The home should have equipment necessary based on the needs of the individuals served (i.e.: grab bars, ramps, visual fire alarms, etc.) 3.006 Does the facility have bathing facilities at a ratio of 1:4? 5123:2-3-06 For every four beds the facility is licensed for, there must be one toilet and one tub or shower. Ex. 12-bed facility must have 3 toilets and 3 tubs or showers per facility. 3.007 If a time out room is used: The door does not have a key lock, but may be held shut by a staff person or mechanism that requires constant physical pressure to keep the mechanism engaged The room has adequate lighting and ventilation The room is safe from hazardous conditions including, but not limited to, the presence of sharp corners or objects, uncovered light fixtures or uncovered electrical outlets The individual is under constant visual supervision 5123:2-2-06 Ensure that lighting and ventilation are properly working View inside the time out room/area View the room from the individual's perspective. 3.008 Was the individual able to independently get around his/her home and have unrestricted access to all areas of the home and grounds unless otherwise indicated in the IP? 5123:2-3-02 Look to see that doors are wide enough for wheelchairs, and ramps when needed. Only staff quarters, bedrooms of other individuals and boiler/mechanical areas may be off-limits to individuals.
opportunities, alternative day service providers, etc. 4.012 Does the ISP include supports to access the full community? 5123:2-3-03 Are the activities similar to those without disabilities? On-going access to the community Individualized vs group opportunities Achieving desired outcomes in the area of community integration 4.013 Are services being delivered in a manner which supports individual choice, preferences, and needs in a manner that supports each individual’s full participation in his/her greater community? 5123:2-3-03 Are opportunities to access the community being offered Engagement in meaningful activities (vocational and non-vocational activities) Age appropriate activities Do activities involve individuals with and without disabilities Section 5 – Provision of services/ip implmentation Question # Question Guidance/Additional Information Compliant Yes/No Plan of Correction (If not compliant) 5.001 Are medication, treatments, health related activities and dietary orders being followed as indicated in the IP? 5123:2-3-04; 5123:2-6-03 Info may come from the medication administration record (MAR), doctor's orders, OT/PT and speech plans and unusual incidents There are 13 health related activities Nursing tasks not authorized by DODD Category 1 Certification require nurse delegation (ex. Catheterization, trache suctioning, etc.)
5.006 Were individuals attending day programming at a building at least 200 feet from the 5123:2-3-04 All individuals should be attending an off-site day activity setting unless otherwise indicated in the IP as contraindicated for the individual. Off-site is defined as any building that is located at least 200 feet from the ICF-IID. A provider who was providing on-site day activity services prior to 7/1/05 may continue to do so. 5.007 Does the ICF-IID ensure that individuals have access to their funds as stipulated in the IP? 5123:2-2-07 Individual funds must be deposited within 5 days of receipt and made available to the individual within 3 days of request. This includes all monies such as personal allowance, employment, gifts, income tax refunds and food stamps. The IP will specify the level of independence the individual has to handle money and any types of assistance to be provided. 5.008 If the IP includes assistance with money management, are the individual’s monies being managed as indicated in the plan? 5123:2-2-07 Bill Paying Banking Shopping Inventories Ensure that burial funds are managed properly and certificates are maintained. 5.009 When the individual receives assistance with money management does the IP include parameters for management based on the areas of focus? 5123:2-2-07 As appropriate/needed based on the service need… The dollar amount anticipated to be available to the individual up request for personal spending.
consent, confidentiality, and the requirements of 5123:2-2-06? 5123:2-2-06; 5123:2-3-04AVERSIVE BSPs ONLY Does the plan have clear procedures? Has the plan addressed staff training and have they been trained? Are restraint and time out used in safe areas? Does the individual have any medical condition that would make the use of a restraint contraindicated for the person? Prone restraints are prohibited in all settings. The ICF can have received approval of their own trainings or utilized the department trainings. Department online trainings of: Behavioral Support Strategies that Include Restrictive Measures, Human Rights Committee, and Rights of People with Developmental Disabilities meet the 5 required areas above. 7.012 If the service plan includes restrictive measures, did the Human Rights Committee review and approve the plan prior to implementation? 5123:2-2-06; 5123:2-3-04AVERSIVE BSPs ONLY Does the plan have clear procedures? Has the plan addressed staff training and have they been trained? Are restraint and time out used in safe areas? Does the individual have any medical condition that would make the use of a restraint contraindicated for the person? Prone restraints are prohibited in all settings. 7.013 If the service plan includes time out or restraint, are the interventions being implemented only when risk of harm is evidenced? 5123:2-2-06; 5123:2-3-04AVERSIVE BSPs ONLY There must be a direct and serious risk of physical harm to the individual or another person. The individual must be capable of
Question # Question Guidance/Additional Information Compliant Yes/No Plan of Correction (If not compliant) 8.001 Upon identification of a MUI, is there evidence that the ICF-IID took the following immediate actions as appropriate: Immediate and on-going medical attention Removal of an employee from direct contact with any at-risk individual when the employee is alleged to have been involved in abuse or neglect until such time as the ICF-IID/DD has reasonably determined that such removal is no longer necessary Other necessary measures to protect the health and safety of at-risk individuals 5123:2-17-02 The ICF-IID must ensure that when a staff person is not removed from the direct contact that the staff person has no unsupervised contact with the alleged victim or any other individual who may be considered at risk. The provider is responsible for notifying the county board or department when there are changes in protective actions (i.e. returning employee to duty, change in supervision levels, etc.) 8.002 Is there evidence that the ICF-IID notified the county board about the below listed incidents within 4 hours of discovery? Abuse (physical, sexual and verbal) Exploitation Misappropriation Neglect Suspicious/Accidental Death Media Inquiry Peer to Peer 5123:2-17-02 Ask how the provider documents the date and time of the initial notification. Check MUI ITS, fax cover sheet or provider documents. Every CB is required to have 24-hour availability. 8.003 Is there evidence that the ICF-IID submitted a written incident report to the county board contact or designee no later than three p.m. the next working day following initial knowledge of a potential or determined major unusual incident? 5123:2-17-02