ADMINISTRATIVE CODE

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER b: HEALTH CARE FACILITIES
PART 220 COMMUNITY-BASED RESIDENTIAL REHABILITATION CENTER DEMONSTRATION PROGRAM CODE

Section 220.1000 Definitions

Section 220.1050 Referenced Materials

Section 220.1100 Demonstration Program Elements

Section 220.1200 Application for and Issuance of a License to Operate a Community-Based Residential Rehabilitation Center Model

Section 220.1300 Obligations and Privileges of Community-Based Residential Rehabilitation Center Models

Section 220.1400 Inspections and Investigations

Section 220.1500 Notice of Violation and Plan of Correction

Section 220.1600 Adverse Licensure Action

Section 220.1700 Policies and Procedures

Section 220.1800 Admission Practices

Section 220.1900 Participant Assessment

Section 220.2000 Individual Rehabilitation Plan

Section 220.2100 Participant Rights

Section 220.2200 Participant Care and Treatment Services

Section 220.2300 Participant Record Requirements

Section 220.2400 Residential Services

Section 220.2500 Medication Administration

Section 220.2600 Discharge and Follow-up Practices

Section 220.2700 Personnel

Section 220.2800 Health Care Worker Background Check

Section 220.2900 Food Service

Section 220.3000 Physical Plant

Section 220.3100 Quality Assessment and Improvement

Section 220.1000 Definitions

The following terms have the meaning ascribed to them here whenever the term is used in this Part.

Abuse – any physical or mental injury or sexual assault inflicted on a participant other than by accidental means in a facility. Abuse means:

Physical abuse refers to the infliction of injury on a participant that occurs other than by accidental means and that requires (whether or not actually given) medical attention.

Mental injury arises from the following types of conduct:

Verbal abuse refers to the use by a licensee, employee or agent of oral, written or gestured language that includes disparaging and derogatory terms to patients or within their hearing or seeing distance, regardless of their age, ability to comprehend or disability.

Mental abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation, or offensive physical contact by a licensee, employee or agent. Sexual harassment or sexual coercion perpetrated by a licensee, employee or agent.

Sexual assault – an act of nonconsensual sexual conduct or sexual penetration, as defined in Section 11-0.1 of the Criminal Code of 2012, including, without limitation, acts prohibited under Sections 11-1.20 through 11-1.60 of the Criminal Code of 2012.

Act – the Alternative Health Care Delivery Act.

Active treatment – an interaction between a participant and staff member that is intended to result in greater autonomy or independence for the participant.

Board – the State Board of Health. (Section 10 of the Act)

Case Manager – a person who is responsible for organizing the provision of services to the participant.

Charitable Care – the intentional provision of free or discounted services to persons who cannot afford to pay for them.

Community-Based Residential Rehabilitation Center Model or Model – a designated site that provides rehabilitation or support, or both, for persons who have experienced an acquired brain injury, who are medically stable, and who no longer require acute rehabilitation care or intense medical or nursing services. (Section 35(4) of the Act)

Comparable Health Care Providers – other community-based residential rehabilitation programs in the region that are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) pursuant to Section 35(4) of the Act.

Demonstration Program or Program – a program to license and study alternative health care models authorized under the Act. (Section 10 of the Act)

Department – the Illinois Department of Public Health. (Section 10 of the Act)

Dietician – a person who is a licensed dietician as provided in the Dietetic and Nutrition Services Practice Act.

Director – the Director of Public Health or designee. (Section 10 of the Act)

Individual Rehabilitation Plan – a coordinated plan that identifies rehabilitation goals and outcomes based on the participant's preferences, strengths, and challenges.

Inspection – any survey, evaluation, or investigation of the Community-Based Residential Rehabilitation Center Model's compliance with the Act and this Part by the Department or designee.

Least Restrictive – treating individuals in the least intrusive manner and the least intrusive environment possible, given each individual's needs and the risk of harm to self or others.

Licensee – a person or entity licensed to operate the Community-Based Residential Rehabilitation Center Model.

Life Skills Trainer – a person who meets the minimum qualifications in Section 220.700(k) and provides training, assistance and supervision to participants in the areas of living skills, therapeutic recreation, and other forms of assistance in both residential and community settings.

Neuropsychologist – a person who is licensed as a psychologist under the Clinical Psychologist Licensing Act who specializes in brain-behavior relationships. The neuropsychologist administers a series of tests to evaluate the person's cognitive, emotional, intellectual, and academic/vocational skills.

Occupational Therapist, Registered (OTR) – a person who is registered as an occupational therapist under the Illinois Occupational Therapy Practice Act.

Operator – a person responsible for the control, maintenance and governance of the Model, its personnel and physical plant.

Owner – an individual, partnership, corporation, association or other person who owns the Model.

Participant – a person who resides in or receives services from a Community-Based Residential Rehabilitation Center Model.

Participant's Representative – a person authorized by the participant or by law to act on behalf of the participant.

Physical Therapist – a person who is registered as a physical therapist under the Illinois Physical Therapy Act.

Physician – a person licensed to practice medicine in all its branches under the Medical Practice Act of 1987.

Registered Nurse – a person who is licensed as a registered professional nurse under the Nurse Practice Act.

