Section III. State Summaries (continued)
New Mexico
Approach
The Department of Health licenses adult residential care facilities. The
survey staff performs on‑site survey/monitoring visits at all adult residential
care facilities to determine compliance with the regulations, investigate complaints,
and investigate the appropriateness of licensure for any alleged unlicensed
facility. When violations are found, the facility submits a plan that addresses
how violations will be corrected, when they will be corrected, how the facility
will identify other residents that potentially could be affected by the same
deficient practice, and how the facility will monitor its corrective actions.
Communicating with Consumers
The Department of Health Web site has links to the licensing regulations,
caregiver criminal background check manual, and incident reporting forms.
The State's Aging and Long Term Services Department Web site contains
a brief description of assisted living under the section on long-term care
services. There is also a link to a list of facilities compiled by the New
Mexico Health Care Association.
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New York
Approach
The Department of Health, Division of Home and Community Based Care licenses
adult care facilities. Licenses are issued for 4 years. Facilities are inspected
annually or more often as needed. Inspections include, but are not necessarily limited to, examination of the medical, dietary, and social services records of the facility, as well
as the minimum standards of construction, life safety standards, quality and
adequacy of care, rights of residents, payments, and all other areas of operation.
Two inspections per year are conducted for private proprietary adult homes.
Other types of inspections include:
- Complete inspections prior to certification or renewal.
- Complete inspections when there are serious or continual deficiencies.
- Summary inspections to determine compliance with key regulatory provisions
in all areas of operation.
- Partial inspections to examine specific areas of operation.
- Inspections in response to a complaint to determine the validity of the
complaint.
- Followup inspections to determine whether deficiencies noted during a previous
inspection have been corrected.
- Other inspections as necessary.
In October 2002, the State implemented new policies regarding the oversight
of adult homes. These new policies include: reinforcement of mandatory
death reporting by homes and immediate investigations of such reports; multi-agency
created profile of deaths at the homes to identify patterns; and increased
surveillance. The Department offers training to operators and select staff.
Training on medication administration was held in 2004. The Department distributes
letters to administrators that address new developments or requirements such
as: reporting of deaths, attempted suicides, and felony crimes; notice of regulation
(failure in systemic practices and procedures); maintenance of safe and comfortable
temperature levels within adult homes; influenza prevention and control; establishment
of a complaint hotline; emergency preparedness guidelines; statistical reporting
requirements; case management obligations; facility access by individuals who
are not residents; sprinkler head recall; waiver request/equivalency notification;
guidelines for dementia units; availability of free or low-cost resources to
residents; and notice of law (e.g., Long-term Care Resident and Employee Immunization
Act).
Communicating with Consumers
The Department of Health Web site has a description and definition of the
various types of residential facilities: adult homes, enriched housing, and
assisted living programs. The Department posted a list of facilities by county
that includes the name, address, phone number, type of facility, and number
of beds. A list of facilities surveyed is posted quarterly. The list includes
the name of the facility, the report date, and areas in which violations
were found (e.g., admission-retention, environmental, resident services,
food service). Details about the content of the report are not posted. A "do
not refer" list is also posted which identifies facilities that have
closed, may not accept new admissions, or are not certified. The site also
has links to relevant press releases.
The Office for the Aging Web site has two resource buttons on the home page.
A click on "senior housing" leads to a page with links to the definitions
of 13 types of housing including adult homes, enriched housing, enriched housing/adult
homes with limited home care agency, and assisted living programs. It also
leads to a list of questions consumers should ask and a search function by
county and type of housing. The search results display the name, address, and
phone number of the facility and a link to the facility's Web site. The "find
help" button leads to a Senior Citizen Resource Guide that describes
adult care homes, assisted living, congregate housing, supportive housing,
and enriched housing.
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North Carolina
Approach
The Department of Health and Human Services, Division of Facility Services
(DFS) licenses adult care homes. County Departments of Social Services (DSS)
monitor adult care homes at least every other month. State staff members
provide consultation, technical assistance, and training to the county monitors.
State staff members also provide monitoring oversight and perform selected
surveys of homes based on compliance history or lack of previous county monitoring.
