In November 2000, a Technical Assistance Unit was established in the OHCQ to encourage compliance efforts and best practices. The unit consists of a team of five nurses, one dietician, and a manager who are separate from and independent of the federal survey team. This unit is supported by $400,000 in state general funds. The state believed that the use of federal funds would limit its flexibility. The OHCQ received $250,000 from operations for the program.
The team performs a second annual survey, the Quality Assurance Survey, at each Maryland nursing facility. While no legislation mandates a specific quality related survey, regulations require two annual surveys be performed for each facility. OHCQ has chosen to design the "Second Survey" to focus on quality assurance, technical assistance, and sharing of best practices. The survey is unannounced, as required by Maryland law. It is intended to be collegial and consultative, rather than punitive, and total separation is maintained between the technical assistance survey and the federal certification survey. When serious violations are identified as part of the second survey, the QA team brings these to the attention of the nursing home staff and requires a plan of correction. Unless the violations are of an egregious nature and threaten resident safety, the QA team continues to track the violations and provides follow-up to ensure corrective action. In one instance (as of October 24, 2002), the violation was, in fact, referred to a federal survey team for treatment as a complaint.