Rehabilitation Team – the primary decision-making body, including the participant and primary rehabilitation personnel, that designs and delivers the aspects of the rehabilitation plan.

Residence – the place where a participant lives that is owned or leased and operated by the Model.

Social Worker – a person who is a licensed social worker or a licensed clinical social worker under the Clinical Social Work and Social Work Practice Act.

Speech/Language Pathologist – a person who is licensed under the Illinois Speech-Language Pathology and Audiology Practice Act and is responsible for diagnosis and treatment of communication disorders, swallowing disorders, and cognitive difficulties.

State Fire Marshal – the Office of the State Fire Marshal, Division of Fire Prevention.

Substantial Compliance – meeting requirements except for variance from the strict and literal performance, which results in unimportant omissions or defects given the particular circumstances involved.

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER c: LONG-TERM CARE FACILITIES
PART 220 COMMUNITY-BASED RESIDENTIAL REHABILITATION CENTER DEMONSTRATION PROGRAM CODE
SECTION 220.1050 REFERENCED MATERIALS

Section 220.1050 Referenced Materials

The following materials are referenced in this Part:

a) State of Illinois Statutes:

1) Alternative Health Care Delivery Act [210 ILCS 3]

2) Criminal Code of 2012 [720 ILCS 5]

3) Dietetic and Nutrition Services Practice Act [225 ILCS 30]

4) Illinois Occupational Therapy Practice Act [225 ILCS 75]

5) Illinois Physical Therapy Act [225 ILCS 90]

6) Medical Practice Act of 1987 [225 ILCS 60]

7) Nurse Practice Act [225 ILCS 65]

8) Clinical Social Work and Social Work Practice Act [225 ILCS 20]

9) Clinical Psychologist Licensing Act [225 ILCS 15]

10) Illinois Speech-Language Pathology and Audiology Practice Act [225 ILCS 110]

11) Illinois Health Facilities Planning Act [20 ILCS 3960]

12) Nursing Home Care Act [210 ILCS 45]

13) Health Care Worker Background Check Act [225 ILCS 46]

b) Federal Statutes

Social Security Act (42 USC ch. 7)

c) State of Illinois Rules

1) Control of Communicable Diseases Code (77 Ill. Adm. Code 690)

2) Control of Tuberculosis Code (77 Ill. Adm. Code 696)

3) Food Service Sanitation Code (77 Ill. Adm. Code 750)

4) Drinking Water Systems Code (77 Ill. Adm. Code 900)

5) Public Area Sanitary Practice Code (77 Ill. Adm. Code 895)

6) Private Sewage Disposal Code (77 Ill. Adm. Code 905)

7) Illinois Accessibility Code (71 Ill. Adm. Code 400)

8) Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100)

9) Health Care Worker Background Check Code (77 Ill. Adm. Code 955)

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.1100 Demonstration Program Elements

a) There shall be an authorized Community-Based Residential Rehabilitation Center Alternative Health Care Model in the Demonstration Program. The Community-Based Residential Rehabilitation Center shall be located in the area of Illinois south of Interstate Highway 70. (Section 30(a-15) of the Act)

b) As an integral part of the services provided, individuals are housed in a supervised living setting while having immediate access to the community. The Residential Rehabilitation Center authorized by the Department may have more than one residence included under the license. A residence may be no larger than 12 beds and shall be located as an integral part of the community. (Section 35(4) of the Act)

c) The programs provided in this setting shall be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The Program shall have been accredited by CARF as a brain injury community-integrative program for at least 3 years prior to licensure under the Act and this Part. (Section 35(4) of the Act)

d) The average length of stay in a Community-Based Residential Rehabilitation Center shall not exceed four months calculated after June 1, 2000. (Section 35(4) of the Act)

e) The Community-Based Residential Rehabilitation Center Demonstration Program (Program) shall be reviewed annually by the Board to determine if it should continue operation for a period up to five years.

f) A Community-Based Residential Rehabilitation Center Model (Model) shall be licensed pursuant to this Part to be considered a participant in the Program.

g) At the midpoint and end of the Program, the Board shall evaluate and make recommendations to the Governor and the General Assembly, through the Department, regarding the Program, in accordance with Section 20(b) of the Act. (Section 20(b) of the Act)

h) The Department shall deposit all application fees, renewal fees and fines collected under the Act and this Part into the Regulatory Evaluation and Basic Enforcement Fund in the State Treasury. (Section 25(d) of the Act)

Section 220.1200 Application for and Issuance of a License to Operate a Community-Based Residential Rehabilitation Center Model

a) Applications for a license to operate a Community-Based Residential Rehabilitation Care Center Model shall be in writing on forms provided by the Department. The application shall be made under oath and shall contain the following:

1) Proof of a Certificate of Need to establish and operate a Community-Based Residential Rehabilitation Center Model issued by the Health Facilities Planning Board under the Illinois Health Facilities Planning Act;

2) The name of the proposed Model;

3) The address of the proposed Model;

4) A precise description of the site of the proposed Model;

5) The number of residences;

6) The number of beds per residence;

7) The number of non-resident participants;

8) The name and address of the registered agent or other individual authorized to receive Service of Process for the Model licensee;

9) The name, address and Illinois license numbers of the following persons:

A) Medical Director,

B) Supervisor of medical services, and

C) Program Coordinator/Director;

10) The Model's admission protocol and transfer criteria as required by Section 220.1700;

11) Information regarding any conviction of the owner or operator of the proposed Model of a felony or of any other crime under the laws of any state or of the United States arising out of or in connection with the operation of a health care facility; and

12) Information regarding any encumbrance on a health care license issued in Illinois or any other state to the owner or operator of the proposed Model.

b) An application for initial and renewal licensure shall be accompanied by an application fee of $500 plus $100 for each Community-Based Residential Rehabilitation Center Model bed.

c) Upon receipt and review of a complete application for licensure, the Department shall conduct an inspection to determine compliance with the Act and this Part.

d) If the proposed Model is found to be in substantial compliance with the Act and this Part, the Department shall issue a license for a period of one year. (Section 30 of the Act) The license shall not be transferable; it is issued to the licensee and for the specific location and number of beds identified in the application.

e) An application for license renewal shall be filed with the Department 90 to 120 days prior to the expiration of the license, on forms provided by the Department.

1) The renewal application shall comply with the requirements of subsections (a) and (b) of this Section; and

2) Upon receipt and review of a complete application for license renewal, the Department may conduct a survey. The Department shall renew the license in accordance with subsection (d) of this Section.

f) The Department may issue a provisional license to any Community-Based Residential Rehabilitation Center Model that does not substantially comply with the provisions of the Act and this Part:

1) A provisional license may be issued only if the Department finds that:

A) The Model has undertaken changes and corrections which upon completion will render the Model in substantial compliance with the Act and this Part; and

B) The health and safety of the participants in the Model will be protected during the period for which the provisional license is issued. (Section 30(c) of the Act)

2) The Department shall advise the applicant or licensee of the conditions under which the provisional license is issued, including:

A) The manner in which the Model fails to comply with the provisions of the Act and this Part;

B) The changes and corrections that shall be completed;

C) The time within which the necessary changes and corrections shall be completed (Section 30(c) of the Act); and

D) The interim actions that are necessary to protect the health and safety of the participants.

g) If, after obtaining its initial Certificate of Need, an Alternative Health Care Delivery Model that is a Community Based Residential Rehabilitation Center seeks to increase the bed capacity of that Center, it must obtain a Certificate of Need from the Health Facilities Planning Board before increasing the bed capacity. (Section 30(b) of the Act)

h) The Community-Based Residential Rehabilitation Center Model license or provisional license shall be prominently displayed in an area accessible to the public.

Section 220.1300 Obligations and Privileges of Community-Based Residential Rehabilitation Center Models

a) Community-Based Residential Rehabilitation Center Models shall, within 30 days after licensure, seek certification under Titles XVIII and XIX of the Federal Social Security Act. (Section 30(d) of the Act)

b) Community-Based Residential Rehabilitation Center Models shall provide charitable care consistent with that provided by comparable health care providers in the geographic area. (Section 30(d) of the Act)

c) A licensed Community-Based Residential Rehabilitation Center Model that continues to be in substantial compliance after the conclusion of the demonstration program shall be eligible for annual license renewals unless and until a different licensure program for that type of health care model is established by legislation. (Section 30(c) of the Act)

Section 220.1400 Inspections and Investigations

a) The Department shall perform licensure inspections of Community-Based Residential Rehabilitation Center Models, as deemed necessary, to ensure compliance with the Act and this Part. (Section 25(c) of the Act)

b) All Community-Based Residential Rehabilitation Center Models to which this Part applies shall be subject to and shall be deemed to have given consent to all inspections by properly identified personnel of the Department, or by other such properly identified persons as the Department might designate. In addition, representatives of the Department shall have access to and may reproduce or photocopy any books, records, and other documents maintained by the Model or the licensee to the extent necessary to carry out the Act and this Part.

c) The Department shall investigate an applicant or licensee whenever it receives a verified complaint in writing of any person setting forth facts which, if proven, would constitute grounds for the denial of an application for a license, refusal to renew a license, or suspension or revocation of a license. (Section 50 of the Act)

d) The Department may also investigate an applicant or licensee on its own motion or based upon complaints received by mail, telephone, or in person. (Section 50 of the Act)

Section 220.1500 Notice of Violation and Plan of Correction

a) Upon determination that the licensee or applicant is in violation of the Act or this Part, the Department shall issue a written Notice of Violation and request a plan of correction. The notice shall specify the violations, and shall instruct the licensee or applicant to submit a plan of correction to the Department within 10 days after receipt of the Notice.

b) Within the ten-day period, a licensee or applicant may request additional time for submission of the plan of correction. The Department may extend the period for submission of the plan of correction for an additional 30 days, when the Department finds that corrective action by the Model to abate or eliminate the violations will require substantial capital improvement. The Department will consider the extent and complexity of necessary physical plant repairs and improvements and any impact on the health, safety, or welfare of the patients of the Model in determining whether to grant a requested extension.

c) Each plan of correction shall be based on an assessment by the Model of the conditions or occurrences that are the basis of the violations and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences. Evidence of such assessment and evaluation shall be maintained by the Model. Each plan of correction shall include:

1) A description of the specific corrective action the Model is taking, or plans to take, to abate, eliminate, or correct the violations cited in the Notice;

2) A description of the steps that will be taken to avoid future occurrences of the same and similar violations; and

3) A specific date by which the corrective action will be completed.

d) Submission of a plan of correction shall not be considered an admission by the Model that the violation has occurred.

e) The applicant or licensee may submit additional information in response to the Notice of Violation that it believes will clarify the condition or alleged violations. The Department will consider the information in reviewing the applicant's or licensee's response and the plan of correction.

f) The Department shall review each plan of correction to ensure that it provides for the abatement, elimination, or correction of the violation. The Department shall reject a submitted plan only if it finds any of the following deficiencies:

1) The plan does not address the conditions or occurrences that are the basis of the violation and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences.

