Mo. Code Regs. tit. 9 § 10-7.120

Current through Register Vol. 49, No. 21, November 1, 2024.

Section 9 CSR 10-7.120 - Physical Environment and Safety

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.

9 CSR 10-7.120

AUTHORITY: sections 630.050 and 630.055, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001.

Amended by Missouri Register May 1, 2019/Volume 44, Number 9, effective 7/1/2019

*Original authority: 630.050, RSMo 1980, amended 1993, 1995 and 630.055, RSMo 1980.