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<regulation prefix="Regulation" num=".04" citation="COMAR 10.07.13.04" title_num="10" subtitle_num="07" chapter_num="13" heading="Administrative Requirements.">
  <paragraph num="A.">
    <text>In addition to the requirements of this chapter, an FRC shall comply with the applicable requirements of COMAR 10.22.02.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Safety and Sanitation.</text>
    <paragraph num="(1)">
      <text>An FRC's grounds, fixtures, and equipment shall:</text>
      <paragraph num="(a)">
        <text>Be maintained in good repair and be clean and attractive;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Be free of unnecessary accumulations of personal property or debris;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Be free of hazards, insects, and rodents; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Be free from fire hazards.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>An FRC shall comply with all applicable local fire and building codes and the Maryland State Fire Prevention Code, which is incorporated by reference in COMAR 29.06.01.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Living Space. An FRC shall:</text>
    <paragraph num="(1)">
      <text>Have bedrooms that:</text>
      <paragraph num="(a)">
        <text>Have at least one outside wall;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Are equipped with or located near toilet and bathing facilities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Accommodate no more than two individuals, provided such arrangement is clinically appropriate; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Measure at least:</text>
        <paragraph num="(i)">
          <text>60 square feet per individual in multiple individuals' bedrooms; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>80 square feet in single individual's bedrooms;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Have adequate bathroom facilities and maintain water temperature that does not exceed 110 degrees Fahrenheit in areas where individuals do not demonstrate the capability to regulate water temperature;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Provide adequate space and equipment for dining, living, health and therapeutic services, recreation, and other program activities; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Provide that the above described living space be:</text>
      <paragraph num="(a)">
        <text>Dedicated to the sole use of individuals committed for court evaluation or committed or confined pursuant to Criminal Procedure Article, Title 3, Annotated Code of Maryland; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Separate from areas used, frequented, or occupied by individuals committed or admitted pursuant to Health-General Article, Title 10, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Infection Control. The FRC shall:</text>
    <paragraph num="(1)">
      <text>Establish policies and procedures to investigate, control, and prevent infections in the facility;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Ensure that facility staff follows these policies and procedures; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Maintain records of actions taken to address and prevent infections.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Food Services. The FRC shall employ a qualified dietitian either full-time or part-time, or on a consultant basis at the facility's discretion, who shall:</text>
    <paragraph num="(1)">
      <text>Provide adequate food and nutrition services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide individuals with a nourishing, well-balanced diet including modified and specially prescribed diets;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Ensure the diet is prepared in accordance with current clinical dietary standards;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Ensure individuals receive at least three meals a day, at regular normal meal times;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Ensure foods are served in variety, appropriate consistency, texture, quantity, in season, and at appropriate temperatures; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Prepare menus in advance and keep them on file a minimum 30 days.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Health Care Services. As clinically appropriate, an FRC shall provide health services for all residents including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Physician services, 24 hours a day;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Annual physical examinations which include:</text>
      <paragraph num="(a)">
        <text>Vision evaluations; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Hearing evaluations;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Immunizations;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Laboratory services;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Nursing services and delegated nursing services in compliance with COMAR 10.27.11;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Medical care or nursing care plans for each individual and reviews of each plan;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Dental care;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Pharmacy services; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Training or supervision of individuals to:</text>
      <paragraph num="(a)">
        <text>Self administer medications;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Perform routine treatments; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Provide for their health care.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Personnel and Staffing.</text>
    <paragraph num="(1)">
      <text>The administrator of an FRC shall:</text>
      <paragraph num="(a)">
        <text>Ensure appropriate employee health screenings; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Obtain certification that an employee or volunteer is free from tuberculosis in a communicable form only if the employee or volunteer will be involved in the direct care of tuberculosis patients.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>An FRC shall provide an adequate staffing plan in accordance with COMAR 10.22.02.11 to meet the needs of individuals served.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An FRC shall employ a Maryland licensed psychologist as the supervising psychologist who shall:</text>
      <paragraph num="(a)">
        <text>Supervise the evaluation and therapeutic treatment of individuals;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Use clinical best practices for the FRC population;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have relevant work experiences and training in conducting and completing functional analyses, assessments, and behavior plans including experience working with individuals with co-occurring diagnoses of mental illness, substance abuse, and an intellectual disability;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Train direct care staff to collect data, and implement behavior plans and other programs in the individual's plan;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Ensure all services provided are documented appropriately in the individual's record; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Ensure all behavior plans are developed in accordance with COMAR 10.22.10.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>An FRC shall employ a Maryland licensed physician who:</text>
      <paragraph num="(a)">
        <text>Is certified in psychiatry by the American Board of Psychiatry and Neurology or who has completed the minimum educational and training requirements to be qualified to take the Board examination; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Has the relevant work experience in providing psychiatric services to individuals with an intellectual disability and co-occurring disorders including mental disorders and addiction diseases.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>An FRC shall employ direct care staff who develop and implement an activity schedule for the individual that includes at a minimum:</text>
      <paragraph num="(a)">
        <text>The individual's preferred activities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Opportunities for recreation and social activities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Times for meals;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Training as indicated in the individual's plan; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The individual's waking and bedtime hours.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>An FRC shall employ a Maryland licensed registered nurse to:</text>
      <paragraph num="(a)">
        <text>Train direct care staff on an individual's nursing care needs and any delegated nursing services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ensure all services provided are documented in the individual's plan.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>The FRC shall have a clinical team that shall include, at a minimum:</text>
      <paragraph num="(a)">
        <text>A Maryland licensed psychologist;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A Maryland licensed certified social worker—clinical (LCSW-C);</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A QDDP;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Direct care staff;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A Maryland licensed registered nurse; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>As necessary:</text>
        <paragraph num="(i)">
          <text>A psychiatrist;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A physician; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Other licensed staff.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Security and Restrictions.</text>
    <paragraph num="(1)">
      <text>A resident may have access to personal electronic devices according to the resident's individual plan.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A resident may not have access to or possess:</text>
      <paragraph num="(a)">
        <text>Illegal products;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Cigarettes, alcohol, or pornography; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Items or objects that the supervising psychologist documents in the individual's record as contraindicated or designates as dangerous to the individual or others.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The administrator of an FRC shall ensure a safe and secure setting for individuals by providing:</text>
      <paragraph num="(a)">
        <text>Adequate staffing;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Adequate supervision of individuals;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Appropriate training for staff to perform their job duties competently; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Designated visitors' rooms with appropriate supervision of individuals during visits as needed.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The administrator of an FRC may utilize the following environmental security measures:</text>
      <paragraph num="(a)">
        <text>Security doors and windows;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Security screens;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Appropriate locks;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Alarm systems;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Electronic monitoring devices;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Video monitoring systems;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Outdoor gates and fences with locks; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Enclosed or locked patios.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>A resident's rights to communications and restrictions of communications are set forth in Health-General Article, §10-702, Annotated Code of Maryland, and adopted herein.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Emergency Management Plans. The administrator of an FRC shall develop an emergency plan for all types of emergencies and disasters in accordance with COMAR 10.07.20.05E.</text>
  </paragraph>
  <paragraph num="J.">
    <text>Standing Committee Approval. An FRC shall assure that the quality assurance standing committee reviews all behavioral plans in accordance with COMAR 10.22.02.14E.</text>
  </paragraph>
</regulation>