community support services policies and procedures … p&p 2013.pdf · revised sept. 2012 no...

Revised Sept. 2012

No representation is made by NMRC regarding the accuracy of the policies and procedures posted on this site. Please contact NMRC should you have a question regarding the current status of a particular policy.

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COMMUNITY SUPPORT SERVICES

POLICIES AND PROCEDURES

MANUAL

Original: January 1997

Revisions: October 2000 October 2001 May 2002 Jan/Feb 2003

February 2004 February 2005 June 2005 December 2006 June 2007 September 2008 April 2009 January 2010 January 2011

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March 2011 September 2012

PURPOSE

These programmatic policies and procedures will assure that the Community Support

Services Department (CSS) at the North Mississippi Regional Center (NMRC) provides

appropriate community placement options for individuals with intellectual and related

disabilities in its northern 23 county catchment area. Information provided here assures the

development and implementation of quality programs assuring whenever possible, the

provision of or referral to supports and services for individuals in his or her own

community. These policies and procedures were developed specifically to meet the

certification, organization and management, human services, intellectual and related

disabilities services, programmatic and record keeping requirements of OSM. General

regulatory and operational information not already described in the NMRC Policies and

Procedures Manual is included in these departmental policies and procedures. It is the

Department's intention to include any or all applicable regulations or requirements of the

Mississippi Board of Mental Health, the Mississippi Department of Bureau of Intellectual

and Developmental Disabilities (BIDD), and the NMRC.

PHILOSOPHY and GOALS

The NMRC’s CSS Department is committed to the provision of quality supports and

services so that individuals and their families have access to their least restrictive and

appropriate level of services and supports that will meet their needs. Services and supports

are provided to the residents of the north Mississippi region, regardless of physical

handicap, disability, race, creed, color, sex, age, religion, national origin or political

affiliation. The CSS Department respects the dignity of each person and values their

participation/input in the choice and provision of services to meet their unique needs.

The continuing review of requests for service, the development and submission of requests

for funding and the implementation of new programs are constantly undertaken. Case

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Management (CM), Alternative Living Arrangements (ALA), Industries (WAC) and

Prevocational (PV), Day Services-Adult (DSA) and ID/DD waiver services are provided

through the CSS Department at NMRC.

The CSS Department is charged primarily with the responsibility of conceptualizing,

developing, implementing and operating services for individuals who have IDD in the

communities of the 23 northern counties of Mississippi. Included in these

responsibilities are the acquisition of funding for and the monitoring of fiscal

management concerns, the staffing of all programs including all personnel matters and

concerns, the programmatic and quality assurance monitoring of all programs, as well as

the planning and projection of needs in north Mississippi in the future. Coordination

and information sharing with other agencies (i.e., Vocational Rehabilitation, Public

School Systems, Health and Welfare Departments) and organizations (i.e., United Way,

ARC, Civic Organizations, and parental groups) assure carefully planned and well

thought out approaches to service provision. In addition to the general responsibilities

of administering and coordinating these services, the staff assures that all individuals

served are served in their least restrictive environment and are afforded every

opportunity necessary for achievement of skills.

1.0 PROCEDURES FOR CERTIFICATION

1.1 Certification

The NMRC community programs operate under the authority of the Department

of Mental Health (DMH) and are certified as DMH/D. All NMRC community

programs which receive funds from DMH will maintain certification as outlined

in Part I, Procedures for Certification, OSM. (Rule 2.1.C & 2.4.B)

1.2 Posting of Certificate

The DMH Certificate of Operation is posted in each certified program location

for public view. This site specific certificate can not be transferred to another

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location. Changes are reported to DMH, the certificate is returned along with

details of the changes and a new certificate is issued. (Rule 4.B.6)

1.3 Waivers

On occasion, a waiver request might be necessary for program operations. This

request can be initiated by a program coordinator (who oversees the service), a

program director (who oversees the specific program) or the department

director. A written request is made by the Coordinator of the respective

program, based on DMH requirements as outlined in Rule 5.0, Waivers of DMH

Standards, and on information from program staff and is submitted to the CSS

Director. The CSS Director in turn provides this information to the Director of

NMRC to pursue the waiver request following the guidelines as outlined in the

OSM. The waiver request is made in writing and provided to the DMH Division

of Certification by the Director of NMRC (Executive Officer). (Rule 5.0)

1.4 Access to Facilities, Programs, Services and Information

DMH program and fiscal staff will be allowed to enter upon or into the premises

of any program or entity it certifies at all reasonable times in order to make

inspections. DMH staff may interview personnel individually concerning

matters or programmatic and fiscal compliance including follow up on matters

reported to the DMH Office of Consumer Services (DMH-OCS). All requests

for access will be honored. Any member of the department’s Peer Review

Committee who is not an employee of the DMH is required to sign

confidentiality statements prior to their review. NMRC staff may request to

view identification if in doubt as to the identity of DMH staff. The visit may be

unannounced. A written report will be submitted by review staff to NMRC.

(Rule 7.0.A & B) If deficiencies are noted, a response is provided by program

staff.

1.5 Changes to be Reported to DMH

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Changes affecting the governing and/or operation of programs are reported in

writing to the Division of Certification in the DMH. Anticipated changes are

reported before they take place. Changes not anticipated are reported as soon as

they occur. Examples of significant changes that must be reported before they

occur include: changes in governing authority (executive and key leadership);

changes in ownership or sponsorship; changes in staffing that would affect

certification status; changes in program site location; increase in the capacity

above that specified on the DMH certificate; changes in program scope; major

alterations to buildings which house the program(s); and termination of

operation (closure) for a period of one (1) day or more due to inclement weather

or other unforeseen circumstances; changes in the name(s) of the program(s) as

certified by DMH; termination or resignation of the governing authority

member(s), Executive Officer, and key leadership; and litigation that may affect

the provision of services. (Rule 7.2)

2.0 ORGANIZATION AND MANAGEMENT

2.1 Governing Authority

The Mississippi Department of Mental Health (DMH) was created by an act of the

Mississippi State Legislature in l974. The governing board of the Department is

composed of nine (9) members appointed by the Governor of Mississippi. Within

the Department, the Executive Director, who is appointed by the Board, oversees

all administrative functions and implements policies established by the State Board

of Mental Health. BIDD directs the operation of the NMRC, which is the

sponsoring agency for the CSS Department, is a public entity under the direction of

the DMH. (Rule 8.A)

The Governing Authority for NMRC is the Board of Mental Health. The bylaws,

policies and procedures, etc., of the Board are located at the Office of the Executive

Director, The DMH in Jackson, Mississippi. (Rule 8.B)

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These bylaws and policies establish in writing the means by which the governing

authority provides for the election or appointment of its officers and members and

the appointment of committees necessary to carry out its responsibilities. (Rule

8.B)

The bylaws and policies show documentation of the adoption of a schedule of

meetings and quorum requirements. Meetings are held at least quarterly with

special meetings as deemed necessary. No action shall be taken unless there is

present a quorum of at least five (5) members (none of which consist of employee

or immediate family members of employees). The meetings are open to the public.

Members of the Board of Mental Health do not receive a per diem that exceeds the

state limit. Minutes of meetings are maintained by the secretary to the Executive

Director of DMH. Minutes include date of the meeting, names of members and

others attending, topics and issues discussed, motions, seconds and votes, public

comment, and establishes an organizational structure as evidenced by an

organizational chart. (Attachment 1) Minutes are located in the office of the

Executive Director, DMH, Jackson, Mississippi. (Rule 8.B)

The Director of NMRC is appointed by the Board of Mental Health and acts as the

Governing Authority for the CSS Department. The current NMRC Director meets

required qualifications of having at least a Master’s Degree in a mental health or

related field with a minimum of three (3) years administrative experience in

programs related to mental health, intellectual/related disabilities, or substance

abuse services and/or programs. The policies and procedures of the NMRC are

located in the offices of each department director at the Center. Documentation of

the appointment of the Director of NMRC as full-time Chief Executive Officer

(CEO), establishment of the Director’s authority and responsibility for the

management of the program and for carrying out the policies of the board, are

maintained in the office of the Executive Director of the DMH, as are policies for

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completion of an annual evaluation of the Center Director annually that is available

for review. Establishment in writing of designated staff positions to be in charge of

all program operations in the absence of the Center Director is maintained in the

Manual of Policies and Procedures, NMRC. Staff are designated as the Assistant

Director for Programmatic Services and the Assistant Director of Administrative

Services. In the absence of the Center Director, issues are routed to the appropriate

Assistant Director.

The NMRC Director supervises the development and annual review of NMRC’s

Policies and Procedures Manual. This manual lists and describes, but is not limited

to, the following; organizational structure of the program (including an

organizational chart), personnel policies and practices, confidentiality policies and

practices, financial management policies and procedures, individual rights policies

and procedures, environmental safety procedures, case record management and

record-keeping policies and procedures, medication control policies and

procedures, policies and procedures for service elements (including specific

location and hours of operation), and policies for written affiliation agreements.

(Rule 8.3)

The Director of the CSS Department is appointed by the Director of the NMRC. In

the absence of the Director of NMRC, guidance and support are provided by the

Assistant Director for Programmatic Services. The Director of the Department is

charged with the responsibility of the overall operation of the programs and

services. In the absence of the Department Director, the ALA/CM Coordinator and

the WAC/DSA Coordinator each assume responsibility for their respective

programs. Decisions requiring collaboration are made jointly with assistance, if

necessary, requested from the CSS Director, the Assistant Director, and/or Center

Director of NMRC. An organizational chart is included as a part of the Policies

and Procedures Manual. (Attachment 1)

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The NMRC’s governing board annually reviews the budget, written affiliation

agreements, all policy and procedure changes, and the disaster preparedness and

response plan.

The HCBS department of the NMRC has established an Individual/Family

Advisory Committee to advise the governing authority comprised of all Department

Directors and the NMRC Director on issues which include the following:

C Individual/family satisfaction;

C Performance Outcomes;

C Program Planning and evaluation;

C Quality assurance/improvement;

C Type and amount of services provided;

C Other issues/items that the advisory committee chooses to

address.

In addition to information gathered by the Review Committee related to

individual/consumer satisfaction with availability, accessibility, and

appropriateness of services received through the department, individuals and family

members are given the opportunity to complete an annual Satisfaction Survey.

(Attachment 30) The results of these surveys are evaluated and used as the basis for

modifications in availability, accessibility and appropriateness of services, as

needed. Survey results are summarized and submitted to the DMH along with the

Program Evaluation and Utilization Report (i.e., Final Narrative Report) within 30

days of the close of the fiscal year. (Attachment 29) Documentation of the fact that

a written report of the review of the utilization of services has been provided to the

governing body, funding source, and appropriate staff members is found in the

minutes of NMRC Department Directors’ Meetings. The written report of

evaluation and program utilization is submitted to within 30 days of the close of the

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fiscal year.

2.2 Policies and Procedure Manual

The CSS Director develops and updates annually the CSS Department Policies

and Procedures Manual. The manual includes, but is not limited to, all policies

mentioned above. It specifically addresses all sections and relevant standards in

Part I and all services provided under Parts II through VII, IX, and XI. Detailed

information and attachments of relevant forms and operational materials are

provided which would assure the continuation of quality program operations in

the absence of experienced staff. (Rule 8.3)

Both policy manuals (NMRC and Departmental) are reviewed and approved at

least annually and updated as appropriate by the governing authority. Review

of the CSS Department Policies and Procedures Manual is conducted annually

at a designated Department Director’s Meeting and is documented in the

minutes and readily accessible to all staff. A copy of the NMRC and CSS’

Policies and Procedures Manual is maintained in the office of the CSS Director.

The CSS Department Policies and Procedures Manual is maintained in the

Department Director's office as well as on site at each satellite program.

Documentation of evidence of reviews of this manual is also maintained in the

personnel file of all individuals employed after January 1, l989 along with

documentation of review of subsequent changes. (Attachment 2) Requests by

the public for review of the departmental manual are documented and the

manual is made available to the individual requesting. (Rule 8.3)

Changes to the policies and procedures will be approved by the governing authority

prior to being instituted. As changes are proposed and approved, new pages will be

distributed to all sites. Pages which bear changes have a notation in the bottom

right corner showing the date approved/revised. (Rule 8.3)

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[NMRC is exempt from 8.4 – the Annual Operations Plan]

2.3 Quality Assurance

Quality management strategies have been put in place which allow for the

collection of performance measures as required by the DMH (when applicable).

Additionally, a Quality Management Committee (QMC) has been developed to

provide oversight of the collection and reporting of DMH performance measures,

written analysis of serious incidents, periodic analysis of DMH required client level

data collection and the oversight for the development and implementation of DMH

required plans of compliance. (Rule 9.0)

3.0 FISCAL MANAGEMENT

The CSS Department follows the business policies and practices as prescribed by the State

Department of Finance and Administration, the Department of Mental Health (DMH) and

the NMRC. The Business Office at NMRC is mandated to implement and carry out the

policies and procedures of fiscal management for all departments, programs and services at

NMRC. The Business Office Policies and Procedures Manual is available in the NMRC

Business Office and the NMRC Director’s Office. (Rule 10.0)

3.1. Budget

The program prepares and maintains annually a formal written, program-oriented

budget of expected revenues and expenditures. CSS programs maintain a budget

by category in the areas of personnel, travel, contractual services, commodities and

equipment. This budget categorizes revenues for the program by source, noting

contribution sources as federal, state and/or local. The budget accounts for federal

funds separately in accordance with the Single Audit Act of 1984. Monthly reports

are provided by the Business Office to the department concerning all programs and

providing current and year-to-date balances and budget remaining. Expenses are

categorized by the types of services or program components provided and/or grant

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funding as mentioned above. Copies of all budgets (pertaining to this department)

are available in the CSS Director's Office and in the Business Office at NMRC.

(Rule 10.1)

3.2. Fiscal Management System

The fiscal management system used by the Business Office of the NMRC

produces monthly financial reports that show the relationship of budget and

expenditures, including both revenues and expenses by category. This system

assures that budgeted amounts in grants with DMH are not exceeded. This

monthly report is prepared and distributed by the NMRC Business Office and

addresses not only departmental standing, but it also addresses each program by

grant and/or cost center code. These reports are available at any time in the

NMRC Business Office. Recipients include the Center Director of NMRC, the

CSS Director and the Program/Service Coordinator. (Rule 10.2)

The fiscal management system provides for control of accounts receivable and

accounts payable, for the handling of cash, credit arrangements, billings, and for

individual accounts in the ALA programs. Presently, there are no discounts or

write-offs. (Rule 10.2)

The fiscal management system used by NMRC’s Business Office produces

monthly financial reports that show the relationship of budget and expenditures,

including both revenues and expenses by category. This monthly report is prepared

and distributed by the Business Office to addresses departmental standing. These

reports are available at any time in the NMRC Business Office. Recipients include

the Director of NMRC, the CSS Director and the Program/Service Director. The

fiscal management system as it now operates provides for control of accounts

receivable and accounts payable, for the handling of cash, credit arrangements and

for generated income accounts in the WAC programs. Presently, there are no

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discounts or write-offs. (Rule 10.2)

The NMRC Business Office assures that all generated income accounts submitted

through the WACs are included in required fiscal audits. Program generated

income reports and related expenditures reports are submitted monthly with the

program’s cash request. (Rule 10.2)

Expenditures of generated income are documented as enhancing or enriching the

program and not being used as a part of the required match. Prior written

approval must be obtained from the CSS Director and the NMRC Director for

expenditures of generated income for supplies needed for subcontracts/products.

The WAC Director submits the appropriate form requesting expenditure

including item, quantity, cost and justification of need. This form is reviewed

by the WAC Coordinator, and if approved, is forwarded to the CSS Director,

and the Director of NMRC. No expenditures from generated income are made

unless the above parties have approved. (Attachments 21 and 22) Quarterly

internal audits are conducted at each WAC program by the staff of the Business

Office at NMRC. At least annually DMH Auditors conduct audits of these

programs. All generated income accounts are included in these required fiscal

audits. (Rule 10.2 & 10.8)

It is the responsibility of the NMRC Business Manager to oversee the accounting

and bookkeeping procedures for the ALA accounts and to conduct audits of the

accounts no less than quarterly. Prior to implementation of an ALA program,

written permission must be obtained from the Business Office to open the bank

accounts required by the program. The procedure and format for requesting

additional bank accounts is outlined in the Business Office Policies and Procedures.

Audited financial statements are conducted by the State Auditor’s office. These

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statements include foundations, component units, and/or related organizations,

presented to the governing authority and to the DMH no later than nine (9)

months of the close of the fiscal year, are in accordance with the Single Audit

Act of 1984 and include a management letter describing all financial operations

of CSS’ community programs. (Rule 10.3)

An independent audit of the fiscal management system is conducted annually. It is

performed by the State Auditor's Office for state agency operated programs. An

internal auditing system is in place through NMRC’s in-house personnel (a

certified public accountant) who conducts a quarterly audit. All generated income

accounts are included in the required fiscal audits. The Business Office submits

program generated income reports and related expenditure reports with the monthly

program cash request. All audit information is presented to the agency's Governing

Authority and to DMH upon completion. This audit is conducted in accordance

with the Single Audit Act of 1984, Circular A-128 (located in Section III of the

Department of Mental Health Service Providers Manual). The annual audit is

completed within nine (9) months of the close of the fiscal year. A management

letter, describing the financial operation of the program, is maintained in the

Executive Director's Office, the State Department of Mental Health. (Rule 10.3 &

4)

All purchases for CSS are routed through the NMRC Business Office. The

Business Office utilizes accounting systems consistent with state agency

requirements, including required computerized journal categories which are

updated at least monthly, providing adequate sources of documentation for all

expenditures for any allocation method utilized, and insuring that checks issued

have two signatures. Two signatures are required on all checks issued by a

program. The ALA program funds are maintained in the Business Office. The

two signatures required for issuance of all checks are those of the Director of

NMRC, and the Business Manager or Accounting Clerk. The WAC program

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funds from generated income are maintained on site at each program. The

Director of that program and the bookkeeper of that program are co-signatories

on that account. All other checks issued pertaining to this department by the

Business Office are signed by the Director of NMRC, the Business Manager of

NMRC and/or the Accounting Clerk. Federal funds are expended in accordance

with the applicable federal cost principles (OMB Circular A-87 for State and

local governments) and that all funds are expended in accordance to procedures

set forth in the DMH Service Provider’s Manual. This is overseen by the

NMRC Business Office to ensure that all accounting and financial personnel

adhere to ethical standards, and to provide for appropriate training of accounting

and financial staff preventing misuse of programs and funds of those individuals

receiving services. (Rule 10.4)

A cost accounting system which defines and determines the cost of single units

of service is in place in the Business Office at the NMRC. Monthly data

reported provides that office with information necessary to calculate the cost of

units of service by program. (Rule 10.4.A)

Supportive documentation, such as time and attendance records, are kept on a

daily basis at each program site, submitted to the CSS Department for approval,

and forwarded to the Payroll Division of the Business Office for review, payroll

computation, and filing. Policies of the NMRC are followed in the area of time

and attendance. (Rule 10.4.B.3)

[Rule 10.5.2 is not applicable as it refers to CMHCs]

3.3 Purchasing Procedures - General

Policies and procedures have been developed which govern the control of

inventories, including purchasing authority and procedures and supply, storage and

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distribution. All purchases made by program staff are approved first by the

Department Director and secondly by the Director of the Business Office. Proper

accounting and administrative controls are in place. All ledgers and journals are

posted at least monthly. Invoices and contracts are kept on file as documentation

for expenditures. (Rule 10.5) The agency's purchasing process including the

procedures involved in preparation and processing of requisitions, bids from

suppliers, purchase orders, receiving reports, vendor invoices, cancelled checks and

contract agreements is described in detail in the NMRC's Policies and Procedures

Manual and the Business Office's Policies and Procedures Manual. Regulations

prescribed by the Bureau of Purchasing are followed strictly. Compliance with

these regulations is assured by review and approval at different levels of

administration. Purchasing, storage, and distribution of assets are governed by

these procedures and are in accordance with federal and state regulations. (Rule

10.5)

Items purchased with grant funds must be entered in the inventory system to

include all equipment on a master list indicating at least the following information

of each piece of equipment:

- Serial number;

- Cost;

Date purchased;

- Grant funded program item is to be used for; and

NMRC inventory number affixed on a label and placed on

the item. (Rule 10.5.A.4)

Documentation of additions to and deletions from fixed asset inventory is

maintained by the NMRC Property Officer and the NMRC Business Office. The

CSS Department receives an inventory list by program each month and submits an

Inventory Addition/Deletion Form (Attachment 28) at the time inventory is

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transferred in or out of a program or is deleted. Inventory is added by the Property

Officer based on receipt of invoices and notification of donations in his office.

DMH-101-01 is used as prescribed by the DMH Service Providers Manual.

Written permission is obtained by NMRC’s Property Officer prior to disposal of

real and personal property paid for with state appropriated funds. (Rule 10.5.A.5)

All property and equipment ledgers are reconciled periodically to general ledger

accounts. (Rule 10.5.A.8)

3.4 Purchasing Procedures – Industries (WACs)

The NMRC WACs operate with matched state funds projected for and included in

the annual agency appropriation. A copy of the budget for each WAC is on file in

the office of the CSS Director, the Business Office and the Office of the Director of

NMRC.

Accounting Procedures

The NMRC's WAC Programs maintain one checking account into which all monies

are deposited and approved expenditures and payroll are paid. All transactions are

by check only and must be co-signed by the program director and the Account

Auditor Technician (AAT) or designated representative. However, if the item to be

purchased is a WAC-made item, cash is accepted. If cash is accepted, two (2) staff

witness the transaction, a duplicate receipt is given and the money is deposited at

the program’s local bank within 24 hours. All mail is opened by the program

director and any money received is noted. These funds are turned over to the AAT

or designated representative for posting and deposit. Receipt records are reconciled

monthly. Bank statements for the account are mailed each month directly to the

WAC Coordinator at which time the statement is opened, reviewed, each page of

the statement initialed and dated. The WAC Coordinator makes a copy of the entire

statement and provides the copy to the Internal Auditor. The original bank

statement is then forwarded to the program to be reconciled monthly by the AAT or

designated representative and reviewed by the program director. Both will sign and

date the statements as they are reconciled.

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Income generated by the WAC is to be used to meet necessary overhead, to pay

individuals, and to make purchases which are directly related to subcontract

work (Program Income, this section). All workshop equipment, supplies, and

facilities are to be used for the production of goods and materials for that WAC

or provision of services to businesses or industries with which the workshop is

subcontracting. None of the above items can be used for personal benefit. In

addition, items produced by the WAC can be sold only to a reputable vendor.

No staff may make or purchase items for personal use or for gifts. An exception

can be made only when items are priced and sold to the general public at either

an open sale or in the context of a retail establishment. Program staff must pay

by check with a receipt kept by the workshop and the price must be the retail

price paid by the public. Program staff may not purchase items which are not

available for purchase to the general public.

Types of Work

Subcontract

When negotiating with an industry or business for a contract, the

WAC must sell its ability to produce, the quality of the

production, and the professionalism of the program. Contracts are

based on a business relationship rather than a charitable donation.

With this in mind the negotiating must include an understanding

of the type of production expected by the company, the quantity

needed, the time frame, and the quality control expectations. All

subcontracts or bid documents with business or industry must

have an agreement signed by the contractor and the WAC. The

agreement must contain a price per quantity, quality control

provisions, specific description of the work to be performed, and a

renegotiation clause. This agreement must be reviewed annually.

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Direct Sales

Workshops may sell prime manufactured products directly to the

public. Direct sales must have consistent pricing on all items and

must be competitive in pricing with similar products on the

market. All sales must have a receipt given to the buyer and a

copy retained by the WAC. Direct sales cannot be used in

conjunction with subcontracting on the same product without a

clause in the subcontract agreement allowing for such.

Consignment Sales

Workshops may enter into a consignment agreement with retail

establishments. However, a receipt in triplicate must be signed

upon delivery to the retail establishment indicating the items

delivered and the price per item. Any direct sales of consignment

items other than through the retailer must be agreed upon between

WAC and retailer prior to any direct sales. In addition, a time

frame for sale of consignment items prior to delivery needs to be

agreed upon between retailer and WAC.

Financial Procedures

The financial operation of the workshop is determined by three main areas:

production, the income, and the payroll.

Production

Production is comprised of preliminary pricing, individual production rate

determination or individual piece rate determination, and production record

keeping.

Production Records

Production records are mandatory for all activities during the daily operation of the

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workshop and include the following: (Attachment 20)

a. individual name

b. pay period

c. day of the week

d. job

e. time intervals per activity

f. number of items or pieces produced

g. rate of pay

h. subtotal of money per job

i. total paid for a two week period

j. total time worked for two week period

k. units per hour produced

The production record should reflect what the individual does throughout the

day. A code chart for production records lists the code for each job and each

element of the job, if necessary. The WAC supervisors or aides are responsible

for maintaining the production records for each individual supervised.

Production records are used by the AAT or designated representative to figure

payroll bimonthly.

Preliminary Pricing

Preliminary pricing is determined by a time study which is required for all

contracts, unless minimum wage is paid. The Time Study Observation form may

vary but must include the date of study, the company, address, description of the

operation, element description, no less than three - twenty minute time recordings,

an average time, start time, stop time, and the pace. Any jigs or devices to improve

production should be assembled and tested prior to the study to maximize speed

and to reduce complicated procedures. (Attachment 19)

From the time study, a price per item or per quantity is determined. The rate of pay

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is based on the prevailing wage for the area for the job or task paid to an

experienced worker with no disabilities. In addition, the bid price to the company

should include any overhead costs needed to produce the quantity required.

Individual Piece-Rate Determination

From the time study, an average unit per hour is computed. This figure is divided

into the prevailing hourly wage (which may exceed but must be at least equivalent

to minimum wage). From this, direct labor cost paid to the individual per unit of

production is determined.

One of the objectives of the workshop is to provide training, thereby, enhancing

work skills. Subsequently, individuals should rotate through jobs in order to

provide training in the various aspects of product production. However, limitations

of individuals and realistic limitations of production may prohibit some individuals

from training in all phases of productions.

Program Income

Program income is generated from subcontracts. The income must be

sufficient to pay individuals, buy supplies related to work, and allow for

miscellaneous workshop expenses. These funds are used to enhance or

enrich the program. They are not being used as part of the required match.

Prior written authorization is not required for individual wage payments.

Authorization for expenditures of generated income for supplies needed for

subcontracts/products is handled in house using a written request form

(Authorization for Expenditures of Generated Income for Supplies) signed by the

CSS Director and the Director of NMRC. (Attachment 21a) Prior written

authorization for utilization of generated income for anything other than

supplies

needed for subcontract/products is maintained by the program and submitted on

Authorization for Expenditures of Generated Income- Other for Requests.

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(Attachment 21b) Payment schedules for work completed should be established in

the negotiation phase of the contract. Payment may be monthly, upon delivery of a

portion of the job, or upon completion of the job. Payment should, however, be at

least monthly to insure cash flow. Actual bookkeeping related to income consists

of

delivery receipts, billing procedures, and writing checks from general account.

Generated income forms may be used to request funds for flowers, cards, etc. in the

event an individual is in the hospital, injured, etc. In no circumstance may

generated

income forms be used to request flowers, cards, etc. for staff or their relatives.

Delivery Receipts

The workshop must maintain delivery receipts for all subcontract work or direct

sales completed and picked up or delivered. (Attachment 23) The delivery receipt

is filled out in triplicate and contains the following.

a. name of the contractor

b. address

c. order number

d. date

e. place of delivery

f. address of delivery

g. number of items delivered

h. the price per item

i. the total amount of delivery

j. any additional cost (i.e. supplies, travel)

k. signature of company representative

Upon delivery of the completed product, the triplicate invoice is signed by the

receiving individual, and at that point, the original is given to the subcontractor.

The two remaining copies are kept at the WAC for accounting and tracking

purposes.

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Billing

Prior to billing, a folder should be set up for each company. The folder will include

a Billing Statement. (Attachment 24) Additionally, a running ledger is kept on each

company noting the date of billing, the amount, and when the bill is paid.

