The facility must develop a written, dated set of policies and procedures that are specific to the population served in
the facility and are available to all staff at all times to direct and ensure compliance with these rules. Policy topics
must include abuse, neglect, exploitation, incidents and accidents, activities, admissions, emergency preparedness,
infection control, nursing, resident rights, staffing, and medications.
151. ACTIVITY REQUIREMENTS.
Each facility must develop and implement a written activity policy that assists, encourages, and promotes residents to
maintain and develop their highest potential for independent living through their participation in planned,
recreational, and other activities. The facility must provide opportunities for the following: (7-1-20)T
01. Socialization. Socialization through group discussion, conversation, recreation, visiting, arts and
crafts, and music;
02. Physical Activities. Physical activities such as games, sports, and exercises which develop and
maintain strength, coordination, and range of motion;
03. Education. Education through special classes or events; and
04. Community Resources for Activities. The facility will utilize community resources to promote
resident participation in integrated activities of their choice both in and away from the facility.
152. ADMISSION REQUIREMENTS.
01. Admissions Policies. Each facility must develop and implement written admission policies and
procedures, which must include:
b. Limitations concerning delivery of routine personal care by persons of the opposite gender;
c. Notification to potential and existing residents and responsible parties if the facility accepts any
residents who are on the sexual offender registry. The registry may be accessed online at http://isp.idaho.gov/sor_id/
d. Notification to potential and existing residents if non-resident adults or children reside in the
02. Resident Admission, Discharge, and Transfer. The facility must have policies addressing
admission, discharge, and transfer of residents to, from, or within the facility.
03. Policies of Acceptable Admissions. Written descriptions of the conditions for admitting residents
to the facility must include:
a. A resident will be admitted or retained only when:
i. The facility has the capability, capacity, and services to provide appropriate care;
ii. The resident does not require a type of service for which the facility is not licensed to provide or
which the facility does not provide or arrange for; and
iii. The facility has the personnel, appropriate in numbers and with appropriate knowledge and skills to
provide such services.
b. No resident will be admitted or retained who requires ongoing skilled nursing or care not within the
legally licensed authority of the facility. Such residents include:
i. A resident who has a gastrostomy tube, arterial-venous (AV) shunt, or supra-pubic catheter inserted
within the previous twenty-one (21) days;
ii. A resident who is receiving continuous total parenteral nutrition (TPN) or IV therapy;
iii. A resident who requires physical restraints, including bed rails;
iv. A resident who is comatose, except for a resident who has been assessed by a physician or
authorized provider who has determined that death is likely to occur within thirty (30) days;
v. A resident who is on a mechanically supported breathing system, except for residents who use
positive airway pressure devices only for sleep apnea, such as CPAP or BiPAP;
vi. A resident who has a tracheotomy who is unable to care for the tracheotomy independently;
vii. A resident who requires the use of a syringe to receive liquid or pureed nourishment directly into
viii. A resident with open, draining wounds for which the drainage cannot be contained;
ix. A resident with a Stage 3 or 4 pressure injury or a pressure injury that is unstageable;
x. A resident with any type of pressure injury or open wound that is not improving bi-weekly;
xi. For any resident who is assessed to require nursing care, the facility must ensure a licensed nurse is
available to meet the needs of the resident.
xii. A resident who has physical, emotional, or social needs that are not compatible with the other
residents in the facility;
xiii. A resident who is violent or a danger to themselves or others;
xiv. Residents who are not capable of self-evacuation must not be admitted or retained by a facility
which does not comply with NFPA, Standard 101 as referenced in Section 004 of these rules.
153. FINANCIAL REQUIREMENTS.
Each facility must develop and implement financial policies and procedures that include:
01. Statement. A statement specifying if the facility does not manage resident funds.
02. Safeguarding of Funds. Policies should specify how residents’ funds will be handled and
safeguarded, if the facility does manage resident funds. Policies must address the following:
a. When a resident’s funds are deposited with, or handled by the facility, the funds must be managed
as described in Section 39-3316, Idaho Code, and Section 550 of these rules;
b. A description of how facility fees are handled;
c. Resident accounts and funds must be separate from any facility accounts;
d. The facility cannot require a resident to purchase goods or services from the facility, other than
items specified in the admission agreement and facility policies;
e. Each transaction with resident funds must be documented at the time to include signatures of the
resident and facility representative with copies of receipts;
f. Residents must have access to their personal funds during normal business hours; and
g. When a resident permanently leaves the facility, the facility can only retain room and board funds
prorated to the last day of the thirty (30) day notice, except in situations described in Sections 217 and 550 of these
rules. All remaining funds are the property of the resident.
