DAR File No. 42234

Human Services, Administration, Administrative Services, Licensing

Rule R501-18

Recovery Residence Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 42234
Filed: 10/16/2017 09:16:33 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

These changes are recommended by a statewide collaborative stakeholder group, including multiple recovery residence licensees, in response to efforts to ensure that the rules governing this service setting are correctly calibrated.

Summary of the rule or change:

This rule change eliminates the staffing differentiation between Recovery Residences that have seven or more clients and those with six or fewer. In effect, this eliminates the option of client/managers and only allows non-client managers. This is in order to ensure similar services and protections for all populations and is a recommendation made from the programs themselves. This change has little potential impact since no licenses have ever been granted for a program with six or fewer clients. Thus, all licenses in the past three years have always had non-client managers. Since the license's inception in 2014, all granted licenses have had seven or more clients at each site. In addition, this rule clarifies what is expected for program staff site visits including daily contact requirements. These requirements were already in the rule, but are being merely clarified. This addition was again program driven as a minimum standard to ensure safe sober environments. The rule amendments also, for safety reasons, clarify that these settings are not be used for those actively abusing substances and that these are not clinical treatment settings. It also clarifies fire safety requirements if a fire clearance is not required by local authorities and clarifies that clients can choose to share their own food without meeting health food handler's requirements. The rule was reorganized for clarity without substantial changes in most areas.

Statutory or constitutional authorization for this rule:

• Section 62A-2-101

Anticipated cost or savings to:

the state budget:

It is not anticipated that the state budget will be affected. Licensing activities and workload remain unchanged by these clarifications.

local governments:

No local governments are involved in recovery residence licensing.

small businesses:

This rule is not expected to have fiscal impact on small businesses. These clarifications primarily are meant to memorialize how the rule is being complied with already by both programs and their assigned licensors. It is more clear for more consistent compliance. If anything, it is likely these clarifications will reduce the workload for recovery residences. These amendments would have had an impact on smaller recovery residences using client managers, but none of those have existed since the rule's inception and no one in the recovery community anticipates any in the future.

persons other than small businesses, businesses, or local governmental entities:

No other persons are affected by this rule.

Compliance costs for affected persons:

It is not anticipated that recovery residences will incur compliance costs from these rule amendments but they may enjoy minimal savings. Fire safety could theoretically cost a bit more due to the clarifications, but also allow an alternative to municipal fire safety clearance that is more likely to save than cost the provider while still ensuring minimum fire safety standards. On the whole, this rule is more clear, but more flexible for providers than their compliance under the former rule.

Comments by the department head on the fiscal impact the rule may have on businesses:

Upon analysis, this rule results in no fiscal impact for businesses.

Ann Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Human Services
Administration, Administrative Services, Licensing
195 N 1950 W 1ST FLR
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Julene Robbins at the above address, by phone at 801-538-4521, by FAX at 801-538-3942, or by Internet E-mail at [email protected]
• Janice Weinman at the above address, by phone at 385-321-5586, by FAX at 801-538-4553, or by Internet E-mail at [email protected]
• Samantha Hanson at the above address, by phone at 801-538-4041, by FAX at , or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/01/2017

This rule may become effective on:

12/08/2017

Authorized by:

Diane Moore, Director

R501. Human Services, Administration, Administrative Services, Licensing.

R501-18. Recovery Residence Services.

R501-18-1. Authority.

This Rule is authorized by Section 62A-2-101 et seq.

 

R501-18-2. Purpose.

This rule establishes:

(1) basic health and safety standards for recovery residences; and

(2) minimum administration [and financial] requirements.

 

R501-18-3. Definitions.

(1) "Currently Enrolled Client" is an individual who is a participatory resident of the sober living environment of a recovery residence and is also referred to as "Client" in this chapter.

(2) "Manager" is an individual designated in-writing by the director to oversee the day-to-day supervision of staff and clients as well as the overall operation of the facility. The manager or substitute manager cannot be a currently enrolled client.

([1]3) "Recovery [r]Residence" is as defined in Subsection 62A-2-101(22) and includes a variety of sober living settings.[

(2) "SUD" means Substance Use Disorder.]

 

R501-18-4. Legal Requirements.

(1) A recovery residence shall comply with this R501-18 and:

(a) R501-1, General Provisions;

(b) R501-2, Core Rules;

(c) R501-14 by either:

(i) participating in the background clearances for all staff; or

(ii) obtaining an approval by the Office of Licensing for an exemption as outlined in R501-14.

