Standards For Alcohol Detoxification Centers


Published: 2015

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The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

ADDICTIONS AND MENTAL HEALTH DIVISION: ADDICTION SERVICES




 

PROGRAMS FOR ALCOHOL AND DRUG PROBLEMS
DIVISION 50
STANDARDS FOR ALCOHOL DETOXIFICATION CENTERS

415-050-0000
Purpose
These rules prescribe standards for
the development and operation of substance use detoxification programs and services
approved by the Addictions and Mental Health Division.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(1) & (2); ADAP 3-1993, f. & cert. ef. 12-6-93,
Renumbered from 309-050-0000; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp),
f. & cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0005
Definitions
(1) “Alcohol and Other Drug Treatment
Staff” means a person certified or licensed by a health or allied provider
agency to provide alcohol and other drug treatment services that include assessment,
development of an Individual Service and Support Plan (ISSP), and individual, group
and family counseling.
(a) For treatment staff holding
certification in addiction counseling, qualifications for the certificate must have
included at least:
(A) 750 hours of supervised
experience in substance use counseling;
(B) 150 contact hours of
education and training in substance use related subjects; and
(C) Successful completion
of a written objective examination or portfolio review by the certifying body.
(b) For treatment staff holding
a health or allied provider license, the license or registration must have been
issued by one of the following state bodies and the person must possess documentation
of at least 60 contact hours of academic or continuing professional education in
alcohol and other drug treatment:
(A) Board of Medical Examiners;
(B) Board of Psychologist
Examiners;
(C) Board of Licensed Social
Workers;
(D) Board of Licensed Professional
Counselors and Therapists; or
(E) Board of Nursing.
(2) “ASAM PPC-2R”
means American Society of Addictions Medicine (ASAM) Patient Placement Criteria
for the Treatment of Substance Related Disorders, Second Edition. ASAM PPC-2R is
a multidimensional clinical guide to be used in matching patients to appropriate
levels of care. (4) "Biennial Plan" means the document prepared by the Community
Mental Health Program (CMHP) or direct contractor and submitted to the Division.
(3) "Client" means a person
receiving services under these rules.
(4) “Community Mental
Health Program” (CMHP) means an entity that is responsible for planning and
delivery of services for individuals with substance use or mental illness diagnoses,
operated in a specific geographic area of the state under an intergovernmental agreement
or a direct contract with the Addictions and Mental Health Division (AMH).
(5) “Coordinated Care
Organization (CCO)” means a corporation, governmental agency, public corporation
or other legal entity that is certified as meeting the criteria adopted by the Oregon
Health Authority under ORS 414.625 to be accountable for care management and to
provide integrated and coordinated health care for each of the organization’s
members.
(6) "County" means the board
of county commissioners or its representatives.
(7) “Detoxification
Technician” means a person who supports program staff in the promotion of
maintaining a safe and orderly subacute environment and may include direct patient
care.
(8) "Division" means the
Addictions and Mental Health Division of the Oregon Health Authority.
(9) “Clinically Managed
Residential Detoxification” means clinically managed residential detoxification
in a non-medical or social detoxification setting. This level emphasizes peer and
social support and is intended for individuals whose intoxication is sufficient
to warrant 24-hour support or whose withdrawal symptoms are sufficiently severe
to require primary medical nursing care services.
(10) "Individual" means a
person receiving services under these rules.
(11) "Licensed Medical Practitioner
(LMP)” means a person who meets the following minimum qualifications as documented
by the Local Mental Health Authority (LMHA) or designee:
(a) Physician licensed to
practice in the State of Oregon; or
(b) Nurse practitioner licensed
to practice in the State of Oregon; or
(c) Physician's Assistant
licensed to practice in the State of Oregon; and
(d) Whose training, experience
and competence demonstrate the ability to conduct a mental health assessment and
provide medication management.
(e) For ICTS and ITS providers,
LMP means a board-certified or board-eligible child and adolescent psychiatrist
licensed to practice in the State of Oregon.
(12) "Local Alcohol and Drug
Planning Committee " (LADCP) means a committee appointed or designated by a board
of county commissioners. The committee must identify needs and establish priorities
for substance use services in the county. Members of the committee must be representative
of the geographic area and include a number of minority members which reasonably
reflect the proportion of the need for substance use treatment and rehabilitation
services of minorities in the community.
