Section B: Policies and Procedures

TABLE OF CONTENTS

SECTION B: POLICIES AND PROCEDURES

CONTENTS:PAGE

Establishing and Reviewing Policy1

New Policy and Procedures Review Form2

Manual Revisions3

Manual Distribution Table4

Non-Discriminatory Policy5

Admission and Discharge Procedures6-9

Guardianship: Need, Appointment, Continuity (Policy Attachment)10

The Individual Habilitation Plan11

Table of IHP Process Time Frames12

“In-Charge Person:” Twenty Four Hour Basis13

Twenty Four Hour Accountability14

Building Procedures: Keystone Residential15

Personal Rights16

DDD Personal Rights17-18

Personal Rights Acknowledgement 19

Human Rights Committee20-25

Human Rights Committee Members25

House Rules26

Grievance Procedure27

Abuse/Neglect & Exploitation28-29

Abuse/Neglect & Exploitation Staff Responsibilities29

Unusual Incidents and Reporting Method30-32

Unusual Incident Report Instructions33-34

Unusual Incident Report (154 Front St.)35-36

Unusual Incident Report (GH’s, SLP, Supervised Apt, Voc)37-38

Procedures for Daily Written Communication39-40

Staff Meetings41

Procedures In Case Of Missing Person42

Procedures In Case Of Death43

Volunteering At Keystone44

Management of Client Funds45-53

Personal Financial Record54

Cash on Hand55

Special Activities Expense Form56

Authorization for Assistance in Financial Management57

Safeguarding Procedures58

Leisure Programming59

Leisure Assessment for G.H.; S.A.; & S.L. Programs60

Leisure Time Assessment Form61

Telephone Use62

Long Distance Consent Form for Keystone Living63

Food Storage for Keystone Residential Program64

Food Service Operation/Food Shopping Policy65

Fire Safety66

Location and Use of the Fire Alarm System at 154 Front St.67

Fire Prevention67

Fire Evacuation Procedures67-73

Fire Evacuation for Overnight Shift at 154 Front St.68

Special Needs and Home Specific Addendum68-71

Fire Safety Equipment Check71

Fire Evacuation Procedures for Weekday Mornings72-73

Severe Weather Procedures74

Emergency Evacuation and Temporary Relocation75

Keystone’s Continuous Quality Improvement Plan76-84

Maintenance of Physical Environment85

Procedures for Safeguarding Equipment86

Criminal Background Checks87-89

Background Check and Release of Information90-91

Employee Injuries Procedure 92-93

First Report of Injury94-96

Concentra Medical Center Employee Injury Form97

Return to Work Program98-99 Physicians Evaluation 100

Smoking Policy101

Mobile Technology in the Workplace102

Emergency Call and On-Site Treatment103

EMS Sign Off Sheet104

Emergency and Accident Procedures105-108

(Use of Vehicles)

Central Registry of Offenders Procedures109

Guardian CircularAppendix A

Investigation PolicyAppendix B UIR Reporting Contact Information Appendix C UIR Category List Appendix D Inventory Sheet Appendix E

Establishing and Reviewing Policy

Policy: Policies are established and reviewed in order to provide for the optimal development of the individual’s we serve.

Procedures: Administrative staff reviews Keystone’s policies regularly, at least annually, to ensure best practice. More frequent reviews occur as needed.

Administrative staff shall be responsible for making changes in their designated areas of responsibility as they become necessary. When changes or new policies become necessary, the pertinent administrative staff shall proceed as follows:

Write and name policy, adding the date and the word “draft.”
Attach the Review form and give the policy to the President for approval.
Forward it to the President or designated staff, who will review it and return it to administrative staff.
Make any needed corrections, remove the word “draft” and reprint the new policy.
Complete the form entitled, “Manual Revisions.”
Attach the completed form to the new policy and give them to the Director of Operations or designee.
The Director of Operations or designee will ensure that the policies are copied and distributed according the “Manual Distribution” table.

Staff and individuals may ask for a review of an existing policy or procedure by contacting any member of the administrative staff, or if they prefer anonymously though the suggestion box. A review meeting will be held and all interested parties will be invited to attend. The President will convey these results of the review to all interested parties.

When appropriate, new policies and procedures will be explained during staff and/or program meetings prior to implementation. Staff and individuals input will be encouraged.

