The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

 DIVISION 50
ADULT FOSTER HOMES
Licensure of Adult Foster Homes
for Adults who are Older or Adults with Physical Disabilities
411-050-0400 [Renumbered to 411-050-0602]
411-050-0401 [Renumbered
to 411-050-0600]
411-050-0405 [Renumbered
to 411-050-0605]
411-050-0408 [Renumbered
to 411-050-0632]
411-050-0410 [Renumbered
to 411-050-0610]
411-050-0412 [Renumbered
to 411-050-0620]
411-050-0415 [Renumbered
to 411-050-0635]
411-050-0420 [Renumbered
to 411-050-0640]
411-050-0430 [Renumbered
to 411-050-0642]
411-050-0435 [Renumbered
to 411-050-0615]
411-050-0440 [Renumbered
to 411-050-0625]
411-050-0443 [Renumbered
to 411-050-0630]
411-050-0444 [Renumbered
to 411-050-0645]
411-050-0445 [Renumbered
to 411-050-0650]
411-050-0447 [Renumbered
to 411-050-0655]
411-050-0450 [Renumbered
to 411-050-0670]
411-050-0455 [Renumbered
to 411-050-0665]
411-050-0460 [Renumbered
to 411-050-0675]
411-050-0465 [Renumbered
to 411-050-0680]
411-050-0480 [Renumbered
to 411-050-0687]
411-050-0481 [Renumbered
to 411-050-0688]
411-050-0483 [Renumbered
to 411-050-0686]
411-050-0485 [Renumbered
to 411-050-0690]
411-050-0487 [Renumbered
to 411-050-0685]
411-050-0491 [Renumbered
to 411-050-0660]
411-050-0600
Purpose
The purpose of the rules in OAR chapter
411, division 050 is to establish the minimum standards and procedures for adult
foster homes that provide care and services for adults who are older or adults with
physical disabilities in a home-like environment that is safe and secure. Adult
foster homes provide necessary care and services through a cooperative relationship
between the resident (or court-appointed guardian) and the resident's care providers
that emphasizes the resident's independence. Adult foster home care and services
are provided in a setting that protects and encourages resident dignity, choice,
and decision-making while addressing the needs of the resident in a manner that
supports and enables the residents to maximize their ability to function at the
highest level of independence possible.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; Renumbered from 411-050-0401, SPD 33-2013, f. 8-30-13, cert. ef.
9-1-13
411-050-0602
Definitions
Unless the context indicates otherwise,
the following definitions apply to the rules in OAR chapter 411, division 050:
(1) "AAA" means an Area Agency
on Aging, which is an established public agency within a planning and service area
designated under Section 305 of the Older Americans Act that has responsibility
for local administration of programs within the Department of Human Services. For
the purpose of these rules, Type B AAAs contract with the Department to perform
specific activities in relation to licensing adult foster homes, including processing
applications, conducting inspections and investigations, issuing licenses, and making
recommendations to the Department regarding adult foster home license denial, revocation,
suspension, non-renewal, and civil penalties.
(2) "Abuse" means "abuse"
as defined in OAR 411-020-0002 (Adult Protective Services).
(3) "Activities of Daily
Living (ADL)" mean the personal, functional activities defined in OAR 411-015-0006
(Long-term Care Service Priorities for Individuals Served) required by an individual
for continued well-being, which are essential for health and safety.
(4) "Adult Foster Home (AFH)"
means any family home or other facility in which residential care is provided in
a home-like environment for compensation to five or fewer adults who are not related
to the licensee, resident manager, or floating resident manager, by blood, marriage,
or adoption and who are 65 years of age or older or an adult with a physical disability.
For the purpose of these rules, "adult foster home" does not include any house,
institution, hotel, or other similar living situation that supplies room or board
only, if no resident thereof requires any element of care. "Facility" and "Home"
are synonymous with "Adult Foster Home".
(5) "Advance Directive" or
"Advance Directive for Health Care" means the legal document signed by a resident
that provides health care instructions in the event the resident is no longer able
to give directions regarding his or her wishes. The directive gives the resident
the means to control his or her own health care in any circumstance. "Advance Directive
for Health Care" does not include Physician Orders for Life-Sustaining Treatment
(POLST).
(6) "Applicant" means a person
who completes an application for an adult foster home license or who completes an
application to become a resident manager, floating resident manager, or shift caregiver.
"Applicant" is synonymous with "Co-applicant".
(7) "Background Check" means
a criminal records check and abuse check as defined in OAR 407-007-0210 (Criminal
Records and Abuse Check for Providers).
(8) "Back-Up Provider" means
a licensee, approved resident manager, or approved floating resident manager who
does not live in the home, who has agreed to oversee the operation of an adult foster
home, of the same license classification or level, in the event of an emergency.
(9) "Behavioral Interventions"
mean those interventions that modify a resident's behavior or a resident's environment.
(10) "Board of Nursing Rules"
means the standards for Registered Nurse Teaching and Delegation to Unlicensed Persons
according to the statutes and rules of the Oregon State Board of Nursing, ORS 678.010
to 678.445 and OAR chapter 851, division 047.
(11) "Care" means the provision
of assistance with activities of daily living to promote a resident's maximum independence
and enhance the resident's quality of life. "Care" includes, but is not limited
to, assistance with bathing, dressing, grooming, eating, money management, recreation,
and medication management excluding assistance with self-medication.
(12) "Caregiver" means any
person responsible for providing care and services to residents, including the licensee,
resident manager, floating resident manager, shift caregivers, and any temporary,
substitute, or supplemental staff, or other person designated to provide care and
services to residents.
(13) "Care Plan" means a
licensee's written description of a resident's needs, preferences, and capabilities,
including by whom, when, and how often care and services are to be provided.
(14) "Centers for Medicare
and Medicaid Services (CMS)" means the federal agency within the United States Department
of Health and Human Services responsible for the administration of Medicaid and
the Health Insurance Portability and Accountability Act (HIPAA).
(15) "Classification" means
a designation of license assigned to a licensee based on the qualifications of the
licensee, resident manager, floating resident manager, and shift caregivers, as
applicable.
(16) "Co-Applicant" is synonymous
with "Applicant" as defined in this rule.
(17) "Co-Licensee" is synonymous
with "Licensee" as defined in this rule.
(18) "Compensation" means
monetary or in-kind payments by or on behalf of a resident to a licensee in exchange
for room, board, care, and services. "Compensation" does not include the voluntary
sharing of expenses between or among roommates.
(19) "Complaint" means an
allegation of abuse, a violation of these rules, or an expression of dissatisfaction
relating to a resident or the condition of an adult foster home.
(20) "Condition" means a
provision attached to a new or existing license that limits or restricts the scope
of the license or imposes additional requirements on the licensee.
(21) "Consumer" means an
individual eligible for Medicaid services for whom case management services are
provided by the Department.
(22) "Criminal Records and
Abuse Check Rules" refers to OAR 407-007-0200 to 407-007-0370.
(23) "Day Care" means care,
assistance, and supervision of an individual who does not stay overnight.
(24) "Delegation" means the
process by which a registered nurse teaches and supervises a skilled nursing task.
(25) "Department" means the
Department of Human Services.
(26) "Director" means the
Director of the Department of Human Services or that person's designee.
(27) "Disability" means a
physical, cognitive, or emotional impairment, which for an individual, constitutes
or results in a functional limitation in one or more activities of daily living.
(28) "Disaster" means a sudden
emergency occurrence beyond the control of the licensee, whether natural, technological,
or man-made that renders the licensee unable to operate the facility or renders
the facility uninhabitable on a temporary, extended, or permanent basis.
(29) "Emergency Preparedness
Plan" means a written procedure that identifies a facility’s response to an
emergency or disaster for the purpose of minimizing loss of life, mitigating trauma,
and to the extent possible, maintaining services for residents, and preventing or
reducing property loss.
(30) "Entity" means an individual,
a trust or estate, a partnership, a corporation (including associations, joint stock
companies, and insurance companies), a state, or a political subdivision or instrumentality,
including a municipal corporation.
(31) “Exclusion Lists”
mean the following federal lists that exclude listed individuals from receiving
federal awards, not limited to Medicaid and Medicare programs:
(a) The U.S. Office of Inspector
General’s Exclusion List at www.exclusions.oig.hhs.gov/; and
(b) The U.S. General Services
Administration’s System for Award Management Exclusion List at www.sam.gov.
(32) "Exempt Area" means
a county where there is a county agency that provides similar programs for licensing
and inspection of adult foster homes that the Director finds are equal or superior
to the requirements of ORS 443.705 to 443.825 and that the Director has exempted
from the license, inspection, and fee provisions of ORS 443.705 to 443.825. "Exempt
area" county licensing rules require review and approval by the Director prior to
implementation.
(33) "Facility" is synonymous
with "Adult Foster Home" as defined in this rule.
(34) "Family Member" means
spouses in a legally recognized marriage or domestic partnership, natural parent,
child, sibling, adopted child, adoptive parent, adoptive sibling, stepparent, stepchild,
stepbrother, stepsister, father-in-law, mother-in-law, son-in-law, daughter-in-law,
brother-in-law, sister-in-law, grandparent, grandchild, aunt, uncle, niece, nephew,
or first cousin.
(35) "Final Point of Safety"
means a designated assembly area located on a public sidewalk or street not less
than 50 feet away from an adult foster home where occupants of the home evacuate
to in the event of an emergency.
(36) "Floating Resident Manager"
means an employee of the licensee, approved by the local licensing authority, who
under the direction of the licensee, is directly responsible for the care of residents
in one or more adult foster homes owned by that licensee. A "floating resident manager"
is not required to live in any one adult foster home owned by his or her employer,
except on a temporary basis, as directed by the licensee, when the regularly scheduled
caregiver is unavailable.
(37) "Home" means the physical
structure in which residents live. "Home" is synonymous with "Adult Foster Home"
as defined in this rule.
(38) "Home-like" means an
environment that promotes the dignity, security, and comfort of residents through
the provision of personalized care and services, and encourages independence, choice,
and decision-making by the residents.
(39) "House Policies" means
the written and posted statements addressing house activities in an adult foster
home.
(40) "Indirect Ownership
Interest" means an ownership interest in an entity that has an ownership interest
in the disclosing entity. "Indirect ownership interest" includes an ownership interest
in any entity that has an "indirect ownership interest" in the disclosing entity.
(41) "Initial Point of Safety"
means a designated area that has unobstructed direct access to a public sidewalk
or street located not less than 25 feet away from an adult foster home where occupants
of the home evacuate to in the event of an emergency and for the purpose of conducting
evacuation drills.
(42) "Investigative Authority"
means the Office of Adult Abuse Prevention and Investigation, local Department offices,
and Area Agencies on Aging that contract with the Department to provide adult protective
services to adults who are older or adults with physical, mental, or developmental
disabilities.
(43) "Legal Representative"
means a person who has the legal authority to act for a resident.
(a) For health care decisions,
the "legal representative" is a court-appointed guardian, a health care representative
under an Advance Directive for Health Care, or a power of attorney for health care.
(b) For financial decisions,
the "legal representative" is a legal conservator, an agent under a power of attorney,
or a representative payee.
(44) "Level" means the designation
of ventilator-assisted care assigned to an adult foster home license based on the
qualifications of the licensee, resident manager, floating resident manager, and
shift caregivers, as applicable.
(45) "Licensed Health Care
Professional" means a person who possesses a professional medical license that is
valid in Oregon. Examples include, but are not limited to, a registered nurse (RN),
nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic
physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant
(PA), or occupational therapist (OT).
(46) "Licensee" means the
person who was issued a license, whose name is on the license, and who is responsible
for the operation of an adult foster home. The "licensee" of the adult foster home
does not include the owner or lessor of the building in which the adult foster home
is situated unless the owner or lessor of the building is also the operator.
(47) "Limited Adult Foster
Home" means a home that provides care and services for compensation to a specific
individual who is unrelated to the licensee but with whom the licensee has an established
relationship of no less than one year.
(48) "Liquid Resource" means
cash or those assets that may readily be converted to cash, such as a life insurance
policy that has a cash value, stock certificates, or a guaranteed line of credit
from a financial institution.
(49) "Local Licensing Authority"
means the local Department offices and Area Agencies on Aging that contract with
the Department to perform specific functions of the adult foster home licensing
process.
(50) "Nursing Care" means
the practice of nursing by a licensed nurse, including tasks and functions relating
to the provision of "nursing care" that are taught or delegated under specified
conditions by a registered nurse to a person other than licensed nursing personnel,
as governed by ORS chapter 678 and rules adopted by the Oregon State Board of Nursing
in OAR chapter 851.
(51) "Occupant" means any
person residing in or using the facilities of an adult foster home, including residents,
licensees, resident manager, friends or family members, day care individuals, and
room and board tenants. A floating resident manager who resides in an adult foster
home on a temporary basis is considered an "occupant".
(52) "Older" means any person
at least 65 years of age.
(53) "Ombudsman" means the
Oregon Long-Term Care Ombudsman or a designee appointed by the Long-Term Care Ombudsman
to serve as a representative of the Ombudsman Program in order to investigate and
resolve complaints on behalf of adult foster home residents.
(54) "Operator" is synonymous
with "Licensee" as defined in this rule.
(55) "Ownership Interest"
means the possession of equity in the capital, stock, or profits of an adult foster
home. Persons with an ownership or control interest mean a person or corporation
that:
(a) Has an "ownership interest"
totaling five percent or more in a disclosing entity;
(b) Has an indirect ownership
interest equal to five percent or more in a disclosing entity;
(c) Has a combination of
direct and indirect ownership interests equal to five percent or more in a disclosing
entity;
(d) Owns an interest of five
percent or more in any mortgage, deed of trust, note, or other obligation secured
by the disclosing entity if that interest equals at least five percent of the value
of the property or assets of the disclosing entity;
(e) Is an officer or director
of a disclosing entity that is organized as a corporation; or
(f) Is a partner in a disclosing
entity that is organized as a partnership.
(56) "Physical Restraint"
means any manual method or physical or mechanical device, material, or equipment
attached to, or adjacent to, a resident's body that the resident may not easily
remove and that restricts freedom of movement or normal access to his or her body.
Physical restraints include, but are not limited to, wrist or leg restraints, soft
ties or vests, hand mitts, wheelchair safety bars, lap trays, and any chair that
prevents rising (such as a Geri-chair). Side rails (bed rails) are considered restraints
when they are used to prevent a resident from getting out of a bed. The side rail
is not considered a restraint when a resident requests a side rail for the purpose
of assistance with turning.
(57) "Prescribing Practitioner"
means a physician, nurse practitioner, physician assistant, chiropractor, dentist,
ophthalmologist, or other healthcare practitioner with prescribing authority.
(58) "Primary Caregiver"
means a qualified licensee or resident manager, who lives in the home, personally
provides care and services, and ensures the health and safety of residents a minimum
of five consecutive days per week. More than one person who meets this criterion
may be considered a "primary caregiver" as specified below:
(a) Co-licensees working
three and four consecutive days and nights per week;
(b) Two approved resident
managers working three and four consecutive days and nights per week; or
(c) A licensee and an approved
resident manager working three and four consecutive days and nights per week.
(59) "P.R.N. (pro re nata)"
means those medications and treatments that have been ordered by a qualified practitioner
to be administered as needed.
(60) "Provider" means any
person operating an adult foster home (i.e., licensee, resident manager, floating
resident manager, or shift caregiver). "Provider" does not include substitute caregivers
or the owner or lessor of the building in which the adult foster home is situated
unless the owner or lessor is also the operator of the adult foster home.
(61) "Provisional License"
means a 60-day license issued in an emergency situation when a licensed provider
is no longer overseeing the operation of an adult foster home. A provisional license
is issued to a qualified person who meets the standards of OAR 411-050-0625 and
OAR 411-050-0630, except for completing the training and testing requirements. (See
OAR 411-050-0635)
(62) "Psychoactive Medications"
mean various medications used to alter mood, anxiety, behavior, or cognitive processes.
For the purpose of these rules, "psychoactive medications" include, but are not
limited to, antipsychotics, sedatives, hypnotics, and antianxiety medications.
(63) "Qualified Entity Initiator
(QEI)" has the meaning set forth in OAR 407-007-0210 (Criminal Records and Abuse
Checks for Providers).
(64) "Relative" means those
persons identified as family members as defined in this rule.
(65) "Reside" means for a
person to live in an adult foster home for a permanent or extended period of time.
For the purpose of a background check, a person is considered to "reside" in a home
if the person's visit is four weeks or greater.
(66) "Resident" means an
adult who is older or an adult with a physical disability who is receiving room
and board and care and services for compensation in an adult foster home on a 24-hour
day basis.
(67) "Resident Manager" means
an employee of the licensee, approved by the local licensing authority, who lives
in the adult foster home, and is directly responsible for the care of the residents.
(68) "Resident Rights" or
"Rights" means civil, legal, or human rights, including, but not limited to, those
rights listed in the Adult Foster Home Residents' Bill of Rights. (See ORS 443.739
and OAR 411-050-0655)
(69) "Residential Care" means
the provision of care on a 24-hour day basis.
(70) "Room and Board" means
receiving compensation for the provision of meals, a place to sleep, laundry, and
housekeeping to adults who are older or adults with physical disabilities and who
do not need assistance with activities of daily living. Room and board facilities
for two or more persons are required to register with the Department under the rules
in OAR chapter 411, division 068, unless registered with the local authority having
jurisdiction. Adult foster homes with room and board tenants are not subject to
OAR chapter 411, division 068.
(71) "Screening" means the
evaluation process used to identify an individual’s ability to perform activities
of daily living and address health and safety concerns.
(72) "Self-Administration
of Medication" means the act of a resident placing a medication in or on his or
her own body. The resident identifies the medication, the time and manner of administration,
and places the medication internally or externally on his or her own body without
assistance.
(73) "Self-Preservation"
in relation to fire and life safety means the ability of a resident to respond to
an alarm without additional cues and reach a point of safety without assistance.
(74) "Services" mean activities
that help the residents develop skills to increase or maintain their level of functioning
or assist the residents to perform personal care, activities of daily living, or
individual social activities.
(75) "Shift Caregivers" mean
caregivers who, by written variance of the local licensing authority, are responsible
for providing care for regularly scheduled periods of time, such as 8 or 12 hours
per day, in homes where there is no licensee or resident manager living in the home.
(76) "Subject Individual"
means "subject individual" as defined in OAR 407-007-0210, including:
(a) Any person 16 years of
age or older and:
(A) All licensed adult foster
home providers and provider applicants;
(B) All persons intending
to work in, or currently working in an adult foster home, including, but not limited
to, caregivers and individuals in training;
(C) Volunteers on the home’s
premises who provide services for, or who have unsupervised access to any resident,
or any resident’s funds, belongings, or confidential information; and
(D) Occupants, excluding
residents, residing in or on the premises of a proposed or currently licensed adult
foster home, including:
(i) Household members;
(ii) Room and board tenants;
and
(iii) Persons staying in
the home for a period of four weeks or more.
(b) "Subject Individual"
does not apply to:
(A) Persons under 16 years
of age;
(B) Residents of the adult
foster home or their visitors;
(C) Persons who live or work
in or on the adult foster home premises who do not:
(i) Have regular access to
the home for meals; or
(ii) Have regular use of
the adult foster home’s appliances or facilities; or
(iii) Have unsupervised access
to the residents or the residents' personal property.
(D) A person providing services
to the residents who is employed by a private business not regulated by the Department.
(77) "Substantial Compliance"
means a level of compliance with these rules where any deficiencies pose no greater
risk to resident health or safety than the potential for causing minor harm.
(78) "Substitute Caregiver"
means any person other than the licensee, resident manager, floating resident manager,
or shift caregiver who provides care and services in an adult foster home under
the jurisdiction of the Department.
(79) "Tenant" means any individual
who is residing in an adult foster home who receives services, such as meal preparation,
laundry, and housekeeping.
(80) "These Rules" mean the
rules in OAR chapter 411, division 050.
(81) "Variance" means an
exception from a regulation or provision of these rules in accordance with OAR 411-050-0642.
(82) "Ventilator-Assisted
Care" means the provision of mechanical assistance to replace spontaneous breathing.
Devices used include, but are not limited to, mechanical ventilators, manual ventilators,
and positive airway pressure ventilators.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 106.010,
443.001-004, 443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0400, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14; APD 50-2014(Temp),
f. 12-31-14, cert. ef. 1-1-15 thru 6-29-15; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0605
License Required
(1) Any facility that meets the definition
of an adult foster home or limited adult foster home in OAR 411-050-0602 must first
apply for and obtain a license from the local licensing authority or an exempt area
county before providing care to any resident for compensation.
(2) A person or entity may
not represent themselves as operating an adult foster home or accept placement of
a resident without being licensed as an adult foster home.
(3) LIMITED ADULT FOSTER
HOME. Any home that meets the definition of a limited adult foster home in OAR 411-050-0602
must first apply for and obtain a limited license from the local licensing authority
before providing care. The license for a limited adult foster home is limited to
the care of a specific resident and the licensee must make no other admissions.
The resident receiving care is named on the license.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.
001 to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-1986; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; SPD 10-2013(Temp), f.
& cert. ef. 5-23-13 thru 11-19-13; Renumbered from 411-050-0405, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13
411-050-0610
Initial License Application and Fees
(1) The applicant must complete the
Department’s application form for the specific type of license requested and
submit the application form to the local licensing authority with the non-refundable
fee.
(a) The application is not
complete until all of the required information is submitted to the local licensing
authority. Incomplete applications are void after 60 calendar days from the date
the local licensing authority receives the application form and non-refundable fee,
and the Department may deny the application if not withdrawn.
(b) Failure to provide accurate
information may result in the denial of the application.
(2) A separate application
is required for each location where an adult foster home is to be operated.
(3) The license application
must include:
(a) Complete contact information
for the applicant including:
(A) A mailing address if
different from the proposed adult foster home; and
(B) A business address for
electronic mail.
(b) Verification of attendance
at a Department-approved orientation program conducted by the local licensing authority
responsible for the licensing of the proposed adult foster home and successful completion
of the Department's Ensuring Quality Care Course and examination. (See OAR 411-050-0625);
(c) The maximum resident
capacity requested;
(d) Identification of:
(A) Any relatives needing
care;
(B) The maximum number of
any room and board tenants;
(C) The maximum number of
day care individuals; and
(D) The names of any other
occupants in the home.
(e) The classification being
requested with information and supporting documentation regarding qualifications,
relevant work experience, and training of staff as required by the Department. To
request a Class 3 license, the license application must include:
(A) Proof of at least three
years of full-time experience providing direct care to adults who are older or adults
with physical disabilities and who required full assistance in four or more of activities
of daily living; and
(B) Current contact information
from at least two licensed health care professionals who have direct knowledge of
the applicant’s abilities and past experience as a caregiver; or
(C) A copy of the applicant's
current license as a health care professional in Oregon, if applicable.
(f) A Health History and
Physician or Nurse Practitioner’s Statement (form SDS 903) regarding the applicant's
ability to provide care;
(g) FINANCIAL INFORMATION.
A completed Financial Information Sheet (form SDS 448A).
(A) An applicant must have
the financial ability and maintain sufficient liquid resources to pay the operating
costs of an adult foster home for at least two months without solely relying on
potential resident income.
(B) Documentation of two
months of liquid resources must include:
(i) The Department’s
current Verification of Financial Resources form (SDS 0448F) completed and stamped
or notarized by the applicant’s financial institution; or
(ii) Documentation on letterhead
of the applicant’s financial institution, which includes:
(I) The last four digits
of the applicant’s account number;
(II) The name of the account
holder and, if the account is not in the applicant’s name, verification the
applicant has access to the account’s funds;
(III) The highest and lowest
balances for each of the most recent three full months; and
(IV) The number of any non-sufficient
fund (NSF) payments in each of the last three full months, if any; or
(iii) Demonstration of cash
on hand equal to a minimum of two months of operating expenses.
(C) If an applicant uses
income from another adult foster home to document possession of at least two months
of operating expenses, the applicant must demonstrate the financial ability and
maintain sufficient liquid resources to pay the operating costs of each home for
at least two months without solely relying on potential resident income.
(h) If the home is leased
or rented, a copy of the completed lease or rental agreement. The agreement must
be a standard lease or rental agreement for residential use and include the following:
(A) The owner and landlord’s
name;
(B) Verification that the
rent is a flat rate; and
(C) The signatures of the
landlord and applicant and the date signed;
(i) If the applicant is purchasing
or owns the home, verification of purchase or ownership;
(j) Documentation of the
initiation of a background check or a copy of an approved background check for each
subject individual as defined in OAR 411-050-0602;
(k) A current and accurate
floor plan that indicates:
(A) The size of rooms;
(B) Which bedrooms are to
be used by residents, the licensee, caregivers, for day care, and room and board
tenants, as applicable;
(C) The location of all the
exits on each level of the home, including emergency exits such as windows;
(D) The location of any wheelchair
ramps;
(E) The location of all fire
extinguishers, smoke alarms, and carbon monoxide alarms;
(F) The planned evacuation
routes, initial point of safety, and final point of safety; and
(G) Any designated smoking
areas in or on the adult foster home premises.
