Fla. Admin. Code R. 65E-9.006
(1) Additional standards for therapeutic group homes. The primary mission of the therapeutic group home is to provide treatment of serious emotional disturbance. Distinguishing features of a therapeutic group home include the following:
(c) If physical restraint is used, the following conditions shall be met:
1. Physical restraint must be applied only during potential emergency or crisis situations for no more than 30 minutes;
2. If the use of physical restraint is required during the child’s stay, the treatment team shall formally review the child’s treatment plan, at least monthly, and revise at the time of the review if determined necessary, to actively address and eliminate its use. As part of its review, the treatment team will determine whether implementation of an individual behavior plan is necessary, considering such factors as the frequency and duration of the physical restraint incidents and the age and cognitive ability of the child; and
3. The guidelines in rule 65E-9.013, F.A.C., related to physical restraint shall be met in addition to those listed above.
(2) Collocation.
(3) Treatment and services.
(d) The provider shall ensure that all staff caring for or providing treatment or services for the child:
1. Have current information about the child’s treatment plan and goals, including the child’s permanency goals if admitted pursuant to section 39.407, F.S.; and
2. Direct all aspects of the child’s treatment, services and daily activities toward meeting the child’s specific treatment goals.
(4) Activities.
(6) Food and nutrition.
(7) Health, medical, and emergency medical and psychiatric services.
(b) The procedure shall clearly specify which staff are available and authorized to provide necessary emergency psychiatric or medical care, or to arrange for referral or transfer to another facility including ambulance arrangements, when necessary. The procedure shall include:
1. Handling and reporting of emergencies. Such procedures shall be reviewed at least yearly by all staff and updated as needed;
2. Obtaining emergency diagnoses and treatment of dental problems;
3. Facilitating emergency hospitalization in a licensed medical facility;
4. Providing emergency medical and psychiatric care; and
5. Notifying and obtaining consent from the parent or legal guardian in emergency situations. This procedure shall be discussed with the child’s parent or guardian upon admission. The discussion shall be documented in the child’s file.
(8) Administration of medication.
(c) An accurate log shall be kept of the administration of all medication including the following:
1. Name of the child for whom it is prescribed;
2. Physician’s name, and reason for medication;
3. Quantity of medication in container when received;
4. Method of administration of medication (i.e., orally, topically, or injected);
5. Amount and dosage of medication administered;
6. Time of day and date medication is to be administered or self-administered and time of day and date medication was taken by the child; and
7. Signature of staff member who administered or supervised self-administration of the medication.
(10) Interpreters, translators and language options. The provider shall establish procedures for identifying and assessing the language needs of each child and providing:
(11) Clothing and personal needs.
(12) Child’s record.
(b) The provider shall develop an individualized record for each child. The form and detail of the records may vary but shall, at a minimum, include:
1. Identification and contact information, including the child’s name, date of birth, Social Security number, gender, race, school and grade, date of admission, and the parent or guardian’s name, address, home and work telephone numbers;
2. Source of referral;
3. Reason for referral to residential treatment, e.g., chief complaint, presenting problem(s);
4. Record of the complete assessment;
5. DSM diagnosis;
6. Treatment plan;
7. Medication history;
8. Record of medication administered by program staff, including type of medication, dosages, frequency of administration, persons who administered each dose, and method of administration;
9. Documentation of course of treatment and all evaluations and examinations, including those from other facilities, such as emergency rooms or general hospitals;
10. Progress notes;
11. Treatment summaries;
12. Consultation reports;
13. Informed consent forms;
14. A chronological listing of previous placements, including the dates of admission and discharge, and dependency and delinquency actions affecting the minor’s legal status;
15. Written individual education plan for the child, when applicable;
16. The discharge summary, which shall include the initial diagnosis, clinical summary, treatment outcomes, assessment of child’s treatment needs at discharge, the name, address and phone number of the person to whom the child was discharged and follow-up plans. In the event of death, a summary shall be added to the record and shall include circumstances leading to the death. All discharge summaries shall be signed by the clinical or medical director;
17. For out of state children, copies of completed interstate compact ICPC 100A and ICPC 100B forms (February 2002) and a copy of each Interstate Compact Transmittal Memorandum and any attachments thereto that were sent to the Residential Treatment Center by the department’s Interstate Compact on the Placement of Children Office;
18. Documentation of any use of restraint, seclusion or time out;
19. A copy of each incident report that includes a clear description of each incident; the time, place, and names of individuals involved; witnesses; nature of injuries, if any; cause, if known; action(s) taken; a description of medical services provided, if any; by whom such services were provided; and any steps taken to prevent a recurrence. Incident reports shall be completed by the individual having first hand knowledge of the incident, including paid and volunteer staff, emergency or temporary staff, and student interns; and