Billing statements are made in triplicate. The billing statement contains the

delivery receipt number, the date of delivery, the amount of bill, any overhead such

as supplies, etc., the amount previously paid, and any balance due. A copy of the

delivery receipt is attached to the billing statement. When a bill is paid on delivery,

this noted in the ledger with the date.

All money will be deposited within two business days of receipt. All contract

money is deposited into the general account. Periodically, or at least yearly, an

assessment should be made to determine the time lines of payments, the cash

flow,

and the profitable nature of the contract.

Purchasing from General Account

All pre-approved purchases made from general account monies are by check

co-signed by the director and the AAT or designated representative.

Supplies bought for subcontract purposes are paid from this account. When

supplies are purchased a store receipt is obtained specifying the number of items,

the cost per item, the total cost, and the signature of the staff member making the

purchase. A copy of the receipt is attached to the billing statement to the

company

when the company is responsible for the cost of the supplies. All items purchased

from subcontract funds must have signed receipts. In instances where equipment

is purchased, the billing and purchasing procedures required by the NMRC must

be applied.

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3.5 Purchasing Procedures - Alternative Living Arrangements (ALA)

The NMRC ALA programs operate on a budget with grant resources (when

allocated) from the State DMH, payments by individuals and house managers and

additional funding through the NMRC self-generated funds. When available, grant

allocations consist of salaries for the ALA house managers, apartment supervisors

and relief staff. In addition, a limited amount of supplemental funds in the

categories of rent, utilities, and supplies are provided. Financial obligations of

individuals and house managers are determined based on living costs and the

amount of supplemental funds. A budget is developed in conjunction with the

approved categorical allocations from grants. The budget is presented to the

Director of the NMRC for approval. A copy of the approved annual budget and

grant proposal is on file in the office of the CSS Director, the Business Office and

the office of the Center Director of NMRC. (Rule 10.6)

All financial transactions for the NMRC ALA are handled through the Business

Office of the NMRC. It is the responsibility of the CSS Director to assure that all

fiscal management policies and procedures for the CSS Department are

implemented and practiced and revised as necessary, but not less than annually.

All purchasing for the ALA must follow purchasing procedures for the NMRC and

are handled through the NMRC Business Office. Most items purchased for the

ALA programs such as food and supplies are purchased on a pre-arranged credit

arrangement with the NMRC and local vendors. House Managers/Supervisors and

the Administrative staff of the CSS Department may make purchases for the ALA

programs. Monthly purchases are made within the boundaries of the prescribed

budget for the individual ALA as developed annually by the CSS Director. Any

purchase from program funds must be accompanied by an itemized receipt for the

purchase signed by the house manager/apartment supervisor or other authorized

staff making the purchase. Any individual purchase over $50 must be approved in

advance by the Director or ALA Coordinator of CSS. All itemized receipts are

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turned in monthly for review by and co-signature of either the ALA Coordinator or

the CSS Director prior to being turned into the Business Office Accounting Clerk

for payment using the check writing procedures as described in the previous

section. Because the NMRC is a state agency with tax exempt status, purchases

made specifically for the ALA program are not taxed. However, purchases made

for individuals from his/her personal accounts are taxed. All purchases made in the

implementation of an ALA program, made to replace furnishings or appliances or

purchases/payments using grant funds are made following NMRC and state

purchasing procedures (state purchase requisition procedures) by the ALA/CM

Coordinator and/or CSS Director with the approval of the Director of NMRC and

the NMRC Business Manager. (Rule 10.6)

Individual’s Savings Accounts

In addition to reporting all information regarding an individual’s change of status in

living arrangements or financial status, some individual’s may achieve ISP goals

allowing them to maintain a personal savings account in the community.

Individuals identified by each ALA Group Home or Apartment staff and who

express the desire for individual commercial savings accounts in order to develop

more independence in money management may have an individual savings

account. This will be based on the following criteria:

1. Individual chooses to participate in Ain house@ banking successfully.

2. Individual can write own name or appropriate mark.

3. Individual participates in contract work or other employment on a

regular basis.

4. Individual understands the concept of money.

5. Individual understands that a paycheck is money.

6. Individual participates in the completion of a deposit or withdrawal

slip by completing at least a portion of it (in addition to the signature) on

his/her own or by copying an example.

7. Individual is recommended by group home and supervised apartment

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staff and meets all the criteria for participation. (Rule 10.6)

To open and maintain an individual savings account, permission from the parent or

guardian (where applicable) must be obtained by the group home or supervised

apartment supervisor. The following procedure will be used upon receipt of

permission. All accounts will be opened at a local commercial bank. (An attempt

to get banks to waive minimum balances, deposits, and other restrictions will be

made.) The Supervisor/Designated staff will assist the individual in opening the

account. No additional names other than the individual’s will be on the account.

Bank statements will be sent to the individual at the program location. Banking

will be done once per week or as program activities dictate. Individuals will sign

and retain a receipt at the WAC documenting receipt of their check and deposit it

into their savings account. Individuals who receive a check from a community

employer will deposit it. A copy will be made of the check and sent to the

Reimbursement Officer. If possible, individuals will complete the deposit and

withdrawal slips when banking. The slips will be kept in the individual’s records.

A cap of $2,000 will be observed on the savings account. Individuals can access

their accounts for purchases and field trip money unless their balance will be $20 or

less. In this case, funds may be requested from the Reimbursement Officer at

NMRC. (Rule 10.6)

Other

A printout of individual account balances is received by the CSS Department on or

about the 20th of each month. At that time, if an individual’s account is within

$200 of reaching the maximum balance, it is the responsibility of the ALA

Coordinator to assure that some of the individual’s personal funds are expended for

needed items. The ALA Coordinator, the House Manager/Supervisor, and the

individual to develop a list of items needed by the individual which must be

reviewed and approved by the CSS Director and meet guidelines of the SSA for

expending surplus funds. House Managers/Supervisors are instructed to encourage

Revised Sept. 2012


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individuals to purchase functional and needed items such as clothing, furniture,

small appliances, etc. in preparation for movement to more independent living

situations. (Rule 10.6)

In-House Savings Account

Individuals of all ALA programs may maintain an "in-house savings" account with

a maximum amount of $50.00. House Managers supervise the use of this account.

All individuals in the program will be offered an in-house savings account.

Individuals will have the option of spending their money on items they may

purchase at local stores or save all or portions of the money in an Ain house@ bank

savings account. Upon successful participation in this system, individual

documentation of deposits and withdrawals of individuals may be eligible to

participate in a commercial savings account. The Supervisor/House Manager will

be in charge of all banking processes and documentation on the Individual’s

Savings Record. (Attachment 18) (Rule 10.6)

The in-house account will be opened and maintained in the following manner.

Each individual will have his/her own Savings Record. These forms will be kept in

a three ring binder. Information kept on the forms will be:

1. Name;

2. Account Number (optional);

3. Date;

4. Transaction (deposit, withdrawal, balance, etc.); and

5. Signature

The Supervisor/Designated Staff will assist the individual in filling out the Savings

Record. These forms will record transactions to the individual’s account as they

occur. A two-part deposit/withdrawal form with be used to document transactions.

The form will indicate all pertinent information to include the above. The staff

assisting the individual in performing the transaction will sign and date the form on

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the indicated lines. The individual will be given the yellow form and the white

original form will be placed in a 5 x 9 envelope with the savings money. The

envelope will have the individual’s name on the front of it and inside should only

have the white receipt and the money. The Supervisor/Designated staff will assist

the individual in filling out this form. (Rule 10.6)

Each time there is a transaction, the Supervisor/Designated staff will count the

individual’s money to ensure that the money in the envelope matches the balance of

the money that is on the Savings Record and the two-part deposit/withdrawal. The

money envelope will be locked in a lock box inside of a locked file cabinet. Upon

completion of the deposit/withdrawal form, the applicable information from that

form will then be transferred to the individual’s Savings Record. Again, the

Supervisor/Designated staff will assist the individual in recording this information.

Ten days from the end of the month the Supervisor/Designated staff will report to

the Reimbursement officer the amount of money in each individual’s Ain-house@

savings account. (At any time, funds permitting, an individual may request funds

for desired purchases requiring larger amounts of money.) The Reimbursement

Officer will be responsible for administering funds in the individual’s NMRC

account. (The Supervisor will be responsible for in-house funds.) (Rule 10.6)

The NMRC Internal Auditor may perform periodic audits of these Ain house@

banking accounts in order to determine compliance with NMRC money

management policy and proper safeguarding of individuals’ assets. Any problems

encountered during the audit will be communicated in memo form to the agency

director, the CSS Director and the ALA Coordinator. Funds for use in the Ain-

house@ bank may include spending money, funds received from family members on

home visits, or cash gifts from family members. (Rule 10.6)

A check is written monthly by the Reimbursement Office for the fixed spending

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money for all individuals. An ALA staff member is responsible for obtaining the

check from the Reimbursement Office, cashing the check, delivering the cash to the

individuals, having the receipt signed and returning the signed receipts to the

Reimbursement Office. An individual cash ledger sheet is maintained on each

individual showing the amount received, the date of receipt and any personal

expenses incurred which are paid from spending (i.e. long distance telephone calls,

personal items, etc.). A signed receipt is obtained from the individual when

spending money is received. The SSA allows an individual drawing SSI to attain a

maximum balance of $2000 in his/her personal account. (Rule 10.6)

Commercial Savings Account Record Keeping

Record-keeping duties, documentation, and the responsibility for individual funds

is assumed by the group home staff. A goal is added to the individual >s ISP before

accounts are opened and the group home/supervised apartment staff approves. The

following procedure is used to maintain records in the ALA Group Homes and

Apartment for individuals with a commercial savings account. A folder for each

individual participating in this program is kept. The folder has 12 compartments

(one for each month). Deposit slips, withdrawal slips, bank statements will be

retained by the month and related information should be clipped together and

placed in the appropriate section of the folder. The Supervisor/Designated staff

person will retain the parent/guardian permission letter in the file. Ten (10) days

from the end of the month, the staff will report via verbal or fax to the

Reimbursement Officer the amount of money in each individual’s commercial

savings account. A monthly report signed by the Supervisor will be completed and

sent to the Reimbursement Office on the first day of the following month. The

form reflects all transactions including deposits and withdrawals and receipted

amounts during that month. A copy is retained and placed in the individual folder.

The WAC payroll register is signed by the WAC Director, Account Auditor

Technician (AAT), and/or Vocational Training Instructor (VTI) and sent to CSS

monthly. Individuals retain receipts for pay received (along with their checks).

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The program director and/or VTI signs receipts and a copy of the receipt is retained

at the WAC. The NMRC Internal Auditor performs periodic audits of the

documentation maintained. The auditor checks each individual’s commercial

savings account (community home or apartment) in order to determine compliance

with the NMRC money management policy and proper safeguarding of

individual’s asset. Any problems encountered during the audit are communicated

in memo form to the agency director, the CSS Director and the ALA Coordinator.

The ALA Coordinator will review the utilization of bank accounts by the individual

each month. Individual progress is documented on the Supervised Activity

Summary or Supported Living Progress Notes and the individual’s ISP. (Rule

10.6)

The Supervisor, with permission from the Coordinator, may assist the individual in

closing the savings account if the individual requests it or there is a prolonged lack

of progress and/or there is inappropriate utilization of the account. (Accounts may

be reinstated contingent upon approval by the Supervisor or Coordinator.)

Reconciling Savings Accounts

The individual’s account paperwork is reconciled with the bank statement when

received and the original bank statement is retained in the home/apartment records.

A verbal account is given to the individual monthly and a copy is mailed to the

Reimbursement Officer. These policies and procedures will be adhered to in each

ALA program.

A Money Management Training Skills program must be completed by the

individual prior to opening a savings account. Any information regarding these

accounts must be reported to the Reimbursement Officer and the Business

Office Accounting Clerk. It is the responsibility of the ALA Coordinator to

communicate with the Reimbursement Officer and the Business Office

Accounting Clerk the date the individual opened the savings account, the name

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and address of the bank in which the account was opened, the savings account

number and the amount initially deposited into the account. A copy of this

information is placed in the individual’s file in the Business Office as well as in

the individual record. It is the responsibility of the ALA Coordinator to assure

that the House Manger or Supervisor of the Apartments turns in monthly to the

Business Office Accounting Clerk copies of any deposit or withdrawal

transactions made by the individual during that month along with the current

balance of the account. A record of the transactions is recorded in the

individual’s savings account passbook with the deposit or withdrawal slips and

will be maintained in the individual record. The Reimbursement Officer is

responsible for reporting information regarding the individual’s savings account

to the SSA. (Rule 10.6)

Individual’s Funds Accounts

All monies collected from ALA individuals are maintained in the individual

programs' general accounts are interest-bearing and are managed by the NMRC

Business Office. Interest accrued on the Operating (Program) Account is credited

to the programs. Individual money in excess of fixed fees is for the personal use of

that individual and is maintained in the NMRC ALA Individual Personal Account

(IPA) which is managed by the NMRC Business Office.

The IPA is an interest-bearing account and accrued interest on the IPA is pro-rated

based on their balance and distributed to their account monthly. The interest

information for each individual is forwarded to the SSA monthly. Upon receipt of

the individual’s monthly check, as well as the individual’s workshop and

competitive employment earnings, the Business Office Reimbursement Officer or

another authorized employee of the Business Office deposits the check in the

NMRC ALA IPA with a receipt attached to the deposit slip. All checks are

stamped, "For Deposit Only - NMRC ALA - Personal". Checks are written

monthly for the individual’s fees and expenses from the IPA and deposited to the

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Program General Account. All expenses related to the operation of the ALA

program are paid by check and recorded on computer. Fixed fees accounts are

maintained by separate ledger sheets which indicate all debits and credits to the

account and by which a current balance can be maintained at all times. Bills must

be accompanied by a signed invoice (individual and/or House Manager, CSS

Director and/or ALA Coordinator) which is maintained on file by the NMRC

Business Office. Bills for rent, utilities (electricity, gas, and cable television), lawn

care, telephone expenses, and pest control are mailed directly to the NMRC

Business Office for payment with subsequent review by the ALA Coordinator or

CSS Director. All other documentation of expenses (food supplies, gas and oil) is

turned in monthly by the program house managers and supervisors to the ALA

Coordinator for review and approval. All expenses require an itemized receipt

signed by the house manager and reviewed and co-signed by the Director or ALA

Coordinator of CSS before sending to the NMRC Business Office where the

receipts are kept on file. Within two months of an individual’s admission to an

ALA, it is the responsibility of the house manager/supervisor to notify the Food

Stamp Unit of the Department of Public Welfare and give all information relative

to an individual receiving food stamps. A Consent for Information Disclosure

Statement must be completed and signed by the individual or legal guardian prior to

release of that information and renewed every six months. It is also the

responsibility of the house manager/supervisor to report the amount of food stamps

received each month for all individuals to the Business Office. The

Reimbursement Office is responsible for generating the food stamp letters that the

house managers pick up at the beginning of each month. The letters contain current

benefits and interest amounts for the previous month. The monthly Food Stamp

Report must balance on hand at the end of the previous month plus food stamps

received during the month minus receipts for food purchases equals food stamps on

hand at the end of the current month. (Attachment 17) The food stamps and food

receipts record is reviewed and signed by the House Manager and is maintained on

file in the Business Office. (Rule 10.6)

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All allowances for individuals such as food stamps or HUD housing allowances are

deducted from the fixed fee charged the individuals. A record is maintained on a

Monthly Food Stamp Report form indicating the amount received for each

individual and the total spent with accompanying receipts. (Attachment 17)

A ledger is maintained in the Business Office for each individual which includes all

checks paid, received, the date and a running balance. All checks from any ALA

account require the joint signature of the Business Manager, Accounting Clerk or

the Director of NMRC.

Individual Spending Money

All individuals receive monthly spending money from their income. The weekly

allowance ranges from $10 to $50 depending on the status of the individual’s

account for each individual enrolled in the ALA programs. It is expected that

house managers will assist individuals in spending a portion of this weekly

allowance for the purchase of any needed personal hygiene items and for planned

activities. Individuals may at any time request funds from their personal accounts

for expenses above and beyond their spending money. If an individual has a need

to purchase clothing, personal supplies or any other needed item over and above

the

amount of cash spending money he/she has, the House Manager/Supervisor with

the permission of the ALA Coordinator may notify the Business Office of the

amount of the needed item and the Business Office Reimbursement Officer will

write a check from the IPA for the amount of the item. Three (3) days notice is

required for a check to be prepared. If the House Manager/Supervisor knows that

an individual will need additional funds prior to the issuance of monthly spending

money, the ALA Coordinator should be notified to increase the spending money

by

the required amount. The House Manager/Supervisor may also purchase the

Revised Sept. 2012


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needed item with the permission of the ALA Coordinator on a charge basis if a

prior credit arrangement has been made with the vendor of the needed item and

obtain an original invoice in that individual’s name to be turned in to the ALA

Coordinator for processing. The amount received for spending is evaluated

monthly to determine the appropriateness of the allocation. Individuals are

required

to sign receipts for acceptance of spending money, which is delivered to them in

cash. Receipts are returned to the Business Office for filing.

Individuals are responsible for their own weekly spending allowance. At no time

shall house managers/supervisors or other CSS staff lend cash to individuals,

borrow from individuals or hold cash for individuals or otherwise handle any cash

belonging to the individual. (Rule 10.6)

Staff Handling of Individual Pay

Each ALA program supervisor is responsible for maintaining an up-to-date

schedule of individual paydays for that program and for ensuring that the staff

member on duty on the day an individual is scheduled to receive their pay (usually

Friday) is aware of the schedule and obtains the check or cash. If an individual is

not paid as scheduled, the program supervisor or designated program staff must

notify the ALA Coordinator no more than three (3) days following the scheduled

payday. In the case of supervised apartment individuals, the staff responsible for

the individual is considered the program supervisor.

The ALA program staff on duty on an individual’s scheduled payday is responsible

for notifying the program supervisor if the individual is not paid on schedule and

proper handling of the check or cash received. The latter includes signing a ledger

(attached) documenting receipt of individual pay. Thereafter, any time the money

(in the form of a check or cash) changes hands, the staff receiving the check or cash

must sign the receipt ledger. As with individual spending money an in-house

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savings, individual pay must be kept in a locked filing cabinet. It is the

responsibility of the program supervisor to ensure that no one other than

appropriate program staff have access to the keys.

Individual pay is turned into the CSS Office as soon as possible after receipt. At no

time should individual pay be held in the program for more than one (1) week, as

this is a violation of the individual’s right to be earning interest on that money.

Staff turning in individual pay to the CSS Office must obtain a receipt in order to

be absolved of responsibility for the money. This necessitates hand delivering of

the money and providing the ledger documenting the pay transactions. Neither

checks nor money should ever be placed in the NMRC mail room or given to

another individual to hold for any reason.

House Managers receive a salary and are required to pay food costs. Fixed

monthly payments are based on the employees schedule and the number of meals

taken at a cost of approximately $1.00 per meal. Food costs are reviewed annually

with adjustments made as needed. Monthly checks are paid to the Business Office

(NMRC ALA Account). Any additional telephone costs (personal long distance

calls) are recorded and the person making the call is responsible for the charge.

(Rule 10.6)

3.6 Payroll

Payroll information is maintained by the NMRC's Business Office for each

individual. Individuals are paid by check signed by the director and AAT or

designated representative of the program. For individuals in the community

programs, their checks are given to the VTI or Director of the home. For

individuals in the Group Home, the individual is given the check and they in

turn, give their check to the House Director. The House Director is then

responsible for getting the check to Oxford. For individuals living in the

apartment program, they are given their check and they deposit their own check

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in their local account. The individuals who live in the community are given

their check. This information contains at least the following:

a. name of individual

b. weekly earnings

c. total earnings per month

d. total earnings per quarter

e. total earnings per year

Individual Payroll

Individual payroll, like any employee/employer relationship, is a reward or

reinforcement for work completed. Therefore, the schedule of payroll must relate

to optimum reinforcement yet be feasible in allowing for the reality of business and

cash flow situations. Individuals will be paid bimonthly for work performed during

the preceding pay period (excluding Tishomingo). An Employee/Client Pay

Receipt (Attachment 25) will be given to each individual each pay period which

indicates the following: date, pay period, individual name, subcontracts utilized,

wages and deductions, staff signature and date, and individual signature and date.

A copy of this receipt is given to each individual for each period after the

individual signs the receipt and receives his/her check. A copy of the receipt is

maintained along with the production record for the corresponding pay period.

Individual payroll determination is made directly from production records. The

AAT or designated representative will figure the rate and pay per day based on

information (time vs. number of items produced) from the records. A total for each

job per week is determined, as well as a total for the week.

Payroll Ledger

A payroll ledger is also maintained which gives individual payroll as well as a

monthly, quarterly, and yearly summary of individual payroll. The ledger

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contains

at least the following:

a. date of payroll

b. individual name

c. check number

d. amount of check

e. when check is cashed

A payroll ledger must be reconciled monthly to determine if accounts balance.

Monthly Report

A monthly Payroll Registry/Financial Report (Attachment 26) is sent to the CSS

Director summarizing the financial activity for the month. The report contains:

a. monthly period

b. income broken down by contractor

c. expenses-any monies expended from general account including payroll

d. the remaining balance

3.7 Social Security/Federal Income Tax

At this time, NMRC sponsored workshops, on the advice of the Director of

Business Services, withholds F.I.C.A., Medicare and Federal Income tax on

individuals. Detailed records of withholding are maintained at the workshops and

in the Business Office.

3.8 U.S. Department of Labor Regulations

All NMRC WAC programs adhere to the regulations pertaining to workers who

are disabled and special minimum wages as described in Section 14c of the Fair

Labor Standards Act. All applicable regulations are followed for compliance.

(Attachment 27)

3.9 Fee Policy

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The fiscal management system includes a fee policy that maintains a current

written schedule of rate, charge and discount policies (if applicable). The fee

policy is immediately accessible to individuals served by the program. No fees

are charged for Industries (WACs) or Case Management (CM) services.

Therefore this standard is not applicable, at this time, to these services.

However, Alternate Living Arrangement (ALA) programs do assess individuals

a portion of their living expenses in the program. Individuals in ALA programs

who are unable to draw government assistance are responsible for paying fees

personally. A breakdown of fees for ALA programs and other information is

provided. (Rule 10.6)

ALA Individuals

All individuals admitted to a NMRC ALA program are required to be

able to pay monthly expenses in order to participate in the program as

well as assume responsibility for any medical of pharmaceutical

expenses over and above that which the individual's monthly income

and/or Medicaid or other insurance will pay. The individual and/or

his/her responsible party must agree in writing at the time of the

individual's admission to the program to assume financial responsibility

for the individual's participation in the program. Failure to pay fees and

expenses on the part of the individual and/or his responsible party for

two consecutive months may result in the individual's termination from

the program. A notice will be sent to the individual and/or his

responsible party at the end of the second month with no receipt of

payment giving notice that within ten (10) days of the receipt of the

notice all outstanding fees and expenses must be paid or the individual

will be automatically terminated from the program.

The NMRC's ALA programs charge monthly fixed fees for the following:

a) rent-rent is based on fair rental value and is assessed the

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individual by dividing the actual cost of renting the home by the

maximum number of individuals which can be enrolled in the

program; and

b) utilities - gas, water, sewage, telephone, electricity, cable

television. A flat rate fee is charged for utilities based on an

estimated annual cost for the individual program for the fiscal

year.

c) food - meals and snacks less food stamps. A flat rate is charged

for food less the amount of food stamps the individual receives.

d) supplies – a flat rate is charged for general supplies used such as

paper products, cleaning agents, kitchen utensils, linens and

other household necessities, etc.

e) travel – A flat rate is charged for travel to and from day

activities, to purchase items for the group home, to transport

individuals to necessary appointments and recreation. Travel

funds are used to purchase gas and oil and to maintain the

agency vehicle operated by the program. (Rule 10.6)

Fees are reviewed and determined annually by the CSS Director, the ALA

Coordinator and the Business Office Accounting Clerk and are based on an

estimated total cost by program for the fiscal year. The estimate is derived from

actual category charges for the previous fiscal year and may vary slightly from

program to program. Actual fees for the current fiscal year for each NMRC

ALA program are outlined under Financial Responsibilities in the ALA Program

Information and Application Packet. (Attachment 5) This information is

reviewed with the individual and his/her responsible party prior to admission to

the program. The individual and his/her legal guardian are notified in writing of

any changes, increases, or reductions in individual fees. The agreement is

signed by the individual/parent/legal guardian and provided in two (2) or more

copies (for the individual and one for the record). Copies of the fee schedule are

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also available on site at each program in the individual’s record and in the

Business Office at NMRC. This fee policy does not relieve NMRC of the

responsibility for the protection of the person and personal property of the

individual receiving services. (Rule 10.6)

The financial operation of the ALA centers around two (2) primary areas, the

individual’s income and the ALA program’s fees and expenses:

A) Individual Income - ALA

(Oxford, Bruce, Tupelo, Clarksdale and Corinth)

All ALA individuals must receive income which approximates the

current amount received from Supplemental Security Income

(SSI). When an individual has been ruled eligible for placement in

one of the ALA programs, an opening in the program exists for

which he/she is appropriate and is offered the placement, the

individual and responsible party are referred to the NMRC

Reimbursement Officer to complete paperwork to obtain SSI

and/or transfer representative payee status to the NMRC.

If the Social Security Administration (SSA) refuses to allow the

NMRC to become representative payee for an individual, the

individual must agree in writing to endorse and forward all benefit

checks for which he/she is a recipient to the NMRC to be used for

their participation in the program (as described in the section titled

Individual Fee Schedule – ALA).

The CSS Department ALA Coordinator is responsible for

forwarding a copy of the individual's initial Application for

Admission to the Reimbursement Officer prior to the individual's

admission date. In addition, as part of the Admission Packet, the

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individual and family will give signed forms requesting that

NMRC become representative payee of any income the individual

is currently receiving. (Attachments 6 and 7) A separate form is

signed for each type of income the individual receives (ex. SSI,

Social Security, VA). These forms, along with an individual

Change of Status Report, are also forwarded to the

Reimbursement Officer by the ALA Coordinator. Following the

formal admission of the individual, the Reimbursement Officer is

responsible for notifying the Social Security Administration, 500

West Main Street, Tupelo, MS, 38801 of the individual's

placement in the ALA, the individual's social security number, the

type of check(s) the individual is receiving and that the

individual's responsible party has signed a form giving permission

for NMRC to be made representative payee. The SSA will then

send the necessary paperwork to be filled out and returned for

processing. In most cases, the two forms which the SSA will send

to be completed are Request to be Selected as Payee (Attachment

8) and Statement for Determining Continuing Eligibility for

Supplemental Income Payment. (Attachment 9)

In the case of a NMRC resident transferring to a NMRC ALA

program, the ALA Coordinator notifies the Reimbursement

Officer of the possible candidate. The Reimbursement Officer

acknowledges financial ability of the individual to participate.

When the transfer is approved the Reimbursement Officer works

with the SSA, completing all necessary forms, etc. Copies of all

forms requested by SSA which are filled out by Reimbursement

Officer are maintained in the individual's files in the

Reimbursement Office. It may take as long as two months for

NMRC to begin receiving a new individual's check(s). The

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Reimbursement Officer is responsible in the interim period prior

to NMRC becoming Representative Payee for maintaining contact

with the individual's family/responsible party to assure that the

individual's check is forwarded to the NMRC within one week of

receipt, or that a check in the amount of the individual's income is

received within one week after the first of the month to assure that

the individual's fees and personal expenses are covered. The

individual's family/responsible party is asked at the time of

admission to sign a form agreeing to forward the individual's

check(s) or personal check in the amount of the individual's

income until NMRC can obtain representative payee. (Attachment

10) At the time that NMRC becomes representative payee for an

individual's check(s), the Center accepts responsibility for

notifying the SSA of any changes in the individual's living

arrangement as well as any change in their financial status. It is

the responsibility of the ALA Coordinator to report any change of

status in the individual's living arrangement to the Reimbursement

Officer using the NMRC ALA Individual Change of Status Report

(Attachment 11). It is the responsibility of the Reimbursement

Officer to report the individual's change of status to the SSA. A

copy of the Change of Status Report is also forwarded to the

Business Office Accounting Clerk by the ALA Coordinator.

An individual who receives SSI automatically receives Medicaid.

The Medicaid card is sent to the same address as the SSI check.