(l) If requesting a license
to operate more than one home, a plan covering administrative responsibilities and
staffing qualifications for each home;
(m) A $20 per bed non-refundable
fee for each non-relative resident;
(n) Three personal references
for the applicant who are not family members as defined in OAR 411-050-0602. Current
or potential licensees and co-workers of current or potential licensees are not
eligible as personal references;
(o) If the applicant intends
to use a resident manager, floating resident manager, or shift caregivers, the Department’s
supplemental application (form SDS 448B) completed by the applicant, as appropriate;
and
(p) Written information describing
the operational plan for the adult foster home including:
(A) The use of substitute
caregivers and other staff;
(B) A plan of coverage for
the absence of the primary caregiver; and
(C) The name of a qualified
back-up provider, approved resident manager, or approved floating resident manager
who does not live in the home but has been oriented to the home. The applicant must
also submit a signed agreement with the listed back-up provider and maintain a copy
in the facility records.
(4) After receipt of the
completed application materials including the non-refundable fee, the local licensing
authority must investigate the information submitted including pertinent information
received from outside sources, inspect the home, and conduct a personal interview
with the applicant.
(5) The Department shall
deny the issuance of a license if cited violations from the home inspection are
not corrected within the time frames specified by the local licensing authority.
(6) The applicant may withdraw
his or her application at any time during the application process by written notification
to the local licensing authority.
(7) An applicant whose license
has been revoked, non-renewed, voluntarily surrendered during a revocation or non-renewal
process, or whose application for licensure has been denied, shall not be granted
a new license by the local licensing authority for a period of not less than one
year from the date the action was final, or for a longer period if specified in
the final order.
(8) All moneys collected
under ORS 443.725 to 443.825 are paid to the Quality Care Fund.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0410, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14; APD 15-2015,
f. 6-24-15, cert. ef. 6-28-15
411-050-0615
Provider Enrollment Agreements, Contracts,
and Refunds
(1) MEDICAID PROVIDER ENROLLMENT AGREEMENT.
(a) An applicant or licensee
who intends to care for residents who are or become eligible for Medicaid services
must enter into a Medicaid Provider Enrollment Agreement with the Department, follow
Department rules, and abide by the terms of the Agreement. The local licensing authority
shall determine that the applicant, licensee, and any owner or officer of the corporation,
as applicable, is not listed on either of the Exclusion Lists prior to approval
of a Medicaid Provider Enrollment Agreement.
(b) An approved Medicaid
Provider Enrollment Agreement does not guarantee the placement of individuals eligible
for Medicaid services in the adult foster home.
(c) An approved Medicaid
Provider Enrollment Agreement is valid for the length of the license unless earlier
terminated by the licensee or the Department. A Medicaid Provider Enrollment Agreement
must be completed, submitted, approved, and renewed with each licensing cycle.
(d) The rate of compensation
established by the Department is considered payment in full. The licensee may not
request or accept additional funds or in-kind payment from any source.
(e) An individual eligible
for Medicaid services may not be admitted into an adult foster home unless and until:
(A) The Department has approved
a Medicaid Provider Enrollment Agreement. The Department shall not issue a Medicaid
payment to a licensee without a current license and an approved Medicaid Provider
Enrollment Agreement in place;
(B) The individual eligible
for Medicaid services has been screened according to OAR 411-050-0655; and
(C) The Department has authorized
the placement. The authorization must be clearly documented in the resident’s
record with other required admission materials. (See OAR 411-050-0655)
(f) The Department shall
not make payment for the date a resident moves from the home, or for any time period
thereafter.
(g) The licensee must enter
into a written agreement with a resident who receives Medicaid services if the licensee
charges for storage of belongings that remain in the adult foster home for more
than 15 calendar days after the resident has left the home.
(A) The written agreement
must be consistent with the licensee's policy with private-pay residents and entered
into at the time of the resident's admission or at the time the resident becomes
eligible for Medicaid services.
(B) The licensee must give
written notice to the resident and the resident's family or other representatives
30 calendar days prior to any increases, additions, or other modifications to the
charges for storage.
(h) A licensee who elects
to provide care for individuals eligible for Medicaid services is not required to
admit more than one resident eligible for Medicaid services. However, if the licensee
has an approved Medicaid Provider Enrollment Agreement, private-pay residents who
become eligible for Medicaid services may not be asked to leave solely on the basis
of Medicaid eligibility.
(i) The licensee or the Department
may terminate a Medicaid Provider Enrollment Agreement according to the terms of
the Agreement.
(j) The Department may terminate
a Medicaid Provider Enrollment Agreement under the following circumstances:
(A) The licensee fails to
maintain substantial compliance with all related federal, state, and local laws,
ordinances, and regulations; or
(B) The license to operate
the adult foster home has been voluntarily surrendered, revoked, or non-renewed.
(k) The Department must terminate
a Medicaid Provider Enrollment Agreement under the following circumstances:
(A) The licensee fails to
permit access by the Department, the local licensing authority, or the Centers for
Medicare and Medicaid Services to any adult foster home licensed to and operated
by the licensee;
(B) The licensee submits
false or inaccurate information;
(C) Any person with five
percent or greater direct or indirect ownership interest in the adult foster home
did not submit timely and accurate information on the Medicaid Provider Enrollment
Agreement form or fails to submit fingerprints if required under the criminal records
and abuse check rules in OAR 407-007-0200 to 407-007-0370;
(D) Any person with five
percent or greater direct or indirect ownership interest in the adult foster home
has been convicted of a criminal offense related to the person’s involvement
with Medicare, Medicaid, or Title XXI programs in the last 10 years; or
(E) Any person with an ownership
or control interest, or who is an agent or managing employee of the adult foster
home, fails to submit timely and accurate information on the Medicaid Provider Enrollment
Agreement form.
(l) If the licensee submits
notice of termination of the Medicaid Provider Enrollment Agreement, the licensee
must:
(A) Simultaneously issue
the Department’s Notice of Involuntary Move or Transfer of Resident form (SDS
901) to each resident eligible for Medicaid services in the licensee’s adult
foster home;
(B) Simultaneously issue
written notification to all residents who pay with private funds; and
(C) Immediately update the
house policies.
(m) If either the licensee
or the Department terminates a Medicaid Provider Enrollment Agreement, a new Medicaid
Provider Enrollment Agreement shall not be approved by the local licensing authority
for a period of not less than 180 days from the date the licensee or the Department
terminated the Agreement.
(n) DEATH OF RESIDENT ELIGIBLE
FOR MEDICAID SERVICES WITH NO SURVIVING SPOUSE. The licensee must forward all personal
incidental funds (PIF) to the Estate Administration Unit, P.O. Box 14021, Salem,
Oregon 97309-5024, within 10 business days of the death of a resident eligible for
Medicaid services with no surviving spouse. (See Limits on Estate Claims, OAR 461-135-0835)
(2) PRIVATE CONTRACT. A licensee
who cares for residents who pay with private funds or individuals receiving only
day care services must enter into a written contract with the resident or person
paying for the resident's care. The written contract is the admission agreement.
The written contract must be signed by all parties prior to the admission of the
resident. A copy of the contract is subject to review by the local licensing authority
prior to licensure and prior to the implementation of any changes to the contract.
(a) The contract must include
but not be limited to:
(A) Services to be provided
and the rate to be charged. A payment range may not be used unless the contract
plainly states when an increase in rate may be expected based on a resident's increased
care or service needs;
(B) Conditions under which
the rates may be changed;
(C) The home's refund policy
in instances of a resident's hospitalization, death, transfer to a nursing facility
or other care facility, and voluntary or involuntary move. The refund policy must
be in compliance with section (3) of this rule;
(D) A statement indicating
that the resident is not liable for damages considered normal wear and tear on the
adult foster home and the adult foster home's contents;
(E) The home’s policies
on voluntary moves and whether or not the licensee requires written notification
of a resident’s intent to not return; and
(F) Any charges for storage
of belongings that remain in the adult foster home for more than 15 calendar days
after the resident has left the home.
(b) The licensee may not
charge or ask for application fees or non-refundable deposits. Fees to hold a bed
are permissible.
(c) The licensee must give
a copy of the signed contract to the resident or the resident's representative and
must retain the original signed contract and any amendments on the premises available
for review.
(d) The licensee may not
include any illegal or unenforceable provision in a contract with a resident and
may not ask or require a resident to waive any of the resident's rights or licensee’s
liability for negligence.
(e) The licensee must give
written notice to a private-pay resident and the resident's family or other representatives
30 calendar days prior to any general rate increases, additions, or other modifications
of the rates. The licensee is not required to give 30 day written notice if the
rate change is due to the resident's increased care or service needs and the agreed
upon rate schedule in the resident's contract has specified charges for those changes.
(3) REFUNDS.
(a) If a resident dies, the
licensee may not retain or require payment for more than 15 calendar days after
the date of the resident’s death, or the time specified in the licensee’s
contract, whichever is less.
(b) If a resident leaves
an adult foster home for medical reasons and the resident or the resident’s
representative indicates the resident's intent to not return, the licensee may not
retain or require payment for more than 15 calendar days after the date the licensee
receives notification from the resident or the resident’s representative or
the time specified in the licensee’s contract, whichever is less.
(c) If a resident who has
paid with private funds becomes eligible for Medicaid services, the licensee must
accept payment from the Department from the date of eligibility forward as payment
in full. The licensee must reimburse the resident or the resident’s representative
within 30 calendar days after the licensee receives payment from the Department
for any private payment received after the resident became eligible for Medicaid
services.
(d) The licensee must act
in good faith to reduce the charge to a resident who has left the home, by seeking
a new resident to fill the vacancy.
(e) The licensee must refund
any unused advance payment to the resident, or the resident’s representative
as appropriate, within 30 calendar days after the resident dies or leaves the home.
(f) If the adult foster home
closes or the licensee gives written notice for the resident to leave, the licensee
waives the right to collect any fees beyond the date of closure or the resident's
departure, whichever is sooner.
(g) If a resident dies or
leaves an adult foster home due to neglect or abuse at the adult foster home that
is substantiated by a Department investigator, or due to conditions of imminent
danger of life, health, or safety, the licensee may not charge the resident beyond
the resident's last day in the home.
(h) The refund policies in
these rules also apply to refunds for resident moves and transfers as described
in OAR 411-050-0645.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.880,
443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0435,
SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0620
Background Check
(1) All subject individuals must have
an approved background check prior to operating, working, training in, or living
in a home. Licensees must maintain approval in accordance with these rules and the
criminal records and abuse check rules, OAR 407-007-0200 to 407-007-0370.
(2) The background check
may not to be used as a screening tool for hiring. New employees may be offered
a position contingent upon passing the background check.
(3) A new background check
must be completed:
(a) Every two years.
(b) Prior to any subject
individual’s change in employment position.
(c) If the Department has
reason to believe a new background check is needed.
(4) PORTABILITY OF BACKGROUND
CHECK APPROVAL. A subject individual may be approved to work in multiple homes in
Oregon only when the subject individual is working in the same employment position.
(5) On or after July 28,
2009, no licensee, licensee applicant, or employee of the licensee who has been
convicted of any of the disqualifying crimes listed in OAR 407-007-0275 shall be
approved by the Department to provide care and services in an adult foster home.
This rule does not apply to:
(a) An employee of the licensee
who was hired prior to July 28, 2009, who continues employment in the same position
with the same licensee; or
(b) Any subject individual
who is an occupant of the home but is neither a licensee nor a caregiver.
(6) The licensee must have
written verification from the local licensing authority that the required background
checks have been completed and approved for all subject individuals. The written
verification may include electronic correspondence, and shall be readily available
upon request.
(7) All subject individuals
must self-report to the licensee any disqualifying condition as described in OAR
407-007-0275 and any potentially disqualifying condition as described in OAR 407-007-0280
and 407-007-0290. The licensee must notify the Department or local licensing authority
within 24 hours if any subject individual has a disqualifying or potentially disqualifying
condition.
(8) The Department must provide
for the expedited completion of a background check for the state of Oregon when
requested by a licensed provider because of a demonstrated immediate staffing need.
Stat. Auth.: ORS 181.537, 410.070, 443.001,
443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775,
443.790
Stats. Implemented: ORS 181.537,
443.001 to 443.004, 443.705-825, 443.875, 443.991
Hist.: SDSD 4-2001, f. &
cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. e b6f. 1-1-07; SPD 22-2009(Temp),
f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 1-2010(Temp), f. & cert. ef.
3-11-10 thru 6-30-10; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; SPD 30-2010, f.
12-29-10, cert. ef. 1-1-11; Renumbered from 411-050-0412, SPD 33-2013, f. 8-30-13,
cert. ef. 9-1-13; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0625
Qualification and Training Requirements
(1) APPLICANT AND LICENSEE QUALIFICATIONS.
An adult foster home applicant and licensee must meet and maintain the requirements
specified in this section. An adult foster home applicant and licensee must:
(a) Live in the home that
is to be licensed at least five days and nights per week and function as the primary
caregiver as defined in OAR 411-050-0602 unless:
(A) There is, or shall be
upon licensure, an approved resident manager who lives in the home and works five
consecutive days and nights per week as the primary caregiver; or
(B) There is, or shall be
upon licensure, two approved primary caregivers who live in the home and work three
and four consecutive days and nights per week respectively; or
(C) A variance for shift
caregivers has been granted according to section (6) of this rule.
(b) Subsections (a)(A), (B),
and (C) of this section are not intended to prohibit the occasional and temporary
absence of the primary caregiver from the adult foster home;
(c) Be at least 21 years
of age;
(d) Possess physical health,
mental health, good judgment, and good personal character, including truthfulness,
determined necessary by the Department to provide 24-hour care for adults who are
older or adults with physical disabilities. An applicant and licensee must have
a statement from a physician, nurse practitioner, or physician assistant indicating
that the applicant or licensee is physically, cognitively, and emotionally capable
of providing care to residents. An applicant or licensee with documented history
or substantiated complaints of substance abuse or mental illness must provide evidence
satisfactory to the Department of successful treatment, rehabilitation, or references
regarding current condition;
(e) Have an approved background
check in accordance with OAR 411-050-0620 and maintain that approval as required;
(f) Be literate in the English
language and demonstrate the ability to comprehend and communicate in English orally
and in writing with the residents and the residents' family members or representatives,
emergency personnel (e.g., emergency operator, law enforcement, paramedics, and
fire fighters), licensed health care professionals, case managers, Department and
local licensing authority staff, and others involved in the care of the residents;
(g) Be able to respond appropriately
to emergency situations at all times; and
(h) Have a clear understanding
of his or her responsibilities, knowledge of the residents' care plans, and the
ability to provide the care specified for each resident; and not be listed on either
of the Exclusion Lists.
(2) APPLICANT AND LICENSEE
TRAINING REQUIREMENTS.
(a) Applicants and licensees
must have the education, experience, and training to meet the requirements of the
requested classification of the home. (See OAR 411-050-0630)
(b) A potential applicant
or applicant must complete the following training requirements prior to obtaining
a license:
(A) Attend a Department-approved
orientation program conducted by the local licensing authority responsible for the
licensing of the proposed adult foster home;
(B) Attend the Department’s
Ensuring Quality Care Course and pass the examination to meet application requirements
for licensure;
(i) Potential applicants
and applicants who fail the first examination may take the examination a second
time; however, successful completion of the examination must take place within 90
calendar days of the end of the Department's Ensuring Quality Care Course.
(ii) Potential applicants
and applicants who fail a second examination must retake the Department’s
Ensuring Quality Care Course prior to repeating the examination.
(C) Comply with the Department’s
January 1, 2015, student policies for the Department's Ensuring Quality Care Course;
and
(D) Have current CPR and
First Aid certification.
(i) Accepted CPR and First
Aid courses must be provided or endorsed by the American Heart Association, the
American Red Cross, the American Safety and Health Institute, or MEDIC First Aid.
(ii) CPR or First Aid courses
conducted online are only accepted by the Department when an in-person skills competency
check is conducted by a qualified instructor endorsed by the American Heart Association,
the American Red Cross, the American Safety and Health Institute, or MEDIC First
Aid.
(3) FINANCIAL REQUIREMENTS.
A licensee applicant and licensee must have the financial ability and maintain sufficient
liquid resources to pay the operating costs of the adult foster home for at least
two months without solely relying on potential resident income.
(a) If an initial license
applicant is unable to demonstrate the financial ability and resources required
by this section, the Department may require the applicant to furnish a financial
guarantee, such as a line of credit or guaranteed loan, to fulfill the requirements
of this rule.
(b) If at any time there
is reason to believe an applicant or licensee may not have sufficient financial
resources to operate the home in compliance with these rules, the local licensing
authority may request additional documentation, which may include verification of
the applicant's or licensee's ability to readily access the requested funds. Circumstances
that may prompt the request of additional financial information include, but are
not limited to, reports of insufficient food, inadequate heat, or failure to pay
employees, utilities, rent, or mortgage. Additional documentation of financial resources
may include, but are not limited to:
(A) The Department’s
Verification of Financial Resources form (SDS 0448F) completed and stamped or notarized
by the applicant’s or licensee’s financial institution;
(B) Documentation on letterhead
of the applicant’s or licensee’s financial institution that includes:
(i) The last four digits
of the applicant’s or licensee’s account number;
(ii) The name of the account
holder, and if the account is not in the applicant’s or licensee’s name,
verification the applicant or licensee has access to the account’s funds;
(iii) The highest and lowest
balances for each of the most recent three full months;
(iv) The number of any non-sufficient
fund (NSF) payments in each of the last three full months, if any; and
(v) Signature of the banking
institution’s representative completing the form and date.
(C) Demonstration of cash
on hand equal to a minimum of two months of operating expenses.
(c) The local licensing authority
must request the least information necessary to verify compliance with this section.
(4) RESIDENT MANAGER REQUIREMENTS.
A resident manager must live in the home as specified in section (1)(a) of this
rule and function as the primary caregiver under the licensee’s supervision.
A resident manager must meet and maintain the qualification and training requirements
specified in sections (1)(a) through (2)(b)(D) of this rule. The local licensing
authority shall verify all the requirements of these rules have been satisfied prior
to approval of a resident manager.
(5) FLOATING RESIDENT MANAGER
REQUIREMENTS.
(a) A floating resident manager
must meet and maintain the qualification and training requirements specified in
sections (1)(c) through (2)(b)(D) of this rule, except as indicated in (5)(b) of
this rule.
(b) If the licensee has one
or more homes within the jurisdiction of more than one local licensing authority,
a currently approved floating resident manager is not required to complete the Department-approved
orientation in more than one licensing authority’s jurisdiction. This exception
does not prohibit the local licensing authority within an exempt area from requiring
the floating resident manager applicant to attend the local licensing authority's
orientation.
(c) The floating resident
manager must be oriented to each home prior to providing resident care in each home.
Documentation of orientation to every home the floating resident manager works in
must be available within each home as stated in section (7) of this rule.
(d) Facility records in each
of the homes a floating resident manager is assigned to work must maintain proof
the floating resident manager has a current and approved background check.
(e) A floating resident manager
may not be used in lieu of a shift caregiver, except on temporary basis, when the
regular shift caregiver is unavailable due to circumstances, such as illness, vacation,
or termination of employment.
(6) SHIFT CAREGIVER REQUIREMENTS.
(a) Shift caregivers may
be used in lieu of a resident manager if granted a written variance by the local
licensing authority. Use of shift caregivers detracts from the intent of a home-like
environment, but may be allowed for specific resident populations. The type of residents
served must be a specialized population with intense care needs, such as those with
Alzheimer's disease, AIDS, or head injuries. If shift caregivers are used, each
shift caregiver must meet or exceed the experience and training qualifications for
the license classification requested.
(b) Shift caregivers must
meet and maintain the qualification and training requirements specified in sections
(1)(c) through (2)(b)(D) of this rule. The local licensing authority shall verify
all the requirements of these rules have been satisfied prior to approval of a shift
caregiver.
(7) CAREGIVER ORIENTATION.
Prior to providing care to any resident, a resident manager, floating resident manager,
and shift caregiver must be oriented to the home and to the residents by the licensee.
Orientation must be clearly documented in the facility records. Orientation includes,
but is not limited to:
(a) Location of any fire
extinguishers;
(b) Demonstration of evacuation
procedures;
(c) Instruction of the emergency
preparedness plan;
(d) Location of resident
records;
(e) Location of telephone
numbers for the residents' physicians, the licensee, and other emergency contacts;
(f) Location of medications
and the key for the medication cabinet;
(g) Introduction to residents;
(h) Instructions for caring
for each resident;
(i) Delegation by a registered
nurse for nursing tasks, if applicable; and
(j) Policies and procedures
related to Advance Directives. (See OAR 411-050-0645)
(8) EMPLOYMENT APPLICATION.
An application for employment in any capacity in an adult foster home must include
a question asking whether the person applying for employment has been found to have
committed abuse. Employment applications must be retained for at least three years.
(9) EXCLUSION VERIFICATION.
(a) A licensee must verify
the resident manager, floating resident manager, and shift caregivers, as applicable,
are not listed on either of the Exclusion Lists prior to employment.
(b) Verification of checking
the Exclusion Lists must be clearly documented in the facility records.
(10) TRAINING WITHIN FIRST
YEAR OF INITIAL LICENSING OR APPROVAL. Within the first year of obtaining an initial
license or approval, the licensee, resident manager, floating resident manager,
and shift caregivers must complete the Six Rights of Safe Medication Administration
and a Fire and Life Safety training as available. The Department or local licensing
authority and the Office of the State Fire Marshal or the local fire prevention
authority may coordinate the Fire and Life Safety training program.
(11) ANNUAL TRAINING REQUIREMENTS.
(a) Each year after initial
licensure, the licensee, resident manager, floating resident manager, and shift
caregivers must complete at least 12 hours of Department-approved training related
to the care of adults who are older or adults with physical disabilities in an adult
foster home setting. Up to four of those hours may be related to the business operation
of the adult foster home.
(b) A licensee, resident
manager, floating resident manager, and shift caregivers, as applicable, must maintain
approved CPR certification.
(c) Registered nurse delegation
or consultation, CPR certification and First Aid training, Ensuring Quality Care
Course (not including approved EQC refresher courses), adult foster home orientation,
Ventilator Assisted Care Course and skills competency checks, or consultation with
an accountant do not count toward the required 12 hours of annual training.
(12) SUBSTITUTE CAREGIVER
REQUIREMENTS. A substitute caregiver left in charge of the residents for any period
of time, may not be a resident, and must at a minimum, meet all of the following
qualifications prior to working or training in the home:
(a) Be at least 18 years
of age.
(b) Have an approved background
check in accordance with OAR 411-050-0620 and maintain that approval as required.
(c) Be literate in the English
language and demonstrate the ability to comprehend and communicate in English orally
and in writing with the residents and the residents’ family members and representatives,
emergency personnel (e.g., emergency operator, law enforcement, paramedics, and
fire fighters), licensed health care professionals, case managers, Department and
local licensing authority staff, and others involved in the care of the residents.
(d) Be able to respond appropriately
to emergency situations at all times.
(e) Have a clear understanding
of his or her responsibilities, have knowledge of the residents' care plans, and
be able to provide the care specified for each resident, including appropriate delegation
or consultation by a registered nurse.
(f) Possess physical health,
mental health, good judgment, and good personal character, including truthfulness,
determined necessary by the Department to provide care for adults who are older
or adults with physical disabilities, as determined by reference checks and other
sources of information.
(g) Have current CPR and
First Aid certification within 30 calendar days of the start of employment.
(A) Accepted CPR and First
Aid courses must be provided by or endorsed by the American Heart Association, the
American Red Cross, the American Safety and Health Institute, or MEDIC First Aid.
(B) CPR or First Aid courses
conducted online are only accepted by the Department when an in-person skills competency
check is conducted by a qualified instructor endorsed by the American Heart Association,
the American Red Cross, the American Safety and Health Institute, or MEDIC First
Aid.
(h) Not be listed on either
of the Exclusion Lists.
(A) Licensees must verify
the substitute caregiver is not listed on either of these Exclusion Lists; and
(B) Clearly document that
verification in the facility’s records.
(13) TRAINING REQUIREMENTS
FOR SUBSTITUTE CAREGIVERS.
(a) A substitute caregiver
must be oriented to the home and to the residents by the licensee or resident manager
prior to the provision of care to any residents. Orientation includes, but is not
limited to:
(A) Location of any fire
extinguishers;
(B) Demonstration of evacuation
procedures;
(C) Instruction of the emergency
preparedness plan;
(D) Location of resident
records;
(E) Location of telephone
numbers for the residents' physicians, the licensee, and other emergency contacts;
(F) Location of medications
and the key for the medication cabinet;
(G) Introduction to residents;
(H) Instructions for caring
for each resident;
(I) Delegation by a registered
nurse for nursing tasks if applicable; and
(J) Education on the policies
and procedures related to Advance Directives. (See OAR 411-050-0645)
(b) A substitute caregiver
must complete the Department’s Caregiver Preparatory Training Study Guide
(DHS 9030) and Workbook (DHS 9030-W) and receive instruction in specific care responsibilities
from the licensee, resident manager, or floating resident manager prior to working
or training in the home. The Workbook must be completed by the substitute caregiver
without the help of any others. The Workbook is considered part of the required
orientation to the home and residents.