54. STAFF TRAINING REQUIREMENTS.
The facility must develop and implement policies and procedures to address the following:
01. Response of Staff to Accidents, Incidents, or Allegations of Abuse, Neglect, or Exploitation of
Residents. The facility must develop policies and procedures to ensure that accidents, incidents, or allegations of
abuse, neglect, and exploitation are identified, documented, reported, investigated, and followed-up with
interventions to prevent re-occurrence and ensure protection.
02. Response of Staff to Emergencies. How staff are to respond to emergency situations, including:
a. Medical and psychiatric emergencies;
b. Resident absence;
c. Criminal situations; and
d. Presence of law enforcement officials at the facility.
03. Notification of Changes to Resident Health or Mental Status. Who and how staff are to notify of
any changes in residents’ health or mental status.
04. Provided Care and Services by Staff. How staff are to provide care and services to residents in
the following areas:
a. Activities of daily living;
b. Dietary and eating, including when a resident refuses to eat or follow a prescribed diet; (3-20-20)T
d. Ensuring each individual’s rights;
e. Medication assistance;
f. Provision of privacy;
g. Social activities;
i. Supporting resident independence; and
j. Telephone access.
05. Intervention Procedures to Ensure Safety of Residents and Staff. How to intervene to ensure
resident and staff safety in unsafe situations that are physically or behaviorally caused.
06. Behavior Management for Residents. The facility must have policies and procedures to ensure
staff are trained and complete timely assessment, plan development, and documentation as described in Section 330
of these rules.
07. Facility Operations, Inspections, Maintenance, and Testing. Plans and procedures for the
operation, periodic inspection, and testing of the physical plant, which includes utilities, fire safety, and plant
maintenance for all areas of the facility’s campus.
08. Hazardous Materials. The handling of hazardous materials.
09. Mechanical Equipment. The handling of potentially dangerous mechanical equipment.
155. EMERGENCY PREPAREDNESS REQUIREMENTS.
Each facility must develop and implement an emergency preparedness plan to follow in the event of fire, explosion,
flood, earthquake, high wind, or other emergency.
01. Relocation Agreements. Each facility must have a written agreement developed between the
facility and two (2) separate locations to which residents would be relocated in the event the building is evacuated and
cannot be reoccupied. The facility will review the relocation agreements annually.
02. Written Procedures. The facility must have written procedures outlining steps to be taken in the
event of an emergency including:
a. Each person’s responsibilities;
b. Where and how residents are to be evacuated; and
c. Notification of emergency agencies.
03. Emergency Generators. Facilities that elect to have an emergency generator must ensure that the
system is designed to meet the applicable codes in NFPA, Standard 110 (within NFPA, Standard 101 as incorporated
in Section 004 of these rules).
156. HOURLY ADULT CARE REQUIREMENTS.
Facilities offering hourly adult care must develop and implement written policies and procedures which include the
01. Services Offered. A description of hourly adult care services, including transportation services (if
offered), meals, activities, and supervision.
02. Individuals Accepted. Types of individuals who may or may not be accepted for hourly adult care.
See Section 152 of these rules.
03. Cost of Hourly Adult Care. Details of the cost of hourly adult care for the person receiving
04. Hours for Care. The specific time periods of hourly adult care, not to exceed fourteen (14)
consecutive hours in a twenty-four (24) hour period.
05. Assistance with Medications. Assistance with medications in the facility must comply with
a. Copies of all physician or authorized provider orders, including orders for all prescribed
medications and treatments.
b. Appropriately labeled medications and treatments the facility safeguards while the person receives
hourly adult care.
06. Staffing. Staffing must be based on the needs of the entire facility, including those receiving hourly
adult care and residents. Hourly adult care may be provided to as many individuals as possible without disrupting the
day-to-day operations and normal activities of the facility.
