Dda Group Home Policies Procedures And Operations

Dda group home policies procedures and operations

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Persons with intellectual and developmental disabilities have the inherent right to fulfill their potential as
human beings and can be helped to lead dignified lives regardless of their level of functioning. The
group home was created to assist eligible persons to realize that potential, to provide an alternative to
institutionalization, and to provide the necessary level of care and services for eligible individuals to live
in and/or near their home communities

1. Both Harrison Avenue Group Home and the Yonce House are operated by Macon Citizens
Habilities, Inc., and each is referred to herein as the group home

2. This group home provides adults with intellectual and developmental disabilities who are eligible for
DDA level of care and are suitable for small-group living in a community setting with residential

3. The group home is licensed under NC General Statute 122 (c) to serve 6 clients at Harrison Avenue
and 3 clients at Yonce House. Both homes are located on Harrison Avenue in Franklin, NC

4. First priority is given to citizens of Macon, Jackson, Swain, Clay, Cherokee, Graham, and Haywood
Counties; however, MCH will take referrals from other counties as well

5. Clients of the DDA group home are restricted to 45 nights out of the group home annually and 15
nights per quarter not to exceed 45 in a year. Longer absences may jeopardize placement

6. Clients and families are made aware of provider choice at least annually

7. Each home serves clients who are eligible for NC Innovations funding or Group Home Moderate
funding, if available

8. NC Innovations addresses the needs of individuals in their community, insures person-centered
planning for each individual, provides for simplicity and ease of service delivery, promotes
movement of individuals to the community from intermediate care facility for persons with
intellectual and developmental disabilities (ICF-IID) group homes and state developmental centers,
and is a Medicaid community care funding source for persons with intellectual and developmental
disabilities. It offers specific services in the community for individuals of all ages who require an ICF-
IID level of care and gives a cost-effective alternative to care in an ICF-IID

9. MCH is responsible for maintaining a current license to operate, internal quality improvement plans,
and maintaining a client’s rights committee

1. The group home provides services according to the principles of normalization and person-centered
planning with a positive, person-centered approach to habilitation

2. Persons with intellectual and developmental disabilities may be considered for NC Innovations
funding and placement in the group home if all of the following criteria are met:
(a) The individual meets the requirements for ICF-IID level of care

(b) The individual is eligible for Medicaid or will be eligible for Medicaid under the NC Innovations
eligibility criteria

(c) The individual resides in an ICF-IID facility or is at high risk of being placed in an ICF-IID facility

(d) The individual’s health, safety and well-being can be maintained in the community under the

(e) The individual requires NC Innovations services, based on medical necessity criteria, as identified
through a family or person-centered planning process. An individual must require at least 1
waiver service as identified in the person-centered planning process and indicated in the Plan of
Care and Cost Summary

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(f) The person-centered planning process assists the individual with their family or guardian in
identifying and accessing a personalized mix of paid and non-paid services that will assist him/her
to achieve personally defined outcomes in the most inclusive community setting

(g) The individual, his/her family, and/or guardian desire NC Innovations participation rather than
institutional services

3. Persons may also be considered for placement if group home moderate state funds are available

4. Each state funded individual will have a PCP which includes a crisis plan. The plan is written and
monitored by the QP

5. The group home promotes a family-like atmosphere and provides the training necessary to help
each client become as independent as possible. Each client is assisted to develop skills which
allow for self-sufficiency, independence, and social acceptance in the community

6. Each client who lives in the group home and/or the representative/legal guardian must enter into an
agreement or contract for services with MCH

7. At least annually provider choice will be reviewed with clients and guardians. If a change is desired,
assistance will be offered to find a more suitable provider

8. At least annually and any time there are updates, each DDA client receives an updated Client
Handbook which describes the services, policies and procedures of the home as well as several
consents for services

See DDA Attachment 1 – DDA Client Handbook
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1. Respect the rights of your housemates

