OVERSIGHT OF ASSISTED LIVING IN THE UNITED STATES: SUMMARIES OF
STATE REQUIREMENTS AND PRACTICES
Since there are no federal rules or standards for assisted living, the development of requirements
for things like quality of care, minimum safety and living standards, residents’ rights and
medication management is left to the individual states.
As a result, standards vary greatly, as does the quality of IMPORTANT NOTE: The Table of
their enforcement and oversight of assisted living Contents below is comprised of
providers. The following tables provide summaries for hyperlinks to the specific chapters –
each state (as available) on issues relating to assisted click on the page number to go
living oversight, as listed in the Table of Contents below. directly to that page.
For an overall summary of this information, see our
related issue brief, Overview of State Survey and Enforcement Laws, Regulations and Policies for
Assisted Living, available at www.assisted-living411.org.
Table of Contents
Is Licensure Required? 2
State Agency Overseeing Licensure/Inspection 3
Frequency of Inspections 5
Announced/Unannounced Inspections 7
Survey Team Composition 8
Training of Surveyors 10
Number of Surveyors (Per Team and/or in State) Error! Bookmark not defined.13
Survey Protocol 12
Can Facilities Challenge Department Findings? 19
Are Inspection Reports Made Available to the Public? 22
Resources on Assisted Living Oversight 25
Important Note: The following charts detail information on state licensure, facility inspections,
types of enforcement actions, and the dissemination of information on assisted living facility
compliance to the public. Please note that they are a work in progress. There are some states for
which we have been unable to find data. We will be continuing to update this material. PLEASE LET
US KNOW IF YOU BELIEVE SOMETHING SHOULD BE CORRECTED OR UPDATED: email@example.com.
State Is Licensure Required?
Alabama Yes, under the Assisted Living Facility Act enacted in 2001. Non-complying
facilities are subject to penalties.
Alaska Yes, under AS 47.32.
Arkansas Yes, Ark. Code 20-10-201.
California ALFs no, RCFs yes.
Connecticut Facilities are not required to be licensed but they may make agreements w/
licensed service agencies.
District of Columbia No
Iowa The state of Iowa allows for either JCAHO or CARF-CCAC accreditation in place of
the state's survey and licensing process.
Kentucky Licensure is not required but certification is required. Fines of up to $500 per day
for facilities operating or marketing themselves as assisted living facilities
Massachusetts Certification Required.
Michigan Yes - Adult Foster Care Homes.
Minnesota Registration is required but not licensure.
Missouri State law makes operation of an unlicensed facility a Class D felony IF abuse or
neglect occurs. Facilities that are not licensed cannot hold themselves out or call
themselves assisted living facilities. Otherwise, unlicensed facilities appear to be
Nebraska Any person intending to establish, operate, or maintain an assisted-living facility
must first obtain a license from the Department. A facility must not hold itself
out as an assisted living facility or as providing health care services unless
licensed under the Health Care Facility Licensure Act.
New Hampshire Yes
New Jersey Yes
New Mexico Yes
New York Operating certificate and licensure required.
North Carolina Yes
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North Dakota Yes
Rhode Island Yes
South Carolina Yes
South Dakota Yes
Washington Yes - "boarding homes" are required to have licenses.
West Virginia Yes
Wisconsin Yes – Residential Care Apartment Complexes are not licensed but rather
registered or certified to serve Medicaid clients. There are seven different types
of surveys: initial, standard, abbreviated, complaint, verification, monitoring, and
self-report. The State determines which type of survey to conduct for each
facility based on a range of factors, including its citation history.
State State Agency Overseeing Licensure/Inspection
Alabama Department of Health, www.adph.org.
Alaska Dept. of Health & Social Services for those w/ mental or developmental
disability. Dept. of Admin. For those who have a physical disability/elderly,
http://www.hss.state.ak.us/dph/cl/all/default.htm or http://doa.alaska.gov.
Arizona Dept. of Health Services, Div. of Licensing, www.azdlhs.gov/als.
Arkansas Dept. of Human Services, LTC Division, http://www.daas.ar.gov.
California California Dept. of Social Services, www.cdss.ca.gov/cdssweb.
Colorado Dept. of Public Health and Environment, Health Facilities Licensing and
Connecticut Dept. of Health, www.ct.gov/dph.
District of Columbia Community Residence Facilities Branch, Child and Residential Care Facilities
Division, Health Regulation Administration,
Delaware Dept. of Health and Social Services, Division of LTC Residents,
Florida Florida Dept. of Elder Affairs establishes regulations,
http://elderaffairs.state.fl.us/index.php. Agency for Healthcare Administration is
responsible for inspection, license issuance, and oversight,
Georgia Office of Regulatory Services,
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Hawaii Department of Health, Office of Health Care Assurance,
Idaho Department of Health and Welfare, http://www.healthandwelfare.idaho.gov.
Illinois Department of Public Health, http://www.idph.state.il.us.
Indiana Department of Health, http://www.in.gov/isdh.
Iowa Department of Elder Affairs develops rules and regulations,
www.state.ia.us/government/dea. Department of Inspections and Appeals
(Health Facilities Division) monitors, inspects and enforces regulations,
Kansas Department of Aging, http://www.agingkansas.org.
Kentucky Cabinet for Health and Family Services, Division of Aging, http://chfs.ky.gov.
Louisiana Department of Social Services, http://www.dss.state.la.us.
Maine Bureau of Elder and Adult Services sets out regulations,
http://www.maine.gov/dhhs/oes. Community Services Program, Division of
Licensing and Regulatory Services performs surveys,
Maryland Regulated by the Department of Health and Mental Hygiene, Office of
Healthcare Quality, http://www.dhmh.state.md.us/ohcq. Inspections performed
by Office on Aging, Dept. of Human Resources, http://www.mdoa.state.md.us.
Massachusetts Executive Office of Elder Affairs,
Michigan Department of Human Services licenses facilities, http://www.michigan.gov/dhs.
Department of Labor and Economic Growth performs fire safety, inspections,
Minnesota Department of Health, http://www.health.state.mn.us.
Mississippi Department of Health, http://www.msdh.state.ms.us.
Missouri Department of Health and Senior Services, http://www.dhss.mo.gov.
Montana Department of Health and Human Services, Montana Licensure Bureau,
Nebraska Department of Health and Human Services, http://www.hhs.state.ne.us.
Nevada Bureau of Licensure and Certification, http://www.doi.state.nv.us.
New Hampshire Department of Health and Human Services, Bureau of Health Facility
New Jersey Department of Health and Senior Services, Division of Long Term Care Systems,
New Mexico Department of Health, http://www.health.state.nm.us.
New York Department of Health, Division of Home and Community Based Care,
North Carolina Department of Health and Human Services, Division of Health Service Regulation,
North Dakota Department of Health, Division of Health Facilities, http://www.ndhealth.gov/HF.
Ohio Department of Health, http://www.odh.ohio.gov.
Oklahoma Department of Health, http://www.ok.gov/health.
Oregon Oregon Division of Seniors and People with Disabilities,
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Pennsylvania Department of Public Welfare, Division of Personal Care Homes,
Rhode Island Department of Health, http://www.health.ri.gov.
South Carolina Department of Health and Environment,
South Dakota Department of Health,
Tennessee Department of Health, Bureau of Health Licensure and Regulation,
Board for Licensing Health Care Facilities,
Division of Health Care Facilities, http://health.state.tn.us/hcf/index.htm.
Texas Department of Aging and Disability Services, http://www.dads.state.tx.us.
Utah Department of Health, Bureau of Health Facility Licensing, Certification, and
Resident Assessment, http://health.utah.gov/hflcra.
Vermont Department of Disabilities, Aging, and Independent Living,
Virginia Department of Social Services, http://www.dss.virginia.gov.
Washington Department of Social and Health Services - Aging and Disability Services
West Virginia Office of Health and Human Resources - Office of Health Facility Licensure and
Wisconsin Dept. of Health and Family Services - Bureau of Quality Assurance,
Wyoming Department of Health, http://wdh.state.wy.us.
State Frequency of Inspections
Alabama Every 18 months.
Arizona Annually, upon complaint.
Arkansas Biannually, by complaint.
California 20% each year, each facility at least once every 5 years.
Colorado New facilities receive health and life inspection each of first two years, then
every other year if no deficiencies. Those with deficiencies = both annually. Also
Connecticut Biannually, upon complaint.
