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Maryland · RSA inspections · COMAR 10.07.05.07 and .20 to .28
OHCQ may inspect a Maryland Residential Service Agency at any time, announced or unannounced, and its 2019 overview says complaints are investigated with unannounced visits. Here is what the rules say about surveys, the records kept at your office, the first survey OHCQ described in 2020, statements of deficiencies, plans of correction within 10 calendar days, informal dispute resolution and the sanctions behind them, and what OHCQ has not said.
Quick answer
OHCQ "may conduct announced or unannounced licensure inspections or complaint investigations to ensure compliance with the requirements of this chapter". COMAR 10.07.05.07A The rules set no interval between surveys, and your agency must be open for inspection during all the business hours on your application. Files on current and recent clients and staff, and your quality assurance activities, stay at the office; other records must be produced within 24 hours. .07C(2)
When a survey or complaint investigation finds a violation, you get a notice and a statement of deficiencies, and you have 10 calendar days to send an acceptable plan of correction with a completion date for each deficiency. .07E You may ask for an informal dispute resolution conference within 10 days. .07F
For a new agency with nurses and aides, OHCQ’s 2020 slides described an unannounced on-site survey after the first three clients, before the regular license. OHCQ slides (2020), slide 56 OHCQ’s current materials do not describe it, so we cannot confirm it for 2026.
OHCQ inspections
Checked against official sources on October 2, 2026.
193
OHCQ complaint investigations of RSAs in FY 2018, up from 37 in FY 2016
OHCQ slides (2020), slide 20What the rule says. "Before approving or denying an application for licensure, the Department may conduct an announced or unannounced on-site inspection of the agency." COMAR 10.07.05.04D If the agency is not compliant and more than one prelicensure visit is needed, the rule text lets the Department charge $250 for each extra visit (the state’s fee; we could not confirm it is still charged) or deny the license. .04K The rule also allows a provisional license for an agency that intends to provide only skilled nursing and home health aide services, which cannot be extended. .04J
What OHCQ described in 2020. OHCQ’s initial license slides for agencies offering skilled nursing with aides set out this order (Internet Archive copy; the slides are no longer on OHCQ’s site):
How many surveys. OHCQ’s 2020 slides gave its RSA survey counts for FY 2016, 2017 and 2018: licensed RSAs 1,139, 1,201 and 1,165; initial surveys of new providers 94, 84 and 124; full surveys 12, 27 and 5; follow-up surveys 10, 6 and 6; complaint investigations 37, 41 and 193. We found no later RSA figures from OHCQ. Slide 20 By our arithmetic, initial surveys of new providers far outnumbered full surveys of licensed agencies in those years.
Where it stands now. OHCQ’s current RSA application and RSA page describe the application, the worker classification certification and change forms, but not a provisional license, a readiness statement or a first survey. OHCQ, RSA page We could not confirm the 2020 process for 2026. If it still applies, your forms (assessment, care plan, RN supervision record, consent and waiver forms, on-call log, complaint report) are read at the survey as closely as your policies were at application. Ask the RSA Team (410-402-8040) what follows your approval letter. The application itself, section by section, is on the Maryland license application page.
Our practical suggestions, not rule text. Each card links the rule it helps you meet and the CareRulebook manual policy that covers it.
The agency must be open for inspection during all the routine business hours on its application, and open the office at other times when OHCQ asks. Make sure someone who can unlock records is there.
COMAR 10.07.05.07A(2), B(1)Manual: Policy 1.5
Current clients, clients discharged in the last 12 months, current staff, staff who left in the last year, and quality assurance activities stay at the office. Everything else must be producible within 24 hours.
COMAR 10.07.05.07C(2)Manual: Policy 7.4
Screening under .10 was the most cited RSA rule in OHCQ’s FY 2018 list. Check each file for the criminal history check, certificate verification, health and TB screening, references, work history, I-9, interview and skills demonstration.
COMAR 10.07.05.10B; OHCQ slides (2020), slide 21Manual: Policy 3.4
The agency keeps accurate documentation of the RN’s supervision. Check every client’s last on-site visit against the 45-day, 3-month or 4-month interval that applies.
