# Title 75 — Department of Human Services

## Article 75-03 — Community Services

## Chapter 75-03-17 — Psychiatric Residential Treatment Facilities for Children

### § 75-03-17-01. Definitions.

1. "Accredited" means to be accredited and in good standing by an independent, not-for-profit
accreditation organization approved by the United States department of health and human
services and the department, including the commission on accreditation of rehabilitation
facilities, the joint commission, and the council on accreditation.
2. "Active treatment" means a strength based, culturally competent, and medically appropriate
treatment designed to meet immediate needs with specific outcome and return to the family or
another less restrictive community setting as soon as clinically possible and when treatment in
a facility is no longer medically necessary.
3. "Aftercare" means followup support and services provided to a resident and family after
discharge from a facility.
4. "Applicant" means the entity requesting licensure as a psychiatric residential treatment facility
for children under this chapter.
5. "Child", "children", or "resident" means an individual or individuals under the age of
twenty-one.
6. "Clinical supervision" means the oversight responsibility for individual treatment plans and
individual service delivery.
7. "Condition" means a violation of the requirements of any applicable law or regulation.

8. "Department" means the department of health and human services.
9. "Diagnostic assessment" means a written summary of the history, diagnosis, and individual
treatment needs of an individual with a mental illness using diagnostic, interview, and other
relevant assessment techniques.
10. "Discharge planning" means the multidisciplinary process that begins at the time of admission
that identifies the child's and family's needed services and supports upon discharge.
11. "Employee" means an individual compensated by the facility to work, including contracted
service providers who conduct onsite training, treatment groups, individual therapy, or other
facility services.
12. "Family-driven" means the family has a primary decisionmaking role in the care of its own
children.
13. "Individual person-centered treatment plan" means a youth-guided and family-driven written
plan of intervention, treatment, and services that is developed under clinical supervision on
the basis of a diagnostic assessment.
14. "Individual with a mental illness" means an individual with an organic, mental, or emotional
disorder that substantially impairs the capacity to use self-control, judgment, and discretion in
the conduct of personal affairs and social relations. "Individual with a mental illness" does not
include an individual with intellectual disabilities of significantly subaverage general intellectual
functioning which originate during the developmental period and is associated with impairment
in adaptive behavior, although an individual who has intellectual disabilities may also be an
individual who has a mental illness. A substance use disorder does not per se constitute
mental illness, although an individual who has a substance use disorder may also be an
individual who has a mental illness.
15. "Initial license" means a license for a new facility that is in effect for one year.
16. "Nonemployee" means an individual, including a volunteer or student intern, who is not
compensated by the facility
17. "Psychiatric residential treatment facility for children" or "facility" means a facility or a distinct
part of a facility that provides to children and adolescents a total, twenty-four-hour, therapeutic
environment integrating group living, educational services, and a clinical program based upon
a comprehensive, interdisciplinary clinical assessment and an individualized treatment plan
that meets the needs of the child and family. The services are available to children in need of
and able to respond to active psychotherapeutic intervention and who cannot be effectively
treated in their own family, in another home, or in a less restrictive setting. The facility must be
in compliance with requirements for psychiatric residential treatment facilities under 42 U.S.C.
1396d [Pub. L. 89-97; 79 Stat. 351] and title 42, Code of Federal Regulations, subpart D,
part 441 and subpart G, part 483.
18. "Residential treatment" means a twenty-four-hour a day program under clinical supervision in
a community residential setting other than an acute care hospital, for the active treatment of
individuals with mental illness.
19. "Sentinel event" means any serious injury or trauma to a resident, death of a resident, or
inappropriate sexual contact.
20. "Serious injury" means any significant impairment of the physical condition of the child as
determined by qualified medical personnel. This includes burns, lacerations, bone fractures,
substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by
someone else.

21. "Serious risk of harm" means a substantial likelihood of:
a. Suicide, as manifested by current suicidal threats, attempts, or significant depression
creating immediate risk of suicide;
b. Killing or inflicting serious bodily harm to self or another individual, as manifested by
current act; or
c. Substantial deterioration in physical health or substantial injury, disease, or death based
on current poor self-control or judgment.
22. "Special treatment procedures" are defined as follows:
a. "Drug used as a restraint" means any drug that:
(1) Is administered to manage a resident's behavior in a way that reduces the safety
risk to the resident or others;
(2) Has a temporary effect of restricting the resident's freedom of movement; and
(3) Is not a standard treatment for the resident's medical or psychiatric condition.
b. "Emergency safety interventions" means the use of restraint or seclusion as an
immediate response to an emergency safety situation.
c. "Emergency safety situation" means unanticipated resident behavior that places the
resident or others at serious threat of violence or injury if no intervention occurs and that
calls for an emergency safety intervention.
d. "Mechanical restraint" means any device attached or adjacent to the resident's body that
the resident cannot easily remove that restricts freedom of movement or normal access
to the resident's body.
e. "Personal restraint" means the application of physical force without the use of any
device, for the purposes of restraining the free movement of a resident's body. The term
personal restraint does not include briefly holding without undue force a resident in order
to calm or comfort the resident, or holding a resident's hand to safely escort a resident
from one area to another.
f. "Physical escort" means the temporary touching or holding of the hand, wrist, arm,
shoulder, or back for the purpose of inducing a resident who is acting out to walk to a
safe location.
g. "Restraint" means a personal restraint, mechanical restraint, or drug used as a restraint.
h. "Seclusion" means the confinement of a resident alone in a room or an area from which
the resident is physically prevented from leaving.
i. "Timeout" means the voluntary option of a resident to move to a designated area from
which the resident is not physically prevented from leaving, for the purpose of providing
the resident an opportunity to regain self-control.
23. "Tier 1 mental health professional" means a licensed psychiatrist, licensed psychologist,
licensed physician or a physical assistant, or an advanced practice registered nurse.
24. "Trauma-informed" means an understanding of the prevalence of traumatic experiences in a
child who receives mental health services and of the profound neurological, biological,
psychological, and social effect of trauma and violence on the child being treated.

25. "Youth-guided" means a child has the right to be empowered, educated, and given a
decisionmaking role in the care of the child's own life.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; July 1,
2012; April 1, 2014; April 1, 2016; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-01, 25-03.2-03
### § 75-03-17-02. Procedures for licensing.

1. Application. An application for license or for renewal as a facility must be submitted to the
department. The department shall determine the suitability of the applicant for licensure under
this chapter. The application must contain any materials the department may require,
including:
a. A comprehensive list and description of the program plan which includes:
(1) A plan demonstrating compliance with this chapter;
(2) A copy of current accreditation certification, accreditation letter, and findings report;
(3) The facility's organizational chart;
(4) The treatment modalities offered, including milieu therapy, family therapy,
psychopharmacology, and psychotherapy;
(5) Prohibited treatment modalities; and
(6) The services provided directly by the facility and those provided by other community
resources, including special education as required by law and contracted services.
b. A copy of all policies and procedures as required by this chapter with a detailed plan for
their implementation.
c. A list of licensed professionals employed or to be employed by or contracting with the
facility.
2. License contents. The license to operate a psychiatric residential treatment facility for
children must specify:
a. The name of the licensee;
b. The premises for which the license is applicable;
c. The number of children who may reside at the facility at any one time;
d. The date of expiration of the license;
e. The facility license number; and
f. The name of the accreditation body.
3. Initial license and license renewal.
a. An initial license for a new facility is in effect for one year. Subsequent licenses shall be
renewed at least once every two years, either through a full onsite license review or the
facility may receive deemed status, at the discretion of the department.
b. The license is valid only on the premises indicated and is not transferable.