Legislation passed in 2005 (SB 622) requires that DFS inspect adult care homes
at least annually. The new law also gives DFS new responsibilities for reviewing
the performance of county DSS functions. DFS will conduct annual reviews of
county oversight activities. DFS may apply a range of corrective actions for
failure to appropriately monitor adult care homes, such as providing technical
assistance, advising staff about policies and procedures, and establishing
a plan of correction. The law sets minimum training requirements for county
adult home specialists.
SB 622 directs the Division of Aging and Adult Services to develop a quality
improvement consultation program. The Division will implement a pilot quality
improvement program and file a report with the legislature that addresses principles
and philosophies that are resident-centered and promote independence, dignity,
and autonomy; approaches to developing a continuous quality improvement process;
dissemination of best practices; the availability of standardized instruments
to measure adult care home performance on quality of life indicators; the training
needs of county DSS staff; clarification of the roles of the DFS and county
DSS offices; and the staffing needed to carry out the program.
Communicating with Consumers
The Department of Health Human Services, Division of Facility Services Web
site has links to the statute and regulations, as well as a listing all adult
care homes, which includes the name of the facility, address, phone number,
and numbers of beds. It also includes a step-by-step explanation of the process
for obtaining a license but notes that there is a moratorium on new licensed
facilities. The site has links to requirements for administrators, an application,
and a schedule for tests for administrators; a list of courses for continuing
education credits; and information about exams for staff who assist with
medication administration. A log of penalties assessed against adult care
homes is posted.
To find information on the Division on Aging and Adult Services Web site,
click on the long-term care options/ombudsman link or the housing link. The
long-term care link leads to adult care homes. This page describes adult care
homes, has a link to a list of licensed facilities, contacts in county Department
of Social Service offices, a description of residents rights, information about
the ombudsman program, and answers to frequently asked questions about long-term
care options. The housing link leads to a statutory definition of assisted
living and a description of multi-unit assisted housing, including independent
housing units with services.
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North Dakota
Approach
The Department of Health, Division of Health Facilities licenses basic care
facilities annually. Facilities are inspected every 2 years. Complaints are
investigated as they occur. The inspections cover quality of life, quality
of care, dietary services, medications, the environment, social services, personal
care, and nursing services and include a life safety code inspection. Inspectors
talk to residents about resident rights and whether they are receiving the
services they need. The number of residents interviewed varies with the size
of the facility.
In 2005, legislation was passed directing the Department to conduct a pilot
study to determine whether announced or unannounced inspections have an impact
on the number of deficiencies found. A report was due to the legislature for
consideration during the 2005-2006 interim sessions, including a recommendation
as to whether the unannounced survey process should continue for all basic
care facilities.
Communicating with Consumers
The Department of Health Web site has links to the regulations and a file
that lists the name, address, phone number, administrator's name, and number
of beds for each basic care facility. The site also allows users to search
a database by city to obtain this information.
The Adult and Aging Services Division uses the Department's Web portal.
The "Senior Information Line" includes a glossary with definitions
of assisted living and adult residential care homes. The site includes provider
information, as well as a list of facilities; the name, address, and phone
number of each facility; links to facility Web sites; and other information.
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Ohio
Approach
The Department of Health licenses residential care facilities. Facilities
are inspected at least once prior to the issuance of a license, at least once
every 15 months, and as the Department considers necessary. The inspections
may be announced or unannounced, except that one unannounced inspection is
conducted at least every 15 months. The State fire marshal or a township, municipal,
or other legally constituted fire department approved by the fire marshal also
inspects a residential care facility prior to issuance of a license, at least
once every 15 months thereafter, and at any other time requested by the director.
Inspections are compliance-based and do not incorporate a consultative or collaborative
component.
The Department formed a speaker's bureau that is available to address
topics related to the regulations and requirements, including the survey process
and rules or statistical review of care issues cited in Ohio.
Communicating with Consumers
The licensing regulations are available on the Department of Health's
Web site. The site also has a link to a searchable database of licensed facilities.
The information listed includes the name, address, and phone number of the
facility; the name of the administrator; an E-mail address; the license status,
date of issue, and date of expiration; licensed capacity; the date the facility
opened; and the special services that are available, such as "dementia," "adult
day care," or "hospice."
