Minnesota Minnesota

Early Intensive Development and Behavioral Intervention Manual

Early Intensive Development and Behavioral Intervention Manual

Health and safety standards

Page posted: 6/18/15

Page reviewed: 10/11/24

Page updated: 10/11/24

Overview

This page provides guidelines for EIDBI provider agencies to help them safely and effectively provide EIDBI services. It includes information about health and safety standards for:

  • · Physical space and equipment.
  • · Emergency preparedness.
  • · Food and water provision.
  • · Medical requirements.
  • · Toileting and sanitation.
  • · Service animals.

    • While EIDBI provider agencies are not legally required to follow these health and safety standards, DHS strongly recommends them as best practice. These standards are comparable to the requirements licensed settings must meet, as defined in Minn. Stat. §245D.06 and Minn. R. 9503.0140.

    Note: For information about required health and safety standards, refer to EIDBI – Rights and responsibilities.

    Physical space and equipment

    If the EIDBI provider agency is in an area of the state that:

  • · Adheres to the Minnesota State Building Code, it must comply with the standards specified in the code.
  • · Does not adhere to the Minnesota State Building Code, it must comply with all applicable local building ordinances.

    • In addition, the provider agency should follow the physical space and equipment standards in this section.

    Indoor and outdoor spaces

    All indoor and outdoor areas used by people should be clean and free from:

  • · Crumbling plaster.
  • · Debris.
  • · Holes in the walls, floors and ceilings.
  • · Litter.
  • · Loose, flaking, peeling or chipped paint and/or wallpaper.

    • All outdoor spaces, if owned or leased by the provider agency and used by people, should be:

  • · Enclosed if next to a body of water, railroads, traffic, machinery or other environmental hazards.
    Note: This does not apply to public parks or playgrounds.
  • · Free of litter, toxic materials, water hazards, machinery, animal waste and sewage contaminants.

    • Elopement and wandering concerns

    By law, all people who receive EIDBI services must be free from seclusion and restraint, except for emergency use of manual restraint (refer to the emergency use of manual restraint section on EIDBI – Rights and responsibilities). In addition, people who receive services must be free from all prohibitions, punishment, restraint, etc., as defined in the Positive Supports Rule (Minn. R. 9544.0060). This includes locks or other devices that contain, restrict, isolate or seclude people from normal activities without monitoring them.

    If a provider has concerns about elopement or wandering, DHS recommends the provider consider environmental adaptations. The provider can:

  • · Set up therapy rooms or spaces away from main exits.
  • · Use safety pads or room dividers to help indicate safe boundaries.
  • · Use adaptive technology and equipment, such as door alarms. For more information, refer to Minnesota Autism Resource Portal – Technology and equipment.
  • · Place preferred items within reach throughout safe areas.
  • · Position themselves between the person receiving services and exits to help redirect the person from eloping from the safe space.
  • · Set clear visual boundaries or reminders, such as “stop signs” or “red lights” to indicate places the person is not allowed to access.
  • · Use visual schedules or timers to help the person know when they can access preferred items or activities.

    • All providers should receive training to identify:

  • · Signs of elopement or possible triggers for each person.
  • · Strategies to redirect them safely and help prevent elopement.

    • If a person demonstrates elopement or wandering behaviors, DHS recommends the provider:

  • · Conduct a functional behavior assessment (FBA) to identify the function of the behavior.
  • · Create treatment goals or an intervention plan within the person’s individualized treatment plan (ITP), based on the results of the FBA. For more information, refer to EIDIB – ITP development and progress monitoring.

    • For example, the provider could establish a mode of functional communication for the person to request a break or access to a preferred area, rather than eloping. The provider also may use the higher intensity intervention service if medically necessary. For more information, refer to EIDBI – Intervention.

    Hazardous areas and objects

    The following areas and objects should be inaccessible to people who receive services:

  • · Bodies of water (e.g., ponds, pools, lakes), unless staff directly supervise people.
  • · Electrical outlets, exposed electrical cords and other electrical objects.
  • · Hazardous objects (e.g., sharp objects, medicines, plastic bags, household supplies, poisonous plants, chemicals).
  • · Kitchens, stairs and other hazardous areas, unless staff directly supervise people.
  • · Radiators, fireplaces, hot pipes and other hot surfaces.