c. License renewals are based on the outcomes of the department's licensure reviews, the
facility's ongoing compliance with the licensure rules set forth in this chapter, and the
facility's accreditation standings. The facility must list the department as a confidential
inquiry for the accrediting body on their accreditation intent to survey prior to each
accreditation review. If the accrediting body determines a facility to not be in good
standing, the facility shall report that determination to the department within five working
days after the facility has learned of that determination.
d. A facility shall submit a license renewal application on a form required by the department
to the department licensor fifteen days prior to the date the department has notified the
facility will be the date the facility's licensure review will begin.
4. Provisional license. The department may issue a provisional license, effective for up to
ninety days, to a facility that has failed to comply with any of the standards of this chapter or
with any other state law or regulation, compliance with which is required for licensure. The
facility will have thirty days from the issuance of the provisional license to submit a written plan
of correction for the department's review and approval. The department may perform an onsite
followup visit to assure that the standards have been met by the facility.
a. The department may renew a provisional license if the licensee demonstrates to the
department that it has made progress towards compliance and can be fully compliant
within the next ninety days. A provisional license may be renewed but may not exceed
one hundred eighty consecutive days.
b. When a facility operating under a provisional license notifies the department that it has
corrected its deficiencies, the department must ascertain whether all deficiencies have
been corrected. Upon finding compliance and sustainability, the department shall issue
an unrestricted license for the balance of the licensing period.
c. The department may apply restrictions to a provisional license to limit the number of
children in residence or the ages of the children in residence while the provisional license
is in effect.
5. License display. A facility shall display its license in a conspicuous place within the facility.
6. Notice of change. A facility shall notify the department in writing at least thirty days before
any of the following changes occur:
a. Transfer of or change in ownership.
b. Transfer of operating rights, including a lease of the facility where the lessor retains no
control of the operation or management of the facility.
c. Change in the name of the facility.
7. Denial and revocation of a license. Failure to comply with any of the standards of this
chapter or other state law or regulation is cause for refusal or revocation of a license.
Conviction of an offense by an owner or operator of a facility does not disqualify the facility
from licensure unless the department determines that the offense has a direct bearing upon
an individual's ability to serve the public as an owner or operator of a psychiatric residential
treatment facility for children, or that, following conviction of any offense, the individual is not
sufficiently rehabilitated under section 12.1-33-02.1.
8. Appeal. An applicant may appeal a license denial or a department decision not to allow an
increase or decrease in bed capacity in accordance with North Dakota Century Code chapter
28-32 and North Dakota Administrative Code chapter 75-01-03.

9. License report procedures.
a. Within thirty days of an onsite review of a facility, the department shall send a license
report to the facility that was reviewed.
b. A license report must contain a description of the programs and services reviewed,
strengths, concerns, recommendations, and conditions.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-02, 25-03.2-03,25-03.2-04, 25-03.2-05, 25-03.2-08
### § 75-03-17-03. Organization and administration.

1. Governing body. The applicant must have a governing body that designates or assigns
responsibility for the operation, policies, program, and practice of the facility. The governing
body shall:
a. Define:
(1) The facility's philosophy;
(2) The facility's purpose;
(3) The facility's function;
(4) The geographical area served by the facility;
(5) The ages and types of children accepted for care by the facility; and
(6) The clinical disorders addressed by the facility's program;
b. Ensure that all policies and procedures required by this chapter are in writing and on file
at the facility and are accessible to all employees, family members, and residents;
c. Develop a records retention policy and procedures consistent with state and federal law;
d. Assure that all vehicles transporting children are:
(1) Subject to routine inspection and maintenance;
(2) Licensed by the state motor vehicle department;
(3) Equipped with seatbelts for every passenger;
(4) Equipped with a first-aid kit and a fire extinguisher;
(5) Carrying no more individuals than the manufacturer's recommended maximum
capacity;
(6) Disability accessible where appropriate; and
(7) Driven by an individual who holds a valid driver's license, of a class appropriate to
the vehicle driven, issued by the driver's jurisdiction of residence; and
e. Obtain sufficient insurance, including:

(1) Liability insurance covering bodily injury, property damage, personal injury,
professional liability; and
(2) Automobile or vehicle insurance covering property damage, comprehensive,
collision, uninsured motorist, bodily injury, and no fault.
2. Quality improvement. The applicant and facility shall implement a quality improvement
program. The applicant and facility shall submit the quality improvement program and
evaluations of the program to the department for review at a minimum of every six months.
The applicant shall create policies and procedures and have them in place to implement its
facility's quality improvement program. The facility must monitor and evaluate the quality and
appropriateness of care of children, and identify performance indicators that will be monitored
to assess the program's effectiveness. The quality improvement program must include:
a. A plan for child and employee safety and protection;
b. A method to evaluate personnel performance and the utilization of personnel;
c. A plan to ensure the facility accesses and maintains copies of the current license of all
employees, contract workers, and consultants when relevant for that individual's role or
function;
d. A system of credentialing, granting, and withholding employee privileges;
e. A method to review and update policies and procedures assuring the usefulness and
appropriateness of policies and procedures;
f. A method to review the appropriateness of admissions, care provided, and employee
utilization;
g. A plan for the review of individual treatment plans that ensures compliance with
paragraph 3 of subdivision b of subsection 3 of section 75-03-17-05;
h. A plan for program evaluations that includes measurements of progress toward the
facility's stated goals and objectives; and
i. A method to evaluate and monitor standards of resident care.
3. Outcomes and data collection. The department shall require a facility to engage in data
management practices to collect and report outcomes every six months. Data collection efforts
will offer facilities a continuous quality improvement process that measures and monitors the
safety, wellbeing, and service delivery provided to children in placement. Facilities must have
written policy to identify a plan to implement, collect, and measure outcomes data
requirements. The policy must also include how a facility will respond to identified data
outcomes by utilizing one or more facility improvement plans every six months.
4. Children's case records. The facility shall establish and implement policies and procedures
to ensure the facility maintains a confidential record for each child which must be current and
reviewed monthly. Each record must contain:
a. An application for service;
b. A social history;
c. A release of information and medical treatment consent form signed by a person who
may lawfully act on behalf of the child and any consent for the use of psychotropic
medications as required under subdivision d of subsection 10 of section 75-03-17-07;

d. The name, address, and telephone number of individuals to be contacted in an
emergency;
e. Reports on medical examinations, including immunizations, any medications received,
allergies, dental examinations, and psychological and psychiatric evaluations which
occurred prior to the placement;
f. An explanation of custody and legal responsibility for the child and relevant court
documents, including custody or guardianship papers;
g. Documentation on all medical examinations, including immunizations, all medications
received, allergies, dental examinations, and psychological and psychiatric evaluations
received during placement;
h. Documentation of medical care given during placement as a result of an admission to the
hospital or inpatient care, including:
(1) Hospitalization admission and discharge records to include history and physical;
(2) Medications administered, with the quantity, directions, physician's name, date of
issue, and name of the pharmacy indicated; and
(3) Significant illnesses or accidents;
i. Records of the annual medical examination required under section 75-03-17-07; and
j. A written agreement between a person who may lawfully act on behalf of the child and
the facility and a record that the person who acted on behalf of the child received a copy.
The agreement must include:
(1) A statement as to who has financial responsibility;
(2) How payments are to be made to cover the cost of care;
(3) Which items are covered by the normal or regular facility charges for care;
(4) Medical arrangements, including the cost of medical care;
(5) Visiting arrangements and expectations;
(6) Arrangements for clothing and allowances;
(7) Arrangements for therapeutic leave;
(8) Regulations about gifts permitted;
(9) Arrangements for participation by the person who acted on behalf of the child
through regularly scheduled interviews with designated employee;
(10) The facility's policy on personal monetary allowance to be provided to the child at
the facility;
(11) Records of special treatment orders; and
(12) Educational arrangements agreed upon discharge.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10

Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-04. Admissions.

1. A child may be admitted to a psychiatric residential treatment facility for children if:
a. The child has been diagnosed by a psychiatrist or psychologist as suffering from a
mental illness or emotional disturbance;
b. The child's situation meets the definition of serious risk of harm; and
c. A less restrictive setting cannot meet the immediate treatment need.
2. The facility shall provide a short-term, intense, focused mental health treatment program to
promote successful return of the child to the community with specific outcomes of the mental
health services to include the child returning to the family or another less restrictive community
living situation as soon as clinically possible.
3. Every facility shall have specific admission policies that describe which professional staff have
admission authority. Admissions must occur emergently and planned. Diagnostic assessment
and plan of care must document immediate need for inpatient psychiatric residential services.
4. A tier 1 mental health professional must complete an assessment of a child upon admission to
a facility.
5. The facility shall grant or deny admission within three business days of receipt of a completed
application.
6. If admission is denied, the facility shall indicate the reason in writing to the individual or referral
source making the application for placement, including recommendations for services and
supports available to the child and family.
7. No child may be denied admission to a facility on the basis of race, color, creed, religion, or
national origin.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-06
### § 75-03-17-05. Diagnosis and treatment while at the facility.

