Fla. Admin. Code R. 65E-9.005
(1) Governing body.
(c) The governing body shall meet no less than once per year. Membership of the governing body shall not be fewer than five (5) members. The provider shall maintain a list of its members, which shall be available to the Agency and the Department and shall:
1. Include the names, address, and terms of membership of each member; and
2. Identify each office and the term of that office.
(d) Responsibilities of the governing body:
1. Ensure organizational policies are in place for the administration and operation of the residential treatment center, including a qualified administrator;
2. Evaluate in writing the administrator’s performance annually;
3. Approve the annual budget of anticipated income and expenditures necessary to provide the services described in its statement of purpose and approve the annual financial audit report;
4. Establish and ensure compliance with written personnel practices;
5. Maintain written minutes of all meetings, which shall be open to inspection by the Agency and the Department, upon request;
6. Develop written policies for selection criteria and rotation of its members;
7. Develop and follow a written plan for the storage of records, including children's records, in the event of the closing of the program;
8. Ensure implementation of an effective quality improvement program that addresses at least the following components:
a. Credentials review and granting of clinical privileges to health care providers including but not limited to physicians, Advanced Nurse Practitioners, psychologists and other staff who oversee/supervise the delivery of mental and behavioral health services;
b. Monitoring of quality indicators; and
c. Mortality reviews.
9. Staff development plan for at least 15 hours per year on job related training to each staff whose duties require direct observation or contact with children.
(3) Organization.
(a) Program. The provider shall have a written description of its philosophy, purpose, objectives, treatment program, services and methods of service delivery. This document shall be available to the Agency, the Department, referral sources, the parent(s), guardian or foster parent(s) and the public upon request. The program description shall include:
1. A description of the population of children served, including age and gender, types of disorders, and financial requirements;
2. The intake and admission process;
3. The types of treatment the provider can offer, based on a child’s individual needs;
4. Methods for involving the parent or guardian in assessment, treatment, discharge, and follow-up care plans; and
5. An organizational chart describing each unit or division and its services, goals, procedures, staffing patterns and relationship to other services and divisions and how these contribute to the goals of the program.
(b) Administration. The provider shall have a written organizational plan, including an organizational chart, for administrative and clinical staff, which clearly explains the responsibilities of staff for services provided by the program. This plan shall include:
1. Lines of authority, accountability and communication; and
2. The names and credentials of the provider’s clinical director and all clinical staff assigned responsibility on any shift for supervision of direct care staff. All clinical staff assigned supervisory responsibility shall have training or experience in child care activities and in the handling of medical and psychiatric emergencies.
(h) Personnel policies, procedures and records.
1. Personnel policies and practices shall be designed, established, followed and maintained to promote the objectives of the provider’s program and to ensure there are sufficient staff to support a high quality of care and treatment.
2. All paid personnel and volunteers shall be screened prior to employment, which shall include employment history checks, checks of references, local criminal records checks through local law enforcement agencies, fingerprinting, statewide criminal records checks through the Florida Department of Law Enforcement, and federal criminal records checks through the Federal Bureau of Investigation.
3. The provider shall have and implement written personnel procedures covering the following areas: job classification; pay plan; staff selection; probation or work-test period; tenure of office; dismissal; salary increases; health evaluations; holidays; leave policies; new employee training/orientation; ongoing staff development training; performance evaluation; employment benefits; and personnel records.
4. Each new employee shall be given a copy of the written personnel procedures when hired and documentation of receipt shall be maintained in the employee’s personnel file. A procedure shall be established and implemented on an ongoing basis for notifying employees of changes in established policies and procedures.
5. There shall be clear job descriptions for all staff, including position title, immediate supervisor, responsibilities and authority, which shall be used as a basis for periodic evaluations by the supervisor.
