(a) Definition. Residential treatment program shall mean a substance abuse program in which drug-free substance abuse treatment and living accommodations are provided to substance abusers and substance dependent persons.

1. (1) Each program shall have a full-time administrator-supervisor whose duties include:

   1. (i) overseeing the day-to-day operations of the program; and
   2. (ii) supervising the work of all staff.
2. (2) To insure that appropriate, quality counseling services are available to clients, each program shall have sufficient counseling staff. At a minimum, there shall be one full-time counselor for every 35 active clients.
3. (3) Each program shall have a specific plan for dealing with medical emergencies. There shall be as part of this plan evidence, such as written agreements with hospitals, clinics or rescue squads, of the availability of emergency medical services. Staff must be informed of procedures to be followed in the case of a medical emergency.
4. (4) Each program shall have written procedures for program operation and control.

5. (5) The personal money of any client in residential treatment shall remain the personal property of that client and shall not be commingled with program funds. The program shall have available, for use at the option of each client, a means of depositing, in a separate account, a client's personal money.

   (c) Screening procedures.

6. (1) Each candidate for admission shall be interviewed to determine the appropriateness of his admission to the program.

7. (2) Any candidate who is found to be inappropriate for admission shall be referred, when necessary, to an appropriate available alternate service.

   (d) Admission procedures.

8. (1) Each new admission shall be interviewed by qualified program staff. The results of this interview shall be recorded in the client's record and shall, at a minimum, include:

   1. (i) a personal history including family, vocational, educational and legal information;
   2. (ii) a substance abuse history including kind(s) of substances abused, when abuse began and prior treatment attempts; and

   3. (iii) notation in the client record that the client received a copy of program rules and regulations that such rules were discussed with the client and that the client indicated that he understood the rules and regulations.

      (2)

   4. (i) A medical and laboratory examination must be performed within 30 days of the client's admission to the program. This exam must, at a minimum, include an investigation of the possibility of infectious disease, including conduct of an intradermal PPD appropriately given and interpreted with necessary follow-up of all positive results, pulmonary, liver, cardiac abnormalities, dermatologic sequelae of addiction and possible concurrent surgical problems, as well as the conduct of a urine screening for drugs. In addition, the following laboratory tests shall be conducted when the examining physician determines that these tests are indicated:

      1. (a) complete blood count and differential;
      2. (b) serological test for syphilis;
      3. (c) microscopic urinalysis;
      4. (d) multiphasic chemistry profile; and

      5. (e) a chest X-ray, EKG or biological test for pregnancy.

         The health status of each residential client must be assessed annually.

   5. (ii) This subdivision shall not apply to a client transferring to a new program who received a medical and laboratory examination within three months prior to admission to the new program. Such transferring client need not be given a repeat medical and laboratory examination unless one is requested by the program physician. However, the new program physician must have, as part of the transfer summary, a medical summary and statement from the client's previous program which indicates any significant medical problems. Copies of the previous examination must be included in the client's file within 30 days.
   6. (iii) A client readmitted to the same program need not receive a repeat medical and laboratory exam if he received a medical and laboratory exam within three months of the date of his/her readmission and the results of the medical and laboratory exam, provided to the program physician within 30 days, do not indicate the need for a new medical and laboratory exam.
   7. (iv) Programs should, however, be cognizant of the risk of infectious disease among their clients. A detailed health history and assessment should be made by the program physician at the time of the client's admission to treatment to ensure that timely treatment of infectious diseases is provided to the client and to minimize the risk of infection of other program clients.

9. (3) Within 10 days of the client's admission or readmission to the program, a preliminary treatment plan addressing the client's individual needs must be devised for him/her. This preliminary plan must show that consideration was given to the appropriateness of the client for treatment in the program, short-term goals for treatment, counseling services required and the supportive services needed by the client. Within 30 days of the development of this preliminary plan, an amended and complete treatment plan must be developed which includes:

   1. (i) long- and short-term goals for treatment generated by both staff and client;
   2. (ii) assignment of a primary counselor;
   3. (iii) description of the type and frequency of counseling to be provided each week; and

   4. (iv) description of the supportive services, particularly the educational or vocational services needed by the client and a plan for meeting those needs.