(13) “Local Mental
Health Authority (LMHA)” means one of the following entities:
(a) The board of county commissioners
of one or more counties that establishes or operates a CMHP;
(b) The tribal council, in
the case of a federally recognized tribe of Native Americans that elects to enter
into an agreement to provide mental health services; or
(c) A regional local mental
health authority comprised of two or more boards of county commissioners.
(14) “Medically Monitored
Detoxification” means an inpatient setting that provides medically managed
intensive inpatient treatment services, labeled by ASAM as “Level III.7-D”,
and automatically also certifies for the provision of Level III.2.D services.
(15) “Medical Assessment”
means a comprehensive survey outlining the information about the individual to aid
in proper diagnosing and treatment of his or her presenting physical symptoms.
(16) “Program”
means an organized system of services designed to address the treatment needs of
patients.
(17) “Psycho-Social
Assessment” means an evaluation of an individual’s mental, physical,
and emotional health.(14) "Rehabilitation" means those services to assist in overcoming
problems associated with a substance use disorder that enable the individual to
function at his or her highest potential.
(18 ) “Skilled Nursing
Staff” means all nurses working within the scope of their license.
(19) “Substance Use
Disorders” means disorders related to the taking of a drug of abuse including
alcohol; to the side effects of a medication; and to a toxin exposure. The disorders
include substance use disorders such as substance dependence and substance abuse;
substance-induced disorders, including substance intoxication, withdrawal, delirium,
and dementia; as well as substance induced psychotic disorder, mood disorder, etc.,
as defined in DSM criteria.
(20) "Treatment" means the
specific medical and non-medical therapeutic techniques employed to assist the individual
in recovering from a substance use disorder.
(21) "Treatment Staff" means
paid staff directly responsible for client care and treatment.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(3); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0005; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0010
Program Approval
(1) Letter of Approval. In order to
receive a Letter of Approval from the Division under the process set forth in OAR
415-012, a programmust must meet the standards set forth in these rules, those provisions
of OAR 309-014 which are applicable, and any other administrative rule applicable
to the program. A Letter of Approval issued to a program must be effective for two
years from the date of issue and may be renewed or revoked by the Division in the
manner set forth in OAR 415-012.
(2) A program seeking approval
under these rules must must establish to the satisfaction of the Division that the
local alcohol and drug planning committee was actively involved in the planning
and review of the program as it relates to the community mental health program plan.
(3) Inspection of a program.
The Division must inspect at least every two years each program under these rules.
Stat. Auth.: ORS 409.410
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(4), (5), & (6); ADAP 3-1993, f. & cert. ef.
12-6-93, Renumbered from 309-050-0010; ADS 2-2008, f. & cert. ef. 11-13-08;
ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0015
Management
of Detoxification Centers
(1) Compliance with the sections of
OAR 309-013, which address general administrative standards for community mental
health contractors.l. In addition to the policy issues required in OAR 309-014,
the program’s personnel policies must include:
(a) The Program's philosophical
approach to stablization;
(b) Rules of employee conduct,
including ethical standards; and
(c) Standards for employee
use and abuse of alcohol and other drugs.
(2) Compliance with the Civil
Rights Act of 1964, as amended in 1972, the Equal Pay Act of 1963, Age Discrimination
in Employment Act of 1967, and any subsequent amendments.
(3) Implementation of a policy
and procedure prohibiting client abuse which is consistent with OAR 407-045.
(4) Implementation of a policy
and procedure for resolving employee performance problems, which must specify the
sequence of steps to be taken when performance problems arise, and identify the
resources to be used in assisting employees to deal with problems which interfere
with job performance.
(5) Maintenance of personnel
records for each member of the Program's staff. The personnel record must:
(a) Contain the employee's
resume and/or employment application, wage and salary information, and the employee's
formal performance appraisals;
(b) Contain documentation
of training/development needs of the employee and identify specific methods for
meeting those needs;
(c) Contain documentation
of any formal corrective actions taken due to employee performance problems;
(d) Contain documentation
of any actions of commendation taken for the employee; and
(e) Be maintained and utilized
in such a way as to insure employee confidentiality. Records must be retained for
a period of three years following the departure of an employee.