District of Columbia Inspect after six months of licensure and then annually; upon complaint and at
Delaware Annually, upon complaint.
Florida Biannually, serious complaints.
Georgia Initial, annual and follow-up inspections, upon complaint.
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Idaho At least annually, began surveying facilities every three years if there had been
no deficiencies for two consecutive surveys and no complaints. Troubled facilities
may be inspected 3 or more times per year.
Illinois Annually and when department deems it necessary.
Indiana Annual, follow-up, upon complaint.
Iowa Biennially, upon complaint.
Kentucky Initial inspection for facility certification, then annually for compliance w/
certification regulations. Unless a formal complaint is lodged, facilities are not
monitored for quality of care.
Louisiana Annually, upon complaint.
Maine Every 1 to 3 years, depending on type of provider.
Maryland Initial inspection followed by six-month follow up, then annually (or up to 15
months for those with exemplary record), and upon complaint.
Massachusetts Initial inspection, biennially, upon complaint
Michigan Annually for homes for the Aged, biennially for adult foster care homes.
Minnesota Annually for assisted living facilities, annually or biennially for licensed home
health care agencies providing services to facilities (facilities are reviewed as
part of the review of the home health care agency as well). The home health care
agency is reviewed biennially if they have been licensed for at least 2 years and
have remained in substantial compliance w/ law).
Missouri Biannually, pursuant to a complaint. Complaints that pose a risk of imminent
harm to residents are inspected within 24 hours, all others within 30 days.
Montana Initial inspection and then annually, biennially or triennially depending upon the
facility. Also upon complaint.
Nebraska May conduct an on-site inspection at any time it deems necessary. Otherwise it
takes a random 25% sample of all state assisted living facilities to survey in a
given year. Facilities must be examined at least once every five years. Inspections
may also be conducted more often upon complaints, incidents involving death or
risk of serious injury, etc.
Nevada Annually, upon complaint.
New Hampshire Annually, upon complaint, follow up inspections after a finding of deficiencies.
New Jersey Annually.
New Mexico Annually.
New York Annually, biannually for private proprietary adult homes, upon complaint, follow
North Carolina Full inspections are done at least annually and upon complaint. In addition,
county departments of social services conduct routine monitoring of the adult
care homes, at least once a quarter.
North Dakota Biennially, upon complaint.
Ohio Every nine to fifteen months, and as the Dept. considers necessary.
Oklahoma At least once every fifteen months, upon complaint, whenever Department
Oregon At least every 2 years, upon complaint, whenever Department deems necessary.
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Pennsylvania At least annually. Complaints are triaged and are investigated according to
timeframes based upon severity. Newly licensed facilities will be re-inspected
within 3 months of the initial licensure.
Rhode Island At least annually, as needed, upon complaint.
South Carolina Biennially or every three years for those facilities with a history of compliance
and no complaints.
South Dakota At least annually (between 9 and 15 months), upon complaint.
Tennessee Every 15 months and as necessary; upon complaint.
Texas Surveyors perform inspections and surveys, follow-up visits, complaint
investigations, investigations of abuse or neglect, and other contact visits from
time to time as they deem appropriate or as required for carrying out the
responsibilities of licensing.
Virginia Those facilities issued a license for 6 months will be inspected at least 2 times
during the 6 month period, with at least one of those inspections being
unannounced. Those with year-long licenses will be inspected at least 3 times
each year, with at least 2 of those inspections being unannounced. Those with
licenses for 2 years will be inspected at least twice a year with at least 1
unannounced inspection. Those with licenses lasting 3 years will be inspected at
least once a year, and that visit will be unannounced.
Washington Every 12-15 months.
West Virginia Annually, upon complaint.
Wisconsin Conducts "periodic" inspections of Residential Care Apartment Complexes
(RCACs), but is not required to. Other facilities are inspected at least every two
years; these include community-based residential care facilities (CBRFs), adult
day care facilities and adult family homes.
Wyoming The state has a contract employee who surveys facilities at least once a year.
State Announced/Unannounced Inspections
Arkansas If facility is deficiency-free for six months or more after licensure, then
unannounced and upon complaint.
California Unannounced for those facilities on probation, have pending complaints,
operate under a plan for compliance or subject to annual inspection by
Connecticut Unannounced, upon complaint.
District of Columbia Unannounced.
Georgia Unannounced and announced as determined by the Department.
Hawaii Unannounced and announced.
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Idaho Initial inspection announced, all others are unannounced.
Illinois Unannounced, consultation visits (rather than surveys) may be announced.
Kansas Initial inspection and then unannounced.
Kentucky Unannounced annual reviews.
Maryland Announced and Unannounced.
Massachusetts Announced and Unannounced.
Michigan Unannounced for homes for the aged. Announced and unannounced for Adult
Foster Care homes.
Minnesota Unannounced for both assisted living facilities home health care agencies.
Nebraska Initial survey is announced, renewal surveys are not announced.
New Jersey Unannounced.
New Mexico Unannounced.
New York Unannounced.
North Carolina Unannounced.
North Dakota Unannounced.
Ohio Announced and unannounced, but at least one unannounced every fifteen
Rhode Island Unannounced.
South Carolina Unannounced.
South Dakota Routine and unannounced.
Virginia Announced and unannounced.
Washington Announced and unannounced.
West Virginia Announced and unannounced.
Wisconsin Announced and unannounced.
Wyoming Initial inspection is unannounced - unclear whether annual inspections are
announced or unannounced.
State Survey Team Composition
Alabama 4-5 surveyors, 24 members in all.
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Arizona 3-4 surveyors with backgrounds in nursing, social work, dietetics, sanitation,
health care administration, counseling.
Arkansas 8 RN’s, 5 Health Facility Surveyors cover 289 facilities, including assisted living,
residential care, adult day care, etc.; surveyors work as team or independently
depending on the size of the facility and the type of survey (annual, follow-up,
complaint, etc.) Comprised of nurses and life safety staff to assess physical
California Any duly authorized officer, employee, or agent of the licensing agency.
Colorado RNs or social workers w/ healthcare background.
Connecticut RNs w/ experience in geriatrics. Size of team depends on size of facility, number
of complaints involved, and estimated length of survey.
District of Columbia Initial inspection conducted by dietician, nurse, social worker and sanitarian.
Delaware Department of Health and Social Services, federally certified inspectors.
Florida Inspection performed by RN or appropriate designee.
Idaho Surveys conducted by RN’s, dieticians, social workers, Mental Retardation
Professionals (QMRP’s), licensed residential care administrators, physical
therapists, occupational therapists (certified nationally and licensed through
state). Eight inspectors cover 278 facilities statewide.
Illinois Surveys conducted by RN’s, Health Facility Surveillance Nurses (HFSN’s);
Surveyors must be college graduates or RN/HFSN’s. Four inspectors cover 290
Indiana Most surveyors are RNs.
Iowa Survey performed by RN and a master's level sociologist.
Kentucky Surveys conducted by Social Service Specialists – requires minimum of bachelor’s
degree in a human services field. Two specialists cover 101 facilities statewide.
Louisiana Survey teams consist of RN’s, pharmacists, and dieticians.
Minnesota Surveys conducted by RN's.
Missouri Survey teams consist of institutional advisory nurses, boarding home surveyors,
medical social workers and environmental sanitarians.
Nevada Inspectors may be RNs, social workers, or generalists with a health or aging
New Hampshire Survey teams are made up of four RNs and one social worker.
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Rhode Island May include RNs and pharmacists.
South Carolina Inspectors must have a college degree and an RNs is available to address clinical
Texas Survey teams are comprised of a registered nurse, social workers and a life safety
code specialist. Each member of the team has assigned tasks. Inspections can be
conducted by a single surveyor or by a survey team depending upon the size of
the facility and the services provided.
West Virginia Survey teams are comprised of an RN, social worker and environmental
State Training of Surveyors
Alaska Quarterly orientations for new homes.
Arizona Federally certified.
Arkansas 4-6 months of Department training paired with experienced surveyor; many
surveyors are federally certified, though not a requirement.
Connecticut Surveyors undergo mandatory federal training and are required to pass Surveyor
Minimum Qualification Test; Surveyors undergo further training at the State
level regarding State regulations.
District of Columbia
Delaware All surveyors are federally certified and some specialize in assisted living.
