id-16-0322-2501: Residential Assisted Living Facilities (ZBR Chapter Rewrite)
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The proposed rule is aimed at updating the guidelines for residential assisted living facilities, which are homes that provide care for people who need help with daily activities. The changes are intended to improve the quality of care and ensure the safety and well-being of residents living in these facilities.
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Dear Senators VANORDEN, Bjerke, Wintrow, and Representatives VANDER WOUDE, Erickson, Rubel: The Legislative Services Office, Research and Legislation, has received the enclosed rules of the Department of Health and Welfare: IDAPA 16.03.22 - Residential Assisted Living Facilities (ZBR Chapter Rewrite)-Proposed Rule (Docket No. 16-0322-2501). Pursuant to Section 67-454, Idaho Code, a meeting on the enclosed rules may be called by the cochairmen or by two (2) or more members of the subcommittee giving oral or written notice to Research and Legislation no later than fourteen (14) days after receipt of the rules' analysis from Legislative Services. The final date to call a meeting on the enclosed rules is no later than 08/01/2025. If a meeting is called, the subcommittee must hold the meeting within forty-two (42) days of receipt of the rules' analysis from Legislative Services. The final date to hold a meeting on the enclosed rules is 08/29/2025. The germane joint subcommittee may request a statement of economic impact with respect to a proposed rule by notifying Research and Legislation. There is no time limit on requesting this statement, and it may be requested whether or not a meeting on the proposed rule is called or after a meeting has been held. To notify Research and Legislation, call 334-4854, or send a written request to the address on the memorandum attached below. Page 1 of 1 Terri Kondeff Director MEMORANDUM TO: Rules Review Subcommittee of the Senate Health & Welfare Committee and the House Health & Welfare Committee FROM: Legislative Drafter - Kyle Slominski DATE: July 15, 2025 SUBJECT: Department of Health and Welfare IDAPA 16.03.22 - Residential Assisted Living Facilities (ZBR Chapter Rewrite)-Proposed Rule (Docket No. 16-0322-2501) Summary and Stated Reasons for the Rule The Idaho Department of Health and Welfare submits notice for proposed rulemaking for residential as- sisted living facilities, IDAPA 16.03.22. The Department states that the proposed rulemaking in in accordance with the Zero-Based Regulation Executive Order and strives to prevent the accumulation of costly, ineffective, and outdated regulations and reduce regulatory burden to achieve a more efficient operation of government. The Department also states that the proposed changes are being made to obtain consistency with S.B. 1102, which became effective July 1, 2025. Negotiated Rulemaking / Fiscal Impact The Department states that negotiated rulemaking was conducted and that notice was published in the April 2, 2025, Administrative Bulletin, Volume 25-4, pages 25-26. The Department also states that there is no anticipated negative fiscal impact to the general fund. Statutory Authority The Department appears to have authority to promulgate this rule pursuant to sections 39-3305 and 39-3358, Idaho Code. cc: Department of Health and Welfare Adam Jones *** PLEASE NOTE *** Per the Idaho Constitution, all administrative rules may be reviewed by the Legislature during the next legisla- tive session. The Legislature has 3 options with this rulemaking docket: 1) Approve the docket in its entirety; 2) Reject the docket in its entirety; or 3) Reject the docket in part. Paul Headlee, Deputy DirectMatt Drake, Manager Keith Bybee, ManagerApril Renfro, Manager Norma Clark, Manager Legislative Services OffResearch & Legislation Budget & Policy AnalyLegislative AuditsInformation Technology Statehouse, P.O. Box 83720 Tel: 208–334–2475 Boise, Idaho 83720–0054 legislature.idaho.gov IDAPA 16 – DEPARTMENT OF HEALTH AND WELFARE 16.03.22 – RESIDENTIAL ASSISTED LIVING FACILITIES DOCKET NO. 16-0322-2501 (ZBR CHAPTER REWRITE) NOTICE OF RULEMAKING – PROPOSED RULE AUTHORITY: In compliance with Section 67-5221(1), Idaho Code, notice is hereby given that this agency has initiated proposed rulemaking procedures. The action is authorized pursuant to Section(s) 39-3305 and 39-3358, Idaho Code. PUBLIC HEARING SCHEDULE: Public hearings concerning this rulemaking will be held as follows: VIRTUALTELECONFERENCES Via WebEx Monday, June 9, 2025 1:00 PM (MT) Join from the meeting link https://idhw.webex.com/idhw/j.php?MTID=mfa92068288da5b29e04435961568c15d Join by meeting number Meeting number (access code): 2829 726 2075 Meeting password: wqHuAZ3Su55 Meeting password when dialing from a phone or video system: 97482937 Join by phone +1-415-527-5035 United States Toll +1-303-498-7536 United States Toll (Denver) Friday, June 20, 2025 9:30 AM (MT) Join from the meeting link https://idhw.webex.com/idhw/j.php?MTID=m2f4078949547e149eb63e486e59c8c76 Join by meeting number Meeting number (access code): 2824 243 4131 Meeting password: dHMPGuh7i22 Meeting password when dialing from a phone or video system: 34674847 Join by phone +1-415-527-5035 United States Toll +1-303-498-7536 United States Toll (Denver) The hearing site(s) will be accessible to persons with disabilities. Requests for accommodation must be made not later than five (5) days prior to the hearing, to the agency address below. proposed rulemaking: The following is a nontechnical explanation of the substance and purpose of the IdahoAdministrative Bulletin Page 126 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule Under Executive Order 2020-01: Zero-Based Regulation, the Department is striving to prevent the accumulation of costly, ineffective, and outdated regulations and reduce regulatory burden to achieve a more efficient operation of government. The rule changes are intended to perform a comprehensive review of this chapter to streamline or simplify this rule language. SB 1102 passed by the 2025 Idaho Legislature revoked certain provisions contained in IDAPA 16.03.22, declaring them null, void, and of no force and effect. This ZBR Chapter Rewrite reflects amendments to codified text as it will look on July, 1, 2025, when the enacted legislation will become law, and not the rule chapter as it is currently enforceable. To view the official text of IDAPA16.03.22 as it is currently effective, click here. FEE SUMMARY: The following is a specific description of the fee or charge imposed or increased: Fees will not be increased as a result of this rulemaking. FISCAL IMPACT: The following is a specific description, if applicable, of any negative fiscal impact on the state General Fund greater than ten thousand dollars ($10,000) during the fiscal year as a result of this rulemaking: There is not anticipated to be a negative fiscal impact exceeding $10,000. NEGOTIATED RULEMAKING: Pursuant to Section 67-5220(1), Idaho Code, negotiated rulemaking was conducted. The Notice of Intent to Promulgate Rules - Negotiated Rulemaking was published in the April 2nd, 2025 IdahoAdministrative Bulletin, Volume 25-4, pages 25 and 26. INCORPORATION BY REFERENCE: Pursuant to Section 67-5229(2)(a), Idaho Code, the following is a brief synopsis of why the materials cited are being incorporated by reference into this rule: N/A. ASSISTANCE ON TECHNICAL QUESTIONS, SUBMISSION OF WRITTEN COMMENTS: For assistance on technical questions concerning the proposed rule, contact Jared Larsen at DHWRules@dhw.idaho.gov. Anyone may submit written comments regarding this proposed rulemaking. All written comments must be directed to the undersigned and must be delivered on or before June 25th, 2025. DATED this 2nd day of May, 2025. Jared Larsen Chief, Legislative and RegulatoryAffairs Idaho Department of Health & Welfare 450 W. State Street, 10th Floor P.O. Box 83720 Boise, ID 83720-0036 (208) 334-5500 phone; (208) 334-6558 fax DHWRules@dhw.idaho.gov 16.03.22 – RESIDENTIAL ASSISTED LIVING FACILITIES 000. LEGALAUTHORITY. The Idaho Board of Health and Welfare is authorized under Sections 39-3305 and 39-3358, Idaho Code, to adopt and enforce rules to protect the health, safety, and individual rights for residents in residential assisted living facilities. (3-15-22) IdahoAdministrative Bulletin Page 127 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 001. TITLE, SCOPE,AND RESPONSIBILITIES.
