Administrative

Policy: 181

Day Program Procedures

Procedure:

NOTE: This Policy is intended to outline the procedures and choices of our curriculum of services offered to people with disabilities and special needs attending "Day Program Services." We desire our services and curriculum to meet customer needs that are customer driven and flexible as well as offer considerable choice. We also desire our curriculum to enhance the lives of our consumers and help them in developing their maximum levels of skills and independence. The curriculum is also reflection of our agency's mission, to Support, Motivate and Improve Lives Everyday - SMILE.

The Marion-Dillon County Board of Disabilities and Special Needs, (MDCBDSN), shall provide through various Activity and Development Centers a curriculum that meets the needs, choices and desires of our consumers and/or their families. The curriculum will also meet all requirements of day program licensing and standards of the South Carolina Department of Disabilities and Special Needs, (SCDDSN) as well as other rules and regulations governing its operation, (ex. Department of Labor). The MDCBDSN will also meet all requirements established by the Centers for Medicaid Services (CMS), concerning the final-rule as it relates to community integration of services.

Our goal and philosophy is to fully integrate and support the full access of consumers receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as people not receiving Medicaid HCBS.

We will provide meaningful work and activities that are integrated and consumer driven. Consumers will be given every opportunity for choice and their hopes, dreams and desires will be considered in a person-centered approach to their care.

The agency no longer has a sub-minimum work certificate with the Department of Labor. All consumers are paid at least the minimum wage for any type of work performed.

Day/Employment Services

1. Day Activity Services: Are supports and services provided in therapeutic settings to enable participants to achieve, maintain, improve, or decelerate the loss of personal care, social or adaptive skills. Services are provided in non-residential settings that are licensed by the state. Community activities that originate from a facility licensed by the state will be provided and billed as Day Activity Service. On site attendance at the licensed facility is not required to receive services that originate from the facility.
2. Career Prep is aimed at preparing participants for careers through exposure to and experience with various careers and through teaching such concepts as compliance, attendance, task completion, problem solving, safety, self-determination and self-advocacy. Services are not job-task oriented, but instead, aimed at a generalized result. Services are reflected in the participants service plan and are directed to habilitative rather than explicit employment objectives. Services will be provided in facilities licensed by the State. DDSN Day activities that originate from a facility licensed by the State will be provided and billed as DDSN Day. On site attendance at the licensed facility is not required to receive services that originate from the facility.
3. Employment Services consist of intensive, on-going supports that enable participants for whom competitive employment at or above minimum wage is desired. The agency fully endorses the employment first initiative wherein consumers who initially come into day services will automatically be referred to our Job Coaches for competitive employment first. Should this not work out they may then receive other day services. Consumers may choose at any time to be referred to Job Coach to receive competitive employment opportunities. Competitive employment standards will apply. The choice of integrated work opportunity will be given to the consumer. Their choice will be the priority in job procurement for that consumer. Employment Services may include services to assist the consumer to locate a job or develop a job on behalf of a consumer. Employment Services are conducted in a variety of settings, particularly work sites where persons without disabilities are employed and include activities such as supervision and training needed to sustain paid work. Employment Services may be provided in group settings, such as mobile work crews or enclaves, or in community-based individual job placements. Consumers will be given the opportunity with supports from the Job Coach, to negotiate their work schedules, pay and benefits with the Employer.
4. Support Center Service includes non-medical care, supervision and assistance provided in a non-institutional, group setting outside of the consumer's home to people who because of their disability are unable to care for and supervise themselves. Services provided are necessary to prevent institutionalization and maintain the consumer's health and safety. The care, supervision and assistance will be provided in accordance with a plan of care. An array of non-habilitative activities and opportunities for socialization will be offered throughout the day but not as therapeutic goals.

Activity and Development Centers

Activity and Development Centers may include but not be limited to the following: Activities may be conducted in large groups or by the consumer themselves if chosen. Activities not on the activity schedule may also be chosen by consumers as desired.

1. Computer Skills: To improve dexterity in fine motor and hand eye coordination, educational development, cognitive skills and to provide recreation and leisure time. Computers, to include laptops and or tablets, and software will be provided and maintained.


