DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES (LOWER
LEVEL) (SOCIAL SECURITY ADMINISTRATION CODE G)
AUTHORITY
Pursuant to 18 VSA § 2014, regulations governing the
standards of care, program, administration and sanitation of community care
homes with personal care are hereby promulgated.
These regulations do not govern the standards of care,
program, administration or sanitation of higher level (SSA Code F) community
care homes.
Section I SCOPE AND
PURPOSE
Community care is based on the concept that people who need
personal help and supervision because of physical or mental disability are
often better cared for in a supportive family setting than an institutional
one.
Community care homes provide personal help and supervision to
typically three to fifteen (but preferably not more than fifteen) people who
need more than room and board, yet less than nursing care or therapeutic
treatment. Ideally, the homes are warm and family-like in atmosphere, and must
be physically comfortable and safe.
These standards are intended to preserve the home, while
insuring a basic quality of care, health, safety and human rights for their
residents.
Section II
DEFINITIONS
A. Community care home is defined
as a place, however named, excluding a licensed foster home, which provides,
for profit or otherwise, room, board and personal care to three or more
residents unrelated to the home operator, hereinafter called "home." The
Commissioner of Social and Rehabilitation Services may establish by rule
different categories of community care homes, based on the level of care
provided.
B. Room and board is
defined as including the provision of room, shelter, laundry, utilities and
furnished sleeping and living accommodations.
C. Personal care is defined as helping a
resident with one or more of the following: eating, dressing, bathing,
grooming, movement, or providing general supervision available on a 24-hour
basis of a resident's physical or mental well-being exclusive of nursing
care).
D. Operator is defined as
the person or persons having the account-ability and primary responsibility for
the supervision and operation of the home.
E. Resident is defined as a person unrelated
to the operator, living in the home as his/her primary residence, who requires
personal care because of physical or mental disability.
F. Licensing agency is the Department of
Social and Rehabilitation Services.
Section III WAIVERS/VARIANCES
The licensing agency may grant, at its discretion, a waiver
for any of these regulations, if
(1)
the waiver does not adversely affect the home's compliance with the intent of
these regulations,
(2) the waiver
does not adversely affect the needs of residents, and
(3) the waiver, in the opinion of the
licensing agency, does not present a clear and distinct hazard to resident's
safety, health or well-being. Standards marked with an asterisk (*) are
intended for new homes and will be waived for homes in operation on July 1,
1977, if the waiver, in the opinion of the licensing agency, does not present a
clear and distinct hazard to resident's safety, health or well-being. The
justification for granting a waiver shall be documented.
Section IV APPEALS PROCEDURE
Any community care home operator whose application for a
license is denied, or whose license is revoked, may request a fair hearing
before the Human Services Board. Fair hearing requests should be mailed to the
Vermont Human Services Board, State Office Building, Montpelier, Vermont
05602.
An oral request may be made by telephoning the Board at
828-3184.
Section V ACCESS
TO COMMUNITY CARE HOMES
The Commissioner of the Department of Social and
Rehabilitation Services shall be responsible for responding to complaints about
the operation of a community care home or the care of residents, filed by any
individual or organization. A community care home operator shall not prevent
access of the Commissioner or his designee to the home, for the purpose of
inspection or investigation of a complaint.
Section VI RESPONSIBILITIES OF OPERATOR
A. General
1. The operator shall be responsible for
managing and supervising the home and carrying out the provisions of these
regulations.
2. The operator shall
obtain and maintain a licensed status.
3. A community care home shall not operate
without a license. It is the responsibility of the operator to insure that a
license application is submitted to the licensing agency and to notify the
licensing agency of any relocation, closure or structural change to his
facility. Sixty (60) days prior notification shall be made. If an emergency
situation prevents the operator from giving the licensing agency sixty (60)
days notice of such a change, the operator shall give notice within 48 hours of
learning of the situation. Relocation of a community care home requires
submission of a new license application.
4. A licensed community care home shall not,
by name or otherwise, create the impression that it is a nursing
home.
5. The licensing agency has
the right to inspect a community care home at any reasonable time without
notice and shall have access to records necessary to verify compliance with
these regulations.
6. The operator
shall ensure that the health, safety and civil rights of the residents
specified by these regulations are protected.
B. Qualifications
1. The operator and staff should be warm and
accepting individuals who have an ability to both give and accept guidance. A
genuine liking and concern for people should be an outstanding
attribute.
2. The operator and
staff must exemplify ability and willingness to offer personal guidance, to
communicate effectively, and to provide good quality care for residents. The
operator and staff must have a genuine concern for people, and be able to
convey this concern to their residents.
3. The operator and staff must be physically
and emotionally capable of performing all duties required to properly supervise
and operate the home. The licensing agency may require physical or mental
evaluations at its own expense (including mileage) by impartial professionals
of its choice.
4. The operator
shall be at least 18 years of age.
C. Supervision
1. The operator shall ensure that an adult
who is capable of supervising the home and providing assistance to the
residents in an emergency is on the premises at all times residents are in the
home.
Upon admission, the operator shall provide a new resident a
written statement of the monthly rate to be charged and a list of services that
are included in that rate. The statement shall be signed by both the operator
and the resident.
3. The
operator shall notify the Department of Social and Rehabilitation Services (or
Department of Mental Health if the resident is under its supervision), in
writing, if in the judgment of the operator, a resident is in need of an
evaluation of his ability to manage his finances and/or property.
4. If the operator of a community care home
assumes responsibility for the management of a resident's financial affairs,
there must be written statement, signed by the resident or his legal guardian,
providing such authorization which shall be revocable at any time by the
resident or his legal guardian.
5.
In cases where the operator manages a resident's financial affairs or is
helping the resident with financial management, the operator shall keep
complete documentation of all receipts and expenditures of those funds of that
resident for which the operator is responsible. Money paid to the resident for
personal expenses may be recorded as a lump sum.
D. Operation
1. Emergency care information, including the
telephone numbers of the fire department, police department, each resident's
physician, or other physicians, and emergency and/or ambulance service, shall
be known to all staff, and kept in a readily accessible place.
2. There shall be a written plan for fire
evacuation approved by local or state fire prevention authorities and all
residents in the home shall be familiar with their responsibilities in the plan
(see attached suggested evacuation plan). The operator shall review fire
evacuation procedures formally with staff and either formally or informally
with residents at least quarterly.
3. New residents should receive fire
evacuation instructions immediately upon admission.
4. The operator shall assist each resident in
having his medical status reviewed at least annually by a physician. If a
resident does not wish to obtain a physical examination, the operator will
document that resident's decision.
5. If a resident is absent from the home, the
operator shall make a reasonable effort to assure that such resident's property
is protected from damage or loss. Resident's property shall not be removed from
the home by anyone, except upon written permission of said resident, his legal
guardian, by permission of the person who has legal custody of the resident or
upon an order of the Court.
The operator shall attempt to obtain permission or
instructions concerning the disposition of property left by a former resident
by attempting to locate by mail the former resident or another appropriate
person described in the preceeding paragraph; or other interested persons such
as relatives or a facility that has received the former resident. If no release
is forthcoming within a reasonable time, but no less than ninety days from the
date of the operator's latest written effort, the operator may contribute the
property to a charitable organization. If no charity will accept the property
it may be discarded. The operator or his employees shall not acquire any
unclaimed property.
6. The
operator shall ensure that a record is maintained, listing in date order the
names of residents admitted and discharged.
7. The operator shall ensure that the
following reports are prepared and submitted:
a. A complete written report to the licensing
agency within 48 hours of every fire, serious injury or accident that occurs in
the home.
b. An annual report
containing the following information: staffing, services provided, rates,
capacity, and number of residents served during the reporting period.
8. Each home shall have at least
one telephone to summon help in case of fire or other emergency. Pay station
telephones are not acceptable for this purpose.
Section VII RIGHTS OF RESIDENTS
A. Each resident shall enjoy family, rather
than guest, dependent or employee status within the home.
B. Each resident shall have help in assuming
as much responsibility for himself and others as possible, and to participate
in family and group activities.
C.
No personal abuse, restraints, deprivations of food or other necessities,
deprivation of rights and privileges, or other similar actions, shall be used
with residents.
D. All information
concerning treatment, past history, personal needs and all personal records of
each resident shall be held in the strictest confidence unless release is
authorized by the resident, or when a medical emergency that constitutes on
immediate danger to the health and safety of the resident occurs.
E. Each resident shall have the right to send
and receive upopened mail. Writing materials, stationery and postage shall be
provided to residents at cost upon request.
Each resident shall have the right to make and recieve
confidential telephone calls. Reasonable access and use of a telephone shall be
permitted upon request to the operator. Residents shall pay for all toll
calls.
F. In accordance
with S ection S below every resident shall, insofar as capable, be expected to
maintain his own living area, and to participate to a reasonable degree in the
usual and customary household duties as is consistent with the resident's
needs, and in accordance with a case plan agreed upon with the placing agency,
if any.