2. Participate in activities and training unless I am ill or have a very good reason

3. Help take care of my home and keep it neat and clean

4. Do not smoke or use other tobacco products in the group home

5. Get ready for bed at a reasonable hour so I do not disturb others

6. Be considerate of others at night if I stay up late

7. Respect the property of my housemates. Do not take nor destroy their things

8. Do not go into the rooms of my housemates unless they invite me in

9. Do not go into the administrative area unless the manager invites me in

10. Do not go outside the group home after dark unless I ask for permission first

11. Do not drink alcoholic beverages in the group home

*Violation of any of these rules may result in the loss of group home privileges such as outings,
participation in special events, shopping, eating out, etc. Continued violation could result in loss of

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1. All applicants must:
(a) Submit a complete application including required attachments

(b) Be approved by the MCH Admissions Committee prior to admission and authorized by the

(c) Have a funding source or be eligible for a funding source

See DDA Attachment 2 -- Application for Admission to DDA Group Home
2. The group home serves individuals who meet the following criteria:
(a) intellectual and developmental disabilities
(b) eligible for ICF-IID level of care as documented on an MR 2 approved by a physician or clinical
(c) resident of the state of NC
(d) at least 21 years of age or older (Harrison Avenue) or 18 years of age or older (Yonce House)
(e) ambulatory if applying to Harrison Avenue
(f) ambulatory or transfer skills if applying to Yonce House
(g) basic toileting and self-feeding skills
3. Applicants are screened based on at least 3 deficits in level of care or the NC SNAP and ICF-IID
level of care. The level of care should include an IDD diagnosis. Other evaluations such as
psychological and intelligence tests may also be used in screening

4. In order to be meet LOC, the applicant is screened to determine if he/she meets the following
(a) have a diagnosis of intellectual and developmental disabilities (per the Diagnostic and Statistical
Manual on Mental Disorders, fourth edition, text revision (DSM-V-TR), Intelligence Quotient (IQ)
test results indicating intellectual and developmental disabilities, or
(b) (b) a condition that is closely related to intellectual and developmental disabilities. Intellectual
and developmental disabilities is a disability characterized by significant limitations both in
general intellectual function resulting in, or associated with, deficits or impairments in adaptive
behavior. The disability must manifest before age 18. Persons with closely related conditions
refers to individuals who have a severe, chronic disability that meets ALL of the following
conditions: a. is attributable to cerebral palsy, epilepsy; or any other condition, other than
mental illness, found to be closely related to intellectual and developmental disabilities because
this condition results in impairment of general intellectual functioning or adaptive behavior
similar to that of mentally retarded persons, and requires treatment or services similar to those
required for these persons. The related condition manifested before age 22 and is likely to
continue indefinitely and have intellectual and developmental disabilities or a related condition
resulting in substantial functional limitations in three or more of the following major life activity
areas (1) self-care (ability to take care of basic life needs for food, hygiene, and appearance),
(2) understanding and use of language (ability to both understand others and to express ideas
or information to others either verbally or non-verbally), (3) learning (ability to acquire new
behaviors, perceptions and information, and to apply experiences to new situations). (4) mobility
(ambulatory, semi-ambulatory, non-ambulatory), (5) self-direction (managing one’s social and
personal life and ability to make decisions necessary to protect one’s life), (6) capacity for
independent living (age-appropriate ability to live without extraordinary assistance). Reports by
physicians, psychologists, and other appropriate disciplines are evaluated to determine whether
an individual has a substantial functional limitation in a major life activity

5. There shall be no discrimination with regard to race, color, sex, religion, national origin, or political
affiliation in considering placement. MCH complies with the Title VI (Civil Rights,
1964), Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act.)
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6. The applicant must be able to have needs met by the group home and must be able to participate in
group home activities without limiting the delivery of services to other clients. The client must agree
to abide by the rules and regulations of the facility

7. The Admissions Committee shall consist of the following members:
(a) Executive director
(b) Program director
(c) QP
(d) RN
(e) MCE Manager
(f) Group home manager
(g) Care Coordinator
8. The Admissions Committee shall review all applications which fulfill the conditions for admission