([c]d) all applicable local, state, and federal laws.

(2) [Prior to offering any residential treatment services, a]A recovery residence wishing to offer clinical treatment services, shall comply with R501-19 and obtain a residential treatment license. No clinical treatment shall occur at a recovery residence site.

(3) [A recovery residence shall comply with the Americans with Disabilities Act.]A recovery residence wishing to offer social detoxification services shall comply with R501-11 and obtain a social detoxification license prior to offering any social detoxification services onsite. No services shall be provided to those in active withdrawl at a recovery residence site.

(4) A recovery residence shall only serve adults.

 

R501-18-5. Administration.

(1) The recovery residence shall ensure that clients receive supportive services from a person associated with the licensee or from a licensed professional. Supportive services include but are not limited to:

(a) vocational services;

(b) peer support;

(c) skills training; or

(d) community resource referral.

(2) A list of current clients shall be maintained on-site at all times and available to the Department of Human Services Office of Licensing upon request.

 

R501-18-6. Staffing.

(1) The [recovery residence]program shall [have an identified recovery residence director(s)who shall have at least one of the following:

(a) a minimum of two years of documented administrative experience in recovery residence;

(b) a minimum of two years documented substance use disorder treatment;

(c) a minimum of two year documented recovery support services; or

(d) minimum Utah licensure as a substance use disorder counselor, licensed clinical social worker or equivalent.]employ, contract with, or otherwise provide as needed, referral information for client access to the following:

(a) Physician

(b) Psychiatrist

(c) Mental health therapist (LCMHT); or

(d) Substance use disorder counselor (SUDSC).

(2) The recovery residence shall have an identified recovery residence director(s) who shall have:

(a) Utah licensure, in good standing, as a substance use disorder counselor, licensed clinical social worker or equivalent; or

(b) a minimum of 2 years experience in one of the following:

(i) administration of a recovery residence;

(ii) substance use disorder treatment education; or

(iii) recovery/support services education.

([2]3) The director's responsibilities that shall not be delegated include:

(a) monitoring all aspects of the program and operation of the facility;

([a]b) policy and procedure development, implementation, compliance and oversight per R501-2 Core Rule requirements and to also include:[;]

(i) clearly defining responsibilities of the director, manager, and staff of the program;

([b]c) [quality assurance plan implementation]supervision, training and oversight of staff;

[(c) training curriculum;

(d) supervision of staff;

]([e]d) overs[ight]eeing [of]all client activities[;].

[(f) ensure continual compliance with local, state and federal laws;

(g) notify the Office of Licensing 30 days prior to changes in program administration or purpose;

(h) ensure that the program is fiscally sound;

(i) ensure program maintains the staffing ratios outlined in program policy and procedure;

(j) ensure that the program has general liability insurance, professional liability insurance, vehicle insurance, and fire insurance; and

(k) monitoring all aspects of the program as outlined in the quality assurance plan.

]([2]4) The recovery residence director may manage directly or employ a manager as defined in this chapter, [who may be a client,] to work under the supervision of the director.[The manager may be responsible for the day-to-day staff, volunteer, and client supervision and operation of the facility. The responsibilities of the manager shall be clearly defined in the recovery residence policies and procedures. Whenever the manager is on leave (vacation, sick, etc.), the director shall designate a substitute to assume managerial responsibility. The recovery residence director, whether physically present or not, shares responsibility for the acts and omissions of the manager.]

(a) The director shall perform the manager's duties when the manager is on scheduled or unscheduled leave unless the manager designates a manager-substitute.

([3]5) The director is responsible for maintaining the following documentation for self and all direct service staff: [recovery residence shall provide each director, recovery residence manager, substitute, and staff, including clients serving in those capacities, with a minimum of:]

(a) 40 hours of training completed prior to working with clients and ongoing training sufficient to maintain proficiency in the topics of:

(i) [. Training topics shall include: SUD curriculum,]recovery services in substance use disorder settings;

(ii) peer support[,];

(iii) emergency overdose [response,];

(iv) recognition [of] and response to [drug]substance -related activities[,]; and

(v) current certifi cation[ed] in [f]First [a]Aid and CPR[;].

(b) documented training [prior to working with clients that includes, but is not limited to: how to comply with Core and Recovery Residence Rules, program policies and procedures, ethics, conflicts of interest, and case management;]regarding compliance with current licensing rules to include:

(i) R501-1, General Provisions;

(A) including the annual required Licensing Code of Conduct; and

(B) Client Rights;

(ii) R501-2, Core Rules;

(iii) R501-18 Recovery Residence rules; and

(iv) all current program policies and procedures.