1. Duties of the facility. The facility shall:
a. Provide for a medical, psychiatric, and psychological assessment of each child no later
than seventy-two hours after admission;
b. Immediately include family and custodians in the active treatment;
c. Involve the families and the person who may lawfully act on behalf of the child in the
person-centered treatment plan;
d. Provide daily therapy and programming that are individually tailored to meeting a child's
need and in sufficient volume to resolve immediate inpatient need. Therapies must
include individual and family components to facilitate rapid return of the child to a family
setting;

e. Provide ongoing and consistent individual therapy utilizing evidence-based models of
care for psychiatric residential treatment facilities for children. Individual therapy must
focus on providing the child skills they need to be successful in their home and
community;
f. Complete a diagnostic assessment, completed by a licensed psychiatrist, no less than
seventy-two hours after admission that includes:
(1) A psychiatric history;
(2) A mental status examination, including an assessment of suicide;
(3) Psychosocial, including family history; and
(4) Complete set of diagnosis and recommendations for immediate treatment; and
g. Ensure therapeutic leave such as weekend overnight visits or day passes with family
must be documented in the child's case file and be tied to family therapy and therapeutic
goals of the child and family, or it must be documented in the child's case file why
weekend overnight visits or day passes are not tied to therapy and therapeutic goals of
the child and family.
2. Specialists. The facility shall provide a sufficient number of qualified psychiatric professionals
to meet the resident needs. Each facility shall provide a minimum of one-half hour per week
per bed of psychiatry time, one hour per week per bed of family therapy time, and two hours
per week per bed of individual therapy time. Each facility shall provide twenty-four-hour
nursing, which may include a combination of onsite or on-call hours.
3. Individual person-centered treatment plan.
a. The facility shall develop and implement an individual person-centered treatment plan
that includes the child's input giving the child a voice and a choice in the treatment
planning and interventions used. The plan must be based upon a comprehensive
interdisciplinary diagnostic assessment, which includes the role of the family, identifies
the goals and objectives of the therapeutic activities and treatment and it must be
developed by an interdisciplinary team. The plan must provide a schedule for
accomplishing the therapeutic activities and treatment goals and objectives, and identify
the individuals responsible for providing services to children consistent with the individual
person-centered treatment plan. Clinical supervision for the individual person-centered
treatment plan must be accomplished by full-time or part-time employment of or contracts
with a licensed psychiatrist, a licensed psychologist, a licensed clinical social worker, or a
nurse who holds advanced licensure in psychiatric nursing. Clinical supervision must be
documented by the clinical supervisor cosigning individual person-centered treatment
plans and by entries in the child's record regarding supervisory activity. The child, and the
person who lawfully may act on the child's behalf, must be involved in all phases of
developing and implementing the individual person-centered treatment plan. The child
may be excluded from planning if excluding the child is determined to be in the best
interest of the child and the reasons for the exclusion are documented in the child's plan.
b. The plan must be:
(1) Based on a diagnosis using the current diagnostic and statistical manual of mental
disorders and a biopsychosocial assessment;
(2) Developed within three business days of admission; and

(3) Reviewed at a minimum every fourteen days and updated or amended to meet the
needs of the child by the interdisciplinary team.
c. The person-centered treatment plan must identify:
(1) Treatment goals that are short term and intense, focused on successful return to
home and community;
(2) Time frames for achieving the goals;
(3) Goals that are achievable and measurable;
(4) The individuals responsible for coordinating and implementing child and family
treatment goals;
(5) Therapeutic intervention or techniques or both for achieving the child's treatment
goals;
(6) The projected length of stay and discharge plan; and
(7) Referrals made to other service providers based on treatment needs, and the
reasons referrals are made.
4. Solicitation of funds. A facility may not use a child for advertising, soliciting funds, or in any
other way that may cause harm or embarrassment to a child or the child's family. A facility may
not make public or otherwise disclose by electronic, print, or other media for fundraising,
publicity, or illustrative purposes, any image or identifying information concerning any child or
member of a child's immediate family, without first securing the child's written consent and the
written consent of the person who may lawfully act on behalf of the child. The written consent
must apply to an event that occurs no later than ninety days after the date the consent was
signed and must specifically identify the image or information that may be disclosed by
reference to dates, locations, and other event-specific information. Consent documents that
do not identify a specific event are invalid to confer consent for fundraising, publicity, or
illustrative purposes. The duration of an event identified in a consent document may not
exceed fourteen days.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-06. Special treatment procedures.

A facility shall have written policies and procedures regarding implementation of special treatment
procedures. Special treatment procedures must be therapeutic and meaningful interventions and may
not be used for punishment, for the convenience of employees, or as substitute for therapeutic
programming. Upon admission, the facility shall inform the child and the person who may lawfully act
on behalf of the child of the facility policy on restraint and seclusion procedures during an emergency
safety situation. The facility shall provide education to the children, providing each child the opportunity
to express the child's opinion and educating the child on alternative behavior choices to avoid the use
of special treatment procedures. Alternatives to behaviors must be documented in each child's
individual person-centered treatment plan. The health, safety, and well-being of children receiving care
and treatment in the facility must be properly safeguarded. A physician shall review the use of special
treatment procedures.

1. Timeout. Employees shall supervise the use of timeout procedures at all times, and shall
document the use of timeout procedures in the child's file. The use of the resident's bedroom
for timeout is prohibited.
2. Physical escort. Employees shall supervise the use of physical escort procedures at all times
and shall document the use of physical escort in the child's file.
3. Physical restraints.
a. Physical restraints must be ordered by a psychiatrist or other physician, a licensed
psychologist, a licensed clinical social worker, or a nurse who holds advanced licensure
in psychiatric nursing. Staff authorized to order physical restraint must be trained in the
use of emergency interventions. A psychiatrist or other physician, a licensed
psychologist, a licensed clinical social worker, or a nurse who holds advanced licensure
in psychiatric nursing must review and sign the order within forty-eight hours after the
ordered physical restraint. Physical restraints may be imposed only in emergency
circumstances and must be used with extreme caution to ensure the immediate physical
safety of the child, an employee, or others after all other less intrusive alternatives have
failed or have been deemed inappropriate;
b. All physical restraints must be applied by employees who are certified in the use of
restraints and emergency safety interventions; and
c. The facility shall have established protocols that require:
(1) Entries made in the child's file as to the date, time, employee involved, reasons for
the use of, and the extent to which physical restraints were used, and which identify
less restrictive measures attempted;
(2) Notification within twelve hours of the individual who lawfully may act on behalf of
the child; and
(3) Face-to-face assessment of children in physical restraint completed by a
psychiatrist or other physician, a licensed psychologist, a licensed clinical social
worker, a nurse who holds advanced licensure in psychiatric nursing, or other
licensed health care professional or practitioner who is trained in the use of safety,
emergency interventions. The face-to-face assessment must be documented in the
child's case file and include assessing the mental and physical well-being of the
child. The face-to-face assessment must be completed as soon as possible, and no
later than one hour after the initiation of physical restraint or seclusion.
4. Seclusion. Seclusion must be ordered by a psychiatrist or other physician, a licensed
psychologist, a licensed clinical social worker, or a nurse who holds advanced licensure in
psychiatric nursing. Staff authorized to order seclusion must be trained in the use of
emergency interventions. A psychiatrist or other physician, a licensed psychologist, a licensed
clinical social worker, or a nurse who holds advanced licensure in psychiatric nursing must
review and sign the order within forty-eight hours after the ordered seclusion. Seclusion may
be imposed only in emergency circumstances after all other less intrusive alternatives have
failed or have been deemed inappropriate. Seclusion is to be used with extreme caution, and
only to ensure the immediate physical safety of the child, an employee, or others. A child's
bedroom may not be used for seclusion. If seclusion is indicated, the facility shall ensure that:
a. The proximity of the employee allows for visual and auditory contact with the child at all
times;
b. Employees conduct assessments of the child every fifteen minutes and document the
assessments in the child's case file;

