<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10" citation="COMAR 07.02.19.10" title_num="07" subtitle_num="02" chapter_num="19" heading="Provider Responsibilities.">
  <paragraph num="A.">
    <text>Level of Care.</text>
    <paragraph num="(1)">
      <text>A CARE home shall provide a level of care based on the provider's ability to:</text>
      <paragraph num="(a)">
        <text>Respond to the resident's need for supervision;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Teach activities of daily living;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Provide personal care services and encouragement; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Facilitate the resident's decision making and planning.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The level of care and services provided to an individual resident shall be:</text>
      <paragraph num="(a)">
        <text>Specified in the residential service agreement;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Based on the initial or most recent assessment of the intensity of the services needed by the resident;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Determined by the case manager using the assessment form provided by the Administration; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Provided by the care provider according to the service plan developed by the case manager, and based on the applicant's needs described in the applicant's assessment form.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Four Levels of Care, as Determined by the Case Manager's Assessment.</text>
      <paragraph num="(a)">
        <text>Level A is minimal supervision, assistance, and personal care, where the provider shall:</text>
        <paragraph num="(i)">
          <text>Perform brief interventions in the applicant's self-care routine; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Carry out general supportive oversight.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Level B is moderate supervision, assistance, and personal care, where the provider shall:</text>
        <paragraph num="(i)">
          <text>Perform substantial or frequent interventions in the applicant's self-care routine; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Provide general supervision and oversight of the applicant's activities.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Level C is extensive supervision, assistance, and personal care, where the provider:</text>
        <paragraph num="(i)">
          <text>Shall perform substantial or frequent interventions in the applicant's self-care routine;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>May implement a plan of teaching elements of activities of daily living; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Shall provide supportive supervision and oversight of the applicant's activities.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Level D is specialized and intense supervision, assistance, and personal care, where the provider:</text>
        <paragraph num="(i)">
          <text>Shall perform very frequent interventions in the applicant's self-care routine;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>May implement a plan of teaching elements of activities of daily living; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Shall provide supportive supervision and oversight of the resident's activities.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Other Provider Responsibilities. The provider shall:</text>
    <paragraph num="(1)">
      <text>Designate and utilize a backup support approved by the local department to provide care in emergency situations or in the provider's extended absence;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the resident with three balanced meals per day or other special diet prescribed by the resident's health care provider;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Provide resident with sufficient, weather appropriate, clothing to maintain hygiene;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Maintain all of the home's equipment and supplies in a safe and functioning condition;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If the provider permits smoking, designate a smoking area;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Post the CARE home certification in the area of the residence visible to residents and visitors;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Establish a fire escape plan, instruct each resident about the plan upon arrival in the home, and practice the plan with all residents at least every 3 months;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Maintain records on each resident that include:</text>
      <paragraph num="(a)">
        <text>Dates of placement and discharge;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Payment sources and amount;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Individualized service plan agreement; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Emergency data;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Provide an area in the home where the resident may have visitors with a reasonable amount of privacy;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>In collaboration with the case manager and resident, establish a written resident-provider agreement which includes the:</text>
      <paragraph num="(a)">
        <text>Method and amount of payment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level and type of service to be provided; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Provider's house rules;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Except in an emergency, provide at least 30 days notice to the resident and resident's case manager if change in placement is required;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Notify the local department or case manager within 24 hours of any:</text>
      <paragraph num="(a)">
        <text>Unusual incident or accident involving a resident or provider such as serious illness, accident, death, significant change in behavior, or move; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Planned or unplanned absence from the home;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>Notify the local department at least 90 days before relocating the home; and</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Notify the local department at least 30 days before making any other changes affecting certification.</text>
    </paragraph>
  </paragraph>
</regulation>