Adult Foster Care Qualified Setting Requirements

Any residence where AFC is provided must be qualified by the AFC provider and meet the setting requirements of 130 CMR 408.435. (A) The qualified setting must be (1) a private residence located in Massachusetts, occupied by the AFC caregiver, and not subject to state licensure or certification as a hospital, nursing facility, resident care facility, group home, ICF/IID Disability, or ALR; (2) accessible to meet the specific needs of its residents, including the specific needs of any member with physical disabilities. The provider may consult the Architectural Access Board guidelines; (3) compliant with local health, fire, safety, occupancy, and state building codes for dwelling units in accordance with 780 CMR 1.00: Board of Building Regulations and Standards; (4) equipped with appropriate safety equipment including, at a minimum, an easily accessible Class ABC fire extinguisher, smoke and carbon monoxide detectors, and a first-aid kit on the premises; (5) adequately heated and clean; (6) in good repair, with the exterior of the residence showing adequate maintenance in regard to paint, stairs, railings, windows, screens, storm windows, and grounds; and (7) occupied by no more than three persons receiving services from the AFC caregiver, no more than two of whom are authorized for AFC level II service payment, regardless of services provided or payer source. (B) The qualified setting must show evidence of regular household maintenance. All interior floors, ceilings, walls, and furnishings must be free of vermin, clean, in good repair, and adequately maintained including, but not limited to, the following: (1) Kitchen Area. The refrigerator and stove must be clean and in good working order. Storage areas must be clean, tidy, and adequate in size. Food must be safe both with respect to where and how it is purchased and to storage, cooking, and dish and utensil sanitation. There must be prompt disposal of trash. There must be a functioning fire extinguisher within easy reach in case of fires. (2) Bathroom. The showers, bathtubs, toilets, and sinks must be clean and in safe working order. There must be adequate hot water daily for bathing and washing. There must be an adequate supply of clean towels and personal-care supplies. The bathroom must be accessible without disturbing the private space of another occupant. Handrails must be installed as needed. (3) Member’s Bedroom. (a) The bedroom must have a door to ensure privacy. The bed must not be a cot. The box spring, mattress, and pillows must be in good condition. The mattress and pillows must have covers. Bed linens must be changed weekly or more often if necessary. The room must also contain a bureau, closet or wardrobe with hangers, chair, bedside table and lamp, a mirror, and nonskid floor covering. There must be at least one window. (b) The member must have the member’s own bedroom or share the bedroom with 1. only one other adult of the same sex; or 2. the member’s spouse or significant other. (c) The member must be given a choice of roommates, if asked to share their bedroom. (d) The member must be allowed the freedom to furnish or decorate their bedroom within the allowances of their living arrangement. (4) Ventilation. The home must be properly ventilated and allow for appropriate temperature conditions in all seasons. (5) Lighting. Lighting must be adequate and switches must be easily accessible. Wiring must not be exposed anywhere in the home. Extension cords, if used, must not be a safety hazard. (6) Stairs. Stairs that are located inside or outside the home must be free of clutter and include a railing or other appropriate equipment to support the needs of the member. (C) The qualified setting must have the following safety and emergency protections. (1) Hallways used by members must have adequate lighting to ensure safety. (2) There must be a written, predetermined emergency evacuation plan for exiting the home. The emergency evacuation plan must be reviewed every other month with the member. (3) The member must have an unobstructed emergency evacuation route out of the home. (4) Fire and carbon monoxide detectors must be installed and operable in the home. When activated, the alarms must be audible in sleeping areas, or reasonably alert the member of the emergency. (5) Emergency procedures including fire drills must be conducted semi-annually. Documentation of emergency evacuation drills must be maintained in the member’s record. (D) The qualified setting must provide meals and snacks in accordance with the following requirements. (1) There must be a daily meal plan that will provide the member’s daily nutritional needs according to the recommended daily allowance established by the American Dietary Association. The meal plan must outline how the member’s meals and snacks are being provided on a regular basis. (2) Meals must be served at regular intervals and may be provided outside the qualified setting. (3) The AFC caregiver must honor the member’s ethnic or religious preferences in food. (4) The AFC caregiver must provide meals and snacks in accordance with the member’s dietary restrictions and preferences. (5) Alternative meal choices and snacks must be stored and made available to the member on a regular basis. (6) The member must be allowed to access food at any time and be offered and receive at least breakfast, lunch, and dinner, and snacks each day, unless otherwise approved by the registered nurse.