07. Accommodations. The facility must provide accommodations appropriate to the time frame for
those receiving hourly adult care, including:
a. Daytime accommodations such as recliners and couches for napping. Napping furniture must be
spaced at least (3) feet apart.
b. Evening accommodations such as beds and bedrooms that are not used by facility residents. Any
bed used overnight by a person receiving hourly adult care will not be counted as a licensed bed.
08. Documentation. Documentation requirements described in Section 330 of these rules.
161. SMOKING REQUIREMENTS.
The facility must develop and implement written rules governing smoking. Nothing in this rule requires a facility to
permit smoking. Smoking policies must be made known to all staff, residents, and visiting public and must ensure:
01. Combustible Supplies and Flammable Items. Smoking is prohibited in areas where combustible
supplies or materials, flammable liquids, gases, or oxidizers are in use or stored.
02. Smoking in Bed. Smoking in bed is prohibited.
03. Unsupervised Smoking. Unsupervised smoking by residents classified as not mentally or
physically responsible, sedated by medication, or taking oxygen is prohibited.
04. Designated Smoking Areas. If smoking is permitted, there must be designated smoking areas
which are specified in policy and clearly marked. Designated smoking areas must have non-combustible disposal
215. REQUIREMENTS FOR A FACILITY ADMINISTRATOR.
Under Section 39-3321, Idaho Code, each facility must have one (1) licensed administrator assigned as the person
responsible for the day-to-day operation of the facility. Multiple facilities under one (1) administrator may be allowed
by the Department based on an approved plan of operation for up to three (3) buildings with a total of no more than
fifty (50) beds, or up to two (2) buildings with a total of no more than eighty (80) beds. The criteria and procedure for
requesting to have multiple facilities under one (1) administrator is posted on the Residential Assisted Living
Facilities Program website.
01. Administrator Responsibility. The administrator is responsible for ensuring that policies and
procedures are developed and implemented to fulfill the requirements in Title 39, Chapter 33, Idaho Code, and
IDAPA 16.03.22, “Residential Assisted Living Facilities.”
02. Availability of Administrator. The facility’s administrator must be on-site sufficiently to ensure
safe and adequate care of the residents. The facility’s administrator or their designee must be available to be on-site at
the facility within two (2) hours. The facility must continuously employ an administrator.
03. Lapse of Administrator. If the facility operates for more than thirty (30) days without a licensed
administrator, it will result in a core issue deficiency.
04. Representation of Residents. The owner or administrator, their relatives, and employees cannot
act as, or seek to become the legal guardian of, or have power of attorney for any resident. Specific limited powers of
attorney to address emergency procedures where competent consent cannot otherwise be obtained, are permitted.
05. Responsibility for Acceptable Admissions. The administrator must ensure that no resident is
knowingly admitted or retained who requires care as defined in Section 39-3307, Idaho Code, and Section 152 of
06. Sexual Offender. The administrator must ensure that a nonresident on the sexual offender registry
is not allowed to live or work in the facility.
07. Notification to Adult Protection and Law Enforcement. The administrator must ensure that
adult protection and law enforcement are notified in accordance with Sections 39-5303 and 39-5310, Idaho Code.
08. Procedures for Investigations. The administrator must ensure the facility procedures for
investigation of complaints, incidents, accidents, and allegations of abuse, neglect, or exploitation are implemented to
ensure resident safety. Procedures must include:
a. Administrator Notification. The administrator, or person designated by the administrator, must be
notified of all incidents, accidents, allegations of abuse, neglect, or exploitation immediately, and notified of
complaints within one (1) business day.
b. Investigation within Thirty Days. The administrator or designee must complete an investigation
and written report of the findings within thirty (30) calendar days for each accident, incident, complaint, or allegation
of abuse, neglect, or exploitation.
c. Resident Protection. Any resident involved must be protected during the course of the
d. Written Response to Complaint within Thirty Days. The person making the complaint must
receive a written response from the facility of the action taken to resolve the matter, or the reason why no action was
taken within thirty (30) days of the complaint.
e. Corrective Action. When abuse, neglect, exploitation, incidents, and accidents occur, corrective
action must be immediately taken and monitored to ensure the problem does not recur.
f. Notification to Licensing Agency within One Business Day. When a reportable incident occurs,
the administrator or designee must notify the Licensing Agency within one (1) business day of the incident.
g. Identify and Monitor Patterns. The administrator or designee must identify and monitor patterns
of accidents, incidents, or complaints and must develop interventions to prevent recurrences.