G. Every resident shall be
encouraged to maintain family and personal ties wherever appropriate.
H. Each resident shall have a secure,
confidential place to store cash and valuables, and shall control his own
money, except where a guardianship or payee exists. Any resident may request
help from the home operator with money management, in which case this request
shall be in writing. This assistance will be provided free of charge. If the
operator is serving as a payee or legal guardian, he may be reimbursed for his
services. Amount and method of reimbursement will be agreed upon between the
operator and resident and within any restrictions established by law or
regulation of Federal and/or State programs providing financial assistance to
the resident. Upon termination of residency, any money held by the operator
shall be transferred to the resident, his legal guardian, or estate within
thirty (30) days of request.
I.
Every resident shall be free to move if he so desiresand shall be entitled to
help in making such a move. If the operator requires a resident to leave, 30
days advance notice shall be given, except in cases of emergency. If the
resident has a guardian or is committed to a State agency, the operator will
promptly notify the responsible individual of the resident's desire to move.
The operator shall provide assistance in making reasonable arrangements for
such a move.
If a resident chooses to leave a community care home, he
shall make every reasonable effort to provide adequate notification to the
operator. The operator shall refund to a resident money paid in advance, on a
per diem basis, provided that a notice of thirty (30) days has been given by
the resident.
J. Every
resident shall have the right to present grievances on behalf of himself or
others to the operator, the licensing agency or appropriate person(s) free from
reprisal.
K. Each resident and
staff member shall be fully informed of these rights and of all rules and
regulations concerning resident care and home responsibilities.
L. Each resident shall be informed of all
charges required by the home, and may request these charges in writing.
Residents shall be given prior notice of thirty (30) days of any change in
monthly rates or charges. If a rate change results from a change in government
reimbursement schedules, residents shall be notified promptly upon receipt of
notice by the operator.
M. Each
resident may associate and communicate privately with persons of his choice,
and may participate in activities of social, religious, and community groups at
his discretion.
N. Each resident
shall be treated with respect, kindness, and full recognition of his dignity
and individuality.
O. Residents'
civil liberties shall not be violated. The facility and its staff, to the
fullest extent possible, shall encourage and assist each resident to exercise
all rights.
P. Married couples
shall have the right to share a private room.
Q. Each resident shall have the right to
receive, entertain and communicate with any person in a private setting subject
to reasonable house rules.
R. Each resident shall have the right to receive medical
care. The operator shall be responsible for notifying the resident's physician
of any change in the resident's health status.
S. No resident shall be obligated to perform
any task for the benefit of the operator without reasonable compensation in
accordance with all applicable Federal and State laws, except as indicated in F
above.
T. Each facility shall
permanently post a copy of the rights of residents and house rules in a
prominent place or provide documentation that each resident has been given a
copy upon admittance and when changes are made.
Section VIII RESIDENT CARE AND SUPERVISION
A. General
The operator shall provide each resident with the personal
care and supervision appropriate to his individual needs.
B. Medication
1. All medications and drugs in the care of
the operator shall be properly labeled and stored in a locked clace.
Prescription drugs shall include on the label, the name of the resident and the
prescribed dosage. Residents on prescribed medication shall be reminded to take
their medication at appropriate times.
2. If necessary, operators, as substitute
family members, may dispense medication at prescribed times.
C. Nutrition
1. Meals shall be of reasonable variety,
attractively served, family style wherever possible, and appropriate to
individual needs as determined by age, activity and physical
condition.
2. A record of all meals
served must be maintained and kept on file for seven (7) days.
3. Three nutritionally balanced meals each
day shall be provided. (See attached guidelines)
D. Emergency
The operator shall arrange appropriate medical or psychiatric
care for residents in any situation which a reasonable person would regard as
an emergency.
E.
Transportation
1. The operator shall provide
or arrange for appropriate local transportation to medical or psychiatric
services as needed.
2. The operator
shall provide or arrange for local transportation to a reasonable number of
community functions such as senior citizens, recreational programs, church
functions, fairs, parades, etc.
3.
Operators shall not be required to provide long distance transportation for
residents without charge. Local transportation, defined as trips under twenty
miles, round trip, shall be provided without charge.
F. Laundry
1. The operator shall provide laundered bed
linens, two bath towels, and one face cloth for each resident at least once per
week.
2. In case of an incontinent
resident, bed linen shall be changed whenever soiled.
3. The operator shall provide without charge
either personal laundry services for residents or laundry facilities for
resident use.
4. If a resident is
incapable of doing personal laundry, it shall be done by the operator often
enough that the resident is never without clean under-garments, outer-wear, and
bed clothes.
G. Medical
Care
1. Residents shall be encouraged to
obtain a medical examination at least once a year.
The operator shall be sufficiantly informed of specific
problems and medical limitations of residents. This requirement may be met by
keeping on file the following information on each resident to be provided to
the operator at the time of placement by the placement agency. If there is no
placement agency, the resident shall provide this information (on the basis of
a current medical examination if available).
a. Name and date of birth;
b. Name, address and telephone number of the
resident's physician;
c. Next of
kin, payee or guardian and address;
d. Social security number;
e. Allergies;
f. Significant medical conditions (heart
condition, diabetes, etc);
g. All
other significant medical information available;
h. All significant physical trauma or events
(falling, fainting, etc).
3. The operator shall be responsible for
scheduling medical appointments for each resident, if the resident cannot do so
himself.
4. Each resident shall be
allowed his own choice of physician.
5. The resident's physician, and if
applicable, his placement agency or mental health agency, shall be called at
the onset of any apparent mental or physical illness. The operator will be
knowledgeable of physicians, in the community, who would be available to
respond to the resident's health needs should his personal physician not be
available when required.
Section IX PHYSICAL ENVIRONMENT
A. General
1. The home must meet all applicable local
building codes, housing codes, zoning ordinances and regulations, the Vermont
Fire and Plumbing Codes, the Vermont Health Regulations and the Vermont
Electrical Code. In the case of conflict between local and State codes, the
more restrictive shall apply.
2.
The home shall provide a comfortable, sanitary and safe environment for
residents.
B. Comfort
For purposes of this section, the following definitions shall
apply:
Basement shall mean a portion of any dwelling located partly
underground, but having less than half its clear floor to ceiling height below
the average grade of the adjoining ground, and having a side-hung door leading
directly out to ground level.
Cellar shall mean a portion of any dwelling having half or
more than half of its clear floor to ceiling height below the average grade of
the adjoining ground.
Occupant includes the operator's family and staff, as well as
residents.
1. Sleeping
a. Rooms shall be clean and comfortable and
provision shall be made for personal possessions and equipment to the extent
possible.
* b. Bedrooms shall not
be occupied by more than two residents.
c. Each resident shall be provided with his
own bed, unless married couples choose otherwise. Members of the opposite sex
shall not be required to share a bedroom.
*
d. Bedrooms occupied by one resident shall provide a
minimum of 70 square feet.
* e.
Bedrooms occupied by two residents shall provide a minimum of 110 square
feet.
* f. No bedroom shall be
occupied by a resident which can only be reached by passing through another
resident's bedroom or through a bathroom or lavatory.
g. Only a room designated for use as a
bedroom shall be used. Halls, storerooms, cellars or unfinished attic rooms
shall not be used as bedrooms.
h. A
bedroom may be located in a basement if the floors and walls are substantially
watertight and it meets all regulations and standards.
i. A bedroom shall not be used by the
operator for any other purpose if occupied by a resident.
*
j. Each bedroom shall be fitted with a full size,
smoothly operating door that is side hung. Folding plastic doors or curtains
are not acceptable.
k. Each
resident shall have at least two bureau drawers, for clothings and other
personal belongings, and adequate closet space.
l. Bedrooms must have adequate
light.
* m. Each bedroom must have
at least one window which opens to the outdoors.
n. Beds and mattresses must be at least 36
inches wide, substantially constructed, in good repair, and comfortable.
Rollaway type beds, cots and folding beds shall not be used.
2. Toilet and bathing facilities
* a. There shall be available for use by all
occupants at least one working flush toilet, one bathtub or shower with hot and
cold running water, and one lavatory with hot and cold running water, for every
eight occupants of the home.
b. The
toilet room and bath or shower room must be ventilated by a window or exhaust
fan.
c. The base of bathtubs and
showers shall have non-slip surfaces which may be a suitable rubber
mat.
d. The toilet and bathing
facilities must afford privacy and be a separate room from any bedroom, living
area, dining area or kitchen.
3. Dining Area
a. There shall be a family dining area for
resident use large enough to accommodate all occupants of the home.
4. Living Area
a. There shall be sufficient living or
recreational area or areas large enough to accommodate all occupants of the
home.
b. The living or recreational
areas shall provide comfortable chairs, tables and lamps, a television or
radio, books, magazines, newspapers, and other forms of recreation.
