1. A. Age Requirements of Other Staff.

   1. (1) Direct resident care staff shall be:

      1. (a) 18 years old or older;
      2. (b) 16 or 17 years old who are enrolled in a certified nursing assistant training program and are supervised until certified; or
      3. (c) 16 or 17 years old and are certified as a nursing assistant.
   2. (2) Other staff not performing direct resident care may be younger than 18 years old.

2. B. Qualifications of Other Staff. The qualifications of other staff include:

   1. (1) Evidence that the staff is:

      1. (a) Free from tuberculosis in a communicable form in accordance with Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities;
      2. (b) Immune to measles, mumps, rubella, and varicella as evidenced by history of disease or vaccination; and
      3. (c) Free from any impairment which would hinder the performance of assigned responsibilities;
   2. (2) Having no criminal convictions or criminal history that indicates behavior that is potentially harmful to residents, as evidenced through a background check completed within 30 calendar days before employment;
   3. (3) Having sufficient skills, education, training, and experience to serve the residents in a manner that is consistent with the philosophy of assisted living;
   4. (4) Participating in and completing an orientation program and ongoing training to ensure that the residents receive services that are consistent with their needs and generally accepted standards of care for the specific conditions of those residents to whom staff will provide services;

   5. (5) Receiving initial and annual training in:

      1. (a) Fire and life safety, including the use of fire extinguishers;
      2. (b) Infection control, including standard precautions, contact precautions, and hand hygiene;
      3. (c) Basic food safety; and
      4. (d) Emergency disaster plans;

   6. (6) Completing basic first aid training taught by a first aid instructor certified by a national organization and recertification every 2 years;

      1. (a) Licensed practical nurses and registered nurses are exempted from basic first aid training and retraining.

   7. (7) Having training or experience in:

      1. (a) The health and psychosocial needs of the population being served as appropriate to their job responsibilities;
      2. (b) The resident assessment process;
      3. (c) The use of service plans; and
      4. (d) Resident’s rights; and
   8. (8) Holding appropriate licensure or certification as required by law.

3. C. With the exception of certified nursing assistants (CNAs) and geriatric nursing assistants (GNAs), if job duties involve the provision of personal care services as described in Regulation .30E of this chapter, an employee:

   1. (1) Shall demonstrate competence to the delegating nurse before performing these services; and

   2. (2) May work for 10 calendar days before demonstrating to the delegating nurse that they have the competency to provide these services, if the employee performing the tasks is accompanied by:

      1. (a) A certified nursing assistant;
      2. (b) A geriatric nursing assistant; or
      3. (c) An individual who has been approved by the delegating nurse.
4. D. Basic cardiopulmonary resuscitation (CPR) training, including a hands-on component, taught by a CPR instructor certified by a nationally recognized organization shall be provided on an initial and ongoing basis to a sufficient number of staff to ensure that a trained staff member is available to perform CPR in a timely manner, 24 hours a day.
5. E. Relief personnel shall be available at all times in the event that the regularly scheduled staff members are unavailable. Relief personnel shall meet the requirements of §B of this regulation.

6. F. Proof of training shall include:

   1. (1) Date of class;
   2. (2) Course content;
   3. (3) Documentation of successful completion of the training content;
   4. (4) Written, electronic, or video proof of attendee participation; and
   5. (5) Signature, qualifications, and contact information of each trainer.
7. G. Training with No Direct Interaction. When the training method does not involve direct interaction between faculty and participant, the assisted living program shall make available to the participant a trained individual to answer questions and respond to issues during the training.

8. H. Training in Cognitive Impairment, Mental Illness, and Behavioral Health.

   1. (1) When job duties involve the provision of personal care services as described in Regulation .30E of this chapter, employees shall receive a minimum of 6 hours of initial training on cognitive impairment, mental illness, and behavioral health within the first 120 calendar days of employment.

   2. (2) The training shall be designed to meet the specific needs of the assisted living program’s population as determined by the assisted living manager, including the following, as appropriate:

      1. (a) An overview of the following:

         1. (i) A description of normal aging and conditions causing cognitive impairment;
         2. (ii) A description of normal aging and conditions causing mental illness;
         3. (iii) Risk factors for cognitive impairment;
         4. (iv) Risk factors for mental illness;
         5. (v) Health conditions that affect cognitive impairment;
         6. (vi) Health conditions that affect mental illness;
         7. (vii) Early identification of and intervention for cognitive impairment;
         8. (viii) Early identification of and intervention for mental illness; and
         9. (ix) Procedures for reporting cognitive, behavioral, and mood changes;

      2. (b) Effective communication, including:

         1. (i) The effect of cognitive impairment on expressive and receptive communication;
         2. (ii) The effect of mental illness on expressive and receptive communication;
         3. (iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and
         4. (iv) Environmental stimuli and influences on communication;

      3. (c) Behavioral intervention, including:

         1. (i) Identifying and interpreting behavioral symptoms;
         2. (ii) Problem solving for appropriate intervention;
         3. (iii) Risk factors and safety precautions to protect the individual and other residents; and
         4. (iv) De-escalation techniques;

      4. (d) Making activities meaningful, including:

         1. (i) Understanding the therapeutic role of activities;
         2. (ii) Creating opportunities for productive, leisure, and self-care activities; and
         3. (iii) Structuring the day;

      5. (e) Staff and family interaction, including:

         1. (i) Building a partnership for goal-directed care;
         2. (ii) Understanding the needs of families; and
         3. (iii) Effective communication between family and staff;

      6. (f) End of life care, including:

         1. (i) Pain management;
         2. (ii) Providing comfort and dignity; and
         3. (iii) Supporting the family; and

      7. (g) Managing staff stress, including:

         1. (i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;
         2. (ii) Identification of stress triggers;
         3. (iii) Self-care skills;
         4. (iv) De-escalation techniques; and
         5. (v) Devising support systems and action plans.

   3. (3) When job duties do not involve the provision of personal care services as described in Regulation .30E of this chapter, employees shall receive a minimum of 2 hours of training on cognitive impairment, mental illness, and behavioral health within the first 120 calendar days of employment. The training shall include:

      1. (a) An overview of the following:

         1. (i) A description of normal aging and conditions causing cognitive impairment;
         2. (ii) A description of normal aging and conditions causing mental illness;
         3. (iii) Risk factors for cognitive impairment;
         4. (iv) Risk factors for mental illness;
         5. (v) Health conditions that affect cognitive impairment;
         6. (vi) Health conditions that affect mental illness;
         7. (vii) Early identification and intervention for cognitive impairment;
         8. (viii) Early identification and intervention for mental illness; and
         9. (ix) Procedures for reporting cognitive, behavioral, and mood changes;

      2. (b) Effective communication, including:

         1. (i) The effect of cognitive impairment on expressive and receptive communication;
         2. (ii) The effect of mental illness on expressive and receptive communication;
         3. (iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and
         4. (iv) Environmental stimuli and influences on communication; and
      3. (c) Behavioral intervention including risk factors and safety precautions to protect the individual and other residents.

   4. (4) Ongoing training in cognitive impairment and mental illness shall be provided annually consisting of, at a minimum:

      1. (a) 2 hours for employees whose job duties involve the provision of personal care services as described in Regulation .30E of this chapter; and
      2. (b) 1 hour for employees whose job duties do not involve the provision of personal care services as described in Regulation .30E of this chapter.

9. I. Training may be provided through various means, including:

   1. (1) Classroom instruction;
   2. (2) In-service training;
   3. (3) Internet courses;
   4. (4) Correspondence courses;
   5. (5) Prerecorded training; or
   6. (6) Other training methods approved by the Department.
10. J. When the training method does not involve direct interaction between faculty and participant, the assisted living program shall make available to the participant during the training a trained individual to answer questions and respond to issues raised by the training.

Authority: Health-General Article, Title 19, Subtitle 18, Annotated Code of Maryland

Effective date: January 1, 1999 (25:26 Md. R. 1923)

Regulation .02B amended effective November 1, 1999 (26:22 Md. R. 1692); July 22, 2002 (29:14 Md. R. 1074)

Regulation .02B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .03 amended effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .04 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .06 amended as an emergency provision effective August 15, 2000 (27:18 Md. R. 1664); amended permanently effective November 27, 2000 (27:23 Md. R. 2147)

Regulation .06E adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .09B, C amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .12D, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .15-1 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .15-2 adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .17B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .17E—G adopted effective October 10, 2005 (32:20 Md. R. 1655)

Regulation .21F, K amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .21P adopted effective March 29, 2004 (31:6 Md. R. 508)

Regulation .26A amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .27C, E amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .28D amended, and E—K adopted, effective November 1, 1999 (26:22 Md. R. 1692)

Regulation .29B amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .36A amended effective March 29, 2004 (31:6 Md. R. 508); December 19, 2005 (32:25 Md. R. 1941)

Regulation .46 amended effective March 29, 2004 (31:6 Md. R. 508)

Regulation .49B amended effective July 22, 2002 (29:14 Md. R. 1074)

Regulations .01—.53 repealed and new Regulations .01—.64 adopted effective December 29, 2008 (35:26 Md. R. 2249)

Regulation .07A amended effective August 19, 2013 (40:16 Md. R. 1344); August 29, 2016 (43:17 Md. R. 953); March 13, 2017 (44:5 Md. R. 292)

Regulation .07C amended effective March 13, 2017 (44:5 Md. R. 292)

Regulation .13A amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .24D amended effective June 25, 2012 (39:12 Md. R. 745)

Regulation .29 amended effective June 25, 2012 (39:12 Md. R. 745)

Chapter revised effective April 28, 2025 (52:8 Md. R. 357)