OAR 411-050 APD - Home and Community-Based Services and Settings for Adult Foster Homes

OAR 411-050 APD - Home and Community-Based Services and Settings for Adult Foster Homes
Secretary of State
Certificate and Order for Filing
TEMPORARY ADMINISTRATIVE RULES
A Statement of Need and Justification accompanies this form.
I certify that the attached copies* are true, full and correct copies of the TEMPORARY Rule(s) adopted on [ upon
filing] by the
Date prior to or same as filing date
Department of Human Services, Aging and People with Disabilities, Office of Licensing
and Regulatory Oversight
411
Agency and Division
Administrative Rules Chapter Number
Kimberly Colkitt-Hallman
500 Summer Street NE, E-48
Salem, OR 97301-1074
Rules Coordinator
Address
to become effective [January
(503) 945-6398
Telephone
1, 2016] through [June 28, 2016].
Date upon filing or later
A maximum of 180 days including the effective date.
RULE CAPTION
APD - Home and Community-Based Services and Settings for Adult Foster Homes
Not more than 15 words that reasonably identifies the subject matter of the agency’s intended action.
RULEMAKING ACTION
List each rule number separately, 000-000-0000.
Secure approval of new rule numbers (Adopted rules) with the Administrative Rules Unit prior to filing
ADOPT:
AMEND:
411-050-0602; 411-050-0615; 411-050-0630; 411-050-0632; 411-050-0635; 411-0500642; 411-050-0645; 411-050-0650; 411-050-0655; 411-050-0662; 411-050-0665;
411-050-0670; 411-050-0685
SUSPEND:
Stat. Auth.: ORS
410.070, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738,
443.742, 443.760, 443.767, 443.775, 443.790
Other Auth.:
Stats. Implemented: ORS
106.010, 443.001-004, 443.705-825, 443.875, 443.991
RULE SUMMARY
The Department of Human Services (Department) is immediately amending OAR
chapter 411, division 050 for adult foster homes for adults who are older or adults with
physical disabilities to align the rules with the newly adopted rules in 411-004.
The Department is also updating the rules to improve and streamline processes and to
make changes to enhance the safety and welfare of adult foster home residents and
licensees. The Department updated the rules to ensure the rules were using current
Department terminology and to perform minor grammar, punctuation, formatting, and
housekeeping changes.
Signed Michael R. McCormick, Deputy Director, Aging and People with Disabilities
Signature
12/29/2015
Date
Secretary of State
STATEMENT OF NEED AND JUSTIFICATION
A Certificate and Order for Filing Temporary Administrative Rules accompanies this form.
Department of Human Services, Aging and People with Disabilities
Agency and Division
411
Administrative Rules Chapter Number
In the Matter of: The
temporary amendment of OAR 411-050-0602; 411-050-0615; 411-0500630; 411-050-0632; 411-050-0635; 411-050-0642; 411-050-0645; 411-050-0650;
411-050-0655; 411-050-0662; 411-050-0665; 411-050-0670; and 411-050-0685
relating to Adult Foster Homes.
Rule Caption: (Not more than 15 words that reasonably identifies the subject matter of the agency’s intended action.)
APD - Home and Community-Based Services and Settings for Adult Foster Homes
Statutory Authority:
ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742,
443.760, 443.767, 443.775, 443.790
Other Authority:
Stats. Implemented:
ORS 106.010, 443.001-004, 443.705-825, 443.875, 443.991
Need for the Temporary Rule(s):
The Department needs to immediately amend the rules in OAR chapter 411, division
050 to align the rules with the newly adopted rules in 411-004 to implement new
regulations promulgated by the Centers for Medicare and Medicaid Services (CMS)
that define the settings in which it is permissible for states to pay for Medicaid Home
and Community-Based Services (HCBS).The purpose of these federal regulations is to
ensure that individuals receive Medicaid-funded HCBS in settings that are integrated in
and support full access to the greater community. This includes opportunities to seek
employment and work in competitive and integrated settings, engage in community life,
control personal resources, and receive services in the community, to the same degree
as individuals who do not receive HCBS.
The Department will do this by updating OAR 411-050 to incorporate these new
regulations into the rules. This will ensure the Department is applying the same
standards to all HCBS settings and that there is no disparity of services depending on
the payment source.
The Department also needs to update the rules to improve and streamline processes
and to make changes to enhance the safety and welfare of adult foster home residents
and licensees. The Department updated the rules to ensure the rules were using
current Department terminology and to perform minor grammar, punctuation,
formatting, and housekeeping changes.
Documents Relied Upon, and where they are available:
Oregon’s Global Transition Plan located at:
http://www.oregon.gov/dhs/seniors-disabilities/HCBS/Pages/index.aspx
Justification of Temporary Rule(s):
Failure to act promptly and immediately amend and adopt a new rule OAR 411-050 will
result in serious prejudice to the Department, the public, adult foster home providers,
and adults who are older and adults with physical disabilities residing in adult foster
homes. These rules need to be adopted promptly so that the rules in 411-050 comply
with the newly adopted rules in OAR chapter 411, division 004, which implement the
new CMS requirements.
411-050 needs to be amended promptly to align rules in the division with the new
standards in OAR 411-004 relating to HCB services and settings and person-centered
service planning. Failing to align the rules may lead to confusion among the program
as there would be differing requirements in different divisions. Also, if the Department,
does not implement rules that comply with the regulations and expectations of CMS,
Oregon risks losing federal funding, which covers approximately 70 percent of the cost
of HCBS. Without this federal funding, Oregon could not fund the current HCB system,
resulting in a significant impact to the state.
Signed Michael R. McCormick, Deputy Director, Aging and People with Disabilities
Signature
12/29/2015
Date
DEPARTMENT OF HUMAN SERVICES
AGING AND PEOPLE WITH DISABILITIES
OREGON ADMINISTRATIVE RULES
CHAPTER 411
DIVISION 50
ADULT FOSTER HOMES
Licensure of Adult Foster Homes for Adults who are Older or Adults
with Physical Disabilities
411-050-0602 Definitions
Unless the context indicates otherwise, the following definitions apply to the
rules in OAR chapter 411, division 050:
(1) "AAA" means an Area Agency on Aging, which is an established public
agency within a planning and service area designated under Section 305 of
the Older Americans Act that has responsibility for local administration of
programs within the Department of Human Services. For the purpose of
these rules, Type B AAAs contract with the Department to perform specific
activities in relation to licensing adult foster homes, including processing
applications, conducting inspections and investigations, issuing licenses,
and making recommendations to the Department regarding adult foster
home license denial, revocation, suspension, non-renewal, and civil
penalties.
(2) "Abuse" means "abuse" as defined in OAR 411-020-0002 (Adult
Protective Services).
(3) "Activities of Daily Living (ADL)" mean the personal, functional activities
defined in OAR 411-015-0006 (Long-term Care Service Priorities for
Individuals Served) required by an individual for continued well-being,
which are essential for health and safety.
(4) "Adult Foster Home (AFH)" means any family home or other facility in
whichwhere residential care is provided in a home-like environment for
compensation to five or fewer adults who are not related to the licensee,
resident manager, or floating resident manager, by blood, marriage, or
Page 1
adoption and who are 65 years of age or older or an adult with a physical
disability. For the purpose of these rules, "adult foster home" does not
include any house, institution, hotel, or other similar living situation that
supplies room or board only, if no resident thereof requires any element of
care. "Facility" and "Home" are synonymous with "Adult Foster Home".
(5) "Advance Directive" or "Advance Directive for Health Care" means the
legal document signed by a resident that provides health care instructions
in the event the resident is no longer able to give directions regarding his or
her wishes. The directive gives the resident the means to control his or her
own health care in any circumstance. "Advance Directive for Health Care"
does not include Physician Orders for Life-Sustaining Treatment (POLST).
(6) "Applicant" means a person who completes an application for an adult
foster home license or who completes an application to become a resident
manager, floating resident manager, or shift caregiver. "Applicant" is
synonymous with "Co-applicant".
(7) "Background Check" means a criminal records check and abuse check
as defined in OAR 407-007-0210 (Criminal Records and Abuse Check for
Providers).
(8) "Back-Up Provider" means a licensee, approved resident manager, or
approved floating resident manager who does not live in the home, who
has agreed to oversee the operation of an adult foster home, of the same
license classification or level, in the event of an emergency.
(9) "Behavioral Interventions" mean those interventions that modify a
resident's behavior or a resident's environment.
(10) "Board of Nursing Rules" means the standards for Registered Nurse
Teaching and Delegation to Unlicensed Persons according to the statutes
and rules of the Oregon State Board of Nursing, ORS 678.010 to 678.445
and OAR chapter 851, division 047.
(11) "Care" means the provision of assistance with activities of daily living
to promote a resident's maximum independence and enhance the
resident's quality of life. "Care" includes, but is not limited to, assistance
with bathing, dressing, grooming, eating, money management, recreation,
and medication management excluding assistance with self-medication.
Page 2
(12) "Caregiver" means any person responsible for providing care and
services to residents, including the licensee, resident manager, floating
resident manager, shift caregivers, and any temporary, substitute, or
supplemental staff, or other person designated to provide care and services
to residents.
(13) "Care Plan" means a licensee's written description of a resident's
needs, preferences, and capabilities, including by whom, when, and how
often care and services are to be provided.
(14) "Centers for Medicare and Medicaid Services (CMS)" means the
federal agency within the United States Department of Health and Human
Services responsible for the administration of Medicaid and the Health
Insurance Portability and Accountability Act (HIPAA).
(15) "Classification" means a designation of license assigned to a licensee
based on the qualifications of the licensee, resident manager, floating
resident manager, and shift caregivers, as applicable.
(16) "Co-Applicant" is synonymous with "Applicant" as defined in this rule.
(17) "Code of Federal Regulations" or "CFR" means the codification of the
rules and regulations published in the Federal Register, and produced by
the executive departments and agencies of the federal government of the
United States.
(187) "Co-Licensee" is synonymous with "Licensee" as defined in this rule.
(198) "Compensation" means monetary or in-kind payments by or on behalf
of a resident to a licensee in exchange for room, board, care, and services.
"Compensation" does not include the voluntary sharing of expenses
between or among roommates.
(2019) "Complaint" means an allegation of abuse, a violation of these rules,
or an expression of dissatisfaction relating to a resident or the condition of
an adult foster home.
Page 3
(210) "Condition" means a provision attached to a new or existing license
that limits or restricts the scope of the license or imposes additional
requirements on the licensee.
(221) "Consumer" means an individual eligible for Medicaid services for
whom case management services are provided by the Department.
(232) "Criminal Records and Abuse Check Rules" refers to OAR 407-0070200 to 407-007-0370.
(243) "Day Care" means care, assistance, and supervision of an individual
who is older, as defined in these rules, who does not stay overnight.
(254) "Delegation" means the process whereby which a registered nurse
teaches and supervises a skilled nursing task.
(265) "Department" means the Department of Human Services.
(27) "Designated Representative" means:
(a) Any adult, such as a parent, family member, guardian, advocate,
or other person who is:
(A) Chosen by the individual, or as applicable the legal
representative;
(B) Not a paid provider for the individual; and
(C) Authorized by the individual, or as applicable the legal
representative, to serve as the representative of the individual,
or as applicable the legal representative, in connection with the
provision of funded supports.
(b) The power to act as a designated representative is valid until the
individual modifies the authorization or notifies the agency that the
designated representative is no longer authorized to act on his or her
behalf.
(c) An individual, or as applicable the legal representative, is not
required to appoint a designated representative.
Page 4
(268) "Director" means the Director of the Department of Human Services
or that person's designee.
(279) "Disability" means a physical, cognitive, or emotional impairment,
which for an individual, constitutes or results in a functional limitation in one
or more activities of daily living.
(3028) "Disaster" means a sudden emergency occurrence beyond the
control of the licensee, whether natural, technological, or man-made that
renders the licensee unable to operate the facility or renders the facility
uninhabitable on a temporary, extended, or permanent basis.
(3129) "Emergency Preparedness Plan" means a written procedure that
identifies a facility’s response to an emergency or disaster for the purpose
of minimizing loss of life, mitigating trauma, and to the extent possible,
maintaining services for residents, and preventing or reducing property
loss.
(320) "Entity" means an individual, a trust or estate, a partnership, a
corporation (including associations, joint stock companies, and insurance
companies), a state, or a political subdivision or instrumentality, including a
municipal corporation.
(313) "Exclusion Lists" mean the following federal lists that exclude listed
individuals from receiving federal awards, not limited to Medicaid and
Medicare programs:
(a) The U.S. Office of Inspector General’s Exclusion List at
www.exclusions.oig.hhs.gov/; and
(b) The U.S. General Services Administration’s System for Award
Management Exclusion List at www.sam.gov.
(324) "Exempt Area" means a county where there is a county agency that
provides similar programs for licensing and inspection of adult foster homes
that the Director finds are equal or superior to the requirements of ORS
443.705 to 443.825 and that the Director has exempted from the license,
inspection, and fee provisions of ORS 443.705 to 443.825. "Exempt area"
Page 5
county licensing rules require review and approval by the Director prior
tobefore implementation.
(335) "Facility" is synonymous with "Adult Foster Home" as defined in this
rule.
(346) "Family Member" means spouses in a legally recognized marriage or
domestic partnership, natural parent, child, sibling, adopted child, adoptive
parent, adoptive sibling, stepparent, stepchild, stepbrother, stepsister,
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,
sister-in-law, grandparent, grandchild, aunt, uncle, niece, nephew, or first
cousin.
(357) "Final Point of Safety" means a designated assembly area located on
a public sidewalk or street not less than 50 feet away from an adult foster
home where occupants of the home evacuate to in the event of an
emergency.
(368) "Floating Resident Manager" means an employee of the licensee,
approved by the local licensing authority, who under the direction of the
licensee, is directly responsible for the care of residents in one or more
adult foster homes owned by that licensee. A "floating resident manager" is
not required to live in any one adult foster home owned by his or her
employer, except on a temporary basis, as directed by the licensee, when
the regularly scheduled caregiver is unavailable.
(379) "Home" means the physical structure in whichwhere residents live.
"Home" is synonymous with "Adult Foster Home" as defined in this rule.
(40) "Home and Community-Based Services" or "HCBS" means Home and
Community-Based Services as defined in OAR chapter 411, division 4.
(41) "Home and Community-Based Settings" or "HCB Settings" means a
physical location meeting the qualities of OAR 411-004-0020 where an
individual receives Home and Community-Based Services. Adult Foster
Homes are HCB Settings, and must comply with Federal regulations
governing those settings.
(3842) "Home-like" means an environment that promotes the dignity,
security, and comfort of residents through the provision of personalized
Page 6
care and services, and encourages independence, choice, and decisionmaking by the residents.
(439) "House Policies" means the written and posted statements
addressing house activities in an adult foster home identified in the
Residency Agreement.
(440) "Indirect Ownership Interest" means an ownership interest in an
entity that has an ownership interest in the disclosing entity. "Indirect
ownership interest" includes an ownership interest in any entity that has an
"indirect ownership interest" in the disclosing entity.
(45) "Individual" means an adult who is at least 65 years of age, or is an
adult with physical disabilities who is receiving Home and CommunityBased Services. For Home and Community-Based Settings, "Resident"
includes individuals receiving day care services.
(46) "Individually-Based Limitation" or "Limitation"
(a) Any limitation to the following areas, as described in OAR 411004-0020(2)(c) to (2)(j), which includes the right to:
(A) Live under a legally enforceable Residency Agreement with
protections substantially equivalent to landlord tenant laws;
(B) The freedom and support to access food at any time;
(C) Have visitors of the resident’s choosing at any time;
(D) Have a lockable door in the resident’s bedroom, which may
be locked by the individual;
(E) Choose a roommate when sharing a bedroom;
(F) Furnish and decorate the resident’s bedroom according to
the Residency Agreement;
(G) The freedom and support to control the resident’s schedule
and activities;
Page 7
(H) Privacy in the resident’s bedroom;
(b) A limitation must be based on a specific assessed need, and may
only be implemented with the informed consent of the resident or the
resident’s legal representative.
(47) "Informed Consent" means:
(a) Options, risks, and benefits have been explained to the individual
and, as applicable the legal representative of the individual, in a
manner that the individual, and as applicable, the representative,
comprehends; and
(b) The individual and, as applicable, the legal representative of the
individual, consents to a person-centered service plan of action,
including any individually-based limitations to the rules, before
implementation of the initial or updated person-centered service plan
or any individually-based limitation.
(418) "Initial Point of Safety" means a designated area that has
unobstructed direct access to a public sidewalk or street located not less
than 25 feet away from an adult foster home where occupants of the home
evacuate to in the event of an emergency and for the purpose of
conducting evacuation drills.
(429) "Investigative Authority" means the Office of Adult Abuse Prevention
and Investigation, local Department offices, and Area Agencies on Aging
that contract with the Department to provide adult protective services to
adults who are older or adults with physical, mental, or developmental
disabilities.
(5043) "Legal Representative" means a person who has the legal authority
to act for an individual. The legal representative only has authority to act
within the scope and limits of his or her authority as designated by the court
or other agreement.
(a) Legal representatives acting outside of his or her authority or
scope must meet the definition of designated representative. For
health care decisions, the "legal representative" is a court-appointed
Page 8
guardian, a health care representative under an Advance Directive for
Health Care, or a power of attorney for health care.
(b) For an individual 18 years of age or older, a guardian appointed
by a court order or an agent legally designated as the health care
representative, where the court order or the written designation
provide authority for the appointed or designated person to make the
decisions indicated where the term "legal representative" is used in
this rule.For financial decisions, the "legal representative" is a legal
conservator, an agent under a power of attorney, or a representative
payee.
(5144) "Level" means the designation of ventilator-assisted care assigned
to an adult foster home license based on the qualifications of the licensee,
resident manager, floating resident manager, and shift caregivers, as
applicable.
(5245) "Licensed Health Care Professional" means a person who
possesses a professional medical license that is valid in Oregon. Examples
include, but are not limited to, a registered nurse (RN), nurse practitioner
(NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic
physician (DO), respiratory therapist (RT), physical therapist (PT),
physician assistant (PA), or occupational therapist (OT).
(5346) "Licensee" means the person who was issued a license, whose
name is on the license, and who is responsible for the operation of an adult
foster home. The "licensee" of the adult foster home does not include the
owner or lessor of the building in whichwhere the adult foster home is
situated unless the owner or lessor of the building is also the operator.
(5447) "Limited Adult Foster Home" means a home that provides care and
services for compensation to a specific individual who is unrelated to the
licensee but with whom the licensee has an established relationship of no
less than one year.
(5548) "Liquid Resource" means cash or those assets that may readily be
converted to cash, such as a life insurance policy that has a cash value,
stock certificates, or a guaranteed line of credit from a financial institution.
Page 9
(5649) "Local Licensing Authority" means the local Department offices and
Area Agencies on Aging that contract with the Department to perform
specific functions of the adult foster home licensing process.
(507) "Nursing Care" means the practice of nursing by a licensed nurse,
including tasks and functions relating to the provision of "nursing care" that
are taught or delegated under specified conditions by a registered nurse to
a person other than licensed nursing personnel, as governed by ORS
chapter 678 and rules adopted by the Oregon State Board of Nursing in
OAR chapter 851.
(518) "Occupant" means any person residing in or using the facilities of an
adult foster home, including residents, licensees, resident manager, friends
or family members, day care individuals, and room and board tenants. A
floating resident manager who resides in an adult foster home on a
temporary basis is considered an "occupant".
(529) "Older" means any person at least 65 years of age.
(6053) "Ombudsman" means the Oregon Long-Term Care Ombudsman or
a designee appointed by the Long-Term Care Ombudsman to serve as a
representative of the Ombudsman Program in order to investigate and
resolve complaints on behalf of adult foster home residents.
(6154) "Operator" is synonymous with "Licensee" as defined in this rule.
(6255) "Ownership Interest" means the possession of equity in the capital,
stock, or profits of an adult foster home. Persons with an ownership or
control interest mean a person or corporation that:
(a) Has an "ownership interest" totaling five percent or more in a
disclosing entity;
(b) Has an indirect ownership interest equal to five percent or more in
a disclosing entity;
(c) Has a combination of direct and indirect ownership interests equal
to five percent or more in a disclosing entity;
Page 10
(d) Owns an interest of five percent or more in any mortgage, deed of
trust, note, or other obligation secured by the disclosing entity if that
interest equals at least five percent of the value of the property or
assets of the disclosing entity;
(e) Is an officer or director of a disclosing entity that is organized as a
corporation; or
(f) Is a partner in a disclosing entity that is organized as a partnership.
(63) "Person-Centered Service Plan" as defined in OAR chapter 411,
division 4.
(a) FOR INDIVIDUALS RECEIVING MEDICAID. The personcentered service plan coordinator completes the person-centered
Sservice plan.
(b) FOR NON-MEDICAID INDIVIDUALS. The person-centered
services plan may be completed by the resident, and as applicable,
the representative of the individual, and others as chosen by the
individual. The licensee may assist non-Medicaid individuals in
developing person-centered service plans when no alternative
resources are available. The elements of the individual’s personcentered service plan may be incorporated into the resident’s care
plan.
(64) "Person-Centered Service Plan Coordinator" means case managers,
services coordinators, personal agents, and other people designated by
DHS or OHA to provide case management services or person-centered
service planning for and with individuals.
(656) "Physical Restraint" means any manual method or physical or
mechanical device, material, or equipment attached to, or adjacent to, a
resident's body that the resident may not easily remove and that restricts
freedom of movement or normal access to his or her body. Physical
restraints include, but are not limited to, wrist or leg restraints, soft ties or
vests, hand mitts, wheelchair safety bars, lap trays, and any chair that
prevents rising (such as a Geri-chair). Side rails (bed rails) are considered
restraints when they are used to prevent a resident from getting out of a
Page 11
bed. The side rail is not considered a restraint when a resident requests a
side rail for the purpose of assistance with turning.
