105 – 170 – E – corrective action plans – should include a deadline (number of business days) for the DBHDS response and require the department response be in writing, this is necessary to prevent providers from being held in limbo and to provide the documentation they need to address licensing agent change (either personnel or evolving standard) and to prepare for implementation of the appeals process.

Concur with other writers that the prevention of reoccurrence is an impossible standard that is not realistic in all cases and should be amended as they suggest.

105-620-A9-Monthly Fire/Evac Drills- when we 1st begin providing services years ago we attempted to have monthly fire drills and it proved counterproductive creating a significant risk to the individual served. Simply, this frequent, repetitive and unnecessary intrusion into the daily lives of the individuals very quickly became recognized, resisted and eventually refused by majority of the individual served. They would literally just sit at the table and look at you and exclaim “it’s just another drill – I’m tired of these (expletive) things”. As a result, the drill failed to serve its intended purpose and actually increased the risk that the individuals would fail to respond in the event of an actual fire/emergency thus increasing the risk to their life.

We have since conducted quarterly fire/evacuation drills, which has not only largely eliminated this concern, but also has allowed the drill to serve its intended purpose thus reducing not increasing the risk to individuals. The empirical evidence from the quarterly fire drills, have also provided documentation that the skills/actions necessary for an appropriate response have been obtained and maintained by both individuals served and staff, as the vast majority of the time over the past 5 years all individuals have been evacuated in less than 1 minute and there was only one occasion in the past 5 years when the evacuation took over 2 minutes (because the individual objected that it was only a drill and no real reason to leave). This provides clear evidence that the skills/actions necessary to assure a safe evacuation can be obtained and maintained with a quarterly drill schedule making more frequent drills unnecessary.

Recommendation: 1st – the requirement should be reduced to only require a quarterly fire/evacuation drill, unless the drill demonstrated an inability for whatever reason to accomplish the evacuation within a specified time frame (2 – 3 minutes), which would then trigger the need for additional drills (perhaps monthly) until successful evacuation time frame is accomplished. 2nd – If the state is concerned about new individuals/staff in the home and the adequacy of skills/actions/supports to safely evacuate demonstrated by those individuals, they could include a requirement that a drill or evacuation demonstration be conducted within the 1st 30 days of an individual served moving into a home or for the 1st 30 days of service for a new staff member.

Requiring a monthly fire/evacuation drill will be counterproductive and will get someone killed when there is a real fire.

105-620-K- monthly smoke detector checks – while advisable and should be encouraged, inclusion is a regulatory requirement is unnecessary and onerous. Modern smoke alarms include built-in alarm devices to warn you if the battery is running low or the alarm is malfunctioning in some way, which coupled with the significant overlap of devices required by other regulations ensure that adequate warning will be provided even in the unlikely event that one of them is dysfunctional. Including this in the regulations creates another unfunded mandate, as now in addition to paying someone to go through the home and pushed 20+ buttons they will have to devise/implement/maintain a documentation system for license review that directly takes time away from quality services for little to no return. Recommendation: 1 – remove the requirement; 2 – exempt small businesses/homes

105-620 – L5 – evacuation postings – the requirement to include the location of fire extinguishers and flashlights on evacuation postings is both unnecessary and counterproductive, especially in smaller homes. The provision is unnecessary because the location and operation of all fire extinguishers in the home are included in the staff training for emergency preparedness as required by other regulations and neither the staff nor individual served are likely to consult the evacuation posting to search out these devices. The provision is counterproductive because it would add significant clutter to an otherwise simple posting that could create confusion and improper response in the event it was actually consulted during emergency. We live in a rural area where occasional electrical disruptions are to be expected and as a result, flashlights are ubiquitously placed throughout the home, including on the window sill and night tables of each individual’s room and multiple places throughout the common areas assuring ready access to anyone who has need of a flashlight. Again, staff are provided information on their location during emergency training, individuals served or trained on the location and neither the staff nor individual served are likely to consult the evacuation posting to search out these devices. Recommendation: 1 – remove the requirement; 2 – exempt small businesses/homes

105-520-D- the continued inclusion of risk triggers/thresholds developed by the department continues to be vague, undefined and potentially a significant concern – – as providers we are required to follow these regulations from the moment (and in this case even before) they are officially implemented; it would therefore appear to be incumbent upon the state to tell us what they actually are before their inclusion in a final draft of the proposed regulations.

105 – 620 – C3 – the continued inclusion of “state performance measures” suffer from the exact same concern is risk trigger/threshold until these are defined they should not be included in any final regulation applying the same analysis as above.