(6) Implementation of personnel
performance appraisal procedures that must:
(a) Be based on pre-established
performance criteria in terms of specific responsibilities of the position as stated
in the job description;
(b) Be conducted at least
annually;
(c) Require employees to
review and discuss their performance appraisals with their supervisors, as evidenced
by their signature on the appraisal document;
(d) Require that when the
results of performance appraisal indicates there is a discrepancy between the actual
performance of an employee and the criteria established for optimum job performance,
the employee must be informed of the specific deficiencies involved, in writing;
and
(e) Require documentation
that when deficiencies in employee performance have been found in an appraisal,
a remedial plan is developed and implemented with the employee.
(7) Implementation of a development
plan which addresses continuing training for staff members.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0015; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0020
Client Rights
Each Program must provide individuals
the following rights and protection in addition to those described in OAR 309-016-0760.:
(1) Individuals must give
written informed consent to treatment. If informed consent is not a possibility
due to the inability of the individuals to understand his or her rights, this fact
must be recorded in the individual’s file.
(2) The Program must have
established and implemented controls on individuals labor within the program. Work
done as part of the individual’s stablization plan or standard program expectations
must be agreed to, in writing, by the individuals.
(3) The Program must develop,
implement and inform individuals of a policy and procedure regarding grievances
which providing for:
(a) Receipt of written grievances
from individuals or persons acting on their behalf;
(b) Investigation of the
facts supporting or disproving the written grievance;
(c) The taking of necessary
action on substantiated grievances within 72 hours; and
(d) Documentation in the
individuals's record of the receipt, investigation, and any action taken regarding
the written grievance.
Stat. Auth.: ORS 409.410
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15-1983, f. 7-27-83,
ef. 10-25-83; ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0020;
ADS 2-2008, f. & cert. ef. 11-13-08; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0025
Admission
of Clients
Each Program must meet the following
standards pertaining to admission of Individuals:
(1) The Program must have
written criteria for admission and for rejecting admission requests which includes
observation for symptoms of withdrawal. The criteria must be available to Individuals,
staff, and the community and be in compliance with ORS 430.397 through 430.401.
(2) The Program must utilize
a written intake procedure. The procedure must include:
(a) A determination that
the Program's services are appropriate to the needs of the Individual;
(b) Steps for making referrals
of individuals not admitted to the Program;
(c) Steps for accepting referrals
from outside agencies;
(d) A specific time limit
within which the initial client assessment must be completed on each Individual;
and
(e) Steps for coordinating
care with payers and entities responsible for care coordination.
(3) The Program must make
available, for Individuals and others, program orientation information. The orientation
information must include:
(a) The Program's philosophical
approach to stablization;
(b) Information on Individuals'
rights and responsibilities while receiving services from the Program;
(c) A written description
of the Program's services; and
(d) Information on the rules
governing Individual's behavior and those infractions, if any, that may result in
discharge or other actions.
(4) In addition to the information
required by the Division's data system, the following information must be recorded
in each Individual's record at the time of admission:
(a) Name, address, and telephone
number;
(b) Who to contact in case
of an emergency;
(c) Name of individual completing
intake; and
(d) Identification of Individual's
family and social support, if any.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0025; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0030
Individual Assessment and Evaluation
Each Program must meet the following
standards pertaining to Individual assessment and evaluation:
(1) The program must develop
and implement a written procedure for assessing medical and psycho -social factors
and evaluating each individual's stabilization needs as soon as the individual is
able.
(2) The procedure must specify
that the assessment and evaluation be the responsibility of a member of the treatment
staff.
Stat. Auth.: ORS 413.042, 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0030; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 6-2013, f. &
cert. ef. 8-1-13
415-050-0035
Stabilization Services
Each Program must meet the following
stabilization standards:
(1) The Program must provide
individual or group motivational counseling sessions and individual advocacy and
case management services; all of which must be documented in individual files.
(2) The Program must encourage
individuals to remain in services for an appropriate duration as determined by the
service plan. Also, the Program must encourage all individuals to enter programs
for ongoing recovery.
(3) The Program must refer
individuals to self-help groups when clinically indicated and to the extent available
in the community.
(4) Individuals fluent in
the language and sensitive to the special needs of the population served must be
provided as necessary to assist in the delivery of services.
(5) The Program must develop
an individualized stabilization plan for each individual accepted for stabilization
following clinical assessments for substance use and medical needs. The stabilization
plan must be appropriate to the length of stay and condition of the individual and
consider safe detoxification, care transition, and medical issue to be addressed.