(A) The local licensing authority
may grant a variance to the Caregiver Preparatory Training Study Guide and Workbook
requirement for a substitute caregiver who:
(i) Holds a current Oregon
license as a health care professional, such as a physician, nurse practitioner,
physician assistant, registered nurse, or licensed practical nurse; and
(ii) Who demonstrates the
ability to provide adequate care to residents based on similar training or at least
one year of experience providing direct care to adults who are older or adults with
physical disabilities.
(B) A certified nursing assistant
(CNA) or certified medical assistant (CMA) must complete the Caregiver Preparatory
Training Study Guide and Workbook and have a certificate of completion signed by
the licensee.
(c) A substitute caregiver
routinely left in charge of an adult foster home for any period that exceeds 48
continuous hours is required to meet the education, experience, and training requirements
of a resident manager as specified in this rule. A licensee may not leave a substitute
caregiver or concurrent substitute caregivers routinely in charge of the home for
any period that exceeds 48 continuous hours within one calendar week. This requirement
is not intended to prevent a qualified substitute caregiver from providing relief
care in the absence of the primary caregiver, such as for a one or two week vacation.
In such an event, the licensee must arrange for the qualified back-up provider to
be available as needed.
(14) If a licensee has demonstrated
non-compliance with one or more of these rules, the Department may require, by condition,
additional training in the deficient area.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1995, f. & cert. ef. 3-15-95; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. &
cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 22-2009(Temp),
f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10;
Renumbered from 411-050-0440, SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 6-2014,
f. 3-31-14, cert. ef. 4-1-14; APD 50-2014(Temp), f. 12-31-14, cert. ef. 1-1-15 thru
6-29-15; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0630
Classification of Adult Foster Homes
(1) The local licensing authority shall
issue a Class 1, Class 2, or Class 3 adult foster home license only if the qualifications
of the applicant, resident manager, floating resident manager, and shift caregivers,
as applicable, fulfill the classification requirements of these rules.
(a) After receipt of the
completed application materials, including the non-refundable fee, the local licensing
authority must investigate the information submitted including any pertinent information
received from outside sources.
(b) The local licensing authority
shall not issue a license if unsatisfactory references or a history of substantial
non-compliance of the applicant within the last 24 months is verified.
(c) The local licensing authority
may issue a Class 1 license if the applicant and resident manager, as applicable,
complete the training requirements outlined in OAR 411-050-0625;
(d) The local licensing authority
may issue a Class 2 license if the applicant, resident manager, and floating resident
manager, as applicable, complete the requirements outlined in OAR 411-050-0625.
In addition, these caregivers must each have the equivalent of two years of full
time experience providing direct care to adults who are older or adults with physical
disabilities;
(e) The local licensing authority
may issue a Class 3 license if the applicant, resident manager, floating resident
manager, and shift caregivers, as applicable, complete the training requirements
outlined in OAR 411-050-0625 and have a current license as a health care professional
in Oregon or possess the following qualifications:
(A) Have the equivalent of
three years of full time experience providing direct care to adults who are older
or adults with physical disabilities and who require full assistance in four or
more activities of daily living; and
(B) Have references satisfactory
to the Department. The applicant must submit current contact information from at
least two licensed health care professionals who have direct knowledge of the applicant's
ability and past experience as a caregiver.
(2) The Department may approve
a licensee to care for residents requiring ventilator-assisted care. The licensee,
resident manager, floating resident manager, or shift caregivers, as applicable,
must meet the criteria for a Class 3 home according to section (1)(e) of this rule
and comply with the additional requirements for adult foster homes serving residents
requiring ventilator assisted care outlined in OAR 411-050-0660.
(3) To change the classification
of a licensed home, the licensee must complete a new initial application and submit
the application form to the local licensing authority as outlined in OAR 411-050-0610.
(4) A licensee may only admit
or continue to care for residents whose impairment levels are within the classification
of the licensed home.
(a) A licensee with a Class
1 license may only admit residents who require assistance in no more than four activities
of daily living.
(b) A licensee with a Class
2 license may provide care for residents who require assistance in all activities
of daily living, but require full assistance in no more than three activities of
daily living.
(c) A licensee with a Class
3 license may provide care for residents who require full assistance in four or
more activities of daily living, but only one resident who requires bed-care or
full assistance with all activities of daily living.
(5) A licensee must request,
in writing, a variance from the local licensing authority if:
(a) A new resident wishes
to be admitted whose impairment level exceeds the license classification;
(b) A current resident becomes
more impaired, exceeding the license classification; or
(c) There is more than one
resident in the home who requires full bed-care or full assistance with all activities
of daily living not including cognition or behavior.
(6) The local licensing authority
may grant a variance that allows the resident to be admitted or remain in the adult
foster home. The local licensing authority must respond in writing within 30 calendar
days after receipt of the licensee's written variance request. The licensee must
prove the following criteria are met by clear and convincing evidence that:
(a) It is the choice of the
resident to reside in the home;
(b) The licensee is able
to provide appropriate care and service to the resident in addition to meeting the
care and service needs of the other residents;
(c) Additional staff is hired
to meet the additional care requirements of all residents in the home as necessary;
(d) Outside resources are
available and obtained to meet the resident's care needs;
(e) The variance shall not
jeopardize the care, health, safety, or welfare of the residents; and
(f) The licensee is able
to demonstrate how all occupants shall be safely evacuated in three minutes or less.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1995, f. & cert. ef. 3-15-95; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. &
cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 22-2009(Temp),
f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10;
Renumbered from 411-050-0443, SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 6-2014,
f. 3-31-14, cert. ef. 4-1-14
411-050-0632
Capacity
(1) Residents must be limited to five
adults who require care and are unrelated to the licensee and resident manager by
blood, marriage, or adoption.
(2) The number of residents
permitted to reside in an adult foster home is determined by the ability of the
staff to meet the care needs of the residents, the fire and life safety standards
for evacuation, and compliance with the facility standards of these rules.
(3) The licensee must demonstrate,
to the local licensing authority’s satisfaction, the ability to meet the needs
of the residents in addition to caring for any children or relatives beyond the
license capacity of the adult foster home.
(4) The local licensing authority's
determination of maximum capacity must ensure:
(a) The ratio of at least
one caregiver per five residents, including any day care individuals and others
requiring care or supervision except as allowed under section (5) of this rule;
(b) Children over the age
of five have a bedroom available that is separate from their parents;
(c) The well-being of the
household, including any children or other family members, shall not be jeopardized;
and
(d) The care needs of day
care individuals shall be met.
(5) When a family member
requires care in a home in which the licensee is the primary, live-in caregiver,
a maximum capacity of five unrelated residents are allowed if the following criteria
are met:
(a) The licensee must be
able to demonstrate the ability to evacuate all occupants from the adult foster
home within three minutes or less (See OAR 411-050-0650);
(b) The licensee must have
sufficient, qualified staff and demonstrate the ability to provide appropriate care
for all residents (See OAR 411-050-0645);
(c) There must be an additional
40 square feet of common living space for each person above the five residents (See
OAR 411-050-0650);
(d) Bathrooms and bedrooms
must meet the requirements of OAR 411-050-0650;
(e) The care needs of day
care individuals must be within the classification of the license and any conditions
imposed on the license; and
(f) The well-being of the
household, including any children or other family members, shall not be jeopardized.
(6) If day care individuals
are in the home, the licensee must have arrangements for the day care individuals
to sleep in areas other than a resident's bed, a resident's private room, or space
designated as common use, in accordance with OAR 411-050-0650.
(7) If room and board tenants
are in the home, each tenant must have:
(a) An approved background
check in accordance with OAR 407-070-0200 to 407-007-0370 (Criminal Records and
Abuse Check Rules);
(b) A tenancy agreement as
defined in OAR 411-068-0040 (Room and Board Facilities); and
(c) A copy of the current
house policies signed and dated by the tenant.
(8) To change the capacity
of a licensed home, the licensee must complete a new initial application and submit
the application to the local licensing authority according to OAR 411-050-0610.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, & 443.991
Hist. SSD 11-1988, f. 10-18-88,
cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. &
cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10,
cert. ef. 7-1-10; Renumbered from 411-050-0408, SPD 33-2013, f. 8-30-13, cert. ef.
9-1-13; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0635
Issuance
(1) The local licensing authority must
issue a license within 60 calendar days after the completed application materials
have been received if the home and applicant are in compliance with these rules.
(2) The license specifies
the type of license and includes:
(a) The name of the licensee
and the name of the resident manager or shift caregivers as applicable, who have
met the requirements to operate the adult foster home;
(b) The address of the premises
to which the license applies;
(c) The license classification
and level if applicable;
(d) The maximum number of
residents; and
(e) The expiration date.
(3) The licensee must be
given a copy of the Department’s inspection report form as follows:
(a) INITIAL LICENSE. Form
SDS 516 identifying any areas of non-compliance and a time frame for correction.
(b) RENEWAL LICENSE. Form
SDS 517A and, if applicable, form SDS 517B citing any violations. The SDS 517B must
specify a time frame for correction of each violation. The time frame for correction
may not exceed 30 calendar days from the date of inspection.
(4) The licensee must post
the most recent inspection reports in the entry of the home or an equally prominent
place and must, upon request, provide a copy of the reports to each resident, person
applying for admission to the home, or the legal representative, guardian, or conservator
of a resident.
(5) The Department may attach
conditions to the license that limit, restrict, or specify other criteria for operation
of the home. The conditions must be visibly posted with the license.
(6) The local licensing authority
shall not issue an initial license unless:
(a) The applicant and adult
foster home are in compliance with ORS 443.705 to 443.825 and these rules;
(b) The applicant currently
operates, or has operated, any other facility licensed by the applicant in substantial
compliance with ORS 443.705 to 443.825;
(c) The local licensing authority
has completed an inspection of the adult foster home that demonstrates the home
is in compliance with these rules;
(d) The Department has completed
a background check in accordance with OAR 411-050-0620;
(e) The local licensing authority
has reviewed the record of sanctions available from the local licensing authority's
files;
(f) The local licensing authority
has determined that the nursing assistant registry maintained under 42 CFR 483.156
contains no finding that the applicant or any nursing assistant employed by the
applicant has been responsible for abuse;
(g) The local licensing authority
has verified the applicant is not listed on either of the Exclusion Lists; and
(h) The applicant has demonstrated
to the local licensing authority the financial ability and resources necessary to
operate an adult foster home.
(7) A license is valid for
one year unless revoked or suspended by the Department.
(8) In seeking an initial
license, the burden of proof to establish compliance with ORS 443.705 to 443.825
and these rules is upon the applicant of the adult foster home.
(9) The local licensing authority
shall not issue a license to operate an additional adult foster home to a licensee
who has failed to achieve and maintain substantial compliance with the rules and
regulations while operating his or her existing home or homes.
(10) PROVISIONAL LICENSE.
Notwithstanding any other provision of this rule or ORS 443.725 or 443.738, the
local licensing authority may issue a 60-day provisional license to a qualified
person.
(a) A provisional license
may be issued if the local licensing authority determines:
(A) An emergency situation
exists after receiving notification that a licensed provider is no longer overseeing
the operation of an adult foster home; or
(B) A new applicant has submitted
an application and bed fee for a license to operate a currently licensed home and
the applicant has demonstrated a good faith effort to submit a timely and complete
application;
(C) The application process
cannot be completed prior to the expiration date of the current license; and
(D) It is in the best interests
of the residents currently residing in the home.
(b) A person is considered
qualified for a provisional license if he or she:
(A) Is at least 21 years
of age;
(B) Has the necessary experience
working with adults who are older or adults with physical disabilities to potentially
qualify for the license classification of the home;
(C) Fully understands and
has the ability to meet the residents’ care needs; and
(D) Meets the requirements
of a substitute caregiver as described in OAR 411-050-0625.
(c) A provisional license
may be extended one time for a period of 30 calendar days if an applicant has demonstrated
a good faith effort to complete the application process and obtain the required
qualifications and trainings.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0415, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0640
Renewal Application and Fees
(1) At least 60 calendar days prior
to the expiration of a license, the local licensing authority must send a reminder
notice and renewal application to the licensed provider. The local licensing authority
must investigate any information in the renewal application and conduct an unannounced
inspection of the adult foster home prior to the license renewal.
(2) A separate application
is required for each location where an adult foster home is to be operated.
(3) RENEWAL APPLICATION REQUIREMENTS.
To renew an adult foster home license, the licensee must complete the Department's
Renewal Application form (SDS 448C) and submit the form to the local licensing authority
with the non-refundable fee prior to the expiration date of the current license.
Timely submission of the renewal application and non-refundable fee shall keep the
license in effect until the local licensing authority or the Department takes action.
(a) The renewal application
is not complete until all of the required application information is submitted to
the local licensing authority.
(b) A renewal application
remaining incomplete at the time of license expiration or failure to provide accurate
information on the renewal application shall result in the denial of the application.
(4) The license renewal application
must include:
(a) Complete contact information
for the licensee, including:
(A) A mailing address if
different from the adult foster home; and
(B) A business address for
electronic mail, if applicable.
(b) The maximum resident
capacity;
(c) Identification of:
(A) Any relatives needing
care;
(B) The maximum number of
any room and board tenants;
(C) The maximum number of
day care individuals; and
(D) The names of any other
occupants in the home.
(d) A Health History and
Physician or Nurse Practitioners’ Statement (form SDS 0903). The Health History
and Physician or Nurse Practitioners' Statement must be updated every third year
or sooner if there is reasonable cause for health concerns;
(e) FINANCIAL INFORMATION
FOR THE HOME’S FIRST LICENSE RENEWAL. A completed Financial Information Worksheet
(form SDS 0448A) demonstrating the financial ability to maintain sufficient liquid
resources to pay the home’s operating costs for at least two months;
(f) If the home is leased
or rented, a copy of the current signed and dated lease or rental agreement. The
agreement must be a standard lease or rental agreement for residential use and include
the following:
(A) The owner and landlord’s
name;
(B) Verification that the
rent is a flat rate; and
(C) Signatures and date signed
by the landlord and applicant, as applicable;
(g) Documentation of a current
approved background check for each subject individual as described in OAR 411-050-0620;
(h) A $20 per bed non-refundable
fee for each non-relative resident;
(i) If the licensee intends
to use a resident manager, floating resident manager, or shift caregivers, the Department’s
supplemental application (form SDS 448B) completed by the applicant or applicants,
as appropriate;
(j) Written information describing
the operational plan for the adult foster home, including:
(A) The use of substitute
caregivers and other staff;
(B) A plan of coverage for
the absence of the resident manager or the shift caregivers, if applicable; and
(C) The name of a qualified
back-up licensee, approved resident manager, or floating resident manager who does
not live in the home but has been oriented to the home. The licensee must submit
a signed agreement with the listed back-up provider annually and maintain a copy
in the facility records.
(k) Proof of required continuing
education credits as specified in OAR 411-050-0625.
(5) LATE RENEWAL REQUIREMENTS
(UNLICENSED ADULT FOSTER HOME). The home shall be treated as an unlicensed facility,
subject to civil penalties, if the required renewal information and fee are not
submitted to the local licensing authority prior to the license expiration date
and residents remain in the home. (See OAR 411-050-0685)
(6) The local licensing authority
shall investigate the information submitted, review the licensing records for the
applicant, conduct an inspection of the home, and provide the licensee a copy of
the Department's inspection report (form SDS 517A and, if applicable, form SDS 517B)
citing any violations and specifying a time frame for correction not to exceed 30
days.
(7) The Department may attach
conditions to the license that limit, restrict, or specify other criteria for operation
of the home. The licensee must visibly post the conditions, if applicable, with
the license according to OAR 411-050-0645.
(8) The Department may deny
a renewal application if cited violations are not corrected within the time frame
specified by the local licensing authority.
(9) The local licensing authority
shall not renew a license unless the following requirements are met:
(a) The applicant and the
adult foster home are in compliance with ORS 443.705 to 443.825 and these rules,
including any applicable conditions and other final orders of the Department;
(b) The local licensing authority
has completed an inspection of the adult foster home;
(c) The Department has completed
a background check in accordance with OAR 411-050-0620;
(d) The local licensing authority
has reviewed the record of sanctions available from the local licensing authority's
files;
(e) The local licensing authority
has determined the nursing assistant registry maintained under 42 CFR 483.156 contains
no finding that the licensee or any nursing assistant employed by the licensee has
been responsible for abuse; and
(f) The local licensing authority
has determined the licensee is not listed on either of the Exclusion Lists.
(10) In seeking the renewal
of a license when an adult foster home has been licensed for less than 24 months,
the burden of proof to establish compliance with ORS 443.705 to 443.825 and these
rules is upon the licensee.
(11) In seeking the renewal
of a license when an adult foster home has been licensed for 24 or more continuous
months, the burden of proof to establish noncompliance with ORS 443.705 to 443.825
and these rules is upon the Department.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 9-2007, f. 6-27-07, cert. ef. 7-1-07; SPD 22-2009(Temp), f.
12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10;
Renumbered from 411-050-0420, SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; SPD 42-2013(Temp),
f. & cert. ef. 10-16-13 thru 4-13-14; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14;
APD 50-2014(Temp), f. 12-31-14, cert. ef. 1-1-15 thru 6-29-15; APD 15-2015, f. 6-24-15,
cert. ef. 6-28-15
411-050-0642
Variances
(1) An applicant or licensee may request
a variance to the provisions of these rules. The variance request must be in writing
and must include clear and convincing evidence that:
(a) The requested variance
does not jeopardize the care, health, welfare, or safety of the residents and all
of the residents’ needs shall be met; and
(b) All residents, in addition
to other occupants in the home, may be evacuated in three minutes or less.
(2) VARIANCES NOT ALLOWED.
Notwithstanding section (1) of this rule, no variance shall be granted by the local
licensing authority from a regulation or provision of these rules pertaining to:
(a) Resident capacity as
described in OAR 411-050-0632;
(b) Minimum age of licensee
and any caregivers as described in OAR 411-050-0625;
(c) The training requirements
of a licensee and all other caregivers except as allowed for provisional licenses
as described in OAR 411-050-0635, or when a substitute caregiver holds an Oregon
health care professional license as described in 411-050-0625;
(d) Standards and practices
for care and services as described in OAR 411-050-0655);
(e) Inspections of the facility
as described in OAR 411-050-0670; or
(f) Background checks as
described in OAR 411-050-0620.
(3) The local licensing authority
shall not grant a variance request to any rule that is inconsistent with Oregon
Revised Statutes.
(4) The local licensing authority
shall not grant a variance request related to fire and life safety without prior
consultation with the Department.
(5) In making a determination
to grant a variance, the local licensing authority must consider the licensee’s
history of compliance with rules governing adult foster homes or other long-term
care facilities for adults who are older or adults with physical disabilities in
Oregon and any other jurisdiction, if appropriate. The local licensing authority
must determine that the variance is consistent with the intent and purpose of these
rules prior to granting the variance. (See OAR 411-050-0600) The local licensing
authority must respond in writing within 30 days of receiving a request for a variance.
The written response must include the frequency of renewal.
(6) A variance is not effective
until granted in writing by the local licensing authority. Variances are reviewed
pursuant to these rules. If applicable, the licensee must re-apply for a variance
at the time of license renewal or more often if determined necessary by the local
licensing authority.
(7) In seeking a variance,
the burden of proof that the requirements of these rules have been met is upon the
applicant or licensee.
(8) If a variance to any
provision of these rules is denied, the applicant or licensee may request a meeting
with the local licensing authority.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0442,
SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14
411-050-0645
Operational Standards
(1) GENERAL PRACTICES.
(a) A licensee must own,
rent, or lease the home to be licensed, however, the local licensing authority may
grant a variance to churches, hospitals, non-profit associations, or similar organizations.
If a licensee rents or leases the premises where the adult foster home is located,
the licensee may not enter into a contract that requires anything other than a flat
rate for the lease or rental. A licensed provider of a building in which an adult
foster home is located may not allow the owner, landlord, or lessor to interfere
with the admission, transfer, or voluntary or involuntary move of any resident in
the adult foster home unless the owner, landlord, or lessor is named on the license.
(b) Each adult foster home
must meet:
(A) All applicable local
business license, zoning, building, and housing codes;
(B) The Fair Housing Act;
and
(C) State and local fire
and safety regulations for a single-family residence, and Oregon Fire Code, Appendix
L.
(c) ZONING. Adult foster
homes are subject to applicable sections of ORS 197.660 to 197.670.
(d) COOPERATION AND ACCESS.
The licensee must cooperate with the Department, Centers for Medicare and Medicaid
Services (CMS), and local licensing and investigative personnel in inspections,
complaint investigations, planning for resident care, application procedures, and
other necessary activities.
(A) Department, CMS, local
licensing, and investigative personnel must be provided access to all resident and
facility records and may conduct private interviews with residents.
(B) The State Long-Term Care
Ombudsman must be provided access to all resident and facility records. Deputy Ombudsman
and Certified Ombudsman Volunteers must be provided access to facility records and,
with written permission from the resident or the resident’s legal representative,
may have access to resident records. (See OAR 114-005-0030)
(e) CONFIDENTIALITY. Information
related to residents must be kept confidential, except as may be necessary in the
planning or provision of care or medical treatment, or related to an inspection,
investigation, or sanction action under these rules.
(f) TRANSPORTATION. A licensee
must arrange for or provide appropriate transportation for residents when needed.
(g) STAFFING STANDARDS. The
licensee must have qualified caregivers, including awake caregivers as necessary,
sufficient in number to meet the 24-hour needs of each resident in addition to caring
for any children or relatives beyond the license capacity of the adult foster home.
In addition, the licensee must comply with the following standards:
(A) A licensee may not employ
a resident manager, floating resident manager, or shift caregiver who does not meet
or exceed the qualifications, training, and classification standards for the adult
foster home as described in OAR 411-050-0625 and 411-050-0630.
(B) A licensee may not employ
or allow any caregiver to train or work in the home who is on either of the Exclusion
Lists.
(h) ABSENCE OF A PRIMARY
CAREGIVER. If a primary caregiver or a shift caregiver is absent from the home for
10 days or more, the licensee must notify the local licensing authority in writing
at least seven days prior to the primary caregiver's absence or immediately upon
knowing of the absence. Notification must state the reason for and anticipated length
of the absence. The licensee must also submit a staffing plan to the local licensing
authority, signed by the back-up provider, demonstrating coverage that meets the
needs of the residents during the primary caregiver's absence.
(i) CHANGE OF PRIMARY CAREGIVER.
If a primary caregiver or a shift caregiver changes during the period the license
covers, the licensee must notify the local licensing authority within 24 hours and
identify who is providing care.
(A) If a licensee assumes
the role as the primary caregiver or shift caregiver when there has been a change
in primary caregiver, the licensee must submit an updated plan of 24-hour coverage
to the local licensing authority within seven days.
(B) If a resident manager,
floating resident manager, or shift caregiver changes, the licensee must submit
a request for a change of resident manager, floating resident manager, or shift
caregiver, as applicable, to the local licensing authority along with:
(i) The Department’s
supplemental application form (SDS 448B) completed by the resident manager applicant,
floating resident manager applicant, or shift caregiver applicant;
(ii) A completed Health History
and Physician or Nurse Practitioner’s Statement (form SDS 903) for the new
applicant;
(iii) Documentation of the
initiation of or a copy of an approved background check; and
(iv) A $10 non-refundable
fee.
(C) When there is a change
in primary caregiver, an approved floating resident manager may assume the responsibilities
of the live-in, primary caregiver until a new primary caregiver is employed. If
a new primary caregiver is not employed within 60 calendar days, the floating resident
manager must be designated as the home’s resident manager and the licensee
must notify the local licensing authority of the change in status.
(D) The local licensing authority
shall issue a revised license when there is a change in a primary caregiver who
is identified on the license.
(j) UNEXPECTED AND URGENT
STAFFING NEED. If the local licensing authority determines an unexpected and urgent
staffing need exists, the local licensing authority may authorize a person who has
not completed the Department's current Ensuring Quality Care Course and passed the
current examination to act as a resident manager or shift caregiver until training
and testing are completed, or for 60 calendar days, whichever period is shorter.
The licensee must notify the local licensing authority of the unexpected and urgent
staffing need in writing and satisfactorily demonstrate:
(A) The licensee's inability
to live in the home and act as the primary caregiver;
(B) The licensee's inability
to find a qualified resident manager or shift caregiver, as applicable; and
(C) The proposed staff person
is 21 years of age and meets the requirements of a substitute caregiver for the
adult foster home as described in OAR 411-050-0625 and 411-050-0630.
(k) RESPONSIBILITY. A licensee
is responsible for the supervision, training, and overall conduct of all caregivers,
family members, and friends when acting within the scope of their employment, duties,
or when present in the home.
(l) SEXUAL ABUSE. Sexual
abuse, as defined in OAR 411-020-0002 (Adult Protective Services), is prohibited.
