<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".22" citation="COMAR 10.07.14.22" title_num="10" subtitle_num="07" chapter_num="14" heading="Preadmission Requirements.">
  <paragraph num="A.">
    <text>Before Move In.</text>
    <paragraph num="(1)">
      <text>Before admission the assisted living manager or designee in collaboration with the delegating nurse shall determine whether:</text>
      <paragraph num="(a)">
        <text>The resident may be admitted under the assisted living program’s licensure category;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Requires a level of care that the Department has approved for the assisted living program; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The resident’s needs can be met by the program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Within 30 days before admission, the assisted living manager or designee shall determine admission eligibilities described in §A(1) of this regulation based on completion of a resident assessment using the Resident Assessment Tool as described in §B of this regulation. The Department may modify the level of care determination made by the assisted living program at any time. The Resident Assessment Tool:</text>
      <paragraph num="(a)">
        <text>Determines the resident’s required level of care;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Forms the basis for development of the resident’s service plan; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Determines whether the resident needs awake overnight monitoring.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Resident Assessment Tool.</text>
    <paragraph num="(1)">
      <text>Within 30 days prior to admission, the prospective resident’s health status shall be documented on the Resident Assessment Tool.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Information on the Resident Assessment Tool shall be based on an examination conducted by a primary physician, certified nurse practitioner, certified registered nurse midwife, registered nurse, or physician assistant that is based on the resident’s current health status.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If the potential resident is admitted on an emergency basis by a local department of social services, the required assessment using the Resident Assessment Tool shall be completed as soon as possible but no later than 14 calendar days after the emergency admission.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Information on the assessment shall include at a minimum:</text>
      <paragraph num="(a)">
        <text>Recent medical history, including any acute medical conditions or hospitalizations;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Significant medical conditions affecting functioning, including the individual’s ability for self-care, cognition, physical condition, and behavioral and psychosocial status;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Other active and significant chronic or acute medical diagnoses;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Known allergies to foods and medications;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Medical confirmation that the individual is free from communicable tuberculosis, and other active reportable airborne communicable diseases;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Current scheduled and as needed (PRN) medications;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Current and other needed treatments and services for medical conditions and related problems;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Current nutritional status, risk factors for malnutrition and dehydration, and, if available, height and weight;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Diets ordered by a health care practitioner;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Medically necessary limitations or precautions; and</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Monitoring or tests that need to be performed or followed up after admission.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Reassessment Documented on the Resident Assessment Tool.</text>
    <paragraph num="(1)">
      <text>The Resident Assessment Tool shall be reviewed at least every 6 months and the review shall be documented by the delegating nurse and assisted living manager.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A new Resident Assessment Tool shall be completed:</text>
      <paragraph num="(a)">
        <text>At least annually;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Within 48 hours, but not later than required by the resident’s condition, after a significant change in a resident’s condition; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Within 48 hours of a delegating nurse’s determination that a new Resident Assessment Tool needs to be completed.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If the previous Resident Assessment Tool did not indicate the need for awake overnight staff, each reassessment or review of the assessment shall include documentation as to whether awake overnight staff is required due to a change in the resident’s condition.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Functional Assessment. Within 30 calendar days before admission, the assisted living manager, or designee, shall collect on the Resident Assessment Tool the following information regarding the current condition of each resident:</text>
    <paragraph num="(1)">
      <text>Level of functioning in activities of daily living;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Level of support and intervention needed, including any special equipment and supplies required to compensate for the individual’s deficits in activities of daily living;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Current physical or psychological symptoms requiring monitoring, support, or other intervention by the assisted living program;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Capacity for making personal and health care related decisions;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Presence of disruptive behaviors, or behaviors which present a risk to the health and safety of the resident or others; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Social factors, including:</text>
      <paragraph num="(a)">
        <text>Significant problems with family circumstances and personal relationships;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Spiritual status and needs; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Ability to participate in structured and group activities, and the resident’s current involvement in these activities.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Resident Requirements for Awake Overnight Staff.</text>
    <paragraph num="(1)">
      <text>Before admission, the assisted living manager shall ensure that the resident is assessed using the Resident Assessment Tool.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>When the resident scores in any of the areas identified as “Triggers for Awake Overnight Staff” in the Resident Assessment Tool, the assisted living program shall provide awake overnight staff or document why awake overnight staff is not necessary in accordance with Regulation .14E of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Short-Term Residential Care Requirements.</text>
    <paragraph num="(1)">
      <text>For persons admitted for short-term residential care, the following are required:</text>
      <paragraph num="(a)">
        <text>Current physical condition and medical status as specified in §B(4) of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Functional assessment as specified in §D of this regulation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A resident agreement, in accordance with Regulations .26 and .27 of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the person is admitted for a subsequent short-term admission, the following are required:</text>
      <paragraph num="(a)">
        <text>Current physical condition and medical status as specified in §B(4) of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Functional assessment as specified in §D of this regulation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A new resident agreement or an addendum to the prior resident agreement.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>A resident admitted as an emergency placement by a local department of social services is exempt from all physical examination and assessment requirements of this regulation if the resident is in temporary emergency shelter and services status, not to exceed 14 calendar days, with notification to the Department of the placement within 48 hours.</text>
  </paragraph>
</regulation>