A consumer guide to long-term care is available on the Department of Aging
Web site. It has a section on housing and care options with a link to the Ohio
Assisted Living Association's Web site. The State legislature directed
the Department to expand the information available about assisted living. The
work plan includes developing a satisfaction survey and a tool to measure regulatory
compliance that was scheduled to be ready in the spring of 2006.
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Oklahoma
Approach
The Department of Health (DOH) is responsible for licensing and
inspection of assisted living centers and continuum of care facilities. DOH
conducts an unannounced inspection of each facility at least once every 15
months. DOH provides written notice of all violations, and the facility has
10 business days to respond with a written plan of correction. After review,
the State provides the facility with its response. If an assisted living center
provides or arranges for skilled nursing care, the State must assess the quality
of that care against applicable national standards of practice adopted by the
American Nurses Association and specialty nursing organizations.
Each center must have a quality assurance committee that meets at least quarterly
to monitor trends and customer satisfaction and document quality assurance
efforts and outcomes. The committee must include an RN or physician, the administrator,
a direct care staff member or person responsible for administering medications,
and a pharmacist consultant if a medication problem is to be monitored or investigated.
The Department may inspect centers whenever it deems it necessary.
Communicating with Consumers
The Department of Health Web site has a listing of facilities, including the
name of the facility, address, phone number, number or beds, number of Alzheimer's
beds, and the facility's identification number.
The Aging Services Division home page has a link to housing information, which
includes a brief description of assisted living, continuum of care facilities,
and residential care. This page also includes a link to the list of facilities
maintained by the Department of Health. A guide on long-term care options presents
brief explanations of residential resources.
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Oregon
Approach
The Oregon Division of Seniors and People with Disabilities (SPD)
licenses assisted living facilities and residential care facilities. The licensing
agency conducts periodic monitoring visits at least every 2 years. The facility
must develop and conduct an ongoing quality improvement program that evaluates
services, resident outcomes, and resident satisfaction. Staff of the Department
may visit, inspect, and monitor assisted living facilities at any time (but
no less often than once every 2 years) to determine whether they are maintained
and operated in accordance with these rules.
Communicating with Consumers
The SPD Web site has a database that allows users to search by facility type,
name, and county. The search generates the name, address, phone number, administrator's
name, original date of license, capacity, and whether the facility accepts
Medicaid. The site also lists facilities that have received an endorsement
for Alzheimer's Care Units. The Web site has several links to tools
for consumers, including an overview, what it means to be licensed, the types
of facilities that might be considered, what the different types of facilities
have in common, and how to start a search for a facility. A consumer's
guide and uniform disclosure form are also posted.
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Pennsylvania
Approach
Personal care homes are licensed by the Department of Public
Welfare, Division of Personal Care Homes. Licenses are issued for 1 year or
less, and homes are inspected at least annually. The survey guidelines are
being revised to reflect changes in the regulations. The draft guidelines,
which are not final, describe the procedures to follow for record reviews,
staff and resident interviews, recording techniques, and methods for determining
compliance. The guidelines also include interpretations of the regulations,
examples of best practices, and recommendations and information that may be
helpful to the personal care home staff. Complaints are triaged and must be
investigated according to timeframes that are based severity. Inspection reports
are available to the public upon request. The results of complaint investigations
are available after redacting. The Department plans to post survey findings
on its Web site within 2 years.
New regulations effective in October 2005 require homes to establish a quality
assessment and management plan that includes incident reports, complaint procedures,
staff training, monitoring of licensing violations and plans for correction,
and establishing resident and/or family councils. The quality management plan
includes the development and implementation of measures to address the areas
needing improvement that are identified during the periodic review and evaluation.
Communicating with Consumers
The Department of Public Welfare maintains a Web
site that has general information about personal care homes, a guide for choosing
a personal care home, and information about filing complaints. The site allows
users to search for personal care homes by county and find the name of the
facility, address, phone number, capacity, and whether it is for profit or
non-profit.
The State's Intra-Government Long-term Care Council prepared two reports
with recommendations on assisted living: Assisted Living: A Choice for
the Future, July 1999 and Assisted Living: Long Term Care and Services
Discussion Finding, February 1999. These discussions and recommendations
address consumer choice, defining assisted living, aging in place, shared risk,
regulation and quality, and funding.
