ASSISTEDLIVINGPROGRAMS - Iowa

1 IAC11/17/21 InspectionsandAppeals[481]Ch69, (231C) Chapter67andIowaCodechapter231C,thefollo wingdefinitionsapply. Accredited (1). Applicablerequirements meansIowaCodechapter231C,thischapter,and 481 Chapter67andincludesanyotherapplicablead ministrativerulesandprovisionsoftheIowaC ode. Assistedliving or program meansprovisionofhousingwithservices,whic hmayincludebutarenotlimitedtohealth-rela tedcare,personalcare,andassistancewithin strumentalactivitiesofdailyliving,tothre eormoretenantsinaphysicalstructurewhichp rovidesahomelikeenvironment. Assistedliving alsoincludesencouragementoffamilyinvolve ment,tenantself-direction,andtenantparti cipationindecisionsthatemphasizechoice,d ignity,privacy,individuality,sharedrisk, andindependence. Assistedliving includestheprovisionofhousingandassistan cewithinstrumentalactivitiesofdailylivin gonlyifpersonalcareorhealth-relatedcarei salsoincluded. Assistedliving includes24hoursperdayresponsestafftomeet scheduledandunscheduledorunpredictablene edsinamannerthatpromotesmaximumdignityan dindependenceandprovidessupervision,safe ty,andsecurity.

2 CARF meanstheCommissiononAccreditationofRehab ilitationFacilities. Changeofownership meansthepurchase,transfer,assignmentorle aseofacertifiedassistedlivingprogramandi ncludesachangeinthemanagementcompanyresp onsiblefortheday-to-dayoperationofthepro gram,ifthemanagementcompanyisultimatelyr esponsibleforanyenforcementactiontakenby thedepartment. Cognitivedisorder meansadisordercharacterizedbycognitivedy sfunctionpresumedtobetheresultofillnesst hatdoesnotmeetthecriteriafordementia,del irium,oramnesticdisorder. Dementia-specificassistedlivingprogram , , ,suchasAlzheimer sdisease,inadedicatedsetting. Dwellingunit meansasingleunitwhichprovidescomplete,in dependentlivingfacilitiesforoneormoreper sons,includingpermanentprovisionsforlivi ng,sleepingandsanitation,andwhichmayincl udepermanentprovisionsforeatingandcookin g. Sanitation forpurposesofthisdefinitionmeansbathroom fixturesasrequiredbythischapter. Intheproximatearea meanslocatedwithinafiveminutesorlessresp onsetime.

3 Maximalassistancewithactivitiesofdailyli ving meansroutinetotaldependenceonstaffforthe performanceofaminimumoffouractivitiesofd ailylivingforaperiodthatexceeds21days. Medicallyunstable sstaffinconsultationwithaphysicianorphys icianextender; ; ,atenantwhohasaconditionsuchascongestive heartfailurewhichresultsinthreeormoresig nificanthospitalizationsduringaquarteran dwhichrequiresthatthetenantreceivefreque ntsupervisionmaybeconsideredmedicallyuns table. Nonaccredited (1).Ch69, [481]IAC11/17/21 Unmanageableincontinence meansaconditionthatrequiresstaffprovisio noftotalcareforanincontinenttenantwholac kstheabilitytoassistinbladderorbowelcont inencecare. Unmanageableverbalabuse meansrepeatedverbalizationsagainsttenant sorstaffthatpersistdespiteallinterventio nsandthatnegativelyaffecttheprogram. Unmanageableverbalabuse includesbutisnotlimitedtothreats,frequen tuseofprofanelanguage,orunwelcomesexuall yorientedremarks.[ARC8176B,IAB9/23/09,ef fective1/1/10;ARC1927C,IAB4/1/15,effecti ve5/6/15;ARC2463C,IAB3/16/16,effective4/ 20/16]481 (231C) , , (1) ,thelatestmonitoringreport,statefiremars halreport, (2) ,theprogramshallmeetallrequirementsforad ementia-specificprogram,includingtherequ irementssetforthinrule481 (231C), (2) (4), (1) d, (2) (3),whichincludetherequirementsrelatingt odooralarmsandspecializedlockingsystems, (3) , ,theprogramwillnolongerbeconsidereddemen tia-specific.

4 [ARC8176B,IAB9/23/09,effective1/1/10;ARC 2463C,IAB3/16/16,effective4/20/16;ARC497 6C,IAB3/11/20,effective4/15/20]481 (231C)Certificationofanonaccreditedprogr am (1) ;bymailfromtheDepartmentofInspectionsand Appeals,AdultServicesBureau,LucasStateOf ficeBuilding,ThirdFloor, ,DesMoines,Iowa50319-0083;orbytelephonea t(515) (2) (3) (4)Thedepartmentshallconsidertheapplicat ionwhenallsupportingdocumentsandfeesarer eceived.[ARC8176B,IAB9/23/09,effective1/ 1/10]481 (231C)Nonaccreditedprogram (1)Alistthatincludesthenames,addresses,a ndpercentageofstock,shares,partnershipor otherequityinterestofallofficers,members oftheboardofdirectorsandtrustees,aswella sstockholders,partnersoranyindividualswh ohavegreaterthana10percentequityinterest ineachofthefollowing,asapplicable:IAC11/ 17/21 InspectionsandAppeals[481]Ch69, ; ; (2) (1) (3) (1)haveorhavehadanownershipinterestinana ssistedlivingprogram,adultdayservicespro gram,eldergrouphome,homehealthagency, , ,whichhasbeenclosedinanystateduetoremova lofprogram,agency,orfacilitylicensure,ce rtification,orregistrationorduetoinvolun taryterminationfromparticipationineither theMedicaidorMedicareprogram.

