Chapter 19. Certified Adult Residential Environment (CARE) Program

“Administration” means the Social Services Administration of the Department of Human Services.

“Adult Foster Family Model of Care” means a program of care where:

“Adult Protective Services (APS)” means the program under COMAR 07.06.14 which protects vulnerable adults who are subject to abuse, neglect, exploitation, or self-neglect.

“Behavioral health impairment” means a substance abuse, mental health or addictive disorder or a combination of these disorders.

CARE Home.

“Case manager” means a local department of social services social worker or family services caseworker who provides a range of services that includes:

“Individual with a disability” means an individual who is 18 years old or older and has a physical, medical, or behavioral health impairment which:

“Institutionalized individual” means an inpatient at a psychiatric hospital, rehabilitation hospital, nursing home, or similar setting.

“Licensed Health Care Provider” has the same meaning as Health Occupations Article, §4-301, Annotated Code of Maryland.

“Linking” means the process of referring a resident to a specific service as part of a plan to meet the resident's needs and ensuring service delivery.

“Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services.

“Protective oversight” means a service of the CARE provider which includes the following:

Provider.

“Public Assistance to Adults (PAA)” means the funding to help cover the cost of the CARE placement for eligible individuals as specified under COMAR 07.03.07.

“Relative” means a spouse, parent, son, daughter, grandparent, grandchild, stepparent, stepchild, brother, or sister, domestic partner or anyone who is related to an individual by blood, adoption, or marriage.

“Resident” means an individual who:

“Resident of Maryland” means an individual who at the time of application is physically present in the State, and has no immediate plans to leave Maryland for residence in another state.

“Individualized service plan agreement” means a written plan which describes:

“Service slot” means the resources, including funding and case management capacity, necessary to provide residential services for an individual with disabilities in a CARE home.

“Service team” means the case manager, provider, resident, and representatives of other agencies and disciplines who have a role in providing services to the resident.

“Specialized professional intervention” means health, nursing, social, psychological, or psychiatric services provided by an individual licensed in his or her profession by this State or another state.

“Supportive housing arrangement” in an adult foster family model of care means a housing arrangement that provides an individual with:

Is a resident of Maryland;

Is an individual with a disability;

Is 18 years old or older;

Has no appropriate and willing relative who will provide a community placement;

Does not require the provider to take responsibility for services beyond the capacity of the CARE program's adult foster care model of housing, including health services, treatment regimens, and interventions that require specialized professional intervention;

Needs the CARE services provided in the CARE home;

Agrees to pay the cost of placement from personal resources or through public assistance;

Is not a relative of the provider; and

Does not pose a risk or danger to him or herself and/or others.

Case management service is available without regard to income for a resident placed by the CARE program.

A resident's income may determine whether the resident will be charged for certain supportive services provided or purchased by the local department.

A completed Project Home application form.

A health history and the applicant's most recent health assessments; and

Consent forms signed by the applicant for the release of information to the local department by:

Rank the applicant according to §E(1) of this regulation; and

Notify the applicant in writing within 30 days of receipt of the complete application that the applicant:

Complete a comprehensive assessment of the applicant's capacities and needs in a community living situation;

Establish the level of care required by the applicant by considering the following characteristics of the applicant:

Determine the amount of income and other resources available to pay for placement;

Determine the availability of an appropriate CARE home;

Decide with the applicant whether CARE service is appropriate;

Send a written notice to the applicant, within 30 days of the case manager's assignment of the case, of the application decision which shall include:

If the local department is unable to place an eligible applicant, refer to §E(1) of this regulation.

Based on the applicant's situation at the time of application, an applicant is ranked on the following descending point system:

Applicants who have equal points under §E(1) of this regulation and are equally appropriate for an available slot shall be offered service in the order in which the local department received the applications for service.

The case manager shall identify an appropriate CARE home and, with the applicant and the provider, make a placement plan.

The selection of an appropriate CARE home shall include consideration of the following:

If the CARE home is located outside the jurisdiction served by the local department:

If needed, ensure that an application for PAA is made by, or on behalf of, the applicant;

Provide confirmation to the local department PAA worker of the placement plan including date, address of CARE home, and level of care; and

Obtain a decision on eligibility for assistance.

The specific goals to be accomplished by the resident;

A list of the services needed to meet the goals as determined by the resident, the case manager, provider, and the service team;

The specific plan for completing the tasks to meet the service needs of the resident, including identifying the individual, either the service team member or the resident, who will perform the task;

A time line for completing tasks;

The expected frequency of contact between the case manager and the resident; and

The schedule for the local department to:

Method and amount of payment;

Level and type of service to be provided by the CARE home; and

Provider's specific house rules.

Complete referrals to services specified in the individualized service plan agreement following the resident's placement in the CARE home; and

Follow-up on referrals as needed, until the delivery of service begins.

