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"(4) not having their outgoing mail read by staff,

unless requested by the resident.

"(i) Residents shall be permitted personal possessions,

4 such as toys, books, pictures, games, radios, arts and crafts 5 materials, religious articles, toiletries, jewelry, and letters. 6 "(j) Regulations shall permit normalized and normaliz7 ing possession and use of money by residents for work pay

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ment and property administration, as for example, in per9 forming cash and check transactions, and in buying cloth

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ing and other items, as readily as other citizens. In accordance with their developmental level—

"(1) allowances or opportunities to earn money

shall be available to residents; and

"(2) residents shall be trained in the value and use of money.

"(k) There shall be provision for prompt recognition and appropriate management of behavioral problems in the living unit. There shall be a written statement of policies and procedures for the control and discipline of residents that is

"(1) directed to the goal of maximizing the

growth and development of the residents;

“(2) available in cach living unit; and

"(3) available to parents or guardians.

"(1) Residents shall participate, as appropriate, in

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1 the formulation of such policies and procedures. Corporal 2 punishment shall not be permitted. Residents shall not dis3 cipline other residents, except as part of an organized self

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government program that is conducted in accordance with 5 written policy.

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"(m) Seclusion, defined as the placement of a resident

7 alone in a locked room, shall not be employed.

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“(n) Except as provided in subsection (p), physical 9 restraint shall be employed only when absolutely necessary to protect the resident from injury to himself or to others, and restraint shall not be employed as punishment, for the 12 convenience of staff, or as a substitute for program. The

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facility shall have a written policy that defines the uses of restraint, the staff members who may authorize its use, and

a mechanism for monitoring and controlling its use. Orders

for restraints shall not be in force for longer than twelve

hours. A resident placed in restraint shall be checked at

least every thirty minutes by staff trained in the use of

restraints, and a record of such checks shall be kept. Mechanical restraints shall be designed and used so as not to cause physical injury to the resident, and so as to cause the least possible discomfort. Opportunity for motion and exercise shall be provided for a period of not less than ten min

utes during each two hours in which restraint is employed.

31-151 O 74 Pt. 1 - 13

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1 Totally enclosed cribs and barred enclosures shall be con

2 sidered restraints.

3 "(o) Mechanical supports used in normative situations 4 to achieve proper body position and balance shall not be 5 considered to be restraints, but shall be designed and 6 applied

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"(1) under the supervision of a qualified professional person; and

"(2) so as to reflect concern for principles of good

body alinement, concern for circulation, and allowance for change of position.

"(p) Chemical restraint shall not be used excessively,

as punishment, for the convenience of staff, as a substitute 14 for program, or in quantities that interfere with a resident's

15 habilitation program.

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"(q) Behavior modification programs involving the

17 use of time-out devices or the use of noxious or aversive

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"(1) reviewed and approved by the facility's re

search review and human rights committees;

"(2) conducted only with the consent of the affected

resident's parents or surrogates;

"(3) described in written plans that are kept on file in the facility;

"(4) restraints employed as time-out devices shall

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be applied for only very brief periods, only during con

ditioning sessions, and only in the presence of the trainer; and

"(5) removal from a situation for time-out purposes

shall not be for more than one hour, and this procedure

shall be used only during the conditioning program, and

only under the supervision of the trainer.

"Subchapter II-Food Services

"SEC. 1141. (a) Food services shall recognize and 10 provide for the physiological, emotional, and cultural needs 11 of each resident, through provision of a planned, nutrition12 ally adequate diet. There shall be a written statement of 13 goals, policies, and procedures that—

ities;

"(1) governs all food service and nutrition activ

“(2) is prepared by, or with the assistance of, a nutritionist or dietition;

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"(3) is reviewed periodically, as necessary, by the nutritionist or dietitian;

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"(4) is in compliance with State and local regulations;

"(5) is consistent with the facility's goals and

policies; and

"(6) is distributed to facility personnel.

"(b) When food services are not directed by a nu

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1 tritionist or dietitian, regular, planned, and frequent con2 sultation with a nutritionist or dietitian should be available. 3 Records of consultations and recommendations shall be main4 tained by the facility and by the consultant. An evaluation 5 procedure shall be established to determine the extent of 6 implementation of the consultant's recommendations. 7 "(c) A nourishing, well-balanced diet, consistent with 8 local customs, shall be provided all residents. Modified diets 9 shall be-

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"(1) prescribed by the resident's program team. with a record of the prescription kept on file;

"(2) planned, prepared, and served by persons

who have received adequate instruction; and

"(3) periodically reviewed and adjusted as needed. "(d) Dietary practices in keeping with the religious 16 requirements of residents' faith groups should be observed 17 at the request of parents or guardians. Denial of a nutritionally adequate diet shall not be used as a punishment. At 19 least three meals shall be served daily, at regular times,

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"(1) not more than a fourteen-hour span between

a substantial evening meal and breakfast of the follow

ing day, and

"(2) not less than ten hours between breakfast and the evening meal of the same day.

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