02. Scope. The purpose of a residential assisted living facility is to provide choice, dignity, and
independence to residents while maintaining a safe, humane, and home-like living arrangement for individuals needing assistance with daily activities and personal care. These rules set standards for providing services that maintain a safe and healthy environment for residential assisted living facilities.. (3-15-22)( )
03. General Provider Responsibilities. The facility must ensure quality services by providing
choices, dignity, and independence to residents. The facility must have an administrator and staff who have the knowledge and experience required to provide safe and appropriate services to all residents of the facility. The facility must be operated consistent with the rules and statutes as it conducts its work. (3-15-22)
04. General Department Responsibilities. The Department is responsible for monitoring and
enforcing the provisions of the statute and this chapter to protect residents in these facilities by providing information, education, and evaluating providers to ensure compliance with statute and these rules. This responsibility includes licensing facilities and monitoring the condition of facilities. (3-15-22) 002. WRITTEN INTERPRETATIONS. This agency has written statements which pertain to the interpretations of the rules of this chapter or to the documentation of compliance with the rules of this chapter. These documents are available for public inspection on the program website http://assistedliving.dhw.idaho.gov. (3-15-22) 003. ADMINISTRATIVEAPPEALSAND CONTESTED CASES. Administrative appeals and contested cases are governed by IDAPA 16.05.03, “Contested Case Proceedings and Declaratory Rulings.” (3-15-22) 004. INCORPORATION BY REFERENCE. The documents referenced in this rule, are incorporated by reference as provided by Section 67-5229(a), Idaho Code. These incorporated documents are available for public review upon request at the Department of Health and Welfare, 450 West State Street, Boise, Idaho 83702, or when available online at the websites provided in these rules. (3-15-22)
01. National Fire ProtectionAssociation (NFPA) Documents. (3-15-22)
a. National Fire Protection Association (NFPA) Standard 101, The Life Safety Code, 2018 Edition, the occupancy chapters and all mandatory referenced documents contained therein under “Mandatory References.” (3-15-22) b. National Fire Protection Association (NFPA) Standard 99, Health Care Facilities Code, 2018 Edition. (3-15-22)
02. Idaho Diet Manual. The manual is available from the Idaho Academy of Nutrition & Dietetics,
Eleventh Edition, 2015, online at http://eatrightidaho.org. (3-15-22)
03. Idaho Food Code. IDAPA16.02.19, “Idaho Food Code.” These rules are available online at http://
adminrules.idaho.gov/rules/current/16/160219.pdf. (3-15-22)
04. Americans with Disabilities Act Accessibility Guidelines. 28 CFR Part 36, Appendix A. This
code is available online at http://www.ada.gov/1991standards/adastd94-archive.pdf. (3-15-22)
05. Idaho Board of Nursing Rules. IDAPA 24.34.01, “Rules of the Idaho Board of Nursing.” These
rules are available online at https://adminrules.idaho.gov/rules/current/24/243401.pdf. (3-15-22)
06. International Building Code. IDAPA 24.39.30, “Rules of Building Safety.” These rules are
IdahoAdministrative Bulletin Page 128 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule available online athttps://adminrules.idaho.gov/rules/current/24/243930.pdf. (3-15-22) 0052. -- 008. (RESERVED) 009. CRIMINAL HISTORYAND BACKGROUND CHECK REQUIREMENTS.
01. Criminal History and Background Check. A residential assisted living facility must complete a
criminal history and background check on employees and contractors hired or contracted with after October 1, 2005, who have direct resident access to residents in the residential assisted living facility. The Department check conducted under IDAPA 16.05.06, “Criminal History and Background Checks,” satisfies this requirement. Other criminal history and background checks may be acceptable provided they meet the criteria in Subsection 009.02 of this rule and the entity conducting the check issues written findings. The entity must provide a copy of these written findings to both the facility and the employee. (3-15-22)( )
02. Scope of a Criminal History and Background Check. The criminal history and background
check must, at a minimum, be fingerprint-based and include a search of the following record sources: (3-15-22) a. Federal Bureau of Investigation (FBI); (3-15-22) b. Idaho State Police Bureau of Criminal Identification; (3-15-22) c. Sexual Offender Registry; (3-15-22) d. Office of Inspector General List of Excluded Individuals and Entities; and (3-15-22) e. NurseAide Registry. (3-15-22)
03. Availability to Work. Any direct resident access individual hired or contracted with on or after
October 1, 2005, must self-disclose all arrests and convictions before having access to residents. (3-15-22) a. If a disqualifying crime as described in IDAPA 16.05.06, “Criminal History and Background Checks,” is disclosed, the individual must not have direct resident access to any resident. (3-15-22) b. The individual is only allowed to work under another employee who has a cleared criminal history and background check that meets the criteria in this rule. The cleared employee must keep the individual waiting for clearance in line-of-sight when the individual has direct resident access until the criminal history and background check is completed and the results are obtained by the facility, unless: while waiting for results. The unlicensed employee may not have one-to-one contact with a resident or access their personal belongings without the supervision of a cleared employee. (3-15-22)( ) i. The individual has completed an alternative criminal history and background check that includes a search of the record sources listed in Subsection 009.02 except for Subsection 009.02.a. in this rule; (3-15-22) ii. The facility determines there is no potential danger to residents; and (3-15-22) iii. This alternative criminal history and background check is only in effect until the required criminal history and background check that meets the criteria in this rule is completed. The results must state whether the individual was cleared or denied based on the completed fingerprint-based background check. (3-15-22)
04. Submission of Fingerprints. The individual’s fingerprints must be submitted to the entity
conducting the criminal history and background check within twenty-one (21) days of their date of hire. (3-15-22)
05. New Criminal History and Background Check. An individual must have a criminal history and
background check when: (3-15-22) a. Accepting employment with a new employer; and (3-15-22) IdahoAdministrative Bulletin Page 129 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule b. The individual’s last criminal history and background check was completed more than three (3) years prior to their date of hire. (3-15-22)
06. Use of Previous Criminal History and Background Check. Any employer is allowed to use a
previous criminal history and background check that meets the criteria in this rule if: (3-15-22) a. The individual has received a criminal history and background check within three (3) years of their date of hire; (3-15-22) b. Prior to the individual being granted unsupervised direct resident access, the employer obtains and retains the individual's previous criminal history and background check results; (3-15-22) c. The employer completes a state-only background check of the individual through the Idaho State Police Bureau of Criminal Identification, within thirty (30) days of obtaining the previous criminal history and background check results; and (3-15-22) d. No disqualifying crimes are found. (3-15-22)
07. Employer Discretion. The new employer, at its discretion, may require an individual to complete a
criminal history and background check at any time, even if the individual has received a criminal history and background check within three (3) years of their date of hire. (3-15-22) 010. DEFINITIONS ANDABBREVIATIONSATHROUGH E.