1. The executive director and/or program director shall be responsible for receiving applications and
will gather information and schedule admissions meetings as needed

2. An application must be completed and returned to MCH with a current psychological evaluation and
social history. An application will be considered incomplete without psychological and social

3. Any evaluations, staffings, goal plans, or special reports from the current day program or institution
must be submitted

4. The applicant must meet financial guidelines to qualify for a HUD home if applying to Harrison
Avenue Group Home

5. MCH staff will meet and interview prospective clients and/or legal guardians, case managers, and
staff or personnel who have worked with the prospective client in the past to determine
appropriateness for placement and ability to fit in with other clients in the facility

6. The applicant must have a legal guardian if recommended by MCH staff, psychological, and/or
medical evaluations. If the applicant does not have a legal guardian, one must be appointed within
90 days of admission if recommended

7. All applications are reviewed by the executive director. All applicants that meet requirements for
admission are presented to the Admissions Committee for consideration

8. The executive director or program manager shall be responsible for informing the applicant and the
legal guardian in writing of the decision of the Admissions Committee

9. Ineligible applicants are notified in writing by the executive director or program director with stated
reasons for ineligibility. The Admissions Committee is also apprised of reasons of ineligibility. All
applicants who are not selected for admission will also be notified in writing

10. Any applicant and the family and/or guardian who is denied admission to the group home has the
right to appeal the decision of the Admissions Committee by notifying the executive director in
writing within 15 working days of the date of notice of rejection. The Admissions Committee will
meet within 15 working days of receipt of notice of the appeal. The applicant may bring to the
Admissions Committee a representative of his/her choice to present an appeal

11. The Admissions Committee makes the final decision regarding acceptance for admission to the
group home

12. If a vacancy occurs at the group home, the executive director or program director contact
appropriate persons to find those in need of services. In addition, MCH maintains a waiting list

13. Applicants who have been determined ineligible may reapply at any time and receive consideration
equal to all other applicants

14. If a vacancy occurs, all eligible applicants are given equal consideration

15. Upon acceptance to the group home, a current medical and social evaluation dated within 30 days
of admission to the group home will be required. A current psychological may be required

16. An agreement in writing will be entered into between the client, legal guardian and the group home
which delineates the responsibilities of the group home as well as the responsibilities of the
client/legal guardian

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17. The applicant and/or guardian are advised of the clients' rights policy. They must give informed
consent to obtain and release information on or before the date of actual admission

1. The discharge committee is made up of the same representatives as the admissions committee and
shall have final determination when a client is discharged from the group home. Other consultants
such as the psychologist, physical therapist, etc. may be included in the decision

2. No client shall be discharged without a recommendation from the executive director, program
manager, and admissions/discharge committee

3. The must be a written discharge plan which provides for continuity of care and recommendations for
continued care for the client to live as normally as possible. Informed consent from the client or
legally responsible person and their involvement is to be part of the discharge plan in order to
provide continuity of care

4. In addition, MCH is responsible for letting the MCO know of an impending discharge and reasons
for discharge

5. The client or legally responsible person shall receive a copy of the discharge plan

6. A client may be discharged if the client and/or family make a request for discharge

7. A client may be discharged if the group home can no longer meet the medical needs

8. A client may be discharged if after a 90-day probationary period if the client's adjustment to the
group home is unsuccessful

9. A client may be discharged if his/her behavior endangers himself and/or others

10. A client may be discharged for non-payment of fees

11. A client may be discharged if the group home is no longer the most appropriate environment for
meeting the client’s needs

See DDA Attachment 3 – MCH Discharge Summary
Services identified in the person-centered plan must be made available to clients of the DDA group
home. Need shall be determined by client’s right to services, habilitation team, and the person-centered
plan of care process

1. Medical services:
(a) Prompt and effective medical treatment is provided as needed

(b) Medical services are arranged as appropriate with informed consent for treatment

(c) If the primary physician is unavailable, Angel Medical Center Emergency Room or AMC Urgent
Care may be contacted

