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Announced or unannounced · COMAR 10.07.05.07

Maryland RSA inspection: the 23 required policies, and the 10-day correction clock

Maryland's Office of Health Care Quality may inspect a Residential Service Agency announced or unannounced under COMAR 10.07.05.07A(1). If an inspection cites a deficiency, the Secretary's notice requires an acceptable plan of correction within 10 calendar days of receipt (.07E(1)(b)). COMAR 10.07.05.08B enumerates the policies inspected, and the licence application makes you cite each one by page number.

Researched and written by Larry Osakwe · Last verified July 25, 2026

Checked against the published rules of the Maryland Department of Health, Office of Health Care Quality (OHCQ), and 8 primary sources linked below. Not a lawyer, not a compliance consultant, and not affiliated with any state agency.

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Informational summary of Maryland regulations, not legal advice. We are not affiliated with any state agency. Verify current requirements with the Maryland Department of Health, Office of Health Care Quality (OHCQ).

What does OHCQ check in a Maryland RSA inspection?

Maryland is unusually explicit: COMAR 10.07.05.08B lists the required policies by name, and the OHCQ licence application makes you write in the document name and page numbers for each one. That means your manual is graded against a published list rather than an inspector's judgment. Each row below is one group from .08B, with the records rules that sit alongside it.

What the surveyor verifiesWhat to have readyWhere it comes from
Administration policies, the largest group in .08B
  • Scope of services, and delineation of services provided when the agency coordinates care within the agency or with another provider (.08B(1)(a)(i)-(ii))
  • Notification to the client, or the client representative with legal authority to make health care decisions, of the agency's responsibilities to coordinate care when appropriate (.08B(1)(a)(iii))
  • Admission criteria, and assessment of potential clients before their acceptance into the program (.08B(1)(a)(iv)-(v))
  • Billing and service records, maintenance of charges and similar items, except for clients receiving services through a managed-care health benefits plan or third-party payor, where records are maintained as that payor requires (.08B(1)(a)(vi))
  • A quality assurance program, and clinical management covering assessment, plans, delegation, and supervision (.08B(1)(a)(vii)-(viii))
COMAR 10.07.05.08B(1)(a)
Personnel and patient-care policies
  • Job descriptions and educational qualifications for all employees and contractors, skill assessments for all employees and contractors, and health requirements for both (.08B(1)(b))
  • Provision of home health care services and the criteria for determining the need for skilled services (.08B(1)(c)(i))
  • Administration of drugs, enteral and parenteral nutrition procedures, frequency of client monitoring, and training and retraining of clients or their family members when indicated (.08B(1)(c)(ii)-(v))
COMAR 10.07.05.08B(1)(b)-(c)
Informed consent, in the two situations the rule names
  • A consent policy for when a client, or a client representative with legal authority to make legal decisions, signs an informed consent form consenting to changes to the agency's recommended plan of care (.08B(1)(d)(i))
  • A consent policy for when a client signs an informed consent form consenting to assistance by a nonlicensed individual with treatments of a routine nature, or with the self-administration of medications (.08B(1)(d)(ii))
COMAR 10.07.05.08B(1)(d)
Environment and safety policies
  • Preparation and storage of enteral formulas, intravenous therapies, other supplies, equipment, and similar items (.08B(1)(e)(i))
  • Infection control procedures, disposal of biomedical waste, maintenance of equipment, and emergency procedures (.08B(1)(e)(ii)-(v))
  • If the agency provides invasive equipment or supplies such as intravenous therapy, an arrangement for 24-hour-a-day equipment maintenance service in case of equipment failure (.08B(3))
COMAR 10.07.05.08B(1)(e), .08B(3)
Records kept on site, versus the 24-hour rule for the rest
  • On site: files on current clients, clients discharged within the last 12 months, current staff, staff discharged within the last year, and quality assurance activities (.07C(2)(a))
  • All other records may be stored off site but shall be available for inspection within 24 hours of the Department's request (.07C(2)(b))
  • On request, copies provided immediately, including client medical records; the Department reimburses copying costs if the licensee asks (.07C(1)(b))
COMAR 10.07.05.07C
Governing authority minutes, the item agencies forget
  • A governing authority that convenes at least annually with management staff to review and advise the agency on policies (.08A(2)(a))
  • Minutes of those meetings recording the participants, the agenda items considered, and the actions taken (.08A(2)(b))
COMAR 10.07.05.08A

Every policy the surveyor checks, written out to COMAR 10.07.05 (Health-General Title 19, Subtitle 4A) with the citation beside it:

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Is the Maryland RSA inspection announced or unannounced?

Either. COMAR 10.07.05.07A(1) lets the Department or its designee conduct announced or unannounced licensure inspections or complaint investigations, so you cannot plan around a notice. The agency shall be open for inspection during all hours identified in the agency's application as routine business hours (.07A(2)), which means the hours you wrote on your own application define when OHCQ can arrive.

  • OHCQ can also ask you to open outside those hours: on request, an agency shall make its offices available for inspection during other than its routine business hours (.07B(1)).
  • Inspection is not limited to your office. On request, the agency shall assist the Department in gaining access to sites where services are provided, both to confirm compliance and to investigate complaints (.07B(2)).
  • Records are part of the inspection surface: a licensee shall maintain records and reports supporting compliance, and all records and reports shall be open to inspection (.07C(1)(a)).