(m) COMMUNICATION.
(A) Applicants for an initial
license must obtain and provide to the local licensing authority a current, active
business address for electronic mail prior to obtaining a license.
(B) A licensee must notify
the local licensing authority within 24 hours upon a change in the home’s
business address for electronic mail.
(C) A licensee must notify
the local licensing authority, the residents and the resident’s family members,
legal representatives, and case managers, as applicable, of any change in the telephone
number for the licensee or the adult foster home within 24 hours of the change.
(D) A licensee must notify
the local licensing authority in writing prior to any change of the licensee's residence
or mailing address.
(2) SALE OR LEASE OF EXISTING
ADULT FOSTER HOMES AND TRANSFER OF LICENSES.
(a) A license is not transferable
and does not apply to any location or person other than the location and person
indicated on the license obtained from the local licensing authority.
(b) The licensee must inform
real estate agents, prospective buyers, lessees, and transferees in all written
communication, including advertising and disclosure statements, that the license
to operate the adult foster home is not transferable and the licensee must refer
them to the local licensing authority for information about licensing.
(c) When a home is to be
sold or otherwise transferred or conveyed to another person who intends to operate
the home as an adult foster home, that person must apply for and obtain a license
from the local licensing authority prior to the transfer of operation of the home.
(d) The licensee must promptly
notify the local licensing authority in writing about the licensee’s intent
to close or convey the adult foster home to another person. The licensee must provide
written notice to the residents and the residents' representatives and case managers,
as applicable, according to section (13) of this rule.
(e) The licensee must inform
a person intending to assume operation of an existing adult foster home that the
residents currently residing in the home must be given at least 30 calendar days’
written notice of the licensee’s intent to close the adult foster home for
the purpose of conveying the home to another person.
(f) The licensee must remain
licensed and responsible for the operation of the home and care of the residents
in accordance with these rules until the home is closed and the residents have been
relocated, or the home is conveyed to a new licensee who is licensed by the local
licensing authority at a level appropriate to the care needs of the residents in
the home.
(3) FORECLOSURE.
(a) A licensee must provide
written notification to the local licensing authority within 10 calendar days after
receipt of any notice of default, or any notice of potential default, with respect
to a real estate contract, trust deed, mortgage, or other security interest affecting
any property occupied or used by the licensee.
(b) The licensee must provide
a copy of the notice of default or warning of potential default to the local licensing
authority.
(c) The licensee must provide
written updates to the local licensing authority at least every 30 days until the
default or warning of potential default has been resolved and no additional defaults
or potential defaults have been declared and no additional warnings have been issued.
Written updates must include:
(A) The current status on
what action has been or is about to be taken by the licensee with respect to the
notice received;
(B) The action demanded or
threatened by the holder of the security interest; and
(C) Any other information
reasonably requested by the local licensing authority.
(d) The licensee must provide
written notification within 24 hours to the local licensing authority upon final
resolution of the matters leading up to or encompassed by the notice of default
or the notice warning of potential default.
(e) If the subject default
property is licensed as an adult foster home, the licensee must provide written
notification of the following within 24 hours to the local licensing authority,
and all the residents and the residents' representatives, if applicable, regarding:
(A) The filing of any litigation
regarding such security interest, including the filing of a bankruptcy petition
by or against the licensee or an entity owning any property occupied or used by
the licensee;
(B) The entry of any judgment
with respect to such litigation;
(C) The passing of the date
40 days prior to any sale scheduled pursuant to the exercise of legal rights under
a security interest, or a settlement or compromise related thereto, of the licensee’s
property or property occupied or used by the licensee; and
(D) The sale, pursuant to
the exercise of legal rights under a security interest, or a settlement or compromise
related thereto, of the licensee’s property or property occupied or used by
the licensee.
(4) MEALS.
(a) Three nutritious meals
must be served daily at times consistent with those in the community. Each meal
must include food from the basic food groups according to the United States Department
of Agriculture (USDA’s) My Plate and include fresh fruit and vegetables when
in season.
(b) Meals must reflect consideration
of a resident's preferences and cultural and ethnic background. This does not mean
the licensee must prepare multiple, unique meals for the residents at the same time.
(c) A schedule of meal times
and menus for the coming week must be prepared and posted weekly in a location accessible
to residents and families.
(A) Meal substitutions for
scheduled menu items in compliance with section (4)(a) of this rule are acceptable
and must be documented on, or attached to, the weekly menu.
(B) The licensee must maintain
the weekly menus for a minimum of the 12 most recent months during which the home
has conducted business.
(d) There must be no more
than a 14-hour span between the evening and morning meals. Snacks do not substitute
for a meal in determining the 14-hour span. Nutritious snacks and liquids must be
offered to fulfill each resident's nutritional requirements.
(e) Food may not be used
as an inducement to control the behavior of a resident.
(f) Home-canned foods must
be processed according to the guidelines of the Oregon State University Extension
Service. Freezing is the most acceptable method of food preservation. Milk must
be pasteurized.
(g) Special consideration
must be given to a resident with chewing difficulties or other eating limitations.
Special diets must be followed, as prescribed in writing, by the resident's physician,
nurse practitioner, or physician assistant.
(h) Adequate storage must
be available to maintain food at a proper temperature, including a properly working
refrigerator. Storage and food preparation areas must be free from food that is
spoiled or expired.
(i) The household utensils,
dishes, glassware, and household food may not be stored in bedrooms, bathrooms,
or living areas.
(j) Meals must be prepared
and served in the home where the residents live. Payment for meals eaten away from
the home for the convenience of the licensee (e.g., restaurants, senior meal sites)
is the responsibility of the licensee. Meals and snacks, as part of an individual
recreational outing by choice, are the responsibility of the resident.
(k) Utensils, dishes, and
glassware must be washed in hot soapy water, rinsed, and stored to prevent contamination.
A dishwasher with a sani-cycle is recommended.
(l) Food preparation areas
and equipment, including utensils and appliances, must be clean, free of offensive
odors, and in good repair.
(5) TELEPHONE.
(a) The home must have a
working landline and corded telephone with a listed number that is separate from
any other number the home has, such as, but not limited to, internet or fax lines,
unless the system includes features that notify the caregiver of an incoming call,
or automatically switches to the appropriate mode. If a licensee has a caller identification
service on the home number, the blocking feature must be disabled to allow incoming
calls to be received unhindered. A licensee may have only one phone line as long
as the phone line complies with the requirements of these rules. Voice over internet
protocol (VoIP), voice over broadband (VoBB), or cellular telephone service may
not be used in place of a landline.
(b) The licensee must make
a telephone that is in good working order available and accessible for the residents
use with reasonable accommodation for privacy during telephone conversations. A
resident with a hearing impairment, to the extent the resident may not hear a normal
telephone conversation, must be provided with a telephone that is amplified with
a volume control or a telephone that is hearing aid compatible.
(c) Restrictions on the use
of the telephone by the residents must be specified in the written house policies
and may not violate the residents' rights. Individual restrictions must be well
documented in the resident's care plan.
(6) FACILITY RECORDS.
(a) Facility records must
be kept current, maintained in the adult foster home, and made available for review
upon request. Facility records include, but are not limited to:
(A) Proof the licensee and
all subject individuals have a background check approved by the Department as required
by OAR 411-050-0620;
(B) Proof the licensee and
all other caregivers have met and maintained the minimum qualifications as required
by OAR 411-050-0625, including:
(i) Proof of required continuing
education. Documentation must include the date of each training, subject matter,
name of agency or organization providing the training, and number of Department-approved
classroom hours;
(ii) Completed certificates
to document the substitute caregivers’ completion of the Department’s
Caregiver Preparatory Training Study Guide and Workbook and to document the resident
manager, floating resident manager, and shift caregivers, as applicable, completion
and passing of the Department’s Ensuring Quality Care Course and examination;
(iii) Documentation of orientation
to the adult foster home for the resident manager, floating resident manager, shift
caregivers, and substitute caregivers, as applicable;
(iv) Employment applications
and the names, addresses, and telephone numbers of all caregivers employed or used
by the licensee; and
(v) Verification that all
caregivers are not listed on either of the Exclusion Lists.
(C) Copies of notices sent
to the local licensing authority pertaining to changes in the resident manager,
floating resident manager, shift caregiver, or other primary caregiver;
(D) Proof of required vaccinations
for animals on the premises;
(E) Well water tests, if
required, according to OAR 411-050-0650. Test records must be retained for a minimum
of three years;
(F) Agreements and specialized
contracts with the Department, copies of the adult foster home’s private-pay
contracts, any contracts with residents eligible for Medicaid services, such as
an agreement pertaining to storage fees after leaving the home, and any other contracts,
such as contracts with room and board tenants or individuals receiving day care
services; and
(G) Records of evacuation
drills according to OAR 411-050-0650, including the date, time of day, evacuation
route, length of time for evacuation of all occupants, names of all residents and
occupants, and which residents and occupants required assistance. The records must
be kept at least three years.
(b) REQUIRED POSTED ITEMS.
The following items must be posted in one location in the entryway or other equally
prominent place in the home where residents, visitors, and others may easily read
them:
(A) The adult foster home
license;
(B) Conditions attached to
the license, if any;
(C) A copy of a current floor
plan meeting the requirements of OAR 411-050-0650;
(D) The Residents’
Bill of Rights;
(E) The home’s current
house policies that have been reviewed and approved by the local licensing authority;
(F) The Department’s
procedure for making complaints;
(G) The Long-Term Care Ombudsman
poster;
(H) The Department’s
inspection forms (form SDS 517A and, if applicable, form SDS 517B), including how
corrections were made since the last annual inspection;
(I) The Department’s
notice pertaining to the use of any intercoms, monitoring devices, and video cameras
that may be used in the adult foster home; and
(J) A weekly menu according
to section (4) of this rule.
(c) POST BY PHONE. Emergency
telephone numbers, including the contact number for at least one back-up provider
who has agreed to respond in person in the event of an emergency and an emergency
contact number for the licensee must be readily visible and posted by a central
telephone in the adult foster home.
(7) RESIDENT RECORDS.
(a) An individual resident
record must be developed, kept current, and readily accessible on the premises of
the home for each individual admitted to the adult foster home. The record must
be legible and kept in an organized manner so as to be utilized by staff. The record
must contain the following information:
(A) A complete initial screening
assessment and general information form (SDS 902) as described in OAR 411-050-0655;
(B) Documentation on form
SDS 913 that the licensee has informed private-pay residents of the availability
of a long-term care assessment;
(C) Documentation that the
licensee has informed all residents of the right to formulate an Advance Directive;
(D) FINANCIAL INFORMATION:
(i) Detailed records and
receipts if the licensee manages or handles a resident’s money. The Resident
Account Record (form SDS 713) or other expenditure forms may be used if the licensee
manages or handles a resident’s money. The record must show amounts and sources
of funds received and issued to, or on behalf of, the resident and be initialed
by the person making the entry. Receipts must document all deposits and purchases
of $5 or more made on behalf of a resident.
(ii) Contracts signed by
residents or the residents' representatives may be kept in a separate file but must
be made available for inspection by the local licensing authority.
(E) Medical and legal information,
including, but not limited to:
(i) Medical history, if available;
(ii) Current prescribing
practitioner orders;
(iii) Nursing instructions,
delegations, and assessments, as applicable;
(iv) Completed medication
administration records retained for at least the last six months or from the date
of admission, whichever is less. (Older records may be stored separately); and
(v) Copies of Guardianship,
Conservatorship, Advance Directive for Health Care, Power of Attorney, and Physician’s
Order for Life Sustaining Treatment (POLST) documents, as applicable.
(F) A complete, accurate,
and current care plan;
(G) A copy of the current
house policies and the current Residents' Bill of Rights, signed and dated by the
resident or the resident's representative;
(H) SIGNIFICANT EVENTS. A
written report (using form SDS 344 or its equivalent) of all significant incidents
relating to the health or safety of the resident, including how and when the incident
occurred, who was involved, what action was taken by the licensee and staff, as
applicable, and the outcome to the resident;
(I) NARRATIVE OF RESIDENT'S
PROGRESS. Narrative entries describing each resident's progress must be documented
at least weekly and maintained in each resident’s individual record. All entries
must be signed and dated by the person writing them; and
(J) Non-confidential information
or correspondence pertaining to the care needs of the resident.
(b) ACCESS TO RESIDENT RECORDS.
(A) Resident records must
be readily available at the adult foster home to residents, the residents' authorized
representatives or other legally authorized persons, all caregivers working in the
home, and the Department, the local licensing authority, the investigative authority,
case managers, and the Centers for Medicare and Medicaid Services (CMS) for the
purpose of conducting inspections or investigations.
(B) The State Long-Term Care
Ombudsman must be provided access to all resident and facility records. A Deputy
Ombudsman and Certified Ombudsman Volunteers must be provided access to facility
records relevant to caregiving and resident records with written permission from
the resident or the resident's legal representative. (See OAR 114-005-0030)
(c) RECORD RETENTION. Records,
including any financial records for residents, must be kept for a period of three
years from the date the resident left the home.
(d) CONFIDENTIALITY. In all
other matters pertaining to confidential records and release of information, licensees
must be guided by the principles and definitions described in OAR chapter 411, division
005 (Privacy of Protected Information).
(8) HOUSE POLICIES. House
policies must be in writing and a copy given to the resident and the resident’s
family or representative at the time of admission and at the time the screening
and assessment is conducted. A signed copy of the house policies must be obtained
at the time of admission and placed in the resident’s record. House policies
must be consistent with the practices of the licensee, staff, occupants, and visitors
of the home. House policies established by the licensee must:
(a) Include any restrictions
the adult foster home may have on the use of alcohol, tobacco, pets, visiting hours,
dietary restrictions, or religious preferences;
(b) Indicate the home’s
policy regarding the presence and use of legal marijuana on the premises;
(c) Include a schedule of
meal times;
(d) Include the home’s
policy regarding refunds for residents eligible for Medicaid services, including
pro-rating partial months and if the room and board is refundable;
(e) Include a clear and precise
statement of any limitation to the implementation of Advance Directives on the basis
of conscience. This rule does not apply to medical professional or hospice orders
for administration of medications. The statement must include:
(A) A description of conscientious
objections as they apply to all occupants of the adult foster home;
(B) The legal authority permitting
such objections under ORS 127.505 to 127.660; and
(C) Description of the range
of medical conditions or procedures affected by the conscientious objection. (See
OAR 411-050-0655)
(f) Not be in conflict with
the Residents’ Bill of Rights, the family atmosphere of the home, or any of
these rules;
(g) Be reviewed and approved
by the local licensing authority prior to the issuance of a license and prior to
implementing any changes; and
(h) Be posted with the required
posted items, in a location where they are easily seen and read by residents and
visitors as described in section (6) of this rule.
(9) RESIDENT MOVES AND TRANSFERS.
The Department encourages licensees to support a resident’s choice to remain
in his or her living environment while recognizing that some residents may no longer
be appropriate for the adult foster care setting due to safety and medical limitations.
(a) If a resident moves out
of an adult foster home for any reason, the licensee must submit copies of pertinent
information from the resident’s record to the resident’s new place of
residence at the time of move. Pertinent information must include at a minimum:
(A) Copies of current prescribing
medical practitioner’s orders for medications, current medication sheets,
and an updated care plan; and
(B) Documentation of actions
taken by the adult foster home staff, resident, or the resident’s representative
pertaining to the move or transfer.
(b) A licensee must immediately
document voluntary and involuntary moves or transfers from the adult foster home
in the resident's record as events take place. (See sections (11) and (12) of this
rule)
(10) VOLUNTARY MOVES AND
TRANSFERS.
(a) If a resident eligible
for Medicaid services or the resident's representative gives notice of the resident's
intent to leave the adult foster home, or the resident leaves the home abruptly,
the licensee must promptly notify the resident's case manager.
(b) A licensee must obtain
prior authorization from the resident, the resident’s legal representative,
and case manager, as applicable, prior to the resident’s:
(A) Voluntary move from one
bedroom to another in the adult foster home;
(B) Voluntary transfer from
one adult foster home to another home that has a license issued to the same person;
or
(C) Voluntary move to any
other location.
(c) Notifications and authorizations
of voluntary moves and transfers must be documented and available in the resident’s
record.
(d) The licensee remains
responsible for the provision of care and services until the resident has moved
from the home.
(11) INVOLUNTARY MOVES AND
TRANSFERS.
(a) A resident may only be
moved involuntarily to another room within the adult foster home, transferred to
another adult foster home operated by the same licensee for a temporary or permanent
stay, or moved from the adult foster home for the following reasons:
(A) Medical reasons. The
resident has a medical or nursing condition that is complex, unstable, or unpredictable
that exceeds the level of care and services the facility provides;
(B) The adult foster home
is unable to accomplish evacuation of the adult foster home in accordance with OAR
411-050-0650;
(C) Welfare of the resident
or other residents;
(i) The resident exhibits
behavior that poses an imminent danger to self or others, including acts that result
in the resident’s arrest or detention;
(ii) The resident engages
in behavior or action that repeatedly and substantially interfere with the rights,
health, or safety of the residents or others; or
(iii) The resident engages
in illegal drug use or commits a criminal act that causes potential harm to the
resident or others.
(D) Failure to make payment
for care or failure to make payment for room and board;
(E) The adult foster home
has had its license revoked, not renewed, or the license was voluntarily surrendered
by the licensee;
(F) The home was not notified
prior to the resident’s admission, or learns following the resident’s
admission, that the resident is on probation, parole, or post-prison supervision
after being convicted of a sex crime defined in ORS 181.805;
(G) The licensee’s
Medicaid Provider Enrollment Agreement or specialized contract is terminated (pertains
only to residents eligible for Medicaid); or
(H) The resident engages
in the use of medical marijuana in violation of the home's written policies or contrary
to Oregon Law under the Oregon Medical Marijuana Act, ORS 475.300 to 475.346.
(b) MANDATORY WRITTEN NOTICE.
A resident may not be moved involuntarily from the adult foster home, or to another
room within the adult foster home, or transferred to another adult foster home for
a temporary or permanent stay without a minimum of 30 calendar days' written notice.
The notice must be delivered in person to the resident and must be delivered in
person or sent by registered or certified mail to the resident's legal representative,
guardian, or conservator, and a copy must be immediately submitted to the resident’s
case manager, as applicable. Where a resident lacks capacity and there is no legal
representative, a copy of the notice must be immediately submitted to the State
Long Term Care Ombudsman. The written notice must:
(A) Be on the Department’s
Notice of Involuntary Move or Transfer of Resident form (SDS 901);
(B) Be completed by the licensee;
and
(C) Include the following
information:
(i) The resident’s
name;
(ii) The reason for the proposed
move or transfer, including the specific reasons the facility is unable to meet
the resident's needs;
(iii) The date of the proposed
change;
(iv) The location to which
the resident is going, if known;
(v) A notice of the right
to hold an informal conference and hearing;
(vi) The name, address, and
telephone number of the person giving the notice; and
(vii) The date the notice
is issued.
(c) LESS THAN 30 DAYS' WRITTEN
NOTICE. A licensee may give less than 30 calendar days’ written notice in
specific circumstances as identified in paragraphs (A) to (C) below, but must do
so as soon as possible using the Department’s Notice of Involuntary Move or
Transfer of Resident form (SDS 901). The notice must be given in person to the resident,
the resident’s representative, guardian, conservator, and a copy must be immediately
submitted to the resident’s case manager, as applicable. The reasons for the
notice must be fully documented in the resident’s record. The licensee remains
responsible for the provision of care and services until the resident has moved
from the home. A licensee may give less than 30 calendar days’ notice only
if:
(A) Undue delay in moving
the resident would jeopardize the health, safety, or well-being of the resident,
including:
(i) The resident has a medical
emergency that requires the immediate care of a level or type the adult foster home
is unable to provide.
(ii) The resident exhibits
behavior that poses an immediate danger to self or others.
(B) The resident is hospitalized
or is temporarily out of the home and the licensee determines he or she is no longer
able to meet the needs of the resident; or
(C) The home was not notified
prior to the resident’s admission, or learns following the resident’s
admission, the resident is on probation, parole, or post-prison supervision after
being convicted of a sex crime defined in ORS 181.805.
(i) In the event a resident
is given notice of an involuntary move due to (11)(c)(C) of this rule, the notice
may be given without reasonable advance notice.
(ii) The resident shall be
given the Department’s Notice of Involuntary Move or Transfer of Resident
form (SDS 901) as stated in (11) of this rule.
(12) RESIDENT HEARING RIGHTS.
A resident, who has been given formal notice of an involuntary move or refused the
right of return or re-admission, is entitled to an informal conference and hearing
prior to the involuntary move or transfer as follows:
(a) INFORMAL CONFERENCE.
The local licensing authority must hold an informal conference as promptly as possible
after the request is received. The local licensing authority must send written notice
of the time and place of the conference to the licensee and all persons entitled
to the notice. Participants may include the resident and at the resident's request
a family member, case manager, Ombudsman, legal representative of the resident,
the licensee, and a representative from an adult foster home association or SEIU
if requested by the licensee. The purpose of the informal conference is to resolve
the matter without an administrative hearing. If a resolution is reached at the
informal conference, the local licensing authority must document the outcome in
writing and no administrative hearing is needed.
(b) ADMINISTRATIVE HEARING.
If a resolution is not reached as a result of the informal conference, the resident
or the resident’s representative may request an administrative hearing. If
the resident is being moved or transferred with less than 30 calendar days’
notice according to section (11)(c) of this rule, the hearing must be held within
seven business days of the move or transfer. The licensee must hold a space available
for the resident pending receipt of an administrative order. These administrative
rules and ORS 441.605(4) governing transfer notices and hearings for residents of
long-term care facilities apply to adult foster homes.
(13) CLOSURE OF ADULT FOSTER
HOMES.
(a) A licensee must notify
the local licensing authority prior to the voluntary closure, proposed sale, or
transfer of ownership of the home, and give the residents and the residents' families,
representatives, and case managers, as appropriate, a minimum of 30 calendar days'
written notice on the Department’s form (SDS 901) according to section (11)
of this rule.
(b) In circumstances where
undue delay might jeopardize the health, safety, or well-being of residents, licensees,
or staff, written notice must be given as soon as possible, according to section
(11)(c).
(c) A licensee must surrender
the physical license to operate an adult foster home to the local licensing authority
at the time of the adult foster home's closure.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.705-795, 443.880
Stats. Implemented: ORS 197.660-670,
441.373, 443.001-004, 443.705-825, 443.875, 443.991
Hist.: SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0644, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14; APD 50-2014(Temp),
f. 12-31-14, cert. ef. 1-1-15 thru 6-29-15; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0650
Facility and Safety Standards
In order to qualify for or maintain
a license, an adult foster home must comply with the following provisions:
(1) GENERAL CONDITIONS.
(a) INTERIOR AND EXTERIOR
PREMISES. The building and furnishings, patios, decks, and walkways, as applicable,
must be clean and in good repair. The interior and exterior premises must be well
maintained and accessible according to the individual needs of the residents. There
must be no accumulation of garbage, debris, rubbish, or offensive odors. Walls,
ceilings, and floors must be of such character to permit washing, cleaning, or painting,
as appropriate.
(b) ADDRESS. The address
numbers of the adult foster home must be placed on the home in a position that is
legible and clearly visible from the street or road fronting the property. Address
numbers must be a minimum of 4 inches in height, made of reflective material, and
contrast with their background.
(c) LIGHTING. Adequate lighting,
based on the needs of the occupants, must be provided in each room, stairway, and
exit way. Incandescent light bulbs and florescent tubes must be protected with appropriate
covers.
(d) TEMPERATURE. The heating
system must be in working order. Areas of the home used by the residents must be
maintained at a comfortable temperature. Minimum temperatures during the day must
be not less than 68 degrees, no greater than 85 degrees, and not less than 60 degrees
during sleeping hours. Variations from the requirements of this rule must be based
on resident care needs or preferences and must be addressed in each resident's care
plan.
(A) During times of extreme
summer heat, the licensee must make reasonable effort to keep the residents comfortable
using ventilation, fans, or air conditioning. Precautions must be taken to prevent
resident exposure to stale, non-circulating air.
(B) If the facility is air-conditioned,
the system must be functional and the filters must be cleaned or changed as needed
to ensure proper maintenance.
(C) If the licensee is unable
to maintain a comfortable temperature for the residents during times of extreme
summer heat, air conditioning or another cooling system may be required.
(e) COMMON USE AREAS. Common
use areas for the residents must be accessible to all residents. There must be at
least 150 square feet of common living space and sufficient furniture in the home
to accommodate the recreational and socialization needs of all the occupants at
one time. Common space may not be located in an unfinished basement or garage unless
such space was constructed for that purpose or has otherwise been legalized under
permit. There may be additional space required if wheelchairs are to be accommodated.
An additional 40 square feet of common living space is required for each day care
individual, room and board tenant, or relative receiving care for remuneration that
exceeds the limit of five.
