We want to begin by saying: safety in assisted living isn’t black & white (it never is). Maryland does many things right—but (of course) there are spots that need attention. We’ll walk through what the laws say, what inspections show, what real families report (yes, we have a story), and how to decide “is this facility safe enough for my loved one?”

What Maryland Requires: Laws & Regulations

Maryland’s Office of Health Care Quality (OHCQ) is the main regulatory agency overseeing Assisted Living Programs (ALPs). The regulations titled COMAR 10.07.14 (just saying that in case you want to Google) were recently updated (April 28, 2025) to strengthen safety, staffing, resident rights, training, etc.

Some key safety / regulatory features now required:

• Assisted Living Managers (ALMs) will need 80-hours of training, must be licensed under the State Board of Long-Term Care Administrators by July 1, 2026.

• On sites with an Alzheimer’s Special Care Unit, there must be awake overnight staff. 

• Staffing schedules must be kept on file for 18 months, showing staff name, shift, and date. 

• Menus must be reviewed by a dietitian / nutritionist, be nutritionally adequate, posted weekly, snacks offered between meals, etc. 

These aren’t just “nice-to-haves.” They are designed to address things that families often worry about: oversight, nutrition, staffing, emergencies.

Inspection Reality: What Happens on the Ground

Regulations are one thing, enforcement is another. So: how does Maryland measure up?

Maryland Matters reported that in 2024, 55.6% of assisted living facilities had received an annual inspection. That is a big improvement (from about 25.7% the prior year). But it also means nearly half of ALPs may still be behind on annual inspections. 

Prior years saw even more concerning drops: in Fiscal Year 2023 only about 25.7% of ALPs had gotten their annual survey. 

So: regulations have been strengthened, but inspections have lagged; the state is working on training more surveyors in order to get back in compliance.

Also: Maryland publishes quality metrics for assisted living (via MHCC / OHCQ), including inspection results, influenza vaccination rates, etc. These are (or should be) available to the public so families can compare. 

What Safety Means, From a Resident / Family Perspective

Rules and inspections are crucial—but what really matters to people moving in or considering moving in? We think safety encompasses:

1. Staffing (how many, how trained, awake staff at night, Alzheimer’s care, etc.)

2. Physical safety (fire, exits, slip hazards, lighting)

3. Medical safety (medication handling, emergencies, infection control)

4. Nutrition / meals (quality, frequency, allergens, dietary needs)

5. Quality of life / dignity (privacy, abuse/neglect prevention, residents’ rights)

We heard from one family whose mother had mild dementia. The facility seemed fine when they toured—nice common rooms, clean corridors—but at night she was often alone (no awake overnight staff even though she was in a memory-care unit). She fell at 2 AM, hit her head. That was a turning point: rules say you must have awake overnight staff in such units. In her case, the facility was under new regulations but had not yet implemented that requirement completely. Scary. Could have been worse. (We mention this not to scare you, but to show: sometimes compliance has lag.)

Where Maryland Shines

We don’t want to be all doom & gloom—there’s good happening:

• The recent regulatory changes are meaningful. Maryland involved many stakeholders, had multiple public comment periods over years (2015 to 2024). That suggests seriousness & commitment. 

• Small-facility ALPs (15 beds or fewer) constitute ~82% of ALPs. That means more intimate settings, which often translate to closer monitoring, more personal attention.

• The requirement for ALMs to be licensed & better trained, and for staffing schedules etc. to be tracked, gives families more transparency & more assurance.

• The public reporting tools (inspection results, quality metrics) allow comparisons; one can check whether a facility has had recent violations, or what kind of inspection score, etc.

Where Risk Still Exists

Even with good laws, gaps remain (as they do everywhere):

• Not all facilities are being inspected annually (or sometimes at all) on schedule. The backlog of inspections & variability in enforcement has been criticized.

• New regulations take time to implement—and not every facility catches up fast. So there may be some facilities operating under older standards.

• In some cases, staffing is still weak, especially overnight, or specialized training (dementia care, Alzheimer’s) is uneven.

• Families sometimes report concerns about medication errors, falls, or neglect (though data specific to ALPs in Maryland for some of those incidents is less readily aggregated).

• Physical risks (fire code, emergency preparedness) may be met on paper but real readiness (drills, staff response) sometimes uncertain.

What to Look for If You’re Touring a Facility (Yes, You Should TOUR)

Because laws and inspections only take you so far, here are tips (from us, learned the hard way):

• Ask to see the latest inspection report. When was it done, what violations (if any)? How were they corrected?

