Section III. State Summaries
This section includes brief State summaries that identify the agency responsible
for issuing regulations, licensing, and providing oversight of licensed facilities.
It is based on a review of State regulations and a conversation with staff
from the licensing agency. The information presented may vary from State to
State based on the discussion with State contacts. The summary describes the
approach to regulation and survey practices and special initiatives. A section
on communicating with consumers describes the information available to consumers
and family members on the Web sites of licensing agencies and aging agencies.
Alabama
Approach
The Department of Health licenses assisted living facilities. Facilities are
monitored through licensing review and periodic inspections by the Board of
Health (depending on funding for inspectors). Incidents are reported through
a hotline. Written reports may be requested to determine the cause of an incident
or whether the facility acted appropriately. Currently, facilities are inspected
every 18 months.
The Department has developed a scoring system based on survey findings that
rates facilities as green, yellow, or red. The ratings must be posted by the
facility for 18 months or until the next survey. Administrators from facilities
receiving a red rating must attend a meeting with the licensing director and
develop a consent agreement that describes the corrective actions that will
be made and the timetable for making them.
Facilities that receive a yellow or red rating often request earlier reviews
to consider corrections they have made that would raise their rating. However,
the Department does not have sufficient staff to make return inspections and
maintain the survey cycle for other facilities. The rating system was implemented
in the fall of 2004. Each facility's survey report and rating will be
posted on the Department's Web site when more ratings have been completed.
The Department spokesperson felt that listing facilities on the Web site as
they were rated would give an unfair advantage to those at the beginning of
the cycle.
The survey staff members follow a protocol that focuses on admission and retention
related criteria. The areas include weight loss, falls, medication administration,
wandering, exiting behaviors, and other behaviors. Interviews with residents
and staff follow a protocol but do not emphasize satisfaction measures because
of their perceived limited use.
Communicating with Consumers
The Department of Public Health Web site includes a list of facilities and
regulations governing assisted living. The list includes the name of the facility,
address, phone number, administrator, type of ownership (corporation, partnership,
limited liability, non-profit), and license number.
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Alaska
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A new section on certification and licensing in the Department of Health
and Social Services is responsible for screening applicants, issuing licenses,
and investigating complaints. The reorganization was implemented to consolidate
all licensing activities and the responsibility for licensing assisted living
homes that had been spread among State agencies.
Licenses for assisted living homes are issued for 2 years. Regulations require
an annual monitoring visit or self-monitoring report filed by the facility.
Surveyors follow a checklist based on the regulatory requirements. Surveyors
observe residents during a tour of the facility to determine the level of activity
and whether they are dressed, groomed, and appear well-nourished. Consumers
may request information about complaints against a facility by telephone, and
surveys findings may be requested in writing.
Staff members of the licensing agency describe its oversight and monitoring
process as consultative. When a pattern of violations is identified, a more
industry-wide—versus a one-on-one—training approach is implemented.
The licensing agency holds orientation sessions quarterly for new assisted
living homes.
Communicating with Consumers
The Department of Health and Social Services, Division of Public Health Web
site includes a guide to licensing for providers, regulations, and a list of
licensed assisted living homes containing the name of the administrator and
the name of the facility, address, phone number, and capacity. Forms related
to the licensing requirements and process will be added to the Web site.
The Division of Senior and Disabilities Services has an extensive array of
materials, including radio and television public service announcements, which
are directed to providers interested in developing assisted living homes.
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Arizona
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The Department of Health Services, Division of Licensing Services is responsible
for licensing and inspecting assisted living facilities. The Division inspects
facilities annually and upon receipt of a complaint. Licenses may be renewed
for 2 years for facilities that do not have deficiencies. Surveyors use a checklist
based on the regulations to guide the on-site review. The review includes record
reviews and interviews with residents, family members if available, and staff.
The interviews are used to determine compliance with the regulations. Residents
may be asked to comment on the food, activities, and who is at the facility
at night. The surveyor may mention the name of the manager and ask if the resident
knows the manager. Questions about making decisions and resident's rights
are also asked.
Surveyors use the same format used for nursing homes to document deficiencies.
Penalties for violations include civil money penalties, provisional licensing,
and restricted admissions. Fines against unlicensed facilities have been increased.
Once survey and complaint findings have been sent to the facility, they are
available to the public.
