If a deficiency exists, the Secretary may impose sanctions that include: A directed plan of correction with corrective measures necessary to protect residents; Imposing adequate staffing levels in a nursing home; Appointing a State monitor subject to § 19-1405 of this subtitle; and Imposing a civil money penalty. A civil money penalty may be imposed when a deficiency exists or an ongoing pattern of deficiencies exists in a nursing home. In determining whether a civil money penalty is to be imposed, the Secretary shall consider, pursuant to guidelines set forth in regulations promulgated by the Secretary, the following factors: The number, nature, and seriousness of the deficiencies; The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months; The degree of risk to the health, life, or safety of the residents of the nursing home caused by the deficiency or deficiencies; The efforts made by, and the ability of, the nursing home to correct the deficiency or deficiencies; and A nursing home’s prior history of compliance. Upon determination by the Department that a deficiency or deficiencies exist, the Department shall notify the nursing home that: Unless corrective action taken pursuant to this section is substantially completed, a civil money penalty will be imposed; or An order imposing a civil money penalty will be issued, pursuant to § 19-1403 of this subtitle which shall include a list of all deficiencies and notice that a civil money penalty may be imposed until the time that the cited deficiencies have been rectified.