The purpose of this chapter is to: Define the roles and responsibilities of the State Coordinating Council and the local care teams in fostering the development of resources necessary to serve children with intensive needs in the State of Maryland; Promote interagency coordination in the provision of such services; and Ensure that State funds for the out-of-State placement of children with intensive needs are allocated in accordance with relevant State and federal laws. In this chapter, the following terms have the meanings indicated. Terms Defined. “Appropriate service or placement” means a service, placement, or plan of care provided in accordance with the requirements of applicable federal and State laws, including: 20 U.S.C. §1400 et seq.; 42 U.S.C. §§620 and 670 et seq.; The Child Abuse Prevention and Treatment Act, 42 U.S.C. §5102 et seq.; The Adoptions and Safe Families Act of 1997 (P. L. 105-89); Courts and Judicial Proceedings Article, §3-820, Annotated Code of Maryland; COMAR 13A.05.01 and 13A.05.02; Health-General Article, Title 15, Annotated Code of Maryland; Applicable regulations in COMAR 10.09; and The reauthorization of the Elementary and Secondary Schools Act of 2001, P.L. 107—110 (January 8, 2002). Child in Need of Out-of-State Placement. “Child in need of out-of-State placement” means a child who is recommended for or placed in an out-of-home placement outside of the State by a public agency. “Child in need of out-of-State placement” does not include a child: Placed in foster care, as defined in Family Law Article, §5-501, Annotated Code of Maryland; or Who is in a hospital for 30 continuous days or less. “Child with intensive needs” means a child who has behavioral, educational, developmental, or mental health needs that cannot be met through available public agency resources because: The child’s needs exceed the resources of a single public agency; or There is no legally mandated funding source to meet the child’s needs; or A child is in need of out-of-State placement. “Children’s Cabinet” means those agencies directed by Executive Order: To examine Maryland’s system of services to children and their families; and To facilitate ongoing improvements to this service delivery system. “Cost sheet” means a document which details the cost of needed services. “Family” means an eligible child’s natural, adoptive, or foster parents, and includes: A guardian; A person acting as parent of a child; and A relative or stepparent with whom a child lives. “Funding agency” means the State or local agency designated by State or federal law as responsible for funding or cofunding educational, residential, or treatment services identified in a child’s plan of care. “Funding letter” means a document generated by the Governor’s Office for Children detailing the cost of educational, residential, or treatment services and the designated funding agencies. “Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland. “Local agency” means the local school system, the local management board, and any local or regional departments, divisions, or offices of the State agencies identified in §B(19) of this regulation. “Local Care Team (LCT)” means the interagency body established in each local subdivision in the State for the purpose of providing a forum for interagency discussions and problem solving and offering referrals and information for families of children with intensive needs. “Local Management Board (LMB)” means the interagency body established by each local jurisdiction in the State for the purpose of overseeing and ensuring the implementation of a local interagency delivery system for children, youth, and families in that jurisdiction. “Notification” means the submission of completed documents as determined and required by the State Coordinating Council. “Out-of-State placement” means the placement of a child with intensive needs in a residential facility outside of the State for which State funding is sought, including: Alternative living units; Group homes; Hospitals; Residential facilities for children with disabilities; Residential treatment centers; Wilderness programs; and Other out-of-home settings as needed or appropriate to meet the intensive needs of a child. “Parent advocate” means an individual who is trained by and actively participates in a parents’ support or advocacy organization whose purpose is to support families of children with intensive needs. “Parent or guardian” means the parent, guardian, or person with legal authority to make decisions regarding the placement or other services provided by public agencies to a child with intensive needs.. “Plan of care” means the plan developed for the out-of-home placement of a child with intensive needs consistent with: The child’s individualized education program, if the child is a student with disabilities; Any court-ordered services; Services covered and authorized under the Maryland Medical Assistance Program if the child is eligible for medical assistance under Health-General Article, Title 15, Annotated Code of Maryland; or Any other service or program mandated by federal or State law with respect to the individual child. “Review” means the SCC discussion of aggregated data compiled by GOC from the notifications submitted by the State placing agencies. “State agency” means the: Maryland Department of Health; Department of Human Services; Department of Juvenile Services; Governor’s Office for Children; and Maryland State Department of Education. “State Coordinating Council (SCC)” means the State interagency body established as a committee of the Children’s Cabinet and which is responsible for: Reviewing and tracking the types, costs, and effectiveness of services required to meet the needs of children who are recommended for out-of-State placements; Coordinating the monitoring of out-of-State placement services to children with intensive needs; and Performing additional functions in accordance with the directives of the Children’s Cabinet. SCC Membership and Organization. The members of the SCC are the following State officials, or their designees: The Secretary of the Maryland Department of Health; The Secretary of the Department of Human Services; The Secretary of the Department of Juvenile Services; The Executive Director of the Governor’s Office for Children; and The State Superintendent of Schools. The Secretary of Budget and Management, or a designee, shall serve as a non-voting, ex officio member of the SCC. The Secretary of the Department of Disabilities, or a designee, shall serve as a non-voting, ex officio member of the SCC. The Children’s Cabinet shall designate up to 3 individuals to serve on the SCC on a rotating basis to represent: Family members or family advocates; and Youth or youth advocates. The Governor’s Office for Children shall provide staff support for the SCC. The SCC shall be chaired by a voting member as follows: The chairman shall serve a term of 12 months; and The chairmanship shall rotate among all voting members. The SCC shall establish and develop procedures to: Review notifications for state funding for the out-of-State placement of individual children with intensive needs; Make recommendations regarding the review of such notifications to the SCC; and Perform other functions as identified by the Children’s Cabinet or the SCC. LCT Membership and Organization. Each LCT shall consist of at least one designee of each of the following bodies: The Alcohol and Drug Administration; The Department of Juvenile Services; The Developmental Disabilities Administration; The local school system; The Mental Hygiene Administration or the local core service agency; The local department of social services; The local health department; and The local management board. The LCT membership shall include a parent of a child with intensive needs from the community, or parent advocate, or both, appointed by the chairman of the LCT in consultation with the local child advocacy community. The LCT membership shall include a non-voting representative of the local office of the Division of Rehabilitative Services to represent individuals who are 16 years old and older. Although each LCT member agency may designate staff to represent it on the LCT, all designees shall possess authority to the extent permitted by federal and State law to commit the resources of the agency that they represent. For all matters decided by a vote of the LCT: Each member agency listed in §B(1) of this regulation has a single vote; and The parent and parent advocate member represented on the LCT each have a single vote. The LCT shall select its chair by: Rotating the chairmanship among the members of the agencies represented on the LCT; or Appointing the LMB’s designee to the LCT as its chair. Each LCT: Shall determine which of its members will have responsibility for its administrative functions; and If 2 or more members will share the responsibility, shall determine the rotation of the administrative functions. General Responsibilities. The SCC shall encourage the implementation of the State’s policies to: Promote the development of a continuum of quality educational, treatment, and residential services in Maryland which will enable children with intensive needs to be served in the least restrictive setting appropriate to their individual needs; and Identify any additional treatment, educational, and residential resources, opportunities, or supports which may provide children with appropriate services in the least restrictive environment. Oversight of Resources for Children with Intensive Needs. The SCC shall oversee the resources available to serve children with intensive needs through the following activities: Establishment, support, and maintenance of a data tracking protocol to support agency accountability and State level service planning capability; Maintenance of a list of all residential facilities for children with intensive needs, which are approved or licensed by State agencies; Coordination of the monitoring of out-of-State facilities for compliance with applicable laws, regulations, and standards; Recommendations to State and local agencies regarding the use of existing community-based services and the development of new and enhanced community-based programs to serve children with intensive needs; Reviewing notifications for State funding of the individual placement of a child in need of out-of-State placement; Tracking the types, costs, and effectiveness of services required to meet the needs of children who are placed in an out-of-State facility; and Providing training and technical assistance to local agency and community partners. Each LCT shall develop policies and procedures to govern the: Conduct of regular meetings of the LCT; and Discussion of any requests for assistance by member agencies of individual children with intensive needs, including procedures for: Timely discussion of all requests for assistance; Expedited discussion of any request for assistance designated as an emergency matter by the referring agency; and Assurances of parental participation, or documentation of the LCT’s diligent efforts to assure parental participation, in the discussion of a child’s care. The LCT shall meet a minimum of four times per calendar year for the purposes stated in Human Services Article, §8-407, Annotated Code of Maryland. The Executive Director of the Governor’s Office for Children may grant waivers to the number of meetings required under §B of this regulation if: The LCT requests a waiver in writing prior to January 1 of the applicable calendar year; The LCT explains the reason for the waiver request; The request does not violate any applicable statute, law, regulation, ordinance, or bylaw; and The request is reasonable under the circumstances. Waivers under this chapter may be granted for a 1-year period, are renewable, and are subject to reconsideration at any time. The denial of a waiver may not be appealed. The placing agency shall submit a notification of State funding for the costs, or a portion of the costs, of the placement, as provided by applicable State laws. Prior to notification of out-of-State placement to the SCC, the placing agency shall notify all appropriate local agencies, the local school system and family members of the placement decision and expected admission date. Prior to notification of out-of-State placement to the SCC, the placing agency shall ensure that funding discussions have included input from all appropriate local agencies, the local school system and family members. The notification shall be on a form specified by the SCC and shall include the following: Information deemed necessary by the SCC to identify the child, the child’s intensive needs, and the nature and costs of the recommended placement; Documentation of the placing agency’s efforts to serve the child in the least restrictive environment appropriate to the child’s needs, including: A description of efforts to identify appropriate community-based services to meet the child’s needs; Reasons why community-based options were considered inadequate to meet the child’s needs or were otherwise rejected; A description of additional supports and services which would be required to provide appropriate services in an in-State facility, a community-based program, or the child’s home; The lack of availability of appropriate in-State facilities and services to meet the needs of the child; and A plan for the child’s return from the out-of-State placement, including: Time frame for the child’s return; Description of services and resources needed to facilitate the child’s return; and As appropriate, identification of a strategy for developing resources needed to facilitate the child’s return which are not currently available in the community. Exception Criteria for Out-of-State Placements. The SCC may review a notification from a placing agency for State funding of an out-of-State placement under one of the following exception criteria: The out-of-State placement is closer to the child’s home than any alternative in-State placement; The plan for the child’s permanent placement includes residence with a caregiver in proximity to the proposed out-of-State placement; The individualized needs of the child cannot be met through available, appropriate in-State resources at a total cost less than or equal to 100 percent of the average cost per placement for all appropriate out-of-State programs for which application would be made for the child; The child is currently in detention, shelter care, or committed to the Department of Juvenile Services pending placement under a court order; Compliance with the federal Individuals with Disabilities Education Act requires out-of-State placement; or The child is hospitalized in an acute care psychiatric hospital under the following circumstances: The child is committed to the Department of Juvenile Services, a local department of social services, or a division of the Maryland Department of Health; The child’s treatment team has determined that the child is ready for discharge. The only available, appropriate placement is out-of-State. The referring agency shall indicate which of the above exceptions is applicable with regard to the placement of the child for whom it has made notification to the SCC. The SCC will meet at least 6 times a year to conduct business meetings and provide trainings and technical assistance. Attendance at LCT. A child’s parents and the child’s legal counsel shall be invited to attend a meeting of the LCT or any portion of the meeting during which the child’s care is discussed. The child’s parents and legal counsel may present information to the meeting participants regarding their position as to the child’s needs and care. Notices to Parents. At least 10 calendar days before a meeting at which a child’s care is to be discussed, the parents and the child’s advocate or counsel shall receive a written invitation to the meeting, including the: Date, time, and location of the meeting; Intent to discuss the child’s care at the meeting; and Child’s right to be represented by an advocate or counsel. The SCC shall develop and implement a process to coordinate the monitoring of out-of-State facilities where Maryland children are being served at State expense. The SCC shall review any monitoring reports of site visits of out-of-State facilities that have been conducted by placing agency monitoring teams. Based upon the findings of a placing agency monitoring team, the SCC shall consult with the monitoring team to determine whether remedial actions are necessary. Each SCC member shall notify appropriate agency staff of any reports of monitoring of out-of-State residential services. The SCC shall review licensing and monitoring reports from each state in which a facility under contract with a placing agency is located. The Department of Human Services, Department of Juvenile Services, Department of Education, and Maryland Department of Health will share official monitoring reports with the SCC within 2 weeks of report being finally approved by the relevant agency head or designee. Before being submitted for publication, any proposed amendments to this chapter shall be reviewed and approved by the Office for Children and the Children’s Cabinet. Education Article, §§8-103—8-303 and 8-401—8-417; Health-General Article, §§2-102, 2-104, 2-105, 4-305—4-307, 7-1007, 10-204, 10-712, 10-1203, and 15-102.1; Human Services Article, §§2-202, 2-203, 2-209, 4-204, 4-205, 4-207, 9-202, 9-204, and 9-221; Annotated Code of Maryland Effective date: September 3, 2001 (28:17 Md. R. 1552) Chapter revised effective April 12, 2004 (31:7 Md. R. 581) COMAR 01.04.01 revised and recodified to COMAR 14.31.01 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 28, 2005 (32:23 Md. R. 1828) Regulations .01—.04 and .06—.14, Local and State Coordinating Councils, repealed and new Regulations .01—.04 and .06—.09, Local Care Teams and State Coordinating Council, adopted effective March 31, 2014 (41:6 Md. R. 381) Regulation .05 repealed and new Regulation .05 adopted effective October 13, 2014 (41:20 Md. R. 1113) The purpose of these regulations is to establish a single point of entry for the licensing of residential child care programs with the Department of Human Services, the Department of Juvenile Services, and the Maryland Department of Health, and to coordinate the licensing process for residential child care facilities and the approval of education programs in such facilities with the Department of Human Services, the Department of Juvenile Services, the Maryland Department of Health, and the Department of Education. These regulations apply to the licensing of the residential child care programs licensed by the Department of Human Services, the Department of Juvenile Services, or the Maryland Department of Health. In this chapter, the following terms have the meanings indicated. Terms Defined. “Agencies” means the Department of Human Services, the Department of Juvenile Services, the Maryland Department of Health, and the Department of Education. “Care” means food, clothing, education, shelter, social or health services, or any combination of these rendered in a residential setting. “Child” means an individual younger than 21 years old, unless otherwise provided by State law. “Children's Cabinet” means those agencies directed by Executive Order: To examine Maryland's system of services to children and their families; and To facilitate ongoing improvements to this service delivery system. “Expansion request” means the materials required by the Office, from an established provider who wishes to expand a residential child care program to an additional location. “Facility” means the physical premises where a residential child care program is operated. “Licensing” means the process undertaken by an agency to issue, suspend, or deny a license. “Monitoring” means the process of assessing continuing compliance with agency licensing requirements and applicable statutes and regulations. “Office” means the Governor's Office for Children. “Program administrator” means the individual designated by the licensee's governing body as having day-to-day responsibility for the administration and operation of a program, including ensuring the care, treatment, safety, and protection of the children residing in the program. “Proposal” means the materials required by the Office from a potential new provider or an established provider to develop a new residential child care facility or program. “Provider” means the operator of a program. “Residential child care program” means a program of care provided in a residential setting by a provider on a 24-hour basis for longer than 24 hours to a child or children unless otherwise provided by State law. “Sanctions” means all or any part of the penalties agencies impose on facilities or providers for failure to comply with the applicable licensing laws and regulations. “Single point of entry review panel” means an interagency panel convened as needed at the request of the Office for Children to review proposals and expansion requests. The Office shall serve as a single point of entry for a: Prospective provider that wishes to establish a residential child care program; and Current provider that wishes to expand an existing residential child care program. Duties of the Single Point of Entry. As the single point of entry, the Office shall: Provide information to persons interested in operating a residential child care program on the process for the licensing, rate setting, contracting, and purchase of beds; Accept proposals from persons interested in developing a residential child care program; Serve as the point of registration for established providers interested in expanding their residential child care programs; Coordinate the review of proposals and requests for registration among the agencies; and Designate a licensing agency to process each completed proposal or request for registration received by the Office. Related Duties. The Office shall disseminate the following information regarding the monitoring of residential child care programs from agencies that license or contract with such programs to other agencies that may place or otherwise serve a child in that program: Agency program monitoring schedules; and Sanctions or corrective actions imposed on a residential child care program by an agency. Providers shall file with the Office: A proposal, if the provider wishes to establish a new residential child care program; or An expansion request, if the provider wishes to expand a current residential child care program. Required Content of a Proposal. To be assigned to a licensing agency, a proposal shall include: Face sheet, in accordance with the format prescribed by the Office; Table of contents; Statement of purpose for the program, which includes the organization's mission; Identification and description of the qualifications of the program administrator; Organizational capability, including: Experience in serving children and youth; Experience in serving special populations in residential programs; Experience in the operation of residential programs for children and youth; and Identity and qualifications of the board of directors; Program needs assessment, including: Needs assessment methodology; Results of needs assessment; Need for type of program or facility proposed; and Criteria for selecting program location; Program description, including: Population served; Residential plan; Program activities, including: Recreation; Tutoring; and After-school activities; Therapeutic services; Family involvement strategies; Model schedule for residents; Program services for summer and holiday periods; and Other program elements; Management plans, including: Financial management plan; Marketing plan; Community relations plan; Quality control plan; and Outcome-based self-evaluation plan; Staffing plan, including: Staffing requirements; Staff qualifications; Staff recruitment; and Training; Education plan, including: Documentation of collaboration with the local school system in the enrollment and education of resident children; The extent of participation in the child's educational activities; and Notice of the provider's intent, if any, to operate an educational program within the residential program's facilities; and Health care plan, including: Residents' access to health care; Supervision of residents' health care needs; Medical emergencies; Mental health services for residents; and Resident nutrition. Required Content of an Expansion Request. To be assigned to a licensing agency, an expansion request shall include: Face sheet; Copy of the program's current license; Description of the specific program expansion requested; and Description of changes, if any, to the licensee's current program that would result from the requested expansion. The Office shall provide detailed instructions regarding the submission of proposals and requests for registration, including: Format of proposals and requests for registration; Filing procedures; and Specific elements to be addressed in each content area. Preliminary Review by the Office. Within 90 days of the receipt of a proposal or expansion request, the Office shall conduct a preliminary review to determine if the proposal is adequate to refer to a licensing agency, based upon the following criteria: Completeness of the proposal or expansion request; Adequacy of the proposal or expansion request in meeting the content requirements of Regulation .05B and C of this chapter; Any prior denial of licensure, sanction taken, or corrective action required by an agency of the program or the program's parent corporation; and Community, county, or regional resource development needs as specified by either the Children's Cabinet or an agency. Based upon a preliminary review, the Office shall: Certify that a program has filed a completed proposal or expansion request in conformance with single point of entry requirements; Require that a program administrator appear before a single point of entry review panel to address any inadequacies identified in the preliminary review and answer any other questions which the panel may have regarding the proposal; or Return the proposal or expansion request with instructions for possible resubmission. Single Point of Entry Review Panel. A single point of entry review panel shall be convened at the request of the Office to review a proposal that has been resubmitted to address inadequacies identified by the Office in its preliminary review. The single point of entry review panel shall comprise: A representative of the Office; and Two representatives designated from the agencies that place children in residential child care facilities or the Department of Education. The program administrator shall represent a program before the panel. At least 10 days before an interview with the panel, the Office shall provide the program with a written list of proposal or expansion request inadequacies or other questions that the panel may ask the program administrator to address. Single Point of Entry Review Panel Recommendations. Within 30 days of an interview with a program administrator, the panel shall: If the panel determines that the program has met single point of entry requirements, recommend that the program be referred to a licensing agency with certification that it has filed a completed proposal or expansion request; or If the panel determines that the program has not met single point of entry requirements: Return the proposal or request for registration to the program or facility with instructions for possible resubmission; or For a resubmission, recommend that the proposal or expansion request be referred to a licensing agency without certification that the program has met single point of entry requirements. Submission of Additional Information. If a provider fails to resubmit an application under §B(3) or D(2)(a) of this regulation within 60 days of the Office's request for additional information, the Office shall consider the provider's proposal or expansion request to have been withdrawn and shall close the provider's file. The Office shall designate a licensing agency from among