Chapter 5123:2-3 Licensing of Residential Facilities

5123:2-3-01 Definitions.

As used throughout rules promulgated pursuant to Chapter 5123:2-3 of the Administrative Code, the following definitions shall apply:

(A) "Adaptive behavior" means the effectiveness or degree with which the individual meets the standards of personal independence and social responsibility expected of his or her chronological age and cultural group.

(B) "Administrator" means the person responsible for the day-to-day operation of a residential facility.

(C) "Adult" means an individual who is eighteen years of age or older.

(D) "Basement" means the portion of a building which is partly or completely below grade. A basement is considered a story above grade when the distance from grade to the finished surface of the floor above the basement is more than six feet for more than fifty per cent of the total perimeter or more than twelve feet at any point.

(E) "Behavior support" has the same meaning as defined in rules adopted by the department.

(F) "Child" means an individual who is under eighteen years of age.

(G) "Consent" means an individual's agreement to allow a procedure or treatment to happen after a full disclosure of facts needed to make the decision. A full disclosure of facts shall be communicated to the individual in a manner the individual can understand. For purposes of this paragraph, "full disclosure" means providing all information about the purpose of the proposed procedure or treatment and the possible outcomes and consequences of agreeing to or not agreeing to the proposed procedure or treatment.

(H) "County board" means a county board of mental retardation and developmental disabilities established under Chapter 5126. of the Revised Code.

(I) "Crib" means a bed with sides which extend at least eighteen inches above the top of the mattress and which does not exceed sixty inches in length. Cribs and barred enclosures may not have tops.

(J) "Department" means the Ohio department of developmental disabilities as established by section 121.02 of the Revised Code.

(K) "Developmental disability" has the same meaning as defined in sections 5123.01 and 5126.01 of the Revised Code.

(L) "Director" means the administrative head of the department as established by section 121.03 of the Revised Code or the director's designee.

(M) "Guardian" means a guardian appointed by the probate court under Chapter 2111. of the Revised Code. If the individual is a minor for whom no guardian has been appointed under that chapter, "guardian" means the individual's parents. If no guardians have been appointed for a minor and the minor is in the legal or permanent custody of a government agency or person other than the minor's natural or adoptive parents, "guardian" means that government agency or person. "Guardian" also includes an agency under contract with the department for the provision of protective service under sections 5123.55 to 5123.59 of the Revised Code.

(N) "Habilitation" has the same meaning as defined in section 5126.01 of the Revised Code.

(O) "Habilitation staff" means those residential facility personnel who work directly with individuals to supervise, assist, and develop routine habilitation skills.

(P) "Individual" means a person with mental retardation or developmental disabilities who is eligible for services pursuant to Chapters 5123. and 5126. of the Revised Code.

(Q) "Individual plan (IP)" has the same meaning as ISP as defined in rule 5123:2-1-11 of the Administrative Code..

(R) "License" means the written approval by the department to a licensee to operate a residential facility.

(S) "Licensee" has the same meaning as defined in section 5123.19 of the Revised Code.

(T) "Licensure office" means the section within the department responsible for the licensure function, including surveys.

(U) "Licensure specialist" means an official of the department who conducts licensure surveys out of the licensure office.

(V) "Major unusual incident" has the same meaning as defined in rule 5123:2-17-02 of the Administrative Code.

(W) "Management contractor" has the same meaning as defined in rule 5123:2-16-01 of the Administrative Code.

(X) "Mental retardation" has the same meaning as defined in section 5126.01 of the Revised Code.

(Y) "Policy" means a principle, plan, or course of action that directs an agency in its management of public affairs.

(Z) "Procedure" means an internal directive written to clarify and implement department or agency rules and policies.

(AA) "Professional staff" means staff licensed, certified, or registered, as applicable by the state, to provide professional services in the field in which they practice.

(BB) "Provider" has the same meaning as licensee.

(CC) "Residential facility" has the same meaning as defined in section 5123.19 of the Revised Code.

(DD) "Residential services" has the same meaning as defined in section 5126.01 of the Revised Code.

(EE) "Revocation" means the nullification of a certificate or license.

(FF) "Rule" has the same meaning as defined in section 119.01 of the Revised Code.

(GG) "Significant change of ownership" has the same meaning as defined in rule 5123:2-16-01 of the Administrative Code.

(HH) "Support staff" means those personnel employed by the residential facility who are not habilitation staff or professional staff, including, but not limited to, secretaries, clerks, housekeepers, maintenance and laundry personnel.

(II) "Survey" includes, but is not limited to, an on-site examination and evaluation of the residential facility, its personnel, and the services provided there with emphasis on the quality of life of the individuals residing in the residential facility.

(JJ) "Unusual incident" has the same meaning as defined in rule 5123:2-17-02 of the Administrative Code.

Replaces: 5123:2-3-01

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/21/81, 9/30/83, 11/16/90, 1/8/94, 5/18/95, 1/1/98

5123:2-3-02 Licensure application, issuance, survey, renewal, and sanction procedures.

(A) Purpose

The purpose of this rule is to outline the process and requirements for an initial and renewal license application, the licensure survey process and the imposition of sanctions for a residential facility.

(B) Definitions

(1) "Renovation" means a permanent change in the physical structure of a licensed facility that results in a change in the use of the facility and/or a change in its floor plan since the most recent issuance of the facility's license.

(2) "Placement of a monitor" means twenty-four-hour per day, or whenever an individual is in the facility, on-site monitoring of a residential facility provided or arranged by the department in order to verify compliance with Chapter 5123. of the Revised Code or rules adopted under that chapter.

(C) The license to operate a residential facility is not transferable and is valid only for the licensee, the premises named on the license, and for the number of individuals specified on the license.

(D) If a licensee proposes to change the location, the licensed capacity and /or the owner or management contractor of the residential facility, the licensee shall follow the requirements outlined in rule 5123:2-16-01 of the Administrative Code.

(E) The director shall initiate disciplinary action against any department employee who notifies or causes the notification to any unauthorized person of an unannounced inspection of a residential facility by the department.

(F) Initial and renewal license application

(1) Following development approval in accordance with rule 5123:2-16-01 of the Administrative Code, each person or government agency who wishes to operate a residential facility shall submit an application for a license, on forms prescribed by the department, to the licensure office not less than thirty days prior to the date of the planned opening of the facility.

(2) The licensee of the residential facility shall submit floor plans at the time of initial application.

(3) When the license application is made for the purpose of obtaining an initial license or for the relocation of an existing license to another location, the department shall conduct a survey of each residential facility for which such application has been made prior to issuing a license. The survey shall be completed within twenty days after the application is received by the licensure office.

(4) The licensee shall arrange for and permit appropriate inspections of the residential facility by all authorized agencies before a license is issued and shall be responsible for payment of all fees charged for inspections required for licensure. Reports of approved inspections shall be filed with the licensure office prior to issuance of a license verifying that the residential facility has passed:

(a) A building safety inspection by a local building inspector or the Ohio division of factory and building if the residential facility serves six or more individuals is required for initial licensure;

(b) A fire safety inspection by a local fire department, state fire marshal or person certified by the state fire marshal's office;

(c) A sanitation inspection by the Ohio department of health or by a county or municipal health department if the residential facility is not served by a public water or sewage system; and

(d) A heating and wiring inspection in lieu of the building inspection by a certified electrician or bona fide heating company if the residential facility serves five or less individuals is required only for initial licensure.

(5) No license will be issued until all required inspections, applications and fees have been submitted by the applicant or licensee, as applicable, and have been reviewed and approved by the department.

(G) Renovations

(1) When the licensee proposes to make renovations to a facility, the licensee shall notify the department in writing no less than thirty days prior to its intent to begin such renovation.

(2) The licensee shall provide any information required by the department in order for the department to determine whether new inspections and/or a licensure survey is required following the renovations.

(3) The department shall provide a written response to the licensee within fourteen days after receiving all the information it needs to determine whether new inspections and/or a licensure survey is required following the renovations.

(H) Denial of license

(1) An application for a license shall be denied if it is determined that the licensee cannot meet the requirements of Chapter 5123. of the Revised Code or rules adopted under that chapter.

(2) If such a determination is made, a letter shall be sent by the department to the licensee by certified mail, return receipt requested, stating the reasons for the denial and offering the licensee a hearing on the denial in accordance with Chapter 119. of the Revised Code. The applicant or licensee, as applicable, shall have thirty days from the date the letter is mailed to request a hearing.

(I) Survey(s)

(1) Initial and renewal

(a) The department shall conduct a survey of a residential facility at least once during the term of the license and may conduct additional surveys as determined by the department. In conducting surveys, the department shall be given access to the residential facility; all records, accounts, and any other documents related to the operation of the facility; the licensee; the individuals residing in the facility; and all persons acting on behalf of, under the control of, or in connection with the licensee. The licensee and all persons acting on behalf of, under the control of, or in connection with the licensee shall cooperate with the department in conducting the survey.

(b) The survey may be unannounced or announced. Surveys shall be generally conducted at times when the individuals are present in the residential facility.

(c) The survey shall consist of a series of observations, interviews, and review of records to determine if the interactions, activities, practices, and conditions within the residential facility are consistent with Chapter 5123. of the Revised Code and rules adopted under that chapter. The survey shall be conducted in accordance with procedures developed by the department and will determine the term of the licensee's subsequent license by utilizing the licensure survey tool as defined in rule 5123:2-3-03 of the Administrative Code.

(2) Special surveys

The department may conduct a survey of a residential facility in response to a complaint, a major unusual incident, or any situation where there is reason to believe that the facility is not being operated in compliance with Chapter 5123. of the Revised Code or rules adopted under that chapter.

(J) Survey report issuance

(1) Following the survey and prior to issuing deficiencies, the department shall conduct an exit interview with the administrator or his or her designee. The administrator or his or her designee may waive, in writing, the exit interview. During the exit interview, the administrator or his or her designee shall be provided an opportunity to respond to any potential deficiencies identified by the department. Information not made available to the licensure surveyor by the conclusion of the exit conference may result in the issuance of a deficiency.

(2) Following each exit interview, unless the director initiates a license revocation proceeding, a report shall be provided to the licensee listing any deficiencies, specifying a timetable within which the licensee shall submit a plan of correction describing how the deficiencies will be corrected, and, when appropriate, specifying a timetable within which the licensee must correct the deficiencies. The report shall be provided to the licensee no later than twenty working days following the exit interview and shall be made available to any person who requests it in accordance with applicable statute and regulations regarding individual confidentiality.

(3) Any licensee who has received the report listing any deficiencies shall submit a plan to correct the deficiencies to the licensure office within the timetable specified in the report. After a plan of correction is submitted, the department shall approve or disapprove the plan. If the plan of compliance is approved, the department shall so notify the licensee and shall verify that the licensee implements the approved plan of correction within the time limits included in the plan.

(4) If the plan of correction is not approved, the department shall so notify the licensee and shall assist the licensee in submitting an acceptable plan of compliance.

(5) A copy of the approved plan of correction shall be provided to any person who requests it in accordance with applicable statute and regulations regarding individual confidentiality.

(6) A licensee may appeal the determination that a deficiency exists by submitting a written statement with supporting documentation to the licensure office within thirty days of receipt of the report. A determination on the appeal shall be made in writing by the licensure office within thirty days of receipt of the appeal. The licensee may file a written appeal to the appropriate deputy director within fourteen days after the date of the determination by the licensure office. The decision of the deputy director shall be the final administrative appeal within the department.

(7) The license shall be issued by the director within twenty days following the determination by the licensure office that compliance with all requirements has been met, an approved plan of correction has been received, and/or compliance with specific requirements has been waived.

(K) The license of a licensee shall remain valid until an expiration date is established in accordance with rule 5123:2-3-03 of the Administrative Code unless the license is terminated, revoked or voluntarily surrendered.

(L) Notwithstanding the term of a license issued in accordance with this rule, the department shall send any required annual inspection form(s) to the licensee no later than ninety days prior to the inspection's due date. The licensee shall submit an approved fire inspection and any other applicable inspections as described in paragraph (F)(4) of this rule to the department no later than the due date indicated on the inspection form.

(M) The director may issue an interim license to operate a residential facility in accordance with rule 5123:2-3-23 of the Administrative Code.

(N) When two or more buildings are adjacent to each other and constitute a single operation, such buildings may be operated under a single license as one residential facility.

(O) The license shall be maintained in the residential facility and shown to anyone upon request.

(P) Any nursing home that contained beds that the Ohio department of health had certified prior to June 30, 1987 as intermediate care facility for the mentally retarded (ICF/MR) beds under Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended is not required to be licensed by the department.

(Q) Sanctions

(1) In proceedings initiated to deny, refuse to renew, or revoke a license under Chapter 5123. of the Revised Code or rules adopted under that chapter, the director may deny, refuse to renew, or revoke a license regardless of whether some or all of the deficiencies that prompted the proceedings have been corrected at the time of the hearing.

(2) If it is determined that a residential facility is not being operated in accordance with Chapter 5123. of the Revised Code or rules adopted under that chapter, the director may take any of the following actions:

(a) Suspensions of admissions to the residential facility in accordance with paragraph

(Q)

(3) of this rule

(b) Placement of a monitor at the residential facility in accordance with paragraph (Q)(4) of this rule;

(c) Non-renewal of the license in accordance with paragraph (Q)(5) of this rule;

(d) Initiation of licensure revocation in accordance with paragraph (Q)(6) of this rule.

(3) Suspension of admission

(a) Appeals from proceedings initiated to order the suspension of admissions to a residential facility shall be conducted in accordance with Chapter 119. of the Revised Code

(b) When a suspension of admission is ordered before providing an opportunity for an adjudication pursuant to Chapter 119. of the Revised Code, the following shall apply:

(i) The licensee may request a hearing not later than ten days after receiving the notice specified in section 119.07 of the Revised Code.

(ii) If a timely request for a hearing is made, the hearing shall commence not later than thirty days after the department receives the request.

(iii) After commencing, the hearing shall continue uninterrupted, except for Saturdays, Sundays and legal holidays, unless the interruptions are agreed to by the licensee and director.

(iv) If a hearing examiner conducts the hearing, the hearing examiner shall file a report and recommendations not later than ten days after the close of the hearing.

(v) Not later than five days after the hearing examiner files the report and recommendations, the licensee may file objections to the report and recommendations.

(vi) Not later than fifteen days after the hearing examiner files the report and recommendations, the director shall issue an order approving, modifying or disapproving the report and recommendations.

(vii) Notwithstanding the pendency of the hearing, the director shall lift the order for suspension of admissions when the director determines that the deficiency that formed the basis for the order has been corrected.

(c) A copy of the order suspending admissions to a facility shall be sent to the county board where the residential facility is located.

(d) The licensee subject to the suspension of admissions shall send written notice to each individual served by the licensee, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor, within three working days of its notification from the department that a suspension of admissions has been imposed on the facility. The notice shall contain information regarding the reason for the suspension and how the individual, parent or guardian can obtain additional information regarding the suspension. The licensee shall send a copy of the notice to the department upon request.

(4) Placement of a monitor

(a) When the director places a monitor in a residential facility, the department shall notify the county board where the facility is located.

(b) The licensee subject to the monitoring shall send written notice to each individual served by the licensee, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor, within three working days of its notification from the department that a monitor has been placed in the facility. The notice shall contain information regarding the reason for the monitoring and how the individual, parent or guardian can obtain additional information regarding the monitoring. The licensee shall send a copy of the notice to the department upon request.

(5) Non-renewal of license

(a) The director may decline to renew the license of a licensee upon its expiration when he or she determines that the residential facility is not being operated in compliance with Chapter 5123. of the Revised Code or rules adopted under that chapter as reflected in the licensure survey tool as defined in rule 5123:2-3-03 of the Administrative Code.

(b) If such a determination is made, a letter shall be sent by the department to the licensee by certified mail, return receipt requested, within twenty days of the survey. The letter shall list the deficiencies identified during the survey and shall inform the licensee of the process of reconsideration. A copy of the letter shall be sent to the county board where the facility is located and to the Ohio department of job and family services and the Ohio department of health if the facility is an ICF/MR.

(c) The licensee shall have twenty days from the date the letter is mailed to request a written reconsideration of the director's decision to not renew the license. The request for reconsideration shall include a plan of compliance that includes actions the licensee will take and timelines.

(d) If the licensee submits a request for reconsideration, the director shall review the request for reconsideration within ten days of receipt of the request and the plan of compliance and determine if it is acceptable. If the plan of compliance is determined to be unacceptable by the director, the director shall send a letter by certified mail, return receipt requested, to the licensee informing the licensee of the director's decision to deny the request for reconsideration and the director's decision to not renew the facility's license upon its expiration and that the licensee must cease operation within thirty days of the receipt of the letter or the license's expiration date, whichever is later, and shall inform the licensee of his right to request a hearing pursuant to Chapter 119. of the Revised Code. The licensee shall have thirty days from the date the letter is mailed to request a hearing which, if timely requested, shall be held in accordance with Chapter 119. of the Revised Code. If the licensee requests a hearing pursuant to Chapter 119. of the Revised Code and if the hearing process extends beyond the expiration date of the licensee's current license, the facility's license shall continue to be valid until the department's decision, pursuant to Chapter 119. of the Revised Code, is rendered.

(e) If the plan of compliance is approved, the department shall conduct a survey to verify the plan of compliance has been implemented within thirty days of the receipt of the request for reconsideration to determine if the licensee has come into substantial compliance with Chapter 5123. of the Revised Code and rules adopted under that chapter.

(f) Within twenty days following the department's plan of compliance survey, the director shall send a letter to the licensee by certified mail, return receipt requested, informing the licensee of the director's decision to reconsider the non-renewal of the license.

(i) If the director determines the licensee has come into substantial compliance with Chapter 5123. of the Revised Code and rules adopted under that chapter, the licensee will be issued a one-year license.

(ii) If the director determines the licensee remains in substantial noncompliance with Chapter 5123. of the Revised Code and rules adopted under that chapter, the letter shall affirm the director's decision to not renew the license of the facility upon its expiration and that the licensee must cease operation within thirty days of the receipt of the letter or the license's expiration date, whichever is later, and shall inform the licensee of his right to request a hearing pursuant to Chapter 119. of the Revised Code. The licensee shall have thirty days from the date the letter is mailed to request a hearing, which, if timely requested, shall be held in accordance with Chapter 119 of the Revised Code.

(a) If the licensee does not request a hearing within the thirty-day time limit, an adjudication order will be rendered pursuant to Chapter 119. of the Revised Code. A copy of the order shall be sent to the county board where the facility is located and to the Ohio department of health and the Ohio department of job and family services if the facility is certified as an ICF/MR. The director shall arrange that a letter or a copy of the order shall also be sent to each individual served by the licensee, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor.

(b) If the licensee requests a hearing within the thirty-day time limit, the director shall set the date, time and place of the hearing in accordance with Chapter 119. of the Revised Code. The licensee shall be notified of the scheduled hearing by certified mail, return receipt requested.

(c) If the hearing process extends beyond the expiration date of the licensee's current license, the facility's license shall continue to be valid until the department's decision, pursuant to Chapter 119. of the Revised Code, is rendered.

(g) If the licensee does not submit a request for reconsideration within the twenty-day time limit, a letter shall be sent by certified mail, return receipt requested, signed by the director, notifying the licensee that the license will not be renewed upon its expiration and that the licensee must cease operation on the expiration date of the license and shall inform the licensee of his right to request a hearing pursuant to Chapter 119. of the Revised Code which, if timely requested, shall be held in accordance with Chapter 119. of the Revised Code. A copy of the letter shall be sent to the county board where the facility is located and to the Ohio department of health and the Ohio department of job and family services if the facility is certified as an ICF/MR. The director shall arrange that a letter shall also be sent to each individual served by the licensee, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor.

(h) If the licensee does not request a hearing within the thirty-day time limit, Revised Code. A copy of the order shall also be sent to the county board where the facility is located and to the Ohio department of health and the Ohio department of job and family services if the facility is certified as an ICF/MR. The director shall arrange that a letter shall also be sent to each individual served by the licensee, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor.

(6) License revocation

(a) When the director initiates license revocation proceedings, no opportunity for submitting a plan of correction shall be given.

(b) The director may initiate licensure revocation proceedings when he or she determines that the residential facility is not being operated in compliance with Chapter 5123. of the Revised Code or rules adopted under that chapter.

(c) If such a determination is made, a letter shall be sent by the department to the licensee by certified mail, return receipt requested, stating the reasons for the revocation and offering the licensee a hearing on the proposed revocation in accordance with Chapter 119. of the Revised Code. The applicant or licensee, as applicable, shall have thirty days from the date the letter is mailed to request a hearing which, if timely requested, shall be held in accordance with Chapter 119. of the Revised Code.

(d) When the director initiates license revocation proceedings, the director shall notify in writing each individual served in the residential facility, the individual's guardian if the individual is an adult for whom a guardian has been appointed, the individual's parent or guardian if the individual is a minor, the county board in which the residential facility is located and to the Ohio department of job and family services and the Ohio department of health if the residential facility is certified as an ICF/MR.

(e) If the hearing process extends beyond the expiration date of the current license, the license of the residential facility shall continue to be valid until the director's decision, pursuant Chapter 119. of the Revised Code, is rendered.

(R) Termination of license

(1) The director may terminate a license if more than twelve consecutive months have elapsed since the residential facility was last occupied by an individualor a when the licensee failed to provide notice of any significant change in the identity of the licensee or management contractor in accordance with rule 5123:2-16-01 of the Administrative Code.

(2) If such a determination is made, the department shall send a letter to the licensee by certified mail, return receipt requested, offering the licensee a hearing on the termination in accordance with Chapter 119. of the Revised Code. The applicant or licensee, as applicable, shall have thirty days from the date the letter is mailed to request a hearing which, if timely requested, shall be held in accordance with Chapter 119. of the Revised Code.

Eff 10-31-77; 6-12-81; 9-30-83; 8-1-87; 8-22-87; 11-16-90; 12-9-91; 1-8-94; 11-2-96; Replaces: 5123:2-3-02 and 5123:2-3-03, eff 1-17-05
Rule promulgated under: RC 119.03
Rule authorized by: RC 5123.04 , 5123.19
Rule amplifies: RC 5123.04 , 5123.19
R.C. 119.032 review dates: 01/17/2010

5123:2-3-03 Establishing a term license.

(A) Purpose

The purpose of this rule is to establish the standards used by the department to determine the license term of a residential facility.

(B) Definitions

(1) "Licensure survey tool" means the instrument used by the department, as indicated in appendix A to this rule, to determine the licensee's compliance with licensure standards.

(2) "Notice of license non-renewal" means that, as a result of a licensure survey and application of the provisions of this rule, the director declines to renew the license of a facility upon its expiration.

(3) "Non-compliance" means any single deficiency that adversely affected the health and/or welfare of the individual or posed a significant risk of serious harm to the individual or the numbers of deficiencies of standards are widespread in relation to the sample surveyed as determined by the department.

(4) "Partial compliance" means that several deficiencies of a standard have been identified and that those deficiencies did not adversely affect the health and/or welfare of an individual, and the numbers of deficiencies are not widespread and pose little or no significant risk of serious harm to the individual in relation to the sample surveyed as determined by the department.

(5) "Substantial compliance" means that no deficiencies of a standard have been identified, or that any deficiencies are minimal in number, isolated, and pose little or no significant risk of serious harm to the individual in relation to the sample surveyed as determined by the department, and any deficiencies did not adversely affect the health and/or welfare of the individual.

(C) Scoring of rules and standards

(1) Each standard shall consist of rules, which shall be evaluated by the department to determine the licensee's compliance with the rule.

