Sec. 14.31.07.05. Secure Care Programs

A. 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.

B. Security. In order to have a license as a secure care program, a licensee shall:

(1) Be licensed by the Department of Juvenile Services;

(2) 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;

(3) Structure the physical plant so that it has:

(a) A 24-hour control center for monitoring and coordinating its security, safety, and communication systems;

(b) A perimeter that can retain the children within it and prevent unauthorized access into it; and

(c) Doors that open out from any room used by children;

(4) Assign and deploy staff so that the children are visually supervised and staff are able to respond immediately to emergencies;

(5) Open mail addressed to a child in front of the child to check for contraband;

(6) Inspect:

(a) On a weekly basis:

(i) The operation of all security devices; and

(ii) For the presence of contraband; and

(b) On a daily basis, all areas occupied by the children; and

(7) Document all inspections and immediately correct all problems or defects found during the inspections.

C. Restraints. The licensee:

(1) May use restraints on children only in conformity with this regulation;

(2) Shall have and follow a written policy on the use of restraints that:

(a) Identifies the type of restraints used by the licensee;

(b) Specifies the criteria for the use of each type of restraint and that the staff authorizes approval and use of each type; and

(c) Establishes procedures for the:

(i) Monitoring and supervision of children in restraints;

(ii) Immediate review of the use of restraints; and

(iii) Documentation of each use of restraints;

(3) Shall prohibit the use of restraint in any manner that causes the child physical pain or undue anxiety; and

(4) Shall train staff upon employment and annually after that in the proper use of restraint.

D. Locked-Door Isolation.

(1) A licensee may place a child in locked-door isolation only if:

(a) Locked-door isolation is clearly necessary to prevent imminent physical harm to the child or other individuals; and

(b) Less restrictive methods of behavior control have failed or cannot reasonably be implemented.

(2) 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.

(3) A licensee shall ensure that a child placed in locked-door isolation:

(a) Does not possess belts, matches, weapons, or other objects or materials that might be used to inflict self-injury;

(b) Does not present imminent danger to self or others;

(c) Is offered 1 hour of large muscle activity every 24 hours that takes place out-of-room and, weather permitting, out-of-doors;

(d) Has all reasonable personal physical needs met;

(e) Receives all scheduled meals and snacks on time; and

(f) Is granted prompt access to bathroom facilities.

(4) Staff shall monitor a child in locked-door isolation by:

(a) Maintaining auditory contact with the child at all times;

(b) Making visual contact with the child every 10 minutes; and

(c) Recording each contact with the child in a permanently bound logbook.

(5) 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.

(6) The room used for locked door isolation shall have:

(a) An area of at least 60 square feet;

(b) A tamper-proof ceiling light fixture with a minimum of a 75-watt bulb;

(c) A door with a window that is impact-resistant, shatterproof, and mounted to allow inspection of the entire room;

(d) Adequate ventilation; and

(e) Equipment and fixtures that are designed and maintained in a manner to prevent their use in an attempted suicide.

(7) 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:

(a) Approve the locked-door isolation every 2 hours;

(b) Obtain for the child every 2 hours an examination by a physician or nurse;

(c) Notify the placing agency and the child's parent if the locked-door isolation continues for more than 8 hours; and

(d) Remove a child from locked-door isolation after 72 hours.