C. Sanitation
1. Personal Health and Cleanliness of Staff
a. All employees shall wear clean outer
garments and shall keep their hands clean at all times while engaged in
handling food, drink, utensils or equipment.
b. Persons preparing food shall have an
annual physical examination, including a blood test and any of the recognized
tuberculin tests.
2.
Food Sanitation
All food and drink shall be sanitary, wholesome, free from
spoilage, and shall be so transferred, stored, prepared and served as to be
safe for human consumption.
3. Building and Housing Hygiene
a. The physical facility used as a community
care home shall be free from health hazards. It shall be kept clean and
comfortable and shall provide space for active recreation, as well as quiet
activities. Heat shall be at least 65 degrees F, 40 inches above the floor, and
the building shall be maintained in good repair to provide protection against
cold temperatures, drafts from the winds and leaks from the rains.
b. All habitable rooms and work areas shall
be provided with adequate lighting.
4. Water Supply
a. The water supply shall be from a source
meeting the requirements of the Vermont Department of Health. It must be tested
annually if not supplied from a municipal source.
b. Hot and cold water in adequate quantity
and pressure to meet the sanitary needs of the residence shall be supplied.
Sewage Disposal
Sewage shall be directed to a municipal type sewer or a
subsurface sewage disposal system that neets requirements of the State Health
Department.
6.
Refuse Control
All garbage and trash must be regularly removed from living
areas and stored in watertight, rodent-proof containers with tight fitting
covers. All garbage, trash, and other waste materials must be removed from the
premises at least once a week, and more often if accumulations warrant the
need.
7. Insect and Rodent
Control
All structures used for community care homes must be
reasonably free of flies, roaches, rodents, and other insects and
vermin.
8. Housekeeping
a. Equipment shall be kept clean.
b. Bedrooms shall have ventilation
capabilities. If residents are to be responsible for keeping their rooms in
order, reasonable cleanliness standards shall be set. There shall be an
adequate supply of bed linen so that beds can be changed as often as necessary
to insure cleanliness.
c. All
poisonous compounds, including those used in rodent control and for cleaning
(except the personal supplies of residents such as cosmetics and personal
hygiene supplies) must be securely stored in a place separate from food, drink,
and utensils.
D. Safety
These standards do not include specific detailed fire safety
codes, which are administered by the Fire Prevention Section, Department of
Labor and Industry (Montpelier, 828-2106). Specific fire safety requirements
applicable to a building are determined by a number of factors such as type of
construction, number of occupied levels, existing arrangements, etc.
1. An operator of a community care home shall
be licensed to serve residents who are ambulatory, capable of following
instructions, and able to leave buildings when directed to do so and when
emergency circumstances require that action.
The licensing agency shall require the facilities to
demonstrate that their referral, intake and operating policies and procedures
insure acceptance of residents who have the above capabilities.
Upon notification by the licensing agency of a community care
home with personal care having met these standards, the Department of Labor and
Industry shall apply the Residential Section, Chapter 11 of the National Fire
Safety Code in its inspection.
a.
Assurance that typical residents meet these criteria shall be conveyed by a
letter from the owner/operator to the licensing agency and/or by other
documents which serve as guidelines for the admission of residents.
(1) In exceptional cases, non-ambulatory
residents may be accepted on an individual basis if approved by the licensing
agency. Criteria to be considered would include:
(a) a determination that the home is
appropriate for the person and that there does not exist, at the time, another
more appropriate facility.
(b) a
determination that the physical characteristics of the facility with regard to
living, sleeping, eating, and other social activities, and particularly access
to exits, do not constitute, in the opinion of the licensing agency, a distinct
hazard to the person's safety or health, nor prevent him from participating
fully in the activities of the home.
(c) In order to ensure maximum protection and
assistance for approved non-ambulatory residents, the home shall develop a
written plan based on the specific needs of such residents, identifying
responsibility, procedures and actions to be undertaken to assure an orderly,
quick and safe evacuation. This plan is subject to the approval of the
licensing agency.
b. The operator shall ensure that there is
adequate assistance available at all times to assist residents to evacuate in
an emergency situation.
c. The
operator shall ensure that fire drills are held quarterly and shall cause
residents to leave building(s) by alternate routes from time to time to
familiarize them with each means of egress.
2. Heating
a. The heating system shall be inspected
annually by a qualified heating specialist and written proof of same provided,
such as is available through a heating system service contract. In no case
shall portable heaters be used, except in emergency circumstances such as
temporary heating system failures. In that case, only U.L. approved or listed
portable electrical units shall be used.
b. If parlor stoves or solid fuel burning
devices are used, instructions from Attachment No. 2 must be
followed.
c. The operator is
responsible for providing heat to all bedrooms, bathrooms, toilet rooms,
lavatories, kitchen, dining and living areas sufficient to heat them to at
least 65 [degrees] F, at all times.
3. Electrical
Documentation must be provided that all new electrical work
has been inspected by a Vermont licensed master electrician and is in
compliance with the Vermont Electrical Code. If the structure requires a waiver
of any fire safety requirements, the licensing agency may require such an
inspection and documentation for the complete electrical system. If corrections
must be made to achieve compliance, the work must be done by a Vermont licensed
electrician and such documentation must be available when corrections have been
made.
4. Exits
There shall be at least two (2) remote means of exit on each
level of occupancy, whereby in case one is blocked by smoke and/or fire, the
other can be used safely.
5. Extinguishers
Appropriate fire extinguishers shall be installed and
maintained in a usuable condition and inspected at appropriate intervals as
specified by manufacturer or local fire authorities. Operators shall consult
with their local fire authority as to type and size appropriate to the hazard
for the kitchen, furnace room, and other locations.
6. Lighting
a. There shall be at least one operating
light fixture or operator-supplied lamp in each room, including basements,
cellars, and attics.
b. Adequate
lighting shall be provided for each hall and stairway, whether inside or
outside, 24 hours a day.
7. Sleeping Rooms
If a sleeping room does not have a door leading directly to
the outside of the home, it must have an exit other than the regular entrance
way. This exit may be either a door or a window which is easily accessable to
agress.
8. General
a. Halls and exit ways shall be free from all
encumbrances and/or impediments. The interior and immediate exterior shall be
maintained free and clear of all clutter and rubbish.
b. Every closet door latch shall be a type
that cannot be locked from the inside.
c. Every bathroom door shall be designed to
permit the opening of the locked door from outside in an emergency
d. Housekeeping in general shall be
maintained in an orderly manner. Areas of storage such as attics and cellars
shall be maintained in a clean and orderly manner.
e. There shall be no portable cooking
equipment (employing flame, gasoline, kerosone or exposed electrical heating
elements) used in the home.
f. All
stairways, balconies, porches, and landings shall have railings in good repair
and shall be clear of all encumbrances.
Section X Licensing Application
& Fees
As required by VSA 18 Chapter 45, Section
2004,
operators will submit a yearly license application to the Department of Social
& Rehabilitation Services. Each application shall be accompanied by a
license fee of $ 5, plus $ 1 per resident bed, (number of residents the
facility will accommodate).
License application fees are not refundable. If an initial
application results in the granting of a license for a number of beds greater
than the number listed on the application, the facility will pay to the
licensing agency, a fee of $ 1 for each bed licensed above the number
identified on the application. Licensed facilities which increase the number of
resident beds between annual licensing periods, will be required to re-apply
and submit a $ 1 fee for each additional bed. The new license issued as a
result of the re-application will expire on the same date identified on the
annual license.
GUIDELINES FOR NUTRITION
|
Milk Group
|
two or more eight ounce cups (cheese and ice cream
supply part of this need)
|
|
Meat Group
|
two or more servings (includes meat,fish, poultry,
eggs, cooked dried beans, and peanut butter)
|
|
Fruit & Vegetables
|
four servings (including a serving of citrus fruit
or tomatoes and a dark green or yellow vegetable)
|
|
Bread and Cereal
|
four or more servings of whole grain or enriched
kinds
|
Attachment No. 1 DRAFT SUGGESTED EVACUATION PROCESSES IN CASE
OF FIRE
(1) Alert all persons in the
household regardless of the size of the fire.
(2) Call the Fire Department ___
phone.
(3) One responsible person
only use fire extinguisher and attempt to extinguish the fire.
(4) All other responsible persons begin
immediately to remove residents from the building.
(5) Ambulatory residents should be instructed
to leave building immediately and where to go after leaving.
(6) Bedfast residents in the close vicinity
to the fire and upper floors should be removed first.
(7) Do not take time to dress, if immediately
available, take a blanket and leave.
(8) Neighbors or passers-by should be
utilized to assist until arrival of the Fire Department.
(9) Never prop or wedge fire doors
open.
(10) After leaving the
building, residents should go to a prearranged destination ___ and stay there
until further instructions.
(11)
After all residents have been removed, a responsible person should check for
all residents and notify firemen of any absent.
(12) A responsible person should be the last
to leave the building.
FIRE AND FIRE DRILL INSTRUCTIONS
ALERT ALL PERSONS IN THE HOUSEHOLD REGARDLESS OF THE SIZE OF
THE FIRE.