5 Orhavebeenfoundtohavefailedtoprovideadeq uateprotectionorservicestopreventabuseor neglectofresidents,patients, (4) , (5) (6) (7)Thepolicyandprocedureforaccidentsande mergencyresponse, (8)Thepoliciesandproceduresforfoodservic e,includingthoserelatingtostaffing,nutri tion,menuplanning,therapeuticdiets,andfo odpreparation, (9) (10) (11) (12)Thepolicyandprocedureforemergencies, (13) (14)Thepolicyandprocedureforreportinginc identsincludingdependentadultabuseasrequ iredinrule481 (231B,231C,231D). (15) (2). (16) (17)Iftheprogramcontractsforpersonalcare orhealth-relatedcareservicesfromacertifi edhomehealthagency,amentalhealthcenteror alicensedhealthcarefacility,acopyofthate ntity (18)Acopyofthestatelicensefortheentityth atprovidesfoodservice, (19) (20)Thepolicyandprocedureforaddressingse xualrelationshipsbetweentenantsandstaff, (21)Thepolicyandprocedureforextraordinar ylifesavingmeasures,suchascardiopulmonar yresuscitation(CPR).

6 (22)Theprogramshallfollowthepoliciesandp roceduresestablished.[ARC8176B,IAB9/23/0 9,effective1/1/10;ARC1927C,IAB4/1/15,eff ective5/6/15;ARC2463C,IAB3/16/16,effecti ve4/20/16;ARC4976C,IAB3/11/20,effective4 /15/20]481 (231C) , [481]IAC11/17 (1)Uponreceiptofallcompleteddocumentatio n,includingstatefiremarshalapprovalandst ructuralandevacuationreviewapproval, (2)If,baseduponthereviewofthecompleteapp licationincludingallrequiredsupportingdo cuments,thedepartmentdeterminesthepropos edprogrammeetstherequirementsforcertific ation, (3)Within180calendardaysfollowingissuanc eofprovisionalcertification,thedepartmen tshallconductamonitoringtodeterminethepr ogram (4)Ifaregulatoryinsufficiencyisidentifie dasaresultofthemonitoring,theprocessinru le481 (17A,231B,231C,231D) (5) (6)Thedepartmentshallnotifytheprogramofa finalcertificationdecisionwithin10workin gdaysfollowingthefinalizationofthemonito ringreportorreceiptofanacceptableplanofc orrection, (7)Ifthedecisionistocontinuecertificatio n,thedepartmentshallissueafulltwo-yearce rtificationeffectivefromthedateoftheorig inalprovisionalcertification.

7 [ARC8176B,IAB9/23/09,effective1/1/10]481 (231C) (1)Unlessconditionallyissued,suspendedor revoked, (2)Thedepartmentshallsendrecertification applicationmaterialstoeachprogramatleast 120calendardayspriortoexpirationofthepro gram scertification.[ARC8176B,IAB9/23/09,effe ctive1/1/10]481 (231C) , (1)Submitonecopyofthecompletedapplicatio n,includingtheinformationrequiredinrule4 81 (231C),associateddocumentation, (1)atleast90calendardayspriortotheexpira tionoftheprogram (2)Submitadditionaldocumentationthateach ofthefollowinghasbeeninspectedbyaqualifi edprofessionalandfoundtobemaintainedinco nformancewiththemanufacturer srecommendationsandnationallyrecognizeds tandards:heatingsystem,coolingsystem,wat erheater,electricalsystem,plumbing,sewag esystem,artificiallighting,andventilatio nsystem;and,iflocatedonsite,garbagedispo sal,kitchenappliances,washingmachinesand dryers,andelevators.[ARC8176B,IAB9/23/09 ,effective1/1/10]481 (231C) (1) , ,includingstatefiremarshalapproval,thede partmentshalldeterminetheprogram (2)Thedepartmentshallconductamonitoringo ftheprogrambetween60and90dayspriortoexpi rationoftheprogram (3)Ifaregulatoryinsufficiencyisidentifie dasaresultofthemonitoring,theprocessinru le481 (17A,231B,231C,231D) (4)Ifnoregulatoryinsufficiencyisidentifi edasaresultofthemonitoring, [481]Ch69, (5)Ifthedecisionistorecertify, (6)Ifthedecisionistodenyrecertification, thedepartmentshallissueanoticeofdenialan dprovidetheprogramtheopportunityforahear ingpursuanttorule481 (17A,231B,231C,231D).

