6 Colo. Code Regs. § 1011-1-4.3

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1011-1-4.3 - Standards for Acute Treatment Services

4.3.1 The BHE shall ensure the admission, assessment, service planning, and discharge requirements in Part 2.6 are met, with the following additions:

(A) The BHE shall ensure clients admitted for acute treatment services are age eighteen (18) years or older, in need of psychiatric care, and cannot be appropriately treated in a less restrictive setting.

(B) Client stays shall generally be seven (7) days or fewer, but may be extended when such extension is determined to be the most appropriate course of treatment based on an updated client assessment and service plan, as follows:

(1) When extending a client stay in the acute treatment services setting, the client shall be assessed for continued appropriateness for treatment in the acute setting at least every three (3) days.

(2) When a client's assessment indicates the client should be transferred to a different setting but placement in that setting is delayed due to lack of availability, the BHE shall document that in the service plan, and continue to reassess the client in accordance with subpart (A), above.

(3) Assessments for continued stays in the acute treatment services setting past ten (10) days shall include consideration regarding whether the client would be more appropriately served, and should be transferred to, a different level of care.

(4) The length of stay in the acute treatment services setting shall not exceed forty-five (45) days.

(C) A client may only be admitted into a locked setting if there is no less restrictive appropriate alternative.

(D) A client may be admitted into a locked setting on a voluntary basis, as long as the following requirements are met and the client signs a form that documents the following:

(1) The client is aware the setting is locked.

(2) The client has the ability to exit the setting with staff assistance and/or permission.

(E) A client who is an imminent danger to self or others shall only be admitted to acute treatment services upon completion of the BHE's assessment and determination that the client's safety and the safety of others can be maintained.

(F) If a client is admitted and BHE personnel subsequently determine the client's behavior cannot be safely and successfully treated in the acute treatment services location, the BHE shall make arrangements to transfer the client to the nearest hospital or other appropriate level of care for further assessment and evaluation.

(G) The BHE shall have policies that identify when a client requires a physical health assessment by a qualified licensed practitioner, including, but not limited to:

(1) Within twenty-four (24) hours of admission,

(2) When there is a significant change in the client's condition,

(3) When a client has evidence of a possible infection, such as swelling or open sores,

(4) When the client experiences an injury or accident that might cause a change in condition,

(5) When the client has known exposure to a communicable disease, or

(6) When a client develops any condition that would have initially precluded admission to the acute treatment service setting.

(H) The BHE shall ensure the client's service plan is created within twenty-four (24) hours after admission. Such service plan shall include any special dietary instructions, physical or cognitive limitations, and a description of the services which the BHE will provide to meet the needs identified in the client's assessment(s).

(1) The client may request a modification of the services identified in the service plan at any time.

(2) The service plan shall include goals of the acute treatment services stay and standards to be met for discharge.

4.3.2 The BHE shall ensure acute treatment services meet oversight, personnel, and training requirements in accordance with Part 2, with the following additions:

(A) The Administrator shall have training in assessment skills, nutrition, and identifying and dealing with difficult situations and behavior management, and be responsible for the overall direction and supervision of staff.

(B) The Clinical Director shall have training in assessment and identifying and treating individuals who display behaviors that are common to individuals with severe and persistent mental health disorders.

(C) The BHE shall ensure the staffing level in each physical location providing acute treatment services is adequate to provide services to meet the needs of the clients at the location, in accordance with the clients' service plans.

4.3.3 The BHE shall ensure compliance with Part 2.9 of this Chapter, regarding medication administration, storage, handling, and disposal, with the following additions or exceptions:

(A) Clients shall not self-administer medications in the acute treatment setting.

(B) The client shall surrender all personal medication upon admission, which shall be inventoried and documented according to Part 4.1.5(B)(1).

(C) Personal medication for which a client has a current, valid prescription, shall be returned to the client upon discharge, unless clinically contraindicated.