Idaho Department training on Medicaid and surveying protocols; 2 classes + 6 online
courses, online training through CMS; 12 week preceptor program in which new
surveyor is paired with 2 experienced surveyors to learn rule interpretation,
survey protocol, etc.; training to inspect kitchens and must receive an Idaho Food
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Illinois Department provides training to surveyors on appropriate assessment, care
planning and treatment of residents w/ mental illness to make sure facility is
complying with state and federal standards regarding care of those persons.
Iowa Training sessions provided jointly by the Department of Elder Affairs and the
Department of Inspections and Appeals.
Kansas Two-day training session provided by the Department of Aging in association
with Kansas Association of Homes and Services for the Aging, Kansas Health Care
Association, and Kansas Adult Care Executives.
Kentucky Surveyors must possess skills, training, experience and ongoing education to
perform certification reviews. It appears that Department provides such training.
Louisiana Department training.
Maine Surveyors receive training through the National Association of Regulatory
Administration; also receive in-service Department training; surveyors are
required as social workers to earn at least 25 Continuing Education Units (CEU’s)
every two years.
Maryland Surveyors are trained by more experienced senior surveyors.
Mississippi Surveyors must pass the Surveyor Minimum Qualifications Test and are required
to spend 2 concurrent days with a licensed facility for training and mentoring
within 6 months of employment.
Missouri A pending bill (SB 755) in the senate would require newly hired inspectors and
surveyors without prior experience in LTC to be assigned to an LTC facility for at
least 2 days within a seven day period to observe the facility operation outside
the survey process before the inspector or surveyor begins survey
responsibilities. Also the Dept. will not assign any surveyor to inspect a facility by
which he or she has been employed in the preceding five years.
Montana Surveyors receive annual training, which is structured based on survey findings
and trends. Thus, if there is a trend of consistent deficiencies in a particular area,
then the training will focus on the specific regulations of that area, how the
regulations should be interpreted and how facilities found in violation may
comply with the requirements.
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North Carolina Surveyors receive annual training, which is structured based on survey findings
and trends. Thus, if there is a trend of consistent deficiencies in a particular area,
then the training will focus on the specific regulations of that area, how the
regulations should be interpreted and how facilities found in violation may
comply with the requirements.
State Survey Protocol
Alaska Activity level, grooming, nourishment.
California Inspection manual, interviews w/ residents and staff, record reviews.
Colorado Interview a min. of 5 residents, at least one every ten standard list of questions
covering care and services. Also use open-ended forum.
Connecticut Resident interviews, staff records, regulatory compliance, actual observation of
District of Columbia
Delaware Surveyors interview a sample of residents.
Florida Check staff, resident and facility records to ensure compliance, interview
residents and family members.
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Georgia Interview six residents and staff or 10% of residents, whichever is greater, w/
open-ended Q's about their well-being, length of stay, how they are treated, if
they have had any problems and whether they were resolved, and if they know
of any other residents who have had problems.
Hawaii Regulatory requirements: surveyors ask standard questions of both residents
and staff regarding residents' needs and compare answers to records.
Idaho Surveyors interview residents on care received, resident rights, residents'
perception of care, how they are treated by staff, what service needs they have
and whether these needs are being met, whether they have had a complaint &
how the facility responds to the complaints, and whether they are involved in
care planning. The number of residents interviewed depends on the size of the
Illinois Surveyors check for compliance w/ regulations, resolution of resident issues and
concerns, and effectiveness of the facility's quality improvement process. The
monitoring process is collaborative, focusing on meeting residents' needs rather
than punishing facility. Surveyors provide facilities w/ info on improving quality
of care. Facilities must have internal quality assurance plan.
Indiana Surveyors interview at least three residents, including resident council president
Iowa Surveyors interview sample of residents, program staff and family members.
Surveyors ask residents about privacy, whether service schedules meet their
preferences, whether their life is meaningful and whether they recommend the
facility to others.
Kansas Facility staff accompany the surveyor during the survey, and the surveyor
identifies and discusses deficiencies with facility staff as he or she progresses
through the survey.
Kentucky Surveyors review the employment records including evidence of criminal
background checks and in-service education & orientation, verify compliance
with AL state statute, review client records to ensure that functional needs
assessment was made for clients, that lease agreement was reached and that
clients personal needs and preferences are on file, and review of any other
records to ensure compliance with state law.
Louisiana Surveyors follow protocol provided on laptop computers. May interview
residents and family members as they see fit.
Maine Surveyors use a standard set of questions to interview residents (at least five)
regarding the care they receive.
Massachusetts Surveyors inspect common areas, service plans, and resident satisfaction
surveys. Check resident records to ensure that there is an assessment , care plan,
resident agreement and disclosure form. Direct care workers are shadowed.
Interview residents and staff.
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Michigan Reviewers follow the licensing manual and use review tools for different aspects
of inspection (e.g. physical plant, quality, fire safety). Review tools are posted on
the dept. website so that facility administrators may review them prior to
inspection. Reviewers may also interview residents, staff and resident
Minnesota Surveys include: an entrance conference, tour, interview w/ staff, residents or
their representatives, observations and a record review. Surveyors review
records of two current and one former resident. The number of residents
interviewed may be expanded depending upon the findings. There are four types
of surveys: focused surveys; expanded surveys (when serious adverse outcomes
or potential for adverse outcomes is identified by the focused survey);
complaints, or as a result of the judgment of the reviewer; licensing follow up
surveys to ensure compliance; and initial inspections.
Mississippi Surveyors follow a handbook during inspection that mirrors regulatory
requirements. Informal interviews are conducted with residents, family members
Missouri Inspectors bring a copy of the regulations and policies with them to refer to
during inspections. They also meet with the administrator and take a tour of the
facility. Inspectors interview between 3 and 25 residents and review facility
records and past inspection reports. The inspectors may refer the facility
administrator to other organizations that have contracted with the state if there
Montana Surveyors interview a 10% sample of residents, staff and families using a
structured questionnaire. Additional interviews may be conducted at the
Nebraska Surveyors meet with facility administrators and staff, tour the facility, and
interview residents. At least four residents are interviewed using Dept. protocol.
For those residents with dementia, family members or representatives are
Nevada Inspectors interview a sample of residents including residents recently admitted
from a hospital or community setting, those who have special care needs and
those who receive home health and hospice care. Annual inspection follows
standard protocols for that looks at primary health and safety regulations such as
care needs, staff training, background checks and medication needs.
New Hampshire The survey process includes an entrance visit, tour, interviews with residents and
family members, if present, as well as staff; record reviews and an exit interview.
Surveyors focus on quality of life and quality of care.
New Jersey The licensing agency conducts an annual resident profile survey, which records
admission and discharge, age, sex, residential setting prior to admission and after
discharge, reason for admission and information about ADLs, medications, and
New Mexico Surveyors inspect facilities pursuant to minimum standards regulations.
New York Surveyors examine medical, dietary, and social service records of the facility, as
well as the minimum standards of construction, life safety standards, quality and
adequacy of care, rights of residents, payments and all other areas of operation.
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North Dakota The inspections cover quality of life, quality of care, dietary services,
medications, environment, social services, personal care, and nursing services
and include a life safety code inspection. Inspectors talk to residents about
resident rights, and whether they are receiving the services they need. The
number of residents interviewed depends upon the size of the facility.
Oklahoma Each center must have a quality assurance committee that meets at least
quarterly to monitor trends and customer satisfaction and document quality
assurance efforts and outcomes. The committee must include an RN or
physician, the administrator, a direct care staff member, and a pharmacist
consultant if a medication problem is to be monitored or investigated.
Oregon Each facility must implement a quality improvement program, which evaluates
services, resident satisfaction and resident outcomes. Inspectors meet with and
advise management on issues concerning methods of care, treatment, training,
records, housing and equipment. Surveyors will ask for staffing plans and
methodology upon inspection to ensure that facility has such a plan. Surveyors
will also further investigate the adequacy of the plan if it is triggered and as
outlined in the survey staff protocol.
Pennsylvania Surveyors review records and interview staff and residents. They may also
provide some consultation to providers. Facilities must establish a quality
assessment and management plan, which includes the development and
implementation of measures to address the areas needing improvement that are
identified during inspection.
