PURPOSE: This rule describes requirements for the physical facilities and safety in Alcohol and Drug Treatment Abuse Programs, Comprehensive Substance Treatment and Rehabilitation Programs (CSTAR), Compulsive Gambling Treatment Programs, Substance Abuse Traffic Offender Programs (SATOP), Required Education Assessment and Community Treatment Programs (REACT), Community Psychiatric Rehabilitation Programs (CPRP), and Psychiatric Outpatient Programs.

1. (1) Applicable Requirements for All Facilities and for Residential Facilities. This rule is organized as follows:

   1. (A) Sections (2) through (9) apply to all facilities and program sites subject to certification by the department; and
   2. (B) Section (10) applies to residential facilities only.

2. (2) Safety Inspections. Each individual shall be served in a safe facility.

   1. (A) All buildings used for programmatic activities or residential services by the organization shall meet applicable state and local fire safety and health requirements. At the time of the initial application and after that, whenever renovations are made, the organization shall submit to the department verification that the facility complies with requirements for the building, electrical system, plumbing, heating system and, where applicable, water supply.
   2. (B) The organization shall maintain documentation of all inspections and correction of all cited deficiencies to assure compliance with applicable state and local fire safety and health requirements. These inspection and documentation requirements may be waived for a nonresidential service site that operates less than three (3) hours per day, two (2) days per week.
   3. (C) A currently certified organization that relocates any program into new physical facilities shall have the new facilities comply with this rule in order to maintain certification. All additions or expansions to existing physical facilities must meet the requirements of this rule.
3. (3) Physical Access. Individuals are able to readily access the organization’s services. The organization shall demonstrate an ability to remove architectural and other barriers that may confront individuals otherwise eligible for services.

4. (4) Adequate Space and Furnishings. Individuals are served in a setting with adequate space, equipment and furnishings for all program activities and for maintaining privacy and confidentiality.

   1. (A) In keeping with the specific purpose of the service, the organization shall make available—

      1. 1. A reception/waiting area;
      2. 2. Private areas for individual counsel-

ing and family therapy;

1. 3. A private area(s) for group counsel-

ing, education and other group services;

1. 4. An area(s) for indoor social and

recreational activities in residential settings and in nonresidential settings where individuals are scheduled for more than four (4) hours per day; and

1. 5. Separate toilet facilities for each sex,

except where reasonable evidence is shown to the department that this is not necessary.

1. (B) The organization shall have appropriate furnishings which are clean and in good repair.
2. (C) The use of appliances such as television, radio and stereo equipment shall not interfere with the therapeutic program.

1. (5) Clean and Comfortable Setting. Individuals are served in settings that are clean and comfortable, in good repair, and in safe operating order. The organization shall—

   1. (A) Provide adequate and comfortable lighting;
   2. (B) Maintain a comfortable room temperature between sixty-eight degrees Fahrenheit (68°F) and eighty degrees Fahrenheit (80°F);
   3. (C) Provide screens on outside doors and windows if they are to be kept open;
   4. (D) Provide effective pest control measures;
   5. (E) Store refuse in covered containers so as not to create a nuisance or health hazard;
   6. (F) Maintain the facility free of undesirable odors;
   7. (G) Provide stocked, readily accessible first-aid supplies; and
   8. (H) Take measures to prevent, detect and control infections among individuals and personnel, and have protocols for proper treatment.
2. (6) Off-Site Functions. If the organization offers certain services at locations in the community other than at its facilities, the organization shall take usual and reasonable precautions to preserve the safety of individuals participating in these off-site locations.

3. (7) Emergency Preparedness. The organization shall have an emergency preparedness plan.

   1. (A) The plan shall address medical emergencies and natural disasters.
   2. (B) Evacuation routes shall be posted, or the organization shall maintain a written evacuation plan.
   3. (C) Staff shall demonstrate knowledge and ability to effect the emergency preparedness plan and, where applicable, the evacuation plan.
   4. (D) Emergency numbers for the fire department, police and poison control shall be posted and readily visible near the telephone.

4. (8) Fire Safety. The organization shall maintain fire safety equipment and practices to protect all occupants.

   1. (A) Portable ABC type fire extinguishers shall be located on each floor used by individuals being served so that no one will have to travel more than one hundred feet (100') from any point to reach the nearest extinguisher. Additional fire extinguishers shall be provided, where applicable, for the kitchen, laundry and furnace areas.
   2. (B) Fire extinguishers shall be clearly visible and maintained with a charge.

   3. (C) There shall be at least two (2) means of exit on each floor used by individuals being served, which are independent of and remote from one another.

      1. 1. Outside fire escape stairs may consti-

tute one (1) means of exit in existing buildings. Fire escape ladders shall not constitute one (1) of the required means of exit.

1. 2. The means of exit shall be free of any

item that would obstruct the exit route.