Revised 6/2015

NEW POLICY/PROCEDURE REVIEW FORM

Person requesting the procedure to be reviewed: ______

Date of the Request: ______

Name of Policy/Procedure: ______

Reason for revision (i.e. change in regulation, best practice, etc.): ______

If regulation, please cite, copy & attach
Attach copy of old policy or procedure with changes highlighted
Attach copy of the new policy, include the date and the word “draft”

Is there a fiscal impact? ______If yes, estimate cost ______

Manual affected: ______

(Procedures/Personnel/Behavioral, etc.)

Date given to Ray Fantuzzi, President: ______

Presidential Review:

No corrections needed ______

Policy requires the following corrections(see below): ______

Date Revisions returned to Ray Fantuzzi, President: ______

President Review of Policy Revisions:

Revisions Approved: ______
Revisions Not Approved:______
If Approved, complete a Manual Revision form, attach the revised policy and give to Kristen Fantuzzi, or designee: ______

______

Ray Fantuzzi, President

______

Date

Revised 6/2015

MANUAL REVISIONS

Date:

To: All Staff

Re: Revisions in the ______Manual.

Section:

Please remove the following procedures/pages:

Section:

Please add the attached/pages:

If you have any questions, please see Kristen Fantuzzi (908 757-1080 ex. 113)

Reviewed 6/2015

MANUAL DISTRIBUTION TABLE

Please note the table below. This explains how the manuals are distributed and the person who is responsible for updating each manual.

MANUAL DISTRIBUTION RESPONSIBLE FOR UPDATING

President / Kyle Thompson
Assistant Executive Director / P. Lynne Conway
Director of Operations / Kristen Fantuzzi
Director of Human Resources / Lisa Mixon
Director of Health Services / Judith Foster, R.N.
Director of Administrative Services / Linda Fantuzzi
Director of Vocational Services / Janet Walden
Director of Support Services / Jennifer Moffett
Director of Quality / Dina Esposito
Program Director (Group Homes/Supportive Living) / Laurie Davis
Program Director (Residential/Group Homes) / HalishaRogers
Program Director (Residential/Group Homes) / Keisha Harris
Program Director (Group Homes/SLP) / Paul Marshall
Nurses / Judith Foster, R.N.
Middlesex Apartment / HalishaRogers
Grant Apartment / Keisha Harris
Supportive Living Program / Dalia James
Balmoral Group Home / Keisha Harris
Brandywine Group Home / Keisha Harris
Catalano-Supervised Apartments / Laurie Davis
Colton Rd. Group Home / Laurie Davis
Dunellen Group Home / Halisha Rogers
Fords Group Home / Paul Marshall
Lawrence Group Home / Laurie Davis
Middlesex Group Home / Laurie Davis
Netherwood Group Home / Paul Marshall
Piscataway Group Home / Keisha Harris
Woodland Group Home / Halisha Rogers
Vocational Program / Janet Walden

If your name appears on this list and you do not have a manual, please see Kristen Fantuzzi.

Revised 6/2015

NON-DISCRIMINATORY POLICY

Admissions, the provision of services, and referrals of those we serve shall be made without regard to race, color, religion, physical or mental disability, ancestry, national origin, age sex, sexual orientation, AIDS or HIV infection, atypical cellular hereditary blood traits or any other legally protected status.

Reviewed 6/2015

ADMISSION/TRANSFER/DISCHARGE PROCEDURES

Admission:

Policy: Applications for admission to Keystone are considered without regard to race, sex, color, national origin, religion, age, physical or mental disability, ancestry, sexual preference/affiliation, including AIDS or HIV infection, atypical cellular hereditary blood traits or any other legally protected status.

The following requirements are necessary:

Have a primary diagnosis of mental retardation
Have an absence of severe emotional problems that require a psychiatric setting.

Procedures for Admission:

The President or designated staff will ensure that prospective admissions and guardians receive information regarding the specific services provided by Keystone as well as fee structures for providing those services.
The sponsoring agency will then forward pertinent information to administrative staff within 30 days.
The President or designated staff will conduct a pre-placement interview and observation with the applicant, preferably in his or her current setting.
An Inter Disciplinary Team or Pre-Placement meeting will be held to determine the course of visits to be undertaken; such as, spending a day in the Vocational Enhancement Program, having dinner and going to the movies with staff and peers, staying overnight, or spending a weekend.
During the individual’s visits, an individualized log will be completed by the staff responsible for providing support to that individual. All information will be forwarded to the Director of Support Services. Accrued information will assist in determining the appropriate placement of the individual.
Should the individual be accepted for placement, the President or designated staff will send a letter of confirmation along with a packet of required pre-admission forms.
Admission will occur only after all of the necessary documentation has been received.
Persons are accepted on a 30-60 day trial period, with the understanding that should serious medical, emotional, or behaviorally problems occur, immediate removal of the person from Keystone will be expected.
A pre-admission report to acquaint staff with the individual will be written by the Assistant Executive Director or designated staff.

