115cmr 7.0
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
115 CMR 7.00: STANDARDS FOR ALL SERVICES AND SUPPORTS
Section
7.01: Scope
7.02: Definitions
7.03: Organization Requirements
7.04: Standards for Services and Supports
7.05: Staffing Standards
7.06: Standards for Safety
7.07: Environmental Standards for All Site Based Services
7.08: Capacity
7.09: Standards for Employment and Day Supports
7.10: Standards for 24 Hour Site Based Respite Services
7.11: Standards for Placement Services
7.01: Scope
(1) The provisions of 115 CMR 7.00 apply to all supports and services that are provided by
public and private providers and subject to licensure and certification or regulation by the
Department, except where such service is exempt through specific language of 115 CMR 7.00.
(2) Any supports or services subject to regulation by the Massachusetts Rehabilitation
Commission and which provide social and pre-vocational supports and work training shall be
subject to the applicable requirements of 115 CMR 7.00.
(3) 115 CMR 7.00 does not apply to programs, services, or facilities subject to regulation under
M.G.L. c. 15D (606 CMR: Department of Early Education and Care), such as children's group
residences, foster care, day care, children's site-based respite, and emergency housing; or under
M.G.L. c. 111 (105 CMR: Department of Public Health), such as skilled nursing facilities, acute
care facilities, intermediate care facilities and health clinics; or under 130 CMR 400.000 through
499.000 (Executive Office of Health and Human Services, Office of Medicaid), such as day
habilitation and adult foster care; or to any programs, services, or facilities for which another
state agency possesses exclusive regulatory authority.
7.02: Definitions
Care Provider. Refers to a person who is recruited and paid by a placement agency to provide
supports in accordance with the individual's ISP and in a manner to foster community
membership, rights and dignity, individual control and decision-making, personal growth and
accomplishment, and personal well-being.
Day Supports. Refers to supports and services that lead to the acquisition, improvement, and
retention of skills and abilities that prepare individuals for work and community participation.
The services are provided in accordance with the individual's ISP and include career exploration
activities that are predominantly job task oriented, community integration experiences,
development of skills in activities of daily living, and the pursuit of personal interests and
hobbies.
Employment Supports. Refers to supports and services designed to assist individuals to obtain
and retain meaningful employment and compensation in integrated work settings that include
supports to explore, develop and retain work skills and to obtain and maintain paid work.
Employment supports are provided in accordance with the individual's ISP and include
individual and small group work intended to assist their movement to competitive employment.
Individualized Home Supports. Refers to less than 24 hour per day supports and services that
are provided regularly to enable individuals to establish, live in or maintain, on an on-going
basis, a household of their own choosing. Services include teaching and fostering the
acquisition, retention or improvement of skills related to personal finance, health, shopping and
use of community resources, community safety, and other social and adaptive skills necessary
to live in the community. Individualized home supports are flexible and designed to meet the
individual's needs as specified in his or her ISP. Individualized home supports do not include
live-in assistance.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.02: continued
Placement Services. Refers to a set of services provided by a placement agency that consists of
recruitment, training, supervision and pay of a care provider to provide residential supports, or
respite services to one or more individuals in the home of the care provider or in the individual's
own home.
Residential Supports. Refers to supports and services provided daily on a 24 hour basis to
individuals who need daily assistance with care, supervision, and skills training to maximize
their independence and participation in typical household activities and routines, participation
in community recreational, cultural and leisure activities, and opportunities to maintain or
expand their relationships with family and friends. Residential supports are provided in
accordance with the individual's ISP and include 24 hour site based respite services and
placement services provided in home and community based settings other than the individual's
family home.
24 Hour Respite Services. Refer to supports and services that are provided on a 24 hour basis
for short term relief for primary caregivers, or short term stabilization services for individuals
who, due to behavioral or environmental circumstances, cannot remain in their current residence.
7.03: Organization Requirements
(1) All providers shall operate in a manner that supports positive outcomes for individuals in
all of the services and supports offered and shall have policies, procedures and systems that:
(a) support people in reaching their goals and aspirations;
(b) reflect the values expressed in the Department's Mission Statement;
(c) are understood and carried out by staff; and
(d) are dynamic documents that are reviewed and revised as necessary to stay current with
best practice in the field.
(2) All providers shall have an effective internal quality management and improvement system
that:
(a) regularly gathers data on program and service quality, including but not limited to,
incidents, restraints, investigations and other program quality information;
(b) regularly reviews the quality data gathered and information from the Department's
reviews of its contract and performance based outcomes;
(c) actively involves individuals and families and must include, but not be limited to, an
evaluation of the individual's satisfaction with the services provided; and
(d) implements service improvements to address issues identified through internal and
external reviews and feedback.
