Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment changes the rule title,
updates environmental and safety requirements, and adds criteria for an
emergency preparedness plan. Requirements for residential facilities are being
moved to 9 CSR 10-3, Substance Use Disorder Treatment Programs.
PURPOSE: This rule describes requirements for the
physical environment and safety in Opioid Treatment Programs, Substance Use
Disorder Treatment Programs, Comprehensive Substance Treatment and
Rehabilitation Programs (CSTAR), Gambling Disorder Treatment Programs, Recovery
Support Programs, Substance Awareness Traffic Offender Programs (SATOP),
Required Education Assessment and Community Treatment Programs (REACT),
Community Psychiatric Rehabilitation Programs (CPRP), and Outpatient Mental
Health Treatment Programs.
(1) General Requirements. The organization
shall provide services in an environment that ensures the health, safety, and
security of individuals served, staff, and others.
(A) All buildings used for programmatic
activities shall meet applicable state and local fire safety, building,
occupancy, and health requirements.
(B) The organization shall maintain
documentation on site of all inspections and correction of any cited
deficiencies to assure compliance with applicable state and local fire safety,
building, and health requirements.
(C) A currently certified/deemed organization
that relocates any program into a new physical environment or constructs an
addition to an existing building(s) must ensure the new location and/or
building(s) comply with this rule in order to maintain certification/deemed
status by the department.
(2) Physical Access. Individuals must be able to
readily access the organization's services. The organization shall demonstrate
an ability to remove architectural and other barriers that may confront
individuals otherwise eligible for services.
(3) Adequate Space and Furnishings. Individuals are
served in an environment with adequate space, equipment, and furnishings for
all program activities and for maintaining privacy and confidentiality.
(A) In keeping with the specific purpose of
the service, the organization shall make available-
1. A reception/waiting area that safely
accommodates individuals served and visitors to the program;
2. Private areas for confidential individual
and group services;
3. An area(s)
for indoor social and recreational activities; and
4. Restrooms in adequate number to meet the
needs of individuals served.
5.
Separate toilet facilities for each sex, except where reasonable evidence is
shown to the department that this is not necessary.
(B) The use of televisions, cell phones,
computers, laptops, or other electronic devices shall not interfere with the
therapeutic program.
(4) Environment. Individuals are served in an
environment that is clean and comfortable and in safe and proper operating
condition. The organization shall-
(A)
Provide adequate and comfortable lighting;
(B) Maintain heating, ventilation, and
cooling systems to ensure a temperature-controlled environment that meets the
reasonable comfort needs of individuals served;
(C) Provide screens on outside doors and
windows if they are to be kept open;
(D) Provide effective pest control
measures;
(E) Store trash and
garbage in covered containers that are removed on a regular basis;
(F) Maintain the facility to be free of
undesirable odors;
(G) Provide
stocked, readily accessible first-aid supplies; and
(H) Take measures to prevent, detect, and
control infections among individuals and personnel, and have protocols for
proper treatment and training of staff, individuals served, and
others.
(5) Off-Site
Functions. If the organization offers services at locations in the community
other than at its physical facility location(s), usual and reasonable
precautions shall be taken to ensure the safety of individuals participating in
services at off-site locations.
(6) Emergency Preparedness and Safety. In keeping with
the specific purpose of the service(s) provided, the organization shall have a
written emergency preparedness plan to maintain continuity of its operations in
preparation for, during, and after an emergency or disaster. Consultation with
the local Federal Emergency Management Agency or other recognized resource for
emergency planning and preparedness in developing the plan is recommended.
(A) The emergency preparedness plan shall
include, but is not limited to, potential medical emergencies, natural
disasters, fires, bomb threats, utility failures, and violent or other
threatening situations. The plan shall be posted and accessible at all times,
at all program locations.
(B) The
plan shall include, but is not limited to-
1.
When evacuation is necessary;
2.
Complete evacuation from each physical facility with a designated gathering
point;
3. When sheltering in place
is appropriate and any additional steps necessary to ensure safety (such as
sealing a room);
4. The safety and
accounting for all persons involved, including responsible staff;
5. Temporary shelter when
applicable;
6. Identification of
essential services;
7. Continuation
of essential services when applicable; and
8. Notification of the appropriate emergency
authorities.
(C)
Evacuation routes with diagrams giving clear directions on how to exit the
building safely and in a timely manner shall be posted in locations easily
accessible to individuals served, staff, and visitors.