    • Equipment, furniture and toys

    All equipment, furniture and toys at the provider agency should be:

  • · Cleaned and disinfected daily and when mouthed or soiled.
  • · Durable and structurally stable, following assembly and installation.
  • · Free of sharp edges, dangerous protrusions, openings or angles that could crush or trap part of a child’s body.
  • · Kept in locations that are accessible to a person who receives services (unless it is contrary to their individual treatment plan).
  • · Lead-free.
  • · Made of a material that the provider can easily clean and disinfect.

    • Rugs should have a non-skid backing or be firmly fastened to the floor. They should be free from tears, curled or frayed edges and hazardous wrinkles.

    Cameras and recording

    DHS recommends that the provider agency discuss camera use with their legal counsel. During the enrollment process, all providers sign and follow the same data privacy laws, restrictions and guidelines in Minnesota Health Care Programs (MHCP) Provider Agreement, DHS-4138 (PDF) and agree to comply with the data privacy provisions in paragraph 21 of the agreement. These data privacy laws, restrictions and guidelines may:

  • · Restrict camera use.
  • · Require people who receive services, their families and staff to consent to camera use.

    • Environmental adaptations

    The provider agency should make reasonable environmental adaptations to meet the specific needs of each person who receives services.

    Personal storage space

    The provider agency should provide an accessible, separate, personal storage space for each person who receives services.

    Room temperature

    The provider agency should keep indoor areas used by people who receive services between 68- and 85-degrees Fahrenheit.

    Emergency preparedness

    The provider agency should follow the emergency preparedness standards described below.

    Training

    All staff should complete training in emergency, accident and evacuation procedures.

    Equipment

    The provider agency should have the following equipment on site:

  • · Battery-operated flashlight.
  • · Battery-operated portable radio.
  • · Fire extinguisher and instructions for its use that are accessible to all staff.
  • · First aid kit that contains sterile bandages, sterile compresses, scissors, an ice bag or cold pack, an oral or surface thermometer and adhesive tape.
  • · First aid kit manual that is accessible to all staff.
  • · Additional first aid kit and manual for staff to take with people who receive services if they travel off site.
  • · Landline telephone that is accessible to all staff.

    • Fire and fire extinguisher inspection

    The provider agency should have a fire marshal inspection on file before it enrolls with MHCP as an EIDBI provider agency. If DHS has reasonable cause to believe a potential hazard exists, DHS may request another inspection and written report by a fire marshal, building official or health authority.

    A qualified inspector must annually service all fire extinguishers. The inspector should write their name and the inspection date on a tag attached to the extinguisher.

    Emergency information

    The provider agency should post the following emergency telephone numbers next to the telephone:

  • · Emergency medical and dental care.
  • · Local fire department.
  • · Police department.
  • · Emergency transportation.
  • · State health authority.
  • · Poison control center.

    • The provider agency should identify and visibly post the following information on site:

  • · A list of staff responsible for each area of the facility in case of an emergency.
  • · Evacuation routes from the facility.
  • · Instructions on how to close off a fire.
  • · Primary and secondary exits from the facility.
  • · Tornado shelter area.
  • · Written emergency and accident procedures. For more information, refer to the incident reports section on EIDBI – Health service records.

    • EIDBI Safety Plan Template, DHS-7109F is an optional document to help providers create an emergency safety plan. For more information, refer to EIDBI – How to complete ITP and Progress Monitoring, DHS-7109.

    Food and water provisions

    Most provider agencies require the person’s parent/primary caregiver to provide meals, snacks and drinks (other than water) for the person who receives services. If the provider agency (instead of the family) provides food for the person, it should meet the following food and water requirements.

    Menus and food preparation

    If the provider agency prepares and supplies food for people who receive services, the provider should make sure:

  • · Menus comply with the nutritional requirements of the United States Department of Agriculture Food and Nutrition Service, 7 C.F.R. §226.20.
  • · Procedures to prepare, handle and serve food and wash food, utensils and equipment comply with the requirements for food and beverage establishments in Minn. R. 4626.

