10- 148 C.M.R. ch. 37, § 5

Current through 2024-25, June 19, 2024

Section 148-37-5 - CORE LICENSING REQUIREMENTS

A.SERVICE TYPES. Youth facilities may be licensed to provide any of the following services:

1. Shelter for Homeless Children

2. Emergency Children's Shelter

3. Transitional Living Program

B.LICENSES

1.Provisional license. The Department will issue a provisional license for a term of 12 months to an applicant that:

a. Has not previously operated a Facility subject to this rule, or is licensed, but has not operated during the term of that license;

b. Complies with all applicable laws and rules, except those which can only be complied with once youth are served by the applicant; and

c. Demonstrates the ability to comply with all applicable laws and rules by the end of the provisional license term.

2.Full license. A full license may be issued for a term of one year to an applicant that demonstrates compliance with this rule and applicable statutes.

3.Conditional license. A conditional license may be issued by the Department, when the Facility fails to comply with applicable laws and rules, and in the judgment of the Commissioner, the best interest of the public would be so served by issuing a conditional license. The conditional license must specify when and what corrections must be made during the term of the conditional license.

4.Amended license required when changes occur. A licensed Facility must notify the Department prior to implementation of any proposed change or modification to any term specified on the physical license and request an updated license. Upon completion of its review, the Department may issue an amended license. The term of the new amended license remains the same as the original license but the effective date for the approved change may be different.

5.Specifications of a license. The license issued by the Department includes the following information:

a. The legal name of the Facility and the principal owners if a for-profit entity, and the senior officer if a not-for-profit entity, and the 'doing business as' name, as applicable;

b. The location of the physical site covered under the license;

c. The number of licensed beds; and

d. The effective date and term of the license.

6.License is non-transferable. A license is non-transferable and non-assignable.

7.License posted. A copy of the current valid license from the Department must be conspicuously posted where it may be seen by the public at the physical site where services are provided.

C.WAIVERS

A Facility may request a waiver of a provision of this rule. The Facility must provide clear and convincing evidence, including, at the request of the Department, expert opinion, which demonstrates to the satisfaction of the Department that the Facility's alternative method will comply with the intent of the rule provision. The Department may waive or modify a provision of this rule under the following terms and conditions:

1. The provision is not mandated by State or federal law;

2. The waiver must not violate the rights of person(s) receiving services;

3. The Facility must submit a written request to the Department for a waiver;

4. The request for a waiver must be accompanied by documentation that demonstrates that the terms of the waiver comply with the intent of the rule;

5. The Department may consult with subject matter experts prior to issuing a decision regarding the request for a waiver;

6. A waiver, when granted, must be for a specific period not to exceed the term of the license;

7. The Facility may request a renewal of the waiver at the time it requests the renewal of its license; and

8. A violation of a waiver is enforceable as a violation of this rule and is subject to the enforcement procedures in this rule.

D.INSPECTIONS AND INVESTIGATIONS

The Department's authorized representative has the right to enter to inspect for compliance with this rule at any time consistent with the usual hours of operation of the Facility, in accordance with 22 M.R.S. §7804.

1.Inspections required. The Facility must submit to regular and unannounced inspection surveys and complaint investigations to receive and maintain a license.

a. The Department must be granted access, within a reasonable amount of time, to any documents and records required to ensure compliance with this rule.

b. The Department may access electronic records either through a State-owned computer or device, through a computer or device provided by the Facility, or with assistance from a Facility's staff member.

c. The Department may copy any documents and records required by this rule as evidence of compliance.

d. The Department has the right to meet or speak in private with any person employed by or receiving services from the Facility for determining compliance with this rule, except that a person receiving services has the right to refuse to meet or speak to the Department's authorized representative. The Department may interview the youth's guardian as necessary.

2.Complaint investigation

a.Complaints. The Department will accept complaints from any person about alleged violations of this rule. The Facility must not retaliate against any youth or their representative for filing a complaint. All licensing violations identified during a complaint investigation will be provided to the Facility in writing, minimally in a Statement of Deficiencies or Violation Identification Letter. The Department may utilize any enforcement action authorized in this rule or under law, including revocation or suspension of a license when circumstances pose imminent risk of harm to youth.

b.Department's toll-free number posted. The Facility must post the Department's toll-free telephone number and other contact information, if available, for youth and legal guardians to contact the Department to make a complaint about the Facility. Child Protective Services, at 1-800-452-1999, available 24 hours per day, 7 days per week. Adult Protective Services, at 1-800-624-8404, available 24 hours per day, 7 days per week.

c.Facility's grievance procedure. The Facility must educate the youth and legal guardians about the Facility's written grievance procedure in a way that is accessible and understandable to all youth, and must include a signed youth or guardian notification of receipt of such education in the youth's record.

d.Investigation. The Department may investigate or have investigated on its behalf complaints, incidents, suspected abuse, neglect, and exploitation, inadequate care or supervision, or the Facility's failure to comply with this rule.

i.Federal or State laws. Department investigations may also involve suspected violation of State or federal law or rules.

ii.On-site investigations. On-site Department investigations may be unannounced.

