D.C. Mun. Regs. r. 22-A3859
An Intensive Residence (IR) shall provide on-site medical assistance, nursing, and rehabilitative services, in addition to meeting the minimum MHCRF requirements for a home-like environment, staffing, and resident care set forth in §§ 3800, 3850 and 3852.
An IR is appropriate for a maximum of eight (8) adults with a principal diagnosis of serious and persistent mental illness who have special needs due to co-morbid medical conditions that cannot be adequately provided for in an SR or SRR. These residents require twenty-four (24) hour staff supervision and enhanced care, and may need periodic one-to-one support for medical conditions or due to the intensity of psychiatric symptoms.
An IR shall have a staff-to-resident ratio of two (2) to eight (8), 6 a.m. to 10 p.m. daily whenever a resident is present. Additional staff shall be available during times of peak activity. At a minimum, the following are peak hours for purposes of complying with this section and receipt of the per diem payments: 6:00 a.m. to 9:00 a.m. and 5:00 p.m. to 8:00 p.m.
The Department may approve a written MHCRF staffing plan with different peak hours upon a showing that the MHCRF is providing adequate staffing coverage based upon the residents' individual schedules. The IR shall maintain a record of any changes in the peak activity hours and work schedules and the reason for the changes.
An IR shall have the capacity to provide one-to-one staffing when necessary as determined by the resident's treatment plan and the immediate needs of the resident and other residents in the facility.
Awake staff is required twenty-four (24) hours per day in an IR.
Staffing shall be provided in accordance with the special program needs of residents including geriatric, dual diagnosis, behavioral, or nursing care, and may include medical, psychiatric, nursing, behavioral, social, and recreational services.
The Residence Director or a staff member shall be present whenever residents are at the residence. In addition, the Residence Director or designee shall arrange for clinical back-up services. The mental health professional designated to provide back-up services shall:
Each Residence Director of an IR shall meet the requirements of § 3851 and shall also meet any additional professional license or experience qualifications, or higher Residence Director-to-resident ratios required pursuant to a current contract between the MHCRF and the Department for IR services.
Each IR shall have a full-time Registered Nurse at the facility a minimum of eight (8) hours per day. In addition, a Licensed Practical Nurse (LPN) shall be on duty at the facility the remaining sixteen (16) hours a day or whenever an RN is not on duty.
"On call" RN nursing consultation, supervision, and support shall be available to the LPN and any other staff on duty whenever an RN is not on duty at the facility. The LPN shall be under the general supervision of a Registered Nurse at all times.
The resident's clinical treatment team and the facility's Residence Director in conjunction with the Department, shall determine whether a person is appropriately placed in an IR.
An IR shall be in compliance with applicable requirements under the Americans with Disabilities Act, including accessibility requirements for bedrooms, living spaces and bathrooms.
D.C. Mun. Regs. r. 22-A3859