13-002 Code Vt. R. 13-162-002-X

Current through August, 2024

Section 13 162 002 - STANDARDS - COMMUNITY CARE HOMES WITH PERSONAL CARE - LOWER AND HIGHER LEVEL (SOCIAL SECURITY ADMINISTRATION CODES G AND F)

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 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.

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

Section IV APPEALS PROCEDURE

An oral request may be made by telephoning the Board at 828-3184.

Section V ACCESS TO COMMUNITY CARE HOMES

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.

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.

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.

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

3. New residents should receive fire evacuation instructions immediately upon admission.

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.

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.

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.

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.

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

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:

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

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.

D. Safety

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

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

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

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.

CALL THE FIRE DEPARTMENT

ONE RESPONSIBLE PERSON ONLY USE FIRE EXTINGUISHER AND ATTEMPT TO EXTINGUISH THE FIRE

AMBULATORY RESIDENTS SHOULD BE INSTRUCTED TO LEAVE BUILDING IMMEDIATELY AND TOLD WHERE TO GO AFTER LEAVING

NON-AMBULATORY RESIDENTS IN THE CLOSE VICINITY AND UPPER FLOORS SHOULD BE MOVED FIRST.

DO NOT TAKE TIME TO DRESS, TAKE A BLANKET AND LEAVE

NEVER PROP OR WEDGE FIRE DOORS OPEN

NEIGHBORS OR PASSERS-BY SHOULD BE UTILIZED TO ASSIST UNTIL ARRIVAL OF THE FIRE DEPARTMENT

AFTER LEAVING THE BUILDING RESIDENTS SHOULD GO TO SOME DESIGNATED PLACE AND STAY THERE UNTIL FURTHER INSTRUCTIONS

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.

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.

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.

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.

13-002 Code Vt. R. 13-162-002-X

Effective Date: December 3, 1977 (SOS Rule Log # 77-152)

Statutory Authority: 18 V.S.A. § 2014