ltccctablenationalassistedlivingoversight2010_000

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					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
Remedies                                                                                       16
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: info@ltccc.org.
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.
Arizona
Arkansas               Yes, Ark. Code 20-10-201.
California             ALFs no, RCFs yes.
Colorado               Yes
Connecticut            Facilities are not required to be licensed but they may make agreements w/
                       licensed service agencies.
District of Columbia   No
Delaware               Yes
Florida                Yes
Georgia                Yes
Hawaii                 Yes
Idaho                  Yes
Illinois               Yes
Indiana                No
Iowa                   The state of Iowa allows for either JCAHO or CARF-CCAC accreditation in place of
                       the state's survey and licensing process.
Kansas                 Yes
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
                       without certification.
Louisiana              Yes
Maine                  Yes
Maryland               Yes
Massachusetts          Certification Required.
Michigan               Yes - Adult Foster Care Homes.
Minnesota              Registration is required but not licensure.
Mississippi            Yes
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
                       legal.
Montana                Yes
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.
Nevada                 Yes
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
Ohio                   Yes
Oklahoma               Yes
Oregon                 Yes
Pennsylvania           Yes
Rhode Island           Yes
South Carolina         Yes
South Dakota           Yes
Tennessee              Yes
Texas                  Yes
Utah
Vermont                Yes
Virginia               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.
Wyoming                Yes




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
                       Certification, http://www.cdphe.state.co.us/hf.
Connecticut            Dept. of Health, www.ct.gov/dph.
District of Columbia   Community Residence Facilities Branch, Child and Residential Care Facilities
                       Division, Health Regulation Administration,
                       http://doh.dc.gov/doh/cwp/view,a,1374,q,577139,dohNav_GID,1844.asp.
Delaware               Dept. of Health and Social Services, Division of LTC Residents,
                       http://dhss.delaware.gov/dhss/dltcrp.
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,
                       http://ahca.myflorida.com .
Georgia                Office of Regulatory Services,
                       http://dhr.georgia.gov/portal/site/DHS/menuitem.24259484221d3c0b50c8798d

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                 d03036a0/?vgnextoid=7d79e1d09cb4ff00VgnVCM100000bf01010aRCRD.
Hawaii           Department of Health, Office of Health Care Assurance,
                 http://hawaii.gov/health/elder-care.
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,
                 https://dia-hfd.iowa.gov/DIA_HFD/Home.do.
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,
                 http://www.maine.gov/dhhs/dlrs.
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,
                 http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eelders.
Michigan         Department of Human Services licenses facilities, http://www.michigan.gov/dhs.
                 Department of Labor and Economic Growth performs fire safety, inspections,
                 http://www.michigan.gov/dleg.
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,
                 http://www.dphhs.mt.gov.
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
                 Administration, http://www.dhhs.state.nh.us/DHHS/BHFA/default.htm.
New Jersey       Department of Health and Senior Services, Division of Long Term Care Systems,
                 http://www.nj.gov/health/healthfacilities.
New Mexico       Department of Health, http://www.health.state.nm.us.
New York         Department of Health, Division of Home and Community Based Care,
                 http://www.health.state.ny.us/facilities/assisted_living.
North Carolina   Department of Health and Human Services, Division of Health Service Regulation,
                 http://www.dhhs.state.nc.us/dhsr.
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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                       http://www.oregon.gov/DHS/spwpd/index.shtml.
Pennsylvania           Department of Public Welfare, Division of Personal Care Homes,
                       http://www.dpw.state.pa.us/servicesprograms/physicaldisabilities/003670204.h
                       tm.
Rhode Island           Department of Health, http://www.health.ri.gov.
South Carolina         Department of Health and Environment,
                       http://www.scdhec.gov/environment.htm.
South Dakota           Department of Health,
                       http://www.google.com/#hl=en&q=south+dakota+department+of+health&aq=f
                       &aqi=g5&aql=&oq=south+dakota+department+of+health&gs_rfai=&fp=a30086a
                       c6d4ad95b.
Tennessee              Department of Health, Bureau of Health Licensure and Regulation,
                       Board for Licensing Health Care Facilities,
                       http://health.state.tn.us/hcf/board.htm.
                       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,
                       http://dail.vermont.gov.
Virginia               Department of Social Services, http://www.dss.virginia.gov.
Washington             Department of Social and Health Services - Aging and Disability Services
                       Administration, http://www.aasa.dshs.wa.gov.
West Virginia          Office of Health and Human Resources - Office of Health Facility Licensure and
                       Certification, http://www.wvdhhr.org/OHFLAC.
Wisconsin              Dept. of Health and Family Services - Bureau of Quality Assurance,
                       http://dhs.wi.gov/rl_DSL/bqa.htm.
Wyoming                Department of Health, http://wdh.state.wy.us.




State                  Frequency of Inspections
Alabama                Every 18 months.
Alaska                 Annually.
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
                       upon complaint.
Connecticut            Biannually, upon complaint.
District of Columbia   Inspect after six months of licensure and then annually; upon complaint and at
                       mayor's discretion.
Delaware               Annually, upon complaint.
Florida                Biannually, serious complaints.
Georgia                Initial, annual and follow-up inspections, upon complaint.



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Hawaii           Biennially.
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.
Kansas           Annually.
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).
Mississippi      Annually.
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
                 up inspection.
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
                 deems necessary.
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.
Utah                   Annually.
Vermont                Annually.
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
Alabama
Alaska
Arizona                Unannounced.
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
                       Medicaid.
Colorado               Unannounced.
Connecticut            Unannounced, upon complaint.
District of Columbia   Unannounced.
Delaware               Unannounced.
Florida                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.
Indiana          Unannounced.
Iowa             Unannounced.
Kansas           Initial inspection and then unannounced.
Kentucky         Unannounced annual reviews.
Louisiana        Unannounced.
Maine            Unannounced.
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.
Mississippi
Missouri         Unannounced.
Montana          Unannounced.
Nebraska         Initial survey is announced, renewal surveys are not announced.
Nevada           Unannounced.
New Hampshire
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
                 months.
Oklahoma         Unannounced.
Oregon           Unannounced.
Pennsylvania     Unannounced.
Rhode Island     Unannounced.
South Carolina   Unannounced.
South Dakota     Routine and unannounced.
Tennessee        Unannounced.
Texas            Unannounced.
Utah
Vermont
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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Alaska
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
                       plants.
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.
Georgia
Hawaii
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
                       facilities statewide.
Indiana                Most surveyors are RNs.
Iowa                   Survey performed by RN and a master's level sociologist.
Kansas
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.
Maine
Maryland
Massachusetts
Michigan
Minnesota              Surveys conducted by RN's.
Mississippi
Missouri               Survey teams consist of institutional advisory nurses, boarding home surveyors,
                       medical social workers and environmental sanitarians.
Montana
Nebraska
Nevada                 Inspectors may be RNs, social workers, or generalists with a health or aging
                       background.
New Hampshire          Survey teams are made up of four RNs and one social worker.
New Jersey
New Mexico
New York
North Carolina


