Is the child to caregiver ratio for a foster by dbh92952

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									Texas Department of Family and Protective Services


              Current Issues in Residential Child Care Licensing
                                       as of July 2, 2007

Links to Subject Areas:
Child-to-Caregiver Ratios
Treatment Services
Foster Home Swimming Pools
Day-Care vs. Residential Standards
Youth For Tomorrow
Waivers and Variances
Fire Inspections
Random Sample Inspections of Foster Homes
Reports of Missing Children

The Child Care Licensing (CCL) program within the Texas Department of Family and
Protective Services (DFPS) has completed the first major overhaul of minimum
standards for residential child care in several years. This update of standards will
strengthen the level of protection for all children in out-of-home care while also
improving the performance of the Residential Child Care Licensing (RCCL) program.

The RCCL standards went into effect on January 1, 2007. Since then, RCCL staff have
been assigning preliminary weights to the new standards and providing technical
assistance during the enforcement of these standards. As of July 1, 2007, RCCL staff
will continue to provide technical assistance in enforcing the standards and will begin
issuing citations for violations.

This document addresses some of the high-profile changes in standards as well as
those standards that have been the source of much confusion. It also addresses other
recent “hot topics” in residential child care that are not related to the revised standards.
For more information on the revised standards, please see the FAQ designed for
providers at: http://www.dfps.state.tx.us/About/Renewal/CCL/faq.asp

Child-to-Caregiver Ratios

In the new minimum standards, the total number of children that can be cared for in a
foster family home or foster group home has not changed. However, to increase the
attention and supervision given to children in substitute care, the new standards do
require a slightly lower child-to-caregiver ratio in some circumstances. Below are
comparisons of the previous and current ratios.




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Texas Department of Family and Protective Services


Foster Family Home Ratios
A foster family home, whether with one caregiver or more, may care for up to six
children total (including biological and adopted children). However, depending on the
characteristics of the children, this number may decrease, if there is only one caregiver.

If the home cares for:                      Then the total number of children that can be cared
                                            for in the home is:
                                            Previous Standard      New Standard
                                            6                      6 (if more than one caregiver);
One or more children under age 5
                                                                   5 (if only one caregiver)
More than two children receiving            6                      6 (if more than one caregiver);
treatment services (except primary                                 4 (if only one caregiver)
medical needs as below)
                                            6                         6 (if more than one caregiver);
One child with primary medical needs
                                                                      4 (if only one caregiver)
                                            6                         6 (if more than one caregiver);
One infant (0-18 months)
                                                                      5 (if only one caregiver)
Two infants (0-18 months)*                  6 with no more than       6 (if more than one caregiver);
                                            two additional children   5 (if only one caregiver)
*Foster homes cannot have more than two     under six years old       with no more than two
infants unless an exception is made for a                             additional children under six
sibling group.                                                        years old
                                            6                         6 (regardless of number of
All other children
                                                                      caregivers)

•   "Treatment services” include specialized services for emotional disorders, mental
    retardation, primary medical needs, and pervasive developmental disorders.
•   “Primary medical needs” are the needs of children who require the use of sterile
    techniques or specialized procedures to promote healing, prevent infection, prevent
    cross-infection or contamination, or prevent tissue breakdown.

Foster Group Home Ratios
A foster group home is a foster family home that cares for seven or more children, and,
as a result, has some additional licensing standards to address the needs of a larger
group. As in the previous standards, a single caregiver in a foster group home may
care for up to eight children total (including biological and adopted children), and a
foster group home with more than one caregiver can care for up to 12 children total.
However, depending on the characteristics of the children, this number may decrease, if
there is only one caregiver.