3.Operating without a license: enter and inspect. The Department is authorized to inspect facilities operating without a license. If the Facility refuses entry during usual hours of operation, the Department will seek an administrative warrant pursuant to Rule 80E of the Maine Rules of Civil Procedure.

E.POLICIES AND PROCEDURES REQUIRED BY FACILITY

All Facility policies must be inclusive of the LGBTQ+ community.

1.Abuse policy. The Facility must have a written policy for handling known instances of youth and adult abuse or neglect and situations in which there exists reasonable cause to suspect abuse or neglect.

2.Communication. The Facility must have written policies regarding visiting and other forms of youth's communication with family, friends, and other people important to the youth, as appropriate.

a.Privacy. The Facility must provide conditions of reasonable privacy for visits and telephone contacts between youth and their families.

b.Electronic devices. The Facility must provide a written policy on the use of internet and personal electronic devices, including but not limited to: personal cell phones, gaming devices, tablets, and social media.

c.Restriction on communication. The Facility's communication policy must include provisions for documentation when the youth's legal guardian has prohibited or restricted communication.

3.Conflict of interest. The Facility must have a written conflict of interest policy that at minimum defines a conflict of interest between staff and youth served.

4.Discharge policies and procedures. The Facility must have written policies and procedures for discharges and must include, as applicable, the criteria for standard discharge; the criteria for emergency discharge; the procedure for children who self-discharge while dangerous to self or others; a method of notification of appropriate persons, including the Department and law enforcement, as appropriate, when a child deemed to be dangerous to self or others self-discharges from the Facility.

5.Diversion control policy. The Facility must maintain a current diversion control policy that contains specific measures to reduce the possibility of diversion of controlled substances from legitimate treatment use, and that assigns specific responsibility for carrying out the diversion control measures and functions described in the Facility's diversion control policy.

6.Eligibility and access to services

a.Eligibility criteria. The Facility must have written eligibility criteria. The Facility must, when applicable, have policies and procedures governing self-admission which must include procedures for notification of legal guardians.

b.Intake, screening, and admission. The Facility must have written policies and procedures for intake, screening, and admission processes.

c.Non-discrimination in providing services. The Facility must not refuse admission to any youth on the grounds of race, sex, sexual orientation, gender identity, religion, disability, or ethnic origin. Admissions may be limited if a prospective youth's needs cannot be met with reasonable accommodation that does not place an undue burden on the Facility or constitute a fundamental change in the Facility's services.

d.Americans with Disabilities Act. The Facility must comply with the Americans with Disabilities Act of 1990 (ADA).

7.Inclusion policy. The Facility must have a policy that addresses how the Facility will ensure equal opportunity for success regardless of the youth's gender identity or gender expression. This policy must include, but is not limited to, safe and accessible bathrooms, safe and gender-affirming sleeping arrangements, inclusive language on signs and forms, provisions for the reporting and prevention of harassment, and staff training on inclusion.

8.Infectious disease policy. The Facility must have a written infectious disease policy for the prevention, control, and investigation of infections which includes:

a. A protocol for early identification, reporting, and monitoring of infections;

b. A protocol for the prevention of the spread of infection consistent with applicable standards of care;

c. Monitoring of staff for infections and prohibiting employees with a communicable disease or infected skin lesions from direct contact with youth food; and

d. Procedures for containment and disposal of biomedical waste.

9.Medication administration policies and procedures. The Facility must have written medication administration policies and procedures, including but not limited to, the acquisition, storage, administration, documentation, and disposal of medication, as well as procedures for staff training.

a. If the Facility allows a youth to self-administer medications or administer medications to their child, medication policies must include the following:

i. a means to assess a youth's ability to responsibly self-medicate or the youth's ability to administer medication to their child;

ii. training for youth concerning medications and side effects, administration procedures, safe storage, and documentation of all medications administered; and

iii. the type of supervision and monitoring provided by staff.

b. The policies must specify who can administer medication, under what circumstances, and procedures for documenting the administration of medication.

10.Personnel policies and procedures. The Facility must have written policies and procedures related to personnel.

11.Record management policies and procedures. The Facility must have a written records management policy. The Facility's record management policies and procedures must include objective criteria to determine when to allow a youth to access their record. It must also describe how the records will be protected against loss, tampering, or unauthorized use.

12.Reportable event policies and procedures.

a.Managing reportable events. The Facility's written policies and procedures must describe in detail how it reports and manages reportable events.

b.Notification of reportable events or dangerous situations. The written policy must include procedures for reporting reportable events. At a minimum, the Facility's written policies must require notifying the Department and the youth's legal guardian that a reportable event has occurred. Reportable events must be reported to the Department and the youth's legal guardian within 72 hours. The Facility may use discretion regarding guardian notification if such notice would put the youth at risk.

13.Rights policy. The Facility must have a written policy concerning the rights and responsibilities of all youth. The policy must include, at minimum, the rights listed in Section 5(H).