(a) For standards one through ten, each rule shall be scored as follows:

(i) Two points shall be given for each rule where substantial compliance is demonstrated by the licensee;

(ii) One point shall be given for each rule where partial compliance is demonstrated by the licensee;

(iii) No points shall be given for each rule where non-compliance is demonstrated by the licensee.

(b) For standard eleven ("General Requirements"), no more than three deficiencies may be cited in order to pass that standard.

(2) The scores for each standard shall be determined by adding the points accrued for each rule within that standard. The facility's score for each standard shall be compared to the following schedule to determine if the facility passed that standard.

Schedule of Scores Needed to Pass Standards

Standard NumberStandardTotal Possible ScoreScore Needed to Pass Standard

1 Service Plan Development and Implementation 32 27

2 Personal Care/Dress 12 10

3 Individual Funds Management 16 (ICF/MR); 26 (Non-ICF/MR) 14 (ICF/MR); 22 (Non-ICF/MR)

4 Behavior Support 28 24

5 Incident Prevention and Reporting 14 12

6 Home Environment 22 19

7 Employment and Staffing 24 20

8 Facility Safety 20 17

9 Facility and Individual Records 16 14

10 Staff Training 26 22

11 General Requirements Not Applicable No More than 3 Deficiencies

(D) Establishing the license term

The term of a license shall be established as follows:

(1) A three-year license shall be issued when:

(a) A facility passes all eleven standards; and

(b) For facilities of fifteen or fewer, there are no deficiencies issued; or

(c) For facilities of sixteen or more, there are no more than four deficiencies issued.

(2) A two-year license shall be issued when:

(a) A facility passes ten standards; and

(b) For facilities of fifteen or fewer, there are no more than four deficiencies issued; or

(c) For facilities of sixteen or more, there are no more than seven deficiencies issued.

(3) A one-year license shall be issued when:

(a) A facility passes less than ten, but at least eight standards; and/or

(b) For facilities of fifteen or fewer, there are more than four but no more than fifteen deficiencies issued; or

(c) For facilities of sixteen or more, there are more than seven but no more than fifteen deficiencies issued.

(4) A notice of license non-renewal is issued when:

(a) A facility passes less than eight standards; or

(b) Any facility is issued more than fifteen deficiencies.

(E) The term of a license shall be established following the licensee's appeal of any deficiencies in accordance with rule 5123:2-3-02 of the Administrative Code.

Appendix A

Licensure Survey Tool

STANDARD 1 SERVICE PLAN DEVELOPMENT AND IMPLEMENTATION

Rule

5123:2-3-04 (F) The licensee shall monitor the physical and psychological health of individuals and coordinate and arrange timely access to needed and preventative evaluations and treatments.

5123:2-3-04 (F) The licensee shall ensure that appropriate records and knowledgeable staff accompany individuals to physical and psychological evaluations or are available to provide pertinent information related to the treatment indicated in the individual's plan.

5123:2-3-05 (D)(3)(a) Before a facility transfers or discharges an individual, the facility must notify the individual, parent of a minor child or guardian, and the county board of the transfer or discharge and the reasons for the move in writing.

5123:2-3-09 (E)(3) The dose, time, frequency, or route of administration shall not be changed, substituted, or omitted except on the order of a licensed health professional authorized to prescribe drugs or a licensed nurse acting within the scope of his/her practice.

5123:2-3-11 (G)(1) Each individual shall participate in a documented training of the facility's fire safety plan within thirty days of residency.

5123:2-3-11 (G)(2) Each individual shall participate in a documented training of the facility's fire safety plan at least once during every twelve-month period.

5123:2-3-11 (G)(3) Each individual shall participate in a documented training of the facility's emergency response plan within thirty days of residency.

5123:2-3-11 (G)(4) Each individual shall participate in a documented training of the facility's emergency response plan at least once during every twelve-month period.

5123:2-3-17 (C) The services and activities described in the IP shall support the individual's choices, meet the individual's needs, and assist the individual in expanding and developing skills that will lead to a more independent, secure and enjoyable life.

5123:2-3-17 (D)(1)(b) Medical evaluations shall be completed every two years. A "medical evaluation" means an evaluation of the individual's general health.

5123:2-3-17 (D)(1)(c) Dental evaluations shall be completed on an annual basis. A "dental evaluation" means an evaluation of the individual's general dental health and hygiene.

5123:2-3-17 (D)(1)(d) An adaptive behavior or independent living skills assessment shall be reviewed and updated at least annually.

5123:2-3-17 (E) An IP shall be developed by an IP coordinator with each individual within one month after the individual's admission to the residential facility and shall be updated at least annually thereafter. The custodian or parent(s), if the individual is a child, or guardian shall be encouraged to participate in the development of the IP....

5123:2-3-17 (F) The IP shall be implemented as written.

5123:2-3-17 (G)(2) The IP coordinator shall also perform and document the following responsibilities: Review the implementation of the IP at least quarterly and revise as needed.

5123:2-3-17 (H) The services and activities described in the IP shall not be provided without the individual's consent or the consent of the parent(s), custodian, or guardian, as applicable. If the individual is a child, consent shall be obtained from the individual's parent(s) unless the individual has a custodian in which case, consent shall be obtained from the custodian. If the individual has a guardian, consent shall be obtained from the guardian. Consent shall be in writing and may be withdrawn in writing at any time.

STANDARD 2 PERSONAL CARE/DRESS

Rule

5123:2-3-12 (B)(1) The licensee shall offer individuals food and daily meals which meet their nutritional needs and preferences. In those cases where an individual cannot meet his/her daily nutritional needs without assistance, assistance shall be provided.

5123:2-3-12 (B)(2) Modified or specially-prescribed diets shall be prepared and served in accordance with the instructions of a physician or licensed dietician. "Modified or specially-prescribed diets" are defined as diets that are altered in any way to enable the individual to eat (for example, food that is chopped, pureed, etc.) or diets that are intended to correct or prevent a nutritional deficiency or health problem. The licensee shall keep on file in the residential facility records of modified or specially-prescribed diets for the previous thirty days.

5123:2-3-12 (B)(6) Fresh food supplies sufficient for three days and staple food supplies sufficient for at least five days shall be available in the residential facility at all times. Such supplies shall be available for inspection by the department.

5123:2-3-12 (B)(7) The licensee shall prepare and store food properly and in accordance with health codes to protect it against contamination and spoilage. Food products shall be stored separately from potentially harmful non-food items, particularly cleaning and laundry compounds, so that confusion in identifying edibles is minimized.

5123:2-3-12 (C)(1) The licensee shall ensure that each individual has an adequate amount of personal clothing in good repair, well-fitting, and comparable in style to that worn by age peers in the community....

5123:2-3-12 (C)(4) Any single item purchased by, or on behalf of the individual, with a purchase price of fifty dollars or more shall be added to the record when acquired and deleted from the record when discarded or lost.

STANDARD 3 INDIVIDUAL FUNDS MANAGEMENT

Rule

5123:2-3-14 (C) Personal funds are the exclusive property of the individual to use as he/she chooses to purchase items, goods, and services of his/her preference.

5123:2-3-14 (D) The licensee shall not require an individual to use personal funds to purchase or for the purchase of items that are reimbursed by the respective funding sources of the licensee.

5123:2-3-14 (H) Each individual has the right to manage his/her own personal financial affairs unless otherwise specified on the individual's plan. If the individual needs assistance with his/her own financial affairs then, based on formal or informal assessments, the individual's plan shall indicate the criteria, parameters, and documentation necessary regarding the assistance to be provided to the individual.

5123:2-3-14 (J)(2)(a) to (J)(2)(g) Personal funds may be established and maintained for an individual in a checking account, savings account, cash account, or any combination thereof. For each type of account established for the individual, the licensee shall maintain an account transaction record which shall contain the following:

(a) the individual's name;

(b) the amount and date all funds are received;

(c) the source of all funds received;

(d) the signature of the person crediting the account, unless electronically deposited;

(e) the amount withdrawn and date of withdrawal;

(f) the signature of the person receiving the debited amount, unless electronically withdrawn;

(g) for checking and savings account(s), a current account balance reconciled to the most recent bank statement.

5123:2-3-14 (J)(2)(h) For cash kept in the facility or other accessible location for use by or on behalf of the individual, the current amount of cash reflected in the transaction record shall equal the amount of cash present for use by the individual.

5123:2-3-14 (J)(2)(i) For each type of account maintained by the licensee, a verification of the reconciliation of the recorded balance to the actual funds available to the individual shall be made by the licensee, or the licensee's designee, no less frequently than once every sixty days. This reconciliation shall contain the date on which the reconciliation was conducted, the signature of the person conducting the reconciliation, and a detailed accounting of any discrepancies by type and amount. A person other than the person who maintains the account transaction record for the individual shall conduct the reconciliation.

5123:2-3-14 (J)(3) Personal funds received on behalf of the individual by the licensee shall be made available for the individual's use within five working days of the licensee's receipt of the funds.

5123:2-3-14 (K) All personal funds expended by the licensee on behalf of an individual shall be accompanied by a receipt for the expenditure. The receipt shall identify the item(s) procured, the date, and the amount of the expenditure. The licensee shall obtain other proof of purchase if a receipt is unavailable.

5123:2-3-18 (D)(2) (RFW) Each individual shall retain a minimum of fifty dollars per month from the total of any unearned source of income. Unearned income includes, but is not limited to SSI, SSDA, railroad retirement, veteran's benefits, and trusts. Food stamps shall be included as unearned income but shall not be applied toward the minimum income to be retained by the individual. The individual is obligated to pay any amount of unearned income in excess of the amount retained by the individual toward, but not to exceed, the contracted amount of room and board per month.

5123:2-3-18 (D)(3) (RFW) The amount of earned income to be retained by the individual shall equal, at a minimum, the first one hundred dollars of the net earned income received per month by the individual, plus on half of any earned income in excess of one hundred dollars per month. The individual is obligated to pay all earned income in excess of the amount retained by the individual toward, but not to exceed, the contracted amount for room and board.

5123:2-3-18 (D)(4) (RFW) The licensee is responsible for calculating and documenting the sum of the individual's unearned and earned income available for room and board as determined in paragraphs (D)(2) and (D)(3) and shall compare it to the actual room and board cost as identified in the contract.

5123:2-3-18 (D)(4)(a) (RFW) If the amount of the individual's unearned and earned income available for room and board following any deductions for patient liability is less than the contracted room and board cost for the month, the entire amount of the individual's unearned and earned income available for room and board shall be paid to the licensee. The balance of the room and board cost shall be billed to the county board by the licensee in accordance with the contract.

5123:2-3-18 (D)(4)(b) (RFW) If the amount of the individual's unearned and earned income available for room and board following any deductions for patient liability is greater than the contracted room and board cost for the month, the individual shall pay the entire cost of the room and board to the licensee. Any unearned and earned income received by the individual in excess of the amount paid for room and board for the month shall be retained by the individual and shall be documented in accordance with rule 5123:2-3-14 of the Administrative Code.

STANDARD 4 BEHAVIOR SUPPORT

(ii) used in an emergency under the following conditions:

(a) the use is necessary to protect the resident from injuring himself or others;

(b) the use is authorized by a professional staff member identified in the written policies and procedures of the residential care facility as having authority to do so;

(c) and the use is reported promptly to the resident's physician by that staff member.

5123:2-3-25 (B)(2)(a)(iii)(b) The parent or legal guardian of the resident gives his informed consent to the use of restraints or aversive stimuli.

5123:2-3-25 (B)(2)(b)(ii)(a),(b),(c) The residential care facility may not use physical restraint;

(a) As a punishment.

(b) For convenience of staff; or

(c) As a substitute for activities or treatment.

5123:2-3-25 (B)(2)(b)(iv) An order for physical restraint may not be in effect longer than twelve hours.

5123:2-3-25 (B)(2)(b)(v) Appropriately trained staff shall check a resident placed in a physical restraint at least every thirty minutes and keep a record of these checks.

5123:2-3-25 (B)(2)(b)(vi) A resident who is in physical restraint shall be given an opportunity for motion and exercise for a period of not less than ten minutes during each two hours of restraint.

5123:2-3-25 (B)(3)(a)(i) Behavior modification programs involving the use of aversive stimuli or timeout devices shall be reviewed and approved by the interdisciplinary team or QMRP.

5123:2-3-25 (B)(3)(a)(ii) Behavior modification programs involving the use of aversive stimuli or timeout devices shall be conducted only with the consent of the affected resident's parents or legal guardian.

5123:2-3-25 (B)(3)(a)(iii) Behavior modification programs involving the use of aversive stimuli or timeout devices shall be described in written plans that are to be kept on file in the residential care facility.

5123:2-3-25 (B)(3)(b) A physical restraint used as a timeout device may be applied only during the behavior modification exercises and only in the presence of the trainer.

5123:2-3-25 (B)(3)(c) For timeout purposes, timeout devices and aversive stimuli may not be used for longer than one hour and then only during that behavior modification program and only under the supervision of the trainer.

STANDARD 5 INCIDENT PREVENTION AND REPORTING

(a) Immediate and ongoing medical attention, as appropriate;

(b) removal of an employee from direct contact when the employee is alleged to have been involved in abuse or neglect until such time as the provider has sufficiently determined that such removal is no longer necessary;

(c) other measures to protect the health and safety of the individual, as necessary.

5123:2-17-02 (D)(3)(a) to (B)(3)(d) The provider shall immediately notify the county board by telephone or other electronic means identified by the county board under any of the following circumstances:

(a) The major unusual incident requires notification of a law enforcement agency;

(b) the major unusual incident requires notification of a public children services agency;

(c) the provider has received inquiries from the media regarding a major unusual incident that has not been previously reported; or (d) the major unusual incident raises immediate concerns regarding the individual's health and safety such that more immediate notification regarding the incident is necessary.

5123:2-17-02 (D)(4) The provider shall submit a written incident report to the county board by five p.m. the next working day following the provider's initial knowledge of any major unusual incident. This report shall be submitted in a format prescribed by the department.

5123:2-17-02 (D)(5) As soon as practicable, but no later than twenty-four hours after becoming aware of a major unusual incident, the provider shall verbally notify the legal guardian or advocate selected by the individual, unless the legal guardian or advocate is the primary person involved that forms the basis for the reported incident. If the provider is unable to verbally notify the guardian or advocate, the provider shall document all efforts made to comply.

5123:2-17-02 (F)(1) The provider shall develop and implement a written procedure for the internal review of all major unusual incidents. The provider shall be responsible for taking all reasonable steps necessary to prevent the reoccurrence of major unusual incidents.

5123:2-17-02 (H)(2) The provider shall develop and implement a written policy and procedure for the internal review of all unusual incidents to ensure that appropriate actions have been taken to protect the health and safety of individuals and patterns or trends have been identified and reviewed. Such policy and procedure shall include a requirement that unusual incidents are reviewed at least weekly to determine whether a series of unusual incidents that would constitute a major unusual incident has occurred.

5123:2-17-02 (H)(3) The provider shall maintain a log of unusual incidents. The provider shall make this log and other records of unusual incidents available to the county board and department upon request.

STANDARD 6 HOME ENVIRONMENT

(a) a building safety inspection by a local building inspector or the Ohio division of factory and building if the residential facility serves six or more individuals is required for initial licensure.

(b) A fire safety inspection by a local fire department, state fire marshal, or person certified by the state fire marshal's office;

(c) a sanitation inspection by the Ohio department of health or by a county or municipal health department if the residential facility is not served by a public water or sewage system; and

(d) a heating and wiring inspection in lieu of the building inspection by a certified electrical or bona fide heating company if the residential facility serves five or less individuals is required only for initial licensure.

5123:2-3-10 (B)(2) Parking spaces, curb cuts, appropriate walkways, exit/entry ramps, toilets, showers, tubs, sinks, doorways, and other features facilitating accessibility shall be provided to the individuals residing in the residential facility.

5123:2-3-10 (D)(4)(b) The residential facility shall provide for individual privacy in toilets, bathtubs, and showers.

5123:2-3-10 (D)(4)(c) Lavatories and bathing facilities shall be supplied with hot and cold running water maintained at a comfortable level for each individual to prevent injury.

5123:2-3-10 (E)(1) All areas of the interior and exterior of the residential facility, the facility grounds and all electrical, plumbing and heating systems of the residential facility shall be maintained in a clean and sanitary manner and in good repair at all times except for normal wear and tear and adequate to meet the needs of the individuals .

5123:2-3-10 (E)(2)(c) Gasoline, kerosene, paints, and all other flammable materials and liquids shall be stored in a safe manner and in accordance with manufacturer's label. Storage of combustible and non-combustible materials shall not produce conditions that will create a fire or a safety or health hazard.

5123:2-3-10 (E)(2)(d) If the residential facility has a gas furnace and/or gas water heater, the licensee shall maintain a carbon monoxide detector in accordance with the manufacturer's specifications.

5123:2-3-10 (F)(1) The licensee shall provide the residential facility with safe, sanitary, appropriate, comfortable, and homelike equipment, furniture, and appliances in good condition except for normal wear and tear, and adequate to meet the needs of the individual.

5123:2-3-10 (F)(2) The licensee shall provide the residential facility with at least one non-pay telephone to which individuals shall have reasonable access to at all times for making local calls. The telephone shall be provided in a location and manner that affords an individual privacy.

5123:2-3-10 (F)(3) The licensee shall maintain in each residential facility a first aid kit stocked with supplies sufficient and appropriate to meet the minor medical emergency needs of the individuals.

5123:2-3-10 (F)(5)(e) The licensee must provide each individual with bedding appropriate to the weather and climate. Linens and bedding for each bed or crib shall be maintained to provide clean and sanitary sleeping accommodations for each individual.

STANDARD 7 EMPLOYMENT AND STAFFING

(2) Obtain a report from BCII regarding the person's criminal record. The licensee shall inform each person at the time of initial application that a criminal records check is required to be conducted and satisfactorily completed as a precondition for employment. The licensee shall request the report from BCII in accordance with section 109.572 of the Revised Code.

5123:2-3-06 (E)(3) When conducting a background investigation, the licensee shall do the following:

(3) Request that the BCII obtain information regarding the person's criminal record from the FBI if the person who is the subject of the background investigation does not present proof that he/she has been a resident of Ohio for the five-year period immediately prior to the date of the background investigation. If the person presents proof that he/she has been a resident of Ohio for that five-year period, the licensee may request that BCII include information from the FBI in its report. For purposes of this paragraph, a person may provide proof of Ohio residency by presenting, with a notarized statement asserting that he/she has been a resident of Ohio for that five-year period, with a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the person's permanent residence, or any other document the licensee considers acceptable.

5123:2-3-06 (E)(4) When conducting a background investigation, the licensee shall contact the registrar of motor vehicles in order to determine and verify that the person has a valid motor vehicle operator's license and to request a certified abstract regarding the record of convictions for violations of motor vehicle laws, if the duties of the position for which the person has applied require the person to transport the individuals or to operate the licensee's vehicles for any other purpose.

5123:2-3-06 (E)(5) When conducting a background investigation, the licensee shall contact the department to inquire whether the person is included in the registry established pursuant to section 5123.52 of the Revised Code.

5123:2-3-06 (E)(6) When conducting a background investigation, the licensee shall contact the Ohio department of health to inquire whether the nurse aide registry established under section 3721.32 of the Revised Code reveals that its director has made a determination of abuse, neglect, or misappropriation of property of a resident of a long-term care facility or residential care facility by the person.

5123:2-3-06 (G)(1)(a) to (G)(1)(yy) Except as provided in paragraphs (L) and (M) of this rule, no licensee may place a person in a direct services position if the person has been convicted of or pleaded guilty to any of the following:

(1) A violation of the following sections of the Revised Code:

(a) 2903.01 (aggravated murder);

(b) 2903.02(murder) ;

(c) 2903.03 (voluntary manslaughter);

(d) 2903.04 (involuntary manslaughter);

(e) 2903.11 (felonious assault);

(f) 2903.12 (aggravated assault);

(g) 2903.13(assault) ;

(h) 2903.16 (failing to provide for a functionally impaired person);

(i) 2903.21 (aggravated menacing);

(j) 2903.34 (patient abuse and neglect);

(k) 2905.01(kidnapping) ;

(l) 2905.02(abduction) ;

(m) 2905.05 (criminal child enticement);

(n) 2907.02(rape) ;

(o) 2907.03 (sexual battery);

(p) 2907.04 (unlawful sexual conduct with a minor, formerly corruption of a minor);

(q) 2907.05 (gross sexual imposition);

(r) 2907.06 (sexual imposition);

(s) 2907.07(importuning) ;

(t) 2907.08(voyeurism) ;

(u) 2907.09 (public indecency);

(v) 2907.21 (compelling prostitution);

(w) 2907.22 (promoting prostitution);

(x) 2907.23(procuring) ;

(y) 2907.25(prostitution) ;

(z) 2907.31 (disseminating matter harmful to juveniles);

(aa) 2907.32 (pandering obscenity);

(bb) 2907.321 (pandering obscenity involving a minor);

(cc) 2907.322 (pandering sexually oriented matter involving a minor);

(dd) 2907.323 (illegal use of minor in nudity-oriented material or performance);

(ee) 2911.01 (aggravated robbery);

(ff) 2911.02(robbery) ;

(gg) 2911.11 (aggravated burglary;

(hh) 2911.12(burglary) ;

(ii) 2919.12 (unlawful abortion);

(jj) 2919.22 (endangering children);

(kk) 2919.24 (contributing to unruliness or delinquency of child);

(ll) 2919.25 (domestic violence);

(mm) 2923.12 (carrying concealed weapon);

(nn) 2923.13 (having weapons while under disability);

(oo) 2923.161 (improperly discharging a firearm at or into a habitation or school);

(pp) 2925.02 (corrupting another with drugs);

(qq) 2925.03 (trafficking in drugs);

(rr) 2925.04 (illegal manufacture of drugs or cultivation of marijuana);

(ss) 2925.05 (funding of drug or marijuana trafficking);

(tt) 2925.05 (illegal administration or distribution of anabolic steroids);

(uu) 3716.11 (placing harmful objects in food or confection);

(vv) 2905.04 (child stealing, as it existed prior to July 1, 1996);

(ww) 2919.23 (interference with custody that would have been a violation of section 2905.04 of the Revised Code as it existed prior to July 1, 1996, had the violation occurred prior to that date);

(xx) 2925.11 (possession of drugs that is not a minor drug possession offense as defined in this rule);

(yy) felonious sexual penetration in violation of former section 2907.12 of the Revised Code.

5123:2-3-06 (J) Prior to employing a person in a direct services position, the licensee shall require the person to submit a statement with the person's signature attesting that he/she has not been convicted of or pleaded guilty to any of the offenses listed or described in paragraphs (G)(1) to (G)(4) of this rule. The licensee also shall require the person to sign an agreement under which the person agrees to notify the licensee within fourteen calendar days if, while employed by the licensee, the person is ever formally charged with, convicted of, or pleads guilty to any of the offenses listed or described in paragraphs (G)(1) to (G)(4) of this rule. The agreement shall inform the person that failure to report formal charges, a conviction, or a guilty plea may result in being dismissed from employment.

5123:2-3-06 (L) The licensee may place a person in a direct service position pending receipt of information concerning the person's background investigation from BCII, the registrar of motor vehicles, or any other state or federal agency if the person submits to the licensee a statement with his/her signature attesting that he/she has not been convicted of or pleaded guilty to any of the offenses listed or described in paragraphs (G)(1) to (G)(4) of this rule. The licensee shall terminate the placement of such person if it is informed that the person has been convicted of or pleaded guilty to any of the offenses listed or described in paragraphs

(G)

(1) to (G)(4) of this rule.