(D) Prescription and over the counter medication shall not be kept in stock or bulk quantities unless such medication is administered by a licensed practitioner.

4.3.4 The BHE may, but is not required to, allow clients to self-administer oxygen while receiving acute treatment services. If self-administration is allowed, the BHE shall have policies and procedures regarding the administration of oxygen, including but not limited to the following:

(A) Clients may self-administer oxygen if the oxygen was prescribed by a physician and a determination has been made that the client is capable of self-administration.

(B) Staff shall assist with the administration as needed for safety.

(C) The BHE shall ensure oxygen is stored and handled in compliance with state and local regulations.

4.3.5 The BHE shall establish written house rules for the acute treatment services setting which do not violate or contradict rules found in this Chapter 3, and which do not restrict an individual's rights. Such house rules shall be provided to the client upon admission, and be prominently posted at the location services are provided.

4.3.6 Alternate Building Standards. The following building standards shall apply only to the physical locations in which acute treatment services are provided and which were licensed as an Acute Treatment Unit under 6 CCR 1011-1, Chapter 6, prior to July 1, 2021.

(A) Such locations shall comply with the standards included in this Part 4.3.6, until such time as an FGI compliance review is triggered in accordance with Part 2.2.1(B), at which time FGI shall apply only to the impacted areas while the remaining areas continue to comply with Part 4.3.6.

(B) The interior environment shall be clean and sanitary, free of hazards to health and safety, including:

(1) Layout, finishes, and furnishings shall minimize the opportunity for residents to injure themselves or others.

(2) Interior areas, finishes, and furnishings shall be maintained in good repair and promote sanitary conditions. All spaces shall have adequate heat, lighting, and ventilation sufficient for its intended use and client needs.

(3) Windows that can be accessed by clients shall have security glazing or other appropriate security features to reduce the possibility of injury or elopement.

(4) Items/substances that could be used for self-harm or harm to others, including, but not limited to, sharp knives and cleaning solutions, shall be appropriately labelled and stored in a safe manner, inaccessible to clients.

(5) The physical location shall be maintained free of infestations of insects and rodents and all openings to the outside shall be screened.

(6) An adequate supply of safe, potable water shall be available.

(7) Hot water shall not be more than 120 degrees Fahrenheit at taps which are accessible by clients, and there shall be a sufficient supply of hot water to meet the needs during peak usage.

(C) The BHE shall provide a clean, sanitary, and secure exterior environment for the year-round use of clients, free of hazards to health and safety.

(1) Exterior areas shall be maintained to prevent hazardous slopes, holes, or other hazards, and shall be kept free of high weeds and grass, garbage, and/or rubbish.

(2) Secure outdoor areas shall be fenced or enclosed to prevent elopement and protect the safety and security of clients.

(D) The BHE shall ensure the following standards are met regarding the physical plant of the acute treatment services location:

(1) The location shall be in compliance with all applicable:

(a) Local zoning, housing, fire, and sanitary codes and ordinances of the city, city and county, or county where the location is situated to the extent that such codes are consistent with federal law.

(b) State and local plumbing laws and regulations, including that plumbing shall be maintained in good repair, free of the possibility of backflow and backsiphonage through the use of vacuum breakers and fixed air gaps, in accordance with state and local codes.

(c) Sewage disposal requirements, including that sewage shall be discharged into a public sewer system or disposed of in a manner approved by the local health department, or local laws if no local health department exists, and the Colorado Water Quality Control Commission.

(2) The BHE shall have common areas adequate to accommodate all clients, including a designated dining area capable of seating all clients, and meeting the following accessibility requirements:

(a) All common areas and dining areas shall be accessible to clients using an auxiliary aid without requiring transfer from a wheelchair to walker or from a wheelchair to a regular chair.

(b) Doors to the accessible rooms shall be at least thirty-two (32) inches wide.

(c) A minimum of two entryways shall be provided for access and egress from the building by clients using a wheelchair.