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North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island           May include RNs and pharmacists.
South Carolina         Inspectors must have a college degree and an RNs is available to address clinical
                       issues.
South Dakota
Tennessee
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.
Utah
Vermont
Virginia
Washington
West Virginia          Survey teams are comprised of an RN, social worker and environmental
                       surveyor.
Wisconsin
Wyoming




State                  Training of Surveyors
Alabama
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.
California
Colorado
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.
Florida
Georgia
Hawaii
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
                       Handler’s Card.



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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.


Indiana
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.
Massachusetts
Michigan
Minnesota
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.




Nebraska
Nevada
New Hampshire

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New Jersey
New Mexico
New York
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.
North Dakota
Ohio

Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming




State                  Survey Protocol
Alabama
Alaska                 Activity level, grooming, nourishment.
Arizona
Arkansas
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
                       care.
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
                facility.
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
                if applicable.
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.

Maryland
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
                representatives.



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
                and staff.
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
                are deficiencies.
Montana         Surveyors interview a 10% sample of residents, staff and families using a
                structured questionnaire. Additional interviews may be conducted at the
                surveyor's discretion.

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
                interviewed.

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
                cognitive status.
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.

www.ltccc.org                                                                                Page 14
North Carolina
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.
Ohio
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
                 errors, etc.).
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
                 surveys.
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


www.ltccc.org                                                                               Page 15
                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
                records.
Utah
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
                least annually.




State           Remedies
Alabama
Alaska          Suspension or revocation of licensure, intake restrictions, type-of-care
                restrictions, administrative fines.
Arizona         Civil money penalties, provisional licensing & restricted admission.


www.ltccc.org                                                                              Page 16
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
                       issue.
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 =
                       last resort.
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,
                       invoke fines
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.
Michigan
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
                 or revocation.
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
                 on admissions.
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.
South Dakota
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.


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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
                       violation.
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?
Alabama
Alaska                 May request violation conference, appeal sanctions, reapply or contest denial of
                       license.
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.
Colorado
Connecticut            May appeal.
District of Columbia   May appeal but appeal does not stay obligation to correct deficiencies.
Delaware
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.
Georgia
Hawaii
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.

Indiana
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.
Nevada
New Hampshire
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
                 one year.
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.
South Dakota
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.



Utah
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
                       Public?
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
                       Protection.
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
                 point.
Maryland         Survey findings and plans of correction posted at facilities.
Massachusetts    Survey reports are available to public through a Freedom of Information Act
                 request.
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
                 Information Act.
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
                 Department.
Utah
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
                 request.


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

National

   1. Residential Care and Assisted Living: State Oversight Practices and State Information Available to
      Consumers, AHRQ (Agency for Healthcare Research and Quality),
      http://www.ahrq.gov/RESEARCH/residentcare.
   2. The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and
      Home Care Costs, Met Life Mature Market Institute,
      http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-market-survey-nursing-
      home-assisted-living.pdf.
   3. 2010 Assisted Living State Regulatory Review, National Center for Assisted Living (provider
      association), http://www.ahcancal.org/ncal/resources/Pages/AssistedLivingRegulations.aspx.



Alabama

   1. Bradley Arant Rose and White, LLP, Alabama Health Law Update 2001 Fourth Special Session,
      2002.
   2. Board of Examiners of Assisted Living Administrators, Functional Analysis and Records
      Disposition Authority, October, 2003,
      http://www.archives.state.al.us/officials/rdas/assistedLiving-New.pdf.
   3. Givhan, R. Marcus, The Assisted Living Survey Process in Alabama: Achieving Favorable
      Outcomes, Johnston Barton Proctor and Rose, LLP,
      http://www.alaaweb.org/Docs/2007/Marc%20Givhan%20Fall%2007%20Presentation.pdf.
   4. Alabama Board of Examiners and Assisted Living Administrators, Rules and Regulations, Code of
      Alabama 1975, Section 34-2A-1-16, December, 2002,
      http://www.boeala.state.al.us/PDFs/RULES_AMENDED_2_11_04.pdf.
   5. Division of Healthcare and Policy Research, University of Colorado Health Sciences Center,
      Promising Practices in State Survey Agencies, December, 2005,
      http://www.cms.gov/SurvCertPromPractProj/Downloads/TeambasedScheduling_Alabama_120
      505.pdf.

Alaska

   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,
      http://www.hss.state.ak.us/dsds/pdfs/ALHGuidebook.pdf.
   2. Regulations, Iowa Department of Inspections and Appeals,
      http://docs.google.com/gview?a=v&q=cache:aia-
      pkDtmmIJ:www.iowa.gov/elderaffairs/Documents/DependentAdultTF/Materials/Mar13/DIA_Ot



www.ltccc.org                                                                                  Page 25
          her%2520_State_Strategies.pdf+Iowa+Department+of+Inspections+and+Appeals+The+departm
          ent+sought+input&hl=en&gl=us&sig=AFQjCNHUWm7fiFLTDoYqoudILqkM7_vutA.



Arizona

    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,
       http://www.azdhs.gov/als/forms/select_al_statutes.pdf.
    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,
       http://hsapps.azdhs.gov/ls/sod/OALLDefinitions.aspx.
    5. Arizona Department of State, Office of Secretary of State,
       http://www.azsos.gov/public_services/Title_09/9-10.htm#ARTICLE_7.