5123:2-3-07 (B)(4) All habilitation staff shall be at least eighteen years of age.

5123:2-3-07 (B)(5) Volunteers shall be appropriately oriented and supervised to ensure the heath and safety of the individuals.

5123:2-3-07 (B)(6)(a) & (B)(6)(b) Habilitation staff and support staff employed after the effective date of this rule shall be tested in accordance with this paragraph. The required tuberculosis test shall include a two-step Mantoux tuberculin skin test administered by a person properly trained to administer tuberculin skin tests, or if the person has a documented history of a significant Mantoux skin test, an x-ray. The person shall not work in the facility until after the results of the first skin test have been obtained and recorded in millimeters of in duration. If the first step in non-significant, a second step shall be performed at least seven, but not more than twentyone, days after the first step was performed. Only a single-step Mantoux is required if the person has documentation of either a single step Mantoux test or a two-step Mantoux test within one year of commencing work.

(a) If either step of the Mantoux test is significant, the person shall have a chest x-ray and shall not enter the residential facility until after the results of the chest x-ray have been obtained and the person is determined to not have active pulmonary tuberculosis. Whenever a chest x-ray is required by this paragraph, a new chest x-ray need not be performed if the person has had a chest x-ray no more than thirty days before the date of the significant Mantoux test. Additional Mantoux testing is not required after one medically documented significant test. A subsequent chest x-ray is not required unless the person develops symptoms consistent with active tuberculosis.

(b) For persons with a significant Mantoux test and the chest x-ray does not indicate active pulmonary tuberculosis , the facility shall require that the person be evaluated and considered for preventive therapy. Thereafter, the facility shall require the person to report promptly any symptoms of tuberculosis which include unexplained weight loss, loss of appetite, chronic cough of more than three weeks, fever, coughing and spitting up blood and night sweats. The facility shall annually document the presence or absence of symptoms suggestive of tuberculosis in such a person and maintain this documentation on file.

5123:2-3-07 (C)(1) Habilitation staff shall be on-duty on the basis of the needs of individuals . On-duty habilitation staff shall be determined by each individual's plan. Staff schedules shall be prepared and available for review for each residential facility.

STANDARD 8 FACILITY SAFETY

Rule

5123:2-3-11 (C)(1)(a) to (C)(1)(f) A current graphic floor plan shall be posted unobstructed on each floor of the residential facility and in an area most appropriate for the posting of staff information. The graphic plan shall include, but may not be limited to:

(a) A primary and secondary means of exit from each floor;

(b) The location of pull stations and fire system control panels, where applicable;

(c) Fire escapes;

(d) The telephone number of the local fire authority or 911;

(e) Designated tornado shelter/safe area(s); and

(f) Designated meeting place(s) in case of fire.

5123:2-3-11 (C)(4) No exit, stairway, corridor, ramp, elevator, fire escape, or other means of exit from a building shall be used for storage purposes or otherwise obstructed from use in case of emergency.

5123:2-3-11 (D)(1)(a) to (D)(1)(d) The licensee shall develop a written fire safety plan that shall include, but is not limited to, the following:

(a) A policy that addresses smoking regulations and the storage of combustible materials.

(b) A fire safety training program that includes provisions for rescue, alarm, contain and evacuate. The training shall be approved by the department or the state/local authority.

(c) Designation of assigned meeting place(s) after a physical evacuation of the residential facility.

(d) A procedure for permitting re-entry to the residential facility following a fire safety drill and/or physical evacuation.

5123:2-3-11 (D)(2)(a) to (D)(2)(c) The licensee shall conduct at least six fire safety drills in a twelve-month period with at least:

(a) Two of these drills conducted during the morning;

(b) Two of these drills conducted during the afternoon/evening: and

(c)One drill during the time when individuals are routinely asleep.

5123:2-3-11 (D)(3) The licensee shall complete a written record of each drill within two days of each drill. A written plan of improvement shall be developed within two days when the fire safety drill cannot be completed in three minutes or less for facilities of five beds or less or in thirteen minutes or less for facilities of six beds or more.

5123:2-3-11(D)(4) A physical evacuation of the residential facility shall occur during at least one fire safety drill for each twelve-month period.

5123:2-3-11 (D)(5)(a) to (D)(5)(d) Each residential facility with six or more individuals shall be equipped with the following:

(a) An automatic sprinkler system meeting the requirements of NFPA 13-D, "Sprinkler Systems in One and Two Family Dwellings." The sprinkler system shall be interconnected with the smoke and fire detection and alarm system.

(b) An automatic sprinkler system meeting the requirements of NFPA 13 "Standard for the Installation of Sprinkler Systems" if a residential facility has seventeen or more individuals, or if a residential facility with six to sixteen individuals is impractical of physical evacuation (thirteen minutes or more). The sprinkler system shall be interconnected with the smoke and fire detection and alarm system. A new residential facility with six to sixteen individuals and classified under the provisions of the Ohio building code as an I-1 use group on or after May 18, 1995, shall be required to have a sprinkler system meeting the requirements of NFPA 13-R, "Installation of Sprinkler Systems in Residential Occupancies Up to Four Stories in Height." (c) A smoke and fire detection and alarm system meeting the requirements of NFPA 72, "National Fire Alarm Code" depending upon the nature of the physical facility involved and such other standards as required by the appropriate building and fire officials.

(d) Fire alarm pull stations near each main exit and in the natural path of escape from a fire, are readily accessible and visible from points which are not likely to be obstructed.

OR

5123:2-3-11 (D)(6)(a) & (D)(6)(c) Each residential facility with five or fewer individuals shall be equipped with the following:

(a) At least a single station smoke detector on each floor of the facility. The smoke detector(s) shall be mounted on the ceiling or wall at a point centrally located in the corridor or area giving access to rooms used for sleeping purposes. Where sleeping rooms are on an upper level, the detector shall be placed at the center of the ceiling directly above the stairway. All detectors shall be installed and maintained in accordance with the manufacturer's recommendations. When the detectors are wall-mounted, they shall be located within twelve inches, but no closer than four inches, of the ceiling. Installation shall not interfere with the operating characteristics of the detector. When activated, the detector shall provide an alarm audible in the residential facility.

(c) An automatic sprinkler system meeting the requirements of NFPA 13-D, "Sprinkler Systems - One and Two Family Dwellings: and a smoke detection system as required in paragraphs

(D)

(6)

(a) of this rule if the residential facility is not capable of being physically evacuated in three minutes or less.

5123:2-3-11 (E)(1)(a) to (E)(1)(c) The licensee shall develop a written emergency response plan that shall include, but is not limited to, the following:

(a) Designating a tornado shelter or safe area in the residential facility and the procedure for accessing the area,

(b) Responses to weather-related emergencies or other disasters when relocation of the individuals is not required, and

(c) Responses to weather-related or other disasters when relocation of the individuals is required, including the designation of a pre-arranged evacuation site(s) to be used in the case of a physical evacuation of the residential facility.

5123:2-3-11 (E)(2) Emergency response plan training shall be approved by the department or the state/local authority.

5123:2-3-11 (E)(3) The licensee shall conduct and document a tornado drill at least once in a twelve-month period.

STANDARD 9 FACILITY AND INDIVIDUAL RECORDS

Rule

5123:2-3-13 (B) All information contained in an individual's record shall be considered privileged and confidential. Records shall be maintained in accordance with state and federal regulations in such a manner to ensure their confidentiality and protect them from unauthorized disclosure of information.

5123:2-3-13 (C)(2) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, legal status of the individual.

5123:2-3-13 (C)(3) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, records of accidents, injuries, seizures, major unusual incidents, and unusual incidents and the treatment or first aid measure administered for each. Information pertaining to abuse/neglect investigations and other confidential information may be maintained at a location other than the residential facility, but shall be provided to licensure for review at the facility upon request.

5123:2-3-13 (C)(4) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, all medical and dental examinations and the most recent immunization records as appropriate to age.

5123:2-3-13 (C)(5)(a) & (C)(5)(b) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, medication and/or treatment records which shall indicate the person who prescribed the medication and/or treatment and the date, time, and person who administered the medication and/or treatment.

5123:2-3-13 (C)(6) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, individual plans.

5123:2-3-13 (C)(8) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, a signed authorization to seek medical treatment or documentation that attempts to seek such authorization were unsuccessful. The licensee shall provide evidence of an annual review of such authorization and, in cases where authorization was not able to be obtained, evidence that attempts to obtain authorization were made on at least an annual basis.

5123:2-3-13 (C)(9) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, if not in the individual's plan, evidence of consents for the participation in services including, but not limited to, medical treatment, behavior support plans, and the use of psychotropic medications.

STANDARD 10 STAFF TRAINING

Rule

5123:2-3-04 (D) The licensee and all employees shall interact with individuals in a way to safeguard the rights of individuals enumerated under sections 5123.62 and 5123.65 of the Revised Code. The licensee shall be responsible for meeting the requirements established under sections 5123.63 and 5123.64 of the Revised Code.

5123:2-3-07 (C)(3) Cross-referenced to 5123:2-3-08 (B)(5) At least one staff person who has current certification in first aid and CPR shall be present when individuals are being served by the licensee regardless of where services are being provided.

5123:2-3-08 (B)(1)(a) All habilitation and support staff, including those persons working through a temporary agency who work directly with individuals, who work in the residential facility, regardless of position or responsibility, shall receive training prior to assuming their duties. The training shall include, but is not limited to, the rights of individuals in accordance with sections 5123.62 and 5123.65 of the Revised Code.

5123:2-3-08 (B)(1)(b) All habilitation and support staff, including those persons working through a temporary agency who work directly with individuals, who work in the residential facility, regardless of position or responsibility, shall receive training prior to assuming their duties. The training shall include, but is not limited to, the prevention, identification, and reporting of major unusual and unusual incidents in accordance with rule 5123:2-17-02 of the Administrative Code.

5123:2-3-08 (B)(4)(a) In addition to the requirements outlined in paragraphs (B)(1) and

(B)

(3) of this rule, habilitation staff shall receive the following training prior to assuming responsibility for the delivery of services to an individual: Training in the programs and techniques necessary to appropriately develop and implement the services of each individual for whom they are responsible as described in the individual's plan.

5123:2-3-08 (C) Following the initial year of employment and during each subsequent year of employment, based on the employee's date of hire, each habilitation staff person shall be required to obtain eight hours of continuing education/training. Continuing education/training shall be designed to enhance the skills and competencies of staff relevant to their job responsibilities.

5123:2-3-08 (C)(1)(a) & (C)(1)(b) The continuing education/training areas shall include annual training in following:

(a) Identification and response to incidents adversely affecting an individual's health and safety; and

(b) Individual rights.

5123:2-3-09 (E)(1) The licensee shall adhere to the applicable standards for giving oral prescribed medications or applying topical prescribed medications, performing health-related activities, administering food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administering subcutaneous insulin injection established under sections 5123.42 to 5123.46 of the Revised Code and rules adopted by the department under Chapter 5123:2-6 of the Administrative Code.

5123:2-3-11 (F)(1) Each employee shall participate in a documented training of fire safety and operation of the facility's fire safety equipment and warning systems within thirty days of employment. Each employee must have training specific to each facility in which they work.

5123:2-3-11 (F)(2) Each employee shall participate in a documented training of fire safety and operation of the facility's fire safety equipment and warning systems at least once during every twelve-month period.

5123:2-3-11 (F)(3) Each employee shall participate in a documented training of the facility's emergency response plan within thirty days of employment. Each employee must have training specific to each facility in which they work.

5123:2-3-11 (F)(4) Each employee shall participate in a documented training of the emergency response plan at least once during every twelve-month period.

5123:2-3-11 (F)(5) Employees may work in a facility, prior to meeting the requirements of paragraphs (F)(1) and (F)(3) of this rule, when at least one staff person who has current training in both fire safety and emergency response is present in the facility, when individuals are in the facility.

STANDARD 11 GENERAL REQUIREMENTS

(N) of that rule have been met. No licensee or administrator shall operate a residential facility if he/she has been convicted of or pleaded guilty to any of the offenses listed or described in paragraphs (G)(1) to (G)(4) of rule 5123:2-3-06 of the Administrative Code. The requirements of this paragraph shall apply only to persons who apply for a license or who become the administrator of a residential facility on or after the effective date of this rule.

5123:2-3-05 (C)(3) and/or 5123L2-3-05 (D)(2) A provider shall not unlawfully discriminate because of disability, race, color, religion, national origin or ancestry, sex, or age including, but not limited to, failing to make reasonable accommodation to the individual's physical, mental, or behavioral disabilities to the extent required by law unless the provider can demonstrate that the accommodation would impose an undue hardship on the operation of the program.

5123:2-3-05 (C)(4) If a vacancy exists, the provider shall determine if the individual meets the facility's admission criteria within thirty calendar days of receiving an application for services and referral information. This timeline may be extended if mutually agreed upon by both the applicant and the provider.

5123:2-3-05 (C)(5) The provider shall notify the individual, parent of a minor child, guardian, county board, and referring party in writing of the outcome of the admissions decision within seven calendar days of making the decision.

5123:2-3-05 (C)(6) Any denial of admission notice must be sent to the individual by certified mail.

5123:2-3-05 (C)(7)(a) to (C)(7)(d) The denial of admission notice shall contain (a) A statement of what action the provider intends to take;

(b) The reasons for the denial of admission;

(c) An explanation of the individual's right to a hearing and the method by which to obtain a hearing including to who the hearing request is to be made and the timelines to request a hearing in accordance with paragraph (E) of this rule; and

(d) The telephone number and address for Ohio legal rights service.

5123:2-3-05 (C)(8) If a vacancy exists, and the applicant requests an appeal, the provider shall not fill the vacancy until the hearing decision is rendered.

5123:2-3-05 (D)(3)(b) Before a facility transfers or discharges an individual, the facility must explain the transfer or discharge and appeal rights to the individual in a language and manner which is understandable to that individual.

5123:2-3-05 (D)(3)(c) Before a facility transfers or discharges an individual, the facility must record the reasons for the transfer or discharge in the individual's record.

5123:2-3-05 (D)(4) The notice of discharge or transfer must be made at least thirty calendar days before the discharge or transfer, except in emergency situations. If at any time prior to the expiration of the thirty-day-period the provider determines that the conditions that constituted the emergency situation no longer exist, the individual may then return to the facility.

5123:2-3-05 (D)(5)(a) The notice must contain the reason for the transfer or discharge.

5123:2-3-05 (D)(5)(b) The notice must contain the effective date of the transfer or discharge.

5123:2-3-05 (D)(5)(c) The notice must contain if the transfer or discharge is due to the provider's inability to meet the individual's needs, a summary of the action taken by the provider to try to meet the individual's needs including working with the county board.

5123:2-3-05 (D)(5)(d) The notice must contain the individual's right to appeal the transfer or discharge and the process to do so.

5123:2-3-05 (D)(5)(e) The notice must contain the phone number and address of Ohio legal rights service.

5123:2-3-05 (D)(6) The notice to the individual must be sent by certified mail.

5123:2-3-05 (D)(7) If an individual requests a discharge or transfer hearing, the facility must maintain services until a decision is rendered after the hearing unless an emergency exists.

5123:2-3-05 (E)(2) The governing board or administrator shall review the decision and notify the appellant in writing by certified mail of the outcome of the review within five calendar days of the request for review.

5123:2-3-06 (C) The licensee shall ensure that no person is placed in a direct services position under a contract with the licensee for the provision of specialized services to individuals residing in a residential facility, including habilitation staff working through a temporary agency, unless that person has successfully completed a background investigation that meets the requirements of this rule.

5123:2-3-06 (G)(2) Except as provided in paragraphs (L) and (M) of this rule, no licensee may place a person in a direct service position if the person has been convicted or pleaded guilty to a felony contained in the Revised Code that is not listed in paragraph (G)(1) of this rule, if the felony bears a direct and substantial relationship to the duties and responsibilities of the position being filled.

5123:2-3-06 (G)(3) Except as provided in paragraphs (L) and (M) of this rule, no licensee may place a person in a direct service position if the person has been convicted or pleaded guilty to any offense contained in the Revised Code constituting a misdemeanor of the first degree on the first offense and a felony on a subsequent offense, if the offense bears a direct and substantial relationship to the position being filled and the nature of the services being provided.

5123:2-3-06 (G)(4) Except as provided in paragraphs (L) and (M) of this rule, no licensee may place a person in a direct service position if the person has been convicted or pleaded guilty to a violation of an existing or former municipal ordinance or law of this state, any other state, or the United States, if the offense is substantially equivalent to any of the offenses listed or described in paragraph (G)(1), (G)(2), or (G)(3) of this rule.

5123:2-3-06 (E)(1) When conducting a background investigation, the licensee shall require the person to complete an employment application, conduct a personal interview with the person, and attempt to obtain references from the person's present and former employers. The employment application shall include the names and addresses of the person's present and former employers. The licensee must maintain evidence in writing that reference checks were attempted and/or completed.

5123:2-3-06 (F) ...no licensee may employ as an MR/DD employee a person who is included in the registry established pursuant to section 5123.52 of the Revised Code.

5123:2-3-07 (B)(1) The licensee shall be responsible for compliance with all applicable federal, state, and local regulations, statutes, rules, codes, or ordinances pertaining to employment including, but not limited to, civil rights agreements; job classifications; wages and hours; workers' compensation; withholding taxes; employment or minors; nondiscrimination of employment because of disability, race, color, religion, national origin, ancestry, sex, or age; and fair employment practices.

5123:2-3-07 (B)(2) The licensee shall have written personnel policies that address applicable federal, state and local regulations pertaining to employment.

5123:2-3-07 (B)(3) The licensee shall employ an administrator except where the licensee serves as the full-time administrator. The administrator of the residential facility shall have at least one year's working experience in the management, care, supervision, or training of individuals with mental retardation or other developmental disabilities...

5123:2-3-07 (B)(3) ...A staff person shall be designated in writing to whom executive authority has been delegated in the absence of the administrator.

5123:2-3-07 (B)(6)(c) After initial screening for tuberculosis required in this paragraph and annually thereafter within one year plus or minus thirty days of the previous year's date of screening, a tuberculosis screening for symptoms suggestive of active tuberculosis shall be conducted for all habilitation and support staff. This screening shall include, at a minimum, questions about the signs and symptoms of tuberculosis as indicated in paragraph (B)(6)(b) of this rule. The frequency of any additional Mantoux skin test screenings or the need for a physician evaluation shall be dependent upon this assessment.

5123:2-3-07 (B)(7) Professional program staff must be licensed, certified, or registered, as applicable by the state, to provide professional services in the field in which they practice.

5123:2-3-07 (C)(2) The licensee must provide sufficient support staff so that habilitation staff are not required to perform support services to the extent that these duties interfere with their primary duties.

5123:2-3-07 (C)(4) When there is a swimming pool on the grounds of the residential facility including facilities in apartment complexes, the pool shall only be used by the individuals in the presence of a person with "Red Cross" or equivalent lifeguard training unless the individual's plan indicates otherwise.

5123:2-3-07 (D) Personnel records shall be maintained for each employee in accordance with the facility's personnel policies.

5123:2-3-08 (B)(1)(c) All habilitation and support staff, including those persons working through a temporary agency who work directly with individuals, who work in the residential facility, regardless of position or responsibility, shall receive training prior to assuming their duties. The training shall include, but is not limited to, an overview of the nature and needs of individuals with mental retardation/developmental disabilities.

5123:2-3-08 (B)(1)(d) All habilitation and support staff, including those persons working through a temporary agency who work directly with individuals, who work in the residential facility, regardless of position or responsibility, shall receive training prior to assuming their duties. The training shall include, but is not limited to, the organization's philosophy, organizational structure, programs, services, and goals.

5123:2-3-08 (B)(2) All habilitation and support staff, including those persons working through a temporary agency, who do not work in the residential facility, regardless of position or responsibility, shall receive training within thirty days of employment in the areas outlined in paragraph (B)(1) of this rule.

5123:2-3-08 (B)(4)(b) In addition to the requirements outlined in paragraphs (B)(1) and

(B)

(3) of this rule, habilitation staff shall receive the following training prior to assuming responsibility for the delivery of services to an individual: Training that focuses on the skills and competencies needed by habilitation staff to meet the needs of the individual(s) for whom they are responsible.

5123:2-3-08 (B)(6) The licensee shall ensure that professional staff, including those persons working through temporary agencies or under contract with the licensee, who work in the residential facility and provide services directly to individuals, provide those services in a competent manner in order to meet the health and safety needs of the individuals in the facility for whom they are responsible as described in the individual's plan.

5123:2-3-08 (B)(7) In addition to the requirements outlined in paragraphs (B)(1) to (B)(4) of this rule, supervisory staff shall complete, within the first ninety days of employment as a supervisor, training that includes, but is not limited to, the rules, regulations, and laws pertaining to the operation of a residential facility as they relate to the supervisor's job responsibilities.

5123:2-3-08 (E)(1) to (E)(6) The licensee shall maintain a written record, which may include electronic records, of each staff person's initial and continuing education/training activities. This information shall be made available to the department upon request and may be maintained at the residential facility or other accessible location. Documentation shall include

(1) The name of the staff person receiving the training;

(2) Dates of training;

(3) Length of training;

(4) The nature (topic) of the training;

(5) The instructor's name, if applicable; and

(6) Brief description of the content of the training.

5123:2-3-09 (C) Self-administration or assistance with the self-adminis tration of prescribed medication shall be done in accordance with rule 5123:2-6-02 of the Administrative Code.

5123:2-3-09 (D) Delegation of nursing tasks, excluding the provisions of health-related activities, shall be done in accordance with Chapter 4723-13 of the Administrative Code.

5123:2-3-09 (E)(2) Prescribed medication shall be given to only those individuals for whom they are prescribed.

5123:2-3-09 (E)(4)(a) to (E)(4)(d) MR/DD personnel holding a valid certificate issued under 5123:2-6-06 of the Administrative Code in facilities of one to sixteen individuals may receive and transcribe a written or oral order for giving oral and/or applying topical prescribed medication currently ordered for a specific individual and for performing health-related activities, excluding administering prescribed medication or food via a stable labeled gastrostomy or stable labeled jejunostomy tub or administering subcutaneous insulin injections.

(a) If the prescribed medication ordered is not one the individual is currently taking, the MR/DD personnel shall contact the licensed health professional authorized to prescribe drugs to order the medication by either calling the order to a pharmacy or providing a written prescription that can be transmitted to a pharmacy either electronically or in person.

(b) Upon receipt of the prescribed medication from the pharmacy, the MR/DD personnel shall copy the information regarding the medication, and how it should be given, from the pharmacy package to the medication administration record.

(c) Following completion of paragraphs (E)(4)(a) and (E)(4)(b) of this rule, the administration of the new prescribed medication may begin.

(d) If an order is given by telephone, the order shall be written in the individual's record and signed by the prescribing health professional within seven days after the order is given.

5123:2-3-09 (E)(5) In a facility of seventeen or more individuals, only a licensed nurse may accept a telephone order for prescribed medication from a licensed health professional authorized to prescribe drugs. If an order is given by telephone, the order shall be written in the individual's record and signed by the prescribing licensed health professional within seven days after the order is given.

5123:2-3-09 (F) Unless otherwise indicated by a prescribing health care professional authorized to prescribe drugs, or when the individual is self-administering medication, all physician's orders for OTC and prescribed medication shall undergo a documented review at least every three months by a licensed health professional acting within the scope of his/her practice. The licensee shall include all known non-prescribed OTC medication being taken by the individual in each review.