Communicating with Consumers
The Division's Web site contains a database of facilities and enforcement
actions for all licensed entities (assisted living, day care, behavioral health,
and nursing facilities). The enforcement action information includes the date
of the action, the amount of the fine (if any), and a number to call for more
information about the action.
The Division is preparing to post survey and complaint findings. Findings
for child care providers will be posted beginning in June 2005. Once completed,
postings for nursing homes and assisted living homes will follow. Surveyors
have been trained to write deficiencies without including confidential information
so their reports can be posted without being redacted.
There is a one-page consumer's guide to choosing an assisted living
facility. The guide includes brief responses to questions and sample questions.
For example, "Who regulates assisted living facilities," "What
is an assisted living facility," "How can I find information about
facilities," "How do I file a complaint," "How can
I choose a facility," and "Questions to ask."
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Arkansas
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The Department of Human Services, Office of Long-term Care, is responsible
for licensing residential care facilities. Facilities are inspected twice a
year and upon receipt of a complaint. Licenses are renewed annually. Surveyors
follow protocols based on regulatory requirements. A separate protocol is used
for facilities that advertise that they provide dementia care. Surveyors use
a form similar to Form 2567 used to prepare citations for nursing homes. Surveyors
interview residents to ask about the quality of the food, administration of
medications, and other services provided by the facility. Survey findings are
available to the public through the Freedom of Information Act (FOIA).
Facilities must maintain written policies, and procedures for monitoring quality
of care are required.
The State believes that providing education to facilities has been successful.
The State conducts mock surveys to educate the staff in newly licensed facilities
about the process and expectations. The State offers staff in conjunction
with the mock survey to teach facility staff about the regulations and how
they are applied. In addition, the licensing agency provides educational seminars
for all licensed facilities, usually in conjunction the with trade associations.
Survey nurses do not provide consultation and training. The agency assigns
different staff to carry out the training and surveying functions.
Communicating with Consumers
The licensing agency's Web site has links to the licensing regulations,
a brief description of various settings, and a search function to find a facility.
The database includes all licensed facilities by county, and it lists facilities
by name rather than by licensing category. The search results include the name,
address, and phone number; Web site and E-mail address (if any); the name of
the administrator; the number of beds; payment sources accepted; and the type
of facility (assisted living, nursing home). The provider section contains
the application form, incident reporting form, and criminal background-check
forms. The consumer section covers all licensed facilities, including assisted
living, nursing homes, and intermediate care facilities for the mentally retarded
(ICF-MRs).
The Division of Aging and Adult Services Web site provides information for
developers interested in building affordable assisted living facilities. An "Assisted
Living Choices" link contains the licensing regulations, a list of affordable
facilities, and information about eligibility and how to apply for coverage.
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California
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The Department of Social Services, Office of Regulatory Development, Community
Care Licensing Division regulates residential care facilities for the elderly
(RCFEs). The licensing agency replaced the system of annual inspections and
now randomly selects and inspects 20 percent of the licensed facilities each
year. The selection is structured to ensure that every facility is inspected
at least every 5 years. Surveyors use a manual that guides the inspection process.
The inspection includes interviews with residents and staff and record reviews.
The surveyor determines the number of interviews he or she conducts at each
facility. Standard protocols are not used.
Surveyors use laptop computers to complete the inspections. Results are uploaded
to a central server. The Division expects to make inspection reports available
to the public on its Web site in the near future.
Legislation passed in 2003 requires unannounced inspections of facilities
that are on probation, have pending complaints, operate under a plan for compliance,
or must have an annual inspection because the facilities receive payment from
Medicaid. Inspectors also verify that residents who were required to move from
the facility by the department are no longer at the facility.
Communicating with Consumers
The Division's Web site contains several documents to assist RCFE operators
in complying with the licensing regulations. An online evaluation manual presents
each regulation and related interpretive guidelines. A set of self-assessment
guides is available; the guides are based on the regulations and serve as a
checklist of the most common citations. Separate guides include a preadmission
questionnaire, resident characteristics and admission criteria, administrative
issues, operations issues (medications, units, and food service), resident
records, and staff records.
The Web site has basic descriptions of the different types of facilities licensed
by the State—residential care facilities for the elderly, residential
care facilities for the chronically ill, adult day care, adult residential
facilities, continuing care retirement communities, and social rehabilitation
facilities—and a database to search for licensed facilities. The results
include the name, contact person, address, phone number of the facility, and
phone number of the regional office that has oversight responsibility. The
Web site also has a section for posting information about new developments,
regulatory changes, and other information of interest.