• Inquire about staffing at night, particularly if dementia care or Alzheimer’s care is involved. Is someone awake, trained, and available?

• Ask how many of the staff have specialized training (memory care, first aid).

• See how medication is handled: Is there a locked cabinet, professional oversight, double check?

• Observe how clean it is: hallways, bathrooms, bedrooms. Clean doesn’t just mean “smells nice”—look for mold, peeling paint, cracked tiles, trip hazards.

• Meals: ask for a sample menu, how dietary restrictions are handled. Do snacks happen between meals? Are menus reviewed by dietitians?

• Emergency plans: fire drills, evacuation procedures, backup power.

• Residents’ interaction: do they look comfortable? Are they isolated? Is there respectful, timely help when someone calls a staff member?

• Contracts / disclosures: what are the fees, what happens if your loved one needs more care than what facility can provide; is there a waiver required, etc.

How Safe Are They, Overall? Our Verdict

Pulling together regulation, inspection data, and family stories, here’s how safe we think assisted living facilities in Maryland are (with qualifiers):

• Relatively safe, but not uniformly perfect. Many facilities meet or exceed the new standards; many families are satisfied. But there is inconsistency, especially in smaller / more rural facilities.

• The recent law changes are promising—they strengthen accountability, training, emergency & overnight staffing, etc. So safety is improving.

• Risks remain, often not because of malicious intent, but due to resource constraints, delays in implementing regulation, variability in management quality.

• If someone does their homework (inspections, tours, asking the right questions), the chance of picking a facility that is unsafe drops a lot. If you skip that, you’re more vulnerable.

Personal Anecdote / Observation

We remember visiting one ALP outside of Annapolis. The facility was lovely: big windows, bright corridors, friendly staff during the day. But as evening fell, we noticed some lights in corridors were flickering; in one wing, the exit sign was dim; the nurse on duty was visibly tired. We asked about backup lighting, and discovered that though regulations required emergency lighting, the facility’s backup battery hadn’t been serviced in some months (it was in the maintenance log, but the test dates were old). It wasn’t dangerous yet—but it was the kind of small oversight that could become serious. We left thinking: “If we were moving in, we’d want that fixed, fast.”

That’s the crux: often safety is in the details—and details need care, oversight, follow-through.

What Maryland / ALPs Could Do Better

Because we care, and because “almost safe” isn’t enough:

• Accelerate the inspection schedule so that more ALPs get inspected annually without delays.

• Ensure enforcement: when violations are found, public outcome information; follow-ups; maybe penalties or corrective action.

• Make sure all ALPs implement the new requirements in full and transparently (e.g. awake overnight staff for Alzheimer/Special Care Units).

• Increase transparency: easier access online to recent inspection reports, violation history, staffing levels.

• Encourage families to report concerning incidents, and create supports for whistleblowing or oversight.

Conclusion 

We believe assisted living facilities in Maryland are becoming safer, much safer than in past decades—but “safe” is not a guarantee. Families and residents deserve more than promises: they deserve proof, transparency, diligence. Maryland has raised the bar via updated regulation; it’s now up to providers, inspectors, families, and oversight bodies to make sure no facility falls through the cracks.

If you’re considering a facility, don’t settle for “seems fine” — ask hard questions, tour at odd hours, read the inspection reports, listen to other families. Because safety lives in the details. And in those details, trust is built (or lost).

FAQs

How often are assisted living facilities inspected in Maryland?
Typically every one to two years, or more often if there’s a complaint. But in practice, many did not get annual inspections in recent years. 

Are new safety regulations going into effect now?
Yes—Maryland updated COMAR 10.07.14 effective April 28, 2025. Many new rules around training, staffing, menus, licensing of ALMs, etc.

What protections are there for residents with Alzheimer’s / dementia?
The law now requires awake overnight staff on approved Alzheimer’s Special Care Units; ALPs must have appropriate staffing, training, and oversight in those units.

Can a facility operate without a license?
No. It is illegal to operate an assisted living program without a proper state license under Maryland law. Facilities must comply with state regulations.

What if a loved one requires more care than their facility is licensed for?
Facilities may apply for waivers in certain circumstances. If a resident requires a higher level of care than the facility is approved for, there are rules about whether a waiver is allowed, and what oversight is needed. 

How can someone find out if a facility has had safety or health violations?
Through the Maryland Quality Reporting website / MHCC reports, and OHCQ inspection results. You can ask the facility for their latest report. Publicly available inspection reports often show up on state health department or Office of Health Care Quality pages.