5123:2-3-09 (G)(1) MR/DD personnel may give OTC medication to an individual that has not been prescribed by a licensed health professional and according to recommended dosage instructions when a licensed pharmacist, licensed nurse or other licensed health professional acting within the scope of his/her practice has reviewed a list of intended OTC medications and/or prescribed medications, and has determined that the OTC medications listed would not be contraindicated for the individual.

5123:2-3-09 (H) The licensee shall develop written procedures for giving or applying prescribed medication and OTC medication to individuals which includes, but is not limited to, the dose, time frequency, and route of the medication taken, as well as documenting any significant responses to the medication, occurrences of undesirable side effects of the medication, and errors in medication administration. The licensee shall comply with the requirements for reporting errors established under paragraph (D) of rule 5123:2-6-07 of the Administrative Code. These records shall be retained as part of the individual's record.

5123:2-3-09 (I)(1) Medication shall be stored in a secure location that meets the assessed needs of the individual and ensures the health and safety of all the individuals in the facility.

5123:2-3-09 (I)(2) The licensee shall develop and follow written procedures for the disposal of any medication. These procedures must include that disposal of prescribed medication is verified and recorded by two staff members or by an independent external entity. The disposal of dangerous drugs shall be done in accordance with rule 4792-9-06("Disposal of Dangerous Drugs which are Controlled Substances") of the Administrative Code.

5123:2-3-09 (I)(3) In the event of the death of an individual, an accounting of medication shall be done immediately, but no later than twenty-four hours following the death, and recorded by two staff members. The licensee shall cooperate with any investigation conducted by a legally authorized entity. Disposal of medication shall occur in a manner prescribed in paragraph (I)(2) of this rule, unless an investigation calls for the disposal of medication to be delayed.

5123:2-3-10 (B)(1) Each building or part of a building and all utilities, sanitary facilities, and appliances shall be constructed, and installed in compliance with all applicable rules of the Ohio building code, the Ohio sanitary code, the Ohio fire code, and any county or municipal building, safety, and fire regulations or codes.

5123:2-3-10 (B)(3) Bathrooms and plumbing fixtures, including grab rails where needed, appropriate to any age and degree of disability(ies) of the individuals shall be provided in the residential facility.

5123:2-3-10 (B)(6) If the residential facility serves children ages six and under who are ambulatory, the outside play area shall be enclosed by a fence with a height sufficient enough to prevent egress from the area.

5123:2-3-10 (B)(7) Swimming pools shall meet the local and state requirements regarding construction, operation, and sanitation of pools.

5123:2-3-10 (C)(1) All liquid wastes from the residential facility shall be discharged into a public sanitary sewerage system or discharged into a sewage treatment system approved by the Ohio department of health or a certified county or municipal health department.

5123:2-3-10 (C)(2) All refuse and other solid waste shall be disposed of immediately after production or shall be stored in leakproof containers with tight-fitting covers which provide protection from animals, rodents, and insects until time of disposal. Such wastes shall be disposed of through a public disposal service or a private contract service or the licensee shall dispose of all refuse and solid wastes in accordance with the requirements of the Ohio department of health and any local regulations, rules, codes, or ordinances.

5123:2-3-10 (C)(3) The water supply of the residential facility shall comply with the Ohio Sanitary Code and any other applicable state or local regulations, rules, codes, or ordinances.

5123:2-3-10 (D)(1)(a) The residential facility shall have a minimum total of eighty square feet of living area for each individual.

5123:2-3-10 (D)(1)(b) Living areas shall not include bedrooms, bathrooms, laundry rooms, closets, hallways, garages, and unfinished basements.

5123:2-3-10 (D)(2)(a) Each bedroom occupied by one individual shall have a minimum total of eighty square feet.

5123:2-3-10 (D)(2)(b) Each bedroom occupied by more than one individual shall have a minimum total of sixty square feet of floor space for each individual.

5123:2-3-10 (D)(2)(c) No bedroom may be occupied by more than two individuals.

5123:2-3-10 (D)(2)(d) No bedroom may be occupied by individuals of the opposite sex unless the individuals are consenting adults or are under the age of six years old.

5123:2-3-10 (D)(2)(e) If the bedroom is below the grade level of the residential facility, the room must have two means of egress, one of which may be a window...

5123:2-3-10 (D)(2)(e) ...The room must have a window that the individual using the room can safely evacuate through.

5123:2-3-10 (D)(2)(f) Living rooms, dining rooms, entryways, closets, corridors, outside porches, unfinished attics, and unfinished basements shall not be used as bedrooms.

5123:2-3-10 (D)(2)(g) Each bedroom shall be adequately ventilated and shall have at least one outside window complete with window treatment(s) to provide adequate privacy for the individual.

5123:2-3-10 (D)(2)(h) Each bedroom occupied by individuals who are nonambulatory shall be located on the first floor unless the residential facility has an automatic fire extinguishing system.

5123:2-3-10 (D)(2)(i) Bedrooms shall not be used as throughways to and from other areas of the residential facility.

5123:2-3-10 (D)(3)(a) The residential facility shall have at least one area used for the preparation and serving of food under sanitary conditions.

5123:2-3-10 (D)(3)(b) Each area used for dining shall have a minimum total of fifteen square feet of floor space for each individual in the residential facility, not including the area generally recognized as counter and appliance space necessary for the normal preparation of meals.

5123:2-3-10 (D)(4)(a) The residential facility shall provide for toilet and bathing facilities appropriate in number, size, and design to meet the needs of the individuals. Toilet and bathing facilities shall be provided on each floor with bedrooms.

5123:2-3-10 (D)(4)(d) Laundry services shall be accessible to the individuals of the residential facility and adequate to meet their needs.

5123:2-3-10 (E)(2)(a) The licensee shall take measures to eliminate and prevent the presence of insects, rodents, and other vermin in and around the residential facility. Opened doors and windows shall be screened. The extermination of insects and rodents shall be done in such a manner as not to create a fire or a safety or health hazard.

5123:2-3-10 (E)(2)(b) All disinfectants, pesticides, poisons, and other toxic substances shall be properly labeled and stored separate from all food products...

5123:2-3-10 (E)(2)(b) ...All substances defined as "hazardous substances" or which are labeled "warning," "caution," or "danger" shall be used only by employees of the residential facility or by individuals who are capable of learning the use of these substances according to function. The storage and use of hazardous substances shall be subject to inspection by the department, appropriate authorized persons from the Ohio department of health, or others authorized by local, state, or federal statutes or regulations.

5123:2-3-10 (E)(2)(e) The licensee shall ensure that sidewalks, escape routes and entrances are free of obstacles and ice and snow.

5123:2-3-10 (E)(2)(f) The licensee shall maintain the heating system of the residential facility in a safe operating condition. The residential facility should be maintained at a comfortable and healthy temperature based on the individuals' needs and desires.

5123:2-3-10 (E)(2)(g) The residential facility's address (numbers) shall be clearly visible from the street.

5123:2-3-10 (F)(4) The licensee shall provide a sufficient supply of soap and basic toiletries (deodorant, shampoo, oral hygiene items, and feminine hygiene products), toilet paper, and clean towels and washcloths to meet the needs of the individuals.

5123:2-3-10 (F)(5) The licensee shall provide each individual with a bed or crib that is sturdy, safe, and in good condition. Hideaway beds and rollaway beds shall not be used.

5123:2-3-10 (F)(5)(a) An individual needing to sleep in a crib shall sleep in a crib which is at least six inches longer than the individual's extended length.

5123:2-3-10 (F)(5)(c) Each individual shall be provided with a clean and comfortable mattress, including box springs where needed.

5123:2-3-10 (F)(5)(d) No individual shall sleep on an exposed mattress or on an exposed mattress cover. Waterproof mattress covers shall be provided for all infants and individuals who are incontinent.

5123:2-3-10 (F)(6) The licensee shall provide each individual with functional bedroom furniture appropriate to the individual's needs and closet and drawer space in the bedroom for in-season clothing and personal possessions with racks and shelves accessible to the individual.

5123:2-3-10 (G) No part of the residential facility shall be off limits to individuals except for staff living quarters, bathrooms located in or adjacent to staff quarters, the bedrooms of other individuals unless consent is given, and mechanical and boiler rooms or other areas of the facility that present a health or safety risk to the individual as identified in the individual's plan.

5123:2-3-10 (H) The licensee shall have sufficient rooms, offices, and other space, including storage space needed by the licensee, administrator, and staff to carry out the functions of the residential facility.

5123:2-3-10 (I) The licensee shall not erect any sign which labels the individuals or functions of the residential facility.

5123:2-3-10 (J) The names of residential facilities and descriptions of the individuals residing in those facilities shall not convey treatment, body parts, illness, disability, or inactivity. A residential facility may not be referred to or use the words "hospital," "nursing home," or "rest home" in its name or letterhead.

5123:2-3-11 (C)(2) The licensee shall develop, in writing, and post at the control panel, instructions for operating and resetting fire system control panels, where applicable.

5123:2-3-11 (C)(3) The residential facility shall provide for two means of exit remote from each other for each floor level except basements which are not used as activity or program areas and are limited to laundry use and storage.

5123:2-3-11 (D)(6)(b) The facility shall be equipped with an approved fire alarm system, which includes bells/sirens/horns/lights or other equipment as may be appropriate, when services are provided to individuals who are visually and/or hearing impaired.

5123:2-3-11 (C)(5) The licensee shall ensure that all sprinkler systems, fire alarms, extinguishing systems, and other safety equipment are properly maintained.

5123:2-3-11 (C)(7) The licensee shall report to the department within one working day, any fire responded to by a local fire department.

5123:2-3-11 (C)(8) The licensee shall notify the department within one working day if an emergency requires the licensee to relocate individuals from the residential facility.

5123:2-3-11 (C)((9) A fire extinguisher, approved by the state/local authority shall be located on each floor and in the natural path of escape from a fire, at readily accessible and visible points which are not likely to be obstructed.

5123:2-3-11 (G)(5) Fire safety and emergency response training shall be appropriate to the individual's functioning level and needs based on the results of an assessment and shall be indicated in the individual's plan.

5123:2-3-12 (B)(3) Menus must be prepared based on the individuals' food preferences and provide a variety of foods at each meal and adjusted for seasonal changes. When individuals substitute menu items, they should be encouraged to choose items that contain the nutritive value comparable to the planned items on the menu. The licensee shall keep on file in the residential facility records of menus, menu modification, and meals served for the previous thirty days.

5123:2-3-12 (B)(4) The licensee shall encourage the individual to participate in the selection of meals to be served and meal preparations.

5123:2-3-12 (B)(8) The licensee shall make reasonable accommodation to observe the dietary dictates of an individual's religion.

5123:2-3-12 (C)(1) The licensee shall have a plan to meet the clothing needs of an individual who does not have personal funds available to cover needed items. All clothing shall be clean and in accordance with the season and the kinds of activities in which the individual is engaged.

5123:2-3-12 (C)(2) The licensee shall be responsible for encouraging each individual to select, purchase, and maintain his/her own clothing and to dress as independently as possible.

5123:2-3-12 (C)(3) The licensee shall record each individual's clothing and personal items within fourteen days of admission. An inventory of each individual's clothing and personal items shall be taken and each individual's record updated at least once during a twelve-month period, and at the time of discharge.

5123:2-3-12 (C)(6) The licensee shall not discard clothing and personal items without the consent of the individual.

5123:2-3-13 (C) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department.

5123:2-3-13 (C)(1) These records shall include, but are not limited to, a current photograph of the individual.

5123:2-3-13 (C)(7) Records for the current calendar year and the previous twelve months shall be maintained at the residential facility....These records shall include, but not be limited to ... reconciliation of the individual's account transaction records....

5123:2-3-13 (D) Records for each individual shall be maintained by the licensee at an accessible location and such records shall be provided to licensure for review at the residential facility upon request. The licensee shall develop a records retention schedule for all records in accordance with applicable state and federal requirements.

5123:2-3-13 (D)(1) to (D)(10) Records shall include, but not be limited to, the following:

(1) Admission & referral records;

(2) All medical and dental examinations, and immunization records as appropriate to age;

(3) All medication and treatment records;

(4) All service documentation and notations of progress;

(5) All records of the individual's account transaction record as defined in 5123:2-3-14 of the Administrative Code;

(6) Records of negotiable items owned by the individual which can be converted to cash or transferred such as bonds or promissory notes;

(7) Investigative files resulting from major unusual incidents or unusual incidents;

(8) Records of clothing and person items;

(9) Discharge summaries, which shall be prepared within seven days following the individual's discharge. The summary shall include the individual's progress during residence and new address of residence;

(10) In the event of an individual's death, a discharge summary, which shall include the disposition of the individual's personal items, shall be completed within seven days of the individual's death.

5123:2-3-14 (B) Personal funds consist of earned and unearned income retained by the individual after satisfying liability requirements to defray the cost of room, board, or services as defined by county board contracts; state requirements, including patient liability for the cost of home and communitybased services (HCBS) waiver services as defined in rule 5101:1-39-95 of the Administrative Code; and federal requirements, including adherence to income restrictions necessary to maintain Medicaid eligibility.

5123:2-3-14 (E) The licensee shall not require an individual to use personal funds to make up the difference between the cost of goods and services and the amount of payment received by the licensee from third party payers for the same goods and services.

5123:2-3-14 (F) In no instance shall the licensee or any staff member of the residential facility borrow money from an individual or fail to account for personal funds of the individual received by the licensee.

5123:2-3-14 (G) The licensee shall not commingle an individual's personal funds with funds of the licensee...

5123:2-3-14 (G) ...The licensee shall not use an individual's personal funds to supplement or replace the personal funds of another individual on a temporary or permanent basis.

5123:2-3-14 (I) If the individual's plan specifies that the licensee or any staff member of the residential facility is providing any assistance to an individual, the licensee shall involve the individual as much as possible in the management of his/her financial affairs.

5123:2-3-14 (J)(1) When the licensee establishes a banking account on behalf of an individual, the licensee may establish a separate banking account for each individual's personal funds, or combine each individual's personal funds in a single banking account, or a combination of both. When individuals' personal funds are combined in one banking account, the licensee shall separately account for each individual's funds and allocate interest, if earned, to each individual's account proportional to the amount of funds each individual maintains in the account.

5123:2-3-14 (L) When the licensee gives funds to an individual from his/her personal account for the individual to expend on his/her behalf, a receipt is required for a single expenditure of fifty dollars or more unless otherwise specified in the individual's plan. When a receipt is unavailable, the licensee shall obtain other proof of purchase. If other proof of purchase is not available, the licensee shall provide written verification for the amount of funds given to the parent or guardian and what was purchased with the funds.

5123:2-3-14 (M) When the licensee gives funds to a parent or guardian to expend for the individual, the amount of funds given shall be recorded in the individual's account transaction record. When the funds are used to purchase a single item of fifty dollars or more, the licensee shall request the parent or guardian to provide a receipt or other proof of purchase. If a receipt or other proof of purchase is not available, the licensee shall provide written verification for the amount of funds given to the parent or guardian and what was purchased with the funds.

5123:2-3-14 (N) Notwithstanding paragraph (M) of this rule, if a violation of this rule results in the loss of personal funds, the licensee shall restore those funds.

5123:2-3-14 (O) When the licensee has control and/or possession of an individual's personal funds, the licensee shall release any balance of personal funds to the individual, after deducting for actual or estimated liabilities owed by the individual, at the time of his/her dis charge or transfer. Within thirty days of the discharge or transfer, the licensee shall prepare a final itemized statement of the individual's personal funds account(s) and shall release any remaining personal funds to the individual with the itemized statement.

5123:2-3-14 (P) In the event of an individual's death and when the licensee has control and/or possession of an individual's personal funds, the licensee shall dispose of the individual's funds in accordance with state regulations and shall document such disposition.

5123:2-3-17 (A) Each individual shall have an individual plan (IP). The IP is a written description of the services and activities to be provided to the individual.

5123:2-3-17 (B) The individual's choices shall be the primary factor for developing the IP. The individual's choices are those expressed directly by the individual, or, if the individual is incapable of expressing his choices, by the individual's parent(s), custodian, or guardian, or by a friend or advocate of the individual's choice.

5123:2-3-17 (D) Evaluations shall be used as a resource to identify appropriate methods of developing the services and activities necessary to support the choices of and meet the needs of the individual.

5123:2-3-17 (D)(1)(a) At least annually, the social history shall be reviewed and updated as needed.

5123:2-3-17 (D)(2) If the results ... are insufficient to identify appropriate methods of developing the services and activities necessary to support the choices of and meet the needs of the individual, additional evaluations shall be obtained.

5123:2-3-17 (E) ...The individual may invite an advocate or friend(s) or any person(s) directly providing services or activities to him to participate in the development of the IP.

5123:2-3-17 (G)(1) The IP coordinator shall also perform and document the following responsibilities: Review the implementation of the IP as needed or upon request.

5123:2-3-17 (G)(3) The IP coordinator shall also perform and document the following responsibilities: Coordinate the services and activities being provided to the individual with service providers, which may include case management services, as identified in the IP.

5123:2-3-17 (I) The IP coordinator shall attempt to resolve disputes that arise when consent is refused or withdrawn by making a reasonable accommodation to provide the individual with alternative services or activities.

5123:2-3-17 (J) Authorized regulatory agents shall have access to the IP. The IP shall be provided to all parties involved in the implementation or the IP. The IP shall be provided to the individual, custodian or parent(s) if the individual is a child, or guardian...

5123:2-3-17 (J) ...The IP shall not be released to other persons without the individual's consent or the consent of the parent(s), custodian, or guardian, as applicable. If the individual is a child, consent shall be obtained from the individual's parent(s) unless the individual has a custodian in which case, consent shall be obtained from the custodian. If the individual has a guardian, consent shall be obtained from the guardian. Consent shall be in writing and may be withdrawn in writing at any time.

5123:2-3-17 (K) The administrator or his designee shall provide administrative oversight to ensure the development, implementation, coordination, review, evaluation and revision, if necessary, of the IP.

5123:2-3-18 (D)(4)(c) Patient liability shall not be deducted from the individual's personal allowance and earned income retained by the individual, but is to be deducted from the unearned and earned income available to pay the licensee for the room and board cost.

5123:2-3-25 (A) All employees of every residential care facility shall treat each resident with kindness, consistency, and respect.

5123:2-3-25 (B) The residential care facility shall have written policies and procedures available to the residents and to parents and guardians. If appropriate, residents shall participate in formulating these policies and procedures.

5123:2-3-25 (B)(1) The written policies and procedures shall include, but not be limited to, enforcement of control and discipline. The residential care facility shall use only constructive methods of discipline.

5123:2-3-25 (B)(1)(a) The residential care facility may not allow corporal punishment of a resident.

5123:2-3-25 (B)(1)(b) The residential care facility may not allow a resident to discipline another resident.

5123:2-3-25 (B)(2)(b)(i) Except as provided for in behavior modification programs, the residential care facility may allow the use of physical restraint on a resident only if absolutely necessary to protect the resident from injuring himself or others.

5123:2-3-25 (B)(2)(b)(iii)(a)(b)(c) The residential care facility shall have a written policy which specifies (a) how and when physical restraints may be used;

(b) the staff member who must authorize its use; and

(c) the method for monitoring and controlling its use.

5123:2-3-25 (B)(2)(b)(vii) An order for physical restraint must not be in effect longer than twelve hours.

5123:2-3-25 (B)(2)(c)(i) The residential care facility may not use chemical restraint excessively.

5123:2-3-25 (B)(2)(c)(ii) The residential care facility may not use chemical restraint as punishment.

5123:2-3-25 (B)(2)(c)(iii) The residential care facility may not use chemical restraint for the convenience of the staff.

5123:2-3-25 (B)(2)(c)(iv) The residential care facility may not use chemical restraint as a substitute for activities or treatment.

5123:2-3-25 (B)(2)(c)(v) The residential care facility may not use chemical restraint in quantities that interfere with a resident's habilitation program.

5123:2-17-02(E)(6) If the provider is an ICF/MR, the ICF/MR shall investigate all major unusual incidents involving individuals receiving services from the ICF/MR. This investigation shall be conducted in accordance with all applicable federal regulations, including 42 C.F.R. 483.420 .

5123:2-17-02(E)(8) An ICF/MR, excluding a developmental center, shall submit to the county board a copy of its investigation report within fourteen days of becoming aware of a major unusual incident.

5123:2-17-02(E)(9) If the provider is not an ICF/MR, the provider may conduct a separate investigation of any major unusual incident. If the provider conducts a separate investigation, the provider shall submit to the county board a copy of its investigation report within fourteen days of becoming aware of a major unusual incident.

5123:2-17-02(E)(11) The provider shall cooperate with all investigations conducted by other entities, and shall respond to all requests for additional information made by the department, county board, or any investigative entity within five working days of receipt of the request.

5123:2-17-02(G)(3) The provider shall review the quarterly reports sent by the county board to identify patterns and trends and take appropriate action as needed. Upon request by the county board or department, the provider shall provide evidence that this review has been conducted and that appropriate action has been taken.

5123:2-17-02 (G)(4) All providers, including county boards, shall each conduct an annual review and analyze the data for the year to identify patterns and trends and take corrective action where needed.

5123:2-17-02 (H)(1) The provider shall develop and implement a policy and procedure that requires anyone who becomes aware of an unusual incident to report it to the person designated by the provider who can initiate proper action. Such policy and procedure shall specify that reports must be made no later than twenty-four hours after the occurrence of the incident.

Effective: 01/01/2006
R.C. 119.032 review dates: 01/17/2010
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 1/17/05

5123:2-3-04 General requirements.

(A) The purpose of this rule is to establish general requirements of the licensee to operate a residential facility. This rule and all other rules for licensed residential facilities will focus on the achievement of outcomes that are important to the individuals served in licensed facilities.

(B) The licensee is responsible for the overall operation of the residential facility including, but not limited to, submitting such reports as may be required and ensuring that the residential facility is in compliance with all rules adopted under Chapter 5123:2-3 of the Administrative Code, rules adopted under other chapters of the Administrative Code pursuant to section 5123.19 of the Revised Code, and all applicable federal, state and local regulations, statutes, rules, codes, and ordinances.

(C) The licensee shall provide or arrange for the transportation of the individuals residing in the residential facility as identified in the individual's plan.

(D) The licensee and all employees interact with individuals in a way to safeguard the rights of individuals enumerated under sections 5123.62 and 5123.65 of the Revised Code. The licensee shall be responsible for meeting the requirements established under sections 5123.63 and 5123.64 of the Revised Code.

(E) If the licensee is a natural person, he/she shall obtain a criminal records check that meets the requirements of rule 5123:2-3-06 of the Administrative Code. The administrator of a residential facility shall also obtain a criminal records check that meets the requirements of that rule. Unless the rehabilitation standards established by the department in paragraph (M) of rule 5123:2-3-06 of the Administrative Code or the requirements of paragraph (N) of that rule have been met, no licensee or administrator shall operate a residential facility if he/she has been convicted of or pleaded guilty to any of the offenses listed or described in paragraphs (G)(1) to (G)(4) of rule 5123:2-3-06 of the Administrative Code. The requirements of this paragraph shall apply only to persons who apply for a license or who become the administrator of a residential facility on or after the effective date of this rule. The requirements of this paragraph shall not apply to licensees, or their administrators, who are natural persons seeking a new license due to one of the following:

(1) A rebuilding of existing licensed beds at the same site or a relocation of existing licensed beds to a new site in accordance with rule 5123:2-16-01 of the Administrative Code;

(2) A change in the licensed capacity of the residential facility in accordance with rule 5123:2-16-01 of the Administrative Code;

(3) A change of funding source in accordance with rule 5123:2-16-01 of the Administrative Code; or

(4) A significant change in ownership in accordance with rule 5123:2-16-01 of the Administrative Code.