The reason for a rule such as this is to prevent you from
making a mistake that may be fatal to you, your family, and residents. Fire is
a treacherous enemy that requires a trained eye to determine the extent or
danger involved when it raises its ugly head. What appears to be a minor little
flame that a cup of water would extinguish, may be concealing a raging furnace
within a wall, under a floor, or in an attic. The fire that appears to be
extinguished may be "playing possum" only to reappear when you least expect it
and finish its dirty work. Why take a chance with your family, and your
resident's lives. You will feel much better having had someone else check it
even if the fire is extinguished.
CALL THE FIRE DEPARTMENT
In case after case it is determined that a contributing
factor in major fires is the delay of sending an alarm. Even five minutes is
too long, for a fire can engulf the whole building in that time. Fire
departments never complain when the fire is out upon their arrival. But if it
is not, you are going to be mighty happy that they are there.
ONE RESPONSIBLE PERSON ONLY USE FIRE EXTINGUISHER AND ATTEMPT
TO EXTINGUISH THE FIRE
Of course someone should attempt to put the fire out, and
this rule may, at first, appear strange. After the alarm bell has been rung and
fire department called (or during the time these things are being done by
someone else) one responsible person should try to put the fire out using
extinguishers or taking the necessary action. The reason we say one person is,
if the fire is of such nature that extinguishers are going to put it out, one
person will probably be able to do it. If the fire is of such nature that more
than one person is required to extinguish it, then it is of sufficient size to
endanger life. Your first obligation is protecting and saving the lives
entrusted in your care. This will also avoid everyone standing around watching
one or two persons fight a fire while precious minutes are being lost, if the
building has to be evacuated.
AMBULATORY RESIDENTS SHOULD BE INSTRUCTED TO LEAVE BUILDING
IMMEDIATELY AND TOLD WHERE TO GO AFTER LEAVING
By having regular fire drills, and instructing all new
incoming residents, the ambulatory residents should know to leave the building
when they hear the alarm bell or when told to do so. They should not be
permitted to just stand around outside or wander off. A regular place to
assemble or meet is a must. There the residents can be accounted for, kept warm
and dry, receive medical or other attention, and be fed and clothed if
necessary. Large heated garages, churches, business and lodge rooms, etc. are
recommended. Strict obedience should be required of all ambulatory residents,
many of whom are similar to little children, during all drills so they will
require as little supervision as possible during any actual emergency. Instruct
any capable ambulatory residents to assist in emergencies.
NON-AMBULATORY RESIDENTS IN THE CLOSE VICINITY AND UPPER
FLOORS SHOULD BE MOVED FIRST.
Non-ambulatory residents, of course, are in great peril and
your interest is to get them all out of the building safely. The residents in
the same room as a fire or directly over the fire in the case of basement fires
are in the greatest immediate danger and should be removed first. However,
remember that heat and dangerous smoke or gases travel upward and residents on
the upper floors should be removed before residents in other rooms on the same
floor level as the fire is occurring. Fire will seldom travel laterally as fast
as it will travel in an upward path. Of course, these are general rules and it
is the responsibility of the attendant to use this as a guide to intelligent
action.
DO NOT TAKE TIME TO DRESS, TAKE A BLANKET AND LEAVE
We are not interested in either modesty or belongings. The
first thought you must have is to the protection or saving of life. If the fire
is of minor nature you and the residents will be back in the building in a
short time and will have lost no clothing or valuables. If the fire is serious,
you do not have time to worry about modesty or clothing.
NEVER PROP OR WEDGE FIRE DOORS OPEN
The fire door is required in homes to keep fire, heat, smoke
and gases from traveling from one part of the building to another. If you prop
it open you may be condemning someone to death. While you are evacuating
residents that fire door may keep another resident alive until you can return
for him or until firemen can reach him. After all the residents have been
removed from a given room, the door should be left completely closed.
NEIGHBORS OR PASSERS-BY SHOULD BE UTILIZED TO ASSIST UNTIL
ARRIVAL OF THE FIRE DEPARTMENT
Plans and requests for assistance from nearby people are
necessary before the emergency occurs. In this way the people are willing and
expect your request. This is especially true of the emergency temporary housing
of the residents. When the emergency occurs, they will come to your aid without
being called.
AFTER LEAVING THE BUILDING RESIDENTS SHOULD GO TO SOME
DESIGNATED PLACE AND STAY THERE UNTIL FURTHER INSTRUCTIONS
These arrangements must be made before the fire and
ambulatory residents should practice going there and waiting even when you have
drills. The responsible person should carry out their part of the drill by
checking the residents to avoid wandering off.
AFTER THE RESIDENTS HAVE BEEN REMOVED, A RESPONSIBLE PERSON
SHOULD CHECK FOR ALL RESIDENTS AND NOTIFY FIREMEN OF ANY ABSENT. AN ACTUAL HEAD
COUNT SHOULD BE CONDUCTED.
The reasons for this rule are obvious. If a resident is found
to be missing it should be decided whether the resident was removed from the
building, if were in the habit of returning to the building without
instructions during fire drills, and if he is still in the building, where
would he most likely go. This information should be brought to the attention of
the firemen at once. The person in charge at the time of the fire, or someone
designated by her, should keep herself available to the fire department
officers during the entire operation.
NEVER, FOR ANY REASON, RETURN TO THE BUILDING AFTER THE
EVACUATION IS COMPLETED UNTIL ORDERED TO DO SO BY ONE OF THE FIRE DEPARTMENT
OFFICERS.
EACH COMPETENT PERSON SHOULD READ THESE INSTRUCTIONS AND BE
FAMILIAR WITH THEM.
Attachment No. 2 CAUTIONS FOR WOOD OR COAL BURNERS
The Fire Prevention Section of the Department of Labor and
Industry offers the following suggestions to persons who may be considering
installing wood or coal stoves or heaters:
Do not place a stove or heater directly on a wood or other
combustible floor. It must be placed on a stove board of non-combustible
material such as 22-28 gauge sheet metal covered asbestos mill board, or on a
fire-proof cement jointed hearth, made of concrete, slate, or brick. No wall,
furniture or other combustible objects may be closer than 36" to the stove. If
1/4" asbestos millboard is used to protect the wall, the stove may be as close
as 30", and if the 1/4" asbestos millboard is covered by 28 gauge sheetmetal on
the side nearest the stove, it may be 24" from the wall. In any event, the
asbestos millboard must be placed against the wall permanently by using a one
inch non-combustible spacer to provide an air space between the millboard and
the wall.
Note: It is extremely important that you distinguish between
asbestos millboard and another which is often mistakenly suggested in place of
it, asbestos cementboard. Asbestos cementboard will not provide the protection
that asbestos millboard does and must not be used in place of it.
The stove must be connected to a masonry or brick chimney or
to an approved prefabricated flue, capable of properly venting a wood burning
heating device. If a brick or masonry chimney is used, make sure that it is
clean and in good repair. The stovepipe to a masonry chimney shall extend
through the wall of the chimney to the inner face, but not beyond the face or
the liner, and it must be firmly cemented to the masonry. A thimble may be used
for easy removal of the pipe for cleaning. The thimble must be permanently
cemented with high temperature cement. The stovepipe must not pass through any
floor or ceiling unless it is guarded by a ventilated metal thimble at least
12" larger in diameter than the stovepipe.
The pipe from the heating unit to the chimney must be lower
at the heating device end of the pipe than at the chimney end. If there is a
downward tilt to the stovepipe, this can trap flue gases, cause smoking and may
create an explosion. Pipes from the heating device to the chimney must be
securely supported and any joints in the pipe must be fastened with sheetmetal
screws, rivets, or other permanent type methods. The entire length of the pipe
shall be accessible for inspection, cleaning and replacement of parts.
Do not use a chimney flue which serves a fireplace unless the
fireplace opening has been sealed or the chimney flue which vents the fireplace
is permanently sealed below the connection from the stove up. Except when
protected with 1/4" asbestos millboard, spaced an inch away from the wall or
ceiling that it protects, a stovepipe should be located at least 18" away from
combustible materials.
One should remember that heating devices which heat by flame
require an adequate supply of oxygen, which comes from the air we breathe in
the room in which the heater is placed. Be sure adequate makeup air is provided
to the room where the heater is located. If necessary, open the window slightly
to insure enough air and to prevent the heating device from taking all the
oxygen and possibly causing injury or death to you or someone in your
family.
Remember also that the surface of any space heating device
will be hot and can start fires if clothing or other combustible materials are
placed on or too close to the unit. Warn children to keep away from such
heaters and be sure that no injuries occur.
Legs of the unit should be 4" to 6" high allowing that amount
of air flow under unit.
Place a 2" layer of sand or ashes in the bottom of the
unit.
Clean flue or stovepipe once per month unless usage is heavy.
Then clean as required.
Clean chimney spring and fall.
Be sure heating unit is clean and in good physical
condition.
