Chapter 13. Forensic Residential Centers (FRCs)
Regulation .01 Scope.LinkCopy Citation
This chapter sets forth requirements for a facility to be licensed as a forensic residential center.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Confined” means an order by the court pursuant to Criminal Procedure Article, §3-106(d)(2), Annotated Code of Maryland.
(2)
“Court-ordered evaluation” means an evaluation ordered by the court under Criminal Procedure Article, §§3-105 and 3-111, Annotated Code of Maryland, to assist the court to determine if an individual is incompetent to stand trial or is not criminally responsible because of mental retardation.
(3)
“Department” means the Maryland Department of Health.
(4)
“Evaluation unit” means a part of the forensic residential center dedicated to performing court-ordered evaluations pursuant to Criminal Procedure Article, Title 3, Annotated Code of Maryland.
(5)
“Forensic residential center (FRC)” means a facility that is:
(a)
Licensed to provide a continuum of integrative services to individuals with an intellectual disability:
(i)
Ordered by the court for an evaluation or to be confined;
(ii)
Court-committed for care or treatment to the Department as incompetent to stand trial or not criminally responsible, who are dangerous as a result of mental retardation; or
(iii)
On conditional release and returned to the facility either voluntarily or on hospital warrant;
(b)
A related institution as defined in Health-General Article, §19-301(o), Annotated Code of Maryland; and
(c)
Not an extended care or comprehensive rehabilitation facility.
(6)
“Incompetent to stand trial (IST)” has the meaning set forth in Criminal Procedure Article, §3-101(f), Annotated Code of Maryland.
(7)
“Not criminally responsible (NCR)” means a verdict of not criminally responsible as set forth in Criminal Procedure Article, §3-109, Annotated Code of Maryland.
(8)
“Qualified developmental disabilities professional (QDDP)” means an individual who coordinates and monitors the delivery of services for individuals with an intellectual disability.
(9)
“Therapeutic care unit” means an FRC or part of an FRC dedicated to providing care or treatment to individuals who are court-committed or confined.
Regulation .03 Licensing Procedure.LinkCopy Citation
A.
The Secretary shall license an FRC that meets the requirements of this chapter.
B.
The license for an FRC shall be effective for 1 year.
C.
The Secretary may renew the license of an FRC if it continues to meet the requirements of this chapter.
D.
Approval, Denial, Revocation, and Sanctions.
(1)
The Secretary may deny an application, suspend, revoke, or impose disciplinary sanctions on the license of an FRC if it fails to comply with the requirements of this chapter.
(2)
Any action to deny an application, suspend, revoke, or impose sanctions on a license shall be governed by COMAR 10.22.03.
Regulation .04 Administrative Requirements.LinkCopy Citation
A.
In addition to the requirements of this chapter, an FRC shall comply with the applicable requirements of COMAR 10.22.02.
B.
Safety and Sanitation.
(1)
An FRC's grounds, fixtures, and equipment shall:
(a)
Be maintained in good repair and be clean and attractive;
(b)
Be free of unnecessary accumulations of personal property or debris;
(c)
Be free of hazards, insects, and rodents; and
(d)
Be free from fire hazards.
(2)
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.
C.
Living Space. An FRC shall:
(1)
Have bedrooms that:
(a)
Have at least one outside wall;
(b)
Are equipped with or located near toilet and bathing facilities;
(c)
Accommodate no more than two individuals, provided such arrangement is clinically appropriate; and
(d)
Measure at least:
(i)
60 square feet per individual in multiple individuals' bedrooms; and
(ii)
80 square feet in single individual's bedrooms;
(2)
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;
(3)
Provide adequate space and equipment for dining, living, health and therapeutic services, recreation, and other program activities; and
(4)
Provide that the above described living space be:
(a)
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
(b)
Separate from areas used, frequented, or occupied by individuals committed or admitted pursuant to Health-General Article, Title 10, Annotated Code of Maryland.
D.
Infection Control. The FRC shall:
(1)
Establish policies and procedures to investigate, control, and prevent infections in the facility;
(2)
Ensure that facility staff follows these policies and procedures; and
(3)
Maintain records of actions taken to address and prevent infections.
E.
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:
(1)
Provide adequate food and nutrition services;
(2)
Provide individuals with a nourishing, well-balanced diet including modified and specially prescribed diets;
(3)
Ensure the diet is prepared in accordance with current clinical dietary standards;
(4)
Ensure individuals receive at least three meals a day, at regular normal meal times;
(5)
Ensure foods are served in variety, appropriate consistency, texture, quantity, in season, and at appropriate temperatures; and
(6)
Prepare menus in advance and keep them on file a minimum 30 days.
F.
Health Care Services. As clinically appropriate, an FRC shall provide health services for all residents including, but not limited to:
(1)
Physician services, 24 hours a day;
(2)
Annual physical examinations which include:
(a)
Vision evaluations; and
(b)
Hearing evaluations;
(3)
Immunizations;
(4)
Laboratory services;
(5)
Nursing services and delegated nursing services in compliance with COMAR 10.27.11;
(6)
Medical care or nursing care plans for each individual and reviews of each plan;
(7)
Dental care;
(8)
Pharmacy services; and
(9)
Training or supervision of individuals to:
(a)
Self administer medications;
(b)
Perform routine treatments; and
(c)
Provide for their health care.
G.
Personnel and Staffing.