(F) The licensee shall monitor the physical and psychological health of individuals and coordinate and arrange timely access to needed and preventative evaluations and treatments. The licensee shall ensure that appropriate records and knowledgeable staff accompany individuals to physical and psychological evaluations or are available to provide pertinent information related to the treatment indicated in the individual's plan.

Effective: 01/01/2006
R.C. 119.032 review dates: 09/30/2005 and 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 9/30/83, 11/16/90, 5/18/95, 4/27/00, 9/22/02

5123:2-3-05 Admission, discharge, and transfer.

(A) Purpose

The purpose of this rule is to establish uniform policies for admission, discharge, and transfer of individuals applying for admission to, or living in, residential facilities licensed by the department.

(B) Definitions

(1) "Discharge" means a permanent movement of an individual to another residence that is not under the jurisdiction of the provider.

(2) "Emergency" means any situation creating a significant risk of substantial harm to individuals or staff in the residential facility if action is not taken.

(3) "Transfer" means a temporary or permanent movement of an individual between facilities under the jurisdiction of the provider.

(C) Admission policies

(1) The provider shall only admit individuals whose service needs can be met.

(2) Admission to a residential facility is voluntary, requiring consent by the individual, parent of a minor child, or guardian.

(3) A provider shall not unlawfully discriminate because of disability, race, color, religion, national origin or ancestry, sex, or age including, but not limited to, failing to make reasonable accommodation to the individual's physical, mental, or behavioral disabilities to the extent required by law unless the provider can demonstrate that the accommodation would impose an undue hardship on the operation of the program including an unreasonable risk of harm to individuals or staff in the residential facility.

(4) If a vacancy exists, the provider shall determine if the individual meets the facility's admission criteria within thirty calendar days of receiving an application for services and referral information. This timeline may be extended if mutually agreed upon by both the applicant and the provider.

(a) When the referring agency is the county board, referral information shall be provided to the provider within seven calendar days of notification of the vacancy.

(b) The referral shall contain background information as well as currently valid assessments of functional, developmental, behavioral, social, health, and nutritional status to allow the provider to determine if it can provide for the individual's needs without creating an unreasonable risk of harm to individuals or staff in the residential facility. The referring entity shall not knowingly withhold information relevant to the admission of the individual.

(c) When admitting an individual, the provider shall consider its ability to maintain an adequate level of services to all individuals residing in the facility.

(5) The provider shall notify the individual, parent of a minor child, guardian, advocate, county board, and referring party in writing of the outcome of the admissions decision within seven calendar days of making the decision.

(6) Any denial of admission notice must be sent to the individual by certified mail.

(7) The denial of admission notice shall contain:

(a) A statement of what action the provider intends to take;

(b) The reasons for the denial of admission;

(c) An explanation of the individual's right to a hearing and the method by which to obtain a hearing including to whom the hearing request is to be made and the timelines to request a hearing in accordance with paragraph (E) of this rule; and

(d) The telephone number and address for Ohio legal rights service.

(8) If a vacancy exists, and the applicant requests an appeal, the provider shall not fill the vacancy until the hearing decision is rendered.

(D) Discharge and transfer policies

(1) The facility must allow each individual to remain in the facility and must not discharge or transfer the individual from the facility unless:

(a) The transfer or discharge is necessary for the individual's welfare and the individual's needs can no longer be met without imposing an undue hardship on the operation of the residential facility;

(b) The individual no longer needs or wants the services provided by the facility or chooses to transfer within the agency;

(c) The individual is creating an unreasonable risk of harm to himself/herself, other individuals, or staff in the residential facility;

(d) Nonpayment for the stay in the facility, including nonpayment of medicaid or other third party payer; or

(e) The facility ceases to operate.

(2) A provider shall not unlawfully discriminate because of disability, race, color, religion, national origin or ancestry, sex, or age including, but not limited to, failing to make reasonable accommodation to the individual's physical, mental, or behavioral disabilities to the extent required by law unless the provider can demonstrate that the accommodation would impose an undue hardship on the operation of the program including an unreasonable risk of harm to individuals or staff in the residential facility.

(3) Before a facility transfers or discharges an individual, the facility must:

(a) Notify the individual, parent of a minor child, or guardian, and the county board of the transfer or discharge and the reasons for the move in writing;

(b) Explain the transfer or discharge and appeal rights to the individual, parent of a minor child, guardian, or advocate in a language and manner which is understandable to the person receiving the information; and

(c) Record the reasons for the transfer or discharge in the individual's record.

(4) The notice of discharge or transfer must be made at least thirty calendar days before the discharge or transfer, except when an emergency exists. If at any time prior to the expiration of the thirty-day period the provider determines that the conditions that constituted the emergency no longer exist, the individual may then return to the facility.

(5) The notice must contain:

(a) The reason for the transfer or discharge;

(b) The effective date of the transfer or discharge;

(c) If the transfer or discharge is due to the provider's inability to meet the individual's needs, without imposing an undue hardship on the operation of the program, including an unreasonable risk of harm to individuals or staff in the residential facility, a summary of the action taken by the provider, including working with the county board, to try to meet the individual's needs or reduce the risk of harm to individuals or staff;

(d) The individual's right to appeal the transfer or discharge and the process to do so; and

(e) The telephone number and address of the Ohio legal rights service.

(6) The notice to the individual must be sent by certified mail.

(7) If an individual, parent of a minor child, guardian, or advocate requests a discharge or transfer hearing, the facility must maintain services or the availability of services until a decision is rendered after the hearing unless an emergency exists.

(E) Administrative review process

(1) The individual, parent of a minor child, guardian, or advocate shall first appeal in writing to the governing board or administrator of the residential facility within seven calendar days of the receipt of the admission, transfer, or discharge notice.

(2) The governing board or administrator shall review the decision and notify the individual, parent of a minor child, guardian, or advocate in writing of the outcome of the review within five calendar days of the request for the review. The notice to the individual shall be sent by certified mail.

(3) The individual, parent of a minor child, guardian, or advocate has five calendar days from receipt of the governing board or administrator review decision to appeal to the director. The appeal shall be in writing and include an explanation as to why the denial of admission, proposed discharge, or proposed transfer decision is incorrect.

(F) Mediation process

(1) The individual, parent of a minor child, guardian, and/or advocate, and the provider shall attend a mediation meeting to try to attain resolution prior to the scheduled admission, discharge, or transfer hearing. Legal representation is not permitted in the mediation meeting.

(2) The department will provide the mediator.

(3) The mediation shall be scheduled within fifteen calendar days of receipt of the appeal. The hearing shall be scheduled within fifteen calendar days of the mediation. Timelines may be extended if mutually agreed upon by all parties.

(4) Unless all parties agree to abide by the recommendations of the mediator, the mediation shall be nonbinding.

(5) Paragraph (C)(8) of this rule may be waived if mutually agreed upon by all parties.

(6) Statements made during the mediation process cannot be used as evidence in any subsequent hearings or court proceedings.

(G) Hearing process

(1) The department will grant an opportunity for a hearing to:

(a) Any individual, parent of a minor child, guardian, or advocate who requests a hearing because the individual's request for admission is denied or not acted on in accordance with paragraphs (C)(4) or (C)(5) of this rule; or

(b) Any individual who has received a discharge or transfer notice and the individual, parent of a minor child, guardian, or advocate requests a hearing.

(2) The department shall deny or dismiss a request if:

(a) The request is not filed within a timely manner;

(b) Neither the individual nor any representative for the individual is present at a scheduled hearing unless there is good cause for the absence; or

(c) The individual, parent of a minor child, guardian, or advocate withdraws the request in writing.

(3) The director shall appoint a hearing officer to hear the appeal. The hearing officer shall not be the same person as the mediator in any given case.

(4) The department will select a time and place for the hearing. The department will attempt to select a time for the hearing that is mutually agreeable to all parties. If this is not possible, the department reserves the right to schedule the hearing to meet the timelines in accordance with this rule.

(5) The individual, parent of a minor child, guardian, or advocate and the provider shall have the opportunity to present evidence at the hearing. Both the individual and the provider may have legal representation.

(6) The burden of proof shall be on the provider to show that the admission, discharge, or transfer decision was in accordance with this rule.

(7) The hearing officer shall review the evidence presented and shall determine if the requirements of this rule have been followed.

(8) The hearing officer shall issue a written recommendation to the director within ten calendar days of the conclusion of the hearing.

(9) The director shall issue a written decision to the parties within five calendar days of receipt of the hearing officer's recommendation, and no later than forty-five calendar days from receiving the request for the hearing.

(10) Timelines may be extended if mutually agreed upon by both parties.

(H) Sanctions

If a provider fails to follow the requirements of this rule or fails to follow the decision of the director, the department may:

(1) Suspend admissions to the facility pursuant to section 5123.19 of the Revised Code and in accordance with the procedures set forth in rule 5123:2-3-02 of the Administrative Code; or

(2) Issue licensure citations pursuant to section 5123.19 of the Revised Code and in accordance with the procedures set forth in rule 5123:2-3-02 of the Administrative Code.

(I) This rule is not intended to abridge any right of appeal that a party aggrieved by the decision of the director may have independent of this rule.

Replaces: 5123:2-3-05

Effective: 07/01/2007
R.C. 119.032 review dates: 11/14/2006 and 07/01/2012
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.18 , 5123.19 , 5123.62 , 5123.67
Prior Effective Dates: 10/31/1977, 06/12/1981, 09/30/1983, 02/25/1984, 03/25/1991, 11/02/1996

5123:2-3-06 [Rescinded] Background investigations for employment with residential facilities.

Effective: 01/01/2013
R.C. 119.032 review dates: 10/16/2012
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19 , 5126.28 , 5126.281
Prior Effective Dates: 10/31/1977, 06/12/1981, 10/24/1987, 11/16/1990, 12/09/1991, 09/22/2002

5123:2-3-07 Employment and staffing.

(A) Purpose

The purpose of this rule is to ensure the outcomes related to health and safety of individuals residing in a residential facility are achieved in part by establishing requirements for employing staff, maintaining personnel records, and establishing minimum staffing standards.

(B) Employment requirements

(1) The licensee shall be responsible for compliance with all applicable federal, state, and local regulations, statutes, rules, codes, or ordinances pertaining to employment including, but not limited to, civil rights agreements; job classifications; wages and hours; workers' compensation; withholding taxes; employment of minors; nondiscrimination of employment because of disability, race, color, religion, national origin, ancestry, sex, or age; and fair employment practices.

(2) The licensee shall have written personnel policies that address applicable federal, state and local regulations pertaining to employment.

(3) The licensee shall employ an administrator except where the licensee serves as the full-time administrator. The administrator of the residential facility shall have at least one year's working experience in the management, care, supervision, or training of individuals with mental retardation or other developmental disabilities. A staff person shall be designated in writing to whom executive authority has been delegated in the absence of the administrator.

(4) All habilitation staff shall be at least eighteen years of age.

(5) Volunteers shall be appropriately oriented and supervised to ensure the health and safety of the individuals.

(6) Habilitation staff and support staff employed on or after the effective date of this rule shall be tested for tuberculosis in accordance with this paragraph. The required tuberculosis test shall include a two-step Mantoux tuberculin skin test administered by a person properly trained to administer tuberculin skin tests, or, if the person has a documented history of a significant Mantoux skin test, an x-ray. The person shall not work in the facility until after the results of the first skin test have been obtained and recorded in millimeters of in duration. If the first step is non-significant, a second step shall be performed at least seven, but not more than twenty-one, days after the first step was performed. Only a single Mantoux is required if the person has documentation of either a single-step Mantoux test or a two-step Mantoux test within one year of commencing work.

(a) If either step of the Mantoux test is significant, the person shall have a chest x-ray and shall not enter the residential facility until after the results of the chest x-ray have been obtained and the person is determined to not have active pulmonary tuberculosis. Whenever a chest x-ray is required by this paragraph, a new chest x-ray need not be performed if the person has had a chest x-ray no more than thirty days before the date of the significant Mantoux test. Additional Mantoux testing is not required after one medically documented significant test. A subsequent chest x-ray is not required unless the person develops symptoms consistent with active tuberculosis.

(b) For persons with a significant Mantoux test and the chest x-ray does not indicate active pulmonary tuberculosis, the facility shall require that the person be evaluated and considered for preventive therapy. Thereafter, the facility shall require the person to report promptly any symptoms of tuberculosis which include unexplained weight loss, loss of appetite, chronic cough of more than three weeks, fever, coughing, and spitting up blood and night sweats. The facility shall annually document the presence or absence of symptoms suggestive of tuberculosis in such a person and maintain this documentation on file.

(c) After initial screening for tuberculosis required by this paragraph and annually thereafter within one year plus or minus thirty days of the previous year's date of screening, a tuberculosis screening for symptoms suggestive of active tuberculosis shall be conducted for all habilitation and support staff. This screening shall include, at a minimum, questions about the signs and symptoms of tuberculosis as indicated in paragraph (B)(6)(b) of this rule. The frequency of any additional Mantoux skin test screenings or the need for a physician evaluation shall be dependent upon this assessment.

(7) Professional program staff must be licensed, certified, or registered, as applicable by the state, to provide professional services in the field in which they practice.

(C) Staffing standards

(1) Habilitation staff shall be on-duty on the basis of the needs of individuals. On-duty habilitation staff shall be determined by each individual's plan. Staff schedules shall be prepared and available for review for each residential facility.

(2) The licensee must provide sufficient support staff so that habilitation staff are not required to perform support services to the extent that these duties interfere with the exercise of their primary duties.

(3) At least one staff person who has current certification in first aid and CPR shall be present when individuals are being served by the licensee regardless of where services are being provided.

(4) When there is a swimming pool on the grounds of the residential facility including facilities in apartment complexes, the pool shall only be used by the individuals in the presence of a person with "Red Cross" or equivalent lifeguard safety training unless the individual's plan indicates otherwise.

(D) Personnel records

Personnel records shall be maintained for each employee in accordance with the facility's personnel policies.

Replaces: 5123:2-3-07

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 10/24/87, 11/16/90, 12/9/91, 5/18/95, 4/27/00

5123:2-3-08 Staff training.

(A) Purpose

The purpose of this rule is to ensure the achievement of positive outcomes of individuals by establishing minimum and continuing education/training requirements for staff of a residential facility. Residential staff will be trained to understand the outcomes that are important to each individual being served as outlined in each individual's IP, will have the skills necessary to implement the IP responsibilities which relate to the residential facility, and will demonstrate those skills in the supports they provide to each individual.

(B) Initial staff training and orientation

(1) All habilitation and support staff, including those persons working through a temporary agency who work directly with individuals, who work in the residential facility, regardless of position or responsibility, shall receive training prior to assuming their duties. The training shall include, but is not limited to, the following:

(a) The rights of individuals in accordance with sections 5123.62 and 5123.65 of the Revised Code;

(b) The prevention, identification, and reporting of major unusual and unusual incidents in accordance with rule 5123:2-17-02 of the Administrative Code;

(c) An overview of the nature and needs of individuals with mental retardation/developmental disabilities; and

(d) The organization's philosophy, organizational structure, programs, services, and goals.

(2) All habilitation and support staff, including those persons working through a temporary agency, who do not work in the residential facility, regardless of position or responsibility, shall receive training within thirty days of employment in the areas outlined in paragraph (B)(1) of this rule.

(3) In addition to the requirements outlined in paragraph (B)(1) of this rule, all staff, including those persons working through a temporary agency, who work in the residential facility shall complete, within the first thirty days of employment, fire safety, evacuation, and emergency response training in accordance with rule 5123:2-3-11 of the Administrative Code.

(4) Habilitation staff training and orientation

In addition to the requirements outlined in paragraphs (B)(1) and (B)(3) of this rule, habilitation staff shall receive the following training prior to assuming responsibility for the delivery of services to an individual:

(a) Training in the programs and techniques necessary to appropriately develop and implement the services of each individual for whom they are responsible as described in the individual's plan.

(b) Training that focuses on the skills and competencies needed by habilitation staff to meet the needs of the individual(s) for whom they are responsible.

(5) The licensee shall ensure that designated staff receive training in first aid and CPR to comply with the requirements established in rule 5123:2-3-07 ("Employment and Staffing") of the Administrative Code.

(6) The licensee shall ensure that professional staff, including those persons working through temporary agencies or under contract with the licensee, who work in the residential facility and provide services directly to individuals, provide those services in a competent manner in order to meet the health and safety needs of the individuals in the facility for whom they are responsible as described in the individual's plan.

(7) Supervisory staff orientation

In addition to the requirements outlined in paragraphs (B)(1) to (B)(4) of this rule, supervisory staff shall complete, within the first ninety days of employment as a supervisor, training that includes, but is not limited to, the rules, regulations, and laws pertaining to the operation of a residential facility as they relate to the supervisor's job responsibilities.

(C) Continuing training

Following the initial year of employment and during each subsequent year of employment, based on the employee's date of hire, each habilitation staff person shall be required to obtain eight hours of continuing education/training. Continuing education/training shall be designed to enhance the skills and competencies of staff relevant to their job responsibilities.

(1) The continuing education/training areas shall include annual training in the following:

(a) Identification and response to incidents adversely affecting an individual's health and safety; and

(b) Individual rights.

(2) Other topics may include, but are not limited to, the following:

(a) CPR and/or first aid;

(b) Behavior supports;

(c) Medication administration and performance of health care tasks;

(d) Occupational safety and health administration (OSHA) requirements;

(e) Principles of self-determination;

(f) Other areas that enhance the skills and competencies of the employee relevant to his/her job responsibilities.

(3) An employee shall be deemed to have met the requirements of paragraph (C) of this rule if such employee is scheduled for training and the training is completed within thirty days of the deadline.

(D) Continuing education/training activities

Continuing education/training activities may be structured or unstructured and may include, but are not limited to, the following:

(1) Lectures, seminars, or formal course work;

(2) Workshops and conferences;

(3) Demonstrations and displays;

(4) Visitations and observations of other facilities, services, and programs;

(5) Distance learning and other electronic methods of learning;

(6) Video and other audio-visual training; and

(7) Staff meetings.

(E) Documentation

The licensee shall maintain a written record, which may include electronic records, of each staff person's initial and continuing education/training activities. This information shall be made available to the department upon request and may be maintained at the residential facility or other accessible location. Documentation shall include:

(1) The name of the staff person receiving the training;

(2) Dates of training;

(3) Length of training,

(4) The nature (topic) of the training,

(5) The instructor's name, if applicable; and

(6) Brief description of the content of the training.

(F) Carryover

(1) Any hours in excess of the amounts required in paragraph (C) of this rule cannot be carried over to any subsequent year.

(2) An employee of a licensee may transfer hours of continuing education/training from one licensee to another provided that the employee has proper documentation that the training was completed.

Replaces: 5123:2-3-08

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 8/1/87, 12/9/91, 5/18/95, 11/20/00

5123:2-3-09 Medication.

(A) Purpose

This rule outlines the criteria and requirements for the administration, documentation, storage, and disposal of prescribed and OTC medication in a residential facility.

(B) Definitions (1) "Drug" has the same meaning as in section 5123.42 of the Revised Code and rule 5123:2-6-01 of the Administrative Code.

(2) "Health-related activities" has the same meaning as in section 5123.42 of the Revised Code and rule 5123.2 -6-01 of the Administrative Code.

(3) "Licensed health professional authorized to prescribe drugs" has the same meaning as in section 5123.41 of the Revised Code and rule 5123:2-6-01 of the Administrative Code

(4) "Licensed nurse" has the same meaning as in section 5123.41 of the Revised Code and rule 5123:2-6-01 of the Administrative Code.

(5) "MR/DD personnel" has the same meaning as in section 5123.42 of the Revised Code and rule 5123:2-6-01 of the Administrative Code.

(6) "Oral prescribed medication" has the same meaning as in rule 5123:2-6-01 of the Administrative Code.

(7) "Over-the-counter (OTC) medication" means medications, herbal remedies or other forms of complementary alternative medicine, or supplements sold to the general public that do not require a prescription. When an OTC medication is prescribed by a licensed health professional authorized to prescribe drugs, the medication is to be treated as though it is a prescribed medication.

(8) "Prescribed medication" has the same meaning as in section 5123.42 of the Revised Code and rule 5123:2-6-01 of the Administrative Code.

(9) "Prescribed medication error" has the same meaning as in rule 5123:2-6-01 of the Administrative Code.

(10) "Prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube" has the same meaning as in rule 5123.2 -6-01 of the Administrative Code.

(11) "Subcutaneous insulin injection" has the same meaning as in rule 5123.2 -6-01 of the Administrative Code.

(12) "Topical prescribed medication" has the same meaning as in rule 5123:2-6-01 of the Administrative Code.

(13) "Tube feeding" has the same meaning as in section 5123.41 of the Revised Code and rule 5123:2-6-01 of the Administrative Code.

(C) Self-administration or assistance with self-administration of prescribed medication Self-administration or assistance with the self-administration of prescribed medication shall be done in accordance with rule 5123:2-6-02 of the Administrative Code.

(D) Delegation of nursing tasks Delegation of nursing tasks, excluding the provision of health-related activities, shall be done in accordance with Chapter 4723-13 of the Administrative Code.

(E) Administration of prescribed medications, performance of health-related activities, performance of tube feedings, and administration of subcutaneous insulin injections

(1) The licensee shall adhere to the applicable standards for giving oral prescribed medications or applying topical prescribed medications, performing health-related activities, administering food or prescribed medication via stable labeled gastrostomy tube or stable labeled jejunostomy tube, or administering subcutaneous insulin injection established under sections 5123.42 to 5123.46 of the Revised Code and rules adopted by the department under Chapter 5123:2-6 of the Administrative Code.

(2) Prescribed medications shall be given to only those individuals for whom they are prescribed.

(3) The dose, time, frequency, or route of administration shall not be changed, substituted, or omitted except on the order of a licensed health professional authorized to prescribe drugs or a licensed nurse acting within the scope of his/her practice.

(4) MR/DD personnel holding a valid certificate issued under rule 5123:2-6-06 of the Administrative Code in facilities of one to sixteen individuals may receive and transcribe a written or oral order for giving oral and/or applying topical prescribed medication currently ordered for a specific individual and for performing health-related activities, excluding administering prescribed medication or food via a stable labeled gastrostomy or stable labeled jejunostomy tube or administering subcutaneous insulin injections.

(a) If the prescribed medication ordered is not one the individual is currently taking, the MR/DD personnel shall contact the licensed health professional authorized to prescribe drugs to order the medication by either calling the order to a pharmacy or providing a written prescription that can be transmitted to a pharmacy either electronically or in person.

(b) Upon receipt of the prescribed medication from the pharmacy, the MR/DD personnel shall copy the information regarding the medication, and how it should be given, from the pharmacy package to the medication administration record.

(c) Following completion of paragraphs (E)(4)(a) and (E)(4)(b) of this rule, the administration of the new prescribed medication may begin.

(d) If an order is given by telephone, the order shall be written in the individual's record and signed by the prescribing licensed health professional within seven days after the order is given.

(5) In a facility of seventeen or more individuals, only a licensed nurse may accept a telephone order for prescribed medication from a licensed health professional authorized to prescribe drugs. If an order is given by telephone, the order shall be written in the individual's record and signed by the prescribing licensed health professional within seven days after the order is given.

