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10.12.04.00.htm 10.12.04.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 12 ADULT HEALTH Chapter 04 Day Care for the Elderly and Adults with a Medical Disability Authority: Health-General Article, §2-104, 14-206, and 14-304; State Government Article, §10-226; Annotated Code of Maryland
10.12.04.01.htm 10.12.04.01. 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, or friend who cares for an individual with a medical disability by mutual agreement; or2) Apply to nutrition sites, senior centers under the auspices of the Department of Aging, or social
10.12.04.02.htm 10.12.04.02. 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, and use of environmental aids to assist the individual to achieve greater independence;d) Toileting; and. e) Dressing.. 2) "Activities coordinator" means the individual assigned to develop and di
10.12.04.03.htm 10.12.04.03. 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 the centers are operated under the same management.C. Posting of License. A center shall post its license in a conspicuous place on the premises to which it applies.
10.12.04.04.htm 10.12.04.04. 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 record completion and retention, the administration and storage of medications, nutrition services, social work support, employee criminal background checks, transportation of participants and participa
10.12.04.05.htm 10.12.04.05. 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. When there is a change of program ownership or a change of location, the licensee shall submit a new application and written request for a new license with an application fee, as established in
10.12.04.06.htm 10.12.04.06. 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: and2) Can demonstrate that granting a waiver will not adversely affect the health and safety of its participants.B. The licensee shall submit a written request to the Department to obtain a waiver. In the written request, the licensee shall address the following issues:
10.12.04.07.htm 10.12.04.07. 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 Department.2) Any part of the center, and any surrounding accessory buildings, are considered part of the center and are subject to inspection.B. Records and Reports..
10.12.04.08.htm 10.12.04.08. 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 as necessary to ensure compliance with this chapter or for the purpose of investigating a complaint.C. In accordance with a written agreement, the Department may delegate certain aspects of its monito
10.12.04.09.htm 10.12.04.09. 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) Adoption of an annual budget; and. 3) Provision of staff capable of performing the center's program.. B. Goals. The center shall have documentation of its philosophy and goals and the services to be pro
10.12.04.10.htm 10.12.04.10. 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 participants.C. The public and participants shall be notified of planned closings..
10.12.04.11.htm 10.12.04.11. 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 admission. Upon request and for good cause shown, the Department may grant an exception to all or part of the preadmission assessment.B. Written Assessment. The health care provider's assessment shall include:.
10.12.04.12.htm 10.12.04.12. 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 following:. 1) The center may not discriminate against the intended participant because of race, color, or national origin according to Title VI of the Civil Rights Act of 1964, 42 U.S.C.
10.12.04.13.htm 10.12.04.13. 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, of his or her rights and all rules and regulations governing participant conduct and responsibilities while attending the program.C. A participant of a center has the right to:. 1) Be treated with consid
10.12.04.14.htm 10.12.04.14. 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 of COMAR 10.12.04.14A(1)a) the staffing ratio at each center shall be determined by the needs of each program participant as determined in the ADCAPS.
10.12.04.15.htm 10.12.04.15. 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 center’s hours of operation, in the service contract agreement. The registered nurse may delegate nursing services as appropriate, to other staff in accordance with COMAR 10.27.09, 10.27.10, and 10.27.11.05H(1)3)
10.12.04.16.htm 10.12.04.16. 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 and other diet modifications as ordered by the participant’s health care provider.3) Rehabilitative Services. Rehabilitative services may include:. a) Physical therapy;. b) Occupational therapy; and.
10.12.04.17.htm 10.12.04.17. 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 those prescribed for the participant by the authorized prescriber.2) All medications shall be accurately and plainly labeled and kept in the original container issued by the prescriber or pha
10.12.04.18.htm 10.12.04.18. 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 orders from a health care provider.. 2) The nurse shall immediately write orders into the participant's record, and sign and date the note.3) The original or faxed medication order shall be
10.12.04.19.htm 10.12.04.19. 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 of participants.B. At least one staff member who is trained in CPR and first aid shall accompany participants taken outside of the center for outings and other activities.C. First aid administered
10.12.04.20.htm 10.12.04.20. 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 consisting of a nourishing food or beverage, or both, to participants.C. The minimum number of meals and snacks shall be provided as follows:. Hours at Center. Minimum Meals and Snacks. Proportion of RDA.
