If you provide treatment services to 25 or more children with primary medical needs or if more than 30% of the children in your care receive treatment services for primary medical needs:
  (1) You must have a licensed registered nurse on staff or on contract to respond to emergencies, questions, or other medical issues. A registered nurse must work full-time at the operation. A registered nurse in this position may be relieved on days off by a licensed registered nurse or by a licensed vocational nurse with appropriate supervision as defined in Tex. Occ. Code §301.353.
  (2) You must arrange for:
    (A) 24-hour availability of nursing, medical, and psychiatric services;
    (B) Licensed nursing services, including 24-hour nursing direction or supervision;
    (C) Assistance with mobility;
    (D) Routine adjustments or replacement of medical equipment; and
    (E) As needed, caregiver supervision of children during the provision of medical and dental services.
  (3) You must ensure that a physician on staff or on contract recommends and approves services at each initial diagnosis and at each review.

Source Note: The provisions of this §748.569 adopted to be effective January 1, 2007, 31 TexReg 7377; amended to be effective September 1, 2010, 35 TexReg 7497; transferred effective March 9, 2018, as published in the Texas Register February 16, 2018, 43 TexReg 909