Rhode Island Facilities are required to develop, implement and maintain quality assurance
programs, which monitor and review personal assistance and resident services,
resident satisfaction, and adverse incidents (e.g. resident complaints, medication
South Carolina Inspectors use a checklist of criteria of compliance during their reviews, and
interview residents based upon inspectors' observations. Inspectors also provide
technical assistance to staff members during their visits. Facilities must also have
a quality improvement program in place, identifying desire outcomes and the
criteria by which effectiveness is accomplished, as well as develop a systematic
method of obtaining feedback from residents on the satisfaction level with care
and services received.
South Dakota Surveyors use protocol based upon regulations. Surveyors observe staff passing
medications, review four records (including one closed record), and interview
three residents using a list of questions that address resident rights, staffing,
meals, activities, and medications. Facilities must develop quality assurance
evaluation plans establishing facility standards, interdisciplinary review of
resident services, resident satisfaction surveys, and documentation of
evaluations. The surveyors provide education and support to facility staff during
Tennessee Surveyors use protocol in accordance with state regulations, but do not provide
on-site consultation during surveys. However, the State does work with assisted
living associations to provide education to providers during association meetings
when specific problem areas are identified.
Texas Surveyors meet with the person in charge (usually the administrator), review the
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survey process, and request lists of residents and staff, schedules, training
records, incident reports, policies and procedures, the services provided, and the
facility's disclosure form. The surveyor observes the general operation of the
facility and resident activities. General interviews are held with a sample of
residents, family members and staff. They also review a sample of resident
Vermont The Department works with facilities in order to help them adhere to
regulations. Each facility must have a quality assurance plan in place, which
includes an internal committee comprised of the director, an RN, a staff member
and a resident.
Virginia Surveyors enter information on a personal computer, which includes standards
and the previous history of compliance for the facility being inspected. Surveys
include an exit interview, during which survey findings are conveyed to the
facility and corrective action plans are drafted.
Surveyors enter information on a personal computer, which includes standards
and the previous history of compliance for the facility being inspected. Surveys
include an exit interview, during which survey findings are conveyed to the
facility and corrective action plans are drafted.
Washington Surveyors review records and speak to residents. Case managers discuss the
plans of Medicaid beneficiaries with facility staff. During regular visits the case
manager checks to see if clients are satisfied, the negotiated plan is being carried
out, and that the plan is appropriate for the resident.
West Virginia Surveyors review a sample of staff and resident records based on the size of the
facility. Surveyors also examine facilities' policies and procedures to see if there
are policies in place to address poor compliance outcomes. Survey teams can
provide technical assistance to facility management and staff.
Wisconsin Surveyors check for compliance w/ regulations in the areas of resident rights,
program services, nutrition and food services, physical environment and safety,
medication and staff training. Surveyors will review resident and staff records;
interviews w/ residents and staff; tour of facility.
Wyoming Surveyors follow a protocol based upon regulations. Facilities are required to
develop and implement a quality improvement program that is re-evaluated at
least annually to ensure effective use and delivery of services. The program must
have a written description, problem areas identified, monitor identified,
frequency of monitoring, and a provision requiring the facility to complete a self-
assessment survey annually, as well as a satisfaction survey that must be
provided to each resident, resident's family, or resident's responsible party at
Alaska Suspension or revocation of licensure, intake restrictions, type-of-care
restrictions, administrative fines.
Arizona Civil money penalties, provisional licensing & restricted admission.
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Arkansas Fines based on level of deficiency: classes A-D. A being most egregious deficiency
that poses an immediate risk of harm, D = least egregious, like administrative
California CMP’s, revocation of licensure for failure to pay CMP’s.
Colorado Monetary fines imposed only for severe deficiencies.
Connecticut Penalties and fines, state-imposed consent order.
District of Columbia Suspension & revocation of licensure, financial penalty, etc….
Delaware Suspension & revocation of licensure, financial penalty, etc….
Florida Money damages.
Georgia Impose fines, revoke a license, limit a license, suspend a license, issue a public
reprimand, "prohibit" individuals in management or control.
Hawaii Director may suspend, revoke or refuse to issue license.
Idaho Suspend admissions (provisional license = professional consultants employed
who file weekly reports to state on progress), civil penalties & revoke license =
Illinois Money penalties, denial, suspension, revocation and refusal to renew license.
Administrative warning, mandatory training, imposed order of correction (for
failure to administer corrective plans of action).
Indiana Fines, suspension, revocation of license, issuing probationary license, limit to
admissions, issue order for immediate correction.
Iowa Denial, suspension, revocation of license, or department may issue conditional,
provisional license based on facility's agreement to implement certain changes.
Kansas Denial, suspension, revocation of license after notice is provided to facility and a
hearing is held in accordance to the Kansas Administrative Procedure Act.
Monetary penalties and injunction against unlicensed facilities and
administrators. Licensees and applicants can also appeal monetary penalties, but
must pay them upfront, and will be refunded in the event that the Secretary of
Aging sustains the appeal. Facilities can appeal to district court following verdict
of Secretary on Aging.
Kentucky Money penalties, denial or revocation of license, injunction against operation.
Louisiana Money penalties, denial, revocation, or non-renewal of license, injunction.
Maine Revoke/suspend license, issue directed plan of correction or conditional license,
Maryland Money penalties for operating without a license, denial, suspension, revocation
of license. Issuing provisional license.
Massachusetts Denial, revocation, modification, suspension, or refusal to renew certification.
Civil money penalties against facilities operating without certification.
Minnesota Monetary penalties, deny, revoke, suspend licensure.
Mississippi Monetary penalties, denial, suspension, revocation of license. Agency may also
ban the facility from further admissions.
Missouri Additional directed staff training, state monitoring, probationary license and
consent agreement, civil monetary penalties, directed Plan of Correction,
receivership, license revocation.
www.ltccc.org Page 17
Montana Denial, suspension, revocation of license or issuance of a provisional license.
Nebraska Monetary fines not to exceed $10,000 per violation, a prohibition on admissions
or readmissions or a limitation on enrollment, or prohibition on the provision of
care or treatment, a period of probation not to exceed two years, a period of
suspension not to exceed three years (during which facility may not operate),
revocation (upon revocation, licensee may not apply for a new license for a
minimum of 2 years after the effective date of the revocation.
Nevada Suspension or revocation of license.
New Hampshire Issue a directed plan of correction to the facility; impose a fine; suspend, revoke
or deny a license; subject the facility to state monitoring.
New Jersey Civil monetary penalty, curtailment of admissions, appointment of a receiver or
temporary management, provisional license, suspension or revocation of license,
and order to cease and desist an unlicensed health care facility.
New Mexico Revocation or suspension of a license, denial of initial or renewal application for
a license, or imposition of intermediate sanctions or civil monetary penalties,
issuance of temporary license for partial compliance.
New York Civil monetary penalties (up to $1,000 per day); licensure limitation, suspension
North Carolina Denial, suspension, revocation of license or issuance of provisional license;
summary suspension; suspension of admission; monetary fines.
North Dakota Denial, revocation of license, imposition of a fine based on unlicensed operation.
Ohio Civil monetary penalties, denial, revocation of a license, limitation on admissions.
Oklahoma Civil monetary penalties, licenses can be revoked, rescinded, terminated,
canceled, involuntarily suspended, or refused renewal.
Oregon Civil monetary penalties; license suspension, revocation, early termination,
inactivation, issuance for less than the standard time or issuance of a provisional
license. Dept. may bring a suit in equity to enjoin facility from operating when
operating without a valid license.
Pennsylvania Civil monetary penalties (violations are classified into three categories Class I, II
and III. Class I violations are the most severe and must be corrected within 24
hours, and carry with them a penalty of $20 per resident, per day. Class II
violations incur penalties between $5 and $15 per resident, per day. Class III
violations carry no monetary penalties unless the facility fails to correct the
violation within 15 days, at which time a penalty is assessed at $3 per resident,
per day. License revocation or nonrenewal, issuance of provisional license, ban
Rhode Island Civil penalties, denial, suspension, or revocation of license; limitation on
admissions; requiring resident removal; or any other corrective action in order to
facilitate compliance with regulations.
South Carolina Civil monetary penalty, deny, suspend, or revoke license.
Tennessee Civil monetary penalties, deny, suspend, revoke license.
Texas Civil monetary penalties, license suspension, revocation.
Utah Issuance of a provisional or conditional license, license revocation.
www.ltccc.org Page 18
Vermont Monetary fine; denial, suspension or revocation of a license.