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Colorado
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The Department of Public Health and Environment, Health Facilities Licensing
and Certification is responsible for regulating and licensing assisted living
facilities. Facilities are licensed annually. New facilities receive a health
and life safety code inspection in each of the first 2 years. If are no serious
problems identified, future surveys are done on alternate years. Facilities
with deficiencies receive both surveys annually. Health survey staff members
are RNs or social workers who have a health care background.
The survey process was changed in 2004. Surveyors found that using a checklist
meant they focused more on process and paper documentation with less observation
and followup. Surveyors start with a tour of the facility and observe as many
residents as possible to identify triggers for further followup. Some residents
may be monitored to see if the services identified in the clinical record are
delivered or to assess their participation in activities. Surveyors interview
a minimum of five residents, plus one interview for every ten residents. Surveyors
use a standard list of questions covering the care and services provided to
them.
In large facilities, surveyors organize a group meeting using open ended
questions that address the quality of the meals, activities, treatment by the
staff, access to help at night, how they spend their day, what kinds of care
they receive, and issues or concerns that should be explored. Surveyors provide
guidance during on-site reviews in a manner that cannot be construed as direction.
In July 2005, the Department implemented a Web-based deficiency reporting
system. Facilities will receive a password to review the deficiencies, develop
a plan of correction, and transmit the plan to the Department. Deficiencies
and plans of correction will be posted on the Department's Web site by
the end of 2005 and will be available to the public. The system was developed
and pilot tested with facilities. Web postings for facilities that do not use
the Web-based process will include the list of deficiencies but not the plans
of correction.
Surveyors and other staff provide technical assistance to providers. Providers
are encouraged to contact the Department with questions rather than waiting
until a problem is discovered.
Communicating with Consumers
The Department's Web site has separate sections for consumers and providers.
The consumer section contains links to licensing regulations, a list of licensed
facilities, a profile of each facility, and the most frequently noted deficiencies.
The facility profiles include information about reportable occurrences and
complaints. Reportable occurrences include unexplained deaths, brain injuries,
spinal cord injuries, life-threatening complications of anesthesia, life-threatening
transfusion errors/reactions, severe burns, missing persons, physical abuse,
verbal abuse, sexual abuse, neglect, misappropriation of property, diverted
drugs, and malfunction/misuse of equipment.
The occurrence report describes the incident, the action taken by the facility, and the Department's findings. Complaint information is presented for the number and type of complaints,
a description of the allegation, and the Department's findings.
The provider section contains licensing information, summaries of advisory
committee meetings, the informal dispute resolution policy, a policy and procedures
checklist, administration training, and interpretive guidelines on resident
agreements, keeping bedridden residents after admission, and hot water temperatures.
In addition to the consumer and provider sections, there is a section on brochures
on the Web site. The brochure section has a guide to choosing a facility and
materials on how to resolve complaints and protect personal property.
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Connecticut
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The Department of Health licenses assisted living service agencies (ALSAs)
that serve residents in managed residential communities. Agencies are licensed
and inspected biennially by RNs with experience in geriatrics. Surveys focus
on resident reviews and interviews with a 10 percent sample of residents who
receive ASLA services, staff records, and other regulatory requirements. Based
on the clinical record reviews, surveyors talk with residents to determine
whether they are receiving the care they need and whether the record correctly
documents resident needs. Survey findings are available to residents and others
upon request. They are not posted in each building.
ALSAs are required to establish a quality assurance committee that consists
of a physician, a registered nurse, and a social worker. The committee meets
every 4 months and reviews the ALSA policies on program evaluations, assessment
and referral criteria, service records, evaluation of client satisfaction,
standards of care, and professional issues relating to the delivery of services.
The quality assurance committee also conducts program evaluations. They examine
the extent to which the managed residential community's policies and resources
are adequate to meet the needs of residents. The committee is also responsible
for reviewing a sample of resident records to determine whether agency policies
are being followed, whether services are being provided only to residents whose
level of care needs can be met by the ALSA, and whether care is being coordinated
and appropriate referrals are being made when needed. The committee submits
an annual report to the ALSA summarizing findings and recommendations. The
report and actions taken to implement recommendations are made available to
the State Department of Public Health.
Communicating with Consumers
The Department of Health's Web site posts online applications for ALSAs
and managed residential communities.