1. 3. Outside stairways shall be substantial-

ly constructed to support people during evacuation. Newly constructed fire exits shall meet requirements of the National Fire Protection Association (NFPA) Life Safety Code.

1. 4. Outside stairways shall be reasonably

protected against blockage by a fire. This may be accomplished by physical separation, distance, arrangement of the stairs, protection of openings exposing the stairs or other means acceptable to the fire authority.

1. 5. Outside stairways at facilities with

three (3) or more stories shall be constructed of noncombustible material, such as iron or steel.

1. (D) Unless otherwise determined by the fire inspector based on a facility’s overall size and use, the requirement of two (2) or more means of exit on each floor shall be waived for those sites that meet each of the following conditions:

   1. 1. Do not offer overnight sleeping

accommodations;

1. 2. Do not cook meals on a regular basis;

and

1. 3. Do not provide services on-site to

twenty (20) or more individuals at a given time as a usual and customary pattern of service delivery.

1. (E) The requirement for two (2) means of exit from the second floor shall be waived for a residential facility if it serves no more than four (4) individuals and each of those individuals—

   1. 1. Is able to hear and see;
   2. 2. Is able to recognize a fire alarm as a

sign of danger;

1. 3. Is ambulatory and able to evacuate

the home without assistance in an emergency; and

1. 4. Has staff available in the event that

assistance is needed.

1. (F) Ceiling height shall be at least seven feet ten inches (7'10") in all rooms used by persons served except as follows:

   1. 1. Hallways and bathrooms shall have a

ceiling height of at least seven feet six inches (7'6"); and

1. 2. Existing facilities inspected and

approved by the department during a certification site survey prior to the effective date of this rule may request an exception from this ceiling height requirement.

1. (G) Combustible supplies and equipment, such as oil base paint, paint thinner and gasoline, shall be separated from other parts of the building in accordance with stipulations of the fire authority.
2. (H) The use of wood, gas or electric fireplaces shall not be permitted unless they are installed in compliance with the NFPA codes and the facility has prior approval of the department.
3. (I) The Life Safety Code of the NFPA shall prevail in the interpretation of these fire safety standards.
4. (J) Fire protection equipment required shall be installed in accordance with NFPA codes.
5. (K) The facility shall be smoke-free, unless otherwise stipulated in program specific rules.

1. (9) Safe Transportation. Where applicable, the organization shall implement measures to ensure safe transportation for persons served.

   1. (A) Agency owned vehicles which are used by the organization to transport persons served shall have—

      1. 1. Regular inspection and maintenance

as legally required; and

1. 2. Adequate first-aid supplies and fire

suppression equipment which are secured in any van, bus or other vehicle used to transport more than four (4) clients. Staff which operate such a vehicle shall have training in emergency procedures and the handling of accidents and road emergencies.

1. (B) All staff who transport persons served shall be properly licensed with driving records acceptable to the agency.
2. (C) There shall be a current certificate of insurance for agency owned vehicles in accordance with the organization’s requirements.

1. (10) Residential Facilities. In addition to the requirements under sections (1) through (8) of this rule, residential facilities shall also meet the following additional requirements:

   1. (A) Residential facilities shall provide—

      1. 1. At least one (1) toilet, one (1) lavato-

ry with a mirror and one (1) tub or shower for each six (6) individuals provided overnight sleeping accommodations;

1. 2. Bathroom(s) in close proximity to the

bedroom area(s);

1. 3. Privacy for personal hygiene, includ-

ing stalls or other means of separation acceptable to the department when a bathroom has multiple toilets, urinals or showers;

1. 4. Laundry area or service;
2. 5. Adequate supply of hot water;
3. 6. Lockable storage space for the use of

each individual being served;

1. 7. Furniture and furnishings suitable to

the purpose of the facility and individuals;

1. 8. Books, newspapers, magazines, edu-

cational materials, table games and recreational equipment, in accordance with the interests and needs of individuals;

1. 9. An area(s) for dining;
2. 10. Windows which afford visual access

to out-of-doors and, if accessible from the outside, are lockable; and

1. 11. Availability of outdoor activities;

2. (B) Bedrooms in residential facilities shall:

   1. 1. Have no more than four (4) individu-

als per bedroom;

1. 2. Have separate areas for males and

females subject to the department’s approval;

1. 3. Provide at least sixty (60) square feet

of floor space per individual in multiple sleeping rooms and eighty (80) square feet per individual in single sleeping rooms. Additional space shall be required, if necessary to accommodate special medical or other equipment needed by individuals. In the computation of space in a bedroom with a sloped ceiling, floor space shall be limited to that proportion of the room having a ceiling height as required elsewhere in this rule. 9 CSR 10-7

Square feet of contiguous floor space for each individual shall be computed by using the inside dimensions of the room in which the person’s bed is physically located less that square footage of floor space required by any other individuals and less any walled, closed space within the room;