[(c) ongoing training to maintain proficiency in the above topics.

(4) A recovery residence with 6 or fewer licensed client capacity:

(a) shall have a recovery residence manager(s), who may be a client, and substitute(s), who may be a client, approved in writing by the recovery residence director;

]([b]6) The recovery residence shall have a [residence ] director[,]or manager [or substitute]conduct on-site visits daily [a minimum of 5 days per week] in order to ensure client[assess] safety and support clients.[These visits shall be scheduled and documented;]

(a) Site visits shall be documented per-site, not per-client;

[( c) shall have a residence director, manager or substitute have daily client contact with each admitted client. These contacts shall be documented;

] (b) site visits shall assess and document the following:

(i) general safety;

(ii) general cleanliness;

(iii) verification that only admitted residents reside or stay overnight at the residence;

(iv) no presence of alcohol or substances of abuse unless lawfully prescribed; and

(v) medications in locked storage.

(7) The director or manager shall have documented face-to-face or telephone daily contact with each admitted client.

([d]8) [t]The recovery residence director shall ensure [that the recovery residence director or a manager, substitute, or staff maintains]administrative on-call availability at all times and remain[s] able to respond to the recovery residence staff and the Office of Licensing immediately by phone, [and remains able to respond in person at the recovery]or at the residence in-person within one hour.

[(5) A recovery residence with 7 or more licensed client capacity:

(a) shall have a recovery residence manager(s), who may not be a client, and substitute(s), who may not be a client, approved in writing by the recovery residence director;

](b) shall have a residence director, manager or substitute on-site a minimum of 7 days per week in order to assess safety and support clients. These visits shall be scheduled and documented;

(c) shall have a residence director, manager or substitute have daily client contact with each admitted client. These contacts shall be documented;

(d) the recovery residence director shall ensure that the recovery residence director or a manager, substitute, or staff maintains on-call availability at all times, and remains able to respond to the recovery residence and the Office of Licensing immediately by phone, and remains able to respond in person at the recovery residence within one hour.

(6) The recovery residence shall determine and comply with a written policy which clearly defines the minimum staff-to-client ratios and levels of supervision of clients by the person(s) associated with the licensee.

(7) The recovery residence shall have a written:

(a) emergency plan posted and available to clients;

(b) grievance procedure posted and available to clients.

(8) A recovery residence which utilizes non-client volunteers shall provide training and evaluation of non-client volunteers. Non-client volunteers providing care without paid staff present shall have direct communication access to the recovery residence manager or recovery residence director at all times. Non-client volunteers shall be trained in recovery residence policies and procedures, objectives, and scope of service. All volunteers will be supervised by the recovery residence director who is responsible for their conduct.

(9) Professional Staff shall include the following individuals who are either employed, under contract or are otherwise available for referral to the clients of the recovery residence:

(a) a licensed physician; and/or

(b) a licensed psychiatrist; and/or

(c) a licensed mental health therapist; and/or

(d) a licensed substance use disorder counselor (SUDC).]

 

R501-18-7. Direct Service.

(1) This subsection supersedes Core Rules, Section R501-2-5. The recovery residence client records shall contain the following:

(a) name, address, telephone number, email;

(b) admission date;

(c) emergency contact information with names, address, email, and telephone numbers;

(d) all information that could affect the health, safety or well-being of the client to include:

(i) medications;

(ii) allergies;

(iii) chronic conditions; or

(iv) communicable diseases;

([d]e) [an] intake [application and assessment]documentation indicating that the client meets the admission criteria , including the following:

(i) not currently using or withdrawing from alcohol or substances of abuse; and

(ii) not presenting with a current clinical assessment that contraindicates this level of care.

([e]f) individual recovery plan, including the signature and title of the [persons]program representative preparing the recovery plan and the signature of the client; the recovery plan shall include the following:

([f]i) documentation of all services provided by the program, including a disclosure that no clinical treatment services occur on-site at the recovery residence; and[, including the signature and title of the persons providing recovery residence services;]

([g]ii) documentation of all referred supportive services, not directly associated with the recovery residence site.[;]

([h]g) the signed written lease agreement for the recovery residence, if required;

([i]h) a signed agreement indication that the client was notified in writing prior to admission regarding: [crisis intervention reports;

(j) the recovery residence's client recovery plan shall offer and document individualized and supportive services;

(k) treatment is not a required component of a recovery residence. However, off-site treatment referrals shall be made available upon request. On-site treatment and other services must first be licensed in accordance with applicable Office of Licensing categorical rules;

(l) clients will be notified prior to admission regarding their responsibilities related to the transportation and location of off-site services.]