(d) A physician performs admission examinations, annual physical examinations, order routine
laboratory work, X-rays, etc

(e) The diagnosing and treatment of an illness shall be according to written orders which have been
prescribed and authenticated by a physician's signature. If the physician uses a stamp, a copy
of the original signature and the physician's stamp must be on file in the MCH facility

(f) MCH shall use an approved medical facility for emergency, inpatient, laboratory, x-ray, and
special studies, etc. or another approved facility if ordered by the physician and with appropriate

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(g) Emergency medical care is available through Angel Medical Center or Angel Urgent Care. If
admission is necessary, the client is admitted under the care of the primary physician or his

(h) Macon County Emergency Medical Service may be utilized if emergency transportation is

(i) MCH is responsible for providing transportation for all clients to meet scheduled medical

(j) Appropriate documentation of all medical services rendered are entered into the client’s medical

(k) The physician should provide notes or dictation of each visit

See DDA Attachment 4 -- Physician's Progress Note
See DDA Attachment 5 -- Physician's Orders
(l) All laboratory/X-ray reports, consultation, etc., are kept in the client's medical record

(m) Medical summaries are completed and documented in each client's record

(n) Medications administered in any MCH facility are only those for which there are standing orders
or those which have been prescribed by a physician

(o) Legal guardians are informed of needed operative procedures, and consent to treatment
according to legal requirements must be obtained

(p) Consent for surgery which must be signed by the legal guardian should include:
(1) need for procedure
(2) expected results
(3) possible complications
(4) description of the procedure
(5) physician’s name
(6) a contact if there are questions
See DDA Attachment 6-- Consent to Surgery and Medical Procedures
(q) The legal guardian must consent to surgery. Consent forms for the hospital or physician may
also be included if required by that facility

(r) Explanation for the procedure should include:
(1) need for procedure
(2) expected results
(3) possible complications
(4) information about procedure
(5) a contact if there are questions
(s) In the event of an emergency situation requiring surgery for a residential client when the legal
guardian cannot be reached to give consent, after making every effort to do so, the surgical
procedure can be authorized by MCH staff as indicated in the Client/Group Home Agreement or
consent to emergency medical services

2. Dental services:
(a) MCH ensures complete dental services to DDA clients

(b) Unless otherwise ordered by the dentist, clients receive prophylaxis treatment at least every 6

(c) Other dental procedures are as recommended by the dentist

4. Nursing services:
(a) The nurse should record observations which pertain to a client's physical status as needed

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(b) The nurse shall record information objectively and accurately

(c) Documentation may include but is not limited to the following:
(1) feeding problems
(2) changes in appetite
(3) changes in appearance
(4) changes in behavior
(5) elevated temperature
(6) any indication of problems
(7) significant weight changes
(8) injuries
(9) edema
(10) seizures differing from pattern
(11) skin changes such as rashes, redness, swelling
(12) symptoms of illness or approaching illness
(d) Changes in body functions such as sleeping, elimination, and eating should be documented

(e) During illness or any time there is a problem, progress or lack of progress should be recorded

There should also be documentation as to the resolution of the illness and effectiveness of any

(f) Vital signs (temperature, pulse, respiration, blood pressure) are taken upon admission to the
group home and otherwise as needed

(g) Blood pressure should be recorded at least monthly

(h) Vital signs should be taken and recorded any time a client appears ill

(i) Vital signs are to be taken as ordered by the physician and as requested by the nurse

5. Nutritional services:
(a) MCH ensures that each client is provided a diet that is appropriate in nutrients, calories, and
form for their physical needs and capabilities

(b) All residential clients shall eat in the dining room except where contraindicated for health
reasons or by the decision of the team responsible for the client's program

(c) Table service shall be provided. The dining area shall be equipped with table, chairs, eating
utensils, and dishes designed to meet the developmental needs of each client

(d) The dining room shall promote a pleasant and homelike environment and will be designed to
stimulate maximum self-development, social interaction, comfort and pleasure