The stabilization plan must include progress notes that:
(a) Identify the problems
from the individual assessment and evaluation;
(b) Specify objectives for
the stabilization of each identified individual problem;
(c) Specify the stabilization
methods and activities to be utilized to achieve the specific objectives desired;
(d) Specify the necessary
frequency of contact for the individual services and activities;
(e) Specify the participation
of significant others in the stabilization planning process and the specified interventions
where appropriate;
(f) Document the individual's
participation in developing the content of the stabilization plan and any modifications
by, at a minimum, including the individual's signature; and
(g) Document any efforts
to encourage the individual to remain in the program's services, and efforts to
encourage the individual to accept referral for ongoing treatment.
(6) The individual record
must document the individual's involvement in stabilization activities and progress
toward achieving objectives contained in the individual's stabilization plan. The
documentation must be kept current, dated, be legible, and signed by the individual
making the entry.
(7) The program must conduct
and document in the individual's record transition planning for individuals who
complete stabilization. The transition plan must include:
(a) Referrals made to other
services or agencies at the time of transition;
(b) The individual's plan
for follow-up, aftercare, or other post-stabilization services; and
(c) Document participation
by the individual in the development of the transition plan.
(8) At transition a stabilization
summary and final evaluation of the individual's progress toward treatment objectives
must be entered in the individual's record.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0035; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0040
Medical Services
Each Program must meet the following
standards for medical services:
(1) The Program must have
written procedures for providing immediate transportation for individuals to a general
hospital in case of a medical emergency.
(2) The Program must have
a written description of its medical policies and procedures. The description must:
(a) Specify the level of
medical care provided; and
(b) Include a written policy
and procedure, developed by the Medical Director, for determining the individual's
need for medical evaluation.
(3) The Medical Director’s
involvement in the development and review of medical operating procedures, quarterly
reviews of physicians' standing orders, and consultation in any medical emergencies
must be documented.
(4) In clinically managed
environments, individuals must have access to intensive inpatient treatment services,
as follows:
(a) Transfer to medically
monitored services as necessary;
(b) Medical evaluation and
consultation is available 24 hours a day by appropriately credentialed persons who
are trained and competent to implement physician-approved protocols.;
(c) Medical evaluation and
consolation must be available 24 hours a day, in accordance with treatment/transfer
practice guidelines;
(d) The initial assessment
must be conducted by appropriately credentialed personnel.
(e) Appropriately licensed
and credentialed staff must be available to administer medications in accordance
with physician orders. (5) In medically monitored environments, individuals must
have access to services which provide intensive inpatient treatment services, as
follows:
(f) LMPss must be available
24 hours a day by telephone;
(g) An individual must be
seen by an LMP within 24 hours of admission, or sooner if medically necessary;
(h) An LMP must be available
to provide onsite monitoring of care and further evaluation on a daily basis;
(i) The initial assessment
must be conducted by a skilled nursing staff.
(j) On-site skilled nursing
care must be provided twenty-four (24) hours per day, seven (7) days per week; and
(k) Appropriately licensed
and credentialed staff must be available to administer medications in accordance
with physician orders.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0040; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0045
Management of Medications
Each Program must have:
(1) A written order signed
by a physician, a physician's standing order, or a physician's order received by
phone and signed by the physician at the earliest opportunity before any medication
is administered to, or self-administered by any individual.
(2) Assurances that medications
prescribed for one individual must not be administered to, or self-administered
by another individual or employee.
(3) A policy that no unused,
outdated, or recalled drugs must be kept in the Program. All unused, outdated, or
recalled drugs must be disposed of in a manner that assures that they cannot be
retrieved, except that drugs under the control of the Food and Drug Administration
must be mailed with the appropriate forms by express, prepaid, or registered mail,
every 30 days to the Oregon Board of Pharmacy. A written record of all disposals
of drugs must be maintained in the Program and must include:
(a) A description of the
drug, including the amount;
(b) The individual for whom
the medication was prescribed;
(c) The reason for disposal;
and
(d) The method of disposal
including:
(A) Drugs that are outdated,
damaged, deteriorated, misbranded, or adulterated shall be quarantined and physically
separated from other drugs until they are destroyed or returned to their supplier.
