Subtitle 07 HOSPITALS › Chapter 02 Nursing Homes

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administrator” means the individual licensed by the Board of Examiners of Nursing Home Administrators who is responsible for the operation of the nursing home. (2) “Attend…

.02 Incorporation by Reference. A. In this chapter, the following documents are incorporated by reference. B. Documents Incorporated. (1) CMS Long-term Care Facility Resident Assessment Instrument 3.0 User’s Manual, (Version 1.14, October 2016). (2) CMS Manual System, Pub. 100-07…

.03 License Required. A. A person may not establish, operate, or continue the operation of an existing comprehensive care facility or extended care facility without first obtaining a license from the Secretary. A license is valid for 2 years from the date of issuance, unless revo…

.04 Licensing Procedure. A. Application for License. (1) An applicant desiring to open a comprehensive care facility or an extended care facility shall file an application with the Secretary, on a written or electronic form provided by the Secretary. (2) An application for a lice…

.05 Licensed Bed Capacity. A. A facility may exceed its licensed bed capacity only if the Department: (1) Requests that the facility exceed its licensed bed capacity; or (2) Approves a request from a facility to exceed its licensed bed capacity. B. Departmental Request of Facilit…

.06 Rights of Applicant if License Denied or Revoked. A. Denial of License — Proposed Facility. The Secretary shall inform the applicant of the reasons for refusal to issue a license. B. Revocation of License. (1) The Secretary may, for cause shown, revoke or refuse to reissue an…

.07 Inspection by Secretary. A. Open at all Times for Inspection. Licensed nursing homes and any premises that an applicant for a license proposes to operate shall be open at all times to inspection by the Secretary and by any agency designated by the Secretary. B. Site Visits an…

.08 New Construction, Conversion, Alteration, or Addition. A. Submission of Plans. (1) The architect or professional engineer of record shall submit stamped and sealed final construction drawings to the Department. (2) The architect or professional engineer of record shall submit…

.09 Administration and Resident Care. A. Responsibility. (1) The licensee shall be responsible for the overall conduct of the comprehensive care facility or extended care facility and for compliance with applicable laws and regulations. (2) The administrator shall be responsible …

.10 Employee Training on Cognitive Impairment and Mental Illness. A. The following employees shall receive a minimum of 8 hours of training on cognitive impairment and mental illness within the first 90 days of employment: (1) Any employee who is licensed, certified, or registere…

.11 Admission and Discharge. A. Written Policy. The nursing home shall develop written policies, consistent with this chapter and COMAR 10.07.09, to govern the nursing care, related medical, and other services that the nursing home provides regarding: (1) Admissions, transfers, a…

.12 Resident's Representative. A. A nursing home shall recognize the authority of: (1) A guardian of the person under Estates and Trusts Article, §13-705, Annotated Code of Maryland; (2) A guardian of the property under Estates and Trusts Article, §13-201, Annotated Code of Maryl…

.13 Resident Care Policies. A. A nursing home shall develop written policies consistent with Regulation .11 of this chapter pertaining to: (1) Physician services; (2) Residents’ rights; (3) Nursing services; (4) Dietetic services; (5) Specialized rehabilitative services including…

.14 Physician Services. A. Responsibility for the Resident's Care. The attending physician shall: (1) Assess a new admission in a timely manner, based on a facility-developed protocol, depending on: (a) The individual's medical stability; (b) Recent and previous medical history; …

.15 Medical Director — Qualifications. A. Medical Director Qualifications. The nursing home shall: (1) Designate a medical director who has at least the following qualifications: (a) A current license as a physician in this State; (b) At least 2 years of experience or specialized…

.16 Medical Director — Responsibilities. A. General Responsibilities. The medical director is responsible for: (1) Overall coordination, execution, and monitoring of physician services; (2) Monitoring and evaluating the health care services and outcomes, including clinical and ph…

.17 Nursing Home’s Responsibilities in Relation to the Nursing Home’s Medical Director. A. The nursing facility shall: (1) Be responsible for working with the medical director to ensure adequate resident care and practitioner performance; (2) Inform the physician of explicit requ…

.18 Nursing Services. A. Organization, Policies, and Procedures. (1) Nursing service personnel shall provide care appropriate to the residents’ needs with the organizational plan, authority, functions, and duties clearly defined. (2) Nurses and support personnel shall be chosen f…

.19 Nursing Services — Staffing. A. Supervisory Personnel — Nursing Homes. (1) Nursing homes shall provide at least the following supervisory personnel: Residents Registered Nurses (a) 2—99 One—full-time (b) 100—199 Two—full-time (c) 200—299 Three—full-time (d) 300—399 Four—full-…

.20 Nursing Services — Director of Nursing. A. Director of Nursing. The nursing home shall provide for an organized nursing service, under the direction of a full-time registered nurse. B. Termination of Services of Director of Nursing. (1) If the nursing home terminates the serv…

.21 Dietetic Services. A. Services Provided. Services may be provided directly by the facility or the facility may contract with a food management company, a caterer, or another facility. The facility and the food management company (or caterer or facility providing service) shal…

.22 Specialized Rehabilitative Services — Occupational Therapy Services, Physical Therapy Services, Speech Pathology and Audiology Services. A. Rehabilitative Services — Admission Policies. In a nursing home which does not accept residents in need of specialized rehabilitative se…

.23 Special Care Units — General. A. A nursing home which holds a current and valid operating license may establish special care units with the approval of the: (1) Office of Health Care Quality; and (2) Department’s Office of Capital Planning, Budgeting and Engineering Services.…

.24 Special Care Units — Respiratory Care Unit. A. A respiratory care unit shall meet the: (1) General requirements established for all special care units as outlined in Regulation .23 of this chapter; and (2) Requirements of this regulation. B. The nursing home shall submit to t…

