Assisted Living Manager.

  1. Qualifications.

(1) The assisted living manager shall at a minimum:

(a) Be 21 years old or older;

(b) Possess a high school diploma, a high school equivalency diploma, or other appropriate education and have experience to conduct the responsibilities specified in §C of this regulation;

(c) For level 3 licensed programs, have:

(i) A 4-year, college-level degree;

(ii) 2 years experience in a health care related field and 1 year of experience as an assisted living program manager or alternate assisted living manager; or

(iii) 2 years experience in a health care related field and successful completion of the 80-hour assisted living manager training program;

(d) Be free from tuberculosis in a communicable form in accordance with Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities (that is, tuberculin skin testing (TST) upon hire or annual sign/symptom screen for those individuals with previous positive TST);

(e) Be immune to measles, mumps, rubella, and varicella as evidenced by history of disease or vaccination;

(f) Have no criminal convictions or other criminal history that indicates behavior that is potentially harmful to residents, documented through either a criminal history records check or a criminal background check completed within 1 month before

employment;

(g) Have sufficient skills, training, and experience to serve the residents in a manner that is consistent with the philosophy of assisted living;

(h) Have verifiable knowledge in:

(i) The health and psychosocial needs of the population being served;

(ii) The resident assessment process;

(iii) Use of service plans;

(iv) Cuing, coaching, and monitoring residents who self-administer medications, with or without assistance;

(v) Providing assistance with ambulation, personal hygiene, dressing, toileting, and feeding; and

(vi) Resident rights;

(i) Receive initial and annual training in:

(i) Fire and life safety;

(ii) Infection control, including standard precautions;

(iii) Emergency disaster plans; and

(iv) Basic food safety; and

(j) Receive initial certification and recertification, when required for:

(i) Basic first aid by a certified first aid instructor; and

(ii) Basic cardiopulmonary resuscitation (CPR) by a certified CPR instructor.

(2) An assisted living manager who has completed the training and passed the examination set forth in Regulation .16 of this chapter shall be presumed to have met the knowledge requirements of §A(1)(g) and (h) of this regulation.

  1. The Department may determine that an individual is not sufficiently qualified to serve as an assisted living manager if that individual’s managerial or administrative experience, or education, is not sufficient to perform the responsibilities set forth in §C of this regulation for the residents the licensee intends to serve.
  2. Duties. The assisted living manager shall:

(1) Be on-site or available on call; and

(2) Have overall responsibility for:

(a) The management of the assisted living program, including recruiting, hiring, training, and supervising all staff, and ensuring that either a criminal history records check or a criminal background check is conducted consistent with the requirements of Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland;

(b) The development and implementation of a staffing plan, which includes an orientation and ongoing training program for all staff, with specific training in the management, assessment, and programming for the resident with cognitive impairment as required by Health-General Article, §19-319.1, Annotated Code of Maryland;

(c) The development and implementation of all policies, programs, and services as required by this chapter;

(d) Requiring all employees to perform hand hygiene with either soap and water or an alcohol-based hand sanitizer before and after each direct resident contact for which hand hygiene is indicated by acceptable practice;

(e) Providing or ensuring, through the coordination of community services, that each resident has access to appropriate medical and psychosocial services, as established in the resident service plan developed under Regulation .26 of this chapter;

(f) Ensuring that there is appropriate coordination of all components of a resident’s service plan, including necessary transportation and delivery of needed supplies;

(g) Ensuring that there is appropriate oversight and monitoring of the implementation of each resident’s service plan;

(h) Ensuring that all record-keeping conforms to the requirements of this chapter and other applicable laws;

(i) Ensuring that all requirements of this chapter and other applicable laws are met;

(j) Implementing a nursing or clinical order of the delegating nurse or documenting in the resident’s record why the order should not be implemented;

(k) Notifying the OHCQ:

(i) When the manager terminates the program’s contract with or employment of a delegating nurse; and

(ii) Of the reason why the contract or employment was terminated; and

(l) Notifying the resident and, if applicable, the resident’s legally authorized representative or interested family member of any:

(i) Significant change in the condition of the resident;

(ii) Adverse event that may result in a change in condition;

(iii) Outcome of the resident’s care that results in an unanticipated consequence; and

(iv) Corrective action, if any.

