# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 18 — Community Mental Health Programs — Therapeutic Nursery Programs

#### Regulation .12 Health and Safety Requirements.

*COMAR 10.21.18.12*

The therapeutic nursery program director shall:

A. Ensure that a criminal background investigation as required under Family Law Article, §§5-560 — 5-568, Annotated Code of Maryland, has been completed and is on file in each staff member's personnel record;

B. If a child is involved in an accident or is injured while in attendance at a therapeutic nursery program:

  (1) Notify the primary caretaker on the day that the accident or injury occurs;

  (2) If the injury is serious, notify the parent or guardian immediately;

  (3) Ensure that appropriate treatment is provided; and

  (4) Document the incident according to the requirements of the risk management policy of the therapeutic nursery;

C. At all times that children are participating in the therapeutic nursery program, ensure that staff are present who hold current certificates indicating approved training in:

  (1) Infant and child cardiopulmonary resuscitation (CPR);

  (2) First aid; and

  (3) If wading or swimming are therapeutic nursery activities, Red Cross water safety;

D. Prepare an emergency evacuation plan that:

  (1) Is approved by the local fire authority;

  (2) Is posted in each room of the therapeutic nursery;

  (3) The staff and children practice at least monthly, and the staff maintain a written record of the dates and times of the practices; and

  (4) Includes:

    (a) Safe routes by which the staff and children may exit each area in the event of fire or other emergency requiring evacuation of the building;

    (b) The address of a location that can be used by the staff and children in the event of fire or other emergency until the parents, guardians, or primary caretakers of the children are notified; and

    (c) The provisions that, during an evacuation or a practice, a designated staff member take out of the building the record of attendance for that date and verify the presence of each child in attendance;

E. Provide telephones that are accessible to the staff in each activity area in the therapeutic nursery, and post the following information next to each telephone:

  (1) 911 telephone number to summon fire, police, and rescue services;

  (2) The name, address, and telephone number of the therapeutic nursery;

  (3) Telephone number of the child protective services unit of the local department of social services; and

  (4) Telephone number of a poison control center;

F. Release a child:

  (1) Only to the child's parent, guardian, or primary caretaker; or

  (2) If so directed by the child's parent, guardian, or primary caretaker, to another individual whose identity is verified;

G. As required by COMAR 10.06.01:

  (1) Report communicable diseases; and

  (2) Restrict attendance by staff and children with communicable diseases;

H. Not permit anyone to use alcohol or controlled dangerous substances on the premises or to smoke cigarettes, cigars, or pipes in rooms or areas approved for use by a child;

I. Implement measures to prevent the spread of disease including requiring that staff wash hands and ensure that a child's hands are washed thoroughly with soap and water after toileting, before handling food, after outdoor activities, and at other times necessary to prevent the spread of disease;

J. Provide for general cleanliness by ensuring that:

  (1) All surfaces, furnishings, materials, and equipment are clean;

  (2) Except for emergencies and clean-up activities that are part of the daily program, cleaning is not conducted while rooms are occupied by children;

  (3) Refuse containers in the building are:

    (a) Noncombustible; and

    (b) If they contain soiled diapers, lined with a disposable liner, covered with a lid, and inaccessible to children; and

  (4) Refuse containers outside the building meet the standards required by local code; and

K. Provide written notification to each staff member and documentation that each staff member has read and understood the notification regarding:

  (1) The location of the telephone and the emergency telephone numbers specified in §E of this regulation;

  (2) The location of each child's emergency form;

  (3) Emergency evacuation procedures;

  (4) Identity of the staff members who have appropriate first aid, CPR, and Red Cross water safety training;

  (5) Signs and symptoms of abuse and neglect;

  (6) The requirements and procedures for reporting suspected child:

    (a) Abuse directly to the local department of social services or law enforcement agency; and

    (b) Neglect directly to the local department of social services;

  (7) Risk management; and

  (8) The contents of this chapter.