(B) Controlled substances
which are expired, deteriorated or unwanted shall be disposed of in conformance
with 21 CFR 1307.21.
(C) Expired, deteriorated,
discontinued, or unwanted controlled substances in a long-term care facility shall
be destroyed and the destruction jointly witnessed on the premises by any two of
the following:
(i) The consultant pharmacist
or registered nurse designee;
(ii) The Director of Nursing
Services or supervising nurse designee;
(iii) The administrator of
the facility or an administrative designee; or
(iv) A Registered Nurse employed
by the facility.
(D) The destruction shall
be documented and signed by the witnesses and the document retained at the facility
for a period of at least three years.
(4) A policy that all prescription
drugs stored in the Program must be kept in a locked stationary container. Only
those medications requiring refrigeration must be stored in a refrigerator.
(5) A policy for program
stored not yet prescribed controlled substance including records and maintain inventories
in conformance with 21 U.S.C. Section 827; 21CFR 1304.02 through 1304.11; 1304.21
through 1304.26; 1304.31 through 1304.33; except that a written inventory of all
controlled substances shall be taken by registrants annually within 365 days of
the last written inventory. All such records shall be maintained for a period of
three years.
(6) A policy that in the
case where a individual self-administers his or her own medication, self-administration
must be recommended by the Program, approved in writing by the Medical Director,
and closely monitored by the treatment staff.
(7) Individual records which
must be kept for each individual for any prescription drugs administered to, or
self-administered by any individual. This written record must include:
(a) Individual's name;
(b) Prescribing physician's
name;
(c) Description of medication,
including prescribed dosage;
(d) Verification in writing
by staff that the medication was taken and the times and dates administered, or
self-administered;
(e) Method of administration;
(f) Any adverse reactions
to the medication; and
(g) Continuing evaluation
of the individual's ability to self-administer the medication.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0045; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0050
Staffing
Pattern
(1) Each Program must be in staffing
compliance with ASAM Patient Placement Criteria 2R as follows:
(a) Clinically Managed Programs
must be staffed by:
(A) Appropriately credentialed
personnel who are trained and competent to implement physician-approved protocols
for patient observation and supervision, determination of appropriate level of care,
and facilitation of patient’s transition to continuing care;
(B) Medical evaluation and
consultation must be available 24 hours a day, in accordance with stabilization
and transfer practice guidelines; and
(C) Staff who assess and
treat patients must be able to obtain and interpret information regarding the needs
of these patients. Such knowledge includes the signs and symptoms of alcohol and
other drug intoxication and withdrawal, as well as the appropriate stabilization
and monitoring of those conditions and how to facilitate entry into ongoing care.
(b) Medically Monitored Programs
must be staffed by:
(A) LMPs who are available
24 hours a day by telephone, available to assess the patient within 24 hours of
admission, or earlier, (if medically necessary), and available to provide on –site
monitoring of care and further evaluation on a daily basis;
(B) A licensed and credentialed
nurse must be available to conduct a nursing assessment upon admission and to oversee
the monitoring of the patient’s progress and medication administration on
an hourly basis, if needed;
(C) Appropriately licensed
and credentialed staff must be available to administer medications in accordance
with physician orders; and
(D) The level of nursing
care must be appropriate to the severity of patient needs.
(2) The Program must maintain
a minimum ratio of paid full-time staff to bed capacity as follows:
(a) 1 through 8 beds —
1 staff person on duty;
(b) 9 through 18 beds —
2 staff persons on duty;
(c) 19 through 30 beds —
3 staff persons on duty;
(d) 31 beds and above —
One additional staff person beyond the three staff required above for each additional
15 beds or part thereof.
(3) The Program’s must
written staffing plan must address the provision of appropriate and adequate staff
coverage during emergency and high demand situations.
(4) The Program must provide
a minimum of one hour per month of personal clinical supervision and consultation
for each staff person and volunteer who is responsible for the delivery of treatment
services. The clinical supervision must relate to the individual's skill level with
the objective of assisting staff and volunteers to increase their treatment skills
and quality of services to individuals.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0050; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0055
Management
Staff Qualifications
Each Program must be directed by a person
with the following qualifications at the time of hire:
(1) For an individual recovering
from a substance-use disorder, continuous sobriety for the immediate past two years.