If the home cares for:           Then the total number of children that can be cared for in the
                                 home is:
                                 Previous Standard                New Standard
                                 12 (if more than one caregiver); 12 (if more than one caregiver);
One or more children
                                 4 (if only one caregiver)        5 (if only one caregiver)
under age 5




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If the home cares for:                Then the total number of children that can be cared for in the
                                      home is:
                                      Previous Standard                New Standard
More than two children                12 (if more than one caregiver); 12 (if more than one caregiver);
receiving treatment                   8 (if only one caregiver)        4 (if only one caregiver)
services (except primary
medical needs as below)
One child with primary                12 (if more than one caregiver);           12 (if more than one caregiver);
medical needs                         8 (if only one caregiver)                  4 (if only one caregiver)
                                      12 (if more than one caregiver);           12 (if more than one caregiver);
All other children
                                      8 (if only one caregiver)                  8 (if only one caregiver)

In most cases, the new caregiver ratios restrict the capacity of foster homes if there is
only one caregiver. When there is more than one caregiver, all caregivers are counted
in the child-to-caregiver ratio unless the additional foster parent/caregiver is routinely
absent for extended periods of time (e.g., traveling for weeks at a time). See Rule
§749.2567 below:

RULE §749.2567 Must a home maintain the child/caregiver ratio at all times?

No. However, even during a time that all children in care are away from the home, at
least one caregiver must be available by phone to:

(1) Respond to emergencies, changes in schedules, or unplanned events; and

(2) Provide care and supervision whenever a child needs the attention of a caregiver,
including when the child returns to the home.

Facility Ratios
In facilities, child-to-caregiver ratios in licensing standards do not set limits for how
many children can be cared for in a facility. Instead, the ratios focus on how many
staff/caregivers should be present per child during waking hours and sleeping hours.
The new standards increase the number of staff in facilities where children are under 5,
where caregivers sleep during sleeping hours, and where at least 30% of the children
receive treatment services.

                                 Number of Children Under                       Number of Children Over Age
                                 Age 5 per Caregiver                            5 per Caregiver
                                 Previous    New Standard                       Previous        New Standard
                                 Standard                                       Standard
WAKING HOURS
Under treatment                  4                4                             8                8
services threshold 1
Over treatment services          4                4                             8                5
threshold

1
    25 children, or 30% of the children in care, receiving treatment services


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                            Number of Children Under                    Number of Children Over Age
                            Age 5 per Caregiver                         5 per Caregiver
                            Previous    New Standard                    Previous        New Standard
                            Standard                                    Standard
SLEEPING HOURS
• If caregiver is asleep    16              4                           16                  16
• If facility is under
   treatment services
   threshold
• If caregiver is awake     24              8                           24                  24
• If facility is under
   treatment services
   threshold
• If caregiver is asleep    16              4                           16                  10
• If facility is over
   treatment services
   threshold
• If caregiver is awake     24              6                           24                  15
• If facility is over
   treatment services
   threshold

For those facilities contracting with Child Protective Services, the ratio must be one
caregiver per five children during awake hours for children with an Intense service level.

Treatment Services

Previously, facilities were licensed for one specific type of care. This often served as a
barrier to offering more permanency to children as their needs change and to offering
suitable placements for sibling groups. The new facility type of “general residential
operation” and the new treatment service and program service categories allow a facility
to offer a wide range of services under one license. This creates both the opportunity
for a facility to offer a broad continuum of care not previously permitted by service-
specific license types and to keep sibling groups together in one placement, despite the
varying special needs of the siblings.

Here are the definitions for treatment services:
(A) Emotional Disorders, such as mood disorders, psychotic disorders, or dissociative disorders, and
    children who demonstrate three or more of the following:
    (i) A Global Assessment Functioning of 50 or below;
    (ii) A current DSM diagnosis;
    (iii) Major self-injurious actions, including recent suicide attempts;
    (iv) Difficulties that present a significant risk of harm to others, including frequent or unpredictable
           physical aggression; or
    (v) A primary diagnosis of substance abuse or dependency and severe impairment because of the
           substance abuse;
(B) Mental Retardation, children who have an intellectual functioning of 70 or below and are
    characterized by prominent, significant deficits and pervasive impairment in one or more of the
    following areas:
    (i) Conceptual, social, and practical adaptive skills to include daily living and self care;
    (ii) Communication, cognition, or expressions of affect;