Arkansas

    1. Informal Dispute Resolution,
       http://sos.state.ar.us/elections/elections_pdfs/register/august_03/016.06.03-016.pdf.
    2. Regulations, Assisted Living Facilities Level II, March, 2006,
       http://www.sos.arkansas.gov/elections/elections_pdfs/register/aug_2002/016.06.02-030.pdf.
    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,
       http://www.sos.arkansas.gov/elections/elections_pdfs/register/01_06/016.06.05-081.pdf.
    3. Regulations, Iowa Department of Inspections and Appeals,
       http://docs.google.com/gview?a=v&q=cache:aia-
       pkDtmmIJ:www.iowa.gov/elderaffairs/Documents/DependentAdultTF/Materials/Mar13/DIA_Ot
       her%2520_State_Strategies.pdf+Iowa+Department+of+Inspections+and+Appeals+The+departm
       ent+sought+input&hl=en&gl=us&sig=AFQjCNHUWm7fiFLTDoYqoudILqkM7_vutA.
    4. Office of Long Term Care, Arkansas Medicaid,
       https://www.medicaid.state.ar.us/InternetSolution/General/units/oltc/index.aspx.


California

    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,
       2005, http://www.dss.cahwnet.gov/ord/entres/getinfo/pdf/arf.pdf.
    2. Carlson, Eric, Assisted Living: Problems and Policy Issues, National Academy of Elder Law
       Attorneys, http://www.naela.com/press/pdf/NAELA_AssistedLiving.pdf.
    3. Assisted Living and Residential Care Facilities, Del Mar Caregiver Resource Center,
       http://www.delmarcaregiver.org/index.php?option=com_content&task=view&id=66&Itemid=8
       1.


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   4. How to Evaluate RCFEs, California Advocates for Nursing Home Reform,
      http://www.canhr.org/RCFE/rcfe_find.htm.

Colorado

   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,
      http://www.cdphe.state.co.us/regulations/healthfacilities/10110107assistedlivingresidences.pd
      f.
   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,
      http://www.cdphe.state.co.us/regulations/healthfacilities/10110107assistedlivingresidences.pd
      f.
   3. Informal Dispute Resolution, Colorado Department of Public Health and Environment, Health
      Facilities and Emergency Medical Services Division Manual, August, 2007,
      http://www.cdphe.state.co.us/hf/alr/IDRPolicy.pdf.
   4. Meeting Notes, Long Term Care Facilities in Rural Colorado, December, 2003,
      http://www.coruralhealth.org/resources/documents/longtermcare2003.pdf.
   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,
      http://www.assistedseniorliving.net/services/colorado/.
   7. Occurrence Reporting Program, Colorado Department of Public Health and Environment,
      http://www.cdphe.state.co.us/hf/static/ncfocc.htm.

Connecticut

   1. 19-3-D105 Assisted Living Services Agency, Department of Public Health, 2006,
      http://www.dir.ct.gov/dph/PHC/docs/50_Assisted_Living_Services.doc.
   2. Connecticut Assisted Living Fact Sheet, Connecticut Assisted Living Association,
      http://www.ctassistedliving.com/pdfs/connecticut_assisted_living_fact_sheet.pdf.
   3. Managed Residential Community, Connecticut Department of Public Health, 2006,
      http://www.ct.gov/dph/lib/dph/family_health/children_and_youth/pdf/mrc_summary_pamphl
      et.pdf.
   4. Wright, Bernadette, Assisted Living in Unlicensed Housing: The Regulatory Experience of Four
      States, AARP Public Policy Institute, April, 2007,
      http://assets.aarp.org/rgcenter/il/2007_08_housing.pdf.

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_-
      _official_code.pdf.
   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,
      http://assets.aarp.org/www.aarp.org_/articles/states/AssistedLivingWhitePaper_08-07.pdf.
   3. An Act D.C. Act 13-297 In the Council of the District of Columbia, District of Columbia Register,
      March, 2000,
      http://assets.aarp.org/www.aarp.org_/articles/states/AssistedLivingWhitePaper_08-07.pdf.
   4. Assisted Senior Living Comprehensive Unbiased Info on 25 DC Senior Living Options,
      http://www.assistedseniorliving.net/services/washington-dc.

Delaware

   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.

Florida

   1. AHCA: Florida Agency for Health Care Administration, Better Health Care for All Floridians,
      Assisted Living Facility, 2009,
      http://www.fdhc.state.fl.us/MCHQ/Long_Term_Care/Assisted_living/alf.shtml.
   2. Chapter 58A-5 Assisted Living Facilities, Florida Agency for Health Care Administration, July
      2008,
      http://www.fdhc.state.fl.us/mchq/long_term_care/assisted_living/common_files/ALF_FAC_58A
      -5.pdf.
   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,
      http://www.leg.state.fl.us/STATUTES/index.cfm?App_mode=Display_Statute&URL=Ch0429/part
      01.htm&StatuteYear=2008&Title=-%3E2008-%3EChapter%20429-%3EPart%20I.
   4. ALF Survey Guideline Index, Florida Agency for Health Care Administration,
      http://ahca.myflorida.com/mchq/Long_Term_Care/Assisted_living/pdf/ALF_Survey_Guideline_I
      ndex.pdf.
   5. Agency for Public Health Care Administration Public Record Search, Florida Agency for Health
      Care Administration,
      http://ahcaxnet.fdhc.state.fl.us/dm_web/(S(ym5cm545osk3bu55ezb1gi55))/Default.aspx.
   6. The 2008 Florida Statutes Chapter 408, Health Care Administration Part II, Health Care Licensing:
      General Provisions, Online Sunshine, 2008,
      http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0408/part0
      2.htm&StatuteYear=2008&Title=-%3E2008-%3EChapter%20408-%3EPart%20II.
   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.



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   9. Assisted Living Facility Full Adverse Incident Report – 15 Day, Florida Agency for Health Care
       Administration, 2006, http://www.floridaaffordableassistedliving.org/documents/AIR-
       15day.pdf.
   10. Assisted Living Facility Initial Adverse Incident Report – 1 Day, Florida Agency for Health Care
       Administration, January 2006,
       http://www.floridaaffordableassistedliving.org/faalEs/documents/AIR-1day.pdf.
   11. Assisted Living in Florida, Florida Agency for Health Care Administration, 2009,
       http://www.floridahealthfinder.gov/reports-guides/assisted-living.shtml.
   12. Owner of Unlicensed Assisted Living Facility Arrested for Neglect, Office of the Attorney General
       of Florida, June, 2009,
       http://www.myfloridalegal.com/newsrel.nsf/newsreleases/94C9BE43669DAC9A852575E50064F
       A46.
   13. Survival Guide for Long-Term Care Providers, Update Since SB 1202, Presentation by the Agency
       for Health Care Administration, September-October, 2002,
       http://ahca.myflorida.com/mchq/long_term_care/ltc/misc/nursing_home_presentation_2_9_0
       2.ppt.
   14. Annual Snapshot 2007-2008, Florida’s Long Term Care Ombudsman Program, Our 2 Cents is No
       Small Change, 2007-2008,
       http://ombudsman.myflorida.com/publications/ar/AnnualSnapshot0209.pdf.
   15. Senate Staff Analysis and Economic Impact Statement, Bill: CS/SB 1652, March, 2001,
       http://www.flsenate.gov/data/session/2001/Senate/bills/analysis/pdf/2001s1652.hc.pdf.