the agencies authorized by State law and regulations to license residential child care facilities for each proposal or expansion request that is: Certified as meeting single point of entry requirements; or Recommended by a review panel for referral without certification to a licensing agency. The Office shall indicate to the licensing agency whether it has certified that the proposal or expansion request has met single point of entry requirements. The Office shall select the licensing agency based upon: The type of program or facility being proposed; State law and regulations governing agency responsibility for specific populations of children; Existing relationships between an agency and a provider; and Any standards established by the Children's Cabinet. Multiple Programs or Facilities. A provider may operate multiple programs or facilities licensed by different agencies. An individual program or facility may not be licensed by more than one agency. Educational Programs in Residential Child Care Facilities. The Office shall refer residential child care programs and facilities that plan to operate an educational program to the Department of Education for processing pursuant to COMAR 13A.09.10. Licensing. The licensing agency designated under Regulation .07 of this chapter shall: Consider the relevant experiences and actions of other agencies with programs or facilities operated by the provider's parent corporation, including: Denial of licensure; Sanctions, including suspension or revocation of licensure; and Corrective action requirements; Issue a written licensing report; Submit the licensing report to the provider and the Office; Do one of the following: Issue or deny the license for the program in accordance with the regulations of the licensing agency; or Deny a license or suspend consideration of a licensing application based upon an action under §A(1) of this regulation; Notify the provider of an action under §A(4) of this regulation within 60 days after the date of receipt of the completed application in accordance with the regulations of the licensing agency; and Notify the provider of the right to and method of requesting a hearing if the license is denied. Monitoring. In consultation with an agency utilizing the program or facility, the licensing agency designated under Regulation .07 of this chapter shall: Monitor the facility at least annually; Notify the Office of its program monitoring schedule; Recommend to the Secretary of the licensing agency sanctions to be imposed upon the program if the program is not in compliance with licensing law and regulations applicable to the program; Inform the Office of any sanctions or corrective actions imposed on a provider; and Notify the provider in writing of proposed sanctions and the right to request, and method for requesting, a fair hearing regarding the imposition of sanctions. A provider upon whom a sanction is imposed under Regulation .07 or .08 of this chapter may file an appeal in accordance with the applicable licensing agency's regulations governing administrative appeals taken pursuant to the Administrative Procedure Act, State Government Article, §§10-201 and 10-405, Annotated Code of Maryland. Article 41, §§6-101 and 6-104; Article 83C, §§2-102, 2-104, and 2-113; Article 88A, §3; Education Article, §2-206; Health General Article, §§2-102, 2-104, 2-105, 4-305—4-307, 7-1007, 10-204, 10-207, 10-516, 10-712, 10-1203, and 15-102.1; Annotated Code of Maryland Effective date: January 6, 1992 (18:26 Md. R. 2829) Regulations .01—.07 repealed and new Regulations .01—.09 adopted effective December 12, 2002 (29:24 Md. R. 1917) COMAR 01.04.02 revised and recodified to COMAR 14.31.02 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 28, 2005 (32:23 Md. R. 1828) The following regulations govern procedures for the development of interagency plans for the provision of services to hospitalized children. In this chapter, the following terms have the meanings indicated. Terms Defined. “Case service coordinator” means a State employee, assigned to the Office for Children, who is responsible for tracking the status of hospitalized children and coordinating interagency efforts to secure the timely and appropriate placement of these children. “Departments” means the Maryland Departments of Health, Human Services, Education, and Juvenile Services. “Discharge plan” means the written plan, developed by the hospital treatment team and qualified professionals from the Departments providing services to the child, which describes the services, treatment, and training appropriate for the child outside the hospital setting. “Hospitalized child” means both State-hospitalized children and privately hospitalized children. “Lead agency” means the Department designated by the multi-agency review team to implement the hospitalized child's discharge plan. “Multi-agency review team” means a committee of senior officials from the Departments and the Office for Children. “Private psychiatric hospital” means Brooklane Hospital, Gundry Glass Hospital, Sheppard and Enoch Pratt Hospital, and Taylor Manor Hospital. “Privately hospitalized child” means an individual under 18 years old, committed by juvenile court order to State custody and who is admitted to a private psychiatric hospital. “State-hospitalized child” means an individual 18 years old admitted to the Mental Hygiene Administration's inpatient hospital-level care. Each State hospital and each private psychiatric hospital, when possible, shall complete an inpatient tracking form for each hospitalized child and report to a designated Department as follows: Within 24 hours after the first business day following the admission of a hospitalized child, the hospital staff shall complete and transmit the inpatient tracking form to the designated Department; and The hospital staff shall update the inpatient tracking forms every 2 weeks and transmit the forms to the designated Department. The case service coordinator shall maintain the tracking forms and any data reports generated from the forms. The case service coordinator shall forward data reports generated from the forms to all Departments. Within 10 working days after a child is hospitalized, the lead agency shall provide case management services to each hospitalized child, in the manner considered appropriate by the lead agency, to assist in securing and maintaining appropriate discharge services and placement. The hospital treatment team and lead agency shall jointly develop for each hospitalized child a discharge plan that includes recommendations for the services needed to maintain the child outside the inpatient setting and provide appropriate treatment. The recommendations in the discharge plan may include the following: Therapy; Education; Residential arrangement; Medications and medical needs; Physical needs; Social and recreational needs; Family involvement in therapy; and Family visitation. The case manager from the lead agency shall attend the discharge planning meeting with the hospital treatment team, or be available by telephone to discuss the discharge plan. The lead agency shall be responsible for implementing the discharge plan. The multi-agency review team shall meet every 2 weeks to review the discharge plan and the tracking forms of each hospitalized child who is ready for discharge or whose tracking forms indicate possible difficulty in obtaining timely and appropriate discharge to assist in resolving problems that might require interagency action or planning. Transitional services include: Therapeutic; Educational; Interim residential; Social; and Recreational. The lead agency shall provide transitional services when the treating physician, in consultation with the hospital treatment team and the lead agency, determines that: The hospitalized child is ready for discharge and remains in the hospital; and Transitional services are necessary to prevent specific clinical deterioration of the hospitalized child. The lead agency, in consultation with the treating physician and the hospital treatment team, other departments, the child, and the child's parents if the parents are available, shall determine the specific transitional services provided to the child. The lead agency may provide transitional services if: The lead agency determines that transitional services are necessary to assist with a hospitalized child's adjustment to an aftercare placement; and Resources are available. Article 41, §§6-101 and 6-104; Article 83C, §§2-102, 2-104, and 2-113; Article 88A, §3; Education Article, §§8-301—8-303 and 8-401—8-417; Health-General Article, §§2-102, 2-104, 2-105, 4-305, 4-307, 7-401, 7-1007, 10-204, 10-207, 10-712, 10-1203, and 15-102.1; Annotated Code of Maryland Effective date: July 31, 1995 (22:15 Md. R. 1117) COMAR 01.04.03 revised and recodified to COMAR 14.31.03 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); recodified permanently effective November 28, 2005 (32:23 Md. R. 1828) Regulation .02 amended as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); amended permanently effective November 24, 2005 (32:23 Md. R. 1828) This chapter outlines the requirements for the determination of rates for the following services purchased by the departments for children: Residential services licensed by: The Department of Human Services; The Department of Juvenile Services; The Maryland Department of Health; or Any State department; Nonresidential services in programs approved or accredited by the Maryland State Department of Education, under COMAR 13A.09.10, or the Department of Juvenile Services; and Out-of-State services from providers licensed, accredited, certified, or approved by the providers' respective states and approved for placement by the departments described in Regulation .02B(9) of this chapter. In this chapter, the following terms have the meanings indicated. Terms Defined. “Advisory Committee” means the Maryland Interagency Rates Advisory Committee which consists of parents, advocates, and providers appointed by the Children's Cabinet. “Allowable variance” means less than or equal to plus one standard deviation from the mean as determined by the factors and methodology outlined in the Manual defined in §B(11) of this regulation. “Child placement agency” means a private agency licensed by the Department of Human Services to receive and place children in foster homes, treatment foster homes, and independent living arrangements. “Children's Cabinet” means those agencies listed under Executive Order 01.01.2024.05C. “Class Guidelines” means the Class Determination Guidelines for Residential Child Care Programs, which are maintained and updated, as necessary, by the Committee. “Committee” means the Maryland Interagency Rates Committee, consisting of an individual or individuals representing: The Maryland Department of Health; The Department of Human Services; The Department of Juvenile Services; The Department of Budget and Management; The Maryland State Department of Education; and The Governor’s Office for Children. “Cost Guidelines” means the Cost Guidelines for Child Placement Agencies, Education Programs, and Non-Residential Programs, which are maintained and updated, as necessary, by the Committee. “Days” means calendar days, unless otherwise specified. “Departments” means the: Maryland Department of Health; Department of Human Services; Department of Juvenile Services; and Maryland State Department of Education. “Educational program” means a program approved under COMAR 13A.09.10 as a nonpublic general education school to operate in conjunction with residential or nonresidential child care program licensed or approved by the Department of Health, Department of Human Services, or Department of Juvenile Services. “Manual” means the Rate Setting Methodology Manual for Providers, which is maintained and updated, as necessary, by the Committee. “Nonpreferred provider” means a provider whose rate or rates, when grouped by service type and, when appropriate, capacity, falls or fall outside an allowable variance. “Nonresidential program” means a community nonresidential youth program that serves youth served by the Department of Juvenile Services and is not otherwise licensed or certified by the State. “Preferred provider” means a provider whose rate or rates, when grouped by service type and, when appropriate, capacity, falls or fall within an allowable variance. “Provider” means an entity licensed, approved, accredited, or certified to provide services to children and adolescents within: Maryland under: COMAR 07.05.01; COMAR 10.21.07; COMAR 16.06.01; or COMAR 14.31.05—14.31.07; Maryland or another state under COMAR 13A.09.10; or A state other than Maryland under the applicable laws of that state. “Provider Instructions” means the Interagency Rates Committee Provider Instructions, which are maintained and updated, as necessary, by the Committee. “Rate” means the daily reimbursement for services provided to children in residential child care programs and other specified programs. “Rate Section” means the Rate Section at the Maryland State Department of Education. Residential Child Care Program. “Residential child care program” means an entity that provides for children 24-hours per day within a structured set of services and activities that are designed to achieve specific objectives relative to the needs of the children served and that include the provision of food, clothing, shelter, education, social services, health, mental health, recreation, or any combination of these services and activities. “Residential child care program” includes a program: Licensed by the Department of Health, the Department of Human Services, or the Department of Juvenile Services; and Subject to the requirements of the Governor’s Office of Children governing operations of residential child care programs. “Unallowable costs” means those expenditures defined by applicable federal regulations and the Cost Guidelines as unreimbursable. The Committee shall develop and maintain a rate setting methodology for reimbursing specified providers. Cost-Based Methodology. Child placement agencies, educational programs, and nonresidential programs shall receive a rate based on a cost-based methodology. The cost-based methodology determines a rate based on an individual provider’s budget, including, but not limited to: Management and general services; Direct services; Education services; Medical services; and Clinical services. The rate determination shall be calculated using: An individual program budget application; A mean annual rate for a specified program category; and A direct care cost comparison metric. The cost-based methodology is contained in the Manual and the Cost Guidelines, which are published on the Maryland State Department of Education website. Class-Based Methodology. Residential child care programs shall receive a rate based on a class-based methodology. The class-based methodology determines a rate based on the level of services provided by the residential child care program. The Committee shall determine the level of services the residential child care program must provide to meet the requirements of each class as defined by the Committee. Each class is assigned a flat rate by the Committee. The class-based methodology is contained in the Manual and the Class Guidelines, which are published on the Maryland State Department of Education website. Renewal Rate Application and Submission. The Rate Section shall distribute the Provider Instructions and applications for determinations of renewal rates to in-State and out-of-State providers whose programs previously received an approved rate from the Committee by December 31 of each year. Except as provided in §A(3) of this regulation, providers shall submit an application to the Rate Section for a renewal rate determination by February 15 of each year in accordance with this chapter. For fiscal year 2025, residential child care programs shall submit an application to the Rate Section by July 31, 2024, for a class-based rate, consistent with the Provider Instructions and Regulation .03C of this chapter. New Rate Application and Submission. On written request by a provider, the Rate Section shall distribute the Provider Instructions and applications for a rate determination for in-State and out-of-State providers whose programs have not previously received an approved rate from the Committee. Providers shall submit to the Rate Section an application for a rate for new programs before anticipated licensure, certification, or approval. Out-of-State Providers. An out-of-State provider that does not have a rate established in the state in which services are provided may submit an application in accordance with this regulation. A provider that provides services in a licensed out-of-State facility which has a rate established by the authorized rate-setting body of the state in which the facility is located shall submit documentation to the Committee of the rates established by the authorized rate-setting body of their respective state, if applicable, instead of an application. Conformance with Manual, Cost and Class Guidelines, and Provider Instructions. Provider applications shall conform to the requirements set forth in the Manual, Cost and Class Guidelines, as appropriate, and the Provider Instructions. Use of Guidelines. Rates for child placement agencies, educational programs, and nonresidential programs shall be determined, excluding unallowable costs, consistent with the Cost Guidelines. Rates for residential child care programs shall be determined consistent with the Class Guidelines. Review of Application. After review of a rate application, the Committee shall take one of the following actions: Approve the rate requested in the application; Return the application to the provider, requesting that additional information or changes to the application be resubmitted within 10 business days; or Deny the rate requested in the application and issue a revised rate. Notification of Approved Renewal Rates. Except as otherwise provided in §C(2) of this regulation, the Committee shall notify providers of their approved rates for applications timely submitted that meet the requirements of the Provider Instructions by June 15 of each year. For fiscal year 2025, the Committee shall notify residential child care programs that submit a timely and complete application to the Rate Section, consistent with Regulation .04A(3) of this chapter, by September 15, 2024. Notification of Approved New Rates. The Committee shall review applications, submitted in conformance with the Provider Instructions, and make a rate determination for new programs within 60 days of receipt. Rate determinations are not final until issuance of a license or accreditation. Effective Dates for Rates. Except as otherwise provided in §E(2) of this regulation, renewal rates shall be in effect at the start of the State fiscal year and remain in effect until the end of that State fiscal year. For fiscal year 2025, rates approved by the Committee for residential child care programs consistent with §C(2) of this regulation shall be in effect October 1, 2024, and remain in effect until June 30, 2025. Rates for new child placement agencies, educational programs, and nonresidentIal programs issued after March 31 of each State fiscal year shall remain in effect until June 30 of the following State fiscal year. Determination of Preferred Providers. The Committee shall categorize child placement agencies according to service type and, when appropriate, capacity. The Committee shall use the methodology in the Manual to determine approved rates within each category and determine preferred providers. The Committee shall publish, annually, a list of all providers and approved rates and shall issue quarterly supplements with changes and additions. Child placement agencies shall be designated as preferred or nonpreferred in the listings, in accordance with the Committee's determination. Conformance with Federal Laws. Rates shall be determined in conformance with relevant federal requirements, including Title IV-E of the Social Security Act. Cost Containment. The Committee may impose cost containment measures to bring the rate structure into conformity with the budget appropriations approved by the General Assembly, and nothing in the Manual, Cost and Class Guidelines, or Provider Instructions shall preclude the implementation of cost containment. A provider may request reconsideration of a Committee determination made under Regulation .05 of this chapter. The Rate Section shall act on behalf of the Committee to receive and process requests for reconsideration. A provider seeking reconsideration of a determination shall file a written request with the Rate Section. The request is to be filed within 30 days of the provider's receipt of notice of the Committee's determination. The Rate Section shall review each request for reconsideration to determine if it provides sufficient information to complete analysis of the request. Each request for reconsideration shall include detailed information regarding: The relief requested; and The basis for the relief. If a request for reconsideration does not include sufficient information for review, the Rate Section shall provide written notice to the provider listing all information required to complete the review. If the provider fails to provide the additional required information within 45 days of receipt of the Rate Section notice, the Rate Section shall void the provider's request for reconsideration. Review by the Committee. Within 30 days of receipt of a complete request for reconsideration from the provider, the Committee shall provide written notification to the provider of its decision to: Grant the request. Grant the request with modification; or Deny the request. A reconsideration of a determination by the Committee under this chapter is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. Filing of an Appeal. A provider may appeal to the Children's Cabinet the Committee's decision regarding a request for reconsideration made under Regulation .06 of this chapter. The provider shall file a written appeal with the Rate Section within 30 days of the provider's receipt of the Committee's decision regarding the request for reconsideration. The appeal shall set forth the specific objections to the Committee's decision regarding the request for reconsideration. Rate Section Requirements. Upon receipt of an appeal, the Rate Section shall: Forward the appeal to the Children's Cabinet or its designee; and Provide to the Children's Cabinet a copy of the record upon which the Committee's decision regarding the provider's request for reconsideration was based, including: The provider's written request for a reconsideration; and Any supporting documentation. Review by the Children's Cabinet. Within 30 days of receipt of an appeal from the provider, the Children's Cabinet or its designee shall: Review the written appeal and the record provided by the Rate Section; Request additional information, if needed, from the provider or the Rate Section; and Issue a final, binding opinion upholding, modifying, or reversing the rate set by the Committee. An appeal to the Children's Cabinet is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. Request for Modification. A provider may request a modification of a current Committee determination during the State fiscal year under the following conditions: To address health and safety issues which arise after the annual rate process; To address an emergency situation, such as fire or natural disaster; To address corrective action issues requested by the licensing agency or by a placing agency in conjunction with the licensing agency; or To address a program modification requested by a licensing or placing agency. The Rate Section shall act on behalf of the Committee to receive and process requests for modifications. A provider seeking modification of a determination shall file a written request with the Rate Section. The Rate Section shall review each request for modification to determine if it provides sufficient information to complete analysis of the request. Each request for modification shall include detailed information regarding: The relief requested; and The basis for the relief. If a request for modification does not include sufficient information for review, the Rate Section shall provide written notice to the provider listing all information required to complete the review. If the provider fails to provide the additional required information within 45 days of receipt of the Rate Section notice, the Rate Section shall void the provider's request for modification. Review by the Committee. Within 30 days of receipt of a complete request for modification from the provider, the Committee shall provide written notification to the provider of its decision to: Grant the request; Grant the request with modification; or Deny the request. A modification of a determination by the Committee under this chapter, or an appeal to the Children's Cabinet, is not a contested case within the meaning of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. An Advisory Committee to the Interagency Rates Committee, composed of parents, advocates, and providers, shall be appointed by the Children's Cabinet. The Advisory Committee may recommend and review policies and procedures regarding rate setting and provide information regarding the impact of rates on children, facilities, providers, and the business community. The Advisory Committee shall meet periodically. An advisory committee to the Interagency Rates Committee composed of parents, advocates, and providers shall be appointed by the Children's Cabinet. The Advisory Committee shall recommend and review policies and procedures regarding rate setting and provide information regarding the impact of rates on children, facilities, providers, and the business community. The Advisory Committee shall meet periodically. Education Article, §§2-206 and 8-417; Family Law Article, §§5-506, 5-507, and 5-509; Health-General Article, §§2-102, 2-104, 2-105, 7-306.1, 10-516, 10-902, 10-1203, and 15-102.1; Human Services Article, §§2-209 and 9-231; Annotated Code of Maryland Effective date: June 29, 1998 (25:13 Md. R. 992) Chapter revised effective February 18, 2002 (29:3 Md. R. 216) COMAR 01.04.05 revised and recodified to 14.31.04 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 24, 2005 (32:23 Md. R. 1828) Chapter revised effective July 1, 2024 (51:10 Md. R. 528) This chapter sets forth the process in Maryland for licensure of residential child care programs and monitoring of residential child care programs for children and youth, and establishes the procedures which applicants must follow in order to obtain licensure. The licensure and monitoring processes are designed to protect the health, safety, and well being of children placed in residential child care programs. This chapter applies to residential child care programs licensed by the Department of Human Services, the Maryland Department of Health, and the Department of Juvenile Services, including the following programs for children: Alternative living units; Emergency shelter placement; Group homes; Mother-infant programs; Nonpublic residential educational facilities; Programs for medically fragile children; Programs for pregnant adolescents; Psychiatric respite care; Residential crisis services; State-operated residential educational facilities; Secure care; Therapeutic group homes; and Wilderness programs. Except as set forth in §C of this regulation, a person shall be licensed under this chapter and COMAR 14.31.06 and 14.31.07 before operating a private residential child care program. This chapter does not apply to the care of children by: A parent or guardian of the child; An individual related to the child by blood or marriage within four degrees of consanguinity or affinity under the civil law rule; An individual who: Exercises temporary care, custody, or control over the child at the request of a parent or guardian of the child; and Who is not otherwise required to be licensed; An individual with whom the child is placed