Virginia Monetary penalty, denial, suspension, revocation of a license; issuance of a
conditional or provisional license.
Washington Denying, suspending, revoking and refusing to renew a license; suspending
admissions; imposing conditions; civil penalties - up to $3,000 per day per
West Virginia Commissioner may ban admissions, reduce the bed capacity of the facility, place
restrictions upon or suspend or revoke license of facility, issue civil penalties.
Wisconsin License suspension, revocation or denial; issuance of a probationary license.
Wyoming License denial, suspension and revocation; issuance of a provisional license;
suspension of admissions.
State Can Facilities Challenge Department Findings?
Alaska May request violation conference, appeal sanctions, reapply or contest denial of
Arizona May request hearing upon license revocation/suspension, intake restrictions,
service restrictions, etc.; May appeal CMP’s or other assessments.
Arkansas Facilities may file an Informal Dispute Resolution to appeal deficiencies and any
civil money penalties incurred due to deficient practices.
California May request appeal within 10 days of receipt of notice of deficiency.
Connecticut May appeal.
District of Columbia May appeal but appeal does not stay obligation to correct deficiencies.
Florida Before penalties for a deficiency are imposed, a licensee has the opportunity to
contest Agency findings. The licensee may disagree with the Agency over the
facts or law reported in the statement of deficiencies.
Idaho Can appeal monetary penalties. Facility must pay penalty within 30 days of
receipt of notice, unless they request administrative review of decision to apply
penalty. Then, must pay penalty determined by administrative review within 30
days unless they request an administrative hearing. That amount must be paid
within 30 days of determination by hearing unless they request judicial review.
Interest accrues on penalties.
Illinois May appeal.
Iowa Can appeal the denial, suspension or revocation of license within 30 days of
receiving notice of denial, suspension, or revocation.
Kansas Any applicant or licensee who is negatively affected by the suspension, denial or
revocation can appeal the order in accordance with the provisions of the act for
judicial review and civil enforcement of agency actions.
Kentucky Facilities have the right to appeal certification findings (both initial and those
made after facility's submission of a plan of correction) by asking for an informal
www.ltccc.org Page 19
dispute resolution meeting. A facility also has the right to an administrative
hearing if an informal dispute resolution is not requested, or when the informal
dispute resolution did not resolve the issue.
Louisiana A facility may appeal any adverse action against them and an Appeal Hearing
Officer or Administrative Law Judge will hold a hearing as outlined by the
Administrative Procedure Act.
Maine Facilities may formally appeal an imposed sanction.
Maryland Plans of correction required, informal dispute resolution available.
Massachusetts Facilities submit plans of correction or appeal findings of department.
Michigan Facilities or individuals (usually administrators) can appeal department's finding
regarding revocation, suspension, or denial of licensure, and then the director or
his/her representative will conduct a hearing. A person aggrieved by the decision
of the director following a hearing may appeal to the circuit court in the county
where the person resides.
Minnesota Licensees (home health care agencies providing services to facilities) can ask for
informal conference w/ department if they disagree with findings. If penalty
assessments are made at the initial or follow-up surveys, the licensee can
request a hearing to contest the fine.
Mississippi Licensee can request administrative hearing. If license is still denied or revoked,
facility can appeal to Chancery Court.
Missouri Facility may appeal to administrative hearings officer through the Informal
Dispute Resolution process.
Montana Licensee can request a hearing before the Dept. appealing the findings. After
Dept. makes its final decision, the licensee can appeal to district court where the
facility is located, but must do so within 30 days.
Nebraska If Dept. decides to temporarily suspend the license, then it will simultaneously
start proceedings for revocation, suspension or limitation of the license and
conduct an administrative hearing in accordance with the Administrative
Procedure Act (APA) no later than ten days after notice of temporary suspension.
If the Dept. Director does not make a decision within 90 days of the initial order
of suspension, then the order will expire. Facilities may appeal the decision of
the Dept. Director in accordance with the APA.
New Jersey Facility may request an informal dispute resolution hearing by written request to
Dept. within 10 days of receipt of the notice of deficiencies.
New Mexico Facility has the right to an administrative appeal of adverse decisions against it,
except for the Dept's decisions on waiver requests.
New York No facility operating certificate can be limited, suspended, or revoked without
giving the facility the opportunity for a hearing. However, an operating
certificate may be temporarily suspended or limited without a hearing for not
more than 60 days.
North Carolina Facility may appeal any imposition of fines by filing an appeal with the North
Carolina Office of Administrative Hearings.
North Dakota Facility has the right to appeal the Department's decision to revoke its license.
Ohio Once a facility's license has been revoked, it may not apply for a new license for
www.ltccc.org Page 20
Oklahoma Facility may contest Department's findings and request a hearing within 10 days
of notification of any Dept. action against the facility.
Oregon Upon notice of imposition of a civil penalty, a facility has 10 days to request a
hearing, appealing such penalty. If the Department renders a facility's license
inactive, the facility has 14 days to appeal this finding and request an
administrative hearing, during which it must submit relevant evidence as to why
the license should not be rendered inactive. If the licensee is dissatisfied with the
outcome of the administrative hearing, it may request a contested case hearing
within 14 days of administrative decision. It may also initially request a contested
case hearing within 14 days of license inactivation.
Pennsylvania Facilities may appeal penalties by sending the total amount of the assessed
penalty to the Secretary of the Department to be placed in an escrow account
with the State Treasurer, and include a letter appealing the penalty. This process
initiates either an administrative hearing or a judicial review. If no violation is
found, the money is remitted to the facility plus interest. If a penalty is assessed,
the money is given to the Commonwealth plus interest and costs.
Rhode Island Facilities are given the opportunity for a hearing within 30 days of notification of
license denial, suspension or revocation. If facility is not satisfied with outcome
of hearing, it is entitled to judicial review. Facilities may also appeal sanctions,
which are imposed due to uncorrected deficiencies.
South Carolina Any enforcement action taken by the Dept. may be appealed in a manner
pursuant to the Administrative Procedures Act.
Tennessee A facility may appeal any disciplinary action taken against it in accordance with
the Uniform Administrative Procedures Act of Tennessee.
Texas If the provider and the inspector cannot resolve a dispute regarding a violation of
regulations, the provider is entitled to an informal dispute resolution (IDR) at the
regional level for all violations. For a violation which resulted in an adverse
action, the provider is entitled to an IDR at either the regional or state office
level. A written request and all supporting documentation must be submitted to
the Regional Director no later than the tenth calendar day after receipt of the
official statement of violations. The provider is also entitled to a formal hearing.
Vermont A facility may file an appeal with the Human Services Board if it is aggrieved by
any decision of the licensing agency.
Virginia Facilities may appeal decisions of the Department that aggrieve them. For most
sanctions, they are entitled to an informal conference, and also may appeal the
Commissioner of the Department's decision to the appropriate circuit court. For
license denial and revocation, facilities are entitled to an administrative hearing
between the informal conference and an appeal to the circuit court.
Washington Facility has right to an informal dispute resolution - must request one in writing
within ten days of receipt of notice of deficiencies. Must file any request for an
adjudicative proceeding with the office of administrative hearings within twenty-
eight days of receiving the notice. Orders of the department imposing licensing
suspension, stop-placement, or conditions for continuation of a license are
www.ltccc.org Page 21
effective immediately upon notice and shall continue pending any hearing.
West Virginia Facilities may appeal findings; must submit the reasons for the appeal and
request for an informal hearing in writing to the commissioner within fifteen (15)
days of receipt of the statement of deficiencies or order. Facilities can also
appeal by means of a judicial review.
Wisconsin Adult family homes may appeal the denial, revocation or suspension of a license
but no other sanctions; CBRFs and RCACs have the right to appeal all sanctions.
Facilities must submit a written request for appeal within 10 days of receipt of
notice of the action by the Dept.
Wyoming Any facility aggrieved by the decisions of the Department may submit a written
request for a hearing within 10 days of receipt of notice of the action against it.
Any facility aggrieved by the decisions of the Department may submit a written
request for a hearing within 10 days of receipt of notice of the action against it.
State Are Inspection Reports Made Available to the
Alabama Yes - Department website.
Alaska Available by request in writing.
Arizona Yes, but don't have to volunteer.
Arkansas Yes - FOI Act.
California Yes, upon request - confidential info removed first.