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Rhode Island
Approach
The Department of Health licenses assisted living facilities and
inspects and investigate facilities at least once a year or as needed. Representatives
of the licensing agency have the right to enter facilities at any time without
prior notice to inspect the premises and services. Facilities are given notice
by the licensing agency of all deficiencies reported as a result of an inspection
or investigation. A consultation/collaboration model may be implemented when
additional staff members are available. The licensing agency noted the importance
of having registered nurses and pharmacy consultants available to monitor the
assessment process, appropriateness of admission, and medication issues.
Residences are required to develop, implement, and maintain a documented,
ongoing quality assurance program to attain and maintain a high quality assisted
living residence. This ongoing process for quality improvement, includes monitoring,
identifying areas to improve, developing methods to improve them, and evaluating
the progress achieved. Areas subject to quality assurance review include at
least personal assistance and resident services, resident satisfaction, and
incidents (for example, resident complaints, medication errors, resident falls,
and injuries of unknown origin).
The administrator must maintain a written plan that includes three areas
for quality assurance/improvement review and describes the monitoring, identification,
and evaluation processes; tracking methods; and the responsible individuals.
There are minimum statutory requirements for the information that must be
disclosed to potential residents and their families: identification of the
residence and its owner and operator; the level of license; admission and discharge
criteria; the services available; financial terms including all fees and deposits
and any first-month rental arrangements; the policy regarding notification
to tenants of increases in fees, rates, services and deposits; and the terms
of the residency agreement.
Communicating with Consumers
Facility licensing regulations are posted on the Department of Health Web site.
The Board of Assisted Living Residence Administrators maintains a Web site
with links to disciplinary actions taken against administrators, members of
the Board, meeting dates, and the regulations for licensing administrators.
The Department of Elderly Affairs home page has a link to home care services
that includes a brief description of assisted living. The Pocket Manual
for Elders has additional information, including telephone numbers for
the Department of Health and the Rhode Island Assisted Living Association.
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South Carolina
Approach
The Department of Health and Environment licenses community residential
care facilities. Facilities are licensed annually. General inspections and
fire, life, and safety inspections are done on alternate years. Facilities with
a history of compliance and no complaints may have a general inspection every
3 years. Inspectors must have a college degree, and an RN is available to assist
with clinical issues. Inspectors provide technical assistance during their
site visits. Facilities may also request technical assistance independent of
an inspection visit. Inspectors use a checklist during their reviews. The process
includes interviews with residents based on the inspector's observations.
Facilities must submit a plan of correction to the State licensing agency
when issues of noncompliance are documented. Consultations are available as
requested by facilities or as deemed appropriate by the State.
Facilities must have a written quality improvement program. The program must
establish desired outcomes and the criteria by which effectiveness is accomplished;
identify and evaluate the causes of deviation from desired outcomes; develop
action plans to prevent future deviations; establish quality indicators; analyze
appropriateness of care plans; review all incidents and accidents including
resident deaths, infections, or other occurrences that threaten the health
and safety of residents; and create a systematic method of obtaining feedback
from residents and other interested parties on the level of satisfaction with
care and services received.
Communicating with Consumers
The Department's Web site includes licensing regulations, a list of licensed
facilities (name, address, phone, contact person, license number and expiration
date, and the licensed capacity), and information for providers. The provider
documents include licensing procedures and requirements, information on criminal
background checks, emergency evacuation requirements, level of care criteria,
changes in medication administration training, a self-inspection guide that
tracks the regulations, special care disclosure requirements, staff orientation
and in-service checklist, a request for consultation form, and frequently asked
questions.
The Office on Aging hosts a Web site with a searchable database of all the
services available in the State. Selecting assisted living (community residential
care facilities) from the drop down menu produces the list of facilities with
descriptions of the services available. Each listing has a link to an array
of information that sometimes varies from facility to facility. The information
includes a description of services available, location, area served, intake
requirements, client information (conditions, age group, sex, grievance process),
fees and payment sources accepted, hours of operation (service availability),
address and phone number, and additional information about eligibility and
affiliated programs or agencies.
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South
Dakota
Approach
The Department of Health licenses assisted living centers for 1 year.