c. The seclusion room is not locked, or is equipped with a lock that only operates with an
employee present such as a push-button lock that only remains locked while it is being
pushed;
d. All nontherapeutic objects are removed from the area in which the seclusion occurs;
e. All fixtures within the room are tamperproof, with switches located outside the room;
f. Smoke-monitoring or fire-monitoring devices are an inherent part of the seclusion room;
g. Security mattresses used are made of fire-resistant material;
h. The room is properly ventilated;
i. Notification of the individual who lawfully may act on behalf of the child is made within
twelve hours of a seclusion and is documented in the child's case file;
j. A child under special treatment procedures is provided a similar diet that other children in
the facility are receiving;
k. No child remains in seclusion:
(1) For more than four hours in a twenty-four-hour period; and
(2) Without physician approval;
l. Seclusion is limited to the maximum time frame per episode for fifteen minutes for
children aged nine and younger and one hour for children aged ten and older; and
m. Face-to-face assessment of children in seclusion is completed by a psychiatrist or other
physician, licensed psychologist, a licensed clinical social worker, a nurse who holds
advanced licensure in psychiatric nursing, or other licensed health care professional or
practitioner who is trained in the use of safety, emergency interventions. The face-to-face
assessment must be documented in the child's case file and include assessing the
mental and physical well-being of the child. The face-to-face assessment must occur no
later than one hour after the initiation of seclusion.
5. Within twenty-four hours of each use of seclusion or physical restraint, the facility shall
conduct a face-to-face discussion which includes the child and all employees involved in the
emergency intervention, except when the involvement of a particular employee may
jeopardize the wellbeing of the child, and which:
a. Evaluates and documents in the child's case file the well-being of the child served and
identifies the need for counseling or other therapeutic services related to the incident;
b. Identifies antecedent behaviors and modifies the child's individual person-centered
treatment plan as appropriate; and
c. Analyzes the incident and identifies needed changes to policy and procedures, employee
training, and strategies that could have been used by an employee, by the child, or by
others which could prevent the future use of seclusion or physical restraint.
6. Within twenty-four hours after the use of physical restraint or seclusion, all employees involved
in the emergency safety intervention, and appropriate supervisory and administrative
employees, shall conduct a debriefing session that includes, at a minimum a review and
discussion of:
a. Precipitating factors to the emergency situation;

b. Alternative techniques that might have prevented the use of physical restraint or
seclusion;
c. The procedures, if any, that employees are to implement to prevent any recurrence of the
use of physical restraint or seclusion; and
d. The outcomes of the intervention, including any injuries that may have resulted from the
use of the physical restraint or seclusion.
7. Employees shall document in the child's record both the face-to-face discussion and
debriefing sessions identified in subsections 5 and 6 and the names of employees involved,
employees excused, and any changes to the child's treatment plan as a result of the face-to-
face discussion and debriefing. The facility also shall document that the person who may
lawfully act on behalf of the child was notified.
8. Special treatment procedure training. Each facility must have policies and procedures
regarding annual training in the use of all special treatment procedures listed in this section,
which comply with the standards set forth by the facility's accrediting body.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 50-11-03, 50-11-03.2
### § 75-03-17-07. Medical care.

The facility shall institute policies and procedures to address the medical care for each child during
placement at the facility, including:
1. Medical examination. Each child must have a medical examination within thirty days prior to
admission or within seventy-two hours of admission.
2. Immunizations. Each child must have current immunizations as required by North Dakota
Century Code section 23-07-17.1.
3. Medical care arrangements. A facility shall make arrangements with a physician for medical
care of each child.
4. Annual medical examination. Each child shall have a medical examination at least annually.
5. Employee instruction. The facility shall train employees what medical care, including first
aid, may be given by employees without specific orders from a physician. The facility shall
instruct employees how to obtain further medical care and how to handle emergency cases.
6. Hospital admission. Each facility shall institute policies and procedures regarding transfers
and discharges from an admission to the hospital. A facility's policies and procedures must
include arrangements made with a hospital for the admission of children from the facility in the
event of serious illness or an emergency.
7. Hospitalization or death reports. A facility shall report all hospitalizations immediately to an
individual who lawfully may act on behalf of the involved child. The facility shall report any
death immediately to the department, an individual who lawfully may act on behalf of the child,
a law enforcement agency, and the county coroner. The facility shall document these contacts
in the involved child's case file.
8. Prescription labels. The facility shall obtain prescribed medications on an individual
prescription basis and labeled according to state and federal rules.

9. Administration of medications.
a. The facility shall institute policies and procedures for guidance in the administration of all
medications. Medications must be administered by a designated employee who is
medication-certified. All medications must be labeled and stored in a locked cabinet, with
the keys for the cabinet kept under the supervision of the designated employee assigned
to administer the medications. The medication cabinet must be equipped with separate
cubicles, plainly labeled with each child's name.
b. The facility shall return medications belonging to a child to the person who lawfully may
act on behalf of the child upon discharge, or the designated individual in charge of
medication storage shall dispose of the medications according to the facility's policies
and procedures for the disposal of medications. The facility's policies and procedures for
the disposal of medications must be in accordance with state and federal requirements
for the disposal of medications.
c. The facility may possess a limited quantity of nonprescription medications. The
medications must be ordered by a physician and administered under the supervision of
medication-certified employee.
d. (1) The facility shall obtain written consent, including via electronic mail, or shall obtain
verbal consent witnessed by another individual, from a person who lawfully may act
on behalf of the child prior to administering:
(a) A newly prescribed medication to the child except in an emergency situation;
(b) A psychotropic medication; or
(c) A medication dosage or dosage range change.
A person who lawfully may act on behalf of the child who receives medication must
be informed of benefits, risks, and the potential side effects of all prescribed
medication. The facility shall obtain written consent within fourteen days verifying
verbal consent received. The facility shall document and file all consents in the
child's case file.
(2) The facility shall institute policies and procedures governing the use of psychotropic
medications, which require documentation in the case file justifying the necessity
and therapeutic advantages for the child receiving psychotropic medication.
Documentation must reflect that a trauma screening has been completed and that
the symptomology that the psychotropic medication is attempting to treat is not
more effectively treated through therapeutic interventions that specifically address
symptomology related to trauma.
e. Upon admission, when a new psychotropic medication is prescribed, and when a
psychotropic medication is discontinued, a child's psychotropic medication regime must
be reviewed by the attending psychiatrist every seven days for the first thirty days and
every thirty days thereafter. Additionally, the facility's nursing staff shall complete an
involuntary movement assessment prior to the start of, or a change in the dose of, a
psychotropic medication. An involuntary movement assessment must be repeated every
three months, or sooner if determined necessary, following completion of the initial
involuntary movement assessment to monitor the child for side effects of the
psychotropic medication.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10

Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-08. Dental care.

Each child shall have an annual dental examination. If a child has not had an examination in the
twelve months prior to admission, an examination must be scheduled within ninety days of admission.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-09. General health.

1. Sleep. Each child must receive enough sleep for the child's age at regular and reasonable
hours, and under situations conducive to rest.
2. Personal hygiene. The facility shall educate children on age-appropriate hygiene.
3. Bathing facilities. The facility shall maintain properly and keep clean toilet facilities.
4. Personal articles. The facility shall ensure that each child has a toothbrush, comb, and an
adequate supply of towels, washcloths, and personal toiletry articles.
5. Daily diet. The facility shall provide food that meets all dietary needs for each child's daily
nutritional requirements, including special dietary needs, such as food allergies and diabetes.
6. Clothing. Each child shall have clothing for the child's exclusive use. The clothing must be
comfortable and appropriate for current weather conditions.
7. Play. The facility shall provide safe, age-appropriate equipment for indoor and outdoor play.
The facility shall provide safety instructions on all equipment prior to the child participating in
the activity.
8. Services. The facility shall provide education on general health and promote positive healthy
activities, such as sufficient therapeutic treatment, and educational, recreational, and leisure
activities.
9. Spirituality. The facility shall make a reasonable effort to make opportunities available for
children to attend spiritual ceremonies within the area in which the facility is located, giving
reasonable consideration to requests by the child or a person with lawful authority to act on
behalf of the child. The facility shall respect the spiritual beliefs of the child and the child's
family.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-10. Education and training.