The Division of Elderly Services' Web site presents a housing directory
that includes listings of assisted living facilities with the name of the facility,
a contact person and phone number. The current directory is dated May 2000.
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District of Columbia
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The District of Columbia licenses community residence facilities. The Assisted
Living Residence Regulatory Act was passed in June 2000. The law includes a
philosophy of care that emphasizes personal dignity, autonomy, independence,
privacy, and freedom of choice. The philosophy is that services and physical
environment should enhance a person's ability to age in place in a home-like
setting by increasing or decreasing services as needed. The rule-making process
has not been completed.
Communicating with Consumers
The Department of Health Web site includes a list of community residence
facilities with the name, address, phone number, and capacity. The site also
contains a link to the licensing application and instruction packet.
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Delaware
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The Department of Health and Social Services, Division of Long Term Care
Residents Protection surveys facilities annually and upon receipt of a complaint.
All surveyors are certified to conduct Federal surveys, and a few specialize
in assisted living. Surveyors interview a sample of residents.
Facilities must develop and implement an ongoing quality assurance program
that includes internal monitoring of performance and resident satisfaction.
Satisfaction surveys of all residents must be conducted twice a year. Revisions
to the regulations will require reporting of falls without injury and falls
with injuries that do not require transfer to an acute care facility or do
not require reassessment of the resident; errors or omissions in treatment
or medication; injuries of unknown source; and lost items, in accordance with
facility policy.
Communicating with Consumers
The Division of Long Term Care Residents Protection Web site includes a list
of facilities (name, address, phone, and capacity), a list of frequently asked
questions, and information about the adult abuse registry and the criminal
background check law.
The Division of Services for Aging and Adults with Physical Disabilities has
a link on the home page that describes assisted living, a link to a list of
facilities, and a link to information on coverage of services in assisted living
settings for Medicaid beneficiaries and other low-income residents. The forms
and publications button has a link to a four-page brochure that describes assisted
living, the services available, and sources of further information.
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Florida
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The Florida Department of Elder Affairs is responsible for establishing regulations
for assisted living facilities. The Agency for Health Care Administration (AHCA)
is responsible for inspection, issuing licenses, and oversight. Licenses are
issued for 2 years. Basic assisted living facilities are inspected twice each
year by a registered nurse or appropriate designee. Facilities with an Extended
Congregate Care or Limited Nursing Services license are visited twice a year.
Survey guidelines are posted on the AHCA Web site. Abbreviated surveys may
be conducted in facilities with a good compliance history.
Complaints are triaged into four levels. The most serious complaints are investigated
within 24-hours. Survey findings are available at local libraries or by submitting
a written request to AHCA.
Surveyors follow protocols that track regulatory requirements including facility records and staff and resident records. Surveyors talk with staff, residents and family members. They observe the residents, ask general questions (e.g., how do you like it here? Is the staff friendly?
How is the food?) to assess whether the resident is receiving needed care and
appropriate followup. For example, residents and/or their family members will
be asked about their appetite if they seem to have lost weight. They also will
be asked about when they began losing weight and how much weight they have
lost. The surveyor will check with the staff to determine whether they are
aware of the weight loss and how it is being addressed.
AHCA hired quality assurance nurses 5 years ago to provide consultation and
assistance to nursing homes to improve compliance and quality of care. The
program has been extended to assisted living facilities, and the nurses accompany
surveyors on monitoring visits.
Rules adopted in 2001 allow facilities to voluntarily adopt an internal risk
management and quality assurance program. Facilities are required to file preliminary
and full adverse incident reports within 1 and 15 days, respectively. The reports
are confidential as provided by law and cannot be used in civil or administrative
actions, except in disciplinary proceedings by the Florida Agency for Health
Care Administration or an appropriate regulatory board. Facilities must also
report monthly liability claims filed. The quality assurance program is intended
to assess care practices, incident reports, deficiencies, and resident grievances
and develop plans of action in response to findings.
Since 2001, AHCA has prepared annual reports to the State legislature on adverse
incidents in assisted living facilities and nursing facilities. Adverse incidents
are those events over which facility staff or personnel could exercise control—rather
than events that occur as a result of the resident's condition—which
resulted in:
- Death.
- Brain or spinal damage.
- Permanent disfigurement.
- Fracture or dislocation of bones or joints.