Assisted Living Managers — Training Requirements.

  1. In addition to the requirements in Regulation .15 of this chapter, by January 1, 2006, an assisted living manager of a program that is licensed for five beds or more shall complete a management training course that is approved by the Department.
  2. The completed manager’s training course shall:

(1) Consist of at least 80 hours of course work and include an examination;

(2) Consist of training programs that include direct participation between faculty and participants; and

(3) Include not more than 25 hours of training through Internet courses, correspondence courses, tapes, or other training methods that do not require direct interaction between faculty and participants.

  1. An assisted living manager employed in a program that is licensed for five or more beds shall complete 20 hours of Department-approved continuing education every 2 years.
  2. A program that fails to employ an assisted manager who meets the requirements of this regulation may be subject to:

(1) Sanctions under Regulation .56 of this chapter; and

(2) A civil money penalty not to exceed $10,000.

  1. The training requirements of §A of this regulation do not apply to an individual who:

(1) Is employed by a program and has enrolled in a Department-approved manager training course that the individual expects to complete within 6 months;

(2) Is temporarily serving as an assisted living manager for less than 45 days, unless the Department has granted an extension of the 45 days, due to an assisted living manager leaving employment and before the hiring of a permanent manager;

(3) Has been employed as an assisted living manager in this State for 1 year before January 1, 2006; or

(4) Is licensed as a nursing home administrator in this State.

  1. The Department may require an individual who is exempt under the provisions of §E of this regulation to complete a manager training course and examination if:

(1) The Department finds that the assisted living manager repeatedly has violated State law or regulations on assisted living; and

(2) Those violations have caused or have the potential to cause physical or emotional harm to a resident.

  1. A program may request an extension from the Department to allow an individual to serve as an assisted living manager for longer than 45 days if the program has shown good cause for the extension.]

.15 Manager and Alternate Manager.

  1. In addition to the requirements in Regulation .14 of this chapter, the manager and alternate manager shall at a minimum:

(1) Possess a high school diploma, a high school equivalency diploma, or other appropriate education and have experience to conduct the responsibilities specified in §I of this regulation;

(2) Have:

(a) A 4-year, college-level degree;

(b) 2 years experience in a health care-related field and 1 year of experience as a manager or alternate manager; or

(c) 2 years experience in a health care-related field and successful completion of the 80-hour manager training course;

(3) For programs licensed for 5 beds or more, have:

(a) Completed an initial 80-hour manager training course, from an institute approved by the Maryland Higher Education Commission; and

(b) Completed 20 hours of continuing education every 2 years, from vendors approved by the Department, in addition to the required annual trainings described in Regulation .14D(7) of this chapter; or

(c) Completed 10 hours of continuing education every 2 years, from an institute approved by the Maryland Higher Education Commission, in addition to the required annual trainings described in Regulation .14D(7) of this chapter.

B. A manager or alternate manager who completes an approved 80-hour manager training course shall be exempt, for a period of 4 years, from the:

(1) Continuing education requirements set forth in this section; and

(2) Required annual trainings set forth in Regulation .14D(7) of this chapter.

C. The completed manager’s training course shall:

(1) Consist of at least 80 hours of course work and include an examination;

(2) Consist of training courses that include direct participation between faculty and participants; and

(3) Include not more than 25 hours of training through Internet courses, correspondence courses, tapes, or other training methods that do not require direct interaction between faculty and participants.

D. A manager or alternate manager who has completed the 80-hour manager’s training course and passed the examination shall be presumed to have met the knowledge requirements of Regulation .14D(6)-(7).

E. The training requirements of §A(3) of this regulation do not apply to an individual who:

(1) Is employed by a program and has enrolled in an approved manager training course that the individual expects to complete within 6 months;

(2) Is temporarily serving as a manager or alternate manager for less than 45 days, unless the Department has granted an extension of the 45 days, due to a manager or alternate manager leaving employment and before the hiring of a permanent manager;

(3) Has been employed as a manager or alternate manager in this State for 1 year before January 1, 2008; or

(4) Is licensed as a nursing home administrator in this State.

F. The Department may require an individual who is exempt under the provisions of §E of this regulation to complete a manager training course and examination if:

(1) The Department finds that the manager or alternate manager repeatedly has violated State law or regulations on assisted living; and

(2) Those violations have caused or have the potential to cause physical or emotional harm to a resident.