(1)
The administrator of an FRC shall:
(a)
Ensure appropriate employee health screenings; and
(b)
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.
(2)
An FRC shall provide an adequate staffing plan in accordance with COMAR 10.22.02.11 to meet the needs of individuals served.
(3)
An FRC shall employ a Maryland licensed psychologist as the supervising psychologist who shall:
(a)
Supervise the evaluation and therapeutic treatment of individuals;
(b)
Use clinical best practices for the FRC population;
(c)
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;
(d)
Train direct care staff to collect data, and implement behavior plans and other programs in the individual's plan;
(e)
Ensure all services provided are documented appropriately in the individual's record; and
(f)
Ensure all behavior plans are developed in accordance with COMAR 10.22.10.
(4)
An FRC shall employ a Maryland licensed physician who:
(a)
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
(b)
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.
(5)
An FRC shall employ direct care staff who develop and implement an activity schedule for the individual that includes at a minimum:
(a)
The individual's preferred activities;
(b)
Opportunities for recreation and social activities;
(c)
Times for meals;
(d)
Training as indicated in the individual's plan; and
(e)
The individual's waking and bedtime hours.
(6)
An FRC shall employ a Maryland licensed registered nurse to:
(a)
Train direct care staff on an individual's nursing care needs and any delegated nursing services; and
(b)
Ensure all services provided are documented in the individual's plan.
(7)
The FRC shall have a clinical team that shall include, at a minimum:
(a)
A Maryland licensed psychologist;
(b)
A Maryland licensed certified social worker—clinical (LCSW-C);
(c)
A QDDP;
(d)
Direct care staff;
(e)
A Maryland licensed registered nurse; and
(f)
As necessary:
(i)
A psychiatrist;
(ii)
A physician; or
(iii)
Other licensed staff.
H.
Security and Restrictions.
(1)
A resident may have access to personal electronic devices according to the resident's individual plan.
(2)
A resident may not have access to or possess:
(a)
Illegal products;
(b)
Cigarettes, alcohol, or pornography; or
(c)
Items or objects that the supervising psychologist documents in the individual's record as contraindicated or designates as dangerous to the individual or others.
(3)
The administrator of an FRC shall ensure a safe and secure setting for individuals by providing:
(a)
Adequate staffing;
(b)
Adequate supervision of individuals;
(c)
Appropriate training for staff to perform their job duties competently; and
(d)
Designated visitors' rooms with appropriate supervision of individuals during visits as needed.
(4)
The administrator of an FRC may utilize the following environmental security measures:
(a)
Security doors and windows;
(b)
Security screens;
(c)
Appropriate locks;
(d)
Alarm systems;
(e)
Electronic monitoring devices;
(f)
Video monitoring systems;
(g)
Outdoor gates and fences with locks; and
(h)
Enclosed or locked patios.
(5)
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.
I.
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.
J.
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.
Regulation .05 Enrollment, Release, and Discharge.LinkCopy Citation
A.
All individuals in an FRC are ordered or committed by the court to the Department, or under the court's jurisdiction pursuant to an order of conditional release as set forth in Criminal Procedure Article, Title 3, Annotated Code of Maryland.
B.
An individual on conditional release who voluntarily agrees to admission to a therapeutic care unit shall be admitted as set forth in the conditional release order.
C.
Release From an FRC.
(1)
Individuals court ordered for evaluation shall be released from the evaluation unit as set forth in Criminal Procedure Article, §3-105 or 3-111, Annotated Code of Maryland.
(2)
Individuals committed as IST or NCR shall be released as set forth in Criminal Procedure Article, Title 3, Annotated Code of Maryland.
D.
Confined individuals shall be discharged as set forth in Health-General Article, §7-503(e), Annotated Code of Maryland.
E.
Individuals admitted pursuant to a hospital warrant shall be discharged as set forth in Criminal Procedure Article, §3-121, Annotated Code of Maryland.
F.
Individuals who voluntarily admit themselves pursuant to a conditional release order shall be discharged as set forth in the conditional release order.
Regulation .06 Services.LinkCopy Citation
A.
Services provided by an FRC shall include:
(1)
As set forth in Criminal Procedure, Title 3, Annotated Code of Maryland, all required evaluations and reports; and
(2)
Therapeutic services designed to prepare the individual for productive community living, that address issues of dangerousness, and are based on an interdisciplinary team assessment considering least restrictive interventions, include but are not limited to:
(a)
For individuals committed as IST, competency attainment services; and
(b)
For all individuals, services as set forth in the Individual Plan and, as clinically appropriate, therapeutic services include, but are not limited to:
(i)
Behavioral and mental health plans and services;
(ii)
Physical, speech, and occupational therapies;
(iii)
Habilitation services including vocational, educational, and life skills training; or
(iv)
Development of an aftercare or services plan.
B.
Therapeutic services for all individuals shall be conducted in space not simultaneously shared or used with individuals who are not residents of the FRC.
Chapter annotations
Authority: Health-General Article, §§2-102 and 7-904; Criminal Procedure Article, §3-102; Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.06 adopted as an emergency provision effective July 10, 2008 (35:16 Md. R. 1388); emergency status extended at 36:2 Md. R. 96; adopted permanently effective January 26, 2009 (36:2 Md. R. 100)
History: Regulation .02B amended effective January 20, 2014 (41:1 Md. R. 13)
History: Regulation .04G amended effective January 20, 2014 (41:1 Md. R. 13)