health and wellness for all arizonans licensing process for residential facilities

Health and Wellness for all Arizonans

Licensing Process for Residential Facilities


Arizona Department of Health ServicesCara Christ M.D., Director

Division of Public Health Licensing

Bureau of Residential Facilities LicensingDiane Eckles, Bureau Chief


Office Locations and Phone Numbers• Phoenix: 150 N. 18th Ave., Suite 420 • 602-364-2639 FAX: 602-324-5872

• Tucson: 400 W. Congress St., Suite 116 • 520-628-6965 FAX: 520-628-6991

Website: http://azdhs.gov/licensing/residential-facilities/index.php

Email: [email protected]

http://azdhs.gov/licensing/residential-facilities/index.php


mailto:[email protected]


This presentation:• You are responsible – know and follow Rules and

Statutes governing Residential Facilities

• The content does not address ALL applicable Rules, it highlights items for INITIAL licensing

• Many Rules are or have been paraphrased and emphasis has been added for clarity


Applicable Rules and Statutes• Licensing of Residential Facilities is governed by the

Arizona Revised Statutes (“A.R.S.”), primarily Title 36: Public Health and Safety, Chapter 4: Health Care Institutions.

• Reference to a statute generally uses this format: A.R.S. § 36-401.A.1. or A.R.S. § 36-401(A)(1)

Statutes are law that authorize the Department to adopt Rules which are specific to each facility type .

http://www.azleg.gov/ArizonaRevisedStatutes.asp?Title=36

http://www.azleg.gov/ArizonaRevisedStatutes.asp?Title=36

http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/36/00401.htm&Title=36&DocType=ARS

http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/36/00401.htm&Title=36&DocType=ARS


Applicable Rules and Statutes

• Reference to a rule is generally in this format:

– Title 9, Chapter 10, Article 8 (specific subclass), Rule Number 803.A.3.a.

– Example of an Assisted Living Rule• R9-10-803.A.3.a.


Rules Governing Residential Facilities

Article 1: GeneralArticle 7: Behavioral Health Residential FacilitiesArticle 8: Assisted Living FacilitiesArticle 11: Adult Day Health Care FacilitiesArticle 16: Behavioral Health Respite HomesArticle 18: Adult Behavioral Health Therapeutic

Homes


BRFL Website

Download and print the Articles specific to your subclass from our website:

http://www.azdhs.gov/licensing/residential-facilities/index.php#providers-home

• Articles 7, 8, 11, 16, and 18 are effective July 1, 2014• Article 1 is effective January 1, 2015





Preparing for Initial Compliance Inspection

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Timelines for Your Initial

• Administrative review = 30 days

• Substantive review = 90

• Overall = 120 (if the extension for timeframes is signed by the applicant, then the overall timeframe is extended to 150 days)


The Initial compliance inspection• Compliance–are you ready for inspection?• Surveyor schedules the inspection• Inspection typically takes about 3-4 hours

depending on: – Size of facility–Completeness of records–Compliance with the rules


The Initial compliance inspection

Policies & Procedures (“P&Ps”) and other documents may be requested for review prior to inspection

Providing them prior to inspection are not required

But it speeds up the process as you can make revisions as necessary before the surveyor comes on-site


Initial Compliance Inspection

Notice of Inspection Rights (“Entrance Letter”) - will be reviewed first. Regardless of subclass, the form is the same.

–Please read carefully.

–Ask Surveyor if any questions or concerns.


Initial Compliance Inspection• Environment (walk-through)

• Review of P&Ps and other records

• Interviews (if needed)

• You must be ready to take residents


Initial Compliance Inspection

• Accompany the Surveyor, ask questions

• Take notes during the survey

• Exit interview – findings–Possible Technical Assistance (TA) and

citations will be discussed


Initial Compliance InspectionThere are four possible outcomes

1. The facility is ready and the surveyor completes the inspection, a license is issued

2. The applicant is missing a few small items (copy of a license, specific policy, etc.) and the surveyor will give a deadline to the applicant to submit the missing documents.

3. The facility is not ready (no furnishings, staff, etc.) and the surveyor ends the inspection. The inspection will be re-scheduled.

4. The surveyor proceeds with the inspection and writes a Statement of Deficiencies to which the applicant needs to submit a Plan of Correction.


Licensure after Initial Inspection• If you have no deficiencies:– A “No-Deficiency” Statement of Deficiencies is written– License issued when all fees paid

• 7-10 business days

– Staff will contact you when license is ready• Can mail or hold for pick-up

• If you have deficiencies:– Surveyor & Team Lead review data to determine citations– A Statement of Deficiencies (SOD) is mailed – An acceptable Plan of Correction is required(POC)


If the Surveyor finds you are not ready• If the inspection is terminated:– A written statement from the provider is needed

requesting “the clock be stopped”• If inspection not terminated:– Deficiencies found will be available to the public

on azcarecheck.com – The license will not be issued until the facility is in

compliance– After 120 days, application is considered

withdrawn


Plan of Correction (POC)• SOD cover letter will provide instructions

regarding deadlines, what needs to be included, and the Informal Dispute Resolution (IDR) process

• POC required:– POC for each citation – Space provided on SOD or you can attach it

separately

• Call your Surveyor with questions

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Fee Remittance Form

• Available on our website

–Calculate licensing fees owed

–All fees must be paid before license issued


Interpretation of “Health Care Institution”

• If a facility has had no residents (has not provided health-related services) for more than 12 months prior to the date the Department’s Surveyor arrives to conduct a compliance inspection, the Department may deny the renewal application.