Cleaning and Disposing of Ashes
Remove ashes to a metal container - pail, empty metal
wastebasket, or metal barrel.
Do not leave ashes in building, place outside and not on a
porch or in another building.
Dispose of ashes when cool.
[SEE FIGURE IN PRINTED VERSION]
Section I SCOPE AND PURPOSE
Community care is based on the concept that people who need
personal help and supervision because of physical or mental disability are
often better cared for in a supportive family setting than an institutional
one.
Community care homes with health care overview and nighttime
supervision provide personal help and supervision to people who need more than
room and board, yet less than nursing care or therapeutic treatment. Ideally,
the homes are warm and family-like in atmosphere and must be physically
comfortable and safe.
These standards are intended to preserve the home, while
insuring a basic quality of care, health, safety and human rights for their
residents.
Section II
DEFINITIONS
A. Community care home with
health care overview and nighttime supervision is defined as a place, however
named, excluding a licensed foster home, which provides, for profit or
otherwise, room, board, personal care, plus health care overview and nighttime
supervision to three or more residents unrelated to the home operator,
hereinafter called "home." The Commissioner of the Department of Social and
Rehabilitation Services may establish by rule different categories of community
care homes, based on the level of care provided.
B. Room and board is defined as including the
provision of food, laundry, shelter, utilities, and furnished sleeping and
living accommodations.
C. Personal
care is defined as helping a resident with one or more of the following:
eating, dressing, bathing, grooming, movement, or providing general supervision
available on a 24-hour basis of a resident's physical or mental well-being
(exclusive of nursing care).
D.
Operator is defined as the person or persons having the accountability and
primary responsibility for the supervision and operation of the home.
E. Resident is defined as a person unrelated
to the operator, living in the home as his primary residence, who requires
personal care and health care overview because of physical or mental
disability.
F. Licensing agency is
the Department of Social and Rehabilitation Services.
G. Nighttime supervision, in homes with 15 or
more beds, is defined as meaning that there shall be at least one responsible
employee, awake and fully dressed, on duty at all times of the day and
night.
H. Health care overview is
defined as providing, in addition to personal care, intermittent overview
performed by a licensed nurse of residents whose periodic physical and/or
mental incapacity requires preventive and maintenance related health care
services, but whose general stability does not require rehabilitative nursing
care.
Section III
WAIVERS/VARIANCES
The licensing agency may grant, at its discretion, a waiver
for any of these regulations, if
(1)
the waiver does not adversely affect the home's compliance with the intent of
these regulations,
(2) the waiver
does not adversely affect the needs of residents, and
(3) the waiver, in the opinion of the
licensing agency, does not present a clear and distinct hazard to resident's
safety, health or well-being. Standards marked with an asterisk (*) are
intended for new homes and will be waived for homes in operation on July 1,
1977, if the waiver, in the opinion of the licensing agency, does not present a
clear and distinct hazard to resident's safety, health or well-being. The
justification for granting a waiver shall be documented.
Section IV APPEALS PROCEDURE
Any community care home operator whose application for a
license is denied, or whose license is revoked, may request a fair hearing
before the Human Services Board. Fair hearing requests should be mailed to the
Vermont Human Services Board, State Office Building, Montpelier, Vermont
05602.
An oral request may be made by telephoning the Board at
828-3184.
Section V ACCESS
TO COMMUNITY CARE HOMES
The Commissioner of the Department of Social and
Rehabilitation Services shall be responsible for responding to complaints about
the operation of a community care home or the care of residents, filed by any
individual or organization. A community care home operator shall not prevent
access of the Commissioner or his designee to the home, for the purpose of
inspection or investigation of a complaint.
Section VI RESPONSIBILITIES OF OPERATOR
A. General
1. The operator shall be responsible for
managing and supervising the home and carrying out the provisions of these
regulations.
2. The operator shall
obtain and maintain a licensed status.
3. A community care home shall not operate
without a license. It is the responsibility of the operator to insure that a
license application is submitted to the licensing agency and to notify the
licensing agency of any relocation, closure or structural change to his
facility. Sixty (60) days prior notification shall be made. If an emergency
situation prevents the operator from giving the licensing agency sixty (60)
days notice of such a change, the operator shall give notice within 48 hours of
learning of the situation. Relocation of a community care home requires
submission of a new license application.
4. A licensed community care home shall not,
by name or otherwise, create the impression that it is a nursing
home.
5. The licensing agency has
the right to inspect a community care home at any reasonable time without
notice and shall have access to records necessary to verify compliance with
these regulations.
6. The operator
shall ensure that the health, safety and civil rights of the residents are
protected.
B.
Qualifications
1. The operator and staff
should be warm and accepting individuals who have an ability to both give and
accept guidance. A genuine liking and concern for people should be an
outstanding attribute.
2. The
operator and staff must exemplify ability and willingness to offer personal
guidance, to communicate effectively, and to provide good quality care for
residents. The operator and staff must have a genuine concern for people, and
be able to convey this concern to their residents.
3. The operator and staff must be physically
and emotionally capable of performing all duties required to properly supervise
and operate the home. The licensing agency may require physical or mental
evaluations at its own expense (including mileage) by impartial professionals
of its choice.
4. The operator
shall be at least 18 years of age.
C. Supervision
1. The operator shall ensure that an adult
who is capable of supervising the home and providing assistance to the
residents in an emergency is on the premises at all times residents are in the
home.
2. Upon admission, the
operator shall provide a new resident a written statement of the monthly rate
to be charged and a list of services that are included in that rate. The
statement shall be signed by both the operator and the resident.
3. The operator shall notify the Department
of Social and Rehabilitation Services (or Department of Mental Health if the
resident is under its supervision), in writing, if in the judgment of the
operator, a resident is in need of an evaluation of his ability to manage his
finances and/or property.
4. If the
operator of a community care home assumes responsibility for the management of
a resident's financial affairs, there must be written statement, signed by the
resident or his legal guardian, providing such authorization which shall be
revocable at any time by the resident or his legal guardian.
5. In cases where the operator manages a
resident's financial affairs or is helping the resident with financial
management, the operator shall keep complete documentation of all receipts and
expenditures of those funds of that resident for which the operator is
responsible. Money paid to the resident for personal expenses may be recorded
as a lump sum.
6. The operator
shall ensure that, in homes with 15 or more beds, there shall be at least one
responsible employee, awake and fully dressed, on duty at all times.
D. Operation
1. Emergency care information, including the
telephone numbers of the fire department, police department, each resident's
physician, or other physicians, and emergency and/or ambulance service, shall
be known to all staff, and kept in a readily accessible place.
2. There shall be a written plan for fire
evacuation approved by local or state fire prevention authorities and all
residents in the home shall be familiar with their responsibilities in the plan
(see attached suggested evacuation plan). The operator shall review fire
evacuation procedures formally with staff and either formally or informally
with residents at least quarterly.
3. New residents should receive fire
evacuation instructions immediately upon admission.
4. The operator shall assist each resident in
having his medical status reviewed at least annually by a physician. If a
resident does not wish to obtain a physical examination, the operator will
document that resident's decision.
5. If a resident is absent from the home, the
operator shall make a reasonable effort to assure that such resident's property
is protected from damage or loss. Resident's property shall not be removed from
the home by anyone, except upon written permission of said resident, his legal
guardian, by permission of the person who has legal custody of the resident or
upon an order of the court.
The operator shall attempt to obtain permission or
instructions concerning the disposition of property left by a former resident
by attempting to locate by mail the former resident or another appropriate
person described in the preceeding paragraph; or other interested persons such
as relatives or a facility that has received the former resident. If no release
is forthcoming within a reasonable time, but no less than ninety days from the
date of the operator's latest written effort, the operator may contribute the
property to a charitable organization. If no charity will accept the property
it may be discarded. The operator or his employees shall not acquire any
unclaimed property.
6. The
operator shall ensure that a record is maintained, listing in date order the
names of residents admitted and discharged.
7. The operator shall ensure that the
following reports are prepared and submitted:
a. A complete written report to the licensing
agency within 48 hours of every fire, serious injury or accident that occurs in
the home.
b. An annual report
containing the following information: staffing, services provided, rates,
capacity, and number of residents served during the reporting period.
8. Each home shall have at least
one telephone with at least one extension per resident-occupied floor, and
additional telephones and extensions as needed to summon help in case of fire
or other emergency. Pay station telephones are not acceptable for this
purpose.
Section
VII RIGHTS OF RESIDENTS
A. Each
resident shall enjoy family, rather than guest, dependent or employee status
within the home.
B. Each resident
shall have help in assuming as much responsibility for himself and others as
possible, and to participate in family and group activities.
C. Physical abuse, restraints, deprivation of
food, deprivation of rights and privileges, or other similar actions, shall not
be used with residents.
D. All
information concerning treatment. Past history, personal needs, and all
personal records of each resident shall be held in the strictest confidence
unless release is authorized by the resident, or when a medical emergency that
constitutes an irrediate danger to the health and safety of the resident
occurs.