09. Administrator’s Designee. A person authorized in writing to act in the absence of the
administrator. An administrator’s designee may act in the absence of the administrator for no longer than thirty (30)
consecutive days when the administrator is on vacation, has days off, is ill, or is away for training or meetings.
10. Ability to Reach Administrator or Designee. The administrator or their designee must be
reachable and available at all times.
11. Minimum Age of Personnel. The administrator will ensure that no personnel providing hands-on
care or supervision services will be under eighteen (18) years of age unless they have completed a certified nursing
assistant (CNA) certification course.
12. Notification to Licensing Agency. The facility must notify the Licensing Agency, in writing,
within three (3) business days of a change of administrator.
216. REQUIREMENTS FOR ADMISSION AGREEMENTS.
01. Initial Resident Assessment and Care Plan. Prior to admission, each resident must be assessed
by the facility to ensure the resident is appropriate for placement in their residential assisted living facility. The
facility must develop an interim care plan to guide services until the facility can complete the resident assessment
process. The result of the assessment will determine the need for specific services and supports.
02. Written Agreement. Prior to, or on the day of admission, the facility and each resident or the
resident’s legal guardian or conservator must enter into a written admission agreement that is transparent,
understandable, and is translated into a language the resident or their representative understands. The admission
agreement will provide a complete reflection of the facility’s charges, commitments agreed to by each party, and the
actual practices that will occur in the facility. The agreement must be signed by all involved parties, and a complete
copy provided to the resident and the resident’s legal guardian or conservator prior to, or on the day of admission. The
admission agreement may be integrated within the Negotiated Service Agreement (NSA), provided that all
requirements for the NSA in Section 320 of these rules and the admission agreement are met. Admission agreements
must include all items described under this rule.
03. Services, Supports, and Rates. The facility must identify the following services, supports, and
a. Unless otherwise negotiated with the resident or the resident’s legal guardian or conservator, basic
services must include the items specified in Section 430 of these rules.
b. The resident’s monthly charges, including a specific description of the services that are included in
the basic services rate and the charged rate.
c. All prices, formulas, and calculations used to determine the resident’s basic services rate including:
i. Service packages;
iii. Assessment forms;
iv. Price per assessment point;
v. Charges for levels of care determined with an assessment; and
vi. Move-in fees or other similar charges.
d. The services and rates charged for additional or optional services, supplies, or amenities that are
available through the facility or arranged for by the facility for which the resident will be charged additional fees.
e. Services or rates that are impacted by an updated assessment of the resident, the assessment tool,
the assessor, and the frequency of the assessment, when the facility uses this assessment to determine rate changes.
f. The facility may charge residents for the use of personal furnishings, equipment, and supplies
provided by the facility unless paid for by a publicly funded program. The facility must provide a detailed itemization
of furnishings, equipment, supplies, and the rate for those items the resident will be charged. (7-1-20)T
04. Staffing. The agreement must identify staffing patterns and qualifications of staff on duty during a
05. Notification of Liability Insurance Coverage. The administrator of a residential assisted living
facility must disclose in writing at the time of admission or before a resident’s admission if the facility does not carry
professional liability insurance. If the facility cancels the professional liability insurance all residents must be notified
of the change in writing.
06. Medication Responsibilities. The agreement must identify the facility’s and resident’s roles and
responsibilities relating to assistance with medications including the reporting of missed medications or those taken
on a PRN basis.
07. Resident Personal Fund Responsibilities. The agreement must identify who is responsible for the
resident’s personal funds.
08. Resident Belongings Responsibility. The agreement must identify responsibility for protection
and disposition of all valuables belonging to the resident and provision for the return of the resident’s valuables if the
resident leaves the facility.