01. Abuse. A non-accidental act of sexual, physical, or mental mistreatment or injury of a resident
through the action or inaction of another individual. (3-15-22)
03. Activities. All organized and directed social and rehabilitative services a facility provides,
arranges, or cooperates with. (3-15-22)
04. Activities of Daily Living. Self-care actions necessary to sustain an individual in daily living,
including bathing, dressing, toileting, grooming, eating, communicating, and managing medications. (3-15-22)
05. Administrator. An individual licensed by the Idaho Bureau of Occupational Licenses as a
Residential Assisted Living FacilityAdministrator. (3-15-22)
06. Administrator’s Designee. A person authorized in writing to act in the absence of the
administrator who is knowledgeable of facility operations, the residents and their needs, emergency procedures, the location and operation of emergency equipment, and how the administrator can be reached in the event of an emergency. (3-15-22)
07. Adult. Aperson who has reached eighteen (18) years of age. (3-15-22)
081. Advance Directive. A written instruction, such as a living will or durable power of attorney for health care, recognized under state law, whether statutory or as recognized by the courts of the State, related to the provision of medical care when the individual is unable to communicate. (3-15-22) 09. Advocate. An authorized or designated representative of a program or organization operating under federal or state mandate to represent the interests of a population group served by a facility. (3-15-22) 10. Ambulatory Person. A person who, unaided by any other person, is physically and mentally capable of walking a normal path to safety, including the ascent and descent of stairs. (3-15-22) 11. Assessment. Information gathered that identifies resident strengths, weaknesses, risks, and needs, to include functional, social, medical, and behavioral needs. (3-15-22) IdahoAdministrative Bulletin Page 130 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 12. Authentication. The process or action of proving or showing authorship to be true, genuine, or valid. (3-15-22) 13. Authorized Provider. An individual who is a nurse practitioner, clinical nurse specialist, or physician assistant. (3-15-22) 1402. Behavior Plan. A written plan that decreases the frequency, duration, or intensity of maladaptive behaviors, and increases the frequency of adaptive behaviors person-centered document outlining strategies to address and modify a specific behavior, developed based on a functional assessment that identifies the underlying cause of the behavior, and includes proactive steps to prevent the behavior, teach alternate appropriate behaviors, and provide reinforcement for positive interactions. (3-15-22)( ) 1503. Call System. A signaling system whereby a resident can contact staff directly from their sleeping room, toilet room, and bathing area. The system may be voice communication, or an audible or visual signal, and may include wireless technology. The call system cannot be configured in such a way as to breach a resident’s right to privacy at the facility, including in the resident’s living quarters, in common areas, during medical treatments, while receiving other services, in written and telephonic communications, or in visits with family, friends, advocates, and resident groups. (3-15-22)( ) 16. Chemical Restraint. A medication used to control behavior or to restrict freedom of movement and is not a standard treatment for the resident's condition. (3-15-22) 1704. Cognitive Impairment. When a person experiences loss of short or long-term memory, orientation to person, place, or time, safety awareness, or loses the ability to make decisions that affect everyday life. (3-15-22) 18. Complaint.Aformal expression of dissatisfaction, discontent, or unhappiness by, or on behalf of, a resident concerning the care or conditions at the facility. This expression could be oral, in writing, or by alternative means of communication. (3-15-22) 1905. Complaint Investigation. A survey to investigate the validity of allegations of noncompliance with applicable state requirements. Allegations will be investigated by the Licensing Agency as described in Section 39-3355, Idaho Code. (3-15-22) 20. Core Issue.A core issue is any one (1) of the following: (3-15-22) a. Abuse; (3-15-22) b. Neglect; (3-15-22) c. Exploitation; (3-15-22) d. Inadequate care; (3-15-22) e. A situation in which the facility has operated for more than thirty (30) days without a licensed administrator overseeing the day-to-day operations of the facility; (3-15-22) f. Inoperable fire detection or extinguishing systems with no fire watch in place pending the correction of the system; or (3-15-22) g. Surveyors denied access to records, residents, or facilities. (3-15-22) 2106. Criminal Offense. Any crime as defined in Section 18-111, Idaho Code, 18 U.S.C. Section 4B1.2(a), and 18 U.S.C. Sections 1001 through 1027. (3-15-22) 22. Deficiency.Adetermination of noncompliance with a specific rule or part of a rule. (3-15-22) IdahoAdministrative Bulletin Page 131 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 23 07. Dementia. A chronic deterioration of intellectual function and other cognitive skills severe enough to interfere with the ability to perform activities of daily living. (3-15-22) 24. Department. The Idaho Department of Health and Welfare. (3-15-22) 2508. Developmental Disability. A developmental disability, as defined in Section 66-402, Idaho Code, means a chronic disability of a person which appears before twenty-two (22) years of age and:. (3-15-22)( ) a. Is attributable to an impairment, such as an intellectual disability, cerebral palsy, epilepsy, autism, or other conditions found to be closely related or similar to one (1) of these impairments that requires similar treatment or services, or is attributable to dyslexia resulting from such impairments; (3-15-22) b. Results in substantial functional limitations in three (3) or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent living, or economic self-sufficiency; and (3-15-22) c. Reflects the need for a combination and sequence of special, interdisciplinary or direct care, treatment, or other services which are of life-long or extended duration, and individually planned and coordinated. (3-15-22) 2609. Direct Resident Access. In-person access with any resident who resides at the facility, or any access to the residents' personal belongings or information. (3-15-22) 27. Director. The Director of the Idaho Department of Health and Welfare or their designee. (3-15-22) 28. Electronic Signature. The system for signing electronic documents by entering a unique code or password that verifies the identity of the person signing and creates an individual “signature” on the record. (3-15-22) 2910. Elopement. When a resident who is cognitively, physically, mentally, emotionally, or chemically impaired, physically leaves the facility premises property or the secured unit or yard without personnel's knowledge. (3-15-22)( ) 30. Exit Conference. A meeting with the facility administrator or designee to: (1) provide review, discussion, and written documentation of non-core issues, and (2) to provide preliminary findings of core issues. (3-15-22) 31. Exploitation. The misuse of a resident's funds, property, resources, identity, or person for profit or advantage. This includes charging a resident for services or supplies not provided or disclosed in the written admission agreement and staff accepting gifts or money for extra services. (3-15-22) 011. DEFINITIONS ANDABBREVIATIONS FTHROUGH N.
