How to Choose an Assisted Living Facility in Montgomery County, MD

By Nimmi Perera - MD-ALM, CMT, CNA · Owner, Bright Hands Assisted Living

Last updated: 2026-04-13

Montgomery County has several hundred licensed assisted living programs, and a family that starts researching in the usual way - a Google search, a paid referral site, a brochure or two - can feel, within a week, that every home is either a glossy five-star palace or a chaotic warehouse. Neither reflexive impression is useful. What you actually want (and what the National Institute on Aging’s residential-facility decision framework recommends) is a short list of homes that (a) are properly licensed for your parent’s current and likely future care needs, (b) have a clean regulatory record, (c) have real reviews from families and not paid-placement testimonials, and (d) will still welcome the tour questions you ask in week three when you know what to ask. Here is the step-by-step method I give families who call and say “I don’t even know where to start.”

Start with OHCQ Licensing

Before you look at a single review or tour a single home, verify licensing. In Maryland, assisted living is regulated by the Office of Health Care Quality (OHCQ), a division of the Maryland Department of Health, under COMAR 10.07.14. Every legal assisted living program in Montgomery County carries an OHCQ license, and that license has a level from 1 to 3 that defines what care the home is permitted to provide. Level 1 is basic ADL (activities of daily living) assistance. Level 2 adds medication administration by a Certified Medication Technician and more intensive ADL support. Level 3 permits the most complex care - two-person transfers, more-intensive medication regimens, and conditions that require close observation. A home licensed at Level 1 is legally prohibited from accepting a resident whose care needs exceed Level 1, even if the family is willing to pay.

Look up the home before you call. The OHCQ Long-Term Care Locator (health.maryland.gov/ohcq) lets you search by facility name, city, or county, and shows the license level, license number, and capacity for every licensed program. If your parent needs medication management now or is likely to need two-person transfers within the next two years, a Level 1 home cannot lawfully provide that care, however much you like the place or the people running it. For the full breakdown of what each level means in practice, see our Maryland assisted living levels guide. One rule of thumb: knowing a home’s license level is the first thing to settle, before a tour rather than after.

Reading OHCQ Inspection Reports

Maryland requires OHCQ to survey every licensed assisted living program regularly, and the reports from those surveys are public. They are posted on the OHCQ locator alongside each home’s license. Most families never read them. The families who do are the ones who avoid the bad decisions. Open the most recent report and look for four things. First, the overall compliance section - a clean survey will list no deficiencies or only minor administrative ones. Second, the violations by class - Class I is the most serious (immediate resident harm or substantial risk of harm), Class II is significant but not immediately dangerous, and Class III is administrative. A single Class I finding on a recent survey is a stop sign; a pattern of Class II findings across multiple years is a yellow flag worth asking about on a tour.

Third, look for substantiated complaints - OHCQ investigates complaints separately from routine surveys and posts the outcomes (residents and families can also file or escalate concerns through the Maryland Long-Term Care Ombudsman, an independent state advocate). An unsubstantiated complaint means the state investigated and found no issue; a substantiated complaint means the state verified the problem occurred. Fourth, look for repeat violations across multiple surveys. A home that fixes a problem once and never has it again is a home that learns. A home that gets cited for the same med-pass error three years running is telling you something about its management. The reports are PDFs and are written in bureaucratic language, but they are readable in 10 minutes per home. You will learn more from them than from two tours.

Reviews: Which to Trust, Which to Ignore

Online reviews are a signal, not a verdict. Google Business reviews are the most useful source for Montgomery County assisted living because they have the largest sample sizes and the hardest-to-manipulate review-authenticity system. Open Google Maps, search the home by name, and read reviews that are at least a year old and come from accounts that have reviewed other local businesses. Look at the distribution: a home with 30 reviews averaging 4.6 stars, spread across three years, with management responses to the occasional 2-star review, is a better signal than a home with 8 reviews all posted in the same month averaging 5.0. Look at the negative reviews carefully - a thoughtful 3-star review with specifics (the medication time drifted, the weekend activities were thin) is more informative than 15 gushing 5-star reviews without specifics.

Caring.com has real reviews but a curated feel and a selection bias toward families who had a good experience. Yelp is thinly populated for Montgomery County assisted living and often skews to complaint-only reviewers. Be wary of the big paid-referral directories. Several are lead-generation businesses that list only the homes paying a commission - often a cut of the first month’s rent - for each placement. A small home that declines to pay simply won’t appear, so a home’s absence from one of those sites tells you nothing about its quality, and its presence tells you it pays the commission, not that it’s good.

Tour Preparation

A tour is not a showing. A tour is a structured conversation with a written list of questions, conducted with two pairs of ears, at a time of day when the home is actually operating. Schedule your tours for a weekday between 10 AM and 2 PM - the morning activity hour, or the lunch service, are the two times when you can see staff interacting with residents under normal conditions. Avoid evenings and weekends for the first tour; those are lower-staffed hours and the home is not at its operational baseline. Bring a written list of questions. Our full checklist is at our tour questions guide, and it covers staffing ratios, medication management, emergency protocols, food, activities, and billing in detail. Bring one other adult with you - a sibling, a spouse, an adult child - because you will miss things you are not listening for, and the second pair of ears catches them.

