.15 Program Components — Required Services.

A. Health Services.

(1) Nursing Services. The center shall provide nursing services under the direction of a registered nurse. The licensee shall fully disclose the services that will be provided outside the adult medical day care centerís hours of operation, in the service contract agreement. The registered nurse may delegate nursing services as appropriate, to other staff in accordance with COMAR 10.27.09, 10.27.10, and—(3).

(2) Consultation with the Health Care Provider. The RN or LPN nurse shall communicate with the participant's health care provider to report observed changes in the participant's health status, including reaction to medicine, and to obtain current medical orders regarding such items as diet, medications, and treatments. The center shall assist participants in locating a regular source of health care if a participant does not have a health care provider.

(3) Mental Health Services. For participants with mental health needs, the program shall provide, when needed, linkage, collaboration, and coordination with the participant's treating psychiatrist or other mental health professional.

(4) Observation. The registered nurse or the licensed practical nurse shall observe the health, functional status, and adherence to a prescribed medical regimen, and document his or her observations in the participant's medical record at least monthly.

(5) The center shall provide meals and snacks to participants in accordance with Regulation .20 of this chapter.

B. Emergency Services and Medical Plan.

(1) The center shall have a written emergency medical plan for linkage and access to:

(a) Emergency medical care including a health care provider on call in the event that a participant's primary care provider is unavailable;

(b) Hospitalization and emergency room care; and

(c) Transportation to the center providing the emergency care.

(2) The center shall have an established procedure to be followed in an emergency that covers:

(a) Immediate care of the participants;

(b) Individuals to be notified; and

(c) Reports to be prepared.

C. Activities Programs.

(1) Activities Plan.

(a) There shall be a written planned program of daily activities that are age appropriate and culturally relevant for individuals served and designed to:

(i) Meet the participant's specific needs, preferences, and interests with the individual's cognitive and physical limitations being noted in the development of the activities; and

(ii) Stimulate interests, rekindle motivation, and provide opportunities for a variety of types and levels of involvement, including small and large group activities.

(b) Staff shall also plan a weekly or monthly calendar of activities that shall be posted in an area of the center where it is plainly visible and easily read by all participants.

(2) Each day's activities shall include:

(a) Physical exercise;

(b) Rest;

(c) Social interaction;

(d) Personal care, if needed; and

(e) Mental stimulation.

(3) The center shall permit participants to choose between group and individual activities during some part of the day.

(4) Participants shall have the choice of refusing to participate in any activity.

D. Activities of Daily Living (ADL). Staff shall provide the assistance needed by participants to complete activities of daily living.