01. Follow-Up Survey. A survey conducted to confirm that the facility is in compliance and has the
ability to remain in compliance. (3-15-22)
02. Governmental Unit. The state, any county, any city, or any department, division, board, or other
agency. (3-15-22) 0311. Hourly Adult Care. Nonresident daily services and supervision provided by a facility to individuals who are in need of supervision outside of their personal residence(s) for a portion of the day. (3-15-22) 04. Immediate Danger.Any resident is subject to an imminent or substantial danger. (3-15-22) 05. Inadequate Care. When a facility fails to provide the services required to meet the terms of the Negotiated ServiceAgreement, or provide for room, board, activities of daily living, supervision, first aid, assistance and monitoring of medications, emergency intervention, coordination of outside services, a safe living environment, IdahoAdministrative Bulletin Page 132 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule engages in violations of resident rights, or takes residents who have been admitted in violation of the provisions of Section 152 of these rules. (3-15-22) 0612. Incident.An event that can cause a resident injury. (3-15-22) 07. Independent Mobility.Aperson’s ability to move about freely of their own choice with or without the assistance of a mobility device such as a wheelchair, cane, crutches, or walker. (3-15-22) 0813. Legal Guardian or Conservator.Acourt-appointed individual designated to manage the affairs or finances of another person who has been found to be incapable of handling their own affairs. (3-15-22) 09. License.A permit to operate a residential assisted living facility. (3-15-22) 10. Licensing Agency. The Residential Assisted Living Facilities Program, a unit of the Division of Licensing and Certification within the Department of Health and Welfare, that conducts inspections and surveys of residential assisted living facilities and issues licenses based on compliance with this chapter of rules, in which “Residential Assisted Living Facilities Program” and “LicensingAgency” are synonymous. (3-15-22) 114. Maladaptive Behavior.Any behavior that interferes with resident care, infringes on any resident's rights, or presents a danger to the resident or others. Involuntary muscle movements are not considered maladaptive behaviors. (3-15-22)( ) 125. Medication. Any substance used to treat a disease, condition, or symptom, which may be taken orally, injected, or used externally, and is available through prescription or over-the-counter. (3-15-22) 136. Medication Administration. The process where a prescribed medication is given by a licensed nurse to a resident through one (1) of several routes. (3-15-22)( ) 147. Medication Assistance. The process whereby a non-licensed care provider is delegated tasks by a licensed nurse, to aid a person who cannot independently self-administer medications. See IDAPA 24.34.01, “Rules of the Idaho Board of Nursing,” Section 010. (3-15-22)( ) 158. Mental Disorders. Health conditions that are characterized by alterations in thinking, mood, behavior, or some combination thereof, that are all mediated by the brain and associated with distress or impaired functioning. (3-15-22) 169. Mental Illness. Refers collectively to all diagnosable mental disorders. (3-15-22) 17. Neglect. Failure to provide food, clothing, shelter, or medical care necessary to sustain the life and health of a resident. (3-15-22) 18. Negotiated Service Agreement. The plan reached by the resident or their representative and the facility which outlines services to be provided and the obligations of the facility and the resident. (3-15-22) 19. Non-Core Issue.Any finding of deficient practice that is not a core issue. (3-15-22) 20. Nursing Assessment. Information gathered related to a resident's health or medical status that has been reviewed, signed, and dated by a licensed registered nurse, as described in Section 305 of these rules. (3-15-22)( ) 012. DEFINITIONS ANDABBREVIATIONS O THROUGH Z. 0121. Outside Services. Services provided to a resident by someone that is not a member of facility personnel. (3-15-22) 0222. Owner. Any person or entity having legal ownership of the facility as an operating business, regardless of who owns the real property. (3-15-22) IdahoAdministrative Bulletin Page 133 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
03. Personal Assistance. The provision by the staff of the facility of one (1) or more of the following
services: (3-15-22) a. Assisting the resident with activities of daily living; (3-15-22) b. Arranging for outside services; (3-15-22) c. Being aware of the resident's general whereabouts; or (3-15-22) d. Monitoring the activities of the resident while on the premises of the facility to ensure the resident's health, safety, and well-being. (3-15-22) 0423. Personnel. Paid individuals assigned the responsibility of providing care, supervision, and services to the facility and its residents. In this chapter of rules, “personnel” and “staff” are synonymous. (3-15-22) 05. Physical Restraint. Any device or physical force that restricts the free movement of, normal functioning of, or normal access to, a portion or portions of an individual's body, except for the temporary treatment of a medical condition, such as the use of a cast for a broken bone. (3-15-22) 0624. Portable Heating Device. Any device designed to provide heat on a temporary basis that is not designed as part of a building's heating system, is not permanently affixed to the building, and, if electrical, is not hardwired to the building's electrical service. This does not include the use of therapeutic devices such as heating pads, heated mattress pads, and electric blankets, which require a physician or authorized provider’s order. (3-15-22) 0725. PRN. Indicates that a medication or treatment prescribed by a medical professional to an individual may be given as needed. (3-15-22) 08. Pressure Injury.Any lesion caused by unrelieved pressure that results in damage to the underlying tissue(s). (3-15-22) 0926. Provisional License. A license which may be issued to a facility not in compliance with the rules pending the satisfactory correction of all deficiencies. (3-15-22) 1027. Publicly Funded Program. Any program funded in whole, or in part, by an appropriation of the U.S. Congress, the Idaho Legislature, or other governmental body. (3-15-22) 1128. Punishment. The use of an adverse consequence with a resident, the administration of any noxious or unpleasant stimulus, or deprivation of a resident's rights or freedom. (3-15-22) 1229. Relative.A person related by birth, adoption, or marriage. (3-15-22) 1330. Repeat Deficiency. A deficiency found on a licensure survey, complaint investigation, or follow- up survey that was also found on the previous survey. (3-15-22) 1431. Reportable Incident. A situation when a facility is required to report information to the Residential Assisted Living Facilities Program, including: (3-15-22) a. Any resident injury of unknown origin (i.e., an injury, the source of which was not observed by any person and could not be explained by the resident); (3-15-22) ba. Any resident injury of significant or suspicious nature (i.e., an injury that includes severe bruising, fingerprint bruises, laceration(s) larger than a minor skin tear, sprains, or fractured bones); (3-15-22) c. Resident injury resulting from accidents involving facility-sponsored transportation (i.e., falling from the facility's van lift, a wheelchair belt coming loose during transport, or a collision); (3-15-22) IdahoAdministrative Bulletin Page 134 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule db. Resident elopement of any duration; (3-15-22) ec. Any significant injury resulting from a resident-to-resident incident; (3-15-22)( ) fd. An incident that results in the resident's need for assessment or treatment outside of the facility at a hospital; or (3-15-22)( ) ge. An incident that results in the resident's death. (3-15-22) 15. Resident. An adult, other than the owner, administrator, their immediate families, or employees, who lives in a residential assisted living facility. (3-15-22) 16. Residential Assisted Living Facility. A facility or residence, however named, licensed in the state of Idaho, operated on either a profit or nonprofit basis for the purpose of providing necessary supervision, personal assistance, meals, and lodging to three (3) or more adults not related to the owner. (3-15-22) 17. Room and Board. Lodging, meals, and utilities. (3-15-22) 1832. Scope. The frequency or extent of the occurrence of a deficiency in a facility. (3-15-22) 19 33. Self-Administration of Medication. The act of a resident taking a single dose of their own medication from a properly labeled container and placing it internally in, or externally on, their own body as a result of an order by an authorized provider. (3-15-22) 20. Story.A level of rooms in a building. (3-15-22) 21. Substantial Compliance. The status of a facility that has no core issue deficiencies. (3-15-22) 22. Substantial Evening Meal. An offering of three (3) or more menu items at one time, one (1) of which is a high-quality protein such as meat, fish, eggs, or cheeses. The meal should represent no less than twenty percent (20%) of the day's total nutritional requirements. (3-15-22) 23. Supervision. A critical watching and directing activity which provides protection, guidance, knowledge of the resident's general whereabouts, and assistance with activities of daily living. The administrator is responsible for providing appropriate supervision based on each resident's Negotiated Service Agreement or other legal requirements. (3-15-22) 2434. Survey. A review conducted by a surveyor to determine compliance with statutes and rules. There are two (2) components to a survey: (1) health care and (2) fire, life, and safety. (3-15-22)( ) 2535. Surveyor. A person authorized by the Department to conduct surveys or complaint investigations to determine compliance with statutes and rules. (3-15-22) 2636. Therapeutic Diet. A diet ordered by a physician or authorized provider as part of treatment for a clinical condition or disease, to eliminate or decrease specific nutrients in the diet (e.g., sodium), to increase specific nutrients in the diet (e.g., potassium), or to provide food the resident is able to eat (e.g., a mechanically altered diet). (3-15-22)( ) 2737. Toxic Chemical. A substance that is hazardous to health if inhaled, ingested, or absorbed through skin. (3-15-22) 2838. Traumatic Brain Injury (TBI). An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment. The term applies to open or closed-head injuries resulting in impairments in one (1) or more areas. (3-15-22) 2939. Unlicensed Assistive Personnel (UAP). Staff, with or without formal credentials, employed to perform nursing care services under the direction and supervision of licensed nurses. (3-15-22) IdahoAdministrative Bulletin Page 135 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 3040. Variance. Permission by the Department to do something contrary to rule. (3-15-22) 013 1. -- 049. (RESERVED) 050. VARIANCES. The Licensing Agency may grant a variance provided the following criteria are met to a rule provided the written requests meet the requirements under Title 67 Chapter 52, Idaho Code. (3-15-22)( )