in individual family care or foster care by a licensed child placement agency, a court of competent jurisdiction, or agency as defined by Regulation .03 of this chapter, and who is otherwise required to be licensed; A youth camp subject to certification by the Maryland Department of Health; A facility subject to the Certificate of Need process under State law; A nonpublic residential school that is not approved to serve students with disabilities under COMAR 13A.05.02.12; A facility listed in Article 83C, §2-117, Annotated Code of Maryland; or A residential facility operated by the Department of Juvenile Services. Special Licensing and Monitoring Requirements. Special licensing and monitoring requirements which differ from or supplement the requirements of this chapter are applicable to the following: Nonpublic residential educational facilities; Secure care programs; Wilderness programs; Programs for medically fragile children; Programs for children with developmental disabilities; Shelter care programs; Programs for pregnant adolescents; and Mother-infant programs. Special licensing and monitoring requirements for the programs listed in §D(1) of this regulation appear in COMAR 14.31.07. In this chapter, the following terms have the meanings indicated. Terms Defined. “Agency” means the Maryland Department of Health, the Department of Human Services, or the Department of Juvenile Services. “Alternative living unit” means a residence owned, leased, or operated by a licensee that: Provides residential services for children who, because of a developmental disability, require specialized living arrangements; Admits not more than three children; and Provides 24 hours of supervision per unit, per day. “Applicant” means a person who seeks a license. “Aversive technique” means the use of painful or noxious stimuli to the body, which is intrusive to the individual's physical, mental, or emotional well being, to terminate challenging or maladaptive behavior. “Behavior plan” means a plan designed to modify a child's behavior through the use of clinically accepted techniques. “Child” means an individual younger than 21 years old, unless otherwise defined in the regulations of an agency that serves children in need of placement in a residential child care program. “Children's Cabinet” means those agencies directed by Executive Order: To examine Maryland's system of services to children and their families; and To facilitate ongoing improvements to this delivery system. “Community-based behavioral respite” means relief services provided by a community residential licensee designed to meet the individual behavioral needs of a child with a serious emotional disturbance for not more than 30 days in a community-based setting. “Corrective action plan” means a program's detailed remedy to correct deficiencies in the program's compliance with State licensing regulations and with other legal requirements identified by the licensing agency or other State or federal agency. “Day” means a calendar day. “Developmental disability” means a severe chronic disability of an individual that: Is attributable to a physical or mental impairment, other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments; Is likely to continue indefinitely; Is manifested before the age of 22; Results in an inability to live independently without external support or continuing and regular assistance; and Reflects the need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are individually planned and coordinated for the individual. “Emergency shelter placement” means the immediate placement of a child in a residential child care program because the placing agency or individual satisfactorily documents that it is physically impossible to accomplish a planned placement as required by this chapter and good practice. “Employee” means an individual who works for a licensee for compensation. “Expansion request” means a request for materials required by the Governor's Office for Children under COMAR 14.31.02 of a licensed provider who wishes to expand a residential child care program to an additional location. “Facility” means the physical premises where a residential child care program is operated. “Group home” means a facility owned, leased, or operated by a licensee that provides: Residential services for youths such as care, diagnosis, training, education, and rehabilitation; and A group living experience. “Individualized educational program” means a plan for special education and related services designed to provide a free appropriate public education to a student with disabilities under 28 U.S.C. §1401 et seq. and COMAR 13A.05.01. “Interagency Rates Committee” means the Maryland Interagency Rates Advisory Committee constituted under COMAR 14.31.04 to establish State reimbursement rates for services to children in residential child care programs and other programs. “License” means the approval granted by a licensing agency to operate a private residential child care program. Licensee. “Licensee” means a corporation that has been granted a license to operate a residential child care program. “Licensee”, unless the context indicates otherwise, includes the corporation's: Board of directors; Officers; Employees; Agents; Assigns; and Volunteers. “Licensing agency” means the agency designated by the Governor's Office for Children to be responsible for licensing a private residential child care program. “Management of disruptive behavior” means an agency-approved curriculum for managing challenging or aggressive behavior. “Mechanical support” means a mechanical device used to support an individual's proper body position, balance, or alignment. “Medically fragile child” means a child who is dependent upon any combination of the following: Mechanical ventilation for at least part of each day; Intravenous administration of nutritional substances or drugs; Other device-based respiratory or nutritional support on a daily basis, including tracheotomy tube care, suctioning, or oxygen support; Other medical devices that compensate for vital body functions; including: Apnea or cardiorespiratory monitors; Renal dialysis; or Other mechanical devices; or Substantial nursing care in connection with disabilities. “Monitoring” means the evaluation of a program's compliance with regulations. “Mother infant programs” are residential child care programs that provide special services and residential care to children who are mothers and their infants. “Nonpublic residential educational facility” means the residential facility of a nonpublic school program approved under COMAR 13A.05.02.12 for the placement of students with disabilities. Parent. “Parent” means a child's biological or adoptive parent. “Parent”, unless otherwise indicated, includes a child's guardian, or custodian or parent surrogate appointed under the Individuals with Disabilities Education Act. " Physical plant" means the building or buildings in which a private residential child care program or state-operated program is operated. “Placing agency” means the agency, individual, or entity that places a child in a private residential child care program or State-operated program. “Program for pregnant adolescents” means a residential program that provides comprehensive prenatal care, dental care, delivery services, pediatric services, and day care arrangements for pregnant minors. Program. “Program” means a private residential child care program. “Program”, unless otherwise indicated, includes the physical plant. “Psychiatric respite” means residential programs on hospital grounds in which children discharged from inpatient psychiatric hospitalizations receive transition services in anticipation of placement in a residential treatment or community-based setting. “Quality assurance plan” means a plan submitted to the licensing agency by the licensee or applicant that documents the means by which achievement of goals and objectives established by the licensee will be measured. Residential Child Care Program. “Residential child care program” means an entity that provides care for children 24-hours-per-day within a structured set of services and activities that are designed to achieve specific objectives relative to the needs of the children served, including the provision of: Food; Clothing; Shelter; Education; Social services; Health; Mental health; Recreation; or Any combination of these services and activities. “Residential child care program” includes residential services for children in: Residential facilities for children with developmental disabilities; Child care homes; Child care institutions; Therapeutic group homes; and Group homes. “Residential crisis services” means intensive mental health and support services that are: Provided to a child with mental illness who is expecting, or is at risk of, a psychiatric crisis that would impair the child's ability to function in the community; Designed to prevent a psychiatric inpatient admission of the child, provide an alternative to the psychiatric inpatient admission, or shorten the length of an inpatient stay; and Provided on a short-term basis in a community-based setting for not more than 30 days. “Secure care program” means a program that employs locked doors or other physical means to prevent egress by alleged or adjudicated delinquent children. “Shelter care” means care in: A shelter care program licensed solely for the temporary care of children for not more than 60 days; or A self-contained structured shelter care program licensed by the Department of Juvenile Services for the temporary care of children for not more than 90 days. “State-operated residential educational facility” means the Maryland School for the Deaf and the Maryland School for the Blind. “Submit” means to deliver a document: In a manner that ensures its receipt by the party to whom it is addressed; and Which is considered complete only upon actual receipt by that party. “Teen mother program” means a licensed residential program that provides care and services for children who are mothers with an infant. “Therapeutic group home” means a small private group home that provides residential child care as well as access to a range of diagnostic and therapeutic mental health services for children and adolescents who have mental disorders. “Treatment foster care” means a 24-hour substitute care program operated by a licensed child placement agency or local department of social services for children with a serious emotional, behavioral, medical, or psychological condition. “Variance” means an alternative to a specific licensing regulation. “Volunteer” means an individual who provides services without compensation at a residential child care program. “Waiver” means the setting aside of a specific licensing regulation. “Wilderness program” means a program: In which facilities and activities are related to nature as much as possible in a site that is left essentially in its natural state; and Where living and program quarters and activities are integrated into the natural environment. Incorporation. Each applicant and licensee shall be incorporated and maintain their corporate status. The applicant shall submit to the licensing agency: A certified copy of the articles of incorporation and by-laws, before licensure and upon request of the licensing agency; and At least 45 days before the proposed implementation date, any changes in the: Corporate name; Articles of incorporation; or By-laws. Before it submits an application for licensure to the licensing agency, an out-of-State applicant shall register and qualify with the Department of Assessments and Taxation to do business in Maryland. Financial Operation. The applicant shall: Upon initial application, provide written documentation that the organization: Is solvent; and Has access to the financial resources to operate for at least 6 months; Base the financial operation of the program on an annual budget that reflects anticipated expenditures and sources of income; Have a sound plan of financing to provide sufficient funds to operate the program; Maintain insurance in the following categories: Fire; Casualty; Professional liability; General liability; and Directors' and officers' liability; Comply with the legal requirements for unemployment compensation and workers' compensation; Submit to the licensing agency an annual audit by an independent certified public accountant who is not: An employee or officer of the corporation; A member of the board of directors; or Related to an employee, officer, or director; Provide the licensing agency access to financial records or financial statements, upon request; Notify the licensing agency of any filing of bankruptcy, and keep the licensing agency informed of any legal actions resulting from the bankruptcy filing; and Notify the licensing agency of any legal action related to the licensee's residential child care programs that is filed against the licensee, and the outcome of the legal action. Initial Inquiries. An applicant initially shall direct inquiries for obtaining a license to the Governor's Office for Children in accordance with COMAR 14.31.02. Based upon a completed proposal submitted by the applicant in accordance with COMAR 14.31.02, the Governor's Office for Children shall designate a licensing agency. The licensing agency shall send an application to the applicant upon referral from the Governor's Office for Children. Application Process. An applicant shall submit a completed application within 6 months of receipt of the application from the licensing agency. Within 60 days after receipt of a complete application, authorized staff individuals at the licensing agency shall: Evaluate the application, including consideration of the factors listed in COMAR 14.31.02.08A; Inspect the proposed physical plant; and Propose to issue or deny the license. Valid License. Unless revoked or suspended, a license is valid for a period of 2 years. Separate License. A license is valid only for the program and the physical plant specified in the license application. A licensee shall obtain a separate license for each physical plant where a program is located. False Information. A licensing agency may deny a new license or a renewed license if the applicant or licensee knowingly provides false information to the licensing agency or the Interagency Rates Committee. Expansion. A licensee may not expand the number of beds for which it is licensed, unless the licensee: Has been serving children in the program without suspension or revocation and has not been subject to a corrective action plan regarding matters concerning the health and safety of children for at least 1 year; and Has written permission from its licensing agency. A licensee who does not meet the conditions of §F(1)(a) and (b) of this regulation shall seek a waiver under Regulation .11 of this chapter to expand a program. A licensee may operate more than one program in the same facility if the programs are: Individually licensed, and the licenses for each program specifically allow for the licensure of the other program in the same facility; and Operated as discrete programs with clear separation of the children in each program. License Renewal. A licensee seeking renewal of its license shall submit to the licensing agency a license renewal application 120 days before its license expires. The licensing agency shall propose to grant or deny a completed renewal application within 60 days of its determination that the application is complete. If the licensing agency is unable to redetermine the licensee's eligibility before the license expires, the licensing agency shall extend the license expiration date until the renewal application process is completed in accordance with the requirements of State Government Article, §10-226, Annotated Code of Maryland. If the licensing agency renews a license to the licensee, the licensee shall return the expired license to the licensing agency. Program Closure. When a licensee closes its program, the license is invalid. Before the licensee closes its program, the licensee shall: Inform the licensing agency and any agency that has placed children in the program at least 30 days in advance of the closing; Submit a written plan for the removal of children from the program to the licensing agency for approval; Implement the plan for the removal of children subject to the oversight of the licensing agency; and Return the license to the licensing agency on the day the program closes. Proposed License Denial. If the licensing agency proposes to deny an application for a license or renewal of a license under §E of this regulation, the licensing agency shall give written notice to the applicant or the licensee of the proposed denial that includes: The facts that warrant the proposed denial of the license or renewal of the license; Citation to the regulations upon which the proposed denial is based; and Notification that, before the denial of the license or renewal of the license, the applicant or licensee may request a hearing under the provisions of Regulation .10 of this chapter. Monitoring Activities. For monitoring purposes, the licensing agency may require the licensee to make its records, personnel, residents, and facilities available on an announced or unannounced basis: At any time, if the agency's visit concerns a matter regarding the health, safety, or proper care of the program's residents; or At a reasonable time during the program's business hours, if the visit concerns other matters. Monitoring activities may include: Reviews of financial, personnel, and child records; Interviews with staff individuals; Interviews with children in care; Site inspections of the physical plant; On-site observations of the agency's program operations; and Any other information gathering pertinent to State law or this chapter. The licensing agency shall monitor each program to evaluate its facilities, policies, and operations: Before the issuance or renewal of a license; At the time of the mid-license period report; and Before the suspension or revocation of a license. Response to Complaints. The licensing agency shall initiate a response to complaints from any source about the licensee within 24 hours. In responding to a complaint, the licensing agency may require the licensee to: Make the program available for agency inspection as provided in §A of this regulation; Provide a written response to the complaint from the licensee; or Complete any additional appropriate procedure deemed necessary by the agency to ensure the safety and welfare of the program's residents. Mid-License Period Evaluation. The licensing agency shall complete a mid-license period evaluation of each program as follows: The licensing agency shall send notification to the licensee 60 days before the end of the first year of the license period that: The program shall submit to the licensing agency a mid-license period report on or before the anniversary of the license issuance date; The mid-license period report shall include: A list of governing board members and officers; The program's audit or audit review for the current year; An operations budget for the current year; and The licensee's current quality assurance plan; and The licensing agency shall conduct a mid-license period review, including: Review of board minutes, personnel records, and children's records; and On-site inspection of the program. Child Safety Concerns. If, at any time during the course of monitoring a program, the licensing agency's monitor has reason to believe that a child residing in a program has been subject to abuse or neglect, the monitor shall report that concern in accordance with Family Law Article, §§5-704 and 5-705, Annotated Code of Maryland. A licensing or placing agency may request that a program be monitored by an interagency team if: Children placed by multiple agencies may be affected by suspected deficiencies in the program's compliance with State licensing or other legal requirements; or The expertise of another agency is required to adequately assess a program's compliance or remedy noncompliance with particular State licensing regulations or other legal requirements. A request to constitute an interagency team shall be made to the Children's Cabinet, or its designee, in writing or in an oral presentation at an official meeting of the Children's Cabinet or its designee. Upon receipt of a request, the Children's Cabinet or its designee shall: Decide whether to authorize formation of an interagency monitoring team; Identify the agencies to be represented on the team; and Specify the scope of the interagency monitoring initiative. The interagency monitoring team shall submit a copy of its findings and recommendations for corrective action to the Children's Cabinet or its designee for final approval. This regulation does not limit agencies from informally collaborating in the monitoring of a program upon mutual agreement. If the licensing agency determines through its monitoring and evaluation activities that a program is deficient in meeting the licensing requirements of this chapter, COMAR 14.31.06, or COMAR 14.31.07, and the licensing agency chooses to require a corrective action plan, it shall: Determine whether it is necessary during the pendency of the corrective action process to: Remove children currently placed in the facility; or Place a moratorium on future placements to the program; Evaluate and, if acceptable, approve the corrective action plan; Determine appropriate timelines for the completion of corrective actions; Conduct periodic monitoring of any program for which it required a corrective action plan: To assess the program's progress toward remedying the deficiencies; and To evaluate the program's viability as it is affected by the licensing agency's action. Upon determining that corrective actions are required to remedy deficiencies, the licensing agency shall give written notice to the program including: A description of the regulation violated or other program violation; A description of any sanctions to be imposed; and The requirements for the licensee's submission of a plan of correction to the licensing agency. Corrective Action Plans. Within 10 days of receipt of a deficiency notice under §B of this regulation, the licensee shall submit a corrective action plan to the licensing agency for approval. The licensing agency shall review the corrective action plan by the effective date of the sanction indicated in the deficiency notice and inform the licensee whether the plan of correction has been accepted. If the licensee fails to submit an acceptable corrective action plan within the agency's timelines, the licensing agency may: Impose additional corrective action measures under this regulation; Provide additional time for the licensee to submit a revised corrective action plan; or Impose sanctions under Regulation .09 of this chapter. Corrective Action Outcomes. If the licensing agency, at any time during the corrective action period, determines that the licensee has failed to fulfill the corrective action plan requirements or makes insufficient progress towards remedying deficiencies, the licensing agency may: Require the removal of currently placed children from the program; Place a moratorium on future placements at the program; or For good cause, grant an extension of time for completion of a corrective action plan. If the licensing agency determines, at the end of the prescribed corrective action period, that the licensee has failed to remedy deficiencies adequately, the agency shall impose sanctions under Regulation .09 of this chapter. Services to Children at Programs with Corrective Action Plans. The placing agency shall identify an expedited, interim placement for a child who must be removed from a program due to deficiencies. If the licensing agency determines that children may no longer be placed in a program with uncorrected deficiencies, the licensing agency may grant a waiver for the placement of an individual child, or group of children, in the program based on the following considerations: The seriousness of the deficiency and its implications for the child's health, safety, and welfare; Applicable legal requirements including: The child's individualized education program, if the child is a student with disabilities; Any court order regarding the child's placement; and Any other legal requirements that may govern in the child's placement; The medical recommendations of the child's treating physician; The availability of alternative placements; and The ability of the program to ensure safe and appropriate services for each child for whom the waiver is sought. Causes for Sanctions. The licensing agency may impose sanctions on a program, regardless of whether a corrective action plan is required in accordance with Regulation .08A of this chapter, for violations of the regulations of this chapter, COMAR 14.31.06 or 14.31.07, or any combination of these. Sanctions may also be imposed for: Misrepresentations of fact to the licensing agency, a placing agency, the Office for Children, or the Interagency Rates Committee; Submission of false financial information to the licensing agency, the Office for Children, or the Interagency Rates Committee; Failure to cooperate with the monitoring activities of the licensing agency or placing agencies under Regulation .06 of this chapter; Failure to prepare or implement an adequate corrective plan under Regulation .08 of this chapter when found to be in noncompliance with the licensing standards of COMAR 14.31.06; or Violations of other federal or State laws or regulations that jeopardize the safety or welfare of the program's residents. Types of Sanctions. Sanctions may include the suspension, revocation, and limitation of the program's license. Limitations on a license may include restrictions on the: Number of children served by the program; Diagnostic and other characteristics of the population served by the program; and Elements of the program's services for which corrective action is deemed necessary by the licensing agency. Revocation. Except as set forth in §D of this regulation, the licensing agency shall give the licensee notice of the intended revocation at least 20 days before a license is revoked. The licensing agency shall include in the notice: A statement of the regulation violated and the nature of the violation; The effective date of the revocation; and A statement describing the licensee's right under Regulation .10 of this chapter to a hearing before the revocation. Unless the licensee files an appeal of the revocation under Regulation .10 of this chapter, the licensing agency shall: Notify the placing agency of the revocation at least 20 days before the intended revocation; and Advise the placing agency to remove the children by the revocation date. Unless the licensee files an appeal under Regulation .10 of this chapter, the licensee shall relinquish care of the children in the program to the placing agency by the revocation date. Other Sanctions. The licensing agency may suspend or limit a license for a violation of these regulations, which the licensing agency determines can be corrected within the period of suspension or limitation. Except as set forth in §E of this regulation, the licensing agency shall give the licensee notice of the intended action at least 20 days before a license is suspended or limited. The licensing agency shall include in the notice: A statement of the regulation violated and the nature of the violation; For proposed license suspensions: The length of the suspension; and The effective date of the suspension; For proposed license limitation: The nature of the limitation on the program's license; The duration of the limitation; and The effective date of the limitation; Information about the licensee's responsibility to submit to the licensing agency a corrective action plan; and A statement describing the licensee's right under Regulation .10 of this chapter to a hearing before the imposition of the suspension or limitation. Unless the licensee files an appeal of the suspension or license limitation under Regulation .10 of this chapter, the licensing agency shall: Notify the