In our continuing series of articles on adult day services, we devote this one to adult day services design, environment and safety.
- The facility housing the ADS program must comply with applicable state and local building regulations, zoning, fire and health codes or ordinances.
- It must be designed in such a way that it is accessible and functional in meeting the identified needs of the population it serves in accordance with the Americans with Disabilities Act.
- Each physical location must develop, maintain, update and enforce an emergency plan for the protection of all persons in the event of an emergency. The written emergency plan must address fire and natural and human caused events identified as a significant risk for the facility and locality. The written emergency plans must specify how the ADS program will notify participants and contacts of closure.
- The facility must have a minimum of one toilet per ten participants in an accessible bathroom. Each bathroom must be equipped with a sink, grab bars and call system appropriate to the population served. The participant’s privacy and comfort must be considered in developing procedures for incontinence care. Each bathroom must contain an adequate supply of liquid hand soap, toilet tissue, and paper hand towels with dispenser or an electrical hand dryer. Common towels are not allowed.
- There must be a minimum of 60 square feet of common floor space per participant. ADS programs serving participants, of which 25 percent or more are cognitively impaired or require the use of adaptive equipment, must provide at least 80 square feet of common floor space per participant.
- The physical building, premises, and equipment must be maintained in a clean and sanitary condition, free of hazards and in good repair.
- Outside space that is used for outdoor activities must be safe, accessible to indoor areas and accessible to those with a disability.
- Heating, cooling, ventilation and lighting must be appropriate for the age and physical condition of the participants to provide for their health and safety.
- Flooring must be easily cleaned and made of a nonskid material. Stairways must have handrails and the stairs must be covered with nonskid material.
- There must be sufficient private space for the provision of confidential staff consultation with the participant, and nursing or therapy services if provided.
- There must be provisions for the participant to rest.
- There must be an accessible telephone available for use by participants.
- Storage space must be provided for files, records, recreational and cleaning supplies.
- Sufficient furniture for the entire participant population must be of sturdy construction that will not easily tip over or move when used for seating or support while walking. The furniture must be safe and comfortable.
- Safe drinking water must be readily available to participants at all times, as well as a supply of safe drinking water as part of the program’s emergency disaster plan. Disposable paper cups, individual drinking cups or drinking fountain must be provided.
- ADS programs that dispense medications must designate a secured area for storing labeled medication away from the participant activity area. Each ADS program must have a written policy for medication management and must designate which staff are trained and authorized to administer medications. The medication management policy, which includes the training program, must be approved by a Registered Nurse or Pharmacist. ADS programs must only dispense physician approved medications.
Safe and Sanitary Environment
With the growing need for these services, it is not uncommon for ADS centers to take care of 50-75 people at a time. All facilities serving 16 or more persons must meet the minimum requirements as outlined in the DHS, Public Health Division’s Food Sanitation Rules. Facilities serving 15 or fewer persons or a facility that purchases meals from an outside meal source or prepare meals must meet the minimum requirements of the Food Sanitation Rules relating to the preparation, storage, and serving of food.
Garbage and refuse containers must be insect-proof, rodent-proof, leak-proof and nonabsorbent. Garbage and refuse must be removed at least once a week from the premises or more often if needed to prevent odors and attraction of insects, rodents and other animals. Items being recycled must be clean and pending removal, stored in a manner that does not present rodent harborage or insect breeding. Recycled items must be stored separately from food supplies and food preparation equipment.
The facility must be kept clean, safe and in good repair. In facilities serving 16 or more persons, a utility sink must be provided.
If a community disposal system is available it must be utilized by the facility. If a septic system is utilized, it must be properly operating and meet code requirements.
Local health department standards must be met regarding communicable diseases.
If permitted, smoking must be supervised in an outdoor, adequately ventilated and designated area away from the main ADS program.
Written procedures for the safe handling of soiled items minimizing the potential for the spread of communicable diseases must be established.
ADS programs must adopt and implement emergency policies and procedures and the plan must be posted and provide the locations of fire extinguishers and exit routes. Staff must be trained in evacuation procedures and major emergency plans as part of their initial orientation and ongoing training and records kept. A fire warning system must be installed in all adult day services facilities to insure the safety of the participants and the staff. At least one fire extinguisher classed as 2A-10BC must be visible and readily accessible.
Written protocol regarding sick or injured participants must be developed and given to participants, family and care providers upon admission.
Emergency first aid kits must be visible and accessible to staff. Personnel trained in first aid and CPR must be on duty whenever participants are present.
At least two well-identified exits must be available.
State requirements for certification and licensing may vary but these comprehensive standards from Oregon can act as a guide for those considering development of Adult Day Services.
Source DHHS, State of Oregon