Colorado Deficiencies and Plans of Correction available on dept. website.
Connecticut Available upon request, not posted in facilities. Advocacy website "Intervention
America" lists survey dates and corrections.
District of Columbia
Delaware Posted at facilities and available from Division of Long Term Care Residents
Florida Reports available at the local county library.
Georgia Yes, on ORS website.
Hawaii Available at facilities upon request. Pending availability on department website.
Idaho Available upon written request to the department and also on licensing website.
Illinois Available from Department upon written request and payment of copying fees.
Indiana Posted at facilities, available upon request to Department of Health.
Iowa Available through the Health Facilities Division website.
Kansas Posted in public area of facility.
Kentucky Must be available (for past three years) in the office of the administrator of the
facility and posted in the lobby. Office of Inspector General must make results of
certification reviews available to the public.
www.ltccc.org Page 22
Louisiana Recent reports are available on Department website and older reports can be
obtained by request to the Department.
Maine Reports are posted at each facility and are available from the licensing
department upon request. May be included on licensing dept. website at some
Maryland Survey findings and plans of correction posted at facilities.
Massachusetts Survey reports are available to public through a Freedom of Information Act
Michigan Inspection and investigation reports are available on the department website.
Minnesota Results of surveys of home care provider licensees conducted after July 2004 are
posted on the department's website.
Mississippi Facilities must make inspection reports available upon request.
Missouri Most recent deficiencies must be posted on Department's website, as well as
instructions on how to obtain full reports.
Montana Inspection reports are available upon written request to Bureau.
Nebraska Available from the Department.
Nevada Available on Department website.
New Hampshire Inspection reports are supposed to be posted at the facility. Also available by
request to Department.
New Jersey Available to the public at the facility.
New Mexico Available from the Department.
New York The Department of Health website lists the violations for individual facilities but
does not post full inspection reports.
North Carolina NC Division of Health Service Regulation, Adult Care Licensure Section provides
list of deficiencies for facilities by county, but not full inspection reports.
North Dakota Available upon request from the Department.
Ohio Available upon request from the Department.
Oklahoma Available upon request from the Department.
Oregon Inspection reports are available at each facility upon request, also available upon
request to Department.
Pennsylvania Available upon request from the Department.
Rhode Island Posted at facilities and available upon request from the Department.
South Carolina Available upon request from the Department pursuant to the Freedom of
South Dakota Facility must make survey results available to residents in an easily accessible
place; also available upon request from Department.
Tennessee Available at facilities to residents upon request; available to all upon request
from the Department.
Texas Survey reports may be posted at the facility or available upon request from the
Vermont Available upon request from the Department.
Virginia Available on Department's website. Also available from facility.
Washington Available upon request from the Department. Available from facility upon
www.ltccc.org Page 23
West Virginia Available upon request from the Department.
Wisconsin Survey findings for the previous three years are available on the Department.
website; also available from facility upon request.
Wyoming Available upon request from the Department.
www.ltccc.org Page 24
Resources on Assisted Living Oversight
1. Residential Care and Assisted Living: State Oversight Practices and State Information Available to
Consumers, AHRQ (Agency for Healthcare Research and Quality),
2. The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and
Home Care Costs, Met Life Mature Market Institute,
3. 2010 Assisted Living State Regulatory Review, National Center for Assisted Living (provider
1. Bradley Arant Rose and White, LLP, Alabama Health Law Update 2001 Fourth Special Session,
2. Board of Examiners of Assisted Living Administrators, Functional Analysis and Records
Disposition Authority, October, 2003,
3. Givhan, R. Marcus, The Assisted Living Survey Process in Alabama: Achieving Favorable
Outcomes, Johnston Barton Proctor and Rose, LLP,
4. Alabama Board of Examiners and Assisted Living Administrators, Rules and Regulations, Code of
Alabama 1975, Section 34-2A-1-16, December, 2002,
5. Division of Healthcare and Policy Research, University of Colorado Health Sciences Center,
Promising Practices in State Survey Agencies, December, 2005,
1. Guide to Assisted Living Home Regulations and Statutes, State of Alaska Department of
Administration, State of Alaska Department of Health and Human Services, April, 2002,
2. Regulations, Iowa Department of Inspections and Appeals,
www.ltccc.org Page 25
1. Arizona Department of Health Services, Office of Assisted Living Licensing, Spring/Summer 2009
Volume 1, Issue 7, 2009, http://www.azdhs.gov/als/hcb/newsletters/summer_2009.pdf.
2. Regulations, Arizona Department of Health Services, Division of Licensing Services,
3. Survey Tool, Arizona Department of Health Services, http://www.azdhs.gov/als/hcb/index.htm.
4. Arizona Department of Health Services, Division of Licensing Services,
5. Arizona Department of State, Office of Secretary of State,
1. Informal Dispute Resolution,
2. Regulations, Assisted Living Facilities Level II, March, 2006,
3. Arkansas Department of Health and Human Services, Division of Medical Services, Elder Choices
and Community Based 2176 Waiver Provider Manual Update Transmittal #59, February, 2006,
3. Regulations, Iowa Department of Inspections and Appeals,
4. Office of Long Term Care, Arkansas Medicaid,
1. Department of Social Services, Manual of Policies and Procedures Community Care Licensing
Division, Adult Residential Facilities Title 22 Division 6, Chapter 6, State of California, November,
2. Carlson, Eric, Assisted Living: Problems and Policy Issues, National Academy of Elder Law
3. Assisted Living and Residential Care Facilities, Del Mar Caregiver Resource Center,
www.ltccc.org Page 26
4. How to Evaluate RCFEs, California Advocates for Nursing Home Reform,
1. Standards for Hospitals and Health Facilities (Promulgated by the State Board of Health) Chapter
II General Licensure Standards, Colorado Department of Public Health and Environment, Health
Facilities and Emergency Medical Services Division, January, 2008,
2. Standards for Hospitals and Health Facilities (Promulgated by the State Board of Health) Chapter
VII Assisted Living Residences, Colorado Department of Public Health and Environment, Health
Facilities and Emergency Medical Services Division, November, 2008,
3. Informal Dispute Resolution, Colorado Department of Public Health and Environment, Health
Facilities and Emergency Medical Services Division Manual, August, 2007,
4. Meeting Notes, Long Term Care Facilities in Rural Colorado, December, 2003,
5. Assisted Living Residences: 30-Hour Administrator Training, Colorado Department of Public
Health and Environment, http://www.cdphe.state.co.us/hf/alr/ALRTraining.htm.
6. Assisted Senior Living Comprehensive Unbiased Info on 781 Colorado Senior Living Options,
7. Occurrence Reporting Program, Colorado Department of Public Health and Environment,
1. 19-3-D105 Assisted Living Services Agency, Department of Public Health, 2006,
2. Connecticut Assisted Living Fact Sheet, Connecticut Assisted Living Association,
3. Managed Residential Community, Connecticut Department of Public Health, 2006,
4. Wright, Bernadette, Assisted Living in Unlicensed Housing: The Regulatory Experience of Four
States, AARP Public Policy Institute, April, 2007,
District of Columbia
1. Assisted Living Residence Regulation Title 44. Charitable and Curative Institutions Subtitle I.
Health Related Institutions Chapter 1, District of Columbia Official Code, Department of Health,
June, 2000, http://hrla.doh.dc.gov/hrla/lib/hrla/assistedliving/assisted_living_residence_-
2. Kasunic, Gerald, Office of the D.C. Long- Term Care Ombudsman Program Overview and
Educational White Paper of Assisted Living Facilities in the District of Columbia, Office of the DC
www.ltccc.org Page 27
Long Term Care Ombudsman,
3. An Act D.C. Act 13-297 In the Council of the District of Columbia, District of Columbia Register,
4. Assisted Senior Living Comprehensive Unbiased Info on 25 DC Senior Living Options,
1. State Residential Care and Assisted Living Policy: 2004, United States Department of Health and
Human Services, 2005, http://aspe.hhs.gov/daltcp/reports/04alcom3.htm#DE.
2. Bedford, R., Toth, T. Delaware Assisted Living and Rest Residential Utilization Statistics January –
December 2008, Center for Applied Demography and Survey Research, University of Delaware,
April, 2009, http://www.dhss.delaware.gov/dph/hsm/files/2008alrrpt.pdf.