(3) All providers shall establish a formal mechanism such as a governing board that provides
oversight to ensure the provision of quality supports to individuals and their families and that
conducts an annual performance evaluation of the provider's chief executive officer.
(4) All providers shall have a process for developing long range plans for the organization.
7.04: Standards for Services and Supports
(1) All providers shall provide supports and services in ways that promote the following
outcomes within the context and location of those supports and services and in accordance with
the individual's ISP, the provider's mission statement, the Department's mission statement, and
115 CMR:
(a) Protection and Affirmation of Rights and Dignity. Protection and affirmation of the
rights and dignity of individuals, including, but not limited to, respect of the individual,
support of an individual's culture and religion, freedom of movement at home and in the
workplace or day program, privacy, appropriate and timely assistance to the individual with
decision-making, support of the individual in exercising his or her rights, and provision of
safeguards whenever limitations are imposed.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.04: continued
(b) Individual Choice and Control. Opportunities for exercising choice and control in all
aspects of an individual's life by providing the education and supports to enable the
individual to make informed decisions, and by promoting an environment and culture where
the individual's opinions are listened to and treated seriously.
(c) Community Membership. Opportunities to participate in, be integrated into, and
contribute to the life of their community through:
1. education and supports to assist individuals to participate in recreational, social, and
leisure activities outside of the home in integrated settings with neighbors, other people
in the community, and consistent with the needs, desires, and choices of each individual;
2. access to the same services and resources used by neighbors and other people in the
community;
3. a home offered by a residential supports provider that is part of a neighborhood,
village, or community and with general design features, layout, and style of decor that
would not stigmatize or devalue the individual. The home should offer the individual
safety, refuge, rest, satisfaction, and enable the individual to exercise control and be at
ease in the home; and
4. work in settings arranged by the provider of employment supports that maximize
integration with other people in the community and with general design features that do
not emphasize the supports' separateness or difference.
(d) Relationships. Supports that help individuals to develop and sustain varied and
meaningful relationships with family, friends, neighbors and co-workers. The supports shall
include education and assistance to help the individuals form friendships, express intimacy
and sexuality in an appropriate, healthy and safe manner, and prepare individuals to receive
visitors.
(e) Skill Acquisition and Accomplishments. Assessment, training, education, supports and
services necessary for the individual to meet the goals in the individual's ISP, to acquire skills
that increase self-reliance and that are necessary to achieve desired and valued outcomes
1. For providers of residential supports and individualized home supports, the supports
and services include skills training and supports to maximize an individual's
independence and performance of household activities and routines, participation in
community recreational, cultural and leisure activities, and opportunities to maintain or
expand their relationships with family and friends.
2. For providers of employment supports, the supports and services include supports to
explore and develop work skills, to obtain and maintain paid work in integrated work
settings, and the supports to help individuals on a pathway to employment by developing
the skills to secure work.
3. For providers of day supports, the services and supports include help that will enable
the individual to explore their work, leisure, and community interests, and to participate
in their preferred activities.
(f) Health, Safety, and Economic Security. That the sites where supports and services are
provided are safe; individuals are protected from abuse, neglect and mistreatment; health care
services meet the needs of the individual; personal funds of individuals are safeguarded; and
the individual is assisted in maximizing economic resources to meet his or her needs.
Included are the requirements that the provider:
1. promote optimal health of the individual by arranging for coordinated routine,
preventive, specialty, and emergency health care, professional clinical services; make
first-aid supplies available; and assure prompt and appropriate response by staff to
emerging health care issues;
2. comply with the Department's requirements governing the storage and use of
prescription and over the counter medication as specified in 115 CMR 5.00: Standards
to Promote Dignity and the Department's guidelines;
3. store, prepare and serve food in a clean, safe, nutritious, tasteful, and appetizing
manner and for each individual to have regularly nourishing and well-balanced meals.
The meals must be provided at least three times a day including one in the morning, one
in the afternoon and one in the evening and be chosen by the individual unless there is
documentation from a physician that the frequency, amount, texture or type of meal is
medically contraindicated for the individual;
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.04: continued
4. provide for the safety and well-being of individuals in both home, day and work
environments, including implementation of the safety plan in accordance with 115 CMR
7.06;
5. provide site based supports and services in a physical setting that meets all applicable
local, state, and federal requirements pertaining to building construction, sanitation,
health, safety, occupational health, and zoning;
6. comply with the applicable environmental requirements of 115 CMR 7.07;
7. prevent abuse and neglect, and comply with all applicable local, state, and federal
reporting requirements;
8. comply with state and federal wage-hour requirements when individuals engage in
any work which must be compensated; and
9. support each individual to obtain personal possessions, including an adequate supply
of fashionable, seasonal clothing as necessary for the individual's health and comfort and
consistent with the individual's choice and preferences, and assist each individual to
maintain his or her clothing in a clean and well-kept manner.
