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.