      (e) Services.

10. (1) Counseling. Each program shall provide to its clients individual, group and family counseling services as appropriate. Counseling must be provided by qualified personnel. Counseling provided shall be documented in each client's record. Family counseling services include services to significant others.

11. (2) Support services.

    1. (i) Each program shall take steps to ensure that, as appropriate, a comprehensive range of rehabilitative services, including, but not limited to vocational, educational, legal, alcoholism, mental health and social services, are made available to each client. The program can fulfill this responsibility by providing these services directly or by referral to an appropriate resource. Support services recommended and utilized shall be documented in each client record.
    2. (ii) Each program must make arrangements with local school districts for school age clients to receive required basic educational services.
12. (3) Medical services. Each program shall be concerned about the general health of its clients. Each client record shall demonstrate that appropriate medical care was recommended to any client whose health status indicated a need for such care.
13. (4) Urinalysis. Urine testing shall be used, when clinically indicated, as a diagnostic tool. Results of any urine testing performed shall be included in the client record. Treatment decisions shall not be made solely on the basis of a single positive urine test result.

14. (5) Treatment review.

    1. (i) A client's treatment plan may be amended at any time, but any such amendment and the reason for it shall be recorded in the client's case record.
    2. (ii) Each client's treatment plan must be reviewed at least quarterly, either by a supervisory staff member who is clinically qualified or at a staff conference at which the treatment process, including progress in meeting vocational and/or educational goals of individual clients is reviewed.
    3. (iii) The case of any client in residential treatment for nine months must be reviewed in staff conference. Any decision to retain such client in residential treatment must be based on the specific client's needs and documentation that such needs can only be met through continued residential care. The involvement of appropriate treatment staff and any outside support staff, e.g., mental health or alcoholism counselors, is encouraged.

    4. (iv) The case of any client who is not responding to treatment; is not meeting the goals, including vocational and educational, defined in the treatment plan; or is disruptive to the program must be discussed at a staff conference and specific plans to address the client's problems in the treatment process must be devised and documented in the client record.

       (f) Client records.

15. (1) Each program shall maintain individual client records for all persons admitted to the program.

16. (2) Each record shall include:

    1. (i) client's name or client code, age, sex, race, marital status, residence;
    2. (ii) results of the admission interview, including documentation that the client received a copy of program rules and regulations;
    3. (iii) results of the physical examination;
    4. (iv) individual client treatment plan and any amendments;
    5. (v) documentation which includes, at a minimum, regular progress notes indicating the date, type, nature and length of each counseling session, as well as a specific description of the client's progress in the program, and any other counseling or support services provided;
    6. (vi) documentation of recommendations concerning client's general health;
    7. (vii) results of any urine testing performed;
    8. (viii) evidence of quarterly treatment plan review;
    9. (ix) when appropriate, evidence of staff conference review; and

    10. (x) when appropriate, statement of reasons for discharge from the program.

        (g) Facility standards.

17. (1) Each residential program must have safe and adequate physical facilities to carry out its program. To insure this, programs must adhere to the following minimum space requirements as appropriate to the services provided:

    1. (i) sleeping areas—80 square feet per resident for single beds, or 40 square feet per resident for two-deck bunks or temporary usage. Maximum dormitory capacity is 24;
    2. (ii) kitchen—50 square feet;
    3. (iii) assembly—6 square feet per person;
    4. (iv) corridor widths—a minimum of 3 feet;
    5. (v) minimum ceiling height in living areas—7 feet 6 inches;
    6. (vi) minimum ceiling height in corridors—7 feet;
    7. (vii) education rooms—20 square feet per person, with a maximum of 40 persons in the room at one time; and
    8. (viii) vocational shops—50 square feet allowed per person.