(6657) "Prescribing Practitioner" means a physician, nurse practitioner,
physician assistant, chiropractor, dentist, ophthalmologist, or other
healthcare practitioner with prescribing authority.
(6758) "Primary Caregiver" means a qualified licensee or resident
manager, who lives in the home, personally provides care and services,
and ensures the health and safety of residents a minimum of five
consecutive days per week. More than one person who meets this criterion
may be considered a "primary caregiver" as specified below:
(a) Co-licensees working three and four consecutive days and nights
per week;
(b) Two approved resident managers working three and four
consecutive days and nights per week; or
(c) A licensee and an approved resident manager working three and
four consecutive days and nights per week.
(6859) "P.R.N. (pro re nata)" means those medications and treatments that
have been ordered by a qualified practitioner to be administered as
needed.
(690) "Provider" means any person operating an adult foster home (i.e.,
licensee, resident manager, floating resident manager, or shift caregiver).
"Provider" does not include substitute caregivers or the owner or lessor of
the building in whichwhere the adult foster home is situated unless the
owner or lessor is also the operator of the adult foster home.
(7061) "Provisional License" means a 60-day license issued in an
emergency situation when a licensed provider is no longer overseeing the
operation of an adult foster home. A provisional license is issued to a
qualified person who meets the standards of OAR 411-050-0625 and OAR
411-050-0630, except for completing the training and testing requirements.
(See OAR 411-050-0635).
Page 12
(7162) "Psychoactive Medications" mean various medications used to alter
mood, anxiety, behavior, or cognitive processes. For the purpose of these
rules, "psychoactive medications" include, but are not limited to,
antipsychotics, sedatives, hypnotics, and antianxiety medications.
(7263) "Qualified Entity Initiator (QEI)" has the meaning set forth in OAR
407-007-0210 (Criminal Records and Abuse Checks for Providers).
(7364) "Relative" means those persons identified as family members as
defined in this rule.
(74) "Representative" means "Designated Representative" and "Legal
Representative" as defined in these rules, unless otherwise stated.
(675) "Reside" means for a person to live in an adult foster home for a
permanent or extended period of time. For the purpose of a background
check, a person is considered to "reside" in a home if the person's visit is
four weeks or greater.
(76) "Residency Agreement" or "Agreement" means the written and legally
enforceable agreement between an adult foster home licensee and an
individual receiving Home and Community Based Services (HCBS) in a
provider owned, controlled, or operated setting. The Residency Agreement
identifies the policies of the home, services to be provided, and the rights
and responsibilities of the individual, and the licensee.
(7766) "Resident" means an adult who is olderat least 65 years of age, or
an adult with a physical disability who is receiving room and board and care
and services for compensation in an adult foster home on a 24-hour day
basis in exchange for compensation. For the purposes of this definition,
Resident includes individuals receiving day care services. (See OAR 411050-0615).
(678) "Resident Manager" means an employee of the licensee, approved
by the local licensing authority, who lives in the adult foster home, and is
directly responsible for the care of the residents.
(7968) "Resident Rights" or "Rights" means civil, legal, or human rights,
including, but not limited to, those rights listed in the Adult Foster Home
Residents' Bill of Rights. (See ORS 443.739 and OAR 411-050-0655).
Page 13
(8069) "Residential Care" means the provision of care on a 24-hour day
basis.
(8170) "Room and Board" means receiving compensation for the provision
of meals, a place to sleep, laundry, and housekeeping to adults who are
older or adults with physical disabilities and who do not need assistance
with activities of daily living. Room and board facilities for two or more
persons are required to register with the Department under the rules in
OAR chapter 411, division 068, unless registered with the local authority
having jurisdiction. Adult foster homes with room and board tenants are not
subject to OAR chapter 411, division 068.
(8271) "Screening" means the evaluation process used to identify an
individual’s ability to perform activities of daily living and address health and
safety concerns.
(8372) "Self-Administration of Medication" means the act of a resident
placing a medication in or on his or her own body. The resident identifies
the medication, the time and manner of administration, and places the
medication internally or externally on his or her own body without
assistance.
(8473) "Self-Preservation" in relation to fire and life safety means the ability
of a resident to respond to an alarm without additional cues and reach a
point of safety without assistance.
(8574) "Services" mean activities that help the residents develop skills to
increase or maintain their the resident's level of functioning or assist the
residents to perform personal care, activities of daily living, or individual
social activities.
(8675) "Shift Caregivers" mean caregivers who, by written variance of the
local licensing authority, are responsible for providing care for regularly
scheduled periods of time, such as 8 or 12 hours per day, in homes where
there is no licensee or resident manager living in the home.
(8776) "Subject Individual" means "subject individual" as defined in OAR
407-007-0210, including: and means (a) Aany person 16 years of age or
older, andincluding:
Page 14
(aA) All licensed adult foster home providers and provider applicants;
(bB) All persons intending to work in, or currently working in an adult
foster home, including, but not limited to, caregivers and individuals in
training;
(cC) Volunteers on the home’s premises who provide services for, or
who have unsupervised access to any resident, or any resident’s
funds, belongings, or confidential information; and
(dD) Occupants, excluding residents, residing in or on the premises
of a proposed or currently licensed adult foster home, including:
(Ai) Household members;
(Bii) Room and board tenants; and
(Ciii) Persons staying in the home for a period of four weeks or
more.
(eb) "Subject Individual" does not apply to:
(A) Persons under 16 years of age;
(B) Residents of the adult foster home or their the resident's
visitors;
(C) Persons who live or work in or on the adult foster home
premises who do not:
(i) Have regular access to the home for meals; or
(ii) Have regular use of the adult foster home’s appliances
or facilities; or
(iii) Have unsupervised access to the residents or the
residents' personal property.
Page 15
(D) A person providing services to the residents who is
employed by a private business not regulated by the
Department.
(8877) "Substantial Compliance" means a level of compliance with these
rules where any deficiencies pose no greater risk to resident health or
safety than the potential for causing minor harm.
(8978) "Substitute Caregiver" means any person other than the licensee,
resident manager, floating resident manager, or shift caregiver who
provides care and services in an adult foster home under the jurisdiction of
the Department.
(9079) "Tenant" means any individual who is residing in an adult foster
home who receives services, such as meal preparation, laundry, and
housekeeping.
(9180) "These Rules" mean the rules in OAR chapter 411, division 050.
(9281) "Variance" means an exception from a regulation or provision of
these rules in accordance with OAR 411-050-0642.
(9382) "Ventilator-Assisted Care" means the provision of mechanical
assistance to replace spontaneous breathing. Devices used include, but
are not limited to, mechanical ventilators, manual ventilators, and positive
airway pressure ventilators.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 106.010, 443.001-004, 443.705-825, 443.875,
443.991
411-050-0615 Provider Enrollment Agreements, Residency
AgreementsContracts, and Refunds
(1) MEDICAID PROVIDER ENROLLMENT AGREEMENT.
(a) An applicant or licensee who intends to care for residents who are
or become eligible for Medicaid services must enter into a Medicaid
Provider Enrollment Agreement with the Department, follow
Page 16
Department rules, and abide by the terms of the Medicaid Provider
Enrollment Agreement. The local licensing authority shall determine
that the applicant, licensee, and any owner or officer of the
corporation, as applicable, is not listed on either of the Exclusion Lists
prior tobefore approval of a Medicaid Provider Enrollment Agreement.
(b) An approved Medicaid Provider Enrollment Agreement does not
guarantee the placement of individuals eligible for Medicaid services
in the adult foster home.
(c) An approved Medicaid Provider Enrollment Agreement is valid for
the length of the license unless earlier terminated by the licensee or
the Department. A Medicaid Provider Enrollment Agreement must be
completed, submitted, approved, and renewed with each licensing
cycle.
(d) The rate of compensation established by the Department is
considered payment in full. The licensee may not request or accept
additional funds or in-kind payment from any source.
(e) An individual eligible for Medicaid services may not be admitted
into an adult foster home unless and until:
(A) The Department has approved a Medicaid Provider
Enrollment Agreement. The Department shall not issue a
Medicaid payment to a licensee without a current license and
an approved Medicaid Provider Enrollment Agreement in place;
(B) The individual eligible for Medicaid services has been
screened according to OAR 411-050-0655; and
(C) The Department has authorized the placement. The
authorization must be clearly documented in the resident’s
record with other required admission materials. (See OAR 411050-0655).
(f) The Department shall not make payment for the date a resident
moves from the home, or for any time period thereafter.
Page 17
(g) The licensee must enter into a written agreement with a resident
who receives Medicaid services if the licensee charges for storage of
belongings that remain in the adult foster home for more than 15
calendar days after the resident has left the home.
(A) The written agreement must be consistent with the
licensee's policy with private-pay residents and entered into at
the time of the resident's admission or at the time the resident
becomes eligible for Medicaid services.
(B) The licensee must give written notice to the resident and the
resident's family or other representatives 30 calendar days prior
tobefore any increases, additions, or other modifications to the
charges for storage.
(h) A licensee who elects to provide care for individuals eligible for
Medicaid services is not required to admit more than one resident
eligible for Medicaid services. However, if the licensee has an
approved Medicaid Provider Enrollment Agreement, private-pay
residents who become eligible for Medicaid services may not be
asked to leave solely on the basis of Medicaid eligibility.
(i) The licensee or the Department may terminate a Medicaid
Provider Enrollment Agreement according to the terms of the
Medicaid Provider Enrollment Agreement.
(j) The Department may terminate a Medicaid Provider Enrollment
Agreement under the following circumstances:
(A) The licensee fails to maintain substantial compliance with all
related federal, state, and local laws, ordinances, and
regulations; or
(B) The license to operate the adult foster home has been
voluntarily surrendered, revoked, or non-renewed.
(k) The Department must terminate a Medicaid Provider Enrollment
Agreement under the following circumstances:
Page 18
(A) The licensee fails to permit access by the Department, the
local licensing authority, or the Centers for Medicare and
Medicaid Services to any adult foster home licensed to and
operated by the licensee;
(B) The licensee submits false or inaccurate information;
(C) Any person with five percent or greater direct or indirect
ownership interest in the adult foster home did not submit timely
and accurate information on the Medicaid Provider Enrollment
Agreement form or fails to submit fingerprints if required under
the criminal records and abuse check rules in OAR 407-0070200 to 407-007-0370;
(D) Any person with five percent or greater direct or indirect
ownership interest in the adult foster home has been convicted
of a criminal offense related to the person’s involvement with
Medicare, Medicaid, or Title XXI programs in the last 10 years;
or
(E) Any person with an ownership or control interest, or who is
an agent or managing employee of the adult foster home, fails
to submit timely and accurate information on the Medicaid
Provider Enrollment Agreement form.
(l) If the licensee submits notice of termination of the Medicaid
Provider Enrollment Agreement, the licensee must comply with the
following requirements:
(A) Simultaneously issue the Department’s Notice of
Involuntary Move or Transfer of Resident form (SDS 901) to
each resident eligible for Medicaid services in the licensee’s
adult foster home; (See OAR 411-050-0645).
(B) Update Residency Agreement and submit to the local
licensing authority for review.Simultaneously issue written
notification to all residents who pay with private funds; and
(C) Obtain signatures of all current residents, or the resident's
representative on the updated Agreement following the local
Page 19
licensing authority’s review.Immediately update the house
policies.
(m) If either the licensee or the Department terminates a Medicaid
Provider Enrollment Agreement, a new Medicaid Provider Enrollment
Agreement shall not be approved by the local licensing authority for a
period of not less than 180 days from the date the licensee or the
Department terminated the Medicaid Provider Enrollment Agreement.
(n) DEATH OF RESIDENT ELIGIBLE FOR MEDICAID SERVICES
WITH NO SURVIVING SPOUSE. The licensee must forward all
personal incidental funds (PIF) to the Estate Administration Unit, P.
O. Box 14021, Salem, Oregon 97309-5024, within 10 business days
of the death of a resident eligible for Medicaid services with no
surviving spouse. (See Limits on Estate Claims, OAR 461-135-0835)
(2) PRIVATE CONTRACTRESIDENCY AGREEMENT. A licensee who
cares for residents who pay with private funds or individuals receiving only
day care services must enter into a written Agreementcontract with allthe
residents or the residents’ representatives, which details the care and
services to be provided, and the rate to be charged. person paying for the
resident's care. The written contract is the admission agreement. The
written Agreementcontract must be signed by all parties prior tobefore the
admission of the resident. A copy of the Agreementcontract is subject to
review by the local licensing authority prior tobefore licensure and prior
tobefore the implementation of any changes to the Agreementcontract.
(a) The Agreementcontract must include, but not be limited to:
(A) Services to be provided and the rate to be charged. For
individuals receiving Medicaid, the Residency Agreement may
state the rate will be "as authorized by the Department". A
payment range may not be used unless the Agreementcontract
plainly states when an increase in rate may be expected based
on a resident's increased care or service needs.;
(B) Conditions under which the rates may be changed.;
(C) The home's refund policy in instances of a resident's
hospitalization, death, transfer to a nursing facility or other care
Page 20
facility, and voluntary or involuntary move. The refund policy
must be in compliance with section (3) of this rule.; and
(D) A statement indicating that the resident is not liable for
damages considered normal wear and tear on the adult foster
home and the adult foster home's contents.;
(b) The Agreement must disclose:
(AE) The home’s policies on voluntary moves and whether or
not the licensee requires written notification of a non-Medicaid
resident’s intent to not return.; and
(BF) Any charges for storage of belongings that remain in the
adult foster home for more than 15 calendar days after the
resident has left the home.
(C) Any policies the adult foster home may have on the use of
alcohol, tobacco, intercoms, and monitors.
(D) The home’s smoking policies in compliance with OAR 411050-0650.
(E) The home’s policy regarding animals. Restrictions may not
apply to animals that provide assistance or perform tasks for
the benefit of a person with a disability. Such animals are often
referred to as services animals, assistance animals, support
animals, therapy animals, companion animals, or emotional
support animals.
(F) The home’s policy regarding the presence and use of legal
medical and recreational marijuana on the premises.
(G) The home’s schedule of meal times with no more than a 14hour span between the evening meal and the following
morning’s meal (See OAR 411-050-0645).
(H) Whether the home serves individuals eligible for Medicaid
services.
Page 21
(I) The home’s policy regarding refunds for residents eligible for
Medicaid services, including pro-rating partial months and if the
room and board is refundable.
(J) A clear and precise statement of any limitation to the
implementation of Advance Directives on the basis of
conscience. This rule does not apply to medical professional or
hospice orders for administration of medications. The statement
must include:
(i) A description of conscientious objections as they apply
to all occupants of the adult foster home;
(ii) The legal authority permitting such objections under
ORS 127.505 to 127.660; and
(iii) Description of the range of medical conditions or
procedures affected by the conscientious objection. (See
OAR 411-050-0655).
(c) The Agreement must:
(A) Not conflict with the Resident’s Rights, the family
atmosphere of the home, or any of these rules; and
(B) Be reviewed and approved by the local licensing authority
before the issuance of a license, and before implementing any
changes.
(d) Effective January 1, 2016 for providers initially licensed after
January 1, 2016, and effective no later than September 1, 2018 for
providers initially licensed before January 1, 2016 the Agreement
must include the freedoms authorized by 42 CFR 441.301(c)(2)(xiii) &
42 CFR 441.530(a)(1)(vi)(F), which must not be limited without the
informed, written consent of the resident or the resident's
representative, and approved by the person-centered service plan
coordinator, which includes the right to:
(A) Live under a legally enforceable agreement with protections
substantially equivalent to landlord tenant laws;
Page 22
(B) The freedom and support to access food at any time;
(C) To have visitors of the resident’s choosing at any time;
(D) Have a lockable door in the resident’s bedroom, which may
be locked by the resident;
(E) Choose a roommate when sharing a bedroom;
(F) Furnish and decorate the resident’s bedroom according to
the Residency Agreement;
(G) The freedom and support to control the resident’s schedule
and activities;
(H) Privacy in the resident’s bedroom.
(eb) The licensee may not charge or ask for application fees or nonrefundable deposits. Fees to hold a bed are permissible.
(fc) The licensee must give a copy of the signed Agreementcontract
to the resident or the resident's representative and must retain the
original signed Agreementcontract and any amendments on the
premises available for review.
(gd) The licensee may not include any illegal or unenforceable
provision in an Agreementcontract with a resident and may not ask or
require a resident to waive any of the resident's rights or licensee’s
liability for negligence.
(he) The licensee must give written notice to a non-Medicaidprivatepay resident and the resident's family or other representatives 30
calendar days prior tobefore any general rate increases, additions, or
other modifications of the rates. The licensee is not required to give
30 day written notice if the rate change is due to the resident's
increased care or service needs and the agreed upon rate schedule
in the resident's Agreementcontract has specified charges for those
changes.
Page 23
(3) REFUNDS FOR NON-MEDICAID RESIDENTS.
(a) If a resident dies, the licensee may not retain or require payment
for more than 15 calendar days after the date of the resident’s death,
or the time specified in the licensee’s Agreementcontract, whichever
is less.
(b) If a resident leaves an adult foster home for medical reasons and
the resident or the resident’s representative indicates the resident's
intent to not return, the licensee may not retain or require payment for
more than 15 calendar days after the date the licensee receives
notification from the resident, or the resident’s representative, or the
time specified in the licensee’s Agreementcontract, whichever is less.
(c) If a resident who has paid with private funds becomes eligible for
Medicaid services, the licensee must accept payment from the
Department from the date of eligibility forward as payment in full. The
licensee must reimburse the resident or the resident’s representative
within 30 calendar days after the licensee receives payment from the
Department for any private payment received after the resident
became eligible for Medicaid services.
(d) The licensee must act in good faith to reduce the charge to a
resident who has left the home, by seeking a new resident to fill the
vacancy.
(e) The licensee must refund any unused advance payment to the
resident, or the resident’s representative as appropriate, within 30
calendar days after the resident dies or leaves the home.
(f) If the adult foster home closes or the licensee gives written notice
for the resident to leave, the licensee waives the right to collect any
fees beyond the date of closure or the resident's departure,
whichever is sooner.
(g) If a resident dies or leaves an adult foster home due to neglect or
abuse at the adult foster home that is substantiated by a Department
investigator, or due to conditions of imminent danger of life, health, or
safety, the licensee may not charge the resident beyond the
resident's last day in the home.
Page 24
(h) The refund policies in these rules also apply to refunds for
resident moves and transfers as described in OAR 411-050-0645.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.880, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
411-050-0630 Classification of Adult Foster Homes
(1) The local licensing authority shall issue a Class 1, Class 2, or Class 3
adult foster home license only if the qualifications of the applicant, resident
manager, floating resident manager, and shift caregivers, as applicable,
fulfill the classification requirements of these rules.
(a) After receipt of the completed application materials, including the
non-refundable fee, the local licensing authority must investigate the
information submitted, including any pertinent information received
from outside sources.
(b) The local licensing authority shall not issue a license if
unsatisfactory references or a history of substantial non-compliance
of the applicant within the last 24 months is verified.
(c) The local licensing authority may issue a Class 1 license if the
applicant and resident manager, as applicable, complete the training
requirements outlined in OAR 411-050-0625;
(d) The local licensing authority may issue a Class 2 license if the
applicant, resident manager, and floating resident manager, as
applicable, complete the requirements outlined in OAR 411-0500625. In addition, these caregivers must each have the equivalent of
two years of full time experience providing direct care to adults who
are older or adults with physical disabilities;
(e) The local licensing authority may issue a Class 3 license if the
applicant, resident manager, floating resident manager, and shift
caregivers, as applicable, complete the training requirements outlined
in OAR 411-050-0625 and have a current license as a health care
professional in Oregon or possess the following qualifications:
Page 25
(A) Have the equivalent of three years of full time experience
providing direct care to adults who are older or adults with
physical disabilities and who require full assistance in four or
more activities of daily living; and
(B) Have references satisfactory to the Department. The
applicant must submit current contact information from at least
two licensed health care professionals who have direct
knowledge of the applicant's ability and past experience as a
caregiver.
(2) The Department may approve a licensee to care for residents requiring
ventilator-assisted care. The licensee, resident manager, floating resident
manager, or shift caregivers, as applicable, must meet the criteria for a
Class 3 home according to section (1)(e) of this rule and comply with the
additional requirements for adult foster homes serving residents requiring
ventilator assisted care outlined in OAR 411-050-0660.
(3) To request a change in the classification of a licensed home, at any
time other than the license renewal period, the licensee shall submit a
written request to the local licensing authority, using the Department’s form
SDS 0748, to amend the licensee’s previous application for a license.To
change the classification of a licensed home, the licensee must complete a
new initial application and submit the application form to the local licensing
authority as outlined in OAR 411-050-0610.
(a) The complete request will include all the required information and
documentation, as applicable, to demonstrate the applicant meets the
standards for the requested classification according to these rules.
(b) Within 60 calendar days’ receipt of the complete written request,
the local licensing authority will investigate the information provided
and shall:
(A) Approve the applicant’s request and issue an amended
license with the requested classification; or
Page 26
(B) Deny the applicant’s request, unless the applicant submits
written notification to withdraw the requested change in
classification. If the request is denied, the Department shall
provide the applicant with Notice and an opportunity for a
contested case hearing pursuant to ORS 183. The Notice shall
state the reasons for the denial and shall be served personally
upon the applicant or by certified or registered mail. Any
request for a contested case hearing must be submitted to the
Department, in writing, by the applicant within 10 days of
service.
