NAC 449.179 Submission and approval of a plan for new construction or remodeling; inspection; evidence of compliance: (NRS 449.0302)
1. Except for a residential facility with less than 11 beds, before a residential facility is constructed or an existing facility is remodeled, the facility must:
(a) Submit the plan for construction or remodeling to the entity designated to review such plans by the Division pursuant to the provisions of NAC 449.0115;
(b) Notify the Bureau of a tentative date for the completion of the construction or remodeling; and
(c) Obtain approval of the plan from the Division.
2. The plan for construction or remodeling must include a description of the materials that will be used to complete the project.
3. Before issuing a license to operate a residential facility, the Bureau shall inspect the facility to ensure that it complies with:
(a) The provisions of NAC 449.156 to 449.27706, inclusive; and
(b) The applicable zoning ordinances and regulations.
4. An applicant for a license to operate a residential facility must submit to the Bureau with his or her application evidence that the applicant and the facility are in compliance with the provisions of NRS 449.001 to 449.240, inclusive, and NAC 449.156 to 449.27706, inclusive.
5. The Bureau shall not perform the inspection required pursuant to subsection 3 until the applicant has submitted to the Bureau the application required pursuant to NRS 449.040, the fee required pursuant to NAC 449.016 and the evidence required pursuant to subsection 4.
The Bureau submits building and remodeling plans to an outside consulting architectural firm to ensure the construction will meet regulations prior to the start of construction. Once the plans are reviewed and approved, the facility may begin construction and must build to the plans and not deviate from the plans.
The Bureau will require the facility to obtain zoning approval from the local municipality. This may be in the form of a business license or zoning verification.
The Bureau will not conduct an initial state licensure survey until all of the required documents are submitted that are listed on the AGC application checklist and the application packet is complete.
Y 0005 3. An applicant for a license or for the renewal of a license for a residential facility for groups shall pay a fee of $35 for each bed in the facility if the facility is paid less than $1,000 per month for services provided to each bed in the facility.
Y 0008 Requirements for purchasing licensed facility:
If an applicant for a license to operate a residential facility desires to purchase a currently licensed facility, the facility must comply with all current state and local requirements relating to health and safety.
A facility is held to the standards under which it is licensed, however when the facility is to be sold, prior to licensure of the new owner, the facility
must be brought into compliance with the latest regulations pertaining to health and safety. For example: NAC 449.211.1 After January 14, 1997, all facilities had to install an automatic fire sprinkler system prior to licensure. If the facility was licensed prior to this date and later sold, the new owner
would have to install the sprinkler system to be licensed.
Y 0025 License: Contents; validity; transferability; issuance of more than one type:
2. The license becomes invalid if the facility is moved to a location other than the location stated on the license. The license may not be transferred to another owner.
If a licensee wishes to move into another location, he/she must submit an application and go through the initial licensing inspection for the new locationand obtain a license prior to moving residents. After the move, the license for the original facility must be returned to the Bureau. If a licensee wishes to sell a facility while still operating and having residents in the facility, the new owner must apply for and obtain a license to operate the facility by submitting a new application and undergoing an initial licensure inspection. The original owner must return his/her old license once the new owner becomes licensed.
Y0026 3. A residential facility may be licensed as more than one type of residential facility if the facility provides evidence satisfactory to the Bureau that it complies with the requirements for each type of facility and can demonstrate that the residents will be protected and receive necessary care and services.
The facility must assure resident rights are protected and ensure the safety of all residents. For example: A facility licensed for the elderly or disabled may designate a particular wing or portion of the facility for Alzheimer’s/dementia care, this would be allowable under the conditions stated above. The portion of the facility designated for Alzheimer’s and related dementia must meet the specific physical environment requirements for protection of residents – such as alarmed exits. The facility must also ensure that staffing requirements are met for both facility types and provide activities suited to both populations as listed in the regulations.
In certain situations, an adult day care facility can be operated inside a residential facility for groups. Both facilities must comply separately with their own licensure regulations. The adult day care must be a distinct and separate part of the building. Residential facilities for groups normally care for the elderly, the handicapped and the disabled, but certain facilities may wish to care for the mentally ill, the mentally retarded, those with chronic illnesses (Hepatitis C and HIV) or provide Assisted Living Services. Those facilities need to apply for special endorsements to care for those types of residents by submitting an endorsement application, license change fee if already currently licensed, and evidence they have received training in the
care of those types of residents.
Y0040 Supervision of residential facility for groups:
A residential facility for groups must not be operated except under the supervision of an administrator of a residential facility for groups or a health services executive licensed pursuant to the provisions of chapter 654 of NRS.
Y 0050 Responsibilities of administrator:
The administrator of a residential facility shall:
1. Provide oversight and direction for the members of the staff of the facility as necessary to ensure that residents receive needed services and protective supervision and that the facility is in compliance with the requirements of NAC 449.156 to 449.27706, inclusive, and chapter 449 of NRS.
If the facility is cited for other deficiencies, the surveyor will assess if the deficiencies are a result of lack of adequate oversight and direction by the administrator. For example: If there is a negative resident outcome and there are deficiencies related to the lack of staff training this may indicate a lack of sufficient administrative oversight. Deficiencies identified as lack of administrator oversight and direction will be reported to the
administrator’s licensing board, the Board of Examiners for Long Term Care Administrators (BELTCA), only if cited at severity 3 or 4.
Y 0051 2. Designate one or more employees to be in charge of the facility during those times when the administrator is absent. Except as otherwise provided in this subsection, employees designated to be in charge of the facility when the administrator is absent must have access to all areas of and records kept at the facility. Confidential information may be removed from the files to which the employees in charge of the facility have access if the confidential information is maintained by the administrator. The administrator or an employee who is designated to be in charge of the facility pursuant to this subsection shall be present at the facility at all times. The name of the employee in charge of the facility pursuant to this subsection must be posted in a public place within the facility during all times that the employee is in charge.
There must be a written statement or some other type of posting by the administrator designating the name of the person in charge. This directive must be posted in a public area for view by residents, visitors, family, and agency personnel. This statement does not relieve the administrator from his/her responsibility for the facility; it only serves to identify who is in charge whenever the administrator is away from the facility. The person
designated as “In- Charge” must have access to all facility records including residents’.
Y 0052 3. Maintain in the facility, and make available upon request, a copy of the provisions of NAC 449.156 to 449.27706, inclusive, and the report of the latest investigation of the facility conducted by the Bureau pursuant to NRS 449.0307.
A current copy of the regulations for Residential Facilities for Groups must be available in the facility for review by residents, visitors, a resident’s family and agency personnel. Copies of the facilities latest annual survey, with re-survey, if it was needed, and complaint investigations must also be
available for review.
Y 0053 4. Ensure that the records of the facility are complete and accurate.
It is the administrator’s responsibility to ensure all employee, resident and facility records are current and contain accurate documentation; includes any facility documents created, updated and maintained to meet the regulatory requirements