Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 12 - ADULT HEALTH
Chapter 10.12.04 - Day Care for the Elderly and Adults with a Medical Disability
Section 10.12.04.14 - Staff
Universal Citation: MD Code Reg 10.12.04.14
Current through Register Vol. 51, No. 26, December 27, 2024
A. Staffing Pattern.
(1) Staffing Ratio.
(a) The staff to participant ratio at each
center shall be minimum of one staff to seven participants (1:7) for a period
of years after the final adoption of COMAR
10.12.04.14A(1)(a).
(b) Two years after the final adoption of
COMA 10.12.04.14A(1)(a),
the staffing ratio at each center shall be determined by the needs of each
program participant as determine in the ADCAPS.
(c) Staffing shall at all times be sufficient
to meet the need of the participants.
(2) The center shall have experienced and
competent relief personnel, with licenses and levels of skill comparable to
regular staff, to operate during absences, vacations, or other period
necessitating substitute staff.
(3)
Relief personnel shall be oriented to the operation of th center.
B. Required Staff.
(1) Director.
(a) The center shall have a director who is
responsible for the overall conduct of the center and for compliance with
applicable laws and Regulations.
(b) The director shall have a bachelor's
degree, preferable in a health and human services field, from an accredited
college o university, or the individual shall be a registered nurse.
(c) The director's duties shall be limited to
the administration and provision of services at the center.
(d) If a center is part of another center,
the center shall have its own director and center staff.
(e) A center with a licensed capacity of 35
or more participants shall have a full-time director.
(f) A center with a licensed capacity of 34
or fewer participants may appoint a director who serves on less than a
full-time basis.
(g) A licensee
operating two adult medical day care sites that are located within 50 miles of
each other may utilize one on-site manager instead of a director at one of the
sites if there are fewer than 50 participants at each site. The on-site manager
shall have the appropriate background, education, and experience to oversee the
administration and provision of services at the center.
(2) Nursing Services.
(a) A center shall have the services of a
registered nurse with at least 3 years experience in a health care
setting.
(b) A registered nurse
shall be on-site or readily available by phone at other times to satisfy the
requirements listed in §B(2)(c) of this regulation.
(c) The duties of the registered nurse shall
include:
(i) Completion of the ADCAPS and the
nursing plan of care.
(ii)
Provision or supervision, or both, of required nursing services to each
participant;
(iii) Supervision of
the LPN and other nursing care staff in accordance with COMAR 10.27.09,
10.27.10, and
10.27.11.05H(1)
;
(iv) Development and ongoing
review of the participant's plan of care; and
(v) Assisting, as necessary, in the delivery
of other required services.
(d) A licensed practical nurse performs in a
team relationship with the registered nurse and shall be on site to meet the
nursing services of each participant consistent with COMAR 10.27.10 when the
registered nurse is not on site.
(e) A certified nursing assistant shall be
present and on site when a registered nurse or licensed practical nurse is not
on site.
(3) Full-time
Activities Coordinator. The center shall have the services of a full-time
activities coordinator who shall have:
(a) A
high school diploma or general equivalency diploma (GED); and
(b) At least 3 years experience in activities
coordination or therapeutic recreation for:
(i) The aged;
(ii) Individuals with disabilities;
or
(iii) Other special
populations.
(4) Staff.
(a) Program assistants shall:
(i) Have a high school diploma or general
equivalency diploma (GED); or
(ii)
Be enrolled currently in a program leading to a high school diploma or
GED.
(b) The center
shall employ sufficient staff to meet the participants' needs.
C. Personnel Policies.
(1) The center shall have written personnel
policies, including at least the following:
(a) Annual leave;
(b) Pay practices;
(c) Employee benefits;
(d) Termination procedures;
(e) Hiring and firing
responsibility;
(f) Review of
applicant and employee criminal conviction histories;
(g) New employee orientation; and
(h) Use and duration of a probationary
period.
(2) The center
shall make a copy of its policies and procedures available to each
employee.
(3) Before hiring, staff:
(a) Shall have a criminal background check as
required in Health-General Article, §19-1901, et seq., Annotated Code of
Maryland; and
(b) May not have
criminal convictions or criminal history that indicates behavior that is
potentially harmful to participants, as evidenced through a criminal history
records check.
D. Position Description. There shall be a written position description for each job that specifies:
(1) The qualifications for the job;
(2) A delineation of the tasks; and
(3) The supervisor of the employee.
E. Staff Training.
(1) When job duties involve the provision of
individual care services, employees shall receive a minimum of 2 hours of
training on cognitive impairment and mental illness within the first 90 days of
employment, including the following as appropriate:
(a) Overview of normal aging and conditions
causing cognitive impairment;
(i) Risk
factors for cognitive impairment;
(ii) Health conditions that affect cognitive
impairment; and
(iii) Early
identification of and intervention for cognitive impairment;
(b) Overview of normal aging and
conditions causing mental illness;
(i) Risk
factors for mental illness;
(ii)
Health conditions that affect mental illness;
(iii) Early identification of and
intervention for mental illness; and
(iv) Procedures for reporting cognitive,
behavioral, and mood changes;
(c) Effective communication including:
(i) The effect of cognitive impairment on
expressive and receptive communication;
(ii) The effect of mental illness on
expressive and receptive communication;
(iii) Effective verbal, nonverbal, tone and
volume of voice, and word choice techniques; and
(iv) Environmental stimuli and influences on
communication; and
(d) Behavioral intervention, including:
(i) Identifying and interpreting behavioral
symptoms;
(ii) Problem solving for
appropriate intervention;
(iii)
Risk factors and safety precautions to protect the individual and other
participants; and
(iv)
De-escalation techniques.
(2) The director shall ensure that:
(a) Per the center's policies, staff and
volunteers receive orientation and training; and
(b) An ongoing educational program is planned
and conducted for the development and improvement of skills of all the center's
personnel, including training related to problems and needs of the elderly,
health impaired, and disabled.
(3) The center shall maintain records that
demonstrate proof of employee attendance and training content of orientation
and in-service programs.
(4) The
center shall provide a minimum of eight in-service training sessions annually,
which shall include, but is not limited to:
(a) Prevention and control of
infections;
(b) Fire prevention
programs and participant-related safety procedures in emergency situations or
conditions;
(c) Accident
prevention;
(d) Training on care of
individuals that is appropriate to the population served by the center, such
as:
(i) Alzheimer's disease;
(ii) Mental illness;
(iii) Developmental disabilities;
and
(iv) Cognitive
impairment;
(e)
Recognition of, and duty to report, abuse, exploitation, neglect, and
self-neglect; and
(f) Safe food
handling and service.
(5) The training that is described in §F
of this regulation may be provided through various means including:
(a) Classroom instruction;
(b) In-service training;
(c) Internet courses;
(d) Correspondence courses;
(e) Prerecorded training; or
(f) Other training methods.
F. When the training method does not involve direct interaction between faculty and trainee, the center shall make available to the trainee a trained individual to answer questions and respond to issues raised by the training.
G. Proof of training shall include:
(1) Date of class;
(2) Course content;
(3) Documentation of successful completion of
the training content; and
(4)
Qualifications and contact information for the trainer.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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