7.05: Staffing Standards
(1) All providers of supports and services unless specifically exempted by law or regulations,
shall be subject to the following requirements:
(a) Screening of Provider Staff and Care Providers.
1. All providers shall comply with applicable federal and state labor laws and not
engage in discriminatory employment practices.
2. All providers shall comply with all required Criminal Offender Record Checks.
3. All providers arranging or providing professional services or consultation shall assure
that such professionals are licensed, certified or registered as required by law to provide
such professional services to the public.
(2) Staff Qualifications. All providers shall assure that the number, organization and
qualifications of staff meet the training, care, support, health, safety, and evacuation needs of the
individuals supported by the provider. This shall be determined by all of the following:
(a) The provider's ability to meet the objectives in the ISP of each individual while
promoting independence and skill development.
(b) The provider's ability to assist each individual to achieve the stated outcomes as set forth
in his or her ISP.
(c) The provider's ability to meet environmental, safety, administrative, and service delivery
requirements as set forth in 115 CMR 7.07.
(d) The provider's ability to develop and competently execute safety plans for all individuals
at the location(s) where supports and services are provided as required in 115 CMR 7.06.
(3) Supervision and Evaluation. All providers shall have adequate staff as determined by all
of the following:
(a) The skills demonstrated by staff in helping individuals to achieve outcomes identified
in the individual's ISP, the provider's mission statement, and the mission statement,
regulations, and standards of the Department.
(b) The level of ongoing supervision that supports staff in increasing their skills and ability
to assist individuals supported by the provider.
(c) The ongoing staff development and training activities that are provided.
(d) Training activities that are tied to the specific needs of individuals supported by the
provider.
(e) Access to technical and clinical consultation to enhance staff's ability to meet
individuals' needs and desires.
(4) All providers shall have current staff job descriptions that describe the education, skills, and
experience required of staff to meet the standards set forth in 115 CMR 7.04.
(5) All providers shall develop and utilize staff performance evaluations to enhance supports
and services to individuals.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.05: continued
(a) Evaluations of staff performance shall be competency-based and shall assess the degree
to which requirements of the employee's job description are achieved by the employee
subject to the evaluation. Comments from individuals, families or guardians of individuals,
and relevant external agencies shall be included in the evaluation of staff performance.
(b) Staff performance evaluations shall occur at least annually.
(c) The results of staff performance evaluations shall be used by the provider to produce
continued improvement in the skills needed by staff to enhance the lives of the individuals
they support.
(6) Training. All providers shall meet the following training requirements for staff, relief staff
and care providers except as otherwise noted in 115 CMR 7.05(6).
(a) Training in the reporting of actual or suspected abuse, neglect, or omission as specified
in M.G.L. c. 19C and 115 CMR 9.00: Investigations and Reporting Responsibilities.
(b) Training in the reporting of incidents as required in 115 CMR,
(c) Training in the implementation of positive behavioral supports and the requirements in
115 CMR 5.00: Standards to Promote Dignity.
(d) For staff, relief staff and care providers who may be expected to use restraint, training
on the requirements in 115 CMR 5.11: Seclusion, Locked Buildings, and Emergency
Restraint and on the appropriate use of restraint using a curriculum approved by the
Department.
(e) For non-licensed staff who will be administering medication at a site that is required to
be registered as a Medication Administration Program (MAP) site, training on the
requirements of 115 CMR 5.15: Medication and on the safe administration of medications
and are MAP certified.
(f) Training in first aid.
(g) Training in cardiopulmonary resuscitation (CPR) for all staff at every site providing 24
hour residential supports, employment supports, day supports or 24 hour site based respite
supports. 115 CMR 7.05(6)(g) shall not apply to residential sites providing less than 24 hour
supports.
(h) Training in all aspects of the safety plan for sites required to have safety plans under
115 CMR 7.06(3).
(i) At least one staff person trained in fire safety by an approved fire safety training agency,
local fire department or from the Department shall be present at every site where residential
supports, day supports or 24 hour site based respite services are provided. All other staff and
care providers are trained in basic fire safety.
(7) Staffing Requirements.
(a) Providers of residential supports, including care providers, shall assure the presence of
staff whenever an individual is present in the home, unless the individual:
1. has an ISP that expressly provides that he or she can be home alone for a defined
period of time; and
2. is 18 years of age or older; and
3. is capable of evacuating from the home within 2½ minutes without assistance.
The Department's approval of an arrangement for any individual to remain in the home
alone for a defined period of time does not change the residential supports into a different
service that does not require 24 hour staffing.