COMAR 10.07.05.12E(2)-(3)Manual: Policy 4.4
When asked, you help OHCQ gain access to the places where services are given. Keep a current list of client addresses and contacts, and tell clients at admission that OHCQ may visit or call.
COMAR 10.07.05.07B(2)Manual: Policy 1.5
Complaint investigation reports go to the Department immediately on request. Each one records the time, date, place and people, the complaint, its disposition and follow-up.
COMAR 10.07.05.09B, DManual: Policy 7.2
Each screening step is set out in Maryland caregiver background checks, and the RN’s visits and records in the registered nurse in a Maryland RSA.
"A licensee shall maintain records and reports to support compliance with the regulations of this chapter. All records and reports shall be open to inspection by the Department." COMAR 10.07.05.07C(1)(a)
The rules do not say whether electronic records that can be opened and printed at the office count as kept "on site". By our reading they should, if a surveyor can see and copy them there at once; it is on our list of questions for OHCQ. What each record holds is set out under records and on-call on the Maryland guide.
OHCQ’s 2019 overview: "The assigned surveyor conducts an unannounced onsite survey of the provider that includes both record reviews and interviews." OHCQ, Complaint Survey Process (2019) OHCQ’s 2019 overview says that once a Statement of Deficiencies is issued, the provider gives OHCQ an acceptable Plan of Correction setting out the method and timeframes for correcting each deficient practice. same
OHCQ’s RSA complaint investigations rose from 37 in FY 2016 to 193 in FY 2018. OHCQ slides (2020), slide 20 By our reading, for most licensed agencies a complaint is the likeliest reason for a visit.
OHCQ’s FY 2018 list is the most recent RSA deficiency list we found. OHCQ slides (2020), slide 21 The table groups its rows by regulation; the manual column is ours.
| State tag | What it covers | FY 2018 citations | Manual |
|---|---|---|---|
| 10.07.05.10 | Screening of employees, independent contractors and contractual employees | 71 and 27 (two rows) | Policy 3.4 |
| 10.07.05.12 | Services provided: RN assessment, care plans, consent, supervision, medication and on-call | 33 and 27 (two rows) | Policy 4.4 |
| 10.07.05.01 | Purpose (the chapter’s minimum standards for licensure) | 34 | Policy 1.3 |
| 10.07.05.04 | Licensing procedures | 23 | Policy 1.3 |
| 10.07.05.06 | Public representation: the license number and OHCQ statement in advertising | 22 | Policy 1.4 |
| 10.07.05.09 | Complaint process | 21 | Policy 7.2 |
| 10.07.05.14 | Clinical records | 20 | Policy 7.4 |
| 10.07.05.16 | Client rights and responsibilities | 19 | Policy 7.1 |
The list is from 2018, when OHCQ licensed about 1,165 RSAs; it now lists 3,065 license numbers. OHCQ RSA list, our count OHCQ has not published a newer list that we found. The 23 policy items, item by item →
Every finding follows the same path, whether it came from a licensure inspection or a complaint investigation. Tick steps off as you go; your progress is saved in this browser only.
When a complaint investigation or survey finds a violation, the Secretary issues a notice that cites it, requires an acceptable plan of correction, warns that failing to correct may bring sanctions, and offers an informal dispute resolution conference (IDR). Note the date you received it: both deadlines run from there.
You may ask for an IDR within 10 days of receiving the statement of deficiencies. The written request fully describes the disagreement and comes with supporting documents. OHCQ decides whether it is held in person, by telephone or in writing; in-person IDRs are informal and not attended by counsel.
Within 10 calendar days of receiving the notice, with the date by which each deficiency will be corrected. Not returning an acceptable plan of correction in time may result in a sanction.
An agency that asks for an IDR still files its plan of correction on time, except for the specific findings it contests. For those, unless the Department directs otherwise, the plan may wait until 5 days after the agency is told the IDR outcome. The IDR process does not delay the effective date of any enforcement action.
Make each correction by its date and keep the evidence with the plan. The Department may also direct how and by when a violation is corrected, and may permit an agency to correct deficiencies by a specified date before deciding on a penalty.
Make statements of deficiencies, reports and plans of correction available on request to clients, client representatives, potential clients and regulators.