(i) program and client responsibilities related to transportation to and location of off-site services;

(ii) program and client responsibilities related to the provision of toiletries, bedding and linens, laundry and other household items;

(iii) program and client responsibilities related to shopping, provision of food and preparation of meals;

(iv) fee disclosures included Medicaid number, insurance information and identification of any other entities who may be billed for the client's services;

(v) rules of the program;

(vi) client rights

(vii) grievance and complaint policy;

(viii) critical incident reports involving the client; and

(iv) discharge documentation.

 

R501-18-8. [Physical Environment]Building and Grounds.

(1) The recovery residence shall ensure that building and grounds are safe and well-maintained. Furnishings, finishings, fixtures, equipment, appliances and utilities are operational and in good condition.[provide written documentation of compliance with the following:

(a) local zoning ordinances;

(b) local business license requirements;

(c) local building codes;

(d) local fire safety regulations;

(e) local health codes; and

(f) local approval from the appropriate government agency for new program services or increased client capacity.

(2) Building and Grounds:

(a) the recovery residence shall ensure that the appearance, safety and cleanliness of the building and grounds are maintained.

 

R501-18-9. Physical Facility.

(1) Live-in staff, who may be a client, shall have a separate sleeping area with a private bathroom.

](2) The recovery residence shall[have a designated secure location that serves as an administrative office for records, secretarial work, and bookkeeping if such work is done onsite.

(3) Bathrooms]:

(a) [the recovery residence shall]have locking bathroom[s]capability sufficient to preserve the privacy of the occupant[.]; [Clients shall have]

(b) provide access to a toilet, [lavatory] sink, and a tub or shower ; as follows per the International Building Code:[.]

(i) maintain a client to toilet ratio of 1:10, and

(ii) maintain a client to tub/shower ratio of 1:8.[These shall be maintained in good operating order and in a clean and safe condition;

(b) client to bathroom ratios shall comply with the residential international building code, as administered by the local government authority;

(c) each bathroom shall be maintained in good operating order;]

([d]c) [there shall be]provide a mirror[s] secured to [the]a wall[s] at convenient height[s];

([e]d) ensure that each bathroom [shall be]is ventilated by [mechanical means or equipped with ]a screened window that opens , a working fan or heating/air conditioning duct that circulates air;

[(f) clients will be notified prior to admission regarding their responsibilities related to the provision of toiletries.

(4) Sleeping Accommodations:

]([a]e) provide a minimum of 60 square feet per client [shall be provided] in a multiple occupant bedroom and 80 square feet in a single occupant bedroom. Storage space shall not be counted;

([b]f) ensure that sleeping areas shall have a source of natural light, and shall be ventilated by [mechanical means or equipped with ]a screened window that opens , a working fan, or heating/air conditioning duct that circulates air;

([c]g) ensure that each client is provided with a solidly constructed bed, [none of which shall be portable, shall be solidly constructed]box spring and mattress that is maintained and provides for client comfort and is commensurate with all other client beds in the residence;

([d]h) [sleeping quarters serving]ensure that male and female [clients]bedrooms are [shall be structurally] separated within the residence either by floors, walls or [and have] locking [bedroom ]doors ;. If locking doors are used, a policy must identify the use of locks to delineate separation;

([e]i) ensure that clients shall be allowed to decorate and personalize bedrooms with respect for other clients and property;

([f]j) if a fire clearance is not required or provided from the local fire authority:

(i) a bedroom on the ground floor shall have a minimum of one window that may be used to evacuate the room in case of fire;

([g]ii) a bedroom that is not on the ground floor (this includes basements) shall have a minimum of two exits, at least one of which shall exit directly to outside the building that may be used to evacuate the room in case of fire;

[(h) furniture and residence equipment shall be of sufficient quantity and quality to meet recovery residence and client needs;

(i) all furniture and residence equipment shall be maintained in a clean and safe condition;

(j) clients will be notified prior to admission regarding their responsibilities related to the provision of bedding and linens.

(5) Weapons Safety:

(a) all facilities shall have and comply with a written weapons policy.