(b) Providers of residential supports, care providers, and providers of 24 hour site-based
respite shall develop a staffing pattern that is sufficient to enable all individuals to evacuate,
with or without assistance, within 2½ minutes in accordance with professionally accepted
fire safety procedures.
1. Assistance from any staff who evacuates and re-enters the building cannot be
considered in determining sufficiency of staffing pattern.
2. Evacuation times may be extended only when an evaluation using the National Fire
Protection Association's Fire Safety Evaluation System ("FSES") has been conducted and
the results based on physical site adaptation, staffing patterns, characteristics of the
individuals in the home, and other relevant factors, demonstrate that the extended
evacuation times are within accepted fire safety standards. Until such time as there is an
approved waiver from the Department, the provider must have sufficient staff to evacuate
all individuals in the home within 2½ minutes. The provider shall ensure that staffing
is sufficient to meet the conditions and evaluation time set in the waiver approved
pursuant to 115 CMR 7.05(7)(b)2.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.05: continued
(c) Providers of residential supports, including care providers and providers of 24 hour site
based respite supports shall have at least one person on duty and present in the home
(including overnight) when any individual is present at the home except as otherwise
provided in 115 CMR 7.05(7)(a).
(d) Successful performance on fire drills required by 115 CMR 7.06(3)(b)7. shall be a factor
in determining the adequacy of the provider's staffing.
7.06: Standards for Safety
(1) Search Plan.
(a) All providers shall prepare, file with the area office update as often as necessary, and
have available at each location where supports and services are provided, a plan for searching
for each individual served by the provider when the individual is missing and:
1. remains unaccounted for after informal attempts to locate him or her have been
ineffective; and
2. is deemed to be in a position of unreasonable risk if alone for an extended period of
time.
(b) All providers shall maintain a completed and updated "Emergency Fact Sheet" for each
individual which shall be immediately accessible to staff, filed with the area office, and shall
include the information required by 115 CMR 4.03(4): Emergency Information.
(c) The provider shall immediately notify the individual's family, guardian, service
coordinator, and area office director of the initiation of search procedures for an individual.
(d) The provider shall notify local and state police and local hospitals as appropriate.
(2) Individual Safety Assessment.
(a) All providers shall assure that individual safety assessments are conducted and that
strategies are developed for meeting the specific and unique safety needs of each individual.
Individual safety assessments shall be conducted as part of the individual's ISP.
(b) The ISP and safety strategies shall be revised when the individual's health, mobility or
other capabilities affecting safety and evacuation change.
(c) Safety strategies may include modification to the location where services are provided,
other environmental modifications and use of assistive technology, staff supports, staff
training focused on the individual's needs, and education of the individual to assure optimal
understanding and independence regarding safety precautions and procedures.
(3) Safety Plan.
(a) All providers, except for providers of individualized home supports of less than 15 hours
per week and providers of individualized home supports or respite in a family home, shall
prepare and file with the area office a written safety plan assuring the safety of individuals
in the event of a disaster, such as fire, explosion, loss of heat or electricity, interior flooding,
or any other circumstances requiring emergency evacuation. Safety plans must be specific
to and must be on hand at each site where supports and services are provided and must be
easily accessible to all staff and others who provide supports and services to the individual.
(b) The safety plan shall include at least the following:
1. Safety strategies for each individual as outlined by the individual safety assessment
required in 115 CMR 7.06(2).
2. An assessment of how group interaction may affect the needs of the individuals
during a fire or other emergency.
3. Evidence of compliance with environmental standards pursuant to 115 CMR 7.07.
4. Use of assistive technology, if appropriate.
5. Sufficient numbers of trained staff to effectively implement the procedures in the
safety plan.
6. Procedures for the safe evacuation of individuals:
a. For sites where residential supports and 24 hour site based respite supports are
provided, safe evacuation is defined as assuring that all individuals can get out of the
home in 2½ minutes, with or without assistance, without reliance on staff who have
evacuated to return to provide assistance, and in accordance with professionally
accepted fire safety evacuation procedures. For sites where employment supports or
day supports are provided, safe evacuation is defined as assuring that individuals can
evacuate in a safe, orderly and timely manner, with staff assigned to individuals
needing assistance.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.06: continued
b. For any individual who needs assistance to evacuate, an evacuation plan specific
to the individual is required.
7. Fire Drills.
a. Providers of residential supports except placement services shall conduct
quarterly fire drills and maintain records of evacuation times, types of assistance, if
needed, and assessments of individual and staff performance. At least two drills per
year shall be conducted in the nighttime when individuals are in bed and asleep.
b. Providers of employment supports or day supports shall conduct two fire drills
annually, with records of evacuation times and type of assistance needed, if any, and
assessments of individual and staff performance.
c. A provider shall not deviate in any respect from the foregoing minimum
requirements for fire drills unless it has provided alternative assurances in the
provider safety plan submitted to and approved by the area director.
d. Records documenting the results of the required fire drills shall be submitted to
the area office at the time safety plans are re-filed pursuant to 115 CMR 7.06(3)(e).