placing agency of the intended suspension or limitation at least 20 days before a license is suspended or limited; and Advise the placing agency to remove the children by the effective date. Unless the licensee files an appeal under Regulation .10 of this chapter, the licensee shall: By the suspension date, relinquish care of the children in the program to the placing agency; or By the license limitation date, modify the program's operations in accordance with the license limitation, including relinquishment of the care of children to the placing agency as necessary. Emergency Action. Notwithstanding any other requirement of these regulations, if the licensing agency determines that action is necessary to protect the health, safety, or welfare of the children or the general public, the licensing agency, without prior notice, may suspend, revoke, or limit a license pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland. If the licensing agency takes an emergency action, the licensing agency shall deliver to the licensee a notice that includes: A statement of the specific regulation violated and the nature of the violation; A description of the action being taken by the licensing agency; For emergency suspensions, information about the licensee's responsibility to submit to the licensing agency a plan of correction; and A statement describing the licensee's right under Regulation .10 of this chapter to a hearing after the emergency action. The licensing agency shall notify the placing agency of the emergency action and advise the placing agency to remove the children immediately. The licensee shall relinquish care of the children in the program to the placing agency. Court Action. If the licensee does not relinquish care of the children as set forth under §§B—E of this regulation, the licensing agency shall take appropriate court action to enjoin the licensee from further caring for the children, including, if applicable, requesting that criminal action be taken pursuant to State law. Right to Hearing. An applicant or licensee has a right to a hearing under the contested case provisions of the Maryland Administrative Procedure Act when: A licensing agency proposes to deny an application for a license; A licensing agency proposes to deny an application for renewal of a license; A licensing agency intends to impose sanctions or to suspend or revoke the license; or The licensee is subject to emergency action. Request. A request for hearing under this regulation shall be submitted to the secretary of the licensing agency within 10 days after notice of the action about which the hearing is requested. Notification. The licensing agency shall notify the placing agency of the final decision of the hearing. The licensing agency may seek to enjoin an institution, agency, society, individual, or set of individuals from operating a private residential child care program without a license or in violation of a term or condition of a license. The licensing agency shall file the request for an injunction in the circuit court in the jurisdiction in which the program is located or has an established place of business. Request for Variance. An applicant or licensee may submit to the licensing agency a written request for a variance. An applicant or licensee shall demonstrate that the variance will: Meet or produce the intended effect of each regulation for which the variance is requested; and Maintain the health, safety, and well-being of the children in the program at or above the level required by the regulation for which the variance is requested. Licensing Agency Action on Request for Variance. The licensing agency shall act on a request for variance and notify the applicant or licensee of its decision within 30 days of receipt of the request, except for good cause. The licensing agency may grant the request for a variance if: The applicant or licensee submitted the request in accordance with the provisions of §A of this regulation; The applicant or licensee has complied with all other licensing regulations; and The licensing agency determines that the requested variance will meet the requirements of §A(2) of this regulation. Unless otherwise specified in the licensing agency's decision, a variance remains in effect for the term of the license. Request for Waiver. An applicant or licensee may submit to the licensing agency a written request for a waiver. The applicant or licensee shall include in the request specific facts upon which the waiver is requested and shall demonstrate that: The waiver is necessary to meet the requirements of State or federal law; or It would be unduly burdensome and inequitable for the applicant or licensee to comply with the provisions of the regulation for which the waiver is requested; and Under the waiver, the program will maintain the health, safety, and well-being of the children in the program at or above the level required by the regulation for which the waiver is sought. Licensing Agency Action on Request for Waiver. The licensing agency shall act on a request for a waiver and notify the applicant or licensee of its decision within 30 days of receipt of the request, except for good cause. The licensing agency may grant the request for a waiver if: The applicant or licensee submitted the request in accordance with the provisions of §C of this regulation; The waiver is consistent with State law; The health, safety, and well-being of the children in the program is not jeopardized by the granting of the waiver; and The licensing agency determines that the requested waiver meets the requirements of §C(2) of this regulation. Unless otherwise specified in the licensing agency's decision, a waiver remains in effect for the term of the license. Appeals. An applicant or licensee aggrieved by the decision of the licensing agency on a request for a variance or waiver may appeal the decision under Regulation .10 of this chapter. This chapter may not be amended unless the amendment is approved by the Office for Children, the Secretary of Health, the Secretary of Human Services, the Secretary of Juvenile Services, and the State Superintendent of Schools. Education Article, §§8-301—8-303 and 8-401—8-417; Family Law Article, §§5-506, 5-508—5-510;Health-General Article, §§2-104, 7-904, 8-404, 10-922, and 10-924; Health Occupations Article, §20-302;Human Services Article, §§2-209, 2-212, 9-203, 9-204, 9-221, 9-231, 9-234, and 9-235; Annotated Code of Maryland Effective date: November 22, 2004 (31:23 Md. R. 1651) COMAR 01.04.06 revised and recodified to COMAR 14.31.05 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 24, 2005 (32:23 Md. R. 1828) Regulation .08A, B amended effective August 4, 2014 (41:15 Md. R. 892) Regulation .09A amended effective August 4, 2014 (41:15 Md. R. 892) This chapter articulates the standards that must be met and maintained by residential child care programs for children and youth. These requirements are designed to protect the health, safety, and well being of children placed in residential child care programs. This chapter applies to residential child care programs licensed by the Department of Human Services (DHS), Maryland Department of Health (MDH), and Department of Juvenile Services (DJS), including the following residential programs for children: Alternative living units; Group homes; Nonpublic residential educational facilities; MDH/Community Mental Health Programs/Residential Crisis Services; State-operated residential educational facilities; and Therapeutic group homes. Except as set forth in §C of this regulation, a person or entity shall be licensed under these regulations before operating a nonpublic residential child care program. This chapter does not apply to the care of children by: A parent or guardian of the child; An individual related to the child by blood or marriage within five degrees of consanguinity or affinity under the civil law rule. An individual who exercises temporary care, custody, or control over the child at the request of a parent or guardian of the child and who is not otherwise required to be licensed; An individual with whom the child is placed in individual family care or foster care by a licensed child placement agency, a court of competent jurisdiction, or agency as defined by Regulation .03 of this chapter, and who is otherwise required to be licensed; A youth camp subject to certification by the Maryland Department of Health; A facility subject to the certificate of need process under State law; A nonpublic residential school that is not approved to serve students with disabilities under COMAR 13A.05.02.12; A facility listed in Human Services Article, §9-226, Annotated Code of Maryland, or a residential facility operated by the Department of Juvenile Services; or A homeless shelter. Special Licensing and Monitoring Requirements. Special licensing and monitoring requirements that differ from or supplement the requirements of this chapter are applicable to the following: State-operated residential educational facilities; Secure care programs; Wilderness programs; Programs for medically fragile children; Programs for children with developmental disabilities; Shelter care programs; Programs for adolescent girls who are pregnant; Mother-baby programs; Therapeutic group homes; MDH Community Mental Health Programs/Residential Crisis Services; and MDH Community Mental Health Programs/Residential Respite Care Services. Special licensing and monitoring requirements for the programs listed in §D(1) of this regulation appear in COMAR 14.31.07. In this chapter, the definitions in COMAR 14.31.05 apply, and the following terms have the meanings indicated. Terms Defined. “Administration” means the licensing agency. “Behavior intervention plan” means a plan that is based on the functional behavioral assessment, designed to address challenging behaviors through the use of positive behavioral interventions, strategies, and supports, developed by a human services professional as defined in §B( 21) of this regulation, who has training and expertise in conducting a behavior functional assessment. “Behavioral consultation” means on-site observation, assessment, and evaluation of the child within the context of the child’s existing program. Behavioral consultation may include: Recommendations regarding structure of the program; Appropriate activities and services; or Consultation with human services professionals. “Behavioral health” means treatment of mental illness, emotional disorders, drug abuse, or alcohol abuse. “Behavioral respite” means relief services provided by a community-based residential program that meets a child’s behavioral needs. “Board” means the board of directors of a residential child care program responsible for the planning and oversight of the operation of the residential child care program. “Certified residential child and youth care practitioner” means an individual who is certified by the Maryland State Board for the Certification of Residential Child Care Program Professionals as defined in COMAR 10.57.01.02B(7). “Challenging behavior” means those behaviors exhibited by a child which are harmful, destructive, or socially unacceptable and necessitate being addressed in the child’s individual plan of care and behavior intervention plan. “Chemical restraint” means the use of medication that is not the current treatment for a child’s condition to control behavior or restrict the child’s movement. “Chief administrator” means the individual, regardless of title, who is appointed by the Board as having responsibility for the overall administration of the organization. “Chief financial officer” means the program executive with the primary responsibility for overseeing the financial activities of the program including financial planning, budget preparation, monitoring cash-flow, record keeping, and reporting to the Board. “Children's Cabinet” means those agencies directed by Executive Order 01.01.2006.03: To examine Maryland's system of services to children and their families; and To facilitate ongoing improvements to this service delivery system. “Contractual and temporary staff” in this chapter are those human services professionals and direct care staff who work at the residential child care program on a contractual or temporary basis or who are placed by a staffing organization with whom the licensee has a contract to perform those duties specified in the job description. “Cordless window covering” has the meaning stated in Family Law Article, §5-505, Annotated Code of Maryland. “Custodial agency” means the agency having primary legal responsibility, which may result from an order of shelter, commitment, limited guardianship, full guardianship, or voluntary placement, time limited, for the child in placement, and may include a child with disabilities. Direct Care Staff. “Direct care staff” means staff assigned to perform direct responsibilities related to activities of daily living, self-help and socialization skills. “Direct care staff” does not include human services professionals, except when a human services professional is specifically assigned to perform the duties of direct care staff as specified in Regulation .06B(1) of this chapter. “Emergency placement” means residential services provided to a child who requires immediate placement in a residential child care program because the child is: Abandoned; At risk of serious immediate danger; or At risk for long-term, out-of-home placement without use of placement as a short-term intervention. “Family” has the meaning stated in Human Services Article, §8-101, Annotated Code of Maryland. “Functional behavior assessment” means the systematic process of gathering information to guide the development of an effective and efficient behavior intervention plan for the problem behavior. “Group home” means a residential child care program, including: Shelter care, including: Emergency; or Structured; Mother-baby programs; Programs for adolescent girls who are pregnant; Psychiatric respite care; Secure care; Programs for children who are medically fragile; Programs for children with developmental disabilities; Residential crisis services; Residential respite care services; Wilderness programs; and Diagnostic evaluation treatment programs. “Human services professional” means: A social worker licensed under Health Occupations Article, Title 19, Annotated Code of Maryland; A psychologist licensed under Health Occupations Article, Title 18, Annotated Code of Maryland; A professional counselor certified under Health Occupations Article, Title 17, Annotated Code of Maryland; A nurse licensed under Health Occupations Article, Title 8, Annotated Code of Maryland; A psychiatrist licensed under Health Occupations Article, Title 14, Annotated Code of Maryland; A guidance counselor certified under COMAR 13A.12.03.02 or a school psychologist certified under COMAR 13A.12.03.10; A certified counselor meeting the requirements under COMAR 10.58.07 to practice alcohol or drug counseling; or For programs serving children with developmental disabilities, an individual with a bachelor’s degree in a human services field who has a minimum of 1 year of full-time experience working directly with persons with developmental disabilities. “Individual plan of care” means an individualized written plan as detailed in Regulation .17C of this chapter. “Licensee” has the meaning stated in COMAR 14.31.05.03B(20). “Mechanical restraint” means any mechanical device that restricts the free movement of an individual. “Medication management” means the facilitation of the safe and effective use of prescription and over-the-counter medications. The management of medications encompasses the way medications are procured, delivered, prescribed, self-administered or staff-administered, documented, and monitored. “Office” means the Governor’s Office for Children. “Permanency plan” means a design for services articulated by the placing agency that specifies: Where and with whom a child shall live; and The proposed legal relationship between the child and the child's permanent caretaker. “Physical restraint” means the use of physical force, without the use of any device or material, to restrict the free movement of all or a portion of a child's body, not including: Briefly holding a child in order to calm or comfort the child; Holding the child by the hand or arm to escort the child safely from one area to another; Moving a disruptive child who is unwilling to leave the area when other methods such as counseling have been unsuccessful; or Breaking up a fight. “Policy” means a set of basic principles adopted by the Board used to enforce procedures and which are in accordance with the requirements for residential child care programs under this chapter. “Positive behavioral interventions, strategies, and supports” means a therapeutic intervention that uses a broad range of systemic and individualized strategies for enhancing positive social and emotional results while preventing or reducing challenging behaviors. “Procedure” means a detailed explanation of how policies will be implemented. “Program administrator” means the individual, regardless of title, certified under Health Occupations Article, Title 20, Annotated Code of Maryland, who is designated by the Board as having the day-to-day responsibility for the overall administration and operation of a program and for assuring the care, treatment, safety, and protection of children. “Prone restraint” means a specific type of restraint in which a child is placed face down on the floor or another surface and physical pressure is applied to the child’s body to keep the child in the prone position. Use of prone restraint is prohibited in Maryland. Protective or Stabilizing Device. “Protective or stabilizing device” means any device or material attached or adjacent to the child’s body for the purpose of enhancing functional skills, preventing unintentional harm to self or others, or ensuring safe positioning of an individual. “Protective or stabilizing device” is limited to: Adaptive equipment prescribed by a health professional, if used for the purpose for which the device is intended by the manufacturer; Seat belts; or Other safety equipment to secure children during transportation. “Residential child and youth care practitioner (RCYCP)” has the meaning stated in Health Occupations Article, Title 20, Annotated Code of Maryland. An RCYCP is direct care staff as defined in COMAR 14.31.06.04B(15). “Restraint” means a technique that is implemented to impede a child’s physical mobility or limit free access to the environment, including chemical, mechanical or physical restraints. “Seclusion” means the confinement of a child alone in a room from which the child is physically prevented from leaving. Use of seclusion is prohibited in residential child care programs in Maryland. “Self-administration of medication” has the meaning stated for “self-administer” in Education Article, §7-421(a)(4), Annotated Code of Maryland. Severe Injury. “Severe injury” means a medical emergency that requires immediate assessment and intervention by a somatic health care provider. “Severe injury” includes, but is not limited to, fractures, dislocations, third-degree burns (destruction of tissue), electric shock, loss or tearing of body parts, all eye emergencies, ingestion of toxic substance or sharp or dangerous objects, and any injury with loss of consciousness or head injuries. “Somatic health care” means medical care that addresses an individual’s physical health care needs. “Structural barrier” means any inanimate object. “Time-out” means the removal of a child to a supervised area, which is unlocked and free of structural barriers that prevent egress for a limited period of time during which the child has an opportunity to regain self-control and is not participating in program activities. “Trauma-informed care” means a person-centered approach which includes assessment, prevention of re-traumatization, and development and implementation of a safe environment plan. It is a system that reduces the risk of exposure, is strengths-based and resilience-focused, promotes respect, and supports cultural and developmental factors. Legal Status. The licensee shall be incorporated under applicable law and maintain documents which identify its incorporation and administrative structure and staffing, including lines of authority. Governance. The corporation shall have by-laws which describe the Board’s legal responsibility for and authority over the policies, finances, and all related activities for implementing the program in accordance with Human Services Article, §8-806. The Board shall: Ensure that the corporation does not discriminate on the basis of: Race; Color; National origin; Religion; Creed; Age; Sex; Sexual orientation; Marital status; Ancestry; or Physical or mental disability; Screen and select the organization’s chief administrator in accordance with corporate policy; Define in writing the role of the chief administrator; Require the chief administrator, or appropriate designee authorized to act in the chief administrator's absence, to be accessible at all times to the agency staff and representatives of the Administration; Conduct an annual written evaluation of the chief administrator; Ensure that the program is housed, maintained, staffed, equipped, and funded to operate the programs effectively and solvently; Consult with the Administration and receive its approval before making a substantive change to the service program plan described in the current license application; Notify the Administration of any change of: The chief administrator within 48 hours; and Address or phone number of the program office at least 14 days before the change; At least every 2 years, in consultation with the chief administrator, formulate, review, and revise as necessary the program’s written materials concerning: Current program and service policy, including short-term and long-term goals; Personnel practices and job descriptions; Fiscal management policy; The program evaluation report; and Be responsible for: The fiscal soundness of the program operation and undertake the review and approval of the: Program’s annual budget; Periodic accounting report; and Annual audit or audit review completed by an independent certified public accountant; and Maintaining the licensee’s continual compliance with the: Provisions of the corporation's charter; Terms of all leases, contracts, or legal agreements to which the licensee is a party; and Relevant federal, State, and local laws and regulations governing the operation of the licensee. Advisory Board. If a licensee is an out-of-State corporation, it shall have an advisory board consisting of at least 3 Maryland residents, at least one of whom shall be a member of the board of directors. The advisory board shall: Meet at least quarterly; Provide input to the licensee regarding the operation of the program and compliance with these regulations; Assist the licensee with its relations with the surrounding community; Meet the requirements of §D(2) and (3) of this regulation; and Perform such other duties as the licensee shall request. Composition and Organization of the Board. The Board shall: Be structured with a president or chair elected from the Board membership who presides at meetings to enable the Board to discharge its responsibilities; Adopt bylaws for its operation; Maintain written minutes of and records of attendance at all its meetings; Ensure that a quorum of its members meet at least quarterly; Include at least five members: At least one of whom is a Maryland resident; At least one of whom shall have demonstrated experience in or knowledge of the human services field; and At least one of whom shall have demonstrated knowledge in the field of accounting, business, or financial management; Maintain a list of its membership with each member's: Phone number; Address; and Term of membership; and Have a plan for periodic change of the Board's composition. An individual who has been convicted of, or who has entered a plea of guilty or nolo contendere to, a charge of child abuse or neglect or contributing to the delinquency of a minor may not be or become a member of the Board or of an advisory board of the corporation or program. An employee of the corporation or program or an immediate family member of an employee of the corporation or the program may not be a voting member of the Board. An individual who is compensated for providing goods or services to the corporation or program may not be a member of the Board. No member of the Board may be a staff person employed by: The Governor’s Office for Children; A licensing agency; Local departments of social services; A placement agency; The State Department of Education; or Any governmental organization which regulates or purchases from the program. Each member of the Board shall complete a training course on the duties and responsibilities of Board members that is offered by the State or approved by the Office within 3 months of appointment to the Board. Chief Financial Officer. The Board shall have a chief financial officer for the corporation. The chief financial officer shall provide a report at least quarterly to the Board on the financial condition of the corporation. Personnel Policies. The board of directors shall: Adopt and adhere to written personnel policies; and Review the policies at least every 2 years. The written policies shall include the following provisions: Annual performance evaluation; Communicable diseases; Confidentiality of records; Description of job responsibilities; Drug and alcohol free workplace; Employee discipline, suspension, and dismissal; Employee supervision; Grievance procedures for employees; Hiring and recruitment of qualified staff; Hours of work; Organizational chart; Orientation and on-going training requirements; Salary and benefits package; Vacation and other leave allowances; A prohibition against the employment of any person whose physical or emotional health, notwithstanding any accommodations required by law, would impair that person's ability to protect the health, welfare, and safety of the program's residents; and A prohibition against employment discrimination based on race, color, national origin, religion, creed, age, sex, sexual orientation, marital status, ancestry, or physical or mental disability. The licensee shall document that all employees have received a copy of the program's personnel policies. A licensee may not appoint as an employee, a member of the board of directors, or a volunteer with unsupervised access to children any individual who: Refuses to submit to: A criminal background check in accordance with State law, including Family Law Article, §§5-560—5-568, Annotated Code of Maryland; or A Child Protective Services clearance; Has an indicated child abuse or neglect finding; or Has a conviction for: Child abuse or neglect; Spousal abuse; Rape; Sexual assault; Homicide; or Any crime against children; Has a conviction within 5 years of applying for a job with the program for assault or a drug-related offense; or Has conviction within 5 years for a violation of the Courts and Judicial Proceedings Article, §3-838 or 3-8A-30, Annotated Code of Maryland. The licensee shall refrain from hiring practices that may result in conflicts of interest, including the concurrent employment of staff persons employed by: A licensing agency; Local departments of social services; A placing agency; or The State Department of Education. The licensee shall establish and post a code of conduct that: Bans sexual harassment or other discrimination against staff and residents; and Requires that staff conduct themselves in a manner appropriate to serve the needs of program residents. The licensee shall: Have written job descriptions for all positions; Document that all employees meet or exceed the minimum qualifications for their positions; Assure that all employees have effective communication skills appropriate to their positions; Maintain adequate staff coverage at all times based on the time of day, the size and nature of the program, and layout of the physical plant; Ensure that, when the program