10.07.02.09

.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 for the implementation and enforcement of all provisions of the Patient's Bill of Rights Regulations under COMAR 10.07.09.

B. Delegation to Administrator.

(1) The licensee, if not acting as an administrator, shall appoint as administrator a responsible person who is:

(a) Qualified by training and experience; and

(b) Licensed by the Board of Examiners of Nursing Home Administrators for the State.

(2) The administrator shall:

(a) Be responsible for the control of the operation on a 24-hour basis; and

(b) With the exception of §B(3) of this regulation, serve full-time.

(3) With the Department’s approval, an administrator may serve on a less than full-time basis for a maximum of two nursing facilities, one of which shall have a licensed capacity of 35 beds or fewer.

(4) The Department shall consider the following factors when deciding whether to approve an administrator to serve on a less than full-time basis:

(a) Geographic location of the facilities;

(b) Ownership of the facilities;

(c) Organizational structure of the facilities;

(d) Size of the facilities; and

(e) Background and experience of the administrator.

C. Absence of Administrator.

(1) In the absence of the administrator, the nursing home at all times shall be under the direct and personal supervision of an experienced, trained, competent employee.

(2) When serving as relief for the administrator, the director of nursing shall designate an experienced, qualified registered nurse to direct the nursing service.

(3) The relief director of nursing shall be freed from other responsibilities.

D. Excessive Absenteeism of Administrator.

(1) If the director of nursing’s absence while covering for the administrator is having an adverse effect on resident care, the Department may require the designation of a specific registered nurse who shall be named the assistant director of nursing.

(2) The Department shall be notified of the name of the assistant director of nursing.

(3) When the designee is replaced, the Department shall be notified of the name of the registered nurse filling the vacancy.

E. Character. The administrator shall:

(1) Be of good moral character;

(2) Be in good physical and mental health; and

(3) Demonstrate a genuine interest in the well-being and welfare of residents in the nursing home.

F. Staffing.

(1) The administrator shall employ sufficient and satisfactory personnel as specified in this chapter to:

(a) Provide maintenance, cleaning, and housekeeping;

(b) Assist residents with eating; and

(c) Give adequate resident care.

(2) Voluntary Admissions Ceiling.

(a) A nursing home may request a voluntary admissions ceiling by submitting a written request to the Department to authorize a temporary restriction on resident admissions based upon anticipated bed usage.

(b) When the nursing home wishes to request that the restriction be removed, the request shall include the specific effective date and a statement that personnel staffing is sufficient to meet the State’s requirements at the designated census level.

(c) The Department shall approve the increase in beds within 72 hours following receipt of the nursing home’s documentation that the required additional staff is in position to serve the increased number of beds.

(d) Management of the nursing home may not permit the resident census to exceed the admissions ceiling without prior approval from the Department.

G. Educational Program.

(1) The administrator shall plan an ongoing educational program to develop and improve the skills of all the nursing home’s personnel, including training related to problems and needs of the aged, ill, and disabled.

(2) The administrator shall maintain records reflecting attendance, by name and title, and training content.

(3) In-service training shall include at least:

(a) Prevention and control of infections;

(b) Fire prevention programs and resident related safety procedures in emergency situations or conditions;

(c) Accident prevention;

(d) Confidentiality of resident information;

(e) Preservation of resident dignity, including protection of the resident’s privacy and personal and property rights;

(f) Physical, functional, and psychosocial needs of the aged ill individuals;

(g) Receipt by each employee of appropriate orientation to the facility and its policies, and to the employee's position and duties;

(h) Approval by the Department of the orientation and training programs.

H. Employment Records. A written application shall be on file for each employee and shall contain at least the:

(1) Employee’s Social Security number;

(2) Home address;

(3) Educational background;

(4) Past employment documentation with references;

(5) Past nursing home employment documentation, including any past instances of abuse of residents, theft, and fires;

(6) Verified licensure of personnel employed; and

(7) Proof of criminal background check.

I. Support Personnel.

(1) To support placement in a specific position, there shall be sufficient documentation in the employee’s record reflecting training and experience.

(2) In instances when an aide is to be assigned to a particular service such as dietary, physical therapy, or occupational therapy, the person in charge of the service shall be responsible for evaluating and approving or disapproving the qualifications.

J. New Support Personnel.

(1) New support personnel shall be credited for 50 percent of their working time until the employee’s orientation program, as approved by the Department, is completed.

(2) Employee Orientation Program.

(a) New support personnel shall have an employee orientation program.

(b) The person in charge of the service to which the employee is assigned shall:

(i) Have input into the contents of the orientation program;

(ii) Determine the number of hours of orientation required for the various levels of support personnel; and

(iii) Following the period of orientation, indicate whether the employee satisfactorily completed the orientation program.

(3) The responsible department’s approval shall be in writing, signed by the appropriate department head whose license number, if applicable, shall be recorded in the record.

(4) In new facilities, the director of nursing and supervisors of dietary services, housekeeping, rehabilitation services, and social services shall be responsible for orienting the new support personnel to the nursing home policies and procedures and to the physical plant.

(5) There shall be a complete orientation for all the employees in life safety and disaster preparedness.

(6) The number of daily admissions of residents shall be controlled to allow sufficient time for on-the-job training.

(7) Before the opening of the nursing home, support personnel shall have a minimum of 2 days of orientation training.

K. Relief Personnel. Provision shall be made for qualified relief personnel during vacations or other relief periods.

L. Availability of Information. The administrator shall make available to the Secretary such information as may be requested to insure that the facility is meeting the requirements of these and other applicable regulations.

M. Except where inappropriate for safety reasons, an employee and any other individual who provides a health care service within or on the premises of the nursing home shall wear a personal identification tag that:

(1) States the name of the individual;

(2) States the profession or other title of the individual; and

(3) Is in a readily visible type font and size.