(4) A licensee may only admit or continue to care for residents whose
impairment levels are within the classification of the licensed home.
(a) A licensee with a Class 1 license may only admit residents who
require assistance in no more than four activities of daily living.
(b) A licensee with a Class 2 license may provide care for residents
who require assistance in all activities of daily living, but require full
assistance in no more than three activities of daily living.
(c) A licensee with a Class 3 license may provide care for residents
who require full assistance in four or more activities of daily living, but
only one resident who requires bed-care or full assistance with all
activities of daily living, not including cognition or behavior.
(5) A licensee must request, in writing, a variance from the local licensing
authority if:
(a) A new resident wishes to be admitted whose impairment level
exceeds the license classification;
(b) A current resident becomes more impaired, exceeding the license
classification; or
(c) There is more than one resident in the home who requires full bedcare or full assistance with all activities of daily living, not including
cognition or behavior.
Page 27
(6) The local licensing authority may grant a variance that allows the
resident to be admitted or remain in the adult foster home. The local
licensing authority must respond in writing within 30 calendar days after
receipt of the licensee's written variance request. The licensee must prove
the following criteria are met by clear and convincing evidence that:
(a) It is the choice of the resident to reside in the home;
(b) The licensee is able to provide appropriate care and service to the
resident in addition to meeting the care and service needs of the
other residents;
(c) Additional staff is hired to meet the additional care requirements of
all residents in the home as necessary;
(d) Outside resources are available and obtained to meet the
resident's care needs;
(e) The variance shall not jeopardize the care, health, safety, or
welfare of the residents; and
(f) The licensee is able to demonstrate how all occupants shall be
safely evacuated in three minutes or less.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001- to 443.004, 443.705-443.825, 443.875,
443.991
411-050-0632 Capacity
(1) Residents must be limited to five adults who require care and are
unrelated to the licensee and resident manager by blood, marriage, or
adoption.
(2) The number of residents permitted to reside in an adult foster home is
determined by the ability of the staff to meet the care needs of the
residents, the fire and life safety standards for evacuation, and compliance
with the facility standards of these rules.
Page 28
(3) The licensee must demonstrate, to the local licensing authority’s
satisfaction, the ability to meet the needs of the residents, in addition to,
caring for any children or relatives beyond the license capacity of the adult
foster home.
(4) The local licensing authority's determination of maximum capacity must
ensure:
(a) The ratio of at least one caregiver per five residents, including any
day care individuals and others requiring care or supervision except
as allowed under section (5) of this rule.;
(b) Children over the age of five have a bedroom available that is
separate from their child's parents.;
(c) The well-being of the household, including any children or other
family members, shall not be jeopardized.; and
(d) The care needs of day care individuals shall be met.
(5) When a family member requires care in a home in whichwhere the
licensee is the primary, live-in caregiver, a maximum capacity of five
unrelated residents are allowed if the following criteria are met:
(a) The licensee must be able to demonstrate the ability to evacuate
all occupants from the adult foster home within three minutes or less
(See OAR 411-050-0650).;
(b) The licensee must have sufficient, qualified staff and demonstrate
the ability to provide appropriate care for all residents (See OAR 411050-0645).;
(c) There must be an additional 40 square feet of common living
space for each person above the five residents (See OAR 411-0500650).;
(d) Bathrooms and bedrooms must meet the requirements of OAR
411-050-0650.;
Page 29
(e) The care needs of day care individuals must be within the
classification of the license and any conditions imposed on the
license; and.
(f) The well-being of the household, including any children or other
family members, shall not be jeopardized.
(6) If day care individuals are in the home, the licensee must have
arrangements for the day care individuals to sleep in areas other than a
resident's bed, a resident's private room, or space designated as common
use, in accordance with OAR 411-050-0650.
(7) If room and board tenants are in the home, each tenant must have:
(a) An approved background check in accordance with OAR 40700770-0200 to 407-007-0370 (Criminal Records and Abuse Check
Rules).;
(b) A tenancy agreement as defined in OAR 411-068-0040 (Room
and Board Facilities); and.
(c) A copy of the current tenancy agreementhouse policies signed
and dated by the tenant.
(8) To request a change to the maximum capacity of a licensed home at
any time other than the license renewal period, the licensee shall submit to
the local licensing authority a written request using the Department’s form,
SDS 0749, to amend the licensee’s previous application for a license.To
change the capacity of a licensed home, the licensee must complete a new
initial application and submit the application to the local licensing authority
according to OAR 411-050-0610.
(a) The complete request will include:
(A) All the required information and documentation, as
applicable, to demonstrate the applicant meets the standards
for the requested capacity according to these rules; and
(B) A $20 non-refundable fee for each additional resident bed
requested.
Page 30
(b) Within 60 calendar days’ receipt of the complete written request,
the local licensing authority must investigate the information provided
and must:
(A) Approve the request and issue an amended license with the
requested capacity; or
(B) Deny the applicant’s request, unless the applicant submits
written notification to withdraw the requested change in
classification. If the request is denied, the Department shall
provide the applicant with Notice and an opportunity for a
contested case hearing pursuant to ORS 183. The Notice shall
state the reasons for the denial and shall be served personally
upon the applicant or by certified or registered mail. Any
request for a contested case hearing must be submitted to the
Department, in writing, by the applicant within 10 days of
service.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, & 443.991
411-050-0635 Issuance
(1) The local licensing authority must issue a license within 60 calendar
days after the completed application materials have been received if the
home and applicant are in compliance with these rules.
(2) The license specifies the type of license and includes:
(a) The name of the licensee and the name of the resident manager
or shift caregivers as applicable, who have met the requirements to
operate the adult foster home.;
(b) The address of the premises to which the license applies.;
(c) The license classification and level if applicable.;
(d) The maximum number of residents; and.
Page 31
(e) The expiration date.
(3) The licensee must be given a copy of the Department’s inspection
report form as follows:
(a) INITIAL LICENSE. Form SDS 516 identifying any areas of noncompliance and a time frame for correction.
(b) RENEWAL LICENSE. Form SDS 517A and, if applicable, form
SDS 517B citing any violations. The SDS 517B must specify a time
frame for correction of each violation. The time frame for correction
may not exceed 30 calendar days from the date of inspection.
(4) The licensee must post the most recent inspection reports in the entry
of the home or an equally prominent place and must, upon request, provide
a copy of the reports to each resident, person applying for admission to the
home, or the legal representative, guardian, or conservator of a resident.
(5) The Department may attach conditions to the license that limit, restrict,
or specify other criteria for operation of the home. The conditions must be
visibly posted with the license.
(6) The local licensing authority shall not issue an initial license unless:
(a) The applicant and adult foster home are in compliance with ORS
443.705 to 443.825 and these rules;
(b) The applicant currently operates, or has operated, any other
facility licensed by the applicant in substantial compliance with ORS
443.705 to 443.825;
(c) The local licensing authority has completed an inspection of the
adult foster home that demonstrates the home is in compliance with
these rules;
(d) The Department has completed a background check in
accordance with OAR 411-050-0620;
Page 32
(e) The local licensing authority has reviewed the record of sanctions
available from the local licensing authority's files;
(f) The local licensing authority has determined that the nursing
assistant registry maintained under 42 CFR 483.156 contains no
finding that the applicant or any nursing assistant employed by the
applicant has been responsible for abuse;
(g) The local licensing authority has verified the applicant is not listed
on either of the Exclusion Lists; and
(h) The applicant has demonstrated to the local licensing authority the
financial ability and resources necessary to operate an adult foster
home.
(7) A license is valid for one year unless revoked or suspended by the
Department.
(8) When the Department reviews a license and determines that the
convenience of both the licensee and the Department will be served, a
license period may be changed to match the renewal schedule of another
license held by the same licensee. The request for a schedule change may
be made by either the Department or the licensee. No license period may
extend beyond one year.
(98) In seeking an initial license, the burden of proof to establish
compliance with ORS 443.705 to 443.825, and these rules, is upon the
applicant of the adult foster home.
(109) The local licensing authority shall not issue a license to operate an
additional adult foster home to a licensee who has failed to achieve and
maintain substantial compliance with the rules and regulations while
operating his or her existing home or homes.
(110) PROVISIONAL LICENSE. Notwithstanding any other provision of this
rule or ORS 443.725 or 443.738, the local licensing authority may issue a
60-day provisional license to a qualified person.
Page 33
(a) A provisional license may be issued if the local licensing authority
determines it is in the best interests of the residents currently residing
in the home, and any of the following exist:
(A) An emergency situation exists after receiving notification
that a licensed provider is no longer overseeing the operation of
an adult foster home.; or
(B) A new applicant has submitted an application and bed fee
for a license to operate a currently licensed home. and theThe
applicant has demonstrated a good faith effort to submit a
timely and complete application; , but the application process
cannot be completed before the expiration date of the current
license.
(C) The application process cannot be completed prior to the
expiration date of the current license; and.
(D) It is in the best interests of the residents currently residing in
the home.
(b) A person is considered qualified for a provisional license if he or
she:
(A) Is at least 21 years of age.;
(B) Has the necessary experience working with adults who are
older or adults with physical disabilities to potentially qualify for
the license classification of the home.;
(C) Fully understands and has the ability to meet the residents’
care needs; and.
(D) Meets the requirements of a substitute caregiver as
described in OAR 411-050-0625.
(c) A provisional license may be extended one time for a period of 30
calendar days if an applicant has demonstrated a good faith effort to
complete the application process and obtain the required
qualifications and trainings.
Page 34
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
411-050-0642 Variances
(1) An applicant or licensee may request a variance to the provisions of
these rules. The variance request must be in writing and must include clear
and convincing evidence that:
(a) The requested variance does not jeopardize the care, health,
welfare, or safety of the residents;
(b) and aAll of the residents’ needs shall be met; and
(cb) All residents, in addition to other occupants in the home, may be
evacuated in three minutes or less.
(2) VARIANCES NOT ALLOWED. Notwithstanding section (1) of this rule,
no variance shall be granted by the local licensing authority from a
regulation or provision of these rules pertaining to:
(a) Resident capacity as described in OAR 411-050-0632.;
(b) Minimum age of licensee and any caregivers as described in OAR
411-050-0625.;
(c) The training requirements of a licensee and all other caregivers
except as allowed for provisional licenses as described in OAR 411050-0635, or when a substitute caregiver holds an Oregon health
care professional license as described in OAR 411-050-0625.;
(d) Standards and practices for care and services as described in
OAR 411-050-0655).;
(e) Inspections of the facility as described in OAR 411-050-0670; or.
(f) Background checks as described in OAR 411-050-0620.
Page 35
(3) The local licensing authority shall not grant a variance request to any
rule that is inconsistent with Oregon Revised Statutes or 42 CFR
441.301(c)(2)(xiii) and 42 CFR 441.530(a)(1)(vi)(F). (See OAR 411-0500655).
(4) The local licensing authority shall not grant a variance request related to
fire and life safety without prior consultation with the Department.
(5) In making a determination to grant a variance, the local licensing
authority must consider the licensee’s history of compliance with rules
governing adult foster homes or other long-term care facilities for adults
who are older or adults with physical disabilities in Oregon and any other
jurisdiction, if appropriate. The local licensing authority must determine that
the variance is consistent with the intent and purpose of these rules prior
tobefore granting the variance. (See OAR 411-050-0600). The local
licensing authority must respond, in writing, within 30 days of receiving a
request for a variance. The written response must include the frequency of
renewal.
(6) A variance is not effective until granted in writing by the local licensing
authority. Variances are reviewed pursuant to these rules. If applicable, the
licensee must re-apply for a variance at the time of license renewal, or
more often if determined necessary by the local licensing authority.
(7) In seeking a variance, the burden of proof that the requirements of
these rules have been met is upon the applicant or licensee.
(8) If a variance to any provision of these rules is denied, the applicant or
licensee may request a meeting with the local licensing authority.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
411-050-0645 Operational Standards
(1) GENERAL PRACTICES.
(a) A licensee must own, rent, or lease the home to be licensed,
however, the local licensing authority may grant a variance to
Page 36
churches, hospitals, non-profit associations, or similar organizations.
If a licensee rents or leases the premises where the adult foster home
is located, the licensee may not enter into a contract that requires
anything other than a flat rate for the lease or rental. A licensed
provider of a building in whichwhere an adult foster home is located
may not allow the owner, landlord, or lessor to interfere with the
admission, transfer, or voluntary or involuntary move of any resident
in the adult foster home unless the owner, landlord, or lessor is
named on the license.
(b) Each adult foster home must comply withmeet:
(A) All applicable local business license, zoning, building, and
housing codes.;
(B) The Fair Housing Act.; and
(C) State and local fire and safety regulations for a single-family
residence, and Oregon Fire Code, Appendix L.
(D) Effective January 1, 2016 for providers initially licensed
after January 1, 2016, and effective no later than September 1,
2018 for providers initially licensed before January 1, 2016,
Home and Community-Based Services and Settings and
Person-Centered Service Plans. (See OAR chapter 411,
division 4).
(c) ZONING. Adult foster homes are subject to applicable sections of
ORS 197.660 to 197.670.
(d) COOPERATION AND ACCESS. The licensee must cooperate
with the Department, Centers for Medicare and Medicaid Services
(CMS), and local licensing and investigative personnel in inspections,
complaint investigations, planning for resident care, application
procedures, and other necessary activities.
(A) Department, CMS, local licensing, and investigative
personnel must be provided access to all resident and facility
records and may conduct private interviews with residents.
Page 37
(B) The State Long-Term Care Ombudsman must be provided
access to all resident and facility records. Deputy Ombudsman
and Certified Ombudsman Volunteers must be provided access
to facility records, and, with written permission from the resident
or the resident’s legal representative, may have access to
resident records. (See OAR 114-005-0030).
(e) CONFIDENTIALITY. Information related to residents must be kept
confidential, except as may be necessary in the planning or provision
of care or medical treatment, or related to an inspection,
investigation, or sanction action under these rules.
(f) TRANSPORTATION. A licensee must arrange for or provide
appropriate transportation for residents when needed.
(g) STAFFING STANDARDS. The licensee must have qualified
caregivers, including awake caregivers as necessary, sufficient in
number to meet the 24-hour needs of each resident in addition to
caring for any children or relatives beyond the license capacity of the
adult foster home. In addition, the licensee must comply with the
following standards:
(A) A licensee may not employ a resident manager, floating
resident manager, or shift caregiver who does not meet or
exceed the qualifications, training, and classification standards
for the adult foster home as described in OAR 411-050-0625
and 411-050-0630.
(B) A licensee may not employ or allow any caregiver to train or
work in the home who is on either of the Exclusion Lists.
(h) ABSENCE OF A PRIMARY CAREGIVER. If a primary caregiver
or a shift caregiver is absent from the home for 10 days or more, the
licensee must notify the local licensing authority, in writing, at least
seven days prior tobefore the primary caregiver's absence or
immediately upon knowing of the absence. Notification must state the
reason for and anticipated length of the absence. The licensee must
also submit a staffing plan to the local licensing authority, that
demonstrates coverage to meet the needs of the residents during the
primary caregiver's absence and is signed by the back-up provider,
Page 38
demonstrating coverage that meets the needs of the residents during
the primary caregiver's absence.
(i) CHANGE OF PRIMARY CAREGIVER. If a primary caregiver or a
shift caregiver changes during the period the license covers, the
licensee must notify the local licensing authority within 24 hours and
identify who is providing care.
(A) If a licensee assumes the role as the primary caregiver or
shift caregiver when there has been a change in primary
caregiver, the licensee must submit an updated plan of 24-hour
coverage to the local licensing authority within seven days.
(B) If a resident manager, floating resident manager, or shift
caregiver changes, the licensee must submit a request for a
change of resident manager, floating resident manager, or shift
caregiver, as applicable, to the local licensing authority along
with:
(i) The Department’s supplemental application form (SDS
448B) completed by the resident manager applicant,
floating resident manager applicant, or shift caregiver
applicant;
(ii) A completed Health History and Physician or Nurse
Practitioner’s Statement (form SDS 903) for the new
applicant;
(iii) Documentation of the initiation of or a copy of an
approved background check; and
(iv) A $10 non-refundable fee.
(C) When there is a change in primary caregiver, an approved
floating resident manager may assume the responsibilities of
the live-in, primary caregiver until a new primary caregiver is
employed. If a new primary caregiver is not employed within 60
calendar days, the floating resident manager must be
designated as the home’s resident manager and the licensee
must notify the local licensing authority of the change in status.
Page 39
(D) The local licensing authority shall issue a revised license
when there is a change in a primary caregiver who is identified
on the license.
(j) UNEXPECTED AND URGENT STAFFING NEED. If the local
licensing authority determines an unexpected and urgent staffing
need exists, the local licensing authority may authorize a person who
has not completed the Department's current Ensuring Quality Care
Course and passed the current examination to act as a resident
manager or shift caregiver until training and testing are completed, or
for 60 calendar days, whichever period is shorter. The licensee must
notify the local licensing authority of the unexpected and urgent
staffing need in writing and satisfactorily demonstrate:
(A) The licensee's inability to live in the home and act as the
primary caregiver;
(B) The licensee's inability to find a qualified resident manager
or shift caregiver, as applicable; and
(C) The proposed staff person is 21 years of age and meets the
requirements of a substitute caregiver for the adult foster home
as described in OAR 411-050-0625 and 411-050-0630.
(k) RESPONSIBILITY. A licensee is responsible for the supervision,
training, and overall conduct of all caregivers, family members, and
friends when acting within the scope of their employment, duties, or
when present in the home.
(l) SEXUAL ABUSE. Sexual abuse, as defined in OAR 411-020-0002
(Adult Protective Services), is prohibited.
(m) COMMUNICATION.
(A) Applicants for an initial license must obtain and provide to
the local licensing authority a current, active business address
for electronic mail prior tobefore obtaining a license.
Page 40
(B) A licensee must notify the local licensing authority within 24
hours upon a change in the home’s business address for
electronic mail.
(C) A licensee must notify the local licensing authority, the
residents and the resident’s family members, legal
representatives, and case managers, as applicable, of any
change in the telephone number for the licensee or the adult
foster home within 24 hours of the change.
(D) A licensee must notify the local licensing authority in writing
prior tobefore any change of the licensee's residence or mailing
address.
(2) SALE OR LEASE OF EXISTING ADULT FOSTER HOMES AND
TRANSFER OF LICENSES.
(a) A license is not transferable and does not apply to any location or
person other than the location and person indicated on the license
obtained from the local licensing authority.
(b) The licensee must inform real estate agents, prospective buyers,
lessees, and transferees in all written communication, including
advertising and disclosure statements, that the license to operate the
adult foster home is not transferable and the licensee must refer them
to the local licensing authority for information about licensing.
(c) When a home is to be sold or otherwise transferred or conveyed
to another person who intends to operate the home as an adult foster
home, that person must apply for and obtain a license from the local
licensing authority prior tobefore the transfer of operation of the
home.
(d) The licensee must promptly notify the local licensing authority in
writing about the licensee’s intent to close or convey the adult foster
home to another person. The licensee must provide written notice to
the residents and the residents' representatives and case managers,
as applicable, according to section (13) of this rule.
Page 41
(e) The licensee must inform a person intending to assume operation
of an existing adult foster home that the residents currently residing in
the home must be given at least 30 calendar days’ written notice of
the licensee’s intent to close the adult foster home for the purpose of
conveying the home to another person.
(f) The licensee must remain licensed and responsible for the
operation of the home and care of the residents in accordance with
these rules until the home is closed and the residents have been
relocated, or the home is conveyed to a new licensee who is licensed
by the local licensing authority at a level appropriate to the care
needs of the residents in the home.
(3) FORECLOSURE.
(a) A licensee must provide written notification to the local licensing
authority within 10 calendar days after receipt of any notice of default,
or any notice of potential default, with respect to a real estate
contract, trust deed, mortgage, or other security interest affecting any
property occupied or used by the licensee.
(b) The licensee must provide a copy of the notice of default or
warning of potential default to the local licensing authority.
(c) The licensee must provide written updates to the local licensing
authority at least every 30 days until the default or warning of
potential default has been resolved and no additional defaults or
potential defaults have been declared and no additional warnings
have been issued. Written updates must include:
(A) The current status on what action has been or is about to be
taken by the licensee with respect to the notice received.;
(B) The action demanded or threatened by the holder of the
security interest; and.
(C) Any other information reasonably requested by the local
licensing authority.
Page 42
(d) The licensee must provide written notification within 24 hours to
the local licensing authority upon final resolution of the matters
leading up to or encompassed by the notice of default or the notice
warning of potential default.
(e) If the subject default property is licensed as an adult foster home,
the licensee must provide written notification of the following within 24
hours to the local licensing authority, and all the residents and the
residents' representatives, if applicable, regarding:
(A) The filing of any litigation regarding such security interest,
including the filing of a bankruptcy petition by or against the
licensee or an entity owning any property occupied or used by
the licensee;
(B) The entry of any judgment with respect to such litigation;
(C) The passing of the date 40 days prior tobefore any sale
scheduled pursuant to the exercise of legal rights under a
security interest, or a settlement or compromise related thereto,
of the licensee’s property or property occupied or used by the
licensee; and
(D) The sale, pursuant to the exercise of legal rights under a
security interest, or a settlement or compromise related thereto,
of the licensee’s property or property occupied or used by the
licensee.
(4) MEALS.
(a) Three nutritious meals must be served daily at times consistent
with those in the community. Each meal must include food from the
basic food groups according to the United States Department of
Agriculture (USDA’s) My Plate and include fresh fruit and vegetables
when in season.
(b) Meals must reflect consideration of a resident's preferences and
cultural and ethnic background. This does not mean the licensee
must prepare multiple, unique meals for the residents at the same
time.