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    (iii) Self-care activities or participation in social activities;
    (iv) Responding appropriately to an emergency; or
    (v) Multiple physical disabilities, including sensory impairments;
(C) Pervasive Developmental Disorder, which is a category of disorders (e.g. Autistic Disorder or Rett’s
    Disorder) characterized by prominent, severe deficits and pervasive impairment in one or more of the
    following areas of development:
    (i) Conceptual, social, and practical adaptive skills to include daily living and self care;
    (ii) Communication, cognition, or expressions of affect;
    (iii) Self-care activities or participation in social activities;
    (iv) Responding appropriately to an emergency; and
    (v) Multiple physical disabilities including sensory impairments; or
(D) Primary Medical Needs, children who cannot live without mechanical supports or the services of
    others because of non-temporary, life-threatening conditions, including the:
    (i) Inability to maintain an open airway without assistance. This does not include the use of inhalers
           for asthma;
    (ii) Inability to be fed except through a feeding tube, gastric tube, or a parenteral route;
    (iii) Use of sterile techniques or specialized procedures to promote healing, prevent infection, prevent
           cross-infection or contamination, or prevent tissue breakdown; or
    (iv) Multiple physical disabilities including sensory impairments.

Some of the new minimum standard rules require additional services for a specific child
who needs treatment services, while other rules add requirements for the operation
based on how many children need treatment services.

For child-placing agencies, the agency must have a full-time treatment director if the
agency is providing treatment services to 30 or more children at any time, or to more
than 50% of the children in the agency’s care.

For facilities, the following is required if the facility is providing treatment services to 25
or more children at any time, or to more than 30% of the children in the facility’s care:

Rule Number      Subject Matter                       Description
748.563          Professional level service           Minimum qualifications are higher for this position.
                 provider
                 (only for children receiving
                 treatment services for emotional
                 disorders)
748.569          Nursing services                     Registered Nurse required.
                 (only for children receiving
                 treatment services for primary
                 medical needs)
748.573          Nursing services                     Nursing personnel must be awake and available at
                 (only for children receiving         the facility on a 24-hour basis.
                 treatment services for primary
                 medical needs)
748.601          Treatment director                   This person must be a full-time employee.
748.861          Pre-service experience for           A caregiver must have 40 hours of supervised child-
                 caregivers                           care experience in an operation that provides the
                                                      same treatment services, or must complete this
                                                      experience at the facility with supervision from an
                                                      experienced caregiver.
748.931          Annual training                      50 hours are required for each caregiver instead of
                                                      20 hours.



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Texas Department of Family and Protective Services


748.1003       Caregiver/child ratio, waking         1:5 required instead of 1:8 for children 5 years old or
               hours                                 older.
748.1007       Caregiver/child ratio, sleeping       If the caregiver is awake, ratios decrease from 1:8 to
               hours                                 1:6 for children under 5 years old and from 1:24 to
                                                     1:15 for children 5 years old or older. If the
                                                     caregiver is asleep, ratio decreases from 1:16 to
                                                     1:10 for children 5 years old or older.
748.2451       Use of seclusion (an emergency        Use of seclusion allowed only for facilities that
               behavior intervention)                provide treatment services to 25 or more children
                                                     with emotional disorders or pervasive developmental
                                                     disorders, or if more than 30% of the children in care
                                                     receive treatment services for emotional disorders or
                                                     pervasive development disorders (also allowed for
                                                     emergency care services).

Foster Home Swimming Pools

The previous minimum standards included no swimming pool requirements for foster
family homes. For foster group homes, the previous minimum standards required a
fence, locked entrance/exit, locked machinery room, and a certified lifeguard on duty
when the pool was in use. Since swimming is such a high-risk activity, the new
minimum standards related to swimming and swimming pools apply to all foster homes,
not just foster group homes. They do NOT require a certified lifeguard when a
swimming pool is in use, although at least one adult providing supervision for the
swimming activity must be able to swim and perform a water rescue, if necessary. The
new minimum standards also require the following:
   • Informing children of the swimming rules and appropriate safety precautions
   • Ensuring children do not have unsupervised access to a pool or other body of
       water
   • Specific height requirement (four feet) for the fence/wall around a home pool
   • Specific requirements for the entrances to the home pool area, such as locks
   • Required life-saving devices
   • Required life jackets for children based on the activity and/or the child’s needs
   • Visibility and supervision requirements, including a specific adult/child ratio for
       swimming
   • Specific rules for wading pools and hot tubs

Here are the FAQs currently on the DFPS website related to foster home swimming
pools:

Does the fence/wall have to be around the pool itself, or can a backyard fence also
serve as the pool fence/wall?
A backyard fence may serve as the pool fence/wall if it meets all fence/wall and gate
criteria in 749.3133. The foster home must be willing to consider the entire backyard as
the pool area, and treat it as such. This means that children may not have
unsupervised access to the backyard and that doors leading to the backyard must
comply with 749.3133(e).