3. Title 16 Health and Social Services, 3000 Division of Long Term Care Residents Protection, 3225
Assisted Living Facilities (Formerly Regulation No. 63), State of Delaware, The Official Website of
the First State, http://regulations.delaware.gov/AdminCode/title16/3000/3225.shtml.
4. Section Within the Division of Long Term Care Residents Protection, State of Delaware, The
Official Website of the First State, http://www.dhss.delaware.gov/dltcrp/sections.html.
1. AHCA: Florida Agency for Health Care Administration, Better Health Care for All Floridians,
Assisted Living Facility, 2009,
2. Chapter 58A-5 Assisted Living Facilities, Florida Agency for Health Care Administration, July
3. The 2008 Florida Statutes, Chapter 429 Assisted Care Communities, Assisted Living Facilities (ss.
429.01-429.54) Part I Assisted Living Facilities, Online Sunshine, 2008,
4. ALF Survey Guideline Index, Florida Agency for Health Care Administration,
5. Agency for Public Health Care Administration Public Record Search, Florida Agency for Health
6. The 2008 Florida Statutes Chapter 408, Health Care Administration Part II, Health Care Licensing:
General Provisions, Online Sunshine, 2008,
7. Minimum Staffing Requirements, Florida Affordable Assisted Living, Department of Elder Affairs,
State of Florida, 2003, http://www.floridaaffordableassistedliving.org/operator/minimum.html.
8. ALF Training Requirements, Florida Affordable Assisted Living, Department of Elder Affairs, State
of Florida, 2003, http://www.floridaaffordableassistedliving.org/developer/training.html.
www.ltccc.org Page 28
9. Assisted Living Facility Full Adverse Incident Report – 15 Day, Florida Agency for Health Care
Administration, 2006, http://www.floridaaffordableassistedliving.org/documents/AIR-
10. Assisted Living Facility Initial Adverse Incident Report – 1 Day, Florida Agency for Health Care
Administration, January 2006,
11. Assisted Living in Florida, Florida Agency for Health Care Administration, 2009,
12. Owner of Unlicensed Assisted Living Facility Arrested for Neglect, Office of the Attorney General
of Florida, June, 2009,
13. Survival Guide for Long-Term Care Providers, Update Since SB 1202, Presentation by the Agency
for Health Care Administration, September-October, 2002,
14. Annual Snapshot 2007-2008, Florida’s Long Term Care Ombudsman Program, Our 2 Cents is No
Small Change, 2007-2008,
15. Senate Staff Analysis and Economic Impact Statement, Bill: CS/SB 1652, March, 2001,
1. 290-9-37-.31 Inspections and Plans of Correction, O.C.G.A., October 2002,
2. Quality in Medicaid Waiver Assisted Living: The Ombudsman Program’s Role and Perspective,
National Association of State Units on Aging, National Long Term Care Ombudsman Resource
Center, National Citizen’s Coalition for Nursing Home Reform, December, 2005,
3. 09 LC 28 4800ER House Bill 850, Georgia General Assembly,
4. Secretary of State Karen Handel…advancing the e-government revolution, State of Georgia
1. Comprehensive Unbiased Info on 58 Hawaii Senior Living Options, Assisted Senior Living, 2009,
2. Hawaii Administrative Rules Title 11, Department of Health Chapter 90, Assisted Living Facility,
Department of Health, http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-90.pdf.
www.ltccc.org Page 29
1. Idaho Statutes Title 29 Health and Safety Chapter 33 Idaho Residential Care or Assisted Living
Act, State of Idaho Legislature, 2009,
2. Comprehensive Unbiased Info on 116 Idaho Senior Living Options, Assisted Senior Living, 2009,
3. Informal Dispute Resolution (IDR) Guidelines for Residential or Assisted Living Facilities, July
4. 16.03.22 Residential Care or Assisted Living Facilities in Idaho, Idaho Department of
Administration, March, 2006, http://adm.idaho.gov/adminrules/rules/idapa16/0322.pdf.
5. Examining Assisted Living, SPOKESMANREVIEW.com, March, 2007,
1. Health Facilities (210 ILCS 9/) Assisted Living and Shared Housing Act, Illinois General Assembly,
2. 96th General Assembly State of Illinois 2009 and 2010 HB 0838, Illinois General Assembly,
3. Title 77: Public Health, Chapter I: Department of Public Health, Subchapter c: Long Term Care
Facilities, Part 295 Assisted Living and Shared Housing Establishment Code, Joint Committee on
Administrative Rules, Administrative Code, May, 2008,
4. Title 77: Public Health, Chapter I: Department of Public Health, Subchapter c: Long Term Care
Facilities, Part 295 Assisted Living and Shared Housing Establishment Code, Section 295.1060
Remedies and Sanctions, Joint Committee on Administrative Rules, Administrative Code,
October 2004, http://www.ilga.gov/commission/jcar/admincode/077/077002950A10600R.html.
5. Title 77: Public Health, Chapter I: Department of Public Health, Subchapter c: Long Term Care
Facilities, Part 295 Assisted Living and Shared Housing Establishment Code, Section 295.1030
Information to be Made Available to the Public by the Department, Joint Committee on
Administrative Rules, Administrative Code,
1. Information Maintained by the Office of Code Revision Indiana Legislative Services Agency,
Indiana Code, IN.gov, 1993, http://www.in.gov/legislative/ic/code/title16/ar28/ch1.html.
2. Points to Consider When Selecting an Assisted Living Facility in Indiana, United Senior Action
3. Article 16.2 Health Facilities; Licensing and Operational Standards, IN.gov,
4. Definitions/Technical Terms, Indiana Health Care Association, 2009
www.ltccc.org Page 30
1. Section 2: Iowa Code 231C and Administrative Rules, Chapter 25 Assisted Living Programs, Elder
Affairs, 2004, http://www.legis.state.ia.us/aspx/ACODocs/DOCS/12-2-2009.321.25.pdf.
2. VA Tests Viability of Assisted Living Contracting, National Center for Assisted Living, Focus,
September, 2002, http://www.ahcancal.org/News/publication/AHCA%20Focus2/al-focus-
3. Health Care Facility Inspection Changes, House Republican Staff Analysis, April, 2009,
4. Media Release, Iowa Department of Inspections and Appeals, March, 2009,
5. Iowa and Illinois Digest, Crews Will Demolish Cedar Rapids Building, thehawkeye.com, 2009,
1. Nursing Facilities Program, Kansas Department of Health and Environment, January, 1996,
2. Statutes and Regulations for the Licensure and Operation of Assisted Living and Residential
Health Care Facilities, Kansas Department on Aging, December, 2003,
3. Assisted Living: A Guide to Kansas Regulations, and the Compliance Inspection Review, Kansas
Advocates for Better Care, 2005, http://www.kabc.org/pdfs/assisted-
4. Long Term Care Program Fact Sheet II, Kansas Department of Health and Environment, July
5. 2007 Joint Training for Adult Home Care Staff and KDOA Surveyors, Compliance and Person-
Centered Care, Kansas Association of Homes and Services for the Aging in Cooperation with
Kansas Department on Aging, Kansas Health Care Association, Kansas Adult Care Executives,
6. 2008 Joint Training for Adult Care Home Staff and KDOA Surveyors, End of Life Issues, Kansas
Association of Homes and Services for the Aging in Cooperation with Kansas Department on
Aging, Kansas Health Care Association, Kansas Adult Care Executives, 2008,
7. Culture Change in Long-Term Care, Kansas Department on Aging, June, 2009,
8. Citation: Assisted Living/Residential Health Care Facilities KAR § 28-39-144-148, KAR 28-39—
9. Statement of Deficiencies and Plan of Correction, Instructions Regarding the Submission of a Plan
of Correction for Resurvey’s, Revisit’s, and Complaint Survey’s, Kansas Department of Health and
Environment, Bureau of Child Care and Health Facilities, Health Facilities Program, May, 2008,
www.ltccc.org Page 31
1. 194A.703 Requirements for Living Units, Kentucky Legislature,
2. 194A.705 Services to Be Provided to Assisted Living Community Clients, Kentucky Legislature,
3. 194A.711 Criteria to Be Met by Clients, Kentucky Legislature,
4. 902 KAR 20:036. Operation and Services, Personal Care Homes, Kentucky Legislature, 1998,
5. 194A.709 Delivery of Health Services by Staff – Abuse, Neglect, and Exploitation of Clients,
Policies and Reporting, Kentucky Legislature, http://www.lrc.state.ky.us/KRS/194A00/709.PDF.