8. Methods to notify fire, police, and hospital facilities for assistance; on-call
administrative staff; and families/guardians. The area director shall be notified as soon
as possible, and in any event, within 12 hours.
9. Provision for transportation and immediate temporaryresettlement of individuals and
staff in another specified location.
10. Provision for the continuity of appropriate supports and services within the first 24
through 48 hours of an emergency pending arrangements with the Department for return
to the original site or occupancy in other locations.
(c) Assurances. The safety plan shall include assurances signed by the head of the provider
that the plan:
1. will be implemented as written and approved;
2. is designed to assure the safety of individuals in the event of a fire or other emergency
as defined in 115 CMR 7.06(3); and
3. will be periodically evaluated for effectiveness.
(d) Initial Filing. For new supports and services, an initial safety plan is required prior to
occupancy of a site and must be modified as the needs of individuals and group interactions
are better known, but within 60 days of initial filing.
(e) Refiling. The safety plan shall be updated and refiled with the area office no less than
every two years if no changes have occurred that warrant refiling during the two year period.
A revised safety plan shall be refiled within 60 days after a change in any of the following:
1. the provider of services at a particular site;
2. the types of supports and services provided at the site;
3. the location where supports and services are provided;
4. the individuals' ability to evacuate;
5. the individuals living in the home;
6. the individuals served where employment supports or day supports are provided, such
that the change necessitates revision to the safety plan;
7. the effectiveness of the plan, as determined by the Department.
(f) Approval. The safety plan shall be reviewed and approved by the area director or
designee within ten working days for all sites where the services and supports are funded or
provided by the Department. For licensed sites where the services and supports are not
funded by the Department, safety plans shall be filed with the area office, but need not be
approved by the area director.
7.07: Environmental Standards for All Site Based Services
(1) All sites where residential supports, 24 hour site based respite supports, employment
supports and day supports are provided must meet all applicable building, sanitary, health, safety,
and zoning requirements.
(2) The environmental requirements 115 CMR of 7.07(3) through (8) shall apply to sites where
residential supports, 24 hour site based respite supports, employment supports and day supports
are provided, unless supports and services are provided in the home of the family of the
individual.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.07: continued
(3) All providers must assure that the sites where supports and services are provided are clean,
environmentally safe, free of vermin and obvious fire and chemical hazards, maintained in
accordance with common fire safety practices, and of sufficient size to accommodate
comfortably the number of individuals and staff it serves. Any objects or conditions that
represent a fire hazard greater than that which could be expected of ordinary household
furnishings shall not be permitted.
(4) All providers must assure that the sites used by persons with substantial mobility
impairment are barrier-free to the extent necessary to permit access to the supports, services,
personal, and common areas. A location shall be deemed to be barrier-free, in whole or part, if
it meets the applicable standards of 521 CMR: Architectural Access Board as adopted by
780 CMR: Board of Building Regulations and Standards.
(5) The following environmental requirements shall apply to sites owned or leased by providers
of residential supports, individualized home supports and 24 hour site based respite supports, and
the homes of care providers.
(a) The site shall include complete living accommodations, including its own kitchen, living
room, dining area, bedrooms, and bathrooms of typical residential design. The site shall
provide for group and individual needs, including opportunities for privacyin clearly defined
living, sleeping, and personal care spaces and areas that are accessible and available
according to individual needs to enable personal development, the development of personal
relationships, and engagement in leisure activities.
(b) The site shall provide physical comfort as well as a pleasing style of decor and an
external appearance that is typical of other homes in the vicinity, except for accommodations
that enhance accessibility for individuals.
(c) The layout of rooms shall permit ready access to common areas, with no intrusion into
private bedroom areas.
(d) The site shall provide conveniently located common storage adequate for a reasonable
amount of individual and group possessions.
(e) Major environmental controls, including those for lighting, appliances, plumbing,
windows, and shades shall be operable by and accessible to individuals.
(f) Heating and plumbing systems shall be installed and maintained for safe, healthy, and
comfortable use by the individuals supported by the provider.
(g) Heating and ventilation systems shall be adequate to maintain comfortable levels
throughout the year.
(h) All substances that are potentially dangerous in nature shall be stored separately from
food and in containers which are accurately labeled. No flammable liquids, such as gasoline,
shall be stored in the site or in spaces attached to the site.
(i) Lighting shall be adequate to meet the individual and group needs of the residents and
shall be provided in all major interior spaces, including walk-in closets and mechanical and
storage rooms.