(f) VIDEO MONITORS. Use of
video monitors detracts from a home-like environment and the licensee may not use
video monitors in any area of the home that would violate a resident’s privacy
unless requested by the resident or the resident's legal representative. The licensee
may not ask the resident or the resident's legal representative to waive the resident’s
right to privacy as a condition of admission to the home.
(2) SANITATION AND PRECAUTIONS.
(a) NON-MUNICIPAL WATER SOURCE.
A public water supply must be utilized if available. If a non-municipal water source
is used, the licensor, a sanitarian, or a technician from a certified water-testing
laboratory must collect a sample annually or as required by the Department. The
water sample must be tested for coliform bacteria. Water testing and any necessary
corrective action to ensure water is suitable for drinking must be completed at
the licensee’s expense. Water testing records must be retained for three years.
(b) Septic tanks or other
non-municipal sewage disposal systems must be in good working order.
(c) COMMODES AND INCONTINENCE
GARMENTS. Commodes used by residents must be emptied frequently and cleaned daily,
or more frequently if necessary. Incontinence garments must be disposed of in closed
containers.
(d) WATER TEMPERATURE. A
resident who is unable to safely regulate the water temperature must be supervised.
(e) LAUNDRY. Prior to laundering,
soiled linens and clothing must be stored in closed containers in an area that is
separate from food storage, kitchen, and dining areas. Pre-wash attention must be
given to soiled and wet bed linens. Sheets and pillowcases must be laundered at
least weekly and more often if soiled.
(f) Garbage and refuse must
be suitably stored in readily cleanable, rodent-proof, covered containers, pending
weekly removal.
(g) VENTILATION. All doors
and windows that are used for ventilation must have screens in good condition.
(h) INFECTION CONTROL. Standard
precautions for infection control must be followed in resident care. Hands and other
skin surfaces must be washed immediately and thoroughly if contaminated with blood
or other body fluids.
(i) DISPOSAL OF SHARPS. Precautions
must be taken to prevent injuries caused by needles, scalpels, and other sharp instruments
or devices during procedures. The puncture-resistant container must be located as
close as practical to the use area. Disposal must be made according to local regulations
as stated in section (5) of this rule. (See 459.386 to 459.405)
(j) FIRST AID. Current, basic
first-aid supplies and a first-aid manual must be readily available in the home.
(k) PESTS. Reasonable precautions
must be taken to prevent pests (e.g., ants, cockroaches, other insects, and rodents).
(l) PETS OR OTHER ANIMALS.
Sanitation for household pets and other domestic animals on the premises must be
adequate to prevent health hazards. Proof of rabies vaccinations and any other vaccinations
that are required for the pet by a licensed veterinarian must be maintained on the
premises. Pets not confined in enclosures must be under control and not present
a danger to the residents or guests.
(m) SAFETY BARRIERS. Patios,
decks, walkways, swimming pools, hot tubs, spas, saunas, water features, and stairways,
as appropriate, must be equipped with safety barriers designed to prevent injury.
Resident access to or use of swimming or other pools, hot tubs, spas, or saunas
on the premises must be supervised.
(3) BATHROOMS. Bathrooms
must:
(a) Provide individual privacy
and have a finished interior with a door that opens to a hall or common-use room.
If a bedroom includes a private bathroom, the door for the private bathroom must
open to the bedroom. No person must have to walk through another person's bedroom
to access a bathroom;
(b) Be large enough to accommodate
the individual needs of the residents and any equipment that may be necessary;
(c) Have a mirror, a window
that opens or other means of ventilation, and a window covering for privacy;
(d) Be clean and free of
objectionable odors;
(e) Have bathtubs, showers,
toilets, and sinks in good repair. A sink must be located near each toilet and a
toilet and sink must be available for the resident’s use on each floor with
resident rooms. There must be at least one toilet, one sink, and one bathtub or
shower for each six household occupants (including residents, day care individuals,
room and board tenants, the licensee, and the licensee’s family);
(f) Have hot and cold water
at each bathtub, shower, and sink in sufficient supply to meet the needs of the
residents;
(g) Have nonporous surfaces
for shower enclosures. Glass shower doors, if applicable, must be tempered safety
glass, otherwise, shower curtains must be clean and in good condition;
(h) Have non-slip floor surfaces
in bathtubs and showers;
(i) Have grab bars for each
toilet, bathtub, and shower to be used by the residents for safety;
(j) Have barrier-free access
to toilet and bathing facilities; and
(k) Have adequate supplies
of toilet paper and soap supplied by the licensee. Residents must be provided with
individual towels and washcloths that are laundered in hot water at least weekly
or more often if necessary. Residents must have appropriate racks or hooks for drying
bath linens. If individual hand towels are not provided, roller-dispensed hand towels
or paper towels in a dispenser must be provided for the residents' use.
(4) BEDROOMS.
(a) Bedrooms for all household
occupants must:
(A) Have been constructed
as a bedroom when the home was built, or remodeled under permit;
(B) Be finished with walls
or partitions of standard construction that go from floor to ceiling;
(C) Have a door that opens
directly to a hallway or common use room without passage through another bedroom
or common bathroom. The bedroom door must be large enough to accommodate the occupant
of the room and any mobility equipment that may be needed by the resident;
(D) Be adequately ventilated,
heated, and lighted with at least one window that opens and meets the requirements
in section (5)(e) of this rule;
(E) Be at least 70 square
feet of usable floor space for one resident or 120 square feet for two residents
excluding any area where a sloped ceiling does not allow a person to stand upright;
and
(F) Have no more than two
occupants per room. (See also OAR 411-050-0632 pertaining to a child’s bedroom.)
This rule is not intended to prohibit a child five years of age or younger from
occupying their parent’s bedroom.
(b) The licensee, any other
caregivers, and family members may not sleep in areas designated as living areas
or share a bedroom with a resident. This rule is not intended to prohibit a caregiver
or other person of the resident’s choosing from temporarily staying in the
resident’s room when required by the resident’s condition.
(c) There must be a bed at
least 36 inches wide for each resident consisting of a mattress and springs, or
equivalent, in good condition. Cots, rollaways, bunks, trundles, daybeds with restricted
access, couches, and folding beds may not be used for residents. Each bed must have
clean bedding in good condition consisting of a bedspread, mattress pad, two sheets,
a pillow, a pillowcase, and blankets adequate for the weather. Waterproof mattress
covers must be used for incontinent residents. Day care individuals may use a cot
or rollaway bed if bedroom space is available that meets the requirements of section
(4)(a) of this rule. A resident's bed may not be used by a day care individual.
(d) Each resident’s
bedroom must have separate, private dresser and closet space sufficient for the
resident's clothing and personal effects including hygiene and grooming supplies.
A resident must be provided private, secure storage space to keep and use reasonable
amounts of personal belongings. A licensee may not use a resident’s bedroom
for storage of items, supplies, devices, or appliances that do not belong to the
resident.
(e) Drapes or shades for
bedroom windows must be in good condition and allow privacy for the residents.
(f) A resident who is non-ambulatory,
has impaired mobility, or is cognitively impaired must have a bedroom with a safe,
second exit at ground level. A resident with a bedroom above or below the ground
floor must demonstrate their capability for self-preservation.
(g) Resident bedrooms must
be in close enough proximity to the licensee or caregiver in charge to alert the
licensee or caregiver in charge to resident nighttime needs or emergencies, or the
bedrooms must be equipped with a functional call bell or intercom within the residents'
abilities to operate. Intercoms may not violate the resident's right to privacy
and must have the capability of being turned off by the resident or at the resident's
request.
(h) Bedrooms used by the
licensee, resident manager, shift caregiver, and substitute caregiver, as applicable,
must be located in the adult foster home and must have direct access to the residents
through an interior hallway or common use room.
(5) SAFETY.
(a) FIRE AND LIFE SAFETY.
Buildings must meet all applicable state and local building, mechanical, and housing
codes for fire and life safety. The home may be inspected for fire safety by the
State Fire Marshal's Office, or the State Fire Marshal’s designee, at the
request of the local licensing authority or the Department using the standards in
these rules, as appropriate.
(b) HEAT SOURCES. All heating
equipment including, but not limited to, wood stoves, pellet stoves, and fireplaces
must be installed in accordance with all applicable state and local building and
mechanical codes. Heating equipment must be in good repair, used properly, and maintained
according to the manufacturer’s or a qualified inspector's recommendations.
(A) A licensee who does not
have a permit verifying proper installation of an existing woodstove, pellet stove,
or gas fireplace must have it inspected by a qualified inspector, Certified Oregon
Chimney Sweep Association member, or Oregon Hearth, Patio, and Barbeque Association
member and follow their recommended maintenance schedule.
(B) Fireplaces must have
approved and listed protective glass screens or metal mesh screens anchored to the
top and bottom of the fireplace opening.
(C) The local licensing authority
may require the installation of a non-combustible, heat-resistant, safety barrier
36 inches around a woodstove to prevent residents with ambulation or confusion problems
from coming in contact with the stove.
(D) Unvented, portable oil,
gas, or kerosene heaters are prohibited. Sealed electric transfer heaters or electric
space heaters with tip-over, shut-off capability may be used when approved by the
State Fire Marshal or the State Fire Marshal's designee. A heater must be directly
connected to an electrical outlet and may not be connected to an extension cord.
(c) EXTENSION CORDS AND ADAPTORS.
Extension cord wiring and multi-plug adaptors may not be used in place of permanent
wiring. UL-approved, re-locatable power taps (RPTs) with circuit breaker protection
and no more than six electrical sockets are permitted for indoor use only and must
be installed and used in accordance with the manufacturer’s instructions.
If RPTs are used, the RPT must be directly connected to an electrical outlet, never
connected to another RPT (known as daisy-chaining or piggy-backing), and never connected
to an extension cord.
(d) LOCKS AND ALARMS. Hardware
for all exit doors and interior doors must be readily visible, have simple hardware
that may not be locked against exit, and have an obvious method of operation. Hasps,
sliding bolts, hooks and eyes, slide chain locks, and double key deadbolts are not
permitted. If a home has a resident with impaired judgment who is known to wander
away, the home must have an activated alarm system to alert a caregiver of the resident's
unsupervised exit.
(e) WINDOWS. Bedrooms must
have at least one window or exterior door that leads directly outside, readily opens
from the inside without special tools, and provides a clear opening of not less
than 821 square inches (5.7 sq. ft.), with the least dimensions not less than 24
inches in height or 20 inches in width. If the interior sill height of the window
is more than 44 inches from the floor level, approved steps or other aids to the
window exit that the occupants are capable of using must be provided. Windows with
a clear opening of not less than 5.0 square feet or 720 square inches with interior
sill heights of no more than 48 inches above the floor may be accepted when approved
by the State Fire Marshal or the State Fire Marshal's designee.
(f) CONSTRUCTION. Interior
and exterior doorways must be wide enough to accommodate the mobility equipment
used by the residents such as wheelchairs and walkers. All interior and exterior
stairways must be unobstructed, equipped with handrails on both sides, and appropriate
to the condition of the residents. (See also section (5)(q) of this rule)
(A) Buildings must be of
sound construction with wall and ceiling flame spread rates at least substantially
comparable to wood lath and plaster or better. The maximum flame spread index of
finished materials may not exceed 200 and the smoke developed index may not be greater
than 450. If more than 10 percent of combined wall and ceiling areas in a sleeping
room or exit way is composed of readily combustible material such as acoustical
tile or wood paneling, such material must be treated with an approved flame retardant
coating. Exception: Buildings supplied with an approved automatic sprinkler system.
(i) MANUFACTURED HOMES. A
manufactured home (formerly mobile homes) must have been built since 1976 and designed
for use as a home rather than a travel trailer. The manufactured home must have
a manufacturer's label permanently affixed on the unit itself that states the manufactured
home meets the requirements of the Department of Housing and Urban Development (HUD).
The required label must read as follows:
"As evidenced by this label
No. ABC000001, the manufacturer certifies to the best of the manufacturer's knowledge
and belief that this mobile home has been inspected in accordance with the requirements
of the Department of Housing and Urban Development and is constructed in conformance
with the Federal Mobile Home Construction and Safety Standards in effect on the
date of manufacture. See date plate."
(ii) If such a label is not
evident and the licensee believes the manufactured home meets the required specifications,
the licensee must take the necessary steps to secure and provide verification of
compliance from the home's manufacturer.
(iii) Manufactured homes
built since 1976 meet the flame spread rate requirements and do not have to have
paneling treated with a flame retardant coating.
(B) STRUCTURAL CHANGES. The
licensee must notify the local licensing authority in writing at least 15 calendar
days prior to any remodeling, renovations, or structural changes in the home that
require a building permit. Such activity must comply with local building, sanitation,
utility, and fire code requirements applicable to a single-family dwelling (see
ORS 443.760(1)). The licensee must forward all required permits and inspections,
an evacuation plan as described in section (5)(l) of this rule, and a revised floor
plan as described in section (5)(o) of this rule to the local licensing authority
within 30 calendar days of completion.
(g) FIRE EXTINGUISHERS. At
least one fire extinguisher with a minimum classification of 2-A:10-B:C must be
mounted in a location visible and readily accessible to any occupant of the home
on each floor, including basements. Fire extinguishers must be checked at least
once a year by a qualified person who is well versed in fire extinguisher maintenance.
All recharging and hydrostatic testing must be completed by a qualified agency properly
trained and equipped for this purpose.
(h) CARBON MONOXIDE AND SMOKE
ALARMS.
(A) CARBON MONOXIDE ALARMS.
Carbon monoxide alarms must be listed as complying with ANSI/UL 2034 and must be
installed and maintained in accordance with the manufacturer's instructions. Carbon
monoxide alarms must be installed within 15 feet of each bedroom at the height recommended
by the manufacturer.
(i) If bedrooms are located
in multi-level homes, carbon monoxide alarms must be installed on each level including
the basement.
(ii) Carbon monoxide alarms
may be hard-wired, plug-in, or battery operated. Hard wired and plug-in alarms must
be equipped with a battery back-up. Battery operated carbon monoxide alarms must
be equipped with a device that warns of a low battery.
(iii) A bedroom used by a
hearing-impaired occupant who may not hear the sound of a regular carbon monoxide
alarm must be equipped with an additional carbon monoxide alarm that has visual
or vibrating capacity.
(B) SMOKE ALARMS. Smoke alarms
must be installed in accordance with the manufacturer's instructions in each bedroom,
in hallways or access areas that adjoin bedrooms, the family room or main living
area where occupants congregate, any interior designated smoking area, and in basements.
In addition, smoke alarms must be installed at the top of all stairways in multi-level
homes.
(i) Ceiling placement of
smoke alarms is recommended.
(ii) Battery operated smoke
alarms or hard-wired smoke alarms with a battery backup must be equipped with a
device that warns of a low battery.
(iii) A bedroom used by a
hearing-impaired occupant who may not hear the sound of a regular smoke alarm must
be equipped with an additional smoke alarm that has visual or vibrating capacity.
(C) All carbon monoxide alarms
and smoke alarms must contain a sounding device or be interconnected to other alarms
to provide, when actuated, an alarm that is audible in all sleeping rooms. The alarms
must be loud enough to wake occupants when all bedroom doors are closed. Intercoms
and room monitors may not be used to amplify alarms.
(D) The licensee must test
all carbon monoxide alarms and smoke alarms in accordance with the manufacturer’s
instructions at least monthly (per NFPA 72). Testing must be documented in the facility
records. The licensee must maintain carbon monoxide alarms, smoke alarms, and fire
extinguishers in functional condition. If there are more than two violations in
maintaining battery operated alarms in working condition, the Department may require
the licensee to hard wire the alarms into the electrical system.
(i) COMBUSTIBLES AND FIREARMS.
Flammables, combustible liquids, and other combustible materials must be safely
and properly stored in their original, properly labeled containers or safety containers
and secured in areas to prevent tampering by residents or vandals.
(A) Oxygen and other gas
cylinders in service or in storage must be adequately secured to prevent the cylinders
from falling or being knocked over;
(B) No smoking signs must
be visibly posted where oxygen cylinders are present;
(C) Firearms must be stored,
unloaded, in a locked cabinet. The firearms cabinet must be located in an area of
the home that is not accessible to the residents; and
(D) Ammunition must be secured
in a locked area separate from the firearms.
(j) HAZARDOUS MATERIALS.
Cleaning supplies, poisons, insecticides, and other hazardous materials must be
properly stored in their original container, or in a container manufactured for
the type of product. The containers must be properly labeled and kept in a safe
area that is not accessible to residents, or near food preparation areas, food storage
areas, dining areas, or medications.
(k) MEDICAL SHARPS. All sharps,
including but not limited to needles and lancets, must be disposed of in approved
sharps containers. Sharps containers must:
(A) Be puncture-resistant;
(B) Be leak-proof;
(C) Be labeled or color-coded
red to warn that the contents are hazardous;
(D) Have a lid, flap, door,
or other means of closing the container and inhibits the ability to remove sharps
from the container;
(E) Not be overfilled;
(F) Be stored in an upright
position in a secure location that is not accessible to residents and not close
to any food preparation or food storage area; and
(G) Must be closed immediately
once full and properly disposed of within ten days, according to the home’s
waste management company’s or pharmacy’s instructions.
(l) EVACUATION PLAN. An emergency
evacuation plan must be developed and revised as necessary to reflect the current
condition of the residents in the home. The evacuation plan must be rehearsed with
all occupants.
(m) ORIENTATION TO EMERGENCY
PROCEDURES. Within 24 hours of arrival, any new resident or caregiver must be shown
how to respond to a smoke alarm, shown how to participate in an emergency evacuation
drill, and receive an orientation to basic fire safety. New caregivers must also
be oriented in how to conduct an evacuation.
(n) EVACUATION DRILL. An
evacuation drill must be held at least once every 90 calendar days, with at least
one evacuation drill per year conducted during sleeping hours. The evacuation drill
must be clearly documented, signed by the caregiver conducting the drill, and maintained
according to OAR 411-050-0645.
(A) The licensee and all
other caregivers must:
(i) Be able to demonstrate
the ability to evacuate all occupants from the facility to the initial point of
safety within three minutes or less. The initial point of safety must:
(I) Be exterior to and a
minimum of 25 feet away from the structure;
(II) Have direct access to
a public sidewalk or street; and
(III) Not be in the backyard
of a home unless the backyard has direct access to a public street or sidewalk.
(ii) Be able to demonstrate
the ability to further evacuate all occupants from the initial point of safety to
the final point of safety within two minutes or less. The final point of safety
must be a minimum of 50 feet away from the structure, and:
(I) Have direct access to
a public sidewalk or street; or
(II) Not be in the backyard
of a home unless the backyard has direct access to a public street or sidewalk.
(B) Conditions may be applied
to a license if the licensee or caregivers demonstrate the inability to meet the
evacuation times described in this section. Conditions may include, but are not
limited to, reduced capacity of residents, additional staffing, or increased fire
protection. Continued problems are grounds for revocation or non-renewal of the
license.
(o) FLOOR PLAN. The licensee
must develop a current and accurate floor plan that indicates:
(A) The size of rooms;
(B) Which bedrooms are to
be used by residents, the licensee, caregivers, for day care, and room and board
tenants, as applicable;
(C) The location of all the
exits on each level of the home, including emergency exits such as windows;
(D) The location of wheelchair
ramps;
(E) The location of all fire
extinguishers, smoke alarms, and carbon monoxide alarms;
(F) The planned evacuation
routes, initial point of safety, and final point of safety; and
(G) Any designated smoking
areas in or on the adult foster home's premises.
(p) RESIDENT PLACEMENT. A
resident, who is unable to walk without assistance or not capable of self-preservation,
may not be placed in a bedroom on a floor without a second ground level exit. (See
also section (4)(f) of this rule)
(q) STAIRS. Stairs must have
a riser height of between 6 to 8 inches and tread width of between 8 to 10.5 inches.
Lifts or elevators are not an acceptable substitute for a resident's capability
to ambulate stairs. (See also section (5)(f) of this rule)
(r) EXIT WAYS. All exit ways
must be barrier free and the corridors and hallways must be a minimum of 36 inches
wide or as approved by the State Fire Marshal or the State Fire Marshal's designee.
Interior doorways used by the residents must be wide enough to accommodate wheelchairs
and walkers if used by residents and beds if used for evacuation purposes. Any bedroom
window or door identified as an exit must remain free of obstacles that would interfere
with evacuation.
(s) RAMPS. There must be
at least one wheelchair ramp from a minimum of one exterior door if an occupant
of the home is non-ambulatory. Wheelchair ramps must comply with the U.S. Department
of Justice’s 2010 Americans with Disabilities Act (ADA) Standards for Accessible
Design (http://www.ada.gov/2010ADAstandards_index.htm, Chapter 4, Accessible
Routes, Section 405, Ramps).
(t) EMERGENCY EXITS. There
must be a second safe means of exit from all sleeping rooms. A provider whose sleeping
room is above the first floor may be required to demonstrate at the time of licensure,
renewal, or inspection, an evacuation drill from the provider's sleeping room using
the secondary exit.
(u) FLASHLIGHT. There must
be at least one plug-in, rechargeable flashlight in good functional condition available
on each floor of the home for emergency lighting.
(v) SMOKING. If smoking is
allowed in a home, the licensee must adopt house policies that restrict smoking
to designated areas.
(A) Smoking is prohibited
in:
(i) Any bedroom including
that of the residents, licensee, resident manager, any other caregiver, occupant,
or visitor;
(ii) Any room where oxygen
is used; and
(iii) Anywhere flammable
materials are stored.
(B) Ashtrays of noncombustible
material and safe design must be provided in areas where smoking is permitted.
(w) EMERGENCY PREPAREDNESS
PLAN. A licensee must develop and maintain a written emergency preparedness plan
for the protection of all occupants in the home in the event of an emergency or
disaster.
(A) The written emergency
plan must:
(i) Include an evaluation
of potential emergency hazards including, but not limited to:
(I) Prolonged power failure
or water or sewer loss;
(II) Fire, smoke, or explosion;
(III) Structural damage;
(IV) Hurricane, tornado,
tsunami, volcanic eruption, flood, or earthquake;
(V) Chemical spill or leak;
and
(VI) Pandemic.
(ii) Include an outline of
the caregiver's duties during an evacuation;
(iii) Consider the needs
of all occupants of the home including, but not limited to:
(I) Access to medical records
necessary to provide services and treatment;
(II) Access to pharmaceuticals,
medical supplies, and equipment during and after an evacuation; and
(III) Behavioral support
needs.
(iv) Include provisions and
supplies sufficient to shelter in place for a minimum of three days without electricity,
running water, or replacement staff; and
(v) Planned relocation sites.
(B) The licensee must notify
the Department or the local licensing authority of the home's status in the event
of an emergency that requires evacuation and during any emergent situation when
requested.
(C) The licensee must re-evaluate
the emergency preparedness plan at least annually and whenever there is a significant
change in the home.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88, Sections (8) thru (10)
renumbered to 411-050-0447; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992,
f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 2-1998(Temp),
f. & cert. ef. 2-6-98 thru 8-1-98; SDSD 6-1998, f. 7-31-98, cert. ef. 8-1-98;
SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07;
SPD 9-2007, f. 6-27-07, cert. ef. 7-1-07; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10;
Renumbered from 411-050-0445, SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 6-2014,
f. 3-31-14, cert. ef. 4-1-14; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0655
Standards and Practices for Care and Services
(1) PRE-ADMISSION SCREENING AND ASSESSMENT.
(a) Prior to admission, the
licensee must conduct and document a screening to determine if a prospective resident's
care needs exceed the license classification of the home. The screening must:
(A) Evaluate the ability
of the prospective resident to evacuate the home within three minutes along with
all the occupants of the home;
(B) Determine if the licensee
and caregivers are able to meet the prospective resident's needs in addition to
meeting the needs of the other residents of the home; and
(C) Include medical diagnoses,
medications, personal care needs, nursing care needs, cognitive needs, communication
needs, night care needs, nutritional needs, activities, lifestyle preferences, and
other information, as needed, to assure the prospective resident's care needs shall
be met.
(b) The screening process
must include interviews with the prospective resident and the prospective resident's
family, prior care providers, and case manager, as appropriate. The licensee must
also interview, as necessary, any physician, nurse practitioner, physician assistant,
registered nurse, pharmacist, therapist, or mental health or other licensed health
care professional involved in the care of the prospective resident. A copy of the
screening document must be:
(A) Given to the prospective
resident or the prospective resident's legal representative; and
(B) Placed in the resident's
record if admitted to the home; or
(C) Maintained for a minimum
of three years if the prospective resident is not admitted to the home.
(c) If the Department or
AAA knows that a person who is on probation, parole, or post-prison supervision
after being convicted of a sex crime defined in ORS 181.805 is applying for admission
to an adult foster home, the Department or AAA shall notify the home of the person’s
status as a sex offender.
(d) The licensee may refuse
to admit a person who is on probation, parole, or post-prison supervision after
being convicted of a sex crime as defined in ORS 181.805.
(e) REQUIRED DISCLOSURES.