E. Each resident shall have
the right to send and receive unopened mail. Writing materials, stationery and
postage shall be provided to residents at cost upon request.
Each resident shall have the right to make and receive
confidential telephone calls. Reasonable access and use of a telephone shall be
permitted upon request to the operator. Residents shall pay for all toll
calls.
F. In accordance
with Section
5,
below, every resident shall, insofar as capable, be expected to maintain his
own living area, and to participate to a reasonable degree in the usual and
customary household duties as is consistent with the resident's needs and in
accordance with a case plan agreed upon with the placing agency, if
any.
G. Every resident shall be
encouraged to maintain family and personal ties wherever appropriate.
H. Each resident shall have a secure,
confidential place to store cash and valuables, and shall control his own
money, except where a guardianship or payee exists. Any resident may request
help from the home operator with money management, in which case this request
shall be in writing. This assistance will be provided free of charge. If the
operator is serving as a payee or legal guardian, he may be reimbursed for his
services. Amount and method of reimbursement will be agreed upon between the
operator and resident and within any restrictions established by law or
regulation of Federal and/or State programs providing financial assistance to
the resident. Upon termination of residency, any money held by the operator
shall be transferred to the resident, his legal guardian, or estate within
thirty (30) days of request.
I.
Every resident shall be free to move if he so desires and shall be entitled to
help in making such a move. If the operator requires a resident to leave,
thirty (32) days advance notice shall be given to the resident, except in cases
of emergency. If the resident has a guardian or is committed to a State agency,
the operator will promptly notify the responsible individual of the resident's
desire to move. The operator shall provide assistance in making reasonable
arrangements for such a move.
If a resident chooses to leave a community care home, he
shall make every reasonable effort to provide adequate notification to the
operator. The operator shall refund to a resident money paid in advance, on a
per diem basis, provided that a notice of thirty (30) days has been given by
the resident.
J. Every
resident shall have the right to present grievances on behalf of himself or
others to the operator, the licensing agency or appropriate person(s) free from
reprisal.
K. Each resident and
staff member shall be fully informed of these rights and of all rules and
regulations concerning resident care and home responsibilities.
L. Each resident shall be informed of all
charges required by the home, and may request these charges in writing.
Residents shall be given prior notice of thirty (30) days of any change in
monthly rates or charges. If a rate change results from a change in government
reimbursement schedules, residents shall be notified promptly upon receipt of
notice by the operator.
M. Each
resident may associate and communicate privately with persons of his choice,
and may participate in activities of social, religious, and community groups at
his discretion.
N. Each resident
shall be treated with respect, kindness, and full recognition of his dignity
and individuality.
O. Resident's
civil liberties shall not be violated. The facility and its staff, to the
fullest extent possible, shall encourage and assist each resident to exercise
all rights.
P. Married couples
shall have the right to share a private room.
Q. Each resident shall have the right to
receive, entertain and communicate with any person in a private setting subject
to reasonable house rules.
R. Each resident shall have the right to receive medical
care. The operator shall be responsible for notifying the resident's physician
of any change in the resident's health status.
S. No resident shall be obligated to perform
any task for the benefit of the operator without reasonable compensation in
accordance with all applicable Federal and State laws, except as indicated in
F. above.
T. Each facility shall
permanently post a copy of the rights of residents and house rules in a
prominent place or provide documentation that each resident has been given a
copy upon admittance and when changes are made.
Section VIII RESIDENT CARE AND SUPERVISION
A. General
The operator shall provide each resident with the personal
care and supervision appropriate to his individual needs.
B. Medication
1. All medications and drugs in the care of
the operator shall be properly labeled and stored in a locked place.
Prescription drugs shall include on the label, the name of the resident and the
prescribed dosage. Residents on prescribed medication shall be reminded to take
their medication at appropriate times.
2. A record of all medications prescribed by
a physician shall be maintained for each resident. A licensed nurse will
monitor drug usage for assurance that it is in accordance with the doctor's
instruction.
C.
Nutrition
1. Meals shall be of reasonable
variety, attractively served, family style wherever possible, and appropriate
to individual needs as determined by age, activity, physical
condition.
2. A record of all meals
served must be maintained and kept on file for (7) seven days.
3. Three nutritionally balanced meals each
day shall be provided. (See attached guidelines)
D. Emergency
1. The operator shall arrange appropriate
medical or psychiatric care for residents in any situation which a reasonable
person would regard as an emergency.
2. The operator shall designate one or more
licensed physicians to be called on in an emergency and to act as general
advisor on home health matters.
E. Transportation
1. The operator shall provide or arrange for
appropriate transportation to medical or psychiatric services as
needed.
2. The operator shall
provide or arrange for transportation to a reasonable number of community
functions such as senior citizens, recreational programs, church functions,
fairs, parades, etc.
3. Operators
shall not be required to provide long distance transportation for residents
without charge. Local transportation shall be provided under twently miles,
round trip, without charge.
F. Laundry
1. The operator shall provide laundered bed
linens, two bath towels, and one face cloth for each resident at least once per
week.
2. In case of an incontinent
resident, bed linen shall be changed whenever soiled.
3. The operator shall provide without charge
either personal laundry services for residents or laundry facilities for
resident use.
4. If a resident is
incapable of doing personal laundry, it shall be done by the operator often
enough that the resident is never without clean under garments, outer wear and
bed clothes.
G. Medical
Care
1. Residents shall be encouraged to
obtain a medical examination at least once a year.
2. The operator shall be sufficiently
informed of specific problems and medical limitations of residents. This
requirement may be met by keeping on file the following information on each
resident to be provided to the operator at the time of placement by the
placement agency. If there is no placement agency, the resident shall provide
this information (on the basis of a current medical examination if available).
a. Name and date of birth;
b. Name, address, and telephone number of the
resident's physician;
c. Next of
kin, payee, or guardian and address;
d. Social security number;
e. Medications currently being
taken;
f. Allergies;
g. Significant medical conditions (heart
condition, diabetes, etc.);
h. All
other significant medical information available;
i. All significant physical trauma or events
(falling, fainting, etc.).
3. The operator shall be responsible for
scheduling medical appointments for each resident, if the resident cannot do so
himself.
4. The medical care of all
residents shall be under the supervision of a licensed physician.
5. Each resident shall be allowed his own
choice of physician.
6. The
resident's physician, and if applicable, his placement agency or mental health
agency, shall be called at the onset of any apparent mental or physical
illness. The operator will be knowledgeable of physicians, in the community,
who would be available to respond to the resident's health needs should his
personal physician not be available when required.
H. Health Care Overview
1. The operator shall ensure and document
that supervision by a licensed nurse is provided not less than:
a. 8 hours per week in homes with 19 or fewer
beds.
b. 16 hours per week in homes
with between 20 and 39 beds.
c. 24
hours per week in homes with 40 or more beds.
2. In case of prolonged or serious illness a
resident shall be transferred to licensed nursing home or hospital when so
ordered by a licensed physician.
I Dietary
1. The operator shall
ensure that residents are provided a modified diet as directed in writing by a
licensed physician.
2. The modified
diet shall be posted prominently in the kitchen.
Section IX PHYSICAL ENVIRONMENT
A. General
1. The home must meet all applicable local
building codes, housing codes, zoning ordinances and regulations, the Vermont
Fire and Plumbing Codes, the Vermont Health Regulations and the Vermont
Electrical Code. In the case of conflict between local and State codes, the
more restrictive shall apply.
2.
The home shall provide a comfortable, sanitary and safe environment for
residents.
B. Comfort
For purposes of this section, the following definitions shall
apply:
Basement shall mean a portion of any dwelling located partly
underground, but having less than half its clear floor to ceiling height below
the average grade of the adjoining ground, and having a sidehung door leading
directly out to ground level.
Cellar shall mean a portion of any dwelling having half or
more than half of its clear floor to ceiling height below the average grade of
the adjoining ground.
Occupant includes the operator's family and staff, as well as
residents.
1. Sleeping
a. Rooms shall be clean and comfortable and
provision shall be made for personal possessions and equipment to the extent
possible.
* b. Bedrooms shall not
be occupied by more than two residents.
c. Each resident shall be provided with his
own bed, unless married couples choose otherwise. Members of the opposite sex
shall not be required to share a bedroom.
*
d. Bedrooms occupied by one resident shall provide a
minimum of 70 square feet.
* e.
Bedrooms occupied by two residents shall provide a minimum of 110 square
feet.
* f. No bedroom shall be
occupied by a resident which can only be reached by passing through another
resident's bedroom or through a bathroom or lavatory.
g. Only a room designated for use as a
bedroom shall be used. Halls, storerooms, cellars or unfinished attic rooms
shall not be used as bedrooms.
h. A
bedroom may be located in a basement if the floors and walls are substantially
watertight and it meets all regulations and standards.
i. A bedroom shall not be used by the
operator for any other purpose if occupied by a resident.
