Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 193 - OFFICE OF ADULT MENTAL HEALTH › Chapter 6 - MENTAL HEALTH LICENSING REGULATIONS › RESIDENTIAL SERVICE STANDARDS

Current through 2024-29, July 17, 2024
These standards, in addition to the core standards, are
				  applied to agencies providing residential services.
Access
RS.1 The agency has policies and procedures governing the
				  establishment of a waiting list, that minimally includes the following:
				  prioritizing clients, selecting clients from the waiting HA, and referring
				  clients to other providers.
RS. 1. A. Policies and procedures governing the establishment
				  of waiting lists and the selection of clients will be in compliance with the
				  Fair Housing Amendments Act.
Assessment
RS.2 A comprehensive assessment is conducted by an individual
				  chosen or agreed to by the client or legally responsible party, with the
				  client's participation, within 20 working days of the client's
				  admission.
RS. 2. A.. The comprehensive assessment minimally addresses
				  the following:
RS. 2. A..1 the client's strengths and weaknesses;
RS. 2. A..2 the client's perception of his or her
				  needs;
RS. 2. A..3 the family/guardian's input and perception of the
				  client's needs when appropriate, and with the client's consent;
RS. 2. A..4 a personal, family, and social history;
RS. 2. A..5 the client's emotional, psychiatric and
				  psychological strengths and needs;
RS. 2. A..6 a physical health status and history, including
				  current prescription and over-the-counter medication use;
RS. 2. A..7 past and current drug/alcohol use;
RS. 2. A..8 a developmental history;
RS. 2. A.9 possible sources of assistance and support in
				  meeting the needs expressed by the client or legally responsible party,
				  including state and federal entitlement programs;
RS. 2. A.10 physical and environmental barriers that may
				  impede the client and family's ability to obtain services;
RS. 2. A..11 history of physical and/or sexual abuse;
RS. 2. A..12 the vocational, educational, social, living,
				  leisure/recreation and medical domains;
RS. 2. A..13 potential need for Crisis Intervention Services;
RS.2. A.14 housing and financial needs;
RS. 2. A..15 status of the Individualized Support Plan; and
RS.2. A..16 the signature of the person who performed the
				  assessment.
Interpretive Guideline for RS.2.A.1 thru RS.2.A.13
The Division of Licensing recognizes that in some cases not
				  all of the information requested in these standards will be able to be
				  obtained. The Division also recognizes that the level of detail required will
				  vary given a variety of factors (the client's level of cooperation, the
				  integrity of the information sources, the length of services or treatment, the
				  condition being addressed, the practitioner's training, etc.). Although the
				  Division will attempt to be sensitive to these factors and flexible in
				  surveying this area, the agency should assure that assessments that do not
				  address all these standards have accompanying documentation that justifies
				  abbreviated or absent information.
RS. 2. B. The agency will establish policies and procedures
				  establishing criteria for the performance of the following assessments:
RS. 2. B.1 a nutritional assessment;
RS. 2. B.2 a cognitive functioning assessment;
RS. 2. B.3 an assessment of the client's capacity to make
				  reasoned
decisions;
RS. 2. B.4 a neurological assessment.
Interpretive Guideline for RS.2.B.2
The client's cognitive functioning assessment should include
				  assessment of the following functions: problem solving, decision making,
				  organization, self-direction, system negotiation skills, concentration, and
				  abstract reasoning. For individuals over 60 years of age, this assessment
				  should also include memory, language, orientation, and visuo-spatial abilities.
Interpretive Guideline for RS.2.B thru RS.2.B.4
These assessments do not necessarily have to be performed in
				  the agency or by agency staff. the intent of these standards are to assure that
				  the agency has mechanisms by which to evaluate the need for these assessments
				  and to perform or refer for assessment those clients whose symptomatology
				  suggests such need.
RS. 2. C The assessment(s) shall be obtained from the client,
				  legally responsible party, community service agencies, and to the extent
				  possible, from other individuals in the community as authorized by the client
				  or legally responsible party.
RS. 2. C.1. In instances in which the client receives
				  community support services and/or has an Individualized Support Plan, the
				  agency will, subject to the client's consent, attempt to coordinate the
				  assessment and subsequent service planning with the community support
				  provider.
RS. 2. C.1.a. Services provided to these clients will be
				  consistent with the targets and objectives of the Individualized Support
				  Plan.
RS. 2. C.1.b. Services provided to these clients will be
				  delivered pursuant to a service agreement negotiated with the community support
				  worker.
RS. 2. D The client record contains a summary evaluation of
				  the data collected in the comprehensive assessment.
RS.3 The agency has a documented policy and procedure on
				  updating assessments that assures that assessments are current and in no case
				  exceed annual updates.
