Standards of licensing and inspection
Deciding to open an assisted living facility can be a daunting task due to the sheer number of regulations you must follow. You have jumped through so many hoops, renovated a home to meet the state requirements, designed your logo, chose a name, etc. and the next step towards accepting residents is receiving your license from the Hawaii Office of Health Care Assurance. Be sure to familiarize yourself with the following regulation prior to submitting an application for licensing:
- 11-90-3 Licensing.
(a) The facility shall meet all requirements for licensure under state law. All assisted living facilities shall be licensed except those operated by the federal government. The licensee shall file an application with the director and the facility shall be licensed pursuant to this chapter prior to admitting residents.
(b) The director or designated representative shall inspect each assisted living facility no less than every two years for relicensing. The director or designated representative, without prior notice, may enter the premises at any reasonable time to secure compliance with or to prevent a violation of this chapter.
(c) Summary reports of licensing inspections shall be kept on file in the facility and shall be available upon request.
(d) No facility licensed under the provisions of this chapter, shall deny admission to any individual on account of race, religion, ancestry, sexual orientation, or national origin.
(e) The director shall prescribe the content and form of the license, and may authorize a waiver or §11-90-3 waivers for a particular facility.
(f) In the event of a change of name, location, ownership, or licensed occupancy, the director shall be notified fifteen days prior to the change; an inspection at the discretion of the director shall be conducted and, if the provisions of this chapter are met, a new license issued.
(g) Every license shall continue in force for a period of no less than two years unless otherwise specified, or unless suspended or revoked.
(h) Following inspection of the facility by the department, a list of deficiencies, if any, shall be presented to the facility. The facility shall return a plan of correction to the department within ten days that addresses each of the deficiencies identified by the department. Facilities shall be allowed a reasonable time to implement the plan of correction. A follow-up survey and inspection shall be made by the department to determine the progress in the plan of correction. If there has not been substantial progress in carrying out the plan of correction, the license shall not be renewed. At the discretion of the director, a provisional license may be issued.
(i) The current license shall be posted in a conspicuous place visible to the public within the facility. A facility that has fulfilled the requirements of licensure shall be known as an assisted living facility and this designation shall be reflected on the facility’s license.
(j) The director may suspend, revoke, or refuse to issue a license for failure to comply with the requirements of this chapter, or for any cause deemed a potential hazard to the health and safety of the residents, employees, or the general public. Any person affected by the director’s final decision of denial, suspension, or revocation may appeal in accordance with chapter 91, HRS.
(k) An applicant for a license or relicensing may be denied a license or relicense for any of the following reasons:
(1) Failure to meet requirements of this chapter;
(2) Financial inability to operate and conduct the facility in accordance with these minimum standards and rules;
(3) Conviction in a court of law; or
(4) Had a substantiated finding of abuse, neglect §11-90-3 or misappropriation of resident funds or property in any civil action.
(l) Penalties, hearing, and appeals. In addition to any other appropriate action to enforce this chapter pursuant to state law, the director may initiate procedures for invoking fines as provided in section 321- 90-9 20, HRS and to revoke the license after hearing held in accordance with chapter 91, HRS. Infractions that may require invoking the procedures in this subsection include, but are not limited to the operation of an assisted living facility without a license granted by the department or if substantive violations of this chapter are found as a result of routine or unannounced inspection of a facility which has a license.
(m) Applicants for licensure or existing licensees applying for license renewal shall pay appropriate fees, as determined by the director. Prior notice of the amount of the fee shall be provided to the licensee.
(n) Separate buildings located contiguously and operated as an integrated unit by the same management are not required to have separate licenses. Distinct staffing plans are required for each building and must be approved in advance by the department.
(o) Applications for licensure shall be made to the department on a form provided by the department and shall include full and complete information as follows:
(1) Identity and financial interest of any person, including stockholders, who have ownership in the facility representing an interest of ten percent or more in such assisted living facility;
(2) Each officer and director of the corporation if the facility is organized as a corporation, each general partner if the facility is organized as a partnership, or the governing body if the facility is government-owned;
(3) A summary of all lease, management, and sales agreements and contracts relative to the direct operation and ownership of the facility. The applicant shall provide a copy of any of the above if requested by the department;
(4) Name of the administrator of the facility and §11-90-4 a list of three references;
(5) Location (address) of the facility and mailing address;
(6) Maximum number of residents to be served at any one time;
(7) Information and supporting documentation regarding qualifications and training of staff as required in these rules;
(8) Verification of evacuation capacity designation for fire and life safety protection;
(9) Proposed annual budget identifying sources of revenue; and
(10) Evidence that the premises comply with state and county building, housing, fire, and other codes, ordinances, and laws for the type of occupancy to be licensed. Compliance shall include but not be limited to the following:
(A) Occupancy requirement of the county building code;
(B) Applicable zoning ordinance of the county;
(C) The obtainment of a use permit if required by the county; and
(D) Applicable state laws and administrative rules relating to sanitation, health, and environmental safety.
- (b) The director or designated representative shall inspect each assisted living facility no less than every two years for relicensing. The director or designated representative, without prior notice, may enter the premises at any reasonable time to secure compliance with or to prevent a violation of this chapter.
Understanding when the window for your license to expire is key to avoiding unnecessary citations. Here are a few tips for working with OHCA when they enter your facility for an inspection
- Work with the surveyor and their team’s needs
- Be professional and try to develop a rapport with the surveyor
- Be honest
- Use their feedback to make needed changes to your facility
- (h) Following inspection of the facility by the department, a list of deficiencies, if any, shall be presented to the facility. The facility shall return a plan of correction to the department within ten days that addresses each of the deficiencies identified by the department. Facilities shall be allowed a reasonable time to implement the plan of correction. A follow-up survey and inspection shall be made by the department to determine the progress in the plan of correction. If there has not been substantial progress in carrying out the plan of correction, the license shall not be renewed. At the discretion of the director, a provisional license may be issued.
A plan of correction is a really good tool to use to make quantitative changes to your facility operations. Ask for your teams input as to how you can correct the deficiency, this will go a long way towards to buy in of your plan of improvement. Make sure to submit this in a timely manner (within 10 days) to avoid further escalation.