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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-A. MENTAL HEALTH |
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Chapter 22-A63. CERTIFICATION STANDARDS FOR SUBSTANCE USE DISORDER TREATMENT AND RECOVERY PROVIDERS |
Section 22-A6323. RESIDENTIAL TREATMENT AND RECOVERY PROGRAMS
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6323 RESIDENTIAL TREATMENT AND RECOVERY PROGRAMS
6323.1 The provisions of this section apply only to residential treatment programs and residential recovery support service (environmental stability) programs, as defined by this chapter.
6323.2 Each residential provider shall carry the following types of insurance in at least the following amounts for each residential program:
(a)Hazards (fire and extended coverage) or resident personal effects coverage in the amount of at least five hundred dollars ($500) per resident to protect resident belongings, with aggregate coverage of at least $500 multiplied by the number of residents; and
(b)A commercial policy for general liability and professional liability for at least:
(1) Three hundred thousand dollars ($300,000) per occurrence with a six hundred thousand dollar ($600,000) aggregate for one (1) to eight (8) beds; or
(2) Five hundred thousand dollars ($500,000) per occurrence with a one million dollar ($1,000,000) aggregate for nine (9) or more beds; and
(c)One hundred thousand dollars ($100,000) per occurrence of sexual abuse or molestation of clients by staff or other persons.
6323.3 Residential facilities’ physical design and structure shall be sufficient to accommodate staff, clients, and functions of the program and shall make available an area(s) for indoor social and recreational activities.
6323.4 A program that provides overnight accommodations shall not operate more beds than the number for which it is authorized by the Department.
6323.5 Other than routine household duties, no client shall be required to perform unpaid work.
6323.6 Upon admission to a residential program, each client shall be provided a copy of the program’s house rules.
6323.7 Each residential program shall have house rules consistent with this chapter and that include, at a minimum, rules concerning:
(a)The use of tobacco;
(b)The use of the telephone;
(c)Viewing or listening to television, radio, CDs, DVDs, or other media;
(d)Movement of clients in and out of the facility; and
(e)The prohibition of sexual relations between staff and clients.
6323.8 Each residential program shall be equipped, furnished, and maintained to provide a functional, safe, and comfortable home-like setting.
6323.9 The dining area shall have a sufficient number of tables and chairs to seat all individuals residing in the facility at the same time. Dining chairs shall be sturdy, non-folding, without rollers unless retractable, and designed to minimize tilting.
6323.10 Each residential program shall permit each client to bring reasonable personal possessions, including clothing and personal articles, to the facility unless the provider can demonstrate that it is not practical, feasible, or safe.
6323.11 Each residential facility shall provide clients with access to reasonable individual storage space for private use.
6323.12 Upon each client’s discharge from a residential program, the provider shall return to the client, or the client’s representative, any personal articles of the client held by the provider for safekeeping. The provider shall also ensure that the client is permitted to take all of his or her personal possessions from the facility. The provider may require the client or client’s representative to sign a statement acknowledging receipt of the property. A copy of that receipt shall be placed in the client’s record.
6323.13 Each residential program shall maintain a separate and accurate record of all funds that the client or the client’s representative or representative payee deposits with the provider for safekeeping. This record shall include the signature of the client for each withdrawal and the signature of facility staff for each deposit and disbursement made on behalf of a client.
6323.14 Each residential facility shall be equipped with a functioning landline or mobile telephone for use by clients. The telephone numbers shall be provided to residents and to the Department.
6323.15 Staff bedrooms shall be separate from resident bedrooms and all common living areas.
6323.16 Each facility housing a residential program shall have a functioning doorbell or knocker.
6323.17 Each bedroom shall comply with the space and occupancy requirements for habitable rooms in 14 DCMR § 402.
6323.18 The provider shall ensure each client has the following items:
(a)A bed, which shall not be a cot;
(b)A mattress that was new when purchased by the provider, has a manufacturer’s tag or label attached to it, and is in good, intact condition with unbroken springs and clean surface fabric;
(c)A bedside table or cabinet and an individual reading lamp with at least a seventy-five (75) watt rate of capacity;
(d)Storage space in a stationary cabinet, chest, or closet that provides at least one (1) cubic foot of space for each client for valuables and personal items;
(e)Sufficient suitable storage space, including a dresser and closet space, for personal clothing, shoes, accessories, and other personal items; and
(a) A waste receptacle and clothes hamper with lid.
6323.19 Each bed shall be placed at least three (3) feet from any other bed and from any uncovered radiator.
6323.20 Each bedroom shall have direct access to a major corridor and at least one (1) window to the outside, unless the Department of Consumer and Regulatory Affairs, or a successor agency responsible for enforcement of the D.C. Housing Code, has determined that it otherwise meets the lighting and ventilation requirements of the D.C. Housing Code for habitable rooms.
6323.21 Each facility housing a residential program shall provide one or more bathrooms for clients that are equipped with the following fixtures, properly installed and maintained in good working condition:
(a)Toilet (water closet);
(b)Sink (lavatory); and
(c)Shower or bathtub with shower, including a handheld shower;
(d)Grab bars in showers and bathtubs.
6323.22 Each residential facility shall provide at least one (1) bathroom for each six (6) occupants in compliance with 14 DCMR § 602.
6323.23 Each bathroom shall be adequately equipped with the following:
(a) Toilet paper holder and toilet paper;
(b) Paper towel holder and paper towels or clean hand towels;
(c) Soap;
(d) Mirror;
(e) Adequate lighting;
(f) Waste receptacle;
(g) Floor mat;
(h) Non-skid tub mat or decals; and
(i) Shower curtain or shower door.
