Policy: 171
Residential Habilitation Services
Procedure:
Residential Services include the care, skills training and supervision provided to participants in a non-institutional setting. The degree and type of care, supervision, skills training and support of participants will be based on the plan and the person's needs. Services include assistance with acquisition, retention, or improvement in skills related to activities of daily living, such as personal grooming and cleanliness, bed making and household chores, eating and the preparation of meals, and social and adaptive skills necessary to enable the participant to reside in a non-institutional setting. Residential Habilitation can be provided in a variety of settings. (Community Training Homes, CRCF, and SLP living situations).
Residential Habilitation Settings:
- Community Training Home I Model (Foster Care) - In the Community Training Home I Model, personalized care, supervision and individualized training are provided, in accordance with a service plan, to a maximum of two (2) people living in a support provider's home where they essentially become one of the family. Support providers are qualified and trained private citizens. CTH-I homes meet Office of State Fire Marshal Foster Home Regulations.
- Community Training Home II Model - The Community Training Home II Model offers the opportunity to live in a homelike environment in the community under the supervision of qualified and trained staff. Care, skills training and supervision are provided according to individualized needs as reflected in the service plan. No more than four (4) people live in each residence.
- Community Integrated Residential Services (CIRS) - This model was created to promote personal development and independence in people with disabilities by creating a customized transition from 24-hour supervised living to a semi-independent living arrangement. Participants are responsible for selecting support providers, house mates and housing. A lease support agreement connects participants with landlords and provides an extra level of support which might be needed to facilitate a positive landlord/tenant relationship. CLOUD homes located in one and two family dwellings, as well as townhouses, shall meet International Residential Code (IRC) standards. CLOUD residential models are not care facilities.
- Supervised Living Model II - This model is for people who need intermittent supervision and supports. They can handle most daily activities independently but may need periodic advice, support and supervision. It is typically offered in an apartment setting that has staff available on-site or in a location from which they may get to the site within 15 minutes of being called, 24 hours daily.
- Supported Living Model I - This model is similar to the Supervised Living Model II; however, people generally require only occasional support. It is offered in an apartment or house setting and staff are available 24 hours a day by phone.
- Community Residential Care Facility (CRCF) - This model, like the Community Training Home II Model, offers the opportunity to live in the community in a homelike environment under the supervision of qualified, trained caregivers. Care, skills training and supervision are provided according to identified needs as reflected in the service plan. See SC DHEC Regulation Number 61- 84 for specific licensing requirements.
The Residential Program will meet all requirements of Residential licensing standards of South Carolina Department of Disabilities and Special Needs, (SCDDSN) as well as other rules and regulations governing its operation, (Alliant and DHEC). The MDCBDSN Residential Program will meet all requirements to be established by the Centers for Medicaid Services, (CMS) concerning the final rule as it relates to all setting types. (Note: The DHEC licensing requirements must be met by a CRCF provider who wishes to become a residential habilitation provider using their CRCF setting).
MDCBDSN Residential Program is a reflection of our agency's mission, to Support, Motivate, and Improve Lives Everyday(SMILE). We will provide meaningful training programs and activities that are integrated and participant driven. Participants will be provided with every opportunity for choice and their hopes, dreams and desires will be considered in a person centered approach to their care.
Community Integration:
MDCBDSN practice provides participants with meaningful experiences for community inclusion. Outings/Activities are provided for participants based on their wants, desires, and needs as a group or individually. All participants are supported to plan and participate in community outings of their choosing each month. Community meetings are held with the participants to discuss what they want to do for the month and plan according to their wants/desires. To include: personal shopping, grocery shopping, running personal errands, in a group or on individual outings. Outings with their family members, friends and other people who are important to them. Also, have access to and control over their own money based on the person's financial plan. Documentation is provided via the monthly activity reports, T-Logs, outing forms and community meetings forms to discuss rights training. (See Policy #172 — Outings; Residential Procedure #172-A — Outings/Activities; Rights Training Manual).
Choice of Setting:
MDCBDSN practice ensures each consumer participate in a pre-screening process before choosing an agency as a provider. Which may include a transition plan for visits, or tour of the facility to include the home, room, meet roommates before the admission meeting. House mates have the opportunity the meet the person and decide if the person is a good fit for the home or not. Each consumer and representative is informed of resident's rights and house rules at the admission meetings. All participants are presented with a residential agreement and lease residency agreement, which provides protections and eviction process and appeals process. Participants can decorate their bedrooms in the manner in which they choose. Documentation is provided via support team meetings and/or pre-admission meetings and admission documents and preliminary plans. (See Admission agreements; Policy #166: Resident Rights; House rules; Lease agreement).