- Limitation of neurological, physical, or sensory function.
- Need for medical attention to which the resident has not given his or her
informed consent, including failure to honor advanced directives.
- Transfer of the resident, within or outside the facility, to a unit providing
a more acute level of care.
Or any event (regardless of facility control) that resulted in:
- Abuse, neglect, or exploitation.
- Resident elopement.
- A report to law enforcement.
Assisted living facilities must notify the Agency within 1 business day of
the occurrence of the incident. The agency is authorized to investigate any
such incident as appropriate and may prescribe measures that must or may be
taken in response to the incident. Assisted living facilities must submit a
complete adverse incident report to the agency for each adverse incident within
15 days of the occurrence. The reporting facility also indicates if the incident
was determined to be an adverse incident. The adverse incident report is confidential
and is not discoverable or admissible in any civil or administrative action,
except in disciplinary proceedings by the agency or the appropriate regulatory
board.
AHCA reported receiving reports on 1,468 incidents between May 2001 and May
2002; 1,302 incidents between May 2002 and May 2003; and 1,996 incidents between
2003 and 2004. AHCA made on-site visits to investigate 48 incident reports.
The 2004 report noted that there has been a decrease in the number of serious
deficiencies, but the reasons for the decline had not been identified. The
reporting process allows licensing staff to observe the facility's risk management
process without actually being on-site. The report noted that the content of
reports from nursing homes has improved since 2001 and now clearly describe
the incident and the action taken by the facility. On the other hand, reports
from assisted living facilities do not clearly describe the incident and the
actions taken to enhance resident safety and prevent recurrence of similar
incidents.
Communicating with Consumers
The Department of Elder Affairs maintains a Web site on assisted living that
includes several resources for developers interested in building affordable
facilities.
The Agency for Health Care Administration's Web site contains links
to the statute and regulations, an application package, survey guidelines,
background screening information, incident reporting forms, and a monthly liability
claim form. The agency is reviewing privacy and other legal issues related
to the posting of survey and complaint findings.
Adverse incidents may be reported online. The Web site explains how to determine
if an incident is adverse and presents guidelines for completing the report
and FAQs. Both sites have links to statutes, regulations, application forms,
specialty licenses, survey guidelines, and approved trainers.
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Georgia
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The Office of Regulatory Services (ORS) conducts initial, annual, and followup
inspections and complaint investigations. Inspections are generally conducted
on an unannounced basis. ORS has the authority to take the following actions
against a licensee: impose fines, revoke a license, limit or restrict a license,
prohibit individuals in management or control, suspend any license for a definite
period or for an indefinite period, or administer a public reprimand. Fines
and revocations are the most common actions. ORS has the authority to take
the following actions against applicants for a permit: refuse to grant a license,
prohibit individuals in management or control, or limit or restrict a license.
Surveyors interview six residents and staff members or 10 percent of the residents,
whichever is greater, using open-ended questions that elicit information about
their well being, length of stay, how they are treated, if they have had any
problems and how they were resolved, and whether they know of problems that
other residents have had
Communicating with Consumers
The ORS Web site includes links to the applicable rules and regulations,
application for a permit, and a list of frequently asked questions about personal
care homes and criminal background checks for employees. The Web site has a
searchable database that also includes inspection reports. Each report includes
a citation and description of the regulation and the evidence supporting the
deficiency.
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Hawaii
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The Department of Health licenses assisted living facilities. Facilities
in good standing receive a 2-year license. A provisional license for a shorter
period of time may be issued for facilities that have substantiated complaints.
Facilities that receive a deficiency and submit an acceptable plan of correction
are determined to be in "good standing."
Surveyors use a protocol that follows the regulatory requirements. Surveyors
ask a standard set of questions during interviews with residents and staff.
Resident questions probe for information about the person's needs, the
service provided, food service, and other areas. Staff members are asked about
their awareness of the resident's needs, the tasks they perform for specific
residents, and the overall care plan. Reponses are compared to the resident's
record.
The licensing agency holds quarterly meetings with providers to discuss general
survey findings and other regulatory issues.
Communicating with Consumers
The Department of Health Web site includes a list of residential care facilities
and the number of reported vacancies. Data for assisted living facilities will
be posted in the near future. Agency staff are examining options for developing
a methodology to profile or rate facilities. The agency is also considering
the posting of survey findings on their Web site, but they need additional
staff support to do so. A comprehensive handbook is available to consumers.