(6) Laundry Service:

]([a]k) the recovery residences shall provide either equipment or reasonable access to equipment for washing and drying of linens and clothing;

[(b) laundry appliances shall be maintained in good operating order and in a clean and safe condition.](l) provide storage commensurate with the clients' assessed ability to safely access hazardous chemicals, materials and aerosols, including but not limited to:

(i) poisonous substances;

(ii) explosive or flammable substances;

(iii) bleach; and

(iv) cleaning supplies;

(m) maintain hazardous chemicals, materials, and aerosols in their original packaging and follow the manufacturer's instructions printed on the label.

(n) maintain a sober environment free from non-prescribed substances and alcohol.

 

R501-18-[10]9 . Food Service.

(1) Meals may be catered, prepared by staff or prepared by clients [at the recovery residence or meals may be catered].

(2) The recovery residence shall have at least one kitchen.

([2]3) If the recovery residence [provides] allows staff or clients to prepare food for clients, it shall comply with food service requirements as follows:

(a) [current weekly menu shall be posted in the kitchen and the office;

(b) the staff or clients responsible for food service shall maintain]develop and follow a food service policy to address:

(i) how [a current list of clients with] special [nutritional] dietary needs and food allergies will be tracked and accommodated;[, shall provide food that meets those needs, and record in the client's service record information relating to special nutritional needs.

(3) The recovery residence shall have one or more kitchens, which shall have clean and safe operational equipment in sufficient quantity for the preparation, storage, serving, and clean-up of all meals.

(4) The recovery residence shall have dining space/s large enough to provide seating for all clients. The dining space shall be maintained in a clean and safe condition.

(5) When meals consumed by clients are prepared by staff or other clients, the recovery residence shall have and comply with a written policy that complies with all minimum requirements of the local Health Department.

(6) Clients will be notified prior to admission regarding their responsibilities related to the provision or preparation of food.]

(ii) how safe food preparation and cleanup will be ensured;

(b) document compliance with, or exemption from, requirements of the local health department to include:

(i) health inspections and clearances; and

(ii) food handler's permits for anyone preparing food for anyone other than self;

(c) food of sufficient nutrition and variety shall be provided;

(d) menus shall be available upon request; and

(e) this does not prohibit clients from preparing their own food and choosing to share with other clients.

(4) The recovery residence shall provide enough seating at tables or tray tables to accommodate all clients simultaneously.

 

R501-18-1[1]0 . Medical Standards.

(1) The recovery residence shall not admit anyone who is currently in an intoxicated state or withdrawing from alcohol or drugs or otherwise unable to understand terms and consent to reside in the recovery residence [experiencing convulsions, in shock, delirium tremens, in a coma or unconscious].

([2]2) Before admission or employment, clients and staff shall be screened for Tuberculosis by a questionnaire approved by the local health department[.]; if further screening is indicated, clients and staff will:

(a) follow appropriate protocol according to the local health department;

(b) provide proof of negative test results for Tuberculosis; and

(c) test annually or more frequently as required.

[(3) All clients and staff shall provide current proof of negative test results for Tuberculosis and shall be tested annually or more frequently when directed by the local health department.

]([4]3) A recovery residence that manages clients' medications shall keep all prescription and non-prescription medications in locked storage that is not accessible by clients when not in active use.

[(5) Each recovery residence shall have and comply with a written policy and procedure regarding the safe storage and disposal of medications.

]([6]4) A recovery residence shall ensure that clients who manage their own medications keep all prescription and non-prescription medications in individually accessed locked storage [when not in active use, using individual locked storage] that is not accessible [by any]to other client s when not in active use [other than the client who owns the medication. Clients will be notified prior to admission regarding their responsibilities related to the provision of locked storage for personal medications].

([7]5) Non-prescription and prescription medications shall be stored in their original manufacturer's packaging together with manufacturer/pharmacy['s] directions and warnings.

[(8) Prescription medications shall be stored in their original pharmacy packaging together with the pharmacy label, directions and warnings.](6) Naloxone shall be safely maintained and available onsite, and staff and clients shall be trained in its proper use.

 

[ R501-18-12. Hazardous Chemicals and Materials.

(1) The recovery residence shall provide safe storage for hazardous chemicals, materials, and aerosols, including but not limited to poisonous substances, explosive or flammable substances, bleach, and cleaning supplies. The recovery residence shall maintain hazardous chemicals, materials, and aerosols in their original packaging and follow the manufacturer's instructions printed on the label.]

 

KEY: licensing, human services, recovery residence

Date of Enactment or Last Substantive Amendment: [December 22, 2014]2017

Authorizing, and Implemented or Interpreted Law: 62A-2-101; 62A-2-106