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The Oregon Administrative Rules contain OARs filed through June 15, 2014
 
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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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