Upon admission, the individual will receive an orientation to their new program. The Program Director is responsible for ensuring this orientation is conducted. The orientation shall include, but not be limited to:

Introduction of other individuals receiving services as well as staff providing services
A review of fire and safety procedures; as well as participation in a fire drill
A complete inventory of personal funds and property
A review and implementation of goal plans
A description and explanation of leisure time opportunities

The individual will also receive the following:

A copy of the written procedures for safekeeping of valuable personal possessions
A written statement explaining the individual’s rights as well as a list of available advocates to assist the individual in understanding these rights
A copy of the rules governing the program
A copy of the grievance procedure
A copy of the procedure regarding toll calls/charges

The Manager or Program Director will make all necessary provisions to explain the above information to the individual.

The guardian will be notified by writing that the individual has had this information explained to him or her. A copy of this notification shall be placed in the individual’s file.

An initial Individual Habilitation Plan is developed within 30 days of admission.

Individuals who meet all requirements for admission may be considered for respite placement. This determination is made by the President or designated staff.

Transfer or Planned Discharge:

Any major change in an individual’s residential service or supports shall include the utilization of the IDT.

In the case of a planned transfer or discharge, at least 30 days prior to the anticipated discharge date, the following will occur:

An addendum to the IHP shall update the existing plan and include the specifics of the transition.
The Assistant Executive Director, in consultation with the individual and his or her guardian, as appropriate, the IDT, and a representative of the placing agency, will develop a discharge plan.
The discharge plan shall assess the individual’s continuing needs and recommend a plan for provision of follow-up services in the individual’s new environment.
The Assistant Executive Director will notify the appropriate Division regional office.
The individual’s full records should be transferred.

Emergency Discharge:

Emergency discharges will only be requested when all possible intervention techniques have proven unsuccessful and the individual’s continual placement at Keystone poses a health or safety risk for the individual or others.

The President or designated staff will request to the sponsoring agency the emergency discharge.
The President will insure a referral packet containing pertinent information is prepared and sent with the individual at the time of discharge.
A discharge summary will be sent, preferably at the time of, but no later than one week from the date of discharge.
The President or designated staff, in conjunction with the Regional office will arrange for transportation. Keystone staff will be available to meet with representatives of the individual’s new placement and to discuss the individual’s needs.

Pre-Admission Requirements

Pre-Admission requirements are collected to provide necessary documentation and ensure an individual’s smooth transition into Keystone. Requirements include, but are not limited to, the following:

Pre-Admission Application
Skill Assessment
Physical Examination
Pre-Admission Medical Requirements
Immunization Record
Free of Contagious Disease Form (within 48 hours)
Consent/Release
Statement of Personal Rights
Authorization for Assistance in Financial Management
Personal Property Inventory, including an adequate supply of clothing, individually marked or labeled
Safekeeping Procedure of Personal Possessions
House rules of Program
Grievance Procedure
Toll calls/charges Procedure
List of Advocates

Revised 6/2015

GUARDIANSHIP: NEED, APPOINTMENT, CONTINUITY

The purpose of this procedure is to indicate that Keystone will assist and cooperate with the Division of Developmental Disabilities in any way necessary regarding following policies and procedures for assessing whether or not individuals with developmental disabilities, who have been formally determined eligible for services from the Division of Developmental Disabilities, are in need of guardianship as per Division Circular #6 (N.J.A.C. 10:43).

See Attached Circular

Appendix A

Adhered 7/10

Reviewed 6/15

THE INDIVIDUAL HABILITATION PLAN

Policy: The Individual Habilitation Plan is developed to ensure quality of individual programming.

Procedures: All individuals will have an Individual Habilitation Plan developed and put into effect within thirty days of admission. Subsequent meetings will be held on a yearly basis.

