Environment

PURPOSE: This rule specifies the environmental requirements for all community residential programs and day programs subject to licensure by the department in accordance with 9 CSR 40-1.055. This rule does not apply to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF) dually licensed by the Department of Health and Senior Services (DHSS). PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Physical Environment. All residential programs and day programs shall be in compliance with applicable state and local building codes, fire codes, and ordinances to ensure the health, safety, and security of all individuals. (A) The physical environment shall— 1. Be clean, structurally sound, and attractive inside and out; 2. Have solid, skid-proof floors that are free from tripping hazards and, unless carpeted, have a smooth finish; 3. Have ceilings at least seven feet, six inches (7'6") in height in all rooms used by individuals served. Allowances may be made by Division of Fire Safety staff for the installation of ductwork and plumbing. No more than forty percent (40%) of the ceiling in each room shall be below minimal height, with no portion of the ceiling lower than six feet, eight inches (6' 8"); 4. Be equipped with a functional heating and air conditioning system with room temperatures maintained to meet the reasonable comfort needs of individuals served; 5. Be free of noxious odors; 6. Have control measures to prevent rodent and insect infestation; 7. Have windows, doors, and vents for ventilation and temperature control that operate as designed and are maintained to repel rodents and insects; 8. Comply with Department of Housing and Urban Development (HUD) 2017 LeadBased Paint Regulations, 24 CFR Part 35, hereby incorporated by reference and available from HUD, 451 7th Street S.W., Washington, DC 20410, (202) 708-1112, TTY (202) 708-1455, available at: https://www.ecfr.gov/cgi-bin/textidx?c=ecfr&SID=e1741143a75841f15fcfd9 30d325ac2b&rgn=div5&view=text&node= 24:1.1.1.1.24&idno=24. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this paragraph of this rule; and 9. Have adequate fencing around swimming pools, sewage lagoons, liquefied petroleum gas (LPG) tanks, and other potentially hazardous areas. (B) Any relocation, construction of additional space, or remodeling of a currently licensed program must be in compliance with 9 CSR 40-1.055 subsection (6)(A). (2) Modular Unit. A residential program or day program shall not be located in a modular unit as defined in section 700.010(8), RSMo. (3) Manufactured Home. A residential program or day program may be located in a manufactured home as defined in section 700.010(6), RSMo. If a manufactured home is being used, documentation must be maintained on site indicating the home meets the HUD Manufactured Home Construction and Safety Standards, 24 CFR Part 3280, hereby incorporated by reference and is available from the U.S. Government Publishing Office, 732 N. Capital Street NW, Washington, DC 20401, (866) 512-1800 and at: https://www.ecfr.gov/cgi-bin/textidx?SID=a2c5655a37054c584f7dd6a0ed240 fb8&node=pt24.5.3280&rgn=div5. This rule does not incorporate any subsequent amendments or additions to the standards listed above. This rule does not prohibit programs from complying with standards set forth in newer versions of the incorporated by reference material listed in this section of this rule. (4) Accessibility. Residential programs and day programs serving individuals with physical disabilities must be barrier free and have grab bars, ramps, railings, or other means of accessibility that are maintained to function properly and comply with the 2010 Americans with Disabilities Act Standards for Accessible Design, hereby incorporated by reference and developed by the U.S. Department of Justice, 950 Pennsylvania Avenue NW, Washington, DC 20530-0001, (202) 514-2000 and available at: https://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm. This rule does not incorporate any subsequent amendments or additions to the standards listed above. This rule does not prohibit programs from complying with standards set forth in newer versions of the incorporated by reference material listed in this section of this rule. (5) Bedrooms. Individuals receiving services in a residential program shall be provided with a bedroom to meet their specific needs. (A) All bedrooms shall— 1. Provide at least sixty (60) square feet of floor space per individual in multiple sleeping rooms, and at least eighty (80) square feet of floor space per individual in single sleeping rooms; 2. Have no more than four (4) individuals in a shared room, except behavioral health community residential programs shall have no more than one (1) individual per room as specified in 9 CSR 40-4.001; 3. Have at least one (1) outside window for evacuation purposes that complies with state and local fire safety codes. Windows