6. Accurate and complete personnel records shall be maintained on each employee. Content shall include:
a. Current background information, including the application, references, proof of satisfactory background screening results as required by section 394.4572, F.S., and documentation to justify initial and continued employment of the individual. Applicants for positions requiring licensure, certification or accreditation shall be employed only after the provider has verified the license or accreditation. Evidence of renewal of license as required by the licensing agent shall be maintained in the employee’s personnel record;
b. Current performance evaluation;
c. Record of any continuing education or staff development programs completed.
(l) Incident notification.
1. The provider shall comply with the department’s and the agency’s procedures for reporting incidents that pose risk of serious psychological and physical harm to children being served.
2. The provider shall develop and implement on an ongoing basis a written procedure for incident notification, reflecting the requirements of the department’s operating procedure CFOP 215-6, which is incorporated by reference.
(4) Fiscal accountability.
(5) Facility standards.
(a) Buildings, grounds and equipment.
1. If the facility accepts children with physical handicaps, the facility shall be handicap accessible.
2. Grounds shall have space for children’s activities, which shall be designed based on the type of activities offered and age appropriateness. The grounds shall be maintained in a safe and reasonably attractive manner and kept free of standing water, debris, garbage, trash and other hazardous conditions.
3. Indoor and outdoor recreation areas shall be provided with equipment and safety measures designed for the needs of children according to age, physical and mental ability.
4. Safety regulations shall be established and followed for all hazardous equipment and children shall be prohibited from the use of such equipment.
5. Pools. Facilities licensed for eight or more children shall meet the public swimming pool requirements of chapter 514, F.S. Facilities licensed for one through seven children shall meet the residential swimming pool requirements for chapter 515, F.S.
6. The interior and exterior of buildings and the furniture and furnishings shall be safe, comfortable, reasonably attractive, in good repair and shall function for the purpose for which such building and furniture has been designed.
7. All heating, air conditioning, electrical, mechanical, plumbing and fire protection systems shall function properly and be in compliance with local codes.
8. Therapeutic group home beds shall meet the requirements of chapter 419, F.S., Community Residential Homes.
(b) Interior accommodations.
(III) The door will have no other features greater than eighteen inches from the floor to which cloth or other material may be securely hung or tied.
d. Floors and walls.
(III) Floor tiles and baseboards are acceptable if attached securely to the floor and walls.
e. Ceilings less than nine feet above the floor shall be monolithic with no appendages that can be securely grasped or tied onto with cloth or other material.
f. Vents less than nine feet above the floor will be covered with small wire mesh, a metal plate, or other high impact resistant material (with holes no larger than three-sixteenth inch) in such a way that one would be unable to securely tie or hang cloth or other material from it and have no exposed sharp edges.
g. Lighting.
(III) Material used to fill space between the fixture and the mounting surface will be hard epoxy or other material that cannot be easily removed.
h. Mirrors and cameras. If mirrors and cameras are located in the seclusion room and are less than nine feet above the floor, they will:
(III) Not possess features to which cloth or other material can be securely tied or hung;
i. Sprinklers. Sprinklers less than nine feet above the floor will:
(III) Will use material to fill between the fixture and the ceiling that is hard epoxy or other material that cannot be easily removed.
j. Windows.
(III) Window cranks will be flush with the window.
k. A toilet room shall be conveniently located near the seclusion room without entering into or through a common use area. It shall not open directly into or be located within the seclusion room. Toilets and sinks will be smooth and devoid of handles or parts to which cloth or other material could be securely tied or hung.
l. Smoke detectors.
(II) The wire mesh or other enclosure will have holes that are not larger than three-sixteenth inch and lack features to which cloth or other material can be securely tied or hung and shall not prevent the smoke detector from properly functioning in accordance with National Fire Protection Association, 72, National Fire Alarm Code.
m. Electrical outlets.
(III) Switches will not protrude so far that they permit serious self-injury.
n. Beds when present will:
(III) Lack features to which cloth or other material can be securely tied, if it is higher than twenty-four inches above the floor.
o. Mattresses and blankets.
(II) Mattresses and blankets will be cleaned after each use, prior to being used by another child.
p. Each seclusion room will be inspected and certified as compliant with the above standards at least yearly and at any time damage or structural change occur.