1. Public education. Any primary or secondary program offered by a facility must be in
compliance with standards established by the department of public instruction. The facility
shall ensure that children comply with all state school attendance laws.
2. Employee training. The facility shall provide quarterly training to employees which is relevant
to address the changing needs of the milieu and according to the requirements of the facility's
accrediting body.

a. All employees on duty must have satisfactorily completed annual training on current first
aid, therapeutic crisis intervention or crisis prevention intervention, suicide awareness
and prevention training, standard precautions as used by the centers for disease control
and prevention, training on institutional child abuse and neglect to include reporting
requirements and prohibition of employer retaliation for reporting, and cardiopulmonary
resuscitation training and have on file at the facility a certificate of satisfactory completion
prior to having direct contact with residents. A certificate must be provided to each
employee demonstrating their competencies in cardiopulmonary resuscitation on an
annual basis and therapeutic crisis intervention on a semi-annual basis. An employee
who is in orientation status and who is in the process of completing the required trainings
and background check may be allowed to job shadow with an employee who the facility
has deemed to be an experienced and competent employee to supervise during
orientation status. The facility ensures that employees who are in orientation status are
always under the supervision of experienced employees and are not left alone with the
children until all required training and background check has been completed.
b. Each employee must be able to recognize the common symptoms of illnesses of
children, signs and symptoms of an overdose, and to note any marked physical defects
of children. The facility shall ensure a sterile clinical thermometer and a complete first-aid
kit are available.
3. Discipline. A facility shall create a trauma-informed culture that promotes respect, healing,
and positive behaviors and which minimizes the use of restrictive behavior management
interventions to the extent possible. Discipline must be constructive or educational in nature
and follow the discipline guidelines of the facility's accrediting body. A facility shall adopt and
implement written policies and procedures for discipline and behavior management consistent
with the following:
a. Only employees of the facility may prescribe, administer, or supervise the discipline of
children. Authority to discipline may not be delegated to children or nonemployees.
b. A child may not be slapped, punched, spanked, shaken, pinched, roughly handled, struck
with an object, or receive any inappropriate physical treatment.
c. Verbal abuse and derogatory actions or remarks about the child, the child's family,
religion, or cultural background may not be used or permitted.
d. A child may not be locked in any room.
e. The facility shall develop and implement a youth-guided, family-driven plan of discipline
as part of the child's person-centered treatment planning, emphasizing the use of positive
behavior supports and therapeutic interventions, that promote an effective means of
discipline. Daily documentation must reflect whether the interventions are effective and if
they need revising.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-11. Children as employees prohibited.

Children may not be solely responsible for any major phase of the facility's operation or
maintenance, including cooking, laundering, housekeeping, farming, or repairing.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008.
General Authority: NDCC 25-03.2-10

Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-12. Discharge.

1. Discharge planning for each child must begin during the admission process. The facility shall
develop an evolving discharge plan within seven days of admission that identifies the child's
and family's needed services and supports upon discharge and include the discharge plan in
the treatment plan. The facility's interdisciplinary team shall review the discharge plan every
fourteen days at the same time as the treatment plan review. The facility's interdisciplinary
team shall update or amend the discharge plan to meet the needs of the child.
2. Prior to discharge, the facility shall complete a discharge plan, coordinate community services
required for the child to return to the home, and provide information for aftercare services with
each child's family, school, and community to ensure continuity of care. The discharge plan
must address and include:
a. Psychiatric, medical, educational, psychological, social, behavioral, developmental, and
chemical dependency treatment needs;
b. The reason for discharge;
c. A progress report, including an update on the child's psychiatric care and treatment
recommendations;
d. An assessment of community-based service needs for the child and family;
e. A statement that the discharge plan recommendations have been reviewed with the child
and the person who lawfully may act on behalf of the child;
f. The name and title of the individual into whose care the child was discharged.
3. The discharge committee shall review and approve each anticipated discharge thirty days
before the discharge and provide the completed discharge plan to the custodian at least
seven days before the anticipated discharge.
4. At least seven days prior to discharge a team meeting involving the child, the person who
lawfully may act on behalf of the child, the facility treatment team, and related community
services providers must take place to ensure the continuity of services consistent with the
child's treatment needs after discharge. As part of the discharge planning requirements,
facilities shall:
a. Identify a prescribing provider in the community and schedule an outpatient visit;
b. Ensure the child has a seven-day supply of needed medication and a written prescription
for medication to last through the first outpatient visit in the community with a prescribing
provider; and
c. Include documentation of the medication plan and arrangements for the outpatient visit in
the medical records in the child's case file. If medication has been used during the child's
treatment in the facility but is not needed upon discharge, the reason the medication is
being discontinued must be documented in the medical records in the child's case file.
5. The discharge committee shall review and approve each discharge from a facility prior to the
discharge. The discharge committee must include the following:
a. Tier 1 mental health professional;
b. Attending therapist;

c. Assigned social worker;
d. Facility nurse;
e. Facility educator;
f. Facility residential staff; and
g. A person who lawfully may act on behalf of the child.
6. The facility shall assist the child and the person who lawfully may act on behalf of the child in
preparing for the transition from residential treatment to return the child home, to a foster
family, adoptive family, an institution, or to the home of relatives.
7. The facility treatment team shall develop a discharge plan that ensures appropriate
appointments are scheduled, based on the child's needs and input from the person who
lawfully may act on behalf of the child, as part of the post discharge plan. Appointments must
support continuity of care addressing needs for individual therapy, psychiatric services and
educational services, and other services or supports that may be appropriate. The facility
treatment team shall provide a copy of the plan to the person who lawfully may act on behalf
of the child and a copy must remain in the chart.
8. If a discharge is not anticipated at least thirty calendar days ahead of time, the discharge is
considered unplanned and the facility shall:
a. Hold a discharge planning meeting involving the child, custodian, parent, guardian,
facility treatment team, additional family members, and any other relevant parties. This
meeting must allow relevant parties time to review the discharge plan and aftercare
engagement strategies while discussing services needed to best meet the needs of the
child; and
b. Create and provide in writing a finalized discharge and aftercare plan to the custodian
and parent or guardian at least seven days before the child's discharge.
9. A child's discharge from the facility may not be based on the child's need for short-term
inpatient treatment at a psychiatric facility.
10. The facility may not discharge a child without community-based support services in place. If a
child does not have a home or safe place for discharge, the facility shall work with the legal
custodian or placing agency to implement a safety plan for the child until a safe place is
available.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-13. Responsibility for notification - Elopement of children.

When a facility confirms that a child's whereabouts are unknown, the facility shall immediately
notify law enforcement officials and the individual who may lawfully act on behalf of the child. The
child's return must be reported immediately to law enforcement and the individual who may lawfully act
on behalf of the child. The facility shall institute policies and procedures for responding to the
elopement of children from the facility.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014.

General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-14. Employee health qualifications.

1. All employees, including nonemployees, must be in good health and physically and mentally
capable of performing assigned tasks.
2. All employees must have a health screening that includes a test for tuberculosis, performed by
or under the supervision of a physician not more than one year prior to or thirty days after
employment. The individual performing the screening shall sign a report indicating the
presence of any health condition that would create a hazard to children of the facility or other
employees.
3. Unless effective measures are taken to prevent transmission, an employee or nonemployee
suffering from a serious communicable disease shall be isolated from other employees,
nonemployees, and children of the facility who have not been infected.
4. Information obtained concerning the medical condition or history of an employee must be
collected and maintained on forms and in medical files separate from other forms and files
and must be treated as a confidential medical record.
5. The facility shall develop a policy regarding health requirements for nonemployees that
addresses tuberculin testing.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-04, 25-03.2-07
### § 75-03-17-15. Staff-to-child ratio.