Georgia

   1. 290-9-37-.31 Inspections and Plans of Correction, O.C.G.A., October 2002,
      http://rules.sos.state.ga.us/docs/290/9/37/31.pdf.
   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,
      http://www.nasua.org/pdf/Medicaid%20Assisted%20Living%20Waiver.pdf.
   3. 09 LC 28 4800ER House Bill 850, Georgia General Assembly,
      http://www.legis.state.ga.us/legis/2009_10/fulltext/hb850.htm.
   4. Secretary of State Karen Handel…advancing the e-government revolution, State of Georgia
      1776, http://rules.sos.state.ga.us/cgi-
      bin/page.cgi?g=DEPARTMENT_OF_HUMAN_RESOURCES%2FOFFICE_OF_REGULATORY_SERVICE
      S%2FRULES_AND_REGULATIONS_FOR_COMMUNITY_LIVING_ARRANGEMENTS%2Fmore2.html
      &d=1.

Hawaii

   1. Comprehensive Unbiased Info on 58 Hawaii Senior Living Options, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/hawaii.
   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.

Idaho




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,
       http://www.legislature.idaho.gov/idstat/Title39/T39CH33.htm.
    2. Comprehensive Unbiased Info on 116 Idaho Senior Living Options, Assisted Senior Living, 2009,
       http://www.assistedseniorliving.net/services/idaho.
    3. Informal Dispute Resolution (IDR) Guidelines for Residential or Assisted Living Facilities, July
       2002,
       http://healthandwelfare.idaho.gov/LinkClick.aspx?fileticket=EqsDSBXa3B4%3D&tabid=280&mid
       =2131.
    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,
       http://www.spokesmanreview.com/breaking/story.asp?ID=9265.

Illinois

    1. Health Facilities (210 ILCS 9/) Assisted Living and Shared Housing Act, Illinois General Assembly,
       January 2001,
       http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1217&ChapAct=210%26nbsp%3BILCS%26n
       bsp%3B9%2F&ChapterID=21&ChapterName=HEALTH+FACILITIES&ActName=Assisted+Living+an
       d+Shared+Housing+Act.
    2. 96th General Assembly State of Illinois 2009 and 2010 HB 0838, Illinois General Assembly,
       February, 2009,
       http://www.ilga.gov/legislation/fulltext.asp?DocName=09600HB0838&GA=96&SessionId=76&D
       ocTypeId=HB&LegID=&DocNum=0838&GAID=10&Session.
    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,
       http://www.ilga.gov/commission/jcar/admincode/077/07700295sections.html.
    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,
       http://www.ilga.gov/commission/jcar/admincode/077/077002950A10300R.html.

Indiana

    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
       Foundation, http://www.usaindiana.org.
    3. Article 16.2 Health Facilities; Licensing and Operational Standards, IN.gov,
       http://www.in.gov/legislative/iac/T04100/A00162.PDF.
    4. Definitions/Technical Terms, Indiana Health Care Association, 2009
       http://www.ihca.org/pagesroot/pages/default.aspx?pageId=58.

www.ltccc.org                                                                                    Page 30
Iowa

   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-
      0209.pdf.
   3. Health Care Facility Inspection Changes, House Republican Staff Analysis, April, 2009,
      http://iowahouserepublicans.com/wp-content/uploads/sf-433.pdf.
   4. Media Release, Iowa Department of Inspections and Appeals, March, 2009,
      http://dia.iowa.gov/Deficiency-free.02.09.pdf.
   5. Iowa and Illinois Digest, Crews Will Demolish Cedar Rapids Building, thehawkeye.com, 2009,
      http://www.thehawkeye.com/Story/IA-IowaToday-071809.

Kansas

   1. Nursing Facilities Program, Kansas Department of Health and Environment, January, 1996,
      http://www.aging.state.ks.us/AdultCareHomes/Newsletters/Sunflower/LCE_Newsletter_Arch/ja
      n96.pdf.
   2. Statutes and Regulations for the Licensure and Operation of Assisted Living and Residential
      Health Care Facilities, Kansas Department on Aging, December, 2003,
      http://www.aging.state.ks.us/PolicyInfo_and_Regs/ACH_Current_Regs/ACH_RegSets/ALF_Regs
      _Complete.pdf.
   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-
      living.pdfhttp://www.kabc.org/pdfs/assisted-living.pdf.
   4. Long Term Care Program Fact Sheet II, Kansas Department of Health and Environment, July
      2002,
      http://www.aging.state.ks.us/AdultCareHomes/Newsletters/Sunflower/LCE_Newsletter_Arch/J
      uly02fs2.pdf.
   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,
      2007, http://www.khca.org/education-brochures/joint-provider.pdf.
   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,
      http://www.kahsa.org/files/public/JointTrainingBrochure.pdf.
   7. Culture Change in Long-Term Care, Kansas Department on Aging, June, 2009,
      http://www.agingkansas.org/CultureChange/Culture_Change_Index.html.
   8. Citation: Assisted Living/Residential Health Care Facilities KAR § 28-39-144-148, KAR 28-39—
      240-256, http://www.nashp.org/Files/KS.pdf.
   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,
      http://www.kdheks.gov/bhfr/download/Statement_of_Deficiency_and_POC_Instructions_HEAL
      TH.rtf.