administrator is unavailable, that the program administrator appoints a qualified staff member to whom on-site authority is delegated; Have sufficient staff to carry out the licensee's administrative, business, clerical, dietary, housekeeping, maintenance, secretarial, and supervisory functions; and Ensure that requests for a criminal background check in accordance with COMAR 12.15.02 and Child Protective Services clearances have been submitted for each prospective employee before the employee begins work at the program. Personnel Record. The licensee shall: Maintain for each staff member a personnel record that contains: An employment application or resume showing qualifications and experience; At least three references documented either by letter or notation of verbal contact indicating: The date the contact was made; The individual making the contact; The individual contacted; and The reference content; A written statement of medical examination by a licensed physician, made at the time of the staff member's employment, certifying that the physician has examined the staff member and found nothing in the individual's general, physical, or emotional condition that would endanger the health and well being of children; A screening for tuberculosis every 2 years administered by the Mantoux method or current Centers for Disease Control and Prevention standard with an analysis of results or, for those staff members whose results were positive, an annual medical certification that the staff member presents no symptoms of active tuberculosis; Documentation of a criminal background check request made in accordance with State law, including COMAR 12.15.02, and a copy of the initial outcome and any periodic updates; Documentation of a request for Child Protective Services check and a copy of the outcome; A completed federal “Employment Eligibility Verification” form (I-9); A copy of current applicable professional credentials; A copy of current cardiopulmonary resuscitation certification for all child care staff; Annual performance evaluations; Documentation of personnel actions, such as disciplinary and commendation reports relating to the individual's employment with the program; For a staff member who drives a motor vehicle to transport children: A copy of the staff member's current driver's license; and An official copy of the staff member's driving record updated every 2 years; Documentation that the staff member has received and read the policies described in Regulations .14 and .15 of this chapter related to the reporting of suspected child abuse and neglect and discipline and control of children; and Documentation that the staff member has received the employee training required under §F of this regulation; Grant a staff member reasonable access to the staff member's own personnel record; and Maintain the personnel file of each employee for a period of 5 years after the employee leaves the employment of the licensee. Training of Child Care Workers. Each employee who provides direct care to children shall receive a minimum of 40 hours of initial and annual training. The program administrator shall designate an employee to accompany new direct care employees on initial tours of duty until the employee's supervisor determines that the new employee: Is able to effectively safeguard the health and safety of the children; and Has completed the requirements of §F(3)(a)—(f) of this regulation. The training of employees who may provide direct care to children shall include: Emergency preparedness and general safety practices; Cardiopulmonary resuscitation leading to certification; Annual first-aid training either through completion of: American Red Cross standard first-aid course which is valid for the period of time recognized by the American Red Cross; or First-aid training by a certified or otherwise qualified instructor; Child abuse and neglect identification and reporting, including training in accordance with any curriculum provided by the licensing agency regarding specific aspects of child abuse and neglect prevention and reporting in residential programs; Suicide risk assessment and prevention; Approved forms of discipline and behavior management techniques including crisis management and the use of isolation and restraints; Medication management; Infection control and Maryland Occupational Safety and Health Bloodborne Pathogen Standards; Parenting issues, collaboration with families, and supporting children and families in making choices; Psychosocial and emotional needs of the children, family relationships, and the impact of separation; Special needs of the population served; Child development; The role of the child care employee; Food preparation, food service, and nutrition, if the employee is involved in preparing meals for residents; and Communication skills. Staff training shall utilize any relevant curriculum approved by the licensing agency. Employee Evaluation. The licensee shall: Evaluate each employee at least once a year; and Document each evaluation with the signature and date of the signature of the employee and the employee's immediate supervisor. Staffing Plan. The licensee shall: Analyze: The number of children the licensee intends to serve; The needs of each of the children to be served; and The needs of the program based on the size and layout of the physical plant; Develop and implement a staffing plan that: Addresses the health and safety needs of each child; Provides each child with the services identified in the child's individual service plan; Provides for the treatment, recreation, education, and social development of children in placement; and Addresses the management of staffing needs, including: Maximum work hours; Deployment of personnel; and Emergency staffing. Program Administrator. The Board shall employ a certified program administrator responsible for: Overall administration of the program; Implementation of all policies; Maintenance of the physical plant; and Fiscal accountability. The program administrator shall be certified as required by Health Occupations Article, Title 20, Annotated Code of Maryland. The Board may appoint a noncertified individual to serve in the capacity of acting program administrator in accordance with Health Occupations Article, Title 20, Annotated Code of Maryland. Direct Care Staff. The licensee shall employ direct child care staff to: Assist the children in meeting the goals and objectives of their individual plans of care; Guide and supervise the children in accordance with the Residents’ Bill of Rights in Human Services Article, §8-707, Annotated Code of Maryland; Manage the children’s behavior; Promote the physical and emotional well-being of the children; and Facilitate the attainment of independent living skills based on the needs of the child. Direct care staff shall be 21 years old or older and have a high school diploma or its equivalent. Human Service Professionals. The licensee shall employ human service professionals appropriate to the needs of the child and the nature of the program to perform functions in accordance with Regulation .17 of this chapter, including: Developing, reviewing, and signing each individual plan of care; Consulting with and training employees regarding implementation of each individual plan of care; Developing, reviewing, and signing each individual plan of care and discharge plan; Participating in the admission process; Providing counseling services to the children directly or through community resources; and Serving as a liaison to the children’s parents or legal guardian, schools, juvenile court, and other social and community services. Other Professional Service Providers. The licensee shall: Obtain any other professional services, including consultation required for the implementation of individual plans of care, that are not available from its employees; Ensure that the professionals are qualified, certified, or licensed appropriately for the nature of the service; and Obtain the signature of the professional in agreement to comply with the licensee’s confidentiality policy. Volunteers or Student Interns. If volunteers or student interns are used, the licensee shall: Adhere to a written plan for the participation of volunteers or student interns; Ensure that volunteers and student interns who have direct contact with the children and who perform the duties of an RCYCP: Are supervised and evaluated by appropriate staff; Are not used to replace a required staff position; Have references verified by the licensee; Are oriented and trained in: The philosophy of the program; The needs and rights of the children; and The methods of meeting those needs; As appropriate, are aware of or have input into the children’s individual plans of care; Annually are screened for tuberculosis by the Mantoux method or the current Centers for Disease Control and Prevention standard and analysis of results or, for a volunteer or student intern whose screening results were positive, provide an annual medical certification that the individual presents no symptoms of active tuberculosis; Are not permitted to have unsupervised access to children until the licensee has: Received the results of a criminal background check; Received the results of a child protective services check; Resubmitted an application for a child protective services check every 2 years from the date of commencement of the provisions of services; and Completed the training required in Regulation .05E of this chapter; and Provide the licensee a copy of applicable professional credentials. General Requirements. The licensee shall: Comply with federal, State, and local building, fire, and health codes and laws, and all applicable local zoning laws; Use a physical plant that is constructed and equipped in a manner consistent with the needs of the children, staff, and visitors and that is constructed and maintained reasonably to protect and to ensure the safety of all staff and residents; Ensure compliance by submitting annually to the licensing agency: Reports of all annual fire and health inspections conducted by the local jurisdiction; or If the local jurisdiction does not conduct annual fire or health inspections annually, written documentation shall be obtained annually from the appropriate public agencies that inspections are not required; Maintain evidence and provide documentation upon request that the physical plant had been tested for and found to be free of hazards from lead paint, asbestos, and radon; Ensure that all facilities maintain at least one working fire extinguisher; If there is evidence of insect or rodent infestation provide documentation of: An inspection; and Insect or rodent treatment, if necessary; and Install telephone service and equipment that is: Not solely provided through the use of cellular phone service; Accessible and usable by staff and residents; In all buildings used by the children. License. The licensee shall prominently display the authentic current residential child care program license on site: In the building bearing the address listed on the license; In an area of the building open and easily accessible to visitors; and In accordance with the requirements of the licensing agency. Building, Grounds, and Equipment. The licensee shall: Maintain all structures and grounds free from health and safety hazards; Ensure that all outside and kitchen trash containers are covered; Remove all trash at least once a week or more frequently as needed; Ensure that all infectious waste is stored in biohazard waste containers and removed on a regular basis; and Locate, install, and safely maintain appropriate playground or other recreational equipment. Counseling and Administrative Space. The licensee shall maintain a designated space separate from the children’s living area: For private discussions and counseling; and For administrative purposes. Living Areas. The licensee shall ensure that each building that houses children: Has adequate space for informal and recreational use by the children; Is not used as a primary residence for any individual other than children placed in the program; Is a smoke and pollutant free environment; Has walls that are: Regularly cleaned and painted; and Kept free of perforations, cracks, or punctures; and Is maintained in a clean and orderly manner. Sleeping Accommodations. The licensee shall ensure that bedrooms occupied by ambulatory children measure at least: 80 square feet of usable floor space in single occupancy bedrooms; or 60 square feet of usable floor space per child in multiple occupancy bedrooms. The licensee shall ensure that bedrooms occupied by non-ambulatory children measure at least: 120 square feet of usable floor space in single occupancy bedrooms; or 100 square feet of usable floor space per child with at least 3 feet between beds in multiple occupancy bedrooms. A licensee shall: Supply individual beds that are: Adequate in size to accommodate the height and weight of the child; and Solidly constructed and consisting of a clean, comfortable, nontoxic, and fire-retardant mattress capable of being disinfected; Maintain separate sleeping rooms for boys and girls who are 2 years old or older; Allow no more than four children to sleep in a bedroom; Ensure that the mattress of any bed in use is far enough away from the ceiling to allow the occupant to sit up in bed; Change all bed linens at least once a week and whenever soiled; Provide waterproof mattress protection for children who are enuretic; Disinfect mattresses after use by another child; Provide the children with a personal bureau or locker for clothing and personal belongings and a designated space for hanging clothing; Allow the children to have some discretion in the decoration of sleeping areas; Assure that all living areas are kept orderly and clean; and Provide a source of natural lighting. For children who sleep in beds, the licensee shall: Provide a pillow, two sheets, and sufficient covering for comfort; Prohibit the use of cots, bunk beds, loft beds, or sleep sofas as beds; and Ensure that only the child assigned to a bed sleeps in it. For infants and other children who require a crib, the licensee shall: Shall provide an age appropriate sized crib for each infant or child in care; May not allow an infant to sleep in a playpen or on a mat at any time; and Shall ensure that: Only the infant assigned to a crib sleeps in it; All cribs and playpens meet industry standards; Mattresses used in cribs and playpens fit snugly; Each infant has sheets, blankets, and other coverings for the infant's exclusive use; Wet, soiled or damaged sheets, mattresses, blankets, or other coverings are immediately replaced; All sheets and blankets are laundered at least once a week, or, if soiled, are laundered before next use; and Cribs and playpens are free of hazards. Bathrooms. The licensee shall: Keep bathrooms in good operating order and maintain sanitary conditions; For every five children, provide at least: One sink with hot and cold water; One bath or shower with hot and cold water; and One flush toilet; Unless the children require assistance, provide toilets and baths or showers that allow for individual privacy; Equip tubs and showers with slip-proof surfaces; Secure mirrors to the walls at heights appropriate for use by the children; and Unless otherwise specified in the child’s individual plan of care, make available 24 hours a day, without children needing to request them, personal hygiene supplies, including but not limited to, toilet paper, soap, shampoo, toothbrushes, towels and washcloths; and Equip bathrooms with adaptive equipment based on the needs of the children served. Kitchens and Dining Areas. The licensee shall: Have equipment and space for meal preparation, storage, serving, eating, and clean-up of meals; Maintain all equipment in clean, safe working order, and ensure that equipment meets all applicable health and safety standards; Unless the licensee documents that disposable dinnerware is necessary to protect the health or safety of the children, refrain from using disposable dinnerware on a daily basis; Ensure that all dishes, cups, and glasses used by the children are: Free from chips, cracks, or other defects; and Properly cleaned between each meal; and Unless otherwise specified in the child’s individual plan of care, ensure that children have access to unlocked food storage areas containing approved between-meal snacks. Furnishings. The licensee shall supply clean, comfortable furniture in good repair. Doorways, Windows, and Window Coverings. The licensee shall supply: Doors that can be opened from the inside and the outside for all bedrooms and bathrooms; Screens that are in good repair and removable in emergencies on all exterior windows that can be opened and exterior doors that may be left open; Window coverings that will ensure privacy; All window coverings, which shall have no draw cord capable of forming a loop greater than 7.25 inches; All new and replacement window coverings, which shall be cordless window coverings; and For each door or window in high-risk areas, such as recreation rooms and stairwells, shatter-resistant material or safety glass. Electrical Systems. The licensee shall ensure that the physical plant has: Electrical equipment, wiring, switches, sockets, and outlets which are maintained in compliance with local and State building codes; Sufficient illumination in rooms, corridors, and stairwells to permit safe usage; and Lighting of exterior areas during the night. Climate Control. The licensee shall: Provide heating and cooling systems which meet all applicable codes; Ensure heating systems that exceed 120°F that are accessible to residents are equipped with protective materials to prevent residents from coming in contact with the heat source; Maintain an air temperature of at least 68°F in the living areas and sleeping quarters of the physical plant; and Prohibit the use of kerosene or open coil heaters. Ventilation. In accordance with all local building codes, the licensee shall supply ventilation for each room used by the children through: A window that can be opened; An exhaust fan; or An air conditioning system. Water. The licensee shall: Provide a continuous supply of potable hot and cold running water; Equip the physical plant with a sanitary potable water distribution system; Ensure that hot water accessible to the children is regulated to a temperature of 110°F or lower; and If water from any source other than a public water supply is used: Annually obtain a water test conducted by the appropriate State or local authority in accordance with State or local law; and Keep on file the most recent test report. Emergencies. The licensee shall: Hold emergency drills: At least monthly; On each shift, at least quarterly; At unexpected times and under varying conditions; and Maintain documentation of drills for 3 years; Post adjacent to all telephones a list of emergency telephone numbers for: Ambulance; Fire; Police; Poison control; and Program administrator; Post accessible copies of the evacuation procedure in conspicuous places on each floor of the physical plant; and Keep exits free of obstruction or impediments to immediate use. The licensee shall develop an emergency plan for foreseeable emergencies and disasters that shall include: Procedures that will be followed before, during, and after an emergency to address the following: Ensuring that documentation regarding children and staff contains current health, contact persons, and other important information that is immediately accessible in the event of an evacuation; Establishing a communication protocol among all appropriate parties that includes redundant communication means; and The notification to parent or legal guardian, licensing agency, and placing agency regarding the action that will be taken concerning the safety and well-being of the children served; The evacuation, transportation, and 72-hour shelter-in-place of children and staff served; The staff coverage, organization, and assignment of responsibilities that include: Staff coverage needs for ongoing shelter-in-place or evacuations; Identification of staff members available to report for or remain at work for extended periods; and Establishment of staff notification and recall contingency plans and procedures; The continuity of services, including: Operations, planning, and financial and logistical arrangements; Procurement of essential goods, equipment, and services to sustain operations for at least 72 hours; Relocation to alternate facilities or other locations; and Reasonable efforts to continue care; Provisions to ensure that the facility’s emergency and disaster plans are shared with local emergency management organizations; An executive summary of the evacuation procedures that shall be provided, on request, to the family member of a child; and Provisions to ensure that all staff and volunteers are aware of the procedures required by this chapter and that all staff and volunteers implement each procedure as adopted. General Safety. The licensee shall: Maintain a written active safety plan; Document accidents; Maintain first-aid kits appropriate in size and content to the nature of the program; Prohibit firearms and chemical weapons on the grounds of or within the physical plant; Maintain poisonous, toxic, or flammable materials in accordance with appropriate health code standards; Except under the supervision of staff for use during celebrations, prohibit the use of candles; Maintain in safe and good repair power-driven equipment; Ensure that power-driven equipment is used by children only under the direct supervision of an employee and in accordance with State law; and Ensure that, if animals are kept on the grounds or in the facility: The animals are, consistent with the local ordinance or State law: Licensed or registered; Vaccinated; and Leashed when outdoors; Children are, when age appropriate, educated regarding the care and grooming of the animal; Children allergic to the animal are not placed with the licensee; A responsible adult is always present when an animal is near an infant; and An animal suspected of becoming dangerous is removed from the grounds and facility. Toys and Equipment. The licensee shall ensure that all toys and equipment used by children are: Sturdy; Of safe construction; Nontoxic; If used by children younger than 3 years old, large enough so they cannot be swallowed by a child; Clean; and In compliance with the standards of the Consumer Product Safety Commission. Transportation. A licensee shall: Supply transportation necessary to implement the children's individual service plans, including: The provision of any necessary specialized transportation to accommodate a child who uses medical equipment; and The capacity to transport children in case of an emergency; Enhance the safety of children during transportation by ensuring: The development and enforcement of appropriate written safety rules for transporting children; Proper registration and maintenance in a safe condition and in conformity with all applicable laws any motor vehicle used for the transportation of children; Retention of maintenance and repair records on all licensee-owned or leased motor vehicles used for the transportation of the children; The availability of a first-aid kit in all vehicles used to transport children; and Compliance with federal and State laws on child restraint; Ensure that an individual who operates a licensee-owned or leased motor vehicle to transport the children is properly licensed to operate that class of vehicle; Ensure that the number of individuals in a motor vehicle used to transport the children does not exceed the vehicle's industry-rated capacity; Assure that any motor vehicle, whether owned by the licensee or a licensee's employee, which is used to transport children is properly insured for that purpose; Meet any special medical needs that a child may have during transportation, including: Advising the motor vehicle's operator if a child's health needs may cause difficulties during transportation, such as seizures, tendency towards motion sickness, or a disability; and For non-ambulatory children in all motor vehicles except automobiles: Using a ramp device or a hydraulic lift, if a ramp device is also available in case of emergency, to permit entry and exit of the children; and Securing wheelchairs to the floor and arranging them with adequate aisle space and access to the exit door; and Curtail the use of 15-passenger vans for the transportation of children as follows: Licensee may not acquire or otherwise put into service a 15-passenger van for the transportation of children; and After January 1, 2006, a licensee may not transport children for any purpose in a 15-passenger van. Swimming Pools, Hot Tubs, and Spas. If an in-ground swimming pool is located on the grounds of a licensee: The pool shall be maintained in a safe and sanitary condition; If a child younger than 8 years old is placed with the licensee, the pool area shall be completely enclosed by a fence that is: At least 4 feet high; and Constructed of wood, concrete, brick, or chain metal; and When the pool is not in use: The pool area shall be protected from access by a locked gate; and The pool shall be completely covered in a manner to prevent access by a child. The licensee shall ensure that an above-ground swimming pool located on the licensee's grounds: Is maintained in a safe and sanitary condition; Is 4 feet above ground at all points; and When not in use, has: A secured cover which prevents access by children, or retractable or removable ladders locked or stored away from the pool; Locked doors and gates that access the pool; and No climbable objects on the pool's exterior. The licensee shall allow children to swim: Only in approved areas; and Under the supervision of sufficient individuals who: Are trained in first aid, water safety, and cardiopulmonary resuscitation; and Have current senior lifesaving certificates from the American Red Cross or its equivalent. Hot tubs and spas are prohibited on the grounds of a licensee's facility. Any applicable State, federal, or local requirement shall control in the event of any conflict by any requirement in this chapter. Community Integration. The licensee shall: Develop and institute a plan to integrate the program into the life of the community, ensuring that children have opportunities to participate in community activities to a degree consistent with their needs and limitations; Ensure that community residents have reasonable access to the program administrator to address concerns about the program staff and residents; Appoint at least one resident of the community to be a member of the Board; and Develop and implement a procedure for the resolution of complaints from the community. Communications with Family and Others. The licensee shall: Before or upon placement, give the child’s parent or legal guardian, the placing agency, and the child, a program handbook that is in a format that is understandable and comprehensive, and includes: The mission of the program and its admission and discharge policy; Normal daily routines; Treatment strategies and disciplinary philosophy; Visiting hours and other procedures related to communication with the child; A procedure through which the child or parent may register grievances regarding the child's care; The program’s policies with respect to accessing health care and the exercise of religion or a life philosophy; and The telephone number of the appropriate staff on duty who may be contacted; Implement a written policy regarding communication which includes visitation, correspondence, reports, and telephone contact between the child and others; Consult with the placing agency to ascertain the child’s status with respect to family member contact and encourage family participation in the plan of care; Consistent with the child's individual plan of care, maintain conditions of reasonable privacy for the child’s visits and telephone contacts; Have flexible visiting hours for visitors who are unable to visit at the regular times; Unless inconsistent with the child’s individual plan of care, permit