Page 43
(c) A schedule of meal times and menus for the coming week must
be prepared and posted weekly in a location accessible to residents
and families.
(A) Meal substitutions for scheduled menu items in compliance
with section (4)(a) of this rule are acceptable and must be
documented on, or attached to, the weekly menu.
(B) The licensee must maintain the weekly menus for a
minimum of the 12 most recent months during which the home
has conducted business.
(C) Effective January 1, 2016 for providers initially licensed
after January 1, 2016, and effective no later than September 1,
2018 for providers initially licensed before January 1, 2016 the
licensee must support the resident’s right to access food at any
time. Limitations may only be used when there is a health or
safety risk, as stated in OAR 411-050-0655, and when a written
informed consent is obtained.
(D) If a resident misses a meal at a scheduled time, an
alternative meal must be made available.
(d) There must be no more than a 14-hour span between the evening
and morning meals. Snacks do not substitute for a meal in
determining the 14-hour span. Nutritious snacks and liquids must be
offered to fulfill each resident's nutritional requirements.
(e) Food may not be used as an inducement to control the behavior
of a resident.
(f) Home-canned foods must be processed according to the
guidelines of the Oregon State University Extension Service.
Freezing is the most acceptable method of food preservation. Milk
must be pasteurized.
(g) Special consideration must be given to a resident with chewing
difficulties or other eating limitations. Special diets must be followed,
Page 44
as prescribed in writing, by the resident's physician, nurse
practitioner, or physician assistant.
(h) Adequate storage must be available to maintain food at a proper
temperature, including a properly working refrigerator. Storage and
food preparation areas must be free from food that is spoiled or
expired.
(i) The household utensils, dishes, glassware, and household food
may not be stored in bedrooms, bathrooms, or living areas.
(j) Meals must be prepared and served in the home where the
residents live. Payment for meals eaten away from the home for the
convenience of the licensee (e.g., restaurants, senior meal sites) is
the responsibility of the licensee.
(A) Meals and snacks, as part of an individual recreational
outing by choice, are the responsibility of the resident.
(B) Payment for food beyond the required three meals and
snacks are the responsibility of the resident.
(k) Utensils, dishes, and glassware must be washed in hot soapy
water, rinsed, and stored to prevent contamination. A dishwasher with
a sani-cycle is recommended.
(l) Food preparation areas and equipment, including utensils and
appliances, must be clean, free of offensive odors, and in good
repair.
(5) TELEPHONE.
(a) The home must have a working landline and corded telephone
with a listed number that is separate from any other number the home
has, such as, but not limited to, internet or fax lines, unless the
system includes features that notify the caregiver of an incoming call,
or automatically switches to the appropriate mode. If a licensee has a
caller identification service on the home number, the blocking feature
must be disabled to allow incoming calls to be received unhindered. A
licensee may have only one phone line as long as the phone line
Page 45
complies with the requirements of these rules. Voice over internet
protocol (VoIP), voice over broadband (VoBB), or cellular telephone
service may not be used in place of a landline.
(b) The licensee must make a telephone that is in good working order
available and accessible for the residents use with reasonable
accommodation for privacy during telephone conversations. A
resident with a hearing impairment, to the extent the resident may not
hear a normal telephone conversation, must be provided with a
telephone that is amplified with a volume control or a telephone that
is hearing aid compatible.
(c) Restrictions on the use of the telephone by the residents must be
specified in the written Residency Agreement house policies and may
not violate the residents' rights. Individual restrictions must be well
documented in the resident's care plan.
(6) FACILITY RECORDS.
(a) Facility records must be kept current, maintained in the adult
foster home, and made available for review upon request. Facility
records include, but are not limited to:
(A) Proof the licensee and all subject individuals have a background check
approved by the Department as required by OAR 411-050-0620.
.;
(B) Proof the licensee and all other caregivers have met and
maintained the minimum qualifications as required by OAR
411-050-0625, including:
(i) Proof of required continuing education. Documentation
must include the date of each training, subject matter,
name of agency or organization providing the training,
and number of Department-approved classroom hours.;
(ii) Completed certificates to document the substitute
caregivers’ completion of the Department’s Caregiver
Preparatory Training Study Guide and Workbook and to
document the resident manager, floating resident
Page 46
manager, and shift caregivers, as applicable, completion
and passing of the Department’s Ensuring Quality Care
Course and examination.;
(iii) Documentation of orientation to the adult foster home
for the resident manager, floating resident manager, shift
caregivers, and substitute caregivers, as applicable.;
(iv) Employment applications and the names, addresses,
and telephone numbers of all caregivers employed or
used by the licensee; and.
(v) Verification that all caregivers are not listed on either
of the Exclusion Lists.
(C) Copies of notices sent to the local licensing authority
pertaining to changes in the resident manager, floating resident
manager, shift caregiver, or other primary caregiver.;
(D) Proof of required vaccinations for animals on the premises.;
(E) Well water tests, if required, according to OAR 411-0500650. Test records must be retained for a minimum of three
years.;
(F) Residency Agreements with all residents and, if applicable,
specialized contracts with the Department, and tenancy
agreements with room and board tenants. Agreements and
specialized contracts with the Department, copies of the adult
foster home’s private-pay contracts, any contracts with
residents eligible for Medicaid services, such as an agreement
pertaining to storage fees after leaving the home, and any other
contracts, such as contracts with room and board tenants or
individuals receiving day care services; and
(G) Records of evacuation drills according to OAR 411-0500650, including the date, time of day, evacuation route, length
of time for evacuation of all occupants, names of all residents
and occupants, and which names of residents and occupants
Page 47
that required assistance. The records must be kept at least
three years.
(H) The Department’s current Adult Foster Home Back-Up
Agreement form (SDS 350) completed by the current back-up
provider and the licensee, as stated in OAR 411-050-0610 and
411-050-0640.
(b) REQUIRED POSTED ITEMS. The following items must be posted
in one location in the entryway or other equally prominent place in the
home where residents, visitors, and others may easily read them:
(A) The adult foster home license;
(B) Conditions attached to the license, if any;
(C) A copy of a current floor plan meeting the requirements of
OAR 411-050-0650;
(D) The Residents’ Bill of Rights;
(E) The home’s policies as stated in the current Residency
Agreementhouse policies that hashave been reviewed and
approved by the local licensing authority;
(F) The Department’s procedure for making complaints;
(G) The Long-Term Care Ombudsman poster;
(H) The Department’s inspection forms (form SDS 517A and, if
applicable, form SDS 517B), including how corrections were
made since the last annual inspection;
(I) The Department’s notice pertaining to the use of any
intercoms, monitoring devices, and video cameras that may be
used in the adult foster home; and
(J) A weekly menu according to section (4) of this rule.
Page 48
(c) POST BY PHONE. Emergency telephone numbers, including the
contact number for at least one back-up provider who has agreed to
respond in person in the event of an emergency and an emergency
contact number for the licensee must be readily visible and posted by
a central telephone in the adult foster home.
(7) RESIDENT RECORDS.
(a) An individual resident record must be developed, kept current,
and readily accessible on the premises of the home for each
individual admitted to the adult foster home. The record must be
legible and kept in an organized manner so as to be utilized by staff.
The record must contain the following information:
(A) A complete initial screening assessment and general
information form (SDS 902) as described in OAR 411-0500655.;
(B) Documentation on form SDS 913 that the licensee has
informed private-pay residents of the availability of a long-term
care assessment.;
(C) Documentation that the licensee has informed all residents
of the right to formulate an Advance Directive.;
(D) FINANCIAL INFORMATION:
(i) Detailed records and receipts, if the licensee manages
or handles a resident’s money. The Resident Account
Record (form SDS 713) or other expenditure forms may
be used if the licensee manages or handles a resident’s
money. The record must show amounts and sources of
funds received and issued to, or on behalf of, the resident
and be initialed by the person making the entry. Receipts
must document all deposits and purchases of $5 or more
made on behalf of a resident.
(ii) Residency AgreementsContracts signed and dated by
the resident or the resident’s representative by residents
or the residents' representatives may be kept in a
Page 49
separate file, but must be made available for inspection
by the local licensing authority.
(E) Medical and legal information, including, but not limited to:
(i) Medical history, if available.;
(ii) Current prescribing practitioner orders.;
(iii) Nursing instructions, delegations, and assessments,
as applicable.;
(iv) Completed medication administration records retained
for at least the last six months or from the date of
admission, whichever is less. (Older records may be
stored separately); and.
(v) Copies of Guardianship, Conservatorship, Advance
Directive for Health Care, Power of Attorney, and
Physician’s Order for Life Sustaining Treatment (POLST)
documents, as applicable.
(F) A complete, accurate, and current care plan.;
(G) Effective July 1, 2016, documentation that supports or
eliminates any individually-based limitation, as described in
OAR 411-050-0655.
(HG) A copy of the current house policies, as identified in the
current Residency Agreement, and the current Resident’s Bill of
Rights, signed and dated by the resident or the resident's
representative.;
(IH) SIGNIFICANT EVENTS. A written report (using form SDS
344 or its equivalent) of all significant incidents relating to the
health or safety of the resident, including how and when the
incident occurred, who was involved, what action was taken by
the licensee and staff, as applicable, and the outcome to the
resident.;
Page 50
(JI) NARRATIVE OF RESIDENT'S PROGRESS. Narrative
entries describing each resident's progress must be
documented at least weekly and maintained in each resident’s
individual record. All entries must be signed and dated by the
person writing them; and.
(KJ) Non-confidential information or correspondence pertaining
to the care needs of the resident.
(b) ACCESS TO RESIDENT RECORDS.
(A) Resident records must be readily available at the adult
foster home to residents, the residents' authorized
representatives or other legally authorized persons, all
caregivers working in the home, and the Department, the local
licensing authority, the investigative authority, case managers,
and the Centers for Medicare and Medicaid Services (CMS) for
the purpose of conducting inspections or investigations.
(B) The State Long-Term Care Ombudsman must be provided
access to all resident and facility records. A Deputy
Ombudsman and Certified Ombudsman Volunteers must be
provided access to facility records relevant to caregiving and
resident records with written permission from the resident or the
resident's legal representative. (See OAR 114-005-0030).
(c) RECORD RETENTION. Records, including any financial records
for residents, must be kept for a period of three years from the date
the resident left the home.
(d) CONFIDENTIALITY. In all other matters pertaining to confidential
records and release of information, licensees must be guided by the
principles and definitions described in OAR chapter 411, division 005
(Privacy of Protected Information).
(8) RESIDENCY AGREEMENT. The current Residency Agreement must
be given to the resident and the resident’s representative, as applicable, at
the time the screening and assessment is conducted. Before the resident’s
admission, a signed and dated copy of the Residency Agreement must be
obtained and placed in the resident’s record. The policies within the
Page 51
Residency Agreement must be consistent with the practices of the
licensee, staff, occupants, and visitors of the home. (See OAR 411-0500615).
(8) HOUSE POLICIES. House policies must be in writing and a copy given
to the resident and the resident’s family or representative at the time of
admission and at the time the screening and assessment is conducted. A
signed copy of the house policies must be obtained at the time of
admission and placed in the resident’s record. House policies must be
consistent with the practices of the licensee, staff, occupants, and visitors
of the home. House policies established by the licensee must:
(a) Include any restrictions the adult foster home may have on the
use of alcohol, tobacco, pets, visiting hours, dietary restrictions, or
religious preferences;
(b) Indicate the home’s policy regarding the presence and use of
legal marijuana on the premises;
(c) Include a schedule of meal times;
(d) Include the home’s policy regarding refunds for residents eligible
for Medicaid services, including pro-rating partial months and if the
room and board is refundable;
(e) Include a clear and precise statement of any limitation to the
implementation of Advance Directives on the basis of conscience.
This rule does not apply to medical professional or hospice orders for
administration of medications. The statement must include:
(A) A description of conscientious objections as they apply to all
occupants of the adult foster home;
(B) The legal authority permitting such objections under ORS
127.505 to 127.660; and
(C) Description of the range of medical conditions or
procedures affected by the conscientious objection. (See OAR
411-050-0655)
Page 52
(f) Not be in conflict with the Residents’ Bill of Rights, the family
atmosphere of the home, or any of these rules;
(g) Be reviewed and approved by the local licensing authority prior to
the issuance of a license and prior to implementing any changes; and
(h) Be posted with the required posted items, in a location where they
are easily seen and read by residents and visitors as described in
section (6) of this rule.
(9) RESIDENT MOVES AND TRANSFERS. The Department encourages
licensee must to support a resident’s choice to remain in his or her living
environment, while recognizing that some residents may no longer be
appropriate for the adult foster care setting due to safety and medical
limitations.
(a) If a resident moves, or intends to move, out of an adult foster
home for any reason, the licensee must cooperate with the potential
provider’s screening and assessment activities as directed by the
resident or the resident’s representative, and submit copies of
pertinent information from the resident’s record to the resident’s new
place of residence at the time of move. Pertinent information must
include, at a minimum:
(A) Copies of current prescribing medical practitioner’s orders
for medications, current medication sheets, and an updated
care plan, including the elements of any person-centered
service plan, and any documentation of limitations; and.
(B) Documentation of actions taken by the adult foster home
staff, resident, or the resident’s representative pertaining to the
move or transfer.
(b) A licensee must immediately document voluntary and involuntary
moves or transfers from the adult foster home in the resident's record
as events take place. (See sections (11) and (12) of this rule).
(10) VOLUNTARY MOVES AND TRANSFERS.
Page 53
(a) If a resident eligible for Medicaid services or the resident's
representative gives notice of the resident's intent to leave the adult
foster home, or the resident leaves the home abruptly, the licensee
must promptly notify the resident's case manager and the local
licensing authority.
(b) A licensee must obtain prior authorization from the resident, the
resident’s legal representative, and case manager, as applicable,
prior tobefore the resident’s:
(A) Voluntary move from one bedroom to another in the adult
foster home;
(B) Voluntary transfer from one adult foster home to another
home that has a license issued to the same person; or
(C) Voluntary move to any other location.
(c) Notifications and authorizations of voluntary moves and transfers
must be documented and available in the resident’s record.
(d) The licensee remains responsible for the provision of care and
services until the resident has moved from the home.
(11) INVOLUNTARY MOVES AND TRANSFERS.
(a) A resident may only be moved involuntarily to another room within
the adult foster home, transferred to another adult foster home
operated by the same licensee for a temporary or permanent stay, or
moved from the adult foster home for the following reasons:
(A) Medical reasons. The resident has a medical or nursing
condition that is complex, unstable, or unpredictable that
exceeds the level of care and services the facility provides.;
(B) The adult foster home is unable to accomplish evacuation of
the adult foster home in accordance with OAR 411-050-0650.;
(C) Welfare of the resident or other residents, including:;
Page 54
(i) The resident exhibits behavior that poses an imminent
danger to self or others, including acts that result in the
resident’s arrest or detention;
(ii) The resident engages in behavior or action that
repeatedly and substantially interfere with the rights,
health, or safety of the residents or others; or
(iii) The resident engages in illegal drug use or commits a
criminal act that causes potential harm to the resident or
others.
(D) Failure to make payment for care or failure to make
payment for room and board.;
(E) The adult foster home has had its license revoked, not
renewed, or the license was voluntarily surrendered by the
licensee.;
(F) The home was not notified prior tobefore the resident’s
admission, or learns following the resident’s admission, that the
resident is on probation, parole, or post-prison supervision after
being convicted of a sex crime defined in ORS 181.805.;
(G) The licensee’s Medicaid Provider Enrollment Agreement or
specialized contract is terminated (pertains only to residents
eligible for Medicaid); or.
(H) The resident engages in the use of legal medical marijuana,
recreational marijuana, or both, in violation of the home's
written policies or contrary to Oregon Law under the Oregon
Medical Marijuana Act, ORS 475.300 to 475.346.
(b) MANDATORY WRITTEN NOTICE. A resident may not be moved
involuntarily from the adult foster home, or to another room within the
adult foster home, or transferred to another adult foster home for a
temporary or permanent stay without a minimum of 30 calendar days'
written notice. The notice must be delivered in person to the resident
and must be delivered in person or sent by registered or certified mail
to the resident's legal representative, guardian, or conservator, and a
Page 55
copy must be immediately submitted to the local licensing authority,
and to the resident’s case manager, as applicable. Where a resident
lacks capacity and there is no legal representative, a copy of the
notice must be immediately submitted to the State Long Term Care
Ombudsman. The written notice must:
(A) Be on the Department’s Notice of Involuntary Move or
Transfer of Resident form (SDS 901);
(B) Be completed by the licensee; and
(C) Include the following information:
(i) The resident’s name;
(ii) The reason for the proposed move or transfer,
including the specific reasons the facility is unable to meet
the resident's needs;
(iii) The date of the proposed change;
(iv) The location to which the resident is goingThe
resident's new location, if known;
(v) A notice of the right to hold an informal conference
and hearing;
(vi) The name, address, and telephone number of the
person giving the notice; and
(vii) The date the notice is issued.
(c) LESS THAN 30 DAYS' WRITTEN NOTICE. A licensee may give
less than 30 calendar days’ written notice in specific circumstances
as identified in paragraphs (A) to (C) below, but must do so as soon
as possible using the Department’s Notice of Involuntary Move or
Transfer of Resident form (SDS 901). The notice must be given in
person to the resident, the resident’s representative, guardian,
conservator, and a copy must be immediately submitted to the local
licensing authority, and to the resident’s case manager, as applicable.
Page 56
The reasons for the notice must be fully documented in the resident’s
record. The licensee remains responsible for the provision of care
and services until the resident has moved from the home. A licensee
may give less than 30 calendar days’ notice only if:
(A) Undue delay in moving the resident would jeopardize the
health, safety, or well-being of the resident, including:
(i) The resident has a medical emergency that requires
the immediate care of a level or type the adult foster
home is unable to provide.
(ii) The resident exhibits behavior that poses an
immediate danger to self or others.
(B) The resident is hospitalized or is temporarily out of the
home and the licensee determines he or she is no longer able
to meet the needs of the resident; or
(C) The home was not notified prior tobefore the resident’s
admission, or learns following the resident’s admission, the
resident is on probation, parole, or post-prison supervision after
being convicted of a sex crime defined in ORS 181.805.
(i) In the event a resident is given notice of an involuntary
move due to (11)(c)(C) of this rule, the notice may be
given without reasonable advance notice.
(ii) The resident shall be given the Department’s Notice of
Involuntary Move or Transfer of Resident form (SDS 901)
as stated in (11) of this rule.
(12) RESIDENT HEARING RIGHTS. A resident, who has been given
formal notice of an involuntary move or refused the right of return or readmission, is entitled to an informal conference and hearing prior tobefore
the involuntary move or transfer as follows:
(a) INFORMAL CONFERENCE. The local licensing authority must
hold an informal conference as promptly as possible after the request
is received. The local licensing authority must send written notice of
Page 57
the time and place of the conference to the licensee and all persons
entitled to the notice. Participants may include the resident and at the
resident's request a family member, case manager, Ombudsman,
legal representative of the resident, the licensee, and a
representative from an adult foster home association or SEIU if
requested by the licensee. The purpose of the informal conference is
to resolve the matter without an administrative hearing. If a resolution
is reached at the informal conference, the local licensing authority
must document the outcome in writing and no administrative hearing
is needed.
(b) ADMINISTRATIVE HEARING. If a resolution is not reached as a
result of the informal conference, the resident or the resident’s
representative may request an administrative hearing. If the resident
is being moved or transferred with less than 30 calendar days’ notice
according to section (11)(c) of this rule, the hearing must be held
within seven business days of the move or transfer. The licensee
must hold a space available for the resident pending receipt of an
administrative order. These administrative rules and ORS 441.605(4)
governing transfer notices and hearings for residents of long-term
care facilities apply to adult foster homes.
(13) CLOSURE OF ADULT FOSTER HOMES.
(a) A licensee must notify the local licensing authority prior tobefore
the voluntary closure, proposed sale, or transfer of ownership of the
home, and give the residents and the residents' families,
representatives, and case managers, as appropriate, a minimum of
30 calendar days' written notice on the Department’s form (SDS 901)
according to section (11) of this rule.
(b) In circumstances where undue delay might jeopardize the health,
safety, or well-being of residents, licensees, or staff, written notice
must be given as soon as possible, according to section (11)(c).
(c) A licensee must surrender the physical license to operate an adult
foster home to the local licensing authority at the time of the adult
foster home's closure.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.705-795, 443.880
Page 58
Stats. Implemented: ORS 197.660-670, 441.373, 443.001-004, 443.705825, 443.875, 443.991
411-050-0650 Facility and Safety Standards
In order to qualify for or maintain a license, an adult foster home must
comply with the following provisions:
(1) GENERAL CONDITIONS.
(a) INTERIOR AND EXTERIOR PREMISES. The building and
furnishings, patios, decks, and walkways, as applicable, must be
clean and in good repair. The interior and exterior premises must be
well maintained and accessible according to the individual needs of
the residents. There must be no accumulation of garbage, debris,
rubbish, or offensive odors. Walls, ceilings, and floors must be of
such character to permit washing, cleaning, or painting, as
appropriate.
(b) ADDRESS. The address numbers of the adult foster home must
be placed on the home in a position that is legible and clearly visible
from the street or road fronting the property. If the home is so situated
that the address number is not legible and clearly visible from the
road fronting the property, such as when the home is accessed via a
lengthy driveway or private access road, then the address numbers
must also be posted where the driveway or private access road joins
the fronting road. The Aaddress numbers must be at least a minimum
of 4 four inches in height, made of reflective material, and contrast
with the their background.
(c) LIGHTING. Adequate lighting, based on the needs of the
occupants, must be provided in each room, stairway, and exit way.
Incandescent light bulbs and florescent tubes must be protected with
appropriate covers.