1. The ratio of employee to children must meet the standards of the facility's accredited body and
be included in the facility's policies and procedures. The facility shall follow the employee-to-
child ratio set by its accrediting body, or the ratios set forth in this subsection, if the ratios set
forth in this subsection require a greater number of employee to children than the ratios set by
the accrediting body. The employee-to-child ratio on the premises during waking hours
Monday through Friday is dependent on the needs of the children and the requirements of the
individual person-centered treatment plans, but may not be less than:
a. Two employees present who are qualified to provide direct care for one to six residents.
b. Three employees present who are qualified to provide direct care for seven to nine
residents.
c. Four employees present who are qualified to provide direct care for ten to twelve
residents.
d. Five employees present who are qualified to provide direct care for thirteen to sixteen
residents.
2. On evenings, nights, weekends, and holidays, during non-programming hours, the ratio of
employees to children is dependent on the needs of the children and the requirements of the
individual person-centered treatment plans. Additionally, the ratio of employee-to-children
must meet the minimum standards of the accrediting body but may not be less than two
employees on premises qualified to provide direct care. The facility shall implement a policy
that if there is an emergency, and additional employees are not available to respond to the

facility within fifteen minutes, the facility will call for law enforcement or emergency medical
assistance.
3. All night employees must be awake and within hearing distance of children. Employees shall
perform bedroom checks at a minimum of every fifteen minutes to assure that each sleeping
child is in that child's assigned room and is safe.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; July 1,
2014; April 1, 2016.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-16. Personnel policies and employee and nonemployee files.

1. The facility shall have clearly written personnel policies. The policies must be made available
to each employee and nonemployee and must include:
a. An employee training and development plan;
b. Procedures for reporting suspected child abuse and neglect for employees and
nonemployees;
c. Procedures for employee evaluation, disciplinary actions, and termination;
d. A prohibition of sexual contact between employees and nonemployees and children in
accordance with the Prison Rape Elimination Act of 2003 [Pub. L. 108-79];
e. Procedures for employee grievances;
f. Both oral and written instructions regarding employee and nonemployee responsibility for
preserving confidentiality;
g. Evaluation procedures that include a written evaluation following the probationary period
for new employees and at least annually thereafter; and
h. A plan for review of the personnel policies and practices with employee and, as
appropriate, nonemployee, participation at least once every three years, or more often if
necessary.
2. The facility shall maintain an individual file on each employee. The file must include:
a. The application for employment including a record of previous employment and the
applicant's statement in answer to the question, "Have you been convicted of a crime?";
b. Annual performance evaluations; or
c. Annual professional development and training records consisting of name of presenter,
date of presentation, topic of presentation, and length of presentation;
d. The following required training certificates:
(1) First-aid training;
(2) Cardiopulmonary resuscitation and automated external defibrillator;
(3) Nonviolent crisis intervention;
(4) Suicide prevention training;

(5) Evidence-based treatment modalities; and
(6) Trauma training;
e. Evidence of the employee having read the law requiring the reporting of suspected child
abuse and neglect, North Dakota Century Code chapter 50-25.1, and having read and
received a copy of the facility's written child abuse and neglect procedures;
f. Results of background checks for criminal conviction record, motor vehicle operator's
license record, as applicable, and child abuse or neglect record;
g. Any other evaluation or background check deemed necessary by the administrator of the
facility; and
h. Documentation of the status of any required license or qualification for the position or
tasks assigned to the employee.
3. The facility shall maintain an individual file on each nonemployee. The file must include:
a. Personal identification information;
b. Results of background checks for criminal conviction record, motor vehicle operator's
license record, as applicable, and child abuse or neglect record;
c. Description of duties;
d. Orientation and training records consisting of name of presenter, date of presentation,
topic of presentation, and length of presentation; and
e. Evidence of the nonemployee having read the law requiring the reporting of suspected
child abuse and neglect, North Dakota Century Code chapter 50-25.1, and having read
and received a copy of the facility's written child abuse and neglect procedures.
4. The facility shall adopt a policy regarding the retention of employee and nonemployee files.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-16.1. Child abuse and neglect reporting.

1. All facility employees and nonemployees, upon hire and annually thereafter, shall certify
having read the law requiring the reporting of suspected child abuse or neglect, North Dakota
Century Code chapter 50-25.1, and having read and received a copy of the facility's written
child abuse and neglect reporting procedures.
2. The facility shall adopt written policies and procedures requiring employees and
nonemployees to report cases of suspected child abuse and neglect. The procedures must
include the following statements:
"All employees and nonemployees shall comply with North Dakota Century Code chapter
50-25.1, child abuse and neglect. Therefore, it is the policy of this facility that an employee or
nonemployee who knows or reasonably suspects that a current resident or former resident
receiving aftercare services whose health or welfare has been, or appears to have been,
harmed as a result of abuse or neglect, that employee or nonemployee shall immediately
report this information to the department.

Failure to report this information in the prescribed manner constitutes grounds for dismissal
from employment or placement of nonemployee and referral of the employee or nonemployee
to the office of the state's attorney for investigation of possible criminal violation."
3. The facility's policies and procedures must address:
a. To whom a report is made;
b. When a report must be made;
c. The contents of the report;
d. The responsibility of each individual in the reporting chain;
e. The status of an employee or nonemployee who is the alleged perpetrator subject of a
report pending assessment, administrative proceeding, or criminal proceeding;
f. The discipline of an employee or nonemployee who is the perpetrator subject of a
confirmed decision or a determination that institutional child abuse or neglect is indicated,
up to and including termination; and
g. The status and discipline of an employee or nonemployee who fails to report suspected
child abuse or neglect.
4. The facility shall cooperate fully with the department throughout the course of any assessment
or investigation of any allegation of child abuse or neglect made concerning care furnished to
a resident. The facility shall, at a minimum, provide the assessors, investigators, or reviewers
with all documents and records available to the facility and reasonably relevant to the
assessment or investigation, and shall permit confidential interviews with employees,
nonemployees, and residents. Internal facility interviews and investigations are not permitted
to occur concurrent with a department assessment or law enforcement investigation. A facility
may use risk reduction techniques to ensure safety and security of employees,
nonemployees, and residents. In the case of an indicated determination, the facility shall notify
the department licensing administrator, in writing, of the corrective action the facility has taken,
or plans to take, to comply with any resulting recommendations from the state child protection
team. The facility shall make assurances that revised facility practice will reduce the risk of the
incident reoccurring. The facility shall respond within thirty days of receiving written notification
of the determination.
History: Effective September 1, 1998; amended effective April 1, 2008; April 1, 2014; April 1, 2016;
April 1, 2022; July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-16.2. Criminal conviction - Effect on operation of facility or employment by facility.

1. A facility operator may not be, and a facility may not employ, in any capacity that involves or
permits contact between the employee, contracted service providers, or nonemployee and
any child cared for by the facility, an individual who is known to have been found guilty of, pled
guilty to, or pled no contest to:
a. An offense described in North Dakota Century Code chapter 12.1- 16, homicide; 12.1-17,
assaults - threats - coercion - harassment; 12.1-18, kidnapping; 12.1-27.2, sexual
performances by children, 12.1-41, Uniform Act on Prevention of and Remedies for
Human Trafficking; or 19-03.1, Uniform Controlled Substance Act, if class A, B, or C
felony under that chapter; or in North Dakota Century Code section 12.1-20-03, gross
sexual imposition; 12.1-20-03.1, continuous sexual abuse of a child; 12.1-20-04, sexual

