In this chapter, the following terms have the meanings indicated. Terms Defined. Abuse of a Resident. “Abuse of a resident” means physical, sexual, mental, or verbal abuse, or the improper use of a physical or chemical restraint or involuntary seclusion as those terms are defined in this regulation. “Abuse of a resident” does not include: The performance of an accepted medical procedure ordered by a health care practitioner practicing within the scope of their license; Compliance with a valid advance directive; or Honoring a resident’s known wishes regarding medical care. Activities of Daily Living. “Activities of daily living” means normal daily activities. “Activities of daily living” includes: Eating or being fed; Grooming, bathing, and oral hygiene, including brushing teeth, shaving, and combing hair; Mobility, transfer, ambulation, and access to the outdoors, when appropriate; Toileting; and Dressing in clean, weather-appropriate clothing. Administration of Medication. “Administration of medication” means the act of preparing and giving a medication to a resident. “Administration of medication” includes: Identifying the time to administer the medication; Opening the medication container; Removing the medication from the container; Giving the medication to the resident. “Administration of medication” does not include residents who have the cognitive ability to recognize their medications but only require assistance such as: A reminder to take the medication; Physical assistance with opening a medication container; or Assistance with removing medication from the container. “Adult medical day care” has the meaning stated in Health-General Article, 14-301, Annotated Code of Maryland. “Advance directive” means: A written or electronic document, voluntarily executed by the declarant consistent with the requirements of Health-General Article, Title 5, Subtitle 6, Annotated Code of Maryland; or A witnessed oral statement, made by the declarant consistent with the provisions of the Health-General Article, Title 5, Subtitle 6, Annotated Code of Maryland. “Alzheimer’s Special Care Unit” means a secured or separated special unit specifically designed for individuals with any type of dementia, including a probable or confirmed diagnosis of Alzheimer’s disease and related dementias. “Assessment” means a process of evaluating an individual’s health, functional and psychosocial history, and condition using the Resident Assessment Tool. “Assist rail” means a hand rail or other similar, substantially constructed device that is installed to enable residents to move safely from one point or position to another. “Assisted living manager” means the individual who is: Designated by an assisted living program to oversee the overall and day-to-day operation of the assisted living program; and Responsible for the duties set forth in Regulation .15 of this chapter. Assisted Living Program. “Assisted living program” means a residential or facility-based program for two or more residents that provides housing and supportive services, supervision, personalized assistance, health-related services, or a combination of these services to meet the needs of individuals who are unable to perform, or who need assistance in performing, the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence for the individuals. “Assisted living program” does not include: A nursing facility, as defined under Health-General Article, §19-301, Annotated Code of Maryland; A State facility, as defined under Health-General Article, §10-101, Annotated Code of Maryland; A program licensed or approved by the Department under Health-General Article, Title 7 or Title 10, Annotated Code of Maryland; A hospice care program licensed by the Department under Health-General Article, Title 19, Annotated Code of Maryland; Services provided by family members; Services provided by a licensed residential service agency or licensed home health agency in an individual’s own home; or A Certified Adult Residential Environment Program that is certified by the Department of Human Services under Human Services Article, §§6-508—6-513, Annotated Code of Maryland. “Authorized prescriber” means an individual who is authorized to prescribe medications under Health Occupations Article, Annotated Code of Maryland. “Background check” means a check of court and other records by a private agency. “Bank” means a bank, trust company, savings bank, savings and loan association, or financial institution that is: Authorized to do business in this State; and Insured by the Federal Deposit Insurance Corporation. “Certified medication technician” means an individual who is certified as a medication technician by the Maryland Board of Nursing under COMAR 10.39.04. “Chemical restraint” means controlling behavior by use of a drug that is not otherwise required to treat medical symptoms. Cognitive Impairment. “Cognitive impairment” means the loss of those thought processes that orchestrate relatively simple ideas, movements, or actions into goal-directed behavior. “Cognitive impairment” includes lack of judgment, planning, organization, self-control, and the persistence needed to manage normal demands of the