Facilities are inspected at least annually, with surveyors using a protocol
based on the regulations. The protocol reviews observation of staff passing
medications, four record reviews (including one closed record), and interviews
with three residents using a list of questions that address resident rights,
staffing, meals, activities, and medications. Surveys and deficiency reports
are computerized.
The governing body of each facility must develop a process to evaluate the
quality of services provided to residents. Quality assurance evaluations must
include the establishment of facility standards, interdisciplinary review of
resident services to identify deviations from the standards and plans of correction,
resident satisfaction surveys, use of services provided, and documentation
of the evaluation. The Department also implemented a quality assurance process.
Staff members review completed surveys to determine if the regulations cited
are correct, whether there is sufficient evidence to issue the citation, and
whether the plan of correction will prevent further violations.
The Department provides education and support to facilities regarding quality
of care and compliance with the regulations during monitoring visits. Licensing
staff are invited regularly to present at the semiannual association meetings.
The State licensing office distributes to facilities up-to-date information
concerning quality and trends in assisted living. The Department holds an annual
public hearing for providers to discuss current issues and concerns.
Communicating with Consumers
The Department of Health Web site has links to the licensing regulations and
a list of licensed facilities.
The Office of Adult Services and Aging Web site describes assisted living
and links to the State licensing regulations, presents a consumer's guide
to assisted living, and links to Medicaid eligibility information. The guide
has sections on requirements for assisted living, considering assisted living,
looking for the right facility, staffing and services, costs, extra costs to
consider, admissions agreement, what to know before signing an agreement, complaints,
notice of non-discrimination, and contact information. Several of the sections
include questions to ask facility staff.
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Tennessee
Approach
The Department of Health, Division of Health and Environment licenses assisted
living centers. Inspections are conducted annually (9-15 months). Revised rules
in 2003 added language concerning the reporting of unusual events. A facility
must report the abuse of a patient or unexpected occurrence or accident that
results in death or a life-threatening or serious injury to a patient to the
Department of Health within 7 business days. Circumstances that could result
in an unusual event are outlined in the regulations. Specific incidents that
may result in a disruption of the delivery of health care services at the facility
also must be reported within 7 business days. The facility must file with the
Department of Health a corrective action report within 40 days of the identification
of the event
Survey staff members have a regulatory focus but do provide education about
the requirements. The State inspection and monitoring process serves as a regulatory
function only. However, when the State develops policy or interpretive guidelines,
they do request the input of industry providers. If through the oversight process
a particular problem area is identified, the State will work with the assisted
living association to provide training and education at association meetings,
rather than provide one-on-one consultation and training to individual providers.
The Department of Health develops interpretive guidelines for regulations.
Department policy was issued to all ALFs in January 2004, to provide criteria
for hospice waivers in the facilities. Another policy bulletin was issued
concerning T.C.A. 68-11-20(5)(A)(i), which prohibits residents with later stages
of Alzheimer's disease or related disorders from being admitted or retained
in an ALF.
Communicating with Consumers
The Department's Web site includes links to the licensing rules, a description
of the process to apply for a license, and a list of facilities (name, address,
phone, administrator, ownership information, the license number, the licensed
capacity, the date of the last survey, the date of the original license, and
the expiration date).
The Commission on Aging and Disability Web site has a link to the list of
licensed facilities posted on the Department of Health's site.
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Texas
Approach
The Department of Aging and Disability Services (DADS) licenses assisted
living facilities. Facilities are licensed annually and are inspected by a
team consisting of a registered nurse, social workers, and a life safety code
specialist. Each member of the team has assigned tasks. During the inspection,
surveyors meet with the person in charge, review the process, and request lists
of residents and staff, schedules, training records, incident reports, policies
and procedures, the services provided, and the facility's disclosure form.
During a tour, the surveyor observes the general operation of the facility
and resident activities. General interviews are held with a sample of residents,
family members, and staff. A sample of resident records is also reviewed. Residents
are asked if they are satisfied with the facility, the services, and food.
If they are not satisfied, they are asked for details that may be explored
with the manager. The team reviews their findings and completes the survey
report. Survey reports may be posted at the facility or requested from the
Department.
Communicating with Consumers
The DADS home page has a "find services" button with a drop-down
menu that has a link to "find and compare long-term care facilities." The
searchable database has information on four types of assisted living facilities.