(j) Each individual shall be provided with bedroom space adequate for sleeping, dressing,
attending to personal appearance and needs, and caring for his or her personal possessions.
The bedroom shall be of sufficient size to comfortably accommodate a bed, dresser, closet
space, and adaptive equipment if required, and to allow for an individual's privacy and
activities.
(6) The following environmental requirements shall apply to sites owned, rented or leased by
providers of residential supports, care providers, and providers of 24 hour site based respite
support:
(a) The bedroom size shall be no less than 90 to 100 square feet for a single bedroom and
130 to 144 square feet for a double bedroom.
(b) The bedroom shall be occupied by one individual; provided, however, two individuals
may share one bedroom if the two individuals, or their guardians if applicable, consent to the
sharing of the bedroom.
(c) Existing sites serving five individuals as of July 15, 2016 must have at least 1½
bathrooms. Any newly developed sites serving five individuals must have two bathrooms.
(7) The following environmental requirements shall apply to sites owned or leased by providers
of residential supports, care providers, providers of employment supports, day supports, and
providers of 24 hour site based respite supports.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.07: continued
(a) All sites shall have two means of egress from floors at grade level; all other floors above
grade level shall have one means of egress and one escape route serving each floor and
leading to grade. This requirement shall not apply to employment supports or day supports
when the second floor is used on an intermittent basis only. Any proven usable path to the
open air outside at grade shall be deemed acceptable as an escape route, including but not
limited to connecting doors, porches, windows within six feet of grade, ramps, fire escapes,
and balcony evacuation systems. Double cylinder dead bolt locks that require key operation
from within are prohibited on egress doors.
(b) All sites providing residential supports shall have a fire extinguisher that is operable and
that is located in the kitchen.
(c) All sites shall have smoke detectors as required by 780 CMR: Board of Building
Regulations and Standards. If more than one detector is required per site, each detector shall
be interconnected so as to activate all other detectors.
(d) All sites shall have carbon monoxide detectors as required by 780 CMR: Board of
Building Regulations and Standards.
(e) All vertical chutes (e.g., laundry chutes, dumbwaiters, heating plenums) shall be sealed
with gypsum board or some other fire retardant material.
(f) Bedroom doors are lockable unless clinically contraindicated or unless an individual,
or his or her guardian, if applicable, chooses a bedroom with access to egress and consents
to the bedroom door not having any lock.
(g) Locks on bedroom doors which do not provide access to an egress shall be permitted
only in accordance with the following:
1. The head of the provider has documentation that the lock may be easily opened from
the inside without a key and that the individual is able to unlock the door from the inside;
and
2. At all times staff carry a key or have immediate access to a key to open the door in
the event of an emergency.
(h) Bedrooms of individuals requiring hands-on physical assistance to evacuate or who have
a mobility impairment, including individuals who use a wheelchair, shall be on a floor at
grade or on a floor with a "horizontal exit," in accordance with 780 CMR: Board of State
Building Regulations and Standards.
(i) Smoking shall be permitted only under the following conditions:
1. Staff may not smoke in the homes of individuals.
2. Smoking shall be prohibited in bedrooms and at sites where employment supports or
day supports are provided.
3. Ashtrays of non-combustible material and safe design shall be provided in all areas
where smoking is permitted.
(8) A provider shall not deviate in any respect from the foregoing environmental requirements
of 115 CMR 7.07(7) as they apply to that provider, unless the provider demonstrates that the
safety needs of individuals are otherwise adequately addressed and has received approval from
the area director within its safety plan as required by 115 CMR 7.06. However, providers of 24
hour site-based respite may not deviate from any of the environmental requirements of 115 CMR
7.07(7) under any circumstances.
7.08: Capacity
(1) The capacity of a site where residential supports or 24 hour site-based respite supports are
provided shall be determined by the Department and may vary depending on the size, location,
and other characteristics of the site; the ages, needs and preferences of the individuals; and the
experience and capability of the provider, provided, however, the capacity shall not exceed five
individuals unless 115 CMR 7.08(2) applies.
(2) All sites providing residential supports and 24 hour site based respite services in existence
and licensed by the Department as of December 1, 1995 shall be permitted to retain for the life
of the original building the capacity in excess of five that was approved under the provider's
license in effect as of that date; unless the Department and the provider determine that the
additional individuals can no longer be accommodated in the home without detriment. If it is
determined at any time that the site can no longer accommodate more than five individuals, the
provider must develop and implement a plan to reduce the capacity to five or fewer.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.08: continued
(3) A site where a care provider provides residential supports or 24 site based respite supports
in the care provider's home may serve no more than three people (including individuals served
by the Department), regardless of funding source. However, any placement service site with a
capacity of four that was approved by the area director and in existence and licensed by the
Department prior to June 1, 2014, may retain the capacity of four. In the event the Department
determines that the site can no longer accommodate four individuals, the provider must develop
and implement a plan to reduce the capacity to three or fewer.
