Subtitle 12 ADULT HEALTH › Chapter 04 Day Care for the Elderly and Adults with a Medical Disability

.01 Scope. A. This chapter applies to day care centers for the elderly and adults with a medical disability as defined in Health-General Article, Title 14, Subtitles 2 and 3, Annotated Code of Maryland. B. This chapter does not: (1) Affect a relative, domestic partner, neighbor, …

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Activities of daily living” means normal daily activities, including: (a) Eating or being fed; (b) Grooming, bathing, and oral hygiene; (c) Mobility, transfer, ambulation,…

.03 License Required. A. A person may not establish, operate, or continue the operation of a center without first obtaining a license from the Secretary. B. Separate License Required. Separate licenses are required for centers that are maintained on separate premises, even though…

.04 Licensing Procedure. A. Letter of Interest. (1) A person desiring to obtain initial licensure for an adult day care center shall submit a letter of interest to the Office of Health Care Quality that contains the following: (a) Policies and procedures that address medical reco…

.05 Changes in a Program that Affect the Operating License. A. Increase in Capacity or Name Change. (1) During the license period, a licensee may not increase capacity, change its name, or change the name under which the program is doing business without the Department's approval…

.06 Waiver of Provisions. A. The Secretary may waive any provision of this chapter if a center: (1) Experiences practical difficulties or unnecessary hardship in complying with the provisions of this chapter: and (2) Can demonstrate that granting a waiver will not adversely affec…

.07 Inspection by the Department. A. Center Open for Inspection. (1) A licensed center and any premises proposed to be operated as a center shall be open at all reasonable times to announced or unannounced inspections by the Department and by any agency designated by the Departme…

.08 Compliance Monitoring. A. The Department shall monitor or inspect a center at least once every 2 years to ensure compliance with the requirements of this chapter. B. The Department may conduct unannounced or announced licensure or complaint investigation visits as frequently …

.09 Administration. A. Governing Body. The governing body shall establish and maintain sound operating procedures, including: (1) Maintenance of an identifiable administrative unit, headed by a director who is responsible for the overall conduct of all center activities; (2) Adop…

.10 Days and Hours of Operation. A. The center shall be open to participants for at least 6 hours per day 5 days a week, exclusive of holidays and other planned closings. B. The center's hours of operation shall be posted in a prominent place accessible to and easily seen by part…

.11 Preadmission Assessment. A. Before admission, the center shall obtain a written assessment from the prospective participant's health care provider, who shall certify that the information provided reflects the individual's health status within 45 days of the individual's admis…

.12 Admission Criteria. A. The center shall develop written criteria for admission. These criteria shall be specific so that the center does not accept individuals whose needs cannot be met by the center. B. Admission Criteria. The admission criteria shall include at least the fo…

.13 Participant Rights. A. The adult day care center shall provide care for participants in a manner and in an environment that maintains or enhances each participant’s dignity and respect. B. The center shall inform the participant, in a language that the participant understands…

.14 Staff. A. Staffing Pattern. (1) Staffing Ratio. (a) The staff to participant ratio at each center shall be a minimum of one staff to seven participants (1:7) for a period of 2 years after the final adoption of COMAR 10.12.04.14A(1)(a). (b) Two years after the final adoption o…

.15 Program Components — Required Services. A. Health Services. (1) Nursing Services. The center shall provide nursing services under the direction of a registered nurse. The licensee shall fully disclose the services that will be provided outside the adult medical day care cente…

.16 Program Components. A. Special Services. (1) The center shall provide or make arrangements for the services listed in §A(2)—(8) of this regulation when the center admits participants that require these services. (2) Diet Modifications. The center shall provide special diets a…

.17 Medication Services and Policies. A. Written policies for the center shall specify that the RN, LPN, or CMT is authorized to procure, receive, control, and manage the administration of medications at the center. B. Medications. (1) Medicine or drugs shall be restricted to tho…

.18 Orders. A. Orders concerning medication, treatment, and diet shall be in effect for the specified number of days indicated by the health care provider. If not specified, the period may not exceed 6 months. B. Verbal Orders. (1) A licensed nurse shall take verbal medication or…

.19 First-Aid and Cardiopulmonary Resuscitation. A. At least one staff member who is trained in first aid and in cardiopulmonary resuscitation (CPR) shall be on-site at the center when participants are in attendance, during outings, medical appointments or during transportation o…

.20 Nutrition. A. The center shall ensure that each participant who is present for 4 or more hours is provided with a meal that meets 1/3 of the recommended dietary allowance of the Food and Nutrition Board of the National Research Council. B. The center shall provide snacks cons…

.21 Comprehensive Assessments. A. The participant shall receive a comprehensive assessment (ADCAPS) that is designed to evaluate the participant's strengths and needs. A registered nurse shall complete the initial assessment within 30 days of a participant's admission and every 1…

.22 Care Planning. A. Individualized Plan of Care. (1) There shall be an individualized plan of care completed for each participant within 30 days following admission. (2) The participant shall participate in the development of the plan of care, along with the multidisciplinary t…

.23 Use of Restraints. A. Policy and Procedures. The center shall have a policy and procedure on the use of any device or medication for the specific purpose of restricting the participant's freedom of motion or movement within the center. B. A participant has the right to be fre…

.24 Discharge. A. Before a center discharges a participant, the center shall: (1) Formulate a discharge plan, including at least a 30-day written advance notice to the participant or the participant's responsible party; and (2) Assist the participant in obtaining the resources ne…

.25 Reports and Actions Required in Unusual Occurrences. A. The center shall immediately report an occurrence such as a communicable disease or food-borne outbreak, poisoning, death, fire, use of restraints or other unusual incident that threatens the health or safety of any part…