Users can search by facility name, county, ZIP code, area code, or State-wide.
Search results list the name of the facility, address, owner, and number of
licensed beds, as well as the number of complaints investigated and substantiated
in 2003, 2004, and 2005, a listing of deficiencies cited during recent inspections,
and recent events such as a change in ownership.
The business link on the home page leads to the long-term care policy and
a link to forms. This page has links to disclosure forms for assisted living
facilities and Alzheimer's assisted living facilities. It also contains links
for providers to a general checklist used by surveyors, a checklist for life
safety code requirements for different types of facilities, a list of providers
of courses for assisted living managers, and several monitoring forms.
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Utah
Approach
The Department of Health, Bureau of Health Facility Licensing, Certification,
and Resident Assessment surveys facilities annually and issues a license for
a 2-year period. The Department's Web site includes a report card that
lists the name of the facility and the number of class I and II violations
in 2001, 2002, and 2003. Details about the violations are not posted. A database
of facilities by county or city includes the name, address, phone, type of
facility, the date the license was issued, and the number of beds. A monthly
census summary is also posted. Forms available on the Web site include interpretive
guidelines, general forms for service plans, incident reports, negotiated risk
contracts, resident assessment, and criminal background checks. A summary of
the levels of care is also available.
Communicating with Consumers
The Health Facility Licensing Web site contains a list of facilities by county
and alphabetically and a comparison of the level of care criteria for assisted
living, nursing homes, home health agencies, hospice, and hospitals. Interpretive
guidelines are posted that list the standard contained in the licensing regulations
and guidelines used by surveyors to determine whether the facility complies
with the standard. An assisted living report lists the number of class I
and class II violations by facility for 2001-2003. The licensing regulations
are posted on the Department's Web site.
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Vermont
Approach
The Department of Disabilities, Aging, and Independent Living licenses assisted
living residences and residential care facilities and conducts annual surveys.
Facilities that receive deficiencies must submit and implement corrective action
plans.
The Department works with facilities to help them comply with the regulations.
The State investigates complaints that merit investigation. Assisted living
residences must have a quality improvement process that includes an internal
committee comprising the director, an RN, a staff member, and a resident. The
committee must meet at least quarterly. Resident satisfaction surveys must
be conducted annually and be used by the committee.
Communicating with Consumers
The Department's home page has a link to "Licensing and Protection." On
the left side of the page there are links to State regulations for assisted
living residences and residential care homes and a list of all residential
care and assisted living facilities. The list includes the name of the facility,
level of care, address, phone number, contact person, and capacity.
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Virginia
Approach
The Department of Social Services may issue 1-, 2-, and 3-year licenses to
assisted living facilities. New legislation requires that administrators of
assisted living facilities be licensed by the Board of Long-term Care Administrators.
Surveyors enter information on a personal computer that has the standards
and the previous history of compliance for the facility being inspected. Survey
findings and corrective action plans are printed during the exit interview.
Surveys are posted on the Department's Web site. Licensing officials
are working to expand the system's capacity to generate management reports
that would allow them to compare facilities owned by one company, to compare
compliance history with other companies, and examine citation patterns of individual
surveyors or regional offices.
Communicating with Consumers
The Department's Web site includes a database with the name of the facility,
address, phone number, administrator, expiration date for the license, and
information about inspections. The database includes inspection dates, whether
the inspection was complaint related, and whether or not there were violations.
Clicking the inspection date loads the areas reviewed, action from previous
violation reports, technical assistance provided, and comments by the surveyor.
The report also lists the standards violated, a description of the violation,
and the corrective action that will be taken by the facility.
The Web site also has tools for providers, including a level of care worksheet,
uniform assessment instrument and care plan, application for licensing and
renewal, medication administration record, record of on-site health care oversight,
record of staff training, model resident agreement, and other forms.
To find information about assisted living on the Department's home page,
click services, topics, and assisted living. The assisted living link describes
what the term assisted living means in Virginia and suggests clicking the link
to the ombudsman program for questions about specific facilities. Click on
publications and long-term care for a provider directory and a consumer guide
that has a section on assisted living. The section explains what assisted living
is and is not in Virginia, levels of services, meals, social activities, amenities,
the admission assessment, staffing, and resident rights and responsibilities.
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