1. 4. Have a separate bed with adequate

headroom for each individual. Cots and convertibles shall not be used. If bunk beds are used they shall be sturdy, have braces to prevent rolling from the top bunk, and be convertible to two (2) floor beds if an individual does not desire a bunk bed;

1. 5. Provide storage space for the belong-

ings of each individual, including space for hanging clothes;

1. 6. Encourage the display of personal

belongings in accordance with treatment goals;

1. 7. Provide a set of linens, a bedspread,

a pillow and blankets as needed;

1. 8. Have at least one (1) window which

operates as designed;

1. 9. Have a floor level which is no more

than three feet (3') below the outside grade on the window side of the room; and

1. 10. Not be housed in a mobile home,

unless otherwise stipulated in program specific rules;

1. (C) Activity space in residential facilities shall:

   1. 1. Total eighty (80) square feet for each

individual, except that additional space shall be required, if necessary to accommodate special medical or other equipment needed by individuals. Activity space includes the living room, dining room, counseling areas, recreational and other activity areas. Activity space does not include the laundry area, hallways, bedrooms, bathrooms or supply storage area; and

1. 2. Not be used for other purposes if it

reduces the quality of services;

1. (D) In all residential facilities, fire safety precautions shall include—

   1. 1. An adequate fire detection and notifi-

cation system which detects smoke, fumes and/or heat, and which sounds an alarm which can be heard throughout the facility above the noise of normal activities, radios and televisions;

1. 2. Bedroom walls and doors that are

smoke resistant. Transfer grilles are prohibited;

1. 3. A range hood and extinguishing sys-

tem for a commercial stove or deep fryer. The extinguishing system shall include automatic cutoff of fuel supply and exhaust system in case of fire; and

1. 4. An annual inspection in accordance

with the Life Safety Code of the National Fire Protection Association (NFPA);

1. (E) Residential facilities with more than four (4) individuals shall provide—

   1. 1. Smoke detectors powered by the elec-

trical system with an emergency power backup. These detectors shall activate the alarm system. They shall be installed on all floors, including basements. Detectors shall be installed in living rooms or lounges. Heat detectors may be used in utility rooms, furnace rooms and unoccupied basements and attics;

1. 2. Smoke detectors in each sleeping

room. Those detectors may be battery operated and are not required to initiate the building fire alarm system;

1. 3. At least one (1) manual fire alarm sta-

tion per floor arranged to continuously sound the smoke detection alarm system or other continuously sounding manual alarms acceptable to the authority having jurisdiction. The requirement of at least one (1) manual fire alarm station per floor may be waived where there is an alarm station at a central control point under continuous supervision of a responsible employee;

1. 4. An alarm which is audible in all

areas. There shall be an annual inspection of the alarm system by a competent authority;

1. 5. A primary means of egress which is a

protected vertical opening. Protected vertical openings shall have doors that are self-closing or automatic closing upon detection of smoke. Doors shall be at least one and onehalf inches (1 1/2") in existing facilities and one and three-fourths inches (1 3/4") in new construction, of solid bonded wood core construction or other construction of equal or greater fire resistance;

1. 6. Emergency lighting of the means of

egress; and

1. 7. Readily visible, approved exit signs,

except at doors leading directly from rooms to an exit corridor and except at doors leading obviously to the outside from the entrance floor. Every exit sign shall be visible in both the normal and emergency lighting mode;

1. (F) In residential facilities with more than twenty (20) individuals—

   1. 1. Neither of the required exits shall be

through a kitchen;

1. 2. No floor below the level of exit dis-

charge, used only for storage, heating equipment or purposes other than residential occupancy shall have unprotected openings to floors used for residential purposes;

1. 3. Doors between bedrooms and corri-

dors shall be one and one-half inches (1 1/2") in existing facilities, and one and threefourths inches (1 3/4") in new construction, solid bonded wood core construction or other construction of equal or greater fire resistance;

1. 4. Unprotected openings shall be pro-

hibited in interior corridors serving as exit access from bedrooms; and

1. 5. A primary means of egress which is

an enclosed vertical opening. This vertical opening shall be enclosed with twenty (20)- minute fire barriers and doors that are selfclosing or automatic closing upon detection of smoke.

1. (G) In detoxification programs—

   1. 1. The means of exit shall not involve

windows;

1. 2. The interior shall be fully sheathed in

plaster or gypsum board, unless the group can evacuate in eight (8) minutes or less; and

1. 3. Bedroom doors shall be one and one-

half inches (1 1/2") in existing facilities, and one and three-fourths inches (1 3/4") in new construction, solid bonded wood core construction or other construction of equal or greater fire resistance, unless the group can evacuate in eight (8) minutes or less.

AUTHORITY: sections 630.050 and 630.055, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. *Original authority: 630.050, RSMo 1980, amended 1993, 1995 and 630.055, RSMo 1980.