Reconsideration of the individualized service plan agreement shall occur:

At the time of reconsideration, the case manager with the resident and service team shall:

Shall explore all possible community resources to provide needed services to the resident; and

May convey unmet needs and barriers to service delivery in writing to the local department's program supervisors or administrators.

The case manager, with the resident, shall arrange a new CARE placement when the:

Time Requirements of Local Department. The local department shall:

Placement in Another Jurisdiction.

The case manager shall have face-to-face visits individually with the resident and with the resident and provider together.

The case manager shall visit the resident:

Under no circumstances shall the resident be seen less than every 2 months.

During each 6-month period, the case manager shall visit the resident and the provider together in the CARE home at least once.

The case manager, with the supervisor's documented approval, may alter the required visitation schedule if the resident's situation requires or permits it.

Within 30 days after the local department obtains information about changes in the resident's circumstances which may affect the resident's eligibility; and

Annually.

A reconsideration of a resident's case plan shall include:

The case manager shall reconsider a case plan:

The local department shall terminate CARE services when at least one of the following situations exists:

When the local department terminates CARE services, the local department shall:

Following termination of CARE services, the case manager shall provide for one month:

If the conduct of the resident poses a threat to the safety or well-being of the provider or the residents in the home, the local department may, without giving 15 days notice, immediately suspend services to the resident for a period not to exceed 30 days. Within 72 hours of the suspension, the local department shall advise the resident in writing of the:

If the CARE Home Certificate is revoked or the case manager determines that the CARE Provider can no longer meet the needs of the resident and the resident refuses another CARE home placement, then the local department may terminate services to the resident.

At the end of the suspension period, the local department shall either reinstate or terminate services. If the local department terminates services, it shall provide the resident with a notice of the termination at least 15 days before the effective date of termination.

Be 21 years old or older;

Document that the provider applicant has sufficient financial resources to establish and operate the CARE home;

Document the provider applicant's place of residence;

Have three satisfactory nonrelative character references;

Have no criminal record or Adult Protective Services or Child Protective Services history that indicates behavior potentially harmful to residents;

Have no household member 18 years old or older and not receiving CARE services who has a criminal record or history indicating potentially harmful behavior to residents;

Be willing to work with the local department and other appropriate agencies for the well-being of the resident;

Exhibit a genuine interest in the welfare of the resident and perform the provider responsibilities appropriate to meet the resident's physical and social needs;

Participate in CARE training programs as required by the local department or the Administration;

Submit a medical statement, from a licensed medical care provider, indicating that the applicant has the physical and mental capacity to provide care to residents; and

Sign a provider agreement stating that the provider shall:

Be 21 years old or older, or 18 through 20 years old and supervised by a staff member 21 years old or older;

Have no criminal record or Adult Protective Services or Child Protective Services history that indicates behavior potentially harmful to residents;

Have three satisfactory nonrelative character references;

Be willing to work for the well-being of the resident with the local department staff and other agencies involved;

Exhibit a genuine interest in the welfare of the resident and be willing to perform provider responsibilities appropriate to meet the resident's physical and social needs;

Attend required CARE training as determined by the local department; and

Submit a medical statement, from a licensed medical care provider, indicating that the backup provider(s) and/or staff has the physical and mental capacity to provide care to residents.

Be owned, held, leased, or otherwise controlled by the provider;

Pass health and fire safety inspections conducted by local health and fire departments or fire marshals, unless the inspections are not available in the local jurisdiction of the residence;

Contain not more than three separate supervised apartment units if an individual home is divided into apartments, unless the supervised apartment units were certified prior to January 1, 2007, in which case the home may be certified as a CARE home with more than three separate supervised apartments;

Provide not more than double occupancy per bedroom for residents;

Provide a minimum of 70 square feet for single occupancy bedrooms and 60 square feet per bed for double occupancy for residents;

Have sleeping areas not used for any other purpose;

When a basement is used as a bedroom, it shall be finished, adequately heated and lighted, have a window and fire egress and be enclosed for privacy;

Provide grab rails in bathrooms and stairways;

Provide a minimum temperature of 68° Fahrenheit in rooms used by residents;

Have toilets, lavatories, baths, and showers adequate in number, location, and size to accommodate the needs of residents and other household members;

When the condition of the resident requires it, have bathroom facilities on any floor where the resident is permitted;

Have an adequate water supply, with well water tested and approved by the local health authorities;

Provide an outside fire escape for a resident bedroom located on the third floor or higher;

Have a minimum of one operable:

Post by each landline telephone the emergency telephone numbers for the police and fire department, and any backup support person;

Have safe and functioning systems for:

Have clean and adequately furnished bedrooms and separate beds for each resident which include:

Have sufficient dishes, glassware, plates, and flatware to provide each resident with a complete set of eating utensils;

Have cleaning supplies, toilet paper, and soap available for use by the residents;

Have at least one comfortably furnished living room and a common dining area available for residents' use; and

Have a safe place to keep residents' valuables such as a locked box.

