01. Training Requirements. To provide assistance with medications, staff must have the following
training requirements, and be delegated as described in this rule.
a. Before staff can begin assisting residents with medications, successful completion of an Idaho
Board of Nursing approved medication assistance course. This training is not included as part of the minimum of
sixteen (16) hours of orientation training or minimum of eight (8) hours of continued training per year.
b. Staff training on documentation requirements and how to respond when a resident refuses or misses
a medication, receives an incorrect medication, or when medication is unavailable or missing.
02. Delegation. The facility nurse must delegate and document assistance with medications and other
nursing tasks. Each medication assistant must be delegated individually, including skill demonstration, prior to
assisting with medications or nursing tasks, and any time the licensed nurse changes.
900. ENFORCEMENT ACTIONS.
Enforcement actions, as described in Sections 901 through 940 of these rules and Sections 39-3357 and 39-3358,
Idaho Code, are actions the Department can impose upon a facility. The Department will consider a facility’s
compliance history, change(s) of ownership, and the number, scope, and severity of the deficiencies when initiating or
extending an enforcement action. The Department can impose any of the enforcement actions, independently or in
conjunction with others.
901. ENFORCEMENT ACTION OF SUMMARY SUSPENSION.
When the Department finds that the facility’s deficient practice(s) immediately place the health or safety of any
residents in danger, the Department may take immediate action through summary suspension of the facility’s license,
the imposition of temporary management, a limit on admissions, and transfer the residents.
910. ENFORCEMENT ACTION OF A CONSULTANT.
A consultant may be required when an acceptable plan of correction has not been submitted, as described in Section
130 of these rules, or if the Department identifies repeat deficient practice(s) in the facility. The consultant is required
to submit periodic reports to the Licensing Agency.
920. ENFORCEMENT ACTION OF LIMIT ON ADMISSIONS.
01. Reasons for Limit on Admissions. The Department may limit admissions for the following
a. The facility is inadequately staffed or the staff is inadequately trained to handle more residents;
b. The facility otherwise lacks the resources necessary to support the needs of more residents;
c. The Department identifies repeat core issues during any follow-up survey; and
d. An acceptable plan of correction is not submitted as described in Section 130 of these rules.
02. Notification of Limit on Admissions. The Department will notify the facility of the limit on
admissions of residents (e.g., a full ban of admissions, a limit of admissions based on resident diagnosis, etc.) pending
the correction of deficient practice(s). Limits on admissions to the facility remain in effect until the Department
determines the facility has achieved full compliance with requirements or receives written evidence and statements
from the outside consultant that the facility is in compliance.
925. ENFORCEMENT ACTION OF CIVIL MONETARY PENALTIES.
01. Civil Monetary Penalties. May be issued when a facility is operating without a license, repeat
deficiencies are identified, or the facility fails to comply with conditions of the provisional license. Actual harm to a
resident or residents does not need to be shown. A single act, omission, or incident will not give rise to imposition of
multiple penalties, even though such act, omission, or incident may violate more than one (1) rule.
02. Assessment Amount for Civil Monetary Penalty. When civil monetary penalties are imposed,
such penalties are assessed for each day the facility is or was out of compliance. The amounts below are multiplied by
the total number of occupied licensed beds according to the records of the Department at the time non-compliance is
03. Notice of Civil Monetary Penalties and Appeal Rights. The Department will give written notice
informing the facility of the amount of the penalty, the basis for its assessment and the facility’s appeal rights.
04. Payment of Penalties. The facility must pay the full amount of the penalty within thirty (30)
calendar days from the date the notice is received, unless the facility requests an administrative review of the decision
to assess the penalty. The amount of a civil monetary penalty determined through administrative review must be paid
within thirty (30) calendar days of the facility’s receipt of the administrative review decision unless the facility
requests an administrative hearing. The amount of the civil monetary penalty determined through an administrative
hearing must be paid within thirty (30) calendar days of the facility’s receipt of the administrative hearing decision
unless the facility files a petition for judicial review. Interest accrues on all unpaid penalties at the legal rate of interest
for judgments. Such interest accruement will begin one (1) calendar day after the date of the initial assessment of the
05. Failure to Pay. Failure of a facility to pay the entire penalty, together with any interest, is cause for
revocation of the license or the amount will be withheld from Medicaid payments to the facility.
930. ENFORCEMENT ACTION OF TEMPORARY MANAGEMENT.
01. Need for Temporary Management. The Department may impose the action of temporary
management in situations where there is a need to oversee operation of the facility and to ensure the health and safety
of the facility’s residents:
a. During an orderly transfer of residents of the facility to other facilities; or
b. Pending improvements to bring the facility into compliance with program requirements.
02. Notice of Temporary Management. The Department will give written notice to the facility of the
imposition of temporary management.
03. Who May Serve as a Temporary Manager. The Department may appoint any person or
organization that meets the following qualifications:
a. The temporary manager must not have any financial interest in the facility to be managed;
b. The temporary manager must not be related, within the first degree of kinship, to the facility’s
owner, manager, administrator, or other management principal;
c. The temporary manager must possess sufficient training, expertise, and experience in the operation
of a facility as would be necessary to achieve the objectives of temporary management. If the temporary manager is
to serve in a facility, the manager must possess an Residential Assisted Living Administrator’s license; and
d. The temporary manager must not be an existing competitor of the facility who would gain an unfair
competitive advantage by being appointed as temporary manager of the facility.