20. Documentation that all of the various notices and copies required by these rules were properly given.
(e) Maintenance of records.
1. Each provider shall maintain a master filing system, including a comprehensive record of each child’s involvement in the program.
2. Records for children currently receiving services shall be kept in the unit where the child is being treated or be directly and readily accessible to the clinical staff caring for the child.
3. The program shall maintain a system of identification and coding to facilitate prompt location and ongoing updating of the child’s clinical records.
4. Records may be removed from the program’s jurisdiction and safekeeping only as required by law or rule.
5. The provider shall establish procedures regarding the storage, disposal, or destruction of clinical records, which are compatible with the protection of rights.
6. Records for each child shall be kept for at least five years after discharge.
7. The provider shall maintain a permanent admission and discharge register of all children served, including name of the child, the child’s parent or guardian, address, date of admission and discharge, child’'s date of birth, custody status, person to which the child was discharged, and address to which discharged.
(13) Quality assurance program. The provider shall develop and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its performance, ensuring compliance with standards, and disseminating results. The quality assurance program shall address and include:
(d) A written system for quality improvement, approved by the provider’s governing board that includes:
1. A written delineation of responsibilities for key staff;
2. A policy for peer reviews;
3. A confidentiality policy complying with all statutory confidentiality requirements, state and federal; and
4. Written, measurable criteria and norms assessing, evaluating, and monitoring quality of care and treatment.
(j) A process for collecting and analyzing data on the use of restraint and seclusion to monitor and improve performance in preventing situations that involve risks to children and staff. The provider shall:
1. Collect and regularly analyze, at least quarterly, restraint and seclusion data to ascertain that restraint and seclusion are used only as emergency interventions, to identify opportunities for reducing the rate and improving the safety of restraint and seclusion use, and to identify any need to redesign procedures;
2. Aggregate quarterly restraint and seclusion data by all settings, units or locations, including:
a. Shift;
b. Staff who initiated the procedure;
c. Details of the interactions prior to the event;
d. Details of the interactions during the event;
e. The duration of each episode;
f. Details of the interactions immediately following the event;
g. Date and time each episode was initiated and concluded;
h. Day of the week each episode was initiated;
i. The type of restraint used;
j. Whether injuries were sustained by the child or staff; and
k. Age and gender of each child for which emergency safety interventions had been found necessary.
3. Prepare and submit a report quarterly to the district/region mental health program office, including the aggregate data and:
a. Number and duration of each instance of restraint or seclusion experienced by a child within a 12-hour timeframe;
b. The number of instances of restraint or seclusion experienced by each child; and
c. Use of psychoactive medications as an alternative for or to enable discontinuation of restraint or seclusion.
(k) Analysis of the use of time-out shall be conducted quarterly by the treatment team and shall include:
1. Patterns and trends, for example, by shift, staff present, or day of the week;
2. Multiple instances of time-out within a 12-hour timeframe;
3. Number of episodes per child; and
4. Instances of extending time-out beyond 30 minutes.
Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08, 5-28-25.