09. Emergency Transfers. The agreement must identify conditions under which emergency transfers
will be made as provided in Section 152 of these rules.
10. Billing Practices, Notices, and Procedures for Payments and Refunds. The facility must
provide a description of the facility’s billing practices, notices, and procedures for payments and refunds. The
following procedures must be included:
a. Arrangement for payments;
b. Under what circumstances and time frame a partial month’s resident fees are to be refunded when a
resident no longer resides in the facility; and
c. Written notice to vacate the facility must be given thirty (30) calendar days prior to transfer or
discharge on the part of either party, except in the case of the resident’s emergency discharge or death. The facility
may charge up to fifteen (15) days prorated rent from the date of the resident’s emergency discharge or death. The
agreement must disclose any charges that will result when a resident fails to provide a thirty (30) day written notice.
11. Resident Permission to Transfer Information. The agreement must specify permission for the
facility to transfer information from the resident’s records to any facility to which the resident transfers.
12. Resident Responsibilities. The agreement must specify resident responsibilities.
13. Restrictions on Choice of Care or Service Providers. The agreement must specify any restriction
on choice of care or service providers, such as home health agency, hospice agency, or personal care services.
14. Advance Directive. The agreement must identify written documentation of the resident’s
preference regarding the formulation of an advance directive in accordance with Idaho state law. When a resident has
an advance directive, a copy must be immediately available for staff and emergency personnel.
15. Notification of Payee Requirements. The agreement must identify if the facility requires as a
condition of admission that the facility be named as payee.
16. Contested Charges. The facility must provide the methods by which a resident may contest
charges or rate increases including contacting the ombudsman for the elderly.
17. Transition to Publicly Funded Program. The facility must disclose the conditions under which
the resident can remain in the facility if payment for the resident shifts to a publicly funded program.
18. Smoking Policy. The admission agreement must include a copy of the facility’s smoking policy.
217. REQUIREMENTS FOR TERMINATION OF ADMISSION AGREEMENT.
01. Conditions for Termination of the Admission Agreement. The admission agreement cannot be
terminated, except under Section 39-3313, Idaho Code, as follows:
a. Giving the other party thirty (30) calendar days written notice;
b. The resident’s death;
c. Emergency conditions that require the resident to be transferred to protect the resident or other
residents in the facility from harm;
d. The resident’s mental or medical condition deteriorates to a level requiring care as described in
Section 39-3307, Idaho Code, and Section 152 of these rules;
e. Nonpayment of the resident’s fees;
f. When the facility cannot meet resident needs due to changes in services, in-house or contracted, or
inability to provide the services; or
g. Other written conditions as may be mutually established between the resident, the resident’s legal
guardian or conservator, and the administrator of the facility at the time of admission.
02. Facility Responsibility During Resident Discharge. The facility is responsible to assist the
resident with transfer by providing a list of skilled nursing facilities, other residential assisted living facilities, and
certified family homes that may meet the needs of the resident. The facility must provide a copy of the resident
record, as described in Section 330 of these rules, within two (2) business days of receipt of a request signed and
authorized by the resident or legal representative.
03. Resident’s Appeal of Involuntary Discharge. A resident may appeal all discharges, with the
exception of an involuntary discharge in the case of nonpayment or emergency conditions that require the resident to
be transferred to protect the resident or other residents in the facility from harm.
a. Before a facility discharges a resident, the facility must notify the resident and their representative
of the discharge and the cause.
b. This notice must be in writing and in a language and manner the resident or their representative can
04. Written Notice of Discharge. The written notice of discharge must include the following:
a. The specific reason for the discharge;
b. The effective date of the discharge;
c. A statement that the resident has the right to appeal the discharge to the Department within thirty
(30) calendar days of receipt of written notice of discharge; (
d. The Residential Assisted Living Facilities Program website, where the appeal must be submitted;
e. The name, address, and telephone number of the local ombudsman;
f. The name, address, and telephone number of Disability Rights Idaho
g. If the resident fails to pay fees to the facility, as agreed to in the admission agreement, during the
discharge appeal process, the resident’s appeal of the involuntary discharge becomes null and void and the discharge
notice applies; and
h. When the notice does not contain all the above required information, the notice is void and must be
05. Receipt of Appeal. Request for an appeal must be received by the Department within thirty (30)
calendar days of the resident’s or resident’s representative’s receipt of written notice of discharge to stop the discharge
before it occurs.