2) The plan is not specific enough to indicate the actual actions the Model will be taking to abate, eliminate, or correct the violation.

3) The plan does not provide for measures that will abate, eliminate, or correct the violation.

4) The plan does not provide steps that will avoid future occurrences of the same and similar violations.

5) The plan does not provide for timely completion of the corrective action, considering the seriousness of the violation, any possible harm to the participants, and the extent and complexity of the correction action.

g) The Department shall notify the licensee or applicant if the plan of correction is rejected, including specific reasons for the rejection of the plan. The Model shall submit a modified plan that addresses the requirements of subsection (c) of this Section within five days after receipt of notice of rejection.

h) If a licensee or applicant fails to make a timely submission of a modified plan of correction, or such modified plan is not acceptable to the Department, a plan of correction shall be specified and imposed by the Department.

i) The Department shall verify the completion of the corrective action required by the plan of correction within the specified time period during subsequent investigations, surveys, and evaluations of the Model.

Section 220.1600 Adverse Licensure Action

a) Before denying a license application, refusing to renew a license, suspending a license, revoking a license, or assessing an administrative fine, the Department shall notify the applicant or the licensee in writing. The notice shall specify the charges or reasons for the Department's contemplated action, and shall provide the applicant or licensee an opportunity to file a request for a hearing within 10 days after receiving the notice. (Section 50 of the Act)

1) A failure to request a hearing within 10 days shall constitute a waiver of the applicant's or licensee's right to a hearing. (Section 50 of the Act)

2) The hearing shall be conducted by the Director or an individual designated in writing by the Director as an Administrative Law Judge, and shall be conducted in conformance with the Department's Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100) and Section 65 of the Act. (Section 55 of the Act)

b) A license may be denied, suspended, or revoked, or the renewal of a license may be denied or administrative fine assessed, for any of the following reasons:

1) Violation of any provision of the Act or this Part.

2) Conviction of the owner or operator of the Community-Based Residential Rehabilitation Center Model of a felony or of any other crime under the laws of any state or of the United States arising out of or in connection with the operation of a health care facility. The record of conviction or a certified copy of it shall be conclusive evidence of conviction.

3) An encumbrance on a health care license issued in Illinois or any other state to the owner or operator of the Community-Based Residential Rehabilitation Center Model.

4) Revocation of any facility license issued by the Department during the previous five years or surrender or expiration of the license during the pendency of action by the Department to revoke or suspend the license during the previous five years, if the prior license was issued to the individual applicant or a controlling owner or controlling combination of owners of the applicant or any affiliate of the individual applicant or controlling owner of the applicant or affiliate of the applicant was a controlling owner of the prior license. (Section 45 of the Act)

c) An action to assess an administrative fine may be initiated in conjunction with or in lieu of other adverse licensure action.

d) The amount of an administrative fine shall be determined based on consideration of the following:

1) The nature and severity of the violations;

2) The Model's diligence in correcting the violations;

3) Whether the Model had been previously cited for similar violations;

4) The number of violations;

5) The duration of uncorrected violations; and

6) The impact or potential impact of the violations on patient health and safety.

e) The administrative fine shall be calculated in relation to the number of days the violation existed, or continues to exist if it has not been corrected. The total amount of the fine assessed shall fall within the following parameters:

1) For a violation that occurred as a single event or incident – between $100 and $5,000 per violation.

2) For a violation that was or is continuing beyond a single event or incident – between $100 and $500 per day per violation.

Section 220.1700 Policies and Procedures

a) The licensee shall have policies and procedures that implement and are consistent with the provisions of this Part.

b) The licensee shall have infection control policies and procedures, which shall include at least the following:

1) Compliance with the Department's Control of Communicable Diseases Code (77 Ill. Adm. Code 690);

2) The use of universal precautions and isolation techniques;

3) A continuing program of instruction for all personnel on the mode of spread of infections; and

4) Posted handwashing techniques.

c) The licensee shall provide for the registration and disposition of complaints without threat of discharge or other reprisal against any employee, volunteer, participant or participant's representative.

d) The licensee shall have policies covering disaster preparedness, including a written plan for staff and children to follow in case of fire, explosion, severe weather, earthquakes or other hazardous circumstance or emergency.

1) All personnel shall be trained in the proper use of a fire extinguisher.