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Texas Department of Family and Protective Services


If the backyard fence also serves as the pool fence/wall, can the children still play in the
backyard?
749.3133(a) requires that children may not have unsupervised access to the pool area.
If the entire backyard is serving as the pool area, children may not play in the backyard
without direct caregiver supervision.

Can a pool cover substitute for the required fence/wall?
No, a pool cover does not substitute for any required pool safety mechanisms, including
the required fence/wall and locked gate.

Do the swimming pool requirements apply to adoptive homes?
749.3131 states that the rules in Division 7 of Subchapter O related to swimming pools
apply only to foster homes or foster/adopt homes, not to homes that are only approved
for adoption. 749.3663(c) requires that the child-placing agency discuss safety issues
and plans to ensure the child’s safety with adoptive applicants who have a swimming
pool, wading pool, hot tub, or other body of water on the premises of their home.

Day-Care vs. Residential Standards

Child Care Licensing (CCL) is sensitive to the many differences in the purpose,
structure, and environment of the various types of child-care settings. However, there
may be some similarities between the day-care and residential standards because of
CCL’s perspective as the regulating body of both day-care and 24-hour care settings. In
those few areas that are common in any group setting for children, such as safety and
sanitation, CCL used this internal expertise in drafting the initial minimum standard
proposals for residential child care settings. Throughout the long development process,
these draft rules were modified greatly for residential settings, and are generally more
limited in scope than those enforced for child day-care operations in Texas.

Youth For Tomorrow

Youth for Tomorrow (YFT) annually reviews a child-placing agency or facility as a whole
to assess what levels of care the facility or agency is able to serve. In addition to
reviewing individual children’s records periodically to determine the appropriate service
level for that child, YFT also reviews facilities and child-placing agencies that contract
with Child Protective Services (CPS) for compliance with a portion of the CPS contract.
Since the new minimum standards strengthen the level of protection for children in
many areas, Licensing minimum standards now overlap with YFT review indicators. For
that reason, YFT’s annual reviews of facilities and child-placing agencies will be
changing to reduce duplication with Licensing standards and instead emphasize those
portions of the CPS residential contract that exceed or differ from minimum standards.

Waivers and Variances

Child Care Licensing (CCL) is open to considering any request for a waiver or variance
of a standard needed for an operation to care for a child, particularly when the situation


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Texas Department of Family and Protective Services


involves a placement emergency. CCL considers waivers or variances based on
specific requests submitted to CCL from individual operations. Each request is carefully
assessed, with CCL attempting to offer flexible and reasonable regulation while also
ensuring the safety, health, and well-being of children in care.

CCL cannot grant a waiver or variance for any requirement in statute. For example,
CCL could not grant a variance for a foster family home to care for seven children, since
the law limits foster family homes to six children.

Excerpts from the Human Resources Code, Chapter 42:
§ 42.042(j) The department may waive compliance with a minimum standard in a
specific instance if it determines that the economic impact of compliance is sufficiently
great to make compliance impractical.
§ 42.048(c) The department may grant a variance of an individual standard set forth in
the applicable standards for good and just cause.

Fire Inspections

CCL requires foster homes to comply with all applicable fire, health, and safety laws,
ordinances, and regulations. CCL requires fire inspections to be conducted by a
government authority or local fire official, since these persons have the expertise to
conduct the best assessment of a home’s fire safety. However, if no government
authority or local fire official is available to conduct an inspection, foster homes can use
the DFPS Fire Prevention Checklist. CCL also requires foster homes to have smoke
detectors and fire extinguishers.

Local fire officials must enforce the fire code adopted by the State Fire Marshal’s office,
but may choose to adopt a code that requires even higher standards of safety.
Recently, the State Fire Marshal’s office adopted the National Fire Protection
Association’s (NFPA) Life Safety Code. This code categorizes certain foster homes as
“residential board and care facilities” and may require of them additional fire safety
measures such as integrated fire alarms and sprinkler systems. These foster homes
include all foster group homes and any foster family home with four or more children
who would not be able to evacuate on their own in case of a fire (for example, children
with primary medical needs).

