1. A. If the Board concludes that a licensee has violated a ground for discipline under Health Occupations Article, §§9-314(b) or 9-3A-12(b), Annotated Code of Maryland, or under this chapter, the Board shall:

   1. (1) Determine the applicable sanction range according to the guidelines set forth in Regulation .08 of this chapter;
   2. (2) Consider the applicable aggravating and mitigating factors set forth in §J of this regulation to determine whether the sanction should fall outside the indicated range of sanctions; and
   3. (3) After considering any applicable aggravating and mitigating factors, impose the appropriate sanction.
2. B. The Board is not required to make findings of fact with respect to any of the factors for determining the sanction indicated by the sanctioning guidelines.
3. C. In the event that a licensee’s violation of the Board’s statutes or regulation does not fall within a sanction range, the Board shall so indicate and use its best judgment to determine the appropriate sanction and consider, to the extent possible, the factors in the sanctioning guidelines.
4. D. If the Board deviates from the sanctioning guidelines, the Board shall state its reasons for the deviation.
5. E. A departure from the sanctioning guidelines is not an independent ground for an appeal or challenge of a Board action.
6. F. Notwithstanding this regulation, in order to resolve a disciplinary proceeding, the Board and the licensee may agree to a surrender of license or a Consent Order with terms and sanction agreed to by the Board and the licensee.
7. G. In a case where there are multiple and distinct violations, the Board may impose a sanction greater than the maximum indicated by the sanctioning guidelines for each individual violation.
8. H. If probation or suspension is imposed, the Board may impose appropriate terms and conditions for the probation or suspension. If a licensee violates the terms or conditions of the probation or suspension, the Board may take further disciplinary action against the licensee, as provided in the Board order.
9. I. Pursuant to Health Occupations Article, §§9-314.1 and 9-3A-13, Annotated Code of Maryland, if a civil fine is imposed, the fine may not exceed $1,000 for a first violation or $5,000 for any subsequent violation of the same provision.

10. J. Aggravating and Mitigating Factors.

    1. (1) Mitigating Factors. In determining whether the sanction falls outside the indicated range of sanctions guidelines listed in Regulation .08 of this chapter, the Board may consider the following mitigating factors:

       1. (a) Absence of a prior disciplinary record;
       2. (b) That the licensee reported the violation to the Board;

       3. (c) That the licensee:

          1. (i) Voluntarily admitted violation;
          2. (ii) Provided full disclosure to the Board; and
          3. (iii) Cooperated during Board proceedings;
       4. (d) That the licensee implemented remedial measures to correct or mitigate harm arising from the violation;
       5. (e) That the licensee made a timely good-faith effort to make restitution or otherwise rectify the consequences of the violation;
       6. (f) Evidence of the licensee’s rehabilitation or potential for rehabilitation;
       7. (g) Absence of premeditation to commit the violation;
       8. (h) Absence of potential harm to or adverse impact on the public;
       9. (i) That the incident was isolated and is not likely to recur; or
       10. (j) If the licensee has worked at the nursing home or assisted living program for a limited period, and the violation was present before beginning work at the facility or program.

    2. (2) Aggravating Factors. In determining whether the sanction of the licensee falls outside the indicated range of sanctions guidelines listed in Regulation .08 of this chapter, the Board may consider the following aggravating factors:

       1. (a) The licensee’s previous criminal or administrative disciplinary history;
       2. (b) If the violation was committed deliberately or with gross negligence or recklessness;
       3. (c) If the violation had the potential for, or caused, serious resident harm;
       4. (d) If the violation was part of a pattern of detrimental conduct;
       5. (e) If the licensee pursued the licensee’s financial gain over a resident’s welfare;
       6. (f) That the resident was especially vulnerable;

       7. (g) That the licensee attempted to:

          1. (i) Conceal the violation;
          2. (ii) Falsify or destroy evidence; or
          3. (iii) Present false testimony or evidence;
       8. (h) That the licensee failed to cooperate with the Board’s investigation; or
       9. (i) That the licensee’s previous attempts at rehabilitation were unsuccessful.

Authority: Health-General Article, §§2-104 and 19-1809; Health Occupations Article, §§1-212, 1-602—1-609, 9-205, 9-313—9-316.1, 9-3A-11—9-3A-17, and
9-401—9-407; State Government Article, §§10-201—10-226; Annotated Code of Maryland

Effective date: January 19, 2026 (53:1 Md. R 22)