<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10" citation="COMAR 10.21.26.10" title_num="10" subtitle_num="21" chapter_num="26" heading="Staff Support and Mental Health Services — Inpatient Admission Alternative.">
  <paragraph num="A.">
    <text>Staff Support. The program director shall ensure:</text>
    <paragraph num="(1)">
      <text>That sufficient staff are on duty at all times to relate to the expected clinical needs of the individuals in the residence; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>At a minimum:</text>
      <paragraph num="(a)">
        <text>The provision of at least one on-site, awake staff for every four individuals receiving RCS or, if a child is in the residence, one staff for every three individuals;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The availability, based upon clinical acuity and the request of on-duty staff, of at least one other staff member to arrive at the RCS program within 1 hour of a request; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>That the program has the capacity for 1:1 coverage, and provides 1:1 coverage when clinically indicated.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Psychiatric Evaluation and Intervention. The program director shall assure that a psychiatrist:</text>
    <paragraph num="(1)">
      <text>Is available on call, 24 hours per day, 7 days per week;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Within 24 hours of an individual's admission:</text>
      <paragraph num="(a)">
        <text>Conducts a face-to-face evaluation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Either:</text>
        <paragraph num="(i)">
          <text>Formulates and documents a psychiatric diagnosis and the rationale for the diagnosis; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Affirms the psychiatric diagnosis formulated under Regulation .06A(4) of this chapter; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Through participation in the ITP, prescribes treatment interventions; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If the individual presents a danger to self, indicates appropriate staff coverage and precautions.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Treatment and Support Services.</text>
    <paragraph num="(1)">
      <text>The program director shall ensure that a mental health professional:</text>
      <paragraph num="(a)">
        <text>Provides regular supervision of all treatment staff; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Each day, either:</text>
        <paragraph num="(i)">
          <text>Monitors, face-to-face, an individual's condition and documents significant changes; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Consults with staff regarding the clinical needs of an individual.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The program director shall assign a treatment coordinator who shall assure that the individual receives:</text>
      <paragraph num="(a)">
        <text>Care or treatment recommended under Regulation .07A of this chapter; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The services under Regulation .09C(1)(c) — (e) of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Medication Services.</text>
      <paragraph num="(a)">
        <text>Monitoring. When required by the individual's ITP, a member of the treatment team credentialed and privileged to do so shall provide medication monitoring, as outlined in Regulation .09C(2)(a) of this chapter.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administration. The program director shall assure that an individual authorized under Health Occupations Article, Annotated Code of Maryland, is available to administer medication in a case where medication administration is required by an individual's ITP.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>