(F) Medication review Unless otherwise indicated by a prescribing licensed health professional authorized to prescribe drugs, or when the individual is self-administering medication, all physician's orders for OTC and prescribed medication shall undergo a documented review at least every three months by a licensed health professional acting within the scope of his/her practice. The licensee shall include all known non-prescribed OTC medication being taken by the individual in each review (G) Administration of OTC medication

(1) MR/DD personnel may give OTC medication to an individual that has not been prescribed by a licensed health professional and according to recommended dosage instructions when a licensed pharmacist, licensed nurse or other licensed health professional acting within the scope of his/her practice has reviewed a list of intended OTC medications and/or prescribed medications, and has determined that the OTC medications listed would not be contraindicated for the individual.

(2) A list of OTC medications is not required for those individuals who self-administer medication or receive assistance with the self-administration of medication.

(H) Procedures for medication administration The licensee shall develop written procedures for giving or applying prescribed medication and OTC medication to individuals which includes, but is not limited to, the dose, time, frequency, and route of the medication taken, as well as documenting any significant responses to the medication, occurrences of undesirable side effects of the medication, and errors in medication administration.

The licensee shall comply with the requirements for reporting errors established under paragraph (D) of rule 5123:2-6-07 of the Administrative Code. These records shall be retained as part of the individual's record.

(I) Storage and disposal of prescribed and OTC medication

(1) Medication shall be stored in a secure location that meets the assessed needs of the individual and ensures the health and safety of all the individuals in the facility.

(2) The licensee shall develop and follow written procedures for the disposal of any medication. These procedures must include that disposal of prescribed medication is verified and recorded by two staff members or by an independent external entity. The disposal of dangerous drugs shall be done in accordance with rule 4729-9-06 ("Disposal of Dangerous Drugs which are Controlled Substances") of the Administrative Code.

(3) In the event of the death of an individual, an accounting of medication shall be done immediately, but no later than twenty-four hours following the death, and recorded by two staff members. The licensee shall cooperate with any investigation conducted by a legally authorized entity. Disposal of medication shall occur in a manner prescribed in paragraph (I)(2) of this rule, unless an investigation calls for the disposal of medication to be delayed.

Eff 10-31-77; 6-12-81; 11-20-00; rescinded and replaced eff. 9-20-04
Rule promulgated under: RC 119.03
Rule authorized by: RC 5123.04 , 5123.19
Rule amplifies: RC 5123.04 , 5123.19 , 5126.41 to 5126.47 , 5123.65
Replaces: former 5123:2-3-21
R.C. 119.032 review dates: 11/20/05

5123:2-3-10 Physical environment requirements.

(A) Purpose

The purpose of this rule is to establish minimum physical environment standards to ensure that individuals living in a residential facility are provided a safe, healthy, and home-like living environment that meet their specific needs.

(B) Construction and building

(1) Each building or part of a building and all utilities, sanitary facilities, and appliances shall be designed, constructed, and installed in compliance with all applicable rules of the Ohio building code, the Ohio sanitary code, the Ohio fire code, and any county or municipal building, safety, and fire regulations or codes.

(2) Parking spaces, curb cuts, appropriate walkways, exit/entry ramps, toilets, showers, tubs, sinks, doorways, and other features facilitating accessibility shall be provided to the individuals residing in the residential facility.

(3) Bathrooms and plumbing fixtures, including grab rails where needed, appropriate to any age and degree of disability (IES) of the individuals shall be provided in the residential facility.

(4) All bathrooms and plumbing fixtures shall be in compliance with the appropriate sections of the state and local regulations, rules, codes, and ordinances.

(5) Only nonlead-based paints or other finishes shall be used in a residential facility.

(6) If the residential facility serves children age six and under who are ambulatory, the outside play area shall be enclosed by a fence with a height sufficient enough to prevent egress from the area.

(7) Swimming pools shall meet the local and state requirements regarding construction, operation, and sanitation of pools.

(C) Sanitation and water

(1) All liquid wastes from the residential facility shall be discharged into a public sanitary sewerage system or discharged into a sewage treatment system approved by the Ohio department of health or a certified county or municipal health department.

(2) All refuse and other solid waste shall be disposed of immediately after production or shall be stored in leakproof containers with tight-fitting covers which provide protection from animals, rodents, and insects until time of disposal. Such wastes shall be disposed of through a public disposal service or a private contract service or the licensee shall dispose of all refuse and solid wastes in accordance with the requirements of the Ohio department of health and any local regulations, rules, codes, or ordinances.

(3) The water supply of the residential facility shall comply with the Ohio sanitary code and any other applicable state or local regulations, rules, codes, or ordinances.

(D) Space requirements and usage

(1) Living area

(a) The residential facility shall have a minimum total of eighty square feet of living area for each individual.

(b) Living areas shall not include bedrooms, bathrooms, laundry rooms, closets, hallways, garages, and unfinished basements.

(c) Living areas shall include, but not be limited to, living rooms, dining rooms, recreation or family rooms, and portion of kitchen floor space available for individual use.

(2) Bedroom

(a) Each bedroom occupied by one individual shall have a minimum total of eighty square feet.

(b) Each bedroom occupied by more than one individual shall have a minimum total of sixty square feet of floor space for each individual.

(c) No bedroom may be occupied by more than two individuals.

(d) No bedroom may be occupied by individuals of the opposite sex unless the individuals are consenting adults or under six years of age.

(e) If the bedroom is below the grade level of the residential facility, the room must have two means of egress, one of which may be the window. The room must have a window that the individual using the room can safely evacuate through.

(f) Living rooms, dining rooms, entryways, closets, corridors, outside porches, unfinished attics, and unfinished basements shall not be used as bedrooms.

(g) Each bedroom shall be adequately ventilated and shall have at least one outside window complete with a window treatment(s) to provide adequate privacy for the individual.

(h) Each bedroom occupied by individuals who are nonambulatory shall be located on the first floor unless the residential facility has an automatic fire extinguishing system.

(i) Bedrooms shall not be used as throughways to and from other areas of the residential facility.

(3) Kitchen and dining

(a) The residential facility shall have at least one area used for the preparation and serving of food under sanitary conditions.

(b) Each area used for dining shall have a minimum total of fifteen square feet of floor space for each individual in the residential facility, not including the area generally recognized as counter and appliance space necessary for the normal preparation of meals.

(4) Bathroom and laundry

(a) The residential facility shall provide for toilet and bathing facilities appropriate in number, size, and design to meet the needs of the individuals. Toilet and bathing facilities shall be provided on each floor with bedrooms.

(b) The residential facility shall provide for individual privacy in toilets, bathtubs, and showers.

(c) Lavatories and bathing facilities shall be supplied with hot and cold running water maintained at a comfortable level for each individual to prevent injury.

(d) Laundry services shall be accessible to the individuals of the residential facility and adequate to meet their needs.

(E) Interior and exterior physical condition

(1) All areas of the interior and exterior of the residential facility, the facility grounds and all electrical, plumbing and heating systems of the residential facility shall be maintained in a clean and sanitary manner and in good repair at all times.

(2) The residential facility shall meet the following safety and maintenance requirements:

(a) The licensee shall take measures to eliminate and prevent the presence of insects, rodents, and other vermin in and around the residential facility. Opened doors and windows shall be screened. The extermination of insects and rodents shall be done in such a manner as not to create a fire or a safety or health hazard.

(b) All disinfectants, pesticides, poisons, and other toxic substances shall be properly labeled and stored separate from all food products. All substances defined as "hazardous substances" or which are labeled "warning," "caution," or "danger" shall be used only by employees of the residential facility or by individuals who are capable of learning the use of these substances according to function. The storage and use of hazardous substances shall be subject to inspection by the department, appropriate authorized persons from the Ohio department of health, or others authorized by local, state, or federal statutes or regulations.

(c) Gasoline, kerosene, paints, and all other flammable materials and liquids shall be stored in a safe manner and in accordance with the manufacturer's label. Storage of combustible and non-combustible materials shall not produce conditions that will create a fire or a safety or health hazard.

(d) If the residential facility has a gas furnace and/or gas water heater, the licensee shall maintain a carbon monoxide detector in accordance with the manufacturer's specifications.

(e) The licensee shall ensure that sidewalks, escape routes, and entrances are free of obstacles and ice and snow.

(f) The licensee shall maintain the heating system of the residential facility in safe operating condition. The residential facility should be maintained at a comfortable and healthy temperature based on the individuals' needs and desires.

(g) The residential facility's address (numbers) shall be clearly visible from the street.

(F) Furnishings and equipment and supplies

(1) The licensee shall provide the residential facility with safe, sanitary, appropriate, comfortable, and homelike equipment, furniture, and appliances in good condition except for normal wear and tear, and adequate to meet the needs of the individuals.

(2) The licensee shall provide the residential facility with at least one non-pay telephone to which individuals shall have reasonable access to at all times for making local calls. The telephone shall be provided in a location and manner that affords an individual privacy.

(3) The licensee shall maintain in each residential facility a first aid kit stocked with supplies sufficient and appropriate to meet the minor medical emergency needs of the individuals.

(4) The licensee shall provide a sufficient supply of soap and basic toiletries

(deodorant, shampoo, oral hygiene items, and feminine hygiene products), toilet paper, and clean towels and washcloths to meet the needs of the individuals.

(5) The licensee shall provide each individual with a bed or crib that is sturdy, safe, and in good condition. Hideaway beds and rollaway beds shall not be used.

(a) An individual needing to sleep in a crib shall sleep in a crib which is at least six inches longer than the individual's extended length.

(b) Side rails and/or bed enclosures may only be used as approved through the individual's plan and in accordance with behavior support rules promulgated by the department.

(c) Each individual shall be provided with a clean and comfortable mattress, including box springs where needed.

(d) No individual shall sleep on an exposed mattress or on an exposed mattress cover. Waterproof mattress covers shall be provided for all infants and individuals who are incontinent.

(e) The licensee must provide each individual with bedding appropriate to the weather and climate. Linens and bedding for each bed or crib shall be maintained to provide clean and sanitary sleeping accommodations for each individual.

(6) The licensee shall provide each individual with functional bedroom furniture appropriate to the individual's needs and closet and drawer space in the bedroom for in-season clothing and personal possessions with racks and shelves accessible to the individual.

(G) No part of the residential facility shall be off limits to individuals except for staff living quarters, bathrooms located in or adjacent to staff quarters, the bedrooms of other individuals unless consent is given, and mechanical and boiler rooms or other areas of the facility that present a health or safety risk to the individual as identified in the individual's plan.

(H) The licensee shall have sufficient rooms, offices, and other space, including storage space, needed by the licensee, administrator, and staff to carry out the functions of the residential facility.

(I) The licensee shall not erect any sign which labels the individuals or functions of the residential facility.

(J) The names of residential facilities and descriptions of the individuals residing in those facilities shall not convey treatment, body parts, illness, disability, or inactivity. A residential facility may not be referred to or use the words "hospital," "nursing home," or "rest home" in its name or letterhead.

(K) A residential facility licensed by the department prior to November 16, 1990 shall be exempt from the increased requirements under paragraphs (B)(2), (B)(3), (D)(1)(a), (D)(2)(a),

(D)

(2)

(c) , (D)(4)(a), and (D)(4)(d) of this rule, except that a residential facility licensed by the department prior to November 16, 1990 shall comply with paragraphs (B)(2) and

(B)

(3) of this rule to the greatest extent possible.

Effective: 01/01/2006
R.C. 119.032 review dates: 09/30/2005 and 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 9/30/83, 10/24/87, 11/16/90, 12/9/91, 5/18/95, 4/27/00

5123:2-3-11 Fire safety and emergency response plans.

(A) Purpose

The purpose of this rule is to ensure the safety of individuals residing in residential facilities by establishing standards for fire safety, responses to weather emergencies, natural disasters or any emergency that may require the physical evacuation or relocation of individuals in a residential facility. The outcome for each individual would be that he/she would be able to safely respond in the event of fire, weather emergencies, natural disasters, or any other emergency.

(B) Definitions

(1) "Emergency response plan" means the licensee's written plan to address training and responses to the following:

(a) Tornados;

(b) Actions to be taken in the event of an emergency or natural disaster that does not require the physical evacuation or relocation of the individuals from the facility;

(c) Actions to be taken in the event of an emergency or natural disaster that requires the physical evacuation or relocation of individuals from the facility.

(2) "Fire safety plan" means the licensee's written plan to address training and response to a fire emergency as referenced in paragraph (D)(1) of this rule.

(3) "Fire safety drill" means a documented simulation of the actions to be taken in response to a fire emergency.

(4) "NFPA" means the "National Fire Protection Association."

(5) "Physical evacuation" means that the individuals residing in the facility physically leave the facility or, in the case of a facility that is classified as I-1 or I-2 occupancy pursuant to section 308 of the Ohio building code, individuals residing in the facility must be moved to a separate fire area within the facility that is separated by a two-hour rated firewall.

(6) "State/local authority" means for fire safety, the local fire department or the state fire marshal's office; or for emergency response, a chapter of the "American Red Cross" or the county emergency management agency.

(C) General requirements

(1) A current graphic floor plan shall be posted unobstructed on each floor of the residential facility and in an area most appropriate for the posting of staff information. The graphic plan shall include, but may not be limited to:

(a) A primary and secondary means of exit from each floor;

(b) The location of pull stations and fire system control panels, where applicable;

(c) Fire escapes;

(d) The telephone number of the local fire department or 911;

(e) Designated tornado shelter/safe area(s); and

(f) Designated meeting place(s) in case of fire.

(2) The licensee shall develop, in writing, and post at the control panel, instructions for operating and resetting fire control panels, where applicable.

(3) The residential facility shall provide for two means of exit remote from each other for each floor level, except basements, which are not used as activity or program areas and are limited to laundry use and storage.

(4) No exit, stairway, corridor, ramp, elevator, fire escape or other means of exit from a building shall be used for storage purposes or be otherwise obstructed from use in case of emergency.

(5) The licensee shall ensure that all sprinkler systems, fire alarms, extinguishing systems, and other safety equipment are properly maintained.

(6) The department may utilize the NFPA 101, 2000 edition, life safety code, "Fire Safety Evacuation System" to determine if additional life safety requirements are needed.

(7) The licensee shall report to the department within one working day any fire responded to by a local fire department.

(8) The licensee shall notify the department within one working day if an emergency requires the licensee to relocate individuals from the residential facility.

(9) A fire extinguisher approved by the state/local authority shall be located on each floor and in the natural path of escape from a fire, at readily accessible and visible points which are not likely to be obstructed.

(10) Individuals may be trained to assist one another in case of fire or other emergency to the extent their abilities permit without additional personal risk and as indicated in the individual's plan.

(11) Fire safety and tornado drills are not required to be unannounced.

(D) Fire safety

(1) The licensee shall develop a written fire safety plan that shall include, but is not limited to, the following:

(a) A policy that addresses smoking regulations and the storage of combustible materials.

(b) A fire safety training program that includes provisions for rescue, alarm, contain and evacuate. The training shall be approved by the department or the state/local authority.

(c) Designation of assigned meeting place(s) after a physical evacuation of the residential facility.

(d) A procedure for permitting re-entry to the residential facility following a fire safety drill and/or physical evacuation.

(2) The licensee shall conduct at least six fire safety drills in a twelve-month period with at least:

(a) Two of these drills conducted during the morning;

(b) Two of these drills conducted during the afternoon/evening; and

(c) One drill during the time when individuals are routinely asleep.

(3) The licensee shall complete a written record of each drill within two days of each drill. A written plan of improvement shall be developed within two days when the fire safety drill cannot be completed in three minutes or less for facilities of five beds or less or in thirteen minutes or less for facilities of six beds or more.

(4) A physical evacuation of the residential facility shall occur during at least one fire safety drill for each twelve-month period.

(5) Each residential facility with six or more individuals shall be equipped with the following:

(a) An automatic sprinkler system meeting the requirements of NFPA 13-D, "Sprinkler Systems in One and Two Family Dwellings." The sprinkler system shall be interconnected with the smoke and fire detection and alarm system.

(b) An automatic sprinkler system meeting the requirements of NFPA 13, "Standard for the Installation of Sprinkler Systems" if a residential facility has seventeen or more individuals, or if a residential facility with six to sixteen individuals is impractical of physical evacuation (thirteen minutes or more). The sprinkler system shall be interconnected with the smoke and fire detection and alarm system. A new residential facility with six to sixteen individuals and classified under the provisions of the Ohio building code as an I-1 use group on or after May 18, 1995, shall be required to have a sprinkler system meeting the requirements of NFPA 13-R, "Installation of Sprinkler Systems in Residential Occupancies Up to Four Stories in Height."

(c) A smoke and fire detection and alarm system meeting the requirements of NFPA 72, "National Fire Alarm Code" depending upon the nature of the physical facility involved and such other standards as required by the appropriate building and fire officials.

(d) Fire alarm pull stations near each main exit and in the natural path of escape from a fire, are readily accessible and visible from points which are not likely to be obstructed.

(6) Each residential facility with five or fewer individuals shall be equipped with the following:

(a) At least a single station smoke detector on each floor of the facility. The smoke detector(s) shall be mounted on the ceiling or wall at a point centrally located in the corridor or area giving access to rooms used for sleeping purposed. Where sleeping rooms are on an upper level, the detector shall be placed at the center of the ceiling directly above the stairway. All detectors shall be installed and maintained in accordance with the manufacturer's recommendations. When the detectors are wall-mounted, they shall be located within twelve inches, but no closer than four inches, of the ceiling. Installation shall not interfere with the operating characteristics of the detector. When activated, the detector shall provide an alarm audible in the residential facility.

(b) An approved fire alarm system, which includes bells/sirens/horns/lights or other equipment as may be appropriate, when services are provided to individuals who are visually and/or hearing impaired.

(c) An automatic sprinkler system meeting the requirements of NFPA 13-D, "Sprinkler Systems - One and Two Family Dwellings" and a smoke detection system as required in paragraph

(D)

(6)

(a) of this rule if the residential facility is not capable of being physically evacuated in three minutes or less.

(E) Emergency response

(1) The licensee shall develop a written emergency response plan that shall include, but is not limited to, the following:

(a) Designating a tornado shelter or safe area in the residential facility and the procedure for accessing the area;

(b) Responses to weather-related emergencies or other disasters when relocation of the individuals is not required;

(c) Responses to weather-related emergencies or other disasters when relocation of the individuals is required, including the designation of a pre-arranged evacuation site(s) to be used in the case of a physical evacuation of the residential facility.

(2) Emergency response plan training shall be approved by the department or the state/local authority.

(3) The licensee shall conduct and document a tornado drill at least once in a twelve-month period.

(F) Staff training

(1) Each employee shall participate in a documented training of fire safety and operation of the facility's fire safety equipment and warning systems within thirty days of employment. Each employee must have training specific to each facility in which they work.

(2) Each employee shall participate in a documented training of fire safety and operation of the facility's fire safety equipment and warning systems at least once during every twelve month period.

(3) Each employee shall participate in a documented training of the facility's emergency response plan within thirty days of employment. Each employee must have training specific to each facility in which they work.

(4) Each employee shall participate in a documented training of the emergency response plan at least once during every twelve-month period.

(5) Employees may work in a facility, prior to meeting the requirements of paragraphs

(F)

(1) and (F)(3) of this rule, when at least one staff person who has current training in both fire safety and emergency response is present in the facility when individuals are in the facility.

(G) Individual training

(1) Each individual shall participate in a documented training of the facility's fire safety plan within thirty days of residency.

(2) Each individual shall participate in a documented training of the facility's fire safety plan at least once during every twelve-month period.

(3) Each individual shall participate in a documented training of the facility's emergency response plan within thirty days of residency.

(4) Each individual shall participate in a documented training of the facility's emergency response plan at least once during every twelve-month period.

(5) Fire safety and emergency response training shall be appropriate to the individual's functioning level and needs based on the results of an assessment and shall be indicated in the individual's plan.

Replaces: 5123:2-3-11

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 11/14/85 (Emer.), 5/5/86, 8/31/86, 10/12/87, 11/16/90, 12/9/91, 5/18/95, 4/27/00

5123:2-3-12 Food, clothing, and personal items.

(A) Purpose

The purpose of this rule is to achieve positive outcomes for the individual by involving the individual in decisions that relate to food and clothing. Each individual will participate in choices related to food and clothing as defined in his/her IP. A residential facility will also be responsible for ensuring that the individual's clothing and personal items are adequately accounted for and maintained by the residential facility.

(B) Food

(1) The licensee shall offer individuals food and daily meals which meet their nutritional needs and preferences. In those cases where an individual cannot meet his/her daily nutritional needs without assistance, assistance shall be provided.

(2) Modified or specially-prescribed diets shall be prepared and served in accordance with the instructions of a physician or licensed dietician. "Modified or specially-prescribed diets" are defined as diets that are altered in any way to enable the individual to eat (for example, food that is chopped, pureed, etc.) or diets that are intended to correct or prevent a nutritional deficiency or health problem. The licensee shall keep on file in the residential facility records of modified or specially-prescribed diets for the previous thirty days.

(3) Menus must be prepared based on the individuals' food preferences and provide a variety of foods at each meal and adjusted for seasonal changes. When individuals substitute menu items, they should be encouraged to choose items that contain the nutritive value comparable to the planned items on the menu. The licensee shall keep on file in the residential facility records of menus, menu modifications, and meals served for the previous thirty days.

(4) The licensee shall encourage the individual to participate in the selection of meals to be served and meal preparations.

(5) The individual shall not be made to eat nor be denied any meal or food item as a form of discipline.

(6) Fresh food supplies sufficient for three days and staple food supplies sufficient for at least five days shall be available in the residential facility at all times. Such supplies shall be available for inspection by the department.

(7) The licensee shall prepare and store food properly and in accordance with health codes to protect it against contamination and spoilage. Food products shall be stored separately from potentially harmful non-food items, particularly cleaning and laundry compounds, so that confusion in identifying edibles is minimized.

(8) The licensee shall make reasonable accommodation to observe the dietary dictates of an individual's religion.

(C) Clothing and personal belongings

(1) The licensee shall ensure that each individual has an adequate amount of personal clothing in good repair, well-fitting, and comparable in style to that worn by age peers in the community. The licensee shall have a plan to meet the clothing needs of an individual who does not have personal funds available to cover needed items. All clothing shall be clean and in accordance with the season and the kinds of activities in which the individual is engaged.

(2) The licensee shall be responsible for encouraging each individual to select, purchase, and maintain his/her own clothing and to dress as independently as possible.

(3) The licensee shall record each individual's clothing and personal items within fourteen days of admission. An inventory of each individual's clothing and personal items shall be taken and each individual's record updated at least once during a twelve-month period, and at the time of discharge.

(4) Any single item purchased by, or on behalf of the individual, with a purchase price of fifty dollars or more shall be added to the record when acquired and deleted from the record when discarded or lost.

(5) The requirements in paragraphs (C)(3) and (C)(4) of this rule do not apply to an individual determined to be capable of self-management of his/her personal possessions and this capability has been documented in the individual's plan.

(6) The licensee shall not discard clothing and personal items without the consent of the individual.

Effective: 01/01/2006
R.C. 119.032 review dates: 09/30/2005 and 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 11/16/90, 12/9/91, 4/27/00

5123:2-3-13 Individual records.

(A) Purpose

The purpose of this rule is to ensure the confidentiality of individual information and to establish standards to ensure that records of the individual are readily accessible for implementation of services and supports and for department review during surveys.