(D) Staff shall demonstrate knowledge and
ability to implement the emergency preparedness plan and, where applicable, the
evacuation plan.
(E) Unannounced
tests/drills of all emergency procedures shall be conducted at least annually
on each shift and at each program location. Results of all tests/drills shall
be reviewed and documented with corrective action taken, as needed, including
training and education of staff.
(7) Hazard Prevention, Detection, and Safety
Equipment. The organization shall maintain fire and other safety equipment in
proper operating condition and implement practices to protect all individuals
from fire, smoke, harmful fumes, and other safety hazards. An annual inspection
in accordance with the Life Safety Code of the National Fire Protection
Association (NFPA) shall be conducted.
(A)
Organizations shall maintain a fire detection and notification system that
detects smoke, fumes and/or heat and sounds an alarm that can be heard
throughout the premises, above the noise of normal activities, radios, and
televisions.
(B) Portable ABC
-rated fire extinguishers shall be located on each floor used by individuals
being served as specified by the local authority. Additional fire extinguishers
shall be located in or near the kitchen, laundry room, furnace room, and other
areas as recommended by the local authority.
(C) Fire extinguishers shall be clearly visible and
maintained with a charge.
(D) Each
floor used by individuals served shall have at least two (2) means of exit that
are independent of and remote from one another.
1. Outside fire escape stairs may constitute
one (1) means of exit in existing buildings. Fire escape ladders shall not
constitute one (1) of the required means of exit.
2. The means of exit shall be free of any
item that would obstruct the exit route.
3. Outside stairways shall be kept clear and
be substantially constructed to support people during evacuation. Newly
constructed fire exits shall meet requirements of the NFPA Life Safety
Code.
4. Outside stairways shall be
reasonably protected against blockage by a fire. This may be accomplished by
physical separation, distance, arrangement of the stairs, protection of
openings, exposing the stairs, or other means acceptable to the local
authority.
5. Outside stairways in
buildings with three (3) or more stories shall be constructed of noncombustible
material, such as iron or steel.
(E) Unless otherwise determined by the local
authority, based on a facility's overall size and use, the requirement of two
(2) or more means of exit on each floor may be waived for sites that meet each
of the following conditions:
1. Do not offer
overnight sleeping accommodations;
2. Do not cook meals on a regular basis;
and
3. Do not provide services
on-site to twenty (20) or more individuals at a given time as a usual and
customary pattern of service delivery.
(F) Combustible supplies and equipment such as oil
base paint, paint thinner, and gasoline, shall be separated from other parts of
the building in accordance with stipulations of the local authority.
(G) Smoke detectors shall be installed in
accordance with the recommendations of the NFPA codes and be functional at all
times.
1. If the program serves individuals
who are deaf, the smoke detectors must have an alarm system designed for
hearing-impaired persons as specified by the NFPA codes.
(H) Organizations using equipment or
appliances that pose a potential carbon monoxide risk shall install a carbon
monoxide detector(s) as specified by the NFPA codes. Carbon monoxide detectors
must be functional at all times.
(I) All staff of the organization must be
trained and demonstrate the ability to operate the organization's fire alarm
system, fire extinguishers, and other safety devices.
(J) The NFPA codes shall prevail in the interpretation
of these fire safety standards.
(K)
The organization shall maintain a smoke-free environment.
(8) Safe Transportation. The organization
shall ensure transportation for individuals served is provided in a safe and
accessible manner as applicable.
(A) All
vehicles used by the organization to transport persons served shall have-
1. Regular inspection and maintenance as
legally required; and
2. Adequate
first-aid supplies and fire suppression equipment secured in any van, bus, or
other vehicle used to transport more than four (4) individuals. Staff operating
such a vehicle shall have training in emergency procedures and the handling of
accidents and road emergencies and have access to a cell phone or other
communication device in the vehicle.
(B) All staff who transport persons served
shall be properly licensed with driving records acceptable to the
agency.
(C) All vehicles used to
transport individuals served shall be properly registered and
insured.
(D) Organizations that
provide transportation for children shall comply with state and federal car
seat laws and regulations.
(E) If
transportation services are contracted, the organization shall conduct an
annual review to ensure the contractor meets the requirements in subsections
(A) through (D) of this section.
*Original authority: 630.050, RSMo 1980, amended 1993, 1995
and 630.055, RSMo 1980.