01. Written Request. A written request for a variance must be sent to the Licensing Agency. The
request must include the following: (3-15-22) a. Reference to the rule for which the variance is requested; (3-15-22) b. Reasons that show good cause why the variance should be granted, the extenuating circumstances which caused the need for the variance, any compensating factors or conditions that may have bearing on the variance such as additional floor space or additional staffing; and (3-15-22) c. Written documentation that ensures residents' health and safety will not be jeopardized if a variance is granted. (3-15-22) 021. Temporary Variance. A temporary variance may be granted for a specific resident or situation. The variance expires when the resident no longer lives at the facility or when the situation no longer exists. (3-15-22)( ) 032. Continuing A Variance. The Licensing Agency reviews the appropriateness of continuing a variance during the survey process. If the facility administrator wishes to continue the variance, an annual request must be submitted to the LicensingAgency in writing. (3-15-22)( ) 04. Decision to Grant a Variance. The decision to grant a variance will not be considered as a precedent or be given any force or effect in any other proceeding. (3-15-22) 053. Revocation of Variance. The LicensingAgency may revoke a variance if circumstances identify a risk to resident health and safety. (3-15-22)( ) 051. -- 099. (RESERVED) 100. LICENSING REQUIREMENTS.
01. Current License. No person, firm, partnership, association, corporation, or governmental unit can
operate, establish, manage, conduct, or maintain a residential assisted living facility in Idaho without a license issued by the Department as required in Section 39-3340, Idaho Code. Any entity found operating as a residential assisted living facility without a license is subject to Section 39-3352, Idaho Code. (3-15-22) 021. Issuance of License. Upon completion of the application process requirements, the Department will issue a residential assisted living facility licenseA license will be issued to any organization upon completing an application demonstrating compliance with these rules. (3-15-22)( ) 032. Distinctive Business Name. Every facility must use a distinctive name, which is registered with the Idaho Secretary of State. If a facility decides to change its name, it will only be changed upon written notification to the Licensing Agency confirming the registration of the name change with the Idaho Secretary of State. This notification needs to be received by the Licensing Agency at least thirty (30) calendar days prior to the date the proposed name change is to be effective The facility will notify the Department within thirty (30) calendar days of a registered name change. (3-15-22)( ) 04. Administrator. Each facility must have an administrator. (3-15-22) IdahoAdministrative Bulletin Page 136 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 05 3. Display of Facility License. The current facility license must be posted in the facility and clearly visible to the general public. (3-15-22) 06. Change in Corporate Shares. When there is a significant change in shares held by a corporate licensee of a residential assisted living facility, which does not alter the overall ownership or operation of the business, that change must be communicated to the Licensing Agency within (60) days of the effective date of change. (3-15-22) 074. Licensee Responsibility. The licensee of the facility is responsible for the operation of the residential assisted living facility, even when a separate administrator is employed. (3-15-22)( ) 101. -- 104. (RESERVED) 105. CHANGE OF OWNERSHIP.
01. Non-Transfer of Facility License. A facility license is not transferable from one (1) individual to
another, from one (1) business entity to another, or from one (1) location to another. When a change of licensee, ownership, lease, or location occurs, the facility must be re-licensed. The new licensee must follow the application procedures, and obtain a license, before commencing operation as a facility. (3-15-22)
02. Application for Change of Ownership. The application for a change of ownership must be
submitted to the LicensingAgency at least ninety (90) days prior to the proposed date of change. (3-15-22)
03. Change of Ownership for a Facility in Litigation. An application for change of ownership of a
facility from a person who is in litigation for failure to meet licensure standards, or who has had a license revoked, must include evidence that there is a bona fide, arms-length agreement and relationship between the two (2) parties. An entity purchasing a facility with an enforcement action acquires the enforcement action. (3-15-22) 106. -- 109. (RESERVED) 110. FACILITY LICENSEAPPLICATION.
01. License Application. License application forms are available online at the Licensing Agency’s
website at http://assistedliving.dhw.idaho.gov. The applicant must provide the following information: (3-15-22) a. A written statement that the applicant has thoroughly read and reviewed the statute, Title 39, Chapter 33, Idaho Code, and IDAPA 16.03.22, “Residential Assisted Living Facilities,” and is prepared to comply with both; (3-15-22) b. A written statement and documentation that demonstrate no license revocation or other enforcement action is in the process of being taken, against a license held, or previously held, by the applicant in Idaho or any other state or jurisdiction; (7-1-24) c. When the applicant is a firm, association, organization, partnership, business trust, corporation, government entity, or company, the administrator and other members of the organization who directly influence the facility's operation must provide the information contained in this rule; (3-15-22) d. Each shareholder or investor holding twenty percent (20%) or more interest in the business must be listed on the application; (7-1-24) ea. Acopy of the Certificate ofAssumed Business Name from the Idaho Secretary of State; (3-15-22) f. A statement from the local fire authority that the facility is located in a lawfully constituted fire district or affirmation that a lawfully constituted fire authority will respond to a fire at the facility; (3-15-22) g. Astatement from a licensed electrician or the local or state electrical inspector that all wiring in the facility complies with current electrical codes; (3-15-22) IdahoAdministrative Bulletin Page 137 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule h. When the facility does not use an approved municipal water or sewage treatment system, a statement from a local environmental health specialist with the public health district indicating that the water supply and sewage disposal system meet the Department's requirements and standards; (3-15-22) ib. Acomplete set of printed operational policies and procedures; (3-15-22) j. Adetailed floor plan of the facility, including measurements of all rooms, or a copy of architectural drawings. See Sections 250 through 260, and Sections 400 through 430 of these rules. (3-15-22) kc. Acopy of the Purchase Agreement, LeaseAgreement, or Deed; and (3-15-22)( ) l. For facilities with nine (9) beds or more, signatures must be obtained from the following: (3-15-22) d. Adetailed floor plan of the facility, including measurements of all rooms, or a copy of architectural drawings; and ( ) e. The following must be obtained: ( ) i. The local zoning official documenting that the facility meets local zoning codes for occupancyOccupancy permit that the facility is located in a lawfully constituted fire district or affirmation that a lawfully constituted fire authority will respond to a fire at the facility; (3-15-22)( ) ii. The local building official documenting that the facility meets local building codes for occupancy; andOccupancy permit that all wiring in the facility complies with current electrical codes; (3-15-22)( ) iii. TheOccupancy permit or evidence that the facility meets local zoning codes for occupancy and local fire official documenting that the facility meets local fire codes for occupancy. (3-15-22)( )
02. Written Request for Building Evaluation. The applicant must request submits a request in
writing to the Licensing Agency for a building evaluation of existing buildings. The request. It must include the physical address of the building that is to be evaluated and, the name, address, and telephone number of the person who is to receive the building evaluation report, and be accompanied by a five hundred dollar ($500) initial building evaluation fee. (3-15-22)( )
03. Building Evaluation Fee. This application and request must be accompanied by a five hundred
dollar ($500) initial building evaluation fee. (3-15-22) 043. Identification of the Licensed Administrator. The applicant must provide a copy of the administrator's license and criminal history background check, and the current address for the primary residence of the administrator. (3-15-22)( ) 05. Failure to Complete Application Process. Failure of the applicant to complete the Licensing Agency's application process within six (6) months of the original date of application, may result in a denial of the application. If the application is denied, the applicant is required to initiate a new licensing application process. (3-15-22) 111. -- 114. (RESERVED) 115. EXPIRATIONAND RENEWAL OF LICENSE.