Therefore, when NMRC applies to be made representative payee

of an SSI check, NMRC is also automatically applying to receive

the Medicaid card. It is not necessary to fill out any forms to

receive the Medicaid card. When the card is received, it is

forwarded to the appropriate ALA home.

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Should an individual receive funds from a source other than SSI

and is not eligible for Medicaid or Medicare benefits, the

individual's family/responsible party must agree in writing at the

time of the individual's admission to ALA on the Financial

Responsibility for any Medical or Pharmaceutical Expense form

the individual incurs over and above the amount of income he/she

is receiving. (Attachment 12)

Emergency medical and dental care is provided to all

individuals served by the ALA program as needed. Needed

services of this nature are provided regardless of the

individual’s ability/inability to pay. In cases where the

individual does not have sufficient funds to pay for such

services, program staff work with local physicians and dentists

who often reduce their fees and work out extended payment

plans. Emergency dental care is also available to these

individuals through the Center’s Dentist at the NMRC.

Because workshop (WAC) earnings create a change in individual's

financial status, the SSA must be informed of the individual's

monthly earnings at the WAC in which he/she is enrolled. The

WAC Coordinator is responsible for assuring that the WAC

Director compiles a list by name and social security number of the

monthly income of each individual who works. These lists are

compiled upon request and sent via email to the Business and

Reimbursement offices. The WAC/DSA Coordinator retains a

copy and forwards the originals to the Reimbursement Officer.

The Reimbursement Officer then forwards the information to the

SSA.

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B) Employed Individuals

If an ALA individual should become employed in competitive

employment in the community, then the SSA (SSI) must be

informed as soon as possible because this employment could

affect the amount of the SSI check and/or social security check.

The Reimbursement Officer must be informed as to when

employment is scheduled to begin (and end), the number of hours

per week the individual will be working, the amount per hour an

individual will earn, and the name, address, and phone number of

the employer. This information is documented on the Client

Change of Employment Status Summary form (Attachment 13).

A copy of this information is also sent to the Business Office

Accounting Clerk and to the CSS Director. The Reimbursement

Officer notifies the SSA with all the above information after the

individual receives his/her first paycheck. It is mandatory that

copies of all checks and check stubs an individual receives from

work be obtained by the WAC Director and maintained in their

individual file. The individual will then turn them in to the

Reimbursement Office where it will be maintained in their

individual file.

It is the responsibility of the Reimbursement Officer to make

any changes in the individual’s employment status. (Rule 10.6)

3.10 Fiscal Management – Other (Industry Policies)

All purchasing for the NMRC WACs from state or grant funds must follow

purchasing procedures of the NMRC using purchase requisition procedures.

Monthly purchases are made within the bounds of the prescribed budget for

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each individual program as developed annually by the CSS Director. Purchase

requisitions are submitted and are signed by the Director of the individual

workshops and are turned in to the WAC Coordinator for review. The CSS

Director co-signs all requisitions and forwards to the Business Office for

processing. If requisitions are denied, they are returned by the Coordinator or

the Director of the department with explanation. If requisitions are approved, a

Purchase Order is issued and the purchase can be made and an original invoice

is obtained. In order to expedite payment, utility, telephone bills and monthly

pest control bills are mailed directly to the NMRC Business Office for

processing of payment. Lessors of the facilities in which the programs are

housed sign an invoice for each of the twelve (12) months of the contract at the

time of the annual renewal of the lease agreement. The invoices are maintained

on file in the Business Office and processed for monthly payment.

All equipment and furnishings required for the implementation of a new WAC are

purchased by the CSS Director with the approval of the Director of the NMRC and

the Business Manager, following state purchasing procedures (requisition process)

and the guidelines of the NMRC Business Office, as prescribed by the DMH

Business Operations Policies and Procedures.

All programs of the NMRC CSS Department have policies which address the

following:

- None discriminate based on ability to pay, race, sex, age, creed,

national origin or disability; (Rule 10.6.B.1)

- A sliding fee scale will be used for individuals who require adjustments if

fees are required. This will be coordinated with the NMRC Business

Office (Rule 10.6.B.2), and

- For programs requiring a fee, the SSBG Income Declaration form is

completed (when applicable) and signed by the individual or individual’s

representative and provides assurance that personal information provided

is

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correct. (Rule 10.6.B.3)

All personnel handling funds are covered by a blanket bond. (Rule 10.6.B.4)

The NMRC by virtue of being an agency of the State of Mississippi is covered by

the Mississippi Tort Liabilities Claims Board which protects employees in civil tort

claims. Any individual involved in the Adopt-A-Friend Program or regular visitors

to the ALA programs are requested to assure insurance coverage in order to

transport ALA individuals. Landlords or individuals owning any property rented

by the programs of the CSS Department carry insurance as they deem appropriate.

Flood insurance may be required by the Department of Real Property Management

to cover replacement of state property. Programs will, if necessary, pay for this

coverage. (Rule 10.6.B.5)

Accounting records are maintained by all programs. The records maintained on

generated income from work contracts detail dollar amounts and fund utilization

as required. (Rule 10.8)

Prior written authorization is obtained from the CSS Director and sent to the

Director of NMRC for all generated income expenditures. All expenditures

must enhance or enrich the program and/or not be used as part of the required

match. (Rule 10.8.A)

PART 4.0 HUMAN RESOURCES

4.1. Personnel Policies

The CSS Department follows the personnel policies and practices as prescribed

by the State Personnel Board, DMH and the NMRC. The personnel department

at NMRC is mandated to implement and carry out the policies that assure that

the hiring, assignment and promotion of employees shall be based on their

qualifications and abilities without regard to sex, race, color, religion, age,

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irrelevant disability, marital status, or ethnic or national origin. (Rule 11.A.1)

An equal opportunity employment policy is stated in the policy manuals of the

above mentioned entities as well as in the State of Mississippi Employees

Handbook and the Department of Mental Health Addendum. Also,

pre-employment inquiries about the nature of an applicant's disability which

does not affect their ability to perform the job are strictly prohibited as stated in

the above referenced manuals. (Rule 11.A.2) Appropriate announcements

regarding the Equal Employment Opportunity Policy are posted in highly

visible locations throughout the remote program sites, at various locations

throughout NMRC’s main campus, and directly adjacent to the Personnel

Department’s main entrance.

The written personnel policies adhered to by the CSS Department describe

personnel practices in the areas of wage and salary administration, employee

benefits, working hours, vacation and sick leave (including maternity leave), annual

job performance evaluations (in writing with documented evidence of review with

the employee), procedure for suspension or dismissal of an employee (including

employee appeal process), private practice by program employees and utilization of

consumers and family members to provide Peer Support Services. (Rule 11.B) The

Department of Mental Health Personnel Policies Manual contains specific

information in regard to the above issues and is available in the office of the CSS

Director and in the office of the Personnel Director. Each employee receives the

State Employee Handbook (Attachment 3) and Department of Mental Health

Addendum (Attachment 4) can contact their immediate Supervisor, the CSS

Director, or the Director of Personnel at any time for clarification or verification of

current policies. The Director of Personnel at NMRC is designated by job

description with the responsibility to implement and/or coordinate personnel

policies and procedures and to maintain personnel records, disseminate

employment information to staff, and to supervise the processing of employment

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forms. The Personnel Office at NMRC operates as a unit of the Division of

Human Resources. (Rule 11.C)

4.2. Personnel Records

A personnel record for each employee/staff member is maintained on site by the

Director of Personnel at NMRC and contains a copy of the employee's current

driver's license and MVR (for designated drivers transporting individuals), Social

Security card, TB test results, a Form I-9, the application for employment which

includes the individual’s employment history and experience, a copy of appropriate

Mississippi license/certification when applicable for all licensed or certified

personnel, a copy of college transcripts, high school diploma and/or GED or other

appropriate documents to verify that educational requirements are met, wage and

salary information, including all changes, a copy of the individual’s annual

performance evaluation, a copy of the individual's job description (job title,

responsibilities of job, skills, knowledge, training/education and experience

requirements), along with documentation of annual reviews by employee and

supervisor which is updated as necessary, documentation of initial (within 30 days

of employment) and annual departmental Policies and Procedures review and

documentation of staff review of subsequent changes (obtained by the CSS

Department), documentation of receipt of employee handbook and DMH

Addendum, and documentation of contact with at least two references, with a

minimum of one of these being a former employer and/or professional reference.

(The NMRC requires two or more character references and one or more

work/professional references). Documentation of General Orientation training is

maintained in the personnel file. General personnel information including some of

the above information is also maintained in the CSS Department for ease of use. In

the case of contractual employees, a copy of the contract or written agreement,

signed and dated by the employee and the Executive Officer is kept, along with a

vita (in lieu of an application), copies of license, certification, college transcripts,

high school diplomas, GED, wage and salary information, contact with two of the

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listed references (one of which is a former employer and/or professional reference)

and a copy of the valid driver’s license. The contract includes effective dates of the

contract and renewal of the contract signifies satisfaction with performance and is

filed in lieu of the annual performance evaluation. The contract clearly describes

the duties of the contractual employee. (Rule 11.1.A-F)

Documentation of drug test results, child registry check (for those working with

children), and criminal background checks on all employees are maintained in

separate files by the NMRC Personnel Office. The NMRC Director of Security and

Director of Risk Management (Human Resources Division) are responsible for

completion and documentation of criminal record background checks. These

comprehensive background check investigations specifically include, but are not

limited to any prior convictions under the Vulnerable Adults Act and Child Abuse

Registry. Currently all new employees of the NMRC are fingerprinted, with these

prints electronically submitted to the Department of Public Safety in Jackson,

Mississippi. Upon no negative findings at this level, they are forwarded to Federal

Bureau of Investigation who responds back to the Department of Public Safety.

This procedure generally takes an average of five working days. This procedure

must be successfully completed with no information received that would exclude

the individual as an employee prior to that individual’s employment. Volunteers

who perform services directly with individuals served are subject to this same

criminal records background check procedure. (Rule 11.1.E)

4.3. Qualifications

Written job descriptions for all positions that identify job title, responsibilities of

the job, and the skills, knowledge, training/education, and experience required or

the job, are available in the form of job specifications as written by the State

Personnel Board. These specifications are available in the departmental files in

the Personnel Office, and with DMH and the State Personnel Board. Job

descriptions are reviewed annually at the time of grant preparation. Any

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changes are noted and any updates are made at that time on the departmental

level. At the time of hire a Job Content Questionnaire is reviewed and signed by

the employee and his/her supervisor. The JCQ, which is a detailed description

of

job tasks and methods used to accomplish them, is updated at that point. A copy

of the JCQ for each employee is on file in the Personnel Office at NMRC

Performance Appraisal Certification is conducted annually by the immediate

supervisor of the employee and is reviewed by a first and second level reviewer.

The Director of NMRC reviews the performance of the CSS Director. The Director

of the CSS Department reviews the performance of the Secretary Principal, the

ALA/CM Coordinator, the WAC/DSA Coordinator, and the Waiver Nursing

Coordinator. The ALA/CM Coordinator reviews the performance of the House and

Apartment Managers and Case Managers. The House Managers (Direct Care

Supervisors - DCS) review the Direct Care Alternate Supervisors (DCAS) and the

relief staff. The WAC/DSA/CE Coordinator reviews the performance of the

Workshop Directors, DSA Directors, and the Director Vs. The WAC and DSA

Directors review their staff respectively. The Waiver Nursing Coordinator reviews

the performance of LPNs employed by the department to provide In-Home Nursing

Respite and HCS (formerly Attendant Care) Services and through the NMRC.

All staff employed on or after July 1, 2002 meet minimum requirements as listed

below or evidence is maintained in their personnel file of their enrollment each

semester in course work toward that degree. Documentation is on file in each

Personnel file providing proof of eligibility for the position. Within the scope of

the CSS Department, this documentation includes that:

Services Directors/Coordinators/Supervisors of service area(s) and/or multiple

counties or sites for WAC/DSA Programs, and Alternative Living Arrangement

Programs (ALA) have at least a Master’s degree in mental health, mental

retardation or a related field and professional licensure or DMH credentialed

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Mental Retardation Therapist (CMRT/LCMRT). (Rule 11.2)

On-site Coordinators/ Directors/Supervisors for WAC /DSA Programs have at least

a Bachelor’s degree in a Mental Health, Mental Retardation, or a related field, and

works under the supervision of an individual with at least a Master’s degree in a

Mental Health, Mental Retardation, or a related field. (Rule 11.2.D)

Behavioral Support/Interventionists providing services coordinated through the

department hold a current license to practice medicine or psychology (verifiable

through their respective state licensing agencies), or are a currently licensed clinical

social worker, or hold a Master’s degree or higher in a related field such as special

education or psychology; AND have four years documented experience developing

and implementing positive Behavioral Support Plans for individuals with IDD.

(Rule 11.3)

Nursing services are not generally provided through CSS. The Department

employs a Waiver Nursing Coordinator who is a Registered Nurse and provides In-

Home Nursing Respite services (not nursing services encompassing diagnosis and

treatment), to HCS individuals. (Rule 11.2.G)

Supervisor of the Waiver Nursing Coordinator meets the definition of Qualified

Mental Retardation Professional by virtue of having at least one year’s experience

working with individuals with intellectual and/or related disabilities and are a

Registered Nurse, licensed physician, has a Master’s degree in psychology from an

accredited program with experience in working with persons with ID/DD or, has a

Bachelor’s in education from an accredited program who has experience in

working with persons with ID/DD, a social worker with a Bachelor’s from an

accredited program and has had specialized training in or experience working

directly with persons with (or a waiver request pending on Waiver Services

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Coordinator). (Rule 11.2.G)

Any psychological services provided or coordinated through the CSS Department

are provided by psychologists licensed by the Mississippi Board of Psychology.

(Rule 11.2.H)

CM services are provided by an individual with at least a Bachelor’s Degree in

Mental Health, Mental Retardation, or related field, or a Bachelor’s level staff

member with training in a Mental Health, Mental Retardation, or a related field,

under the supervision of an individual with a Master’s degree in a Mental Health,

Mental Retardation, or a related field. (Rule 11.2.M)

All direct care staff such as Aides, House Managers, Apartment Supervisors, Work

Floor Supervisors, Direct Care Workers, are required to have at least a high school

diploma or equivalent (GED). Support staff (Secretaries and Account Auditor

Technicians, etc.) have at least a high school education or a GED and are at least 18

years old. (Rule 11.2.R)

The NMRC does utilize volunteers throughout the services it offers. Volunteers

who participate in the CSS program, follow the policies and procedures set forth by

the governing body of the NMRC. The NMRC Policy and Procedure Manual

outlines the scope and objectives of the volunteer service (their roles and activities),

the responsibility of supervising individuals placed under their care, the process for

recruitment, assignment, and evaluation of each volunteer, and all are required to

attend an orientation training program prior to working with the individuals NMRC

serves. (Rule 11.8)

PART 5.0 TRAINING/STAFF DEVELOPMENT

In addition, support staff providing direct waiver services including Direct Care

Workers (DCWs) providing Home and Community Supports - HCS (formerly

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Attendant Care) and/or In-Home Respite (IHR) Services, Prevocational (PV),

Supported and Supervised Residential Habilitation, and DSA services have

documentation of completion of training in DMH DCW Training program or an

equivalent approved by DMH. (Rule 12.0.A)

NMRC staff are required to successfully complete a General Orientation

program. (Attachment 31) Staff of community programs are required to

participate in other training as identified by the administrative offices of the

NMRC and the NMRC Staff Development offices. Regular staff development

opportunities are offered by the NMRC and staff attend as assigned or required.

CSS staff are required to attend and participate in any training and/or meetings

required by DMH. Documentation of all training is maintained in the Staff

Development Offices of NMRC. (Rule 12.0.A)

Prior to actual delivery of service all new CSS staff members receive General

Orientation through the Staff Development Department of NMRC. Topics

addressed by this training include, but are not limited to:

a. Agency’s mission and overview of the agency’s policies and procedures

b. DMH Operational Standards (as applicable)

c. DMH Record Guide and Record Keeping (as applicable)

d. Basic First Aid and CPR

e. Infection Control (Universal Precautions and Hand-washing)

f. Workplace Safety (Fire and Disaster, Emergency/Disaster Response,

Incident Reporting, Reporting Abuse and Neglect – Vulnerable Adults

Act/MS Child Abuse Law)

g. Rights of Individuals Receiving Services

h. Confidentiality including appropriate state/federal regulations governing

confidentiality, and addressing requests for such information

i. Family/Cultural Issues and Respecting Cultural Differences

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j. Basic Standards of Ethical and Professional Conduct (Drug Free

Workplace, Sexual Harassment, acceptable professional

organizational/credentialing standards and guidelines as appropriate to

discipline.

k. Accurate gathering, documentation and reporting of data elements

outlined in the current version of DMH’s Manual of Uniform Data

Standards for staff responsible for data collection and entry.

(Attachment 22) (Rule 12.0.B)

Additional training in areas not otherwise specified in these standards will be

provided (i.e., staff training plans and continuing educational plans specific to each

position class). Staff of the CSS Department ID/DD programs are offered quarterly

staff training relating to their service areas and individuals with ID/DD.

Participation in this training is documented in the Staff Development training

records. Topics are selected jointly by the CSS and the Staff Development staff

and are specifically chosen to be pertinent to service delivery in the ALA, WAC,

CM and business and community education programs. Coordinators of programs

will assure that training is appropriate and that all staff participate. (Rule 12.1 & 2)

Employees who supervise individuals who are served through NMRC’s ICF/MR

program(s) are required to complete 20 hours of Department of Justice Training

each year.

For direct service providers, a minimum of 30 hours of continuing education every

two (2) years is completed and documented. Persons in administration/support, a

minimum of 16 hours is completed every two (2) years and for medical personnel,

they are required to meet those training requirements set forth by their licensing

agency. (Rule 12.2.A)

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At a minimum, Staff Training Plans and Continuing Education Plans address the

following areas:

a) Crisis Prevention and Intervention

b) Recovery/Resiliency Oriented Systems of Care

c) Person-Centered Planning

d) Wrap around (NA)

e) Accurate gathering, documentation and reporting of data elements outlined

in the current version of DMH’s Manual of Uniform Data Standards for

staff responsible for data collection and entry. (Rule 12.3.A)

The Staff Development department of the NMRC develops the initial training and

annual required trainings for each class of employee. Throughout the year,

trainings are offered by various departments and entities to ensure all individuals

providing services receive updated training on various aspects related to their work

setting. (Rule 12.3.B)

In addition to the trainings offered through the Staff Development department, the

CSS department sets departmental meetings/training sessions to review various

topics not covered by others. All CSS staff attend trainings annually which address

crisis prevention and intervention, abuse reporting, record keeping and items found

in the OSM relative to the expectations of that specific program. (Rule 12.3.B)

All staff are required to participate in orientations, program/position specific

training, staff development opportunities, and other meetings as required by their

specific position. (Rule 12.3.B)

Documentation is on file in one location and includes name of training, instructor’s

name and credentials, date of training, actual time spent training, topic(s) covered

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and learning objectives. (Rule 12.3.C)

6.0 HEALTH/ENVIRONMENTAL SAFETY

All facilities meet state and local fire, health and safety codes. The CSS

Department has an established method for all fire equipment located in each of its

facilities to be inspected at least annually. Remote facilities are inspected and

approved by appropriate local and state agencies (or for those with sprinkler

systems, they are inspected by a licensed company and/or local fire authorities) at

least annually and written records of fire and health inspections are maintained on

site at each program with a copy in the departmental files. During this inspection,

fire extinguishers are checked and are recharged or replaced if and when needed at

a minimum of every 6 years. The offices at NMRC housing the CM and Waiver

Services programs are inspected and approved by appropriate local and state

agencies at least annually and records maintained in the Engineering Department.

Any noted citations are corrected as soon as possible with documentation obtained

by appropriate fire and health authorities following correction. Inspections are

conducted on or before the anniversary date of the previous inspection and are on

official forms with authorized signatures. (Rule 13.1.A & D)

Evidence of a systematic pest control program is maintained at each program.

However for the Alternative Living Arrangement Programs (ALA) and Lafayette

Industries, the original contract is on file in the NMRC Business Office. Other

WAC programs maintain documentation of monthly payment to pest control

companies. The CM program is housed on the campus of the NMRC and evidence

of pest control for those offices is also maintained by the Business Office. Monthly

visits are made to each program routinely with additional visits as requested by

program staff. Ongoing pest control problems are reported immediately to the

Coordinator of the program and additional attention from the pest control

contractor is requested. Documentation is maintained regarding the treatment of

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ongoing problems. If problems are treated by in house personnel, records are

maintained which include purchase of chemical and materials needed and a signed

and dated report verifying dates and times of application/treatment. (Rule 13.1.F)

Fire extinguishing equipment and smoke alarms are placed and securely mounted

in

strategic locations in each program as prescribed by the local fire department. In

addition, smoke alarms are located in each bedroom, kitchen and hallway in all

ALA/Home and Community Supports programs. Extinguishers and/or smoke

alarms/detectors are placed in areas where special conditions warrant. Fire

extinguishers are also maintained on each program vehicle. All extinguishers are

mounted in a secure manner. Each program’s extinguishers are visually inspected

by program staff monthly and documented on an inspection tag and visually

inspected/pressure checked at least annually by an independent local business

specializing in such inspections. This equipment is also approved and inspected

annually at the time of the annual fire inspection. Fire officials note the date on

tags

attached to the extinguishers, and note any problems with smoke alarms on

inspection reports. Problems are immediately corrected. Carbon monoxide

detectors are located in all programs utilizing natural gas or where there is an open

flame. One carbon monoxide detector is provided for each 1,000 square feet of

program area. Carbon monoxide detectors inspected at least annually by an

independent local business specializing in such inspections, with documentation

maintained on site and provided to departmental records. (Rule 13.1.G, H, I & J)

The Fire and Disaster Plan specifies escape routes and all procedures. A

representative sample of a community program Fire and Disaster Escape Plan can

be found as an attachment. (Attachment 33) Documentation of the review of the

plan and training of staff is maintained in the Staff Development Department at

NMRC. Evacuation plans specific to the program identifying escape routes, are

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posted at highly visible locations throughout each program environment. These

escape routes indicate, clearly in red, where a person is in relation to the nearest

exit. Site specific plans are posted in each location. The plan is posted in each

program. (Rule 13.2.A & B)

From each living/service area, two means of exit are provided which are remote

from each other and so arranged/constructed to minimize the possibility that both

may be blocked by fire or other emergency conditions. All exits are located and

exit accesses are arranged so that exits in all programs are readily accessible at all

times.

All exits are located and exit accesses are arranged so that exits in all programs are

readily accessible at all times. (Rule 13.2.C)

Exits for all programs are marked by a lighted sign with lettering, at a minimum,

six (6) inches in height on a contrasting background in plan lettering. These exit

signs are visible from any direction of access and are lighted at all times. All signs

operate on a battery back-up system in the event of electrical failure. (Rule 13.2.D)

All accessible windows are operable from the inside without the use of tools and

provide a clear opening of no fewer than 20 inches in width and 24 inches in

height. For windows not meeting this accessibility requirement, alternate multiple

exists from the living/service are available. (Rule 13.2.E)

No door in any path of exit, or the exit door itself in all programs is locked when

the building is occupied unless an emergency system is in place that will allow the

door to unlock in an emergency. (Rule 13.2.F)

Locks, if provided on exit doors in any program, do not require the use of a key for

operation from inside the building. (Rule 13.2.G)

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The physical environment of all CSS programs is maintained in a clean, well-kept

condition, with all equipment kept in a good state of repair. Items requiring repair

or replacement are addressed through requisition and/or NMRC purchasing

procedures as appropriate. (Rule 13.3.A)

All CSS programs are required to perform an environmental assessment of each

of it’s programs and document their findings on an Environmental/Safety

Checklist Form. (Attachment 35) Water temperature of all hot water fixtures

used by individuals served in programs of the CSS Department is maintained in

a

range between 100 and 120 degrees Fahrenheit. Water temperature is monitored

and documented at least monthly. In occurrences where water temperature

exceeds the acceptable range, corrective action (i.e., notification of landlord

and/or NMRC Engineering, as appropriate) is taken immediately and

documented. Individuals served are monitored and are not allowed to

independently utilize hot water fixtures until the corrective action is taken.

(Rule

13.3.B)

Emergency lighting systems are located in program corridors and/or hallways to

provide required illumination automatically in the event of any interruption of

normal lighting such as failure of public utility or other outside power supply,

opening of a circuit breaker or fuse, or any manual act which disrupts the power

supply. Emergency lighting systems are inspected for appropriate operation at least

monthly with inspections documented by program staff. (Rule 13.3.C)

Program kitchens are utilized in ALA/Residential Habilitation programs to prepare

and serve meals. Kitchens in WAC/Pre-Vocational programs are utilized to

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facilitate the serving of meals and snacks individuals bring from home. Kitchens in

DSA programs are utilized to serve meals and snacks which are not generally

prepared on site, but are otherwise provided through contractual arrangements.

DSA kitchens also play a vital role in training individuals served in Daily Living

Skills. For all program kitchens, a two compartment sink or automatic dishwasher

is provided. Adequate supplies of dishes and cooking/serving utensils are

maintained consistent with the function of the program as described above.

Adequate refrigeration and space for food storage is supplied, with no food stored

on the floor. As previously described, approved fire extinguishing equipment and

smoke detectors/alarms are strategically placed to provide immediate detection of

smoke fire in program kitchens. (Rule 13.3.D)

Restroom door locks in all programs are designed or have been modified to permit

the opening of the locked door from the outside. (Rule 13.3.E)

Furniture and furnishings are carefully chosen to assure that they are safe,

comfortable, appropriate and adequate for the program and individuals served.

The environment is clean and kept in good repair. (Rule 13.3.F & 32.0.G)

Storage of supplies, including flammable liquids, toxic cleaning agents, and other

harmful materials are stored so as to provide for the safety of individuals served

and the staff working in the program. (Rule 13.3.G)

Each program maintains adequate floor space for a lounge/dining/visitation area

that is easily accessed and can be exited in the event of an emergency. (Rule

13.3.H)

Safety of all individuals is of utmost importance. All programs equipped with a

forklift/electric stacker are trained annually in the appropriate use and operation of

such equipment. When forklifts/electric stackers are used to remove pallets from

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vehicles, the “Dulaney Protocol” is required. This protocol involves the use of

industrial-strength straps along with clasps that secure the load in such a way the

clasps will not open and thereby potentially come back and hit the person

unloading the vehicle. The person must use the forklift/electric stacker when using

this procedure. (No staff may physically remove the pallets without the use of the

forklift.)

