Sec. 14.31.06.13. Health Care

A. General Health Services. The licensee shall:

(1) Establish and implement a written plan for the provision of preventive, routine, and emergency medical, dental, optical, and mental health care for the children;

(2) Establish and implement a written policy for documenting and addressing health complaints; and

(3) Obtain written authorization from a parent, legal guardian, or other authorized individual for emergency and non-emergency medical, dental, optical, or mental health care.

B. Medication Administration Policy.

(1) The licensee shall observe written policies for the management and administration of medications to children.

(2) The policy shall comply with all relevant State statutes and regulations.

C. Medication Management.

(1) The licensee shall maintain medications as follows:

(a) 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;

(b) 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

(c) The licensee shall discard outdated or discontinued prescription and over-the-counter medications in a manner that prohibits misuse.

(2) For a newly admitted child, the licensee shall:

(a) Continue any current medications that the child is receiving at the time of admission to the program; and

(b) 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.

(3) For each child in the program who receives medications, the licensee shall:

(a) 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

(b) Document all medication taken, including the:

(i) Name of the child;

(ii) Name of the medication;

(iii) Frequency and dosage of the medication;

(iv) Date, time, and type of administration of the medication; and

(v) Name and signature of the employee who administered the medication or supervised its self-administration;

(c) Notify the prescribing physician in any case of a medication error or drug reaction; and

(d) 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.

(4) The licensee shall include the training provided under Regulation .05E(4)(g) of this chapter to all direct care staff regarding:

(a) The therapeutic benefits and side effects of medications used by children in the program; and

(b) Medication administration, in accordance with the requirements of §B of this regulation.

(5) The licensee shall prohibit the use of medication for the purpose of group control, experimentation, or research.

(6) 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.

D. Somatic Health Care. The licensee shall:

(1) Establish and implement written policies and procedures for the provision of somatic health care services;

(2) 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;

(3) Arrange for access to prompt diagnosis and treatment of acute illnesses;

(4) Arrange for access to continuing care for chronic illnesses;

(5) Arrange for hospitalization for a child when deemed necessary by the licensee’s somatic health care provider; and

(6) 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

E. Dental Care. The licensee shall:

(1) Provide the children with access to dental care through a dentist licensed to practice dentistry in the State;

(2) 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;

(3) Have each child examined by a dentist at least every 12 months or more frequently as prescribed by the dentist; and

(4) Arrange for access to prompt treatment of acute dental needs.

F. 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.

G. Immunization. The licensee shall:

(1) 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

(2) Maintain a record of immunizations in the child's individual case record.

H. Physical Examination. The licensee shall secure a physical examination for each child, with a copy of the documentation of the examination:

(1) 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

(2) 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.

I. 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:

(1) Communication of the need for immediate assistance;

(2) Transportation of the child;

(3) 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

(4) Supervision of the child and the children remaining at the program.

J. Communicable Diseases. The licensee shall:

(1) Establish and implement a policy for managing communicable diseases, including isolation when necessary;

(2) Establish and implement a policy that requires staff to exercise standard precautions with respect to communicable diseases and infection control; and

(3) 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.

K. Suicide Prevention. The licensee shall establish and follow procedures for suicide prevention and intervention.