18. (2) Each residential substance abuse program must be in a facility which is clean, sanitary, safe and suitable for the comfort and care of the residents. Each facility must have, as appropriate:

    1. (i) an interior fire alarm system, with sound sufficient to alert all occupants. Such system must be maintained in operating condition;
    2. (ii) sufficient fire extinguishers of appropriate size and type with a tag showing the latest recharging date. Extinguishers shall be conspicuously located where they will be readily accessible and immediately available in the event of fire;
    3. (iii) smoke and fire barriers of one-hour fire rating installed between floors of buildings of more than two stories;
    4. (iv) walls and doors of a minimum of one-hour fire rating for all corridors of residential buildings of more than two stories;
    5. (v) two means of egress with doors equipped with appropriate hardware and in compliance with the applicable codes;
    6. (vi) exit signs of legible letters not less than 6 inches high and ¾-inch wide strokes, on contrasting backgrounds. Illuminated exit signs of same size letters are required in places of assembly and at exits of residential building corridors and passages;
    7. (vii) adequate protection from hazards in heater and boiler rooms;
    8. (viii) a smoke detector that emits a distinctive signal of its own, or activates the fire alarm system. A direct connection to the local fire department is advisable where available. In its absence, a telephone shall be provided on each floor, with the local fire department's telephone number posted in bold print on a contrasting background;
    9. (ix) storage facilities for personal articles in all approved bedrooms;
    10. (x) adequate lighting and ventilation;
    11. (xi) there shall be a minimum of one toilet and one lavatory for each 10 residents and a minimum of one tub or shower for each 10 residents. All facilities shall provide sufficient lavatory facilities to insure the privacy of male and female clients;
    12. (xii) a building heating system capable of supplying sufficient heat to maintain a temperature of 68 degrees Fahrenheit;
    13. (xiii) furnishings which include comfortable beds;
    14. (xiv) linen supplied at least weekly;
    15. (xv) dining space and a comfortable living room with facilities for recreation;
    16. (xvi) an adequate and safe water supply; and
    17. (xvii) proper disposal of waste and sewage.

19. (3) Each residential program shall observe at least the following safety precautions:

    1. (i) fire drills, utilizing the interior fire alarm system, shall be conducted every month. They shall be held at different times of the day and night when the building is occupied. A written record shall be maintained, indicating the time the drill is held, the number of participants and how long it took to evacuate the building;
    2. (ii) fire regulations and evacuation routes shall be posted in bold print on contrasting backgrounds and in conspicuous locations;
    3. (iii) all buildings shall have at least one telephone line;
    4. (iv) there must be a first aid area equipped with basic first aid supplies;
    5. (v) there shall be an employee certified in first aid, cardiopulmonary resuscitation onsite at all times the program is in operation;
    6. (vi) employees shall be trained in the use of firefighting equipment and the means of rapidly evacuating the building;
    7. (vii) night lights of no less than one footcandle measured at the floor shall be provided in all hallways and stairways;
    8. (viii) shielding shall be provided for all unprotected high temperature piping, etc., which is located where people can come in contact with exposed surfaces;
    9. (ix) unvented open-flamed space heaters shall not be used;
    10. (x) only metal containers with fitted covers shall be used for storage of refuse;
    11. (xi) all flammable materials shall be stored in metal cabinets;
    12. (xii) there shall be no obstructions to corridors or exits or accumulation of combustible materials in unauthorized areas; and

    13. (xiii) emergency lighting shall have sufficient capability to provide for the safe evacuation of the building.

        (h) Food service.

20. (1) Three meals a day shall be served in each residential program. All meals should be properly prepared and nutritionally balanced.

21. (2) Minimum standards.

    1. (i) The food preparation center shall have access to a lavatory.
    2. (ii) Dishwashing facilities shall be provided with a three-compartment sink or automatic dishwasher.
    3. (iii) A three-day supply of food shall be available in refrigerated storage. Such storage must have a temperature range between 32 degrees and 40 degrees Fahrenheit.
    4. (iv) A three-day supply of food shall be available in dry storage.
    5. (v) Adequate waste disposal facilities shall be available.
    6. (vi) A janitor's closet for storage of housekeeping utensils and equipment shall be available.
    7. (vii) There shall be no exposed wooden walls in the food preparation area. Walls around the stove and appliances shall be covered with galvanized or other nonflammable, nonporous materials.
    8. (viii) There shall be a hood with an exhaust fan over cooking equipment.

(b) Program administration and staffing.