It describes different residential options and provides checklists to compare
facilities. The handbook is not available on the Web site.
The Executive Office on Aging Web site has a series of links (information,
useful links, and locating services) that lead to a search function: AssistGuide.
This function allows consumers to search for available services, including
assisted living facilities.
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Idaho
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The Department of Health and Welfare licenses residential and assisted living
facilities. With the exception of the initial surveys for licensure, all inspections
and investigations are unannounced. Inspections are conducted at least annually.
Historically, the State used a consultative process that improved overall quality
of care and compliance. Surveyors provided input and suggestions to address
problems that were identified.
Because of staff shortages, there is less time
to provide consultation during the survey process. In October 2004, the department
began surveying facilities every 3 years if there had been no deficiencies
during two consecutive surveys and no complaints. To qualify, facilities must
not have citations in the core survey areas—abuse, neglect, exploitation,
providing adequate care to meet the needs of the resident, fire suppression/smoke
detection system operable, allowing surveyors access to facility/staff/residents—and
have a licensed administrator responsible for the day-to-day operation of the
facility.
About 25 percent of the facilities qualify for an abbreviated
survey. The abbreviated surveys include an off-site review; entrance conference;
tour of the facility; observations; interviews with residents, family members/representatives,
and staff; record review, technical assistance; and an exit conference.
Surveyors interview residents about the care received, resident rights, the
resident's perception of care, how they are treated by staff, what service
needs they have and whether these needs are being met, whether they have a
complaint, how the facility responds to complaints, and whether they are involved
in care planning and other areas. The guidelines determine how many residents
are interviewed based on the size of the facility; 3-10, three residents; 11-20,
four residents; 21-50, seven residents; and 51 or more, ten residents.
Inspections include reviews of the quality of care and service delivery, resident
records, and other items relating to the operation of the facility. If deficiencies
are found, the administrator submits a plan of correction, and followup surveys
are conducted to determine if corrections have been made. Complaints against
the facility are investigated by the licensing agency.
Communicating with Consumers
The Bureau of Facility Standards' Web site will be expanded to include
the 10 more frequently cited deficiencies, training programs, technical guidance,
and links to best practices. Best practice information will include links to
two State associations, the Centers for Disease Control and Prevention, the
Agency for Healthcare Research and Quality, and national Web sites with links
to best practices.
The Web site also includes a survey and technical assistance guide, policies
and procedures, and survey checklists for residents' rights, the administrator,
training, records, resident care, activity, nursing services and medications,
food services, environment and fire/life safety, and behavior management.
The Commission on Aging is collaborating with the Idaho Legal Aid Services
to prepare a consumer guide that will be posted on the Commission's Web
site.
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Illinois
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The Department of Public Health licenses assisted living and shared housing
establishments. Facilities are inspected annually. Visits are not announced
and focus on compliance with the rules, solving resident issues and concerns,
and the facility's quality improvement (QI) process.
The monitoring process is collaborative in nature, with an emphasis on meeting
the needs of the residents. During this process, surveyors provide information
on best practices and share concerns about the quality of care. They provide
suggestions for how to improve services and/or offer the names of individuals
the facility may contact for assistance. Oversight is not enforcement-driven
but is based more on a social model promoting quality of care. Contract employees
are being replaced with State employees for monitoring activities, particularly
individuals who understand the social model and philosophy of assisted living.
Each facility must have a QI program that covers oversight and monitoring
and resident satisfaction. A system is needed to detect and resolve problems.
The existence, results, and process of the QI system cannot be used as evidence
in any civil or criminal proceeding.
Facilities participating in the supportive living facilities (SLF) program
are certified by Medicaid and are monitored at least annually by the Department
of Public Aid. Monitoring includes contract requirements, resident autonomy,
resident rights, adequacy of service provision, quality assurance process,
safety of the environment, program policies and procedures, information provided
to low-income residents, review of resident assessment and service plans, resident
satisfaction surveys, check-in system, and food service.
Facilities must have a grievance process and a quality assurance process.
Complaints may be heard informally. If not resolved or if the resident prefers,
grievances may be submitted through the facility's formal process. Residents
may use the Medicaid appeals process for denial or delay of service.