G. The Department may determine that an individual is not sufficiently qualified to serve as a manager or alternate manager if that individual’s managerial or administrative experience, or education, is not sufficient to perform the responsibilities set forth in §I of this regulation.

  1. The manager shall be on-site or available on call. The alternate manager shall be available to assume the responsibilities described in §I of this regulation when the manager is not available.
  2. Duties. The manager shall have overall responsibility for:

(1) Notifying the delegating nurse/case manager within 2 hours of all significant resident changes, hospitalizations, and returns to the facility;

(2) The management of the program, including recruiting, hiring, training, and supervising all staff, and ensuring that either a criminal history records check or a criminal background check is conducted consistent with the requirements of Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland;

(3) The development and implementation of a staffing plan, which includes orientation and ongoing training for all staff, with specific training in the management, assessment, and programming for the resident with cognitive impairment as required by Health-General Article, §19-319.1, Annotated Code of Maryland;

(4) The development and implementation of all policies, programs, and services as required by this chapter;

(5) Providing or ensuring, through the coordination of community services, that each resident has access to appropriate medical and psychosocial services, as established in the resident service plan developed under Regulation .22 of this chapter;

(6) Ensuring that there is appropriate coordination of all components of a resident’s service plan, including necessary transportation and delivery of needed supplies;

(7) Ensuring that there are appropriate oversight and monitoring of the implementation of each resident’s service plan;

(8) Ensuring that all record-keeping conforms to the requirements of this chapter and other applicable laws;

(9) Implementing a nursing or clinical order of the delegating nurse/case manager or document in the resident’s record why the order should not be implemented;

(10) Collaborating with the pharmacist, delegating nurse/case manager, and prescriber to ensure the pharmacy recommendations as described in Regulation .25 of this chapter are implemented or documenting in the resident’s record why the recommendation should not be implemented;

(11) Ensuring that all requirements of this chapter and other applicable laws are met;

(12) Notifying the OHCQ:

(a) When the manager terminates the program’s contract with or employment of a delegating nurse/case manager; and

(b) Of the reason why the contract or employment was terminated;

(13) Notifying the resident, the resident’s representative, or interested family member of any:

(a) Significant change in condition of the resident;

(b) Adverse event that may result in a change in condition;

(c) Outcome of the resident’s care that results in an unanticipated consequence; and

(d) Corrective action, if any; and

(14) Ensuring all residents and staff are aware of the option of an annual influenza vaccine as evidenced by documented acceptance or refusal of the vaccine, and documented surveillance of non-immune staff during the recognized flu season.

10.07.14.17

Manager Training — Basic Courses]

  1. [The assisted living manager’s training shall include the following courses:] The 80-hour manager’s training shall include the following courses:

(1) Philosophy of assisted living, 2 hours, including:

(a) Philosophy and background of assisted living and aging in place;

(b) Objectives and principles of assisted living resident programs;

(c) Comparison of assisted living to other residential programs;

(d) Basic concepts of choice, independence, privacy, individuality, and dignity; and

(e) Normalization of the environment;

(2) Aging process and its impact, 4 hours, including:

(a) Physical characteristics of the assisted living residents;

(b) Psychosocial characteristics of the assisted living residents;

(c) Basic needs of the elderly and disabled; and

(d) Activities of daily living;

(3) Assessment and level of care waiver, 6 hours, including:

(a) Purpose and process;

(b) Guidelines for conducting assessments;

(c) Level of care assessments; and

(d) Collaboration with a case manager and delegating nurse;

(4) Service planning, 6 hours, including:

(a) Required services;

(b) Enhanced scope of services;

(c) Development of individualized service plans;

(d) Scheduling of appropriate activities;

(e) Structure of activities;

(f) Care notes; and

(g) Collaboration with case manager and delegating nurse;

(5) Clinical management, 20 hours, including:

(a) Role of the delegating nurse;

(b) Appropriate nurse delegation;

(c) Concept of self-administration of medications;

(d) Concept of medication management;

(e) Assistance with self-administration of medications;

(f) Administration of medications;

(g) Coordination of services and care providers;

(h) Collaboration with case manager and delegating nurse;

(i) Preventing medication errors;

(j) Patient safety;