01. Application for License Renewal. The facility must submit to the Licensing Agency an annual
report and application for renewal of a license at least thirty (30) days prior to the expiration of the existing license. (3-15-22)
02. Existing License. The existing license, unless suspended, surrendered, or revoked, remains in force
IdahoAdministrative Bulletin Page 138 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule and effect until the LicensingAgency has acted upon the application renewal, when such application for renewal has been filed. (3-15-22) 116. -- 125. (RESERVED) 126. EFFECT OF ENFORCEMENTACTIONAGAINSTALICENSE. The Department will not review an application of an applicant who has an action, either current or in process, against a license held by the applicant either in Idaho or any other state or jurisdiction. (3-15-22)( ) 127. FREQUENCY OF INSPECTIONS.
01. No Core Issues. Facilities without core issue deficiencies during two (2) consecutive licensure
surveys, will be inspected at least every thirty-six (36) months. For facilities with core issue deficiencies, surveys will be conducted at the discretion of the LicensingAgency, at least every fifteen (15) months. ( )
02. Complaint Investigations. Complaint investigations will occur based on the severity of the
complaint. ( )
03. Correction of Non-Core Issues. The facility must correct non-core issues within thirty (30)
calendar days of the exit conference. If the facility is unable to meet this timeframe, they must inform the Department within thirty (30) calendar days of the exit conference. ( ) 1278. – 14950. (RESERVED) 150. POLICIESAND PROCEDURES. 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. (3-15-22) 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 participate in planned, recreational, and other activities. The facility must provide opportunities for the following: (3-15-22)( )
01. Socialization. Socialization through group discussion, conversation, recreation, visiting, arts and
crafts, and music; (3-15-22)
02. Physical Activities. Physical activities such as games, sports, and exercises which develop and
maintain strength, coordination, and range of motion; (3-15-22)
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. (3-15-22) 152. ADMISSION REQUIREMENTS.
01. Admissions Policies. Each facility must develop and implement written admission policies and
procedures, which must include: (3-15-22) a. The purpose, quantity, and characteristics of available services; (3-15-22) b. Limitations concerning delivery of routine personal care by persons of the opposite gender; (3-15-22) IdahoAdministrative Bulletin Page 139 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 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/ search.html; and (3-15-22) d. Notification to potential and existing residents if non-resident adults or children reside in the facility. (3-15-22) 02b. Resident Admission, Discharge, and Transfer. The facility must have policiesCriteria for addressing admission, discharge, and transfer of residents to, from, or within the facility. (3-15-22)( ) 032. Policies of Acceptable Admissions. Written descriptions of the conditions Policies for admitting residents to the facility must include: (3-15-22)( ) a. Aresident will be admitted or retained only when: (3-15-22) ia. The facility has the capability, capacity, and services to provide appropriate care; (3-15-22) iib. 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 (3-15-22) iiic. The facility has the personnel, appropriate in numbers and with appropriate knowledge and skills to provide such services. (3-15-22) 153. FINANCIAL REQUIREMENTS. Each facility must develop and implement financial policies and procedures that include: (3-15-22)
01. StatementResident Funds. Astatement policy specifying if how the facility does not will manage
resident funds. (3-15-22)( )
02. Safeguarding of Funds. Policies should s Specify how residents' funds will be handled managed
and safeguarded, and be in compliance with Section 39-3316, Idaho Code. iIf the facility does manage resident funds., Ppolicies must address the following: (3-15-22)( ) 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; (3-15-22) b. Adescription of how facility fees are handled; (3-15-22) c. Resident accounts and funds must be separate from any facility accounts; (3-15-22) da. 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; (3-15-22) eb. Each transaction with resident funds must be documented at the time to include signatures of the resident and facility representative with copies of receipts; include copies of receipts. (3-15-22)( ) f. Residents must have access to their personal funds during normal business hours; and (3-15-22) g03. Funds at Discharge. 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. Per the admissions agreement, the facility may charge a fee for the repair of damages or cleaning the room.All remaining funds are the property of the resident. (3-15-22)( ) 154. STAFFTRAINING RESIDENT SAFETY REQUIREMENTS. The facility must develop and implement a written, dated set of policies and procedures that are specific to the populations served in the facility and are available to all staff at all times to direct and ensure compliance with these rules. The facility must develop and implement policies and procedures to address the following: (3-15-22)( ) IdahoAdministrative Bulletin Page 140 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
01. Response of Staff to Accidents, Incidents, orAllegations of Abuse, Neglect, or Exploitation of
Residents. The facility must develop policies and procedures to ensure that This includes how 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. (3-15-22)( )
02. Response of Staff to Emergencies. How staff are to respond to Staff responsibilities in emergency
situations, including: (3-15-22)( ) a. Medical and psychiatric emergencies; (3-15-22) b. Resident absence; (3-15-22) c. Criminal situations; and (3-15-22) d. Presence of law enforcement officials at the facility. (3-15-22)
03. Notification of Changes to Resident Health or Mental Status. Who and how staff are to notify of
Staff responsibilities and notification requirements for any changes in residents’health or mental status. (3-15-22)( )
04. Provided Care and Services by Staff. How s Staff are to provide responsibilities when providing
care and services to residents in the following areas: (3-15-22)( ) a. Activities of daily living; (3-15-22) b. Dietary and eating, including when a resident refuses to eat or follow a prescribed diet; (3-15-22) c. Dignity; (3-15-22) d. Ensuring each individual’s rights; (3-15-22) e. Medication assistance; (3-15-22) f. Provision of privacy; (3-15-22) g. Social activities; (3-15-22) h. Supervision; (3-15-22) i. Supporting resident independence; and (3-15-22) j. Telephone access. (3-15-22)
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. (3-15-22) 065. 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. (3-15-22) 076. 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. (3-15-22) 087. Hazardous Materials. The handling of hazardous materials. (3-15-22) IdahoAdministrative Bulletin Page 141 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 09 8. Mechanical Equipment. The handling of potentially dangerous mechanical equipment. (3-15-22) 09. Smoking Requirements. The facility must develop and implement written rules governing smoking. Smoking policies must be available to staff, residents, and visiting public and must ensure: ( ) a. Smoking is prohibited in areas where combustible supplies or materials, flammable liquids, gases, or oxidizers are in use or stored. ( ) b. Smoking in bed is prohibited. ( ) c. Unsupervised smoking by residents classified as not mentally or physically responsible, sedated by medication, or taking oxygen is prohibited. ( ) d. If smoking is permitted, there must be designated smoking areas which are clearly marked. Designated smoking areas must have non-combustible disposal receptacles. ( ) 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 natural disaster, or other emergency. (3-15-22)( )
01. Relocation Agreements. Each facility must have a current 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. (3-15-22)( )
02. Written Procedures. The facility must have written procedures outlining steps to be taken in the
event of an emergency including: (3-15-22) a. Each person's responsibilities; (3-15-22) b. Where and how residents are to be evacuated; and (3-15-22) c. Notification of emergency agencies. (3-15-22)
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). (3-15-22) 156. HOURLYADULT CARE REQUIREMENTS. Facilities offering hourly adult care must develop and implement written policies and procedures which include the following: (3-15-22)
01. Services Offered. A description of hourly adult care services, including transportation services (if
offered), meals, medical assistance, activities, and supervision, and documentation requirements. (3-15-22)( )