    • If a food service provider other than the provider agency provides food, the provider agency should make sure the procedures to serve food comply with Minn. R. 4626.

    Dietary needs

    The person may have special dietary needs identified by their medical provider or parent/primary caregiver. If the provider agency provides food, the agency should serve food that meets the person’s dietary needs. If the special dietary items are not part of the provider agency’s food menu, the agency can require the person or their parent/primary caregiver to provide them.

    The provider agency should:

  • · Document the person’s special dietary needs and the duration of those needs in the person’s health record.
  • · Inform all staff who provide services to the person of their special dietary needs.

    • Food allergies

    If the person has food allergies, the provider agency should:

  • · Inform all staff who provide services to the person of their food allergies.
  • · Make the person’s food allergy information available in food preparation and serving areas.

    • Meals and snacks availability

    The provider agency should make the following available to the person:

  • · One snack if the person receives services at the agency for more than two hours but less than five hours.
  • · Either one meal and two snacks, or two meals and one snack, if the person receives services at the agency for five or more hours.

    • An EIDBI staff member should sit with and oversee the person during meal and snack times.

    Food storage

    The provider agency should refrigerate all perishable foods, including food the person or their parent/primary caregiver supplies. The refrigerator temperature should be 40-degrees Fahrenheit or less.

    Sanitation

    The provider agency should use sanitary procedures to:

  • · Prepare, handle and store all food and drinks.
  • · Clean the dishes and utensils provided to the person by the agency.
  • · Wash surfaces used for meals (e.g., tables, highchair trays) with soap and water before and after each use.

    • Water

    The provider agency should:

  • · Have a safe water supply.
  • · Make drinking water available to people who receive services throughout its hours of operation.
  • · Offer drinking water to people who receive services at frequent intervals.

    • If a provider agency uses water from a privately owned well that is not governed by Minn. R. 4720, it should have a Minnesota Department of Health-certified laboratory test the water for coliform bacteria and nitrates. The agency should keep the test results in its administrative record.

    Medical standards

    The provider agency should follow the medical standards described below.

    Information

    The provider agency should file the following information in each person’s health service record:

  • · The person’s physical and medical status.
  • · Emergency contact.

    • This information should be:

  • · Available to staff.
  • · Current when the person begins to receive EIDBI services (i.e., last updated no more than 12 months before the service start date)
  • · Updated annually after the person begins to receive EIDBI services.

    • For more information, refer to EIDBI – Health service records.

    Sickness

    If a person who receives services becomes sick at a provider agency, the agency should immediately:

  • · Notify the person’s parent/primary caregiver.
  • · Provide a space for them as they wait for transportation home.

    • This space should:

  • · Be separate from areas used by other people who receive services.
  • · Have a cot or bed and a blanket for the sick person.
  • · Be supervised by a staff member when a sick person is in the space.

    • Reports

    If an incident occurs while a person receives services, the agency staff member who was responsible for the person at the time of the incident should complete a report. For more information, refer to the incident reports section on EIDBI – Health service records.

    Contagious disease or condition

    The provider agency should include a requirement in its policies that a person’s parent/primary caregiver should inform the provider agency within 24 hours (not including weekends and holidays) if a medical or dental provider diagnoses a person who receives services with any of the following diseases or conditions:

  • · A contagious, reportable disease specified in Minn. R. 4605.7040.
  • · Chicken pox.
  • · Impetigo.
  • · Lice.
  • · Ringworm.
  • · Scabies.

    • The provider agency should include a requirement in its policies that it should notify the following people when a person who receives services is diagnosed with one of the above diseases or conditions:

  • · Legal guardians of all other people who receive services and were exposed to the disease or condition on the same day the agency receives notification from the sick person’s legal guardian.
  • · Health authority within 24 hours from when the agency receives notification from the sick person’s legal guardian.