Operational utilities (e.g., light, water/sewer, heating/cooling, etc.) are

maintained in all programs. A procedure is in place in the event of a power

failure. This procedure is available for DMH review. (Rule 13.3.I)

No stove or combustion heater is located so as to block escape in case of fire

arising from a malfunction of the stove or heater. (Rule 13.3.J) No portable heaters

are allowed in service areas. (Rule 13.3.K)

DMH may require additional square footage in any program in order to

accommodate the needs of the individuals in the program. (Rule 13.3.L)

At the NMRC the Personnel Officer is charged with the responsibilities of acting as

coordinator of the compliance process. However, departmental staff who work

more closely with the community programs are responsible for assuming

compliance with the Americans with Disabilities Act (ADA) to the greatest degree

possible. Information regarding the ADA and Section 504 of the Rehabilitation

Act is readily available through CSS staff and the Personnel Office at NMRC. The

information regarding requirements and protection of the ADA is posted in all

programs. It is also used as a reference point for providing information and

answering questions. The grievance procedure is in place to provide a prompt and

fair resolution of complaints. It is distributed to all programs and posted. A

self-evaluation was conducted by the NMRC. The firm of Albert and Lewis

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Architects was employed to assess all facilities as to physical accessibility. Results

of that evaluation are on file in the NMRC Director's Office. The CSS Department

has contacted all individuals from whom properties are rented and informed them

of the law and the regulations concerning accessibility. These individuals have also

been asked to conduct a survey of the property they own using the "Checklist for

Existing Facilities" distributed by the Disability and Business Technical Assistance

Center. The Center's compliance officer assumes responsibility for other Titles

affecting this department. A transition plan has been developed and submitted to

the DMH. The CSS Department will make every effort to meet the accessibility

needs of any individual or potential individual at such time as services involving

accessibility issues are provided. Further, prior to rental of any building,

representatives of DMH will be requested to visit and review the property and

provide the program with documentation regarding the acceptability and suitability

of the property. All leases will require basic accessibility features and will include

a statement regarding the conditions under which further accessibility features

could be required or termination of the lease could occur. (Rule 13.4.A)

In most cases, the clear width of doorways when the door is in the full open

position is no fewer than thirty-two inches in width. (Rule 13.4.B)

All CSS programs have at least one restroom that is accessible to individuals with

physical disabilities. In the event that only one accessible restroom is available in

the program, it is designated for unisex use. For ID/DD programs that are non-

residential in nature, private changing stations are available at the program. (Rule

13.4.C)

All accessible restrooms have grab bars behind the toilet and on the side wall

nearest to the toilet and on the side wall nearest the lavatory/sink. (Rule 13.4.D)

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All faucets, soap dispensers, hand dryers and towel holders are positioned to be

within reach of an individual using a wheelchair and are useable with one closed

fist. (Rule 13.4.E)

All program doors including stall doors are operable with a closed fist from inside

the exit. (Rule 13.4.F)

Programs containing drinking fountains have at least one fountain accessible to

individuals using wheelchairs. Accessible drinking fountains:

a. Have clear floor space of at least 30 by 48 inches in front;

b. Have a spout no higher than 36 inches from the floor; and

c. Have controls mounted on the front or side near front

edge and are operable with a closed fist. (Rule 13.4.G)

Any doors opening onto stairs have a landing that is at a minimum the width of the

door. Those doors accessing a stairway and not having a landing are designated as

prohibited areas to individuals. (Rule 13.5.A)

Minimum head room on stairs to clear all obstructions in all programs is at least six

feet and eight inches (6'8"). (Rule 13.5.B)

All facilities adhere to a stair width of not less than 32 inches, tread depth of not

fewer than nine (9) inches and riser height of not more than eight (8) inches. Stair

width, tread and/or riser height which do not meet these specifications are

designated as prohibited to individual use. (Rule 13.5.C)

All facilities adhere to the requirement that guards and handrails continue the full

length of the ramp or stairs, be provided on both sides of all stairs and ramps rising

more than 30 inches above the floor, or grade below. Handrails will provide at

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least one and one-half inches (1.5”) between the inner side of the rail and the

support wall, and are located between 30 inches to 34 inches above the tread of the

step or ramp. (Rule 13.5.D)

Any steps, ramps, platforms and landings at any program are designed for not

fewer than 100 pounds per square foot and have a slip resistant surface. (Rule

13.5.E)

Each program has a first aid kit readily available. If an entity has more than one

(1) program, it will share the same kit if easily accessible to both programs.

Contents of the first aid kit include gloves, adhesive bandages, gauze, first aid

tape, nonprescription pain relief tablets, sterile pads, antiseptic wipes, and a first

aid booklet. (Rule 13.6)

6.0 Transportation of Individuals Receiving Services

The NMRC ALA program provides transportation to individuals of that

program primarily for transportation to and from the WACs and community

employment. Other uses of the van include conducting center/program business,

individual outings, shopping trips, appointments, etc. Any use of the vehicles

other than those mentioned above and/or any out of town trips must be approved

by the ALA Coordinator or the CSS Director. The NMRC WAC programs

maintain at least one vehicle at each program. Primarily the vehicle is used to

transport individuals in the waiver and contract work from local businesses to

the workshops. Other uses of the vehicle include conducting Center business,

making contacts with business and industry, community awareness and job

exploration activities, and occasionally transporting an individual to and/or

from appointment or to and/or from community employment job sites. WAC/

Prevocational and DSA programs assist with transportation services for

individuals served when no other means of transportation is available to the

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individual. Any use of the vehicle other than those mentioned above must be

approved by the CSS Director. Staff are not to use center vehicles for personal

errands. It is allowable for staff who are traveling on NMRC business, to stop

for lunch, supper, etc. but personal errands are not to be done with or without

individuals present. (Rule 13.7)

No unauthorized persons will drive the program vehicles. All program vehicles

and staff drivers comply with applicable laws of Mississippi regarding motor

vehicle operation, inspection, licensure and maintenance. (Rule 13.7.A) All

drivers must be approved to drive through the NMRC Risk Management office

and comply with rules of the NMRC Motor Vehicle Policy. All drivers will be

required, on an annual basis, to sign a Vehicle Use Agreement Form

(Attachment 45a). This form is also to be used by staff any time there are

changes in the status of their license. Operators are responsible for driving

appropriately. Any report of misuse is to be reported by the employee

immediately to the agency head by completing a vehicle Misuse Incident Report

form. (Attachment 45b) Any staff member transporting individuals in a 15-

passenger van (or larger) must hold a commercial driver's license and be

approved to drive through the NMRC Personnel Office. Station wagons,

minivans and personal passenger vehicles require a regular driver’s license.

Services to children 0-6 are not provided by this department. Therefore no

children are transported on program vehicles. (Rule 13.7.B.1)

For individuals served/transported, one (1) staff person in addition to the driver

is required for every six (6) individuals transported. (Rule 13.7.B.2)

A securely mounted/fixed fire extinguisher and safety supplies (flashlights,

flares or reflectors, and first aid kits) are kept on all vehicles used to transport

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individuals. The first aid kit contains gloves, adhesive bandages, gauze, first aid

tape, non-prescription pain relief tablets, sterile pads, antiseptic wipes, and a

first aid booklet. Quarterly checks are conducted to assure that vans are

appropriately stocked with the above mentioned equipment and supplies and

that any medication has not expired. (Rule 13.7.C)

As a state agency the programs are not required to carry liability insurance.

However, staff members who drive agency vehicles are required to carry

appropriate liability insurance. (Rule 13.7.D)

Vehicles are equipped with an operable seat belt for each passenger transported.

No services for children (ages 0-6) are provided by the department. Therefore,

approved safety seats/restraint devices are not utilized. All passengers must wear

a seatbelt during the operation of a vehicle. When transporting individuals in

private vehicles (subject to appropriate insurance) no more individuals may be

transported than can be accommodated with an operable seat belt and seat belts

must be worn during the operation of a vehicle. (Rule 13.7.E)

All authorized drivers of the vehicles which are used to transport individuals are

responsible for assuring they are accessible to the individual’s receiving services

at all times. (Rule 13.7.F.1 & 6) There are procedures in place at each program

to account for the arrival and departure of each individual. (Rule 13.7.F.2)

Each staff has a way to communicate (i.e., cell phone) in the event of an

emergency. (Rule 13.7.F.3) House Managers and the WAC/PV/DSA Director

are responsible for the completion of the Vehicle Maintenance Log/Vehicle

Checklist (including washer water, all belts, engine oil, transmission, radiator,

tires, headlights, brake lights, dome lights, turn signals and wiper blades) or it is

completed by service station personnel or knowledgeable staff at least monthly.

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A Monthly Travel Log is also maintained, completed by the driver at the time of

the trip and turned in monthly. (Attachment 46) This form includes date, point

of departure, beginning and end odometer, points of destination, total mileage

and the operator's signature. House Managers, Workshop Directors, DSA

Directors and Program Coordinators are also responsible for noting expiration

dates of inspection stickers and taking proper steps to obtain a new one.

Purchase of gas, oil and routine maintenance is the responsibility of the House

Managers and Workshop Directors. Gas or other vehicle charges are made

using the state gas card. Repairs to vehicles are coordinated by program staff.

(Rule 13.7.F.4) If a service station is used, the name of the service station,

signature or initials of person conducting the check and the date must be

documented on the Monthly Vehicle Maintenance Checklists. (Attachment 45c)

The checklist is turned in to the CSS Department with other monthly reports.

Mileage and maintenance records, as discussed above, are maintained in the

Departmental Files and the Engineering Department. Records of maintenance

other than the above are maintained in the Business Office of NMRC (invoices

for service, record of payment, etc.).

If an individual cannot be left at their designated home or pre-arranged site,

documentation is in place which specifies an alternate plan of action agreed

upon by their family/legal guardian which ensures the safety of the individual at

all times. (Rule 13.7.F.5)

Smoking is not permitted in any vehicle belonging to NMRC.

WAC/Prevocational (PV) and Day Services – Adult (DSA) programs provide

regular job exploration and community awareness activities respectively,

requiring transportation of individuals into the community. DSA community

awareness and prevocational community integration/job exploration activities

are conducted in groups of no more than six (6) individuals with at least one

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staff person. Additional staff from the DSA, WAC, and PV programs are

provided as necessary to ensure the safety and well being of individuals

participating. Community Awareness activities are conducted at least weekly

for each individual receiving DSA services. Programs do not exclude

individuals requiring one-on-one assistance from these community awareness

activities. (Rule 13.7.F.6)

6.2 Medication Control

In the ALA/Community Living, DSA, and WAC/Prevocational programs

operated by CSS, all prescription drugs are obtained by the individuals served

from a licensed physician and are administered by the individuals themselves, as

there is no licensed physician or licensed nurse on staff in these programs.

Medication, if it must be administered to individuals being served in DSA

programs and the individual is not able to self medicate, is administered by

family members if prescription medication is taken on the program premises.

Medicines administered to individuals receiving In-Home Nursing Respite

service are administered by Licensed Practical Nurses. (Rule 13.8.A)

All medications are clearly labeled. Prescription medications also include the

name of the individual for whom it was prescribed. (Rule 13.8.B)

Medication prescribed for specific individuals are discarded when no longer

used

by said individual. (Rule 13.8.C)

All prescription medications in use in CSS programs are stored in a well lit area

in a special container designated for their purpose and able to be securely locked

when not in use. (Rule 13.8.D)

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Records are maintained by ALA /Residential Habilitation programs staff to:

ensure receipt of individuals' informed consent; provide an accurate record of

medication(s), both prescription and non-prescription, in current use; ensure that

those prescription medications for a specific individual are discarded when no

longer used by that individual; and provide an accurate monitoring of

self-administration of medication by individuals. (Rule 13.8.C & I; 33.1.C.1)

Records are maintained in the individual’s file when not in use.

Adequate space is provided in a secure, well-lit area to ensure the safe storage of

drugs. (Medication storage containers in use in the Supported Apartments are

not locked to allow individual access during times when supervisory staff is not

present.) Medication requiring refrigeration and kept in a refrigerator

containing

different types of items is stored in a separate locked compartment or container

labeled for that purpose. Prescription medication is stored separately (i.e.,

separate cabinet or compartment) from non-prescription medication, and within

those categories, medication for internal use is physically separated (different

file

drawer, cabinet or shelf which are plainly labeled according to such use) from

medication for external use. All storage areas, compartments, and/or containers

are labeled as to the category of medication being stored. (Rule 13.8.D-G)

Policies regarding the transportation and delivery of medications follows the

rules as described in the NMRC Policy and Procedures Manual. (Rule 13.8.H)

During a period when medication is being administered, both forms described

below are posted for the duration. (Rule 13.8.I) The following documentation

is used:

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The Informed Consent for Medication includes the illness/condition, name of

physician, medication and dosage, possible side effects, date prescribed, and

date terminated/discarded. Medications used for chronic conditions (ex. birth

control, seizure control) are designated as such. Documentation of the

individual having been informed of side effects of medication is completed and

signed by the individual prior to beginning any prescription medication

prescribed by a physician. (Attachment 42)

The Medication Schedule includes individual’s name, known drug allergies,

date of initiation of medication, medications and dosage, special instructions,

individual reactions, and a charting of administration times. (Attachment 43)

No prescription medications are stored on site at the WAC programs with the

exception of a small supply kept in a well lit area in locking cabinets for use in

the event of a natural disaster (e.g. earthquake, tornado, etc.) which would result

in individuals remaining at the program for extended periods. The medication

supplies are returned home/restocked semi-annually.

A Medication Profile is completed at least annually and individuals who are on

medication bring only the current day's medication with them to the program.

Individuals administer their own medications (self medicate) under the

supervision of program staff. This log is maintained to provide accurate

documentation of non-prescription medication taken. (Attachment 44) Daily

dosages of medication requiring refrigeration are stored in a locked container

marked for that purpose. Non-prescription medications are stored in a well lit

area or in a special container designed for that purpose. Medications for internal

use are physically separated from medications for external use, with respective

storage areas labeled as to the category of medication being stored. Storage

areas for medication are securely locked when not in use.

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There are no staff medical personnel for group homes, supported apartments and

WAC. However, documentation of the individual having been informed of side

effects is completed and signed by the individual prior to beginning any

prescription medication prescribed by a physician. (Attachment 44) Documentation

is on the Medication Profile Form. (Rule 13.8.I)

6.3 Disaster Preparedness and Response

NMRC’s Safety Manual (contains the Continuity of Operations Plan – “COOP”

and

each CSS Program Handbook (ALA programs) and Guidebook (WAC programs)

encompass all areas identified in Section 13.9. Within these documents contain

information regarding the development of and maintenance of a contingency plans

in the event of an emergency and/or natural disaster. (Rule 13.9)

All facilities have a written plan of evacuation in case of fire or natural disaster.

The

Staff Development Department, in conjunction with departmental staff, develops a

plan specifically for the program and conducts annual training and review

based on that plan. In programs where individuals are present (group homes,

supported apartments, WAC/Pre-vocational centers, and DSA program) emergency

telephone numbers are posted in a conspicuous location near each telephone.

Numbers for police, fire, poison control center and Ambulance/Emergency

Medical

Services (EMS) are included in this list. The local Disaster Coordinator’s name

and

phone number is available in each of the ALA program guidebooks and is

available at each WAC/PV/DSA site. (Rule 13.9) The Risk Management Director

along with the Coordinator and Program Director of each program in each county

meet with local and state emergency management personnel to coordinate and plan

response protocols. (Rule 13.9)

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All NMRC-CSS staff are required to respond to an emergency/disaster when

possible. Procedures are in place to ensure communication is provided in a

timely and secure manner to all those receiving services as well as other staff,

governing authorities and DMH/BIDD staff. (Rule 13.9)

Post-disaster/emergency procedures are in place to: account for all individuals

served; the conditions and procedures for evacuation and procedures for agency

closure. (Rule 13.9)

NMRC’s Safety Manual (Continuity of Operations Plan) is approved annually

through the governing board. This manual includes responses to natural/manmade

disasters, fires, bomb threats, utility failures, and other threatening situations.

(Rule

13.9.A.1-15 & B.1-6)

A description of the building, including structure, means of egress, and location of

smoke detectors, fire extinguishers, carbon monoxide detectors, and other

equipment is included. (Rule 13.9.A.13-15)

The plans and training identify assignment of tasks and responsibilities of staff by

position provide information pertaining to the specific disaster, fire, or other

threatening situations, provide for training in the notification of authorities and the

use of emergency equipment. (Rule 13.9.B)

For the ALA programs, alternate placement has been established in the event of

a fire, flooding, bomb threat, etc. Vital records will be maintained on the

NMRC campus in Central Records or in storage and secured accordingly. (Rule

13.9.B.4 & 5)

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Copies of Disaster Plans and the Safety Manual (Continuity of Operations Plan)

are maintained on site at each location and at the NMRC Administrative offices.

(Rule 13.9.C)

Any changes made to the response plans are documented and approved by

NMRC’s governing body. This information is sent out to all programs in

writing. (Rule 13.9.D)

Written efficiency reports document quarterly fire drills for WAC/Prevocational

and DSA programs monthly fire drills conducted on the previously specified

rotating time frame for ALA/Residential Habilitation programs, quarterly

disaster

drills for all programs. Fire and Disaster Drill written efficiency reports include

staff participation, date, time start/stop, type of drill, time required for

completion

of drill including time drill began and time drill ended, individual performance,

whether scheduled or unscheduled, staff participating and completion of

assignments, and signature of staff completing the report. Written efficiency

reports are prepared and signed following all drills. (Attachment 34)

All written assessment/efficiency reports including performance information

relating to individuals are filed with the CSS Department with monthly

paperwork. Copies are distributed to the departmental files and the Risk

Management Department at NMRC. Originals are returned to the program for

filing. CSS staff housed at NMRC, including CM staff, participate in annual

drills conducted by the Staff Development Department at NMRC. (Rule

13.9.E)

ALA residential programs conduct one fire drill a month. Drills are rotated among

the following time frames: 7 a.m. to 3 p.m., 3 p.m. to 11 p.m., 11 p.m. to 7 a.m.

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Disaster drills are conducted quarterly in the ALA/Residential programs.

WAC/Prevocational and DSA programs conduct fire drills and disaster drills

Quarterly rotating the nature of the event, prior to the anniversary date of the

previous drill. The CM programs are all housed on the campus of NMRC. These

programs participate in both a fire drill and a disaster drill annually. (Rule 13.9.E)

All CSS’ community residential sites maintain extra supplies in the event of an

emergency and/or natural disaster to support them for up to 72 hours after the

event.

These supplies include the following:

a) Non-perishable foods

b) Manual can opener

c) Water

d) Flashlights and batteries

e) Plastic sheeting and duct tape

f) Battery powered radio

g) Prescription and non-prescription medications based on the

needs of individuals in the program and guidance of agency

medical staff

h) Personal hygiene items (Rule 13.9. F&G)

7.0 RIGHTS OF INDIVIDUALS RECEIVING SERVICES

7.1 Rights

Communicating the objectives of the service, expectations, and a thorough

understanding of rights of individuals served and families is primary in insuring

optimal adjustment and training of individuals participating in CSS programs

operated by the NMRC. Information is provided regarding the fact that this

program does not discriminate on the basis of race, color, creed, age, physical

handicap, disability, political origin, religion, sex, or national origin in admitting

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individuals into the program. A large degree of goal attainment for the

individual is dependent upon his/her understanding of these. Each individual

receiving services and/or parent(s)/legal guardian(s) is informed of their rights

by approved staff while being served by the program at intake and at least

annually thereafter while he/she continues to receive service. (Rule 14.0 &

14.1.A)

Contents of the Rights of Individuals Receiving Services are presented verbally and

a copy is given to the parents, legal guardian, and/or individual. Information

included in the Rights of Individuals Receiving Services and other general

agreements and stated rules is presented (by each staff who are trained and

understand their responsibility) in printed form and interpreted verbally to insure

that the language is understandable to the individual and/or family. For individuals

and/or families with a language barrier or handicap special communication

provisions are made to insure adequate understanding (for non-English or deaf

individual’s information is translated or sign language used). (Rule 14.0 & 14.1)

The Human Rights Committee, comprised of a majority of non-NMRC employed

persons, reviews and ensures these individual rights as stated and assures that

individuals are not subjected to corporal punishment or unethical treatment. (Rule

14.0)

The BIDD Record Guide (referred to in this manual as Record Guide)

stipulates their rights must be written in such a way that staff members

understand their roles in maintaining and/or explaining these rights are clearly

defined and done annually. (Rule 14.1.B)

Each individual served by programs operated by CSS:

1. Is fully informed, verbally and in writing, prior to or at the time of

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admission of program options and of other services available and

of any related charges if applicable. In addition, financial

responsibilities, if applicable, are also explained at this time.

(Rule 14.0.A)

2. Is fully informed of all program and regulations. Informing the

individual of his/her rights and responsibilities are done no more than

one month prior to admission, within five days after admission, or at

the time of admission. Individuals already in the program are

informed within five days following any policy change. The

informing is conducted by the Program Director, Service Coordinator,

Case Manager or House Manager. Rules are posted at residential

programs. (Rule 14.0.B)

3. The program is responsible for serving any individual who is found to

be appropriate and eligible for services at such time as space becomes

available. For individuals who the program is unequipped to serve, the

program will make referral to appropriate services. (Rule 14.0.C)

4. Has the right to refuse treatment. (Rule 14.0.D) The individual has the

right to refuse to participate in recommended programming, however,

consistent refusal to participate may be the grounds for termination of

services from the program.

5. Has the right to ethical treatment including but not limited to the

following:

a) Not to be subjected to corporal punishment or

unethical treatment

b) The right to be free from all forms of abuse or

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harassment;

c) The right to be free from restraints of any form

that are not medically necessary or are used as a

means of coercion, discipline, convenience or

retaliation by staff; and

d) The right to considerate, respectful treatment

from all employees and volunteers. (Rule

14.0.E)

6. Has the right to voice opinions, recommendations, and to file a

Written grievance which will result in program review and response

without retribution. (Rule 14.0.F) An individual may file

grievances,

recommend changes, or seek reparation of a violated right by:

(a) Contacting his/her Service Coordinator between 8:00

a.m. and 4:30 p.m., Monday through Friday at

234-1476. The Service Coordinator will provide

information and contact appropriate personnel to

consider the change, suggestion, or violation.

(b) Contacting the CSS Director when inadequate

information or lack of action is taken. You may

telephone the Director at 234-1476 or by speaking

personally with him/her in the office at the NMRC.

7. The individual also has the right to request a hearing regarding

violation of rights. To request a hearing:

a) Contact the Service Coordinator or CSS Director.

The Service Coordinator will document by memo

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the request and forward to the Director within 24

hours of the occurrence of the infraction during

the regular work week.

b) Following a decision by the Director, the

individual may appeal the decision to the

Director of NMRC.

c) Following a decision by the Director of NMRC,

the individual may appeal the decision to the

Human Rights Committee.

At any time an individual may contact the Disability

Rights Mississippi, by writing, them at 5330 Executive

Place, Jackson, Mississippi, 39206 or by calling

1-800-722-4057, toll free or by dialing 1-601-

981-8207. The individual may also contact the DMH-

OCS at 1-877-210-8513 to assist with complaints,

grievances, or problem resolution.

8. Has the right to personal privacy, including privacy with respect to

visitors in day programs and residential programs as much as

physically possible. Each individual enrolled in the CSS program

is treated with consideration, respect, and full recognition of his or

her dignity and individuality including privacy. The individual

has the right to privacy to the maximum degree of feasibility, in

light of the physical environment and individual needs. They are

given privacy with respect to visitors in day programs and

residential programs. Preferences of each individual enrolled

related to activities, food, clothing, entertainment, and friendships

are given primary consideration in scheduling activities and in

staff decision making. Individuals may move freely in the least

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restrictive environment that his/her treatment and safety permits.

(Rule 14.0.G)

9. The program’s nondiscrimination policies related to HIV infection

and AIDS. (Rule 14.0.H) Programs operated through CSS do not

discriminate on the basis of disability, including HIV infection and

AIDS in accordance with the ADA and NMRC policy.

10. Has the right to considerate, respectful treatment from all

employees of the provider program. (Rule 14.0.I)

11. Has the right to have reasonable access to the clergy and advocates

and access to legal counsel at all times. An individual has the

right to be represented by legal counsel and to secure a lawyer for

help with legal problems. Financial responsibility is the

individual’s. (Rule 14.0.J)

12. Has the right to review his/her records, except as restricted by law.

(Rule 14.0.K)

13. Has the right to participate in and receive a copy of the

Individual Service Plan (ISP) including but not limited to the

following:

a) Has the right to make informed decisions

regarding his/her care, including being

informed of his/her health status, being

involved in care planning and habilitation,

and being able to request or refuse

treatment. This right will not be construed

as a mechanism to demand the provision of

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treatment or services deemed medically

unnecessary or inappropriate. Yearly, the

individual and/or legal guardian is included

in the planning and/or review of his/her

ISP. If an individual and/or legal guardian

is unable to participate in the process,

reasons for lack of participation must be

documented by the ISP Coordinator. This

documentation is noted in the individual’s

record. Individuals are informed during

ISP planning regarding program options

and the individual’s preferences and

requests given preference in deciding the

plan. Requests are documented in his/her

ISP. (Rule 14.0.L.1)

b) Has the right to access information contained in

his/her records within a reasonable time frame (if

5 days are exceeded in responding to such a

request, the reason for delay must be documented

and communicated). No programs operated

through CSS will frustrate the legitimate efforts

of individuals being served to gain access to their

own records and will actively seek to meet these

requests as quickly as it record keeping system

permits. Access to records may be restricted by

state statute 41-21-102 (7) in certain

circumstances where such access is medically

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contraindicated. (Rule 14.0.L.2)

c) Has the right to be informed of any hazardous

side effects of medications prescribed by staff

medical personnel. No medication is prescribed

by staff medical personnel as there are none.

However, documentation of the individual having

been informed of side effects is completed and

signed by the individual prior to beginning any

prescription medication prescribed by a

physician. (Rule 14.0.L.3)

14. Has the right to retain all Constitutional rights, except as restricted

by due process and resulting court order. (Rule 14.0.M)

Individuals served are encouraged and assisted, throughout the

period of enrollment, to exercise rights as a resident and a citizen

and may voice grievances and recommend changes in policies and

services to staff and/or to outside representatives of his/her choice,

free from restraint, interference, coercion, discrimination, or

reprisal. Individuals who desire and are able to vote are assisted

by NMRC personnel to the designated voting place if the

individual is registered in this county. If registered in another

county or if the individual is unable to be transported to the poll,

assistance is offered in obtaining an Absentee Ballot. Individuals

will cast ballots in private without the influence of any staff

member.

15. Has the right to have a family member or representative of

his/her choice notified promptly of his/her admission to a

hospital. (Rule 14.0.N)

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16. Has the right to receive care in a safe setting. (Rule 14.0.O)

17. May be discharged from the program for his/her welfare or that of

other individuals, or for non-payment of his or her stay if in a

residential program or for failure to maintain a suitable day

activity.

a) An individual may be recommended for service

termination at any time by the House Manager,

Program Director, and/or the appropriate Service

Coordinator. Approval or disapproval will be by

the recommendation of the CSS Director. The

resident/guardian will receive written or verbal

notice and rationale for termination ten days prior

(except in case of an emergency) and referral to

other suitable services. The form of

communication (written or verbal) will be

determined by the Service Coordinator, with the

most expedient and appropriate means chosen.

b) The individual, parent and/or legal guardian may

appeal the decision of the CSS Director to the

Director of the NMRC. A decision in written

form will be furnished no more than five days

after the appeal and arguments have been

presented. If the decision is upheld, the

individual, parent and/or legal guardian will be

notified by the CSS Director within one working

day of the decision having been made.

c) An individual may request termination from the

program. A two week notice is expected. The

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request will be presented to the House Manager

or Program Director for review by the

appropriate Service Coordinator and/or CSS

Director.

18. An individual has the right to refuse any search of personal

possessions unless he/she is present and unless adequate reasons have

been presented and appropriate legal steps have been taken. Personal

possessions may be searched in cases of extreme emergency.

However, documentation must be made in the individual's record of

any search made and the appropriateness of such actions must be

reviewed by the ISP Team to insure that no violation of individual

rights has occurred.

19. An individual has the right to seek, obtain and/or maintain

employment outside the program unless specific employment is

deemed by the ISP Team as a possible risk to the physical and/or

mental health of the individual or others. Such determination must be

documented in the individual’s record.

20. An individual has the right to send/receive mail without hindrance.

21. In residential programs the individual is encouraged to manage their

personal spending money. While ISP objectives are often targeted to

address needs in this area, all individuals are encouraged to further

develop money management skills.

7.2 ALA Programs - Additional Individual Rights

In addition to those previously described, individuals served in the

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ALA/Community Living programs of CSS:

A. Are provided with a means of communicating with persons

outside the program;

B. Are allowed visitation by close relative and/or significant others

during reasonable hours;

C. Are provided with safe storage, accessibility, and accountability of

funds; Individual funds are safely stored, accessible and

accountable.

D. Are provided means and opportunity to conduct private telephone

conversations with family and friend, unless clinically

contraindicated and documented in the individual’s case record.

Any restriction on private use of the telephone is reviewed at a

minimum every seven days.

E. Are not required to do work which would otherwise require

payment to other program staff or contractual staff. An

individual is not required to do any work for the program unless

it is part of a current ISP or is felt to be reinforcing of skills

already attained. The ISP and any additional household tasks

undertaken by the individual on a regular basis must be

reviewed by the ALA Coordinator monthly to evaluate the

effectiveness and to determine if a therapeutic need continues.