2) All personnel shall be trained in the evacuation plan.

e) The licensee shall develop, with the approval of the medical director, policies and procedures to be followed during various medical emergencies. The types of medical emergencies addressed should be based on the needs of the participants being served and may include, but are not limited to, foreign body aspiration, poisoning, allergic reactions, asthma, convulsions, insulin shock, and acute respiratory distress.

f) The licensee shall develop policies and procedures concerning the transportation of non-resident participants.

g) The licensee shall develop policies and procedures concerning the handling of participants' funds. Such policies and procedures shall be at least as stringent as those set forth in Section 2-201 of the Nursing Home Care Act [210 ILCS 45/2-201].

h) The licensee shall develop policies and procedures concerning the role and level of supervision of students and interns in the operation of the Model and the care of participants.

Section 220.1800 Admission Practices

a) The licensee shall designate the individual or group that is responsible for making admission decisions.

b) The licensee shall establish written admission criteria that:

1) Identify individuals who can be served by the programs available through the Model;

2) Ensure nondiscrimination of participants based on disability, race, religion, sex, source of payment, and any other basis recognized by applicable State and federal laws;

3) Ensure that participants are medically stable and no longer require acute rehabilitative care or intense medical or nursing services. (Section 35(4) of the Act)

c) The licensee shall establish a preadmission screening process to ensure that the admission criteria are met and that outcome goals are addressed. The proposed plan of care shall serve as the rehabilitation plan until the comprehensive assessment is completed and a rehabilitation plan is developed for the individual.

d) Physician orders for medications (if necessary) and information concerning any other immediate medical care needs shall be submitted to the licensee at the time of the participant's admission.

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.1900 Participant Assessment

a) The licensee shall establish policies and procedures defining the assessment process.

b) Within two weeks after admission, each participant shall be assessed by a physician, a registered nurse, and a case manager. In addition, a speech/language pathologist, occupational therapist, or neuropsychologist shall complete an assessment of the participant's cognitive abilities. The physician, with input from the registered nurse, shall determine the participant's need for evaluation by a dietician or other specialized medical evaluations. Participants who were admitted prior to June 1, 2000, shall have an assessment completed within 60 days after June 1, 2000, unless an assessment has already been completed. An assessment, which meets the requirements of this Section, completed at a hospital may be accepted by the Model.

c) The assessment shall:

1) Identify pathological diagnoses or conditions requiring rehabilitation;

2) Identify the potential benefits related to rehabilitation intervention;

3) Include the desired outcomes and expectations of the participant;

4) Include the outcomes anticipated by the persons conducting the assessments;

5) Use assistive technology, as needed, in the assessment process;

6) Be used to direct the development of the participant's rehabilitation plan; and

7) Coordinate with the assessments completed prior to admission to the extent possible to avoid duplicative testing.

d) Assessment outcomes shall be reported to appropriate personnel and to the participant and/or participant's representative.

e) Further assessments shall be completed by appropriate staff members to develop a rehabilitation plan and refine the outcome goals specific to the individual.

Section 220.2000 Individual Rehabilitation Plan

a) Within 10 business days after completion of the assessment conducted pursuant to Section 220.1900, the results of the assessment (designed by the rehabilitation team) shall be used to revise the individualized rehabilitation plan to establish goals and objectives that incorporate the unique strengths, abilities, and preferences of the person served and relate to the services and environment to which the person will be discharged. The design of individualized program plans shall be consistent with the outcome goals that are established for each resident. (Section 35(4) of the Act)

b) The individual rehabilitation plan shall include, at a minimum:

1) The desired outcome goals for the program;

2) Identification of targeted objectives to achieve the outcome goals;

3) Services needed to support the targeted objectives;

4) Anticipated time frames for accomplishing the goals and objectives; and

5) Persons responsible for implementing the rehabilitation plan.

c) The licensee shall define the members of the rehabilitation team who will develop and review the rehabilitation plan. The members of the rehabilitation team shall include, at a minimum:

1) The participant;

2) Participant representative, if he or she chooses to participate, and any other persons chosen by the participant;

3) A person assigned to coordinate services for the person (case manager or designee);

4) A nurse; and

5) Persons providing services for the participant, based on the assessment.

d) The rehabilitation team shall meet at least every 30 days to implement and modify, as needed, the rehabilitation plan and discharge plan.

e) The case manager or case manager designee shall ensure that the rehabilitation plan is implemented and the appropriate services are coordinated to ensure the rehabilitation plan is followed.

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.2100 Participant Rights

a) The licensee shall establish a Participant's Bill of Rights, which shall include:

1) The right to information to facilitate decision making;

2) The right to be free of harm from physical abuse, mental abuse, sexual abuse, and physical punishment;

3) The right to access and/or referral to guardians, conservators, self-help groups, and/or advocacy groups, and legal assistance;

4) The protection of basic human rights, including rights to adequate food, shelter, education, dignity, and respect;

5) The right to request discharge from the facility;

6) The right to equal and effective treatment;

7) The right to confidentiality;

8) The right to refuse treatment;

9) The right to have input into the rehabilitation plan;

10) Freedom from discrimination on the basis of race, religious practice, color, national origin, sex, age, handicap, marital status, or source of payment;

11) The right to engage in unrestricted communication;

12) The right to privacy (but not necessarily a single bedroom);

13) The right to retain and use personal clothing and possessions;