individual’s environment. “Common ownership community” means: A condominium organized under Real Property Article, Title 11, Annotated Code of Maryland; A homeowners association organized under Real Property Article, Title 11B, Annotated Code of Maryland; or A cooperative housing corporation organized under Corporations and Associations Article, Title 5, Subtitle 6B, Annotated Code of Maryland. “Common-use telephone” means a telephone that is: Within the facility; Accessible to residents; Located so that residents can have private conversations; and Available to residents to make free local calls. “Consultant” means an individual or organization, under contract with a licensee, that may: Have partial or full responsibility and control over one or more areas of operations of the assisted living provider; and Provide expertise related to: One or more licensure requirements; or Standards of care. “Contact precautions” means the use of a private room, if available, and appropriate personal protective equipment, such as gowns, gloves, or masks to prevent the transmission of certain organisms between an infected individual and others. “Controlled dangerous substance (CDS)” means a medication or substance listed in Schedule I through Schedule V as defined in Criminal Law Article, §5-101, Annotated Code of Maryland. “Criminal history records check” means a check of criminal history information, as defined in Criminal Procedure Article, §10-201, Annotated Code of Maryland, by the Department of Public Safety and Correctional Services. “Delegating nurse” means a nurse who: Is licensed to practice registered nursing in this State as defined in Health Occupations Article, Title 8, Annotated Code of Maryland; and Has successfully completed the Board of Nursing’s approved training program for registered nurses, delegating nurses, and case managers in assisted living. “Delegation of nursing tasks” means the formal process approved by the Maryland Board of Nursing which permits a professional nurse to assign nursing tasks to an unlicensed individual, a certified nursing assistant, or a medication technician, in accordance with COMAR 10.27.11.03, through: A nursing assessment of the patient’s nursing care needs prior to delegation of tasks; Instructing the unlicensed individual, certified nursing assistant, or medication technician, or verifying their competency; Supervising of the delegated task in accordance with COMAR 10.27.11.04; Retaining accountability and responsibility for the delegated task; Evaluating the performance of the delegated task; and Assuring accurate documentation of outcomes on the nursing record. “Department” means the Maryland Department of Health. “Discharge” means releasing a resident from an assisted living program, after which the releasing program no longer is responsible for the resident’s care. “Emergency admission” means the temporary admittance of an individual in an assisted living program when the individual’s health and safety would be jeopardized by not permitting immediate admittance. “Emergency Medical Services form” means a form issued by the Maryland Institute for Emergency Medical Services Systems for the purpose of documenting emergency medical services and do not resuscitate orders as defined in Health-General Article, §5-601(k), Annotated Code of Maryland, including a Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form. Facilitating Access. “Facilitating access” means: Making appropriate referrals for care and treatment; Arranging for the appointment and involvement of appropriate health care decision makers, when necessary; and Facilitating contact between the resident, the resident representative, the health care or social service professional, and needed services. “Facilitating access” does not mean guaranteeing payment for services that are not: Covered by the resident agreement; or Paid for by the resident or the resident agent. “Facility” means the physical plant in which an assisted living program is operated. “Family” means a group of two or more individuals related by legal status or affection who consider themselves a family. “Family council” means a group of individuals who work together to protect the rights of and improve the quality of life for residents of an assisted living program. “Financial exploitation” means the misappropriation of a resident’s assets or income, including: Spending the resident’s assets or income against the will of or without the consent of the resident or the resident agent; Spending the resident’s assets or income for the use and benefit of a person other than the resident, if the resident or resident agent has not consented to the expenditure; or The resident agent’s misappropriation of the resident funds. “Frequent” means occurring or appearing quite often or at close intervals, but not continuously. “Health care practitioner” means a physician, a certified nurse practitioner, or a physician assistant who provides health care services and is licensed under Health Occupations Article, Annotated Code of Maryland. “Health condition” means the status of a resident’s physical, mental, and psychosocial well-being. “Home health services” means those services