14.Routine and emergency healthcare policy. The Facility must have a written youth healthcare policy. The policy must:

a. Include a plan for informing guardians of the need for medical and/or dental services of youth served, as appropriate, notwithstanding the youth's ability to consent in accordance with 22 M.R.S. §§ 1502 and 1503;

b. Include evidence of access to emergency medical and mental health services at all times;

c. Include a means of appraising the general health of each child while in care and provision of guidance in the areas of personal care and hygiene;

d. Require at least one on duty staff in each residence to be certified in first aid and cardiopulmonary resuscitation (CPR)24 hours a day; and

e. Require adequate first aid supplies to meet reasonably anticipated situations.

15.Smoking policy. The Facility must have a written policy regarding smoking at the Facility. Facilities may prohibit smoking on the premises or have a designated smoking area on the premises, per 22 M.R.S. §1580-A(3) and Rules Relating to Smoking in the Workplace, 10-144 C.M.R. Ch. 250.

16.Weapons policy. The Facility must have a written policy regarding weapons on site, which prohibits all staff and youth from possessing weapons while at the Facility and must include guidelines for staff response to situations that may arise.

F.RECORDS REQUIRED BY FACILITY

1.Record management.

a.Record maintenance. The Facility must maintain clean, readable records in an orderly, accessible format in a secure and private space, and must have written record retention policies and procedures that address the archiving and destruction of records consistent with all applicable State and federal statutes. Records must be made available to the Department upon request.

b.Record retention. The Facility must maintain the youth's records for a period of no fewer than seven years after the youth's discharge, unless specified otherwise in applicable State or federal laws. At that time the records may be disposed of in a manner which maintains their confidentiality.

2.Personnel Records.The Facility must maintain a personnel record for each staff member which must include:

a. Employment history;

b. Reference letters from former employers and/or personal references, or phone notes on such references, per Section 8(A);

c. Results of background checks, per Section 8(B) and 8(C);

d. Applicable professional credentials and certifications, per Section 8(A);

e. Periodic performance evaluations;

f. Personnel actions, other applicable materials, reports, and notes relating to the individual's employment with the Facility;

g. Starting and termination dates;

h. A statement read and signed by the employee which includes the definitions of abuse and neglect per 22 M.R.S. §4002(1) and outlines the responsibility to report all incidents of child abuse or neglect per 22 M.R.S. §4011-A;

i. A statement read and signed by the employee which includes the definitions of abuse, neglect, and exploitation per 22 M.R.S. §3472 and outlines the responsibility to report all incidents of adult abuse, neglect, or exploitation per 22 M.R.S. §3477; and

j. Documentation of training completed.

3.Volunteer and intern records. The Facility must maintain a personnel file for each volunteer or intern having direct contact with the youth in care which must contain:

a. Employment history;

b. Results of background checks; per Section 8(B) and 8(C);

c. Reference letters from former employers and/or personal references, or phone notes on such references, per Section 8(A);

d. A statement read and signed by the volunteer or intern which includes the definitions of abuse and neglect per 22 M.R.S. §4002(1) and outlines the responsibility to report all incidents of child abuse or neglect per 22 M.R.S. §4011-A;

e. A statement read and signed by the volunteer or intern which includes the definitions of abuse, neglect, and exploitation per 22 M.R.S. §3472 and outlines the responsibility to report all incidents of adult abuse, neglect, or exploitation per 22 M.R.S. §3477; and

f. Documentation of trainings attended.

4.Employee and volunteer access to records. The Facility must provide staff members and volunteers reasonable access to their personnel file and must allow them to add any written statement.

5.Youth records. Youth record entries must meet the following criteria:

a. Records must be specific, factual, relevant, and legible;

b. Records must be current, from intake through discharge;

c. Records must be completed, signed with identifying credentials, and dated by the person who provided the service.

d. Content of youth record. The Facility must maintain documentation in the youth's record in chronological order. The youth's record is not limited to, but must include, when available, the following information:

i. Demographic information. The name, gender, race, religion, verified birth date;

ii. Legal guardian information, when applicable, including the name, address, telephone number, and other contact information;

iii. Date of admission and source of referral;

iv. Documents relating to referral and admission;

v. The name, address, telephone number and relationship to the youth of the person with whom the youth was living if the youth was not living with their parent(s) or legal guardian prior to admission;

vi. Court documents (not applicable for Shelters for Homeless Children);

vii. Intake assessment;

viii. Care Plan;

ix. Progress notes;

x. Incident Reports. In addition to reportable events, other significant incidents, including all accidents, personal injuries and illness and pertinent incidents related to youth's care plan must be documented. The record must include documentation of who was notified of the incident;

xi. Discharge summary (not applicable for Shelters for Homeless Children); and

xii. Authorization of release of information.

e.Missing information. The Facility must place a written explanation in the youth's record for the absence of any required information.

f.Access to youth's record. A youth or the youth's legal guardian may access the youth's records if the information does not contain material which violates the right of privacy of another individual or material that must be withheld from release under law or by the order of the court.

g.Denial of access. If serious harm to the youth is likely to result from review of the youth's record, the Facility may deny, or otherwise limit, access to part or all of the youth's record. The request, findings and notification must be included in the youth's record.

i.Procedure to determine harm and denial. The Facility's record management policy must include objective criteria to determine when it would be harmful to allow access to a youth's record.