02. IndividualsAccepted. Types of individuals who may or may not be accepted for hourly adult care.
See Section 152 of these rules. (3-15-22)
03. Cost of Hourly Adult Care. Details of the cost of hourly adult care for the person receiving
services. (3-15-22)
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. (3-15-22)
05. Assistance with Medications. Assistance with medications in the facility must comply with
IDAPA 24.34.01, “Rules of the Idaho Board of Nursing,” including: (3-15-22) a. Copies of all physician or authorized provider orders, including orders for all prescribed IdahoAdministrative Bulletin Page 142 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule medications and treatments. (3-15-22) b. Appropriately labeled medications and treatments the facility safeguards while the person receives hourly adult care. (3-15-22) 02. Hourly Adult Care. The facility must keep record of names, dates, and description of services provided. ( ) 063. 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. (3-15-22) 074. Accommodations. The facility must provide accommodations appropriate to the time frame for those receiving hourly adult care, including:. (3-15-22)( ) a. Daytime accommodations such as recliners and couches for napping. Napping furniture must be spaced at least (3) feet apart. (3-15-22) 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. (3-15-22) 08. Documentation. Documentation requirements described in Section 330 of these rules. (3-15-22) 157. -- 160. (RESERVED) 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: (3-15-22)
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. (3-15-22)
03. Unsupervised Smoking. Unsupervised smoking by residents classified as not mentally or
physically responsible, sedated by medication, or taking oxygen is prohibited. (3-15-22)
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 receptacles. (3-15-22) 162. – 215. (RESERVED) 216. REQUIREMENTS FOR RESIDENTADMISSIONAGREEMENTS.
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. (3-15-22)
01. Pre-Admission. 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 assessment must include the following: ( ) a. Documentation of level of assistance required for activities of daily living including bathing, IdahoAdministrative Bulletin Page 143 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule dressing, toileting, grooming, eating, communicating and the use of adaptive equipment; ( ) b. Pre-admission nursing assessment; ( ) c. Documentation of any maladaptive behaviors including history, intensity, duration, and frequency, including potential contributing factors and mitigation efforts; and ( ) d. Documentation of the need for related outside services, including service type, name and frequency. ( )
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. The admission agreement will provide a complete reflection of the facility’s charges, commitments agreed to by each party, and the services to be provided by the facility. The agreement must include the following: (3-15-22)( )
03. Services, Supports, and Rates. The facility must identify the following services, supports, and
applicable rates: (3-15-22) 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. (3-15-22) 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. (3-15-22) c. All prices, formulas, and calculations used to determine the resident’s basic services rate including: (3-15-22) i. Service packages; (3-15-22) ii. Fee-for-service rates; (3-15-22) iii. Assessment forms; (3-15-22) iv. Price per assessment point; (3-15-22) v. Charges for levels of care determined with an assessment; and (3-15-22) vi. Move-in fees or other similar charges. (3-15-22) 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. (3-15-22) 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. (3-15-22) 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. (3-15-22) IdahoAdministrative Bulletin Page 144 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 04a. Staffing. The agreement must iIdentify staffing patterns and qualifications of staff on duty during a normal day. (3-15-22) ( ) 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. (3-15-22) 06b. Medication Responsibilities. The agreement must iIdentify 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. (3-15-22)( ) 07c. Resident Personal Fund Responsibilities. The agreement must iIdentify who is responsible for the resident's personal funds. (3-15-22)( ) 08d. Resident Belongings Responsibility. The agreement must iIdentify 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. (3-15-22)( ) 09e. Emergency Transfers. The agreement must iIdentify conditions under which emergency transfers will be made as provided in Section 152 of these rules. (3-15-22)( ) 10f. Billing Practices, Notices, and Procedures for Payments and Refunds. The facility must pProvide a description of the facility’s billing practices, notices, and procedures for payments and refunds. The following procedures must be included: (3-15-22)( ) ai. Arrangement for payments; (3-15-22) bii. 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 (3-15-22) ciii. 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. (3-15-22) 11g. Resident Permission to Transfer Information. The agreement must sSpecify permission for the facility to transfer information from the resident's records to any facility to which the resident transfers. (3-15-22)( ) 12h. Resident Responsibilities. The agreement must sSpecify resident responsibilities.(3-15-22)( ) 13i. Restrictions on Choice of Care or Service Providers. The agreement must sSpecify any restriction on choice of care or service providers, such as home health agency, hospice agency, or personal care services. (3-15-22)( ) 14j. Advance Directive. The agreement must iIdentify 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. (3-15-22) ( ) 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. (3-15-22) 16k. Contested Charges. The facility must pProvide the methods by which a resident may contest charges or rate increases including contacting the ombudsman for the elderly. (3-15-22) ( ) IdahoAdministrative Bulletin Page 145 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 17l. Transition to Publicly Funded Program. The facility must dDisclose the conditions under which the resident can remain in the facility if payment for the resident shifts to a publicly funded program. (3-15-22) ( ) 18m. Smoking Policy. The admission agreement must iInclude a copy of the facility's smoking policy. (3-15-22)( ) 217. REQUIREMENTS FOR TERMINATION OFADMISSIONAGREEMENT.