14) Unless previously arranged, the right not to be transferred or discharged, except in an emergency situation. The individual, his or her guardian (if applicable), and other responsible persons shall be notified immediately;

15) The right to the services of a representative of the State agency or program charged with regulating, licensing, or monitoring the program;

16) The right to seek legal assistance;

17) The right to pursue productive and recreational choices;

18) The right to be paid for labor provided to the Model, other than labor that is an element of the rehabilitation program as outlined in the Individual Rehabilitation Plan;

19) The right to regularly review the rehabilitation plan;

20) The right to make recommendations for changes in Model policy that will have an impact on the participant or the participant's rehabilitation program;

21) The right to choose a personal physician;

22) The right to make contacts with the community and to achieve the highest level of independence, autonomy, and interaction with the community; and

23) The right to determine, within the bounds of good personal hygiene, his or her dress, hair style, or other personal choices according to individual preference.

b) The licensee shall establish a Participants' Bill of Rights policy, which includes:

1) A mechanism to communicate these policies to the persons served;

2) Grievance procedures; and

3) Procedures for documenting, investigating, and resolving allegations of infringements of rights, including reporting to the Department.

Section 220.2200 Participant Care and Treatment Services

a) The licensee shall provide access to appropriate emergency and specialty medical services.

b) A case manager shall be designated for each participant. A case manager may serve one or more participants. The provision of services for each participant shall be organized through the case manager or case manager designee who shall:

1) Assume responsibility for implementation of the rehabilitation plan;

2) Assist the participant in becoming oriented to his/her program;

3) Enable the program to proceed in an orderly, purposeful, and goal-oriented manner;

4) Promote the program's responsiveness to the needs and preferences of the participant;

5) Promote the participant's ongoing engagement in discussions of plans, goals and status;

6) Participate consistently in team conferences concerning the participant;

7) Maintain communication with family members, guardian (if designated), and funding source of the participant; and

8) Facilitate the discharge process and arrangements for the discharge plan.

c) Functional outcome goals shall be established for each individual. The licensee shall provide those services that are indicated by the rehabilitation plan and consistent with the outcome goals and the overall needs of the individual. Services shall include, but not be limited to:

1) Case management;

2) Training and assistance with activities of daily living;

3) Nursing consultation;

4) Traditional therapies (physical, occupational, speech);

5) Functional interventions in the residence and community (job placement, shopping, banking, recreation);

6) Counseling;

7) Self-management strategies;

8) Productive or vocational activities; and

9) Multiple opportunities for skill acquisition and practice throughout the day. (Section 35(4) of the Act)

d) The Program shall provide active and least restrictive treatment.

1) The Program shall provide active treatment through the delivery of services that are intended to promote the personal autonomy or independence of all persons served. This shall be reflected in program philosophies or missions, as well as trainings, materials, practices, and staff performance appraisal systems.

2) The Program shall deliver services in the least restrictive or intrusive manner possible and in a living situation that affords the greatest degree of autonomy possible for each person served.

A) With respect to interventions, programs shall adopt a model for determining procedural restrictiveness and shall demonstrate or justify in each situation that less restrictive procedures have been tried or considered prior to implementing any procedure that could impinge on an individual's rights.

B) Clinical documentation shall reflect that persons are treated in or are being prepared to reside in the least restrictive living arrangements possible, considering their existing strengths and needs.

e) Day treatment or individualized outpatient services shall be provided for persons who reside in their own home (Section 35(4) of the Act) at the request of a physician or funding agency and shall meet the following criteria:

1) Assessment need be completed only for the specific service, or services, to be provided by the Model.

2) The rehabilitation team for the participant receiving outpatient services shall include the participant, the participant's representative, if desired, and those therapists providing services.

3) Each service provided shall develop treatment goals for the participant.

Section 220.2300 Participant Record Requirements

The licensee shall maintain participant records that are accessible to the participant and to service providers. Confidentiality of participants' medical records shall be ensured. Records shall include, but are not limited to:

a) Medical records;

b) Preadmission screening results;

c) Participant initial and ongoing assessment results;

d) Records pertaining to participants' property; and

e) Individualized rehabilitation plan.

Section 220.2400 Residential Services

a) The licensee shall provide 24-hour supervision in each congregate living environment. At least one staff member shall be present in each residence at all times when participants are present.

b) The licensee shall provide an emergency response system.

c) The licensee shall provide 24-hour access to assistance in each apartment living setting.

d) The licensee shall have policies and procedures in place to guide decisions regarding the necessary level of supervision each participant requires in the residence and the community.

Section 220.2500 Medication Administration

a) Except for medications allowed in subsection (f), the only medications allowed in the residence are those for particular individual participants. The medication of each participant shall be kept and stored in the original container received from the pharmacy or as packaged by the nurse, when preparing unit dose packages from multi-dose containers.

1) Each multi-dose medication container shall indicate the participant's name, physician's name, prescription number, name, strength of dose, route of administration, frequency of dose and quantity of drug, date this container was last filled, the initials of the pharmacist filling the prescription, the identity of the pharmacy, the refill date and any necessary special instructions.

2) Each single unit or unit dose package shall contain the proprietary and nonproprietary name of the drug and the strength of the dose. The name of the participant and the physician do not have to be on the label of the package, but they must be identified with the package in a straightforward method to assure the drug is administered to the correct person.