(e) A nourishing, well-balanced diet, consistent with local customs shall be provided to all clients

Enough time shall be allowed for eating to promote development of self-feeding skills,
encourage socialization, and provide a pleasant meal-time experience

(f) Staff shall eat with the clients in a family-style arrangement. Food is prepared according to the
menu and placed on the table family style

(g) Clients serve themselves under the supervision of the staff and receive assistance as

(h) Meal times should be comparable to those normally observed in the community. There shall be
at least 3 meals served daily at regular times with no more than a 14-hour span between a
substantial evening meal and breakfast the next morning unless an adequate snack is

(i) Food shall be served as soon as possible after preparation in order to conserve nutritive values
and palatability and shall be served in an attractive manner, in appropriate quantity, and at the
developmental level of the client

(j) Dietary practices in keeping with the religious requirements of the clients' faith groups should
be observed at the request of parents or guardians

(k) Food served to clients and not consumed shall be discarded

(l) Denial of a nutritionally adequate diet shall not be used as a punishment

(m) Substitutions will be made for food allergies

(n) Food likes/dislikes will be honored as much as possible

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(o) The menus will be approved by a registered dietitian to insure that they meet the nutritional
needs and developmental abilities of the clients. A 4-week cycle menu is used. When
changes are made, substitutions are noted on the backs of the menus. The changes should
be of equal nutritional value. Menus and substitutions are kept on file for 3 months. The menu
in use is posted in the kitchen. Modified diets must be ordered by a physician. The dietitian will
plan the diet according to the objectives of the American Dietetic Association

(p) Special diet patterns must be planned in writing and kept on file

(q) Recipes for regular and therapeutic diets are available in the kitchen and used when preparing
food to ensure a standardized product

(r) Standardized portions for each food are specified in the menu. Food is prepared based on
serving size and number of portions needed. Clients eat family style. Staff must encourage
clients to eat well-balanced meals

(s) A snack may be offered to clients in keeping with their total daily nutrition needs. Between-
meal nourishments are served on special diets as prescribed

(t) A supply of non-perishable foods to meet the requirements of planned menus for a minimum of
3 days shall be provided; however, it is recommended that a week's supply be provided

(u) The manager or designate is responsible for purchasing food supplies. Foods will be
purchased according to the menu. A minimum stock level of 3 days should be kept on hand

Food is bought locally at a supermarket as needed

(v) Food storage procedures shall meet state and local regulations. Dry or staple food items are
stored at least 12 inches off the floor, in a ventilated room, not subjected to sewage, or waste
water backflow, or contaminated by leakage, rodents, or vermin

(w) All food, raw or prepared, is stored in a sanitary manner

(x) Cleaning supplies shall be stored separately from food supplies

(y) Non-perishable food supplies are stored on shelves in the pantry

(z) Stock shall be rotated and older stock used first

(aa) Food shall be kept in air-tight containers to prevent spoilage and to keep out bacteria

(bb) Perishable food is stored in the refrigerator or freezer. Frozen foods will be kept at a
temperature of 0 F

(cc) General storage (dairy, meat, fruits and vegetable) shall be 34  - 45  F

(dd) All garbage shall be handled and stored in a sanitary manner

(ee) Food served to clients and not consumed must be discarded. Food scraps are disposed of by
putting them in the garbage receptacle or down the garbage disposal. Paper, cans, bottles
may be put into the trash compactor (unless recycled). When the compactor is filled, the bag
should be emptied, tied closed, and put into a trash receptacle to be picked up by garbage

(ff) Bones and other items which do not go into the disposal or compactor should go into a
garbage receptacle lined with a plastic bag. When these bags are full or become smelly, they
should be tied closed and put into an outdoor receptacle of adequate size which is made of
non-absorbent material, leak proof, and has a close-fitting lid

(gg) It is essential that a high standard of personal hygiene be maintained at all times

(hh) Food preparers should maintain a high standard of cleanliness. Clothes should always be
clean. Hair should be properly groomed and arranged in a manner that it will stay in place