DFPS is working with the State Fire Marshal’s office to address this at the state level as
well as with county fire authorities on individual cases. Child-placing agencies are
encouraged to share fire inspection issues with CCL staff so that we can continue to
problem-solve each individual case with the proper authorities.

Random Sample Inspections of Foster Homes

The 79th Texas Legislature in 2005 added the following to Chapter 42 of the Human
Resources Code:
      42.044(e) “The department shall periodically conduct inspections of a


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        random sample of agency foster homes and agency foster group homes.
        The department shall use the inspections to monitor and enforce compliance
        by a child-placing agency with rules and standards established under Section
        42.042.”
Prior to this legislation taking effect, Child Care Licensing (CCL) staff were only present
in foster homes to conduct abuse/neglect investigations. The new random sample
inspections give CCL staff a greater opportunity to assess how agency foster homes are
complying with minimum standards, and how child-placing agencies are ensuring this
compliance. Foster homes are not cited as a result of these inspections, but the child-
placing agency may be cited for any deficiencies noted during the inspections.

CCL staff understand how disruptive a licensing inspection can be for a foster home’s
routine. CCL staff typically schedule the inspection in advance and attempt to conduct
the inspection as efficiently as possible so that the foster family can get back to their
usual activities. Each foster home is given a feedback card, so that they can contact
CCL with any compliments or concerns regarding the inspection of their home. To date,
CCL has conducted over 2,000 agency home inspections and has received
approximately 1,000 feedback cards in response to those inspections. Of the feedback
cards received thus far, over 95% have indicated a positive experience.

Reports of Missing Children

Related Law and Rule
HRC, 43.063(a)(1), added to the law during the 79th Legislative Session, mandates that
a missing child be considered a reportable serious incident for residential child-care
operations.

Rules 748.303(a)(7) to (9) and 749.503(a)(7) to (9) require the following reporting of
runaways or missing children:

                          Notification to Law    Notification to Child     Notification to
Age Range                 Enforcement            Care Licensing            Parents
(7) A child               Immediately upon       Within 2 hours of         Within 2 hours of
    developmentally or    determining the        notifying law             notifying law
    chronologically       child is missing.      enforcement.              enforcement.
    under 6 years old
(8) A child               Within 2 hours of      Within 2 hours of         Within 2 hours of
    developmentally or    determining the        notifying law             determining the
    chronologically 6     child is missing, if   enforcement, if the       child is missing, if
    to 12 years old       the child is still     child is still missing.   the child is still
                          missing.                                         missing.
(9) A child 13 years      No later than 24       No later than 24          No later than 24
    old or older          hours from when        hours from when           hours from when
                          the child’s absence    the child’s absence       the child’s absence
                          is discovered and      is discovered and         is discovered and
                          the child is still     the child is still        the child is still
                          missing.               missing.                  missing.


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Texas Department of Family and Protective Services




What the Operation Should Do
  1. Report information about the missing child to Child Care Licensing (CCL), law
      enforcement, and the child’s parents as required by minimum standards.
  2. Document the serious incident as required by minimum standards.
  3. Be prepared for a possible investigation into the circumstances surrounding the
      incident.

What CCL Will Do
CCL will make a reasonable determination about the risks involved to the child. The
following are examples of criteria used in determining what type of investigation is
warranted:
• A report of a missing child under six years old will almost always be investigated by
    an abuse/neglect investigator for neglectful supervision.
• For a child six to 12 years old, the circumstances surrounding the incident will
    determine whether the investigation is conducted by an abuse/neglect investigator or
    by the assigned licensing representative for minimum standards compliance.
• For a child 13 years old or older, investigation will depend on the circumstances
    surrounding the incident. For example, if a 17-year-old child with no special needs
    runs away unexpectedly, the report of this runaway may be closed without any
    investigation after contacting the operation. However, if, for example, the 17-year-
    old is diagnosed with mental retardation, has a developmental age of 5 years old,
    and ran away from a locked setting, this would likely warrant an abuse/neglect
    investigation.




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