the child to receive and send mail; Establish and implement written procedures for all overnight visits away from the program which address: Documentation of permission from the placing agency, parent, or guardian; Determination of the duration of the visit; and Documentation of the: Name and address of the individual responsible for the child while absent from the program; Child's location while absent from the program; and Time of the child's departure from and return to the program; Prohibit restrictions on a child’s access to the child’s attorney; and When a child’s communication with an individual outside the program is curtailed or terminated: Inform the child and, unless unsafe for the child, the individual affected by the restriction; and Include a written statement of the reasons for the restriction in the child's case file. Normal Daily Routines. The licensee shall: Have a written plan of normal daily routines which shall be made available to the children and employees; and Unless inappropriate, permit the children to participate in planning normal daily routines. Public Relations. Before using a child's picture or other uniquely identifying information for the purpose of public relations in any form, the licensee shall obtain the written consent of: The child, if appropriate; The child's parent or legal guardian; and If required, the juvenile court. The licensee may not use a child, a child’s picture, or other uniquely identifying information in any way that would likely be harmful or cause embarrassment to the child or the child’s family. Child Grievance Procedure. The licensee shall establish and follow a written grievance procedure that: Includes: Each step in the process; Specific timelines; and Identification of the person who should receive the grievance; Requires documentation of receipt of the procedure in the child's individual case record; and Documents all grievances and communicates corrective actions to the: Licensing agency; and The child and the child’s parents or legal guardian, as appropriate. The licensee shall provide the child and the child’s parents or legal guardian unimpeded access to a description of how to file a grievance, including: Any formal grievance forms or other requirements for the format and content of the complaint; Guidance for obtaining staff and other assistance in completing and filing a grievance; and Instructions regarding the identity, address, and telephone number of the individuals designated to receive and act upon grievances. The licensee shall post the name and telephone number of the licensing agency and child protective services contact persons near every telephone that is accessible to staff and residents. The licensee shall ensure that there is no retaliation against a child or a child’s family for filing a grievance. The grievance procedure shall be approved by the licensing agency. General. The licensee shall have a structured plan of care designed to meet the children's physical needs and well-being. Food and Nutrition. The licensee shall: Serve food that meets or exceeds the children's recommended dietary allowances as established by the Food and Nutrition Board of the National Academy of Sciences; Maintain at least a 72-hour supply of food in accordance with the planned menu; Maintain nonperishable food items in the event of an emergency, in accordance with the licensee’s emergency preparedness plan; Provide each child three meals each day, which are approved by a registered dietician and offer nutritious between-meal snacks, with not more than 14 hours between dinner and breakfast the following day; Offer approved supplementary or modified nutritionally sufficient diets for religious, cultural, life philosophy, or health reasons, as appropriate; Prohibit forced feeding of or withholding of food from a child as a form of discipline; Ensure that if employees are served food from the facility, it shall be the same food as that served to the children; Observe the applicable requirements of the Maryland Department of Health and local health departments; and Design menus that: Are kept on file for 12 months; Are approved at least annually by an individual licensed by the State to practice dietetics; Are planned at least a week in advance; Document the actual foods served, including comparable substitutions; and Document any between-meal snacks provided. Children’s Personal Funds. The licensee shall: Have and observe a written policy concerning a child’s personal funds which addresses: The child's access to the child's personal funds; Accrual of interest into the child's account from an interest bearing account; Accounting for the child's funds on request; and The limit, if any, placed on the personal funds a child may bring into and hold while in the program; Make an inventory of the child's personal funds and other belongings upon admission, and update the inventory as needed; Treat money earned by a child or received by the child as a gift or as an allowance as the child's personal property; Account for and maintain a child's personal funds separate from program funds; Transfer a child’s personal funds to the child within 5 business days of discharge from the program; As applicable, deduct reasonable sums from a child's allowance as restitution for damage done, if the practice is consistent with the licensee’s program and written restitution policy; and Ensure that restitution shall be paid from the child’s personal funds in accordance with the child’s court order. Clothing. The licensee shall: Ensure that the children have an adequate supply of clean, comfortable, well-fitting clothes, and shoes for indoor and outdoor wear; Treat a child's clothing as the child's personal property; Allow a child to be involved, as appropriate, in the selection, care, and maintenance of the child's clothing; Use donated clothing only if suitable and in good condition; and Transfer a child's clothing to the child upon discharge. Other Personal Belongings. The licensee shall have a policy regarding personal belongings that will: Allow a child to possess appropriate personal belongings; Make reasonable provisions for the protection of a child's personal belongings; and Transfer to a child the child's personal belongings upon discharge. The licensee may limit the size, value, or type of personal belongings that a child may bring to the program. Personal Hygiene. The licensee shall: Instruct the children in good habits of personal care, hygiene, and grooming; and Provide each child with culture-specific and gender-specific hygiene products, including, but not limited to: A toothbrush and toothpaste; Mouthwash and dental floss; A comb and brush; Clean towels and washcloths; Soap; Shampoo and conditioner; Body lotion or moisturizer; Deodorant; and Feminine hygiene products. Sleep. The licensee shall: Establish and follow routines for waking the children and putting them to bed; and Provide children the opportunity each night for at least 8 hours of uninterrupted sleep, except in the event of an emergency or drill. General. The licensee shall provide services designed to meet the children's needs for guidance, learning, and personal development. Each child shall be treated in compliance with a “Residents’ Bill of Rights,” as set forth in Human Services Article, §8-707, Annotated Code of Maryland. Education. Each licensee shall collaborate with the placing agency and document efforts to: Ensure that each child of mandatory school age who has not earned a high school diploma or certificate of completion under COMAR 13A.03.02.02 is receiving an appropriate elementary or secondary school education; If the child is a student with disabilities, cooperate with the team constituted under COMAR 13A.05.01 as appropriate to ensure that the child receives special education and related services as provided for in the child's individualized education program; and Ensure that each child above the mandatory school age who has not received a secondary school diploma or certificate of completion under COMAR 13A.03.02.02 participates in: A secondary school education program; A tutoring program to prepare the child to take the General Educational Development Test under COMAR 13A.03.03; or Developmentally appropriate vocational skills training. The placing agency and licensee shall work cooperatively with the local school system to: Facilitate the child’s enrollment in school within the local school system within 3 school days of placement at the facility, and if not feasible, document in writing all attempts and rationale for the delay; Ensure that the child attends the local school whenever feasible and appropriate consistent with Education Article, §4-122(a)(4), Annotated Code of Maryland; and Participate as appropriate in the child's educational activities. If a licensee determines that there is a need to establish educational services in its facility, the licensee shall: Obtain a certificate of approval in accordance with COMAR 13A.09.10, if the licensee intends to establish a nonpublic educational program or GED program; or Establish a tutoring program for children who are concurrently enrolled in a public or nonpublic educational program. Each licensee shall notify the placing agency and the licensing agency when a child is suspended from school for more than 3 days. Each licensee shall immediately notify the placing agency and the licensing agency when a child is expelled from school. Each licensee shall develop an individualized daily program plan for a child who has been suspended or expelled from school. Recreation and Leisure. The licensee shall develop a written plan that: Provides the children with a range of indoor and outdoor recreation and leisure activities both in the program and in the community; and Bases recreation and leisure activities on a child’s needs and interests and the group composition. Life Skills Training. The licensee shall provide each child with life skills training appropriate to the age and capability of the child in areas including: Accessing community resources and services; Conflict resolution; Dating, marriage, and family planning; Decision making; Money management; Nutrition; Personal hygiene and grooming; Personal relationships; Personal safety; and Time management. Work Experience. The licensee: Shall train a child in work readiness according to the child's age and capability; Shall develop appropriate work experiences for a child that: Do not interfere with a child's time for school, study periods, sleep, community activities, or family visits; Comply with federal and State law on labor and employment and child labor; and Do not use a minor as a substitute for child care staff; Shall change the child’s routine duties often to provide a variety of experience; and For a child who legally is not attending school, shall document informing the child of opportunities of or assistance to the child in the attainment of gainful employment or facilitation of the participation of the child in a vocational academic program geared to the acquisition of suitable employment or necessary life skills. General Health Services. The licensee shall: Establish and implement a written plan for the provision of preventive, routine, and emergency medical, dental, optical, and mental health care for the children; Establish and implement a written policy for documenting and addressing health complaints; and Obtain written authorization from a parent, legal guardian, or other authorized individual for emergency and non-emergency medical, dental, optical, or mental health care. Medication Administration Policy. The licensee shall observe written policies for the management and administration of medications to children. The policy shall comply with all relevant State statutes and regulations. Medication Management. The licensee shall maintain medications as follows: The licensee shall store medications in a locked drawer, cabinet, or container intended for medication storage, or, if a refrigerator is required, in a locked container in the refrigerator; The licensee shall store all Schedule I and Schedule II controlled substances, as defined in Criminal Law Article, Title 5, Annotated Code of Maryland, under two consecutive locks; and The licensee shall discard outdated or discontinued prescription and over-the-counter medications in a manner that prohibits misuse. For a newly admitted child, the licensee shall: Continue any current medications that the child is receiving at the time of admission to the program; and Within 3 days of admission, consult with the licensee’s medical care provider, psychiatrist, or the child’s primary care physician concerning the continuation of a current medication. For each child in the program who receives medications, the licensee shall: As medically indicated, obtain from the child’s medical care provider a review of the child’s medications and documentation of the reasons for continuing, discontinuing, or changing medication, depending on the child’s medical needs; and Document all medication taken, including the: Name of the child; Name of the medication; Frequency and dosage of the medication; Date, time, and type of administration of the medication; and Name and signature of the employee who administered the medication or supervised its self-administration; Notify the prescribing physician in any case of a medication error or drug reaction; and Coordinate with the pharmacy and the child’s parents or legal guardian to provide information about appropriate administration of medications during the child’s home visits. The licensee shall include the training provided under Regulation .05E(4)(g) of this chapter to all direct care staff regarding: The therapeutic benefits and side effects of medications used by children in the program; and Medication administration, in accordance with the requirements of §B of this regulation. The licensee shall prohibit the use of medication for the purpose of group control, experimentation, or research. The licensee shall coordinate with the child's health care provider and the placing agency at the time of the child's discharge to ensure continuity in the administration of medications to the child. Somatic Health Care. The licensee shall: Establish and implement written policies and procedures for the provision of somatic health care services; Provide the children with access to somatic health care through a physician licensed to practice medicine in the State or, under the supervision of a licensed physician, a nurse practitioner or physician’s assistant appropriately certified or licensed to practice in the State; Arrange for access to prompt diagnosis and treatment of acute illnesses; Arrange for access to continuing care for chronic illnesses; Arrange for hospitalization for a child when deemed necessary by the licensee’s somatic health care provider; and As authorized by State and federal law, make available to the child, the child's parent or legal guardian, and the placing agency a copy or summary of the child's health record Dental Care. The licensee shall: Provide the children with access to dental care through a dentist licensed to practice dentistry in the State; Unless a child has been examined and treated as necessary during the 6 months before the child’s admission to the program, have each child examined by a dentist within 30 days after admission; Have each child examined by a dentist at least every 12 months or more frequently as prescribed by the dentist; and Arrange for access to prompt treatment of acute dental needs. Vision and Audiological Care. The licensee shall provide the child with access to vision and audiological care as authorized by the child’s primary care physician through an appropriate professional licensed to practice in the State. Immunization. The licensee shall: Within 30 days after admission and subject to the provisions of State law, provide for the immunization of any child who has not been immunized in accordance with the immunization schedules of the American Academy of Pediatrics; and Maintain a record of immunizations in the child's individual case record. Physical Examination. The licensee shall secure a physical examination for each child, with a copy of the documentation of the examination: Within 30 days of admission or earlier if indicated by the child’s health status, unless a child has been examined and treated as necessary during the 12 months before the child’s admission to the program; and After the examination conducted under §H(1) of this regulation, according to a schedule established by the child's medical care provider, the American Academy of Pediatrics, or the Early and Periodic Screening, Diagnosis, and Treatment schedule. Emergency Health Services. The licensee shall establish and implement written policies and procedures for emergency medical, dental, or mental health needs requiring emergency hospital treatment, including: Communication of the need for immediate assistance; Transportation of the child; Notification to the licensing agency, the placing agency, and, unless inconsistent with the child’s individual plan of care, the child’s parent or legal guardian; and Supervision of the child and the children remaining at the program. Communicable Diseases. The licensee shall: Establish and implement a policy for managing communicable diseases, including isolation when necessary; Establish and implement a policy that requires staff to exercise standard precautions with respect to communicable diseases and infection control; and Comply with Maryland Occupational Safety and Health Bloodborne Pathogen Standards and the Centers for Disease Control and Prevention's guidelines for the prevention of communicable diseases and other health emergencies. Suicide Prevention. The licensee shall establish and follow procedures for suicide prevention and intervention. Written Policy. The licensee shall establish and implement a written policy that sets out, in compliance with State law and regulations: The definitions of child abuse and neglect; The procedures to be followed if the licensee has reason to believe that a child has been subjected to abuse or neglect; and The penalties that the program may impose for failure to comply with the policy. Reporting Requirements. An individual who notifies the local department of social services or appropriate law enforcement agency under this regulation also shall report and give all information required by State law to: The program administrator; or If the program administrator is the individual alleged to be responsible for the abuse or neglect, a specified officer of the licensee. The licensee may not prevent an individual from making a report of abuse or neglect or take disciplinary action against an individual for making in good faith a report of abuse or neglect. The licensee shall cooperate in the conduct of any investigation or proceeding brought as result of a report of abuse or neglect by: Allowing employees to participate in the investigation and to provide testimony without loss of leave, pay, or other benefits; and Disciplining employees who fail or refuse to report abuse or neglect when required to do so or do not cooperate in the investigation or provide testimony when requested. Within 48 hours after a licensee files a report of child abuse or neglect with the local department of social services or the appropriate law enforcement agency, or within 48 hours after it becomes known to the licensee that the report has been filed, the licensee shall: Submit a written report to the licensing agency informing it of the activity; and Unless inconsistent with the child’s individual plan of care, inform the child’s parent or legal guardian of the allegation. Within 10 days after a local department of social services makes a finding regarding a report that a child may have been subjected to abuse or neglect by an individual associated with the licensee, the licensee shall submit to the licensing agency a written final report indicating any necessary corrective action that the licensee will undertake and put into effect not more than 30 days after the final report. Employee's Signature. The licensee shall ensure that as a condition of employment, all employees read and sign a statement acknowledging receipt of the policy established under §A of this regulation. Administrative Leave. Upon being notified of or making a report alleging that an employee has subjected a child to abuse or neglect, the licensee shall immediately place the employee on administrative leave and remove the employee from access to the children. This regulation does not prohibit a licensee from suspending without pay or discharging an employee alleged to have subjected a child to abuse or neglect. Multidisciplinary Consultation. When the local department of social services asks the program administrator to participate on a multidisciplinary case consultation team to investigate a report of child abuse or neglect and to help formulate a corrective action plan, the program administrator or designee shall participate on the team. Posting Telephone Numbers. The licensee shall post conspicuously the telephone number supplied by the local department of social services for reporting child abuse or neglect. General Policies. The licensee shall establish and follow written policies and procedures that: Are communicated to the child, the child’s parent or legal guardian, program personnel, licensing agency, and the placing agency; Incorporate the principles of positive behavioral interventions, strategies and supports, and trauma-informed care into all prevention and intervention strategies; Specify the approved procedures for the administration of prevention and intervention strategies and supports; Identify the program personnel authorized to administer each form of prevention and intervention strategies and supports; Include the procedures for training program personnel in the use and administration of each form of prevention and intervention strategies and supports that incorporate the principles listed in §A(1)(b) of this regulation; and Annually review the forms of prevention and intervention strategies and supports. A licensee may not use the following as disciplinary measures: Physical, mental, and verbal abuse, or corporal punishment; Assignment of physically strenuous exercise or work; The withholding of: Food; Water; Sleep; Mail; Family visits; or Program participation other than recreation or leisure activities; Forced feeding of a child; Chemical restraints, unless in compliance with State law and ordered by a physician; Mechanical restraints, except as permitted by other applicable State regulations or ordered by a court of competent jurisdiction; or Physical restraint, except when failure to do so would result in harm to others or to the child. A program may not delegate behavioral interventions, strategies, and supports of a child to another child or group of children. Interventions Strategies. General Program Requirements. Program staff shall be encouraged to use an array of prevention and intervention strategies to increase adaptive behaviors or decrease targeted behaviors, as specified in the behavior intervention plan, that incorporate the following principles: Positive behavioral intervention strategies and supports; Trauma-informed care; and Individualized behavioral assessments and planning in accordance with COMAR 14.31.06.17. Program staff may use restraint only: After less restrictive or alternative approaches have been considered and: Attempted; or Determined to be inappropriate; In a humane, safe, and effective manner; Without intent to harm or cause discomfort; When consistent with documented medical or psychological limitations and the child’s individual plan of care; and If the staff member performing the restraint has current certification in the use of restraint via the training program used by the licensee that has been approved by the State. Nothing in this chapter shall limit the responsibilities of law enforcement, judicial authorities, or security personnel. Safe Environment Plan. General. The program shall develop a safe environment plan during intake and admission. The safe environment plan shall be reviewed and updated in conjunction with the child’s individual plan of care, or more frequently, as appropriate. The program shall partner with the child, the child’s parent or legal guardian, as applicable, and the custodial agency to develop a plan to create and maintain a nonviolent and healing environment and to prevent the use of restraint. The safe environment plan shall be easily accessible to program personnel at all times. Unless otherwise documented in a plan, the safe environment plan shall include the following: Physical space that the program shall provide to make the child feel safe, comforted, and in control of the child’s behavior; The triggers and situations that increase stress or fear and may cause the child to lose control of his or her behavior and how the child’s loss of control of his or her behavior is manifested; The methods for calming or soothing that the child prefers and has found to be successful; The child’s preferences regarding positive, nonphysical interventions, strategies, and supports if the child’s level of agitation increases; The medication that is appropriate clinically and agreed to and prescribed by the child’s treating physician that the child may choose to take voluntarily, if the child’s level of agitation increases despite the use of the alternative interventions identified in the safe environment plan; Any medical information that can affect the safety of a restrictive intervention; Any trauma history that the child has experienced; Any preferences or contraindications to the debriefing process; and The time frame in which law enforcement will be notified in the event of a child being absent without leave, not to exceed time limits as specified in COMAR 14.31.06.16. The program shall ensure that all program personnel working directly with the child: Are fully briefed on each child’s safe environment plan; and Honor the child’s requests and preferences identified in the plan, unless clinically contraindicated in a particular situation. The treatment team shall: Review the safe environment plan with the child following any post-restraint debriefing, and at other times consistent with the program’s policy, make any necessary changes identified by the child, staff, or both as appropriate; and Ensure that staff, the child’s parent or legal guardian, and the custodial agency are informed of any subsequent modifications made to safe environment and individual plan of care. Use of Time Out. Program personnel may use time-out to address a child’s behavior if: The safe environment plan supports time-out; The child requests time-out; The child’s behavior unreasonably interferes with the program activities; or The child’s behavior constitutes an emergency, and time-out is necessary to protect a child or other person from imminent, serious, physical harm after other less intrusive interventions have failed or been determined to be inappropriate. A setting used for time out shall: Provide program personnel with the ability to see the child at all times; Provide adequate lighting, ventilation, and furnishings; and Be unlocked and free of structural barriers to prevent egress. Program personnel shall supervise a child placed in time-out and provide a child in time-out with: An explanation of the behavior that resulted in the use of time-out; and Explanation and instruction on the behavioral expectations when the child returns to the milieu. Each period of time-out shall be appropriate to the developmental level of the child and the degree of severity of the behavior, and may not exceed 30 minutes. A child’s parent or legal guardian, the custodial agency, and program personnel may at any time request a meeting to address the use of time-out and to: Conduct a functional behavioral assessment; and Develop, review, or revise a child’s plan of care. Restraint. Physical Restraint. The use of physical restraint must be in accordance with the approved behavior management system used by the licensee. The