    • Medication

    If the provider agency administers either prescription or non-prescription medication to a person who receives services, the agency should:

  • · Have written permission from the person’s legal guardian.
  • · Keep all medication in its original container.
  • · Label each person’s medication with their name.
  • · Only give a medication to the person whose name is on the label.
  • · Follow written instructions from either the medication’s manufacturer or a medical provider who is legally authorized to prescribe medications.
    Note: The person’s name and instructions on the label are considered instructions.
  • · Not administer a medication after its expiration date.
  • · Store all medications according to the directions on the original container and in a place inaccessible to people who receive services.
  • · Return unused portions to the person’s legal guardian or destroy them.

    • Examples of non-prescription medications that require a legal guardian’s permission to administer include:

  • · Diapering products.
  • · Sunscreen lotions.
  • · Insect repellents.

    • When the provider agency gives prescribed medication to a person, the provider agency should document the following information in the person’s health record:

  • · Person’s name.
  • · Medication name or prescription number.
  • · Date and time.
  • · Dosage amount.
  • · Name and signature of the staff member who dispensed it.

    • Toileting and sanitation

    Staff should assist people who need help with toileting and sanitation as needed. The provider agency should provide:

  • · Toilet paper.
  • · Liquid hand soap.
  • · Facial tissues.
  • · Single-use paper towels or warm-air hand dryers.
  • · Private toileting.
  • · Diaper-changing areas for school-age children and younger children when their individual treatment plan includes the need for this adaptation.

    • Toilets for toddlers and preschoolers

    To meet the needs of toddlers and preschoolers, the provider agency may use:

  • · Step stool and child-size toilet seat cover to access a regular-size toilet.
  • · Child-size toilet.
  • · Toilet training chair.

    • Specialized toiletry items

    If a person needs specialized toiletry items, their legal guardian should provide them. If the legal guardian provides specialized toiletry items, the provider agency should make instructions for using these items available to all staff who work with the person.

    Diaper changing

    The provider agency should change diapers in a diaper-changing area or in the bathroom. The diaper-changing area should:

  • · Be separate from areas used for food storage, food preparation and eating.
  • · Have a hand sink with hot and cold running water within three feet of it.
  • · Have a smooth, nonabsorbent surface and floor covering.
  • · Have a sanitary container to dispose of soiled and wet diapers.
  • · Include posted diaper-changing procedures.

    • Hand washing

    Staff should monitor hand washing and assist people who need help with hand washing. A person should wash their hands with soap and water:

  • · After staff change their diaper.
  • · After they use a toilet or toilet training chair.
  • · Before they eat a meal or snack.

    • Staff should wash their hands with soap and water:

  • · After they change a person’s diaper.
  • · After they assist a person with toileting or eating.
  • · After they use toilet facilities.
  • · Before they handle food, eat or assist a person with eating.

    • For more resources and guidelines, refer to:

  • · Center for Disease Control and Prevention – Guideline for hand hygiene in health-care settings (PDF).
  • · Minnesota Department of Health – Hand hygiene.
  • · World Health Organization – Latest publications.

    • Hand sinks and steps

    The provider agency should:

  • · Not use a common basin or hand sink filled with standing water.
  • · Have hand sinks available in the toilet area.
  • · Not use hand sinks in the toilet area for custodial work or food preparation.
  • · Not allow the hot water temperature in hand sinks to exceed 120 degrees Fahrenheit.

    • The provider agency may use sturdy and washable portable steps to meet toddlers’ and preschoolers’ hand-washing needs.

    Cleaning

    The provider agency should:

  • · Clean toilet facilities daily.
  • · Empty, wash (with soap and water) and disinfect toilet training chairs after each use.
  • · Wash (with soap and water) and disinfect toilets and toilet seats daily and whenever soiled.

    • Service animals

    If service animals or therapy animals are present at the provider agency, the agency should notify people’s legal guardians of the animals’ presence.

    For more information, refer to U.S. Department of Justice – Frequently asked questions about service animals and the Americans with Disabilities Act (ADA).

    Additional resources

    EIDBI – Health service records
    EIDBI – How to complete ITP and Progress Monitoring, DHS-7109
    EIDBI – Intervention
    EIDIB – ITP development and progress monitoring
    EIDBI – Resources
    EIDBI – Rights and responsibilities
    EIDBI Safety Plan Template, DHS-7109F
    Minnesota Autism Resource Portal – Technology and equipment

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