(k) Medication monitoring;

(l) Pharmacy consultation;

(m) Medication storage;

(n) Infection control, to include standard precautions, contact precautions, and hand hygiene;

(o) Appropriate staffing patterns;

(p) Pressure sores;

(q) Effective pain management;

(r) Basic first aid;

(s) Cardiopulmonary resuscitation (CPR); and

(t) Substance abuse;

(6) Admission and discharge criteria, 4 hours, including:

(a) Overview of criteria for admission and discharge;

(b) Resident contracts;

(c) Resident rights;

(d) Financial management of resident’s funds; and

(e) Working with families of residents;

(7) Nutrition and food safety, 8 hours, including:

(a) Menu and meal planning;

(b) Basic nutritional needs;

(c) Safe food handling;

(d) Preventing food-borne illnesses;

(e) Therapeutic diets; and

(f) Dehydration;

(8) Dementia, mental health, and behavior management, 12 hours, including:

(a) An overview consisting of:

(i) Description of normal aging and conditions causing cognitive impairment;

(ii) Description of normal aging and conditions causing mental illness;

(iii) Risk factors for cognitive impairment;

(iv) Risk factors for mental illness;

(v) Health conditions that affect cognitive impairment;

(vi) Health conditions that affect mental illness;

(vii) Early identification and intervention for cognitive impairment;

(viii) Early identification and intervention for mental illness; and

(ix) Procedures for reporting cognitive, behavioral, and mood changes;

(b) Effective communication consisting of:

(i) Effect of cognitive impairment on expressive and receptive communication;

(ii) Effect of mental illness on expressive and receptive communication;

(iii) Effective communication techniques, including verbal, nonverbal, tone and volume of voice, and word choice; and

(iv) Environmental stimuli and influences on communication, including setting, noise, and visual cues;

(c) Behavioral intervention consisting of:

(i) Identifying and interpreting behavioral symptoms;

(ii) Problem solving for appropriate intervention;

(iii) Risk factors and safety precautions to protect other residents and the individual;

(iv) De-escalation techniques; and

(v) Collaboration with case manager or delegating nurse;

(d) Making activities meaningful consisting of:

(i) Understanding the therapeutic role of activities;

(ii) Creating opportunities for activities, including productive, leisure, and self-care; and

(iii) Structuring the day;

(e) Staff and family interaction consisting of:

(i) Building a partnership for goal-directed care;

(ii) Understanding family needs; and

(iii) Effective communication between family and staff;

(f) Managing staff stress consisting of:

(i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;

(ii) Identification of stress triggers;

(iii) Self-care skills;

(iv) De-escalating techniques; and

(v) Devising support systems and action plans;

(9) End of life care, 4 hours, including:

(a) Advance directives;

(b) Hospice care;

(c) Medial Orders for Life-Sustaining Treatment (MOLST)

(d) Power of attorney;

 (e) Appointment of a health care agent;

(f) Living will;

(g) Pain management;

(h) Providing comfort and dignity; and

 (i) Supporting the family;

(10) Management and operation, 4 hours, including:

(a) Role of the assisted living manager;

(b) Overview of accounting, accounts payable, and accounts receivable;

(c) The revenue cycle and budgeting;

(d) The basics of financial statements;

(e) Hiring and training of staff;

(f) Developing personnel policies and procedures;

(g) Census development; and

(h) Marketing;

(11) Emergency planning, 4 hours, including:

(a) Fire, disaster, and emergency preparedness;

(b) Occupational Safety and Health Administration (OSHA) requirements;

(c) Maintaining the building, grounds, and equipment;

(d) Elopements;

(e) Transfers to the hospital;

(f) Evacuations;

(g) Power outages;

(h) Severe weather;

(i) Fire;

(j) Emergency response systems; and

(k) Security systems;

(12) Quality assurance, 4 hours, including:

(a) Incident report processes; and

(b) Quality improvement processes; and

(13) Survey process, 2 hours, including:

(a) State statutes and regulations;

(b) What to expect during a survey; and

(c) Documentation.

  1. A person seeking to offer the [assisted living] manager training course shall obtain approval [by the Department by:] through the Maryland Higher Education Commission.

(1) Submitting the proposed curriculum and training materials to the Department; and

(2) Being available for an in-person or telephone interview by the Department

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