<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 10.07.02.09" title_num="10" subtitle_num="07" chapter_num="02" heading="Administration and Resident Care.">
  <paragraph num="A.">
    <text>Responsibility.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Delegation to Administrator.</text>
    <paragraph num="(1)">
      <text>The licensee, if not acting as an administrator, shall appoint as administrator a responsible person who is:</text>
      <paragraph num="(a)">
        <text>Qualified by training and experience; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Licensed by the Board of Examiners of Nursing Home Administrators for the State.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The administrator shall:</text>
      <paragraph num="(a)">
        <text>Be responsible for the control of the operation on a 24-hour basis; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>With the exception of §B(3) of this regulation, serve full-time.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The Department shall consider the following factors when deciding whether to approve an administrator to serve on a less than full-time basis:</text>
      <paragraph num="(a)">
        <text>Geographic location of the facilities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ownership of the facilities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Organizational structure of the facilities;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Size of the facilities; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Background and experience of the administrator.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Absence of Administrator.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>When serving as relief for the administrator, the director of nursing shall designate an experienced, qualified registered nurse to direct the nursing service.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The relief director of nursing shall be freed from other responsibilities.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Excessive Absenteeism of Administrator.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department shall be notified of the name of the assistant director of nursing.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>When the designee is replaced, the Department shall be notified of the name of the registered nurse filling the vacancy.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Character. The administrator shall:</text>
    <paragraph num="(1)">
      <text>Be of good moral character;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be in good physical and mental health; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Demonstrate a genuine interest in the well-being and welfare of residents in the nursing home.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Staffing.</text>
    <paragraph num="(1)">
      <text>The administrator shall employ sufficient and satisfactory personnel as specified in this chapter to:</text>
      <paragraph num="(a)">
        <text>Provide maintenance, cleaning, and housekeeping;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assist residents with eating; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Give adequate resident care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Voluntary Admissions Ceiling.</text>
      <paragraph num="(a)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Management of the nursing home may not permit the resident census to exceed the admissions ceiling without prior approval from the Department.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Educational Program.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The administrator shall maintain records reflecting attendance, by name and title, and training content.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>In-service training shall include at least:</text>
      <paragraph num="(a)">
        <text>Prevention and control of infections;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Fire prevention programs and resident related safety procedures in emergency situations or conditions;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Accident prevention;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Confidentiality of resident information;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Preservation of resident dignity, including protection of the resident’s privacy and personal and property rights;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Physical, functional, and psychosocial needs of the aged ill individuals;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Receipt by each employee of appropriate orientation to the facility and its policies, and to the employee's position and duties;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Approval by the Department of the orientation and training programs.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Employment Records. A written application shall be on file for each employee and shall contain at least the:</text>
    <paragraph num="(1)">
      <text>Employee’s Social Security number;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Home address;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Educational background;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Past employment documentation with references;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Past nursing home employment documentation, including any past instances of abuse of residents, theft, and fires;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Verified licensure of personnel employed; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Proof of criminal background check.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Support Personnel.</text>
    <paragraph num="(1)">
      <text>To support placement in a specific position, there shall be sufficient documentation in the employee’s record reflecting training and experience.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>New Support Personnel.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Employee Orientation Program.</text>
      <paragraph num="(a)">
        <text>New support personnel shall have an employee orientation program.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The person in charge of the service to which the employee is assigned shall:</text>
        <paragraph num="(i)">
          <text>Have input into the contents of the orientation program;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Determine the number of hours of orientation required for the various levels of support personnel; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Following the period of orientation, indicate whether the employee satisfactorily completed the orientation program.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>There shall be a complete orientation for all the employees in life safety and disaster preparedness.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The number of daily admissions of residents shall be controlled to allow sufficient time for on-the-job training.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Before the opening of the nursing home, support personnel shall have a minimum of 2 days of orientation training.</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>Relief Personnel. Provision shall be made for qualified relief personnel during vacations or other relief periods.</text>
  </paragraph>
  <paragraph num="L.">
    <text>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.</text>
  </paragraph>
  <paragraph num="M.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>States the name of the individual;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>States the profession or other title of the individual; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Is in a readily visible type font and size.</text>
    </paragraph>
  </paragraph>
</regulation>