Service Planning
RS.4 An initial service plan is developed within 72 hours
				  following admission and is based on preliminary assessment findings.
RS.5 There is documented evidence that the service planning
				  and revision process involves the client, legally responsible party, and other
				  representatives and professionals whom the client identifies.
Interpretive Guideline for RS.5
The client and legally designated guardian shall be fully and
				  actively involved in the development or revision of the service plan, if
				  possible. It the client consents, the client's designated representative e,
				  family members or significant others shall be included in the development and
				  revision of the service plan, unless contraindicated. When these individuals do
				  not attend, their absence is noted. Each agency shall document good faith
				  efforts, including at least 24 hour notice of any service planning meeting, to
				  involve guardians, representatives or legally responsible parents.
RS.6 A comprehensive service plan is developed for each
				  client, with the client's consent, and within 20 working days of
				  admission.
RS. 6. A. The comprehensive service plan minimally contains
				  the following:
RS. 6. A.1 problem statements;
RS. 6. A.2 short- and long-range goals based upon client
				  needs with a projection of when such goals will be attained;
RS. 6. A.3 objectives stated in terms which allow objective
				  measurement of progress;
RS. 6. A.4 multidisciplinary input and specification of
				  treatment responsibilities;
RS. 6. A.5 client input and signature;
RS. 6. A.6 signatures of all people participating;
RS. 6. A.7 the methods and frequency of treatment,
				  rehabilitation, support;
RS. 6. A.8 a description of any physical handicap and any
				  accommodations necessary to provide the same or equal services and benefits as
				  those afforded non-disabled individuals; and
RS. 6. A.9 criteria for discharge or release to a less
				  restrictive setting.
RS. 6. B Justification for not addressing problems identified
				  in the assessments is documented in the client record.
Interpretive Guideline for RS.6.B
The intent of this standard is to assure that the clinical
				  staff considers all of the client's identified problems in formulating the
				  service plan. problems that are not reflected on the service plan should have
				  accompanying documentation identifying the rationale for not addressing the
				  problems at this time. This documentation can take many forms including
				  progress notes service plan narratives, etc.
RS.7 The service plan is designed so that the client's
				  progress towards service plan goals can be monitored and evaluated.
Interpretive Guideline for RS.7
Service plans should have measurable goals and some means for
				  reflecting when, or to what degree, a goal has been attained. The organization
				  should also have mechanisms that document monitoring and evaluation of client
				  goals, e.g., quality assessment, treatment plan review documents.
RS.8 The service plan is reviewed at major decision points in
				  each client's treatment course, upon client request, and no less frequently
				  than every 90 days.
Interpretive Guideline for RS.8
Major decision points may include, but are not necessarily
				  limited to the following: when there is a change in the client's condition,
				  when a service appears not to benefit the client, when the client is under- or
				  over- utilizing services.
RS.9 Unmet service needs are documented in the service
				  plan.
Interpretive Guideline for RS.9
If at the time of the service planning meeting, team members
				  know on the basis of reliable information that the needed services are
				  unavailable, they shall note them as "unmet service needs" on the service plan
				  and develop an interim plan based upon available services that meet, as nearly
				  as possible, the actual needs of the client. The organization should also
				  document notification of the organization's leadership and the Commissioner
				  regarding the unavailability of service that is causing the unmet service
				  need.
RS.10 The agency has a policy and procedure for providing
				  clients with a copy of their service plan within one week following its
				  formulation, review or revision and notification of client recourse should they
				  disagree with any aspect of the plan.
RS. 10. A. The agency will not fail to provide a copy of the
				  client's service plan and/or notify them of recourse should they
				  disagree.
Discharge Planning
RS.11 Each client record contains documentation of current
				  discharge or termination planning, if appropriate.
RS. 11. A. Planning for discharge to another setting or
				  service will be contingent upon the client's consent to the establishment of
				  such a discharge as a goal.
RS.12 A discharge summary is entered in the client record
				  within 15 days of discharge and includes the client's course of treatment and
				  ongoing needs at discharge.
RS. 12. A. Each discharge summary minimally addresses, but
				  need not be limited to the following:
RS. 12. A.1 the reasons for termination of service;
RS. 12. A.2 the final assessment, including the general
				  observations and significant findings of the client's condition initially,
				  while services were being provided and at discharge;
RS. 12. A..3 the course and progress of the client with
				  regard to each identified problem; and
RS. 12. A.4 the recommendations and arrangements for further
				  continued service needs.
RS.13 The agency has policies and procedures that specify
				  under what conditions services may be discontinued or interrupted which
				  minimally include how and when the client is notified.