The individual’s input and understanding of the IHP process is extremely important. The individual’s IHP is scheduled to coincide with his or her schedule. If the individual chooses not to attend, the Manager, Program Director or designated staff member will review the results of the IHP meeting with the individual within twenty-four hours of the meeting date.

During the IHP meeting, a brief history and overview of the individual’s placement and adjustment will be given. Following this, the individual’s preferences, capabilities and needs will be discussed. The Manager or Assistant Manager will present a skill assessment. This assessment will include an Adaptive Behavior/Health/Safety/Risk Assessment and/or such self-management competencies as the ability to self-medicate, remain unsupervised and/or manage money. Annual goals will be established based upon the individual’s strengths and weaknesses.

The understood universal goal for each individual is the enhancement and development of skills needed for greater independent functioning. Recommendations will be made regarding the appropriateness of the individual’s current placement. Discharge and transfer plans will be developed when appropriate and necessary.

The Manager, Program Director and/or designated staff will review the individual’s program on a monthly basis. Monthly progress reports will be written by the Assistant Manager and become part of the individual’s file. Recommendations and comments regarding the individual’s program will be recorded. Goal accomplishments and the need for additional goals and programming will be noted. The IDT will reconvene to determine the individual’s current needs.

Revised 6/2015

TABLE OF IHP PROCESS TIME FRAMES

STEPS IN THE IHP PROCESS / WHO DOES IT / WHEN IS IT DONE
Confirm or determine who is on the interdisciplinary team / Manager/Individual Served / 30-60 days before meeting
Schedule the IHP meeting with all team members / Manager/Individual Served / 30-60 days before meeting
Complete Life Plan with individual (and help from others if needed) / Manager or Designee / 30-60 days before meeting
Complete Assessments / Manager or Designee / 30-45 days before meeting
Review previous IHP, assessments and medical records for additional information / Manager or Designee / 15-30 days before meeting
Review assessments with individual, family and other team members / Manager / 10-15 days before meeting
Write up narrative sections of IHP (Sections 1-15) / Manager or Designee / 10-15 days before meeting
Conduct the IHP meeting / Manager/Individual Served / Not Applicable
Complete the written IHP document / Manager/Individual Served or Designee / Within 10 days after meeting
Develop implementation guides & tracking record / Manager or Designee / Within 20 days after meeting
Begin implementation of IHP / All designated team members / Mtg. < 15th next month
Mtg. > 15th-2nd month
Send IHP to individual, DDD case manager, other programs serving individual, guardian and family / Manager
*Make copy of cover sheet / By 10 days after meeting
Gather data for monthly monitoring and write & mail progress report / Manager or Designee / Every month
Convene additional meetings if individual’s circumstances change / Manager / Whenever Needed

Revised 6/2015

“IN-CHARGE PERSON” ON A TWENTY-FOUR HOUR BASIS

Policy: The President is responsible for the overall operation of the agency on a twenty-four hour basis.

Procedures: When not in the office, the President may be reached by telephone. When out of the area, the President will designate a staff until he returns. The designated staff will also be accessible through the telephone.

Each shift, (7-3p; 3-11p; & 11-7a) has a “Shift Coordinator” who is responsible for the overall program during his or her shift. The “Shift Coordinator” makes certain the program runs smoothly and that all procedures are followed. The “Shift Coordinator” Person reports directly to the Manager and/or his designated staff.

The shift coordinator completes a written report in the Critical Log Book.

Revised 6/2015

PROCEDURE FOR INSURING ROUND-THE-CLOCK ACCOUNTABILITY OF INDIVIDUALS

It is the policy of Keystone to ensure the safety and accountability of our individuals at all times.

Procedures: Each Direct Service Staff is responsible for serving the needs of the individuals in his/her care. The Direct Service Staff is expected to know where each individual is at all times.

At the end of each shift, each Direct Service Staff is responsible for verbally communicating which individuals are present and which are not, to the arriving staff. He/she is also responsible for listing the names of these individuals in the Daily Log Book.

If at any time an individual is missing or has not returned from work or school at the usual time, the “In-Charge” Person should be notified immediately.

In regards to the Keystone Residential Program, the “In-Charge” Person is responsible for documenting, in the Office Report Book, the names of all individuals who are not present in the building at the end of his/her shift. Additionally, documentation is necessary whenever individuals leave for any period of time with family or friends.