250. REQUIREMENTS FOR BUILDING CONSTRUCTION AND PHYSICAL STANDARDS.
Minimum construction must meet all requirements of this rule to include codes and standards incorporated by
reference in Section 004 of these rules, and all local and state codes that are applicable to residential assisted living
facilities. Where there are conflicts between the requirements in the codes, the most restrictive condition must apply.
01. Construction Changes. For all new construction, changes of occupancy, modifications, additions,
or renovations to existing buildings, the facility must submit construction drawings with specifications to the
licensing authority for review and approval prior to any work being started. All new construction and conversions
must install audible and visual notification devices for fire alarm systems in all common areas and resident rooms no
matter the size of facility.
02. Plans and Specifications. Plans must be prepared, signed, stamped, and dated by an architect or
engineer licensed in the state of Idaho. A variance of this requirement may be granted by the Licensing Agency when
the size of the project does not necessitate involvement of an architect or engineer. This must include the following:
a. Plans and specifications must be submitted to the Licensing Agency to ensure compliance with
applicable construction standards, codes, and regulations;
b. Plans must be drawn to scale, but no less than a scale of one-eighth (1/8) inch to one (1) foot;
c. Plans must be submitted electronically;
d. A physical address approved by the city;
e. Life safety plans;
f. Fire alarm shop drawings; and
g. Fire sprinkler system drawings and calculations.
03. Approval. All buildings, additions, and renovations are subject to approval by the Licensing
Agency and must meet applicable requirements.
04. Walls and Floor Surfaces. Walls and floors must be of such character to permit cleaning. Walls
and ceilings in kitchens, bathrooms, and utility rooms must have washable surfaces.
05. Toilets and Bathrooms. Each facility must provide:
a. A toilet and bathroom for resident use so arranged that it is not necessary for an individual to pass
through another resident’s room to reach the toilet or bath;
b. Solid walls or partitions to separate each toilet and bathroom from all adjoining rooms;
c. Mechanical ventilation to the outside from all inside toilets and bathrooms not provided with an
operable exterior window;
d. Each tub, shower, and lavatory with hot and cold running water;
e. At least one (1) flushing toilet for every six (6) residents;
f. At least one (1) tub or shower for every eight (8) residents;
g. At least one (1) lavatory with a mirror for each toilet; and
h. At least one (1) toilet, tub or shower, and lavatory in each building in which residents sleep, with
additional units if required by the number of persons.
06. Accessibility for Persons with Mobility and Sensory Impairments. For residents who have
mobility or sensory impairments, the facility must provide a physical environment which meets the needs of the
person for independent mobility and use of appliances, bathroom facilities, and living areas. New construction must
meet the requirements of the Americans with Disabilities Act Accessibility Guidelines (ADAAG). Existing facilities
must comply, to the maximum extent feasible, with 28 CFR Sections 36.304 and 36.305 regarding removal of barriers
under the Americans with Disabilities Act, without creating an undue hardship or burden on the facility, and must
provide as required, the necessary accommodations:
a. Ramps for residents who require assistance with ambulation must comply with the requirements of
the ADAAG 4.8;
b. Bathrooms and doors large enough to allow the easy passage of a wheelchair as provided for in the
c. Grab bars in resident toilet and bathrooms in compliance with ADAAG 4.26;
d. Toilet facilities in compliance with ADAAG 4.16 and 4.23;
e. Non-retractable faucet handles in compliance with ADAAG 4.19, with the exception of self closing valves under 4.19.5, and 4.27; and
f. A suitable hand railing must be provided on both sides of all stairs leading into and out of a
building for residents who require the use of crutches, walkers, or braces.
07. Lighting. The facility must provide adequate lighting in all resident sleeping rooms, dining rooms,
living rooms, recreation rooms, and hallways.