imposition; 12.1-20-05, corruption or solicitation of minors; 12.1-20-05.1, luring minors by
computer or other electronic means; 12.1-20-06, sexual abuse of wards; 12.1-20-07,
sexual assault; 12.1-20-12.3, sexual extortion; 12.1-21-01, arson; 12.1-22-01, robbery, if
class A or B felony under subsection 2 of that section; 12.1-22-02, burglary, if a class B
felony under subdivision b of subsection 2 of that section; 12.1-29-01, promoting
prostitution; 12.1-29-02, facilitating prostitution; 12.1-31-05, child procurement;
12.1-31-07, endangering an eligible adult - penalty; 12.1-31-07.1, exploitation of an
eligible adult - penalty; 14-09-22, abuse of a child;or 14-09-22.1, neglect of a child;
b. An offense under the laws of another jurisdiction which requires proof of substantially
similar elements as required for conviction under any of the offenses identified in
subdivision a; or
c. An offense, other than an offense identified in subdivision a or b, if the department
determines that the individual has not been sufficiently rehabilitated.
(1) The department will not consider a claim that the individual has been sufficiently
rehabilitated until any term of probation, parole, or other form of community
corrections or imprisonment for all other criminal convictions has elapsed.
(2) An offender's completion of a period of five years after final discharge or release
from any term of probation, parole, or other form of community corrections or
imprisonment, without subsequent charge or conviction, is prima facie evidence of
sufficient rehabilitation.
2. A facility shall establish written policies, and engage in practices that conform to those
policies, to effectively implement subsection 1.
3. The department has determined the offenses enumerated in subdivisions a and b of
subsection 1 have a direct bearing on the individual's ability to serve the public in a capacity
involving the provision of foster care to children.
4. In the case of offenses described in North Dakota Century Code section 12.1-17-01, simple
assault; 12.1-17-03, reckless endangerment; 12.1-17-06, criminal coercion; 12.1-17-07,
harassment; 12.1-17-07.1, stalking; 12.1-22-01, robbery, if a class C; or 12.1-31-07.1,
exploitation of an eligible adult - penalty, if class B or C felony or a class A misdemeanor; or
chapter 19-03.1, Uniform Controlled Substances Act, if a class A, B, or C felony; or equivalent
conduct in another jurisdiction which requires proof of substantially similar elements as
required for conviction, the department may determine that the individual has been sufficiently
rehabilitated if five years have elapsed after final discharge or release from any term of
probation, parole, or other form of community corrections or imprisonment, for all other
criminal convictions. The department may not be compelled to make such determination.
5. The department may discontinue processing a request for a criminal background check for
any individual who provides false or misleading information about the individual's criminal
history.
6. An individual is known to have been found guilty of, pled guilty to, or pled no contest to an
offense when it is:
a. Common knowledge in the community;
b. Acknowledged by the individual; or
c. Discovered by the facility, authorized agent, or department as result of a background
check.

7. The facility shall require a fingerprint-based criminal background check and child abuse or
neglect index be completed for each employee and nonemployee.
8. The facility shall make an offer of employment to an employee or an offer of placement to a
nonemployee conditional upon the individual's consent to complete required background
checks. While awaiting the results of the required background checks, a facility may choose to
provide training and orientation to an employee or nonemployee. However, until the completed
and approved required background check results are placed in the employee or nonemployee
file, the employee or nonemployee shall only have supervised interaction with any child cared
for by the facility.
9. A facility shall establish written policies specific to how the facility will proceed if a current
employee or nonemployee is known to have been found guilty of, plead guilty to, or pled no
contest to a criminal offense.
10. If a prospective employee has previously been employed by one or more group homes,
residential child care facilities, or facilities, the facility shall request a reference from all
previous group home, residential child care facility, and facility employers regarding the
existence of any determination or incident of reported child abuse or neglect in which the
prospective employee is the perpetrator subject.
11. The facility shall perform a background check for reported suspected child abuse or neglect
each year on each facility employee. Each employee, including direct care staff, supervisors,
administrators, administrative, and facility maintenance staff, shall complete a department-
approved authorization for child abuse and neglect background check form no later than the
first day of employment and annually thereafter to facilitate the background checks required
under this subsection.
12. The department may excuse an individual from providing fingerprints if usable prints have not
been obtained after two sets of prints have been submitted and rejected. If an individual is
excused from providing fingerprints, the department may conduct a nationwide name-based
criminal history record investigation in any state in which the person lived during the eleven
years preceding the signed authorization for the background check.
13. A facility shall establish written policies and engage in practices that conform to those policies,
to effectively implement this section.
14. Fingerprint-based criminal background check results must be reviewed as follows:
a. If an individual disputes the accuracy or completeness of the information contained in the
fingerprint-based criminal background check required under this chapter, the individual
may request a review of the results by submitting a written request for review to the
department within thirty calendar days of the date of the results. The individual's request
for review must include a statement of each disputed item and the reason for the dispute.
b. The department shall assign the individual's request for review to a department review
panel.
c. An individual who has requested a review may contact the department for an informal
conference regarding the review any time before the department has issued its final
decision.
d. The department shall notify the individual of the department's final decision in writing
within sixty calendar days of receipt of the individual's request for review.
e. The final decision of the review panel may not be appealed.

History: Effective April 1, 2016; amended effective July 1, 2022; April 1, 2024; October 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-04.1, 25-03.2-07
### § 75-03-17-17. Facility employee.

1. The facility's employees shall include:
a. An executive director who has a bachelor's degree in a behavioral science, or a
bachelor's degree in any field and two years of experience in administration;
b. A program director who has a bachelor's degree in social work, psychology, or in a
related field with professional experience working with children suffering from mental
illnesses or emotional disturbances;
c. Facility care employees who are at least twenty-one years of age and have sufficient
training and demonstrated skills experience to perform assigned duties;
d. A sufficient number of qualified psychiatric professionals, employed or contracted, to
meet the resident needs; and
e. Educators, where onsite education is provided.
2. Nonemployees may be used to augment and assist other employees in carrying out program
or treatment plans. Nonemployees shall receive orientation training regarding the program,
employees, and children of the facility, and the functions to be performed.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2016; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-18. Safety, buildings, and grounds.

1. Compliance with fire, sanitation, and zoning standards. An applicant shall demonstrate
compliance with applicable state or local fire, sanitation, and zoning standards. The premises
to be used must be in fit, safe, and sanitary condition and properly equipped to provide good
care and treatment.
a. Fire. For fire safety, the facility shall meet the applicable life safety standards established
by the city. If the city has not established life safety standards, the facility shall comply
with chapter 21 of the Life Safety Code of the national fire protection association, 1985
edition, and amendments thereto.
(1) Compliance is shown by submitting the written report of an authorized fire inspector,
following an initial or subsequent inspection of a building which states the:
(a) Rated occupancy and approval of the building for occupancy; or
(b) Existing hazards, and recommendations for correction which, if followed, would
result in approval of the building for occupancy.
(2) All electrical and heating equipment must be approved by underwriters laboratories,
incorporated, or another nationally recognized testing laboratory.
b. Sanitation. Compliance with sanitation standards is shown by submitting a statement
prepared by a licensed environmental health professional or authorized public health
officer, following an initial or subsequent annual inspection, that the building's plumbing,

sewer disposal, water supply, milk supply, and food storage and handling comply with the
applicable rules of the department and the department of environmental quality.
c. Zoning. Compliance with zoning requirements is shown by submitting a statement
prepared by the appropriate county or municipal official having jurisdiction that the
premises are in compliance with local zoning laws and ordinances.
2. Safety. Safety requirements of a facility must include:
a. Prohibition of smoking on the premises;
b. Procedures for water safety where swimming facilities are on the grounds;
c. A copy of the Red Cross manual on first-aid measures, or a book of its equivalent, and
first-aid supplies;
d. Prohibiting a child's possession and use of any firearms while at the facility;
e. Advising children of emergency and evacuation procedures upon admission and
thereafter every two months;
f. Training in properly reporting a fire, in extinguishing a fire, and in evacuation from the
building in case of fire. Fire drills must be held monthly. Fire extinguishers must be
provided and maintained throughout each building in accordance with standards of the
state fire marshal; and
g. Telephones with emergency numbers posted by each telephone in all buildings that
house children.
3. Buildings and grounds. The facility must have sufficient outdoor recreational space, and the
facility's buildings must meet the following standards:
a. Bedrooms. Each child must have eighty square feet [7.43 square meters] in a single
sleeping room, and sixty square feet [5.57 square meters] per individual in a multiple
occupancy sleeping room; the child's own bed, and bed covering in good condition; and a
private area to store the child's personal belongings. A facility may not permit more than
two children in each sleeping room; children to sleep in basements or attics;
nonambulatory children to sleep above the first floor; and a child to share a bedroom with
a child of the opposite sex.
b. Bathrooms. The facility's bathroom facilities must have an adequate supply of hot and
cold water; be maintained in a sanitary condition; have separate toilet and bath facilities
for male and female children, and employees; and have one bathroom that contains a
toilet, washbasin, and tub or shower with hot and cold water for every four children.
c. Dining and living rooms must have suitably equipped furnishings designed for use by
children within the age range of children served by the facility.
d. The facility shall provide sufficient space for indoor quiet play and active group play.
e. The facility shall provide adequate heating, lighting, and ventilation.
f. Employee quarters must be separate from those of children, although near enough to
assure proper supervision of children.
g. A facility shall provide a quiet area for studying.

h. A facility shall lock all outbuildings on the property at all times when not in use by facility
employees.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; April 1, 2016; April 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-07
### § 75-03-17-19. Interstate compact on the placement of children.