7.09: Standards for Employment and Day Supports
(1) In addition to the requirements of 115 CMR 7.01 through 7.07, providers of employment
supports or day supports shall adhere to the following standards:
(a) Integrated, individual employment is the preferred service option and outcome for adults
of working age.
(b) All individuals are to be encouraged and supported in seeking and securing employment
or becoming engaged on a pathway to employment.
(2) Providers of employment supports including individual and group options shall adhere to
the following standards:
(a) Individuals are educated about the benefits of integrated employment.
(b) Career planning is provided through the development of an individualized plan that
identifies specific job goals and support needs.
(c) Individuals are supported to acquire and maintain jobs in an integrated work setting.
(d) Individuals are supported to improve job skills and foster career advancement
opportunities.
(e) Individuals are supported to interact with co-workers and others without disabilities.
(3) Providers of day supports shall adhere to the following standards:
(a) For all providers of day supports, provide a full range of community activities that
provides opportunities for developing, enhancing, and maintaining competency in personal,
social and community activities and includes, but is not limited to:
1. career exploration,
2. community integration experiences,
3. skill development and training,
4. development of activities of daily living,
5. socialization experiences and support to enhance interpersonal skills, and
6. pursuit of personal interests and hobbies.
(b) For providers of day supports that include supports to prepare individuals for work:
1. inform individuals and their families about the benefits of integrated employment.
2. develop and implement individualized support strategies that address habilitative
goals necessary to prepare individuals for work;
3. conduct assessments to identify specific interests, skills and support needs;
4. develop relevant skills that lead to employment;
5. develop job placement plans based on assessments; and
6. develop and implement approaches and strategies to support expanding integrated
community employment and meaningful community integration.
7.10: Standards for 24 Hour Site Based Respite Services
(1) In addition to the requirements of 115 CMR 7.01 through 7.08, all providers of respite
services shall:
(a) minimize upset and disruption of the individual's typical life patterns and enable the
individual to participate in life routines in accordance with the individual's ISP;
(b) to the extent possible obtain a thorough knowledge of each individual's medical needs,
including his or her ability to communicate health and medication needs; determine each
individual's ability to evacuate in an emergency and take necessary actions to assist the
individual in the transition between home and provider, where feasible and when requested
by the individual, family, or other primary care provider.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.11: Standards for Placement Services
(1) In selecting the care provider the placement agency shall comply with the following:
(a) The placement agency shall assess the personal characteristics of the care provider and,
where applicable, other members of the household who will be providing supervision or
services with respect to their ability and appropriateness to serve the individual as determined
through interviews, review of any prior service assessments, and information from at least
two personal references. The placement agency shall also inquire of the care provider and
the personal references as to whether any reports have been filed against the provider under
M.G.L. c. 119 regarding the abuse, mistreatment, or neglect of children; under
M.G.L. c. 19C, regarding abuse of adults with disabilities; under M.G.L. c. 19A, regarding
abuse of elders; or under M.G.L. c. 111, regarding abuse of a resident in a facility licensed
or certified by the Department of Public Health.
(b) In assessing the care provider's ability to provide supports and services to individuals,
the placement agency shall consider the following factors:
1. motivation for application;
2. characteristics, number, and age of the individuals the care provider can adequately
serve;
3. geographical location of the care provider's home in relation to the needs of the
individual the placement agency intends to serve;
4. ability to adjust to family changes which will occur when the individual is placed;
5. capacity to integrate the individual into daily routines and patterns of living without
undue disruption;
6. flexibility to meet the individual's changing needs;
7. ability to accept the individual's relationship with his or her natural parents and other
family members;
8. ability, if and when appropriate, to assist an individual to make the transition to a
more independent living arrangement; and
9. previous work experience, competencies, or training in providing supports and
services to persons with intellectual disability or other disabilities, and relevant personal
experiences.
(c) The placement agency shall assure that the minimum age for a person providing
residential supports to an individual eligible for the Department's services in the care
provider's own home is 21 years of age, except that a person 18 of age or older may provide
such services if the person works under the direct supervision of someone 21 years of age or
older and through training or experience exhibits the knowledge and competencies as set
forth in 115 CMR 7.11(2)(a) prior to the provision of services. The age of any care provider
shall be considered in determining the appropriateness of placing specific individuals with
that person based on the individual's ISP.
(d) The placement agency shall assess whether the care provider's employment, if any,
outside the home will decrease the provider's capacity to meet the requirements of 115 CMR
7.00 and that adequate provision exists for the care and supervision of individuals during any
such absences.