.25 Special Care Units — Dementia Care Unit. A. A dementia care unit shall meet the: (1) General requirements established for all special care units as outlined in Regulation .24 of this chapter; and (2) Requirements of this regulation. B. Dementia Unit Disclosure. (1) The disclo…

.26 Pharmaceutical Services. A. Definition. In this regulation, the term “committee” means the pharmaceutical services committee. B. Duties of the Nursing Home. (1) The nursing home shall provide appropriate methods and procedures for administering drugs and biologicals to the nu…

.27 Pharmaceutical Management. A. Administration Procedures. (1) Medications, legend and non-legend, administered to residents shall be ordered in writing by the resident’s physician. (2) Medications shall be administered by: (a) Appropriately licensed personnel in accordance wit…

.28 Laboratory and Radiologic Services. A. Approved Source. Laboratory services provided by the facility shall meet the applicable conditions established under COMAR 10.10.01 Medical Laboratories in Maryland. B. Provisions of Services. If the facility does not provide laboratory …

.29 Dental Services. A. Provision for Dental Care. Residents shall be assisted to obtain routine and emergency dental care. B. Advisory Dentist. There shall be an advisory dentist who shall: (1) Recommend oral hygiene policies and practices for the care of the residents and for a…

.30 Social Work Services. A. Services Provided. The nursing home shall provide or make arrangements for services to identify and meet the resident’s medically related physical, social, and behavioral health needs. B. Social Work Staff Responsibility. (1) Social services responsib…

.31 Resident Activities. A. Activities Program. The nursing home shall provide: (1) A program of structured and unstructured activities; and (2) Activities designed and monitored appropriately to meet the day-to-day needs and interests of each resident and encourage: (a) Self-car…

.32 Clinical Records. A. Records for all Residents. Records for all residents shall be maintained in accordance with accepted professional standards and practices. B. Contents of Record. Contents of record shall include: (1) Identification and summary sheet or sheets including: (…

.33 Infection Prevention and Control Program. A. Infection Prevention and Control Program. The nursing home shall establish, implement, and maintain an effective infection prevention and control program that: (1) Investigates, controls, and prevents infections in a timely manner …

.34 Employee Health Program. A. The nursing home’s infection prevention and control program shall monitor the relevant health status of all employees, as it relates to infection prevention and control. The nursing home shall refer to the following guidelines in implementing its e…

.35 Resident Health Program. A. Immunization. (1) The nursing home shall offer influenza and pneumococcal immunization to each resident. (2) The nursing home shall obtain written consent to administer the immunization from: (a) The resident; or (b) The resident's representative. …

.36 Volunteer Health Program. A. The nursing home shall urge that volunteers, defined as individuals who spend an average of 8 hours per week or more in the resident care areas and who receive no pay or benefits, receive annual influenza vaccination and tuberculin skin testing as…

.37 Infection Control — Standard Precautions. A. Standard Precautions. All employees shall routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or the body fluids of any resident is anticipated as outlined in: (1) 2007…

.38 Reports and Action Required in Unusual Circumstances. A. Serious Emotional Disturbances. A facility may not accept or keep patients who destroy property or are dangerous to themselves or others, or who have acute symptoms of mental illness. B. Action to Be Taken if a Patient …

.39 Transfer Agreement. A. Written Agreement. A written agreement with at least one acute hospital shall be effected which shall provide for the following actions: (1) Planning to ensure that all services required for the continuity of resident care will be made available promptl…

.40 Emergency and Disaster Plan. A. Emergency and Disaster Plan. (1) The licensee shall develop an emergency and disaster plan that includes procedures that shall be followed before, during, and after an emergency or disaster, including: (a) Evacuation, transportation, or shelter…

.41 Physical Plant — New and Existing Construction Requirements. A. Construction of a New Nursing Home. (1) A new nursing home shall be constructed, equipped, and maintained to protect the health and safety of residents, personnel, and the public. (2) A nursing home desiring to p…

.42 Physical Plant — General Requirements. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. B. A nursing home shall comply with all applicable federal, State, and local governing laws, regulations, standards, ord…

.43 Physical Plant — Plumbing. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. B. Plumbing. (1) Plumbing shall be installed in conformance with all applicable federal, State, and local codes and ordinances. (2) …

.44 Physical Plant — Heating and Cooling. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. B. Temperatures. A nursing home shall maintain a minimum design temperature of 75°F or 24°C for all occupied areas. C. He…

.45 Physical Plant — Ventilation. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. B. An existing nursing home shall provide for adequate ventilation through windows or mechanical means or a combination of both. …

.46 Physical Plant — Emergency Power. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. B. Emergency Electrical Power. (1) The nursing home shall provide emergency electrical power. (2) Emergency power for the pur…

.47 Nursing Care Unit. A. Size. Nursing care units may not exceed 60 beds. The Department may specify the numbers and types of personnel for each unit which exceeds 40 beds. B. Common Space. The nursing home shall provide a living room for residents’ use with a sufficient number …

.48 Call Systems. A. Call System. (1) A nurse call system shall be installed and maintained in operating order in all nursing units. (2) A call system shall be maintained in a manner that will provide visible and audible signal communication between nursing service personnel and …

.49 Resident Bedroom in Nursing Home. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home unless a waiver has been granted by the Office of Health Care Quality in accordance with Regulation .03G of this chapter. B. B…

.50 Body-Holding Room. A. Body-Holding Room — New Construction and Existing Nursing Home. (1) A body-holding room shall be equipped with ventilation by mechanical means at the same rate and specifications as designed for soiled linen sorting and storage areas. (2) A nursing home …