(d) TEMPERATURE. The heating system must be in working order.
Areas of the home used by the residents must be maintained at a
comfortable temperature. Minimum temperatures during the day must
be not less than 68 degrees, no greater than 85 degrees, and not
less than 60 degrees during sleeping hours. Variations from the
Page 59
requirements of this rule must be based on resident care needs or
preferences and must be addressed in each resident's care plan.
(A) During times of extreme summer heat, the licensee must
make reasonable effort to keep the residents comfortable using
ventilation, fans, or air conditioning. Precautions must be taken
to prevent resident exposure to stale, non-circulating air.
(B) If the facility is air-conditioned, the system must be
functional and the filters must be cleaned or changed as
needed to ensure proper maintenance.
(C) If the licensee is unable to maintain a comfortable
temperature for the residents during times of extreme summer
heat, air conditioning or another cooling system may be
required.
(e) COMMON USE AREAS. Common use areas for the residents
must be accessible to all residents. There must be at least 150
square feet of common living space and sufficient furniture in the
home to accommodate the recreational and socialization needs of all
the occupants at one time. Common space may not be located in an
unfinished basement or garage unless such space was constructed
for that purpose or has otherwise been legalized under permit. There
may be additional space required if wheelchairs are to be
accommodated. An additional 40 square feet of common living space
is required for each day care individual, room and board tenant, or
relative receiving care for remuneration that exceeds the limit of five.
(f) VIDEO MONITORS. Use of video monitors detracts from a homelike environment and the licensee may not use video monitors in any
area of the home that would violate a resident’s privacy unless
requested by the resident or the resident's legal representative. The
licensee may not ask the resident or the resident's legal
representative to waive the resident’s right to privacy as a condition of
admission to the home.
(2) SANITATION AND PRECAUTIONS.
Page 60
(a) NON-MUNICIPAL WATER SOURCE. A public water supply must
be utilized if available. If a non-municipal water source is used, the
licensor, a sanitarian, or a technician from a certified water-testing
laboratory must collect a sample annually or as required by the
Department. The water sample must be tested for coliform bacteria.
Water testing and any necessary corrective action to ensure water is
suitable for drinking must be completed at the licensee’s expense.
Water testing records must be retained for three years.
(b) Septic tanks or other non-municipal sewage disposal systems
must be in good working order.
(c) COMMODES AND INCONTINENCE GARMENTS. Commodes
used by residents must be emptied frequently and cleaned daily, or
more frequently if necessary. Incontinence garments must be
disposed of in closed containers.
(d) WATER TEMPERATURE. A resident who is unable to safely
regulate the water temperature must be supervised.
(e) LAUNDRY. Prior toBefore laundering, soiled linens and clothing
must be stored in closed containers in an area that is separate from
food storage, kitchen, and dining areas. Pre-wash attention must be
given to soiled and wet bed linens. Sheets and pillowcases must be
laundered at least weekly and more often if soiled.
(f) Garbage and refuse must be suitably stored in readily cleanable,
rodent-proof, covered containers, pending weekly removal.
(g) VENTILATION. All doors and windows that are used for
ventilation must have screens in good condition.
(h) INFECTION CONTROL. Standard precautions for infection control
must be followed in resident care. Hands and other skin surfaces
must be washed immediately and thoroughly if contaminated with
blood or other body fluids.
(i) DISPOSAL OF SHARPS. Precautions must be taken to prevent
injuries caused by needles, scalpels, and other sharp instruments or
devices during procedures. The puncture-resistant container must be
Page 61
located as close as practical to the use area. Disposal must be made
according to local regulations as stated in section (5) of this rule. (See
459.386 to 459.405).
(j) FIRST AID. Current, basic first-aid supplies and a first-aid manual
must be readily available in the home.
(k) PESTS. Reasonable precautions must be taken to prevent pests
(e.g., ants, cockroaches, other insects, and rodents).
(l) PETS OR OTHER ANIMALS. Sanitation for household pets and
other domestic animals on the premises must be adequate to prevent
health hazards. Proof of rabies vaccinations and any other
vaccinations that are required for the pet by a licensed veterinarian
must be maintained on the premises. Pets not confined in enclosures
must be under control and not present a danger to the residents or
guests.
(m) SAFETY BARRIERS. Patios, decks, walkways, swimming pools,
hot tubs, spas, saunas, water features, and stairways, as appropriate,
must be equipped with safety barriers designed to prevent injury.
Resident access to or use of swimming or other pools, hot tubs, spas,
or saunas on the premises must be supervised.
(3) BATHROOMS. Bathrooms must:
(a) Provide individual privacy and have a finished interior with a door
that opens to a hall or common-use room. If a resident’s bedroom
includes a private bathroom, the door for the private bathroom must
open to the bedroom. No person must have to walk through another
person's bedroom to access a bathroom.;
(b) Be large enough to accommodate the individual needs of the
residents and any equipment that may be necessary.;
(c) Have a mirror, a window that opens or other means of ventilation,
and a window covering for privacy.;
(d) Be clean and free of objectionable odors.;
Page 62
(e) Have bathtubs, showers, toilets, and sinks in good repair. A sink
must be located near each toilet and a toilet and sink must be
available for the resident’s use on each floor with resident rooms.
There must be at least one toilet, one sink, and one bathtub or
shower for each six household occupants (including residents, day
care individuals, room and board tenants, the licensee, and the
licensee’s family).;
(f) Have hot and cold water at each bathtub, shower, and sink in
sufficient supply to meet the needs of the residents.;
(g) Have nonporous surfaces for shower enclosures. Glass shower
doors, if applicable, must be tempered safety glass, otherwise,
shower curtains must be clean and in good condition;.
(h) Have non-slip floor surfaces in bathtubs and showers.;
(i) Have grab bars for each toilet, bathtub, and shower to be used by
the residents for safety.;
(j) Have barrier-free access to toilet and bathing facilities; and.
(k) Have adequate supplies of toilet paper and soap supplied by the
licensee. Residents must be provided with individual towels and
washcloths that are laundered in hot water at least weekly or more
often if necessary. Residents must have appropriate racks or hooks
for drying bath linens. If individual hand towels are not provided,
roller-dispensed hand towels or paper towels in a dispenser must be
provided for the residents' use.
(4) BEDROOMS.
(a) Bedrooms for all household occupants must have:
(A) Have bBeen constructed as a bedroom when the home was
built, or remodeled under permit.;
(B) A Be finished interior with walls or partitions of standard
construction that go from floor to ceiling.;
Page 63
(C) Have aA door that opens directly to a hallway or common
use room without passage through another bedroom or
common bathroom. The bedroom door must be large enough to
accommodate the occupant of the room and any mobility
equipment that may be needed by the resident.;
(D) Be aAdequately ventilationed, heatinged, and lightinged
with at least one window that opens and meets the
requirements in section (5)(e) of this rule.;
(E) Be Aat least 70 square feet of usable floor space for one
resident or 120 square feet for two residents excluding any area
where a sloped ceiling does not allow a person to stand upright;
and .
(F) Have nNo more than two occupants per room. (See also
OAR 411-050-0632 pertaining to a child’s bedroom.). This rule
is not intended to prohibit a child five years of age or younger
from occupying their his or her parent’s bedroom.
(b) The licensee, any other caregivers, and family members may not
sleep in areas designated as living areas or share a bedroom with a
resident. This rule is not intended to prohibit a caregiver or other
person of the resident’s choosing from temporarily staying in the
resident’s room when required by the resident’s condition.
(c) There must be a bed at least 36 inches wide for each resident
consisting of a mattress and springs, or equivalent, in good condition.
Cots, rollaways, bunks, trundles, daybeds with restricted access,
couches, and folding beds may not be used for residents. Each bed
must have clean bedding in good condition consisting of a
bedspread, mattress pad, two sheets, a pillow, a pillowcase, and
blankets adequate for the weather. Waterproof mattress covers must
be used for incontinent residents. Day care individuals may use a cot
or rollaway bed if bedroom space is available that meets the
requirements of section (4)(a) of this rule. A resident's bed may not
be used by a day care individual.
(d) Each resident’s bedroom must have a separate, private dresser
and closet space sufficient for the resident's clothing and personal
Page 64
effects, including hygiene and grooming supplies. A resident must be
provided a private, secure storage space to keep and use reasonable
amounts of personal belongings. A licensee may not use a resident’s
bedroom for storage of items, supplies, devices, or appliances that do
not belong to the resident.
(e) All resident bedroom doors must have a locking device on the
inside of the door, released by a single action. (See OAR 411-0500650(5)). Providers licensed before January 1, 2016, have until
September 1, 2018 to fully implement this requirement.
(fe) Drapes or shades for bedroom windows must be in good
condition and allow privacy for the residents.
(gf) A resident who is non-ambulatory, has impaired mobility, or is
cognitively impaired must have a bedroom with a safe, second exit at
ground level. A resident with a bedroom above or below the ground
floor must demonstrate their his or her capability for self-preservation.
(hg) Resident bedrooms must be in close enough proximity to the
licensee or caregiver in charge to alert the licensee or caregiver in
charge to resident nighttime needs or emergencies, or the bedrooms
must be equipped with a functional call bell or intercom within the
residents' abilities to operate. Intercoms may not violate the resident's
right to privacy and must have the capability of being turned off by the
resident or at the resident's request.
(ih) Bedrooms used by the licensee, resident manager, shift
caregiver, and substitute caregiver, as applicable, must be located in
the adult foster home and must have direct access to the residents
through an interior hallway or common use room.
(5) SAFETY.
(a) FIRE AND LIFE SAFETY. Buildings must meet all applicable state
and local building, mechanical, and housing codes for fire and life
safety. The home may be inspected for fire safety by the State Fire
Marshal's Office, or the State Fire Marshal’s designee, at the request
of the local licensing authority or the Department using the standards
in these rules, as appropriate.
Page 65
(b) HEAT SOURCES. All heating equipment including, but not limited
to, wood stoves, pellet stoves, and fireplaces must be installed in
accordance with all applicable state and local building and
mechanical codes. Heating equipment must be in good repair, used
properly, and maintained according to the manufacturer’s or a
qualified inspector's recommendations.
(A) A licensee who does not have a permit verifying proper
installation of an existing woodstove, pellet stove, or gas
fireplace must have it inspected by a qualified inspector,
Certified Oregon Chimney Sweep Association member, or
Oregon Hearth, Patio, and Barbeque Association member and
follow their inspector’s recommended maintenance schedule.
(B) Fireplaces must have approved and listed protective glass
screens or metal mesh screens anchored to the top and bottom
of the fireplace opening.
(C) The local licensing authority may require the installation of a
non-combustible, heat-resistant, safety barrier 36 inches
around a woodstove to prevent residents with ambulation or
confusion problems from coming in contact with the stove.
(D) Unvented, portable oil, gas, or kerosene heaters are
prohibited. Sealed electric transfer heaters or electric space
heaters with tip-over, shut-off capability may be used when
approved by the State Fire Marshal or the State Fire Marshal's
designee. A heater must be directly connected to an electrical
outlet and may not be connected to an extension cord.
(c) EXTENSION CORDS AND ADAPTORS. Extension cord wiring
and multi-plug adaptors may not be used in place of permanent
wiring. UL-approved, re-locatable power taps (RPTs) with circuit
breaker protection and no more than six electrical sockets are
permitted for indoor use only and must be installed and used in
accordance with the manufacturer’s instructions. If RPTs are used,
the RPT must be directly connected to an electrical outlet, never
connected to another RPT (known as daisy-chaining or piggybacking), and never connected to an extension cord.
Page 66
(d) LOCKS AND ALARMS. Hardware for all exit doors and interior
doors must be readily visible, have simple hardware that may not be
locked against exit, and have an obvious method of operation. Hasps,
sliding bolts, hooks and eyes, slide chain locks, and double key
deadbolts are not permitted. If a home has a resident with impaired
judgment who is known to wander away, the home must have an
activated alarm system to alert a caregiver of the resident's
unsupervised exit.
(A) All resident bedroom doors must have a locking device on the
inside of the door, released by a single action. Providers licensed
before January 1, 2016, have until September 1, 2018 to fully
implement this requirement.
(B) The lock on each resident’s bedroom door must have a
personalized key that locks and unlocks only the lock on the
resident’s bedroom door.
(C) Each Resident shall be provided a key to the lock for his or
her bedroom.
(D) A set of master keys to all of the resident’s’ locked doors
must be immediately available to the licensee and all other
caregivers in the home.
(E) If a home has a resident with impaired judgment who is
known to wander away, the home must have an activated alarm
system to alert a caregiver of the resident’s unsupervised exit.
(e) WINDOWS. Bedrooms must have at least one window or exterior
door that leads directly outside, readily opens from the inside without
special tools, and provides a clear opening of not less than 821
square inches (5.7 sq. ft.), with the least dimensions not less than 24
inches in height or 20 inches in width. If the interior sill height of the
window is more than 44 inches from the floor level, approved steps or
other aids to the window exit that the occupants are capable of using
must be provided. Windows with a clear opening of not less than 5.0
square feet or 720 square inches with interior sill heights of no more
Page 67
than 48 inches above the floor may be accepted when approved by
the State Fire Marshal or the State Fire Marshal's designee.
(f) CONSTRUCTION. Interior and exterior doorways must be wide
enough to accommodate the mobility equipment used by the
residents such as wheelchairs and walkers. All interior and exterior
stairways must be unobstructed, equipped with handrails on both
sides, and appropriate to the condition of the residents. (See also
section (5)(q) of this rule).
(A) Buildings must be of sound construction with wall and
ceiling flame spread rates at least substantially comparable to
wood lath and plaster or better. The maximum flame spread
index of finished materials may not exceed 200 and the smoke
developed index may not be greater than 450. If more than 10
percent of combined wall and ceiling areas in a sleeping room
or exit way is composed of readily combustible material such as
acoustical tile or wood paneling, such material must be treated
with an approved flame retardant coating. Exception: Buildings
supplied with an approved automatic sprinkler system.
(i) MANUFACTURED HOMES. A manufactured home
(formerly mobile homes) must have been built since in
1976 or later and designed for use as a home rather than
a travel trailer. The manufactured home must have a
manufacturer's label permanently affixed on the unit itself
that states the manufactured home meets the
requirements of the Department of Housing and Urban
Development (HUD). The required label must read as
follows:
"As evidenced by this label No. ABC000001, the
manufacturer certifies to the best of the
manufacturer's knowledge and belief that this
mobile home has been inspected in accordance
with the requirements of the Department of Housing
and Urban Development and is constructed in
conformance with the Federal Mobile Home
Construction and Safety Standards in effect on the
date of manufacture. See date plate."
Page 68
(ii) If such a label is not evident and the licensee believes
the manufactured home meets the required
specifications, the licensee must take the necessary steps
to secure and provide verification of compliance from the
home's manufacturer.
(iii) Manufactured homes built since in 1976 or later meet
the flame spread rate requirements and do not have to
have paneling treated with a flame retardant coating.
(B) STRUCTURAL CHANGES. The licensee must notify the
local licensing authority, in writing, at least 15 calendar days
prior tobefore any remodeling, renovations, or structural
changes in the home that require a building permit. Such
activity must comply with local building, sanitation, utility, and
fire code requirements applicable to a single-family dwelling
(see ORS 443.760(1)). The licensee must forward all required
permits and inspections, an evacuation plan as described in
section (5)(l) of this rule, and a revised floor plan as described
in section (5)(o) of this rule, to the local licensing authority
within 30 calendar days of completion.
(g) FIRE EXTINGUISHERS. At least one fire extinguisher with a
minimum classification of 2-A:10-B:C must be mounted in a location
visible and readily accessible to any occupant of the home on each
floor, including basements. Fire extinguishers must be checked at
least once a year by a qualified person who is well versed in fire
extinguisher maintenance. All recharging and hydrostatic testing must
be completed by a qualified agency properly trained and equipped for
this purpose.
(h) CARBON MONOXIDE AND SMOKE ALARMS.
(A) CARBON MONOXIDE ALARMS. Carbon monoxide alarms
must be listed as complying with ANSI/UL 2034 and must be
installed and maintained in accordance with the manufacturer's
instructions. Carbon monoxide alarms must be installed within
15 feet of each bedroom at the height recommended by the
manufacturer.
Page 69
(i) If bedrooms are located in multi-level homes, carbon
monoxide alarms must be installed on each level,
including the basement.
(ii) Carbon monoxide alarms may be hard-wired, plug-in,
or battery operated. Hard wired and plug-in alarms must
be equipped with a battery back-up. Battery operated
carbon monoxide alarms must be equipped with a device
that warns of a low battery.
(iii) A bedroom used by a hearing-impaired occupant who
may not hear the sound of a regular carbon monoxide
alarm must be equipped with an additional carbon
monoxide alarm that has visual or vibrating capacity.
(B) SMOKE ALARMS. Smoke alarms must be installed in
accordance with the manufacturer's instructions in each
bedroom, in hallways or access areas that adjoin bedrooms,
the family room or main living area where occupants
congregate, any interior designated smoking area, and in
basements. In addition, smoke alarms must be installed at the
top of all stairways in multi-level homes.
(i) Ceiling placement of smoke alarms is recommended.
(ii) Battery operated smoke alarms or hard-wired smoke
alarms with a battery backup must be equipped with a
device that warns of a low battery.
(iii) A bedroom used by a hearing-impaired occupant who
may not hear the sound of a regular smoke alarm must be
equipped with an additional smoke alarm that has visual
or vibrating capacity.
(C) All carbon monoxide alarms and smoke alarms must
contain a sounding device or be interconnected to other alarms
to provide, when activateduated, an alarm that is audible in all
sleeping rooms. The alarms must be loud enough to wake
Page 70
occupants when all bedroom doors are closed. Intercoms and
room monitors may not be used to amplify alarms.
(D) The licensee must test all carbon monoxide alarms and
smoke alarms in accordance with the manufacturer’s
instructions at least monthly (per NFPA 72). Testing must be
documented in the facility records. The licensee must maintain
carbon monoxide alarms, smoke alarms, and fire extinguishers
in functional condition. If there are more than two violations in
maintaining battery operated alarms in working condition, the
Department may require the licensee to hard wire the alarms
into the electrical system.
(i) COMBUSTIBLES AND FIREARMS. Flammables, combustible
liquids, and other combustible materials must be safely and properly
stored in their original, properly labeled containers or safety
containers and secured in areas to prevent tampering by residents or
vandals.
(A) Oxygen and other gas cylinders in service or in storage,
must be adequately secured to prevent the cylinders from
falling or being knocked over.;
(B) No smoking signs must be visibly posted where oxygen
cylinders are present.;
(C) Firearms must be stored, unloaded, in a locked cabinet.
The firearms cabinet must be located in an area of the home
that is not accessible to the residents.; and
(D) Ammunition must be secured in a locked area separate
from the firearms.
(j) HAZARDOUS MATERIALS. Cleaning supplies, poisons,
insecticides, and other hazardous materials must be properly stored
in their original container, or in a container manufactured for the type
of product. The containers must be properly labeled and kept in a
safe area that is not accessible to residents, or near food preparation
areas, food storage areas, dining areas, or medications.
Page 71
(k) MEDICAL SHARPS. All sharps, including, but not limited to
needles and lancets, must be disposed of in approved sharps
containers. Sharps containers must:
(A) Be puncture-resistant;
(B) Be leak-proof;
(C) Be labeled or color-coded red to warn that the contents are
hazardous;
(D) Have a lid, flap, door, or other means of closing the
container and inhibits the ability to remove sharps from the
container;
(E) Not be overfilled;
(F) Be stored in an upright position in a secure location that is
not accessible to residents and not close to any food
preparation or food storage area; and
(G) Must be closed immediately once full and properly disposed
of within 10ten days, according to the home’s waste
management company’s or pharmacy’s instructions.
(l) EVACUATION PLAN. An emergency evacuation plan must be
developed and revised as necessary to reflect the current condition of
the residents in the home. The evacuation plan must be rehearsed
with all occupants.
(m) ORIENTATION TO EMERGENCY PROCEDURES. Within 24
hours of arrival, any new resident or caregiver must be shown how to
respond to a smoke alarm, shown how to participate in an emergency
evacuation drill, and receive an orientation to basic fire safety. New
caregivers must also be oriented in how to conduct an evacuation.
(n) EVACUATION DRILL. An evacuation drill must be held at least
once every 90 calendar days, with at least one evacuation drill per
year conducted during sleeping hours. The evacuation drill must be
Page 72
clearly documented, signed by the caregiver conducting the drill, and
maintained according to OAR 411-050-0645.
(A) The licensee and all other caregivers must:
(i) Be able to demonstrate the ability to evacuate all
occupants from the facility to the initial point of safety
within three minutes or less. The initial point of safety
must:
(I) Be exterior to and a minimum of 25 feet away
from the structure;
(II) Have direct access to a public sidewalk or street;
and
(III) Not be in the backyard of a home unless the
backyard has direct access to a public street or
sidewalk.
(ii) Be able to demonstrate the ability to further evacuate
all occupants from the initial point of safety to the final
point of safety within two minutes or less. The final point
of safety must be a minimum of 50 feet away from the
structure, and:
(I) Have direct access to a public sidewalk or street;
or
(II) Not be in the backyard of a home unless the
backyard has direct access to a public street or
sidewalk.
(B) Conditions may be applied to a license if the licensee or
caregivers demonstrate the inability to meet the evacuation
times described in this section. Conditions may include, but are
not limited to, reduced capacity of residents, additional staffing,
or increased fire protection. Continued problems are grounds
for revocation or non-renewal of the license.
