - 4x
Second Quarter Total - ISx
Monthly Average - 5x per month
Six Month Total — 31x
Semi - annual Month Average — 5x per month
Behavior
David's previous goal was to reduce the frequency of aggression from 6x per
month to 3x per month by 3/02. David has not met this goal. David's new goal
will be to reduce frequency of this behavior from 5x per month to 2x per month
by 9/02.
2, Temper Tantrums
Description of the Behavior
Tantrums, are defined as using obscene language. David will frequently make
obscene remarks. He generally speaks rapidly and makes the remark in a quiet
voice. This is also defined as yelling or screaming.
Count as a separate episode whenever there are 10 minutes between David's
inappropriate behaviors.
Antecedent of the Behavior.
David is mostly likely to use obscene language when he is asked to take a
shower, when he isn't able to have more food when he wants it, or when staff
tries to do something that he doesn't want them to do, such as adjust his
clothing.
Communicative Function of the Behavior.
This is another behavior that David exhibits when he is angry or upset about
something. This also seems to be something else that he does in order to try to
intimidate staff into giving him something that he wants or avoiding a request.
Baseline of the Behavior.
Since David's last review the following monthly behavior counts have occurred.
September — 15x'
October —16x
November —14x
First Quarter Total — 45x
Monthly Average —14x per month
December —15x
January —16x
February —13x
Second Quarter Total — 44x
Monthly Average —14x per month
Six Month Total — 89x
Semi- annual Month Average —14x per month
Behavior Goal.
David's previous goal will be to reduce frequency of tantrums from 16x per
month to 10x per month by 3/02. David did not meet this goal. David's new
goal will be to reduce frequency of temper tantrums from 14x per month to 8x
per month by 9/02.
3. Resistiveness
Description of the Behavior
Resistiveness is defined as refusing to comply with a staff request after it has
been made for the second time. David will occasionally say no or pull away from
staff that has made a request.
Count each time the behavior occurs followed by compliance with that directive
as one incident. If he is non - compliant for the day still count as one incident
with intensity of 5.
Antecedents of the Behavior.
David is most likely to be resistive when staff ask him to take a shower. He will
also sometimes resist when staff asks him to complete a chore such as sweeping
the floor.
Communicative Function of the Behavior
This is David's way of indicating that he doesn't want to do what staff has
requested or that or that he is uncomfortable with something that they have
asked.
Baseline of the Behavior.
David hs had the following number of episodes of this behavior since his last
review:
September — 20x
October —14x
November —16x
First Quarter Total — 50x
Monthly Average —16x per month
December —15x
January —17x
February —13x
Second Quarter Total — 45x
Monthly Average —15x per month
Six Month Total — 95x
Yearly Month Average —15x per month
Behavior Goal.
David's previous goal was to reduce incidents of resistiveness from 17x per
month to 13x per month by 3/02. He did not meet his goal. David's new goal
will be to reduce frequency of being resistiveness from 15x a month to 10x per
month by 9/02.
4. Elopement
Description of the Behavior:
This behavior is defined as leaving the house or group, or attempting to do so,
without notifying the staff and using the proper sign out procedure.
Count each incident or attempt as one incident.
Antecedents of the Behavior.
David will often engage-in this behavior when -he is mad or upset about-,
something that the staff has asked him to do, or when he asked to have
something and has been denied. At times the behavior will also occur when he
is with group in the community and is ready to go before the others.
Communicative Function of the Behavior:
This appears to be David's way of attempting to avoid things he does not like, or
does not want to do. At times, he may also be using this behavior to tell staff he
is tired and needs time alone to rest.
Baseline of the Behavior.
David has had the following frequency of incidents per month since the last
annual review.
September — Ix
October —1x
November — Zx
First Quarter Total — 4x
Monthly Average -1x per month
December — ix
January — 2x
February — Ix
Second Quarter Total — 4x
Monthly Average - Zx per month
Six Month Total — 8x
Semi - annual Monthly Average -1x per month
Behavior
David's goal will be to reduce attempts to leave the facility without using the
proper sign out procedure from .5x per month to Ox per month by 3/02. David
will maintain the count on this behavior at 0 for three consecutive months.
David has not met this goal. David's new goal will be to reduce incidents of
elopement from ix per month to Ox per month for three consecutive months by
9/02.
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