shall operate as designed, without the use of tools to open or close, provide full visual access to the outdoors, have a clear opening of not less than twenty inches (20") in width and twenty-four inches (24") in height, and be no more than forty-four inches (44") above the finished floor. Any latching window device must be operable from not more than fifty-four inches (54") above the finished floor; 4. Have a floor level which is no more than three feet (3') below the outside grade on the window side of the room; 5. Have a clean and comfortable pillow, mattress, and bed. Cots, convertible beds, and bunk beds shall not be used. Hospital beds may be used in accordance with an order from the individual’s primary healthcare provider. Each individual’s mattress shall be at least as long as his/her height with the exception of individuals in the developmental period, in which case the mattress shall be at least four inches (4") longer than his/her height; 6. Have furnishings in good operating condition for each individual including, at a minimum, a chair (with the exception of individuals using a wheelchair or those who prefer not to have a chair), closet space, a place for storage of personal items, and space for hanging pictures or wall decor; 7. Have clean sheets, pillowcases, mattress cover, bedspread, and blanket(s) to meet individual needs; and 8. Have an interior door for safety and privacy, unless staff supervision and monitoring are required as documented in the Individual Support Plan (ISP), Individual Treatment Plan (ITP), or care plan of the individual served. Locking devices for bedroom doors must comply with regulations of the 2018 National Fire Protection Association (NFPA) Life Safety Code 101, hereby incorporated by reference and available from NFPA, 1 Batterymarch Park, Quincy, MA 02169-9101, (617) 770-3000 or 1-800-3443555, available at: www.nfpa.org. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this paragraph of this rule. (6) Living Space. Programs shall have a living room and/or recreational area(s), kitchen, and dining area(s) with sufficient equipment, supplies, and furnishings to meet the needs of individuals served. Equipment and furnishings shall include, at a minimum, tables, chairs, sofas, and bookshelves to meet individual needs. (A) Furnishings and equipment shall be clean and in good operating condition. (B) All windows shall operate as designed, without the use of tools, and provide visibility to the outdoors. (C) Kitchens must have a window or other adequate exhaust ventilation system. (D) Areas designated as living/recreational space shall not be used as sleeping space. (7) Bathrooms. Each residential program or day program shall have at least one (1) bathroom with at least one (1) toilet, one (1) sink with mirror, and one (1) tub or shower in good operating condition, including hot and cold running water, for each six (6) individuals being served. (A) Bathrooms must have a window or other adequate ventilation and be designed to meet the needs of individuals served. (B) For multi-stall bathrooms, separate bathrooms shall be available for each sex unless reasonable justification is provided to the department that this is not necessary. (8) Water Supply. If the water supply is not that of the city or county in which the program is located, the water supply must meet the drinking water regulations promulgated by the Department of Natural Resources, 10 CSR 60. (9) Electrical. The program’s electrical system must comply with all state and local regulations and the NFPA 2017 National Electrical Code, hereby incorporated by reference and available from NFPA, 1 Batterymarch Park, Quincy, MA 02169-9101, (800)-344-3555, available at: https://www.nfpa.org/NEC/electrical-codesand-standards. A written statement from a licensed electrician must be submitted to the department when the program applies for an initial license and whenever modifications are made, verifying the electrical system is in compliance with these regulations. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this section of this rule. (A) Each program shall have sufficient lighting and electrical outlets to meet the needs of individuals served. Extension cords shall not be used. (B) If surge protectors/power strips are used, they must be Underwriters’ Laboratory (UL) approved or comply with other recognized electrical appliance approval standards. Surge protectors/power strips shall not be placed under rugs, in doorways, or other areas where they may present a tripping hazard or be subject to physical damage. (10) Plumbing. The plumbing system in the program shall comply with all state and local regulations and the 2018 National Standard Plumbing Code, hereby incorporated by reference and developed by and available from the International Association of Plumbing and for Community Residential Programs and Day Programs Mechanical Officials, 180 S. Washington St., Suite 100, Falls Church, VA 22046, (800) 533-7694, available at: https://www.phccweb.org/tools-resources/nspc/. A written statement from a licensed plumber must be submitted to the department at the time of the program’s initial application for licensure and whenever modifications are made, verifying the plumbing system is in compliance with these regulations. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this section of this rule. (A) Clean water must be distributed to all plumbing fixtures and wastewater must leave the building to an approved area without presence of sewer gas or backups. (B) Plumbing fixtures and pipes must be free of leaks and threats to individual health and safety. (C) Hot water must be thermostatically controlled so the water temperature does not exceed one hundred twenty degrees Fahrenheit (120°F). (D) Water-heating equipment must be installed in accordance with the 2018 National Standard Plumbing Code and in a manner that does not present safety hazards to individuals served. Unless enclosed, water heaters shall not be located in bedrooms or living areas where safety hazards may exist. Fuel-burning equipment must be properly vented and have proper clearance from combustible materials. (E) The program must utilize a public sewage system, if available. If a public sewage system is not available, a private sewage disposal system that complies with all local and state regulations and the requirements of the 2018 National Standard Plumbing Code, hereby incorporated by reference shall be used, developed by and available from the International Association of Plumbing and Mechanical Officials, 180 S. Washington St., Suite 100, Falls Church, VA 22046, (800) 533-7694, available at: h t t p s : / / w w w. p h c c w e b. o rg / t o o l s - resources/nspc/. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this subsection of this rule. (11) Telephones. An adequate number of telephones, appropriate to the needs of individuals being served in the program, must be reasonably accessible and located to allow individuals to make and receive private calls. Free local telephone access shall be available for individuals to contact their healthcare providers or other service providers such as behavioral health, developmental disabilities, housing, employment, and educational resources. (A) Cellular phones may be used when all of the following conditions are met: 1. The phone must always have a signal; 2. The phone must always be charged; 3. The phone is set up to allow individuals to make and receive normal calls; 4. The phone must remain in the program at all times; and 5. The emergency plan for the program must address the use of cellular phones. (B) Telephone numbers for the local fire department, police and/or sheriff’s department, Access Crisis Intervention, Missouri Adult Abuse and Neglect Hotline, National Suicide Prevention Lifeline, and department’s Office of Constituent Services shall be readily accessible where telephones are located. (C) The telephone number for each individual’s support team member(s) or administrative agent/affiliate staff shall be readily accessible to individuals served and staff in the program. (12) Safety Risks. Hazardous flammable or combustible materials, toxic cleaning supplies, sharp objects, and other items determined as potentially harmful shall be stored based upon the assessed safety needs of individuals being served in the program, as specified in their ISP, ITP, or care plan. These items must be inaccessible to individuals served if they are unable to handle them safely. (A) Unless prohibited, firearms and/or ammunition on the premises or in vehicles shall be kept in a locked space or container that cannot be accessed by anyone other than the owner of the firearm and/or ammunition. (13) Maintenance. The program director shall ensure there is a system in place for ongoing maintenance of the program premises. (14) Transportation. Vehicles used by program staff to transport individuals served shall be properly registered, insured, and maintained. Vehicles shall have working seat belts and be accessible if used to transport individuals with physical disabilities. The agency shall comply with state and federal seat belt and car seat laws and regulations when transporting individuals served. Verification of a current driver’s license for all staff providing transportation must be maintained in personnel files. (A) Program staff are responsible for the care, safety, and supervision of individuals served when they are transported from the operating site to other locations in the community. (B) Staffing ratios shall be maintained at any time the program transports individuals away from its operating site. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed May 14, 2020, effective Dec. 30, 2020. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.