Page 73
(o) FLOOR PLAN. The licensee must develop a current and accurate
floor plan that indicates:
(A) The size of rooms;
(B) Which bedrooms are to be used by residents, the licensee,
caregivers, and for day care, and room and board tenants, as
applicable;
(C) The location of all the exits on each level of the home,
including emergency exits such as windows;
(D) The location of wheelchair ramps;
(E) The location of all fire extinguishers, smoke alarms, and
carbon monoxide alarms;
(F) The planned evacuation routes, initial point of safety, and
final point of safety; and
(G) Any designated smoking areas in or on the adult foster
home's premises.
(p) RESIDENT PLACEMENT. A resident, who is unable to walk
without assistance or not capable of self-preservation, may not be
placed in a bedroom on a floor without a second ground level exit.
(See also section (4)(f) of this rule).
(q) STAIRS. Stairs must have a riser height of between 6 to 8 inches
and tread width of between 8 to 10.5 inches. Lifts or elevators are not
an acceptable substitute for a resident's capability to ambulate stairs.
(See also section (5)(f) of this rule).
(r) EXIT WAYS. All exit ways must be barrier free and the corridors
and hallways must be a minimum of 36 inches wide or as approved
by the State Fire Marshal or the State Fire Marshal's designee.
Interior doorways used by the residents must be wide enough to
accommodate residents' wheelchairs and walkers, and beds that are
used by residents and beds if used for evacuation purposes. Any
Page 74
bedroom window or door identified as an exit must remain free of
obstacles that would interfere with evacuation.
(s) RAMPS. There must be at least one wheelchair ramp from a
minimum of one exterior door if an occupant of the home is nonambulatory. Wheelchair ramps must comply with the U.S.
Department of Justice’s 2010 Americans with Disabilities Act (ADA)
Standards for Accessible Design
(http://www.ada.gov/2010ADAstandards_index.htm, Chapter 4,
Accessible Routes, Section 405, Ramps).
(t) EMERGENCY EXITS. There must be a second safe means of exit
from all sleeping rooms. A provider whose sleeping room is above the
first floor may be required to demonstrate at the time of licensure,
renewal, or inspection, an evacuation drillhow the premises will be
evacuated from the provider's sleeping room using the secondary
exit.
(u) FLASHLIGHT. There must be at least one plug-in, rechargeable
flashlight in good functional condition available on each floor of the
home for emergency lighting.
(v) SMOKING. If smoking is allowed in a home, Tthe licensee must
identify the home’s smoking policies in the home’s Residency
Agreement. If smoking is allowed in or on the premises of the home:
adopt house policies that restrict smoking to designated areas.
(A) The Residency Agreement must restrict smoking to
designated areas, and Smoking is prohibited smoking in:
(i) Any bedroom, including that of the residents, licensee,
resident manager, any other caregiver, occupant, or
visitor;
(ii) Any room where oxygen is used; and
(iii) Anywhere flammable materials are stored.
(B) Ashtrays of noncombustible material and safe design must
be provided in areas where smoking is permitted.
Page 75
(w) EMERGENCY PREPAREDNESS PLAN. A licensee must
develop and maintain a written emergency preparedness plan for the
protection of all occupants in the home in the event of an emergency
or disaster. Emergency supplies, consistent with the community
standards (including www.redcross.org/prepare/location/home-family)
must be kept current and readily available in the home.
(A) The written emergency plan must:
(i) Include an evaluation of potential emergency hazards
including, but not limited to:
(I) Prolonged power failure or water or sewer loss;
(II) Fire, smoke, or explosion;
(III) Structural damage;
(IV) Hurricane, tornado, tsunami, volcanic eruption,
flood, or earthquake;
(V) Chemical spill or leak; and
(VI) Pandemic.
(ii) Include an outline of the caregiver's duties during an
evacuation.;
(iii) Consider the needs of all occupants of the home
including, but not limited to:
(I) Access to medical records necessary to provide
services and treatment.;
(II) Access to pharmaceuticals, medical supplies,
and equipment during and after an evacuation; and.
(III) Behavioral support needs.
Page 76
(iv) Include provisions and supplies sufficient to shelter in
place for a minimum of three days without electricity,
running water, or replacement staff; and.
(v) Planned relocation sites.
(B) The licensee must notify the Department or the local
licensing authority of the home's status in the event of an
emergency that requires evacuation and during any emergent
situation when requested.
(C) The licensee must re-evaluate the emergency
preparedness plan at least annually and whenever there is a
significant change in the home.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
411-050-0655 Standards and Practices for Care and Services
(1) PRE-ADMISSION SCREENING AND ASSESSMENT.
(a) Prior toBefore admission, the licensee must conduct and
document a screening to determine if a prospective resident's care
needs exceed the license classification of the home. The screening
must:
(A) Evaluate the ability of the prospective resident to evacuate
the home within three minutes along with all the occupants of
the home;.
(B) Determine if the licensee and caregivers are able to meet
the prospective resident's needs in addition to meeting the
needs of the other residents of the home; and.
(C) Include medical diagnoses, medications, personal care
needs, nursing care needs, cognitive needs, communication
needs, night care needs, nutritional needs, activities, lifestyle
Page 77
preferences, and other information, as needed, to assure the
prospective resident's care needs shall be met.
(b) The screening process must include interviews with the
prospective resident and the prospective resident's family, prior care
providers, and case manager, as appropriate. The licensee must also
interview, as necessary, any physician, nurse practitioner, physician
assistant, registered nurse, pharmacist, therapist, or mental health or
other licensed health care professional involved in the care of the
prospective resident. A copy of the screening document must be:
(A) Given to the prospective resident or the prospective
resident's legal representative; and.
(B) Placed in the resident's record if admitted to the home; or
(C) Maintained for a minimum of three years if the prospective
resident is not admitted to the home.
(c) If the Department or AAA knows that a person who is on
probation, parole, or post-prison supervision after being convicted of
a sex crime as defined in ORS 181.805 is applying for admission to
an adult foster home, the Department or AAA shall notify the home of
the person’s status as a sex offender.
(d) The licensee may refuse to admit a person who is on probation,
parole, or post-prison supervision after being convicted of a sex crime
as defined in ORS 181.805.
(e) REQUIRED DISCLOSURES.
(A) The licensee must disclose the home’s policies and
practices to a prospective resident or the prospective resident’s
legal representative, as applicable. A copy of the home’s
current and approved Residency Agreement identifying the
home’s policies shall be provided to the prospective resident
and his or her representative. (See OAR 411-050-0615).,
including:
Page 78
(A) HOUSE POLICIES. The licensee must provide a copy of
the house policies and disclose any policies that may limit the
prospective resident's activities or preferences while living in
the adult foster home. Examples include, but are not limited to,
the use of tobacco or alcohol, pets, religious practices, dietary
restrictions, and the use of intercoms and monitors. The
licensee must disclose the home’s policy regarding the legal
presence and use of medical marijuana. (See OAR 411-0500645);
(B) CONTRACT. The licensee must provide a copy of any
contract a prospective resident or the prospective resident’s
legal representative may be asked to sign;
(C) MEDICAID ENROLLMENT STATUS. The licensee must
inform a prospective resident or the prospective resident’s
representative if the home serves individuals eligible for
Medicaid services; and
(BD) LONG-TERM CARE ASSESSMENT. The licensee must
inform a prospective private-pay resident or the prospective
resident's representative, if appropriate, of the availability of
long-term care assessment services provided through the
Department or a certified assessment program. The licensee
must document on the Department’s form (SDS 913) that the
prospective private-pay resident has been advised of the right
to receive a long-term care assessment. The licensee must
maintain a copy of the form in the resident’s record upon
admission and make a copy available to the Department upon
request.
(2) PRIOR TOBEFORE ADMISSION.
(a) The licensee must obtain and document general information
regarding a resident prior tobefore the resident's admission. The
information must include the names, addresses, and telephone
numbers of the resident's relatives, significant persons, case
managers, and medical or mental health providers. The information
must also include the date of admission and, if available, the
Page 79
resident's medical insurance information, birth date, prior living
facility, and mortuary.;
(b) Prior toBefore admission, the licensee must obtain and place in
the resident's record:
(A) Prescribing practitioner's written or verbal orders for
medications, treatments, therapies, and special diets, as
applicable. Any verbal orders must be followed with by written
orders within seven calendar days of the resident's admission.
Attempts to obtain written orders must be documented in the
resident’s record.;
(B) Prescribing practitioner or pharmacist review of the
resident's preferences for over-the-counter medications and
home remedies; and.
(C) Any medical information available, including the resident's
history of accidents, illnesses, impairments, or mental status
that may be pertinent to the resident's care.
(c) The licensee must ask for copies of the resident's Advance
Directive, Physician’s Order for Life Sustaining Treatment (POLST),
and proof of court-appointed guardianship or conservatorship, if
applicable. Copies of these documents must be placed in a prominent
place in the resident’s record and sent with the resident if the resident
is transferred for medical care.;
(d) The licensee must provide written information to the resident or
the resident's representative about the resident's right to make
decisions concerning Advance Directives and the resident's right to
accept or refuse medical care. The licensee must provide:
(A) A written copy of the adult foster home's policies regarding
implementation of Advance Directives; and
(B) A clear and precise statement of limitation if the licensee is
not able to implement an Advance Directive on the basis of
conscience that includes:
Page 80
(i) Identification of the state legal authority under ORS
127.625 permitting a conscientious objection; and
(ii) Descriptions of medical conditions or procedures
affected by the licensee's conscientious objection.
(de) The licensee must review the Resident’s’ Bill of Rights and the
home’s current Residency Agreement house policies with the
resident and the resident's legal representative, as appropriate.
These reviews discussion must be documented by having the
resident, or the resident’s representative, sign and date a copy of the
Residency Agreement house policies that have been approved by the
local licensing authority and the current Resident’s' Bill of Rights
(form SDS 305A). A copy of the signed and dated house
policiesResidency Agreement and Residents’ Bill of Rights must be
maintained in the resident’s record.
(3) SCREENING PRIOR TOBEFORE RE-ADMISSION. When a resident
temporarily leaves the home including, but not limited to, a resident’s
hospitalization, the licensee shall conduct the necessary elements of the
pre-admission and screening assessment requirements, and document
those findings to:
(a) Determine whether readmission to the home is appropriate for the
classification of the home.;
(b) Determine whether the licensee can continue to meet the
resident’s care and safety needs in addition to those of the other
residents.;
(c) Demonstrate compliance with these rules.; and
(d) If applicable, demonstrate the basis for refusing the resident’s readmission to the home according to OAR 411-050-0645 (11).
(4) CARE PLAN.
(a) During the initial 14 calendar days following the resident's
admission to the home, the licensee must continue to assess and
document the resident's preferences and care needs. The
Page 81
assessment and care plan must be completed by the licensee and
documented within the initial 14-day period. The care plan must
describe the resident's needs, preferences, and capabilities, and
what assistance the resident requires for various tasks, and must
include:. The resident's care plan must also include:
(A) By whom, when, and how often care and services shall be
provided;
(B) The resident's ability to perform activities of daily living
(ADLs);
(C) Special equipment needs;
(D) Communication needs (examples may include, but are not
limited to, hearing or vision needs, such as eraser boards or
flash cards, or language barriers, such as sign language or
non-English speaking);
(E) Night needs;
(F) Medical or physical health problems, including physical
disabilities, relevant to care and services;
(G) Cognitive, emotional, or other impairments relevant to care
and services;
(H) Treatments, procedures, or therapies;
(I) Registered nurse consultation, teaching, delegation, or
assessment;
(J) Behavioral interventions;
(K) Social, spiritual, and emotional needs, including lifestyle
preferences, activities, and significant others involved;
(L) The ability to exit in an emergency, including assistance and
equipment needed;
Page 82
(M) Any use of physical restraints or psychoactive medications;
and
(N) Dietary needs and preferences.
(b) The licensee must review and update each resident's care plan
every six months and when a resident's condition changes. The
review must be documented in the resident's record at the time of the
review and include the date of the review and the licensee's
signature. If a care plan contains many changes and becomes less
legible, a new care plan must be written.
(b) Effective July 1, 2016, the licensee must identify any individuallybased limitations to the following freedoms on the Department’s
Individual Consent to HCBS Limitations form:
(A) Support to access to food at any time;
(B) Visitors of the resident’s choosing at any time;
(C) A lock on the resident’s bedroom, lockable by the resident;
(D) Choice of a roommate, if sharing a bedroom;
(E) Support to furnish and decorate the resident’s bedroom as
the resident chooses;
(F) Freedom and support to control the resident’s schedule and
activities; and
(G) Privacy in the resident’s bedroom.
(c) Effective July 1, 2016, a limitation to any freedom in (b) of this rule
must be supported by a specific assessed need due to threats to the
health and safety of the resident or others. For Medicaid-eligible
residents, the person-centered service plan coordinator must
authorize the limitation and the individual must consent to the
limitation. The licensee must incorporate and document all applicable
elements identified in OAR 411-004-0040, including:
Page 83
(A) The specific and individualized assessed need justifying the
limitation.
(B) The positive interventions and supports used before any
limitation.
(C) Less intrusive methods that have been tried, but did not
work.
(D) A clear description of the condition that is directly
proportionate to the specific assessed need.
(E) Regular reassessment and review to measure the ongoing
effectiveness of the limitation.
(F) Established time limits for periodic review of the limitation to
determine if the limitation should be terminated or remains
necessary. The limitation must be reviewed at least annually.
(G) The informed consent of the resident or, as applicable, the
legal representative of the resident, including any discrepancy
between the wishes of the resident and the consent of the legal
representative.
(H) An assurance that the interventions and support do not
cause harm to the individual.
(d) Limitations are not transferable between care settings. Continued
need for any limitation at the new care setting must comply with the
requirements as stated in OAR 411-050-0655.
(e) The licensee must review and update each resident’s care plan
every six months and when a resident’s condition changes. The
review must be documented in the resident’s record at the time of the
review and include the date of the review and the licensee’s
signature. If a care plan contains many changes and becomes less
legible, a new care plan must be written.
(5) PERSON-CENTERED SERVICE PLAN. A Medicaid-eligible resident’s
case manager will complete a person-centered service plan, pursuant to
Page 84
OAR 411-004-0030. The licensee must incorporate all applicable elements
identified in the person-centered service plan that the provider is
responsible for implementing.
(a) The licensee must notify the resident’s case manager in the event
a review and change or removal of an existing limitation is warranted,
and when a new limitation is supported by a specific assessed need.
(A) All attempts to notify the resident’s case manager about a
review to change, remove, or add a limitation must be
documented, and available in the resident’s record.
(B) The licensee will not be held responsible for any failure on
the case manager’s part to conduct a review of current
limitations or to complete the person-centered service plan.
(b) Providers may assist non-Medicaid residents in developing a
person-centered service plan when no alternative resources are
available.
(65) REGISTERED NURSE CONSULTATION.
(a) RN CONSULTATION AND ASSESSMENT. A licensee must
obtain a medical professional consultation and assessment to meet
the care needs of a resident as required in these rules. A registered
nurse consultation must be obtained when a skilled nursing care task,
as defined by the Oregon State Board of Nursing, has been ordered
by a physician or other licensed health care professional.
(b) A licensee must also request a registered nurse consultation
under the following conditions:
(A) When a resident has a health concern or behavioral
symptoms that may benefit from a nursing assessment and
provider education.;
(B) When written parameters are needed to clarify a prescribing
practitioner p.r.n. order for medication and treatment (See
section (76)(g) of this rule).;
Page 85
(C) Prior to Before the use of physical restraints when not
assessed, taught, and reassessed, according to section (76)(o)
of this rule, by a physician, nurse practitioner, physician
assistant, Christian Science practitioner, mental health clinician,
physical therapist, or occupational therapist.;
(D) Prior toBefore requesting psychoactive medications to treat
behavioral symptoms or the use of new psychoactive
medications when not assessed, taught, and reassessed
according to section (76)(h) of this rule, by a physician, nurse
practitioner, physician assistant, or mental health practitioner.;
and
(E) When care procedures are ordered that are new for a
resident, the licensee, or other caregivers.
(c) RN DELEGATIONS. A registered nurse may determine a nursing
care task be taught utilizing the delegation process. RN delegations
are not transferable to other residents or caregivers. (Refer to OAR
chapter 851, division 047).
(d) Documentation of nurse consultations, delegations, assessments,
and reassessments must be maintained in the resident’s record and
made available to the Department upon request.
(76) STANDARDS FOR MEDICATIONS, TREATMENTS, AND
THERAPIES.
(a) MEDICATIONS. The licensee and caregivers must demonstrate
an understanding of each resident's medication administration
regimen. Medication resource material must be readily available at
the home and include the reason a medication is used, any specific
instructions, the medication's actions, and common side effects.
(b) WRITTEN ORDERS. The licensee must obtain and place a
signed order in the resident's record for any medications, dietary
supplements, treatments, or therapies that have been ordered by a
prescribing practitioner. The written orders must be carried out as
prescribed unless the resident or the resident's legal representative
Page 86
refuses to consent. The prescribing practitioner must be notified if the
resident refuses to consent to an order.
(A) CHANGED ORDERS. Changes to a written order may not
be made without a prescribing practitioner order. The
prescribing practitioner must be notified if the resident refuses
to consent to the change order. Changes to medical orders
obtained by telephone must be followed-up with signed orders
within seven calendar days. Changes in the dosage or
frequency of an existing medication require a new properly
labeled and dispensed medication container. If a new properly
labeled and dispensed medication container is not obtained, the
change must be written on an auxiliary label attached to the
medication container, not to deface the existing original
pharmacy label, and must match the new medication order.
Attachment of the auxiliary label must be documented in the
residents’ record. (See section (76)(f)(D) of this rule).
(B) DOCUMENTATION OF CHANGED ORDERS. Attempts to
obtain the signed written changes must be documented and
readily available for review in the resident's record. The
resident’s medications, including medications that are
prescribed, over-the-counter medications, and home remedies,
must be reviewed by the resident's prescribing practitioner or
pharmacist at least annually. The review must be in writing,
include the date of the review, and contain the signature of the
prescribing practitioner or a pharmacist.
(c) MEDICATION SUPPLIES. The licensee must have all currently
prescribed medications, including p.r.n. medications, and all
prescribed over-the-counter medications available in the home for
administration. Refills must be obtained prior tobefore depletion of
current medication supplies. Attempts to order refills must be
documented in the resident’s record.
(d) HEALTH CARE PROFESSIONAL ORDERS (IMPLEMENTED BY
AFH STAFF). The licensee who implements a hospice, home health,
or other licensed medical professional-generated order must:
Page 87
(A) Have a copy of the hospice, home health, or licensed
medical professional document that communicates the written
order.;
(B) Transcribe the order onto the medication administration
record (MAR).;
(C) Implement the order as written; and.
(D) Include the order on subsequent medical visit reports for the
prescribing practitioner to review.
(e) HOSPICE AND HOME HEALTH ORDERS (IMPLEMENTED BY
NON-AFH STAFF). A licensee must allow a resident to receive
hospice services. The licensee who provides adult foster home
services to a recipient of hospice or home health services, but who
does not implement a hospice or home health-generated order must:
(A) Have a copy of the hospice or home health document that
communicates the written order; and
(B) Include the order on subsequent medical visit reports for the
prescribing practitioner to review.
(f) MEDICATION ADMINISTRATION RECORD (MAR). A current,
written medication administration record (MAR) must be kept for each
resident and must:
(A) List the name of all medications administered by a
caregiver, including over-the-counter medications and
prescribed dietary supplements. The MAR must identify the
dosage, route, and the date, and time each medication and
supplement is to be given.;
(B) Identify any treatments and therapies administered by a
caregiver. The MAR must indicate the type of treatment or
therapy and the time the procedure must be performed.;
(C) Be immediately initialed by the caregiver administering the
medication, treatment, or therapy as it is completed. A
Page 88
resident's MAR must contain a legible signature that identifies
each set of initials.;
(D) Document changed and discontinued orders immediately
showing the date of the change or discontinued order. A
changed order must be written on a new line with a line drawn
to the start date and time.; and
(E) Document missed or refused medications, treatments, or
therapies. If a medication, treatment, or therapy is missed or
refused by the resident, the initials of the caregiver
administering the medication, treatment, or therapy must be
circled, and a brief, but complete, explanation must be recorded
on the back of the MAR.
(g) P.R.N. MEDICATIONS. Prescription medications ordered to be
given "as needed" or "p.r.n." must have specific parameters indicating
what the medication is for and specifically when, how much, and how
often the medication may be administered. Any additional instructions
must be available for the caregiver to review before the medication is
administered to the resident.
(A) P.R.N. DOCUMENTATION. As needed (p.r.n) medications
must be documented on the resident’s MAR with the time,
dose, the reason the medication was given, and the outcome.
(B) P.R.N. ADVANCE SET-UP. As needed (p.r.n.) medications
may not be included in any advance set-up of medication.
(h) PSYCHOACTIVE MEDICATIONS.
(A) A licensee is not required to request an evaluation of a
resident's use of a psychoactive medication if the resident is
admitted to the home and the resident has been prescribed the
psychoactive medication for a condition that is currently
monitored by a physician, nurse practitioner, physician
assistant, or mental health professional and the written order for
the psychoactive medication is in the resident’s record.
Page 89
(B) If a resident is admitted to a home with no documented
history as to the reason for taking a psychoactive medication, or
if the licensee requests medical professional intervention to
address behavioral symptoms, the licensee must request a
physician, nurse practitioner, physician assistant, or mental
health professional evaluate the resident's need for the
psychoactive medication and the intended effect of the
medication, common side effects, and circumstances for
reporting. The evaluation request must be documented in the
resident’s record and include:
(i) A probable cause of the resident's behavior.;
(ii) Behavioral and environmental interventions to be used
instead of or in addition to psychoactive medication, if
applicable. Alternative interventions must be tried as
instructed by a licensed medical professional and the
resident’s response to the alternative interventions must
be documented in the resident’s record prior tobefore
administering a psychoactive medication; and.