ii.Written findings. The Facility's written decision to deny access to a youth's record must be based on objective criteria and must include the findings of fact.

iii.Review of findings. The Facility's administrator or designee must review the findings and approve or deny access to the youth's record.

iv.Notification. The Facility must issue written notification of the decision to the requestor.

h.Information provided to legal guardian. Within 72 hours of admission, whenever possible, the Facility must provide the legal guardian with written information which must include:

i. A description of the philosophy of the Facility;

ii. A description of normal daily routines;

iii. A description of behavior management practices;

iv. Visiting hours and other procedures related to communication with youth;

v. A copy of grievance procedures and/or formal complaint processes;

vi. A description of any religious policy including affiliation; and

vii. The name and telephone number of a staff person whom the legal guardian may contact on an ongoing basis.

G.REPORTING REQUIREMENTS

1.Requirement to report abuse and neglect.

a.Report child abuse or neglect. The Facility must immediately report any suspected abuse or neglect of a child to the Department of Health and Human Services, Office of Child and Family Services, Child Protective Intake, at 1-800-452-1999, available 24 hours per day, 7 days per week.

b.Report adult abuse, neglect or exploitation. The Facility must immediately report any suspected abuse, neglect or exploitation of an incapacitated or dependent adult to the Department of Health and Human Services, Office of Aging and Disability Services, Adult Protective Services, at 1-800-624-8404, 24 hours per day, 7 days per week.

c.Reporting requirement. The Facility must inform all direct care workers of their status and responsibility as mandated reporters of suspected abuse or neglect of a youth. The Facility must ensure that the telephone number of the Department's Child Protective Intake Unit (1-800-452-1999) is readily available to personnel. If applicable, the Facility must ensure that the Office of Aging and Disability Services, Adult Protective Services Intake Unit telephone number is available (1-800-624-8404).

2.Requirement to report changes to Facility.

a.Substantial change. The Facility must notify the Department, in writing, 90 calendar days prior to any substantial change, including but not limited to change in administrator. The Facility may not increase youth capacity or begin new construction, additions, or alterations without the Department's prior approval.

b.Change in location, or name. The Facility must notify the Department, in writing, at least 90 calendar days prior to a change in location or name.

3.Requirement to report legal proceedings.

a. The Facility must provide written notification to the Department within two business days after the Facility receives notice of any legal proceedings related to the provision of services or the continued operation of the Facility, whether brought against the Facility or against any youth in the Facility.

b. The program administrator or designee must notify the Department within 24 hours after receiving notice or learning of an arrest or indictment of Facility personnel related to criminal activity that is alleged to have occurred on the grounds of the Facility or any location where services are provided.

H.RIGHTS OF YOUTH

Youth rights. Youth have the following rights:

1.Right to freedom from abuse or neglect. Youth must be free from emotional, verbal, physical or sexual abuse or neglect. Suspected abuse or neglect must be reported to the appropriate office of the Department, in accordance with this rule and applicable statutes. Documentation must be maintained in the Facility that a report has been made;

2.Right to confidentiality. Youth records, and information about youth in the Facility are confidential;

3.Right to freedom from harmful actions or practices. Youth have the right to freedom from harmful actions or practices and practices that are potentially harmful;

4.Right to a safe and healthy environment. Youth have a right to an environment that meets the health and safety standards set out in this rule and applicable statutes;

5.Right to be free from discrimination. Youth must be provided services without regard to race, age, national origin, religion, disability, sex, sexual orientation, gender identity or family composition;

6.Right to consideration and respect. Youth must be treated with dignity, consideration and respect in full recognition of their individuality;

7.Right to communication. The Facility must ensure that it is adhering to polices covered in Section 5(E)(2). Youth may communicate with and maintain relationships with people who are important to them.

a. Youth may have access to phones and mail.

b. Nothing prohibits a youth's attorney, clergyman, advocate or an authorized representative from visiting, corresponding with or telephoning the youth.

I.ADMISSIONS

The Facility must not refuse admission to any youth on the grounds of race, gender, sexual orientation and identity, religion, disability or ethnic origin. Admissions may be limited if a prospective youth's needs cannot be met with reasonable accommodation that does not place an undue burden on the Facility or constitute a fundamental change in the Facility's program or services.

1.Placement agreement (not applicable for Shelters for Homeless Children).

a. The Facility must negotiate a written placement agreement at the time of the youth's admission that must include at least the following by reference or attachment:

i. Description of the roles and responsibilities of all agencies and persons involved with the youth and youth's family;

ii. Authorizations to care for the youth;

iii. Authorizations to obtain routine and emergency medical care for the youth, including consent forms signed by the legal guardian as applicable prior to placement that allows the Facility to authorize all necessary medical care in the event that the parent or guardian is not available, medications, routine tests, immunization and emergency medical or surgical treatment, notwithstanding the youth's ability to consent in accordance with 22 M.R.S. §§1502 and 1503;

iv. Designation of responsibility for routine medical arrangements; and

v. Arrangements regarding visits, mail, telephone calls, vacations, gifts and family contact and involvement.

b.Signatures on placement agreement. The Facility must ensure that a written placement agreement is signed by and provided to the youth, the parent or legal guardian, and a Facility representative or Department representative if guardian is unreachable or unwilling to sign. A copy of the agreement must be placed in the youth's record.

c.Documentation of involvement. When the involvement of the youth, the parent or legal guardian, the authorized representative or other party is not feasible or in the best interest of the youth, the reasons must be documented in the youth's record.