151 or More Beds $29,200
04. Powers and Duties of the Temporary Manager. The temporary manager has the authority to
direct and oversee the management, and to hire and discharge any consultant or personnel, including the
administrator of the facility. The temporary manager has the authority to direct the expenditure of the revenues of the
facility in a reasonable and prudent manner, to oversee the continuation of the business and the care of the residents,
to oversee and direct those acts necessary to accomplish the goals of the program requirements, and to direct and
oversee regular accounting. When the facility fails or refuses to carry out the directions of the temporary manager, the
Department will revoke the facility’s license.
a. The temporary manager must observe the confidentiality of the operating policies, procedures,
employment practices, financial information, and all similar business information of the facility, except that the
temporary manager must make reports to the Department;
b. The temporary manager may be liable for gross, willful or wanton negligence, intentional acts of
omissions, unexplained shortfalls in the facility’s fund, and breaches of fiduciary duty;
c. The temporary manager does not have authority to cause or direct the facility, its owner, or
administrator to incur debt, unless to bring the facility into compliance with these rules, or to enter into any contract
with a duration beyond the term of the temporary management of the facility;
d. The temporary manager does not have authority to incur, without the permission of the owner,
administrator, or the Department, capital expenditures in excess of two thousand dollars ($2,000), unless the capital
expenditures are directly related to correcting the identified deficiencies;
e. The temporary manager does not have authority to cause or direct the facility to encumber its assets
f. The temporary manager does not have authority to cause or direct a facility, which holds liability or
casualty insurance coverage, to cancel or reduce its liability or casualty insurance coverage; and
g. The temporary manager does not have authority to cause or direct the sale of the facility, its assets
or the premises on which it is located.
05. Responsibility for Payment of the Temporary Manager. All compensation and per diem costs of
the temporary manager must be paid by the licensee.
06. Termination of Temporary Management. A temporary manager may be replaced under the
a. The Department may require replacement of any temporary manager whose performance is
deemed unsatisfactory by the Department. No formal procedure is required for such removal or replacement, but
written notice of any action will be given to the facility.
b. A facility subject to temporary management may petition the Department for replacement of a
temporary manager whose performance it considers unsatisfactory. The petition must include why the replacement of
a temporary manager is necessary or appropriate.
935. ENFORCEMENT ACTION OF A PROVISIONAL LICENSE.
A provisional license may be issued when a facility has one (1) or more core issues, when non-core issues have not
been corrected, have become repeat deficiencies, or an acceptable plan of correction is not submitted as described in
these rules. The provisional license will state the conditions the facility must follow to continue to operate.
940. ENFORCEMENT ACTION OF REVOCATION OF FACILITY LICENSE.
01. Revocation of Facility’s License. The Department may revoke a license when the facility
endangers the health or safety of residents, or when the facility is not in substantial compliance with the provisions of
Title 39, Chapter 33, Idaho Code, or this chapter of rules.
02. Reasons for Revocation or Denial of a Facility License. The Department may revoke or deny any
facility license for any of the following reasons:
a. The licensee has willfully misrepresented or omitted information on the application or other
documents pertinent to obtaining a license;
b. When persuaded by a preponderance of the evidence that such conditions exist which endanger the
health or safety of any resident;
c. Any act adversely affecting the welfare of residents is being permitted, aided, performed, or abetted
by the person or persons in charge of the facility. Such acts may include neglect, physical abuse, mental abuse,
emotional abuse, violation of civil rights, criminal activity, or exploitation;
d. The licensee has demonstrated or exhibited a lack of sound judgment essential to the operation and
management of a facility;
e. The licensee has violated any of the conditions of a provisional license;
f. The facility lacks adequate personnel, as required by these rules or as directed by the Department,
to properly care for the number and type of residents residing at the facility;
g. Licensee refuses to allow the Department or the protection and advocacy agencies full access to the
facility environment, facility records, and the residents as described in Sections 130 and 550 of these rules;
h. The licensee has been guilty of fraud, gross negligence, abuse, assault, battery, or exploitation with
respect to the operation of a health facility, residential assisted living facility, or certified family home;
i. The licensee is actively affected in their performance by alcohol or the use of drugs classified as
j. The licensee has been convicted of a criminal offense other than a minor traffic violation within the
past five (5) years;
k. The licensee is of poor moral and responsible character or has been convicted of a felony or
defrauding the government;
l. The licensee has been denied, or the licensee’s wrong-doing has caused the revocation of any
license or certificate of any health facility, residential assisted living facility, or certified family home;
m. The licensee has previously operated any health facility or residential assisted living facility
without a license or certified family home without a certificate;
n. The licensee is directly under the control or influence of any person who has been the subject of
proceedings as described in this rule;
o. The licensee is directly under the control or influence of any person who is of poor moral and
responsible character or has been convicted of a felony or defrauding the government;
p. The licensee is directly under the control or influence of any person who has been convicted of a
criminal offense other than a minor traffic violation in the past five (5) years;
q. The licensee fails to pay civil monetary penalties imposed by the Department as described in
Section 925 of these rules;
r. The licensee fails to take sufficient corrective action as described in Section 130 of these rules; or
s. The number of residents currently in the facility exceeds the number of residents the facility is
licensed to serve