14- 118 C.M.R. ch. 5, § 17 - ENVIRONMENT AND SAFETY

17.1 Compliance. The agency shall ensure and document continuous compliance with all applicable laws, rules and regulations governing the location, occupancy, use, maintenance, construction and renovation of physical structures used in the delivery of licensed/certified services.

17.1.1 Evidence. Evidence of compliance shall include, but not be limited to, approval from local fire departments (if utilized in lieu of inspection by the State Fire Marshall), local boards of zoning and code enforcement, and local health departments, as applicable.

17.1.1.1 The agency shall be required, upon the request of the Licensing Authority, to produce documentation of compliance regarding construction or renovation.

17.1.2 Waivers. Documentation shall include all applicable waivers.

17.2 Structures. All structures used in the delivery of licensed/certified services shall be maintained in good repair and free from danger to health or safety, and shall be appropriate to the services provided.

17.2.1 General.

17.2.1.1 The agency shall meet current requirements of the Americans with Disabilities Act of 1990 ( 42 USC § 12101, et seq.), the Rehabilitation Act of 1973 ( 42 USC § 794 ), and the Maine Human Rights Act ( 5 M.R.S.A. §4551, et seq.), including all new construction, renovation, remodeling or repair requirements.

17.2.1.2 No products containing asbestos shall be used for any purpose, nor permitted to remain on the interior of any structure utilized for the delivery of licensed /certified services.

17.2.1.3 No paint that contains lead or products containing asbestos shall be used for any purpose. All interior lead-based paint or flaking paint must be removed or permanently covered.

17.2.2 Building Interiors.

17.2.2.1 Buildings shall structurally accommodate the services provided therein.

17.2.2.2 Indoor temperatures shall be maintained at a comfortable level, based on the needs of the clients.

17.2.2.3 Administrative and counseling services shall occupy space that is separate and distinct from living areas, when applicable.

17.2.2.3.1 Counseling space shall be such that privacy and confidentiality are ensured.

17.2.2.4 Adequate separate space shall be provided for staff whose duties and responsibilities include living-in, sleeping-over, or similar functions. The separation of client and staff sleeping areas shall be absolute.

17.2.2.5 Doors to bedrooms, closets or bathrooms that can be locked must have an emergency release mechanism readily available, that can be activated from both the interior and the exterior of the room or closet.

17.2.2.6 Living rooms, lounges, day rooms or other common areas, when provided, shall accommodate a variety of recreational activities, shall be clean, well lighted, ventilated, and properly equipped.

17.2.2.7 Bathrooms shall be equipped to facilitate maximum self-help by individuals and shall be large enough to permit staff assistance of individuals, if necessary.

17.2.2.8 Bedrooms or other sleeping areas, when provided, shall be separated by gender, and shall have enough space to reasonably provide clean, comfortable accommodations for clients and their belongings.

17.2.3 Furnishings. The agency shall supply furniture for use in all structures used for the provision of licensed/certified services. Furniture shall be comfortable, appropriate for the use intended, well maintained and clean. Nothing in these rules prohibits the use of furniture personally owned by clients in residential programs, provided that the furniture is serviceable, safe, and clean.

17.2.4 Smoking areas. No smoking shall be permitted in any part of the building. To the extent authorized by Maine Law, separate smoking areas shall be provided if smoking is permitted on the grounds. Nothing in these rules requires an agency to permit smoking on its premises.

17.2.5 Nutrition and Food Service. Programs providing prepared meals and snacks shall maintain policies and procedures to govern all aspects of nutrition and food services and shall include but not be limited to:

17.2.5.1 the planning of menus to meet the nutritional needs of the individuals receiving services, including the provision of special foods, meals, supplements or diets, as applicable.

17.2.5.1.1 records of menus planned and meals actually served shall be maintained by the program for 90 days and shall be subject to review by the Licensing Authority.

17.2.5.2 purchasing, storage and preparation of food to preserve nutrients and minimize the risk of food borne illness;

17.2.5.3 the consumption of food by staff at the program site;

17.2.5.4 sanitation of the food preparation and service areas, cooking utensils and dishware;

17.2.5.5 Kitchens used to prepare and serve meals for clients being properly equipped and maintained in clean and serviceable condition.

17.2.6 Laundry. Programs providing laundry services for personal clothing or bedding, whether the service is provided by program staff or through a contracted service, or made available to persons receiving services on a self-serve or staff supervised basis, shall maintain policies and procedures to govern all aspects of this service.

17.3 Utilities.

17.3.1 Condition of utilities. Utilities shall be maintained in good repair and in a manner consistent with applicable codes.

17.3.1.1 Electrical systems and fixtures shall be maintained in good repair and shall be adequate for the purpose. Exterior lighting shall be adequate to ensure safety.