*
j. Each bedroom shall be fitted with a full size,
smoothly operating door that is side hung. Folding plastic doors or curtains
are not acceptable.
k. Each
resident shall have at least two bureau drawers, for clothing and other
personal belongings, and adequate closet space.
l. Bedrooms must have adequate
light.
* m. Each bedroom must have
at least one window which opens to the outdoors.
n. Beds and mattresses must be at least 36
inches wide, substantially constructed, in good repair, and comfortable.
Rollaway type beds, cots and folding beds shall not be used.
2. Toilet and bathing facilities
* a. There shall be available for use by all
occupants at least one working flush toilet, one bathtub or shower with hot and
cold running water, and one lavatory with hot and cold running water, for every
eight occupants of the home.
b. The
toilet room and bath or shower room must be ventilated by a window or exhaust
fan.
c. The base of bathtubs and
showers shall have non-slip surfaces which may be a suitable rubber
mat.
d. The toilet and bathing
facilities must afford privacy and be a separate room from any bedroom, living
area, dining area or kitchen.
e.
Hand or grab rails shall be provided in toilet rooms, shower stalls, and near
bathtubs.
3. Dining Area
There shall be a family dining area for resident use large
enough to accommodate all occupants of the home.
4. Living Area
a. There shall be sufficient living or
recreational area or areas large enough to accommodate all occupants of the
home.
b. The living or recreational
areas shall provide comfortable chairs, tables and lamps, a television or
radio, books, magazines, newspapers, and other forms of recreation.
C. Sanitation
1. Personal Health and Cleanliness of Staff
a. All employees shall wear clean outer
garments and shall keep their hands clean at all times while engaged in
handling food, drink, utensils or equipment.
b. Persons preparing food shall have an
annual physical examination, including a blood test and any of the recognized
tuberculin tests.
2.
Food Sanitation
All food and drink shall be sanitary, wholesome, free from
spoilage, and shall be so transferred, stored, prepared and served as to be
safe for human consumption.
3. Building and Housing Hygiene
a. The physical facility used as a community
care home shall be free from health hazards. It shall be kept clean and
comfortable and shell provide space for active recreation, as well as quiet
activities. Heat shall be at least 65 degrees F, 40 inches above the floor, and
the building shall be maintained in good repair to provide protection against
cold temperatures, drafts from the winds and leaks from the rains.
b. All habitable rooms and work areas shall
be provided with adequate lighting.
4. Water Supply
a. The water supply shall be from a source
meeting the requirements of the Vermont Department of Health. It must be tested
annually by the Department of Health if not supplied from a municipal
source.
b. Hot and cold water in
adequate quantity and pressure to meet the sanitary needs of the residence
shall be supplied.
5.
Sewage Disposal
Sewage shall be directed to a municipal type sewer or a
subsurface sewage disposal system that meets requirements of the State Health
Department.
6. Refuse
Control
All garbage and trash must be regularly removed from living
areas and stored in watertight, rodent-proof containers with tight fitting
covers. All garbage, trash and other waste materials must be removed from the
premises at least once a week, and more often if accumulations warrant the
need.
7. Insect and Rodent
Control
All structures used for community care homes must be
reasonably free of flies, roaches, rodents, and other insects and
vermin.
8. Housekeeping
a. Equipment shall be kept clean.
b. Bedrooms shall have ventilation
capability. If residents are to be responsible for keeping their rooms in
order, reasonable cleanliness standards shall be set. There shall be an
adequate supply of bed linen so that beds can be changed as often as necessary
to insure cleanliness.
c. All
poisonous compounds, including those used in rodent control and for cleaning
(except the personal supplies of residents such as cosmetics and personal
hygiene supplies) must be securely stored in a place separate from food, drink,
and utensils.
D. Safety
These standards do not include specific detailed fire safety
codes, which are administered by the Fire Prevention Section, Department of
Labor and Industry (Montpelier, 828-2106). Specific fire safety requirements
applicable to a building are determined by a number of factors such as type of
construction, number of occupied levels, exiting arrangements, etc.
1. Evacuation
The operator shall insure that there is adequate assistance
available at all times to assist residents to evacuate in an
emergency-situation.
2.
Heating
a. The heating system shall be
inspected annually by a qualified heating specialist and written proof of same
provided, such as is available through a heating system service contract. In no
case shall portable heaters be used, except in emergency circumstances such as
temporary heating system failures. In that case, only U.L. approved or listed
portable electrical units. shall be used.
b. If parlor stoves or solid fuel burning
devices are used, instructions from Attachment No. 2 must be
followed.
c. The operator is
responsible for providing heat to all bedrooms, bathrooms, toilet rooms,
lavatories, kitchen, dining and living areas sufficient to heat them to at
least 65 degrees F. at all times.
3. Electrical
Documentation must be provided that all new electrical work
has been inspected by a Vermont licensed master electrician and is in
compliance with the Vermont Electrical Code. If the structure requires a waiver
of any fire safety requirements, the licensing agency may require such an
inspection and documentation for the complete electrical system. If corrections
must be made to achieve compliance, the work must be done by a Vermont licensed
electrician and such documentation must be available when corrections have been
made.
4. Exits
There shall be at least two (2) remote means of exit on each
level of occupancy, whereby in case one is blocked by smoke and/or fire, the
other can be used safely.
5. Extinguishers
Appropriate fire extinguishers shall be installed and
maintained in a usable condition, and inspected at appropriate intervals as
specified by manufacturers or local fire authorities. Operators shall consult
with their local fire authority as to type and size appropriate to the hazard
for the kitchen, furnace room, and other locations. (See Attachment No.
3.)
6. Lighting
a. There shall be at least one operating
light fixture or operated-supplied lamp in each room, including basements,
cellars and attics.
b. Adequate
lighting shall be provided for each hall and stairway, whether inside or
outside, 24 hours a day.
7. Sleeping Rooms
If a sleeping room does not have a door leading directly to
the outside of the home, it must have an exit other than the regular entrance
way. This exit may be either a door or a window which is easily accessable to
egress.
8. General
a. Halls and exit ways shall be free from all
encumbrances and/or impediments. The interior and immediate exterior shall be
maintained free and clear of all clutter and rubbish.
b. Every closet door latch shall be a type
that cannot be locked from the inside.
c. Every bathroom door shall be designed to
permit the opening of the locked door from outside in an emergency.
d. Housekeeping in general shall be
maintained in an orderly manner. Areas of storage such as attics and cellars
shall be maintained in a clean and orderly manner.
e. There shall be no portable cooking
equipment (employing flame, gasoline, kerosene, or exceed electrical heating
elements) used in the home.
All stairways, balconies, porches, and landings shall have
railings in good repair and shall be clear of all encumbrances.
GUIDELINES FOR NUTRITION
|
Milk Group
|
two or more eight ounce cups (cheese and ice cream
supply part of this need)
|
|
Meat Group
|
two or more servings (includes meat,fish, poultry,
eggs, cooked dried beans, and peanut butter)
|
|
Fruit & Vegetables
|
four servings (including a serving of citrus fruit
or tomatoes and a dark green or yellow vegetable)
|
|
Bread and Cereal
|
four or more servings of whole grain or enriched
kinds
|
Attachment No. 2 DRAFT SUGGESTED EVACUATION PROCEDURES IN
CASE OF FIRE
(1) Alent all persons in
the household regardless of the size of the fine.
(2) Call the Fine Department ___
phone.
(3) One responsible person
only use fine extinguisher and attempt to extinguish the fine.
(4) All other responsible persons begin
immediately to remove residents from the building.
(5) Ambulatony residents should be instnucted
to leave building immediately and where to go aften leaving.
(6) Bedfast residents in the close vicinity
to the fire and upper floors should be removed first.
(7) Do not take time to dress, if immediately
available, take a blanket and leave.
(8) Neighbors or passer-by should be utilized
to assist until arrival of the Fine Depantment.
(9) Neven prop or wedge fire doors
open.
(10) Aften leaving the
building, residents should go to prearranged destination ___ and stay there
until further instructions.
(11)
Aften all residents have been removed, a responsible person should check for
all residents and notify firemen of any absent.
(12) A responsible person should be the last
to leave the building.
FIRE AND FIRE DRILL INSTRUCTIONS
ALERT ALL PERSONS IN THE HOUSEHOLD REGARDLESS OF THE SIZE OF
THE FIRE.
The reason for a rule such as this is to prevent you from
making a mistake that may be fatal to you, your family, and residents. Fire is
a treacherous enemy that requires a trained eye to determine the extent or
danger involved when it raises its ugly head. What appears to be a minor little
flame that a cup of water would extinguish, may be concealing a raging furnace
within a wall, under a floor, or in an attic. The fire that appears to be
extinguished may be "playing possum" only to reappear when you least expect it
and finish its dirty work. Why take a chance with your family, and your
resident's lives. You will feel much better having had someone else check it
even if the fire is extinguished.
