1. Meals.

(1) The [assisted living manager] shall ensure that:

(a) A resident is provided three meals in a common dining area and additional snacks during each 24-hour period, 7 days a week;

(b) Meals and snacks are well-balanced, varied, palatable, properly prepared, and of sufficient quality and quantity to meet the daily nutritional needs of each resident with specific attention given to the preferences and needs of each resident;

(c) All food is prepared in accordance with all state and local sanitation and safe food handling requirements;

(d) Food preparation areas are maintained in accordance with all state and local sanitation and safe food handling requirements; and

(e) Residents have access to snacks or food supplements during the evening hours.

(2) Menus.

(a) Menus shall be written at least 1 week in advance with portion sizes tailored to each resident.

(b) Menus shall be maintained on file, as served, for 2 months.

(c) As part of the licensure approval and renewal process, an applicant shall submit a 4-week menu cycle with documentation by a licensed dietician or nutritionist that the menus are nutritionally adequate.]

(2) The program shall post a weekly menu in a conspicuous place that is visible to residents and other interested parties.

(3) Menus as served, including portion size, shall be maintained on file for 1 month.


(3) (4) Special Diets.

(a) The assisted living program] Program  staff shall:

(i) Prepare or arrange for the provision of special diets as ordered by the resident’s [personal physician] health care practitioner or as needed by the resident’s condition; and

(ii) Document special diets in the resident’s record.

(b) If the diet is beyond the capability of the program, the resident or the resident’s [physician] health care practioner shall make other arrangements for the resident’s care, or the program shall discharge the resident.

  1. Monitoring. The [assisted living] manager shall ensure that each resident is monitored on a daily basis to ensure that:

(1) The resident’s service plan is being properly implemented; and

(2) All adaptive equipment, ambulation devices, and other necessary independent living aids are in proper working order.

  1. Nursing Services. The [assisted living] manager, in consultation with the delegating nurse or case manager, shall ensure that all nursing services are provided consistent with the Nurse Practice Act, Health Occupations Article, Title [10] 8, Annotated Code of Maryland.
  2. Personal Care Services. The [assisted living] manager shall provide or ensure the provision of all necessary personal care services, including, but not limited to, the range of assistance needed by a resident to complete the following activities of daily living[:], as defined in Regulation .02B of this chapter.

(1) Eating or being fed;

(2) Personal hygiene, grooming, bathing, and oral hygiene, including brushing teeth, shaving, and combing hair;

(3) Mobility, transfer, ambulation, and access to the outdoors, when appropriate;

(4) Toileting and incontinence care; and

(5) Dressing in clean, weather-appropriate clothing.]

  1. Housekeeping Services. The [assisted living] manager shall ensure that:

(1) Housekeeping services are provided; and

(2) All areas of the facility are maintained in a clean and orderly condition.

  1. Health Care and Social Services. The assisted living manager is responsible for facilitating access to any appropriate health care and social services for the resident as determined in the resident’s assessment, including but not limited to:

(1) Social work services;

(2) Rehabilitative services, including occupational, physical, speech, and audiology therapies;

(3) Home health services;

(4) Hospice services;

(5) Skilled nursing services;

(6) Physician services;

(7) Oral health care;

(8) Dietary consultation and services;

(9) Counseling;

(10) Psychiatric services; and

(11) Other specialty health and social work services such as services for residents with cognitive impairment.

  1. Social and Spiritual Activities.

(1) The [assisted living] manager shall provide or arrange appropriate opportunities for socialization, social interaction, and leisure activities which promote the physical and mental well-being of each resident, including facilitating access to spiritual and religious activities consistent with the preferences and background of the resident.

(2) To encourage resident participation in social and recreational activities, the assisted living manager shall:

(a) Provide or arrange for transportation to these activities in accordance with the resident’s service plan; and

(b) Assist a resident with communication, interpersonal, and social skills, including managing difficult behaviors in accordance with the resident’s service plan.

  1. Special Care Needs – Monitoring and Oversight

(1) Every resident shall receive appropriate care, services, and oversight in accordance with State and federal guidelines, and accepted standards of nursing and medical practice, and in compliance with the resident-specific waiver provisions of Regulation .19 of this chapter. Resident service plans shall reflect increased monitoring and oversight needed by residents with special care needs, which include at a minimum:

(a) Frequent falls;

(b) Decubitus ulcer care;

(c) Oxygen therapy;

(d) Enteral feedings;

(e) Foley care;

(f) Ostomy care;

(g) Therapeutic drug levels;

(h) Mental illness or psychiatric care; and

(i) Diabetic management.

(2) At a minimum, appropriate care includes:

(a) Using proper infection control techniques to prevent infection and cross-contamination;

(b) Providing care and services to promote healing;

(c) Ensuring that staff have demonstrated competency to the delegating nurse/case manager in the provision of care that meets the special care needs of the resident; and

(d) Notifying when incidents occur and there is a need for medical or nursing evaluation and treatment, the:

(i) Resident, or if appropriate, the resident’s representative;

(ii) Program’s delegating nurse/case manager; and

(iii) Resident’s health care practitioner, if appropriate.