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Kentucky

    1. 194A.703 Requirements for Living Units, Kentucky Legislature,
        http://www.lrc.state.ky.us/krs/194A00/703.PDF.
    2. 194A.705 Services to Be Provided to Assisted Living Community Clients, Kentucky Legislature,
        http://www.lrc.state.ky.us/KRS/194A00/705.PDF.
    3. 194A.711 Criteria to Be Met by Clients, Kentucky Legislature,
        http://www.lrc.state.ky.us/krs/194A00/711.PDF.
    4. 902 KAR 20:036. Operation and Services, Personal Care Homes, Kentucky Legislature, 1998,
        http://www.lrc.ky.gov/kar/902/020/036.htm.
    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,
        http://www.kentuckyassistedliving.org/site/387/assisted_living_faqsbps.aspx.
    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
        http://www.lrc.state.ky.us/KRS/194A00/700.PDF.
    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,
        2000, http://www.lrc.state.ky.us/krs/194A00/725.PDF.
    11. Kentucky’s Assisted Living Requirements, Kentucky Assisted Living Facilities Association,
        http://www.kentuckyassistedliving.org/site/373/assisted_living_requirements.aspx.
    12. 216.573 Injunction to Terminate Operation of Facility, Kentucky Legislature, July, 1982,
        http://www.lrc.state.ky.us/KRS/216-00/573.PDF.
    13. Kentucky’s Assisted Living Law: Why a Bluegrass State Success Story Matters, Nursing Homes
        Long Term Care Management, March 2001,
        http://www.kentuckyassistedliving.org/Portals/_ExpressSite/pdf/KYAssistedLivingLaw.pdf.
    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,
        http://www.lrc.state.ky.us/KRS/194A00/723.PDF.
    16. 194A.719 In-Service Education for Staff and Management, Kentucky Legislature,
        http://www.lrc.state.ky.us/krs/194A00/719.PDF.
    17. Let’s Talk Assisted Living, Department for Aging and Independent Living, March, 2009,
        http://chfs.ky.gov/NR/rdonlyres/F1DEEA0A-7E54-455C-90B0-
        048A3C31D583/0/LetsTalkNewsletterMarch09.pdf.
    18. 216.590 Training of Surveyors and Investigators, Kentucky Legislature, July 1982,
        http://www.lrc.state.ky.us/krs/216-00/590.PDF.
    19. 910 KAR 1:240. Certification of Assisted Living Communities, Kentucky Legislature,
        http://www.lrc.state.ky.us/kar/910/001/240.htm.

Louisiana

   1. Adult Residential Care Minimum Standards, Louisiana Administrative Code, Title 48 – Chapter
      88, Department of Social Services State of Louisiana, March, 1999,
      http://www.dss.state.la.us/assets/docs/searchable/OS/licensing/Adult_Residential.pdf.



www.ltccc.org                                                                                   Page 32
Maine

   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,
      http://www.assistedseniorliving.net/services/maine.
   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,
      http://www.maine.gov/dhhs/oes/rulemaking/Section63_final_clean.doc.
   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.

Maryland

   1. Maryland’s Assisted Living Resident Assessment and Level of Care Scoring Tool, Department of
       Health and Mental Hygiene, October, 2006,
       http://www.dhmh.state.md.us/ohcq/download/alforms/al_tool_guide.pdf.
   2. Maryland Guide to Assisted Living, Maryland Health Care Commission, 2005,
       http://mhcc.maryland.gov/consumerinfo/assistedliving.
   3. Assisted Living Facilities: Government Agencies Involved in the Oversight of ALF Operators,
       Maryland’s People’s Law Library, November, 2007, http://www.peoples-
       law.org/housing/assisted_living/find_govt.htm.
   4. 10.07.14.11 Investigation by Department, Maryland Office of the Secretary of State,
       http://www.dsd.state.md.us/comar/getfile.aspx?file=10.07.14.11.htm.
   5. State Licensing: Maryland Senior Housing and Care, New Lifestyles, The Source for Seniors, 2004,
       http://www.newlifestyles.com/resources/state_licensing/MD.aspx.
   6. 10.07.14.07 Licensing Procedure, Maryland Office of the Secretary of State,
       http://www.dsd.state.md.us/comar/getfile.aspx?file=10.07.14.07.htm.
   7. 10.07.14.04 License Required, Maryland Office of the Secretary of State,
       http://www.dsd.state.md.us/comar/getfile.aspx?file=10.07.14.04.htm.
   8. Guide to Assisted Living Facilities, Assisted Living Facility Survey Reports, Maryland Health Care
       Commission, February, 2009,
       http://mhcc.maryland.gov/consumerinfo/assistedliving/inspectionreport.aspx.
   9. Assisted Living and Senior Living California, ElderHomeFinders, 2007,
       http://www.elderhomefinders.com/assisted-living-and-senior-living-california.
   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-
       law.org/housing/assisted_living/docs/Assisted%20living%20reviews%20faulted%20--
       %20baltimoresun.pdf.
   11. Assisted Living Regulations Background, Taking Care of Mom and Dad, 2009,
       http://www.takingcareofmomanddad.net/AssistedLiving/Regulations.
   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,
       March, 1999, http://www.dhmh.state.md.us/ohcq/download/memo/al03301999a.pdf.



www.ltccc.org                                                                                  Page 33
Massachusetts

   1. Current Assisted Living Regulations, Massachusetts Assisted Living Facilities Association, 2008,
      http://www.massalfa.org/docs/al_regulations.html.

Michigan

   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
      Michigan Department of Human Services, September, 1984,
      http://www.michigan.gov/documents/dhs/BCAL-PUB-0332_281384_7.pdf.
   3. Overview: Assisted or Assistive Living, Department of Human Services, Michigan.gov, 2009,
      http://www.michigan.gov/dhs/0,1607,7-124-5455_27716_27717---,00.html.
   4. Assisted Living, Erratic Regulation, With No Federal Regulation and Limited State Laws,
      Negligence Cases Are Growing, CBS News, November, 2006,
      http://www.cbsnews.com/stories/2006/11/13/cbsnews_investigates/main2177892.shtml.

Minnesota

   1. Minnesota Statutes of 2007 Chapter 144G. Assisted Living Services, Minnesota Office of the
      Revisor of Statutes, 2007,
      https://www.revisor.leg.state.mn.us/statutes/?id=144G&view=chapter&year=2007.
   2. Minnesota Statutes 144D Housing With Services Establishments, Minnesota Office of the Revisor
      of Statutes, 2008,
      https://www.revisor.leg.state.mn.us/statutes/?id=144D&view=chapter&year=2008#stat.144D.0
      3.
   3. Class F Home Care Provider Survey Results (Formerly Assisted Living Home Care Provider Survey),
      Minnesota Department of Health, May, 2009,
      http://www.health.state.mn.us/divs/fpc/profinfo/cms/alhcp/alhcpsurveyresults.htm.
   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
      Four States, April, 2007, http://assets.aarp.org/rgcenter/il/2007_08_housing.pdf.
   7. 2008 Minnesota Statutes, 144D.02 Registration Required, Minnesota Office of the Revisor of
      Statutes, 2008, https://www.revisor.leg.state.mn.us/statutes/?id=144D.02.
   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,
      http://aspe.hhs.gov/daltcp/Reports/04alcom.htm.
   9. Minnesota’s Assisted Living Legislation, Articlesbase, May, 2009,
      http://www.articlesbase.com/elderly-care-articles/minnesotas-assisted-living-legislation-
      902128.html.