(2) Education and/or work
experience as follows:
(a) Five years of paid full-time
experience in the field of substance use disorders, with at least one year in a
paid administrative capacity; or
(b) A Bachelor's degree in
a relevant field and four years of paid full-time experience with at least one year
in a paid administrative capacity; or
(c) A Master's degree in
a relevant field and three years of paid full-time experience with at least one
year in a paid administrative capacity.
(3) Knowledge and experience
demonstrating competence in planning and budgeting, fiscal management, supervision,
personnel management, employee performance assessment, data collection, and reporting.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0055; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0060
Staff Qualifications
Each Program must have:
(1) An identified clinical
supervisor who has the following qualifications at the time of hire:
(a) For an individual recovering
a substance-use disorder, continuous sobriety for the immediate past two years;
(b) Education and/or work
experience as follows:
(A) Five years of paid full-time
experience in the field of substance use with a minimum of two years of direct substance
use treatment experience; or
(B) A Bachelor's degree in
a relevant field and four years of paid full-time experience, with a minimum of
two years of direct substance abuse treatment experience; or
(C) A Master's degree in
a relevant field and three years of paid full-time experience with a minimum of
two years of direct substance use treatment experience.
(c) Knowledge and experience
demonstrating competence in the treatment of the disease of substance use, including
the management of substance withdrawal, individual evaluation; motivational, individual,
group, family and other counseling techniques; clinical supervision, including staff
development, service planning and case management; and utilization of community
resources including Alcoholics Anonymous, Al-Anon, and Alateen.
(2) If the Program's director
meets the qualifications of the clinical supervisor, the director may be the Program's
clinical supervisor.
(3) The Program's treatment
staff must:
(a) For individuals recovering
from a substance-use disorder, have maintained continuous sobriety for the immediate
past two years at the time of hire;
(b) Have training knowledge
and/or experience demonstrating competence in the treatment of the disease of substance
use, including the management of substance withdrawal; individual evaluation; motivational
counseling techniques; and the taking and recording of vital signs;
(c) Within six weeks of employment,
be currently certified or in process of certification in first aid methods including
cardiopulmonary resuscitation.
(4) The Program’s medical
staff must:
(a) For an individual recovering
a substance-use disorder, continuous sobriety for the immediate past two years;
(b) Operate within the scope
of their practice;
(c) Be appropriately credentialed
and certified by the appropriate board or body; and
(d) Knowledge and experience
treating the disease of substance abuse.
(5) Detoxification Technicians,
when employed by a program, must:
(a) For an individual recovering
a substance-use disorder, continuous sobriety for the immediate past two years;
and
(b) Knowledge and experience
treating the disease of substance abuse.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0060; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0065
Use of Volunteers
Each Program utilizing volunteers must
have the following standards for volunteers:
(1) A written policy regarding
the use of volunteers that must include:
(a) Philosophy, goals, and
objectives of the volunteer program;
(b) Specific responsibilities
and tasks of volunteers;
(c) Procedures and criteria
used in selecting volunteers, including sobriety requirements for individuals recovering
from a substance use disorder;
(d) Terms of service of volunteers;
(e) Specific accountability
and reporting requirements of volunteers;
(f) Specific procedure for
reviewing the performance of volunteers and providing direct feedback to them; and
(g) Specific procedure for
discontinuing a volunteer's participation in the program.
(2) There must be documentation
that volunteers complete an orientation and training program specific to their responsibilities
before they participate in assignments. The orientation and training for volunteers
must:
(a) Include a thorough review
of the Program's philosophical approach to stabilization;
(b) Include information on
confidentiality regulations and individual's rights;
(c) Specify how volunteers
are to respond to and follow procedures for unusual incidents;
(d) Explain the Program's
channels of communication and reporting requirements and the accountability requirements
for volunteers;
(e) Explain the procedure
for reviewing the volunteer's performance and providing feedback to the volunteer;
and
(f) Explain the procedure
for discontinuing a volunteer's participation.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15-1983, f. 7-27-83,
ef. 10-25-83; ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0065;
ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f. & cert. ef. 2-4-13
thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0070
Building
Requirements
In addition to the building requirements
for outpatient Alcohol and Other Drug treatment programs, detoxification programs
must meet the following standards:
(1) Prior to construction
of a new building or major alteration of or addition to an existing building:
(a) One set of plans and
specifications must be submitted to the State Fire Marshal for approval;
(b) Plans must be in accordance
with the State of Oregon Structural Specialty Code and Fire and Life Safety Regulations;
(c) Plans for construction
containing 4,000 square feet or more must be prepared and bear the stamp of an Oregon
licensed architect or engineer; and
(d) The water supply, sewage,
and garbage disposal system must be approved by the agency having jurisdiction.