use of prone restraint is prohibited in residential child care facilities. The use of physical restraint is prohibited in residential child care facilities unless: The parent or legal guardian of a child has been notified before admission that the use of physical restraint may be necessary; and There is an emergency situation and physical restraint is necessary to protect a child or other individuals from imminent, serious, physical harm after other less intrusive, nonphysical interventions have failed or been determined inappropriate. Physical restraint may be applied only by program personnel who have successfully completed State-approved training in the appropriate use of physical restraint consistent with §G of this regulation. In applying physical restraint, program personnel may only use the least amount of force necessary to protect a child or other person from imminent, serious physical harm. A physical restraint: Shall be removed as soon as the resident is calm; and May not last longer than 30 minutes per occurrence or longer than the approved behavior management system used by the licensee. Trained staff shall constantly monitor the use of restraint for the following: Proper technique; Level of consciousness of the youth being restrained; Breathing; and Other safety factors. The program administrator or designee shall be contacted immediately after the initiation of the restraint. Mechanical Restraint. The use of mechanical restraint is prohibited in residential child care facilities, except as permitted in COMAR 14.31.07.08. Program personnel are not prohibited from using a protective or stabilizing device prescribed by a health care professional. The use of seclusion is prohibited in Maryland residential child care facilities. Referral to Team. If restraint is used, and the child’s behavior intervention plan does not include the use of restraint, the team specified in Regulation .17A of this chapter shall meet within 5 business days of the incident to consider: The review of the safe environment plan; The need for a functional behavioral assessment; Reviewing or developing appropriate behavioral interventions; and Revising or implementing a behavior intervention plan. If a child’s behavior intervention plan includes the use of restraint, it shall specify how often the team shall meet to review or revise, as appropriate, the child’s behavior intervention plan. When a team meets to review or revise a child’s behavior intervention plan, the team shall consider: Existing health, physical, psychological, and psychosocial information; Information provided by the parent or legal guardian and the custodial agency; and Observations by program personnel and related service providers. The program shall provide the parent or legal guardian, the child, the custodial agency, and the child’s attorney with written notice when a team proposes or refuses to initiate or change the child’s behavior intervention plan to include the use of restraint. A parent or legal guardian or child may request an appeal through the program's grievance process in accordance with Regulation .09E of this chapter if the parent or legal guardian or child disagrees with the team’s decision to propose, or refuse to initiate, or change the child’s behavior intervention plan to use restraint. Documentation Requirements for the Use of Restraint. Documentation of events surrounding the utilization of restraint in the child’s record shall include, but not be limited to: Type of restraint used; Rationale for the restraint and expected outcome of the intervention; The safe environment plan or other less restrictive interventions, de-escalation techniques, or all of these utilized prior to the implementation of restraint and the child’s response to each; The child’s response during and after the implementation of the restraint; The length of time in restraint; Description of the specific precipitating factors leading to the restraint, including: Description of observable behavioral, emotional, and physical characteristics of the child involved; Degree of restriction or loss of privileges; Any event, situation, or condition immediately preceding the behavior that prompted the use of restraint; and The behavior that prompted the use of a restraint; Specific location where the restraint occurred, and general activity occurring within the environment before the incident; Staffing level, types of program personnel (male, female, unlicensed, licensed); Unit capacity and unit population; The names of the program personnel who observed the behavior that prompted the use of restraint; The names and signatures of the program personnel implementing, observing, and monitoring the use of restraint; A description of the restraint event, including: The child’s behavior and reaction during the restraint; and The name and signature of the administrator informed of the use of restraint; Physical condition, including any observable or reportable injuries of the child during and after the restraint, including: Description of any injuries sustained; On-site first aid intervention; and Off-site medical treatment; Medication, as identified in the child’s safe environment plan, administered before, during, or after the restraint; Date and time of the restraint; and Notification: To the program administrator or designee; To the parent or legal guardian; To the placement agency; and To the licensing agency in writing, the information described in Regulation .18D of this chapter. Debriefing. Staff. Within 24 hours of the incident, program personnel involved in the incident and the clinical coordinator, supervisor, or designee shall discuss and document the management of the incident by addressing the following: The precipitating factors of the incident; Program personnel response to the incident; De-escalation techniques or less restrictive interventions attempted, or both, and the child’s response to each; Timeliness of program personnel intervention; Program personnel's ability to function as a team and improvements that could be made; Adequacy of program personnel response and need for additional staff; Aspects of the incident that should be the focus for discussion for the team; and Other interventions that could have been used to prevent the restraint. Child. Within 24 hours of the incident, unless contraindicated by the safe environment plan, the child involved in the incident and the program administrator or designee shall discuss and document the management of the incident by addressing the following: The precipitating factors of the incident; Program personnel response to the incident; De-escalation techniques or less restrictive interventions attempted, or both, and the child’s response to each; Timeliness of program personnel intervention; Program personnel's ability to function as a team, and improvements that could be made; Adequacy of program personnel response, and need for additional staff; Aspects of the incident that should be the focus for discussion for the team; and Other interventions that could have been used to prevent the restraint. If the child declines to participate in the debriefing: Program personnel shall document efforts to conduct the debriefing, efforts to engage the child in the process, and the reasons the child declined to participate; and Negative consequences may not be imposed upon the child for nonparticipation. Administrative Procedures. Each residential child care facility shall develop policies and procedures to address: A continuum of prevention and intervention strategies that incorporate the principles of positive behavioral interventions, strategies and supports, and trauma-informed care; The prevention of self-injurious behaviors; Methods for identifying and defusing potentially dangerous behavior; The use and documentation of time-out consistent with Regulation .15D of this chapter; and The use of restraint consistent with Regulation .15E of this chapter. Quality Assurance. Each residential child care facility shall develop a quality assurance process to: Ensure that each child’s needs are addressed; Monitor and address the incident management findings, frequency, and types of restraints utilized; Implement measures to reduce the use of restraint; and Annually review policies and procedures, and provide them to program personnel and the parent or legal guardian. Training. Each residential child care facility shall provide training to program personnel on this chapter and the appropriate implementation of policies and procedures developed in accordance with §A of this regulation. The program personnel shall receive training on current professionally accepted practices and standards from a vendor whose training program has been approved by the State and which includes all of the following: Positive behavioral intervention strategies and supports; Trauma-informed care; and Restraint. Training shall be required: Before program personnel may work with children independently; and At least annually. Each residential child care facility shall identify program personnel authorized to serve as a program wide resource to: Assist with training on de-escalation techniques; and Ensure proper administration of time out and restraint. Monitoring and Compliance. Each residential child care facility shall develop policies and procedures on: Monitoring the use of time out and restraint; and Receiving and investigating complaints regarding time out and restraint practices. The residential child care facility shall report the use of restraint to: The parent or legal guardian within 24 hours of the incident unless otherwise specified in the safe environment plan by the parent or legal guardian; The placement agency; The licensing agency in writing, information described in Regulation .18D of this chapter; and Child Protective Services, as required by Regulation .14 of this chapter. The licensing agency may monitor and request any information regarding any matter related to time-out or restraint implemented by a residential child care facility. Written Policy. The licensee shall have and follow a written policy to govern its actions when a child is discovered to be absent without leave. Child’s Return. Unless otherwise specified in the child’s individual plan of care, if the child has not returned to the program within 1 hour of the program discovering that the child is missing or unaccounted for, the licensee shall notify: The local law enforcement authority; The placing agency; The licensing agency; and The child’s parent or legal guardian, unless inconsistent with the child’s individual plan of care. Notification. When a child who was missing or unaccounted for returns to the program, the licensee shall immediately notify: The local law enforcement authority; The child’s parent or legal guardian; The placing agency; and The licensing agency. General Requirements. The licensee shall have and follow written policies regarding: Admission; Individual plan of care; Behavior intervention plan; Behavior support services; and Discharge. The licensee shall form a team comprised of at least the following individuals to participate in the: Admission process: A representative designated by the placing agency; Program staff responsible for the care and supervision of the child; Unless clearly inappropriate, the child; and If appropriate, the child’s parent or legal guardian; and Development of the individual plan of care and the discharge plan: A representative designated by the placing agency; A human service professional from the program considering the admission; Program staff responsible for the care and supervision of the child; The child’s parent or legal guardian, if consistent with the child’s permanency plan; and Unless clearly inappropriate, the child. Each team shall: Document those present and participating; and Indicate in the individual case record the reason, if known, why an invited individual did not attend. Admission. The licensee shall include in its admission policy a: Statement of nondiscrimination consistent with Title VII of the Civil Rights Act and State Government Article, Title 20, Annotated Code of Maryland; Provision for an assessment to determine the child’s needs and the licensee’s ability to meet them; and Method for notifying, when appropriate, a child’s parent or legal guardian if the child is self-admitted. The licensee may not admit a child referred by an out-of-State placing agency without documentation that the agency has initiated actions to abide by any applicable interstate compact. The licensee may not admit into care: More children than the number specified in its license; Children outside of the age range specified in the license; or Children not of the gender specified in the license. In order to admit a child whose characteristics and needs do not fit the profile approved by the licensing agency, the licensee shall document that it has: Obtained oral permission from the licensing agency before the child's admission; and Requested written documentation of the licensing agency’s permission within 5 days of the child’s placement, which describes: The reasons for the placement; and How the program will ensure adequate and appropriate care for the child. Except for emergency placements, the licensee shall admit a child only upon receipt of at least: A social history or predisposition report, to include any history of abuse or neglect; A health history that is not older than 6 months, including, if applicable, a list of currently prescribed medications; A mental health screening report that: Includes screening for the child's risk of suicide; and Was completed in less than 72 hours before the child's placement; An educational history; Medical insurance documentation; If required by federal or State law, any psychological, psychiatric, or developmental assessment that is not older than 12 months; Emergency telephone numbers to contact the child’s parent or legal guardian; If applicable, a document that specifies a guardian or custodian of the child other than the biological parent; The child's permanency plan; Authorizations necessary for providing care, including: Medical, dental, and behavioral health authorizations for routine and emergency care; Any applicable court order or master's recommendation; and Applicable non-court order for shelter care. For emergency placements, the licensee and the placing agency shall ensure that the licensee receives the documents specified in §§A, B, and C of this regulation within 24 hours of the child's placement. If it has the discretion to refuse to admit a child referred by the placing agency, the licensee shall process each referral promptly and submit to the placing agency its decision on the referral within 10 days after receipt. The licensee shall: Examine each child upon admission; Document in the child's individual case record any illness, fever, rash, bruise, or injury; and Take appropriate action as necessary. Within 3 days after admission, the licensee shall include in a child’s individual case record: A preliminary, individualized assessment of the child’s needs performed by a human service professional; A safe environment plan; and Any document listed in §B(4) of this regulation not received before the child’s placement. Individual Plan of Care. The licensee shall require the team convened pursuant to §A(2)(b) of this regulation: To develop for each child, within 30 days after admission, an individual plan of care that includes: An evaluation that meets the requirements of the Early and Periodic Screening, Diagnosis and Treatment program; If appropriate, a behavior intervention plan as defined in §D of this regulation; Measurable objectives with time frames leading to the achievement of goals; Implementation dates and strategies; Individuals responsible for providing the supports, services, implementation, and monitoring of the plan; Documentation indicating whether or not the child and parent or legal guardian agree with the plan; Education, including special education and related services to implement the individualized education program of a student as required under the Individuals With Disabilities Education Act; Family relationship; Health care; Life skills development; Personal, emotional, and social development; Recreation plan; Vocational training; The placing agency’s permanency plan; and Other areas as appropriate; and To execute the: Review and update of every child’s individual plan of care at least every 90 days; Modification of the individual plan of care as required by the child’s needs, interests, and circumstances; and Documentation of monthly progress toward achievement of goals and estimated length of stay. Behavior Plan. The licensee shall have a comprehensive written policy that identifies the process by which a behavior intervention plan is determined to be appropriate. The licensee shall ensure that a behavior intervention plan is developed for each child for whom it is appropriate that includes: An assessment of each challenging behavior as identified in the individual plan of care; A description of the function of current behaviors including their frequency and severity; The behavioral objectives for the child including: Criteria for determining achievement of the objectives established; A description of the adaptive skills to be learned by a child that serve as alternatives to behaviors that present a danger to self or serious bodily harm to others; A description of the adaptive skills to be learned by a child that serve as functional alternatives to the challenging behavior or behaviors to be decreased; Identification of the individual or individuals responsible for monitoring the behavior intervention plan; The data to be collected to assess progress towards meeting the behavior intervention plan’s objectives; Documentation for the use of physical restraint, the reason for its use, and the length of time used; and For licensees of the Maryland Department of Health, documentation for the use of mechanical restraint, the reason for its use, and the length of time used; Take into account the medical condition of the child; and Describe the treatment techniques and when the techniques are to be used. Before implementation, the licensee shall ensure that each behavior intervention plan that includes the use of restraints includes the written informed consent of: The child, when appropriate; The child’s parent or legal guardian, when appropriate; and The placing agency’s designee. If the program is licensed to serve children with developmental disabilities, each behavior intervention plan that includes the use of restraints shall be approved by the standing committee established under COMAR 14.31.07.08 before the plan’s implementation. Behavior Support Services. A licensee who contracts for behavior support services as determined by the behavior intervention plan shall ensure that its contractor: Meets the requirements of this chapter; and Is knowledgeable about the licensing agency's service delivery system. Behavior support services may include: Behavioral consultation; Temporary augmentation of staff; Behavioral training; and Behavioral respite services. In addition to the training requirements in COMAR 10.22.02.10—.11 for licensees of the Maryland Department of Health and the training and requirements of this chapter, the licensee shall ensure that staff who provide behavior support services, before being assigned independent duties, receive training in the: Principles of behavioral change; and Use of a specific behavior management technique as outlined in the child’s behavior intervention plan. Discharge. For planned discharges, the licensee shall: Except for emergency shelter placement, and at least 30 days before a planned discharge, prepare a discharge plan which includes: The name, address, telephone number, and relationship of the individual with whom the child will be residing upon discharge; A statement of unmet identified and continuing needs including but not limited to behavioral and somatic health, education, family and peer relationships, employment, behavior, medications, and recommendation for follow-up treatment; and Within 30 calendar days after discharge, submit to the placing agency a discharge summary which includes: A final summary of the child’s performance in the program; A summary of the child’s health, dental, optical, and behavioral health records; and A summary of services provided to the child, including behavioral and somatic health, education, family and peer relationships, employment, behavior, medications, and recommendation for follow-up treatment. For unplanned discharges, the licensee shall: Provide at least 72 hours’ notice to the placing agency unless there is imminent risk of harm to self or others; At the time of discharge, provide to the placement agency a discharge plan which includes: Specific details of the reason for discharge; and A statement of unmet and continuing needs; and Within 30 calendar days after discharge, submit to the placing agency a discharge summary which includes: A final summary of the child’s performance in the program; A final summary of the child’s medical, dental, optical, and behavioral health records; and A summary of services provided to the child. General Requirements. The licensee shall: Submit reports and maintain records as directed by the licensing and contracting agencies in order to ensure compliance with these regulations and other federal and State laws; and Comply with requirements for incident reporting as specified by the licensing and contracting agencies. Confidentiality of Records. The licensee shall: Have and follow written procedures for the maintenance and security of individual case records and health records in accordance with State and federal law, which include: The identity of the staff persons responsible for the custody and maintenance of the records; A prohibition on the release of records except in accordance with law or contractual obligation; and A notice that employees may not disclose or knowingly permit the disclosure of any information concerning the child or the child’s family to any unauthorized person; Destroy records, in accordance with timelines established by State and federal law, in a manner that will preserve their confidentiality; and Ensure that if the program’s parent corporation dissolves, its individual case records concerning children served by the program are given to the placing agency. Record Maintenance. The licensee shall: Maintain a register of the children currently in the program which includes the child's: Name; Sex; Date of birth; Placing agency; and Dates of admission and anticipated discharge; Retain for the later of 5 years after discharge of a child, or 3 years after the child becomes 18 years old, individual case records; Retain financial records for at least 6 years from the date of their creation or after any contract with the State terminates; and Protect all documents against fire damage, theft, and unauthorized disclosure. Program Planning and Evaluation. The licensee shall have a formal process for program planning and evaluation which includes at least: A clearly stated written mission for the program approved by the board of directors; A set of measurable goals and objectives which is based upon the mission, program, population served, and State-mandated outcome measures; A periodic review of achievement of goals and objectives; and A correction plan approved by the Board for unmet goals. Program Quality Improvement. The licensee shall: Develop and implement an ongoing quality improvement plan; and Annually review and evaluate the quality and effectiveness of the services provided. Education Article, §§8-301—8-303 and 8-401—8-417; Family Law Article, §§5-506, 5-508—5-510;Health-General Article, §§2-104, 7-904, 8-404, 10-922, and 10-924; Health Occupations Article, §20-302;Human Services Article, §§2-209, 2-212, 9-203, 9-204, 9-221, 9-231, 9-234, and 9-235; Annotated Code of Maryland Effective date: November 22, 2004 (31:23 Md. R. 1651) COMAR 01.04.07 revised and recodified to COMAR 14.31.06 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 24, 2005 (32:23 Md. R. 1828) Regulation .02 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .03B amended effective May 19, 2008 (35:10 Md. R. 973); June 10, 2013 (40:11 Md. R. 975) Regulation .04 amended effective May 19, 2008 (35:10 Md. R. 973); June 10, 2013 (40:11 Md. R. 975) Regulation .05E amended effective April 13, 2015 (42:7 Md. R. 571) Regulation .06 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .06A amended effective May 19, 2008 (35:10 Md. R. 973) Regulation .07 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .08 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .09 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .09A amended effective May 19, 2008 (35:10 Md. R. 973) Regulation .10 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .11B amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .12 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .13 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .14 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .15 repealed and new Regulation .15 adopted effective May 19, 2008 (35:10 Md. R. 973) Regulation .15 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .16 amended effective June 10, 2013 (40:11 Md. R. 975) Regulation .17 amended effective August 4, 2014 (41:15 Md. R. 892) Regulation .18 amended effective June 10, 2013 (40:11 Md. R. 975); August 4, 2014 (41:15 Md. R. 892) Regulation .18A amended effective May 19, 2008 (35:10 Md. R. 973) Regulation .19 amended effective June 10, 2013 (40:11 Md. R. 975) The purpose of this chapter is to establish specialized licensing and monitoring standards that supplement or alter the core licensing standards of COMAR 14.31.05 and 14.31.06 for particular types of residential child care programs. This chapter contains specialized licensing standards for the following types of residential child care programs: State-operated residential educational facilities; Secure care programs; Wilderness programs; Programs for medically fragile children; Programs for children with developmental disabilities; Shelter care programs; Programs for pregnant adolescents; Mother-infant programs; Therapeutic group homes; Community mental health programs providing residential crisis services; and Community mental health programs providing respite care services. In this chapter, the definitions in COMAR 14.31.05 and 14.31.06 apply, and the following terms have the meanings indicated. Terms Defined. “Developmental Disabilities Administration” means the Developmental Disabilities Administration of the Maryland Department of Health. “Infant” means a child younger than 24 months old. “Locked door isolation” means the involuntary restriction of a child from others for a period of time to a designated area from which the child may not leave, for the purpose of providing the child with an opportunity to gain behavioral control. Scope. This regulation applies only to the Maryland School for the Deaf and the Maryland School for the Blind. Applicable Core Regulations. The standards for residential child care programs established in COMAR 14.31.05 apply to residential educational facilities only to the extent that they are specifically referenced in §§D—F of this regulation. Licensing and Monitoring. Licensing Agency. The Department of Human Services is the licensing agency for residential education facilities. A residential educational facility may request a variance or waiver of the provisions listed in this subsection by filing a request for variance or waiver under COMAR 14.31.05.13. Residential educational facilities shall be monitored and evaluated as provided in COMAR 14.31.05.07 —.09 only with respect to the standards set out in §§D—F of this regulation. The governance and operation of residential educational facilities shall otherwise be regulated under the provisions of Education Article, §8-301 et seq., Annotated Code of Maryland. Licensing Standards. Employees of residential education facilities who provide supervision for children when the children are not attending