Plan for 60 to 90 minutes per tour. A tour that the home tries to wrap up in 30 minutes is a tour where the home does not want the questions you are about to ask. Ask to see a resident room (not only the model/marketing room), the kitchen and dining area, and any outdoor space. Ask to walk through a typical day’s schedule posted on the wall. Ask who you will call if there is a problem at 3 AM. None of these are hostile questions; all of them are normal.

The Shortlist Method

Aim for three homes. After the OHCQ licensing filter and the inspection-report filter, you should have a short list of three to five candidates. Pick the three you are most interested in and tour all three in the same week, ideally on the same weekday at similar times. Ask each home the same ten or twelve questions, in the same order, and write the answers down immediately after each tour (not during - the note-taking changes the interaction). At the end of the three tours, the right answer is usually clear; when it is not, it is because two homes are comparably good and the decision is style and fit rather than quality. That is a good problem to have.

One tour is not enough because you have nothing to compare it to. Eight tours is too many because the homes blur together and you start making decisions from fatigue rather than fit. Montgomery County is large enough to support a meaningful shortlist at every price point and care level - you do not need to settle for “the only one with an opening,” and a home that pressures you by claiming the last bed is closing tomorrow is using a sales tactic you should register and remember.

Red Flags

The red flags that should end a tour early, in roughly the order you will encounter them on a tour gone wrong:

• Dirty common areas at a random hour on a weekday. A home that is actually clean is clean on a Tuesday at 11 AM, not only on Saturday when the marketing director walks families through.
• A strong odor of urine or feces in common areas. Occasional isolated incidents happen; a persistent ambient odor means cleaning is not keeping up with incontinence care, which means care routines are not keeping up with resident needs.
• Staff turnover questions dodged. Ask “what’s your annual caregiver turnover rate and how long has your longest-tenured caregiver been here?” A confident answer is a number and a name. A change of subject is worth noticing.
• Resident rooms “off-limits.” A home that will not let you see an actual (non-model) resident room, with a resident’s consent, is showing you only the staged version of how residents live. Ask to see a lived-in room.
• Pressure to sign that day. A good home will hold a bed for 48 to 72 hours in good faith. A demand for a deposit before you leave is a sales tactic worth slowing down for, not a deadline you have to meet.
• No specific answer on medication credentials. “Our staff handles meds” leaves the important detail out. “Our day shift has two CMTs and our overnight is a CMT under our named delegating RN” is the level of specifics to listen for.
• No written emergency protocol. Ask to see it. A home that cannot produce one does not have one.

Any one of these on its own is a data point. Several in the same visit is reason to keep the home off your shortlist.

Decision Framework

When you are down to two homes that cleared the regulatory filters, passed the tours, and survived the red-flag screen, use this framework to decide. First, separate must-haves from nice-to-haves. Must-haves for most Montgomery County families: correct license level, medication management by credentialed staff, a written emergency protocol, a caregiver ratio you can live with, and a documented overnight model. Nice-to-haves: the specific activities program, the dining style, the decor, the neighborhood feel. Decide the must-haves first and do not let a home’s nice-to-haves compensate for a must-have gap. A beautiful home that is licensed below your parent’s care needs cannot lawfully keep her once those needs are documented, however much else it has going for it.

Second, weigh price against care. Within Montgomery County, the monthly range for assisted living runs roughly from the mid-$5,000s to well over $10,000 depending on level of care, home size, and amenities. A higher price does not guarantee better care; a larger facility folds amenity overhead into every rent check, while a smaller home can put more of the rate toward direct care. When clinical quality and amenities pull in different directions, the clinical side is the one that affects how your parent actually does. For detail on pricing, see our Silver Spring assisted living guide, which breaks down cost by care level and home size. Third, weigh location against the specific home. A home 20 minutes further from your house, with the right license level and the right staff, is a better decision than a closer home that will discharge your parent in 18 months when her care needs rise.

Next Step: Tour Bright Hands

If you are building a Montgomery County shortlist, start here. Bright Hands is a small, owner-operated, Level 3 licensed assisted living home in Silver Spring. Our Maryland OHCQ Level 3 license means we are permitted to care for residents with the most complex assisted living needs - and in practice, it is what lets a resident who moves in at 82 with just medication management still be with us at 87 when she needs two-person transfers. Five residents, one caregiver to five residents during the day plus a separate awake caregiver overnight, the owner on site, medication management by CMTs under a named delegating RN, and a written emergency protocol posted in the caregiver binder. We welcome the hard questions; they are the right questions.

We are happy to be one of the three homes on your tour list. If our size or style is not the right fit, we will say so - a larger community with a memory-care wing suits some residents better, and we would rather point you there than talk you into a home that is wrong for your parent. The goal is the right home, not necessarily ours. Visit our contact page to schedule a tour, or call the number at the bottom of this page.

Frequently Asked Questions

Helpful guides

• Assisted Living Tour Questions Checklist
• Maryland Assisted Living Levels Explained
• Silver Spring Assisted Living Guide 2026
• Small Assisted Living Home vs. Large Facility in Maryland
• Book a Tour at Bright Hands