(2) Interiors: All rooms
used by individuals must have floors, walls, and ceilings that meet the interior
finish requirements of the State of Oregon Structural Specialty Code and Fire and
Life Safety Regulations:
(a) A separate dining room
or area must be provided for exclusive use of individuals, program staff, and invited
guests, and must:
(A) Seat at least one-half
of the individuals at a time with a minimum of 15 square feet per occupant; and
(B) Be provided with adequate
ventilation.
(b) A separate living room
or lounge area must be provided for the exclusive use of individuals, program staff,
and invited guests and must:
(A) Provide a minimum of
15 square feet per occupant; and
(B) Be provided with adequate
ventilation.
(c) Sleeping areas must be
provided for all individuals and must:
(A) Be separate from the
dining, living, multi-purpose, laundry, kitchen, and storage areas;
(B) Be an outside room with
a window that can be opened, and is at least the minimum required by the State Fire
Marshal;
(C) Have a ceiling height
of at least seven feet, six inches;
(D) Provide a minimum of
60 square feet per individual, with at least three feet between beds;
(E) Provide permanently wired
light fixtures located and maintained to give light to all parts of the room; and
(F) Provide a curtain or
window shade at each window to assure privacy.
(d) Bathrooms must be provided
and conveniently located in each building containing a bedroom and must:
(A) Provide a minimum of
one toilet and one hand-washing sink for each eight individuals, and one bathtub
or shower for each ten individuals;
(B) Provide one hand-washing
sink convenient to every room containing a toilet;
(C) Provide permanently wired
light fixtures located and maintained to give adequate light to all parts of the
room;
(D) Provide arrangements
for personal privacy for individuals;
(E) Provide a privacy screen
at each window;
(F) Provide a mirror; and
(G) Be provided with adequate
ventilation.
(e) A supply of hot and cold
water installed and maintained in compliance with rules of, the Authority , Health
Services, Office of Public Health Systems, must be distributed to taps conveniently
located throughout the detoxification program;
(f) All plumbing must comply
with applicable codes;
(g) Laundry facilities, when
provided, must be separate from:
(A) Resident living areas,
including bedrooms;
(B) Kitchen and dining areas;
and
(C) Areas used for the storage
of unrefrigerated perishable foods.
(h) Storage areas must be
provided appropriate to the size of the detoxification program. Separate storage
areas must be provided for:
(A) Food, kitchen supplies,
and utensils;
(B) Clean linens;
(C) Soiled linens and clothing;
(D) Cleaning compounds and
equipment; and
(E) Poisons, chemicals, insecticides,
and other toxic materials, which must be properly labeled, stored in the original
container, and kept in a locked storage area.
(i) Effective July 1, 2012,
programs both licensed and funded by AMH must not allow tobacco use in program facilities
and on program grounds.
[Publications: Publications referenced are
available from the agency.]
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0070; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0075
Client Furnishings
and Linens
(1) Each Program must provide furniture
for each individual which must include:
(a) A bed with a frame and
a clean mattress and pillow;
(b) A private dresser or
similar storage area for personal belongings which is readily accessible to the
individual; and
(c) Access to a closet or
similar storage area for clothing and
(2) Linens must be provided
for each individual and must include:
(a) Sheets and pillowcases;
(b) Blankets, appropriate
in number and type for the season and the individual's comfort; and
(c) Towel and washcloth.
(3) A locked area not readily
accessible to individuals for safe storage of such items as money and jewelry.
Stat. Auth.: ORS 413.042 & 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0075; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0080
Safety
The program must meet the following
safety requirements:
(1) At no time must the number
of individuals served exceed the approved capacity;
(2) A written emergency plan
must be developed and posted next to the telephone used by program staff and must
include:
(a) Instructions for the
program staff or designated resident in the event of fire, explosion, accident,
death, or other emergency and the telephone numbers of the local fire department,
law enforcement agencies, hospital emergency rooms, and the detoxification program's
designated physician and on-call back-up program staff;
(b) The telephone number
of the administrator or clinical supervisor and other persons to be contacted in
case of emergency; and
(c) Instructions for the
evacuation of individuals and program staff in the event of fire, explosion, or
other emergency.