08. Ventilation. The facility must be ventilated, and precautions taken to prevent offensive odors.
09. Plumbing. All plumbing in the facility must comply with local and state codes. All plumbing
fixtures must be easily cleanable and maintained in good repair. The temperature of hot water at plumbing fixtures
used by residents must be between one hundred five degrees Fahrenheit (105°F) and one hundred twenty degrees
10. Heating, Ventilation, and Air-Conditioning (HVAC). Equipment must be furnished, installed,
and maintained to meet all requirements of current state and local mechanical, electrical, and construction codes. An
HVAC system must be provided for the facility that is capable of maintaining a minimum temperature of seventy
degrees Fahrenheit (70°F) and a maximum temperature of seventy-eight degrees Fahrenheit (78°F) during the day,
and a minimum of sixty-two degrees Fahrenheit (62°F) and a maximum temperature of seventy-five degrees
Fahrenheit (75°F) during the night. Wood stoves, gas fireplaces, or solid burning fireplaces are not permitted as the
sole source of heat, and the thermostat for the primary source of heat must be remotely located away from any of
a. Portable heating devices of any kind are prohibited. Portable electric space heaters and movable
fuel-fired heaters are considered portable comfort heating devices. Exceptions are heated mattress pads, electric
blankets, and heating pads when ordered by an authorized provider or physician; (7-1-20)T
b. All fireplaces must provide a safety barrier and have heat-tempered glass fireplace enclosures
equivalent to ASTM Standard;
c. Boilers, hot water heaters, and unfired pressure vessels must be equipped with automatic pressure
d. Fire and smoke dampers must be inspected, serviced, and cleaned once every four (4) years by a
person professionally engaged in the business of servicing these devices or systems. A copy of these results must be
kept in the facility.
11. Dining, Recreation, Shower, Bathing, and Living Space. The total area set aside for these
purposes must be no less than thirty (30) square feet per licensed bed. A hall or entry cannot be included as living or
12. Resident Sleeping Rooms. The facility must ensure that:
a. Resident sleeping rooms are not in attics, stairs, halls, or any other room commonly used for other
than bedroom purposes;
b. A room with a window that opens into an exterior window well cannot be used for a resident
c. Not more than four (4) residents can be housed in any multi-bed sleeping room in facilities licensed
prior to July 1, 1991. New facilities or buildings converted to a licensed facility after July 1, 1991, cannot have more
than two (2) residents in any multi-bed sleeping room. When there is any change in ownership of the facility, the
maximum number of residents allowed in any room is two (2);
d. Square footage requirements for resident sleeping rooms must provide for not less than one
hundred (100) square feet of floor space per resident in a single-bed sleeping room and not less than eighty (80)
square feet of floor space per resident in a multi-bed sleeping room. For facilities constructed after January 1, 2021,
square footage requirements for resident sleeping rooms must provide at least one hundred (100) square feet of floor
space per resident for both single-bed and multi-bed sleeping rooms.
e. Each resident’s sleeping room must be provided with an operable exterior window. An operable
window is not required where there is a door directly to the outside from the sleeping room;
f. The operable window sill height must not exceed thirty-six (36) inches above the floor in new
construction, additions, or remodeling;
g. The operable window sill height must not exceed forty-four (44) inches above the floor in existing
buildings being converted to a facility;
h. Each resident sleeping room must provide a total window space that equals at least eight percent
(8%) of the room’s total square footage;
i. Window screens must be provided on operable windows;
j. Resident sleeping rooms must have walls that run from floor to ceiling, have doors that will limit
the passage of smoke, and provide the resident(s) with privacy;
k. Ceiling heights in sleeping rooms must be at least seven (7) feet, six (6) inches; and
l. Closet space in each resident sleeping room must provide at least four (4) usable square feet per
resident. Common closets used by two (2) or more residents must have substantial dividers for separation of each
resident’s clothing. All closets must be equipped with doors. Free-standing closets are deducted from the square
footage of the sleeping room.
13. Secure Environment. If the facility accepts and retains residents who have cognitive impairment
and have a history of elopement or attempted elopement, the facility must provide an interior environment and
exterior yard that is secure and safe. Because measures to secure the environment may be effective for one (1)
resident, but not another, the type of the security provided must be evaluated for effectiveness in protecting each
resident, based on their individual needs and abilities, and adjusted as necessary. These measures must be
incorporated into the NSA of each applicable resident.
