A patient at Maryland’s maximum-security mental hospital killed a fellow inmate late Thursday, the second fatal attack in a week inside the facility in Jessup and the third in the past 13 months, officials said Friday.

The clutch of violence prompted a Maryland Cabinet secretary to acknowledge that “more needs to be done” to improve safety at the Clifton T. Perkins Hospital.

The hospital treats those accused of felonies who are deemed not competent to stand trial or not criminally responsible for their actions. On Friday, it had 239 patients, just shy of its 248-patient capacity, hospital officials said. The vast majority were under maximum security. There are 450 staff members at Perkins.

Rogelio Mondragon, 40, whose last address was in the Langley Park area, was killed in his room, and Maryland State Police are investigating the case as a homicide, authorities said. He died of blunt-force trauma to his head and face, and there were signs of severe trauma near his neck, an autopsy found.

Mondragon was charged in a 2010 rape of an 11-year-old girl in Silver Spring and had been in Montgomery County Court on Thursday for a routine annual evaluation of his competency and then returned to the hospital, said Mondragon’s attorney, Jonathan Fellner. “I was shocked, really shocked” to learn of his death, Fellner said.

Andre Mayo, 46, of Baltimore was held without bond Friday in Howard County on a murder charge in Mondragon’s death, court records show. Authorities did not say why Mayo was being held at Perkins.

The death comes a week after Vitaly Davydov, 24, of North Potomac was accused of killing his roommate at Perkins. Davydov was at Perkins after being deemed not criminally responsible in the 2006 beating death of his Rockville psychiatrist.

In September 2010, a female patient was strangled by a known sex offender at the hospital, police said. State officials said at the time that the death appeared to be the first killing in the hospital’s 50-year history. That case is pending.

Joshua M. Sharfstein, secretary of Maryland’s Department of Health and Mental Hygiene, said that “Perkins Hospital has taken many steps to strengthen the safety of its environment, but more needs to be done.”

On Friday, an additional employee was added to each shift to watch patients, bringing the total to two per shift, a change discussed after the Oct. 21 attack. The hospital also has cameras in the hallways, but not in patients’ rooms.

Sharfstein called the events “tragic and unacceptable” and ordered a full safety review.

“There may be some patients who are not ready” for a hospital setting, Sharfstein said. “That is a question that has to be asked as part of this.”

The hospital will review each patient’s supervision level. Perkins Hospital has seven maximum-security, two medium-security and one minimum-security units, officials said at a news briefing after Mondragon’s death.

Surveillance video shows Mayo entering Mondragon’s room twice within 30 minutes before 6:30 p.m. Thursday. Hospital staff doing their regular checks found Mondragon’s body at that time, police said.

The two were not roommates, according to police. As staff cleared the floor’s patients for investigators, state police said, Mayo approached one worker and “provided information about the assault.” Mayo’s hands and face indicated “he may have been in a fight,” the police account noted.

A motive for the killing has not been determined, said Greg Shipley, spokesman for the state police. Mondragon had two roommates but was alone in the room, Shipley said.

Laura Cain, managing attorney for the adult mental health unit for the Maryland Disability Law Center, said the killings — while “unprecedented” — “certainly speak to serious dysfunction.” But she cautioned against “succumbing to the pressure of fear and just going into lockdown.”

Both she and Patrick Moran, director of the Maryland chapter of the American Federation of State, County and Municipal Employees, which represents about 350 employees at Perkins, said the hospital has made some safety improvements in the past year.

But, Moran said, “there has to be a more-comprehensive plan put forward for an overhaul and a more common-sense approach that includes talking to frontline employees who work with these patients minute-to-minute.”