2. Health, Exercise, Physical Fitness and Aerobic Activities: To improve overall well-being and increase physical stamina. Exercise has been proven to reduce stress in most people. This will also increase knowledge of personal health. Exercise equipment will be obtained for these classes. Special Olympics training and participation will be conducted and supported as funds allow.


3. Arts and Crafts Activities: To provide recreational and leisure time as well as improve dexterity, fine and gross motor skills, offer greater self-esteem in accomplishment. These types of art activities are to include painting, drawing, making collages, etc. Items will be identified for possible sale such as jewelry, art projects for greeting cards, craft projects for sale, etc. Art and craft supplies will be obtained as funds allow. Craft items may be sold at the agency's resale shop.


4. Music and Acting Activities: To provide recreational and leisure time as well as improve fine and gross motor skills by using musical instruments. Acting activities will increase cognitive development in memorizing parts for plays. Musical instruments will be obtained for the music classes as funds allow. Examples of musical instruments would vary from keyboards, ukuleles, tambourines, castanets, kazoos, flutes, tom-toms, rattles, etc. These should also offer our consumers greater self-esteem in accomplishment.


5. Advanced Independent Living Skills: Higher skill level development to include courses from the Clemson Extension, (when available). This will be a time-limited course and a certificate will be given upon completion. This certificate may be used as a prerequisite for referral to a Supervised Living Program if available.


6. Educational Development: Increase functional development of skills in alphabet, counting, reading, writing, math, history, literature, horticulture (greenhouse), etc. Educational materials needed for this program will be obtained by the agency.


7. Community Awareness/Inclusion: This will include community outings of small or large groups in visiting places in the community to increase their social skills and knowledge and awareness of their rights as citizens. Examples of places to visit and participate could include museums, libraries, theatres, restaurants, courthouse, community centers, gyms, swimming pools, etc. Outings could be in neighboring counties if necessary, if approved in advance by the Day Supports Administrator or their designee. Consumers who wish to volunteer in the community at any of the above mentioned locations or animal shelters, hospitals, etc. may volunteer and will be given a choice of available volunteer opportunities. The consumer's plan will be amended as necessary to provide for this choice.


8. Consumer Rights and Self-determination Course: This may be a time-limited and/or an on-going course for consumers to learn their rights as consumers and citizens in the community. Examples could include the right to vote, due process, constitutional rights, and protection from discrimination due to disability, grievance process, appeals process, improving problem solving skills, increasing self-esteem, identifying and making choices, expressing opinions and feelings to others, etc. Advocacy groups will be established to represent all consumers with issues regarding services, activities or their rights as consumers in our agency.


9. Recreational Activities: Recreation activities provide care and supervision to consumers in order to maintain their health, enhance social skills, and enjoy and benefit from the recreational activities. Recreational activities would include activities at the day program that are primarily recreational in nature, to include watching television/DVD's, listening to music, reading magazines, doing games or puzzles, arts and crafts, group recreational activities. Also to include outside activities such as visits to the State Fair, Aquariums, amusement parks, local parks, theatres, etc. Any consumers may choose to participate in recreational activities. A fee will be charged to pay for at least half of the costs of trips outside of the Pee Dee Area. Ex. Myrtle Beach, Carowinds, Six Flags, etc.


10. Simulated Work: Simulated work will be non-paid work aimed at increasing or maintaining skill levels in jobs that may be available within the community. These skills would include endurance, quantity and quality of work, dexterity, fine and gross motor skills, etc.

Adult Day Service Options

Primarily consumers will be assessed to receive up to two different options of services: Day Activity, Career Prep, Employment Services or Support Center.

Consumers may choose activity centers as described in 1 through 10.

Consumers/parents and the consumer may have input in the options and Activity Centers they would like at the time of the annual plan. The Day Program Administrator or designee may also accept changes to the selected activities at any time during the year. The plan must be amended to indicate the changes.

Staff - Team Leaders Responsibilities

Activity centers will be supervised by the Marion-Dillon Day Program Direct Support Staff, (Specialist A's) with special expertise in the area. These staff will be considered Team leaders for their respective activity center. Groups will work as a team in accomplishing goals for the consumer as well as team goals. Special activities may be offered from time to time as available. Outside groups, individuals or non-direct support employees may participate as special activity instructors as resources and schedules are available.