Our suggestions. Write the 10-day date on the notice the day it arrives. Answer each deficiency on its own line: what you did or will do, who is responsible, and a real completion date. Keep the evidence of each correction with the plan, and add the finding to your quality assurance program so it does not recur. If a date is too tight, ask OHCQ before it passes; the rules do not say whether OHCQ extends the 10 days.
The rules do not set a form or portal for plans of correction, or a time for OHCQ to say whether a plan is acceptable. Send it the way the notice asks.
CareRulebook
CareRulebook’s Maryland manual includes Policy 1.5, Inspections, surveys and plans of correction: open for inspection, records on and off site, helping OHCQ reach clients’ homes, statements of deficiencies on request, plans of correction within 10 calendar days and informal dispute resolution, with an inspection-day checklist, an inspection log and a plan of correction worksheet. The other policies the RSA rules list come with it, and your own registered nurse reads and adopts the clinical ones.
$199CareRulebook founding price for the first 50 Maryland agencies, then $249. Not an OHCQ fee.
A plan of correction is the usual answer to a finding. For completeness, here is what the rules allow beyond it. These are the state’s sanctions and penalties, not CareRulebook charges.
Beyond penalties, suspension and revocation, the Secretary may restrict the number or types of clients, require remedial instruction, require an approved management firm, mandate staffing patterns, direct how and by when violations are corrected, notify (or make the agency notify) affected clients and families, increase monitoring visits, or set conditions for continued operation.
For a deficiency or a continuing pattern of deficiencies. The Secretary weighs the nature, number and seriousness of the deficiencies, any pattern over the preceding 24 months, the risk to clients, the agency’s efforts and ability to correct, and its compliance history. A penalty may not exceed $10,000 per instance or $1,000 per day.
The Department may let the agency correct by a specified date, impose up to $1,000 a day until sustained compliance, or impose a penalty for each instance. If an agency misses a correction date it was given, the penalty can be up to $1,000 a day until correction is verified and sustained. A proposed civil money penalty is issued as an order stating the deficiencies, the amount, how it was calculated and the appeal rights.
In setting the amount the Secretary also considers whether the penalty would jeopardize the agency’s financial ability to keep operating, and other factors as justice may require.
The Secretary may suspend a license immediately when public health, safety or welfare imperatively requires it. A hearing request does not stay it; the agency returns the license, stops services, and helps clients make other arrangements. The agency may ask for a prompt show cause hearing as well as an evidentiary hearing.
For cause shown, the Secretary may deny, revoke or refuse to reissue a license for inability or failure to comply with the RSA rules, under the Administrative Procedure Act. If the licensee violates a condition or requirement of an imposed sanction, the Secretary may suspend or revoke the license.
Where the rules give a right of appeal (a civil money penalty, an emergency suspension, a denied application, or a sanction limiting the number or types of clients or a suspension or revocation for breaking a sanction), file a hearing request with the Office of Administrative Hearings, copied to OHCQ, within 30 days of receiving the notice, with a copy of the Secretary’s action.
Each competent client and client representative is notified within at least 30 days of a significant change in licensure status, a voluntary surrender, or a denial, revocation or suspension.
Criminal penalties are separate. Operating an RSA in violation of the rules is a misdemeanor with a fine of up to $1,000 on conviction; each day it continues after the first conviction is a separate offense. Health-General §19-4A-09 Operating without a license carries its own penalties. COMAR 10.07.05.27; §19-4A-08
These are on our list of questions for OHCQ. Until it answers, plan for an unannounced visit at any time in your business hours.
No. Not on any schedule the rules set. COMAR 10.07.05 lets OHCQ make announced or unannounced licensure inspections and complaint investigations, and requires the agency to be open for inspection during all its stated business hours, but it names no interval between surveys. Maryland’s home health agency rules do set one; the RSA rules do not. Treat every business day as a day OHCQ could arrive.
"may conduct announced or unannounced licensure inspections or complaint investigations to ensure compliance with the requirements of this chapter."
No. The notice requires an acceptable plan of correction within 10 calendar days of receiving it, with a completion date for each deficiency. The 30-day period in the rules is for asking for a hearing on an action by the Secretary, such as a sanction or penalty, which is a different step.