The rules require that facilities establish an internal quality assurance
plan that covers resident satisfaction; an evaluation of the care and services
provided; tracking improvements based on care outcomes; a system of quality
indicators; procedures for preventing, detecting and reporting resident neglect
and abuse; and ongoing quality improvement. A system with outcome indicators
must be developed that measures: quality of services; residents' rating
of services; cleanliness and furnishings in common areas; service availability
and adequacy of service provision and coordination; provision of a safe environment;
socialization activities; and resident autonomy.
Communicating with Consumers
The Department of Public Health's Web site contains the assisted living
regulations, a list of facilities, and the application to obtain a license.
The Department of Public Aid Web site has a list of facilities and fact sheets
for providers and residents that explain the program and certification requirements.
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Indiana
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The Department of Health regulates residential care facilities. The Department
conducts annual surveys, followup surveys, and complaint investigations. Survey
findings are posted at each facility and may be obtained from the Department
of Health upon request. Most surveyors are registered nurses, and they use
a protocol that tracks the regulations to guide their survey activities. During
the on-site review, surveyors interview at least three residents, including
the resident council president, if applicable. A standard set of questions
based on the resident rights provisions of the regulations are asked, such
as:
- Are you able to have privacy when you want it?
- Do staff and other residents respect your privacy?
- Do you have a private place to meet with visitors?
- Do you have privacy when you are on the telephone?
- Do you receive your mail unopened?
- Are you aware of the rights you have as a resident?
- Does staff treat you with respect?
- Does staff make an effort to resolve your problems?
- Has any resident or staff member ever physically harmed you?
- Has anyone ever taken anything belonging to you without permission?
- Has anyone ever yelled or swore at you? If so, did you report this
to someone? How did they respond?
Responses to the interviews are recorded on a form. Surveyors respond
to questions from facility staff but do not provide consultation. Complaints
are investigated based on their assigned priority level. Complaints alleging
harm are investigated within 10 business days.
Communicating with Consumers
The Department of Health's Web site includes a list of facilities (name,
address, and telephone and fax numbers), a link to the regulations governing
residential care facilities, and links to a training manual for special care
facilities. The Family and Social Services Administration Web site includes
a disclosure form that must be completed by special care facilities.
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Iowa
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The Department of Elder Affairs is responsible for developing regulations
for assisted living programs. Monitoring, inspections, and enforcement are
the responsibility of the Department of Inspections and Appeals (DIA). Certificates
are issued for 2 years. Monitoring visits are also done every 2 years by a
registered nurse and masters level sociologist.
A protocol based on
the certification requirements is used to guide the review. Monitors interview
a sample (10-20 percent) of tenants, program staff, and family members using
a protocol. Tenants are asked a series of questions about privacy, whether
service schedules meet their preferences, whether their life is meaningful,
and whether they recommend the facility to others. The regulations require
that DIA make on-site visits to investigate complaints within 48 hours if there
is immediate danger; however, the Department usually investigates within 24
hours.
During the monitoring process, staff members hold community meetings with
tenants during their site reviews. The meetings often identify concerns about
quality and practice for the monitors. A summary of the community meeting is
included in the monitoring report, which is posted on the DIA Web site. During
the review, rules may be clarified and explained to site managers and staff.
Monitoring staff members often participate in training meetings organized by
three associations representing assisted living programs.
Communicating with Consumers
The DIA Adult Services Bureau Web site includes frequently asked questions,
a list of standard facilities and dementia care facilities (name, address,
phone, contact, number of units and beds, and the initial certification date),
an application form and packet, and a form to request a waiver of a rule.
Inspection reports and complaint investigations were available for reviews
that have been done since the regulations were changed in May 2004. After July
2005, reports were no longer posted due to staff reductions. Users must enter
the name of the facility to access survey and complaint information. The information
includes the date and type of the visit, number of deficiencies, percent quality,
certification action, number of violations, class and description, fine amount,
whether the violation is one time or daily, and the status of the violation.
The monitoring report includes the number of residents, tenant satisfaction,
complaint history and observations from resident records, policy, and practice.
The monitoring process includes interviews with residents and family members
and a community meeting. The report includes a narrative summary of the interviews
and meeting. The complaint report includes the date of the investigation, relevant
definitions of terms, accreditation status, complaint history, a description
of the complaint, and the findings.
Complaints may be submitted online through the Web site. The site also includes
a registry for certified nurse aides.
The Department of Elder Affairs' Web site has links to the regulations
governing certification of facilities, a brief description about assisted living,
and a number to call to register complaints.
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