1. The facility shall comply with the interstate compact on the placement of children and the
interstate compact for juveniles.
2. All placements from any state which has not adopted the interstate compact on the placement
of children or the interstate compact on juveniles must comply with all North Dakota laws and
rules prior to the arrival of a child at a facility.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-06
### § 75-03-17-20. Rights and obligations of the applicant.

1. Right to apply for license. An applicant has the right to apply to receive a license to operate
a facility under this chapter.
2. Entry and inspection.
a. The department may evaluate a facility's compliance with this chapter at any time
through:
(1) An announced or unannounced onsite review; or
(2) A request for written documentation verifying compliance.
b. The applicant shall allow authorized representatives of the department to enter any of the
applicant's buildings or facilities to determine the extent to which the applicant is in
compliance with the rules of the department, to verify information submitted with an
application for licensure or license renewal, and to investigate complaints. Inspections
must be scheduled for the mutual convenience of the department and the facility unless
the effectiveness of the inspection would be substantially diminished by prearrangement.
3. Access to records. The applicant shall allow duly authorized representatives of the
department to inspect the records of the applicant, to facilitate verification of the information
submitted with an application for licensure, and to determine the extent to which the applicant
is in compliance with the rules of the department.
4. Denial of access to facilities and records. Any applicant or licensee which denies access,
by the authorized representative of the department, to a facility or records for the purpose of
determining the applicant's or licensee's state of compliance with the rules of the department
shall have its license revoked or application denied.
5. License refusal or revocation. Failure to comply with any of the standards of this chapter or
other state law or regulation is cause for refusal or revocation of a license. Conviction of an
offense by an owner or operator of a facility does not disqualify the facility from licensure
unless the department determines that the offense has a direct bearing upon an individual's
ability to serve the public as an owner or operator of a psychiatric residential treatment facility

for children or that, following conviction of any offense, the individual is not sufficiently
rehabilitated under North Dakota Century Code section 12.1-33-02.1.
6. Appeal. An applicant may appeal a license denial in accordance with North Dakota Century
Code chapter 28-32 and North Dakota Administrative Code chapter 75-01-03.
7. Deemed status. The department may recognize "deemed status" for those providers who are
accredited by nationally recognized bodies who review and certify providers of psychiatric
residential treatment services for children. When applying for licensure or licensure renewal,
proof of accreditation or "deemed status" in the form of the accreditation agency's most recent
review and certification must be submitted to the department. "Deemed status" means status
conferred on a facility accredited by a national accreditation body based on standards that
exceed the standards set forth in these licensure rules.
History: Effective December 1, 1989; amended effective September 1, 1998; April 1, 2008; April 1,
2014; July 1, 2022; April 1, 2024.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-02, 25-03.2-03, 25-03.2-07, 25-03.2-08, 25-03.2-09
### § 75-03-17-21. Increase or decrease in the number of licensed beds in a facility.

1. A facility may not increase or decrease bed capacity without approval of the department. A
facility requesting a bed capacity change shall submit a request to the department licensor. To
qualify for an increase, a facility must:
a. Be in compliance with this chapter.
b. Submit a plan for the use of its beds.
2. The department shall review the facility's request and may approve or deny the request
considering the programming need for the beds and the number of beds available.
History: Effective April 1, 2014.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03.1
### § 75-03-17-22. Incident and sentinel event reporting.

1. The facility shall have a written policy outlining the documentation of incidents that occur while
the resident is in placement. The policy must include:
a. A description of an incident as an unplanned occurrence that resulted or could have
resulted in injury to an individual or damage to property, specifically involving the public,
residents, or agency employees and nonemployees; incidents involving law enforcement,
including in the case of a runaway, criminal activity, behavior resulting in harm to others,
or restraint injury; and incidents involving outbreak of a serious communicable disease,
harassment, violence, and discrimination; and
b. Notification must be made to the custodian and parent or guardian immediately or no
more than twelve hours;
2. The facility shall have a written policy outlining the documentation of sentinel events that occur
while the resident is in placement. The policy must include:
a. A description of a sentinel event as an unexpected occurrence involving death or serious
physical or psychological injury not related to the natural course of a resident's illness or
underlying medical condition, including any process variation for which a reoccurrence

would carry a significant chance of a serious adverse outcome, trauma to a resident,
attempted suicide by the resident, or inappropriate sexual contact; and
b. Notification must be made to the custodian and parent or guardian, and the department
immediately or no more than twelve hours;
3. Documentation of an incident or sentinel event must be completed and placed in the resident's
record. The report must include:
a. Resident's name, age, and sex;
b. A description of the incident or event;
c. The date, time, and location of the incident or event;
d. The name of each employee or nonemployee involved;
e. Methods used to address the resident's behavior, including duration of each intervention;
f. Detailed description of the technique or approach engaged with the resident at the time
of the incident or event;
g. Results achieved from methods used to address resident behavior; and
h. Injuries received by either the resident, employee, or nonemployee in using physically
enforced separation or restraint, how the injuries occurred, and any medical care
provided;
4. The facility shall maintain a log of written reports of incidents involving residents;
5. Direct care staff must be given time at the beginning of each shift to be informed of or review
incident reports occurring since their last shift; and
6. Employees, nonemployees, and residents must be given time to debrief the incident with
clinical staff.
History: Effective July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-10
### § 75-03-17-23. Conditions.

1. The department may require immediate correction of a condition that threatens the life or
safety of a resident.
2. The facility shall submit to the department a plan of corrective action within thirty days of
receiving the licensure visit report. The facility shall be allowed sixty days after the plan of
corrective action is submitted to and approved by the department to implement the plan and
satisfy the conditions.
3. The department may conduct another onsite review before issuing the license after a facility
has developed a plan of corrective action.
4. If the facility does not satisfy a condition or develop a plan of corrective action to satisfy the
condition within the time frames allowed, the department may impose a ninety-nine-day
suspension of the facility's license. At the end of the ninety-nine-day suspension, if the
condition has been corrected, the department may issue a one-year provisional license to the

facility. If the facility has not corrected the condition, the department may revoke the facility's
license.
5. Upon written request by the facility and upon showing a need for an extension created by
circumstances beyond the control of the facility and documentation that the facility has
diligently pursued correction of the condition, the department may grant extensions of time to
correct conditions.
6. A facility which has had its license revoked is prohibited from submitting a new application to
the department for consideration for a license for any facility during the three hundred
sixty-five days following a license revocation.
History: Effective July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-10
### § 75-03-17-24. Variance.

Upon written application and good cause shown to the satisfaction of the department, the
department may grant a variance regarding a specific provision of this chapter upon such terms as the
department may prescribe, except no variance may permit or authorize a danger to the health or safety
of any resident cared for by the facility and no variance may be granted except at the discretion of the
department. A facility shall submit a written request to the department justifying the variance. A refusal
to grant a variance is not subject to appeal.
History: Effective July 1, 2022.
General Authority: NDCC 25-03.2-10
Law Implemented: NDCC 25-03.2-03, 25-03.2-10
