(a) Definition. Ambulatory treatment program shall mean a substance abuse program in which drug-free substance abuse treatment services, but not living accommodations, are provided to substance abusers and substance-dependent persons. This treatment must be provided on a regular basis and may be provided daily if necessary.

1. (1) Each program shall have an administrator-supervisor on duty either onsite or at a central administrative location during the program's hours of operation. His duties shall 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 equivalent 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 hospital emergency rooms; clinics or rescue squads, of the availability of emergency 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.

   (c) Screening procedures.

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

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

   (d) Admission procedures.

7. (1) Each admission, including readmissions, 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 substance abuse, when abuse began and prior treatment attempts; and
   3. (iii) notation in the record that the client received a copy of program rules and regulations and that such rules were discussed with the client and that the client indicated that he understood those rules and regulations.
8. (2) An overall health history shall be taken from each newly enrolled or readmitted client within 21 days of the date of admission. Such history must be in a form approved by the division and shall be included in each client's file. In the event that the history reveals health conditions requiring further investigation, the program shall recommend appropriate medical care, and document such recommendation in the client record. In lieu of taking a health history, programs may accept a signed written statement from the client's physician that the client is currently under such physician's care for general health needs. Programs must, however, be cognizant of the risk of infectious disease among their clients. Programs should ensure that the health history taken is detailed and appropriately and promptly assessed with appropriate referrals for medical care made.

9. (3) Within 21 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 be recorded in the client's record and 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 45 days of the development of this preliminary plan, an amended and complete treatment plan to address the client's individual needs 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 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. Each program shall take steps to ensure that as appropriate a comprehensive range of rehabilitative services, including but not limited to vocational, educational, legal, mental health, alcoholism and social services, are made available to each client. The program can fulfill this responsibility by providing these services directly or by referral. Support services recommended and utilized shall be documented in each client record.
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) The 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 by a supervisory staff member who is clinically qualified.
    3. (iii) Each program shall have regular staff conferences, at least once every three months, at which the treatment progress of individual clients is reviewed. The involvement of appropriate treatment staff and outside support staff, e.g., mental health and alcoholism counselors, is encouraged.

    4. (iv) The case of any client who is not responding to treatment; is not meeting the goals, including vocational or educational goals, 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's record.

       (f) Client records.

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

16. (2) Each individual 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 was informed of the voluntary nature of treatment and that program rules and regulations were discussed with the client and he/she indicated that he understood the rules and regulations;
    3. (iii) client's health history or other appropriate documentation;
    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 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 treatment plan review quarterly;
    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 ambulatory 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) kitchen—50 square feet;
    2. (ii) assembly—six square feet per person;
    3. (iii) education rooms—20 square feet per person (40-person maximum);
    4. (iv) vocational shops—50 square feet per person;
    5. (v) corridor widths—three feet minimum; and
    6. (vi) minimum ceiling height in living areas—seven feet six inches.

18. (2) Each ambulatory program must be in a facility which is clean, sanitary, safe and suitable for the care and comfort of the program clients. 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) the building heating system shall be capable of supplying sufficient heat to maintain a temperature of 68 degrees;
    5. (v) an adequate and safe water supply;
    6. (vi) proper disposal of waste and sewage;
    7. (vii) two means of egress with doors equipped with appropriate hardware and in compliance with applicable codes;
    8. (viii) 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
    9. (ix) adequate protection from hazards in heater and boiler rooms.

19. (3) Each ambulatory 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 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 takes 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 and cardiopulmonary resuscitation on site 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) shielding shall be provided for all unprotected high temperature piping, etc. located where people can come in contact with exposed surfaces;
    8. (viii) unvented open-flamed space heaters shall not be used;
    9. (ix) only metal containers with fitted covers shall be used for storage of any refuse;
    10. (x) all flammable materials shall be stored in metal cabinets;
    11. (xi) there shall be no obstructions to corridors or exits or accumulation of combustible materials in unauthorized areas;

    12. (xii) when appropriate, emergency lighting shall be provided in places of assembly with a capacity of 50 or more persons.

        (h) Food service.

        Any ambulatory program providing food to clients must adhere to the requirements of section 1030.1(h) of this Part.

(b) Program administration and staffing.