10.12.04.21.htm 10.12.04.21. 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 120 days thereafter as long as there is no change in the participant's condition. The assessment shall include:1) Health status;. 2) Functional status;. 3) Participation in activities;.
10.12.04.22.htm 10.12.04.22. 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 team, unless the center documents the reasons why the participant is unable or unwilling to participate.3) The plan of care shall be consistent with the comprehensive assessment and shall include a proble
10.12.04.23.htm 10.12.04.23. 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 free of restraints used in violation of this chapter. C. Improper Use of Chemicals or Drugs. Chemicals or drugs may not be used for participants in the fo1) In excessive dose, including duplicate drug therapy;.
10.12.04.24.htm 10.12.04.24. 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; and2) Assist the participant in obtaining the resources needed to implement the plan.. B. The 30-day written notice of discharge specified in §A of this regulation is not required when:. 1) The health or safety of the participant or other individuals in the cent
10.12.04.25.htm 10.12.04.25. 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 participant or staff member to:1) The Office of Health Care Quality;. 2) The local health officer, as required by law;. 3) Participant; and. 4) Family and, if applicable, guardian.. B. The center shall docum
10.12.04.26.htm 10.12.04.26. 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 discharge, except as provided in Health-General Article, §4-403, Annotated Code of Maryland.C. Confidentiality. The center shall maintain records so that they are accessible only to the direct
10.12.04.27.htm 10.12.04.27. 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 accordance with all applicable federal, State, and local requirements.C. A participant may not be in transit for more than 1 hour without an opportunity for a rest stop:.
10.12.04.28.htm 10.12.04.28. 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 shall also comply with the requirements of the Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq.2) Where possible, the center shall be located at street level. If a propos
10.12.04.29.htm 10.12.04.29. 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 the adult medical day care center when an emergency occurs;2) Notification of families, staff and licensing authorities regarding the action that will be taken concerning the safety and well-being of the parti
10.12.04.30.htm 10.12.04.30. 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 used easily by individuals with limited agility, permitting feet to rest on the floor and having armrests; andd) Clean, safe, and in good repair.. 2) The center shall have sufficient furniture for
10.12.04.31.htm 10.12.04.31. 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.
10.12.04.32.htm 10.12.04.32. 32 Infection Control.. There shall be sufficient hand-washing facilities to ensure that employees maintain adequate infection control procedures.
10.12.04.33.htm 10.12.04.33. 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 equipment in food service areas.C. All food service areas shall include, at a minimum:. 1) At least one hand-washing sink;. 2) At least one three-compartment sink or one commercial grade dishwashing machine;.
10.12.04.34.htm 10.12.04.34. 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 required based upon the toileting needs of the participants.3) Bathrooms shall be accessible to individuals in compliance with the requirements of the Americans with Disabilities Act of4) The center shall provi
10.12.04.35.htm 10.12.04.35. 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 storage, and dryer lint exhaust and control.C. The center shall maintain laundry facilities in a safe and sanitary manner..
10.12.04.36.htm 10.12.04.36. 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 26.04.02.B. Loss of Water Supply. The center shall establish written emergency procedures that enable the center to have water in all essential areas in the event of the loss of the noC. Adequacy of Water Pres
10.12.04.37.htm 10.12.04.37. 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 available. If no approved public sewerage system is available, a private sewage disposal system may be used if the Department of the Environment approves the system according to COMAR 26.04.02.
10.12.04.38.htm 10.12.04.38. 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 101, Life Safety Code, which is incorporated by reference in COMAR 29.06.01.06, and all applicable State and local codes.3) A center may not use space heaters or portable heaters unless approved b
10.12.04.39.htm 10.12.04.39. 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 shaded light fixtures.