14. Call System. The facility must have a call system available for each resident to call for assistance
and still be ensured a resident’s right to privacy at the facility, including in the resident’s living quarters and common
areas, during medical treatment, and other services, and in written and telephonic communications, or in visits with
family, friends, advocates, and resident groups. The call system cannot be a substitute for supervision. For facilities
licensed prior to January 1, 2006, when the current system is no longer operational or repairable the facility must
install a call system as defined in Section 010 of these rules.
15. Dietary Standards. Each facility must have a full-service kitchen to meet the needs of the
residents. Any satellite kitchen must meet all applicable requirements.
255. REQUIREMENTS FOR ADDITIONAL PHYSICAL STANDARDS.
01. Fire District. The facility site must be in a lawfully constituted fire district. (3-20-20)T
02. Roads. The facility must be served by an all-weather road and kept open to motor vehicles at all
times of the year.
03. Medical Accessibility. The facility site must be accessible to authorized providers or emergency
medical services within thirty (30) minutes driving time. (3-20-20)T
260. REQUIREMENTS FOR ENVIRONMENTAL SANITATION.
01. Water Supply. The facility must have an adequate water supply that is safe and of a sanitary
a. The water supply must be from an approved private, public, or municipal water supply; (7-1-20)T
b. Water from a private supply must have water samples submitted annually to either a private
accredited laboratory or to the Public Health District Laboratory for bacteriological examination. The Department
may require more frequent examinations if warranted; and
c. There must be a sufficient amount of water under adequate pressure to meet sanitary and fire
sprinkler system requirements of the facility at all times.
02. Sewage Disposal. All sewage and liquid waste must be discharged into a municipal sewage system
where such a system is available. If a municipal sewage system is not available, sewage and liquid waste must be
collected, treated, and disposed of in a manner approved by the Department.
03. Garbage and Refuse Disposal. Garbage and refuse disposal must be provided to ensure that:
a. The premises and all buildings must be kept free from the accumulation of weeds, trash, and
b. Material not directly related to the maintenance and operation of the facility must not be stored on
c. All containers used for storage of garbage and refuse must be constructed of durable, nonabsorbent
material, and must not leak. Containers must be provided with tight-fitting lids unless stored in a vermin-proof room
or enclosure; and
d. Garbage containers must be maintained in a sanitary manner. Sufficient containers must be
afforded to hold all garbage and refuse which accumulates between periods of removal from the facility. Storage
areas must be clean and sanitary.
04. Insect and Rodent Control. A pest control program must be in effect at all times. This program
must effectively prevent insects, rodents, and other pests from entrance to, or infestation of, the facility. (7-1-20)T
05. Linen and Laundry Facilities and Services.
a. The facility must have available at all times a quantity of linen essential to the proper care and
comfort of residents;
b. Linen must be of good quality, not thread-bare, torn, or stained;
c. Linens must be handled, processed, and stored in an appropriate manner that prevents
d. Adequate facilities must be provided for the proper and sanitary washing and drying of linen and
other washable goods laundered in the facility;
e. The laundry must be situated in an area separate and apart from where food is stored, prepared, or
f. The laundry area must be well-lighted, ventilated, adequate in size for the needs of the facility,
maintained in a sanitary manner, and kept in good repair;
g. Care must be taken to ensure soiled linen and clothing are properly handled to prevent
contamination. Clean linen and clothing received from a laundry service must be stored in a proper manner to prevent
h. Residents’ and personnel’s personal laundry must be collected, transported, sorted, washed, and
dried in a sanitary manner and cannot be washed with general linens (e.g., towels and sheets). (7-1-20)T
06. Housekeeping and Maintenance Services. Housekeeping, maintenance personnel, and equipment
must be provided to maintain the interior and exterior of the facility in a clean, safe, and orderly manner. Prior to
occupancy of any sleeping room by a new resident, the room must be thoroughly cleaned including the bed, bedding,
07. Toxic Chemicals. All toxic chemicals must be properly labeled. Toxic chemicals cannot be stored
where food is stored, prepared, or served, where medications are stored, and where residents with cognitive
impairment have access.