(a) The psychiatric residential treatment facility shall have:

1. (1) A physician currently licensed by the Arkansas State Medical Board who has experience in the practice of adolescent psychiatry;
2. (2) A director of nursing or nurse manager currently licensed in Arkansas as a registered nurse;
3. (3) A clinical director who has at least a master’s degree in a human services field and is currently licensed in Arkansas as a mental health professional as recognized by the Arkansas Medicaid Program;
4. (4) One (1) or more therapists having at least a master’s degree in a human services field and who are currently licensed as a mental health professional as recognized by the Arkansas Medicaid Program; and
5. (5) A therapist assigned to each child who is responsible for assessments, treatment planning, and casework services.

(d)

1. (1) The psychiatric residential treatment facility shall maintain the following minimum staffing ratios:

   1. (A) One (1) staff person per four (4) residents, for a minimum ratio of one to four (1:4), from 6:00 a.m. to 10:00 p.m., or 7:00 a.m. to 11:00 p.m.; and
   2. (B) One (1) staff person per eight (8) residents, for a minimum ratio of one to eight (1:8), from 10:00 p.m. to 6:00 a.m., or 11:00 p.m. to 7:00 a.m., depending on age and need.

2. (2) The staff, for purposes of this ratio, shall:

   1. (A) Be staff dedicated to provide direct care in that particular milieu;
   2. (B) Be awake at all times;
   3. (C) Provide and document a visual check on each child at least every fifteen (15) minutes but no greater than twenty (20) minutes during the one to eight (1:8) ratio;
   4. (D) Provide supervision and treatment on each child during the one to four (1:4) ratio.
3. (3) The psychiatric residential treatment facility shall maintain a daily census report to include the child’s name and room or building assignment.

(f)

1. (1) Staffing ratios listed above are a minimum standard.

2. (2) The psychiatric residential treatment facility shall have written policies and procedures that:

   1. (A) Demonstrate how the staffing pattern will be adjusted when necessary to meet the individual needs and acuity of youth as those fluctuate over time;
   2. (B) Document how the psychiatric residential treatment facility continuously monitors the appropriateness of its staffing pattern to ensure the safety of both the residents and the staff;
   3. (C) Shall include specific methods used by the psychiatric residential treatment facility to monitor metrics such as restraints and seclusions and other adverse incidents, and documentation of how the psychiatric residential treatment facility uses this monitoring to make ongoing decisions about staffing patterns; and
   4. (D) Document how the psychiatric residential treatment facility continuously monitors the appropriateness of its staffing pattern to ensure that residents receive appropriate, individualized care, treatment, and therapeutic interactions.
3. (3) The documentation in this subsection shall include specific methods used by the psychiatric residential treatment facility to monitor metrics such as clinical progress and outcomes, and documentation of how the psychiatric residential treatment facility uses this monitoring to make ongoing decisions about staffing patterns.

(g)

1. (1) Beds exceeding licensure and permit will be authorized only in cases of emergency.
2. (2) An emergency exists when it can be demonstrated that the resident’s health or safety would be placed in immediate jeopardy if relocation were not accomplished.
3. (3) A fire, natural disaster such as a flood or tornado, or other catastrophic event that necessitates resident relocation will be considered an emergency.
4. (4) The Office of Long-Term Care must be contacted for prior authorization of the overbed, and all authorizations must be in writing.