17.3.1.2 Heating elements shall be installed, operated, and insulated in a manner that ensures safety. Only approved heat sources shall be used.

17.3.2 Telephone services. Telephone services shall be provided in all structures used for the provision of licensed/certified services. They may be hard-wired or portable/cellular, at the agency's discretion; however, client confidentiality must be assured.

17.3.3 Water. Water derived from sources other than an approved public water supply shall be subjected to water analysis by the Maine Department of Health and Human Services, Division of Health Engineering or other approved laboratory on a bi-annual basis at minimum, but no less than is needed to ensure the safety of the water.

17.3.3.1 The agency shall maintain records of compliance with this rule and shall maintain records of interventions taken to remedy any findings requiring correction, and the results of the interventions.

17.3.3.2 Heated water accessible to individuals in care for personal use shall be regulated so as not to cause burns.

17.4 Grounds.

17.4.1 Hazards. The agency shall maintain the grounds of buildings used in the provision of licensed/certified services in a manner which ensures that they are free from any hazard to health or safety.

17.4.2 Unreasonable Risk. Areas presenting an unreasonable risk to persons receiving residential services such as steep grades, cliffs, open pits, swimming pools, high voltage transformers, or high speed roads, shall be fenced or have erected natural barriers sufficient to prevent access. Fences and natural barriers shall be maintained in good repair.

17.5 Safety and Sanitation.

17.5.1 Garbage. Garbage and rubbish shall be stored securely in noncombustible, covered containers separate from inside living areas or other areas that compromise the safety of persons receiving services, and shall be removed on a regular basis.

17.5.2 Routine Maintenance and Cleaning. There shall be evidence of routine maintenance and cleaning programs in all areas of all agency buildings or structures used for the provision of licensed/certified services.

17.5.2.1 Policies governing the provision of housekeeping services shall be maintained.

17.5.2.2 Policies governing the provision of grounds maintenance services shall be maintained.

17.5.3 Storage areas. The agency shall provide secured storage space in every building or location used for the provision of licensed/certified services for all potentially harmful materials.

17.5.3.1 Outbuildings shall be secured at all times when not in use.

17.5.3.2 Poisonous or toxic materials shall be labeled and stored in locked storage spaces that are not used for any other purpose.

17.5.3.3 Poisonous, toxic, or flammable materials and their containers shall be stored, used and disposed of in compliance with all applicable regulations, rules and laws.

17.5.4 Power Driven Equipment. Power driven equipment shall be maintained in safe and good repair. Safety features shall not be disabled, disconnected or removed and shall be in use during operation. Use of power driven equipment by clients, when appropriate, shall be monitored by staff.

17.5.5 Firearms. Firearms, ammunition and other weapons shall not be permitted on the grounds or within the building of any structure under agency control used for the delivery of licensed/certified services, except as required for law enforcement officers.

17.5.6 Swimming Pools. Swimming pools shall be maintained free from contamination in accordance with Department of Health and Human Services, Maine Center for Disease Control and Prevention, Division of Environmental Health Rules Relating to Public Swimming Pools and Spas. .When individuals receiving services have access to the pool, the agency must have on duty an individual who has a current water safety instructor certificate or senior lifesaving certificate from the Red Cross or its equivalent.

17.5.7 Domestic Animals. The agency shall ensure that domestic animals kept or maintained at any building or location under control of the agency shall have current and appropriate vaccinations as required by law and shall otherwise be maintained according to applicable law, rule and regulation.

17.5.8 Transportation. The agency shall ensure that there are policies governing the transportation of clients.

17.5.8.1 all vehicles used to transport clients shall be in a safe condition, and equipped in a manner consistent with the seasons.

17.5.8.2 the number of people permitted in any vehicle shall not exceed the number of seats and seat belts available and in working condition.

17.5.8.3 there shall be staff supervision in any vehicle used to transport clients adequate to manage the situation.

17.5.9 Routine and Emergency Health Care. There shall be specific policies and procedures governing the provision of routine and emergency health care to persons receiving services. The policies and procedures shall be specific to the needs of the population served, services provided, and duration of service delivery. The policies and procedures shall describe the extent of services provided, may include a statement that specific services are not provided or arranged by the program, or may describe the method to summon emergency help from other resources. The policies and procedures shall address, but not be limited to:

17.5.9.1 emergency medical services, including intervention in suicides, which shall be available during all the times the program is operational,

17.5.9.2 emergency psychiatric services,

17.5.9.3 emergency transportation, which shall be accessible during all the times the program is operational,

17.5.9.4 first aid and CPR administration by trained program staff, including the maintenance of first aid supplies adequate to meet situations reasonably anticipated.

17.5.10 Management of infectious diseases. The agency shall have written policies and procedures governing the management of infectious diseases, to include at minimum screening policies and procedures and maintenance of universal precautions.