The licensee must disclose the home’s policies and practices to a prospective
resident or the prospective resident’s legal representative, as applicable,
including:
(A) HOUSE POLICIES. The licensee
must provide a copy of the house policies and disclose any policies that may limit
the prospective resident's activities or preferences while living in the adult foster
home. Examples include, but are not limited to, the use of tobacco or alcohol, pets,
religious practices, dietary restrictions, and the use of intercoms and monitors.
The licensee must disclose the home’s policy regarding the legal presence
and use of medical marijuana. (See OAR 411-050-0645);
(B) CONTRACT. The licensee
must provide a copy of any contract a prospective resident or the prospective resident’s
legal representative may be asked to sign;
(C) MEDICAID ENROLLMENT STATUS.
The licensee must inform a prospective resident or the prospective resident’s
representative if the home serves individuals eligible for Medicaid services; and
(D) LONG-TERM CARE ASSESSMENT.
The licensee must inform a prospective private-pay resident or the prospective resident's
representative, if appropriate, of the availability of long-term care assessment
services provided through the Department or a certified assessment program. The
licensee must document on the Department’s form (SDS 913) that the prospective
private-pay resident has been advised of the right to receive a long-term care assessment.
The licensee must maintain a copy of the form in the resident’s record upon
admission and make a copy available to the Department upon request.
(2) PRIOR TO ADMISSION.
(a) The licensee must obtain
and document general information regarding a resident prior to the resident's admission.
The information must include the names, addresses, and telephone numbers of the
resident's relatives, significant persons, case managers, and medical or mental
health providers. The information must also include the date of admission and, if
available, the resident's medical insurance information, birth date, prior living
facility, and mortuary;
(b) Prior to admission, the
licensee must obtain and place in the resident's record:
(A) Prescribing practitioner's
written or verbal orders for medications, treatments, therapies, and special diets,
as applicable. Any verbal orders must be followed with written orders within seven
calendar days of the resident's admission. Attempts to obtain written orders must
be documented in the resident’s record;
(B) Prescribing practitioner
or pharmacist review of the resident's preferences for over-the-counter medications
and home remedies; and
(C) Any medical information
available, including the resident's history of accidents, illnesses, impairments,
or mental status that may be pertinent to the resident's care.
(c) The licensee must ask
for copies of the resident's Advance Directive, Physician’s Order for Life
Sustaining Treatment (POLST), and proof of court-appointed guardianship or conservatorship,
if applicable. Copies of these documents must be placed in a prominent place in
the resident’s record and sent with the resident if the resident is transferred
for medical care;
(d) The licensee must provide
written information to the resident or the resident's representative about the resident's
right to make decisions concerning Advance Directives and the resident's right to
accept or refuse medical care. The licensee must provide:
(A) A written copy of the
adult foster home's policies regarding implementation of Advance Directives; and
(B) A clear and precise statement
of limitation if the licensee is not able to implement an Advance Directive on the
basis of conscience that includes:
(i) Identification of the
state legal authority under ORS 127.625 permitting a conscientious objection; and
(ii) Descriptions of medical
conditions or procedures affected by the licensee's conscientious objection.
(e) The licensee must review
the Residents’ Bill of Rights and the home’s current house policies
with the resident and the resident's legal representative, as appropriate. The discussion
must be documented by having the resident sign and date a copy of the house policies
that have been approved by the local licensing authority and the current Residents'
Bill of Rights (form SDS 305A). A copy of the signed house policies and Residents’
Bill of Rights must be maintained in the resident’s record.
(3) SCREENING PRIOR TO RE-ADMISSION.
When a resident temporarily leaves the home including, but not limited to, a resident’s
hospitalization, the licensee shall conduct the necessary elements of the pre-admission
and screening assessment requirements, and document those findings to:
(a) Determine whether readmission
to the home is appropriate for the classification of the home;
(b) Determine whether the
licensee can continue to meet the resident’s care and safety needs in addition
to those of the other residents;
(c) Demonstrate compliance
with these rules; and
(d) If applicable, demonstrate
the basis for refusing the resident’s re-admission to the home according to
OAR 411-050-0645 (11).
(4) CARE PLAN.
(a) During the initial 14
calendar days following the resident's admission to the home, the licensee must
continue to assess and document the resident's preferences and care needs. The assessment
and care plan must be completed by the licensee and documented within the initial
14-day period. The care plan must describe the resident's needs, preferences, and
capabilities, and what assistance the resident requires for various tasks. The resident's
care plan must also include:
(A) By whom, when, and how
often care and services shall be provided;
(B) The resident's ability
to perform activities of daily living (ADLs);
(C) Special equipment needs;
(D) Communication needs (examples
may include, but are not limited to, hearing or vision needs, such as eraser boards
or flash cards, or language barriers, such as sign language or non-English speaking);
(E) Night needs;
(F) Medical or physical health
problems, including physical disabilities, relevant to care and services;
(G) Cognitive, emotional,
or other impairments relevant to care and services;
(H) Treatments, procedures,
or therapies;
(I) Registered nurse consultation,
teaching, delegation, or assessment;
(J) Behavioral interventions;
(K) Social, spiritual, and
emotional needs, including lifestyle preferences, activities, and significant others
involved;
(L) The ability to exit in
an emergency, including assistance and equipment needed;
(M) Any use of physical restraints
or psychoactive medications; and
(N) Dietary needs and preferences.
(b) The licensee must review
and update each resident's care plan every six months and when a resident's condition
changes. The review must be documented in the resident's record at the time of the
review and include the date of the review and the licensee's signature. If a care
plan contains many changes and becomes less legible, a new care plan must be written.
(5) REGISTERED NURSE CONSULTATION.
(a) RN CONSULTATION AND ASSESSMENT.
A licensee must obtain a medical professional consultation and assessment to meet
the care needs of a resident as required in these rules. A registered nurse consultation
must be obtained when a skilled nursing care task, as defined by the Oregon State
Board of Nursing, has been ordered by a physician or other licensed health care
professional.
(b) A licensee must also
request a registered nurse consultation under the following conditions:
(A) When a resident has a
health concern or behavioral symptoms that may benefit from a nursing assessment
and provider education;
(B) When written parameters
are needed to clarify a prescribing practitioner p.r.n. order for medication and
treatment (See section (6)(g) of this rule);
(C) Prior to the use of physical
restraints when not assessed, taught, and reassessed, according to section (6)(o)
of this rule, by a physician, nurse practitioner, physician assistant, Christian
Science practitioner, mental health clinician, physical therapist, or occupational
therapist;
(D) Prior to requesting psychoactive
medications to treat behavioral symptoms or the use of new psychoactive medications
when not assessed, taught, and reassessed according to section (6)(h) of this rule,
by a physician, nurse practitioner, physician assistant, or mental health practitioner;
and
(E) When care procedures
are ordered that are new for a resident, the licensee, or other caregivers.
(c) RN DELEGATIONS. A registered
nurse may determine a nursing care task be taught utilizing the delegation process.
RN delegations are not transferable to other residents or caregivers. (Refer to
OAR chapter 851, division 047)
(d) Documentation of nurse
consultations, delegations, assessments, and reassessments must be maintained in
the resident’s record and made available to the Department upon request.
(6) STANDARDS FOR MEDICATIONS,
TREATMENTS, AND THERAPIES.
(a) MEDICATIONS. The licensee
and caregivers must demonstrate an understanding of each resident's medication administration
regimen. Medication resource material must be readily available at the home and
include the reason a medication is used, any specific instructions, the medication's
actions, and common side effects.
(b) WRITTEN ORDERS. The licensee
must obtain and place a signed order in the resident's record for any medications,
dietary supplements, treatments, or therapies that have been ordered by a prescribing
practitioner. The written orders must be carried out as prescribed unless the resident
or the resident's legal representative refuses to consent. The prescribing practitioner
must be notified if the resident refuses to consent to an order.
(A) CHANGED ORDERS. Changes
to a written order may not be made without a prescribing practitioner order. The
prescribing practitioner must be notified if the resident refuses to consent to
the change order. Changes to medical orders obtained by telephone must be followed-up
with signed orders within seven calendar days. Changes in the dosage or frequency
of an existing medication require a new properly labeled and dispensed medication
container. If a new properly labeled and dispensed medication container is not obtained,
the change must be written on an auxiliary label attached to the medication container,
not to deface the existing original pharmacy label, and must match the new medication
order. Attachment of the auxiliary label must be documented in the residents’
record. (See section (6)(f)(D) of this rule)
(B) DOCUMENTATION OF CHANGED
ORDERS. Attempts to obtain the signed written changes must be documented and readily
available for review in the resident's record. The resident’s medications,
including medications that are prescribed, over-the-counter medications, and home
remedies, must be reviewed by the resident's prescribing practitioner or pharmacist
at least annually. The review must be in writing, include the date of the review,
and contain the signature of the prescribing practitioner or a pharmacist.
(c) MEDICATION SUPPLIES.
The licensee must have all currently prescribed medications, including p.r.n. medications,
and all prescribed over-the-counter medications available in the home for administration.
Refills must be obtained prior to depletion of current medication supplies. Attempts
to order refills must be documented in the resident’s record.
(d) HEALTH CARE PROFESSIONAL
ORDERS (IMPLEMENTED BY AFH STAFF). The licensee who implements a hospice, home health,
or other licensed medical professional-generated order must:
(A) Have a copy of the hospice,
home health, or licensed medical professional document that communicates the written
order;
(B) Transcribe the order
onto the medication administration record (MAR);
(C) Implement the order as
written; and
(D) Include the order on
subsequent medical visit reports for the prescribing practitioner to review.
(e) HOSPICE AND HOME HEALTH
ORDERS (IMPLEMENTED BY NON-AFH STAFF). A licensee must allow a resident to receive
hospice services. The licensee who provides adult foster home services to a recipient
of hospice or home health services, but who does not implement a hospice or home
health-generated order must:
(A) Have a copy of the hospice
or home health document that communicates the written order; and
(B) Include the order on
subsequent medical visit reports for the prescribing practitioner to review.
(f) MEDICATION ADMINISTRATION
RECORD (MAR). A current, written medication administration record (MAR) must be
kept for each resident and must:
(A) List the name of all
medications administered by a caregiver, including over-the-counter medications
and prescribed dietary supplements. The MAR must identify the dosage, route, and
the date and time each medication and supplement is to be given;
(B) Identify any treatments
and therapies administered by a caregiver. The MAR must indicate the type of treatment
or therapy and the time the procedure must be performed;
(C) Be immediately initialed
by the caregiver administering the medication, treatment, or therapy as it is completed.
A resident's MAR must contain a legible signature that identifies each set of initials;
(D) Document changed and
discontinued orders immediately showing the date of the change or discontinued order.
A changed order must be written on a new line with a line drawn to the start date
and time; and
(E) Document missed or refused
medications, treatments, or therapies. If a medication, treatment, or therapy is
missed or refused by the resident, the initials of the caregiver administering the
medication, treatment, or therapy must be circled, and a brief, but complete, explanation
must be recorded on the back of the MAR.
(g) P.R.N. MEDICATIONS. Prescription
medications ordered to be given "as needed" or "p.r.n." must have specific parameters
indicating what the medication is for and specifically when, how much, and how often
the medication may be administered. Any additional instructions must be available
for the caregiver to review before the medication is administered to the resident.
(A) P.R.N. DOCUMENTATION.
As needed (p.r.n) medications must be documented on the resident’s MAR with
the time, dose, the reason the medication was given, and the outcome.
(B) P.R.N. ADVANCE SET-UP.
As needed (p.r.n.) medications may not be included in any advance set-up of medication.
(h) PSYCHOACTIVE MEDICATIONS.
(A) A licensee is not required
to request an evaluation of a resident's use of a psychoactive medication if the
resident is admitted to the home and the resident has been prescribed the psychoactive
medication for a condition that is currently monitored by a physician, nurse practitioner,
physician assistant, or mental health professional and the written order for the
psychoactive medication is in the resident’s record.
(B) If a resident is admitted
to a home with no documented history as to the reason for taking a psychoactive
medication, or if the licensee requests medical professional intervention to address
behavioral symptoms, the licensee must request a physician, nurse practitioner,
physician assistant, or mental health professional evaluate the resident's need
for the psychoactive medication and the intended effect of the medication, common
side effects, and circumstances for reporting. The evaluation request must be documented
in the resident’s record and include:
(i) A probable cause of the
resident's behavior;
(ii) Behavioral and environmental
interventions to be used instead of or in addition to psychoactive medication, if
applicable. Alternative interventions must be tried as instructed by a licensed
medical professional and the resident’s response to the alternative interventions
must be documented in the resident’s record prior to administering a psychoactive
medication; and
(iii) A plan for reassessment
by the resident’s prescribing physician, nurse practitioner, physician assistant,
or mental health professional.
(C) The prescription and
order for a psychoactive medication must specify the dose, frequency of administration,
and the circumstance for use (i.e., specific symptoms). The licensee and all caregivers
must be aware of and comply with these parameters.
(D) The licensee and all
caregivers must know the intended effect of a psychoactive medication for a particular
resident and the common side effects, as well as the circumstances for reporting
to the resident's physician, nurse practitioner, physician assistant, or mental
health professional.
(E) The resident's care plan
must identify and describe the behavioral symptoms for which psychoactive medications
are prescribed and a list of all interventions, including behavioral, environmental,
and medication.
(F) Psychoactive medications
must never be given to discipline a resident or for the convenience of the caregivers.
(i) MEDICATION CONTAINERS
AND STORAGE.
(A) MEDICATION CONTAINERS.
Each of the resident's prescribed medication containers, including bubble packs,
must be clearly labeled by the pharmacy. All medications, including over-the-counter
medications, must be in the original container. Medications stored in advanced set
up containers are required to be labeled as described in these rules.
(B) OVER-THE-COUNTER PRODUCTS.
Over-the-counter products such as medications, vitamins, and supplements purchased
for a specific resident’s use must be marked with the resident's name. Over-the-counter
items in stock bottles (with original labels) may be used for multiple residents
in the home and must be clearly marked as the house supply.
(C) STORAGE OF RESIDENT MEDICATION.
All resident medications, including over-the-counter medications, must be kept in
a locked, central location that is cool, clean, dry, not subject to direct sunlight,
and separate from medications belonging to the licensee, caregivers, and all other
non-residents. Medications requiring refrigeration must also be locked and stored
separately from non-resident medications.
(D) STORAGE OF NON-RESIDENT
MEDICATION. All non-resident medications must be kept locked and separate from resident
medications. Residents shall not have access to medications belonging to the licensee,
caregivers, other household members, or pets.
(j) DISPOSAL OF MEDICATION.
Outdated, discontinued, recalled, or contaminated medications, including over-the-counter
medications, may not be kept in the home and must be disposed of within 10 calendar
days of expiration, discontinuation, or the licensee’s knowledge of a recall
or contamination. A licensee must contact the local DEQ waste management company
in their area for instructions on proper disposal of unused or expired medications.
(k) DOCUMENTATION OF DISPOSAL.
The disposal of a resident's medication must be documented in the resident’s
record and the documentation must be readily available in the resident's record.
(A) The disposal of a controlled
substance must be documented in the resident’s record and the disposal must
be witnessed by a caregiver who is 18 years of age or older.
(B) Documentation regarding
the disposal of medications and controlled substances must include:
(i) The date of disposal;
(ii) Description of the medication,
(i.e., name, dosage, and amount being disposed);
(iii) Name of the resident
for whom the medication was prescribed;
(iv) Reason for disposal;
(v) Method of disposal;
(vi) Signature of the person
disposing of the medication; and
(vii) For controlled substances,
the signature of the caregiver who witnessed the disposal according to this rule.
(l) ADVANCED SET-UP. The
licensee may set-up each resident's medications for up to seven calendar days in
advance (excluding p.r.n. medications) by using a closed container manufactured
for the advanced set-up of medications. If used, each resident must have his or
her own container with divisions for the days of the week and times of the day the
medications are to be given. The container must be clearly labeled with the resident's
name, name of each medication, time to be given, dosage, amount, route, and description
of each medication. The container must be stored in the locked area with the residents'
medications.
(m) SELF-ADMINISTRATION OF
MEDICATION. A licensee must have a prescribing practitioner written order of approval
for a resident to self-medicate. A resident able to handle his or her own medical
regimen may keep their medications in their own room in a lockable storage area
or device. Medications must be kept locked except those medications on the residents’
own person. The licensee must notify the prescriber of the medication if the resident
shows signs of no longer being able to self-medicate safely.
(n) INJECTIONS. Subcutaneous,
intramuscular, and intravenous injections may be self-administered by a resident
if the resident is fully independent in the task or may be administered by a relative
of the resident or an Oregon licensed registered nurse (RN). An Oregon licensed
practical nurse (LPN) may give subcutaneous and intramuscular injections. A caregiver
who has been delegated and trained by a registered nurse under provision of the
Oregon State Board of Nursing (OAR 851-047-0000 to 851-047-0040) may give subcutaneous
injections. Intramuscular and intravenous injections may not be delegated. See OAR
411-050-0650 (5) for storage and disposal requirements of sharps, including but
not limited to used needles and lancets.
(o) PHYSICAL RESTRAINTS.
Physical restraints may only be used when required to treat a resident’s medical
symptoms or to maximize a resident’s physical functioning. Physical restraints
may only be used after a written assessment is completed as described below and
all alternatives have been exhausted. Licensees and caregivers may use physical
restraints in adult foster homes only in compliance with these rules, including
the Residents’ Bill of Rights listed in section (8) of this rule. Prior to
the use of any type of physical restraint, the following must be completed:
(A) ASSESSMENT. A written
assessment must be obtained from the resident’s physician, nurse practitioner,
physician assistant, registered nurse, Christian Science practitioner, mental health
clinician, physical therapist, or occupational therapist that includes consideration
of all other alternatives.
(B) ORDERS. If it is determined
that a physical restraint is necessary following the assessment and trial of other
measures, the least restrictive restraint must be used and as infrequently as possible.
The licensee must obtain a written order from the resident’s physician, nurse
practitioner, physician assistant, or Christian Science practitioner prior to the
use of a physical restraint. The written order must include specific parameters,
including the type of physical restraint, circumstances for use, and duration of
use, including:
(i) Procedural guidance for
the use of the physical restraint;
(ii) The frequency for reassessment;
(iii) The frequency and procedures
for nighttime use; and
(iv) Dangers and precautions
for using the physical restraint.
(C) Physical restraints may
not be used on an as needed (p.r.n.) basis in an adult foster home.
(D) CONSENT. Physical restraints
must not be used without first obtaining the written consent of the resident or
the resident’s legal representative.
(E) DOCUMENTATION. If it
is determined a physical restraint is necessary following the assessment and trial
of other measures, the written order for the use of a physical restraint must be
documented in the resident’s care plan explaining why and when the restraint
is to be used, along with instructions for periodic release. Any less restrictive,
alternative measures planned during the assessment, and cautions for maintaining
the resident's safety while restrained must also be recorded in the resident's care
plan. The resident’s record must include:
(i) The completed assessment
as described in this rule;
(ii) The written order authorizing
the use of the physical restraint from the resident’s physician, nurse practitioner,
physician assistant, or Christian Science practitioner;
(iii) Written consent of
the resident or the resident’s legal representative to use the specific type
of physical restraint; and
(iv) The reassessments completed
by a medical professional as described above in subsection (B) of this rule.
(F) DAYTIME USE. A resident
physically restrained during waking hours must have the restraints released at least
every two hours for a minimum of 10 minutes and be repositioned, offered toileting,
and provided exercise or range-of-motion exercises during this period. The use of
restraints, restraint release, and activities that occurred during the release period
must be documented in the resident's record.
(G) NIGHTTIME USE. The use
of physical restraints at night is discouraged and must be limited to unusual circumstances.
If used, the restraint must be of a design to allow freedom of movement with safety.
The frequency of night monitoring to address resident safety and care needs must
be determined in the assessment. Tie restraints of any kind must not be used to
keep a resident in bed.
(H) If any physical restraints
are used in an adult foster home, the restraints must allow for quick release at
all times. Use of restraints may not impede the three-minute evacuation of all occupants
of the home.
(I) Physical restraints may
not be used for the discipline of a resident or for the convenience of the adult
foster home.
(7) RESIDENT CARE.
(a) Care and supervision
of residents must be in a home-like atmosphere. The training of the licensee and
caregivers and care and supervision of residents must be appropriate to the age,
care needs, and conditions of the residents in the home. Additional staff may be
required if, for example, day care individuals are in the home or if necessary to
safely evacuate the residents and all occupants from the home as required by OAR
411-050-0650.
(b) If a resident has a medical
regimen or personal care plan prescribed by a licensed health care professional,
the provider must cooperate with the plan and ensure the plan is implemented as
instructed.
(c) NOTIFICATION. The licensee
must notify emergency personnel, the resident’s physician, nurse practitioner,
physician assistant, registered nurse, family representative, and case manager,
as applicable, under the following circumstances:
(A) EMERGENCIES (MEDICAL,
FIRE, POLICE). In the event of an emergency, the licensee or caregiver with the
resident at the time of the emergency must first call 911 or the appropriate emergency
number for their community. This does not apply to a resident with a medical emergency
who practices Christian Science;
(i) If a resident is receiving
hospice services, the caregivers must follow the written instructions for medical
emergencies from the hospice nurse.
(ii) If a resident has a
completed Physician’s Orders for Life-Sustaining Treatment (POLST) or other
legal documents, such as an Advance Directive or Do Not Resuscitate (DNR) order,
copies of the documents must be made available to the emergency personnel when they
arrive.
(B) HOSPITALIZATION. In the
event the resident is hospitalized;
(C) HEALTH STATUS CHANGE.
When the resident’s health status or physical condition changes; and
(D) DEATH. Upon the death
of the resident.
(d) The licensee shall not
inflict, or tolerate to be inflicted, abuse or punishment, financial exploitation,
or neglect of the residents.
(e) The licensee must exercise
reasonable precautions against any conditions that may threaten the health, safety,
or welfare of the residents.
(f) A qualified caregiver
must always be present and available at the home when a resident is in the home.
A resident may not be left in charge in lieu of a caregiver.
(g) ACTIVITIES. The licensee
must make available at least six hours of activities per week that are of interest
to the residents, not including television and movies. Information regarding activity
resources is available from the local licensing authority. Activities must be oriented
to individual preferences as indicated in the resident's care plan (See section
(4) of this rule). Documentation of the activities offered to each resident and
the resident's participation in those activities must be recorded in the resident's
records.
(h) DAY CARE. Prior to the
admission of each day care individual, the licensee must:
(A) Conduct and document
a screening as described in section (1)(a) of this rule;
(B) Obtain current medical
professional orders as described in section (6) of this rule if medications are
to be administered and the necessary delegations, as applicable; and
(C) Develop and maintain
a current, written medication administration record (MAR) as described in section
(6) of this rule if medications are to be administered.
(i) DIRECT INVOLVEMENT OF
CAREGIVERS. The licensee or caregivers must be directly involved with the residents
on a daily basis. If the physical characteristics of the adult foster home do not
encourage contact between the caregivers and residents and among residents, the
licensee must demonstrate how regular positive contact occurs.
(j) RESIDENT MONEY. If the
licensee manages or handles a resident's money, a separate account record must be
maintained in the resident's name. The licensee may not under any circumstances
commingle, borrow from, or pledge any of a resident's funds. The licensee may not
act as a resident’s guardian, conservator, trustee, or attorney-in-fact unless
related by birth, marriage, or adoption to the resident as follows: parent, child,
brother, sister, grandparent, grandchild, aunt, uncle, niece, or nephew. Nothing
in this rule may be construed to prevent the licensee or the licensee’s employee
from acting as a representative payee for the resident. (See also OAR 411-020-0002
and ORS 127.520)
(A) Personal incidental funds
(PIF) for individuals eligible for Medicaid services must be used at the discretion
of the individual for such things as clothing, tobacco, and snacks (not part of
daily diet).
(B) The licensee and other
caregivers may not accept gifts from the residents through undue influence or accept
gifts of substantial value. Caregivers and family members of the caregivers may
not accept gifts of substantial value or loans from the resident or the resident's
family. The licensee or other caregivers may not influence, solicit from, or suggest
to any of the residents or the residents' legal representatives that the residents
or the residents' legal representatives give the caregiver or the caregiver's family
money or property for any purpose.
(C) The licensee may not
subject the resident or the resident’s representative to unreasonable rate
increases.
(k) The licensee and other
caregivers may not loan money to the residents.
(8) RESIDENTS' BILL OF RIGHTS.
The licensee, the licensee's family, and employees of the home must guarantee not
to violate these rights and to help the residents exercise them. The Residents'
Bill of Rights provided by the Department must be explained and a copy given to
each resident at the time of admission. The Residents’ Bill of Rights states
each resident has the right to:
(a) Be treated as an adult
with respect and dignity;
(b) Be informed of all resident
rights and all house policies;
(c) Be encouraged and assisted
to exercise constitutional and legal rights, including the right to vote;
(d) Be informed of their
medical condition and the right to consent to or refuse treatment;
(e) Receive appropriate care,
services, and prompt medical care as needed;
(f) Be free from abuse;
(g) Complete privacy when
receiving treatment or personal care;
(h) Associate and communicate
privately with any person of choice and send and receive personal mail unopened;
(i) Have access to and participate
in activities of social, religious, and community groups;
(j) Have medical and personal
information kept confidential;
(k) Keep and use a reasonable
amount of personal clothing and belongings, and to have a reasonable amount of private,
secure storage space;
(l) Be free from chemical
and physical restraints except as ordered by a physician or other qualified practitioner.
