Health and Wellness for all Arizonans
Licensing Process for Residential Facilities
Health and Wellness for all Arizonans
Arizona Department of Health ServicesCara Christ M.D., Director
Division of Public Health Licensing
Bureau of Residential Facilities LicensingDiane Eckles, Bureau Chief
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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]
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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
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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 .
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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.
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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
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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
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Health and Wellness for all Arizonans
Health and Wellness for all Arizonans
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)
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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
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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
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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.
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Health and Wellness for all Arizonans
Initial Compliance Inspection• Environment (walk-through)
• Review of P&Ps and other records
• Interviews (if needed)
• You must be ready to take residents
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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
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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.
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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)
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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
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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
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Health and Wellness for all Arizonans
Health and Wellness for all Arizonans
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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.
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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
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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
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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
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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
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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
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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
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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
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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).
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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
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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
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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
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Health and Wellness for all Arizonans
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.