(3) The detoxification program
must provide fire safety equipment appropriate to the number of individuals served,
and meeting the requirements of the State of Oregon Structural Specialty Code and
Fire and Life Safety Regulations:
(a) Fire detection and protection
equipment must be inspected as required by the State Fire Marshal;
(b) All flammable and combustible
materials must be properly labeled and stored in the original container in accordance
with the rules of the State Fire Marshal; and
(c) The detoxification program
must conduct unannounced fire evacuation drills at least monthly. At least once
every three months the monthly drill must occur between 10 p.m. and 6 a.m. Written
documentation of the dates and times of the drills, time elapsed to evacuate, and
program staff conducting the drills must be maintained.
(4) At least one program
staff who is trained in First Aid and CPR must be onsite at all times
[Publications: Publications referenced
are available from the agency.]
Stat. Auth.: ORS 409.410
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0080; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 6-2013, f. &
cert. ef. 8-1-13
415-050-0085
Sanitation
Each Program must comply with the following
sanitation standards:
(1) All floors, walls, ceilings,
window, furniture, and equipment must be kept in good repair, clean, neat, orderly,
and free from odors;
(2) Each bathtub, shower,
hand-washing sink, and toilet must be kept clean and free from odors;
(3) The water supply in the
detoxification program must meet the requirements of the rules of the Health Division
governing domestic water supplies;
(4) Soiled linens and clothing
must be stored in an area separate from kitchens, dining areas, clean linens and
clothing and unrefrigerated food;
(5) All measures necessary
to prevent the entry into the program of mosquitoes and other insects must be taken;
(6) All measures necessary
to control rodents must be taken;
(7) The grounds of the program
must be kept orderly and free of litter, unused articles, and refuse;
(8) Garbage and refuse receptacles
must be clean, durable, water-tight, insect- and rodent proof and kept covered with
a tight-fitting lid;
(9) All garbage solid waste
must be disposed of at least weekly and in compliance with the rules of the Department
of Environmental Quality; and
(10) Sewage and liquid waste
must be collected, treated and disposed of in compliance with the rules of the Department
of Environmental Quality.
Stat. Auth.: ORS 413.042, 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0085; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 6-2013, f. &
cert. ef. 8-1-13
415-050-0090
Food Service
The detoxification program must meet
the requirements of the State of Oregon Sanitary Code for Eating and Drinking Establishments
relating to the preparation, storage, and serving of food. At minimum:
(1) Menus must be prepared
in advance to provide a sufficient variety of foods served in adequate amounts for
each resident at each meal;
(2) Records of menus as served
must be filed and maintained in the detoxification program records for at least
30 days;
(3) All modified or special
diets must be ordered by an LMP;
(4) At least three meals
must be provided daily;
(5) Supplies of staple foods
for a minimum of one week and of perishable foods for a minimum of a two-day period
must be maintained on the premises;
(6) Food must be stored and
served at proper temperature;
(7) All utensils, including
dishes, glassware, and silverware used in the serving or preparation of drink or
food for individuals must be effectively washed, rinsed, sanitized, and stored after
each individual use to prevent contamination in accordance with Health Division
standards; and
(8) Raw milk and home-canned
vegetables, meats, and fish must not be served or stored in a residential program.
[Publications: Publications referenced
are available from the agency.]
Stat. Auth.: ORS 409.410
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(6); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0090; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 3-2013(Temp), f.
& cert. ef. 2-4-13 thru 8-2-13; ADS 6-2013, f. & cert. ef. 8-1-13
415-050-0095
Variances
Requirements and standards for requesting
and granting variances or exceptions are found in OAR 415-012-0090.
Stat. Auth.: ORS 413.042, 430.256
Stats. Implemented: ORS 430.306
& 430.345 - 430.375
Hist.: MHD 15(Temp), f. 1-16-74,
ef. 2-1-74; MHD 45, f. & ef. 7-20-77; MHD 15-1983, f. 7-27-83, ef. 10-25-83,
Renumbered from 309-052-0000(7); ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered
from 309-050-0095; ADS 2-2008, f. & cert. ef. 11-13-08; ADS 6-2013, f. &
cert. ef. 8-1-13

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