What happens if OHCQ cites a deficiency?

A clock starts. Under .07E(1), if a complaint investigation or survey inspection identifies a regulatory violation, the Secretary issues a notice citing the violation, requiring an acceptable plan of correction within 10 calendar days of receipt, advising that failure to correct may result in sanctions, and offering an informal dispute resolution conference. The plan must state the date by which each deficiency will be corrected (.07E(2)).

  • The 10 days run from receipt of the notice, not from the inspection date, and the plan has to be acceptable rather than merely submitted. Failure to return an acceptable plan within the allotted timeframe may itself result in a sanction (.07E(2)).
  • The informal dispute resolution conference (IDR) offered under .07E(1)(d) is a route to contest a citation you believe is wrong, which is worth knowing before you sign a plan of correction agreeing to it.
  • Deficiency findings are not private. An agency shall make any statements of deficiencies, reports, and plans of correction available on request to clients, client representatives, potential clients, and federal, State, or local regulatory or law enforcement agencies (.07D).

Do the skilled-care policies apply to a non-medical agency?

Not necessarily, and Maryland publishes the way out. COMAR 10.07.05 governs Residential Service Agencies broadly, so .08B lists policies for drug administration, enteral and parenteral nutrition, and intravenous therapy that a personal-care-only agency may never perform. Under .08B(2) the Department may waive a required policy on the agency's written explanation as to why it is inappropriate or unnecessary to that agency's specific operation.

  • The waiver is not an afterthought bolted on later: the OHCQ licence application contains a dedicated section for requesting one, where you list the specific policy or procedure from .08B and explain why it does not fit.
  • Where a waiver has been requested for a given policy, the application instructs you to enter N/A in that policy's document-and-page-number field rather than leaving it blank.
  • Requesting a waiver is a written argument about your scope of services, which is why the scope-of-services policy under .08B(1)(a)(i) is worth drafting first and precisely.

What else does the RSA licence application require?

Beyond the policies, OHCQ's application requires a business plan demonstrating the financial or administrative ability to operate in compliance with the chapter (COMAR 10.07.05.04A(2)h), an organizational chart, a letter of good standing from the Maryland Department of Assessments and Taxation, and workers' compensation documentation. The business plan must contain a one-year operating budget, a marketing plan identifying the populations to be served, and a detailed and specific description of agency services.

  • Corporations and LLCs not required to carry workers' compensation coverage submit a Certificate of Compliance instead; sole proprietorships and partnerships with no employees submit a Letter of Exemption.
  • Incomplete applications expire: OHCQ holds an application for 180 days from the date of initial receipt, after which it is deemed inactive and administratively closed, and reapplying means submitting a new application.
  • Adding a home health care service later is not a light amendment. A licensed RSA adding a new service must complete the initial licensure application again and submit it with all required attachments, including any policies or procedures related to the new service.
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Maryland survey FAQ

How long do I have to submit a plan of correction in Maryland?

10 calendar days from receipt of the notice of violation. COMAR 10.07.05.07E(1)(b) requires the residential service agency to submit an acceptable plan of correction within that window, and .07E(2) requires the plan to include the date by which each deficiency will be corrected. Failure to return an acceptable plan in time may result in a sanction.

Does OHCQ give notice before inspecting a residential service agency?

Not necessarily. COMAR 10.07.05.07A(1) permits announced or unannounced licensure inspections and complaint investigations. The agency must be open for inspection during all hours it identified as routine business hours on its application (.07A(2)), and on request must also open outside those hours (.07B(1)).

Which records must a Maryland RSA keep on site?

Files on current clients, clients discharged within the last 12 months, current staff, staff discharged within the last year, and quality assurance activities (COMAR 10.07.05.07C(2)(a)). Everything else may be stored off site but must be available for inspection within 24 hours of the Department's request (.07C(2)(b)).

Can a Maryland RSA skip a required policy it does not need?

Only with a waiver. COMAR 10.07.05.08B(2) lets the Department waive a policy required by §B on the agency's written explanation as to why it is inappropriate or unnecessary to the agency's specific operation. The OHCQ application has a section for making that request, and instructs you to enter N/A for that policy's page reference.

How many policies does COMAR 10.07.05.08B require?

The rule enumerates 23 named items across five groups: administration (8), personnel (3), patient care (5), informed consent (2), and environment and safety (5). The list is prefaced with “including but not limited to,” so it is a floor rather than a ceiling, and the licence application asks you to cite the document and page numbers for each.

Does my agency need a governing authority in Maryland?

Yes. COMAR 10.07.05.08A requires an agency to have a governing authority that convenes at least annually with management staff to review and advise the agency on policies, and to keep minutes recording the participants, the agenda items considered, and the actions taken.

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Sources

Last verified: July 25, 2026. Informational summary, not legal advice; not affiliated with any state agency. We do not guarantee survey results. Regulations change, so confirm current requirements with the Maryland Department of Health, Office of Health Care Quality (OHCQ) before relying on them.

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