(iii) A plan for reassessment by the resident’s prescribing
physician, nurse practitioner, physician assistant, or
mental health professional.
(C) The prescription and order for a psychoactive medication
must specify the dose, frequency of administration, and the
circumstance for use (i.e., specific symptoms). The licensee
and all caregivers must be aware of and comply with these
parameters.
(D) The licensee and all caregivers must know the intended
effect of a psychoactive medication for a particular resident and
the common side effects, as well as the circumstances for
reporting to the resident's physician, nurse practitioner,
physician assistant, or mental health professional.
(E) The resident's care plan must identify and describe the
behavioral symptoms for which psychoactive medications are
Page 90
prescribed for and a list of all interventions, including
behavioral, environmental, and medication.
(F) Psychoactive medications must never be given to discipline
a resident or for the convenience of the caregivers.
(i) MEDICATION CONTAINERS AND STORAGE.
(A) MEDICATION CONTAINERS. Each of the resident's
prescribed medication containers, including bubble packs, must
be clearly labeled by the pharmacy. All medications, including
over-the-counter medications, must be in the original container.
Medications stored in advanced set up containers are required
to be labeled as described in these rules.
(B) OVER-THE-COUNTER PRODUCTS. Over-the-counter
products such as medications, vitamins, and supplements
purchased for a specific resident’s use must be marked with the
resident's name. Over-the-counter items in stock bottles (with
original labels) may be used for multiple residents in the home
and must be clearly marked as the house supply.
(C) STORAGE OF RESIDENT MEDICATION. All resident
medications, including over-the-counter medications, must be
kept in a locked, central location that is cool, clean, dry, not
subject to direct sunlight, and separate from medications
belonging to the licensee, caregivers, and all other nonresidents. Medications requiring refrigeration must also be
locked and stored separately from non-resident medications.
(D) STORAGE OF NON-RESIDENT MEDICATION. All nonresident medications must be kept locked and separate from
resident medications. Residents shall not have access to
medications belonging to the licensee, caregivers, other
household members, or pets.
(j) DISPOSAL OF MEDICATION. Outdated, discontinued, recalled, or
contaminated medications, including over-the-counter medications,
may not be kept in the home and must be disposed of within 10
calendar days of expiration, discontinuation, or the licensee’s
Page 91
knowledge of a recall or contamination. A licensee must contact the
local DEQ waste management company in their the home's area for
instructions on proper disposal of unused or expired medications.
(k) DOCUMENTATION OF DISPOSAL. The disposal of a resident's
medication must be documented in the resident’s record and the
documentation must be readily available in the resident's record.
(A) The disposal of a controlled substance must be
documented in the resident’s record and the disposal must be
witnessed by a caregiver who is 18 years of age or older.
(B) Documentation regarding the disposal of medications and
controlled substances must include:
(i) The date of disposal.;
(ii) Description of the medication, (i.e., name, dosage, and
amount being disposed).;
(iii) Name of the resident for whom the medication was
prescribed.;
(iv) Reason for disposal.;
(v) Method of disposal.;
(vi) Signature of the person disposing of the medication;
and.
(vii) For controlled substances, the signature of the
caregiver who witnessed the disposal according to this
rule.
(l) ADVANCED SET-UP. The licensee may set-up each resident's
medications for up to seven calendar days in advance (excluding
p.r.n. medications) by using a closed container manufactured for the
advanced set-up of medications. If used, each resident must have his
or her own container with divisions for the days of the week and times
of the day the medications are to be given. The container must be
Page 92
clearly labeled with the resident's name, name of each medication,
time to be given, dosage, amount, route, and description of each
medication. The container must be stored in the locked area with the
residents' medications.
(m) SELF-ADMINISTRATION OF MEDICATION. A licensee must
have a prescribing practitioner written order of approval for a resident
to self-medicate. A resident able to handle his or her own medical
regimen may keep their his or her medications in their his or her own
room in a lockable storage area or device. Medications must be kept
locked except those medications on the residents’ own person. The
licensee must notify the prescriber of the medication if the resident
shows signs of no longer being able to self-medicate safely.
(n) INJECTIONS. Subcutaneous, intramuscular, and intravenous
injections may be self-administered by a resident if the resident is
fully independent in the task or may be administered by a relative of
the resident or an Oregon licensed registered nurse (RN). An Oregon
licensed practical nurse (LPN) may give subcutaneous and
intramuscular injections. A caregiver who has been delegated and
trained by a registered nurse under provision of the Oregon State
Board of Nursing (OAR 851-047-0000 to 851-047-0040) may give
subcutaneous injections. Intramuscular and intravenous injections
may not be delegated. (See OAR 411-050-0650 (5) for storage and
disposal requirements of sharps, including, but not limited to used
needles and lancets).
(o) PHYSICAL RESTRAINTS. Physical restraints may only be used
when required to treat a resident’s medical symptoms or to maximize
a resident’s physical functioning. Physical restraints may only be
used after a written assessment is completed as described below and
all alternatives have been exhausted. Licensees and caregivers may
use physical restraints in adult foster homes only in compliance with
these rules, including the Resident’s’ Bill of Rights listed in section
(98) of this rule. Prior toBefore the use of any type of physical
restraint, the following must be completed:
(A) ASSESSMENT. A written assessment must be obtained
from the resident’s physician, nurse practitioner, physician
assistant, registered nurse, Christian Science practitioner,
Page 93
mental health clinician, physical therapist, or occupational
therapist that includes consideration of all other alternatives.
(B) ORDERS. If it is determined that a physical restraint is
necessary following the assessment and trial of other
measures, the least restrictive restraint must be used and as
infrequently as possible. The licensee must obtain a written
order from the resident’s physician, nurse practitioner,
physician assistant, or Christian Science practitioner prior
tobefore the use of a physical restraint. The written order must
include specific parameters, including the type of physical
restraint, circumstances for use, and duration of use, including:
(i) Procedural guidance for the use of the physical
restraint.;
(ii) The frequency for reassessment.;
(iii) The frequency and procedures for nighttime use; and.
(iv) Dangers and precautions for using the physical
restraint.
(C) Physical restraints may not be used on an as needed
(p.r.n.) basis in an adult foster home.
(D) CONSENT. Physical restraints must not be used without
first obtaining the written consent of the resident or the
resident’s legal representative.
(E) DOCUMENTATION. If it is determined a physical restraint is
necessary following the assessment and trial of other
measures, the written order for the use of a physical restraint
must be documented in the resident’s care plan explaining why
and when the restraint is to be used, along with instructions for
periodic release. Any less restrictive, alternative measures
planned during the assessment, and cautions for maintaining
the resident's safety while restrained, must also be recorded in
the resident's care plan. The resident’s record must include:
Page 94
(i) The completed assessment as described in this rule.;
(ii) The written order authorizing the use of the physical
restraint from the resident’s physician, nurse practitioner,
physician assistant, or Christian Science practitioner.;
(iii) Written consent of the resident or the resident’s legal
representative to use the specific type of physical
restraint.; and
(iv) The reassessments completed by a medical
professional as described above in subsection (B) of this
rule.
(F) DAYTIME USE. A resident physically restrained during
waking hours must have the restraints released at least every
two hours for a minimum of 10 minutes and be repositioned,
offered toileting, and provided exercise or range-of-motion
exercises during this period. The use of restraints, restraint
release, and activities that occurred during the release period
must be documented in the resident's record.
(G) NIGHTTIME USE. The use of physical restraints at night is
discouraged and must be limited to unusual circumstances. If
used, the restraint must be of a design to allow freedom of
movement with safety. The frequency of night monitoring to
address resident safety and care needs must be determined in
the assessment. Tie restraints of any kind must not be used to
keep a resident in bed.
(H) If any physical restraints are used in an adult foster home,
the restraints must allow for quick release at all times. Use of
restraints may not impede the three-minute evacuation of all
occupants of the home.
(I) Physical restraints may not be used for the discipline of a
resident or for the convenience of the adult foster home.
(87) RESIDENT CARE.
Page 95
(a) Care and supervision of residents must be in a home-like
atmosphere. The training of the licensee and caregivers and care and
supervision of residents must be appropriate to the age, care needs,
and conditions of the residents in the home. Additional staff may be
required if, for example, day care individuals are in the home or if
necessary to safely evacuate the residents and all occupants from
the home as required by OAR 411-050-0650.
(b) If a resident has a medical regimen or personal care plan
prescribed by a licensed health care professional, the provider must
cooperate with the plan and ensure the plan is implemented as
instructed.
(c) NOTIFICATION. The licensee must notify emergency personnel,
the resident’s physician, nurse practitioner, physician assistant,
registered nurse, family representative, and case manager, as
applicable, under the following circumstances:
(A) EMERGENCIES (MEDICAL, FIRE, POLICE). In the event
of an emergency, the licensee or caregiver with the resident at
the time of the emergency must first call 911 or the appropriate
emergency number for their home’s community. This does not
apply to a resident with a medical emergency who practices
Christian Science.;
(i) If a resident is receiving hospice services, the
caregivers must follow the written instructions for medical
emergencies from the hospice nurse.
(ii) If a resident has a completed Physician’s Orders for
Life-Sustaining Treatment (POLST) or other legal
documents, such as an Advance Directive or Do Not
Resuscitate (DNR) order, copies of the documents must
be made available to the emergency personnel when they
arrive.
(B) HOSPITALIZATION. In the event the resident is
hospitalized.;
Page 96
(C) HEALTH STATUS CHANGE. When the resident’s health
status or physical condition changes; and.
(D) DEATH. Upon the death of the resident.
(d) The licensee shall not inflict, or tolerate to be inflicted, abuse or
punishment, financial exploitation, or neglect of the residents.
(e) The licensee must exercise reasonable precautions against any
conditions that may threaten the health, safety, or welfare of the
residents.
(f) A qualified caregiver must always be present and available at the
home when a resident is in the home. A resident may not be left in
charge in lieu of a caregiver.
(g) ACTIVITIES. The licensee must make available at least six hours
of activities per week that are of interest to the residents, not
including television and movies. Information regarding activity
resources is available from the local licensing authority. Activities
must be oriented to individual preferences as indicated in the
resident's care plan (See section (4) of this rule). Documentation of
the activities offered to each resident and the resident's participation
in those activities must be recorded in the resident's records.
(h) DAY CARE. Prior toBefore the admission of each day care
individual, the licensee must:
(A) Conduct and document a screening as described in section
(1)(a) of this rule;.
(B) Obtain current medical professional orders as described in
section (76) of this rule, if medications are to be administered
and the necessary delegations, as applicable; and.
(C) Develop and maintain a current, written medication
administration record (MAR) as described in section (76) of this
rule, if medications are to be administered.
Page 97
(i) DIRECT INVOLVEMENT OF CAREGIVERS. The licensee or
caregivers must be directly involved with the residents on a daily
basis. If the physical characteristics of the adult foster home do not
encourage contact between the caregivers and residents and among
residents, the licensee must demonstrate how regular positive
contact occurs.
(j) RESIDENT MONEY. If the licensee manages or handles a
resident's money, a separate account record must be maintained in
the resident's name. The licensee may not under any circumstances
commingle, borrow from, or pledge any of a resident's funds. The
licensee may not act as a resident’s guardian, conservator, trustee, or
attorney-in-fact unless related by birth, marriage, or adoption to the
resident as follows: parent, child, brother, sister, grandparent,
grandchild, aunt, uncle, niece, or nephew. Nothing in this rule may be
construed to prevent the licensee or the licensee’s employee from
acting as a representative payee for the resident. (See also OAR
411-020-0002 and ORS 127.520).
(A) Personal incidental funds (PIF) for individuals eligible for
Medicaid services must be used at the discretion of the
individual for such things as clothing, tobacco, and snacks (not
part of daily diet).
(B) The licensee and other caregivers may not accept gifts from
the residents through undue influence or accept gifts of
substantial value. Caregivers and family members of the
caregivers may not accept gifts of substantial value or loans
from the resident or the resident's family. The licensee or other
caregivers may not influence, solicit from, or suggest to any of
the residents or the residents' legal representatives that the
residents or the residents' legal representatives give the
caregiver or the caregiver's family money or property for any
purpose.
(C) The licensee may not subject the resident or the resident’s
representative to unreasonable rate increases.
(k) The licensee and other caregivers may not loan money to the
residents.
Page 98
(98) RESIDENT’S' BILL OF RIGHTS.
(a) Resident’s Bill of Rights. The licensee, the licensee's family, and
employees of the home must guarantee not to violate these rights
and to help the residents exercise them. The Residents' Bill of Rights
provided by the Department must be explained and a copy given to
each resident at the time of admission. The Residents’ Bill of Rights
states each resident has the right to:
(Aa) Be treated as an adult with respect and dignity.;
(Bb) Be informed of all resident rights and all house policies as
written in the Residency Agreement.;
(Cc) Be encouraged and assisted to exercise constitutional and
legal rights, including the right to vote.;
(Dd) Be informed of his or hertheir medical condition and the
right to consent to or refuse treatment.;
(Ee) Receive appropriate care, services, and prompt medical
care as needed.;
(Ff) Be free from abuse.;
(Gg) Complete privacy when receiving treatment or personal
care.;
(Hh) Associate and communicate privately with any person of
choice and send and receive personal mail unopened.;
(Ii) Have access to, and participate in, activities of social,
religious, and community groups.;
(Jj) Have medical and personal information kept confidential.;
(Kk) Keep and use a reasonable amount of personal clothing
and belongings, and to have a reasonable amount of private,
secure storage space.;
Page 99
(Ll) Be free from chemical and physical restraints except as
ordered by a physician or other qualified practitioner. Restraints
are used only for medical reasons, to maximize a resident's
physical functioning, and after other alternatives have been
tried. Restraints are not to be used for discipline or
convenience.;
(Mm) Manage his or her their own financial affairs unless legally
restricted.;
(Nn) Be free from financial exploitation. The licensee may not
charge or ask for application fees or non-refundable deposits or
solicit, accept, or receive money or property from a resident
other than the amount agreed to for services.;
(Oo) A written agreement regarding services to be provided and
the rates to be charged. The licensee must give 30 days' written
notice before any change in the rates or the ownership of the
home.;
(Pp) Not be transferred or moved out of the adult foster home
without 30 calendar days' written notice and an opportunity for a
hearing. A licensee may transfer a resident only for medical
reasons, for the welfare of the resident or other residents, or for
nonpayment.;
(Qq) A safe and secure environment.;
(Rr) Be free of discrimination in regard to race, color, national
origin, gender, sexual orientation, or religion;.
(Ss) Make suggestions or complaints without fear of retaliation.;
and
(Tt) Be free of discrimination in regard to the execution of an
Advance Directive, Physician's Order for Life-Sustaining
Treatment (POLST), or Do Not Resuscitate (DNR) orders.
Page 100
(b) Effective January 1, 2016 for providers initially licensed after January 1,
2016, and effective no later than September 1, 2018 for providers initially
licensed before January 1, 2016 the following additional rights may not be
violated or limited, without prior consent from the person-centered service
plan coordinator, the individual, and the individual's representative, if
applicable:
(A) To live under a legally enforceable Residency Agreement
with protections substantially equivalent to landlord tenant laws.
(B) The freedom and support to access food at any time.
(C) To have visitors of the resident’s choosing at any time.
(D) To have a lockable door in the resident’s bedroom, which
may be locked by the resident.
(E) To choose a roommate when sharing a bedroom.
(F) To furnish and decorate the resident’s bedroom according
to the Residency Agreement.
(G) The freedom and support to control the resident’s schedule
and activities.
(H) To privacy in the resident’s bedroom.
(10) INDIVIDUALLY-BASED LIMITATIONS. This section and (11) of this
rule will become effective on July 1, 2016.
(a) Individual limitations must be supported by a specific assessed
need. A limitation may be implemented only with the informed
consent of the resident, or the resident’s legal representative.
Limitations may only be considered to the rights identified in (9)(b) of
this rule.
(b) Limitations are not transferable between care settings.
Page 101
(11) REQUIRED DOCUMENTATION FOR INDIVIDUALLY-BASED
LIMITATIONS. Each limitation under consideration must be documented on
the Department-approved consent form. Documentation must include:
(a) The reason the limitation is needed.
(b) The positive interventions and supports used before any
individually-based limitation.
(c) Less intrusive methods that were tried before and did not work.
(d) A clear description of how the limitation supports the assessed
need of the resident.
(e) A way to regularly measure if the limitation is working.
(f) When the limitation will be reviewed or removed.
(g) Informed consent from the resident or resident’s legal
representative, including any discrepancy between the wishes of the
individual and the consent of the legal representative.
(h) An assurance that the limitation will not be harmful to the resident.
Stat. Auth.: ORS 127.520, 410.070, 441.373, 443.001, 443.004, 443.725,
443.730, 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001- to 443.004, 443.705- to 443.825,
443.875, 443.991, 443.373
411-050-0662 Qualifications and Requirements for Limited Adult
Foster Homes
(1) To qualify for a limited adult foster home license the applicant or
licensee must submit:
(a) A completed application for initial or renewal limited licenses.;
(b) The Department’s Health History and Physician's or Nurse
Practitioner's Statement that indicates the applicant or licensee is
physically, cognitively, and emotionally capable of providing care to a
Page 102
specific adult who is older or who has a physical disability and with
whom the applicant has an established relationship of not less than
one year. The Health History and Statement must be submitted
initially and every third year or sooner if there is reasonable cause for
health concerns.;
(c) Documentation of the initiation of a background check or copy of
an approved background check for each subject individual.;
(d) Completion of the Department’s Caregiver Preparatory Training
Study Guide (DHS 9030) and Workbook (DHS 9030-W).; and
(e) A $20 non-refundable fee. If the licensee requests and is granted
a variance from the capacity limitation of one resident, a $20 per bed
non-refundable fee for each non-relative resident is required.
(2) The applicant or licensee must demonstrate a clear understanding of
the resident's care needs.
(3) The applicant or licensee must live in the home that is to be licensed.
(4) The applicant or licensee must own, rent, or lease the home wherein
which care is being provided. The applicant or licensee must provide
verification of proof of ownership or a copy of the signed and dated rental
or lease agreement as applicable.
(5) A caregiver must be available at all times, 24 hours a day, 7 seven days
a week, when the resident is in the home. The caregiver must have the
knowledge and ability to meet the resident’s care needs. All caregivers
must:
(a) Have an approved background check according to the Criminal
Records and Abuse Check rules (OAR 407-007-0200 through 407007-0370) prior tobefore working in the home.;
(b) Complete the Department’s Caregiver Preparatory Training Study
Guide (DHS 9030) and Workbook (DHS 9030-W).; and
(c) Be at least 18 years of age.
Page 103
(6) The licensee must notify the local licensing authority if the licensee shall
be absent from the home 10 days or more and the resident shall be
remaining in the home during the absence. The licensee must also submit
a staffing plan to the local licensing authority demonstrating coverage
during the absence that meets the needs of the resident.
(7) The resident's bedroom must be in close enough proximity to the
licensee or caregiver in charge to alert him or her to nighttime needs or
emergencies, or the bedroom must be equipped with a functional call bell
or intercom within the resident’s abilities to operate.
(8) The licensee and caregiver must have a complete understanding of the
resident’s medications. The licensee must have a copy of current
prescribing practitioner orders including, if applicable, written authorization
for self-administration of medications.
(9) Medications must be stored in their original labeled container except
when stored in a 7seven-day closed container manufactured for advanced
set-up of medications.
(10) The licensee and caregiver must place used, disposable syringes and
needles, and other sharp items in a puncture-resistant, red container
designed for disposal of sharp items. Disposal must be according to local
regulations as stated in section 411-050-0655(6). (See ORS 459.386through 459.405).
(11) The licensee, the licensee’s family, and employees of the home must
guarantee not to violate the Resident’s’ Bill of Rights as outlined in OAR
411-050-0655.
(12) The licensee must have a copy of any Advance Directive, Physician
Order for Life-Sustaining Treatment (POLST), and Do Not Resuscitate
(DNR) orders.
(13) The home must have a working landline and corded telephone. If the
licensee has a caller identification service on the home number, the
blocking feature must be disabled to allow incoming calls to be received
unhindered. Voice over internet protocol (VoIP), voice over broadband
(VoBB), or cellular telephone service may not be used in place of a
landline.
Page 104
(14) CONSTRUCTION. Interior and exterior doorways used by a resident
must be wide enough to accommodate wheelchairs and walkers if used by
the resident. Interior and exterior stairways must be unobstructed,
equipped with handrails, and appropriate to the condition of the resident.
(15) Hardware for all exit doors and interior doors must be readily visible
and have simple hardware that may not be locked against exit and must
have an obvious method of operation. Bedrooms for all residents must
have a lockable door for the resident’s privacy, as stated in OAR 411-0500650. The locking device must release by a single-action on the inside of
the room and open to a hall or common-use room. The resident shall be
provided a key to the lock for his or her bedroom. A master key to the
resident’s door locks must be quickly available to the licensee and all other
caregivers in the home. Providers licensed before January 1, 2016, have
until September 1, 2018 to fully implement this requirement. Hasps, sliding
bolts, hooks and eyes, slide chain locks, and double key deadbolts are not
permitted. If a home has a resident with impaired judgment who is known to
wander away, the home must have an activated alarm system to alert a
caregiver of the resident’s unsupervised exit.
(16) Buildings must be of sound construction with wall and ceiling flame
spread rates at least substantially comparable to wood lath and plaster or
better. The maximum flame spread of finished materials may not exceed
200 and the smoke developed index may not be greater than 450. If more
than 10 percent of combined wall and ceiling areas in a sleeping room or
exit way is composed of readily combustible material such as acoustical tile
or wood paneling, such material must be treated with an approved flame
retardant coating. Exception: Buildings supplied with an approved
automatic sprinkler system.