2.Placement Limitations.

a. The Facility must not admit more youth into care than the number specified by the license.

b. The Facility must not admit any youth under the age that's indicated on the license.

c. The Facility may not admit a youth, as determined by the administrator or designee:

i. Who is deemed dangerous to self or others; or

ii. Whose primary need is medical or psychiatric hospitalization.

3.Information provided to youth. At admission, the Facility must provide the following to each youth in an accessible format:

a. A document explaining the Facility's internal rules, which must be signed and dated by the youth;

b. A copy of the Facility's policy governing visiting and other forms of communication with family, friends and other persons important to the youth.

4.Safety orientation. During the youth's first full day, the Facility must assign a staff member to orient the youth regarding emergency procedures and the location of emergency exits. A written confirmation that such orientation has occurred must be placed in the youth's record.

5.Release of information. Unless otherwise permitted by law, the Facility must, prior to releasing confidential information about a youth, obtain an informed consent form signed and dated by the youth's legal guardian that includes the following information:

a. Identification of the person or agency to whom the information is to be disclosed, including the relationship to the youth;

b. The specific information to be disclosed;

c. The reason for disclosure;

d. The expiration date of the consent, not to exceed one year from the date of signature of the legal guardian. The Facility must ensure that the release remains current and upon expiration a new release is obtained as appropriate; and

e. Notice of the guardian's right to revoke consent for a release of information at any time.

6.Information about youth or youth's family. The Facility must maintain the confidentiality of the youth's records. Staff of the Facility must not disclose or knowingly permit the disclosure of any information concerning the youth or the youth's family to an unauthorized person.

7.Photographs or electronic media. The Facility must obtain the written informed consent of the youth (if they can sign) and the legal guardian for the use of any photographs and electronic media images.

8.Consent for fundraising, publicity or research. The Facility must obtain the written informed consent of the youth, if appropriate to the youth's capability, and consent of the youth's legal guardian prior to involving the youth in any activity related to fundraising or publicity for the Facility.

J.INTAKE

The Facility must complete an intake assessment in accordance with Section 7 of this rule.

1.Assessment. The intake assessment must include, as available, strengths and needs regarding the youth's housing history, social, health care coverage, prior medical history, medication, and family and social relationships, housing, life skills, employment, income and money management, education, child care, legal status, and mental health history including self-harm, suicidal ideation and substance use if appropriate, and other pertinent data. The assessment should also ascertain the youth's gender identity, and preferred sleeping arrangements. The assessment must include the reason for admission.

2.Emergency Intake. In an emergency situation, necessitating immediate placement, the Facility must gather as much information as possible about the child to be admitted and the circumstances necessitating placement. The Facility must record this information in an emergency admission note (not applicable for Shelters for Homeless Children).

3.Medical Emergency. The Facility must arrange for immediate medical emergency care if needed at time of admission.

4.Signature. The assessment must include the date, signature, and credentials of the person completing the assessment.

K.CARE PLANS

1.Care plan. Youth facilities must develop, within 15 days of admission, a care plan for each youth that includes an assessment of the youth's needs. Each youth must be encouraged to participate in the development of their care plan.

a. The care plan must include the following:

i. Findings of the assessment;

ii. Measurable action steps and target dates to complete each action step, and the homeless youth's progress toward reaching their goals;

iii. Referrals for needed services and supports that are not provided directly by the Facility; and

iv. The written care plan must be signed by the administrator or designee, youth, and youth's legal guardian, if feasible. The signed, dated care plan must be placed in the youth's record.

L.DISCHARGE REQUIREMENTS

Facilities must develop a transition and discharge plan for each youth that addresses the youth's needs at the time of discharge (not applicable for Shelters for Homeless Children).

1.Discharge summary. The discharge process must include involvement of the youth, the youth's legal guardian and others as appropriate. When a youth is discharged, the Facility must compile a written summary within 30 days of the date of discharge. The discharge summary must be kept in the youth's record. The discharge summary must include:

a. Date of discharge, reason for discharge and the name, telephone number, address and relationship of the person to whom the youth was discharged;

b. A summary of services provided during care including prescribed medications, a summary of growth and accomplishments during care;

c. The assessed needs which remain to be met and alternative service possibilities which might meet those needs; as appropriate; and

d. Recommendations for an aftercare plan and identification of who is responsible for follow-up services.

2.Unplanned or emergency discharge.

a. The Facility must document any unplanned or emergency discharge to describe the circumstances of that discharge.

b. When there is an unplanned discharge, the discharge summary must include the circumstances leading to the unplanned discharge, the actions taken by the Facility and reasons supporting the Facility's discharge of the youth. In cases of emergency discharge, the Facility must immediately notify the guardian.