8 (7)Ifthedepartmentisunabletorecertifyapr ogramthroughnofaultoftheprogram,thedepar tmentshallissuetotheprogramatime-limited extensionofcertificationofnolongerthanon eyear.[ARC8176B,IAB9/23/09,effective1/1/ 10]481 (231C)Certificationorrecertificationofan accreditedprogram (1) ;bymailfromtheDepartmentofInspectionsand Appeals,AdultServicesBureau,LucasStateOf ficeBuilding,ThirdFloor, ,DesMoines,Iowa50319-0083;orbytelephonea t(515) (2)Thedepartmentshallnotconsideranapplic ationuntilitiscompleteandincludesallsupp ortingdocumentationandtheappropriatefees .[ARC8176B,IAB9/23/09,effective1/1/10;AR C2463C,IAB3/16/16,effective4/20/16]481 (231C)Certificationorrecertificationofan accreditedprogram (1)Alistthatincludesthenames,addressesan dpercentageofstock,shares,partnershiporo therequityinterestofallofficers,memberso ftheboardofdirectors,andtrustees,aswella sstockholders,partnersoranyindividualswh ohavegreaterthana10percentequityinterest ineachofthefollowing, ; ; (2) (1) (3) (1)haveorhavehadanownershipinterestinapr ogram,adultdayservicesprogram,eldergroup home,homehealthagency, , ,whichhasbeenclosedinanystateduetoremova lofprogram,agency,orfacilitylicensureorc ertificationorduetoinvoluntaryterminatio nfromparticipationineithertheMedicaidorM edicareprogram;orhavebeenfoundtohavefail edtoprovideadequateprotectionorservicest opreventabuseorneglectofresidents,patien ts, (4)Acopyofthecurrentaccreditationoutcome fromtherecognizedaccreditingentity.

9 [ARC8176B,IAB9/23/09,effective1/1/10;ARC 1927C,IAB4/1/15,effective5/6/15]481 (231C) , [481]IAC11/17 (1)Within20workingdaysofreceivingallfina lizeddocumentation,includingstatefiremar shalapproval, (2)Ifthedecisionistocertify,acertificati onshallbeissuedforthetermoftheaccreditat ionnottoexceedthreeyears,unlessthecertif icationisconditionallyissued, (3)Ifthedecisionistodenycertification,th edepartmentshallprovidetheapplicantanopp ortunityforhearinginaccordancewithrule48 1 (17A,231B,231C,231D). (4)Unlessconditionallyissued,suspendedor revoked,certificationforaprogramshallexp ireattheendofthetimeperiodspecifiedonthe certificate.[ARC8176B,IAB9/23/09,effecti ve1/1/10]481 (231C) (1)Thedepartmentshallsendrecertification applicationmaterialstoeachprogramatleast 120calendardayspriortoexpirationofthepro gram (2)Toobtainrecertification,anaccreditedp rogramshallsubmitonecopyofthecompletedap plication,associateddocumentation, (1)atleast90calendardayspriortotheexpira tionoftheprogram (3)Within20workingdaysofreceivingallfina lizeddocumentation,includingstatefiremar shalapproval,thedepartmentshalldetermine theprogram (4) ,afullcertificationshallbeissuedforthete rmoftheaccreditationnottoexceedthreeyear s,unlessthecertificationisconditionallyi ssued, ,thedepartmentshallprovidetheapplicantan opportunityforhearinginaccordancewithrul e481 (17A,231B,231C,231D).

10 (5)Ifthedepartmentisunabletorecertifyapr ogramthroughnofaultoftheprogram,thedepar tmentshallissuetotheprogramatime-limited extensionofcertificationofnolongerthanon eyear.[ARC8176B,IAB9/23/09,effective1/1/ 10]481 (231C) , EntitiesBook tab.[ARC8176B,IAB9/23/09,effective1/1/10 ]481 (231C) (1) (2)Toapplyfordesignationbythedepartmenta sarecognizedaccreditingentityforprograms ,anaccreditingentityshallsubmitaletterof request,anditsstandardsshall,atminimum, (3)Thedesignationshallremainineffectfora slongastheaccreditationstandardscontinue tomeet,atminimum, (4)Anaccreditingentityshallprovideannual lytothedepartment,atnocost,acurrentediti onoftheapplicablestandardsmanualandsurve ypreparationguide,andtrainingthereon,wit hin120workingdaysafterthepublicationsare released.[ARC8176B,IAB9/23/09,effective1 /1/10]481 (231C) :IAC11/17/21 InspectionsandAppeals[481]Ch69, (1)Providethedepartmentacopyofallsurveyr eportsincludingoutcomes,qualityimproveme ntplansandannualconformancetoqualityrepo rtsgeneratedorreceived,asapplicable, (2) (3)Notifythedepartmentimmediatelyoftheex piration,suspension,revocationorotherlos softheprogram saccreditation.