8026 PSYCHIATRIC CRISIS STABILIZATION PROGRAM REQUIREMENTS

8026.1 Psychiatric crisis stabilization services offer therapeutic, community-based, home-like treatment for individual age eighteen (18) or older living in the community; who are in need of support to ameliorate psychiatric symptoms; who are voluntary; and, based upon a psychiatric assessment conducted on-site, are deemed appropriate for residential services within a structured, closely monitored temporary setting.

8026.2 Psychiatric crisis stabilization services shall provide an opportunity for individuals to move out of a stressful situation into a safe and secure therapeutic environment in order to prevent acute psychiatric hospitalization or to maintain stabilization following a hospital stay.

8026.3 Psychiatric crisis stabilization programs shall ensure that all referrals are screened by a psychiatrist upon admission and that there is documented evidence of the need for psychiatric crisis stabilization services.

8026.4 Each program shall be equipped, furnished, and maintained to provide a functional, safe, and comfortable home-like setting.

8026.5 Psychiatric crisis stabilization programs shall permit, as appropriate, each individual served to bring reasonable personal possessions, including clothing and personal articles, to the facility unless the provider demonstrates that it is not practical, feasible, or safe.

8026.6 Each program shall, as appropriate, provide individuals with access to reasonable individual storage space for private use.

8026.7 Upon an individual's discharge, the provider shall return to the individual or the individual's representative as appropriate, any personal articles held by the provider for safekeeping. The provider shall also ensure that the individual is permitted to take all of their personal possessions from the facility. The provider may require the individual or the individual's representative to sign a statement acknowledging receipt of the property. The provider shall place a copy of that in the individual's record.

8026.8 Each program shall maintain, as appropriate, a separate and accurate record of all funds that the individual, individual's representative or representative payee deposits with the provider for safekeeping. This record shall include the signature of the individual for each withdrawal and the signature of facility staff for each deposit and disbursement made on behalf of an individual served.

8026.9 Each program site shall be equipped with a functioning landline or mobile

telephone for use by individuals served, as appropriate. The telephone numbers shall be provided to residents and to the Department.

8026.10 Staff break rooms shall be separate from resident bedrooms.

8026.11 Each program site shall have a functioning doorbell or knocker.

8026.12 Each bedroom shall comply with the space and occupancy requirements for habitable rooms in 14 DCMR § 402.

8026.13 The provider shall ensure each individual has the following items:

(a) A bed, which is not a cot;

(b) A mattress that was new when purchased by the provider, has a manufacturer's tag or label attached to it, and is in good, intact condition with unbroken springs and clean surface fabric;

(c) A bedside table or cabinet and an individual reading lamp with at least a seventy-five (75) watt, or its LED light bulb equivalent, rate of capacity;

(d) Storage space in a stationary cabinet, chest, or closet that provides at least one (1) cubic foot of space for each individual served for valuables and personal items;

(e) Sufficient suitable storage space, including a dresser and closet space, for personal clothing, shoes, accessories, and other personal items; and

(f) A waste receptacle and clothes hamper with lid.

8026.14 Each bed shall be placed at least three (3) feet from any other bed and from any uncovered radiator.

8026.15 Each bedroom shall have direct access to a major corridor and at least one (1) window to the outside, unless DCRA, or a successor agency responsible for enforcement of the D.C. Housing Code, has determined that it otherwise meets the lighting and ventilation requirements of the D.C. Housing Code for habitable rooms.

8026.16 Each facility housing a residential program shall provide one (1) or more bathrooms for individuals that are equipped with the following fixtures, properly installed and maintained in good working condition:

(a) Toilet (water closet);

1. (b) Sink (lavatory);
2. (c) Shower or bathtub with shower, including a handheld shower; and
3. (d) Grab bars in showers, bathtubs, and by the toilets.8026.17 Each program site shall provide at least one (1) bathroom for each six (6) occupants in compliance with 14 DCMR § 602.8026.18 Each bathroom shall be adequately equipped with the following:- (a) Toilet paper holder and toilet paper;
4. (b) Paper towel holder and paper towels or clean hand towels;
5. (c) Soap;
6. (d) Mirror;
7. (e) Adequate lighting;
8. (f) Waste receptacle;
9. (g) Floor mat;
10. (h) Non-skid tub mat or decals; and
11. (i) Shower curtain or shower door.8026.19 The provider shall ensure each individual's privacy and safety in the bathroom.8026.20 Each residential program shall promote each individual's participation and skill development in menu planning, shopping, food storage, and kitchen maintenance, if appropriate.8026.21 Each residential program shall provide appropriate equipment (including a washing machine and dryer) and supplies on the premises or through a laundry service to ensure sufficient clean linen and the proper sanitary washing and handling of linen and the individual's personal clothing.8026.22 Each program shall ensure that every individual has at least three (3) washcloths, two (2) towels, two (2) sheet sets that include pillow cases, a bedspread, a pillow, a blanket, and a mattress cover in good and clean condition.