3) When the unit dose system is used for packaging oral medication, house staff trained in administering medication may assist participants in the self-administration or in taking their medication by carrying the medication from the locked area where it is stored and handing it to the participant. If the participant is unable to receive or open the container, staff may open the container for the participant and assist him or her in consuming or applying the medication. If cognitive or behavioral limitations result in poor compliance, staff may open the container for the participant.

b) All oral medication packaged in multi-dose containers, prescribed medication given through a feeding tube, and all parenteral medication must be administered by a licensed nurse or physician, and all intravenous parenteral medication must be administered by a registered nurse or physician, unless the medication is self-administered by the participant.

c) All participants shall be evaluated by the rehabilitation team to determine their self-medication capability. Each participant determined to have the capability to learn to administer his or her own medications shall have written objectives developed by the team based on this evaluation and stated in specific behavioral terms that permit the progress of the resident to be assessed and recorded.

d) The licensee shall provide, either directly or through arrangements with a consultant nurse, training and supervision necessary for identified participants to gain independence in self-administering their own medications as approved in writing by the participant's physician, and documented in the participant's individual plan.

e) To be considered "capable of self-administering their own medications," participants must, at a minimum, be able to identify their medication by size, shape, or color and know when they should take it, and the amount to be taken each time.

f) A licensee may stock a small supply of medications regularly available without prescription at a commercial pharmacy, such as over-the-counter cough syrups, laxatives, and analgesics. These shall be given to a participant only upon the order of a physician.

g) The licensee shall have in each residence a first aid kit that contains items appropriate to treat minor cuts, burns, and abrasions.

h) All medications shall be properly stored in a secured location not accessible to unauthorized individuals.

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.2600 Discharge and Follow-up Practices

a) The licensee shall prepare written discharge plans prior to discharge of each participant.

b) The discharge plan shall include:

1) Participant's diagnosis of disability;

2) Outcome goals established for the rehabilitation plan;

3) Summary of the services provided;

4) Outcome goals achieved and not achieved;

5) Reason for discharge; and

6) Recommendations and referrals to assist the participant after discharge.

c) The licensee shall conduct appropriate follow-up on all persons served after discharge.

d) The follow-up activities shall be summarized in a report that directly relates the participant's current status to his/her status at discharge.

Section 220.2700 Personnel

a) The licensee shall provide adequate, properly trained and supervised staff to meet each participant's individual rehabilitation plan. Services shall be provided by a coordinated rehabilitation team.

b) The licensee shall define, through job descriptions, the minimum education and experience requirements for all staff, consultants, and contract staff providing services to the Community-Based Residential Rehabilitation Center Model.

c) The licensee shall provide an initial orientation and routine, pertinent training to all staff. This training may include demonstration, one-on-one training, small group exercises, or lectures. All training conducted shall be documented with:

1) Date;

2) Start and end time;

3) Instructors;

4) Course title and short description of content; and

5) Attendance records, including staff member's written signature.

d) The licensee shall develop and maintain written personnel policies, which are followed in the operation of the Model.

e) Each employee shall have an initial health evaluation, which shall be used to ensure that employees are not placed in positions that would pose undue risk of infection to themselves, other employees, participants or visitors. Individuals who were employed by the Model prior to June 1, 2000, shall have an initial health evaluation within six months after licensure of the Model.

1) The initial health evaluation shall be completed not more than 30 days prior to nor 30 days after the employee's first day of employment.

2) The initial health evaluation shall include a health inventory from the employee, including an evaluation of the employee's immunization status.

3) The initial health evaluation shall include tuberculin testing in accordance with the Department's Control of Tuberculosis Code (77 Ill. Adm. Code 696).

f) The licensee shall designate a program manager or director.

g) A registered nurse shall be responsible for managing the day-to-day health needs of every residential participant. Residential staff, as well as clinical team members, shall support health-related programs, as requested by the registered nurse under the direction of the treating physician.

h) The Model shall have a Supervisory Nurse, who shall be a registered nurse and who shall:

1) Promote the competency, numbers, and staff levels of nursing personnel appropriate to meet the rehabilitation and complex needs of the persons served;

2) Identify and implement a nursing program and structure to ensure that the persons served will receive coordinated services;

3) Provide ongoing monitoring of compliance with nursing standards in practice and documentation; and

4) Provide orientation and ongoing training in rehabilitation nursing skills.

i) The Model shall have a Medical Director or Medical Consultant who coordinates and advises personnel on medical matters. The Medical Director or Consultant shall:

1) Have training and experience in dealing with the needs of persons with acquired brain injuries;

2) Be participating in an active clinical practice; and

3) Provide direction and consultation on a regular basis as dictated by the needs of the persons served.

j) The Model shall employ case managers to organize the provision of services to participants. Minimum qualifications shall include:

1) A bachelor's degree in a social service field; and

2) Three years of direct service to persons with disabilities, in either a medical or rehabilitation setting.

k) The Model shall employ life skills trainers to provide training, assistance and supervision to participants in the areas of living skills, therapeutic recreation and other forms of assistance in both residential and community settings. Minimum qualifications shall include:

1) A high school diploma, general education development (GED) diploma or, in lieu of high school diploma or GED diploma, proof of active enrollment at a college or university;