(B) Confidentiality of records

All information contained in an individual's record shall be considered privileged and confidential. Records shall be maintained in accordance with state and federal regulations in such a manner to ensure their confidentiality and protect them from unauthorized disclosure of information.

(C) Records at the residential facility

Records for the current calendar year and the previous twelve months shall be maintained at the residential facility for each individual and shall be made available for review by licensure and other representatives of the department. These records shall include, but not be limited to, the following:

(1) A current photograph of the individual.

(2) Legal status of the individual.

(3) Records of accidents, injuries, seizures, major unusual incidents, and unusual incidents and the treatment or first aid measure administered for each. Information pertaining to abuse/neglect investigations and other confidential information may be maintained at a location other than the residential facility, but shall be provided to licensure for review at the facility upon request.

(4) All medical and dental examinations and the most recent immunization records as appropriate to age.

(5) Medication and/or treatment records which shall indicate:

(a) The person who prescribed the medication and/or treatment; and

(b) The date, time, and person who administered the medication and/or treatment.

(6) Individual plans.

(7) Reconciliations of the individual's account transaction records as required in paragraph (J)(2)(i) of rule 5123:2-3-14 of the Administrative Code.

(8) A signed authorization to seek medical treatment or documentation that attempts to seek such authorization were unsuccessful. The licensee shall provide evidence of an annual review of such authorization and, in cases where authorization was not able to be obtained, evidence that attempts to obtain authorization were made on at least an annual basis.

(9) If not in the individual's plan, evidence of consents for the participation in services including, but not limited to, medical treatments, behavior support plans, and the use of psychotropic medications.

(D) Retention of records

Records for each individual shall be maintained by the licensee at an accessible location and such records shall be provided to licensure for review at the residential facility upon request. The licensee shall develop a records retention schedule for all records in accordance with applicable state and federal requirements. Records shall include, but not be limited to, the following:

(1) Admission and referral records;

(2) All medical and dental examinations, and immunization records as appropriate to age;

(3) All medication and/or treatment records;

(4) All service documentation and notations of progress;

(5) All records of the individual's account transaction record as defined in rule 5123:2-3-14 of the Administrative Code;

(6) Records of negotiable items owned by the individual which can be converted to cash or transferred such as bonds or promissory notes;

(7) Investigative files resulting from major unusual incidents or unusual incidents;

(8) Records of clothing and personal items; and

(9) Discharge summaries which shall be prepared within seven days following the individual's discharge. The summary shall include the individual's progress during residence and new address of residence.

(10) In the event of an individual's death, a discharge summary, which shall include the disposition of the individual's personal items, shall be completed within thirty days of the individual's death.

Replaces: 5123:2-3-13

Effective: 01/01/2006
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 9/30/83, 11/16/90, 12/9/91, 5/18/95, 4/27/00

5123:2-3-14 Personal funds of the individual.

(A) The purpose of this rule is to achieve the outcome of involvement of the individual in the management of his/her personal funds as identified in the individual's IP and to establish standards of accountability in the licensee's handling of an individual's personal funds when the individual's plan indicates the licensee to be responsible for handling the individual's funds.

(B) Personal funds consist of earned and unearned income retained by the individual after satisfying liability requirements to defray the cost of room, board, or services as defined by county board contracts; state requirements, including patient liability for the cost of home and community-based services (HCBS) waiver services as defined in rule 5101:1-39-95 of the Administrative Code; and federal requirements, including adherence to income restrictions necessary to maintain medicaid eligibility.

(C) Personal funds are the exclusive property of the individual to use as he/she chooses to purchase items, goods, and services of his/her preference.

(D) The licensee shall not require an individual to use personal funds to purchase or for the purchase of items that are reimbursed by the respective funding sources of the licensee.

(E) The licensee shall not require an individual to use personal funds to make up the difference between the cost of goods and services and the amount of payment received by the licensee from third party payers for the same goods and services.

(F) In no instance shall the licensee or any staff member of the residential facility borrow money from an individual or fail to account for personal funds of the individual received by the licensee.

(G) The licensee shall not commingle an individual's personal funds with funds of the licensee. The licensee shall not use an individual's personal funds to supplement or replace the personal funds of another individual on a temporary or permanent basis.

(H) Each individual has the right to manage his/her own personal financial affairs unless otherwise specified on the individual's plan. If the individual needs assistance with his/her own financial affairs then, based on formal or informal assessments, the individual's plan shall indicate the criteria, parameters, and documentation necessary regarding the assistance to be provided to the individual.

(I) If the individual's plan specifies that the licensee or any staff member of the residential facility is providing any assistance to an individual, the licensee shall involve the individual as much as possible in the management of his/her financial affairs.

(J) When the licensee has control and/or possession of an individual's personal funds, the licensee may establish a banking account for the individual or the individual may establish his/her own account.

(1) When the licensee establishes a banking account on behalf of an individual, the licensee may establish a separate banking account for each individual's personal funds, or combine each individual's personal funds in a single banking account, or a combination of both. When individuals' personal funds are combined in one banking account, the licensee shall separately account for each individual's funds and allocate interest, if earned, to each individual's account proportional to the amount of funds each individual maintains in the account.

(2) Personal funds may be established and maintained for an individual in a checking account, savings account, cash account, or any combination thereof. For each type of account established for the individual, the licensee shall maintain an account transaction record which shall contain the following:

(a) The individual's name;

(b) The amount and date all funds are received;

(c) The source of all funds received;

(d) The signature of the person crediting the account, unless electronically deposited;

(e) The amount withdrawn and date of withdrawal;

(f) The signature of the person receiving the debited amount, unless electronically withdrawn;

(g) For checking and savings account(s), a current account balance reconciled to the most recent bank statement;

(h) For cash kept in the facility or other accessible location for use by or on behalf of the individual, the current amount of cash reflected in the transaction record shall equal the amount of cash present for use by the individual;

(i) For each type of account maintained by the licensee, a verification of the reconciliation of the recorded balance to the actual funds available to the individual shall be made by the licensee, or the licensee's designee, no less frequently than once every sixty days. This reconciliation shall contain the date on which the reconciliation was conducted, the signature of the person conducting the reconciliation, and a detailed accounting of any discrepancies by type and amount. A person other than the person who maintains the account transaction record for the individual shall conduct the reconciliation.

(3) Personal funds received on behalf of the individual by the licensee shall be made available for the individual's use within five working days of the licensee's receipt of the funds.

(K) All personal funds expended by the licensee on behalf of an individual shall be accompanied by a receipt for the expenditure. The receipt shall identify the item(s) procured, the date, and the amount of the expenditure. The licensee shall obtain other proof of purchase if a receipt is unavailable.

(L) When the licensee gives funds to an individual from his/her personal account for the individual to expend on his/her own behalf, a receipt is required for a single expenditure of fifty dollars or more unless otherwise specified in the individual's plan. When a receipt is unavailable, the licensee shall obtain other proof of purchase. If other proof of purchase is not available, the licensee shall provide written verification for the amount of funds given to the individual and what was purchased with the funds.

(M) When the licensee gives funds to a parent or guardian to expend for the individual, the amount of funds given shall be recorded in the individual's account transaction record. When the funds are used to purchase a single item of fifty dollars or more, the licensee shall request the parent or guardian to provide a receipt or other proof of purchase. If a receipt or other proof of purchase is not available, the licensee shall provide written verification for the amount of funds given to the parent or guardian and what was purchased with the funds.

(N) Notwithstanding paragraph (M) of this rule, if a violation of this rule results in the loss of personal funds, the licensee shall restore those funds.

(O) When the licensee has control and/or possession of an individual's personal funds, the licensee shall release any balance of personal funds to the individual, after deducting for actual or estimated liabilities owed by the individual, at the time of his/her discharge or transfer. Within thirty days of the discharge or transfer, the licensee shall prepare a final itemized statement of the individual's personal funds account(s) and shall release any remaining personal funds to the individual with the itemized statement.

(P) In the event of an individual's death and when the licensee has control and/or possession of an individual's personal funds, the licensee shall dispose of the individual's funds in accordance with state regulations and shall document such disposition.

(Q) The department may conduct a personal funds audit of a residential facility at the department's discretion.

Effective: 01/01/2006
R.C. 119.032 review dates: 09/30/2005 and 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19 , 5123.62
Prior Effective Dates: 5/18/95, 4/27/00

5123:2-3-15 Procedures to waive licensure rule requirements.

(A) For adequate reasons and when requested in writing by a licensee, the director may waive a condition or specific requirement of a rule in Chapter 5123:2-3 of the Administrative Code or a rule in other chapters of the Administrative Code adopted by the department to license or regulate the operation of residential facilities.

(B) The director may require or solicit input regarding the licensee's request for a rule waiver from individuals residing in the residential facility, the individuals' guardians, or the county board for the county in which the residential facility is located.

(C) The director shall grant or deny a request for a rule waiver within ten working days of receipt of the request or within such longer period of time as the director deems necessary and may put whatever conditions on the rule waiver as are determined to be necessary.

(D) Approval to waive a condition or specific requirement shall not be contrary to the rights, health, or safety of the individuals residing in the residential facility.

(E) The decision to grant or deny a rule waiver is final and may not be appealed.

Replaces: 5123:2-3-15

Effective: 11/12/2012
R.C. 119.032 review dates: 11/12/2017
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/1977, 06/12/1981, 11/16/1990, 04/27/2000

5123:2-3-16 Emergency removal of individuals from a residential facility.

(A) The purpose of this rule is to ensure the health, safety, and welfare of individuals residing in a residential facility licensed under section 5123.19 of the Revised Code by establishing a process by which the director or his/her designee may order the emergency removal of an individual(s) being served in a residential facility.

(B) Where all other available interventions have proved ineffective or not feasible, the director or his/her designee may order the immediate removal of an individual(s) from a residential facility whenever conditions at the facility present an immediate danger of physical or psychological harm to an individual(s).

(C) The removal of an individual(s) under the provisions of this rule may only be implemented with the written consent of the individual(s) or parent(s) of a minor child or guardian(s), as applicable.

(D) When conditions at a residential facility present an immediate danger of physical or psychological harm and the individual(s) or parent(s) of a minor child or guardian(s), as applicable, do not give consent for the removal, the process for removing the individual must be done in accordance with sections 5126.30 to 5126.333 of the Revised Code.

(E) Upon receipt of allegations that the physical or psychological health or safety of an individual(s) is in danger, the county board shall determine if the situation is one of immediate danger. The department, at its own discretion, may also investigate such situations.

(F) When an allegation, as described in paragraph (E) of this rule, is received by the county board, the county board shall file a major unusual incident report with the department and conduct an investigation to establish the validity of the alleged facts in accordance with the procedures outlined in rule 5123:2-17-02 of the Administrative Code.

(G) During the interview and/or investigation process, the county board shall explain the nature of the situation and all known potential outcomes to the individual(s) or parent(s) of a minor child or guardian(s), as applicable, in a manner reasonably expected to be understood.

(H) If a determination is made that the situation is one of immediate danger, the county board shall contact the director or his/her designee with a request to remove the individual(s). The request shall include a description of the incident(s) and/or circumstances which led to the conditions at the facility presenting the immediate danger of physical or psychological harm to the individual(s). The county board shall submit the request to remove and description of the incident(s) and/or circumstances which led to the conditions at the facility presenting the immediate danger of physical or psychological harm to the individual(s) in writing to the director within twenty-four hours of the county board's contact with the director or his/her designee.

(I) The director or his/her designee shall determine whether the individual(s) shall be removed from the residential facility based upon information received from the county board, the department, and any other sources including the licensee if, in the opinion of the director, such communication with the licensee does not threaten the health or safety of the individual(s) and shall inform the county board of that determination. The director or his/her designee shall notify the ombudsman section of Ohio legal rights service in accordance with section 5123.604 of the Revised Code of any action being considered pursuant to this rule. The director or his/her designee shall notify the licensee of any action being taken to remove the individual(s) if, in the opinion of the director or his/her designee, the act of notification does not threaten the health and safety of the individual(s).

(J) The county board shall be responsible for removing the individual(s) and for arranging transportation, placement, and services in the least restrictive alternative available. The county board shall ensure implementation of all components of the individual's plan and compliance with all provisions of state and federal regulations related to the individual's eligibility for services and service delivery. The department will assist in facilitating placements of individuals into the least restrictive alternative available.

(K) The county board may arrange for or provide services to an individual(s) removed under the provisions of this rule for up to sixty days without soliciting proposals as required in rule 5123:2-16-01 of the Administrative Code. During this sixty day period, the county board shall be required to solicit proposals for service provision in accordance with rule 5123:2-16-01 of the Administrative Code.

(L) When written consent for the removal has been obtained, the county board shall attempt to notify the parent of a minor child or guardian of the individual, as appropriate, prior to the actual removal of an individual. If such notice is not made prior to the actual removal, it shall be made as soon as practicable after the removal.

(M) The department may initiate the revocation of the facility's license under rule 5123:2-3-02 of the Administrative Code when an individual(s) has been removed pursuant to this rule. When determining whether a license should be revoked in accordance with this rule, the department shall consider the following factors which include, but are not limited to:

(1) The overall health, safety, and welfare of the individuals residing in the residential facility;

(2) Any negligence on the part of the licensee which contributed to or caused the emergency removal;

(3) Historical, documented, and substantial non-compliance with licensure rules and regulations of the residential facility in question.

(N) The director or his/her designee, upon receipt of written information from the county board or any other reliable source indicating that the circumstances which led to the emergency removal no longer exist, and with the consent of the individual or parent of a minor child or guardian, as applicable, may permit the individual to return to the residential facility.

(O) The director or his/her designee shall notify the county board and the ombudsman section of Ohio legal rights service when an individual(s) returns to the facility following an emergency removal.

(P) When the licensee is the county board or when there are circumstances that are determined by the department to potentially present a conflict of incentives, the department may conduct the investigation outlined in this rule, or may request that an investigation be conducted by another county board, a council of governments, or any other entity authorized to conduct such investigations.

(Q) Notwithstanding the provisions of this rule, the licensee may initiate the discharge of an individual in accordance with the provisions of rule 5123:2-3-05 of the Administrative Code.

(R) The licensee shall not fill the vacancy created by the emergency removal of the individual until it has transferred or discharged the individual in accordance with rule 5123:2-3-05 of the Administrative Code.

Replaces: Former 5123:2-1-13

Effective: 07/01/2007
R.C. 119.032 review dates: 11/14/2006 and 07/01/2012
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 12/09/1988, 09/20/2001

5123:2-3-17 Individual plan (IP).

(A) Each individual shall have an individual plan (IP). The IP is a written description of the services and activities to be provided to the individual.

(B) The individual's choices shall be the primary factor for developing the IP. The individual's choices are those expressed directly by the individual or, if the individual is incapable of expressing his choices, by the individual's parent(s), custodian, or guardian, or by a friend or advocate of the individual's choice.

(C) The services and activities described in the IP shall support the individual's choices, meet the individual's needs, and assist the individual in expanding and developing skills that will lead to a more independent, secure, and enjoyable life.

(D) Evaluations shall be used as a resource to identify appropriate methods of developing the services and activities necessary to support the choices of and meet the needs of the individual.

(1) Evaluations shall include at a minimum an individual's social history, medical and dental evaluations, and an adaptive behavior or independent living skills assessment.

(a) At least annually, the social history shall be reviewed and updated as needed.

(b) Medical evaluations shall be completed every two years. A "medical evaluation" means an evaluation of the individual's general health.

(c) Dental evaluations shall be be completed on an annual basis. A "dental evaluation" means an evaluation of the individual's general dental health and hygiene.

(d) An adaptive behavior or independent living skills assessment shall be reviewed and updated at least annually.

(2) If the results from these four evaluations are insufficient to identify appropriate methods of developing the services and activities necessary to support the choices of and meet the needs of the individual, additional evaluations shall be obtained.

(E) An IP shall be developed by an IP coordinator with each individual within one month after the individual's admission to the residential facility and shall be updated at least annually thereafter. The custodian or parent(s), if the individual is a child, or guardian shall be encouraged to participate in the development of the IP. The individual may invite an advocate or friend(s) or any person(s) directly providing services or activities to him to participate in the development of the IP.

(F) The IP shall be implemented as written.

(G) The IP coordinator shall also perform and document the following responsibilities:

(1) Review the IP as needed or upon request;)

(2) Review the implementation of the IP at least quarterly and revise as needed; and

(3) Coordinate the services and activities being provided to the individual with service providers, which may include case management services, as identified in the IP.

(H) The services and activities described in the IP shall not be provided without the individual's consent or the consent of the parent(s), custodian, or guardian, as applicable. If the individual is a child, consent shall be obtained from the individual's parent(s) unless the individual has a custodian in which case, consent shall be obtained from the custodian. If the individual has a guardian, consent shall be obtained from the guardian. Consent shall be in writing and may be withdrawn in writing at any time.

(I) The provider shall attempt to resolve disputes that arise when consent is refused or withdrawn by making a reasonable accommodation to provide the individual with alternative services or activities.

(J) Authorized regulatory agents shall have access to the IP. The IP shall be provided to all parties involved in the implementation of the IP. The IP shall be provided to the individual, custodian or parent(s) if the individual is a child, or guardian. The IP shall not be released to other persons without the individual's consent or the consent of the parent(s), custodian, or guardian, as applicable. If the individual is a child, consent shall be obtained from the individual's parent(s) unless the individual has a custodian in which case, consent shall be obtained from the custodian. If the individual has a guardian, consent shall be obtained from the guardian. Consent shall be in writing and may be withdrawn in writing at any time.

(K) The administrator or his designee shall provide administrative oversight to ensure the development, implementation, coordination, review, evaluation and revision, if necessary, of the IP.

Replaces: 5123:2-3-17

R.C. 119.032 review dates: 03/28/2006 and 03/24/2008

Promulgated Under: 119.03

Statutory Authority: 5123.04, 5123.19

Rule Amplifies: 5123.04, 5123.19

Prior Effective Dates: 10/31/77, 6/12/81, 11/16/90, 12/9/91, 5/18/95

5123:2-3-18 Calculation of room and board payment for an individual residing in a residential facility.

(A) Purpose

The purpose of this rule is to identify components of room and board and to establish standards and procedures for determining the amount of retained earned and unearned income of an individual and the amount of room and board payment for which an individual is responsible when residing in a residential facility licensed under section 5123.19 of the Revised Code other than an intermediate care facility for the mentally retarded (ICF/MR) certified under Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq., as amended.

(B) Definitions

(1) "Earned income" has the same meaning as in rule 5101:1-39-15 of the Administrative Code.

(2) "Patient liability" has the same meaning as in rule 5101:1-39-24 of the Administrative Code.

(3) "Room and board" means the following items, costs, and/or expenses, which are not reimbursable through medicaid, that are allowable expenses incurred by the licensee in order to provide needed supports and services to an individual residing in a licensed facility. The total amount of monthly room and board cost attributable to each individual shall be based upon available resources of the county board, shall be identified in a written contract between the licensee and the county board, and shall be available for review by the department. The room and board amount shall be reviewed at least annually and amended as necessary. Room and board includes the provider's actual and reasonable cost of administration related to property management and the purchasing of goods and services.

(a) Supplies and household goods including:

(i) Non-food supplies and minor equipment used in the storage, preparation, serving, and delivery of food such as dishes, dish washing detergent, cooking utensils, silverware, wraps and containers to preserve food, and propane gas for grills.

(ii) Adaptive minor equipment as identified in an individual plan (IP), routine medical supplies including, but not limited to, first aid supplies, support stockings, lubricating jellies, enema administering apparatus and enemas, and over-the-counter medications.

(iii) Supplies required for the protection of individuals and staff while performing procedures that involve potential contact with bodily fluids including, but not limited to, gloves, gowns, goggles, and eye wash.

(iv) Non-medicaid covered expenses including, but not limited to, prescriptions, dental services, laboratory services, vision services, eyeglasses, ambulance and emergency services, hearing aids, respiratory therapy, oxygen, and incontinence supplies.

(v) Medical equipment not covered under medicaid or another payer including, but not limited to, wheelchairs, prosthetics, orthotics, enteral pumps, bed cradles, headgear, heat cradles, hernial appliances, splints, traction equipment, specialized mattresses and cushions, tracheotomy care sets, catheters, atomizers, nebulizers, tube feeding sets and supplies, hypodermic needles, and syringes.

(vi) Supplies needed to implement IPs and/or to assist in the performance and/or acquisition or maintenance of habilitation skills such as personal hygiene supplies. Examples include, but are not limited to, hair and nail care items, lotions, powder, dental hygiene supplies, shaving items, and the cost of haircuts.

(vii) Household supplies including, but not limited to, trash cans and bags, general household cleaning supplies, paper products, towels, bedding, laundry detergent, and minor equipment used for laundry and housekeeping.

(viii) Contracted janitorial and household cleaning and laundry services.

(ix) The cost of recreational and/or social activities (e.g., admission ticket and travel) for an individual and for staff, as specified in the IP, necessary to accompany the individual to recreational and/or social activities.

(b) Utilities including fuel oil, natural and propane gas, metered electrical services, water and sewage expenses, local and long distance telephone service and equipment purchased or leased which is available for use by residents, the cost of security services provided for the benefit of residents, and the cost of local television reception provided for the benefit of residents.

(c) Food including all raw, prepackaged, and prepared food (meals and/or snack items) eaten inside or outside the home (e.g., at restaurants) by the residents and like expenses for staff if consumed while providing supervision or services to the residents, and nutritional supplements, additives, and vitamins as identified in the IP.

(d) Housing including:

(i) Rental or lease costs (from non-related parties) for building and land, building depreciation (excluding the value of the land) using the straight line method of depreciation over forty years and interest expense as incurred, real property taxes, and insurance on content and property. Includes housing cost from related parties limited to the related parties' actual cost or fair market value, whichever is less. Excludes amortization expense, over the life of state property grants received by the provider for renovations.

(ii) Supplies for repair and maintenance of the home and lawn/yard and repair cost to the home's minor equipment or structure. Includes maintenance contracts for snow removal, lawn care, pest control, and carpet cleaning. Includes purchased services and personnel expenses, supplies, and equipment for personnel who perform maintenance or building repair and trash removal services, or for employees of the licensee performing maintenance duties.

(iii) Depreciation and current interest expense of facility equipment, furniture, and other furnishings that meet the provider's capitalization policy, using the straight line method of depreciation for all equipment, furniture, and furnishings. Guidelines established by the internal revenue service (IRS) shall be used to determine the number of years of useful life of the asset to be depreciated. Includes, but is not limited to, dietary equipment such as ranges, ovens, dishwashers, refrigerators, and food processors and household furnishings including, but not limited to, vacuum cleaners and lawn/yard care equipment.

(iv) Lease or rental of any item of facility equipment, furniture, and other furnishings and/or the cost of all furniture and equipment under the capitalization policy of the provider.

(v) Major maintenance to the facility to improve and/or maintain the structural integrity of the facility, and to maintain a safe and healthy living environment. Examples include, but are not limited to, roof replacement, repairs to the foundation, interior and exterior walls, floors, replacement/repair of electrical, heating and cooling, plumbing, septic and sewer systems, additions and/or renovations to the home that benefit the residents of the home. The straight line method of depreciation shall be used for depreciating all improvements. Improvements shall be depreciated over a period not less than the remaining useful life of the property and not more than the useful life of the improvement as determined by the IRS. Includes interest expense if funds were borrowed to complete the work.

(e) Clothing items for each resident residing in the facility.

(4) "Unearned income" has the same meaning as in rule 5101:1-39-16 of the Administrative Code.

