COMAR 10.07.05.12 — Services Provided (Residential Service Agencies)

What this rule requires your agency to do

• 1The agency shall ensure the care plan at a minimum addresses the services to be provided, when/how often, how and by whom, long- and short-range goals, and physical/safety needs.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 2For clients requiring skilled services or ADL assistance, the agency shall have an RN provide oversight and periodic on-site supervision at least every 45 days (if staff administer medications), every 3 months (if staff assist with self-administration), or every 4 months (otherwise), with accurate documentation.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 3The agency shall establish 24-hour/7-day on-call access, respond to emergency inquiries within 1 hour, maintain a log of inquiries, and provide clients with written on-call procedures and phone number.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 4If staff administer medications, the agency shall provide for administration by licensed/certified staff per the plan of care, only as ordered by the physician, and shall document medications administered/taken, medication errors, and adverse drug reactions with corrective action.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 5An agency shall take reasonable measures to ensure all referred individuals provide services in accordance with Maryland laws and regulations, including the Health Occupations Article.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 6A registered nurse shall assess each new client who requires skilled services and assistance with the activities of daily living, participate in developing the plan of care and assigning personnel, and determine whether a certified nursing assistant is required.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 7Informed consent for changes to or waiver of recommended care shall be given only after a documented discussion of risks and benefits, signed and dated by the client or authorized representative, and documented in the client's records; a waiver of skilled services form shall be signed by a cognitively capable adult client and kept in the record.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))
• 8A client's plan of care shall be based on assessments of health, function, and psychosocial condition, and an assessment shall be completed before services begin (with stated exceptions), within 48 hours for enumerated skilled-care needs, at client/representative request, and at least annually.(COMAR 10.07.05.12 — Services Provided (Residential Service Agencies))