provided as defined in Health-General Article, §§19-401—19-410 or §§19-4A-01—19-4A-10, Annotated Code of Maryland. “Household member” means an individual living in an assisted living program who is not a resident or staff member. “Incident” means: The death of a resident from other than natural causes; The disappearance or elopement of a resident; An assault on a resident resulting in injury; An injury to a resident which may require treatment by a health care practitioner, or an event such as a fall which could subsequently require treatment; Abuse, neglect, or financial exploitation of a resident; An error or omission in medication or treatment which may result in harm to the resident; An emergency situation or natural disaster; or Any other event that results in death, permanent harm, or severe temporary harm. “Informal dispute resolution (IDR)” means an informal process that provides an assisted living program the opportunity to dispute one or more deficiencies cited in a written statement of deficiencies issued by the Department or the Department’s designee related to a recent survey. “Instrumental activities of daily living” means home management skills, such as shopping for food and personal items, preparing meals, or handling money. “Intensive” means highly concentrated. “Intermittent nursing care” means nursing care which is provided episodically, irregularly, or for a limited time period. Involuntary Seclusion. “Involuntary seclusion” means the separation of a resident from others or from the resident’s room or confinement to the resident’s room with or without roommates, against the resident’s will or the will of the resident representative. “Involuntary seclusion” does not mean separating a resident from other residents on a temporary and monitored basis. “Lavatory” means a basin used to maintain personal cleanliness that has hot and cold running water and sanitary drainage. “Law enforcement agency” means the Maryland State Police or a police agency of a county or municipal corporation. “License” means a document issued by the Secretary to operate an assisted living program in the State. “Licensed pharmacist” means an individual who is authorized to practice pharmacy under Health Occupations Article, Title 12, Annotated Code of Maryland. “Licensed physician” means an individual who is authorized to practice medicine under Health Occupation Article, Title 14, Annotated Code of Maryland. “Licensee” means the person to whom a license is issued. “Management firm” means an organization, under contract with an applicant for a license or a current licensee, that is intended to have or has full responsibility and control over the day-to-day operations of the assisted living program. “Medical Orders for Life-Sustaining Treatment (MOLST) form” means the form required to be developed pursuant to Health-General Article, §5-608.1, Annotated Code of Maryland. “Medical record” has the meaning stated in Health-General Article, §4-301, Annotated Code of Maryland. Mental Abuse. “Mental abuse” means an intentional course of conduct resulting in or intended to produce emotional harm. “Mental abuse” does not include the performance of an accepted clinical or medical procedure. “Minimal” means the least amount required to produce the desired result. “Neglect” means depriving a resident of adequate food, clothing, shelter, supervision, essential medical treatment, or essential rehabilitative therapy. Nursing Overview. “Nursing overview” means a process by which a registered nurse assures that the health and psychosocial needs of the resident are met. “Nursing overview” includes: Observation; Assessment; Staff education; and The development, implementation, and evaluation of a resident’s service plan. “Occasional” means occurring from time to time, on an infrequent or irregular basis, with no particular pattern. “Office of Health Care Quality (OHCQ)” means the Office of Health Care Quality of the Maryland Department of Health. “Ongoing” means continuing over an extended period of time. “Person” means an individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind and any partnership, firm, association, corporation, or other entity. “Personal representative” means an individual appointed by the court with the duties and authority to settle and distribute the estate of the decedent consistent with Estates and Trusts Article, §7-401, Annotated Code of Maryland. “Physical abuse” means the sustaining of any physical injury or pain to a resident as a result of cruel or inhumane treatment, or as a result of a malicious act by any individual. Physical Restraint. “Physical restraint” means the use of a device or physical action to prevent, suppress, or control head, body, or limb movement that cannot be readily and easily removed by the resident. “Physical restraint” does not mean a protective device as defined in this regulation. “Plan of correction” means a written response from the assisted living program that addresses how each deficiency cited as a result of a survey by the Department or the Department’s designee will be corrected. “Protective device” means any device or equipment, except bedside rails: That: Shields a resident