An individual may be required to make his/her bed, do his/her

laundry and ironing, keep his/her living area neat and clean, and

share responsibility for meal preparation. It is the policy of CSS

that individuals do not work for the program, with the exception

of WAC/Prevocational programs. For work performed in these

programs, wages are paid in accordance with local, state, and

federal requirements. (Rule 14.1.D)

F. Records of individuals enrolled in the ALA Residential programs

for whom the NMRC is representative payee are maintained and

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on file in the NMRC Reimbursement office. (Rule 14.1.E)

G. For these individuals, a record of sums of money received

for/from each individual and all expenditures of such money are

kept up to date and available for inspection. A report is

prepared and distributed to the individual and/or his lawful

agent quarterly. The individual is furnished a receipt for all

sums of money received. Bills maintained by the

Reimbursement Office for services/items purchased by the

individual serve as the receipt for expenditures. (Rule 14.1.F)

7.3 Behavior Support Plan (BSP)

BSIS are provided to individuals who exhibit behavior problems which cause them

not to be able to benefit from other services being provided or cause them to be so

disruptive in their environment(s) there is imminent danger of causing harm to

themselves or others. (Rule 52.0.A)

The expected outcome for BSIS is for individuals to receive training and

supports necessary to decrease maladaptive behaviors which interfere with

individuals remaining at home and in the community. (Rule 52.0.B)

Behavior Support and Intervention Services must include the following:

1. Assessing the individual’s environment and identifying antecedents of

particular behaviors, consequences of those behaviors, and maintenance

factors for the behaviors.

2. Developing a positive Behavior Support Plan (BSP).

3. Implementing the plan, collecting data, and measuring outcomes to assess

the effectiveness of the plan.

4. Training staff and/or family members to maintain and/or continue

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implementing the plan.

5. Assisting the individual in becoming more effective in controlling his/her

own behavior either through counseling or by implementing the BSP.

6. Documentation of collaboration with medical and ancillary therapies to

promote coherent and coordinated services addressing behavioral issues and to

limit the need for psychotherapeutic medications, when applicable.

7. Training of staff responsible for implementing the BSP by the staff

member who conducted the Functional Behavior Assessment (FBA) and

developed the BSP prior to implementation of behavior management

strategies identified in the plan. (Rule 52.0.C)

BSI may provide services at the same time another service is being provided as long

as it is clearly documented that the intervention is:

1. Observing the individual for the Functional Behavior Assessment (FBA).

2. Collecting data via observation and intervention.

3. Training staff who provide another ID/DD Waiver service to the individual.

4. Shadowing and/or intervening in undesired behaviors while the individual is

receiving another ID/DD Waiver service.

5. Designed to be intensive and short-term. (Rule 52.0.D)

Written Approval of Behavior Support Plan

A. In the community living programs, the BSP is approved by the following:

1. The parent(s)/legal representative

2. The individual (if appropriate)

3. The behavior support/interventionist

4. The director of the service

5. The NMRC Director of the program/agency or his/her designee. (Rule 52.2.A)

B. If the individual is not enrolled in a day or residential program, the BSP

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is approved by the following:



3. The behavior support/interventionist. (Rule 52.2.A & B)

A BSP is developed by the individual’s ISP team in conjunction with the Behavioral

Support/Interventionist employed by the Psychology Department of the NMRC when

emergency restraint or escort are implemented more than three (3) times within a 30 day

period with the same individual. The BSP addresses the behaviors warranting continued

utilization of physical restraint/escort procedure in emergency situations. (Rule

14.5.K.1-2)

Orders for the use of emergency physical restraint/escort are not written on an as needed

(PRN) basis. (Rule 14.5.K.1) The BSP is developed with the signature of the Behavioral

Support Interventionist and the Director of Psychology. When implementing physical

restraint/escort as specified in the BSP, the individual’s treating psychologist is

consulted within 24 hours and the consultation is documented in the individual’s case

record. (Rule 14.5.K.3) The trained Program Director who is competent will conduct a

face-to-face assessment of the individual’s mental and physical well-being as soon as

possible, but not later than within one (1) hour of the initiation of the intervention.

(Rule 14.5.K.4) Any intervention conducted is conducted only by staff who have

successfully completed DMH-approved training for managing aggressive or risk-to-self

behavior. Any intervention conducted is monitored as the intervention occurs by the on-

site Supervisor or Program Director who has also successfully completed this training.

Staff record an account of the use of physical restraint/escort in a behavior management

log that is maintained in the individual’s record by the end of the work day. (Rule

14.5.K.5) This log includes:

H. Name of the individual from whom physical restraint/escort

intervention was implemented;

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I. Time that physical restraint/escort intervention began;

J. Behavior warranting utilization of physical restraint/escort

intervention;

K. Type of physical restraint/escort that was utilized during

intervention;

L. Documentation of less restrictive methods of managing behavior

which have been determined to be ineffective in management of

the individual’s behavior;

M. Documentation of visual observation by staff of the individual

while he/she is in physical restraint/escort, including a description

of behavior at that time;

N. Time that the physical restraint/escort intervention ended; O. Signature of staff implementing physical restraint/escort procedure

and staff observing the individual for whom the physical

restraint/escort intervention was implemented.

P. Documentation of the on site Supervisor or Program Director’s

assessment of the restrained/escorted individual’s mental and

physical well-being during and after physical restraint/escort

utilization, including the time the assessment was conducted.

Q. Documentation that clearly describes the precipitating events that

necessitated the use of physical restraint/escort in emergency

situations. (Rule 14.5.K.5)

Physical restraint may be utilized only for the time necessary to address and de-

escalate the behavior requiring the intervention and in accordance with the

approved BSP. Individuals will not be restrained for more than 55 minutes at any

one time and must be released after those 55 minutes. A face-to-face assessment

occurs at least every 20 minutes while the individual is being restrained. (Rule

14.5.H)

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Physical restraint/escort intervention is in accordance with a written

modification

of the individual’s comprehensive ISP. The ISP and BSP and meets the

following requirements:

A. Physical restraint/escort must be implemented in the least

restrictive manner possible;

R. Physical restraint/escort must be in accordance with safe,

appropriate restraining techniques;

S. Physical restraint/escort must be ended at the earliest possible time

(i.e., when the individual’s behavior has de-escalated and that

individual is no longer in danger of harming him/herself or

others);

T. Physical restraint/escort must not be used as a form of punishment,

coercion, or staff convenience;

U. Supine and prone restraints are prohibited as part of an

individual’s BSP; and

V. All physical restraint/escort intentions can only be implemented

by someone holding certification of training in a DMH-approved

program.

Time Out (i.e., a behavior management technique which moves

an individual from social reinforcement into a non-locked room

for the purpose of calming) is not utilized with individuals at

programs operated through CSS. (Rule 14.6)

Use of Restraints

In programs operated by CSS, physical restraint and or escort interventions

as a component of a Behavior Support Plan are only conducted for those

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community individuals receiving Behavior Support/Intervention services

through the HCBW or individuals receiving WAC services who reside in

CSS or ICF/MR Group Homes.

All staff are required to complete PASS, a DMH-approved program for

managing aggressive or risk-to-self behavior in order to implement

emergency physical restraint/escort procedures safely. (Rule 14.5.D) A

list of qualified supervisory or senior staff members is retained at each

applicable program. (Rule 14.5.E) Emergency physical restraint/escort

interventions of this nature for individuals residing at home not covered in

the above categories remain subject to the following policies and

procedures.

1. Has the right to be free from mechanical restraint (i.e., the use of

a mechanical device, material, or equipment attached or adjacent

to the individual’s body that he or she cannot easily remove that

restricts freedom of movement or normal access to one’s body)

unless being used for adaptive support. (Rule 14.5.A)

2. The use of seclusion, defined as a behavior control technique

involving locked isolation, is prohibited in programs operated by

CSS. (Rule 14.5.B)

3. Chemical restraint (i.e., a drug or medication that is used as a

restraint to manage behavior or restrict the individual’s freedom of

movement that is not a standard treatment for the individual’s

medical or psychiatric condition) is prohibited in programs

operated by CSS. (Rule 14.5.C)

4. Physical restraint (i.e., personal restriction that immobilizes or

reduces the ability of an individual to move his or her arms, legs,

or head freely) and escort (i.e., the temporary holding of the hand,

wrist, arm, shoulder, or back for the purpose of indicting an

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individual who is acting out to walk to a safe location) may be

used only in an emergency (i.e., a situation where the individual’s

behavior is violent or aggressive and where the behavior presents

an immediate and serious danger to the safety of the individual

being served, other individuals served, staff, or others) to protect

the individual from injury to himself or others and after all other

less restrictive appropriate alternatives are exhausted and

documented in the individual’s record and it is deemed necessary

and authorized by a senior clinical staff member or his/her

designee. If emergency physical restraint/escort is authorized,

renewal must be given by a senior clinical staff member at least

every 24 hours. Written authorization and justification for escort

or emergency physical restraint, as approved by the senior clinical

staff member, is noted at the time of incident on the Summary of

Contacts/Emergencies form in individual records. Neither

emergency physical restraint nor escort is used as punitive

measures. (Rule 14.5.F.1)

Emergency physical restraint may be used only in emergencies

when individual’s behavior may result in injury to himself or

others and when all other less restrictive measures have been

exhausted. (Rule 14.5.F.2) Emergency physical restraint may not

be used as punishment.

Emergency physical restraint and escort are used as specified in a

Behavioral Support Plan only when all other less restrictive

alternatives have been determined to be ineffective to protect the

individual or others from harm. Utilization of less restrictive

alternatives must be documented in the individual’s record.

Emergency physical restraint and escort are used in accordance

with a Behavior Support Plan by order of a physician or other

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independent practitioner as permitted by State licensure

rules/regulations governing the scope of practice of the

independent practitioner and the provider and documented in the

individual’s record. (Rule 14.5.G-K)

Escort (i.e., the temporary holding of the hand, wrist, arm,

shoulder, or back for the purpose of indicting an individual who is

acting out to walk to a safe location) can be used only in extreme

cases when an individual’s behavior may result in injury to

himself or others and when all other less restrictive measures have

been exhausted. (Rule 14.5.F)

7.4 Staff Roles in Protecting Rights of Individuals

Each staff has a role in and responsible for protecting and maintaining each

individual’s rights and being able to explain each right to the individual in a

manner understandable to the person receiving services and/or legal

guardian/representative prior to admission and annually. (Rule 14.1.A & B)

This objective is accomplished through specific training provided prior to hire

and annually thereafter. Through this training, staff learn how to implement and

maintain these rights. The training includes: the effects of stigma; developing

empathy; nondiscrimination; and the roles of family members and caregivers in

treatment and services. (Rule 14.1.C) An individual receiving services cannot

be required to do work which would otherwise require payment to other

program staff or contractual staff. (Rule 14.1.D) A record of any individuals

for whom NMRC is the legal representative or a representative payee is on file

with supporting documentation. (Rule 14.1.E) For individuals with a

conservator or representative payee a record of sums of money received

for/from the individual and all expenditures of such money is kept up to date

and available for inspection and a receipt is available upon request. (Rule

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14.1.F)

7.5 Ethical Conduct

All staff members are required to adhere to the highest ethical and moral conduct

in

their interactions with the individuals and families members we serve as well as in

their use of program funds and grants (when applicable). Examples of breeches in

ethical conduct include but are not limited to, the following situations from which

a

provider is prohibited from engaging in:

a) Borrowing money or property

b) Accepting gifts of monetary value

c) Sexual (or other inappropriate) contact

d) Entering into business transactions (unless otherwise pre-approve

by the Center Director)

e) Physical, mental, or emotional abuse

f) Theft, embezzlement, fraud, or other actions constituting a

violation of laws regarding vulnerable adults, violent crimes or

moral turpitude

g) Exploitation

h) Failure to maintain proper professional and emotional boundaries

i) Aiding, encouraging, exciting the performance of illegal or

immoral acts

j) Making reasonable treatment-related needs of the individual

secondary or subservient to the needs of the employer or

volunteer

k) Failure to report knowledge of unethical or immoral conduct or

giving false statements during inquiries to such conduct

l) Action or inaction, which indicates clear failure to act in an

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ethical, moral, legal, and professional manner

m) Breech of and/or misuse of confidential information (Rule 14.2)

7.6 Cultural Competency

Information included in the Rights of Individuals Receiving Services and other

general agreements and stated rules is presented in printed form and interpreted

verbally to insure that the language is understandable to the individual and/or

family. For individuals and/or families with a language barrier or disability, special

provisions are made to insure adequate understanding (for non-English proficient

or

hearing impaired, the individual’s information is translated or sign language used).

Refer to NMRC’s Cultural Competency Policy (Attachment 48) (Rule 14.3.A)

Language assistance services are offered in a timely manner during all hours of

operation. (Rule 14.3.B)

Verbal offers and written notices informing individuals receiving services of their

rights to receive language assistance services are provided to individuals in their

preferred language. (Rule 14.3.C)

The provider must assure the competence of the language assistance provided.

(Rule 14.3.D)

Family and/or friends of the individual should only be utilized to provide

interpreter services when requested by the individual receiving services. (Rule

14.3.E)

Service providers must make available easily understood consumer related

materials and post signage in the language of groups commonly represented in

the service area. (Rule 14.3.F)

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7.7 Serious Incident Reports (SIRs) and Records

The term "serious incident" refers to and includes suicide attempts on program

property or at a program sponsored event; unexplained absence from a residential

program of twenty-four (24) hour duration; death of an individual on program

property or program sponsored event; an unexplained absence from a residential

program; emergency hospitalization or emergency room treatment of an individual

while in the program; accidents which require hospitalization, may be related to

abuse or neglect, or in which the cause is unknown or unusual; disasters, such as

fires, floods, tornados, hurricanes, blizzards, etc.; any mandatory evacuation by

local authorities that affects the program and any use of seclusion or restraint (Rule

15.0.A.1-9)

All serious incidents involving individual(s) or staff member(s) on program

property or at a program sponsored event are documented and reported

immediately to the CSS Director, the agency director, DMH-BQMOS,

parent(s)/guardian(s) or other significant persons as identified by the individual and

documented in individual records or personnel records and a central file on site.

(Rule 15.0.A)

Documentation regarding serious incidents includes a description of events and

actions, written reports and telephone calls to the DMH-BQMOS (see written

documentation and notification below). (Rule 15.0.B) Incidents are reported

immediately by program staff to the individual’s parent/guardian, next of kin,

and/or significant other as designated in the individual’s record, the Coordinator

of the program and the Department Director. SIRs are reported to the DMH-

BQMOS as soon as possible, but no later than 24 hours or the next working day

followed by a complete SIR form. If a final resolution has not been met at that

time, a report must be sent indicating such. Once a resolution has been made, it

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is documented and the final SIR is sent to BIDD. Staff are encouraged to report

all incidents which could possibly be considered serious even if it does not meet

the following indicators.

In the event of an individual death, the staff person in charge of the program at that

time will notify their ALA/WAC Coordinator who will then notify the CSS

department director and they will then notify the NMRC Director. The Director of

CSS will verbally notify BQMOS within eight (8) hours to be followed by the SIR

form within 24 hours. (Rule 15.1)

All accidents (whether they seek a physician’s services or not) will be recorded

on an Individual Accident Report form (Attachment 36) to be placed in

individuals' files. Written incident reports regarding serious occurrences

involving staff or individuals will be completed within twenty-four (24) hours

on the Serious Incident and Accident Report forms. Written documentation of

serious occurrences is recorded on a Serious Incident Report form including the

following information: date, time and location of incident, name of

individual(s) and/or staff member(s) involved, the circumstances surrounding

incident and intervention procedures implemented, documentation of

notification of designated personnel and final disposition. (Attachment 37) A

copy of either of the reports is filed in the CSS office and is available for review

by appropriate personnel in the CSS Department and the NMRC Director's

office.

The Quality Management Committee (QMC) meets at least quarterly to review

all SIRs and Critical Events during that time period and has the responsibility to

analyze the SIR reporting and documenting process. The committee determines

if the accident could have been prevent, requests any remedial actions that is felt

should be taken, if the SIR was reported in a timely manner, documented and

this information maintained for further review if needed. (Rule 15.2 & 15.3)

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Disasters or emergencies which require closure of programs are reported to

DMH by telephone within twenty-four (24) hours of occurrence or the next

working day. A Disaster Report form including events and actions taken is

completed and forwarded to the CSS Director with copies to the Director of

NMRC and DMH within five days following the event. (Attachment 38)

7.8 Grievance and Complaint Resolution

Grievance and Complaint Resolution policies and procedures are in place by which

individuals served by programs operated by the CSS Department of the NMRC

may resolve complaints or may appeal the decision of an NMRC staff member

without retribution. These policies and procedures include:

1. Access to fair and impartial process for reporting and resolving grievances

and complaints

2. Being informed and provided a copy of the local procedure for filing a

grievance/complaint

3. That individuals receiving services and/or their parent(s)/legal guardian(s)

are informed of the procedures for reporting/filing a complaint/grievance

with DMH including their toll free telephone number

4. Posting in a prominent public area the OCS informational poster

(Rule 14.4.A.1-4)

The policies and procedures for resolution at the program/center level, includes at a

minimum:

a) Definition of complaints and grievances

b) Statement that any complaint/grievance can be expressed without

retribution

c) Opportunity to appeal to the executive officer of the program as well

as the governing board of the program

d) Time frames for decision making

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e) Toll free number for filing a grievance/complaint with the DMH

(Rule 14.4.B.1-5)

The individual, parent, guardian, or advocate may appeal a decision of an NMRC

staff member by:

1. Contacting the Program Supervisor between 8:00 a.m. and 4:30 p.m.

Program Supervisors for the various services offered through the CSS

Department area specified as:

WAC/Prevocational/Day Services-Adult WAC/DSA Director

Community Employment WAC Director

Community Living/Residential House/Apartment Manager

Regional Case Management ALA/CM Coordinator

HCS - Formerly Attendant Care/Respite Nursing Coordinator

2. The Program Supervisor will gather and provide information as well

as contact appropriate personnel in order to consider the appeal. The

Program Supervisor will provide a decision in writing to the individual,

parent, guardian, or advocate which will uphold or overturn the decision

made by the staff member. Within this time frame, the Program

Supervisor will also provide in writing to the CSS Director the decision

made and supporting evidence/documentation forming the basis for that

decision. (Rule 14.4.C)

3. After issuance of the written decision of the Program Supervisor, the

individual, parent, guardian or advocate may appeal this decision to the

CSS Director by calling 234-1476, extension 37699, writing CSS

Department, NMRC, 967 Regional Center Drive, Oxford, Mississippi

38655, or by seeing the CSS Director in the CSS offices at the NMRC.

The CSS Director will gather and provide information as well as contact

appropriate personnel in order to consider the appeal and provide a written

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decision, upholding the decision or overturning the decision within five (5)

working days to (1) the individual, parent, guardian, or advocate, and (2)

the Director of the NMRC.

4. After issuance of the written decision of the CSS Director, the

individual, parent, guardian, or advocate may appeal this decision to the

Director of the NMRC by calling 234-1476. The Director of the NMRC

will gather information, contact appropriate personnel, and render a

decision to the individual, parent, guardian, or advocate.

5. The Director’s decision may be appealed to the Human Rights

Committee.

6. At any time, the individual, parent, guardian, or advocate may contact

Disability Rights Mississippi by writing 5305 Executive Place, Jackson,

MS, 39206 or by calling 1-800-981-8207, toll free or by dialing 1-601-

772-4057.

7. At any time, the individual, parent, guardian, or advocate may contact

the DMH-OCS to file a complaint/grievance by calling toll-free 1-877-

210-8513. (Attachment 32a. and 32b)

8. Retribution, punishment, or retaliation in any manner directed toward

any individual who files a grievance/complaint described in this procedure

is prohibited.

Individuals are informed of the above grievance/complaint resolution procedure

including availability of the toll-free number which is posted prominently in all

programs upon enrollment with a copy provided to the individual and written

documentation of such maintained in the record. This procedure is in compliance

with those established by the DMH-OCS (Rule 14.4.D)

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8.0 SERVICE ORGANIZATION

8.1 General Section

As a program operated by the NMRC which is funded through DMH, CSS

complies with additional applicable specifications set forth by individual program

grants/contracts as well as requirements outlined in the DMH Record Guide. All

programs operated through CSS submit all reports required by the DMH according

to established time lines. Current and accurate data are maintained for submission

of all reports and data and comply with requirements of DMH Provider Bulletins.

(Rule 16.0.A-D)

Any and all revisions to the OSM (numbers affected and date effective) will be

adhered to and incorporated into the CSS department’s Policies and Procedures

Manual. NMRC’s Director will then sign off on the revised manual.

If an interpretation of a standard is needed, a request is made in writing to DMH

from the Center Director or their designee.

8.2 Admission to and Eligibility for Services

All services offered through CSS may be accessed through the completion of a

comprehensive pre-admission evaluation conducted by the Diagnostic Services

Department of NMRC. Individuals may be referred by CSS staff to Diagnostic

Services for scheduling the pre-admission evaluation or individual may be referred

by Diagnostic Services to CSS for specific services. Readmission to services is

accomplished based on availability and admission requirements for the specific

services set forth in the OSM and the Record Guide. (Rule 16.2)

A service description and admission/readmission criteria for specific services

offered through CSS are as follows:

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A) ALA/Residential Habilitation (Supervised and Supported)

Eligibility requirements include that the individual be 21 years

of age, be certified developmentally disabled, possess a current

psychological and medical evaluation, and be approved by the

Administrative Screening and Review Committee of the

NMRC. Enrollment in the HCBW is required for Residential

Habilitation services. Also, specific requirements of the Record

Guide must be met.

B) Case Management

Eligibility requirements for this program include

intellectual/developmental disability certification and a current

psychological and medical evaluation, and approval by the


NMRC, in addition to all specific requirements of the Record

Guide.

C) WAC/PV Services

Eligibility requirements include that the applicant be 21 years of

age or older, have developmental disability certification, have a

current medical examination, reside in the service area of the

respective WAC (i.e., the county in which the program is

located or an adjacent county), and approval of the


NMRC. Individuals seeking Prevocational Services must be

enrolled in the HCBW with DMH/DOM approval for this

service on the individual’s Plan of Care. Specific requirements

of the Record Guide must also be met.

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D) Day Services - Adult

Eligibility requirements for this service include developmental

disability certification and a current psychological and medical

evaluation, approval by the Administrative Screening and

Review Committee of the NMRC, and enrollment in the HCBW

program with DMH/DOM approval for this service on the

individual’s Plan of Care. In addition to all specific

requirements of the Record Guide.

E) HCS (Formerly Attendant Care)





with DMH/DOM approval for this service on the individual’s

Plan of Care. In addition to all specific requirements of the

Record Guide.

F) HCBW In-Home Nursing





with DMH/DOM approval for this service on the individual’s

Plan of Care. In addition specific requirements of the Record

Guide must also be met. (Rule 16.2)

For a more descriptive listing for each service to include population served,

determination for eligibility for the service, number of individuals served,

expected results/outcomes, and the methodology used to evaluate those

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outcomes, can be found later in the document. (Rule 16.2.B)

The CSS programs provide equal access to treatment and services for

individuals with ID/DD. (Rule 16.2.C)

Individuals accessing services through CSS receive a comprehensive pre-

admission evaluation through the Diagnostic Services Department of the

NMRC. Intake information is taken by the Diagnostic Services staff and is

included in the comprehensive evaluation report which is made available to the

Administrative Screening and Review Committee and other NMRC

departments, including CSS, where the individual is seeking service. If a pre-

admission evaluation is not required because it has recently been done in the

past, Diagnostic Services disseminates the reports, including intake information

to the requesting department. Requesting appropriate consent to obtain relevant

records from other providers is conducted by the staff of the Diagnostic Services

Department prior to the pre-admission evaluation. (Rule 16.2.D)

All admission material is explained to the individual and their family/legal

guardian/representative at intake. (Rule 16.2.F)

The process for informing individuals of their rights and responsibilities,

including any applicable program rules for residential services, prior to or at the

time of admission and annually thereafter is noted under each program

description. (Rule 16.2.G)

Individuals found ineligible for services offered through CSS are referred to

other agencies, services, and/or providers by the Case Manager who sits on the

Administrative Screening and Review Committee. Documentation of referrals

and follow-up contacts are maintained in the individual’s CM record. In the

event that the individual is not eligible for CM services, the Social Worker on

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the Diagnostic Services Interdisciplinary Evaluation Team is responsible for

referrals and follow-up, with documentation maintained in the individual’s

Diagnostic Services record. (Rule 16.2.H)

In the event that the program or programs desired is operating at capacity and an

individual may not be enrolled following approval of eligibility, the individual

is placed on a service utilization roster which is maintained by the program(s)

concerned. Individuals on this roster are ranked according to date of application

for services with those individuals waiting the longest offered placement first

when program vacancies occur. If individuals decline offered

placement/services three times, the individual’s name is moved to the bottom of

the service utilization roster. (Rule 16.2.I)

The Monthly Waiting List Report and Client Data Enrollment Report are

submitted monthly (by the 15th of the month following) to DMH documenting

the number of deletions and/or additions made to the various programs’ Waiting

List during that month. Individuals are identified by age, sex, race, diagnosis

and their home county. Additional information regards referral sources and

referrals made relevant to each individual. (Attachments 40 & 41) (Rule 16.2.I)

Programs operated through CSS do not discriminate on the basis of disability,

including HIV infection and AIDS in accordance with the ADA

and NMRC policy. (Rule 16.2.J)

Each service provides a program schedule to the individual receiving services and

their family/legal guardian/representative which at a minimum includes:

- Hours of daily operation/service/availability of program

- Number of days per year the service/program is available

Scheduled dates of closure and reasons (Rule 16.2.K)

Individuals acknowledge in writing any fees and the amount of the fee for which

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they will be responsible for payment. (Rule 16.2.L)

8.3 Program Postings/Required Information

All program rules for any service and/or program are available to those being

served and are posted and are in a highly visible location for those being served.

(Rule 16.3.A)

For day programs and community living programs, emergency telephone numbers

(police, fire, poison control center and EMS services) is located near each

telephone. (Rule 16.3.B) Other contact information is kept on file in a secure

location at each program site to include the family member(s) or other contacts and

the case manager for the individual. (Rule 16.3.C)

8.4 Service and Program Design

Each program provides an individualized plan of treatment (Individual Service

Plan – ISP) designed to promote independence in the most integrated setting.

Long-term goals and short-term objectives are identified based on the

individual’s strengths, needs and behavioral deficits of individuals and/or

families/legal guardians. An assessment of needs is conducted annually.

Program needs are identified and evaluations of program goals and objectives

are based on observations by and discussions of the CSS Director, the

WAC/DSA Coordinator, and the ALA/CM Coordinator. This annual evaluation

measures performance against stated goals and objectives and allows for review

and modification as needed. (Attachment 29) The written report of evaluation

and program utilization documents annual results. The overall plan for

providing services includes measurable goals and objectives for each program

including strategies for achievement and means of evaluation. This information

is reviewed and updated annually, and is approved by the Governing Authority.

(Rule 16.4.A)

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Each individual receiving services in the CSS department has the right to make

informed decisions regarding his/her care, including being informed of his/her

health status, being involved in care planning and habilitation, and being able to

request or refuse treatment. (Rule 16.4.B)

Preferences of each individual enrolled related to activities, food, clothing,

entertainment, and friendships are given primary consideration in scheduling

activities and in staff decision making. Their participation in activities helps them

develop skills necessary to help in a smooth transition to a more integrated setting,

level of service or level of care.

All services are designed based on interests, desires, wishes, and desired personal

interest expressed by the individual/family and are based on these requirements of

the individual, rather than on the availability of services. (Rule 16.4.C & D)

Should an individual’s placement be terminated due to performance deficiencies

or other problems, the Director or Manager of that program will meet with the

individual and appropriate CSS staff (i.e. WAC/DSA Coordinator, ALA

Coordinator, and/or Department Director). At this staffing a determination will

be made as to the disposition of the individual’s case. If applicable, a

psychologist may be asked to evaluate the situation and provide feedback.

Courses of action would include location of an alternative placement, if

available; provision of retraining/counseling; and/or another alternative. These

determinations are made on a case by case basis and are subject to the approval

of the Department Director. All efforts are documented. (Rule 16.4.E)

8.5 Staffing

A level of staffing adequate to meet the needs of individuals and ensure their

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health, safety, and welfare is maintained in all programs operated through CSS.