10.12.04.40.htm 10.12.04.40. 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 according to generally accepted sanitation standards. Maintenance and housekeeping functions may not interfere with the provision of care or the activities program of the center.C. The center shall devel
10.12.04.41.htm 10.12.04.41. 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 that is located within a licensed nursing home or hospital shall meet the applicable requirements of NFPA 101 Life Safety Code.C. The center shall ensure that a floor plan with evacuation routes from th
10.12.04.42.htm 10.12.04.42. 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 and procedures shall include at least the following provisions:. 1) The center shall prohibit smoking in any hazardous location where flammable liquids, combustible gases, or oxygen are stored;
10.12.04.43.htm 10.12.04.43. 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 manner or within a specific time frame, or both;2) Require the center to use the services of a management firm that is approved by the Department;. 3) Mandate staffing patterns that specify the numb
10.12.04.44.htm 10.12.04.44. 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 specified in a written agreement between the Department and the State monitor and shall include, but are not limited to:1) Conducting periodic on-site inspections to assess the center's complianc
10.12.04.45.htm 10.12.04.45. 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 qualifications, or both; or2) Permit the center the opportunity to correct the deficiencies by a specific date.. B. If the center does not correct the deficiency or deficiencies, the Depar
10.12.04.46.htm 10.12.04.46. 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 party, a show cause hearing shall be held before the Director of the Office of Health Care Quality to show cause why the admission restriction was not appropriately imposed.C. Within 21 days after a
10.12.04.47.htm 10.12.04.47. 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 number, nature, and seriousness of the deficiencies;. 2) The extent to which the deficiency or deficiencies are part of an ongoing pattern during the preceding 24 months;3) The degree of risk to
10.12.04.48.htm 10.12.04.48. 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. A civil money penalty imposed under this chapter for actual harm deficiencies may not exceed:. 1) $5,000 per instance; or.
10.12.04.49.htm 10.12.04.49. 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 penalties under this chapter.
10.12.04.50.htm 10.12.04.50. 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 offense; and2) When a civil money penalty is imposed, the Secretary shall issue an order which includes the:. a) Deficiency or deficiencies on which the order is based;.
10.12.04.51.htm 10.12.04.51. 51 Emergency Suspension.. A. The Secretary may immediately suspend a license on finding that the public health, safety, or welfare imperatively requires emergency action.B. The Department shall deliver a written notice to the center:. 1) Informing it of the emergency suspension;. 2) Giving the reasons for the action and the regulation or regulations with which the licensee has failed to comply that forms the basis for the emergency suspension; and
10.12.04.52.htm 10.12.04.52. 52 Denial or Revocation of License.. A. Denial or Revocation of License. The Secretary, for cause shown, shall notify the center of its decision to deny or revoke the center's license. The denial or revocation shall be stayed if a hearing is requested.B. The Department shall notify the center in writing of the following:. 1) The effective date of the denial or revocation;. 2) The reason for the denial or revocation;. 3) The regulations with which the licensee has fai
10.12.04.53.htm 10.12.04.53. 53 Hearings.. A. A request for a hearing shall be filed with the Office of Administrative Hearings, with a copy to the Office of Health Care Quality of the Department, not later than 30 days after receipt of notice of the Secretary's action. The request shall include a copy of the Secretary's action.B. A hearing requested under this chapter shall be conducted in accordance with:. 1) State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland;. 2) COMAR 28.02.01; and.
10.12.04.9999.htm 10.12.04.9999. Administrative History Effective date: January 12, 1979 (6:1 Md. R. 17). Regulations .01; .02B, E; .03A, C, D; .04A―E; .05A, G, H, L, M, N; .06A; .07A, C; .08B; .09C; and .11B, K amended effective July 11, 1980 (7:14 Md. R. 1350)Regulation .04F repealed effective July 11, 1980 (7:14 Md. R. 1350) ―. Chapter recodified from COMAR 10.26.01 to COMAR 10.12.04 and Regulations .01, .02A, .04―08, .09C, .10A, and .11A amended effective November 13, 1989 (16:22 Md. R. 2365)
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