from self-injury; Prevents a resident from aggravating an existing physical problem; or Prevents a resident from precipitating a potential physical problem; That may limit, but does not eliminate, the movement of the resident’s head, body, or limbs; and That is prescribed by a health care practitioner. “Quality assurance” means a system for maintaining professionally acceptable standards of care by: Identifying opportunities to improve; Studying problems, if any, and their root causes; and Implementing and monitoring interventions to ensure the intended improvement is achieved and sustained. “Relief personnel” means qualified individuals who have been hired to substitute for certain staff members: In emergency situations; or When the assisted living manager or other staff is absent from the assisted living program for extended hours. “Resident” means an individual 18 years old or older who requires assisted living services. “Resident agent” means a person who manages, uses, or controls the funds or assets that legally may be used to pay an applicant’s or resident’s share of the costs or other charges for assisted living services. “Resident agreement” means a document signed by both the resident or the resident agent and the assisted living manager, or designee, stating the terms that the parties agree to, including, at a minimum, the provisions set forth in Regulations .26 and .27 of this chapter. “Resident Assessment Tool” means Maryland’s Assisted Living Resident Assessment and Level of Care Scoring Tool that is: Developed by the OHCQ with input from assisted living program staff; and Used by assisted living programs to assess the current health, physical, and psychosocial status of prospective and current residents. Resident Representative. “Resident representative” means a person referenced in Regulation .35 of this chapter. “Resident representative” does not include an assisted living program owner or employee that has been designated as a representative payee for a resident. Restraint. “Restraint” means any chemical restraint or physical restraint as defined in §B(15) and (64) of this regulation. “Restraint” does not include a protective device. “Sanction” means a disciplinary penalty imposed for a violation of statutes or regulations relating to the operation of an assisted living program, including, but not limited to, those penalties referenced in Regulations .58, .59, .61, .63, and .64 of this chapter. “Secretary” means the Secretary of Health or the Secretary’s designee. “Self-administration of medication” means a resident having the cognitive and physical ability to take medication as prescribed by an authorized prescriber: At the correct time; By the correct route; and In the correct dosage. “Service plan” means a written plan developed by an assisted living program in conjunction with the resident and the resident representative, if appropriate, which identifies, among other things, services that the assisted living program will provide to the resident based upon the resident’s needs as determined by the Resident Assessment Tool. “Sexual abuse” means a crime listed in Criminal Law Article, Title 3, Subtitle 3, Annotated Code of Maryland. “Short-term residential care” means a stay, either continuous or intermittent, in an assisted living program of not more than 30 consecutive days from the date of initial admission, which cannot exceed 180 days per year. Significant Change of Condition. “Significant change of condition” means a shift in a resident’s health, functional, cognitive, behavioral, or psychosocial conditions that either causes an improvement or deterioration in a resident’s condition as described in the Resident Assessment Tool. “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 recur. “Staff” means supervisors, assistants, aides, or other employees, including independent contractors retained by an assisted living program, to provide the care and services required by this chapter. “Standard precautions” means a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. “Substantial” means considerable in importance, degree, amount, frequency, or extent. “Trauma-informed approach” means an approach to care delivery that: Recognizes the widespread impact and signs and symptoms of trauma in residents; and Incorporates knowledge about trauma into care plans, policies, procedures, and practices to avoid re-traumatization. “Trauma-informed care” means an approach to delivering care that involves understanding, recognizing and responding to the effects of all types of trauma. “Treatment” means medical or psychological management to cure, slow the progression of, maintain, or improve a disease or condition. “Unclaimed deceased resident” means a resident of an assisted living program: Who has not prearranged and prepaid for the disposal of the resident’s body; or For whom no individual has claimed the body and assumed funeral or burial responsibility. “Verbal abuse” means the use of any oral or gestured language that includes disparaging or derogatory terms, which is directed to a resident, or within a resident’s hearing distance, regardless of the resident’s age, ability to comprehend, or disability.