(Rule 16.5.A) Day to day provision of services is supervised by staff who meet

minimum requirements defined in Part VI, Section C, Qualifications. Staff are

qualified by demonstrated competence, specialized background, education, and

experience to manage the operation of the respective programs.

Only licensed health care professionals provide nursing care, medical services,

or medication in accordance to the criteria, standards, and practices set by their

licensing entity. (Rule 16.5.B)

Contractual services are provided through CSS’ HCBW Nursing Respite and Home

and Community Supports (formerly Attendant Care). A written interagency

agreement is on file which covers the individual’s roles and responsibilities of both

parties, procedures for obtaining necessary informed consent, including the release

of and sharing of information, and assurances that OSM standards will be met by

both parties indentified in the agreement. (Rule 16.5.C)

8.6 Confidentiality

Employees of the CSS Department are required to maintain the confidentiality

rights of individuals they serve at all times across situations and locations, such as

in waiting areas, hallways, or other areas to which the public has access, while

speaking on the telephone, or in conversing with colleagues. (Rule 16.6.A)

8.7 Case Record Management and Record Keeping

Services operated through CSS meet applicable OSM. Records are maintained

at the program sites in the ALA/Community Living, WAC/Prevocational, and

Day Services – Adult Programs. Records for NMRC’s CM services are

maintained in the CSS department office on the campus of the NMRC.

Authorized staff may have access to the records 24 hours per day, 7 days per

week. A list of staff authorized to review records is posted on each filing

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cabinet containing individual records.

An Individual Record Location Index is maintained for documentation of

whereabouts of individual files that may have been removed from the program

or central file location. A sign out control sheet in each individual’s file is

signed by anyone viewing the record. (Rule 16.7.B) In case of an emergency,

vacation, or during a closing, records may be obtained from the Program

Director, Service Coordinator or the CSS Director. (Rule 16.7.C) Entries in

records of individuals served must be legible, dated, signed, and include the

credentials of the staff making the entry. Corrections of original information

entered in the record(s) of individuals served must be made by marking a single

line through the changed information. Changes must be initialed and dated by

the individual making the change. Correction fluid, erasing, or totally marking

out original information is prohibited. (Rule 16.7.D) Any reference to another

individual in the record of the person receiving services is not permissible.

(Rule 16.7.E)

Regarding closed cases, when no contacts regarding an individual are recorded

for twelve (12) months, the case is closed. Closure also occurs at the time of

termination by request at the time of withdrawal from the program, for failure to

follow established policy, at the time of referral to another program or similar

circumstances. Closed records are maintained according to DMH standards.

(Rule 16.7.F)

Case records are maintained for all individuals served through CSS and follow

the format required by the Record Guide. Case records include (when

applicable) the following:

Face Sheet or Identification Data Form which consists of data items as

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specified in the Core Individual Data Set of the current DMH Manual of

Uniform Data Standards. Certain ancillary data as required by DMH is

also included. The face sheet is contained in the individual record, is

completed within 30 days of admission for services, is signed and dated

by the individual/legal representative and the staff who assists in

completion and is updated as needed and reviewed at least annually.

The date of annual review is initialed and included in the individual’s

record. (Attachment 22)

Summary of Activities related to the service being provided of each

contact;

An Assessment of Progress made toward goals and objectives of the

Comprehensive ISP, PCP;

A statement of immediate plans for future activities related to the

service being provided; and

The date, type of service being rendered, time-in and time-out for each

service event, and the length of time spent in providing the service.

(Rule 16.7.G.1-4)

8.8 Assessment

An intake assessment is included on all new cases and a new updated

intake on all reopened cases is included. Intakes will be contained in

the current volume of the record. The intake includes at a minimum the

description of the primary and secondary presenting problems, history

of the presenting problem, history of previous services and placements,

medical history, family history, educational/vocational achievement,

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source of referral, initial diagnosis/assessment and DSM Code and any

specific service requirement elements. (Rule 16.8.F)

Individual Service Plan (ISP)

The ISP includes a summary of the initial and each subsequent

review including names of staff participating in the initial staffing

and each subsequent staffing/review, service notes and/or contact

summaries and service documentation relating to movement of

individuals toward the stated objectives. The ISP is updated as

needed and reviewed and revised annually. The ISP process is

conducted as described in the Record Guide.

Case Management (CM) Service Plan

The individual, family/guardian, and CM jointly develop a Service

Plan according to the desires and preferences of the individual. The

development occurs during a face to face meeting that is conducted

at least annually and is subject to change in accordance with the

individual’s desire for services and supports.

Documentation of initial staffing and further staffing/review

Medication/Drug Use Profile is filed in the individual’s record

Transfer/Discharge Termination Summary

The summary for closed cases includes reason for admission,

summary of therapeutic activities provided, reason for discharge,

assessment of progress toward treatment/habilitation/service plan

objectives, discharge instructions given to the individual or their

authorized representative, parent(s)/legal guardian(s), including

referrals and any other information deemed appropriate to address

the needs of the individual being discharged. The

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discharge/termination summary is described in the Record Guide.

Release/Consent Forms

Copies of all signed Consent to Treatment, Acknowledgment of

Individual’s Rights, and Release of Information forms are filed in

the individual’s record.

Assessment/Evaluations

Evaluations and diagnostic assessments are filed in the individual’s

record.

Eligibility Certification

All applicable DMH checklists and certifications of eligibility are

filed in the appropriate section of the individual record.

Consent to Release Information Acknowledging Presence

All applicable Consent to Release Information Acknowledging

Presence forms are filed in the appropriate section of the

individual’s record.

Guardianship Documentation

For individuals who have a legal guardian/conservator appointed by

a court of competent jurisdiction, copies of the guardian/conservator

order are filed in the appropriate section of the individual’s record.

Persons Served in Residential Program

For individuals in our ALA program, a Visitation Agreement and a

Telephone Agreement are reviewed and documented. A Medical

Screening Report is completed and accessible in the individual’s

file.

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A licensed physician with psychiatric training or documented

competency in the use of the DSM diagnostic criteria, a licensed clinical

psychologist, or a psychiatric/mental health nurse practitioner certifies

that services are medically necessary for individuals receiving services

provided through the CSS department. Certification and recertification

is documented as part of the ISP. (Rule 16.8.F)

Individualized assessments performed by our Diagnostic and Evaluation team is

located in each individual’s record as part of their Initial Assessment process.

(Rule 16.8.F)

Individual Records

Written policies and procedures are in place governing the compilation,

storage, and dissemination of individual case records insuring the

individual’s right to privacy and confidential treatment of all information

contained in his/her records, and his/her written consent is required for the

release of information to persons not otherwise authorized under law to

receive it. This procedure includes designated person(s) to distribute

records to staff, specific procedures to assure that records are secure in

each program, and procedures to limit access to records to those who have

specific need for the record including written documentation listing those

persons. All information concerning an individual served by NMRC's CSS

Department is confidential and may not be released without the written

consent of the individual. The procedure for release of information

complies with state and federal regulations Exceptions to the requirement

of a prior written release include: upon court order of a court of competent

jurisdiction, upon request by medical personnel in a medical emergency, or

when necessary for the continued treatment or continued benefits of the

individual. (Rule 16.6.B & C)

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Records are the responsibility of the program supervisors (Workshop

Directors, House Managers, Case Managers, Program Directors, and

Waiver coordinators) and can be released to staff only by those designated

persons. The staff are responsible for processing inquiries or requests for

individual information. In case of emergency, vacation or after hour

situations, records may be obtained from the Program Director, Service

Coordinator or the CSS Director. These staff are authorized to make such

a release and must compile and enter into the individuals record an entry

consisting of: the individual’s name or case number; the date and time of

the disclosure; the information disclosed; to whom the information was

disclosed and the reason for the disclosure; and the name, credential, and

title of the individual disclosing the information. Emergency situation

procedures are also described in Section 5.5. - Case Record Management

and Record Keeping. Records are kept on site at each program in a locked

file cabinet. This includes individual case records and/or any records

containing information pertaining to individuals. A Sign Out Sheet is

maintained in each record indicating the person viewing the record, the

date, and the reason for viewing the record. Access to case records is

limited to staff of the programs who have been determined to have specific

need for the record C namely for updating/recording pertinent information.

(Rule 16.6.C.1 & 2)

Access to individual records is limited to the above except in cases where

the individual has signed a release, a medical emergency, verifiable federal

or state reviews, court order from a court of competent jurisdiction, or

when necessary for the continued treatment/benefit of the individual. In

the case of state or federal review (other than DMH staff), a written

statement indicating the purpose of the review, the staff conducting the

review, a statement that the reviewer is bound by applicable regulations

regarding confidentiality, the reviewer’(s) signature(s) and the date signed

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is required. Proof of identity is requested prior to record review. (Rule

16.6.C.3)

The release of individual information is carried out in accordance with all

applicable state and federal laws. Individual records and information is not

released except upon written authorization of the individual or, when

applicable, his/her legally authorized representative; upon order of a court

of competent jurisdiction; upon request by medical personnel in a medical

emergency or when necessary for the continued treatment of the

individual. (Rule 16.6.C.4)

All records and/or other documentation at all programs containing any

information pertaining to individuals are kept in a secure room or in a

locked file cabinet when not in use. (Rule 16.6.C.2)

All individual case records are marked "Confidential." (Rule 16.6.E.)

When releasing individual information with written consent, the

member of the staff responsible for processing inquiries or requests for

that individual information is the WAC Director and/or Coordinator,

House Manager, ALA Coordinator and Case Manager. The Department

Director and Coordinators also have the authority to release

information. All staff follows the following procedure:

A) The individual (or legal guardian when an individual is under

18 or has been adjudicated incompetent by a court of law) signs a

Release of Information Form (Attachment 39) which includes

name of the program making the disclosure, the name/title of the

person or organization to which disclosure is being made, the

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name of the individual receiving services, the purpose or need for

the disclosure, a statement that the consent may be revoked at any

time except when action on it has already been taken, the specific

condition, event or date on which the consent will automatically

expire (not to exceed 12 months from date of inception), the extent

and nature of the information to be disclosed, the date the consent

is signed, the signature of the individual receiving services or

person who is either authorized to give consent or authorized to

sign in lieu of the individual served, and the signature of a witness

to the authorization by the individual served to release/obtain the

information. No individuals are enrolled below the age of 15

being treated for alcohol and drug abuse, therefore the dual

signature does not apply. However, an attempt is made to allow

the individual, whenever possible to co-sign with a legal guardian.

B) The information is released.

C) The Information Disclosure form is filed in the individual

record.

When releasing individual information in the case of a medical emergency

or court order without written consent, the following procedure is

followed:

A) The Coordinator responsible for that program and/or the

Department Director is notified by the program staff and

the situation requiring the release is described;

B) Authority to make the release is given or denied;

C) If approved, the staff (WAC Director, House Manager,

Case Manager, or their Coordinator) compiles the

following information and places it in the individual

record; the individual’s name and case number, the date

and time of the disclosure, the information disclosed, to

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whom the information was disclosed and the individual

disclosing the information.

D) If disapproved, the procedures to obtain written consent

are followed. (Rule 16.6.C.4)

The disclosure of information pertaining to a person answering to a

particular description, name or other identification that has or has not

been attending the program is prohibited without written consent of the

person or guardian specifically authorizing such disclosure. No staff is

permitted to indicate the presence of any individual to visitors or callers

or identify the individual in any way as a former or current member of

the CSS Programs unless prior written consent has been obtained and

documented. (Rule 16.6.C.5)

The re-disclosure of information obtained by the program and released

by the program to agencies outside CSS or the NMRC without specific

written consent of the person to whom it pertains is prohibited. (Rule

16.6.C.6)

Written consent of the individual (or legal guardian) is obtained prior to

disclosing identifying individual information to third-party payers,

including food stamp offices, Department of Rehabilitation Services,

and the SSA. Since this information is requested and used regularly by

other service agencies (food stamp, social security) a release form is

prepared and signed using the above procedures for written consent for

up to a one year period. Any additional information requested by an

agency, not previously listed on the existing release form, requires a

new consent to release information form. (Rule 16.6.C.7)

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The Consent to Release Information form includes the following

information and is used in all programs (Attachment 39):

a. The name of the program which is to make the disclosure.

b. The name or title of the person or organization to which

disclosure is made.

c. The name of the individual receiving services.

d. The purpose or need for the disclosure.

e. A statement that the consent may be revoked at any time except

when action on it had already been taken.

f. The condition, event, or date on which the consent will

automatically expire, not to exceed 12 months.

g. The extent and nature of information to be disclosed.

h. The date when consent is signed.

i. The signature of the individual receiving services or the person

who is either authorized to give consent or authorized to sign in

lieu of the individual.

j. The signature of a witness to the authorization by the individual

receiving services to release/obtain information. (Rule 16.6.C.)

The NMRC Community Programs do not release individual records regarding

treatment for program review to state or federal reviewers other than DMH staff

without first questioning identification and securing a written statement

indicating the purpose of the review, the staff to conduct the review, a statement

indicating the reviewer(s) are bound by applicable regulations regarding

confidentiality and all others that apply, and the reviewer(s) signature(s) and

date signed. (Rule 16.6.F)

8.9 Service Outcome Measures

The CSS Department at NMRC is dedicated to the provision of quality

community based services. A constant monitoring and review process,

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established by the departmental standards, assures that this is achieved in

existing programs. Objectives of the department include, but are not limited to,

the following:

a. to provide all individuals with the opportunity to function in his

or her least restrictive environment,

b. to allow the opportunity for skill acquisition and movement,

c. to assure that activities and training programs are functional and

appropriate,

d. to assist individuals who have developmental or related

disabilities in accessing any and all available services needed

for his/her most complete habilitation,

e. to foster a positive attitude in the community with regard to the

citizens who have developmental or related disabilities through

a good program of public relations,

f. to provide continuous training to NMRC staff and individuals in

the community regarding NMRC's CSS as well as specific

information regarding the many ways an individual with

developmental or a related disability can participate in and

contribute to the community,

g. to identify gaps in service and develop strategies to close those

gaps, to operate existing programs at capacity in individual

placement, and

h. to maintain capacity in staff positions, allowing only a minimal

vacancy rate.

A primary goal of the department is the development of additional programs

and/or services as funding allows in order to meet the needs of individuals with

ID/DD. A comprehensive review of program needs and requests for service is

conducted prior to implementation of a program.

Objectives, activities, time frames and evaluation methods are documented in

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each grant. This information provides an easy means of identifying goals and

objectives (See the Record Guide).

Each certified program under the CSS umbrella has developed, at a minimum, at

least one outcome measure. Outcome measures address the key success

indicator(s) for a service and those are based on a clinical or professionally

recognized definition of the service, expert opinion, provider experience, and

literature review.

A data system has been devised in which data is collected on progress made on

each outcome measure and documented accordingly. In order to assess the

impact of services on the reduction of the use of institutional care, data is

collected monthly on number of individuals maintained in the community and

number of persons institutionalized. Trends, an increase or decrease in the

utilization of services, are identified and an assessment is made on the quality

of services provided to individuals living in the community. Annual satisfaction

surveys (indicating any decreased use of institutional care as a result of services)

serve as an adjunct to objective data collected. To supplement the quality

assurance

and program evaluation activities which the CSS department routinely conducts,

CSS also takes part in a Review Committee, consisting of individuals from other

NMRC units, service areas, or departments (internal), as well as peers from other

DMH Regional Centers when available (external). A minimum of three (3)

members of the Peer Review Committee will evaluate the operations and records of

CSS at least annually. Appropriateness of services will be assessed by examination

of interdisciplinary recommendations and Plans of Care/Service Plans as well as

information provided by individuals and/or families receiving services through the

department. For each evaluation session conducted, a written report will be

submitted to the CSS Director within 30 days, in a format consistent with that

utilized by BIDD program planner/evaluators which outlines deficiencies and

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recommendations regarding program records, appropriateness and effectiveness of

services rendered. These reports are incorporated into the Final Narrative Report

which is submitted to the Director of the NMRC, reviewed and approved by the

Governing Authority, appropriate staff members and funding sources and will be

maintained in departmental files for on-site DMH/BIDD inspection.

All outcome measures are compatible with the service’s goals and meet DMH’s

certification requirements. Once developed, they must be approved by DMH.

Data collected to measure outcomes is available for review at the program site.

9.0 INTELLECTUAL, DEVELOPMENTAL & RELATED DISABILITIES

9.1 Day Services - Adult

The DSA program operated under the CSS department are designed to foster

greater independence, personal choice, provide individual training and support

in the acquisition, retention, or improvement of self-help, socialization, positive

behavior, and adaptive skills. This training builds personal care skills, enhances

development of social and interpersonal skills, and encourages individual

interaction with community resources. (Rule 28.0.A) Intended outcomes

include but are not limited to increased competency in activities of daily living,

a positive self image, and enhanced social interactions. An individual’s

program of activities is planned on the basis of such things as the individual’s

interests, likes, dislikes, length of time an individual should be scheduled for

each day, special rest periods, size of group he/she can function in and relate to

best, need for individual attention, special limitations of activities and diet.

DSA services are provided by the NMRC in Batesville, Booneville, Hernando,

and Tupelo. An Activity Plan (AP) is developed from a functional skills

assessment for each individual enrolled in the DSA Program within 30 days of

admission, and will be based on the desired outcomes identified during the

development of the Plan of Care. (Rule 28.0.B) Programs are able to

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accommodate a wide range of needs (e.g., ambulatory, verbal people to non-

ambulatory, non-verbal people who may need suctioning, be fed through a G-

tube, etc.).

Eligibility requirements for this service include developmental disability

certification and a current psychological and medical evaluation, approval by

the Administrative Screening and Review Committee of the NMRC, and

enrollment in the HCBW program with DMH/DOM approval for this service on

the individual’s Plan of Care. In addition to all specific requirements of the

Record Guide. Eligible individuals are not denied services from the program of

their choice based on the severity of their disability.

Specialized supervision is provided to ensure the individual’s health and safety.

All employees in the DSA Program are trained according to regulations of the

NMRC and DMH. The program maintains documentation of the training of

program staff by certified speech/language pathologists, registered occupational

therapists, and/or registered physical therapists, in order to coordinate and

incorporate these services in the S/HP and daily activities.

DSA services are based on these requirements of the individual, rather than on

the availability of services and may include the following:

1. Transportation is provided between the individual’s place of

residence and the site of the habilitation services, or between

habilitation sites in places where the individual receives

habilitation in more than one place as a component part of

habilitation services. Cost of transportation is included in the

rate paid to providers of the appropriate type of habilitation

services. Transportation is accessible for persons with

disabilities. (Rule 28.0.B.2)

2. Staff help train the individual with personal care services and

activities of daily living, such as assistance with walking,

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grooming, eating, toileting, communication, and/or dressing.

(Rule 28.0.B.3)

3. Staff assist individuals with activities both passive and active,

that promote personal growth and enhance the self-image and/or

improve or maintain the individual’s abilities and skills.

Opportunities are provided for varied activities, active and

passive, and for the individual to make choices about the

activities in which he/she participates. Individuals receiving

services are exposed to and involved in activities and events

within their community. These activities are documented in

each individual’s record. Cultural enrichment experiences will

be provided to program participants both on site and in

conjunction with community access/community awareness

activities conducted by program staff. (Rule 28.0.B.4)

4. Individuals are encouraged to make choices about the activities

they would like to participate in which promotes independence.

(Rule 28.0.B.5)

5. Staff implement positive Behavior Support Plans and

foundations of PASS. (Rule 28.0.B.6)

6. Staff assist each individual in need of assistance particularly in

the areas of utilizing mobility and communication devices.

(Rule 28.0.B.7)

7. Staff develop and implement program activities of training and

instruction which encourage the development of creative

capacities of the program participants.

8. Staff develop and implement program activities targeted toward

the improvement of physical and emotional well being of the

individuals served.

9. Individuals are provided with activities that foster the

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development of interpersonal relationships that are safe and

wanted by the individual.

DSA services take place at a certified DMH site. DSA programs are currently

located in Batesville, Hernando, Prentiss and Tupelo where opportunities exist

for community integration activities that assist the individual in accessing,

participating in, and becoming familiar with his/her local communities. Services

are available to individuals five (5) days per week for four (4) to six (6) hours

per day, unless provided as an adjunct to other day activities included on the

Plan of Care, and depending on the needs of the individual. Maximum

Medicaid billing for DSA services is six (6) hours per day. Planned activities

are available whenever the program is in operation. (Rule 28.0.C.1 & 3)

The facilities housing the DSA Program meet the basic standards for life safety

and are conducive to maturation and learning. Appropriate opportunities for

community integration and exposure outside the center-based setting will be

provided. A minimum of 50 square feet of space per individual is maintained in

the training area(s) of each program. Additional square footage for people who

require the use of a wheelchair has been taken into consideration in selection

and development of program facilities. (Rule 28.0.C.2) Documentation of

community integration activities are planned during normal program hours and

are based on choices/requests of individuals served and conducted and

documented weekly. (Rule 28.0.C.3 & 4) These trips are available for review

on site at the DSA programs.

Community Awareness/Inclusion/Integration activities designed to expose

individuals to community resources, facilities, and attractions and to integrate

individuals served with individuals without disabilities in normal activities are

conducted for each individual served at least weekly, but more often as

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indicated by each persons. These activities are documented in each individual’s

record.

At least weekly, one community outing will provide the opportunity for

enhancing one’s daily living skills/needs and/or address leisure/social/other

community events. (Rule 28.0.C.4) Community outings are based on

choices/requests of the individuals served. Documentation of choices offered

and the chosen activities must be maintained in the person’s file. (Rule

28.0.C.5)

Individuals requiring one-on-one assistance are offered the opportunity to

participate in all activities. (Rule 28.0.C.6)

There is at least two (2) staff assigned to provide center-based care for every

eight (8) people receiving DSA services. One of these staff may be the on-site

supervisor. Depending upon the physical capabilities of the individuals,

additional staff may be required. (Rule 28.0.D)

Community participation activities are provided in groups of no more than six

(6) participants with at least one (1) staff member, depending on the needs of the

individuals being served. If anyone requires mobility assistance there must be at

least two (2) staff (the driver and one other) for those six (6) individuals. (Rule

28.0.E) The programs will provide the level of staff necessary to ensure the

health and welfare of the individuals and cannot exclude individuals because

they require one-on-one assistance for community participation activities.

DSA programs will secure equipment and supplies which are age and size

appropriate for each individual concerned to meet the individual’s habilitation

needs, including equipment/supplies that are necessary to enable the individual

to fully participate in desired activities. Examples include, but are not limited to

adaptive seating, adaptive feeding supplies, safety equipment, etc. (Rule 28.0.F

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& G)

The DSA program will maintain documentation of training of program staff by

certified speech/language pathologists, registered occupational therapists, and/or

registered physical therapists, in order to coordinate and incorporate these

services in the individualized habilitation/service plan and daily activities.

Each individual receives a minimum of one mid-morning snack, one nutritious

noon meal and one mid-afternoon snack. Individuals are offered choices about

what they eat. (Rule 28.0.H)

9.2 Prevocational Services (PV)

WAC/PV and DSA staff operate under the supervision and direction of an on-

site Program Director. The Program Director in turn operates under the

direction and supervision of the WAC/DSA Coordinator.

The primary purpose of the PV program is to provide WAC services for persons

in the northern 23 counties of Mississippi. This program provides training in

every area necessary for more independent vocational functioning. Individuals

have the opportunity to develop functional skills, be trained in a work situation,

and are paid based on production and the Federal Minimum Wage on certain

projects. In addition, individuals are trained in appropriate work behavior,

dress, and other self-help skills necessary for a work setting. This program adds

a vital link in the continuum of services to individuals who have been diagnosed

with mental retardation and/or developmental or related disabilities, all of whom

have potentials that can be reached and maintained.

PV services are offered to persons not expected to obtain community

employment within 12 months. PV services consist of a range of activities

directed at specific habilitation goals that are designed to lead to vocational skill

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development. PV services can be either center-based or community-based.

(Rule 28.1.A)

NMRC provides center-based PV services as a part of the NMRC WAC/PV

Services programs. NMRC WAC/PV services programs are certified as a WAC

in accordance with Section 14C of the Fair Labor Standards Act.

PV services are provided by NMRC’s WACs in Batesville, Booneville, Bruce,

Clarksdale, Corinth, Fulton, Grenada, Hernando, Holly Springs, Iuka, Oxford,

Pontotoc, Senatobia, Tishomingo, and Verona, Mississippi. The services and

training are provided as specified in the individual’s service/habilitation plan are

based on the requirements of the individual, rather than on the availability of

services. (Rule 28.1.B)

Within 30 calendar days of admission each individual enrolled in the program

receives an evaluation of his/her needs in the area of vocational and functional

skills. From this assessment, an Activity Plan is developed. (Rule 28.1.C)

Any individual receiving PV services and receiving special-minimum wage for any

type of contract or piece-rate work is located in a certified WAC operated by the

NMRC and meets requirements of the DOL. (Rule 28.1.B)

The scope of the evaluation identifies the individual's strengths and needs as

well as identifying training needs ascertained from the vocational reference by

utilizing an assessment tool, CFA Assessment, which is used upon admission

and conducted annually thereafter. (Rule 28.1.C)

Individuals enrolled in the NMRC PV program will be engaged in training and

services centering on underlying, functional habilitative goals and objectives

which might include attention span, remaining at the work station, holding

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items, asking for assistance and various motor skills, etc. PV services will be

reflected in the Plan of Care developed for that individual. Goals will be

habilitative in nature with the goal to develop these skills before moving to

employment or specific vocational objectives.

Documentation is maintained in each individual’s file to indicate that these PV

services are not otherwise available under a program funded under the

Rehabilitation Act of 1973 or Public Law 94-142.

Transportation is provided between the individual’s residence and the site of PV

or between habilitation sites (in cases where the individual receives habilitation

services in more than one place) as a component part of habilitation services.

Transportation is accessible for persons with disabilities. (Rule 28.1.D.1)

PV services include specialized supervision to ensure the individual’s health and

safety. All employees in the PV waiver program will be trained according to

regulations of the NMRC and DMH. (Rule 28.1.D.2)

Staff will help the individual to acquire appropriate attitudes and work habits,

including instruction in socially appropriate behaviors on and off job sites, and

socially appropriate hygiene and grooming activities, through formal training

programs and informal interactions modeling appropriate behavior.

(Rule 28.1.D.3)

Proper care and handling of equipment, materials, tools and machines are taught

to each individual as applicable to their current work. (Rule 28.1.D.4)

Staff will utilize training programs designed to train the individual to follow

directions, adapt to work routine and carry out assigned duties from supervisors

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and/or co-workers in an effective and efficient manner. (Rule 28.1.D.5)

Individuals participating in the program will be assisted in adjusting to the

productive and social demands of the workplace. Through the activities of the

program, individuals participating in PV services will become familiar with job

production and performance requirements. Staff will utilize training programs

designed to train the individual to follow directions, adapt to work routine and

carry out assigned duties from supervisors and/or co-workers in an effective and

efficient manner. (Rule 28.1.D.6)

Staff will utilize the daily operation and schedule of the program to provide

instruction on the appropriate use of job-related facilities such as break areas,

lunch rooms/cafeterias and restrooms. (Rule 28.1.D.6)

Program staff and other professionals as required may provide mobility training,

including the utilization of public transit systems, if available in the local area.

Staff my assist and train individuals in the area of personal care but this cannot

be for the entirety of the service.

When a person initially declines participation in such activities, this is also

documented. Although an individual may initially decline participation,

program staff continue to offer opportunities and options for community

integration and employment.

Opportunities for community integration and exposure to work experiences

outside the center-base setting are provided regularly by WAC/PV programs and

offered at least one time per month. These activities are documented in each

individual’s record. (Rule 28.1.D.8.a)

Community integration and job exploration activities are provided in groups of

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no more than six (6) participants with at least one (1) staff member, depending

on the needs of the individuals being served. If anyone requires mobility

assistance there must be at least two (2) staff (the driver and one other) for those

six (6) individuals. The programs will provide the level of staff necessary to

ensure the health and welfare of the individuals and cannot exclude individuals

because they require one-on-one assistance for community participation

activities. (Rule 28.1.D.8.b & c)

If an individual begins earning more than 50% of the minimum wage, the

individual along with appropriate staff will review the necessity and

appropriateness of the service. (Rule 28.1.E)

Each PV program has a “Return to Prevocational Services” policy for

individuals previously enrolled in PV services who obtain community

employment and are resultantly terminated from PV services, if his/her

employment is discontinued, the individual is guaranteed a position back in the

PV program. (Rule 28.1.F)

At least two (2) staff are assigned to each PV program for every 16 persons

engaged in program activities during programmatic hours. (Rule 28.1.G)

PV services operate a minimum of five (5) days per week for at least six (6)

hours per day, with a maximum allowable billing of six hours of service per day

per person. (Rule 28.1.H)

A minimum of 50 square feet of usable space per individual receiving services

must be maintained in the service area. (Rule 28.1.I)

Lunch and/or snacks are made available for individuals who do not bring their

own. (Rule 28.1.J)

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The Activity Plan includes a Career Development Plan that addresses an

individual’s goals for integrated community employment and objectives to

support the achievement of those goals. (Rule 28.1.K)

9.3 Industries

The target group includes individuals who are 18 years of age or older who are

residents of one of the counties served, and who must have a diagnosis of

mental retardation/developmental disability certification. Individuals between

the ages of 16-21 will be considered if they have certification indicating that

they have completed Special Education or a statement from school officials

indicating that they can no longer be served by the school system. All

individuals must be determined to be eligible by a psychological and medical

evaluation and must be certified as developmentally disabled before entering the

program. Parents are required to complete the necessary application forms and

obtain current medical information. (Before the individual is enrolled in the

program, there will be a conference with the parents to discuss policies and

share information about the individuals. If possible, both parents will be

involved in this meeting. Arrangements will be made for the individual to visit

the Center with the parents before enrollment.) Some school districts have made

an agreement with their local WAC that any student in their last semester of

school and has an MR/DD diagnosis is eligible to attend the WAC a couple of

days a week to act as a transition period to help ease the anxiety for the

individual when he/she graduates. An Interagency Agreement Form is signed

by the WAC, local school officials and the student’s guardian. (Attachment 47)

Specific requirements of the Record Guide are also met. (Rule 29.0.A)

Each program is certified by the U.S. Department of Labor as evidenced by the

Department of Labor (DOL) certificate. Applications for renewal are submitted

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every other August, beginning in 1997. New program applications are filed

within one quarter of the opening of the program. The appropriate DOL

certificate is posted in a public area at each WAC site. (Rule 29.0.B)

The central program component of the WAC programs is the provision of work.

Subcontracts are obtained from local industries for such activities as packaging

screws, stuffing envelopes, cutting samples for textile companies, simple

assembly, and/or during down time in-house production of products. The

purpose of these activities is to teach individuals with ID/DD work skills and

good work habits. Efforts are also made to teach individuals functional skills

applicable to the work setting, such as the handling of money and knowledge of

time concepts. Counseling is also a component provided to the individuals and

their families. The Director and other staff members work with each person to

establish realistic goals and expectations which the individual may be expected

to attain. Individuals are encouraged to interact appropriately at the work place

and are instructed in proper work behavior. Preventive measures are maintained

to assure safety. While the aim of the program is to train individuals in

occupational skills in order to provide avenues of gainful employment, some

individuals may have more difficulty than others participating in the labor

market. However, when an individual progresses to the point of competitive

employment, the Center makes every effort to secure appropriate employment of

the individual.

Production records are maintained which indicate performance in the general

occupational skills areas, work training and work habits. Individuals are paid a

piece rate wage based on time and motion studies conducted by the staff.

Records pertaining to individual wages and community wage rates are

maintained by the program. Service notes are kept on individual progress in the

objective areas outlined in the ISP.

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WAC services for adults provide vocational, educational, prevocational, as well

as some social and recreational services to individuals with developmental

and/or related disabilities in the community. The provision of these services

encourages a higher degree of independence, skills which will allow the

individual to remain in the community, and social integration into various

aspects of community involvement.

WAC services provide work and functional skills training as needed and wanted

by the individual. The following are provided in the provision of WAC

services:

A. Work

1. Work must be real, remunerative, productive and

satisfying for the individual served for transitional or

extended work periods.

2. Work must be both planned and adequate to keep

individuals productively occupied. (Rule 29.0.C)

3. Each individual’s ISP contains goals and objectives for

the acquisition of skills for specific work tasks taught

either in the workshop or on the job. (Rule 29.0.D)

B. Non-work

1. Each individual’s S/HP contains optional work and/or

community integration/community employment related

activities, based on personal choice.

2. These activities are addressed when work is reduced or

when the individual chooses. WAC staff provide the

following services through the use of audio-visual aids,

guest speakers, books and brochures; as needed:

a. interviewing skills

b. visiting community job sites (job exploration)

c. transportation training

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d. relationships/communication at work and/or

e. providing information about jobs in community

employment (Rule 29.0.C)

3. Application to or utilization of community resources

(community awareness) as needed and includes:

a. the bank

b. transportation

c. recreational/leisure activities/plans

d. community living options, and/or

e. medical services

The provision of these services will be determined by the ISP Team and will be

documented in the ISP, on an in service sign out sheet signed after completion

of training, if applicable, and/or through documentation of community

awareness/inclusion activities/trips conducted which is placed in the individual’s

case record.

4. Daily living skill needs provided as needed and include:

a. shopping at the grocery store/supermarket

b. using the pay telephone

c. preparing meals

d. grooming and appearing

e. making doctors appointments

f. toileting skills and/or

g. eating/feeding skills

The provision of services will be determined by the ISP and will be documented

in the ISP and on an in-service sign out sheet to be signed after training is

received. These services will be provided through the use of video tapes, guest

speakers, books and brochures.

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Each WAC program’s Director is responsible for aggressively seeking to

provide a variety of work which is representative of job opportunities in the

community, to fulfill the training needs of the persons served. Documentation

includes monthly subcontract contact reports as well as required documentation

for new and ongoing contracts. (Rule 29.0.E)

Any WAC not actively seeking work is in jeopardy of being placed on

probation by the BIDD. If work is not found for and efforts are not documented

detailing their activities and progress towards locating and obtaining adequate

work, the probation period could last for a maximum of six (6) months. If there

is sufficient documentation on efforts made to locate and obtain work but have

yet to secure work, the WAC may continue to operate at the discretion of the

BIDD Director. Those programs without sufficient documentation could be

decertified.

In order to assure reasonable accommodation in assisting the individual increase

his/her productivity all programs, as needed; modify equipment, jigs and

fixtures, modify the work site and commonly used surrounding areas, purchase

assistive aids and devices, and/or allow flex time, part-time, extended break time

for rest. (Rule 29.0.F)

All wage payments in all programs are monetary and no in kind or barter

payments are made. Records pertaining to individual wages include the

individual’s name, hours worked, task(s) performed, wages paid, method of

payment and the individual’s signature upon payment. Records containing this

information are the production records, payroll ledger and individual wage

statement. (Rule 29.0.G)

Each person receives a written statement of each pay period indicating hours

worked, gross pay, deduction(s), net pay and the individual’s signature which is

maintained in their record (Employee/Client Pay Receipt). (Attachment 25)

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This information is located on the check stub. (Rule 29.0.H)

Pay periods for individuals do not exceed 31 days in any program. Currently,

Alcorn, Calhoun, Coahoma, DeSoto, Grenada, Itawamba, Lafayette, Lee,

Marshall, Panola, Pontotoc, Prentiss, and Tate operating on a two week pay

period schedule. Tishomingo Industries are operating on a once a month pay

period. (Rule 29.0.I)

Wage payments in all programs are based on individual performance and not on

pooled and/or group wage payments. In the case of jobs involving mobile work

area, employers may pay for the work performed in one payment. However,

this payment represents payment to the individual of minimum wage or above.

All payments to individuals for subcontract work are based on individual

performance. Time studies, as required by the US Department of Labor, are

maintained at each program and are available for DMH review. (Rule 29.0.J)

Community wage rate information is obtained annually by all programs and

includes prevailing wage for the type of work, dates obtained, source of

information. (Rule 29.0.K)

Each WAC program has a “Return to Work” policy for individuals previously

enrolled in WAC services who obtain community employment and are

resultantly terminated from WAC services, if his/her employment is

discontinued, the individual is guaranteed a position back in the WAC program.

(Rule 29.0.L)

Meetings between the individuals and management are held and documented at

least annually to discuss matters of mutual concern which include:

a. informing those served concerning any aspects of program

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operation and plans which bear upon their wages or welfare.

b. enlisting informed cooperation to achieve efficient use of

resources of the program in the best interest of those served.

c. seeking suggestions from those served about

changes/improvements they would like to see and answering

their questions. (Rule 29.0.M)

A minimum of 50 square feet of space per individual is maintained in the

working/training area in each program. Each program has adequate floor space

for a lounge/break/dining area separate from the work area. (Rule 29.0.N)

Preventive measures are maintained at all times to provide for the safety of the

staff and individuals. Regular review of job procedures and/or potential

problems is conducted by the workshop director. The following areas of safety

are addressed (as dictated by the contract work/jobs available at the workshop):

a. Safety in operating machinery - individuals are instructed

concerning operation of machinery prior to their engaging in

operation. Periodic training on safety and giving instructions in

the use of equipment (safety training is conducted annually for

staff by the Staff Development Department at the NMRC.

Safety training for individuals (employees) is conducted

annually by workshop staff. Instructions on the use of

equipment are given as needed by the manufacturer to the staff

and from the staff to the individuals (employees).

(Rule 29.0.O.1)

b. Protective clothing, shoes and eyewear - these items are

prescribed as necessary, (Rule 29.0.O.2)

c. Proper storage of flammable liquids or other harmful materials

(all flammable liquids and/or other materials if not in the

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original container are clearly marked and are stored in locked

cabinets or storage facilities), (Rule 29.0.O.3)

d. Storage of raw materials and finished products outside the work

area. Provisions are made at each WAC for the storage and

control of raw materials and finished products by the WAC

Supervisor, under the guidance of the WAC Director. Within

the space constraints of current facilities, receiving and shipping

areas are identified and labeled, so as to minimize the disruption

of work flow and facilitate the efficient movement and storage

of raw materials and finished products during the day to day

operation of the program, (Rule 29.0.O.4)

e. Replacement of worn or frayed electrical cords or machinery

(worn or frayed electrical cords are replaced immediately/worn

out or unsafe equipment is discarded and/or replaced), (Rule

29.0.O.5)

f. Maintenance of space and equipment in a safe manner (all

workshop staff are charged with maintaining the space and

equipment in a safe manner. Any problems and/or needs should

be reported immediately to the WAC Coordinator), (Rule

29.0.O.6)

g. Perform required maintenance of equipment (maintenance that

can be completed on site, such as oiling, rotating, etc., is

conducted by workshop staff. Other required maintenance is

contracted for with local businesses. Maintenance required for

safety is documented), and

h. Each individual's potential and desire for alternate vocational

placement/community employment are assessed at least

annually. Referrals to other services are made when desired

individuals are referred for necessary services, as indicated on

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the annual assessment, when these services are not available

through the WAC program. Such referrals are generally made

through CSS’ CM program.

10.0 COMMUNITY LIVING

10.1. Types of Community Living Services

Alternative Living Arrangements (ALA)/Community Living Services

Note: This section applies to individuals who are not in the waiver and either

lives in the group home or apartment program and to persons who are in the

ID/DD waiver and either live in the group home or apartment program (now

referred to as Home and Community Supports – HCS). Both programs are

overseen through CSS. ALA/HCS House Managers operate under the

supervision and direction of the ALA/CM Coordinator.

CSS’ HCS program include those persons who live in apartment programs

operated under the direction of the ALA/CM Coordinator. (Rule 30.0.B)

Individuals who require 24 hour/7 days per week staffing coverage participate in

our Supervised Living Program. (Rule 30.0.C)

10.2 Service Manuals

The policy and procedure manual for the CSS Department is written to address

programs and services operated by the department and to specifically address all

applicable sections and standards in the OSM, 2012. (Rule 30.1.A)

The manual contains the following information:

a. A person friendly, person first definition of the service being

provided (Rule 30.1.B.1)

b. The philosophy, purpose, and goals

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1. Method for accomplishing stated goals and objectives

2. Expected outcomes

3. Methods to evaluate expected outcomes (Rule

30.1.B.2)

c. Admission to the services (Rule 30.1.B.3)

d. Description of the program’s components and services,

including the minimum levels of staffing required for the

protection and guidance of individuals to be served in the

program (Rule 30.1.B.4)

e. Description of how the service addresses the following items, to

include but not limited to:

1. Visitation

a. Individual’s right to define their family and support

systems for visitation purposes unless contraindicated

b. All actions regarding visitors is documented in the case

record

c. Restrictions on visitors is reviewed at a minimum daily

d. Visitation rights cannot be withheld as punishment

2. Daily private communication without hindrance;

a. Restrictions on private telephone use is reviewed daily

b. All actions regarding restrictions on outside

communication is documented in the case record

c. Communication rights must not be withheld as

punishment

3. Dating

4. Off-site activities

5. Household tasks

6. Curfew

7. Use of alcohol, tobacco, and other drugs

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8. Respecting the rights of other residents’ property, safety, health

and choices; (Rule 30.1.B.5.1-h)

h. Collection of fees to include basic charges, time frame, special service

charges, refund of charges/deposits, and financial agreement.

(Rule 30.1.B.6.a-f)

i. Room, person, and/or possession searches, to include but not limited to

circumstances in which the search may occur, staff designated to

authorize

searches, documentation of searches, and consequences of discovery of

prohibited items. (Rule 30.1.B.7.a-d)

j. Prohibitive substance abuse screening, to include but not limited

to circumstances in which screens may occur, staff designated to

authorize screening, documentation of screening, and consequences of

refusing to submit to screening, and process for individuals to

confidentially report the use of prohibited substances prior to being

screened. (Rule 30.1.B.8.a-f)

k. Orientation to Community Living Services

a. Familiarization of the neighborhood

b. Introduction of support staff and other residents

c. Description of written materials provided upon

admission; and

d. Description of the process for informing

individuals/parents/guardians of their rights,

responsibilities, and any applicable program rules

prior to or at the time of admission. (Rule

30.1.B.9.a-d)

l. Assisting individuals in arranging and accessing routine and emergency

medical and dental care, to include but not limited to; agreements

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with local physicians and hospitals, and dentists to provide routine

care and

emergency care and the process for gaining permission from

parent/guardian if necessary. (Rule 30.1.B.10.a-c)

m. Responsibility of the staff for implementing the protection of the

individual and his/her personal property and rights (Rule 30.1.B.11)

n. The need for and development, implementation and supervision of

behavior change/management programs (Rule 30.1.B.12)

o. Risk assessment and mitigation (Rule 30.1.B.13)

p. Discharge criteria (Rule 30.1.B.14)

For the Supervised Living programs, additional items are addressed in the Program

Manual. These are:

q. A description of meals which are provided three (3) times a day along

with snacks. Individuals take part in the planning of the menu with

assistance from staff to ensure the meals are varied and nutritious.

Preparation descriptions are also addressed. (Rule 30.1.C.1)

r. Assistance in personal hygiene care and grooming (Rule 30.1.C.2)

s. Medication management (includes storing/dispensing) (Rule

30.1.C.3)

t. Prevention of and protection from infection (Rule 30.1.C.4)

u. Pet policy which must address (Rule 30.2.A)

1. Documentation of required vaccinations against rabies and

other communicable diseases (Rule 30.2.A.1)

2. Procedures to ensure pets will be maintained in a sanitary

manner (Rule 30.2.A.2)

3. Procedures to ensure pets will be kept away from food

preparation sites and eating areas (Rule 30.2.A.3)

4. Procedures for controlling pets to prevent injury to

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individuals living in the home as well as visitors and staff (Rule

30.2.A.4)

Smoking is not permitted within 10 feet of the entrance of a supervised

living program. (Rule 30.3)

All visitors to any CSS program are required to sign in at a designated point of

contact. Employees on duty shall not have visitors except in the case of a bona fine

emergency, and then only with the approval of the Program Coordinator or

Department Director. Visitors shall comply with the rule and regulations of the

CSS department and the NMRC. Visitors under the age of 15 years of age are not

permitted in the individual’s home at any time unless accompanied by an adult.

Employees are requested not to allow visits to the home without appropriate

approval. Employees are not permitted to escort friends or visitors about their

home or admit them without permission from the Program Coordinator and/or the

Department Director. Employees shall not transact private business with visitors

during hours while on duty without permission. Employees who need to return to

their program outside their business hours must seek prior approval from the

Program Coordinator and/or Department Director. (Rule 30.1.B.5.a)

10.3 Admission to Supervised Residential Habilitation Programs

Within thirty (30) calendar days of the date of admission and annually

thereafter, persons admitted to supervised/supported residential habilitation are

assessed regarding their present functioning level and abilities in the area of

community living skills, as well as their ability to benefit from a community

living setting which is utilized in the development of an individualized ISP

designed to ensure benefit from inclusion in the program. Each individual

enrolled in HCS or SLPs participates in a suitable day activity, which

coordinates with residential activities. Options include regular employment,

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training, DSA, senior’s club, or sheltered employment program. For those

wishing to “retire”, they may choose to stay at home and participate in those

activities they wish as long as they have the funds to maintain their portion of

the rent, utilities, food, etc. Activities, seminars, training, etc. as well as

transportation will be made available to those persons who choose to retire and

can afford to do so.

Through the ISP process and annual review and update of individual

accomplishments, program staff remains aware of the attainment of skills and

improvement of abilities by the individual. The appropriateness of movement

by individuals to a less restrictive environment is identified by program staff at

such time as it is believed the individual has gained the skills necessary for such

a move. The CM program can provide information and referral in this case.

(Rule 30.1.B.2 & 3)

Persons entering or being admitted to a HCS program are evaluated prior to

enrollment and annually thereafter. The annual evaluation ensures that the

individual continues to meet established criteria. A needs assessment is

completed on each individual upon admission and annually thereafter. (Rule

30.1.B.3)

Individuals participating in the HCS programs are involved in appropriate day

activities, such as WAC and/or competitive employment. Participation in

activities outside the program is encouraged. The acquisition and improvement

of individual skills is stressed in the ALA environment. Each individual,

through the ISP, is involved in experiences which promote acquisition of skills

and focus on maximizing development in all areas. Residents are expected to

participate in the operation and upkeep of the home environment in preparation

for a greater degree of independent functioning. Responsibilities are discussed

and a schedule of assigned duties is developed, followed, and reviewed

regularly for therapeutic need. Individuals who express an interest in improving

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skills are encouraged to participate in one of these programs and are assisted in

enrolling and/or obtaining the service. (Rule 30.1.B.4)

Individuals are encouraged to participate in community recreational activities

such as skating, swimming, movies, local sporting events, and shopping which

are available within walking distance of all programs. Transportation is also

provided to locations farther away. Individuals who express a desire to do so

occasionally participate in recreational activities sponsored by the NMRC, but it

is the philosophy of the program to access CSS and encourage community

involvement whenever possible. (Rule 30.1.B.4)

All supervised living programs provide 24 hour supervision of individuals by

qualified employees/staff. Full time staff members are designated as Home

Managers and are responsible for the management of the group home rented by

eligible individuals, are at least 21 years of age, literate, licensed to drive in

Mississippi, and are immediately available on site when individuals served are

present. Individuals residing in supervised community living programs operated

by NMRC are given the opportunity to express their desires with regard to the

number of individuals who share their home. These statements are on file.

Supervised apartments provide on-site staff at regular time intervals each day, as

well as 24 hour availability of staff by phone. One staff person is available for

every six individuals served, depending on each person’s identified level of

support. (Rule 30.1.B.4)

Supervised Residential Habilitation programs include, but are not limited to:

a. Supervision

b. Monitoring of health and physical condition of the

individual; and

c. Assistance in areas identified by the individual and/or

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family that may include:

(1) personal hygiene;

(2) housekeeping;

(3) transportation;

(4) community integration activities;

(5) leisure activities;

(6) money management;

(7) shopping, and

(8) cooking, etc.

Opportunities are provided for and individuals are encouraged to participate in

social, cultural, recreational, and religious activities that are available to

everyone. By nature of the community, individuals do have access to a variety

of the above as well as additional educational opportunities. Documentation of

the individual’s stated preference is maintained in each individual’s record.

(Rule 30.1.B.4)

10.4 Handbook Requirements

Each supervised community living program develops its own written set of

"house guidelines" governing conduct within that program which residents are

expected to follow. These are developed considering the rights of individuals

with individual input, are developed with respect to each person’s privacy,

safety, health, and choices, and carry individual and house manager signatures,

are filed in individual records and are posted in each program. The ALA staff

will obtain written consent from the resident prior to acknowledging his

presence in the program to visitors or callers. Any releases involved in

identifying an individual as a resident in the program are filed in the individual

record. (Attachment 39)

CSS’ Community Living programs have developed the “Alternative Living

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Arrangements Handbook” written in person-first, person-friendly manner that

can be easily understood. It is distributed and reviewed with the individual and

their family/legal guardian upon admission and had orientation. (Rule 30.4.A)

Once reviewed, it is documented and then reviewed annually. The individuals

receiving services are given opportunities to provide input in the development of

the handbook. (Rule 30.4.B, C & D) A professor from the University will be

requested to help read the information to the individual if English is not their

preferred language. (Rule 30.4.E) This handbook acts as a guideline and not a

rule book. (Rule 30.4.F)

10.5 Fee Agreements

A written financial agreement is documented between the ALA programs

operated by CSS and the individual served, indicating at a minimum:

a. Procedures for setting and collecting fees;

b. A detailed description of the basic charges agreed upon, the

period covered by the charges, services for which any special

charges are made, and agreements regarding refunds for any

payment made in advance;

c. The time period covered by each charge

d. The service(s) for which special charge(s) are made

e. A written financial agreement is explained and reviewed with

individual and family member/legal guardian prior to or at the

time of admission

f. A copy of the financial agreement is signed and dated by the

individual and family member/legal guardian indicating the

contents of the agreement were explained to them and they are

in agreement. (Rule 30.5.1-6)

10.6 Discharge Requirements

Procedures to discharge or terminate an individual from the program are in place

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and documented. A summary for closed cases includes reason for discharge,

assessment of progress toward their ISP objectives, discharge instructions given

to the individual or their authorized representative, parent(s)/legal guardian(s),

including referrals and any other information deemed appropriate to address the

needs of the individual being discharged. (Rule 30.6)

10.7 Supported Living Options (non-waiver)

Service Components

SLS for persons with IDD who are not participants in the waiver are

provided residences for no more than four (4) people. (Rule 31.1.A)

Individuals in the SLS program function with a greater degree of

independence than those in Supervised Living. Contacts take place on a

regular basis, at least one time per week in order to ensure the individual

is succeeding. During the day, individuals may engage in activities of

the provider program, supported, community or transitional

employment, competitive employment, or other community activities.

(Rule 31.1B)

Methods, procedures and activities are developed to provide

independent living choices for the individual(s) served in the

community. (Rule 31.1.C)

Procedures are in place for individuals to access any other needed

services in the event of an emergency. (Rule 31.1.E)

These individuals have the authority and responsibility to maintain their

residence as they choose (to the greatest extent possible). (Rule 31.1.F)

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Support is available as needed to provide money management training;

independent living skills training and support; community resources

training and support; and access to mental health, IDD, health, and other

community services. (Rule 31.1.G.1-4)

10.8 Specific Requirements for all Supervised Living

This section applies to environmental and programmatic requirements. (Rule

32.0.A). Individuals in Supervised Living are prohibited from having friends,

family members, etc., living with them who are not also receiving services as a

part of the program. (Rule 32.0.C)

The program has on-site staff assigned coverage 24 hours a day, 7 days per

week with a staff member designated as responsible for the program at all times

and have male/female coverage when necessary. (Rule 32.0.D) In addition,

these programs are overseen by a full-time site manager. (Rule 32.0.E) Efforts

are made to duplicate, to the maximum extent possible, a home environment.

(Rule 32.0.F) Furniture and furnishings are chosen which most closely resemble

items one might find in a home setting. Equipment and kitchen utensils are

identical to items found in the home. Furniture and furnishings are carefully

chosen to assure that they are safe, comfortable, appropriate and adequate for

the program and individuals served. (Rule 32.0.G)

Living rooms, day rooms, and/or recreations rooms in the homes are provided for

the up to five (5) residents of the programs and visitors. At least one of these

designated rooms is available in all programs and has at least two (2) means of

escape. These rooms are equipped with attractive, functional furniture with

sufficient seating space to accommodate all residents of the program so it presents a

“home-like” environment. (Rule 32.0.H.1)

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Laundry facilities and equipment in all residential programs have exterior

mechanical ventilation systems. (Rule 32.0.I) Each residential program maintains

separate storage areas for sanitary linen, food (no food supplies may be stored on

the floor), and cleaning supplies. (Rule 32.0.J)

Adequate heating and cooling systems are provided in all residential programs

capable of maintaining program temperature between 68 degrees and 78 degrees

Fahrenheit. (Rule 32.0.K)

Auditory smoke/fire alarms, with a noise level loud enough to awaken residents,

are located in each kitchen, bedroom and hallway and/or corridor in all Alternative

Living Arrangement programs. Carbon monoxide detectors have been installed in

all group homes using gas heat and/or appliances. (Rule 32.1.B)

All programs equipped with fuel burning equipment/appliances have carbon

monoxide alarms/detectors placed in a central location outside of the sleeping

areas. (Rule 32.1.C)

Training is provided to the individuals to include the “PASS” (Pull, Aim,

Squeeze and Sweep) method of using a fire extinguisher in putting out a fire;

fire, smoke and carbon monoxide safety and the use of the detectors; hot water

safety; and any other health/safety issues based on the needs of each resident.

(Rule 31.2.C.1-4)

For all community living/residential programs operated by CSS, each bedroom and

living room area has at least two (2) means of escape, one (1) of which is a door or

stairway providing a means of unobstructed travel to the outside of the building at

street or ground level. All exit doors located nearest the resident’s bedroom remain

unlocked and can be accessed using a closed fist from the inside while remaining

locked on the outside. (Rule 32.1.D & E)

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Except for apartments, for all ALA/residential programs operated by CSS, all

designated exit doors leading to the outside of the home feature lever action

continuously open one way locking doors which permit exit from the inside to the

outside, but restrict entry from the outside to the inside. No required path of travel

to the outside from any room in the programs must go through another room or

apartment not under the immediate control of the occupant of the first room, nor

through a bathroom or other space subject to locking. (Rule 32.1.E & F)

Each living area has two (2) means of exit and is readily accessible at all times,

remote from each other, and so arranged it minimizes the possibility both may be

blocked by fire or other emergency condition. (Rule 32.1.G)

Resident Bedrooms meet the following specifications:

All bedrooms for individuals served have an outside exposure at ground level or

above. All windows are operable. (Rule 32.3.A)

All bedrooms for individuals served in all programs have the minimum floor area

of 80 sq. ft. per person with multiple occupancy, 100 sq. ft. per person if single

occupancy required by the DMH standards. (Rule 32.3.B. 1-2)

No more than two (2) persons are housed in any one bedroom. Bedrooms are

appropriately furnished with a minimum of a single bed, chest of drawers, with

adequate storage space per individual. If closets do not offer enough space or if

they do not exist in the program, wardrobes are provided as a substitute. A mirror

is available for individual use in each bedroom. (Rule 32.3.C & D)

Bedrooms are located so as to minimize the entrance of unpleasant odors, excessive

noise or other nuisances. (Rule 32.3.E)

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Cots and roll-away beds are not used. Single beds are used and are provided with

good grade mattresses at least four inches thick. Individuals who desire to purchase

or bring their own beds are encouraged to use a good grade mattress. (Rule 32.3.F)

Each bed is equipped with a minimum of one (1) pillow and case, two (2) sheets, a

spread and a blanket(s). An adequate supply of linens is maintained by each

program to allow for changes once per week and for emergencies. (Rule 32.3.G)

Restrooms

Each program has at least one bathroom that contains at least one operable toilet

and one operable lavatory/sink for each resident and one operable shower or tub for

each five (5) residents served. Bathrooms are also equipped with soap dishes,

towel racks, shower curtains or doors, and grab bars. (Rule 32.4.A & B)

All staff in the CSS ALA programs ensure residents enrolled in the Supported and

Supervised Living programs has appropriate clean, comfortable well-fitting clothes

and shoes.

A maximum of 6 individuals may be served in a single home and there must be at

least one (1) staff person on-site for every 6 individuals served. (Rule 33.0. D & E)

Supervised Living - CSS

The ALA program offers community placement for individuals who have

ID/DD in nine (9) Supervised Living Programs (SLP). Two (2) group home

programs housing adult male individuals and one (1) group home program for

adult female individuals who provide Supervised Living are located in Oxford,

Mississippi. A group home for adult female individuals and one (1) for adult

male individuals are operated in Bruce, Mississippi. One (1) group home for

adult female individuals, one (1) group home for adult male individuals are

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located in Tupelo. One (1) male group home is operated in Corinth and

Clarksdale, Mississippi, and each provides Supervised Living services to adult

males.

Eligibility requirements include that the individual be 21 years of age, certified

developmentally disabled, possess a current psychological and medical

evaluation, and be approved by the Administrative Screening and Review

Committee of the NMRC. Also, specific requirements of the Record Guide

must be met.

The purpose of the SLP program is to provide alternatives to institutionalization,

as well as to provide alternatives for persons who can no longer be maintained

in the community or family home. The ALA staff will provide counseling,

training and follow-up services through all program phases. All individuals

living in NMRC’s SLPs receive supports tailored to their individual needs to

include assistance in the acquisition, retention or improvement in skills related

to living in the community. The programs provide a home-like environment

designed to foster independent living through supervision and training in

independent living skills. (Rule 33.1)

All SLPs operated by CSS are located in residential areas of the communities

concerned and are approved by DMH prior to occupancy. Retail stores and/or

shopping centers, public recreation facilities, and churches are within a reasonable

proximity to the programs.

Service Components for Supervised Living

Supervised Living Services provide tailored supports which assist with the

acquisition, retention, or improvement in skills related to living in the community.

Learning and instruction are coupled with the elements of support, supervision and

engaging participation to reflect the natural flow of learning, practice of skills and

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other activities as they occur during the course of an individual’s day. (Rule

33.1.A)

All individuals admitted to ALA/residential programs operated by CSS have a

medical screening by a licensed physician or certified nurse practitioner,

including a statement from the examiner which verifies that the individual is

sufficiently free from disease and does not have any health condition that would

create a hazard for other individuals or employees of the service. The result of

the examination is placed in each individual’s record. No one is admitted or

retained in the residential services programs without such required

documentation. This screening is completed within 72 hours of admission to the

service, but no earlier than thirty (30) days prior to admission. (Rule 33.1 C)

Staff providing SLP services assist the individuals by monitoring their health

and/or physical condition. The following documentation is contained in each

individual’s record: making doctor/dentist/optical appointments; transporting

and accompanying to and from appointments; and conversations with medical

professionals (if the individual gives consent). (Rule 33.1.C.1) Staff provide

transportation to and from community activities and events, other places of the

individual’s choice, work, and other sites as documented in their service plan.

(Rule 33.1.C.2)

10.9 Supported Employment

The service provided by the program is assisting individuals with ID/DD in

obtaining supported work or competitive employment and providing an

opportunity for the individual to develop functional skills. Competitive

employment is defined as having a job in a business(es) in the community

where individuals without disabilities are employed. Additionally,

Employment Services may consist of activities to support and/or assist an

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individual in starting his/her own business.

(Rule 49.0.A)

The individual responsible for assisting the individuals of the WAC and ALA

programs in preparing for competitive employment is the WAC Coordinator

and staff. These staff work with employers in the areas served by the WACs

and ALA programs to identify jobs available to the individuals and make

employers aware of incentives, such as tax breaks, skills and competencies of

individuals with developmental and/or related disabilities and other incentives

which are available to them. They work as needed with individuals at the work

site providing training and coaching, job development, and follow up providing

ongoing levels of support necessary for maintaining the job. Individual records

and contact information are maintained by the program staff. (Rule 49.0.B.1-2)

Finally, the staff work with the employer and individual, once the individual has

obtained competitive employment, to provide any supports needed to assist the

individual in maintaining employment. (Rule 49.0.B.3)

Transportation services are provided for all individuals served in the

employment program, between the individual=s place of residence and the site of

job-site. Accessible transportation is provided for those individuals served as

needed. (Rule 49.0.C)

This service is expected to increase the independence, productivity and

integration of a person with developmental and/or related disabilities into the

work setting with non-disabled peers. The individual and his community

benefit from success. (Rule 49.0.D)

The programs are working on developing a collaborative working agreement

with the Department of Vocational Rehabilitation, whereby additional support

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services may be accessed for individuals enrolled in the employment program.

The target group for this service is persons enrolled in WAC and/or ALA

programs operated by the NMRC who are prepared to enter competitive

employment and who have expressed a desire to move from sheltered work into

competitive work. Individuals from the community and/or referred to NMRC

by Vocational Rehabilitation will be served on an individual basis, as staff and

time allows.

Eligibility requirements include that the individual be at least 21 years of age

(preferred), hold a Certificate of Developmental Disabilities, current

psychological and medical information and reside within the service area.

Specific requirements of the Record Guide must also be met. If the family

submits an application for services in Diagnostic Services and request the

participation of their individual in NMRC=s employment program, the family

will

be required to agree to placement of the individual in their local WAC (pending

availability) for a 3 month trial basis. (It will be at the discretion of the WAC

Director to place the individual in a community job prior to the end of the trial

period.)

All individuals currently placed in competitive placements are paid minimum

wage or better. (Rule 49.0.E) Pay begins with the first day on the job

regardless of how much training is necessary for the individual. Therefore, a

written program for the conclusion of training/support and the commencement

of paid employment is not necessary. An Employment Agreement Form

(Attachment 50) is signed between the employer and the WAC Director which

outlines job duties, schedule of pay dates and pay rate. The WAC Director also

completes an extensive service plan for the individual at the time of admission

to the program. This plan is updated annually. Criteria for Termination are also

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developed and agreed to by the individual.

Provision of this service can only be facilitated in groups of no more than

three (3) individuals and one (1) staff person if providing supported

employment. (Rule 49.0.F)

Employment services cannot be provided in Prevocational or WAC Centers and

cannot be used to support volunteer work or unpaid internships. The

employment program includes personal care/assistance when specified in the

individual’s Activity Plan. (Rule 49.0.G)

Documentation must be maintained in the record of each individual receiving

Supported Employment Services that verifies the service is not available under a

program funded under Section 110 of the Rehabilitation Act of 1973 or the

Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). (Rule

49.0.H)

10.10 HCS - Home and Community Supports (Formerly Attendant Care)

HCS services are provided by a Certified Nurse’s Assistant (CNA) who is on

the register for such, by someone who has completed a Nurse Aid Training

Program and has documentation of such, by someone who has completed Direct

Care Worker Training, or someone approved by DMH for service provision to a

particular individual. Individuals are not left unattended at any time during the

provision of HCS services. Direct supervision is provided at all times.

The purpose of HCS services is to provide support services designed to meet

daily living needs and to ensure adequate support for optimal functioning at

home or in the community. HCS services are non-medical in nature and involve

no nursing skills. Day to day provision of HCS services is under the

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supervision of a Registered Nurse. Depending on the individual’s specific

needs as specified on the Plan of Care, HCS services may include, but not be

limited to: support to activities of daily living; assistance with housekeeping

directly related to the individual; food shopping, meal preparation, and feeding

the individual; and support in accessing community resources.

Depending on the individual’s specific needs as specified on the Plan of Care,

HCS services may include, but not be limited to:

Support for activities of daily living such as bathing (sponge, tub), personal

grooming and dressing, personal hygiene, toileting, transferring, assisting with

ambulation, etc. (Rule 51.0.B.1)

Food shopping, meal preparation and assistance with eating, but does not

include the cost of the meals themselves. (Rule 51.0.B.2)

Provide assistance in ambulation and/or transferring themselves from one place

to another. (Rule 51.0.B.3)

Support for community participation by accompanying and assisting the

individual as necessary to access community resources and support for

participating in community activities, including appointments, shopping, and

community recreation/leisure resources, and socialization opportunities. (Rule

51.0.B.4 & 5)

Assistance with feeding and meal preparation for the individual, housekeeping

that is directly related to the individual’s disability and which is necessary for the

health and well-being of the individual (e.g., changing bed linens, straightening

area used by individual, doing personal laundry of the individual, cleaning the

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individual’s equipment such as wheelchairs, walkers, etc.). (Rule 51.0.B.6)

Assistance with any other activity mentioned or addressed in the individual’s

ISP. (Rule 51.0.B.7)

10.11 HCS - In Home Nursing Respite Services (IHNR)

The CSS Department of the NMRC offers IHN which provides services to an

individual on a short-term basis for the purpose of relieving the family or

caretaker or to meet planned or emergency needs. (Rule 51.0.A) The need for

IHN is determined by a physician or RN and is dependent on whether or not the

individual requires nursing care (as defined in the Nurse Practice Act) in the

absence of the caretaker. Providers of IHN services for individuals served by

CSS must be Licensed Practical Nurses (LPN) or Registered Nurses (RN) who

hold a current valid license in the State of Mississippi. LPN’s/RNs may be

employed on-staff or work for the program on a contractual basis to provide this

service.

IHNR services may include, but are not limited to the following:

a. Assistance with personal care needs such as

bathing, dressing, grooming, toileting;

b. Assistance with feeding;

c. Assistance with transferring/ambulation;

d. Play/leisure/exercise/socialization activities;

e. Assistance in housekeeping directly related to

the individual’s health and welfare;

f. Occasionally, taking the individual on an

outing in the community; and/or

g. Other activities specified on the individual’s

Service Plan. (Rule 51.0.B)

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IHNR services are used only for the purpose of relieving the participant’s

caregiver from the constant demands of caring for the individual. Activities

outside the home cannot be the main purpose of the service. (Rule 51.0.C)

This service is only available to individuals living in a family home residence

and is not permitted for individuals living independently (either with or without

a roommate), in any type of group home, in any type of staffed residence.

(Rule 51.0.D)

Individuals are not left unattended at any time during the provision of IHN

services. Direct supervision is provided at all times. (Rule 51.0.E)

Nurses who provide In-Home Nursing Respite Services must practice according

to the Mississippi Nurse Practice Act and Nursing Rules and Regulations. (Rule

51.0.F)

10.12 Family Members as Providers of In-Home Nursing Respite

Providers seeking approval for a family member to serve as In-Home Nursing

Respite staff, regardless of relationship or qualifications, must get prior

approval from the Director of BIDD.

1. Requests for approval should be sent directly to the Director of the

BIDD.

2. Each request is considered on a case-by-case basis.

3. Each request must include a copy of the proposed staff’s current

nursing license, as well as documentation of reference checks.

4. If the proposed staff person does not meet the qualifications as

outlined in Part II: Chapter 11, a waiver of the OSM must be

requested through the BQMOS. (Rule 51.1.A)

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The following types of family members will not be considered for approval

and are NOT allowed to provide IHNR:

1. Those who live in the same home;

2. Those that are parents/step-parents of the minor receiving the

services;

3. Those who are a spouse, relative or anyone else who is normally

expected to provide care for the individual receiving the services;

and

4. Anyone who lives in the home with the individual,

regardless of relationship, cannot provide IHNR to the individual.

(Rule 51.1.B)

Family members employed as staff to provide IHNR must meet the

qualifications and training requirements outlined in Part II: Chapters 11 and 12.

(Rule 51.1.C)

IHN services for individuals served by the CSS Department of the NMRC must

be by individuals who are employed on staff or contractually who are: Licensed

Practical Nurses (LPNs) or Registered Nurses (RNs) who hold a current valid

license in the State of Mississippi. The need for nursing respite is dependent

upon whether or not the individual served requires nursing care, as defined in

the Nurse Practice Act, in the absence of the care provider.

The NMRC, as a waiver service provider, does not utilize self-employed

individuals to provide IHN or HCS (formerly Attendant Care) services. Those

individuals providing waiver services who are not fully NMRC (i.e., state

service) employees are employed by NMRC as contractual workers.

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IHN services are only provided to individuals who have IHN services approved

on their individual Plan of Care and as authorized by the HCBW coordinator.

The amount of service provided cannot exceed the amount authorized by the

HCBW coordinator.

Behavior Support Plan (BSP)

BSIS are provided to individuals who exhibit behavior problems which cause them

not to be able to benefit from other services being provided or cause them to be so

disruptive in their environment(s) there is imminent danger of causing harm to

themselves or others. (Rule 52.0.A)

The expected outcome for BSIS is for individuals to receive training and

supports necessary to decrease maladaptive behaviors which interfere with

individuals remaining at home and in the community. (Rule 52.0.B)

Behavior Support and Intervention Services must include the following:

1. Assessing the individual’s environment and identifying antecedents of

particular behaviors, consequences of those behaviors, and maintenance

factors for the behaviors.

2. Developing a positive Behavior Support Plan (BSP).

3. Implementing the plan, collecting data, and measuring outcomes to assess

the effectiveness of the plan.

4. Training staff and/or family members to maintain and/or continue

implementing the plan.

5. Assisting the individual in becoming more effective in controlling his/her

own behavior either through counseling or by implementing the BSP.

6. Documentation of collaboration with medical and ancillary therapies to

promote coherent and coordinated services addressing behavioral issues and to

limit the need for psychotherapeutic medications, when applicable.

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7. Training of staff responsible for implementing the BSP by the staff

member who conducted the Functional Behavior Assessment (FBA) and

developed the BSP prior to implementation of behavior management

strategies identified in the plan. (Rule 52.0.C.1-7)

BSI may provide services at the same time another service is being provided as long

as it is clearly documented that the intervention is:

1. Observing the individual for the Functional Behavior Assessment (FBA).

2. Collecting data via observation and intervention.

3. Training staff who provide another ID/DD Waiver service to the individual.

4. Shadowing and/or intervening in undesired behaviors while the individual is

receiving another ID/DD Waiver service.

5. Designed to be intensive and short-term. (Rule 52.0.D)

Written Approval of Behavior Support Plan

A. In the community living programs, the BSP is approved by the following:



3. The behavior support/interventionist

4. The director of the service

5. The NMRC Director of the program/agency or his/her designee. (Rule 52.2.A)

B. If the individual is not enrolled in a day or residential program, the BSP

is approved by the following:



3. The behavior support/interventionist. (Rule 52.2.A & B)

ID/DD Waiver Home and Community Supports (HCS)

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Home and Community Supports (HCS) offer services for individuals who are in the

ID/DD waiver and require assistance to complete their daily living needs, ensure

adequate functioning in their home and in the community, and provide safe access

to the community. (Rule 53.0.A)

Supported Living Services are residences provided for three (3) or more people.

At this time, there are only one (1) or two (2) individuals living in a residence.

Contacts by staff are made with the individual on a regular basis, at least one

time per week in order to ensure they are succeeding in the program. They are

on call 24 hours per day/7 days per week in case of emergency and/or to manage

unplanned needs which may arise. During the day, individuals engage in a

variety of activities.

Individuals in the HCS program are provided the following:

a. Activities of daily living

b. Assistance in housekeeping directly related to their health and welfare

c. Assistance with the use of adaptive equipment

d. Support and assistance for community participation (appointments,

banking, shopping, recreation and leisure activities, socialization opportunities)

(Rule 53.0.B.1-4)

HCS cannot be provided in schools or be a substitute for educational services or

other day services for which the individual is appropriate (e.g., Day Services-

Adults, Prevocational Services, Supported Employment, and/or Indsutries

Services). (Rule 53.0.C)

Staff in this program are, at all times during service provision, responsible for

the monitoring and supervision of those persons in the program. (Rule 53.0.D)

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Staff are not allowed to provide medical treatment as defined in the Mississippi

Nurse Practice Act and Rules and Regulations. They cannot accompany a minor

on a medical visit without parent/legal representative present. (Rule 53.0.E)

HCS provided during overnight hours must be provided in the individual’s

legal residence. Any exceptions to this standard are prior approved by the

Director of the BIDD. (Rule 53.0.F)

Persons admitted to the HCS program must have a diagnosis of mental

retardation/developmental disability certification. Individuals have certification

indicating that they have completed special education or a statement from

school officials indicating that they can no longer be served by the school

system.

HCS staff may assist individuals with money management, but cannot receive or

disburse funds on the part of the individual. Policies and procedures have been

implemented to ensure the individual maintains their own financial resources.

These policies and procedures include:

a. No staff or agency name on the individual’s account

b. The individual must be present when making a financial transaction

c. HCS person documents the amount of money received and its intended

purpose if family gives the individual money to spend in the community

and the family member must then sign the document to verify the

purchase.

d. Upon their return home, the HCS staff gives the family the receipts and

Any spending money left over.

e. Documentation is maintained in the individual’s case record. (Rule 53.1.A)

Family Members as Providers of HCS Approval for a family member to serve as HCS staff, regardless of relationship or

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qualifications, must get prior approval from the Director of the BIDD.

1. Requests for approval should be sent directly to the Director of the BIDD.

2. Each request for approval is considered on a case-by-case basis.

3. Each request must include a copy of the proposed staff’s high school

diploma or GED equivalent as well as documentation of reference checks.

4. If the proposed staff person does not meet the qualifications as outlined in

Part II: Chapter 11, a waiver of a standard in the OSM must be requested

through the BQMOS. (Rule 53.2.A)

The following types of family members will not be considered for approval and are

NOT allowed to provide HCS:

1. Those who live in the same home

2. Those that are parents/step-parents of the minor receiving the services

3. Those who are a spouse, relative or anyone else who is normally expected to

provide care for the individual receiving the services

4. Anyone who lives in the home with the individual, regardless of

relationship, cannot provide HCS to the individual.

Family members employed as staff to provide HCS meet the qualifications and

training requirements outlined in Part II: Chapters 11 and 12. (Rule 53.2.B)

CASE MANAGEMENT SERVICES

Because the purpose of this program is to provide an access mechanism for CSS

for persons with ID/DD in Mississippi, a major component of the project is the

identification and coordination of services available not only through those

agencies mandated to serve persons with ID/DD, but also through those

organizations which provide services to the general population for which those

with ID/DD may be eligible. The provision and coordination of these services

are an integral part of helping individuals access needed medical, social,

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education, and other services to help them reach their highest level of

independence.

Each individual is offered CM services as part of the pre-admission evaluation

process through NMRC’s Diagnostic Services Department. When desired

services are not immediately available, CM services are offered and

documentation is maintained in the individual’s record. CM services are offered

at least every 12 months. If the individual refuses CM, the refusal is

documented in writing. Documentation is also maintained in a central location

in the Case Management office.

In order to adequately develop a Case Management Service Plan and provide

Case Management services, the Case Manager (CM) will not only involve the

individual but their family/parents/legal guardian and documented.

The CM Program maintains a CM unit under the supervision and direction of

the ALA/CM Coordinator. A full-time CM is assigned to individuals enrolled in

the program. The department maintains a list of the case load that is available

for review by DMH and maintains a current comprehensive collection of

community resources which includes, but is not limited to:

a. Name of agency;

b. Eligibility requirements;

c. Contact person;

d. Services available; and

e. Telephone number

Termination: Individuals shall be terminated from CM for any one of the

following reasons:

1. Death;

2. Individual moves from catchment area and is transferred to

another CMs caseload;

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3. Individual/family requests termination of CM services in

writing;

4. Individual is admitted for long-term care in a residential

program;

5. Individual and/or family fails to respond to correspondence

and/or requests for information or relocate leaving no

forwarding address. After documented extensive efforts to

locate the individual/family the case may be closed; and

6. No individual contact has been made for 12 months.

The CM program maintains documentation through contacts, directories,

correspondence, and other program materials that the CM has developed and

maintains relationships with a variety of other health and social service agencies

to help ensure appropriate referrals and service provision.

The Case Management program makes available and includes, at a minimum the

following service components designed to assist individuals in securing

resources needed and chosen by the individual and/or family which will help the

individual live successfully in the community:

b. Outreach Services - CM will develop a thorough

knowledge of service agencies in the region and

through out the state. This includes visiting placement

sites, establishing contacts with persons in other

agencies, and being familiar with application

procedures, waiting lists, etc., so that referral sources

are aware of case management services.

c. Intake Services - CM will obtain complete

identification data on all individuals served, including

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medications used, contact with other agencies,

addresses, phone numbers, family, etc.

d. Emergency/Crisis Intervention - CM is aware of

resources and procedures for emergency placement or

intervention when an individual is in need of immediate

attention, such as respite services at the state residential

centers and/or hospital admission.

e. Information and Referral - CM provides individuals,

families, and other service agencies with information

regarding placement sites, financial resources,

application procedures, etc. The CM has knowledge of

or be able to obtain information about the referral

process to other programs and services.

f. Diagnosis and Evaluation - Although the CM does not

perform evaluations or diagnose individuals, the CM is

responsible for referring an individual for evaluation, if

needed, or for obtaining copies of prior evaluations if

one has been performed within the established time line

before the individual is enrolled in the CM system.

g. Service Planning - The individual, family/guardian, and

CM will jointly develop a Service Plan according to the

desires and preferences of the individual. The

development of this Service Plan must occur during a

face to face meeting that is conducted at least annually.

The Service Plan is subject to change in accordance

with the individual’s desire for services and supports.

h. Service Coordination - The CM will assist the

individual in accessing all the services and supports

he/she desires by making the appropriate referrals or

otherwise assisting the individual in contacting the

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service/support. The CM will also assist the individual

in making the transition to the new service/support.

The CM will stay in contact with the individual and the

service agencies once the individual has been referred

for services/support to ensure that the individual has

begun and continues to receive the services/supports

he/she desires. If a CM is unable to contact someone

for 12 months, the case is then closed. All

documentation of contacts is maintained in the

individual’s record.

CM is a voluntary service. Individuals and/or their guardians must sign a Case

Management Services Agreement form during a face to face meeting indicating

their desire for the service on or within one year prior to the individual’s

admission into the program. Individuals may withdraw from the service at any

time with a written request. This form must be renewed annually so that the

continuation of services is consistent with the needs and desires of the

individual and family.

Individuals enrolled in the project are assigned to status determination which is

based on the individual’s support system. The status determination includes the

following:

Potential/Temporary: This status includes individuals referred for immediate

CM services but who have not been ruled eligible and individuals contacting

CM for a temporary service such as assistance in obtaining equipment but do

not have an ongoing need not to exceed 120 days.

Each individual’s non-work needs, which affect their functioning in the

community, are identified by program staff and referrals made for support

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needed are documented. The CM staff at NMRC maintains a record of all WAC

individuals (unless the individual has requested in writing that they not) and will

work cooperatively with workshop staff in accessing services for individuals.

Documentation of referrals can be found in CM records. As needs are identified

for individuals enrolled in PV waiver services, the program’s director will

coordinate with the HCBW coordinator to assure that all needs are met.

The ALA/CM Coordinator maintains supervisory responsibilities for the

program, acts as liaison with the CSS Director and the Director of NMRC, and

provides technical assistance to the Regional Case Manager. All administrative

functions of

the program are assigned to the ALA/CM Coordinator under the supervision of

the CSS Director.

Eligibility requirements for this program include developmental disability

certification and a current psychological and medical evaluation in addition to

all specific requirements of the Record Guide.

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GLOSSARY

A. Certified Peer Support Specialist (CPS) - CPS provide non-clinical peer

support that is person-centered and recovery/resiliency focused. CPS is a self-identified consumer/family member (past or present) of mental health services who has successfully completed the DMH approved Certified Peer Specialist training and certification exam.

B. Chemical restraint - a medication used to control behavior or to restrict the

individual’s freedom of movement and is not standard treatment of the individual’s medical or psychiatric condition.

C. Community-based - services and supports are located in or strongly linked to

the community, in the least restrictive setting supportive of an individual's safety and treatment needs. Services and supports should be delivered responsibly and seamlessly where the person lives, works, learns and interacts.

D. Cultural Competency - the acceptance and respect for difference, continuing

self- assessment regarding culture, attention to dynamics of difference, ongoing development of cultural knowledge and resources and flexibility within service models to work towards better meeting the needs of minority populations.

E. Days - calendar days.

F. Director – an individual with overall responsibility for a service or service area. This individual must have at least a Master’s degree in a mental health or related field and (1) a professional license or (2) DMH Credentials as a Mental Health Therapist or DMH credentialed Intellectual/Developmental Disabilities Therapist (as appropriate to the population being served and/or supervised).

G. DMH Credentials – examples include Certified Mental Health Therapist

(CMHT), Certified ID/DD Therapist (CIDDT).

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H. Grievance - a written statement made by an individual receiving service alleging a violation of rights or policy.

I. Immediate Family member-spouse, parent, stepparent/child, sibling, child.

J. Legal representative – the legal guardian or conservator for an

individual as determined in a court of competent jurisdiction.

K. Mechanical restraint - the use of a mechanical device, material, or equipment attached or adjacent to the individual’s body that he or she cannot easily remove that restricts freedom of movement or normal access to one’s body.

L. Medical Screening - Components of medical screening include: patient personal information, doctor’s information (name, etc.), exam information – BP, pulse, height, weight, current diagnosis, current meds, statement of freedom from communicable disease, physical and dietary limitations and allergies. Must be signed by a licensed physician/nurse practitioner.

M. Peer - A self-identified consumer or family member of a consumer of

mental health services.

N. Peer Support Service - Peer Support Services are person-centered activities that allow consumers/family members the opportunity to direct their own recovery and advocacy processes. Peer Support is a helping relationship between peers and/or family member that is directed toward the achievement of specific goals defined by the individual. Peer Support Services include a wide range of structured activities to assist individuals in their individualized recovery/resiliency process. Specific goals may include the areas of wellness and recovery/resiliency, education & employment, crisis support, housing, social networking, development of community roles and natural supports, self-determination and individual advocacy.

O. Peer Support Supervisor - An individual credentialed according to the

standards and guidelines determined by DMH. Prior to, or immediately upon acceptance in a Peer Support Supervisory position, this individual will be required to receive basic Peer Specialist training specifically developed for supervision within the Peer Specialist program, as provided by DMH.

P. Person-centered process – identification of the supports needed for individual

recovery and resilience. Individualized and Person-centered means that the combination of services and supports should respond to an individual's needs,

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and should work with the strengths unique to each individual's natural and community supports. Services and supports should be designed to help the person served identify and achieve his/her own recovery goals. The public mental health system must also recognize, respect and accommodate differences as they relate to culture/ethnicity/race, religion, gender identity and sexual orientation. However, an individualized/person-centered process must recognize the importance of the family and fact that supports and services impact the entire family.

Q. Physical escort - temporary holding of hand, wrist, arm, shoulder, or back for

the purpose of inducing an individual who is acting out to walk to a safe area.

R. Physical restraint - personal restriction that immobilizes or reduces the ability of an individual to move his or her arms, legs, or head freely. Such term does not include a physical escort.

S. Professional License – examples include Licensed Professional Counselor (LPC), Licensed Psychologist, Licensed Master Social Worker (LMSW), Licensed Certified Social Worker (LCSW), and Medical Doctor.

T. Program - the single service provision site.

U. Provider - the overall agency/entity. Provider does not refer to an individual

staff member or program site.

V. Psychiatric Services – includes interventions of a medical nature provided by medically trained staff to address medical conditions related to the individual’s mental illness or emotional disturbance. Medical services include medication evaluation and monitoring, nurse assessment, and medication injection.

W. Results-oriented - services and supports that lead to improved outcomes for

the person served. People have as much responsibility and self-sufficiency as possible, taking into consideration their age, goals and personal circumstances. Recovery- oriented services means services that are dedicated to and organized around actively helping each individual served to achieve full personal recovery in their real life and service environment.

X. Seclusion - a behavior control technique involving locked isolation. Such

term does not include a time-out.

Y. Supervisor - an individual with predominantly supervisory and administrative

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responsibilities on-site in the day-to-day provision of services for such areas as Work Activity Services, Day Services-Adults, Psychosocial Rehabilitation Services, Day Support Services, etc. This individual must have at least a Bachelor’s degree in a Mental Health, ID/DD, or a related field, and be under the supervision of an individual with a Master’s degree in a Mental Health, ID/DD, or a related field.

Z. Time Out - behavior management technique which removes an individual from

social reinforcement into a non-locked room, for the purpose of calming. The time-out procedure must be part of an approved treatment program. Time-out is not seclusion.

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