3.Unauthorized absence.

a. The Facility must notify the youth's legal guardian, the placing agency, and the appropriate law enforcement official in the event of unauthorized absence of a youth for more than four hours.

b. If a youth elopes from the Facility, staff members must conduct a review of available information to assess whether the youth may be at risk of human trafficking. If human trafficking is suspected, the Facility will immediately make a report to Child Protective Services or Adult Protective Services as appropriate.

M.HEALTHCARE

1. The Facility must arrange for health services for youth according to their needs. The Facility must ensure at least the following:

a. Ongoing appraisal of the general health of each youth;

b. Comprehensive education and guidance concerning health, personal care and hygiene as appropriate and accessible to the youth;

c. Access to emergency medical and mental health services at all times;

d. Staff that are adequately certified in first aid and cardiopulmonary resuscitation (CPR), such that at least one CPR-trained staff is available 24 hours a day, 7 days a week in each residence;

e. The Facility operates in accordance with appropriate hygienic standards for the control of contagious diseases; and

f. Fully stocked first aid kits that are accessible to each major activity area of the Facility must be available. These kits must be checked and restocked regularly. Each building and vehicle that is used by youth must be equipped with first aid supplies adequate to meet the needs of the youth.

2. In accordance with 22 M.R.S. §§ 1502 and 1503, a minor may give consent to all medical, mental, dental or other health counseling and services under particular conditions. A written statement affirming that the minor is living separately from parents or legal guardians and is independent of parental support must be placed in the minor's record.

N.MEDICATION ADMINISTRATION, CONSENT, AND STORAGE

1.Administration of medication. The Facility must ensure that all persons administering medications are trained to administer medications and use safe and acceptable methods and procedures.

a. The Facility must ensure that staff responsible for medication administration are oriented to the Facility's procedures and have access to current information regarding medications being used within the Facility, including but not limited to, side effects of medications, contraindications and doses.

2.Licensed medical practitioner's order required. Facilities must not administer, arrange for or discontinue a medication or treatment without a written order signed and dated by an authorized practitioner licensed to prescribe medications.

3.Medication upon admission. Youth taking medication at the time of admission should continue doing so as long as the medication is in its original prescription bottle with label. Medications cannot be changed without a prescriber's order.

4.Injectable medications. Injectable medication must be administered by staff who are trained to administer injectable medications.

5.Medication Administration. For Facilities that administer medications, there must be:

a.Medication record.The Facility must maintain a written medication record for each youth. The youth's medication administration record must include, but is not limited to, the following information:

i. The written order for each medication or treatment prescription;

ii. Possible adverse side effects of prescribed medication; and

iii. Incident reports for medication errors and adverse reactions. Adverse reactions must be reported to the medical provider who prescribed the medication.

b.Medication administration record (MAR) schedule. The youth's MAR must be made available to all staff members responsible for administering medication to the youth. A copy of the MAR must be placed in the youth's record. The Facility must have a written MAR for each youth to whom prescribed medication is administered which must contain:

i. Name of youth;

ii. Name of prescribing practitioner;

iii. Telephone number and other contact information at which prescribing practitioner can be reached in case of medical emergency;

iv. Reason for prescribing medication;

v. Date medication was prescribed;

vi. Generic or commercial name of medication;

vii. Dosage level, route and time of day when medication is to be administered; and

viii. Chart showing the date, time, dosage and initials of the individual administering the medication as well as the individual's full signature written somewhere legibly on the document.

6.Storage of medication administered by the Facility. The Facility must maintain medications in their original containers in a locked storage cabinet. The cabinet must be equipped with separate cubicles, plainly labeled, or with other physical separation for the storage of each youth's medications.

7.Medication Consent. Facilities must obtain consent from a minor's legal guardian for any initial medications ordered or changes in dosage, if required. Pursuant to 22 M.R.S. §1502, a minor may give consent for certain specific health services as well as treatment for substance use disorder or for emotional or psychological problems. Pursuant to 22 M.R.S. §1503, a minor may consent to all medical, mental, dental, and other health counseling and services provided certain conditions are met. The Facility must document the guardian or youth's consent.

8.Youth's consent to medication. When a youth is 14 years of age or older, the Facility must also obtain written informed consent from the youth prior to administration of the prescribed psychotropic medication except when the youth lacks the capacity to provide informed consent. A youth of any age prescribed psychotropic medication should, when possible, give informed consent, and be consulted and monitored for input, progress, and side effects.

9.External-use medications and treatments. The Facility must keep medications and treatments administered by the Facility that are for external use separate from medication taken internally.

10.Psychotropic Medication (not applicable for Shelters for Homeless Children). The Facility which admits youth using psychotropic medications must:

a. Confirm with the guardian and document medications have been prescribed by a physician and document such contact, unless confirming with the guardian poses a risk to the youth;

b. Obtain a current physician's report stating the reasons for prescribing the medications, the expected/desired results of the medications, if possible;

c. On a daily basis, a staff member trained in the recognition of side effects of the prescribed medication must complete the daily monitoring report. Facility staff must monitor the youth who receives psychotropic medication; and

d. Psychotropic medication reactions must be reported immediately to the medical provider who prescribed the medication, documented in an incident report and kept in the youth's record. The Facility must follow up and document recommendations from the provider.

