Maryland ALF Bed Increase: How to Go from 5 Beds to 8

This week a provider reached out to me — her family owns an assisted living home here in Maryland, and they’re in the middle of expanding from 5 beds to 8. Her comment: “We wish there was a straightforward checklist for this.” She’s right, there isn’t one. So here it is.

The one-liner: you cannot serve more residents than the bed count printed on your license — even with empty bedrooms — and raising that number is a formal bed increase request through the Office of Health Care Quality (OHCQ) that requires proof of your local approvals (fire safety, use and occupancy, zoning) before OHCQ will act.

Who this applies to

Licensed Maryland assisted living programs adding beds at their current address. (Moving to a bigger building is a different animal — a relocation is a full re-licensing with 60–75 days’ advance notice. Opening a second home is a new license entirely.)

One framing note before we start: Maryland’s assisted living regulations were completely rewritten effective April 28, 2025 — the new COMAR 10.07.14. If your reference point is the old chapter, renumber your bookmarks.

How the approval actually works

Under COMAR 10.07.14.08, a bed increase is submitted on OHCQ’s form — it’s now an online Smartsheet form linked from the OHCQ Assisted Living Providers page — and the regulation requires you to attach, at a minimum, “proof of compliance with all local requirements for fire safety, use and occupancy, and zoning permits.”

Read that again: the local approvals come first. OHCQ is the last stop, not the first. If approved, OHCQ issues a new license showing the higher bed count — and until that license is in your hands, resident #6 cannot move in.

Here’s the order I’d work in.

Step 1: Call your county first — 5 to 6 is the big jump

The part that surprises most owners: in many Maryland counties the meaningful line isn’t 8 beds, it’s going from 5 residents to 6.

Crossing to 6+ residents can change how your building is classified under the county building code — often from a residential dwelling to an R-4 “residential care” occupancy. That reclassification can trigger:

• A change-of-use / building permit process with your county permitting office
• A new use and occupancy certificate at the higher capacity
• Commercial-grade plan review for any renovations

Prince George’s County, for example, runs entirely separate permitting tracks for assisted living with 5 or fewer occupants versus 6 or more. Your county may draw the lines differently — call your permitting office before you spend a dollar on construction.

Zoning: many counties treat small assisted living homes (typically up to 8 residents) as a permitted use in residential zones, but the paperwork varies — some want a zoning verification letter on file. Get written confirmation that 8 residents is permitted at your address.

Step 2: Fire safety — talk to the fire marshal early

Your fire safety approval has to reflect the new occupant load. Expect:

• A fire marshal inspection at the higher capacity
• Sprinkler system review — sprinklers are required for assisted living occupancies under the fire and building codes, and if you’re converting spaces (a den into a bedroom, a basement buildout), coverage may need to be extended, with plans from a licensed Maryland sprinkler contractor
• Smoke alarms, egress, and emergency lighting checked against the added bedrooms — every resident room needs compliant exits

Step 3: Make sure the house measures up for 8

Before OHCQ signs off, the building has to meet the new COMAR 10.07.14 physical plant standards at the higher census. The headline numbers:

• Resident rooms: at least 80 square feet of functional space for a single room, 120 square feet for a double
• Bathing: at least 1 bathtub or shower per 8 occupants — at exactly 8 residents one bathing room still works, but you’re at the limit
• Common areas: dining and living space adequate for the full census, not just the bedrooms

This is also why so many small providers stop at exactly 8: at 9 or more occupants, stricter ratios kick in — 1 toilet and 1 hand sink per 4 occupants, with at least one on every floor that has a resident room. Eight is the sweet spot for a converted single-family home.

Step 4: Scale the program, not just the building

OHCQ isn’t approving a house — it’s approving a program that can safely serve more residents. Refresh:

1. Your staffing plan — under the new regs it has to match resident acuity, and awake overnight staff is driven by each resident’s Resident Assessment Tool, not by bed count
2. Your delegating nurse arrangement — confirm your DN’s capacity covers the larger census
3. Your emergency preparedness plan — evacuating 8 residents is a different exercise than 5
4. Food service, medication storage, laundry — all scaled to the new census

Step 5: Submit to OHCQ — then wait for the license

With the local proof in hand, submit the Bed Increase request through the Smartsheet form on the OHCQ providers page, with your fire safety, use and occupancy, and zoning documentation attached.

Then wait. I’ll say it once because it’s the most common and most expensive mistake in this process: do not admit residents above your current licensed capacity while the request is pending. Operating over capacity puts the whole license at risk.

The realistic timeline

Between county permits, construction, fire marshal scheduling, and OHCQ processing, plan on months, not weeks — and the county permitting phase is usually the long pole, not OHCQ. Start the local conversations before you knock down walls.

The checklist

• Call county permitting: does 6+ residents change my occupancy classification?
• Zoning confirmation in writing for 8 residents at this address
• Building permits for any conversions or renovations
• Sprinkler coverage reviewed/extended by a licensed sprinkler contractor
• Fire marshal inspection at the new capacity
• New use and occupancy certificate
• Bedrooms meet the 80/120 square foot functional space minimums
• Bathing ratio: at least 1 tub or shower per 8 residents
• Staffing plan, delegating nurse coverage, and emergency plan updated for 8
• OHCQ Bed Increase form submitted with all local proof attached
• New license in hand before resident #6 moves in

The fine print

The bed increase requirement is COMAR 10.07.14.08; the physical plant standards are in the new COMAR 10.07.14 (effective April 28, 2025), and the bed increase form lives on the OHCQ Assisted Living Providers page — OHCQ’s line for questions is 410-402-8217. County specifics — occupancy reclassification, sprinkler plan review, zoning paperwork — vary by jurisdiction, so verify with your local permitting office and fire marshal before making decisions.

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The Care Insider is not affiliated with or endorsed by the Office of Health Care Quality or the Maryland Department of Health. This is operator-to-operator plain-language explanation, not legal advice — always read the original guidance.