Or. Admin. Code § 309-040-0315 - License Application and Fees
(1)
A completed, written application must be submitted by the applicant in a form
and manner required by the Division along with the required $20 per bed
non-refundable fee. The application is not complete until all information is
received by the Division.
(2)
Incomplete initial applications are void after 60 calendar days from the date
the Division receives the application and non-refundable fee. The Division will
deny the incomplete application if not withdrawn.
(3) An applicant must submit a separate
complete application packet for each location operated as an AFH.
(4) The application must include the
following:
(a) The location of the
AFH;
(b) A brief description of the
physical characteristics of the home;
(c) The name, address, telephone number, and
email address of the provider;
(d)
The distinct name of the AFH;
(e)
The maximum capacity requested and a written statement describing family
members needing care, residents who receive respite care, persons who receive
day care, or residents who receive room and board only;
(f) A written statement from a physician,
nurse practitioner, or physician assistant regarding the mental and physical
ability of the applicant to provide care and services to residents and to
operate the AFH. If the applicant employs a resident manager, the applicant
must provide a written statement from a physician, nurse practitioner, or
physician assistant regarding the mental and physical ability of the resident
manager to provide personal care and services to residents and to operate the
AFH;
(g) A completed financial
information form provided demonstrating to the Division the applicant's
financial ability and resources necessary to operate the AFH. Financial ability
must include, but is not limited to, providing the Division with a current
credit report, list of unsatisfied judgments, pending litigation, and unpaid
taxes and notifying the Division regarding whether the applicant is in
bankruptcy. If the applicant is unable to demonstrate the financial ability and
resources required, the Division may require the applicant to furnish a
financial guarantee as a condition of initial licensure in accordance with ORS
443.735(3)(e);
(h) A signed letter of acknowledgment from
the Community Mental Health Program or designee for the applicant to be
licensed to operate the AFH;
(i)
Proof of experience providing direct care and services to adults with mental
illness;
(j) Documentation of an
approved check in accordance with OAR
943-007-0001 through 0501 for
the provider, the resident manager, caregivers, volunteers, and other occupants
16 years of age or older, excluding residents and other persons as defined in
ORS 443.735;
(k) Written background information pertaining
to any current or previous licensure or certification by a state agency,
including those licenses or certificates granted to a business or person
affiliated with the business, including:
(A)
Copies of all current licenses or certificates;
(B) Disclosure of any adverse action taken or
proposed on any current or previous license or certificate, and documentation
showing the final disposition of any suspension, denial, revocation, or other
disciplinary actions initiated on any current or previous license or
certificate, including settlement agreements, where applicable; and
(C) Documentation of any substantiated
allegations of abuse or neglect pertaining to the applicant or anyone employed
by or contracted with the applicant.
(l) Verification of completion of all
required trainings for the provider, resident manager if applicable, and all
substitute caregivers including, but not limited to:
(A) Division-approved AFH Provider
Orientation;
(B) Mandatory Abuse
Reporting;
(C) Current CPR and
First Aid certification;
(i) Accepted CPR and
First Aid courses must be provided by or meet the standards of the American
Heart Association or the American Red Cross.
(ii) CPR or First Aid courses conducted
online are only accepted by the Department when an in-person skills competency
check is conducted by a qualified instructor meeting the standards of the
American Heart Association, the American Red Cross.
(m) Verification of home ownership
or copy of current lease or rental agreement that includes;
(A) The owner and landlord's name;
(B) Verification that the rent is a flat
rate; and
(C) Signatures of the
landlord and applicant and the date signed.
(n) A floor plan of the AFH containing the
required components as outlined in OAR
309-040-0370(3).
(o) One copy of written approved certificate
of occupancy based on the change of use of the setting, issued by the city or
county building codes authority having jurisdiction;
(p) A completed AFH Self-Inspection related
to HCBS compliance and Fire Safety, using division approved forms;
(q) The AFH plan of operation, including:
(A) The use of substitute caregivers and
other staff;
(B) A description of
how the providers or substitute caregivers must be directly involved with
residents on a daily basis
(C) How
the providers and substitute caregivers will be prepared to communicate with
all residents who live in the home including residents with limited English
proficiency.
(D) Detail how
transportation and community engagement will occur.
(5) The Division must determine
compliance with these rules based on receipt of the completed application
material and fees, a review and investigation of information submitted, an
in-person inspection of the AFH, and interviews with the applicant and other
individuals as determined necessary by the Division.
(6) The applicant may withdraw the
application at any time during the application process by notifying the
Division in writing.
(7) The
Division may elect to deny an application when:
(a) The applicant has previously had any
adverse action taken on a certificate or license by the oversight body;
or
(b) Action taken on a
certificate or license may include but is not limited to denial, suspension,
conditions, intent to revoke, nonrenewal, or revocation by the Division, the
Authority, the Oregon Department of Human Services, or any other state
agency;
(c) The applicant fails to
provide accurate information; and
(d) The applicant may appeal the denial of
the application by submitting a request for reconsideration in writing to the
Division within 14 calendar days from receipt of the denial notice. The
Division must make a decision on the appeal within 30 days of receipt of the
appeal. The decision of the Division is final.
(8) An applicant whose license has been
revoked or voluntarily surrendered, following a receipt of Notice of Intent to
Revoke or Notice of Intent to Not Renew from the Division, or whose application
has been denied by the Division for reasons relating to, but not limited to,
criminal convictions, civil proceedings against the applicant, or substantiated
allegations of abuse by the applicant, may not be permitted to submit an
application for one year from the date that the revocation, non-renewal,
surrender, or denial is made final. A longer period may be specified in the
order revoking or denying the license.
(9) The AFH must be in full compliance with
all Home and Community Based required qualities of
42CFR §
441.710(a)(1), OAR
410-173-0035, and OAR
411-004.
(10) At or about 90 days
after initial licensure, the Division will inspect the AFH to ensure compliant
operation.
Notes
Statutory/Other Authority: ORS 413.042 & ORS 443.420
Statutes/Other Implemented: ORS 443.705 - 443.825
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