17.5.10.1 The infectious diseases include, but are not necessarily limited to, HIV (Human Immunodeficiency Virus), tuberculosis, Hepatitis (any type), rubella (measles), mumps, varicella (chicken pox), pediculosis (lice), scabies (e.g., Sarcoptes scabiei).

17.5.10.2 Screening policies applicable to both clients and staff shall address the criteria for testing and referrals to further treatment, and must consider the limits of inquiry allowed by law (i.e., HIV screening).

17.5.10.3 Universal precautions and other precautions recommended by the Maine Center for Disease Control and Prevention, the US Public Health Service or the Centers for Disease Control, as applicable, shall be enforced.

17.5.11 Sewage. Sewage disposal systems other than public systems shall be maintained in proper working order to prevent back flow, over flow, seepage, or other circumstances capable of risking the health of persons using the building.

17.6 Emergency Management Plans. The agency shall adopt written procedures for staff and clients to follow in case of emergency or disaster.

17.6.1 Plan Development. Plans shall be developed with the assistance of qualified fire, health and safety personnel and shall include, but not necessarily be limited to:

17.6.1.1 evacuation of all buildings;

17.6.1.2 assignment and deployment of staff during emergencies;

17.6.1.3 notification of guardians, the placement agency and the Licensing Authority, as applicable;

17.6.1.4 management of medical and psychiatric emergencies;

17.6.1.5 searches for lost persons, if applicable; and

17.6.1.6 weather emergencies.

17.6.2 Staff Access to Plans. Copies of emergency management plans shall be readily available to all staff at all times.

17.6.3 Emergency Practices. Emergency practices shall be developed and implemented, and shall include but not necessarily be limited to:

17.6.3.1 posting emergency numbers adjacent to telephones for fire, police, physician(s), poison control, health agency and ambulance;

17.6.3.2 posting fire evacuation procedures in conspicuous locations throughout buildings;

17.6.3.3 instructing clients and staff in fire prevention, reporting, management and building evacuation;

17.6.3.4 training all staff on all shifts to perform assigned tasks during emergencies, including the use and location of fire fighting equipment. The occupants of each agency building utilized in the provision of licensed/certified services shall be drilled in emergency procedures, including actual evacuation of individuals to safe areas four (4) times per year for non-residential programs and monthly for residential programs, unless a higher standard is required by the State Fire Marshall.

17.6.3.4.1 Emergency drills shall be held at unexpected times and under varying conditions to simulate the possible conditions of fires or other disasters.

17.6.3.4.2 Records of such emergency drills shall be maintained, noting dates and time, evacuation time, exits used, problems or barriers encountered and the corrective measures to be implemented henceforth.

17.6.3.5 developing and implementing plans for the evacuation of any individuals, who may be physically, emotionally or perceptually impaired, and who are likely to be served by the agency.

17.7 Medication administration. There shall be specific policies and procedures governing the acquisition, storage, administration and disposal of prescription and over-the-counter medication, consistent with the services provided at the program.

17.7.1 The policies and procedures shall include, but not necessarily be limited to:

17.7.1.1 identification of staff positions authorized and appropriately credentialed to order, dispense, acquire, store, administer or dispose of medication, including schedule drugs and psychotropic medication;

17.7.1.2 specific training and supervision required of staff so authorized;

17.7.1.3 procedures to order, dispense, acquire, store, administer or dispose of medication, including scheduled drugs and psychotropic medication;

17.7.1.4 procedures for the acquisition of informed consent from the person for whom the medication is ordered, and the guardian if one has been appointed, including cases of emergency. This shall include the following:

17.7.1.4.1 The acquisition of informed consent and signatures of persons aged 14 and older obtained prior to the first administration of any psychotropic medication and again prior to the first administration of any change in medication, dosage or route of administration, unless documentation of clinical incapacity exists in the client record.

17.7.1.4.2 The exercise of the client and guardian's rights to revoke consent, in writing or verbally, at any time, and the resulting actions to be taken by the agency, including consultation with the prescribing physician.

17.7.1.5 the identification and documentation of drug or medication allergies or significant side effects;

17.7.1.6 documentation of formal mechanisms for ensuring that medication issues are communicated in writing between program staff and outside prescribers, along with documentation of administration or refusal of medication, including dosage, route and timing;

17.7.1.7 medication errors, accidental or intentional overdoses, allergic reactions or significant side effects. This must include the agency's review of related critical incidents and development and implementation of plans for improvement based on the review and the method to ensure notification to the Office of Substance Abuse within 24 hours of the incident;

17.7.1.8 the acquisition, identification, storage, administration and disposal of medication;

17.7.1.9 the provision for daily monitoring and documentation of the condition of each client who receives medication administered by the program, to specifically address the presence or absence of expected outcomes, behavioral changes, or side effects.

Notes

14- 118 C.M.R. ch. 5, § 17