2) A valid government issued identification;

3) Certification in cardiopulmonary resuscitation (CPR) and first aid;

4) Completion of Office of Safety and Health Administration (OSHA) training;

5) Completion of vital signs and physical transfer training;

6) Ability to manage physical transfers of adults and to lift 50 lbs. for short distances and 3 ft. high;

7) Good written and verbal communications skills;

8) Ability to work independently;

9) Passage of a background check and physical examination in accordance with requirements of the Department of Children and Family Services prior to working with adolescent program participants; and

10) For staff who will be transporting participants, the licensee shall ensure that all persons who transport participants on behalf of the licensee hold a valid driver's license and have an insurable driving record.

l) Prior to employing any individual in a position that requires a State license, the Model shall contact the Illinois Department of Financial and Professional Regulation to verify that the individual's license is active. A copy of the license shall be placed in the individual's personnel file.

m) The Model shall check the status of all applicants with the Health Care Worker Registry prior to hiring.

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.2800 Health Care Worker Background Check

A facility shall comply with the Health Care Worker Background Check Act [225 ILCS 46] and the Health Care Worker Background Check Code (77 Ill. Adm. Code 955).

(Source: Amended at 30 Ill. Reg. 850, effective January 9, 2006)

Section 220.2900 Food Service

a) At least three meals a day shall be provided and prepared by either residential staff or participants assisted by residential staff as needed.

b) Snacks shall be offered between meals and at bedtime.

c) Menus shall be developed according to the participants' preferences, ascertained through a group decision-making process, and shall be reviewed by a dietician.

d) Menus shall be planned at least one week in advance. All menus, as actually served, shall be kept on file for no fewer than 30 days.

e) If a participant's rehabilitation plan includes training in meal planning and preparation, this Part shall not preclude that participant from planning and preparing his or her own meals in the residence.

f) Supplies of staple foods adequate to prepare a minimum of three days meals and of perishable foods adequate to prepare a minimum of three days meals shall be maintained on the premises of each residence.

1) Primary food supply of staple and perishable foods is maintained at a licensee food distribution location.

2) Life skills trainers pick up food supplies in three- and four-day intervals.

3) Access to additional staple and perishable foods is available at the licensee food distribution location.

g) All food served shall be prepared in accordance with the Department's Food Service Sanitation Code (77 Ill. Adm. Code 750).

(Source: Amended at 42 Ill. Reg. 16740, effective August 30, 2018)

Section 220.3000 Physical Plant

a) The facility shall be kept in a clean, safe, and orderly condition and in good repair.

1) Electrical, mechanical, heating/air conditioning, fire protection and sewage disposal systems shall be maintained.

2) Furnishings and furniture shall be maintained in a clean, safe condition.

3) Attics, basements, stairways, and similar areas shall be kept free of accumulation of refuse, newspapers, boxes, and other items.

4) Bathtubs, shower stalls and lavatories shall not be used for janitorial, laundry or storage purposes.

5) All cleaning compounds, insecticides and other potentially hazardous compounds or agents shall be stored in locked cabinets or rooms.

b) The licensee shall have an effective means of supplying clean linen.

1) Clean linen shall be protected from contamination during handling, transport and storage.

2) Soiled linen shall be handled, transported and stored in a manner that protects individuals and the environment from contamination. Soiled diapers shall be placed in special diaper receptacles immediately after removal from the participant.

c) The water supply shall comply with all applicable State codes and local ordinances. Each facility shall be served by:

1) Water from a municipal water system; or

2) A water supply that complies with the Department's Drinking Water Systems Code (77 Ill. Adm. Code 900); or

3) A water supply that complies with the Department's Public Area Sanitary Practice Code (77 Ill. Adm. Code 895).

d) All sewage and liquid wastes shall be discharged into a public sewage disposal system or shall be collected, treated, and disposed of in a private sewage disposal system that is designed, constructed, maintained and operated in accordance with the Department's Private Sewage Disposal Code (77 Ill. Adm. Code 905).

e) Each residence shall meet the requirements of the Illinois Accessibility Code (71 Ill. Adm. Code 400).

f) Each residence shall meet the requirements of the local fire authority or the Illinois State Fire Marshal.

Section 220.3100 Quality Assessment and Improvement

a) The licensee shall develop and implement a quality assessment and improvement program designed to meet at least the following goals:

1) Ongoing monitoring and evaluation of the quality of services provided by the program, including but not limited to:

A) Accomplishment of outcome goals;

B) Accomplishment of program goals;

C) Participant satisfaction; and

D) Quality of life.

2) Routine review of quality indicators to ensure identification of problem areas.

3) Identification and implementation of corrective action to address problem areas.

b) The licensee shall have a written quality assessment plan, which shall include but is not limited to:

1) A statement of its mission and philosophy;

2) A statement of its goals;

3) Measurable objectives; and

4) Identification of the persons responsible for administering the program.

c) The Department and the Board shall have access to any materials or documents generated pursuant to the facility's quality assessment and improvement or that pertain to utilization and satisfaction, and financial viability of the facility. Such information shall be used by the Department and the Board to evaluate and assess the facility in relation to the requirements of the Act and shall be confidential.