6323.24 Each residential provider shall ensure that properly anchored grab bars or handrails are provided near the toilet or other areas of the bathroom, if needed by any resident in the facility.
6323.25 Adequate provision shall be made to ensure each client’s privacy and safety in the bathroom.
6323.26 Each residential program shall promote each client’s participation and skill development in menu planning, shopping, food storage, and kitchen maintenance, if appropriate.
6323.27 Each residential program shall provide appropriate equipment (including a washing machine and dryer) and supplies to ensure sufficient clean linen and the proper sanitary washing and handling of linen and clients’ personal clothing.
6323.28 Each program shall ensure that every client has at least three (3) washcloths, two (2) towels, two (2) sheet sets that include pillow cases, a bedspread, a pillow, a blanket, and a mattress cover in good and clean condition.
6323.29 Each blanket, bedspread, and mattress cover shall be cleaned regularly, whenever soiled, and before being transferred from one resident to another.
6323.30 Providers shall ensure that clients are allowed access to all scheduled or emergency medical and dental appointments.
6323.31 Providers serving parents and children must take precautions to ensure child safety, including but not limited to protection for windows, outlets, and stairways.
6323.32 Each facility housing a program that provides services for parents with children shall have extra supplies for babies to include diapers and powdered milk.
6323.33 The following provisions apply only to residential treatment programs, as defined by this chapter. These provisions do not apply to residential recovery support services programs (i.e., environmental stability services):
(a) A program that provides overnight accommodations shall ensure that evening and overnight shifts have at least two (2) staff members on duty;
(b) Children and youth under eighteen (18) may not reside at an adult residential treatment facility or visit overnight at a facility not certified to serve parents and children. This information must be included in the house rules;
(c) Each provider shall maintain a current inventory of each client’s personal property and shall provide a copy of the inventory, signed by the client and staff, to the client;
(d) Each provider shall take appropriate measures to safeguard and account for personal property brought into the facility by a resident;
(e) Each provider shall provide the client, or the client’s representative, with a receipt for any personal articles to be held by the provider for safekeeping that includes and the date it was deposited with the provider and maintain a record of all articles held for safekeeping;
(f) Each residential treatment program shall have a licensed dietitian or nutritionist available, a copy of whose current license shall be maintained on file, to provide the following services:
(1) Review and approval of menus;
(2) Education for individuals with nutrition deficiencies or special needs;
(3) Coordination with medical personnel, as appropriate; and
(4) A nutritional assessment for each client within three (3) calendar days of admission unless the client has a current assessment or doctor’s order for dietary guidelines;
(g) The provider shall provide at least three (3) meals per day and between meal snacks that:
(1) Provide a nourishing, well-balanced diet in accordance with dietary guidelines established by the United States Department of Agriculture;
(2) Are suited to the special needs of each client; and
(3) Are adjusted for seasonal changes, particularly to allow for the use of fresh fruits and vegetables.
(h) The provider shall ensure that menus are written on a weekly basis, that the menus provide for a variety of foods at each meal, and that menus are varied from week to week and adjusted for seasonal changes. Menus shall be posted for the clients’ review;
(i) The provider shall ensure that a copy of each weekly menu is retained for a period of six (6) months. The menus retained shall include special diets and reflect meals as planned and as actually served, including hand-written notations of any substitutions. The provider shall also retain receipts and invoices for food purchases for six (6) months. The records required to be retained by this subsection are subject to review by the Department;
(j) Each meal shall be scheduled so that the maximum interval between each meal is no more than six (6) hours, with no more than fourteen (14) hours between a substantial evening meal and breakfast the following day;
(k) If a client refuses food or misses a scheduled meal, appropriate food substitutions of comparable nutritional value shall be offered;
(l) If a client will be away from the program during mealtime for necessary medical care, work, or other scheduled appointments, program shall provide an appropriate meal and in-between-meal snack for the client to carry with him or her and shall ensure that the meal is nutritious as required by these rules and suited to the special needs of the client;
(m) Each piece of bed linen, towel, and washcloth shall be changed and cleaned as often as necessary to maintain cleanliness, provided that all towels and bed linen shall be changed at least once each week;
(n) No person who is not a client, staff member, or child of a client (only in the case of programs for parents and children) may reside at a facility that houses a residential treatment program;
(o) A residential treatment program providing meals shall implement a written Nutritional Standards Policy that outlines their procedures to meet the dietary needs of its clients, ensuring access to nourishing, well-balanced, and healthy meals. The policy shall identify the methods and parties responsible for food procurement, storage, inventory, and preparation;
(p) The Nutritional Standards Policy shall include procedures for individuals unable to have a regular diet as follows:
(1) Providing clinical diets for medical reasons, when necessary;
(2) Recording clinical diets in the client’s record;
(3) Providing special diets for clients’ religious needs; and
(4) Maintaining menus of special diets or a written plan stating how special diets will be developed or obtained when needed.
(q) A residential treatment program shall make reasonable efforts to prepare meals that consider the cultural background and personal preferences of the clients;
(r) Meals shall be served in a pleasant, relaxed dining area that accommodates families and children; and
(s) Under the supervision of a Qualified Practitioner, all Level 3 programs except MMIIWM programs shall:
(1) Provide training in activities of daily living;
(2) Provide therapeutic recreational activities designed to help the client learn ways to use leisure time constructively, develop new personal interests and skills, and increase social adjustment; and
(3) Ensure that staff providing activities listed in subparagraphs (1) and (2) above have a high school degree or a GED and at least twenty (20) hours of in-service training per year regarding issues of substance abuse.