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The proposed changes are DSS’ latest step in the department’s plan for overall child residential reform. Recently, the State Legislature passed and the Governor signed SB 238 by Senator Willie Mount, which gives DSS the authority to revoke the licenses of child residential facilities that do not meet the agencies licensing standards. Previously, DSS had to bring recommendations for license revocation to the Louisiana Advisory Committee on Licensing of Child Care Facilities and Child Placing Agencies, which determined what actions could be taken when a facility was not in compliance with DSS standards.
The latest revision of the licensing standards is a key step in reforming child residential care because providers will have specific guidelines to follow and will be aware of the standards by which the facility providing residential care to children will be evaluated.
“The children in our care who are placed in child residential homes are among the most vulnerable in our state, and we must ensure that the care provided in homes across the state is in the best interest of these children,” said DSS Secretary Kristy Nichols. “The proposed licensing changes were developed using the Child Welfare League of Americas standards as a guideline, and we also evaluated the way other states license child residential facilities to ensure that high quality services are being provided consistently in all facilities to keep children safe and in a stable home-like environment staffed by qualified and properly trained individuals.”
Nichols said that the goal of these new regulations also is to streamline and clarify the requirements for child residential facilities for both providers and surveyors in an effort to increase compliance and ensure that the standards are applied consistently during the monitoring process.
The most significant changes to the child residential licensing standards were made in five key areas. They include:
- Improving the safety of children;
- Ensuring that appropriate services are provided to children;
- Improving the environment in which children live;
- Providing for workforce qualifications and training for staff; and
- Clarifying the monitoring process for providers and surveyors.
In addition, specific prohibited discipline practices are outlined such as corporal punishment, withholding family visits, harsh physical work or denial of school.
“In the same way that the standards outline specific prohibited practices where discipline is concerned, it was very important that the standards establish specific timelines and clear guidelines regarding appropriate behavior interventions, such as time-out, restraint and seclusion,” said Nichols. “The new standards will provide for monitoring, review and reporting of these interventions to make sure children are protected and that safe and appropriate disciplinary actions are administered when necessary without harming the child.”
To ensure that the appropriate services are provided to children in care, a pre-admission screening process will be required to make sure the specific needs of each child, including special services related to a physical disability, can be met by the facility. More stringent timelines will be established for the development of individualized service plans for children. Plans will be initiated at 15 days instead of 30 days, and will be reviewed by an interdisciplinary on a quarterly basis.
Additionally, the newly proposed regulations establish specific guidelines to ensure that medical, dental and specialized needs of children are met in a timely manner. The regulations also require that the State Sanitary code be followed regarding food service and that children have input into the food they are served.
“We know that the best environment for a child is in a home, but when the safety and security of a child is at risk and he or she must be removed, it is our responsibility to provide a setting that is home-like rather than institutional,” said Nichols. “The new standards will place more emphasis on safe, clean and orderly home-like settings for children faced with unfortunate and trying circumstances.”
According to Nichols, the new standards improve the quality of the environment in which children live. Some requirements to promote a more home-like setting include a limit of two children to a room, a closet in or adjacent to a child’s bedroom, a one to six ratio for showers and toilets and mandated temperature controls for heating and air systems.
The standards also specify staff qualifications, outline specific job duties for staff and require more orientation and annual training to promote the delivery of quality services. The provider will have to put a Quality Improvement program in place to ensure that self-evaluation is conducted and improvements in service delivery are made on an ongoing basis.
“In addition to providing clarification and reorganizing the standards to remove any inconsistencies, a major change will be made to the initial licensing process so that we are clear with providers from the very beginning about our what is expected,” said Nichols. “To provide the quality of care and the level of oversight needed where vulnerable children are involved, it is very important potential providers are knowledgeable about the program and the standard of care expected once licensed.”
Nichols said the initial licensing process will be enhanced to make sure the provider expectations are outlined and understood and that deficiencies are addressed on the initial visit by DSS licensing staff. Any identified deficiencies will be documented and providers will be required to submit a time specific corrective action plan to be approved by DSS prior to revisiting the child residential home.
Nichols also said that training has been provided for the DSS licensing team regarding facility deficiencies. The standards mandate that deficiencies are written to include the extent and affect of the non-compliance. All work and evaluation processes have been written to provide clarity and consistency for the licensing staff, and a complaint process will be established to mandate that all complaints are investigated. Rules will be established to outline the receipt, prioritizing and investigation of all complaints, and complainants will be notified at the end of the investigation.
The new regulations will be formally proposed on August 20. A comment period of 120 days will follow for the public to review the standards. After the comment period, the new regulations will be implemented in December 2009.