Refusal of psychotropic medication (not applicable for Shelters for Homeless Children).

When a youth refuses a psychotropic medication the Facility must immediately document in the youth's record the date and time, the name of the person attempting to administer the medication and the youth's stated reason for refusal.

12.Staff medications. Staff must secure their own personal medication in a way that makes it inaccessible to youth.

O.BEHAVIOR MANAGEMENT

1.Behavior management interventions. Behavior management interventions must be positive, strength-based, and assist youth to manage their own behavior. Consequences, including natural and logical, must be connected to the behavior, not excessive, and administered as soon as possible after the incident.

a. Interventions must comply with the Facility's own written policies and procedures.

b. Administration of behavior management cannot be administered by youth, volunteers, or inadequately trained staff.

2.Prohibited practices. The Facility must ensure that youth are not subjected to:

a. Practices that are cruel, severe, or unusual;

b. Verbal abuse, ridicule or humiliation;

c. Any type of physical punishment in any manner upon the body;

d. Administration of psychotropic medications as a means of punishment or discipline;

e. Group punishment;

f. Physical restraint;

g. Seclusion; or

h. Isolation.

P.PHYSICAL PLANT

1.General condition of the Facility and premises. The Facility must maintain all structures and the grounds of the Facility in good repair and free from danger to health or safety. Immediate steps must be taken to correct any condition in the physical Facility or on the premises that poses a danger to a youth's life, health, or safety. Areas deemed by the Department to be unsafe such as steep grades, cliffs, open pits, swimming pools, high voltage boosters, or high speed roads, must be fenced off or have natural barriers to protect youth.

2.Local laws and codes. All building sites must be accessible for the population intended to be served and in compliance with all applicable State and federal requirements. The Facility must maintain documentation from the appropriate municipal official indicating compliance with all local laws or codes relative to the type of Facility for which it is licensed. This requirement is necessary upon initial licensure and whenever a change occurs, such as, but not limited to: building renovations, remodeling, repair, or new construction. Such changes must be in compliance with applicable federal, State, and local law including Life Safety Code requirements designated by the State Fire Marshal's Office.

3.Porches, elevated walkways, and elevated areas. The Facility must have barriers to prevent falls from porches, elevated walkways, and elevated areas.

4.Roads and driveways. Roads and driveways must be regularly maintained and passable at all times of the year.

5.Water supply and temperature. Facilities must have an adequate, safe and sanitary water supply. Water temperatures in youth areas must not exceed 120° Fahrenheit. There must be an adequate supply of hot water to meet the needs of the Facility.

a. Prior to initial operation and annually thereafter, a Facility that obtains its water supply from any source other than an approved public water system must submit to the Department a written satisfactory water analysis report completed by a Maine-certified laboratory.

b. Initial testing requirement for facilities serving water from a municipal public water source. In order to hold a license, applicants serving water from a municipal public water system must collect one first-draw lead sample prior to receiving a license. The sample container must be from a Maine-certified laboratory and have a one-liter capacity.

c. Initial testing requirements for facilities serving water from their own well. A Facility serving drinking water from their own well must demonstrate satisfactory water quality by testing for the following contaminants by a Maine-certified laboratory:

i. Fluoride;

ii. Uranium;

iii. Arsenic;

iv. Lead (first-draw sample);

v. Total coliform bacteria; and

vi. Nitrates.

d.Ongoing annual water tests for facilities with wells. A Facility serving water from its own well must test the water annually for coliform bacteria and nitrates. Samples must be analyzed and results reported by a Maine-certified laboratory. Facilities must maintain water quality reports for Department inspection.

e.Public drinking water system. Facilities must comply with any applicable rules and regulations governing public water systems.

f.Lead testing. Regardless of the water source, every five years, the Facility must conduct a first-draw lead sample test.

6.Plumbing and sewage disposal. The Facility must ensure that all plumbing and sewage disposal is compliant with all local, State, and federal codes and requirements.

7.Garbage. All garbage which is stored outside must be stored securely in noncombustible, covered containers and must be removed on a regular basis not less than weekly.

8.Heating systems. Facilities must have a central heating system that can maintain a safe and comfortable ambient temperature with a minimum of 65° Fahrenheit.

a.Annual inspection. Heating systems other than electric heating systems must be inspected annually by a qualified technician who is certified to work on the system. The Facility must have written evidence that the heating system passed the inspection.

b. Heating elements. The Facility must install and insulate heating elements, including hot water pipes, in a manner that ensures the safety of youth if accessible to youth.

c. The Facility must remove or encapsulate any friable asbestos insulation within the building.

9.Cooling. If the indoor temperature exceeds 82° Fahrenheit, the Facility must cool the space.

10.Lighting. Exterior areas must have sufficient lighting to ensure the safety of youth and staff. Rooms, corridors, and stairways within the Facility must be sufficiently illuminated. Corridors and stairways within a Facility's sleeping area must be illuminated during the night or when activated by a motion detector. Open flame lighting is prohibited.