(3) The following requirements shall be met for bedrooms:

(a) No client shall be assigned to any room other than a regularly designated bedroom. Temporary occupancy of a room not designated as a bedroom is permissible on a limited basis when the use of the assigned bedroom is contraindicated due to circumstances related to client safety or emergent issues. Justification for such placement, and the length of placement, shall be documented in the client record.

(b) No more than two (2) clients shall occupy a bedroom.

(c) Each designated bedroom shall have at least 100 square feet for a single occupant, or 120 square feet for a double occupancy bedroom. Bathroom areas and closets shall not be included in the determination of square footage.

(d) Each client shall have separate storage facilities adequate for personal articles, such as a closet or locker, available inside their bedroom. When the treatment program indicates, shelves shall be provided for folded garments in lieu of hanging garments.

(e) Each bedroom shall include a comfortable, standard-sized bed with a clean mattress, mattress protector, and pillow. Rollaway-type beds, cots, folding beds or bunk beds shall not be permitted.

(f) The bedroom shall have a safe and sanitary method to store the client's towel, such as a breakaway towel rack.

(g) Extension cords and multiple-use electrical sockets shall be prohibited in client bedrooms.

(h) The bedroom shall include a chair unless contraindicated, in which case alternate seating shall be provided in close proximity to the bedroom.

(4) The following standards shall be met for bathrooms:

(a) There shall be at least one full bathroom for every six (6) clients, including a toilet, sink, toilet paper dispenser, mirror, tub or shower, and towel rack.

(b) Bathrooms shall be equipped with soap dispensers or the physical location shall have a procedure in place that prevents clients from sharing soap.

(c) Each floor with bedrooms shall have at least one bathroom which can be accessed without entering a bedroom.

(d) The physical location shall have at least one full bathroom accessible to any client using an auxiliary aid, including properly-installed grab bars at each tub and/or shower, and adjacent to each toilet.

(e) Bathtubs and shower floors shall have non-skid surfaces.

(f) Toilet seats shall be constructed of non-absorbent materials and free of cracks.

(g) Clients shall have individualized personal care articles and supplies, such as soap and towels, and such articles and supplies shall not be shared.

(h) Toilet paper shall be available at all times in each bathroom.

(I) Liquid soap and paper towels shall be available at all times in the common bathrooms.

(5) The following standards shall be met for seclusion rooms:

(a) The seclusion room shall be constructed to prevent client hiding, escape, injury, or suicide, and shall be free of all protrusions, sharp corners, hardware, fixtures or other devices, and furnishings which may cause injury to the client.

(b) The seclusion room shall maintain a temperature appropriate for the season.

(c) The seclusion room shall be located in a manner affording direct observation of the client by BHE staff.

(d) The seclusion room shall have an area of at least one-hundred (100) square feet.

(e) The seclusion room shall have a window that allows someone outside the room to see into all of the corners of the room. All windows in the seclusion room shall be constructed to prevent breakage and otherwise prevent self-harm.

(f) Doors to the seclusion room shall be at least thirty-two (32) inches wide, and shall open outward.

(g) Light fixtures and other electrical outlets in the seclusion room shall be limited to those required and necessary, shall be recessed, and shall be constructed to prevent self-harm. Such fixtures and outlets shall be controlled by labeled on/off switches located outside the seclusion room.

(6) The BHE shall meet the following requirements regarding linen and laundry:

(a) The BHE may have laundry room(s) with residential-style washer(s) and dryer(s) in an area with adequate square footage and ventilation for the number of washers and/or dryers included in the space.

(b) The laundry room(s) shall not be used for storage of soiled or clean linen.

(c) There shall be a separate enclosed area for receiving and holding soiled linen until ready for pickup or processing, in addition to a separate enclosed area for clean linen storage.

(d) There shall be hand-washing, or other appropriate hand-sanitizing, facilities in each area where unbagged, soiled linen is handled.

6 CCR 1011-1-4.3