In this chapter, the following terms have the meanings indicated. Terms Defined. “Activities of daily living” means normal daily activities including: Eating or being fed; Grooming, bathing, oral hygiene including brushing teeth, shaving, and combing hair; Mobility, transferring, ambulation, and access to the outdoors, when appropriate; Toileting; and Dressing in clean, weather-appropriate clothing. “Agency” means a residential service agency as defined in §B(25) of this regulation. “Branch office” means a satellite office of a residential service agency that: Is operated by the same person, corporation, or other business entity that manages the parent residential service agency; and Along with the parent residential service agency has the same: Ownership tax identification number as the parent residential service agency; Upper-level management; Policies and procedures; and Services within the same geographic area as the parent residential service agency. “Certified care” means a service or services that: May be performed for compensation only by an individual who is certified by the Board of Nursing, including a certified medication technician, a certified medicine aide, or a certified nursing assistant; and Include nursing functions that are routinely delegated by a registered nurse. “Certified medication technician” means an individual who: Has completed a Board-approved medication technician training program; and Is certified by the Board as a medication technician. “Certified medicine aide” means an individual who is: A certified nursing assistant who has completed a Board-approved course in medication administration; and Certified by the Board as a certified medicine aide. “Certified nursing assistant” means an individual, regardless of title, who: Routinely performs for compensation delegated nursing tasks which were delegated by a registered nurse or licensed practical nurse; and Is certified by the Maryland Board of Nursing as a certified nursing assistant. “Client representative” means an individual with legal authority to make decisions on behalf of the client as set forth in Regulation .13 of this chapter. “Clinical record” means a written account of all services provided to a client by the agency as well as all pertinent medical information necessary to provide care. “Department” means the Maryland Department of Health. “Governing authority” means the individual, partnership, agency, group, corporation, or other entity that is designated to assume full responsibility for the policy determination, management, operation, and financial liability of the agency. “Home health care” includes any of the following services: Audiology and speech pathology; Dietary and nutritional services; Drug services; Home health aide; Laboratory; Medical social services; Nursing; Occupational therapy; Physical therapy; Provision of invasive medical equipment; and Home medical equipment services. “Home medical equipment services” means the delivery, installation, maintenance, or replacement of, or instruction in the use of, medical equipment used by a sick or disabled individual to allow the individual to be maintained in a noninstitutional environment. “Household or family support services” means performance of tasks necessary to supplement an individual’s ability to perform: Child care for children who require no medical attention; or Instrumental activities of daily living. “Informal dispute resolution conference (IDR)” means an informal meeting that provides a licensee the opportunity to question the Department about deficiencies cited on a recent inspection. “Informed consent” means the willing, uncoerced acceptance of medical intervention by a client or a client representative with legal authority to make health care decisions after adequate disclosure of the nature of the intervention, and its risks and benefits, as well as alternatives with their risks and benefits. “Instrumental activities of daily living” means: Light housekeeping and home management; Meal planning and preparation; or Shopping and errands. “Intravenous therapy” means the provision of services and monitoring and instruction related to substances that are administered intravenously, including but not limited to: Total parenteral nutrition (TPN); Hydration therapy; Chemotherapy; Antibiotic therapy; and Blood and blood products. “Invasive medical equipment” means a device that invades tissue or a body cavity for the purpose of maintaining treatment modalities, including but not limited to: Intravenous lines, whether enteral or parenteral; Catheters; Ventilators; Gastric or nasogastric tubes; Tracheostomy; and Ostomies. “Law enforcement agencies” mean the Maryland State Police or a police agency of a county or municipal corporation. “License” means a document issued by the Secretary to a person to operate a residential service agency in this State. “Medical equipment” means technologically sophisticated medical devices including but not limited to: Oxygen and oxygen delivery systems; Ventilators; Respiratory disease management devices; Electronic and computer-driven wheelchairs and seating systems; Apnea monitors; Transcutaneous electrical nerve stimulator (T.E.N.S.) units; Low air loss cutaneous pressure management devices; Sequential compression devices; Neonatal home phototherapy devices; Feeding pumps; and Electrically powered hospital beds. “Personal care provider under the Medical Assistance Personal Care Program” means an individual or personal care agency that has been approved by the Department as meeting requirements set forth in COMAR 10.09.20 and 10.09.36 to provide personal care services to individuals who are certified for and receiving Medical Assistance benefits. “Plan of correction” means a written response from the residential service agency that addresses each deficiency cited as a result of an inspection by the Department. Residential Service Agency. “Residential service agency” means: An individual, partnership, firm, association, corporation, or other entity of any kind that is engaged in a nongovernmental business of employing or contracting with individuals to provide at least one home health care service for compensation to an unrelated sick or disabled individual in the residence of that individual; or An agency that employs or contracts with individuals directly for hire as home health care providers. “Residential service agency” does not include: A home health agency that is licensed under Health-General Article, Title 19, Subtitle 4, Annotated Code of Maryland; An individual, partnership, firm, association, corporation, or other entity of any kind that is required to be licensed as a home health agency under Health-General Article, Title 19, Subtitle 4, Annotated Code of Maryland; A home-based hospice care program that is licensed under Health-General Article, Title 19, Subtitle 9, Annotated Code of Maryland; A hospital that is licensed under Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland; A related institution that is licensed under Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland; A nursing referral service agency that is licensed under Health-General Article, Title 19, Subtitle 4B, Annotated Code of Maryland, that screens or refers individuals for a client’s selection or rejection as its sole business operation, and does not itself provide any home health care service; A personal care provider under the Medical Assistance Personal Care Program; An individual practicing in a health occupation for which the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland; A business entity consisting of a group of individuals licensed under the same title of Health Occupations Article, Annotated Code of Maryland, which provides only that same, single, licensed health care service to its clients; or A residential rehabilitation services provider approved under regulations adopted under Health-General Article, §10-901, Annotated Code of Maryland. “Secretary” means the Secretary of Health. Significant Change of Condition. “Significant change of condition” means a change in a client’s health, functional, or psychosocial condition that causes either an improvement or a deterioration in a client’s condition. “Significant change of condition” does not include any ordinary, day-to-day fluctuations in health status, function, or behavior or an acute short-term illness, such as a cold, unless these fluctuations continue to reoccur. “Skilled care” means a service or services that may be provided only by an individual who: Is licensed under Health Occupations Article, Annotated Code of Maryland; and Exercises specialized knowledge, judgment, and skill. “Skilled services” means services provided by or under the supervision of a registered nurse and in accordance with the plan of treatment. “Waiver of services” means an informed agreement by a competent adult client to receive certified care or skilled services that are less than the level of care that is recommended by the licensee or a representative of the licensee.