11.Electrical equipment. All electrical equipment, wiring, switches, sockets, and outlets must be maintained in good order and safe condition.

12.Doors and windows. The Facility must have doors on all bedrooms and bathrooms that can be readily opened from both sides. Doors on closets may be removed. Windows and window covers must be kept clean and in good repair and must ensure the safety and privacy of youth.

13.Insect and rodent control. There must be an effective pest control program so that the Facility is free of pests and rodents.

14.Locked storage of poisonous, toxic, or flammable materials. Poisonous, toxic, flammable and other dangerous materials must be stored in locked compartments used for no other purpose when not in use. They must not be stored with household cleaning solutions or other non-food supplies. They must be stored in a location that is separate from food storage and preparation areas, cleaning equipment and utensil storage rooms and medication storage areas.

15.Kitchen and dining areas. Kitchens used for meal preparation must be equipped with the necessary items for the preparation, storage, serving and clean-up of all meals. All kitchen equipment must be kept in working order and in sanitary condition.

16.Youth living area. Youth living areas must be cleaned regularly, well-maintained and kept in good repair. Administrative and counseling services must occupy space separate and distinct from youth living areas, and provide for privacy and security of discussions, and records.

17.Laundry room. If an onsite laundry room is utilized, it must be kept sanitary and in good repair. Linen and clothing must be regularly laundered and handled using proper sanitary techniques. Clothes dryers must be vented to the exterior of the building unless designed by the manufacturer to operate without ventilation, and approved for use in this type of Facility by the State Fire Marshal's Office.

18.Staff quarters. A Facility utilizing live-in staff must provide adequate separate living space for these staff.

19.Youth sleeping areas.

a. The Facility must provide a designated area for rest and sleep for each youth. Those sleeping areas may consist of dormitory style rooms, individual bedrooms or shared bedrooms.

b. The Facility must separate male and female sleeping areas. Youth will be assigned sleeping areas per their gender identity.

c. The Facility must provide beds and mattresses that are clean, solidly constructed, and in good repair.

i. Beds provided for youth must be proportional to the youth's height and no fewer than 30 inches wide;

ii. If a bunk bed, provide sufficient head room to allow the occupant of each bunk to sit up;

iii. If a bunk bed, be limited to double bunk beds;

iv. Sheets, pillow cases, and blankets must be provided for each youth;

v. All beds must have a minimum three (3) foot separation to afford privacy and permit emergency evacuation.

20.Youth bedrooms. Youth bedrooms must:

a. Provide at least 74 square foot floor area for a single occupant;

b. Provide at least 50 square foot floor area for each occupant;

c. Include a direct source of natural light (not applicable for Shelters for Homeless Children);

d. Include windows which open or a mechanical ventilation system;

e. Allow no more than four (4) children to occupy a designated bedroom space; and f. Provide adequate storage space for each youth's belongings.

21.Bathroom facilities. The Facility's bathrooms must:

a. Have a minimum of one (1) wash basin, one (1) bath or shower, and one (1) toilet for every eight (8) youth;

b. Have a safe and adequate supply of hot and cold running water;

c. Have bathtubs or showers with slip-proof surfaces;

d. Have toilets and baths or showers which allow for individual privacy;

e. Contain mirrors secured to the walls at convenient heights and other furnishings necessary to meet each youth's basic hygiene needs;

f. Be maintained in good operating condition;

g. Be maintained in a sanitary condition;

h. Have an adequate supply of toilet paper, hand-cleansing soap and paper towels or an approved hand-drying device available to youth; and

i. Be equipped with grab bars that meet the Americans with Disabilities Act standards.

22.Towel, linen and bedding supplies. Facilities must have adequate towel, linen, and bedding supplies. A complete linen change must be available at all times.

23.Smoking. Smoking must be prohibited in every part of the building. The Facility may permit smoking on Facility grounds in accordance with applicable rules and regulations governing workplace smoking. The Facility must clearly designate smoking areas with signs.

24.Firearms prohibited. Firearms, other weapons, and ammunition are prohibited on the grounds or within the building of any structure under the Facility's control that is used for the delivery of services. If law enforcement enter the premises in an official capacity, they may carry weapons.

25.Pets. Pets, except fish in aquariums, are not permitted in common dining areas during meals. No animals are permitted in common food preparation areas. The Facility must maintain documented proof of rabies vaccinations for pets. Pets may not present a danger to youth, staff, or guests. Facilities must be free of pet odors and must dispose of pet waste regularly. Service animals are not pets and are not subject to rules governing pets.

26.Routine maintenance and cleaning. There must be evidence of routine maintenance and cleaning in all areas of the Facility.

27.Equipment. The Facility must replace or repair broken, run-down, or defective furnishings and equipment.

28.Exits. The Facility must assure that every exit is free of all obstruction or impediments for immediate use in the case of fire or other emergency.

29.Telephones. The Facility must provide a sufficient number of telephones for the youths' use.

30.Ventilation. The Facility must have adequate ventilation.

10- 148 C.M.R. ch. 37, § 5