school shall provide the licensee with documentation of: An annual screening for tuberculosis administered by the Mantoux method or current Centers for Disease Control and Prevention standard with an analysis of results or, for those staff members whose results were positive, an annual medication certification that the staff member presents no symptoms of active tuberculosis; A copy of current cardiopulmonary resuscitation certification; A written statement of medical examination by a licensed physician, made at the time of the staff member's employment, certifying that the physician has examined the staff member and found nothing in the individual's general, physical, or emotional condition which would endanger the health and well-being of children; Request for criminal background check and copy of outcome upon receipt; and Protective services clearance from the appropriate department of social services. Licensee Documentation. The licensee shall provide the licensing agency annually with documentation of: On-site fire inspections by the local fire department; On-site health inspections by the local health department; and Weekly menus approved by an individual licensed by the State to practice dietetics. Child Abuse and Neglect Reporting. The licensee shall provide the licensing agency with: A written procedure for reporting child abuse or neglect; A verbal report of any suspected child abuse or neglect within 1 hour of the suspected abuse or neglect; A written report within 24 hours of the suspected abuse or neglect; and A written incident report within 24 hours of any incident which threatens the life, health, or general well being of a child in care. Licensing Requirements. In addition to the requirements set out in this regulation, a licensee that provides secure care shall also meet the requirements of COMAR 14.31.05 and 14.31.06. Security. In order to have a license as a secure care program, a licensee shall: Be licensed by the Department of Juvenile Services; Identify in its application for licensure the specific security measures to be used by the program and demonstrate that the measures are necessary in order to provide care for the children to be served by the applicant; Structure the physical plant so that it has: A 24-hour control center for monitoring and coordinating its security, safety, and communication systems; A perimeter that can retain the children within it and prevent unauthorized access into it; and Doors that open out from any room used by children; Assign and deploy staff so that the children are visually supervised and staff are able to respond immediately to emergencies; Open mail addressed to a child in front of the child to check for contraband; Inspect: On a weekly basis: The operation of all security devices; and For the presence of contraband; and On a daily basis, all areas occupied by the children; and Document all inspections and immediately correct all problems or defects found during the inspections. Restraints. The licensee: May use restraints on children only in conformity with this regulation; Shall have and follow a written policy on the use of restraints that: Identifies the type of restraints used by the licensee; Specifies the criteria for the use of each type of restraint and that the staff authorizes approval and use of each type; and Establishes procedures for the: Monitoring and supervision of children in restraints; Immediate review of the use of restraints; and Documentation of each use of restraints; Shall prohibit the use of restraint in any manner that causes the child physical pain or undue anxiety; and Shall train staff upon employment and annually after that in the proper use of restraint. Locked-Door Isolation. A licensee may place a child in locked-door isolation only if: Locked-door isolation is clearly necessary to prevent imminent physical harm to the child or other individuals; and Less restrictive methods of behavior control have failed or cannot reasonably be implemented. A licensee shall have and follow written procedures for the use of locked-door isolation that identify the staff authorized to approve the use of locked-door isolation. A licensee shall ensure that a child placed in locked-door isolation: Does not possess belts, matches, weapons, or other objects or materials that might be used to inflict self-injury; Does not present imminent danger to self or others; Is offered 1 hour of large muscle activity every 24 hours that takes place out-of-room and, weather permitting, out-of-doors; Has all reasonable personal physical needs met; Receives all scheduled meals and snacks on time; and Is granted prompt access to bathroom facilities. Staff shall monitor a child in locked-door isolation by: Maintaining auditory contact with the child at all times; Making visual contact with the child every 10 minutes; and Recording each contact with the child in a permanently bound logbook. The licensee shall ensure that a room used for locked-door isolation is designed and constructed to safeguard the health, safety, and well-being of children. The room used for locked door isolation shall have: An area of at least 60 square feet; A tamper-proof ceiling light fixture with a minimum of a 75-watt bulb; A door with a window that is impact-resistant, shatterproof, and mounted to allow inspection of the entire room; Adequate ventilation; and Equipment and fixtures that are designed and maintained in a manner to prevent their use in an attempted suicide. In order for a child to be held in locked-door isolation for longer than 30 minutes during a 12-hour period, the program administrator shall: Approve the locked-door isolation every 2 hours; Obtain for the child every 2 hours an examination by a physician or nurse; Notify the placing agency and the child's parent if the locked-door isolation continues for more than 8 hours; and Remove a child from locked-door isolation after 72 hours. Additional Requirements. In addition to the requirements set forth in COMAR 14.31.05 and 14.31.06, a licensee shall ensure that a wilderness program also meets the requirements of this regulation. With the exception of §§B and C of this regulation, the requirements of COMAR 14.31.06.07 are not applicable to wilderness programs. Living Environment. The living environment, including all sleeping and food preparation, and personal hygiene facilities, of a wilderness program shall: Be well drained and free from depressions in which water may stagnate; Be free from noxious plants and uncontrolled weeds or brush; and Have an approved sanitary landfill or similar disposal facility for solid wastes that is not subject to inundation by flooding. The licensee shall ensure that every wilderness site has available an adequate supply of potable water. Food Preparation and Storage. If food is prepared at a central dining building, the licensee shall meet the requirements set out in COMAR 14.31.06.07 for kitchens. If food is prepared away from a central dining building, the licensee shall: Store food in a manner that deters spoilage and contamination; Ensure that perishable food stored in ice chests is: Maintained at a refrigerated temperature; and Is not stored in an ice chest for more than 24 hours; Ensure that all surfaces that come in contact with food are clean and, when preparing meat products and other foods, not sources of cross contamination; and Clean thoroughly and store all dishes, cooking, and eating utensils in a manner to avoid contamination. Toilet and Personal Hygiene Facilities. If a water supply is not available, the licensee shall provide sanitary type privies, or portable toilets, that meet local or State health department standards. The licensee shall maintain all toilet and personal hygiene areas in a sanitary manner to eliminate health or pollution hazards. The licensee shall locate privies at least 150 feet from a stream, lake, or well and at least 75 feet from a sleeping area. At sites not equipped with a permanent toilet facility, the licensee shall provide at least one privy or portable toilet for every 15 people. Heating. The licensee shall install and ventilate heating stoves that use combustible fuel in a manner that prevents fire hazards and dangerous concentrations of gases. Sleeping Areas. The licensee shall use: Bedding that is adequate for protection and comfort in cold weather; Sleeping bags that are fiber-filled, fire retardant, and rated for 0°F; Mattresses and pillows that meet federal regulations; and Screening or mosquito nets in the children's personal sleeping areas. Clothing. The licensee shall provide each child with an adequate supply of clean clothing, suitable for outdoor living and appropriate for weather conditions, and sturdy, water resistant outdoor shoes or boots. Fire Safety. The licensee shall equip each wilderness site with a fire extinguisher located not more than 75 feet from each combustible fuel heating device or campfire. Additional Requirements. In addition to the requirements set out in COMAR 14.31.05 and 14.31.06, a program for medically fragile children also shall meet the requirements of this regulation. Staff. The licensee shall: Ensure that a health care professional licensed to practice in the State trains child care staff, based on the individual needs of each child; and Obtain consultation services from a pediatric medical specialist for input on the placement of and ongoing care decisions regarding the children. Physical Plant. If specialized equipment is necessary for a child, the licensee shall provide adequate square footage space in excess of the minimum standards otherwise required by COMAR 14.31.06. The licensee shall equip the physical plant with sufficient electrical service and outlets for assistive technology or special equipment. The licensee shall maintain a back-up generator for electrical outages and, if necessary, provide for emergency sources of heat. Emergency Medical Plan. The licensee shall ensure that each child's individual service plan includes a child-specific emergency protocol that is immediately accessible to employees. Emergency Management Plan. As part of its emergency management plan, the licensee shall notify public utilities of the existence of the program. Additional Requirements. In addition to the requirements set out in COMAR 14.31.05 and 14.31.06, a program for children with developmental disabilities also shall meet the requirements of this regulation. Quality Assurance. The licensee shall conform to the quality assurance standards established in COMAR 10.22.02.14. Standing Committee. The licensee shall establish a standing committee or committees to: Perform the quality assurance functions set forth in COMAR 14.31.05; Review the licensee's protocol for identifying, reporting, documenting, investigating, and reviewing of incidents to ensure compliance with the licensing agency's procedures; Monitor implementation of the licensee's protocol identified in §C(2) of this regulation, including a review of all incidents in an effort to identify deficient practices and recommend necessary corrective action; Approve all behavior plans that use restrictive techniques to ensure that the behavior plan complies with the requirements of COMAR 10.22.10, 10.22.04.03A, and 14.31.05.15; Review, approve, and establish the time frame for the restriction of a right if it is not related to a challenging behavior, in accordance with COMAR 10.22.04.03A, or other requirements appropriate to the licensing agency; Review the licensee's policies and procedures and practices to ensure that they adequately protect the legal and human rights of each child served by the licensee; and Unless otherwise provided for, be organized to perform the functions set forth in §A of this regulation for one or more licensees. Standing Committee Composition. For programs licensed by the Maryland Department of Health, the committee or committees shall include an equal number of licensee staff, and child proponents or members of the community who are not employed by the licensee. For a committee member who is remunerated only to serve as a member of the committee, that member is not counted as staff or as a member of the community. For programs serving children with developmental disabilities licensed by other licensing agencies, the committee shall be established in accord with the licensing agency's policy. Consultation. The committee or committees may consult with a licensed health professional such as a social worker, psychologist, physician, physician's assistant, nurse practitioner, or board-certified clinical pharmacist, as needed. Conflict of Interest. A committee member may not participate in the decision making process of any: Incident in which the committee member was involved; or Behavior plan that the committee member has developed. Meetings. The committee or committees shall meet as needed to perform the functions identified in §E of this regulation, with at least a majority of members present. Confidentiality. The committee or committees shall ensure confidentiality of information regarding the child in accordance with Health-General Article, §7-1010, Annotated Code of Maryland, and COMAR 14.31.06.18. Use of Restraints. For licensees of the Maryland Department of Health, appropriate methods of preventing or managing challenging behaviors may include the use of mechanical restraints. Change in Licensure Status. A licensee may voluntarily surrender its license in accordance with COMAR 10.22.02.02F. A licensee wishing to open, close, or relocate a site shall meet the requirements of COMAR 14.31.05.05. If a licensee is required to open, close, or relocate a site due to an emergency and the notice requirements set forth in COMAR 14.31.05.09E cannot be met, the licensee shall notify the regional director who shall notify the licensing agency to ensure compliance with all relevant regulations. Policies and Procedures. A licensee shall develop and adopt written policies and procedures in addition to those policies and procedures required in COMAR 14.31.06 to ensure: The fundamental rights of residents in accordance with Health-General Article, §7-1002, Annotated Code of Maryland; Confidentiality for each individual in accordance with Health-General Article, §7-1010, Annotated Code of Maryland; The implementation of a grievance process with safeguards that protect against retaliatory actions for the filing of any grievance; The reporting and investigation of all incidents, including those involving life-threatening conditions, in accordance with the Developmental Disabilities Administration's procedures on reportable incidents; The administration of medications in accordance with the practices established by the curriculum of the Developmental Disabilities Administration on medication training; Compliance with COMAR 10.27.11; Assurance that, before a child is to be required to pay for property damage caused by the individual's actions, the child's individual plan shows evidence that: The child has a history of destructive behavior that has been documented in the child's behavior plan; The child has a behavior plan that addresses the destructive behavior; The child's family has the ability to pay for damages; The licensee's standing committee has reviewed and approved the damage payment; and The licensee has reported this approval to the regional director of the Developmental Disabilities Administration; Compliance with Health-General Article, §5-605, Annotated Code of Maryland; and The absence of a financial or personal conflict of interest for members of the governing body, staff, care providers, volunteers, and standing committee members in their work with the program. In addition to the requirements set out in COMAR 14.31.05 and 14.31.06, a licensee shall ensure a program that provides shelter care also meets the requirements of this regulation. Requirements for Non-Agency Placements. If a person or entity other than an agency places a child in shelter care, the licensee shall seek authorization for the placement by: Moving, within 24 hours after admission, to acquire legal custody of the child; or Requesting the consent of the child's parent for the placement and for any routine or emergency medical, dental, or mental health care. If the licensee is unable to obtain consent, the licensee shall document the efforts made to obtain consent and the reasons for the failure. The licensee shall ensure that a child newly admitted to shelter care receives timely health care, including: Within 24 hours of admission, an initial health screening by a medical care provider; Immediate treatment of any communicable disease or serious injury; and Within 30 days of admission, a comprehensive medical examination. The licensee shall ensure the provision of appropriate educational services for all children placed in the facility in accordance with the requirements of COMAR 14.31.06.12A. In addition to the requirements set out in COMAR 14.31.05 and 14.31.06, a licensee shall ensure a program caring for pregnant adolescents also meets the requirements of this regulation. A program caring for pregnant adolescents shall ensure that: All pregnant adolescents receive comprehensive prenatal care, including: A medical care program outlined by a licensed medical professional; and Participation in a child birth class provided by a qualified and competent childbirth educator. Arrangements for the delivery of the child are made: By the end of the second trimester; In situations when the adolescent is already pregnant beyond the second trimester, upon admission to the facility; or Within 15 consecutive calendar days of the adolescent's admission to the facility. Delivery arrangements are clearly recorded in the adolescent's medical record to which appropriate employees have access in an emergency; Pregnant adolescents receive a dental examination within 3 consecutive calendar months of admission, and that needed dental care is provided; Identification of pediatric services is provided at least 3 months before anticipated delivery; and Day care arrangements in an approved day care home or center are made. In addition to the requirements set out in COMAR 14.31.05 and 14.31.06, a licensee shall ensure a program that provides mother-infant services also meets the requirements of this regulation. A licensee may provide care and service for children who are mothers with an infant if: The licensing agency approves the program in writing; The licensee ensures that adolescents follow the advice of a licensed physician regarding the health care of the adolescent's child; The licensee provides the mother with: Sanitary space, a table, and plumbing necessary to change diapers; Competent instruction in the care and nurturing of infants; Limits on her social activities to ensure that she is responsible for her infant; Opportunity, encouragement, and structure for the completion of her education; Encouragement to develop her capacity for and understanding of her independence; Assurance that any child care center or home where the infant may be placed during daytime hours is licensed under State law; Professional guidance, training, and counseling in human sexuality; and A bed in a room separate from where the infant sleeps after the infant is 6 months old; The licensee assures that the infant is provided with: Protection from harm; Access to health care; Proper food and nutrition; Physical warmth and nurture; Protection from disease; Physical comfort; Proper sleeping environment in an appropriate crib; Appropriate feeding schedule; Regularly changed diapers in a sanitary environment; When the infant is 6 months old, a crib in a room separate from where the mother sleeps; Pediatric care in accordance with Early and Periodic Screening, Diagnosis, and Treatment schedules; and Required immunizations; The licensee ensures that direct care workers in this program: Receive 10 hours of training specific to infant care before assuming duties in a mother-infant program as part of the training requirements of COMAR 14.31.06; and Annually receive 15 hours of training specific to the mother-infant program as part of the training requirements of COMAR 14.31.06; and The program provides the licensing agency with a written policy regarding the care of an adolescent's child by another adolescent in residence in which the following conditions are met: The adolescent assumes care of no more than one other child in addition to her own at any time; The adolescents discuss the expectations of the caregiver, including: Duration of child care; The child's nutritional and toileting needs; and Any arrangements for compensation or exchange of baby-sitting; and The arrangement is reviewed and approved by the program administrator or the program administrator's designee. A therapeutic group home shall meet the requirements of COMAR 14.31.05 and 14.31.06, with the following exceptions: COMAR 14.31.06.17B; COMAR 14.31.06.17C; and COMAR 14.31.06.17D. A therapeutic group home shall also meet the requirements of the following regulations found in COMAR 10.21.07: COMAR 10.21.07.02; COMAR 10.21.07.03B; COMAR 10.21.07.05B; COMAR 10.21.07.05C; COMAR 10.21.07.06B; COMAR 10.21.07.07; COMAR 10.21.07.08A(1); COMAR 10.21.07.08C; COMAR 10.21.07.09; COMAR 10.21.07.10C; COMAR 10.21.07.11; COMAR 10.21.07.12; COMAR 10.21.07.13B; COMAR 10.21.07.14; and COMAR 10.21.07.17B. In addition to the requirements of COMAR 14.31.05 and 14.31.06, a community mental health program providing residential crisis services shall meet the requirements of COMAR 10.21.26. In addition to the requirements of COMAR 14.31.05 and 14.31.06, a community mental health program providing respite care services shall meet the requirements of COMAR 10.21.27. Article 41, §§6-101 and 6-104; Article 83C, §§2-102, 2-104, 2-113, 2-120, and 2-123—2-125; Education Article, §§8-301—8-303; Family Law Article, §§5-506, 5-508, 5-509, 5-509.1, and 5-510; Health-General Article, §§2-104, 7-904, 8-404, 10-922, and 10-924; Annotated Code of Maryland Effective date: November 22, 2004 (31:23 Md. R. 1651) COMAR 01.04.08 revised and recodified to COMAR 14.31.07 as an emergency provision effective June 30, 2005 (32:15 Md. R. 1314); revised and recodified permanently effective November 28, 2005 (32:23 Md. R. 1828) Effective date: Regulations .01—.09 adopted as an emergency provision effective September 17, 2007 (34:21 Md. R. 1911); adopted permanently effective October 8, 2007 (34:20 Md. R. 1741) Regulations .01—.09 repealed effective March 31, 2014 (41:6 Md. R. 381) The purpose of this chapter is to establish a process for developing and issuing a statement of need for residential child care programs licensed by the Department of Human Services or the Department of Juvenile Services. This chapter applies to the development and issuance of a statement of need for residential child care programs to be licensed by the Department of Human Services or the Department of Juvenile Services. This chapter also applies to the relocation of an existing or previously licensed residential child care program to another site and the expansion or increase in the number of placements of an existing residential child care program. In this chapter, the following terms have the meanings indicated. Terms Defined. “Agencies” means the Department of Human Services and the Department of Juvenile Services. “Expansion request” means the materials required by the Office submitted by a licensed provider that seeks to add additional beds to an existing facility, to expand the physical site or to duplicate a residential child care program in a new location. “Facility” means the physical premises where a residential child care program that is licensed by the Department of Human Services or the Department of Juvenile Services is operated. “Licensing” means the process undertaken by the Agencies to issue, suspend, revoke, or deny a license. “Office” means the Governor's Office for Children. “Proposal” means the materials required by the Office, submitted by a potential new provider or an established provider, to develop a new residential child care facility or program, or an expansion request. “Provider” means the operator of a residential child care program. “Residential child care program” means a program of care provided in a residential setting by a provider on a 24-hour basis, for longer than 24 hours, to a child or children, unless otherwise provided by State law. A residential child care program does not include any program licensed by Maryland Department of Health. “Statement of need” means an official certification of public need in a county or region issued by one of the Agencies for the location and/or establishment of a residential child care program. A Statement of Need shall be issued by the Department of Human Services or the Department of Juvenile Services before: A prospective licensee may submit to the Office a proposal for a residential child care program in accordance with COMAR 14.31.02; An existing or previously licensed residential child care program is relocated to another site; The physical site of a residential child care program is expanded; or The number of placements in a residential child care program is increased. In developing a statement of need, the Agencies shall: Consider needs identified in the State Resource Plan and the Interagency Strategic Plan; Consider the specialized mental, physical, and behavioral health and development needs of children in the county or region affected by the statement of need; and Give notice and an opportunity to comment on the proposed statement of need to stakeholders in the counties or regions affected by the statement of need, including: State and local child-serving agencies; Providers of residential and community-based services for children; and Children, parents, foster parents, and other guardians. When the need for a residential child care program is identified, the Agencies shall publish a notice of a statement of need in the Maryland Register. The statement of need shall include: Identification of the geographic area or areas of need, including the primary region or regions of residence of the children who will be placed in the facility; Identification of population to be served, including specialized mental, physical, behavioral health, and developmental needs of the children affected by the statement of need; Description of services that will be provided; Description of the current availability of the proposed services in the region or regions; Description of the actual or projected number of children who need the proposed services from the region or regions; Number of beds required; Description of the methodology used as the basis for the agency's calculations set forth in a manner that permits independent verification if requested; Date by which proposals must be submitted; Date by which beds must be available; and Selection criteria. Proposals for a residential child care program must be submitted to the Office in accordance with COMAR 14.31.02 only in response to a published statement of need. The Agencies may not grant a license for a residential child care program unless a statement of need has been issued. The Agencies may not delegate their authority to issue a statement of need. The Agencies shall perform the licensure for a residential child care program in accordance with the applicable provisions of COMAR 14.31.05. The Agencies shall perform an evaluation of responses to requests for proposals, and selection of a contractor in accordance with the applicable provisions of COMAR 21.05.03 and other applicable statutes and regulations. When the licensing agency rejects a proposal submitted in response to a request for proposals issued in conjunction with a statement of need under this regulation, a provider has a right to protest the rejection to the licensing agency procurement officer under the protest provisions of COMAR 21.10.02. A provider has a right to a hearing under the licensing provisions of COMAR 14.31.05.10 when the licensing agency denies an application for a license under this regulation. Human Services Article, §§2-209, 8-703.1, and 9-204, Annotated Code of Maryland Effective date: July 26, 2010 (37:15 Md. R. 1000)