Maryland nursing home responsiveness requirements

Anyone who believes a resident has been abused must promptly report it to law enforcement, the Department's licensing unit (now OHCQ), or the Office on Aging; a facility employee must report within 3 days of learning of the alleged abuse or face a penalty of up to $1,000.

An employee of a nursing facility who believes that a resident has been abused: (a) Shall report the alleged abuse as set forth in §C(1) of this regulation within 3 days after learning of the alleged abuse; (b) May be subject to a penalty imposed by the Secretary of up to $1,000 for failing to report an alleged abuse within 3 days after learning of the alleged abuse.

The statute behind COMAR 10.07.09.15: a person who believes a resident of a related institution has been abused must report promptly to an appropriate law enforcement agency AND the Office of Health Care Quality, and an institution employee who fails to report within 3 days is liable for a civil penalty of up to $1,000.

A person who believes that a resident of a related institution has been abused shall report promptly the alleged abuse to an appropriate law enforcement agency and the Office of Health Care Quality in the Department.

The administrator must immediately report to the local health department and the Department any internal or external emergency or disaster, infectious disease, poisoning, or any other serious occurrence that threatens the welfare, safety, or health of any resident.

The administrator of the nursing home shall immediately report to the local health department and the Department the occurrence of: (a) Infectious disease; (b) Poisoning; (c) Internal emergency or disaster; (d) External emergency or disaster, (e) Any symptomatic condition of importance to public health that affects the nursing home; or (f) Any other serious occurrence that threatens the welfare, safety, or health of any resident.

The attending physician must designate alternate physicians who respond in a timely manner when the attending is unavailable, keep the facility supplied with current phone/fax/pager numbers for both the attending and the alternates, and brief the on-call alternates about residents with active acute conditions.

Adequate Ongoing Coverage. The attending physician shall: (1) Designate an alternate physician or physicians who shall respond in an appropriate, timely manner if the attending physician is unavailable; (2) Update the facility about the attending physician's current office address, phone, fax, and pager numbers to enable appropriate, timely communications, as well as the current office address, phone, fax, and pager numbers of designated alternate physicians;

The attending physician must respond to emergency and routine notifications from the facility within a time frame set by facility protocol, and must respond promptly to reported acute or other significant changes in a resident's condition.

Respond in an appropriate time frame, based on a facility-developed protocol, to emergency and routine notification, to enable the facility to meet its clinical and regulatory obligations;

A Maryland nursing home must staff at least one registered nurse 24 hours a day, 7 days a week, provide a minimum of 3 hours of bedside care per occupied bed per day, and never let the ratio of bedside nursing personnel to residents fall below 1:15.

A nursing home shall be staffed with at least one registered nurse, 24 hours per day and 7 days per week.

Licensed nursing personnel must be on duty 24 hours a day, and at least one licensed nurse must be on duty at all times as charge nurse, able to recognize significant changes in a resident's condition and take necessary action.

Charge Nurse. (1) At least one licensed nurse shall be: (a) On duty at all times; and (b) Be designated by the director of nursing to be in charge of the nursing activities during each tour of duty. (2) The charge nurse or nurses shall have the ability to recognize significant changes in the condition of residents and to take necessary action.

A nurse who questions the care a resident is receiving, or believes needed consultation has not been obtained, must escalate to the supervisor, then the director of nursing, then the medical director or principal physician.

Responsibility to Report Care that Is Considered Questionable. (1) If a nurse questions the care provided to any resident or believes that appropriate consultation is needed and has not been obtained, the nurse shall inform the supervisor. (2) If indicated, the supervisor shall refer the matter to the director of nursing. (3) If warranted, the director of nursing shall report the matter to the medical director or principal physician.

Every nursing facility resident has the right to reasonable access to the private use of a telephone, alongside rights to privacy in the resident's room and privacy in written communication.

A resident has the right to: ... (19) Reasonable access to the private use of a telephone;

Residents, representatives, and interested individuals may present complaints to the nursing facility's administration or staff, the Office on Aging, the Department, or other persons or groups, by telephone, mail, or in person, including anonymously and free from reprisal, restraint, interference, coercion, or discrimination; the facility must investigate the allegations within 30 days and advise the complainant of the action being taken, may not require the complainant's signature, must send the Office on Aging and the Department a copy of any complaint the complainant indicates was not resolved to the complainant's satisfaction, and must keep a permanent record of all complaints for inspection.

A complaint may be made to the nursing facility in person, orally or in writing, by telephone or by mail, and may be reported anonymously;

The licensee must maintain an emergency and disaster plan covering notification of families and staff, a resident tracking system, current per-resident medical fact sheets including family/legal-representative contact information reviewed at least monthly and kept readily accessible in a central location, documented agreements with receiving facilities and transportation sources, a named emergency planning liaison whose contact information goes to the local emergency management organization, and registration of at least four representatives on the Maryland Health Alert Network updated within 5 business days of any change.

Notification of families and staff regarding the action that will be taken concerning the safety and well-being of the residents; ... Maryland Health Alert Network. (a) A nursing home shall register with the Maryland Health Alert Network. (b) A nursing home shall register at least four representatives, including the administrator and the director of nursing. (c) Following any changes in the initial registration of the four representatives, a nursing home shall update the information within 5 business days of the change.

A nurse call system giving visible and audible signal communication between staff and residents must be installed and kept in operating order in all nursing units, with readily accessible detachable extension cords to each resident's bed, a visible signal above each bedroom door, call devices in every resident bathroom and bathing area and in the rehabilitation area, and resetting only at the station where the call originates (.48A). An approved wireless pager or wireless-device system may be used as an alternative (.48B): it must be issued to all assigned direct care staff, receive signals from bedrooms, bathrooms, bathing areas and therapy areas, be connected to the emergency power supply, sound continuously or intermittently until answered, and its audible signal may not be turned off at the nursing station.

A nurse call system shall be installed and maintained in operating order in all nursing units. (2) A call system shall be maintained in a manner that will provide visible and audible signal communication between nursing service personnel and residents. ... (8) The nurses' call system shall require resetting at the station where the call originates.

Every nursing home must run a quality assurance program with a named manager and a committee including the DON, administrator, a social worker, the medical director, a dietitian-nutritionist and a geriatric nursing assistant; the committee meets monthly, files its QA plan with OHCQ at initial licensure, files changes within 30 days, reviews and approves the plan at least yearly, and prepares monthly reports for the ombudsman, family council and residents' council.

A nursing home shall establish an effective quality assurance program that includes components described in this regulation and Regulation .65 of this chapter. ... The quality assurance committee shall: ... (2) Meet monthly to carry out quality assurance activities; ... (5) Submit any changes to the quality assurance plan to the Office of Health Care Quality within 30 days of the changes; ... (7) Prepare monthly reports for the ombudsman, family council, and residents' council.

The QA plan must contain written procedures for concurrent clinical review, ongoing monitoring against measurable thresholds, resident complaints, accidents and incidents, and abuse and neglect — including who reports incidents, the time frame for reporting, and immediate notification of the family, guardian or responsible party.

The nursing home's quality assurance committee shall develop and implement a quality assurance plan that includes procedures for: (1) Concurrent review; (2) Ongoing monitoring; (3) Resident complaints; (4) Accidents and incidents; and (5) Abuse and neglect.