Restraints are used only for medical reasons, to maximize a resident's physical
functioning, and after other alternatives have been tried. Restraints are not to
be used for discipline or convenience;
(m) Manage their own financial
affairs unless legally restricted;
(n) Be free from financial
exploitation. The licensee may not charge or ask for application fees or non-refundable
deposits or solicit, accept, or receive money or property from a resident other
than the amount agreed to for services;
(o) A written agreement regarding
services to be provided and the rates to be charged. The licensee must give 30 days'
written notice before any change in the rates or the ownership of the home;
(p) Not be transferred or
moved out of the adult foster home without 30 calendar days' written notice and
an opportunity for a hearing. A licensee may transfer a resident only for medical
reasons, for the welfare of the resident or other residents, or for nonpayment;
(q) A safe and secure environment;
(r) Be free of discrimination
in regard to race, color, national origin, gender, sexual orientation, or religion;
(s) Make suggestions or complaints
without fear of retaliation; and
(t) Be free of discrimination
in regard to the execution of an Advance Directive, Physician's Order for Life-Sustaining
Treatment (POLST), or Do Not Resuscitate (DNR) orders.
Stat. Auth.: ORS 127.520, 410.070, 443.001,
443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775,
& 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88, Renumbered from 411-050-0445(8)
thru (10); SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert.
ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. & cert.
ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10,
cert. ef. 7-1-10; Renumbered from 411-050-0447, SPD 33-2013, f. 8-30-13, cert. ef.
9-1-13; APD 50-2014(Temp), f. 12-31-14, cert. ef. 1-1-15 thru 6-29-15; APD 15-2015,
f. 6-24-15, cert. ef. 6-28-15
411-050-0660
Qualifications and Requirements for Ventilator-Assisted
Care
Adult foster homes that provide ventilator-assisted
care for residents must meet the following requirements in addition to the other
requirements set forth in these rules:
(1) LICENSE REQUIRED. A person
or entity may not represent themselves as operating an adult foster home that provides
ventilator-assisted care or accept placement of an individual requiring ventilator-assisted
care without being licensed as a ventilator-assisted care adult foster home.
(2) APPLICATION. An applicant
or licensee must meet and maintain compliance with OAR 411-050-0610.
(a) To apply for a license
to provide ventilator-assisted care, an applicant or licensee must complete the
Department’s ventilator-assisted care application form (SDS 448V) and submit
the application with the required information and nonrefundable fee as outlined
in OAR 411-050-0610 to the local licensing authority.
(b) To renew a license to
provide ventilator-assisted care, a licensee must complete the Department’s
ventilator-assisted care application form (SDS 448V) and submit the application
with the required information and nonrefundable fee as outlined in OAR 411-050-0640
to the local licensing authority.
(c) Applications are processed
according to OAR 411-050-0610 and 411-050-0640.
(d) Applications must be
approved by the Department prior to the issuance of a ventilator-assisted care license.
(3) QUALIFICATIONS AND TRAINING.
An applicant, licensee, and all other caregivers must meet and maintain compliance
with OAR 411-050-0625. In addition:
(a) The applicant, licensee,
resident manager, floating resident manager, or shift caregivers, as applicable,
must demonstrate one year of full-time experience in providing ventilator-assisted
care.
(b) The applicant or licensee,
as applicable, must have experience operating a Class 3 adult foster home in substantial
compliance with these rules for at least one year.
(c) An applicant for an adult
foster home providing ventilator-assisted care must be the primary caregiver and
live in the home where ventilator-assisted care is to be provided for a minimum
of one year from the date the initial ventilator-assisted care license is issued.
The licensee may employ a resident manager to be the primary live-in caregiver after
providing ventilator-assisted care for the one year period. The resident manager
must be approved by the local licensing authority and the Department.
(d) The applicant, licensee,
and all other caregivers must successfully complete the Department’s approved
training pertaining to ventilator-assisted care and other training as required.
Training is required on an annual basis and must be completed by the licensee, resident
manager, floating resident manager, shift caregivers, and substitute caregivers,
as applicable, prior to approval of a renewed ventilator-assisted care license.
(4) CLASSIFICATION. An applicant
for a ventilator-assisted care license must possess the minimum qualifications outlined
in section (3) of this rule. The applicant and licensee must meet and maintain compliance
with OAR 411-050-0630. The local licensing authority shall issue a Level A, Level
B, or Level C ventilator-assisted care adult foster home license to qualified applicants.
(a) A licensee with a Level
C ventilator-assisted care license may admit a maximum of one resident who requires
ventilator-assisted care. The local licensing authority may issue a Level C license
if the applicant has:
(A) Satisfied the requirements
described in section (3) above; and
(B) Successfully operated
a Class 3 home in substantial compliance with these rules for a period of not less
than one year.
(b) A licensee with a Level
B ventilator-assisted care license may admit a maximum of three residents who require
ventilator-assisted care. The local licensing authority may issue a Level B license
if the licensee has:
(A) Satisfied the requirements
described in section (3) above; and
(B) Successfully operated
and provided ventilator-assisted care in their Level C home in substantial compliance
with these rules for a period of not less than one year; or
(C) The applicant or licensee,
as applicable, has a current license as a health care professional in Oregon.
(c) A licensee with a Level
A ventilator-assisted care license may admit a maximum of five residents who require
ventilator-assisted care. The local licensing authority may issue a Level A license
if the licensee has:
(A) Satisfied the requirements
described in section (3) above; and
(B) Successfully operated
and provided ventilator-assisted care in their Level B home in substantial compliance
with these rules for a period of not less than one year.
(5) CAPACITY. An applicant
and licensee must meet and maintain compliance with OAR 411-050-0632. The number
of residents permitted to reside in a ventilator-assisted care adult foster home
is determined by the level of the home, the ability of the staff to meet the care
needs of the residents, the fire and life safety standards, and compliance with
these rules. A licensee may only admit or continue to provide ventilator-assisted
care for residents according to the level of the home's license. A licensee may
admit other residents who do not require ventilator-assisted care within the approved
license capacity listed on the home's license.
(6) OPERATIONAL STANDARDS.
A licensee must meet and maintain compliance with OAR 411-050-0645. In addition:
(a) A minimum of two qualified
and approved caregivers must be on site and available to meet the routine and emergency
care and service needs of the residents 24 hours a day. A minimum of one of the
two qualified and approved caregivers must be awake during nighttime hours.
(b) All caregivers must demonstrate
competency in providing ventilator-assisted care.
(c) All caregivers must be
able to evacuate the residents and any other occupants of the home within three
minutes or less.
(d) The applicant and licensee
must have a satisfactory system in place to ensure the caregivers are alert to the
24-hour needs of residents who may be unable to independently call for assistance.
(e) All caregivers must know
how to operate the back-up generator without assistance and be able to demonstrate
how to operate the back-up generator upon request by the Department or local licensing
authority.
(7) FACILITY STANDARDS. An
applicant and licensee must meet and maintain compliance with OAR 411-050-0650.
In addition:
(a) The residents’
bedrooms must be a minimum of 100 square feet, or larger if necessary, to accommodate
the standard requirements of OAR 411-050-0650, the needs of the resident, and the
equipment and supplies necessary for the care and services needed by individuals
requiring ventilator-assisted care.
(b) Homes that provide ventilator-assisted
care for residents must have a functional, emergency back-up generator. The generator
must be adequate to maintain electrical service for resident needs until regular
service is restored. Hard wired, back-up generators must be installed by a licensed
electrician. Back-up generators must be tested monthly and the test must be documented
in the facility records.
(c) The home must have a
functional, interconnected carbon monoxide and smoke alarm system with back-up batteries.
(d) The home must have a
functional sprinkler system and maintenance of the sprinkler system must be completed
as recommended by the manufacturer. A home that does not have a functional sprinkler
system but was approved to provide ventilator-assisted care prior to September 1,
2013, must install a functional whole-home sprinkler system no later than July 31,
2015.
(e) Each resident’s
bedroom must have a mechanism in place that enables the resident to summon a caregiver’s
assistance when needed. The mechanism must be within the abilities of the resident
to use. The summons must be audible in all areas of the adult foster home.
(8) STANDARDS AND PRACTICES
FOR CARE AND SERVICES. Licensees must meet and maintain compliance with OAR 411-050-0655.
In addition:
(a) The licensee must conduct
and document a thorough screening of a prospective resident on the Department’s
form (SDS 902).
(b) Prior to admitting a
resident requiring ventilator care to the adult foster home, the licensee must obtain
preauthorization from the Department.
(c) The licensee must have
a primary care physician identified for each resident being considered for admission.
(d) The licensee must retain
the services of a registered nurse (RN) consultant to work in the home who is licensed
by the State of Oregon and trained in the care of individuals requiring ventilator-assisted
care. RN services include, but are not limited to, the provision of medical consultation
and supervision of resident care, skilled nursing care as needed, and delegation
of nursing care to caregivers. When the licensee is an RN, a back-up RN licensed
by the State of Oregon and trained in the care of individuals requiring ventilator-assisted
care must be identified and available to provide nursing services in the absence
of the licensee.
(e) The licensee must develop
individual care plans for each resident with the RN consultant addressing the expected
frequency of nursing supervision, consultation, and direct service intervention.
The RN consultation must be documented on the resident's completed care plan with
the RN’s signature and date signed.
(f) The licensee must have
physician, RN, and respiratory therapist consultation services, all licensed by
the State of Oregon and trained in the care of individuals requiring ventilator-assisted
care available on a 24-hour basis and for in-home visits as appropriate. The licensee
must call the appropriate medical professional to attend to the emergent care needs
of the residents.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 410.070,
443.001-004, 443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88, Renumbered from 411-050-0445(8)
thru (10); SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert.
ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. & cert.
ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10,
cert. ef. 7-1-10; Renumbered from 411-050-0491, SPD 33-2013, f. 8-30-13, cert. ef.
9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14; APD 15-2015, f. 6-24-15, cert.
ef. 6-28-15
411-050-0662
Qualifications and Requirements for Limited
Adult Foster Homes
(1) To qualify for a limited adult foster
home license the applicant or licensee must submit:
(a) A completed application
for initial or renewal limited licenses;
(b) The Department’s
Health History and Physician's or Nurse Practitioner's Statement that indicates
the applicant or licensee is physically, cognitively, and emotionally capable of
providing care to a specific adult who is older or who has a physical disability
and with whom the applicant has an established relationship of not less than one
year. The Health History and Statement must be submitted initially and every third
year or sooner if there is reasonable cause for health concerns;
(c) Documentation of the
initiation of a background check or copy of an approved background check for each
subject individual;
(d) Completion of the Department’s
Caregiver Preparatory Training Study Guide (DHS 9030) and Workbook (DHS 9030-W);
and
(e) A $20 non-refundable
fee. If the licensee requests and is granted a variance from the capacity limitation
of one resident, a $20 per bed non-refundable fee for each non-relative resident
is required.
(2) The applicant or licensee
must demonstrate a clear understanding of the resident's care needs.
(3) The applicant or licensee
must live in the home that is to be licensed.
(4) The applicant or licensee
must own, rent, or lease the home in which care is being provided. The applicant
or licensee must provide verification of proof of ownership or a copy of the signed
and dated rental or lease agreement as applicable.
(5) A caregiver must be available
at all times, 24 hours a day, 7 days a week, when the resident is in the home. The
caregiver must have the knowledge and ability to meet the resident’s care
needs. All caregivers must:
(a) Have an approved background
check according to the Criminal Records and Abuse Check rules (OAR 407-007-0200
through 407-007-0370) prior to working in the home;
(b) Complete the Department’s
Caregiver Preparatory Training Study Guide (DHS 9030) and Workbook (DHS 9030-W);
and
(c) Be at least 18 years
of age.
(6) The licensee must notify
the local licensing authority if the licensee shall be absent from the home 10 days
or more and the resident shall be remaining in the home during the absence. The
licensee must also submit a staffing plan to the local licensing authority demonstrating
coverage during the absence that meets the needs of the resident.
(7) The resident's bedroom
must be in close enough proximity to the licensee or caregiver in charge to alert
him or her to nighttime needs or emergencies, or the bedroom must be equipped with
a functional call bell or intercom within the resident’s abilities to operate.
(8) The licensee and caregiver
must have a complete understanding of the resident’s medications. The licensee
must have a copy of current prescribing practitioner orders including, if applicable,
written authorization for self-administration of medications.
(9) Medications must be stored
in their original labeled container except when stored in a 7-day closed container
manufactured for advanced set-up of medications.
(10) The licensee and caregiver
must place used, disposable syringes and needles, and other sharp items in a puncture-resistant,
red container designed for disposal of sharp items. Disposal must be according to
local regulations as stated in section 411-050-0655(6). (See ORS 459.386 through
459.405)
(11) The licensee, the licensee’s
family, and employees of the home must guarantee not to violate the Residents’
Bill of Rights as outlined in OAR 411-050-0655.
(12) The licensee must have
a copy of any Advance Directive, Physician Order for Life-Sustaining Treatment (POLST),
and Do Not Resuscitate (DNR) orders.
(13) The home must have a
working landline and corded telephone. If the licensee has a caller identification
service on the home number, the blocking feature must be disabled to allow incoming
calls to be received unhindered. Voice over internet protocol (VoIP), voice over
broadband (VoBB), or cellular telephone service may not be used in place of a landline.
(14) CONSTRUCTION. Interior
and exterior doorways used by a resident must be wide enough to accommodate wheelchairs
and walkers if used by the resident. Interior and exterior stairways must be unobstructed,
equipped with handrails, and appropriate to the condition of the resident.
(15) Hardware for all exit
doors and interior doors must be readily visible and have simple hardware that may
not be locked against exit and must have an obvious method of operation. Hasps,
sliding bolts, hooks and eyes, slide chain locks, and double key deadbolts are not
permitted. If a home has a resident with impaired judgment who is known to wander
away, the home must have an activated alarm system to alert a caregiver of the resident’s
unsupervised exit.
(16) Buildings must be of
sound construction with wall and ceiling flame spread rates at least substantially
comparable to wood lath and plaster or better. The maximum flame spread of finished
materials may not exceed 200 and the smoke developed index may not be greater than
450. If more than 10 percent of combined wall and ceiling areas in a sleeping room
or exit way is composed of readily combustible material such as acoustical tile
or wood paneling, such material must be treated with an approved flame retardant
coating. Exception: Buildings supplied with an approved automatic sprinkler system.
(a) MANUFACTURED HOMES. Manufactured
home (formerly mobile homes) units must have been built since 1976 and designed
for use as a home rather than a travel trailer. The unit must have a manufacturer's
label permanently affixed on the unit itself that states the unit meets the requirements
of the Department of Housing and Urban Development (HUD). The required label must
read as follows:
"As evidenced by this label No. ABC000001,
the manufacturer certifies to the best of the manufacturer's knowledge and belief
that this mobile home has been inspected in accordance with the requirements of
the Department of Housing and Urban Development and is constructed in conformance
with the Federal Mobile Home Construction and Safety Standards in effect on the
date of manufacture. See date plate."
(b) If such a label is not evident and
the licensee believes the unit meets the required specifications, the licensee must
take the necessary steps to secure and provide verification of compliance from the
manufacturer.
(c) Mobile homes built since
1976 meet the flame spread rate requirements and do not have to have paneling treated
with a flame retardant coating.
(17) The applicant or licensee
must meet minimal fire safety standards including:
(a) A functional smoke alarm
with back-up battery must be installed in all sleeping areas and hallways or access
ways that adjoin sleeping areas;
(b) A functional carbon monoxide
alarm with back-up battery must be installed within 15 feet of each bedroom and
at a height as recommended by the manufacturer;
(c) At least one fire extinguisher
with a minimum classification of 2-A:10-B:C must be mounted in a visible and readily
accessible location on each floor, including basements, and be checked at least
once a year by a qualified person who is well versed in fire extinguisher maintenance.
All recharging and hydrostatic testing must be completed by a qualified agency properly
trained and equipped for this purpose;
(d) The licensee must have
a safe evacuation plan and may be required to demonstrate their evacuation plan.
The licensee may be required to install an Americans with Disabilities Act (ADA)
compliant ramp for the safety of all occupants;
(e) The licensee and all
occupants must be able to evacuate within 3 minutes to an initial point of safety
exterior to and away from the structure, with access to a public sidewalk or street.
The licensee and all occupants must be able to demonstrate the ability to further
evacuate all occupants from the initial point of safety to the final point of safety
within two minutes or less;
(f) Smoking is prohibited
in any bedroom including that of the resident, the licensee, occupants, or caregivers
and in any room where oxygen is used or stored;
(g) The home must be built
of standard construction and must meet all applicable state and local building,
mechanical, and housing codes for fire and life safety;
(h) A resident must have
a bedroom that:
(A) Was constructed as a
bedroom when the home was built or remodeled under permit;
(B) Is finished with walls
or partitions of standard construction that go from floor to ceiling;
(C) Has a door large enough
to accommodate the occupant of the room and any equipment that may be necessary
such as a hospital bed or wheelchair;
(D) Be adequately ventilated,
heated, and lighted with at least one operable window or exterior door that leads
directly outside as a secondary egress for resident use; and
(E) Has at least 70 square
feet of usable floor space.
(i) All exit ways, including
windows, must remain unobstructed at all times;
(j) Flammable materials cannot
be stored within 36 inches of open flame or heat sources;
(k) Only sealed electric
transfer heaters or electric space heaters with tip-over shut-off capability may
be used when approved by the State Fire Marshal or State Fire Marshal’s designee.
Heaters must be plugged directly into an outlet and may not be used with extension
cords; and
(l) The licensee must install
or make available any supportive device necessary to meet the resident’s needs
and ensure resident safety including, but not limited to grab bars, ramps, and door
alarms.
(18) A license is not transferable
and does not apply to any location or person other than the location and the person
indicated on the license obtained from the local licensing authority.
(19) The licensee must notify
the local licensing authority at least 30 days prior to any change in residential
or mailing address.
(20) The Department, the
local licensing authority, and the Centers for Medicare and Medicaid Services (CMS)
have authority to conduct inspections with or without advance notice to the licensee
or the resident of a home. The licensee must allow and authorize other caregivers
and occupants to permit entrance and access to the home and the resident for the
purpose of assessing, monitoring, inspection, investigation, and other duties within
the scope of the Department, the local licensing authority, or CMS.
(21) The applicant or licensee
must obtain any training and maintain resident record documentation deemed necessary
by the Department to provide adequate care for the resident.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004,
443.705-825, 443.875, 443.991
Hist.: SPD 33-2013, f. 8-30-13,
cert. ef. 9-1-13; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0665
Abuse Reporting, Complaints, and Notification
of Findings
(1) ABUSE REPORTING. Abuse is prohibited.
The facility employees and licensee may not permit, aid, or engage in abuse of residents
who are under their care. Abuse and suspected abuse must be reported in accordance
with OAR 411-020-0020.
(a) STAFF REPORTING. All
facility employees must immediately report abuse and suspected abuse to the investigative
authority.
(b) LICENSEE REPORTING. The
licensee must immediately notify the investigative authority of any incident of
abuse or suspected abuse, including events overheard or witnessed by observation.
(c) LAW ENFORCEMENT AGENCY.
The local law enforcement agency must be called first when the suspected abuse is
believed to be a crime (e.g., rape, murder, assault, burglary, kidnapping, theft
of controlled substances).
(2) IMMUNITY AND PROHIBITION
OF RETALIATION.
(a) The licensee may not
retaliate against any resident after the resident or someone acting on the resident's
behalf has filed a complaint in any manner, including, but not limited to:
(A) Increasing or threatening
to increase charges;
(B) Decreasing or threatening
to decrease services;
(C) Withholding rights or
privileges;
(D) Taking or threatening
to take any action to coerce or compel the resident to leave the facility; or
(E) Threatening to harass
or abuse a resident in any manner.
(b) The licensee must ensure
any complainant, witness, or employee of a facility is not subjected to retaliation
by any caregiver, (including the caregiver's family and friends who may live in
or frequent the adult foster home) for making a report, being interviewed about
a complaint, or being a witness, including, but not limited to, restriction of access
to the home or a resident or, if an employee, dismissal or harassment.
(c) Anyone who, in good faith,
reports abuse or suspected abuse has immunity, as approved by law, from any civil
liability that might otherwise be incurred or imposed with respect to the making
or content of an abuse complaint.
(3) Immunity under this rule
does not protect self-reporting licensees from liability for the underlying conduct
that is alleged in the complaint.
(4) The local licensing authority
must furnish each adult foster home with a Complaint Notice that states the telephone
number of the Department, the investigative authority, and the Long-Term Care Ombudsman,
and the procedure for making complaints.
(5) Any person who believes
these rules have been violated may file a complaint with the Department, the local
licensing authority, or the investigative authority.
(6) The Department or the
investigative authority shall investigate complaints in accordance with the adult
protective services rules in OAR chapter 411, division 20, OAR chapter 407, division
45, or OAR chapter 943, division 45, as applicable.
(7) Immediate protection
shall be provided for the residents by the Department, the local licensing authority,
or the investigative authority, as necessary, regardless of whether the investigative
report is completed. The licensee must immediately cease any practice that places
a resident at risk of serious harm.
(8) PRELIMINARY FINDINGS.
The Department, through the investigative authority, shall provide, by written communication
or electronic mail, a copy of the preliminary abuse investigation report to the
licensee and complainant within seven business days of the completion of the investigation:
(a) The report shall be accompanied
by a notice informing the licensee and complainant of their right to give additional
information about the content of the report to the investigative authority within
10 calendar days of receipt of the report.
(b) The investigative authority
must review the responses and reopen the investigation or amend the report if the
additional evidence warrants a change.
(9) A copy of the entire
report shall be sent to the Department upon completion of the investigation report.
(10) NOTIFICATION OF FINDINGS.
Upon a determination of substantiated abuse or a rule violation, the Department
must provide written notification of its findings to the licensee.
(a) CONTENT. The written
notice shall:
(A) Explain the nature of
each allegation;
(B) Include the date and
time of each occurrence;
(C) For each allegation,
include a determination of whether the allegation is substantiated, unsubstantiated,
or inconclusive;
(D) For each substantiated
allegation, state whether the violation was abuse or another rule violation;
(E) Include a copy of the
complaint investigation report;
(F) State that the complainant,
any person reported to have committed wrongdoing, and the facility have 15 calendar
days to provide additional or different information; and
(G) For each allegation,
explain the applicable appeal rights available.
(b) APPORTIONMENT. If the
Department determines there is substantiated abuse, the Department may determine
the licensee, an individual, or both the licensee and an individual were responsible
for abuse. In determining responsibility, the Department shall consider intent,
knowledge, and ability to control, and adherence to professional standards, as applicable.
(A) LICENSEE RESPONSIBLE.
Examples of when the Department shall determine the licensee is responsible for
the abuse include, but are not limited to, the following:
(i) Failure to provide sufficient,
qualified staffing in accordance with these rules without reasonable effort to correct;
(ii) Failure to check for
or act upon relevant information available from a licensing board;
(iii) Failure to act upon
information from any source regarding a possible history of abuse by any staff or
prospective staff;
(iv) Failure to adequately
train, orient, or provide sufficient oversight to staff;
(v) Failure to provide adequate
oversight to residents;
(vi) Failure to allow sufficient
time to accomplish assigned tasks;
(vii) Failure to provide
adequate services;
(viii) Failure to provide
adequate equipment or supplies; or
(ix) Failure to follow orders
for treatment or medication.
(B) INDIVIDUAL RESPONSIBLE.
Examples of when the Department determines an individual is responsible include,
but is not limited to:
(i) Intentional acts against
a resident, including assault, rape, kidnapping, murder, or sexual, verbal, or mental
abuse;
(ii) Acts contradictory to
clear instructions from the facility, such as those identified in section (10)(b)(A)
of this rule, unless the act is determined by the Department to be the responsibility
of the facility;
(iii) Callous disregard for
resident rights or safety; or
(iv) Intentional acts against
a resident's property (e.g., theft or misuse of funds).
(C) An individual shall not
be considered responsible for the abuse if the individual demonstrates the abuse
was caused by factors beyond the individual's control. "Factors beyond the individual's
control" are not intended to include such factors as misuse of alcohol or drugs
or lapses in sanity.
(D) NURSING ASSISTANTS. In
cases of substantiated abuse by a nursing assistant, the written notice shall explain:
(i) The Department’s
intent to enter the finding of abuse into the Nursing Assistant Registry following
the procedure set out in OAR 411-089-0140; and
(ii) The nursing assistant’s
right to provide additional information and request a contested case hearing as
provided in OAR 411-089-0140.
(c) DISTRIBUTION.
(A) The written notice shall
be mailed to:
(i) The licensee;
(ii) Any person reported
to have committed wrongdoing;
(iii) The complainant, if
known;
(iv) The Long-term Care Ombudsman;
and
(v) The local licensing authority.