8026.23 Each blanket, bedspread, and mattress cover shall be cleaned regularly, whenever soiled, and before being transferred from one resident to another.8026.24 Each piece of bed linen, towel, and washcloth shall be changed and cleaned as often as necessary to maintain cleanliness, provided that all towels and bed linen shall be changed at least once each week.8026.25 Only individuals being served and staff members may reside at each program site.8026.26 Providers shall ensure that individuals can access all scheduled or emergency medical and dental appointments.8026.27 Each provider shall inventory each individual's personal property and secure any valuables and medications, etc., and maintain a current written inventory of secured property, a copy of which shall be provided, signed by the individual and staff, to the individual.8026.28 Each provider shall take appropriate measures to safeguard and account for personal property brought into the facility by a resident.8026.29 Each provider shall provide the individual, or the individual's representative, with a receipt for any personal articles to be held by the provider for safekeeping. The provider shall document the date that the personal articles were deposited with the provider and maintain a record of all articles held for safekeeping.8026.30 Each piece of bed linen, towel, and washcloth shall be changed and cleaned as often as necessary to maintain cleanliness, provided that all towels and bed linen shall be changed at least once each week.8026.31 No person who is not an individual served by the program, staff member, or child of an individual served by the program may reside at a facility that houses a residential program.8026.32 Each residential program shall have a licensed dietitian or nutritionist available, a copy of whose current license shall be maintained on file, to provide the following services:- (a) Review and approval of menus;

- (b) Education for individuals with nutrition deficiencies or special needs;

- (c) Coordination with medical personnel, as appropriate; and

1. (d) A nutritional assessment for each individual within three (3) calendar days of admission unless the individual has a current assessment or doctor's order for dietary guidelines.
2. 8026.33 The provider shall offer at least three (3) meals per day and in-between-meal-snacks that:
3. (a) Are nourishing and well-balanced in accordance with dietary guidelines established by the United States Department of Agriculture;
4. (b) Are suited to the special needs of each individual; and
5. (c) Are adjusted for seasonal changes and allow for the use of fresh fruits and vegetables.
6. 8026.34 The provider shall ensure that menus are written on a weekly basis, that the menus provide for a variety of foods at each meal, and that menus are varied from week to week. Menus shall be posted for the individuals' review.
7. 8026.35 The provider shall retain a copy of each weekly menu for a period of six (6) months. The menus retained shall include special diets and reflect meals as planned and as actually served, including handwritten notations of any substitutions. The provider shall also retain receipts and invoices for food purchases for six (6) months. The records required to be retained by this subsection are subject to review by the Department.
8. 8026.36 Each meal shall be scheduled so that the maximum interval between each meal is no more than six (6) hours, with no more than fourteen (14) hours between a substantial evening meal and breakfast the following day.
9. 8026.37 If an individual refuses food or misses a scheduled meal, the provider shall offer appropriate food substitutions of comparable nutritional value.
10. 8026.38 If an individual will be away from the program during mealtime for necessary medical care, work, or other scheduled appointments, the program shall provide an appropriate meal and in-between-meal snack for the individual to carry with him or her and shall ensure that the meal is nutritious as required by these rules and suited to the special needs of the individual.
11. 8026.39 A residential program providing meals shall implement a written Nutritional Standards Policy that outlines their procedures to meet the dietary needs of the individuals in its program, ensuring access to nourishing, well-balanced, and healthy meals. The policy shall identify the methods and parties responsible for food procurement, storage, inventory, and preparation.

8026.40 The Nutritional Standards Policy shall include procedures for individuals unable to have a regular diet as follows:- (a) Providing clinical diets for medical reasons, when necessary;

- (b) Recording clinical diets in the individual's record;

- (c) Providing special diets for individuals' religious needs; and

- (d) Maintaining menus of special diets or a written plan stating how special diets will be developed or obtained when needed.8026.41 A program shall make reasonable efforts to prepare meals that consider the cultural background and personal preferences of the individuals.8026.42 Meals shall be served in a pleasant, relaxed dining area.8026.43 The dining area shall have a sufficient number of tables and chairs to seat all individuals residing in the facility at the same time. Dining chairs shall be sturdy, non-folding, without rollers unless retractable, and designed to minimize tilting.8026.44 Upon admission, a program shall submit new or revised Plan of Care, along with a Discharge Plan, to the Department with the authorization request.8026.45 Psychiatric crisis stabilization programs shall provide the following services necessary to assess, treat, medicate, and stabilize residents:- (a) Comprehensive Nursing Assessment and Plan of Care:

- (i) Programs shall provide or ensure a comprehensive health assessment is completed within twenty-four (24) hours of admission in order to determine medical necessity for primary health care and coordinate care with the health care provider;

- (ii) A nurse shall perform ongoing assessment of individuals as clinically indicated. A nurse shall coordinate development of a new or revised Plan of Care, and monitor that care is rendered as outlined in the Plan of Care. A nurse shall perform medication evaluations, including the administration and monitoring of medications, obtaining consent to accept medications, and educating individuals as to the benefits, risks, and side effects of the medications prescribed. If an individual experiences a change in clinical status, the nurse must work with the on-call psychiatrist

regarding a change in Plan of Care;

1. (iii) Pursuant to the requirements set forth in 22-A DCMR §§ 3411 and 3412:
2. (A) CSAs, ACT providers, or CBI providers shall coordinate the Plan of Care for individuals enrolled in MHRS; and
3. (B) For individuals only receiving Clubhouse services, who are not linked with a CSA, ACT provider, or CBI provider, the Clubhouse shall coordinate the Plan of Care;
4. (iv) Services provided at a psychiatric crisis stabilization program shall be coordinated with the individual's assigned CSA, ACT provider, CBI provider, or Clubhouse provider (whichever is applicable), to ensure continuity of care; and
5. (v) If the individual is not yet enrolled with a CSA, ACT provider, or CBI provider; or is only enrolled with a Clubhouse provider, the psychiatric crisis stabilization provider shall work with the Department to enroll in MHRS services and establish a new Plan of Care.(b) Psychiatric Consultation and Assessment:- (i) A psychiatrist shall be available for consult by telephone twenty-four (24) hours per day, seven (7) days per week year-round. A psychiatrist shall be available on-site at least part-time (fifteen [15] hours per week);
6. (ii) A psychiatric assessment shall be performed within twenty-four (24) hours of admission;
7. (iii) A psychiatrist shall provide ongoing psychiatric management for the duration of an individual's stay. A psychiatrist shall conduct a review of a newly admitted individual's status after forty-eight (48) hours, and then every seventy-two (72) hours thereafter, at a minimum, unless there is a change of status that requires more frequent visits;
8. (iv) A psychiatrist shall perform medication evaluations, including the prescribing, monitoring, and titration of medications; including obtaining consent to accept medications and educating individuals as to the benefits, risks, and side effects of the medications

prescribed;

1. (v) A psychiatrist shall facilitate admission of individuals to inpatient settings as required; and
2. (vi) A psychiatrist shall oversee the clinical care of all individuals served in a psychiatric crisis stabilization program.(c) Crisis Counseling: Crisis counseling is immediate and short-term psychological care designed to assist individuals in a behavioral health crisis situation. Crisis counseling focuses on minimizing the stress of the precipitating event, providing emotional support, and improving the individual's coping strategies.(d) Medication Monitoring: This includes monitoring the side effects and interactions of medication and the adverse reactions which an individual may experience, and providing education and direction for symptom and medication self-management.(e) Discharge planning shall be conducted for all individuals discharged from a psychiatric crisis stabilization program. Discharge planning criteria shall include at least the following activities prior to discharge from the program:- (i) A review of the individuals' psychiatric, social, and physical needs;
3. (ii) Completion of referrals to appropriate community services providers, where the individual so desires, to address the individual's identified needs;
4. (iii) If the individual so desires, the provider shall arrange for appointments with community providers which shall be made as soon as possible after leaving the psychiatric crisis stabilization program. When an appointment for behavioral health services cannot be made within a reasonable period of time, the psychiatric crisis stabilization provider shall coordinate with a mobile crisis and outreach team to provide crisis stabilization services until the initial appointment occurs; and
5. (iv) Each individual shall be given the opportunity to participate in the development of his or her discharge plan. If clinically appropriate, the provider shall immediately and intensely engage the individuals' family and community supports in post-discharge planning. However, no person or family member shall be required

to agree to an individual's discharge. The provider shall note any person who objects to the individual's discharge plan or any part thereof in the individual's record.

8026.46 Qualified practitioners of psychiatric crisis stabilization services in accordance with this chapter and with their scope of practice are:

(a) Psychiatrists;

(b) Psychologists;

(c) LICSWs;

(d) APRNs;

(e) RNs;

(f) PAs;

(g) LISWs;

(h) LPCs;

(i) Psychology Associates;

(j) LGSWs; and

(k) LGPCs.

8026.47 Credentialed staff shall be permitted to provide psychiatric crisis stabilization services under the supervision of an independently licensed practitioner.

SOURCE: Final Rulemaking published at 68 DCR 1623 (February 5, 2021).