Except under circumstances set forth in Regulation .16 of this chapter, the local department shall evaluate the provider applicant and the residence through the following activities:

If an application is incomplete, the local department shall send a written notification to the provider applicant which shall include a:

Within 90 days of the start of the evaluation process as set forth in §B of this regulation, the local department shall notify the provider applicant in writing of the decision regarding the application.

If the decision is to certify the provider applicant, the notice shall include the:

Temporary Certification.

If the decision is to deny the application, the notice shall include the:

Residence does not meet the requirements specified in Regulation .07 of this chapter; or

Applicant:

A CARE home shall provide a level of care based on the provider's ability to:

The level of care and services provided to an individual resident shall be:

Four Levels of Care, as Determined by the Case Manager's Assessment.

Designate and utilize a backup support approved by the local department to provide care in emergency situations or in the provider's extended absence;

Provide the resident with three balanced meals per day or other special diet prescribed by the resident's health care provider;

Provide resident with sufficient, weather appropriate, clothing to maintain hygiene;

Maintain all of the home's equipment and supplies in a safe and functioning condition;

If the provider permits smoking, designate a smoking area;

Post the CARE home certification in the area of the residence visible to residents and visitors;

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;

Maintain records on each resident that include:

Provide an area in the home where the resident may have visitors with a reasonable amount of privacy;

In collaboration with the case manager and resident, establish a written resident-provider agreement which includes the:

Except in an emergency, provide at least 30 days notice to the resident and resident's case manager if change in placement is required;

Notify the local department or case manager within 24 hours of any:

Notify the local department at least 90 days before relocating the home; and

Notify the local department at least 30 days before making any other changes affecting certification.

A certificate is valid for 1 year from the date of issuance.

A temporary certificate is valid for 90 days from the date of issuance.

Level D may have applicants at Levels A, B, C, or D;

Level C may have only applicants at Level A, B, or C;

Level B may have only applicants at Level A or B; or

Level A shall have only applicants at Level A.

A provider may not provide care for more than the number of CARE residents stated on the certificate.

A CARE home may have not more than:

Within 30 days after the local department obtains information about changes in the provider's circumstances or the residence which affect the certification; and

At least once a year.

The local department shall send the provider an application:

When the local department's recertification visit precedes the expiration date of the certificate, the provider may complete the application at the face-to-face recertification visit.

The recertification application notice shall include an application due date to allow the local department to make its decision within the required time limits.

Visit the residence and interview the provider to discuss any changes in circumstances;

Review status of criminal record for:

Contact if possible, all case managers who worked with residents in the home during the current certification year and evaluate their assessment of the home;

Request and review reports of health and fire inspections if needed and available;

Review the qualification of backup providers or providers, and staff where appropriate;

Arrange for any required CARE training for the provider and staff;

Determine the number of CARE residents the home may care for and the level of care to be provided; and

Advise the provider in writing within 90 days of the beginning of the recertification process of the decision to deny or recertify as set forth in Regulation .08C of this chapter.

Upon finding that a violation requires immediate action to protect the health, safety, or welfare of a resident in the provider's care; and

For not more than 60 days from the date of the department’s knowledge of the violation.

The local department shall notify the provider of the probationary status in writing within 10 days of the local department's knowledge of a violation.

The probation notice shall include the:

The provider or the CARE home fails to meet certification requirements as stated in Regulation .07 of this chapter;

The provider fails to disclose pertinent information related to certification or provides false information to the local department;

Conditions in the home represent a threat to the health, safety, or welfare of a resident;

The provider requests that the certificate be revoked;

The provider fails to submit required information by the due date on the recertification application to the local department; or

The provider fails to abide by the provider agreement or any set of written procedures required by the local department.

Decision;

Reason for revocation;

Regulation supporting the decision; and

Provider's right to appeal the decision and the method of obtaining a fair hearing.

All residents of the home;

Individuals responsible for residents' placement in the home including:

MDH, Office of Health Care Quality.

Notice that the certificate is revoked or expired;

A description of the violation;

An offer to assist in the resident's relocation to another approved home or other living arrangement; and

Notice that the local department shall terminate benefit payment to a PAA recipient if the recipient is not living in a certified home.

Maintain a waiting list; and

Serve eligible applicants in the order in which they are ranked in accordance with Regulation .04E of this chapter.

Maintain a waiting list; and

Study applicants in the order in which they applied, unless special needs of resident applicants awaiting placement can be met only by later provider applicants with specific services.