RS. 13. A. For agencies serving DMHMR class members, the
				  agency shall first obtain prior written approval for discontinuing or
				  interrupting services from the Department.
RS. 13. B For agencies serving DMHMR class members, the
				  agency shall give thirty days advance written notice to the client and the
				  client's guardian. If the client poses a threat of imminent harm to persons
				  employed or served by the agency, the agency shall give notice that is
				  reasonable under the circumstances.
RS. 13. C For agencies serving DMHMR class members, the
				  agency shall give such notice as may be required by law or regulation.
RS. 13. D For agencies serving DMHMR class members, the
				  agency shall assist the client in obtaining the services from another agency.
RS. 13. E For agencies serving DMHMR class members, the
				  agency shall provide documented evidence in the client record of compliance
				  with these standards, through letters, progress notes, phone logs, and/or
				  facsimile.
RS.14 The agency will have a discharge protocol that protects
				  the client from summary discharge and allows the agency to maintain program
				  integrity.
RS. 14. A. The agency has a policy and procedure for
				  discharging clients that include the terms upon which a client may be
				  discharged (e.g., disciplinary reasons, under-utilization of the
				  program).
RS. 14. B. Except in emergency cases, clients shall be given
				  30 days notice before discharge.
RS. 14. C. The agency will not summarily discharge clients.
				  All substantiated complaints will be assessed for the seriousness of the
				  violation and actions taken to achieve compliance.
RS.15 The agency documents the client's stated preference for
				  living situation in the discharge plan.
Interpretive Guideline for RS.15
When the client's preference for living situation cannot be
				  accommodated, the reasons are documented.
RS.16 Applicants who are not eligible for services will be
				  referred to appropriate services, if required, available and desired.
RS. 16. A. The agency has a policy and procedure on referral
				  and/or transfers of individuals deemed inappropriate for services offered by
				  the agency that minimally includes communicating the rationale for the
				  referral/transfer to the applicant and providing them with a list of
				  alternative service providers and advocacy services.
RS. 16. B. The agency provides and documents other assistance
				  as required to assist the individual to obtain access the services to which
				  they are referring him/her.
Health
RS.17 If food services are provided, the facilities for the
				  preparation and serving of food shall be inspected and approved by the
				  Department of Human Services.
RS. 17. A If food is either prepared or served at the
				  facility, then the agency shall either a DHS Eating Establishment license or
				  show written evidence from DHS indicating that they need no such
				  license.
RS. 17. B. When the agency requires a DHS license, the
				  agency's Eating Establishment license is current.
RS.18 The agency shall have methods for obtaining on- or
				  off-site medical services for all clients.
RS. 18.A. The agency defines in policy and procedure those
				  medical services delivered on-site. For those medical services not provided
				  on-site, letters of agreement and/or procedures for accessing medical service
				  provider(s) are in effect.
Physical Plant
RS.19 A secure and readily accessible storage area of
				  adequate size is available to accommodate client belongings.
RS. 19. A. The agency has a policy and procedure related to
				  what personal belongings may be brought to the agency.
Residential Services
RS.20 Residential service agencies provide or arrange for
				  comprehensive treatment, training and support of clients.
RS. 20. A. Residential service agencies provide or arrange
				  for support and training in the following areas:
RS. 20. A.1 housekeeping and home maintenance skills;
RS. 20. A.2 mobility and community transportation
				  skills;
RS. 20. A.3 interpersonal relationships, including spouse,
				  family and friends;
RS. 20. A.4 health maintenance, including personal hygiene,
				  exercise and fitness, nutrition and diet management, and use of medical
				  services and medicine;
RS. 20. A.5 safety practices, including dealing with injuries
				  and life threatening emergencies;
RS. 20. A.6 financial management, including techniques of
				  client purchasing, banking, taxes, budgeting and repaying debts;
RS. 20. A.7 basic academic skills;
RS. 20. A.8 management of personal and legal affairs;
RS. 20. A.9 contingency planning, problem-solving,
				  decision-making;
RS. 20. A.10 self-advocacy and assertiveness training;
RS. 20. A.11 utilization of community services and resources,
				  including laundromats, library, post office, client affairs offices,
				  etc.
RS. 20. A.12 recreational and leisure time activities;
RS. 20. A.13 work attitude and skills exploration;
RS. 20. A.14 menu planning and meal preparation;
RS. 20. A.15 use of the telephone;
RS. 20. A.16 human sexuality; and
RS. 20. A.17 client affairs and rights, including familiarity
				  with warranties, policies and procedures of governmental and community service
				  agencies.
Interpretive Guideline for RS.20.A through RS.20.A.17.
For providers of children's residential services, these
				  topics will be addressed as applicable on an age appropriate
				  basis.