"Requiring the residential service agency to submit an acceptable plan of correction within 10 calendar days of receipt of the notice of violation or deficiency;"
It depends. Only for the findings you contest. You may ask for an informal dispute resolution conference within 10 days of receiving the statement of deficiencies. The plan of correction for every other finding is still due on time; for the contested findings, unless the Department directs otherwise, it may wait until 5 days after you are told the IDR outcome. The IDR does not delay any enforcement action.
"When a licensee requests an IDR as provided in §F of this regulation, the licensee shall file a plan of correction within the required time, except to the extent that the licensee contests specific findings."
No. Not by OHCQ’s own description. Its 2019 overview says a complaint is triaged by severity and assigned to a surveyor, who makes an unannounced on-site survey with record reviews and interviews. The rule allows announced or unannounced complaint investigations, and OHCQ accepts anonymous complaints.
"The assigned surveyor conducts an unannounced onsite survey of the provider that includes both record reviews and interviews."
COMAR 10.07.05 sets no interval. It lets OHCQ make announced or unannounced licensure inspections and complaint investigations, and requires the agency to be open for inspection during all the business hours on its application. Maryland’s home health agency rules do set a survey interval; the RSA rules do not. OHCQ’s 2020 slides counted 5 to 27 full RSA surveys a year between FY 2016 and FY 2018, against 84 to 124 initial surveys of new providers, and 193 complaint investigations in FY 2018. We found no later RSA figures.
It may. The rule lets the Department inspect the agency on site, announced or unannounced, before approving or denying an application, and if more than one prelicensure visit is needed because the agency is not compliant, the rule text allows a $250 fee per extra visit (the state’s fee; we could not confirm it is still charged) or denial. In 2020 OHCQ described a different order for agencies with nurses and aides: a 90-day provisional license, three clients admitted within 45 days, then an unannounced on-site survey by an OHCQ nurse surveyor before the regular license. OHCQ’s current application and RSA page do not describe that process, so ask the RSA Team what applies now.
10 calendar days from receiving the notice of violation or deficiency. The plan gives the date by which each deficiency will be corrected, and not returning an acceptable plan in time may bring a sanction. If you ask for an informal dispute resolution conference, the plan for the findings you contest may wait until 5 days after you are told the outcome, unless the Department directs otherwise; the rest is still due on time.
Yes, through informal dispute resolution (IDR). Ask in writing within 10 days of receiving the statement of deficiencies, fully describing the disagreement and attaching supporting documents. OHCQ decides whether it is held in person, by telephone or in writing, and in-person IDRs are not attended by counsel. The IDR does not delay any enforcement action. A civil money penalty, an emergency suspension, a denied application or a sanction limiting the number or types of clients is appealed separately, by a hearing request to the Office of Administrative Hearings within 30 days.
Files on current clients, clients discharged within the last 12 months, current staff, staff discharged within the last year, and quality assurance activities. Other records may be stored off site but must be available for inspection within 24 hours of the Department’s request. On request, the agency gives OHCQ copies of records and reports, including clients’ medical records, immediately, except records allowed off site.
It can. When OHCQ asks, the agency helps it gain access to the places where services are given, to check compliance and to investigate complaints. OHCQ’s 2020 description of the initial survey included home visits or telephone interviews with clients.
Yes. For a deficiency or a continuing pattern of deficiencies, the Department may impose a civil money penalty of up to $10,000 per instance or up to $1,000 a day until sustained compliance, or let the agency correct by a set date first. These are the state’s penalties, not CareRulebook charges. Other sanctions include limits on the number or types of clients, a required management firm, mandated staffing, and more frequent monitoring visits.
Yes. Policy 1.5, Inspections, surveys and plans of correction, covers being open for inspection, records on site and off site, helping OHCQ reach clients’ homes, statements of deficiencies on request, plans of correction within 10 calendar days, informal dispute resolution and complaint reports, with an inspection-day checklist, an inspection log and a plan of correction worksheet. The manual is rule-verified against COMAR 10.07.05; your own registered nurse reads and adopts the clinical policies.
COMAR 10.07.05 was last amended in 2017, and OHCQ has signalled a 2026 update to the RSA training rules. Leave your email and we will tell you when a Maryland change affects your inspections or your policies.
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