13. Ventilation and lighting.
a. The facility shall provide outside ventilation by means of windows, louvers, air conditioners, or mechanical ventilation in rooms used by children. Windows and doors used for outside ventilation shall be operable and shall have screens in good repair.
b. All areas of the facility occupied by children shall be temperature-controlled in a manner conducive to comfort, safety and privacy. Unless otherwise mandated by federal or state authorities, a temperature of 72 to 82 degrees Fahrenheit during waking hours and 68 to 82 degrees Fahrenheit during sleeping hours shall be maintained in all areas used by children. Cooling devices shall be placed or adjusted in a manner that minimizes drafts. Table fans and floor fans shall have protective covers.
c. The facility shall provide sufficient lighting for the comfort and safety of children, including in classrooms, study areas, bathrooms and food service areas.
d. All incandescent bulbs and fluorescent light tubes shall be protected with covers or shields.
e. Hallways to bedrooms and bathrooms shall be illuminated at night.
f. The facility shall provide egress lighting that will operate if there is a power failure.
1. The facility’s space and furnishings shall enable staff to respect the child’s right to privacy and provide adequate supervision.
2. The facility shall have a common area large enough to accommodate group activities for the informal use by children.
3. The facility shall have one or more dining areas large enough to comfortably accommodate the number of persons normally served.
4. The facility shall have indoor recreation space large enough to accommodate the number of children scheduled for indoor activities.
5. Study areas shall have tables, chairs, appropriate lighting and bookshelves suitable for children’s use.
6. For residential treatment centers, if administrative offices are housed in the facility, they shall be separated from the children’s living area. Administrative offices do not include nursing or staff monitoring stations. Therapeutic group homes may have an office space in the facility for administrative purposes, including storage of children’s records.
7. There shall be a room available, which may be used for multiple purposes, to allow staff and children to talk privately and without interruption.
8. Potable drinking water shall be readily available and easily accessible to children.
9. Clocks and calendars shall be provided.
10. Bathrooms shall be provided and shall be separated from halls, corridors and other rooms by floor to ceiling walls. Children shall not have to go through another child’s bedroom to get to a bathroom. Each bathroom shall have:
a. At least one toilet, washbasin, and tub or shower easily accessible to the bedroom area for each six children;
b. When multiple toilets are located in a single room, they shall be separated by individual toilet stalls to provide individual privacy;
c. Bathrooms with non-slip surfaces in showers or tubs;
d. Toilet paper and holders, individual hand towels or disposable paper towels and soap dispensers;
e. Distortion-free mirrors at a height convenient for use by children;
f. A place for toiletry storage; and
g. In a facility that houses children with physical handicaps that limit mobility, all toilet and bathing areas shall meet the requirements of the Florida Building Code for accessibility.
11. Bedrooms.
a. Children shall not share sleeping areas with adolescents, and children or adolescents shall not share sleeping areas with adults.
b. Separate sleeping areas shall be provided for boys and girls.
c. The provider shall not permit children with physical handicaps that limit mobility to sleep above the first floor.
d. Bedrooms shall have at least 50 square feet of usable floor space per resident.
e. Bedrooms with multiple occupancy shall be limited to a maximum of 4 occupants.
f. Bedrooms for children shall be separated from halls, corridors, and other rooms by floor to ceiling walls.
g. Children’s bedrooms shall be ventilated, well-lighted and located convenient to a bathroom and shall have at least one operable exterior window.
h. Each bedroom shall be furnished with the following equipment for each child: personal storage space, such as a dresser; space for hanging clothes; a bed and mattress in good repair, which is at least 36 inches wide and 72 inches long, bedding suited to the seasons and a pillow.
i. Clean sheets, pillow cases, and blankets shall be provided for each child upon arrival. Sheets and pillowcases shall be laundered at least weekly unless greater frequency is indicated. A bedspread must be provided. Blankets or quilts must be available for use during cold weather. Bedspreads and blankets or quilts must be laundered at least quarterly, or more often, as needed.
j. Sleeping areas shall be assigned based on children’s individual needs for group support, privacy or independence and shall be appropriate to their ages, developmental levels and clinical needs.
k. Children shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their rooms. The provider shall have and follow written procedures specifying what types of decoration are acceptable.