Mississippi

   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,
      http://www.msdh.state.ms.us/msdhsite/_static/resources/341.pdf.
   2. Title 15 – Mississippi Department of Health Part III – Office of Health Protection, Subpart 01 –
      Health Facilities Licensure and Certification, Chapter 48 Minimum Standards for Personal Care
      Homes Residential Living, Mississippi State Department of Health, January, 2008,
      http://msdh.ms.gov/msdhsite/_static/resources/342.pdf.

Missouri

   1. Nursing Homes – How They’re Inspected, Department of Health and Senior Services, 2009,
      http://www.dhss.mo.gov/NursingHomesInspected.
   2. Missouri, Citation: Residential Care Facilities, Missouri Revised Statutes § 198.003 et. seq.;
      Missouri Code of Regulations, Title § 19 30-86.012 et seq.; Title 19 30-88, State Residential Care
      and Assisted Living Policy: 2004, http://aspe.hhs.gov/daltcp/reports/04alcom3.htm#MO.
   3. Rules of Department of Health and Senior Services, Division 30 – Division of Regulation and
      Licensure, Chapter 86 – Residential Care Facilities and Assisted Living Facilities, Code of State
      Regulations, April, 2009, http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-86.pdf.
   4. Title 19 – Division of Health and Senior Services, Division 15 – Division of Senior and Disability
      Services, Chapter 1 – Organization, Missouri Code of State Regulations, 2009,
      http://www.sos.mo.gov/adrules/csr/current/19csr/19c15-1.pdf.
   5. Laws, Regulations & Manuals, Department of Health and Senior Services,
      http://www.dhss.mo.gov/NursingHomes/LawsRegs.html.

Montana

   1. Assisted Living Survey Tool, mt.gov, Department of Public Health & Human Services, November,
      2006, http://www.dphhs.mt.gov/qad/surveytools/armsurveytool.pdf.
   2. Assisted Living Packet, What is an Assisted Living Facility in Montana? mt.gov, Department of
      Public Health & Human Services, October, 2008,
      http://www.dphhs.mt.gov/qad/assistedliving/index.shtml.

Nebraska

   1. Job description: Facilities Surveyor Consultant, March 2009,
      http://www.das.state.ne.us/emprel/JobSpecs/X/pdf/X62450.pdf.

Nevada

   1. Statutes Governing Assisted Living Services, 2006,
      http://aspe.hhs.gov/daltcp/reports/2007/07alcomNV.pdf.
   2. Licensing Regulation and Inspection, http://leg.state.nv.us/NRS/NRS-449.html.

New Hampshire

   1. Draft: Citation Assisted Living Residence –Supported Residential Health Care and Residential
      Care Facilities, 2007, http://aspe.hhs.gov/daltcp/reports/2007/07alcomNH.pdf.
   2. New Hampshire Code of Administrative Rules, May 2010, http://www.nharch.org/He-
      P%20805%20certified%20rules.doc.




www.ltccc.org                                                                                    Page 35
New Jersey

   1. Standards for Licensure of Assisted Living Residences, Comprehensive Personal Care Homes, and
      Assisted Living Programs, February 2007,
      http://www.nj.gov/health/healthfacilities/documents/ltc/regnjac836.pdf.
   2. An Overview of Long Term Care, Health Care Association of New Jersey,
      http://www.hcanj.org/ltcguide.htm.

New York

   1. Frequently Asked Questions, Empire State Association of Assisted Living, http://www.ny-
      assisted-living.org/consumer/faq.htm.
   2. New Assisted Living Regulations, Chapter 10 consisting of Part 1001 added to Title 10 (Health) of
      the Official Compilation of Codes, Rules and Regulations of NYS,
      http://www.health.state.ny.us/facilities/assisted_living/adopted_regulations/docs/assisted_livin
      g_residences_laws_and_regulations.pdf.
   3. NY Department of Health – Assisted Living,
      http://www.health.state.ny.us/facilities/assisted_living.


North Carolina

   1. General Information, NC Division of Health Service Regulation, Adult Care Licensure Section,
      2009, http://www.ncdhhs.gov/dhsr/acls/index.html.
   2. Adult Care Homes, NC Administrative Code, Title 10A, Chapter 13, NC Division of Health Service
      Regulation, 2008, http://www.ncdhhs.gov/dhsr/acls/rules.html.
   3. Assisted Living in North Carolina, North Carolina Assisted Living Association, 2010,
      http://www.ncala.org/assistedliving/ncal.html.
   4. Assisted Living Consortium Making Headway on Senate Request for Standards, National Center
      for Assisted Living, January 2002,
      http://www.ahcancal.org/News/publication/AHCA%20Focus2/al-focus-0201.pdf.

North Dakota

   1. North Dakota Assisted Living Facilities, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/north-dakota.
   2. Assisted Living Facilities, North Dakota Century Code Chapter 50-32, 2009,
      http://www.legis.nd.gov/cencode/t50c32.pdf.
   3. Licensing of Assisted Living Facilities, North Dakota Century Code Chapter 75-03-34, 2009,
      http://www.legis.nd.gov/information/acdata/pdf/75-03-34.pdf.
   4. State Residential Care and Assisted Living Policy, U.S. Department of Health and Human
      Services, Assistant Secretary for Planning and Evaluation, 2004,
      http://aspe.hhs.gov/daltcp/Reports/04alcomND.pdf.