(e) The placement agency shall assess the composition of the care provider's household to
ensure that the number and characteristics of other members of the household do not
adversely affect either the capacity of the provider to give adequate time, energy, and
attention to individuals served or the appropriateness of the environment for specific
individuals in accordance with their needs.
(f) The placement agency shall assure that a care provider is serving only individuals 18
years of age or older unless there is prior approval by the area director. The approval shall
be based on the area director's consideration of the circumstances and relationships of all
individuals who will be supported in the home and the capacity of the care provider to meet
their needs.
(g) The placement agency shall conduct and document a review of the home of the person
who may be selected as the care provider in accordance with the standards set forth in
115 CMR 7.07(1) and (3) through (7).
(2) The placement agency shall assure that care providers shall have sufficient pre-service and
in-service training to assure that they have the information and skills necessary to meet the needs
of individuals to be supported.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.11: continued
(a) Prior to the delivery of services, the placement agency shall assure that the care provider
demonstrates knowledge and competence in at least the following areas: the current value
base of service delivery; the nature and treatment of individuals with developmental
disabilities; relevant principles of care, treatment, and the provision of supports; first aid;
CPR; seizure care; and fire and safety considerations.
(b) The placement agency shall assure that the care provider annually receives sufficient
ongoing in-service training to continue to meet the needs of individuals served.
(3) The placement agency shall execute a written agreement with the person indicating that the
care provider will:
(a) comply with all applicable state laws, standards, and regulations;
(b) report any changes of location, household composition, or other conditions that may
affect the person's continued suitability and ability to provide supports prior to such changes
or as soon thereafter as practicable, but no later than 24 hours after such changes;
(c) permit on-site review of the home;
(d) permit a representative of the placement agency and an employee of the Department
authorized to conduct surveys under 115 CMR 8.03(3): Survey Team to visit the home, as
often as deemed necessary by the placement agency or the Department, to monitor
compliance with the Department's regulations. Such visits may be made at any time, with
or without notice, but should ordinarily be made with prior notice and at normal hours,
giving due regard to the privacy of the individuals supported in the home, family members
and other residents, and to any disruption that the visit may cause;
(e) cooperate with the placement agency and the Department in maintaining liability
insurance coverage, where applicable; and
(f) arrange for emergency medical treatment of the individual and for notification of the
placement agency and the individual's physician, family, and guardian, if any, and service
coordinator of emergencies or symptoms reasonably appearing to require medical attention.
(4) The placement agency shall conduct an annual assessment of the skills of the care providers,
with such assessment made available to the Department.
(5) The placement agency should determine whether the care provider is the sole provider of
residential supports or whether there will be shared responsibility with a spouse or other adult
members of the provider's family. If there is shared responsibility, the additional person(s) must
be identified and determined appropriate as a care provider in accordance with the requirements
of 115 CMR 7.11(1) through (4) and all other applicable regulations.
(6) The placement agency shall, prior to placement, determine and document the
appropriateness of the placement in relation to the needs and age of the individual and the
capacity and other characteristics of the care provider and of the home.
(7) Prior to placement, except in emergencies in which case as soon after placement as possible,
the placement agency shall furnish the care provider with sufficient personal, medical, legal, and
behavioral information to enable the care provider to care for the individual. Such information
shall include, at least:
(a) information on medication, special diets, allergies and other pertinent medical needs and
the name(s) and telephone number(s) of the person(s) designated by the placement agency
for the care provider to contact in the event of a medical or other emergency involving the
individual;
(b) information on the individual's work, training, school, or other supports; and
(c) information on the individual's legal status with respect to custody (if a minor) or
guardianship, and, if applicable, the name, address, and telephone number of the guardian,
and specific authority, limitations, and rights of the individual in relation to custody or the
guardianship.
(8) Except in emergencies, a representative of the placement agency shall participate in the first
meeting of the care provider and the individual.
115 CMR: DEPARTMENT OF DEVELOPMENTAL SERVICES
7.11: continued
(9) After a placement is made, the placement agency shall visit the individual at the home to
ensure its continuing appropriateness. The frequency of visits and the length of time over which
visits are conducted may vary depending on the individual circumstances, but in no event shall
the placement agency visit each home where residential or 24 hour respite supports are provided
less frequently than once monthly, unless otherwise instructed in writing by the Department.
(10) The placement agency shall, within a week after such supports initially have been
provided, and at least quarterly thereafter if the supports continue to be provided, contact the
individual and his or her family or other primary care provider to obtain a written evaluation of
the arrangement. The evaluation shall include an assessment of the individual's and family's
satisfaction with the supports and services provided by the placement agency and the care
provider and with the degree to which the services meet the individual's needs.
REGULATORY AUTHORITY
115 CMR 7.00: M.G.L. c. 19B, §§ 1 and 13 through 15.