All Day Program direct support staff will be Team leaders in one or more area or activity center. Consumers may move to other activity groups during the day if desired. Care will be taken to make sure accountability for all consumers is given.

Team leaders will be responsible for the annual assessment for the consumers in their group. This assessment will be taken into account during the person-centered plan meetings. Consumers are encouraged to attend their plan meetings and their input if any will be documented in the plan. Consumers are also encouraged to invite whomever they would like to attend their plan meetings to include agency staff, family, co-workers and other friends. Consumers will be given a choice of facilitator of their person-centered plan through their case manager. Changes to plans may be made at any time if this is the desire of the consumer during the service year. Consumers will be provided information by their case manager about how to make a request for additional HCBS, or changes to their current HCBS. This will be offered upon their quarterly visits/monitorship with each consumer.

Consumer Rights and Privacy

Consumers will be informed of their rights upon entry and at various times thereafter to include right's training and consumer advocacy. Consumer rights will also be posted in various and prominent areas of our day centers. See above Rights and Self Determination Courses.

Schedules will offer choices of activities, classes or outings and consumers may schedule their day accordingly. They will not have to be in the same group during the day unless they choose to do so.

Day services consumers may move freely from one location to another and talk with other consumers at any time during the day. Accountability levels will be considered to ensure safety. Consumers may also walk outside within the premises of our Day Center Campuses as dictated by their accountability levels. Fences behind our day centers are for protection of our agency vans and equipment such as lawn mowers, etc. These fences will be locked at night but open during the day for consumers to enter and exit as needed.

HCBS Consumers may associate with other non-HCBS consumers such as State-Funded Consumers during their daily activities. Consumers may choose to do an activity by themselves if desired.

All information about consumers will be kept private. Staff will follow confidentiality policy/practices and ensure that, for example, there are no posted schedules of consumers for PT, OT, medications, restricted diet, etc., in a general open area. Consumers who need assistance with their personal appearance to appear as they desire, and is provided in private, as appropriate. Consumers will be respected and given dignity to have privacy when using the bathroom facilities as well as receiving medications or health services or discussing their health services in a private area. Health information regarding consumers will be stored in a locked and private location.

Behavior plans will be implemented by staff as directed and trained by the Behavior Analyst. Consent from the consumer (or the Human Rights Committee if applicable), will be given for restraints that may be imposed. The agency uses the Mandt Crisis Intervention curriculum. Staff will be trained in the proper use of the Mandt. Positive Behavior Supports strategies will be incorporated to prevent or re-direct inappropriate behaviors. Unauthorized mechanical restraints such as posey blankets or jackets, are prohibited. Unauthorized physical restraints such as prone (floor) restraints are prohibited. Chemical restraints are also prohibited. Putting consumers in a locked room is also prohibited.

Consumers will have a locked storage area to store personal belongings.

Assistive devices needed by consumers will be obtained within available resources.

Consumers may have visitors at the centers at any time during the work day.

Any concerns or grievances a consumer or their family may have may be submitted verbally or in writing to their team leader, day center director or their case manager. Also, consumers will be informed that they may call the after-hours case management number to log and file a complaint. This number is (843) 992-1374. The grievance will be reviewed and resolved by the center director and the Day Services Administrator/Executive Director if not resolved. All grievances will be addressed within 10 working days of the original grievance. No retaliation of any type will be given against any consumer or their family submitting a grievance.

Units of Service

The Day Program will offer 2 units of service each program day for each consumer. Each unit will be a minimum of 2 hours. The agency will be provide transportation to the center and back home for each consumer choosing 2 units a day. A consumer may choose to receive only 1 unit per day. Should this be the case, transportation will only be provided for 1 way each day. Parents/guardians shall be responsible for providing transportation to or from, if 1 unit is selected.

A free lunch will be provided to each day program consumer and will be considered part of the A.M. unit. A free snack will also be offered/provided for each unit of service. These lunches and snacks will be provided through the DSS Food (CACFP) program. Should a consumer not choose the lunch or snack provided they may, if they have the funds, choose to purchase a snack from our snack machines or order/obtain food from a local restaurant. A consumer may also eat a meal at a different time and in a different location if requested.