Ohio

   1. Blog Archive, Glass City Jungle, July 8, 2009,


www.ltccc.org                                                                                 Page 36
         http://glasscityjungle.com/wordpress/2009/07/yesterday-was-26th-day-of-conference-
         committee-strickland-signs-2nd-temporary-budget.
   2.    Ohio Assisted Living Facilities, Assisted Senior Living, 2009,
         http://www.assistedseniorliving.net/services/ohio.
   3.    General provisions and prohibitions, Ohio Administrative Code, Chapter 3701-17-51, 1 April
         2007,
         http://www.odh.ohio.gov/ASSETS/7F629329BEB9441FA0A3DBD96BBFDE45/Fr17_51.PDF.
   4.    Residential Care Facilities /Assisted Living, Ohio Department of Health, 1 February 2007,
         http://www.odh.ohio.gov/odhPrograms/ltc/rcfacal/rcfac1.aspx.
   5.    Inspections and Investigations, Ohio Administrative Code, Chapter 3701-17-53, 1 April 2007,
         http://www.odh.ohio.gov/ASSETS/2D070613F0D84CD8869C59420D5EF1E9/Fr17_53.PDF.


Oklahoma

   1. Long Term Care Certificate of Need Act, Oklahoma Statutes, Title 63 Section 1-850, 28 April
      2009, http://www.ok.gov/health/documents/HRDS-HFS-LTC%20CON%20act.pdf.
   2. Oklahoma Assisted Living Facilities, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/oklahoma.
   3. Certificate of Need Disclosure Statement, Health Resources Development Service, Oklahoma
      State Department of Health, 1 March 2006, http://www.ok.gov/health/documents/HRDS-HFS-
      614%20CN%20Disclosure%20Statement%20Revised%2003-06.pdf.
   4. Continuum of Care and Assisted Living, Ohio Administrative Code Title 310 Chapter 663, 25 June
      2007, http://www.ok.gov/health/documents/HRDS_Chapt663.pdf.

Oregon

   1. Office for Oregon Health Policy and Research Oregon Community-Based Long Term Care
      Assisted Living and Residential Care Facilities Utilization in 2006, February 2008,
      http://egov.oregon.gov/OHPPR/RSCH/docs/2006ALF-RCF_Report_final.pdf.
   2. DHS: Seniors and People with Disabilities Division Oregon Consumer Guide: Assisted Living and
      Residential Care Facilities, http://dhsforms.hr.state.or.us/Forms/Served/DE9098.pdf.
   3. Seniors and people with physical disabilities, Choosing a Long-term Care Setting,
      http://www.oregon.gov/DHS/spwpd/ltc/ltc_guide/index.shtml.
   4. Oregon State Archives, Oregon Administrative Rules contain OARs filed through July 15, 2009,
      Department of Human Services, Seniors and People with Disabilities Division, Division 54
      Residential Care and Assisted Living Facilities,
      http://arcweb.sos.state.or.us/rules/OARS_400/OAR_411/411_054.html.
   5. Assisted Senior Living Comprehensive Unbiased Info on 180 Oregon Senior Living Options,
      http://www.assistedseniorliving.net/services/oregon.
   6. Residential Care And Assisted Living Facilities Chapter 411 Division 54 Questions and Answers,
      http://www.ohca.com/docs/alfrcf/RALF_Questions_Answers.pdf.
   7. The OHCA Perspective, Oregon Health Care Association newsletter, September 2006,
      http://www.illuminage.com/docs/ohca_sept06per.pdf.


Pennsylvania




www.ltccc.org                                                                                   Page 37
   1. The Pennsylvania Code, Chapter 2600 Personal Care Homes,
      http://www.pacode.com/secure/data/055/chapter2600/chap2600toc.html.
   2. The Pennsylvania Bulletin, Rules and Regulations, Title 55 Public Welfare Personal Care Homes,
      October 2002, http://www.pabulletin.com/secure/data/vol35/35-17/823.html.

Rhode Island

   1. Chapter 23-17.4 Assisted Living Residence Licensing Act Index of Sections,
      http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.4/INDEX.HTM.
   2. Health and Safety Assisted Living Residence Licensing Act Judicial Review of License Action,
      http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.4/23-17.4-9.HTM.
   3. Health and Safety Assisted Living Residence Licensing Act Expiration and Renewal of License,
      http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.4/23-17.4-7.HTM.
   4. Rules and Regulations for Licensing Assisted Living Residences R23-17.4-ALR, January 2004,
      http://www.rules.state.ri.us/rules/released/pdf/DOH/DOH_2869.pdf .
   5. Health and Safety Assisted Living Residence Licensing Act License Required for Assisted Living
      Residence Operation, http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.4/23-17.4-4.HTM.
   6. Assisted Senior Living Comprehensive Unbiased Info on 104 Rhode Island Senior Living Options,
      http://www.assistedseniorliving.net/services/rhode-island.
   7. Health and Safety Assisted Living Residence Licensing Act Penalty for Violation
      http://www.rilin.state.ri.us/Statutes/TITLE23/23-17.4/23-17.4-10.2.HTM.

South Carolina

   1. Assisted Senior Living Comprehensive Unbiased Info on 242 South Carolina Senior Living
      Options, http://www.assistedseniorliving.net/services/south-carolina.
   2. Local Assisted Living Centers' Inspection Results Hard to Get, The Post and Courier, July 26,
      2009,
      http://www.postandcourier.com/news/2009/jul/26/local_assisted_living_centers_inspection90
      437.
   3. DHEC South Carolina Department of health and Environmental Control Regulation Number 61-
      84 Standards for Licensing Community Residential Care Facilities, December 5, 2003,
      http://www.scdhec.gov/administration/regs/docs/61-84.pdf.

South Dakota

   1. Citation: Assisted Living Centers: Article 44:04 et seq. General Approach and Recent
      Developments, December 2006, http://aspe.hhs.gov/daltcp/reports/2007/07alcomSD.pdf.
   2. South Dakota Legislature Administrative Rules, 44:04:01:07.01 Plans of Correction, December
      16, 2001, http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=44:04:01:07.01.
   3. Department of Human Services Strategic Plan,
      http://dhs.sd.gov/DHS%20Strategic%20Plan%20(Long%20version)1-9-09.pdf.
   4. Ready to Work, Governor's Office of Economic Development South Dakota, Business Start Up
      Packet, Licensing and Registering Your Business
      http://www.sdreadytowork.com/dbisd/startup/step8.asp.
   5. South Dakota Legislature Administrative Rules 44:04:04:12:01 Requirements for Assisted Living
      Centers, December 2002, http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=44:04:04:12.01.




www.ltccc.org                                                                                 Page 38
   6. South Dakota Legislature Administrative Rules Chapter 44:04:17 Residents Rights in Nursing
      Facilities and Assisted Living Centers,
      http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=44:04:17.