CALL THE FIRE DEPARTMENT
In case after case it is determined that a contributing
factor in major fires is the delay of sending an alarm. Even five minutes is
too long, for a fire can engulf the whole building in that time. Fire
departments never complain when the fire is out upon their arrival. But if it
is not, you are going to be mighty happy that they are there.
ONE RESPONSIBLE PERSON ONLY USE FIRE EXTINGUISHER AND ATTEMPT
TO EXTINGUISH THE FIRE
Of course someone should attempt to put the fire out, and
this rule may, at first, appear strange. After the alarm bell has been rung and
fire department called (or during the time these things are being done by
someone else) one responsible person should try to put the fire out using
extinguishers or taking the necessary action. The reason we say one person is,
if the fire is of such nature that extinguishers are going to put it out, one
person will probably be able to do it. If the fire is of such nature that more
than one person is required to extinguish it, then it is of sufficient size to
endanger life. Your first obligation is protecting and saving the lives
entrusted in your care. This will also avoid everyone standing around watching
one or two persons fight a fire while precious minutes are being lost, if the
building has to be evacuated.
AMBULATORY RESIDENTS SHOULD BE INSTRUCTED TO LEAVE BUILDING
IMMEDIATELY AND TOLD WHERE TO GO AFTER LEAVING
By having regular fire drills, and instructing all new
incoming residents, the ambulatory residents should know to leave the building
when they hear the alarm bell or when told to do so. They should not be
permitted to just stand around outside or wander off. A regular place to
assemble or meet is a must. There the residents can be accounted for, kept warm
and dry, receive medical or other attention, and be fed and clothed if
necessary. Large heated garages, churches, business and lodge rooms, etc. are
recommended. Strict obedience should be required of all ambulatory residents,
many of whom are similar to little children, during all drills so they will
require as little supervision as possible during any actual emergency. Instruct
any capable ambulatory residents to assist in emergencies.
NON-AMBULATORY RESIDENTS IN THE CLOSE VICINITY AND UPPER
FLOORS SHOULD BE MOVED FIRST.
Non-ambulatory residents, of course, are in great peril and
your interest is to get them all out of the building safely. The residents in
the same room as a fire or directly over the fire in the case of basement fires
are in the greatest immediate danger and should be removed first. However,
remember that heat and dangerous smoke or gases travel upward and residents on
the upper floors should be removed before residents in other rooms on the same
floor level as the fire is occurring. Fire will seldom travel laterally as fast
as it will travel in an upward path. Of course, these are general rules and it
is the responsibility of the attendant to use this as a guide to intelligent
action.
DO NOT TAKE TIME TO DRESS, TAKE A BLANKET AND LEAVE
We are not interested in either modesty or belongings. The
first thought you must have is to the protection or saving of life. If the fire
is of minor nature you and the residents will be back in the building in a
short time and will have lost no clothing or valuables. If the fire is serious,
you do not have time to worry about modesty or clothing.
NEVER PROP OR WEDGE FIRE DOORS OPEN
The fire door is required in homes to keep fire, heat, smoke
and gases from traveling from one part of the building to another. If you prop
it open you may be condemning someone to death. While you are evacuating
residents that fire door may keep another resident alive until you can return
for him or until firemen can reach him. After all the residents have been
removed from a given room, the door should be left completely closed.
NEIGHBORS OR PASSERS-BY SHOULD BE UTILIZED TO ASSIST UNTIL
ARRIVAL OF THE FIRE DEPARTMENT
Plans and requests for assistance from nearby people are
necessary before the emergency occurs. In this way the people are willing and
expect your request. This is especially true of the emergency temporary housing
of the residents. When the emergency occurs, they will come to your aid without
being called.
AFTER LEAVING THE BUILDING RESIDENTS SHOULD GO TO SOME
DESIGNATED PLACE AND STAY THERE UNTIL FURTHER INSTRUCTIONS
These arrangements must be made before the fire and
ambulatory residents should practice going there and waiting even when you have
drills. The responsible person should carry out their part of the drill by
checking the residents to avoid wandering off.
AFTER THE RESIDENTS HAVE BEEN REMOVED, A RESPONSIBLE PERSON
SHOULD CHECK FOR ALL RESIDENTS AND NOTIFY FIREMEN OF ANY ABSENT. AN ACTUAL HEAD
COUNT SHOULD BE CONDUCTED.
The reasons for this rule are obvious. If a resident is found
to be missing it should be decided whether the resident was removed from the
building, if were in the habit of returning to the building without
instructions during fire drills, and if he is still in the building, where
would he most likely go. This information should be brought to the attention of
the firemen at once. The person in charge at the time of the fire, or someone
designated by her, should keep herself available to the fire department
officers during the entire operation.
NEVER, FOR ANY REASON, RETURN TO THE BUILDING AFTER THE
EVACUATION IS COMPLETED UNTIL ORDERED TO DO SO BY ONE OF THE FIRE DEPARTMENT
OFFICERS.
EACH COMPETENT PERSON SHOULD READ THESE INSTRUCTIONS AND BE
FAMILIAR WITH THEM.
Attachment No. 2 CAUTIONS FOR WOOD OR COAL BURNERS
The Fire Prevention Section of the Department of Labor and
Industry offers the following suggestions to persons who may be considering
installing wood or coal stoves or heaters:
Do not place a stove or heater directly on a wood or other
combustible floor. It must be placed on a stove board of non-combustible
material such as 22-28 gauge sheet metal covered asbestos mill board, or on a
fire-proof cement jointed hearth, made of concrete, slate, or brick. No wall,
furniture or other combustible objects may be closer than 36" to the stove. If
1/4" asbestos millboard is used to protect the wall, the stove may be as close
as 30", and if the 1/4" asbestos millboard is covered by 28 gauge sheetmetal on
the side nearest the stove, it may be 24" from the wall. In any event, the
asbestos millboard must be placed against the wall permanently by using a one
inch noncombustible spacer to provide an air space between the millboard and
the wall.
Note: It is extremely important that you distinguish between
asbestos millboard and another which is often mistakenly suggested in place of
it, asbestos cementboard. Asbestos cementboard will not provide the protection
that asbestos millboard does and must not be used in place of it.
The stove must be connected to a masonry or brick chimney or
to an approved prefabricated flue, capable of properly venting a wood burning
heating device. If a brick or masonry chimney is used, make sure that it is
clean and in good repair. The stovepipe to a masonry chimney shall extend
through the wall of the chimney to the inner face, but not beyond the face or
the liner, and it must be firmly cemented to the masonry. A thimble may be used
for easy removal of the pipe for cleaning. The thimble must be permanently
cemented with high temperature cement. The stovepipe must not pass through any
floor or ceiling unless it is guarded by a ventilated metal thimble at least
12" larger in diameter than the stovepipe.
The pipe from the heating unit to the chimney must be lower
at the heating device end of the pipe than at the chimney end. If there is a
downward tilt to the stovepipe, this can trap flue gases, cause smoking and may
create an explosion. Pipes from the heating device to the chimney must be
securely supported and any joints in the pipe must be fastened with sheetmental
screws, rivets, or other permanent type methods. The entire length of the pipe
shall be accessible for inspection, cleaning and replacement of parts.
Do not use a chimney flue which serves a fireplace unless the
fireplace opening has been sealed or the chimney flue which vents the fireplace
is permanently sealed below the connection from the stove up. Except when
protected with 1/4" asbestos millboard, spaced an inch away from the wall or
ceiling that it protects, a stovepipe should be located at least 18" away from
combustible materials.
One should remember that heating devices which heat by flame
require an adequate supply of oxygen, which comes from the air we breathe in
the room in which the heater is placed. Be sure adequate makeup air is provided
to the room where the heater is located. If necessary, open the window slightly
to insure enough air and to prevent the heating device from taking all the
oxygen and possibly causing injury or death to you or someone in your
family.
Remember also that the surface of any space heating device
will be hot and can start fires if clothing or other combustible materials are
placed on or too close to the unit. Warn children to keep away from such
heaters and be sure that no injuries occur.
Legs of the unit should be 4" to 6" high allowing that amount
of air flow under unit.
Place a 2" layer of sand or ashes in the bottom of the
unit.
Clean flue or stovepipe once per month unless usage is heavy.
Then clean as required.
Clean chimney spring and fall.
Be sure heating unit is clean and in good physical
condition.
Cleaning and Disposing of Ashes
Remove ashes to a metal container - pail, empty metal
wastebasket, or metal barrel.
Do not leave ashes in building, place outside and not on a
porch or in another building.
Dispose of ashes when cool.
[SEE FIGURE IN PRINTED VERSION]
DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES (HIGHER
LEVEL) (SOCIAL SECURITY ADMINISTRATION CODE F)
AUTHORITY
Pursuant to 18 VSA § 2014, regulations governing the
standards of care, program, administration and sanitation of community care
homes with health care overview and nighttime supervision are hereby
promulgated.
These regulations do not govern the standards of care,
program, administration or sanitation of lower level (SSA Code G) community
care homes.