THE RULES

Regardless of Subclass, each facility must follow Article 1. The most current version of Article 1 is effective January 1, 2015.

The following slides contain some rules that are consistent amongst AL and BH facilities


Tuberculosis (“TB”) Testing

• Acceptable documentation of freedom from infectious TB [R9-10-113(1)(a)]:–Mantoux (PPD) skin test OR–Written statement signed by a medical

practitioner that the person is free from infectious TB• Statement MAY be based on a chest X-ray, but

does not HAVE to be– If you use an X-ray, it needs to specifically

address TB


Tuberculosis (“TB”) Testing

TB test administered AND read prior to providing servicesNo more than twelve months old

TB infection control program (R9-10-113.2.)–Optional – Takes the place of requirements above


Tuberculosis (“TB”) Testing• Caregiver example:– TB skin test 01 December 2014 –Hired 01 November 2015• TB test is valid• Can provide services to residents

– If hired after 01 December 2015, new TB test needed before providing services–New TB test needed: November 1st – December

31st• 60-day window for new TB test


Quality Management R9-10-704/804Quality management program – how to:

Identify, document, & evaluate incidents

Collect data to evaluate services to residents

Make changes/take action to address care concerns

Submit regular reports to governing authority

Reports maintained for 12 months

Sample QM plan and documents available on our website


Drug and toxicology reference guidesR9-10-816.D. or R9-10-718.D.:

1. Current drug reference guide available for use by personnel members

2. Current toxicology reference guide available for use by personnel members– Toxnet: http://toxnet.nlm.nih.gov/

Online resources are acceptable IF always available to personnel members

http://toxnet.nlm.nih.gov/




Disaster Plan: R9-10-818.A.1/R9-10-720.B.1.

Disaster plan must include:a. When, how, and where residents relocatedb. Ensure medical records will be available c. Ensure medications will be available d. Obtaining food and water

Plan must be accessible to staff


Facility tour• Surveyor tours entire facility and grounds

• Ensures compliance with:

–R9-10-818, 819, and 820 (for Assisted Living Facilities)

–R9-10-720, 721, and 722 (for Behavioral Health Residential Facilities).


Physical Plant: R9-10-820/R9-10-722Facility, premises, & equipment sufficient to meet:

The facility’s scope of servicesNeeds of the residents

Common area and dining areaSpace and furnishings sufficient to meet the

needs of the residentsAt least one bathroom is:

Accessible from a common areaUseable by residents & visitors


Environmental: R9-10-819.A/721.APremises & equipment:

Clean – disinfected as neededFree from conditions that may cause injury

Pest control programGarbage: covered containers lined w/plastic bagsFacility temperature: 70º to 84º F.Sufficient lighting to ensure safety and monitor

residents

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Environmental: R9-10-819.A/721.A cont.

Hot water temperature between 95º to 120º F.Sufficient hot and cold water to meet resident

needsWasher/dryer or laundry service Soiled linen/clothing storageOxygen containers secured uprightPoisonous or toxic materials locked

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Environmental: R9-10-819.A/721.A cont.Flammable liquids and hazardous materials

stored properlyEquipment tested, calibrated, maintained in

working order Pets and animals controlled for safety,

vaccinated, and licensedNon-municipal water tested, safe to drinkNon-municipal sewage system in working order


Physical Plant: R9-10-820.F./722.D.2A swimming pool must be enclosed (no windows or doors that open into the pool area) by a wall or fence:That is at least 5 feet in heightHas no vertical openings greater than 4 inchesHas no horizontal openings (except at bottom) Is not chain-link fenceHas no space between the ground and fence

rail that exceeds 4 inches

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Physical Plant: R9-10-820.F./722.D.2A swimming pool has:A self-closing, self-latching gate:

Opens away from the swimming poolLatch is at least 54 inches from the groundLocked when the swimming pool is not in use

A life preserver or shepherd’s crook available in the swimming pool area

R9-10-820.G./722.E.: Unenclosed spas are covered and locked if not in use

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Online ResourcesBureau of Residential Facilities Licensing Website: http://azdhs.gov/licensing/residential-facilities/index.php

Frequently Asked Questions (update coming soon)License application formsHow to prepare a Plan of Correction (“POC”)Informal Dispute Resolution (“IDR”) ProcessLinks to rules, statutes, and enforcement actions

www.azcarecheck.com: Facility information, including survey history and enforcement actions


http://www.azcarecheck.com/


Breakout Sessions

• After a short break, Assisted Living Facility Providers and Behavioral Health Residential Facility Providers will meet in separate rooms to go over rules that are specific to each facility type.

health and wellness for all arizonans licensing process for residential facilities

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