Subtitle 07 HOSPITALS › Chapter 14 Assisted Living Programs

.01 Purpose. The purpose of this chapter is to set minimum, reasonable standards for licensure of assisted living programs in Maryland. This chapter is intended to maximize independence and promote the principles of individuality, personal dignity, freedom of choice, and fairness…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) Abuse of a Resident. (a) “Abuse of a resident” means physical, sexual, mental, or verbal abuse, or the improper use of a physical or chemical restraint or involuntary seclu…

.03 Incorporation by Reference. In this chapter, the following documents are incorporated by reference: A. Centers for Disease Control and Prevention (CDC) Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 2005, which is incorpora…

.04 License Required. A. A person may not operate an assisted living program in the State without obtaining a license from the Secretary and complying with the requirements of this chapter. B. Providing housing under a landlord-tenant arrangement does not, in and of itself, exclu…

.05 Levels of Care. A. An assisted living program may provide: (1) The level of care for which the assisted living program has been approved; and (2) Any lower level of care. B. At the time of initial licensure, an applicant shall: (1) Request approval to provide services at one …

.06 Restrictions. A. Restricted Nomenclature. An assisted living program licensed under this chapter may not use in its title or advertising the words “hospital”, “sanitarium”, “nursing”, “convalescent”, “rehabilitative”, “sub-acute”, or “hospice”. B. Advertising an Assisted Livi…

.07 Licensing Procedure. A. Application for License. (1) To obtain and maintain a license, an applicant shall meet all of the requirements of: (a) This chapter; (b) Other applicable federal, State, and local laws and regulations; and (c) Health-General Article, §19-311, Annotated…

.08 Changes in an Assisted Living Program that Affect the Operating License. A. General Information Related to Licensure. (1) A licensee shall immediately notify the Department of any change in the information the licensee had submitted with the most recent application. (2) A lic…

.09 Licensure Standards Waiver. A. The Department may grant an assisted living program a waiver from the licensure requirements of this chapter with or without conditions. B. The Department may not, however, grant a waiver from the requirements of Regulation .23A of this chapter.…

.10 Uniform Disclosure Statement. A. When an assisted living program changes the services reported on its Uniform Disclosure Statement filed with the Department under Regulation .07A(2)(b) of this chapter, the program shall file an amended Uniform Disclosure Statement with the De…

.11 Investigation by Department. A. Assisted Living Program to Be Open for Inspection. (1) An assisted living program operated by a licensee, and any premises proposed to be operated as an assisted living program, shall be open at all times to announced or unannounced inspections…

.12 Compliance Monitoring. A. The Department shall be responsible for monitoring and inspecting assisted living programs to determine compliance with the requirements of this chapter. B. Consistent with an interagency agreement, the Department may delegate certain aspects of its …

.13 Administration. A. Quality Assurance. (1) The assisted living program manager or their designee shall develop and implement a quality assurance plan. (2) Quality Assurance Plan. (a) The quality assurance plan shall include an annual facility risk assessment for tuberculosis, …

.14 Staffing Plan. A. Following an analysis of the number of residents that the assisted living program intends to serve and the individual needs of each resident, the assisted living program shall develop a staffing plan that identifies the type and number of staff needed to pro…

.15 Assisted Living Manager. A. Qualifications. (1) An individual shall be licensed as required by Health Occupations Article, §9-3A-01, Annotated Code of Maryland, before the individual may practice as an assisted living manager in Maryland. (2) The assisted living manager shall…

.16 80-Hour Assisted Living Manager Training Course. A. In addition to the requirements in Regulation .15 of this chapter, by January 1, 2006, an assisted living manager shall complete an 80-hour manager training course that is approved by the Department. B. The completed manager…

.17 80-Hour Assisted Living Manager Basic Training Course. A. The 80-hour assisted living manager basic training course shall include the following content: (1) Philosophy of assisted living, 2 hours, including: (a) Philosophy and background of assisted living and aging in place;…

.18 Alternate Assisted Living Manager. An alternate assisted living manager shall: A. Be available to assume the responsibilities described in Regulation .15C(2)(a)—(l) of this chapter when the assisted living manager is not available; B. Be 21 years old or older; C. Have 2 years…

.19 Other Staff — Qualifications. A. Age Requirements of Other Staff. (1) Direct resident care staff shall be: (a) 18 years old or older; (b) 16 or 17 years old who are enrolled in a certified nursing assistant training program and are supervised until certified; or (c) 16 or 17 …

.20 Personnel Records. The assisted living program shall maintain the following information for each staff member: A. Full name, age, and gender; B. Address and telephone number; C. Educational background; D. Employment history; E. Notes on references; F. Performance evaluations;…

.21 Delegating Nurse. A. The assisted living program shall have a current and signed agreement with a registered nurse for services of a delegating nurse and delegation of nursing tasks. If the delegating nurse is an employee of the assisted living program, the employee’s job des…

.22 Preadmission Requirements. A. Before Move In. (1) Before admission the assisted living manager or designee in collaboration with the delegating nurse shall determine whether: (a) The resident may be admitted under the assisted living program’s licensure category; (b) Requires…

.23 Admission Requirements. A. Discrimination Prohibited. An assisted living program licensed under this chapter may not discriminate in admitting or providing care to an individual because of the individual’s: (1) Race; (2) Color; (3) National origin; (4) Sexual orientation; (5)…

.24 Resident-Specific Level of Care Waiver. A. An assisted living program may request a resident-specific waiver to continue to provide services to a resident if: (1) The resident’s level of care exceeds the level of care for which the assisted living program has authority to pro…

.25 Payment of Funds Before Admission. If an assisted living program requires payment of funds before admission, the funds shall be fully refundable unless the assisted living program discloses, in writing, what portion is not refundable.