Individualized Rights:
MDCBDSN recognizes that despite disabilities, each person has the same human, civil, and constitutional rights as any citizen. MDCBDSN practice supports each with rights training to inform of their rights. Rights training is conducted twice monthly to support them to learn about their rights and responsibilities, also, how to exercise their rights. Staff are provide with a rights training manual which provides them a guide on training each session. Rights information is posted in an area accessible to all participants. Included in the rights are the process for filing grievances or complaints, expressing complaints freely without fear of staff consequences, all health information and records are kept confidential, health related and personal care skills are conducted in private, personal lockable storage, privacy in receipt and sending of mail and phone calls. Posting of employee information will not be posted in common areas or visible to participants in the home. Abuse training is also included in the monthly trainings. Participants are supported to learn what constitutes abuse, how to report it and whom to report it. Participants are encouraged and supported to tell someone if there are unhappy with the staff and feel safe. Participants are that they have the right not to answer questions about what they reported. SLED number is posted with the contact number visible to participants and they are support to learn its location. Documentation is provided via rights training forms with consumer signatures indicating their participation and T-Logs/GER's via Therap. (See Rights/Abuse Training Procedure; Policy #166: Resident Rights; Abuse policy; Policy #165: Consumer Grievance Policy; Policy #155: Confidentiality of Consumer Records).
Autonomy and Independence:
MDCBDSN practice supports participants to move about their homes freely and have access to all areas of the home, unless otherwise address in the behavior support plan or Support Plan and approved by Human Rights Committee. Participants are supported to choose their own activities and schedule them based on their personal interest and preferences to include but not limited to: the flexibility to remain at home if they choose, have in their possession a key to the house and their bedroom if they desire, can lock doors unless otherwise stated in the plan, participate in meal planning, meal preparation and grocery shopping, participate in household chores, reasonable flexibility with wake up times, choose what time to go to their rooms or go to bed, choose where, when and who they see and choose where and when they eat and what they eat. Assistive devices are available for participants who require them to move or access the setting. Documentation is provided via rights training forms with consumer signatures indicating their participation and T-Logs via Therap. (See Procedure to remain at home; Procedure for meal planning/preparation/shopping, and Rights Training Manual; Policy #185: Resident Home/bedroom key replacement/loss key).
Choice of Services:
MDCBDSN licensing requirements dictate that each consumer must have a residential plan. Prior to providing service to a consumer a preliminary plan must be developed to ensure health, safety, supervision and rights protection while the consumer is undergoing functional assessment for service planning. Within 30-days of admission a plan must be developed, and annually thereafter, and updated as needed it ensure accuracy. The plan must include the consumer's goals/objectives, type and frequency of care to be provided, functional skills training to be provided, type and frequency of supervision to be provided, and another other supports to be provided and how each support will be documented. MDCBDSN practice supports participants and representatives to take an active part in own lives by scheduling their plan meeting and choosing who they would like to invite to their meeting, and if they want a facilitator for the service planning. Participants and their representatives are supported to participate in their plan meetings and given the option of have a facilitator for service planning. Included in the services are intensive behavioral intervention. When the consumer exhibits behavior that: pose a risk to him/herself, others, or the environment; Interferes with his/her ability to function in his/her typical environments; Interferes with his/her ability to acquire, gain or maintain skills, abilities and/or independence and/or interferes with his/her ability to participate in the life of the community. The problem behavior must be addressed in a comprehensive behavior plan; which includes direct and indirect assessment by a qualified provider and individualized for each person and presented to Human Rights Committee for approval. Documentation is provided via rights training forms with consumer signatures indicating their participation and T-Logs/GER's via Therap, Plan signature sheet. (See rights training manual; residential plan with signature sheet; BSP; Policy #158: Family notification; and Policy #131: Involvement of Families).
Self-Determination:
MDCBDSN recognizes that Residential Habilitation Services requires services for support and encouragement to grow and develop, to gain autonomy, become self-reliant and pursue their own interests and goals. MDCBDSN practice supports participants to learn their rights and encourages them to take advantage of those rights to include: eating meals at the time they choose, in a location of their choosing, without assigned seating, have access of food throughout the day without requesting from staff, to choose to go or not to go on group outings, encourage to let staff know when they need to run personal errands or want to go on an individual outing. Activities are planned with input of the participants. Documentation is provided via rights training forms with consumer signatures indicating their participation and T-Logs via Therap. (See Procedure for outing/activities; Procedure for meal planning/preparation/shopping; House rules and Rights Training Manual).
Visitors:
MDCBDSN recognizes that family and friends offer people fundamental support, protection and safety net while opening the way to new opportunities and experiences. Participants are supported and encourage to meet others and participate in the community in meaningful ways. MDCBDSN in conjunction with the person identifies the people who are important to each person and assist them with re-establishing or maintaining contact with them in a way that protects the relationships. Participants are supported to learn that they have the right to have visitors in the home without signing in or out without prior notice, can answer the door to greet their guest and allow them in the home, have people over anytime they choose, have a private place to meet with their visitor, have visitors stay overnight with the agreement of housemates. Documentation is provided via rights training forms with consumer signatures indicating their participation and T-Logs via Therap. (See Procedure for visitors/overnight stay of visitor; House rules and Rights Training Manual).