.26 Records. A. Records. The center shall maintain records that are needed to operate the center, as required by the Department, and to document the progress of the participants. B. Retention. The center shall maintain participants' records for at least 5 years from the date of d…

.27 Transportation. A. The center shall provide or arrange transportation to enable participants to attend the center and to participate in activity outings, medical appointments, or other participant required services. B. The center and its staff shall operate vehicles in accord…

.28 Physical Plant. A. New Center. (1) A new center shall be designed, constructed, and maintained according to applicable federal, State, and local codes and regulations for building, zoning, fire, food, safety, health and other related codes or ordinances, or both. The center s…

.29 Emergency Preparedness. A. The center shall develop an emergency and disaster plan that includes policies and procedures that shall be followed before, during, and after an emergency or disaster, including: (1) The safe management of individuals who are receiving services at …

.30 Furniture, Furnishings, and Supplies. A. Furniture. (1) The furniture in a center shall be: (a) Appropriate for use by individuals with disabilities; (b) Sturdy and secure so that it cannot easily tip when used for support while walking or seated; (c) Designed so that it is u…

.31 Work Stations. A. The center shall provide at least one work station for use of nurses, social workers, program assistants, or other appropriate staff and consultants. B. Work stations shall have sufficient storage space for records and to meet the needs of the center.

.32 Infection Control. There shall be sufficient hand-washing facilities to ensure that employees maintain adequate infection control procedures.

.33 Food Service Area. A. Whether prepared on-site or off-site, food shall: (1) Be prepared and served under sanitary conditions; and (2) Meet the requirements of COMAR 10.15.03. B. The Department shall approve all plans for the construction and renovation of facilities and equip…

.34 Bathrooms. A. General Requirements. (1) Bathrooms shall be located not more than 30 feet from the primary activity areas. (2) The center shall provide at least one toilet and one hand-washing sink for every 10 participants. Additional toilets and hand-washing sinks may be req…

.35 Laundry Facilities. A. Laundry facilities shall be available on-site for use if a participant's clothing becomes soiled while he or she is at the center. B. The area or areas where laundry facilities are located shall be equipped with exhaust ventilation, secure chemical stor…

.36 Water Supply. A. Water Supply. A center 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 used if the Department of the Environment approves the source in accordance with COMAR 26.…

.37 Plumbing and Sewage. A. Plumbing. All plumbing in a center shall be installed and maintained according to all applicable federal, State, and local building codes and sanitation regulations. B. Sewage. A center shall be served by an approved public sewage disposal system, if a…

.38 Heating, Air Conditioning, and Ventilation. A. Heating. (1) The center shall have a properly maintained and operating central heating system that is capable of maintaining 75°F throughout the participants' section of the building. (2) The heating system shall comply with NFPA…

.39 Lighting. A. The center shall ensure that lighting levels in all areas are appropriate for the type of activity. B. Glare from windows exposed to direct sunlight shall be kept at a minimum by using window coverings and glare from lights shall be kept at a minimum by using sha…

.40 Sanitation. A. The center shall have sufficient maintenance and housekeeping personnel to assure that the center is clean, orderly, attractive, and safe at all times. B. The center shall ensure that maintenance and housekeeping activities are completed on a regular basis and …

.41 Safety. A. Fire Safety. The center shall comply with the provisions of: (1) COMAR 20.06.01; (2) NFPA 101 Life Safety Code, which is incorporated by reference in COMAR 29.06.01.06; and (3) All other applicable federal, State, and local fire codes and regulations. B. A center t…

.42 Smoking. A. The center shall prohibit smoking in all indoor areas in accordance with COMAR 09.12.23. B. If smoking is permitted in exterior areas, the center shall establish and implement smoking policies and procedures that minimize the risk of fire. C. The smoking policies …

.43 Sanctions. A. If the Department determines that a deficiency or deficiencies exist, the Secretary may impose sanctions against the licensee. B. The Secretary may impose the following sanctions, as appropriate: (1) Direct the licensee to correct the deficiencies in a specific …

.44 State Monitor. A. If the Department determines that a deficiency or deficiencies exist, the Department may appoint a State monitor who is qualified on the basis of education and experience to oversee correction of the deficiencies. B. The duties of the State monitor shall be …

.45 Mandated Staffing Pattern. A. When the Department determines that a deficiency or deficiencies exist, the Department shall notify the center of the deficiency or deficiencies and may either: (1) Mandate a staffing pattern that specifies the number of personnel or personnel qu…

.46 Admission Restriction. A. If the Secretary determines that a serious health or fire safety deficiency exists in a center, the Secretary immediately may restrict new admissions to the center for not more than a 30-day period. B. Within 7 days after a request by an aggrieved pa…

.47 Civil Money Penalties. A. The Secretary may impose a civil money penalty if a deficiency or an ongoing pattern of deficiencies exists in a center. B. In determining whether a civil money penalty is to be imposed, the Secretary shall consider the following factors: (1) The num…

.48 Amount of Civil Money Penalties. A. A civil money penalty imposed under this chapter for potential for more than minimal harm deficiencies may not exceed: (1) $3,000 per instance; or (2) $300 per day for an ongoing pattern of deficiencies until the center is in compliance. B.…

.49 Civil Money Penalties — Hearings. A. A hearing on the appeal shall be held in accordance with the State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. B. The Secretary shall have the burden of proof with respect to the imposition of the civil money pena…

.50 Civil Penalties — Unlicensed Center. A. Imposition of Penalty. The Secretary may impose a civil money penalty on a person who manages or operates an unlicensed center as follows: (1) A civil money penalty imposed on a person under this chapter may not exceed $10,000 for each …