(B) A copy of the written
notice must be placed in the Department's facility complaint file.
(11) Upon receipt of a notice
that substantiates abuse for victims covered by ORS 430.735, the facility must provide
written notice of the findings to the individual found to have committed abuse,
residents of the facility, and the residents’ case manager and legal representatives.
(12) Licensees who acquire
substantiated complaints pertaining to the health, safety, or welfare of residents
may be assessed civil penalties, have conditions placed on their licenses, or have
their licenses suspended, revoked, or not renewed.
(13) COMPLAINT REPORTS. Copies
of all completed complaint reports must be maintained and available to the public
at the local licensing authority. Individuals may purchase a photocopy upon requesting
an appointment to do so.
(14) The Department and the
local licensing authority shall not disclose information that may be used to identify
a resident in accordance with OAR 411-020-0030, Confidentiality, and federal HIPAA
Privacy Rules. Completed reports placed in the public file must be in compliance
with OAR 411-050-0670 and:
(a) Protect the privacy of
the complainant and the resident. The identity of the person reporting suspected
abuse must be confidential and may be disclosed only with the consent of that person,
by judicial process (including administrative hearing), or as required to perform
the investigation by the Department or a law enforcement agency;
(b) Treat the names of the
witnesses as confidential information; and
(c) Clearly designate the
final disposition of the complaint.
(A) PENDING COMPLAINT REPORTS.
Any information regarding the investigation of the complaint may not be filed in
the public file until the investigation has been completed.
(B) COMPLAINT REPORTS AND
RESPONSES. The investigation reports, including copies of the responses with confidential
information deleted, must be available to the public at the local licensing authority
office along with other public information regarding the adult foster home.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 124.050,
124.060, 124.075, 443.001-004, 443.705-825, 443.875, 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SDSD 11-2001, f. 12-21-01,
cert. ef. 1-1-02; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; SPD 22-2009(Temp),
f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10;
Renumbered from 411-050-0455, SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13; APD 50-2014(Temp),
f. 12-31-14, cert. ef. 1-1-15 thru 6-29-15; APD 15-2015, f. 6-24-15, cert. ef. 6-28-15
411-050-0670
Inspections
(1) The local licensing authority must
conduct an inspection of an adult foster home and all structures on the adult foster
home property:
(a) Prior to issuance of
a license;
(b) Prior to the annual renewal
of a license. The local licensing authority must conduct this inspection unannounced;
(c) Upon receipt of an oral
or written complaint of violations that threaten the health, safety, or welfare
of residents; or
(d) Anytime the Department
has probable cause to believe a home has violated a regulation or provision of these
rules or is operating without a license.
(2) The Department may conduct
inspections:
(a) Any time such inspections
are authorized by these rules and any other time the Department considers it necessary
to determine if a home is in compliance with these rules or with conditions placed
upon the license;
(b) To determine if cited
violations have been corrected; and
(c) For the purpose of routine
monitoring of the residents' care.
(3) State or local fire inspectors
must be permitted access to enter and inspect adult foster homes regarding fire
safety upon the Department's request.
(4) The Department, the local
licensing authority, the investigative authority, and the Centers for Medicare and
Medicaid Services (CMS) have authority and must have full access to examine and
copy facility and resident records, including but not limited to, admission agreements,
private pay resident contracts, and resident account records, as applicable.
(5) PRIVATE INTERVIEW. Department,
local licensing authority, investigative authority, and CMS staff have authority
to interview the licensee, resident manager, other caregivers, and the residents.
Interviews must be confidential and conducted privately.
(6) Licensees must authorize
all staff to permit the Department, local licensing authority, the investigative
authority, and CMS staff, for the purpose of inspection, investigation, and other
duties within the scope of their authority:
(a) Entrance to the adult
foster home and any other structure on the premises; and
(b) Access to resident and
facility records.
(7) The Department, local
licensing authority, the investigative authority, and CMS has authority to conduct
inspections with or without advance notice to the licensee, staff, or the residents
of the home. The Department, local licensing authority, and CMS shall not give
advance notice of any inspection if it is believed that notice might obstruct or
seriously diminish the effectiveness of the inspection or enforcement of these rules.
(8) If Department, local
licensing authority, the investigative authority, or CMS staff are not permitted
access for inspection, a search warrant may be obtained.
(9) The inspector must respect
the private possessions of the residents, licensee, and staff while conducting an
inspection.
(10) PUBLIC FILE. The local
licensing authority must maintain current information on all licensed adult foster
homes and must make all non-confidential information available to prospective residents
and other interested members of the public at local licensing authority offices
throughout the state as authorized by law. The information includes:
(a) The location of the adult
foster home and the name and mailing address of the licensee if different;
(b) A brief description of
the physical characteristics of the home;
(c) A copy of the current
license that indicates the current classification, level, and capacity of the home,
as applicable;
(d) The date the licensee
was first licensed to operate that home;
(e) The date of the last
licensing inspection including any fire inspection, the name and telephone number
of the office that performed the inspection, and a summary of the inspection findings;
(f) Copies of all non-confidential
portions of complaint investigations involving the home, together with the findings,
actions taken by the Department, and responses from the licensee and complainant,
as appropriate. All complaint terminology must be clearly defined and the final
disposition clearly designated;
(g) Any license conditions,
suspensions, denials, revocations, non-renewals, civil penalties, variances, or
other actions taken by the Department involving the home; and
(h) Whether care is provided
primarily by the licensed provider, a resident manager, or shift caregivers.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; Renumbered from 411-050-0450, SPD 33-2013, f. 8-30-13, cert. ef.
9-1-13
411-050-0675
Procedures for Correction of Violations
(1) If, as a result of an inspection
or investigation, the Department determines that abuse has occurred, the licensee
shall be notified verbally to immediately cease the abusive act. The Department
shall follow-up with a written confirmation of the warning to cease the abusive
act and shall include notification that further sanctioning may be imposed.
(2) If an inspection or investigation
indicates a violation of these rules other than abuse, the local licensing authority
shall notify the licensee of the violation in writing.
(3) The notice of violation
may not include information that may be used to identify a resident in accordance
with OAR 411-020-0030, Confidentiality, and federal HIPAA Privacy Rules. Notices
placed in the public file must be in compliance with OAR 411-050-0670 and must include
the following:
(a) A description of each
condition that constitutes a violation;
(b) Each rule that has been
violated;
(c) A specific time frame
for correction, not to exceed 30 calendar days after receipt of the notice. The
local licensing authority may approve a reasonable time in excess of 30 calendar
days if correction of the violation within that time frame is not practical. If
the licensee requests more than 30 calendar days to correct the violation, such
time must be specified in the licensee’s plan of correction and must be found
acceptable by the local licensing authority;
(d) Sanctions that may be
imposed against the home for failure to correct the violation;
(e) The right of the licensee
to contest the violation if an administrative sanction is imposed; and
(f) The right of the licensee
to request a variance as provided in OAR 411-050-0642.
(4) At any time after receipt
of a notice of violation or an inspection report, the applicant, the licensee, the
local licensing authority, or the Department may request a meeting. The meeting
must be scheduled within 10 business days of a request by any party.
(a) The purpose of the meeting
is to discuss the violation stated in the notice of violation, provide information,
and to assist the applicant or licensee in achieving compliance with the requirements
of these rules.
(b) The request for a meeting
by an applicant, licensee, local licensing authority, or the Department does not
extend any previously established time frame for correction.
(5) The applicant or licensee
must notify the local licensing authority of correction of the violation by completing
a written response in the provider’s statement of correction section on the
violation. Notification of correction of the violation must be submitted to the
local licensing authority no later than the date specified in the notice of violation.
(6) The local licensing authority
may conduct a re-inspection of the home after the date the local licensing authority
receives the report of compliance, or after the date the violation must be corrected
as specified in the notice of violation.
(7) For violations that present
an imminent danger to the health, safety, or welfare of residents, the licensee
must correct the violation and abate the conditions no later than 24 hours after
receipt of the notice of violation. The local licensing authority may inspect the
home after the 24-hour period to determine if the violation has been corrected as
specified in the notice of violation.
(8) If residents are in immediate
danger, the license may be immediately suspended and arrangements made to move the
residents.
(9) If, after inspection
of a home, the violations have not been corrected by the date specified in the notice
of violation or if the local licensing authority has not received a report of compliance,
the Department may institute one or more administrative sanctions.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443..001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0460, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13
411-050-0680
Administrative Sanctions
(1) An administrative sanction may be
imposed for non-compliance with these rules. An administrative sanction includes
one or more of the following actions:
(a) Attachment of conditions
to a license;
(b) Civil penalties;
(c) Denial, suspension, revocation,
or non-renewal of license; and
(d) Reclassification of a
license.
(2) If the Department imposes
an administrative sanction, the Department shall serve a notice of administrative
sanction upon the licensee personally, by certified or registered mail, or by certified
electronic mail if requested by the licensee.
(3) The notice of administrative
sanction shall state:
(a) Each sanction imposed;
(b) A short and plain statement
of each condition or act that constitutes a violation;
(c) Each statute or rule
allegedly violated;
(d) A statement of the licensee's
right to a contested case hearing;
(e) A statement of the authority
and jurisdiction under which the hearing is to be held;
(f) A statement that the
Department's files on the subject of the contested case automatically become part
of the contested case record upon default for the purpose of proving a prima facie
case; and
(g) A statement that the
Department shall issue a final order of default if the licensee fails to request
a hearing within the specified time.
(4) The licensee must comply
with any final order of the Department.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443..001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0465,
SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13
411-050-0685
Civil Penalties
(1) Except as otherwise provided in
this rule, civil penalties, not to exceed $100 per violation to a maximum of $250,
may be assessed for a general violation of these rules.
(2) Mandatory penalties up
to $500, unless otherwise required by law, shall be assessed for falsifying resident
or facility records or causing another to do so.
(3) A mandatory penalty of
$250 shall be imposed for failure to have either the licensee or other qualified
caregiver on duty 24 hours per day in the adult foster home.
(4) A mandatory penalty of
$250 shall be imposed for dismantling or removing the battery from any required
smoke alarm or failing to install any required smoke alarm.
(5) The Department shall
impose a civil penalty of not less than $250 nor more than $500 on a licensee who
admits a resident knowing that the resident's care needs exceed the license classification
of the licensee and the admission places the resident or other residents at risk
of harm.
(6) Civil penalties up to
a maximum of $1,000 per occurrence may be assessed for substantiated abuse.
(7) If the Department or
the Department's designee conducts an investigation and abuse is substantiated and
if the abuse resulted in the death, serious injury, rape, or sexual abuse of a resident,
the Department shall impose a civil penalty of not less than $2,500 for each violation.
(a) To impose this civil
penalty, the Department must establish that:
(A) The abuse arose from
deliberate or other than accidental action or inaction;
(B) The conduct resulting
in the abuse was likely to cause death, serious injury, rape, or sexual abuse of
a resident; and
(C) The person with the finding
of abuse had a duty of care toward the resident.
(b) For the purposes of this
civil penalty, the following definitions apply:
(A) "Serious injury" means
a physical injury that creates a substantial risk of death or that causes serious
disfigurement, prolonged impairment of health, or prolonged loss or impairment of
the function of any bodily organ.
(B) "Rape" means rape in
the first, second, or third degree as described in ORS 163.355, 163.365, and 163.375.
(C) "Sexual abuse" means
any form of nonconsensual sexual contact including but not limited to unwanted or
inappropriate touching, sodomy, sexual coercion, sexually explicit photographing,
or sexual harassment. The sexual contact must be in the form of any touching of
the sexual or other intimate parts of a person or causing such person to touch the
sexual or other intimate parts of the actor for the purpose of arousing or gratifying
the sexual desire of either party.
(D) "Other than accidental"
means failure on the part of the licensee, or licensee's employees, agents, or volunteers
for whose conduct licensee is responsible, to comply with applicable Oregon Administrative
Rules.
(8) In addition to any other
liability or penalty provided by law, the Department may impose a penalty for any
of the following:
(a) Operating the home without
a license;
(b) The number of residents
exceeds the licensed capacity;
(c) The licensee fails to
achieve satisfactory compliance with the requirements of these rules within the
time specified, or fails to maintain such compliance;
(d) The home is unable to
provide adequate level of care to the residents;
(e) There is retaliation
or discrimination against a resident, family, employee, or any other person for
making a complaint against the home;
(f) The licensee fails to
cooperate with the Department or fails to cooperate with the prescribing practitioner
or licensed health care professional in carrying out a resident's care plan; or
(g) The licensee fails to
obtain an approved background check from the Department prior to employing a caregiver
in the home.
(9) A civil penalty may be
imposed for violations other than those involving the health, safety, or welfare
of a resident if the licensee fails to correct the violation as required when a
reasonable time frame for correction was given.
(10) Any civil penalty imposed
under this rule becomes due and payable 10 calendars days after the order imposing
the civil penalty becomes final by operation of law or on appeal. The notice must
be delivered in person or sent by registered or certified mail and must include:
(a) A reference to the particular
sections of the statute, rule, standard, or order involved;
(b) A short and plain statement
of the matters asserted or charged;
(c) A statement of the amount
of the penalty or penalties imposed; and
(d) A statement of the right
to request a hearing.
(11) The person to whom the
notice is addressed shall have 10 calendar days after receipt of the notice in which
to make written application for a hearing. If a written request for a hearing is
not timely received, the Department shall issue a final order by default.
(12) All hearings shall be
conducted according to the applicable provisions of ORS 183.
(13) When imposing a civil
penalty, the Department shall consider the following factors:
(a) The past history of the
person incurring the penalty in taking all feasible steps or procedures to correct
the violation;
(b) Any prior violations
of statutes, rules, or orders pertaining to the facility;
(c) The economic and financial
conditions of the person incurring the penalty;
(d) The immediacy and extent
to which the violation threatens or threatened the health, safety, or welfare of
one or more residents; and
(e) The degree of harm to
residents.
(14) If the person notified
fails to request a hearing within the time specified, or if after a hearing the
person is found to be in violation of a license, rule, or order, an order may be
entered assessing a civil penalty.
(15) Unless the penalty is
paid within 10 calendar days after the order becomes final, the order constitutes
a judgment and may be recorded by the county clerk, which becomes a lien upon the
title to any interest in real property owned by that person. The Department may
also initiate a notice of revocation for failure to comply with a final order.
(16) Civil penalties are
subject to judicial review under ORS 183.480, except that the court may, at its
discretion, reduce the amount of the penalty.
(17) All penalties recovered
under ORS 443.790 to 443.815 are paid to the Quality Care Fund.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 11-1988, f. 10-18-88,
cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10 Renumbered from 411-050-0487, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13; APD 6-2014, f. 3-31-14, cert. ef. 4-1-14
411-050-0686
Conditions
(1) Conditions may be attached to a
license and take effect immediately upon notification by the Department or the delivery
date of the notice, whichever is sooner. The type of condition attached to a license
must directly relate to a risk of harm or potential risk of harm to residents. Conditions
may be attached upon a finding that:
(a) Information on the application
or initial inspection requires a condition to protect the health, safety, or welfare
of the residents;
(b) A threat to the health,
safety, or welfare of a resident exists;
(c) There is reliable evidence
of abuse, neglect, or exploitation; or
(d) The home is not being
operated in compliance with these rules.
(2) Examples of conditions
that may be imposed on a licensee include, but are not limited to:
(a) Restricting the total
number of residents based upon the ability of the licensee to meet the health and
safety needs of the residents;
(b) Restricting the number
of residents a provider may admit or retain within a specific classification or
level based upon the ability of the licensee and staff to meet the health and safety
needs of all the residents;
(c) Changing the classification
of the license based on the licensee’s ability to meet the specific care needs
of the residents;
(d) Requiring additional
staff to meet the resident's care needs;
(e) Requiring additional
qualifications or training of licensee and staff to meet specific resident care
needs;
(f) Restricting admissions
when there is a threat to the current residents of the home and admitting new residents
would compound that threat; and
(g) Restricting a licensee
from allowing persons on the premises who may be a threat to a resident's health,
safety, or welfare.
(3) In accordance with OAR
411-050-0680, the licensee shall be notified in writing of any conditions imposed,
the reason for the conditions, and be given an opportunity to request a hearing
under ORS 183.310 to 183.550. A licensee must request a hearing in writing within
21 calendar days after the receipt of the notice. Conditions take effect immediately
and are a final order of the Department unless later rescinded through the hearings
process.
(4) In addition to, or in-lieu
of, a contested case hearing, a licensee may request an informal conference with
the Department of conditions imposed. The informal conference does not diminish
the licensee's right to a hearing.
(5) Conditions imposed remain
in effect until the Department has sufficient cause to believe the situation that
warranted the condition has been remedied. If the licensee believes the situation
that warranted the condition has been remedied, the licensee may request in writing
that the condition be removed.
(6) Conditions must be posted
with the license in a prominent place in the home and be available for inspection
at all times.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443..001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 11-1988, f. 10-18-88,
cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92,
cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. &
cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; Renumbered from 411-050-0483,
SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13
411-050-0687
Denial, Revocation, or Non-Renewal of License
(1) The Department shall deny, revoke,
or refuse to renew a license where the Department finds:
(a) There has been substantial
non-compliance with these rules or where there is substantial non-compliance with
local codes and ordinances or any other state or federal law or rule applicable
to the health and safety of caring for residents in an adult foster home;
(b) The Department has conducted
a background check and determined the applicant or licensee is not approved in accordance
with OAR 411-050-0620;
(c) The licensee allows a
caregiver, or any other person, excluding the residents, to reside or work in the
adult foster home, who has been convicted of potentially disqualifying crimes, and
has been denied, or refused to cooperate with the Department in accordance with
OAR 411-050-0620; or
(d) The applicant or licensee
falsely represents that he or she has not been convicted of a crime.
(2) The Department shall
deny, revoke, or refuse to renew a license where the Department of Human Services
has received notice from the Department of Revenue in accordance with ORS 305.385.
(3) The Department may deny,
revoke, or refuse to renew an adult foster home license if the applicant or licensee:
(a) Submits incomplete or
untrue information to the Department;
(b) Has a history of, or
demonstrates financial insolvency, such as foreclosure, eviction due to failure
to pay rent, or termination of utility services due to failure to pay bills;
(c) Has a prior denial, suspension,
revocation, or refusal to renew a certificate or license to operate a foster home
or residential care facility in this or any other state or county;
(d) Is associated with a
person whose license for a foster home or residential care facility was denied,
suspended, revoked, or refused to be renewed due to abuse or neglect of the residents,
creating a threat to the residents, or failure to possess physical health, mental
health, or good personal character within three years preceding the present action,
unless the applicant or licensee is able to demonstrate to the Department by clear
and convincing evidence that the person does not pose a threat to the residents.
For purposes of this subsection, an applicant or licensee is "associated with" a
person if the applicant or licensee:
(A) Resides with the person;
(B) Employs the person in
the foster home;
(C) Receives financial backing
from the person for the benefit of the foster home;
(D) Receives managerial assistance
from the person for the benefit of the foster home;
(E) Allows the person to
have access to the foster home; or
(F) Rents or leases the adult
foster home from the person.
(e) Has threatened the health,
safety, or welfare of any resident;
(f) Has abused, neglected,
or exploited any resident;
(g) Has a medical or psychiatric
problem that interferes with the ability to provide care and services;
(h) Has previously been cited
for the operation of an unlicensed adult foster home;
(i) Does not possess the
good judgment or character deemed necessary by the Department;
(j) Fails to correct a violation
within the specified time frame;
(k) Refuses to allow access
and inspection;
(l) Fails to comply with
a final order of the Department to correct a violation of the rules for which an
administrative sanction has been imposed, such as a license condition;
(m) Fails to comply with
a final order of the Department imposing an administrative sanction, including the
imposition of a civil penalty;
(n) Fails to take or pass
the Department's Ensuring Quality Care Course and examination;
(o) Fails to obtain an approved
background check for subject individuals according to OAR 411-050-0620 on more than
one occasion;
(p) Has previously surrendered
a license while under investigation or administrative sanction during the last three
years;
(q) Is not currently or has
not previously been in compliance with employment or tax laws; or
(r) Fails to operate the
home or any other facility in substantial compliance with ORS 443.705 to 443.825.
(4) If the Department issues
a notice of revocation for the reason of abuse, neglect, or exploitation of a resident,
the licensee may request a review in writing within 10 calendar days after receipt
of the notice of the revocation. If a request is made, the Department must review
all material relating to the allegation of abuse, neglect, or exploitation and the
revocation within 10 calendar days. The Department shall determine, based on a review
of the material, whether to sustain the decision. If the Department does not sustain
the decision, the license shall be restored immediately. The decision of the Department
is subject to a contested case hearing under ORS 183.
(5) If a license is revoked
or not renewed, the licensee is entitled to a contested case hearing preceding the
effective date of the revocation or non-renewal if the licensee requests a hearing
in writing within 21 calendar days after receipt of the notice. If no written request
for a hearing is timely received, the Department shall issue the final order by
default. The Department may designate its file as the record for purposes of default.
(6) A license subject to
revocation or non-renewal remains valid during an administrative hearings process
even if the hearing and final order are not issued until after the expiration date
of the license.
(7) If an initial license
is denied for any reason other than the results of a test or inspection, the applicant
is entitled to a hearing if the applicant requests a hearing in writing within 60
calendar days after receipt of the denial notice. If no written request for a hearing
is timely received, the Department shall issue a final order by default. The Department
may designate its file as the record for purposes of default.
(8) If a license is revoked
or not renewed, the Department may arrange for residents to move for the residents'
protection.
Stat. Auth.: ORS 410.070, 430.735, 443.001,
443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775,
& 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 2-1987(Temp), f. & ef. 5-5-87; SSD 10-1987, f. 10-29-87, ef.
11-1-87; SSD 11-1988, f. 10-18-88, cert. ef. 11-1-88; SSD 3-1992, f. 5-26-92, cert.
ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert.
ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert.
ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10; SPD 9-2010,
f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0480, SPD 33-2013, f. 8-30-13,
cert. ef. 9-1-13
411-050-0688
Suspension of License
(1) The Department may immediately suspend
a license for reason of abuse, neglect, or exploitation of a resident if:
(a) The Department finds
that the abuse, neglect, or exploitation causes an immediate threat to any of the
residents; or
(b) The licensee fails to
operate the home or any other facility in substantial compliance with ORS 443.705
to 443.825.
(2) The licensee may request
a review of the decision to immediately suspend a license by submitting a request,
in writing, within 10 calendar days after receipt of the notice and order of suspension.
Within 10 calendar days after receipt of the licensee's request for a review, the
Department must review all material relating to the allegation of abuse, neglect,
or exploitation and to the suspension, including any written documentation submitted
by the licensee within that time frame. The Department shall determine, based on
a review of the material, whether to sustain the decision. If the Department does
not sustain the decision, the suspension shall be rescinded immediately. The decision
of the Department is subject to a contested case hearing under ORS 183 if requested
within 90 calendar days.
(3) The Department shall
suspend a license upon written notice from the Department of Revenue in accordance
with ORS 305.385, and after notice to the licensee and a hearing if requested.
(4) If a license is suspended,
the Department may arrange for residents to move for the resident's protection.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 3-1996, f. 3-29-96,
cert. ef. 4-1-96; SDSD 4-2001, f. & cert. ef. 3-1-01; SPD 31-2006, f. 12-27-06,
cert. ef. 1-1-07; SPD 22-2009(Temp), f. 12-31-09, cert. ef. 1-1-10 thru 6-30-10;
SPD 9-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 411-050-0481, SPD 33-2013,
f. 8-30-13, cert. ef. 9-1-13
411-050-0690
Criminal Penalties
(1) Operating an adult foster home without
a license is punishable as a Class C misdemeanor ORS 443.991(5).
(2) Refusing to allow access
and inspection of a home by Department or local licensing authority staff or state
or local fire inspection is a Class B misdemeanor ORS 443.991(6).
(3) The Department may commence
an action to enjoin operation of an adult foster home:
(a) When an adult foster
home is operated without a valid license; or
(b) After a notice of revocation
or suspension has been given and a reasonable time for placement of individuals
in other facilities has been allowed.
Stat. Auth.: ORS 410.070, 443.001, 443.004,
443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001
to 443.004, 443.705 to 443.825, 443.875, & 443.991
Hist.: SSD 14-1985, f. 12-31-85,
ef. 1-1-86; SSD 2-1987(Temp), f. & ef. 5-5-87; SSD 11-1988, f. 10-18-88, cert.
ef. 11-1-88; SSD 3-1992, f. 5-26-92, cert. ef. 6-1-92; SSD 3-1992, f. 5-26-92, cert.
ef. 6-1-92; SSD 3-1996, f. 3-29-96, cert. ef. 4-1-96; SDSD 4-2001, f. & cert.
ef. 3-1-01; SPD 31-2006, f. 12-27-06, cert. ef. 1-1-07; Renumbered from 411-050-0485,
SPD 33-2013, f. 8-30-13, cert. ef. 9-1-13
 


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