6. Assisted Living FAQs/BPs, Kentucky Assisted Living Facilities Association, 1996-2009,
7. 194A.707 Certification – Administrative Regulations – Accreditation by Other Organizations –
Fees – Compliance, Kentucky Legislature, http://www.lrc.state.ky.us/krs/194A00/707.PDF.
8. 194A.700 Definitions for KRS 194A.700 to 194A.729, Kentucky Legislature
9. 194A.715 Duty of Assisted Living Community to Provide Consumer Information to Interested
Persons, Kentucky Legislature, http://www.lrc.state.ky.us/KRS/194A00/715.PDF.
10. 194A.725 Religious Orders Exempt from KRS 194A.700 to 194A.729, Kentucky Legislature, July,
11. Kentucky’s Assisted Living Requirements, Kentucky Assisted Living Facilities Association,
12. 216.573 Injunction to Terminate Operation of Facility, Kentucky Legislature, July, 1982,
13. Kentucky’s Assisted Living Law: Why a Bluegrass State Success Story Matters, Nursing Homes
Long Term Care Management, March 2001,
14. 216.557 Classification of Violations – Exemption From State Penalty if Federal Penalty Assessed,
Kentucky Legislature, http://www.lrc.state.ky.us/KRS/216-00/557.PDF.
15. 194A.723 Penalties for Operating Without Certification, Kentucky Legislature,
16. 194A.719 In-Service Education for Staff and Management, Kentucky Legislature,
17. Let’s Talk Assisted Living, Department for Aging and Independent Living, March, 2009,
18. 216.590 Training of Surveyors and Investigators, Kentucky Legislature, July 1982,
19. 910 KAR 1:240. Certification of Assisted Living Communities, Kentucky Legislature,
1. Adult Residential Care Minimum Standards, Louisiana Administrative Code, Title 48 – Chapter
88, Department of Social Services State of Louisiana, March, 1999,
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1. Maine, Citation: Assisted Living Programs: 10-149 Chapter 113, Residential Care and Assisted
Living Compendium: 2007, 2007, http://aspe.hhs.gov/daltcp/reports/2007/07alcomME.pdf.
2. Comprehensive Unbiased Info on 120 Maine Senior Living Options, Assisted Senior Living, 2009,
3. Section 63: In-Home and Community Support Services for Elderly and Other Adults, 10-149 Ch. 5
Office of Elder Services Policy Manual, October, 2005,
4. Regulations Governing the Licensing and Functioning of Assisted Housing Programs, Department
of Secretary of State, http://www.maine.gov/sos/cec/rules/10/ch113.htm.
1. Maryland’s Assisted Living Resident Assessment and Level of Care Scoring Tool, Department of
Health and Mental Hygiene, October, 2006,
2. Maryland Guide to Assisted Living, Maryland Health Care Commission, 2005,
3. Assisted Living Facilities: Government Agencies Involved in the Oversight of ALF Operators,
Maryland’s People’s Law Library, November, 2007, http://www.peoples-
4. 10.07.14.11 Investigation by Department, Maryland Office of the Secretary of State,
5. State Licensing: Maryland Senior Housing and Care, New Lifestyles, The Source for Seniors, 2004,
6. 10.07.14.07 Licensing Procedure, Maryland Office of the Secretary of State,
7. 10.07.14.04 License Required, Maryland Office of the Secretary of State,
8. Guide to Assisted Living Facilities, Assisted Living Facility Survey Reports, Maryland Health Care
Commission, February, 2009,
9. Assisted Living and Senior Living California, ElderHomeFinders, 2007,
10. Garland, Greg, Assisted Living Reviews Faulted, Audit finds state did only a quarter of required
facility inspections last year, baltimorsun.com, August, 2007, http://www.peoples-
11. Assisted Living Regulations Background, Taking Care of Mom and Dad, 2009,
12. Important Message to Assisted Living Facilities with 15 or Fewer Residents, Subject: House Bill
296, State of Maryland Department , Maryland Department of Health and Mental Hygiene,
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1. Current Assisted Living Regulations, Massachusetts Assisted Living Facilities Association, 2008,
1. Act No. 218 of the Public Acts of 1979, As Amended, Pertaining to the Regulation of Adult Foster
Care Facilities, Bureau of Children and Adult Licensing, State of Michigan Department of Human
Services, 1979, http://www.michigan.gov/documents/dhs/BCAL_PUB_39_220945_7.pdf.
2. Licensing Rules for Adult Foster Care Homes, Bureau of Children and Adult Licensing, State of
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3. Overview: Assisted or Assistive Living, Department of Human Services, Michigan.gov, 2009,
4. Assisted Living, Erratic Regulation, With No Federal Regulation and Limited State Laws,
Negligence Cases Are Growing, CBS News, November, 2006,
1. Minnesota Statutes of 2007 Chapter 144G. Assisted Living Services, Minnesota Office of the
Revisor of Statutes, 2007,
2. Minnesota Statutes 144D Housing With Services Establishments, Minnesota Office of the Revisor
of Statutes, 2008,
3. Class F Home Care Provider Survey Results (Formerly Assisted Living Home Care Provider Survey),
Minnesota Department of Health, May, 2009,
4. Guide to the Survey Process for Class F Home Care Providers, Minnesota Department of Health,
December, 2006 http://www.health.state.mn.us/divs/fpc/profinfo/cms/alhcp/classfguide.pdf.
5. Guide to MN Statute 144GAssisted Living Review Process, Minnesota Department of Health,
January, 2007, http://www.health.state.mn.us/divs/fpc/profinfo/cms/als/als_Guideto144G.pdf.
6. Wright, Bernadette, Ph.D. Assisted Living in Unlicensed Housing: The Regulatory Experience of
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8. Mollica R., Johnson-LaMarche, Heather, O’Keefe, Janet, State Residential Care and Assisted
Living Policy: 2004, U.S. Department of Health and Human Services, March, 2005,
9. Minnesota’s Assisted Living Legislation, Articlesbase, May, 2009,
1. Title 15 – Mississippi Department of Health Part III – Office of Health Protection, Subpart 01 –
Health Facilities Licensure and Certification, Chapter 47 Minimum Standards for Personal Care
www.ltccc.org Page 34
Homes Assisted Living, Mississippi State Department of Health, January, 2008,
2. Title 15 – Mississippi Department of Health Part III – Office of Health Protection, Subpart 01 –
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1. Nursing Homes – How They’re Inspected, Department of Health and Senior Services, 2009,
2. Missouri, Citation: Residential Care Facilities, Missouri Revised Statutes § 198.003 et. seq.;
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5. Laws, Regulations & Manuals, Department of Health and Senior Services,
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Public Health & Human Services, October, 2008,
1. Job description: Facilities Surveyor Consultant, March 2009,
1. Statutes Governing Assisted Living Services, 2006,
2. Licensing Regulation and Inspection, http://leg.state.nv.us/NRS/NRS-449.html.
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www.ltccc.org Page 35
1. Standards for Licensure of Assisted Living Residences, Comprehensive Personal Care Homes, and
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1. Frequently Asked Questions, Empire State Association of Assisted Living, http://www.ny-
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1. General Information, NC Division of Health Service Regulation, Adult Care Licensure Section,
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for Assisted Living, January 2002,
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1. Blog Archive, Glass City Jungle, July 8, 2009,
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2. Ohio Assisted Living Facilities, Assisted Senior Living, 2009,
3. General provisions and prohibitions, Ohio Administrative Code, Chapter 3701-17-51, 1 April
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5. Inspections and Investigations, Ohio Administrative Code, Chapter 3701-17-53, 1 April 2007,
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1. The Pennsylvania Code, Chapter 2600 Personal Care Homes,
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7. Health and Safety Assisted Living Residence Licensing Act Penalty for Violation
1. Assisted Senior Living Comprehensive Unbiased Info on 242 South Carolina Senior Living
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6. South Dakota Legislature Administrative Rules Chapter 44:04:17 Residents Rights in Nursing
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2. Inspections and Surveys, Texas Administrative Code Title 40, Part 1, Chapter 92, Subchapter E,
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4. Wyoming Assisted Living Facilities, Assisted Senior Living, 2009,
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