Nails should be short, rounded and scrubbed. Only wedding bands or other flat, plain rings
may be worn while preparing food. Nails should be cleaned with a small brush before handling

(ii) Food preparers should not work around food when they have a cold, infection, cut, boils, etc.,
which may be transmitted to the food. If the preparer has a small cut, burn, etc., gloves should
be worn. Handwashing should be done before beginning food preparation and as necessary
during cooking

6. Psychological services:
(a) Psychological services will be provided to assess and facilitate as appropriate the maximum
intellectual, emotional, and adaptive capacity of each client. Psychological services are
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intended solely to maximize the personal freedom and sense of well-being required by each

(b) Psychological services will be provided by a licensed psychologist

(c) All clients are examined using standardized psychological tests prior to admission and are
evaluated after that as needs arise

(d) Every effort will be made to:
(1) utilize positive reinforcement, especially social reward and extinction procedures
(2) avoid negative reinforcement and punishment

(e) Special effort will be taken to ensure that the least restrictive and most normative measures are

(f) Psychological services will carefully conform to the ethics of the American Psychological
Association and the laws and guidelines on human rights as contained in the state statutes and
will on all occasions employ the most humanitarian procedures

7. Recreation services:
Recreation and leisure services shall be provided in an organized manner so that clients' needs may be
met with the highest quality of recreational programming available

8. Social services:
(a) MCH requires a social history at the time of admission to services and updated as necessary
or with the ISP. The social history may be part of the ISP

(b) The social history should list the referral source, i.e., the names of the agency and persons
making and supporting the request for admission. It should also include a brief statement of
the reasons for the request for admission, the family's and agency's expectations, including the
length of admission and the services needed, a statement regarding the family's or agency's
expected role in coordinating a service or treatment plan and a clear delineation of this
responsibility as well as a description of the referring agency's relationship with the family

(c) The social history should present the problem, briefly summarize the client's developmental
history, summarize precipitating factors for the request, describe the client's level of intellectual,
social, and behavioral functioning at the time of the request, state the needs specifically for
level of service, supervision, and training, and state the inappropriateness or unavailability of
any other levels of care in the community

(d) The social history should include family information and list in profile form who is living at home
and who is the primary care giver for the client. This information should include ages,
occupations, education, relationship to the client, status of current physical and mental health
and degree of care given by those primary persons

(e) The social history should also contain any additional profile information regarding significant
family members or others not included in the above mentioned family information and
list any other additional family dynamics that significantly impact upon the client. It should
note the family's potential for growth and involvement while the client resides in the group

(f) The social information should also include financial information, state whether the client is
currently receiving Medicaid, is eligible for Medicaid, has the Medicaid application in process,
receives SSI, receives Social Security, or receives any other form of government benefits,
family support, or long-term financing including trust funds or anticipated inheritances and list
any other financial information of significance

(g) The social information should address guardianship, i.e., state of legal status as needing,
having, or in the process of receiving a guardian of the person, a guardian of the estate, or a
general guardian, and list any other information regarding the client's legal status

(h) The social history should include a history of services provided in the past, state the referring
agency's level of involvement with the client, family, and other agencies on behalf of the client
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during the past year, and describe special expertise and knowledge of the client that agencies
other than the referring agency may have of the client including historical information

9. Physical therapy services:
(a) Physical therapy service is to provide, directly and indirectly, the highest level of professional
care and treatment to clients who would benefit from these services. Service is provided in an
atmosphere conducive to optimal physical and psycho-social development and maintenance

(b) Any treatment program will be carried out by the licensed physical therapist if indicated or by
appropriately trained direct care staff who will function under the supervision of the therapist

(c) Data on treatment progress will be collected and recorded in a progress note and will be
evaluated periodically as a means of determining the appropriateness and effectiveness of the

(d) A referral from a physician in the State of North Carolina may indicate a need for physical

Policy 1. All applicants must: (a) Submit a complete application including required attachments. (b) Be approved by the MCH Admissions Committee prior to admission and authorized by the …

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