1. (a) At least one caregiver shall be on duty in a residential psychiatric treatment center whenever at least one child in treatment is present. At least two caregivers, at least one of whom is awake during the resident sleeping hours, shall be on duty in a residential psychiatric treatment center whenever two or more or more children who are under 10 years of age are present.

2. (b) Except as provided in (a) of this section, the caregiver-to-child ratio in a residential psychiatric treatment center must be as follows:

   1. (1) in a facility or separate unit of the facility with fewer than 10 residents, one caregiver for every three children during any time children are awake and engaged in activity that is outside their sleeping quarters or outside sleeping hours;
   2. (2) in a facility or separate unit of the facility with 10 or more residents, one caregiver for every five children during any time children are awake and engaged in activity that is outside their sleeping quarters or outside sleeping hours;

   3. (3) one awake caregiver during sleeping hours for every six children who are less than 10 years of age, or one awake caregiver for every 10 children who are 10 years of age or greater, if

      1. (A) the facility has in place procedures for the caregiver to be able to call in another awake staff member as needed; and
      2. (B) the caregiver has access to an on-call mental health professional for consultation.

3. (c) For purposes of this section, the administrator, medical director, or clinical director may each be counted as a caregiver, if the

   1. (1) facility serves nine or fewer children; and

   2. (2) administrator, medical director, or clinical director is

      1. (A) physically present in or adjacent to the treatment or activity unit or other space where the children are currently located, or is present in an area adjoining the location of the children; and
      2. (B) known by the children and other caregivers to be readily accessible and available to meet their needs.
4. (d) The residential psychiatric treatment center shall have procedures in place to add more caregiver staff on any shift if internal or external circumstances justify the use of additional staff to keep the residents or employees safe, or to meet the treatment needs of one or more residents.

(Eff. 6/21/2001, Register 158)