.26 Resident Agreement — General Requirements and Nonfinancial Content. A. Except as otherwise provided under §E of this regulation, for a person admitted for other than short-term residential care, the resident or the resident agent and the assisted living manager or their desig…

.27 Resident Agreement — Financial Content. A. The resident agreement shall include financial provisions, which include at a minimum: (1) Obligations of the assisted living program and the resident, or the resident agent, as to: (a) Handling the finances of the resident; (b) The …

.28 Service Plan. A. Service Plan Development. (1) The assisted living manager, or designee, shall ensure that all services are provided in a manner that respects and enhances the dignity, privacy, and independence of each resident. (2) A service plan for each resident shall be d…

.29 Resident Record. A. The assisted living manager shall ensure that an individual record or log is maintained at the assisted living program for each resident in a manner that ensures security and confidentiality, and which includes at a minimum: (1) Resident Assessment Tools; …

.30 Services. A. Meals. (1) The assisted living manager shall ensure that: (a) A resident is provided three meals in a common dining area and additional snacks during each 24-hour period, 7 days a week; (b) Meals and snacks are well-balanced, varied, palatable, properly prepared,…

.31 Medication Management and Administration. A. All unlicensed staff who will administer medications to residents shall have first completed the medication administration course that is taught by a registered nurse who is approved by the Maryland Board of Nursing to teach the ce…

.32 Alzheimer’s Special Care Unit. A. Initial Approval of an Alzheimer’s Special Care Unit. An assisted living program requesting the initial approval to operate an Alzheimer’s Special Care Unit shall submit to the Department a written description of the Alzheimer’s Special Care …

.33 Incident Reports. A. Staff of the assisted living program shall complete an incident report within 24 hours of having knowledge that an incident, as defined in Regulation .02B(39) of this chapter, occurred. B. The assisted living program shall make incident reports available …

.34 Relocation and Discharge. A. Relocation within the Facility. (1) The assisted living program may not relocate a resident within the facility except in accordance with the terms and conditions of the resident agreement. (2) An assisted living program shall notify a resident an…

.35 Resident Representative. A. An assisted living program shall recognize the applicable 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, An…

.36 Resident’s Rights. A. Resident Bill of Rights. (1) An assisted living program shall develop a Resident Bill of Rights that, at a minimum, includes the following rights: (a) Be treated with consideration, respect, and full recognition of the resident’s human dignity and indivi…

.37 Abuse, Neglect, and Financial Exploitation. A. An assisted living program shall develop and implement policies and procedures prohibiting abuse, neglect, and financial exploitation of residents. B. An assisted living program may not knowingly employ an individual who has any …

.38 Restraints. A. The resident has the right to be free of restraints used in violation of this chapter. B. A protective device as defined in Regulation .02B(66) of this chapter is not considered a restraint. C. Improper Use of Chemicals or Drugs. Chemicals or drugs may not be u…

.39 Protection of a Resident’s Personal Funds. A. A resident may: (1) Manage the resident’s financial affairs; or (2) Consistent with State law, choose any individual who is willing and able to handle the resident’s financial affairs. B. An assisted living program may refuse to h…

.40 Misuse of Resident’s Funds. A. A person may not misappropriate a resident’s assets or income, including spending the resident’s assets or income against or without the consent of the resident or, if the resident is unable to consent, the resident agent. B. An individual who w…

.41 Approval of Burial Arrangements for Unclaimed Deceased Residents. A. An assisted living program shall ascertain and document on admission of the resident, or within 14 calendar days of admission, any arrangements the resident has made, or wishes to make, with regard to burial…

.42 General Physical Plant Requirements. A. The facility and exterior grounds, shall be kept: (1) In good repair; (2) Clean; (3) Free of any object, material, or condition that may create a health hazard, accident, or fire; (4) Free of any object, material, or condition that may …

.43 Water Supply. A. Approved Source. A facility shall be served by water from an approved public water supply. If an approved public water supply is not available, a private water supply may be accepted if it is approved by the local jurisdiction in which the program is located …

.44 Sewage Disposal. The facility shall be served by an approved public sewage disposal system, if available. If an approved public sewage disposal system is not available, a private sewage disposal system may be accepted if approved by the local jurisdiction in which the program…

.45 Security. A. The facility shall provide: (1) Lockable exterior doors and windows; and (2) An effective automated device or system to alert staff to individuals entering or leaving the building. B. A facility need not use an automated alert for an exit door when the exit is st…

.46 Assist Rails. A. An assisted living program shall provide assist rails in stairways used by residents and for all toilets, showers, and bathtubs used by residents unless, through a waiver request, the Department determines that the physical abilities of the residents make the…

.47 Emergency Preparedness. A. The facility shall comply with: (1) All applicable local fire and building codes; and (2) The National Fire Protection Association (NFPA) 101 Life Safety Code, including Chapter 24 of NFPA 101 if the facility is a one or two family dwelling as defin…

.48 Smoking. A. The assisted living program shall have a written smoking policy that indicates whether or not the program permits smoking. B. When smoking is permitted, the assisted living program shall: (1) Establish smoking policies and procedures which are designed to minimize…

.49 Common Use Areas. A. Multipurpose Space. (1) The assisted living program shall provide at least 35 square feet of usable multipurpose floor space per licensed bed. Multipurpose space includes: (a) Dining; (b) Living; and (c) Indoor recreational space. (2) Usable floor space i…

.50 Resident’s Room and Furnishings. A. Resident Room. (1) More than two residents may not share a resident room. (2) An assisted living program shall provide at least 80 square feet of functional space for single occupancy resident rooms and 120 square feet of functional space f…