The Code of Maryland Regulations as Applied to Residential Assisted Living Facilities

To be licensed as a Residential Assisted Living facility (RAL) in the State of Maryland, you must follow the Code of Maryland Regulations (COMAR)  http://www.dsd.state.md.us/COMAR/searchall.aspx.  The code provides detailed regulations for procedural, safety and health protocols within the senior living industry.  

COMAR, is the official compilation of all administrative regulations issued by agencies of the state of Maryland. The COMAR regulations are reviewed and updated frequently. The following regulations apply to all assisted living and memory care communities and are the key points to look for when evaluating facilities: 

1. Licensure requirements and procedures. Make sure the facility is licensed in the state of Maryland, by the Office of Healthcare Quality. 
2. Uniform disclosure statement. A document that explains exactly the amenities and care abilities of the community. Review this – it includes the details about what services the facility can provide, what care ability they are authorized to perform (i.e., lifting, sliding scale insulin, catheter).
3. Quality assurance program. All RALs need to have this in place. It is a requirement for assisted living communities to have a quality assurance program, including how to use incident reports for accidents such as falls.
4. A staffing plan and defined rules. All RALs need to have their plan documented, i.e., for when an awake caregiver is needed at night, or having a care provider on premise 24/7. For example, dementia patients require awake care 24/7. 
5. Requirements for staff training. Trainings such as CPR, medication management, and dementia training are critical for competent staff and compliance.
6. A delegating nurse. Every RAL must have a registered nurse staff member who will complete a resident assessment upon admission and at least every 45 days for each resident or when a resident’s condition changes, such as in declining health, running a temperature, or developing a new cough. 
7. A preadmission requirement. RALs in Maryland must require a few things of each new resident prior to move in: A physician pre-check/Doctors orders called Healthcare Care Practitioner Assessment Form, an advanced directive in the Maryland form (MOLST), a TB test, AND NOW A COVID Vaccine or negative covid test. 
8. Clients plan of care guidance.  Every resident must have a specific plan of care, which the caregivers must follow. An example of a “plan of care” is what kind of diet is medically needed or the need for oxygen and how often. 
9. Meal standards. Each RAL must meet requirements for meals that are balanced & nutritional and planned in advance. The plan must be posted for the whole month, and must include protein, fruit, and vegetables. The Maryland Office of Healthcare Quality will audit the facility for this requirement. 
10. Medication management. Medications must be managed and given to residents by a licensed medication technician. In most cases the residents medical list must be reviewed quarterly by a pharmacist. 
11. Resident record requirements. There must be established protocols on how the facility must chart the health needs for each resident. Each resident has a health record or log which is stored in a locked cabinet. 
12. Resident rights documentation. COMAR requires each RAL to post necessary documentation about resident rights. These rights include the right to be treated with respect, dignity, consideration, and full recognition of a resident’s human dignity and individuality. 
13. Smoking rules must be posted. Smoking is only allowed outside in a designated area.
14. Bathroom minimums. Each RAL must have one bathroom per every 4 residents.
15. Posted Emergency Plans. Facilities must have a posted emergency preparedness plan and additional safety measures in place. For example, they are required to have accessible fire extinguishers, and smoke alarms.
16. Residential agreements. All residents must be provided for signature a residential agreement.

Maryland COMAR rules apply to all RAL communities, from those that are large and have 200 residents to communities that are small and have only 3 residents. The above regulations are those most relevant to consider when evaluating a residential facility. They provide a clear picture of the type of care, official safety measures in place, and establish clear guidelines for consistency and professionalism. The goal of the COMAR regulations is to keep residents healthy, happy, and well cared for.  CarePatrol will have this information for you and make this process very easy for you to chose a RAL.