(C) General provisions

(1) Items identified as room and board shall meet the requirements specified in Chapter 5123:2-3 of the Administrative Code.

(2) For the purpose of this rule, earned and unearned income shall be considered in the month it is received by the licensee.

(3) Each individual shall retain a minimum of seventy-five dollars per month from the total of any unearned source of income. Unearned income includes, but is not limited to, supplemental security income, social security disability income, railroad retirement, veteran's benefits, and trusts. Food stamps shall be included as unearned income but shall not be applied toward the minimum income to be retained by the individual.

(4) The amount of earned income to be retained by the individual shall equal, at a minimum, the first one hundred dollars of the net earned income received per month by the individual, plus one-half of any earned income in excess of one hundred dollars per month.

(5) Any one-time payment or reconciliation of earned or unearned income that exceeds the individual's regular monthly earned or unearned income may be applied to past months, not to exceed six months, for room and board payments, including payments made by county boards in accordance with paragraph (D)(3) of this rule. Examples of one-time payments include, but are not limited to, social security back payments, tax refunds, and estate or inheritance income. The specific criteria for such payments shall be contained in the contract between the licensee and the county board. The individual shall not be assessed for future room and board costs as a result of receiving a one-time payment or reconciliation.

(D) Responsibilities of the county board

(1) A county board and licensee shall provide sufficient information to each other in order to determine reasonable and appropriate room and board expenses. Unusual or atypical room and board expenses, resources, and responsible entities shall be identified in the individual's plan.

(2) The county board shall identify assets of the individual, resources, and alternatives to pay for or otherwise provide services required by the individual to meet room and board expenses incurred.

(3) When an individual receives no earned or unearned income in a month, the county board shall be responsible to provide the individual with a minimum monthly allowance of seventy-five dollars.

(4) The county board is responsible for paying the licensee the amount owed to the licensee for room and board based on the contract established in accordance with paragraph

(B)

(3) of this rule, adjusted for earned and unearned income of the individual as calculated in accordance with paragraph (E)(2) of this rule.

(E) Responsibilities of the licensee

(1) A licensee and county board shall provide sufficient information to each other in order to determine reasonable and appropriate room and board expenses. Unusual or atypical room and board expenses, resources, and responsible entities shall be identified in the individual's plan.

(2) The licensee is responsible for calculating and documenting the sum of the individual's earned and unearned income available for room and board as determined in accordance with paragraph (C) of this rule and shall compare it to the room and board amount identified in the contract.

(a) If the amount of the individual's earned and unearned income available for room and board following any deductions for patient liability is less than the contracted room and board cost for the month, the entire amount of the individual's earned and unearned income available for room and board shall be paid to the licensee. The balance of the room and board cost shall be billed to the county board by the licensee in accordance with the contract.

(b) If the amount of the individual's earned and unearned income available for room and board following any deductions for patient liability is greater than the contracted room and board cost for the month, the individual shall pay the entire cost of the room and board to the licensee. Any earned and unearned income received by the individual in excess of the amount paid for room and board for the month shall be retained by the individual and shall be documented in accordance with rule 5123:2-3-14 of the Administrative Code.

(c) Patient liability shall not be deducted from the individual's personal allowance and earned income retained by the individual, but shall be deducted from the earned and unearned income available to pay the licensee for the room and board cost.

(F) Responsibilities of the individual, guardian, and/or payee

(1) The individual, guardian, or payee of the individual, as applicable, is responsible for providing the licensee and/or county board with the information pertaining to the individual's earned and unearned income in order to determine the individual's obligation to pay for room and board.

(2) The individual, guardian, or payee of the individual, as applicable, is responsible for paying the licensee the amount owed to the licensee for room and board as determined in paragraph (E)(2) of this rule in a timely manner.

(G) For individuals residing in a non-ICF/MR licensed facility who are not receiving waiver services, the amount of room and board cost attributable to each individual shall be identified in a written contract between the licensee and the individual or parent, guardian, or payee, as applicable, and shall be determined as prescribed in paragraphs (E) and (F) of this rule.

Replaces: 5123:2-3-18

Effective: 07/01/2008
R.C. 119.032 review dates: 07/01/2013
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 09/20/2001

5123:2-3-19 Licensed providers of waiver services.

Licensed providers under section 5123.19 of the Revised Code seeking to provide waiver services under a home and community-based services waiver administered by the department shall submit an application to provide waiver services in accordance with procedures established by the department and shall comply with those service-specific waiver requirements in Chapters 5123:2-8, 5123:2-9, and 5123:2-13 of the Administrative Code that are in addition to the other licensure requirements in Chapter 5123:2-3 of the Administrative Code.

Replaces: 5123:2-3-19

Effective: 10/01/2009
R.C. 119.032 review dates: 10/01/2014
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.045 , 5123.19 , 5111.871
Rule Amplifies: 5123.04 , 5123.045 , 5123.19 , 5111.871
Prior Effective Dates: 04/28/2003

5123:2-3-20 Receipt, investigation, and disposition of complaints.

(A) Purpose

The purpose of this rule is to describe the process involving the receipt, investigation, and disposition of complaints when they involve a residential facility.

(B) Any person may submit a complaint to the department at any time. A complaint shall be submitted in writing or in person. A person who is not able to submit a report in writing independently shall be assisted by the department in submitting the complaint. The department shall provide specific information as to where persons can submit complaints to the department, including any toll-free number for submitting complaints.

(C) Department staff shall be trained to assess a complaint to determine if the complaint should be referred to another entity including, but not limited to, law enforcement, a county board, or another entity within or external to the department in accordance with rule 5123:2-17-01 of the Administrative Code.

(D) If it is determined that the complaint involves a residential facility, the department shall assess whether the complaint involves allegations that pose an immediate risk to an individual's health and/or welfare.

(1) If it is determined that an immediate risk to the individual's health or welfare exists, the department shall take measures to ensure that any conditions that pose a risk to the health and welfare of the individual have been corrected and shall initiate an investigation of the complaint by the end of day following receipt of the complaint..

(2) If it is determined that no immediate risk to the individual's health or welfare exists, the department shall conduct and complete an investigation within ten working days following the receipt of the complaint.

(E) The department shall complete a written report within five working days following the conclusion of the investigation.

(F) The disposition of the complaint may include, but is not limited to:

(1) No action, if the allegations in the complaint cannot be substantiated;

(2) The issuance of licensure citations, as appropriate;

(3) Referral to another entity;

(4) Other action, as appropriate, based on the findings of the investigation.

(G) The department shall send a written statement to the complainant within twenty working days of the conclusion of the investigation acknowledging receipt of the complaint and the general actions taken by the department to address the complaint.

Eff 1-17-05
Rule promulgated under: RC 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
R.C. 119.032 review dates: 01/17/2010

5123:2-3-21 Public notification program of adverse action taken by the department.

(A) The purpose of this rule is to establish a program under which public notification is made by the department when an adverse action has been taken against a licensee.

(B) Definitions.

The following definitions shall apply to this rule:

(1) "Adverse action" means any of the following actions taken by the department:

(a) The initiation of license revocation of a residential facility; or

(b) The issuance of an order for the suspension of admissions to a residential facility; or

(c) The placement of a monitor in a residential facility; or

(d) The emergency removal of individuals from a residential facility.

(2) "Public notification" means posting information regarding any adverse action on the department's web site in a format prescribed by the department.

(C) Procedures for posting, amending, and removing public notification

(1) Public notification shall be made within three working days following any adverse action taken by the department against a licensee when that action is taken within eighteen months of the most recent adverse action taken against that same licensee and the latest action is being taken for the same or a substantially similar violation of a provision under Chapter 5123. of the Revised Code that applies to residential facilities or the rules adopted under such a provision.

(2) The public notification shall remain until:

(a) The action taken by the department is found to be unjustified. In such a case, the public notification shall be amended to reflect the unjustified action for a period of thirty calendar days after which the public notification is removed.

(b) The licensee has corrected the violation that resulted in the adverse action. In such a case, the public notification shall be amended to reflect the corrective action taken by the licensee. The public notification shall remain for a period of eighteen months after which it shall be removed if no other adverse action has been taken against the licensee during that time.

Eff 1-17-05
Rule promulgated under: RC 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
R.C. 119.032 review dates: 01/17/2010

5123:2-3-22 Licensing fees for residential facilities.

(A) Purpose

The purpose of this rule is to establish fees and procedures for the licensing of residential facilities.

(B) Fee schedule

Licensing fees shall be based on the term of a license as established in rules 5123:2-3-02 and 5123:2-3-03 of the Administrative Code:

(1) For an interim license, the fee shall be forty dollars; and for the renewal of an interim license, the fee shall be twenty-five dollars.

(2) For a one-year license, the fee shall be fifty dollars.

(3) For a two-year license, the fee shall be seventy-five dollars.

(4) For a three-year license, the fee shall be one hundred dollars.

(C) The applicant shall submit the fee in a manner prescribed by the department. The fee shall be paid in the form of a cashier's check, corporate check or money order, payable to the Ohio department of developmental disabilities. The fee is non-refundable.

Eff 1-17-05
Rule promulgated under: RC 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
R.C. 119.032 review dates: 01/17/2010

5123:2-3-23 Issuance of interim licenses.

(A) Purpose

The purpose of this rule is to establish the procedures and criteria to administer the issuance of interim licenses to residential facilities.

(B) Scope

The director may issue an interim license to operate a residential facility if either of the following is the case:

(1) The director determines that an emergency exists requiring immediate placement of persons in a residential facility, that insufficient beds are available, and that the residential facility is likely to receive a license issued in accordance with rule 5123:2-3-02 of the Administrative Code within thirty days after issuance of the interim license; or

(2) The director determines that the issuance of an interim license is necessary to meet a temporary need for a residential facility.

(C) Application process

(1) The applicant shall submit an application for an interim license in a manner and on forms prescribed by the department no later than thirty days prior to the date the applicant desires the interim license to be effective, unless the director determines an emergency or other unanticipated circumstances reasonably precluded the applicant from submitting the application at least thirty days in advance of the date the license is requested.

(2) the director shall issue an interim license if he or she determines that the applicant meets the requirements of Chapter 5123. and rules adopted under that chapter.

(D) Term of interim license

(1) an interim license shall be issued for a period of thirty days.

(2) an interim license may be renewed by the director for a period not to exceed an additional one hundred fifty days.

Replaces: part of rule 5123:2-3-02 , Eff 1-17-05
Rule promulgated under: RC 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19
Prior Effective Dates: 10/31/77, 6/12/81, 9/30/83, 8/1/87, 8/22/87, 11/16/90, 1/8/94
R.C. 119.032 review dates: 01/17/2010

5123:2-3-24 Participation of individuals in day activities.

(A) Purpose

The purpose of this rule is to ensure that individuals who live in an ICF/MR are able to maximize community participation by being afforded the opportunity to participate in day activities.

(B) Definitions

(1) "Day activities" means participation in activities delivered by the ICF/MR that include, but are not limited to, any of the following:

(a) Activities in the community available to the general public;

(b) Activity centers, adult day care, sheltered work programs, or other programs.

(2) "Off-site" means a location where day activities are delivered that is:

(a) Not in the same building as the ICF/MR; and/or

(b) Not in any residential facility; and/or

(c) Not within two hundred feet of the building housing the ICF/MR.

(C) Notwithstanding paragraph (B)(2) of this rule, the ICF/MR may provide day activities on-site when the individual's service plan indicates the reasons why delivering day activities off-site would be contraindicated for the individual. The determination shall be supported by the evaluations and assessments in the individual's plan and by the condition and/or behavior of the individual. The individual's plan shall be consented to by the individual or the individual's guardian acting on behalf of the individual.

(D) Any ICF/MR that was delivering day activities on the property of the ICF/MR prior to July 1, 2005, is not subject to the restriction in paragraph (B)(2) of this rule and may continue to provide day activities at that same location.

(E) In cases where the entity that provided day activities prior to July 1, 2005 is unwilling or unable to provide day activities after July 1, 2005 for the add-on rate (inclusive of transportation), the ICF/MR may provide day activities to those affected individuals, notwithstanding the requirements in paragraph (B)(2) of this rule, for eighteen months from the date the ICF/MR is notified by the day activity provider that he or she is unwilling or unable to provide the day activity or the effective date of this rule, whichever is later.

Replaces: 5123:2-3-24

Effective: 03/20/2006
R.C. 119.032 review dates: 03/20/2011
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.19
Rule Amplifies: 5123.04 , 5123.19 , 5123.67
Prior Effective Dates: 7/1/05 (Emer.)

5123:2-3-25 Discipline, restraint, behavior modification, and abuse of residents.

(A) All employees of every residential care facility shall treat each resident with kindness, consistency, and respect.

(B) The residential care facility shall have written policies and procedures available to the residents and to parents and guardians. If appropriate, residents shall participate in formulating these policies and procedures. The written policies and procedures shall include, but not be limited to, enforcement of the following:

(1) Control and discipline. The residential care facility shall use only constructive methods of discipline. The residential care facility may not allow:

(a) Corporal punishment of a resident;

(b) A resident to discipline another resident; or

(c) A resident to be placed alone in a locked room.

(2) Chemical and physical restraints

(a) Each resident shall be free from chemical and physical restraints unless the restraints are:

(i) Authorized by a physician in writing for a specified period of time;

(ii) Used in an emergency under the following conditions:

(a) The use is necessary to protect the resident from injuring himself or others;

(b) The use is authorized by a professional staff member identified in the written policies and procedures of the residential care facility as having authority to do so; and

(c) The use is reported promptly to the resident's physician by that staff member; or

(iii) Used during a behavior modification session for a resident who has mental retardation or other developmental disabilities under the following conditions:

(a) The use is authorized in writing by a physician; and

(b) The parent or legal guardian of the resident gives his informed consent to the use of restraints or aversive stimuli.

(b) Physical restraints

(i) Except as provided for in behavior modification programs, the residential care facility may allow the use of physical restraint on a resident only if absolutely necessary to protect the resident from injuring himself or others.

(ii) The residential care facility may not use physical restraint:

(a) As punishment;

(b) For convenience of staff; or

(c) As a substitute for activities or treatment.

(iii) The residential care facility shall have a written policy which specifies:

(a) How and when physical restraints may be used;

(b) The staff member who must authorize its use; and

(c) The method for monitoring and controlling its use.

(iv) An order for physical restraint may not be in effect longer than twelve hours.

(v) Appropriately trained staff shall check a resident placed in a physical restraint at least every thirty minutes and keep a record of these checks.

(vi) A resident who is in physical restraint shall be given an opportunity for motion and exercise for a period of not less than ten minutes during each two hours of restraint.

(vii) Mechanical devices used for physical restraint shall be designed and used in a way that causes the resident no physical injury and the least possible physical discomfort.

(viii) A totally enclosed crib or a barred enclosure is a physical restraint.

(ix) Mechanical supports used to achieve proper body position and balance are not physical restraints. However, mechanical supports shall be designed and applied under the supervision of a qualified professional and in accordance with the principles of good body alignment, concern for circulation, and allowance for change of position.

(c) Chemical restraints. The residential care facility may not use chemical restraint:

(i) Excessively;

(ii) As punishment;

(iii) For the convenience of the staff;

(iv) As a substitute for activities or treatment; or

(v) In quantities that interfere with a resident's habilitation program.

(3) Behavior modification programs

(a) Behavior modification programs involving the use of aversive stimuli or timeout devices shall be:

(i) Reviewed and approved by the interdisciplinary team or a QMRP;

(ii) Conducted only with the consent of the affected resident's parents or legal guardian; and

(iii) Described in written plans that are kept on file in the residential care facility.

(b) A physical restraint used as a timeout device may be applied only during behavior modification exercises and only in the presence of the trainer.

(c) For timeout purposes, timeout devices and aversive stimuli may not be used for longer than one hour and then only during the behavior modification program and only under the supervision of the trainer.

(4) Abuse. Each resident shall be free from mental and physical abuse. No operator, administrator, employee, or other person shall fail to report within twenty-four hours any suspected, alleged, observed, or reported abuse or neglect of any resident to the local law enforcement authority, the county welfare department with children's protective services, or the children's services board and board of mental retardation and developmental disabilities, the licensure office, and, in the case of children, the county welfare department with children's protective services or the county children's services board.

R.C. 119.032 review dates: 10/04/2004 and 12/30/2005

Promulgated Under: 119.03

Statutory Authority: 5123.04, 5123.19

Rule Amplifies: 5123.04, 5123.19

Prior Effective Dates: 10/31/77, 9/30/83

5123:2-3-26 Development of licensed residential beds.

(A) Purpose

The purpose of this rule is to establish uniform standards and procedures governing the development of residential facilities subject to licensure under section 5123.19 of the Revised Code. No person or government agency may apply for a license to operate a residential facility without obtaining development approval in accordance with this rule.

(B) Definitions

(1) "Applicant" means a person, as defined in section 1.59 of the Revised Code, or government agency submitting a proposal and seeking approval from the department for development of licensed beds.

(2) "Development" means an applicant's plan for the operation of a licensed residential facility including a plan for modification or replacement and which is subject to approval by the department.

(3) "Intermediate care facility for individuals with intellectual disabilities" (or "intermediate care facility") means an intermediate care facility for the mentally retarded certified as in compliance with applicable standards for the medicaid program by the director of health in accordance with Title XIX of the Social Security Act, 79 Stat. 286 (1965), 42 U.S.C. 1396 .

(4) "Licensed bed" means a bed in a residential facility licensed by the department pursuant to section 5123.19 of the Revised Code.

(5) "Management contractor" means a person, as defined in section 1.59 of the Revised Code, or government agency that controls administrative or management services for a licensee.

(6) "Modification" means:

(a) A change in the identity of the licensee or management contractor of a licensed residential facility;

(b) A significant change in ownership of a licensed residential facility that occurs as the result of an acquisition, sale of a majority interest, merger, or when a family member is added or removed from a license held by a family-owned business;

(c) A change in the address of some or all of the licensed beds;

(d) An increase or decrease in the number of licensed beds operated at a specific address;

(e) The rebuilding of a licensed residential facility at the same address;

(f) A change in the type or source of funding of a licensed residential facility; or

(g) Transition of an intermediate care facility from licensure by the Ohio department of health to licensure by the department.

(7) "Replacement" means assigning licensed beds to a different licensee when a license is revoked, terminated, or not renewed by the department or is voluntarily surrendered by a licensee and the department determines that the beds are needed to provide services to individuals who resided in the residential facility in which the beds were located.

(C) Moratorium on licensed beds

(1) The department shall maintain a written record of the maximum number of licensed beds that are permitted in accordance with division (D) of section 5123.196 of the Revised Code.

(2) The department shall not approve a proposal for the development of licensed beds or issue a license under section 5123.19 of the Revised Code if the approval or issuance will cause the number of licensed beds to exceed the number of licensed beds permitted by section 5123.196 of the Revised Code.

(D) General principles

(1) A residential facility may continue to operate at the capacity and configuration for which it is licensed as of the effective date of this rule.

(2) An applicant who has obtained approval for a development proposal shall be permitted to proceed with development at the capacity and configuration for which approval has been granted as of the effective date of this rule.

(3) The number of licensed beds in an intermediate care facility shall not exceed eight.

(4) The number of licensed beds in a residential facility that is not an intermediate care facility shall not exceed four.

(5) Licensed residential facilities shall not exist on adjoining property sites.

(6) No more than one distinct and separate physical structure may be licensed on the same property site.

(7) Notwithstanding paragraph (D)(6) of this rule, multiple apartments within an apartment building or complex of apartment buildings on the same property site may be licensed individually when the apartments serve as the best alternative for maximizing community integration.

(8) A county board may assume ownership of a residential facility only when no other person or government agency desiring to operate the residential facility is qualified.

(E) Standards for reviewing development proposals

In reviewing development proposals, the department shall consider:

(1) The extent to which the development proposal supports integration into the community;

(2) The objective of reducing the number of beds on a single site;

(3) The objective of reducing the number of beds in a single building;

(4) The outcome of prior licensure reviews;

(5) The need for services in the local community;

(6) The need for capital improvements at the residential facility;

(7) For licensed beds in a residential facility that is not an intermediate care facility, compatibility with home and community-based character set forth by the centers for medicare and medicaid services;

(8) The provider's ability to meet the financial requirements of the development proposal; and

(9) The county board's recommendation regarding the development proposal.

(F) Development proposal process

(1) The applicant shall submit a development proposal to the department in writing. The proposal shall:

(a) Identify the owner of the license to operate the facility, the operator of the facility if different from the owner, the lessor of the facility if any, and any related party as defined in division (Z) of section 5111.20 of the Revised Code to the owner or operator of the facility;

(b) Describe the modification or replacement accurately and completely; and

(c) Include an explanation if a modification is sought under paragraph (B)(6)(c), (B)(6)(d), (B)(6)(e), or (B)(6)(f) of this rule.

(2) The department shall notify the applicant in writing of the approval or disapproval of the development proposal together with a statement of reason within sixty days of receipt of a complete application. The department shall maintain on its website a list of development proposals and action taken thereon.

(3) The department shall establish specific timelines for implementation of a development proposal at the time of development approval.

(a) Failure to meet established timelines may result in withdrawal of development approval.

(b) Revisions or extensions to established timelines require prior written approval by the department.

(4) When a license is revoked, terminated, or not renewed by the department or is voluntarily surrendered by a licensee and the department determines that the beds are needed to provide services to individuals who resided in the residential facility in which the beds were located, the department may authorize the county board of the county where the replacement beds are located to develop a request for proposal for the purpose of recommending a licensee.

(a) The department shall establish and make available the format, procedure, timelines, and criteria for evaluation for the request for proposal process to be used by a county board.

(b) The county board shall solicit proposals from any interested applicants and shall ensure all interested applicants are afforded an equal opportunity to respond to the request for proposal. Written notice shall be provided to the general public and to all interested licensees as prescribed by the department.

(c) The county board shall submit all proposals and its recommendation to the department within ten days after completing its review of the proposals.

(d) The department shall consider the county board's recommendation and shall notify in writing, the county board and all applicants of its decision within thirty days after receiving the county board's recommendation. The department shall provide each applicant its rationale in selecting or choosing not to select a particular licensee.

(5) A person or government agency desiring to operate a residential facility shall, upon obtaining development approval pursuant to this rule and establishing the facility, apply for a license for the residential facility in accordance with rule 5123:2-3-02 of the Administrative Code.

(6) A person or government agency submitting a development proposal to place a licensed bed on hold for future development shall have three hundred sixty-five days from the date of approval of the development proposal to apply for a license for the residential facility in accordance with rule 5123:2-3-02 of the Administrative Code.

(7) The applicant may appeal the decision of the department regarding a development proposal in accordance with rule 5123:2-17-01 of the Administrative Code.

(G) The provisions of this rule may be waived pursuant to rule 5123:2-3-15 of the Administrative Code.

Replaces: 5123:2-16-01

Effective: 11/12/2012
R.C. 119.032 review dates: 11/12/2017
Promulgated Under: 119.03
Statutory Authority: 5123.04 , 5123.042 , 5123.19
Rule Amplifies: 5123.04 , 5123.042 , 5123.19 , 5123.196
Prior Effective Dates: 09/30/1986 (Emer.), 12/05/1986, 08/22/1987, 10/12/1987, 06/16/1988, 02/01/1990 (Emer.), 04/30/1990, 10/28/1993, 12/05/1996 (Emer.), 03/20/1997, 08/12/2002, 07/22/2004

5123:2-3-38 Significant change of ownership. [Rescinded].

Rescinded eff 7-22-04