(a) MANUFACTURED HOMES. Manufactured home (formerly mobile
homes) units must have been built since in 1976 or later and
designed for use as a home rather than a travel trailer. The unit must
have a manufacturer's label permanently affixed on the unit itself that
states the unit meets the requirements of the Department of Housing
and Urban Development (HUD). The required label must read as
follows:
Page 105
"As evidenced by this label No. ABC000001, the manufacturer
certifies to the best of the manufacturer's knowledge and belief
that this mobile home has been inspected in accordance with
the requirements of the Department of Housing and Urban
Development and is constructed in conformance with the
Federal Mobile Home Construction and Safety Standards in
effect on the date of manufacture. See date plate."
(b) If such a label is not evident and the licensee believes the unit
meets the required specifications, the licensee must take the
necessary steps to secure and provide verification of compliance
from the manufacturer.
(c) Mobile homes built since in1976 or later meet the flame spread
rate requirements and do not have to have paneling treated with a
flame retardant coating.
(17) The applicant or licensee must meet minimal fire safety standards
including:
(a) A functional smoke alarm with back-up battery must be installed in
all sleeping areas and hallways or access ways that adjoin sleeping
areas.;
(b) A functional carbon monoxide alarm with back-up battery must be
installed within 15 feet of each bedroom and at a height as
recommended by the manufacturer.;
(c) At least one fire extinguisher with a minimum classification of 2A:10-B:C must be mounted in a visible and readily accessible location
on each floor, including basements, and be checked at least once a
year by a qualified person who is well versed in fire extinguisher
maintenance. All recharging and hydrostatic testing must be
completed by a qualified agency properly trained and equipped for
this purpose.;
(d) The licensee must have a safe evacuation plan and may be
required to demonstrate their the evacuation plan. The licensee may
be required to install an Americans with Disabilities Act (ADA)
compliant ramp for the safety of all occupants.;
Page 106
(e) The licensee and all occupants must be able to evacuate within 3
three minutes to an initial point of safety exterior to and away from the
structure, with access to a public sidewalk or street. The licensee and
all occupants must be able to demonstrate the ability to further
evacuate all occupants from the initial point of safety to the final point
of safety within two minutes or less.;
(f) Smoking is prohibited in any bedroom, including that of the
resident, the licensee, occupants, or caregivers and in any room
where oxygen is used or stored.;
(g) The home must be built of standard construction and must meet
all applicable state and local building, mechanical, and housing codes
for fire and life safety.;
(h) A resident must have a bedroom that:
(A) Was constructed as a bedroom when the home was built or
remodeled under permit.;
(B) Is finished with walls or partitions of standard construction
that go from floor to ceiling.;
(C) Has a door large enough to accommodate the occupant of
the room and any equipment that may be necessary such as a
hospital bed or wheelchair.;
(D) Be Has adequately ventilationed, heated, and lightinged
with at least one operable window or exterior door that leads
directly outside as a secondary egress for resident use.; and
(E) Has at least 70 square feet of usable floor space.
(i) All exit ways, including windows, must remain unobstructed at all
times.;
(j) Flammable materials cannot must not be stored within 36 inches of
open flame or heat sources.;
Page 107
(k) Only sealed electric transfer heaters or electric space heaters with
tip-over shut-off capability may be used when approved by the State
Fire Marshal or State Fire Marshal’s designee. Heaters must be
plugged directly into an outlet and may not be used with extension
cords; and.
(l) The licensee must install or make available, any supportive device
necessary to meet the resident’s needs and ensure resident safety
including, but not limited to, grab bars, ramps, and door alarms.
(18) A license is not transferable and does not apply to any location or
person other than the location and the person indicated on the license
obtained from the local licensing authority.
(19) The licensee must notify the local licensing authority at least 30 days
prior tobefore any change in residential or mailing address.
(20) The Department, the local licensing authority, and the Centers for
Medicare and Medicaid Services (CMS) have authority to conduct
inspections with or without advance notice to the licensee or the resident of
a home. The licensee must allow and authorize other caregivers and
occupants to permit entrance and access to the home and the resident for
the purpose of assessing, monitoring, inspection, investigation, and other
duties within the scope of the Department, the local licensing authority, or
CMS.
(21) The applicant or licensee must obtain any training and maintain
resident record documentation deemed necessary by the Department to
provide adequate care for the resident.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
411-050-0665 Abuse Reporting, Complaints, and Notification of
Findings
(1) ABUSE REPORTING. Abuse is prohibited. The facility employees and
licensee may not permit, aid, or engage in abuse of residents who are
Page 108
under their care. Abuse and suspected abuse must be reported in
accordance with OAR 411-020-0020.
(a) STAFF REPORTING. All facility employees must immediately
report abuse and suspected abuse to the investigative authority.
(b) LICENSEE REPORTING. The licensee must immediately notify
the investigative authority of any incident of abuse or suspected
abuse, including events overheard or witnessed by observation.
(c) LAW ENFORCEMENT AGENCY. The local law enforcement
agency must be called first when the suspected abuse is believed to
be a crime (e.g., rape, murder, assault, burglary, kidnapping, theft of
controlled substances).
(2) IMMUNITY AND PROHIBITION OF RETALIATION.
(a) The licensee may not retaliate against any resident after the
resident or someone acting on the resident's behalf has filed a
complaint in any manner, including, but not limited to:
(A) Increasing or threatening to increase charges;
(B) Decreasing or threatening to decrease services;
(C) Withholding rights or privileges;
(D) Taking or threatening to take any action to coerce or
compel the resident to leave the facility; or
(E) Threatening to harass or abuse a resident in any manner.
(b) The licensee must ensure any complainant, witness, or employee
of a facility is not subjected to retaliation by any caregiver, (including
the caregiver's family and friends who may live in or frequent the
adult foster home) for making a report, being interviewed about a
complaint, or being a witness, including, but not limited to, restriction
of access to the home or a resident or, if an employee, dismissal or
harassment.
Page 109
(c) Anyone who, in good faith, reports abuse or suspected abuse has
immunity, as approved by law, from any civil liability that might
otherwise be incurred or imposed with respect to the making or
content of an abuse complaint.
(3) Immunity under this rule does not protect self-reporting licensees from
liability for the underlying conduct that is alleged in the complaint.
(4) The local licensing authority must furnish each adult foster home with a
Complaint Notice that states the telephone number of the Department, the
investigative authority, and the Long-Term Care Ombudsman, and the
procedure for making complaints.
(5) Any person who believes these rules have been violated may file a
complaint with the Department, the local licensing authority, or the
investigative authority.
(6) The Department or the investigative authority shall investigate
complaints in accordance with the adult protective services rules in OAR
chapter 411, division 20, OAR chapter 407, division 45, or OAR chapter
943, division 45, as applicable.
(7) Immediate protection shall be provided for the residents by the
Department, the local licensing authority, or the investigative authority, as
necessary, regardless of whether the investigative report is completed. The
licensee must immediately cease any practice that places a resident at risk
of serious harm.
(8) PRELIMINARY FINDINGS. The Department, through the investigative
authority, shall provide, by written communication or electronic mail, a copy
of the preliminary abuse investigation report to the licensee and
complainant within seven business days of the completion of the
investigation:
(a) The report shall be accompanied by a notice informing the
licensee and complainant of their right to give additional information
about the content of the report to the investigative authority within 10
calendar days of receipt of the report.
Page 110
(b) The investigative authority must review the responses and reopen
the investigation or amend the report if the additional evidence
warrants a change.
(9) A copy of the entire report shall be sent to the Department upon
completion of the investigation report.
(10) NOTIFICATION OF FINDINGS. Upon a determination of substantiated
abuse or a rule violation, the Department must provide written notification
of its findings to the licensee.
(a) CONTENT. The written notice shall:
(A) Explain the nature of each allegation.;
(B) Include the date and time of each occurrence.;
(C) For each allegation, include a determination of whether the
allegation is substantiated, unsubstantiated, or inconclusive.;
(D) For each substantiated allegation, state whether the
violation was abuse or another rule violation.;
(E) Include a copy of the complaint investigation report.;
(F) State that the complainant, any person reported to have
committed wrongdoing, and the facility have 15 calendar days
to provide additional or different information; and.
(G) For each allegation, explain the applicable appeal rights
available.
(b) APPORTIONMENT. If the Department determines there is
substantiated abuse, the Department may determine the licensee, an
individual, or both the licensee and an individual were responsible for
abuse. In determining responsibility, the Department shall consider
intent, knowledge, and ability to control, and adherence to
professional standards, as applicable.
Page 111
(A) LICENSEE RESPONSIBLE. Examples of when the
Department shall determine the licensee is responsible for the
abuse include, but are not limited to, the following:
(i) Failure to provide sufficient, qualified staffing in
accordance with these rules without reasonable effort to
correct.;
(ii) Failure to check for or act upon relevant information
available from a licensing board; .
(iii) Failure to act upon information from any source
regarding a possible history of abuse by any staff or
prospective staff; .
(iv) Failure to adequately train, orient, or provide sufficient
oversight to staff; .
(v) Failure to provide adequate oversight to residents.;
(vi) Failure to allow sufficient time to accomplish assigned
tasks; .
(vii) Failure to provide adequate services.;
(viii) Failure to provide adequate equipment or supplies.;
or
(ix) Failure to follow orders for treatment or medication.
(B) INDIVIDUAL RESPONSIBLE. Examples of when the
Department determines an individual is responsible include, but
is not limited to:
(i) Intentional acts against a resident, including assault,
rape, kidnapping, murder, or sexual, verbal, or mental
abuse;.
Page 112
(ii) Acts contradictory to clear instructions from the facility,
such as those identified in section (10)(b)(A) of this rule,
unless the act is determined by the Department to be the
responsibility of the facility.;
(iii) Callous disregard for resident rights or safety; or.
(iv) Intentional acts against a resident's property (e.g.,
theft or misuse of funds).
(C) An individual shall not be considered responsible for the
abuse if the individual demonstrates the abuse was caused by
factors beyond the individual's control. "Factors beyond the
individual's control" are not intended to include such factors as
misuse of alcohol or drugs or lapses in sanity.
(D) NURSING ASSISTANTS. In cases of substantiated abuse
by a nursing assistant, the written notice shall explain:
(i) The Department’s intent to enter the finding of abuse
into the Nursing Assistant Registry following the
procedure set out in OAR 411-089-0140; and
(ii) The nursing assistant’s right to provide additional
information and request a contested case hearing as
provided in OAR 411-089-0140.
(c) DISTRIBUTION.
(A) The written notice shall be mailed to:
(i) The licensee;
(ii) Any person reported to have committed wrongdoing;
(iii) The complainant, if known;
(iv) The Long-term Care Ombudsman; and
Page 113
(v) The local licensing authority.
(B) A copy of the written notice must be placed in the
Department's facility complaint file.
(11) Upon receipt of a notice that substantiates abuse for victims covered
by ORS 430.735, the facility must provide written notice of the findings to
the individual found to have committed abuse, residents of the facility, and
the residents’ case manager and legal representatives.
(12) Licensees who acquire substantiated complaints pertaining to the
health, safety, or welfare of residents may be assessed civil penalties, have
conditions placed on their licenses, or have their licenses suspended,
revoked, or not renewed.
(13) COMPLAINT REPORTS. Copies of all completed complaint reports
must be maintained and available to the public at the local licensing
authority. Individuals may purchase a photocopy upon requesting an
appointment to do so.
(14) The Department and the local licensing authority shall not disclose
information that may be used to identify a resident in accordance with OAR
411-020-0030, (Confidentiality), and federal HIPAA Privacy Rules.
Completed reports placed in the public file must be in compliance with OAR
411-050-0670 and must:
(a) Protect the privacy of the complainant and the resident. The
identity of the person reporting suspected abuse must be confidential
and may be disclosed only with the consent of that person, by judicial
process (including administrative hearing), or as required to perform
the investigation by the Department or a law enforcement agency.;
(b) Treat the names of the witnesses as confidential information; and.
(c) Clearly designate the final disposition of the complaint.
(A) PENDING COMPLAINT REPORTS. Any information
regarding the investigation of the complaint may not be filed in
the public file until the investigation has been completed.
Page 114
(B) COMPLAINT REPORTS AND RESPONSES. The
investigation reports, including copies of the responses with
confidential information deleted, must be available to the public
at the local licensing authority office along with other public
information regarding the adult foster home.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 124.050, 124.060, 124.075, 443.001-004,
443.705-825, 443.875, 443.991
411-050-0670 Inspections
(1) The local licensing authority must conduct an inspection of an adult
foster home and all structures on the adult foster home property:
(a) Prior toBefore issuance of a license;
(b) Prior toBefore the annual renewal of a license. The local licensing
authority must conduct this inspection unannounced;
(c) Upon receipt of an oral or written complaint of violations that
threaten the health, safety, or welfare of residents; or
(d) Anytime the Department has probable cause to believe a home
has violated a regulation or provision of these rules or is operating
without a license.
(2) The Department may conduct inspections:
(a) Any time such inspections are authorized by these rules and any
other time the Department considers it necessary to determine if a
home is in compliance with these rules or with conditions placed upon
the license.;
(b) To determine if cited violations have been corrected; and.
(c) For the purpose of routine monitoring of the residents' care.
Page 115
(3) State or local fire inspectors must be permitted access to enter and
inspect adult foster homes regarding fire safety upon the Department's
request.
(4) The Department, the local licensing authority, the investigative authority,
and the Centers for Medicare and Medicaid Services (CMS) have authority
and must have full access to examine and copy facility and resident
records, including, but not limited to, admission agreements, private pay
Rresidencyt Agreementscontracts, and resident account records, as
applicable.
(5) PRIVATE INTERVIEW. Department, local licensing authority,
investigative authority, and CMS staff have authority to interview the
licensee, resident manager, other caregivers, and the residents. Interviews
must be confidential and conducted privately.
(6) Licensees must authorize all staff to permit the Department, local
licensing authority, the investigative authority, and CMS staff, for the
purpose of inspection, investigation, and other duties within the scope of
their the inspector’s or investigator’s authority:
(a) Entrance to the adult foster home and any other structure on the
premises; and
(b) Access to resident and facility records.
(7) The Department, local licensing authority, the investigative authority,
and CMS has authority to conduct inspections with or without advance
notice to the licensee, staff, or the residents of the home. The Department,
local licensing authority, and CMS shall not give advance notice of any
inspection if it is believed that notice might obstruct or seriously diminish
the effectiveness of the inspection or enforcement of these rules.
(8) If Department, local licensing authority, the investigative authority, or
CMS staff are not permitted access for inspection, a search warrant may be
obtained.
(9) The inspector must respect the private possessions of the residents,
licensee, and staff while conducting an inspection.
Page 116
(10) PUBLIC FILE. The local licensing authority must maintain current
information on all licensed adult foster homes and must make all nonconfidential information available to prospective residents and other
interested members of the public at local licensing authority offices
throughout the state as authorized by law. The information includes:
(a) The location of the adult foster home and the name and mailing
address of the licensee if different.;
(b) A brief description of the physical characteristics of the home.;
(c) A copy of the current license that indicates the current
classification, level, and capacity of the home, as applicable.;
(d) The date the licensee was first licensed to operate that home.;
(e) The date of the last licensing inspection including any fire
inspection, the name and telephone number of the office that
performed the inspection, and a summary of the inspection findings.;
(f) Copies of all non-confidential portions of complaint investigations
involving the home, together with the findings, actions taken by the
Department, and responses from the licensee and complainant, as
appropriate. All complaint terminology must be clearly defined and
the final disposition clearly designated;.
(g) Any license conditions, suspensions, denials, revocations, nonrenewals, civil penalties, variances, or other actions taken by the
Department involving the home; and.
(h) Whether care is provided primarily by the licensed provider, a
resident manager, or shift caregivers.
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, & 443.790
Stats. Implemented: ORS 443.001- to 443.004, 443.705- to 443.825,
443.875, & 443.991
411-050-0685 Civil Penalties
Page 117
(1) Except as otherwise provided in this rule, civil penalties, not to exceed
$100 per violation to a maximum of $250, may be assessed for a general
violation of these rules.
(2) Mandatory penalties up to $500, unless otherwise required by law, shall
be assessed for falsifying resident or facility records or causing another to
do so.
(3) A mandatory penalty of $250 shall be imposed for failure to have either
the licensee or other qualified caregiver on duty 24 hours per day in the
adult foster home.
(4) A mandatory penalty of $250 shall be imposed for dismantling or
removing the battery from any required smoke alarm or failing to install any
required smoke alarm.
(5) The Department shall impose a civil penalty of not less than $250 and
no nor more than $500 on a licensee who admits a resident knowing that
the resident's care needs exceed the license classification of the licensee
and the admission places the resident or other residents at risk of harm.
(6) Civil penalties up to a maximum of $1,000 per occurrence may be
assessed for substantiated abuse.
(7) If the Department, or the Department's designee, conducts an
investigation and abuse is substantiated and if the abuse resulted in the
death, serious injury, rape, or sexual abuse of a resident, the Department
shall impose a civil penalty of not less than $2,500 for each violation.
(a) To impose this civil penalty, the Department must establish that:
(A) The abuse arose from deliberate or other than accidental
action or inaction.;
(B) The conduct resulting in the abuse was likely to cause
death, serious injury, rape, or sexual abuse of a resident; and.
(C) The person with the finding of abuse had a duty of care
toward the resident.
Page 118
(b) For the purposes of this civil penalty, the following definitions
apply:
(A) "Serious injury" means a physical injury that creates a
substantial risk of death or that causes serious disfigurement,
prolonged impairment of health, or prolonged loss or
impairment of the function of any bodily organ.
(B) "Rape" means rape in the first, second, or third degree as
described in ORS 163.355, 163.365, and 163.375.
(C) "Sexual abuse" means any form of nonconsensual sexual
contact including, but not limited to, unwanted or inappropriate
touching, sodomy, sexual coercion, sexually explicit
photographing, or sexual harassment. The sexual contact must
be in the form of any touching of the sexual or other intimate
parts of a person or causing such person to touch the sexual or
other intimate parts of the actor for the purpose of arousing or
gratifying the sexual desire of either party.
(D) "Other than accidental" means failure on the part of the
licensee, or licensee's employees, agents, or volunteers for
whose conduct licensee is responsible, to comply with
applicable Oregon Administrative Rules.
(8) In addition to any other liability or penalty provided by law, the
Department may impose a penalty for any of the following:
(a) Operating the home without a license.;
(b) The number of residents exceeds the licensed capacity.;
(c) The licensee fails to achieve satisfactory compliance with the
requirements of these rules within the time specified, or fails to
maintain such compliance.;
(d) The home is unable to provide adequate level of care to the
residents.;
Page 119
(e) There is retaliation or discrimination against a resident, family,
employee, or any other person for making a complaint against the
home.;
(f) The licensee fails to cooperate with the Department or fails to
cooperate with the prescribing practitioner or licensed health care
professional in carrying out a resident's care plan; or.
(g) The licensee fails to obtain an approved background check from
the Department prior tobefore employing a caregiver in the home.
(9) A civil penalty may be imposed for violations other than those involving
the health, safety, or welfare of a resident if the licensee fails to correct the
violation as required when a reasonable time frame for correction was
given.
(10) Violations requiring a mandatory civil penalty, which occurred while the
licensee was operating the AFH, will be imposed by the Department, even
if the licensee subsequently closes the home or voluntarily surrenders the
license.
(110) Any civil penalty imposed under this rule becomes due and payable
10 calendars days after the order imposing the civil penalty becomes final
by operation of law or on appeal. The notice must be delivered in person or
sent by registered or certified mail and must include:
(a) A reference to the particular sections of the statute, rule, standard,
or order involved.;
(b) A short and plain statement of the matters asserted or charged.;
(c) A statement of the amount of the penalty or penalties imposed.;
and
(d) A statement of the right to request a hearing.
(121) The person to whom the notice is addressed shall have 10 calendar
days after receipt of the notice in which to make written application for a
hearing. If a written request for a hearing is not timely received, the
Department shall issue a final order by default.
Page 120
(132) All hearings shall be conducted according to the applicable provisions
of ORS 183.
(143) When imposing a civil penalty, the Department shall consider the
following factors:
(a) The past history of the person incurring the penalty in taking all
feasible steps or procedures to correct the violation;
(b) Any prior violations of statutes, rules, or orders pertaining to the
facility;
(c) The economic and financial conditions of the person incurring the
penalty;
(d) The immediacy and extent to which the violation threatens or
threatened the health, safety, or welfare of one or more residents;
and
(e) The degree of harm to residents.
(154) If the person notified fails to request a hearing within the time
specified, or if after a hearing the person is found to be in violation of a
license, rule, or order, an order may be entered assessing a civil penalty.
(165) Unless the penalty is paid within 10 calendar days after the order
becomes final, the order constitutes a judgment and may be recorded by
the county clerk, which becomes a lien upon the title to any interest in real
property owned by that person. The Department may also initiate a notice
of revocation for failure to comply with a final order.
(176) Civil penalties are subject to judicial review under ORS 183.480,
except that the court may, at its discretion, reduce the amount of the
penalty.
(187) All penalties recovered under ORS 443.790 to 443.815 are paid to
the Quality Care Fund.
Page 121
Stat. Auth.: ORS 410.070, 443.001, 443.004, 443.725, 443.730, 443.735,
443.738, 443.742, 443.760, 443.767, 443.775, 443.790
Stats. Implemented: ORS 443.001-004, 443.705-825, 443.875, 443.991
Page 122
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertisement