Library: Policy

340:110-3-168. Requirements for residential treatment facilities

Revised 9-14-24

(a) Residential treatment facilities. A residential treatment program cares for children under 24-hour medical care with emotional, psychological, or mental disorders.

(b) Requirements. The program complies with Oklahoma Administrative Code (OAC) 340:110-3-145 through 340:110-3-165.1, except as otherwise provided in this Section.

(1) complies with the rules regarding personnel, per OAC 340:110-3-153.1; and

(2) employs a psychiatrist and adequate medical personnel meeting residents' medical needs.

(d) Ratios and resident supervision. The program is exempt from the rules, per OAC 340:110-3-153.2, regarding residents' supervision.

(1) The program employs a sufficient number of child care personnel to adequately supervise and meet residents' needs. Supervision is the function of overseeing and guiding residents, including awareness of, and responsibility for, each resident's ongoing activities. Personnel are awake and accessible at all times.

(2) The program maintains a ratio of one personnel for:

(A) six residents (1:6) during awake hours; and

(B) eight residents (1:8) during sleeping hours.

(3) Personnel may only count in ratio while directly caring for residents. Personnel performing other duties may not count in ratio.

(4) The doors may be locked when psychiatric residential treatment admission is ordered by a licensed psychiatrist or physician.

(e) Admission. Within 24-hours of admission, a health care professional reviews and approves the admission assessment.

(f) Service planning. The program is exempt from the rules, per OAC 340:110-3-154(b)(1) and (2), regarding service plans.

(1) The program meets the requirements in:

(A) (1) and (2) of this subsection; and

(B) OAC 340:110-3-154(b)(1)(A) and (B) and (b)(2)(B) and (C).

(2) A written service plan for each resident is:

(A) developed and documented within seven-program business days after admission; and

(B) reviewed at least every 30-calendar days thereafter unless required by other licensing or contracted entities.

(g) Portable pools. The program is exempt from the rules, per OAC 340:110-3-163(14)(B). Therapeutic water activities are permitted when prescribed by an attending licensed physician, included in a treatment plan, and provisions are made to ensure hygienic practices. When portable pools are used as a therapeutic activity , residents, are directly supervised at all times. Portable pools are:

(1) no larger than six feet in diameter; and

(2) contain no more than six inches water depth.

(h) Discharge procedures. The program meets the rules, per OAC 340:110-3-154(d), regarding discharge procedures. The program:

(1) supplies the resident with two weeks' worth of prescribed medication, when appropriate; and

(2) documents in the resident's file at least one scheduled outpatient follow-up contact within two weeks of discharge.

(i) Visitation. The program is exempt from the rules, per OAC 340:110-3-154.1(b)(2), regarding visitation restriction reviews. Visitation restrictions are:

(1) explained to the resident and parents or legal guardian;

(2) documented in the resident's records; and

(3) reviewed every seven-calendar days.

(j) Behavior management. The program is exempt from the rules, per OAC 340:110-3-154.2(b)(7) and (10), regarding seclusion and restraint. If the program uses seclusion and chemical restraint, requirements in (1) through (5) of this subsection are met.

(1) Seclusion. Seclusion is only used when less-restrictive interventions, per program policy, were attempted or when an immediate intervention is required to protect the resident, personnel, or others. The resident is released from seclusion when no longer deemed a risk to self or others. A written incident report is completed within 24-hours following each use of seclusion.

(A) Seclusion is only used with a health care professional's specific verbal authorization. Within 24-hours, the authorization is written and signed by the health care professional and maintained with the seclusion log.

(B) Personnel continuously monitor residents in seclusion, either by direct contact or with audiovisual equipment, and directly verify residents' well-being at least every 15 minutes. Residents receive appropriate medical and psychological services.

(D) Residents are released from seclusion when sufficiently in control and no longer a serious and immediate danger.

(i) Residents 10 years of age and older do not remain in seclusion longer than two hours or a total of six non-consecutive hours within a 24-hour period.

(ii) Residents 9 years of age and younger do not remain in seclusion longer than one hour within a 24-hour period.

(2) Seclusion room. A room used for seclusion includes:

(A) at least 60 square feet and a seven foot, six inch ceiling height;

(B) a safety glass window, mirror, or camera allowing for seclusion room full-observation;

(D) no hardware, equipment, or furnishings presenting a physical hazard or suicide risk;

(E) natural or mechanical ventilation;

(F) a temperature between 65 and 85 degrees Fahrenheit;

(G) lighting ; and

(H) an automatic fire suppression system.

(3) Mechanical restraint. Mechanical restraint is not used on residents 18 years of age and younger, per OAC 317:30-5-95.39.

(4) Chemical restraint. Chemical restraint is only used when less restrictive interventions, per program policy, were attempted or when an immediate intervention is required to protect the resident, personnel, or others. A written incident report is completed within 24-hours following each chemical restraint use.

(A) Chemical restraint is only used with a health care professional's verbal authorization prior to administration. Within 24-hours, the authorization is written and signed by the health care professional and maintained with the restraint log.

(B) Chemical restraint is administered in a humane manner.

(C) Personnel continuously monitor residents, either by direct contact or with audiovisual equipment, and directly verify residents' well-being at least every 15 minutes.

(D) The resident receives appropriate medical and psychological services.

(5) Seclusion and restraint log. A seclusion and restraint log is maintained and includes the seclusion or restraint:

(A) date and time ;

(B) authorizing health care professional's name;

(D) observation times, including resident's activity description at each observation, and the signature of the observing personnel; and

(E) release time.