Tennessee

   1. Tennessee Assisted Living Facilities, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/tennessee.
   2. Standards for Assisted-Care Living Facilities, Tennessee Codes Annotated, Chapter 1200-08-25,
      December 2009, http://www.state.tn.us/sos/rules/1200/1200-08/1200-08-25.20091223.pdf.

Texas

   1. Licensing Standards for Assisted Living Facilities, Texas Administrative Code, Title 40, Part 1,
      Chapter 92, Subchapter C,
      http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=92&sch=
      C&rl=Y.
   2. Inspections and Surveys, Texas Administrative Code Title 40, Part 1, Chapter 92, Subchapter E,
      Rule §92.81, 1 August 1998,
      http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=
      &p_ploc=&pg=1&p_tac=&ti=40&pt=1&ch=92&rl=81.
   3. Licensing Standards for Assisted Living Facilities Handbook, Texas Department of Aging and
      Disability Services, January 2009, http://www.dads.state.tx.us/handbooks/ls-alf/H/index.htm.
   4. Standards for Type A, Type B and Type E Assisted Living Facilities, Texas Administrative Code
      Title 40, Part 1, Chapter 92, Subchapter C, Rule §92.41, 1 April 2007,
      http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=
      &p_ploc=&pg=1&p_tac=&ti=40&pt=1&ch=92&rl=41.
   5. Determinations and Actions Pursuant to Inspections, Texas Administrative Code, 1 September
      2003,
      http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=
      &p_ploc=&pg=1&p_tac=&ti=40&pt=1&ch=92&rl=82.
   6. How to Become an ALF Provider, Texas Department of Aging and Disability Services, 21 May
      2010, http://www.dads.state.tx.us/providers/ALF/howto.html.

Utah

   1. Assisted Living Facilities, Utah Administrative Code R432-270, 1 June 2010,
      http://www.rules.utah.gov/publicat/code/r432/r432-270.htm.
   2. Sample survey form, Utah Department of Health, 31 March 2009,
      http://www.loginsdch.com/upload/306/6334_2009%20Orchard%20Cove%20State%20Survey.p
      df.
   3. General Licensing Provisions, Utah Administrative Code R432-2, 1 June 2010,
      http://www.rules.utah.gov/publicat/code/r432/r432-002.htm.

Vermont

   1. Assisted Living Residence Licensing Regulations, Department of Aging and Disabilities, 15 March
      2003, http://www.dail.state.vt.us/Regulations/AssistedLivingRegsFinal.pdf.
   2. Vermont Assisted Living Facilities, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/vermont.

www.ltccc.org                                                                                 Page 39
    3. Statutes & Regulations, Department of Disabilities, Aging & Independent Living, 2010,
       http://dail.vermont.gov/dail-statutes.



Virginia

    1. General Procedures and Information for Licensure, Department of Social Services, December
       2006, http://www.dss.virginia.gov/files/division/licensing/crf/applicable_regulations/032-05-
       017-8.pdf.
    2. Rights and Responsibilities of Residents of Assisted Living Facilities, Code of Virginia §63.2-1808,
       2007, http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-1808.

Washington

    1. Boarding Homes Licensing Rules, Washington Administrative Code Chapter 388-78A, 15 January
       2010, http://apps.leg.wa.gov/WAC/default.aspx?cite=388-78A.
    2. Washington Assisted Living Facilities, Assisted Senior Living, 2009
       http://www.assistedseniorliving.net/services/washington.
    3. Long Term Care Facility Track Record, Long Term Care Ombudsman Washington State, 30 May
       2008, http://www.ltcop.org/ChoosingFacSection1.htm.

West Virginia

    1. West Virginia Alzheimer’s Disease Registry, West Virginia Code of State Rules, Title 64 Series 94,
       2010, http://apps.sos.wv.gov/csrdocs/pdfdocs/64-94.pdf.
    2. Assisted Living Program, West Virginia Office of Health Facility Licensure and Certification, 2
       March 2010, http://www.wvdhhr.org/OHFLAC/Residential/WV_Laws.aspx.
    3. West Virginia Assisted Living Facilities, Assisted Senior Living, 2009,
       http://www.assistedseniorliving.net/services/west-virginia.
    4. Assisted Living Residences, West Virginia Code of State Rules, Title 64 Series 14, Eff. 1 May 2006,
       http://apps.sos.wv.gov/csrdocs/pdfdocs/64-14.pdf.

Wisconsin

    1. Guidelines for Assisted Living Enforcement, State of Wisconsin Department of Health Services,
       Division of Quality Assurance, Bureau of Assisted Living, October 2009,
       http://dhs.wisconsin.gov/publications/p6/p63200.pdf.
    2. Community-Based Residential Facilities, Wisconsin Administrative Code, Department of Health
       Services Chapter 83, Eff. 1 April 2009, http://www.legis.state.wi.us/rsb/code/dhs/dhs083.pdf.
    3. Survey Guide, Assisted Living Facilities, State of Wisconsin Department of Health Services,
       Division of Quality Assurance, Bureau of Assisted Living, July 2009,
       http://dhs.wisconsin.gov/publications/p6/p63186.pdf.
    4. Residential Care Apartment Complexes (RCAC’s) – Provider Information, Wisconsin Department
       of Health Services, 16 December 2009, http://dhs.wisconsin.gov/rl_dsl/RCACs/RCACprovds.htm.
    5. Wisconsin Assisted Living Facilities, Assisted Senior Living, 2009,
       http://www.assistedseniorliving.net/services/wisconsin.

Wyoming



www.ltccc.org                                                                                      Page 40
   1. Rules and Regulations for Licensure of Assisted Living Facilties, Wyoming Secretary of State Rules
      Database, 28 June 2001, http://soswy.state.wy.us/Rules/RULES/4451.pdf.
   2. Rules for Program Administration of Assisted Living Facilities, Wyoming Department of Health
      Aging Division, 12 December 2007, http://soswy.state.wy.us/Rules/RULES/4450.pdf.
   3. Rules and Regulations, Wyoming Department of Health, 2008,
      http://wdh.state.wy.us/ohls/ruleslist.html.
   4. Wyoming Assisted Living Facilities, Assisted Senior Living, 2009,
      http://www.assistedseniorliving.net/services/wyoming.




www.ltccc.org                                                                                  Page 41

				
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