12. A seclusion room must meet the following standards:
a. Be a single room of at least 50 square feet and shall be constructed to minimize the child’s hiding, escape, injury or suicide;
b. Allow staff full view of the resident in all areas of the room from outside of the room;
c. Doors.
(6) Health, sanitation and safety.
(7) Housekeeping.
(8) Codes and standards.
(9) Transportation safety.
(10) Disaster and emergency preparedness.
(a) EMERGENCY PLAN COMPONENTS. Each facility shall prepare a written comprehensive emergency management plan in accordance with CF-MH 1065, “Emergency Management Planning Criteria for Residential Treatment Facilities,” dated 08/2007, which is incorporated by reference. This document is available on the Department’s website at https://www.myflfamilies.com/general-information/publications-forms/. The comprehensive emergency management plan must, at a minimum address the following:
1. Provision for all hazards.
2. Provision for the care of residents remaining in the facility during an emergency including pre-disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment.
3. Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications.
4. Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies.
5. Identification of residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation.
6. Identification of and coordination with the local emergency management agency.
7. Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents; transportation; and reporting to the county office of emergency management the number of residents who have been relocated and the place of relocation.
8. The identification of staff responsible for implementing each part of the plan.
(c) EMERGENCY PLAN APPROVAL. The plan shall be submitted for review and approval to the county emergency management agency.
1. Any revisions must be made and the plan resubmitted to the county office of emergency management within 30 days of receiving notification from the county agency that the plan must be revised.
2. Newly-licensed facility and facilities whose ownership has been transferred, must submit an emergency management plan within 30 days after obtaining a license.
3. The facility shall review its emergency management plan on an annual basis. Any substantive changes must be submitted to the county emergency agency for review and approval.
a. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule.
b. Changes in the identification of specific staff must be submitted to the county emergency management agency annually as a signed and dated addendum that is not subject to review and approval.
4. Any plan approved by the county emergency management agency shall be considered to have met all the criteria and conditions established in this rule.
(d) PLAN IMPLEMENTATION. In the event of an internal or external disaster the facility shall implement the facility’s emergency management plan in accordance with section 252.356, F.S.
1. All staff must be trained in their duties and are responsible for implementing the emergency management plan.
2. If telephone service is not available during an emergency, the facility shall request assistance from local law enforcement or emergency management personnel in maintaining communication.
(e) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency.
1. The facility shall report the evacuation to the local office of emergency management or designee and to the area Department of Children Mental Health Program Office within six hours of the evacuation order and when the evacuation is complete if the evacuation is not completed within the six hour period.
2. The facility shall not be re-occupied until the area is cleared for reentry by the local emergency management agency or its designee and the facility can meet the immediate needs of the residents.
3. A facility with significant structural damage must relocate residents until the facility can be safely re-occupied.
4. The facility is responsible for knowing the location of all residents until the resident has been relocated from the facility.
5. The facility shall provide the Agency with the name of a contact person who shall be available by telephone 24-hours a day, seven days a week, until the facility is re-occupied.
6. The facility shall assist in the relocation of residents and shall cooperate with outreach teams established by the Department of Health or emergency management agency to assist in relocation efforts. Resident needs and preferences shall be considered to the extent possible in any relocation decision.
(11) Aquatic safety. For facilities that offer aquatic programs, the provider shall have and implement on an ongoing basis procedures that include:
(e) Lifesaving equipment shall be immediately accessible during aquatic activities. Minimum lifesaving equipment shall include:
1. A whistle or other audible signal device;
2. A first aid kit; and
3. A ring buoy, rescue tube, life jacket or other appropriate flotation device with an attached rope of sufficient length for the area.
Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.