01. Conditions for Termination of the Admission Agreement. The admission agreement cannot be
terminated, except under Section 39-3313, Idaho Code, as follows: (3-15-22) a. Giving the other party thirty (30) calendar days written notice; (3-15-22) b. The resident's death; (3-15-22) c. Emergency conditions that require the resident to be transferred to protect the resident or other residents in the facility from harm; (3-15-22) 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; (3-15-22) e. Nonpayment of the resident's fees; (3-15-22) f. When the facility cannot meet resident needs due to changes in services, in-house or contracted, or inability to provide the services; or (3-15-22) 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. (3-15-22)
01. Notification. Before a facility discharges a resident, the facility must notify the resident or their
representative in writing and their representative of the discharge and the cause. ( )
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. (3-15-22)( )
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. (3-15-22) a. Before a facility discharges a resident, the facility must notify the resident and their representative of the discharge and the cause. (3-15-22) b. This notice must be in writing and in a language and manner the resident or their representative can understand. (3-15-22) 043. Written Notice of Discharge. The written notice of discharge must include the following: (3-15-22) a. The specific reason for the discharge; (3-15-22) b. The effective date of the discharge; (3-15-22) IdahoAdministrative Bulletin Page 146 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 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; (3-15-22) dc. The Residential Assisted Living Facilities Program website, where the appeal must be submittedA statement informing the resident of their appeal rights including timelines and methods; (3-15-22)( ) ed. The name, address, and telephone number of the local ombudsman; (3-15-22) fe. The name, address, and telephone number of Disability Rights Idaho; (3-15-22) gf. 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 (3-15-22)( ) hg. When the notice does not contain all the above required information, the notice is void and must be reissued. (3-15-22)
04. 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. ( )
05. Receipt of Appeal. Request for an appeal must be received by t The Department must receive the
appeal request 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 receipt of written notice of discharge. (3-15-22)( ) 218. -- 249. (RESERVED) 250. REQUIREMENTS FOR BUILDING CONSTRUCTION AND PHYSICALSTANDARDS. 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. (3-15-22)
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. (3-15-22)
02. Plans and Specifications. Plans must be prepared, signed, stamped, and dated by an architect or
engineer licensed in the state of Idaho.Avariance of this requirement may be granted by the LicensingAgency when the size of the project does not necessitate involvement of an architect or engineer. This must include the following: and submitted to the Department after approval of local authorities. (3-15-22)( ) a. Plans and specifications must be submitted to the Licensing Agency to ensure compliance with applicable construction standards, codes, and regulations; (3-15-22) b. Plans must be drawn to scale, but no less than a scale of one-eighth (1/8) inch to one (1) foot; (3-15-22) c. Plans must be submitted electronically; (3-15-22) d. Aphysical address approved by the city; (3-15-22) e. Life safety plans; (3-15-22) f. Fire alarm shop drawings; and (3-15-22) IdahoAdministrative Bulletin Page 147 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule g. Fire sprinkler system drawings and calculations. (3-15-22)
03. Approval. All buildings, additions, and renovations are subject to approval by the Licensing
Agency and must meet applicable requirements. (3-15-22)
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. (3-15-22) 054. Toilets and Bathrooms. Each facility must provide: (3-15-22) 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; (3-15-22) b. Solid walls or partitions to separate each toilet and bathroom from all adjoining rooms; (3-15-22) c. Mechanical ventilation to the outside from all inside toilets and bathrooms not provided with an operable exterior window; (3-15-22) d. Each tub, shower, and lavatory with hot and cold running waterAdequate number of bathrooms to meet the needs of the residents admitted to the facility; (3-15-22)( ) e. At least one (1) flushing toilet for every six (6) residents; (3-15-22) f. At least one (1) tub or shower for every eight (8) residents; (3-15-22) g. At least one (1) lavatory with a mirror for each toilet; and (3-15-22) 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. (3-15-22) 065. 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:. (3-15-22)( ) a. Ramps for residents who require assistance with ambulation must comply with the requirements of theADAAG 4.8; (3-15-22) b. Bathrooms and doors large enough to allow the easy passage of a wheelchair as provided for in the ADAAG 4.13; (3-15-22) c. Grab bars in resident toilet and bathrooms in compliance withADAAG 4.26; (3-15-22) d. Toilet facilities in compliance withADAAG 4.16 and 4.23; (3-15-22) 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 (3-15-22) 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. (3-15-22) 07. Lighting. The facility must provide adequate lighting in all resident sleeping rooms, dining rooms, living rooms, recreation rooms, and hallways. (3-15-22) IdahoAdministrative Bulletin Page 148 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 08. Ventilation. The facility must be ventilated, and precautions taken to prevent offensive odors. (3-15-22) 096. 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 Fahrenheit (120°F). (3-15-22)( ) 1007. 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 these sources. (3-15-22)( ) 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 in resident sleeping areas; (3-15-22)( ) b. All fireplaces must provide a safety barrier and have heat-tempered glass fireplace enclosures equivalent toASTM Standard that is tip resistant and ensures resident safety; (3-15-22)( ) c. Boilers, hot water heaters, and unfired pressure vessels must be equipped with automatic pressure relief valves; (3-15-22) 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. (3-15-22) 1108. 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 recreation space. (3-15-22) 1209. Resident Sleeping Rooms. The facility must ensure that: (3-15-22) a. Resident sleeping rooms are not in attics, stairs, halls, or any other room commonly used for other than bedroom purposes; (3-15-22) b. A room with a window that opens into an exterior window well cannot be used for a resident sleeping room; (3-15-22) ca. Not more than four two (42) 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); (3-15-22)( ) db. 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. (3-15-22) e. Each resident's sleeping room must be provided with an operable exterior window. An operable IdahoAdministrative Bulletin Page 149 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule window is not required where there is a door directly to the outside from the sleeping room; (3-15-22) f. The operable window sill height must not exceed thirty-six (36) inches above the floor in new construction, additions, or remodeling; (3-15-22) gc. The operable window sill height must not exceed forty-four (44) inches above the floor in existing buildings being converted to a facility; (3-15-22)( ) 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; (3-15-22) id. Window screens must be provided on operable windows; and (3-15-22)( ) 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; (3-15-22) k. Ceiling heights in sleeping rooms must be at least seven (7) feet, six (6) inches; and (3-15-22) le. 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. (3-15-22) 130. 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 The secured environment and security provided must be evaluated and adjusted as necessary to meet the needs of all residents. (3-15-22)( ) 141. Call System. The facility must have a call system available for each resident to call for assistance and still be ensured a maintain the 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. (3-15-22)( ) 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. (3-15-22) 251. -- 254. (RESERVED) 255. REQUIREMENTS FOR ADDITIONAL PHYSICAL STANDARDS.
02. Roads. The facility must be served by an all-weather road and kept open to motor vehicles at all
times of the year. (3-15-22)
03. Medical Accessibility. The facility site must be accessible to authorized providers or emergency
medical services within thirty (30) minutes driving time. (3-15-22) 256. -- 259. (RESERVED) 260. REQUIREMENTS FOR ENVIRONMENTAL SANITATION. IdahoAdministrative Bulletin Page 150 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
01. Water Supply. The facility must have an adequate water supply that is safe and of a sanitary
quality Water supply must be from an approved private, public, or municipal water supply. (3-15-22)( ) a. The water supply must be from an approved private, public, or municipal water supply; (3-15-22) ba. 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. (3-15-22)( ) 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. (3-15-22)
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. (3-15-22) 032. Garbage and Refuse Disposal. Garbage and refuse disposal must be provided to ensure that: (3-15-22) a. The premises and all buildings must be kept free from the accumulation of weeds, trash, and rubbish; (3-15-22) b. Material not directly related to the maintenance and operation of the facility must not be stored on the premises; and (3-15-22)( ) 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 (3-15-22) dc. 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. (3-15-22)( ) 043. 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. (3-15-22)( ) 054. Linen and Laundry Facilities and Services. (3-15-22) a. The facility must have available at all times a quantity of linen essential suitable to the proper care and comfort of residents; and (3-15-22)( ) b. Linen must be of good quality, nNot thread-bare, torn, or stained; (3-15-22)( ) c. Linens must be hHandled, processed, and stored in an appropriate manner that prevents contamination; (3-15-22)( ) d. Adequate facilities must be provided for the proper and sanitary washing and drying of linen and other washable goods laundered in the facility; (3-15-22) ed. The laundry must be sSituated in an area separate and apart from where food is stored, prepared, or served; (3-15-22)( ) 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; (3-15-22) ge. Care must be taken to ensure sSoiled linen and clothing are must be properly handled to prevent IdahoAdministrative Bulletin Page 151 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule contamination. Clean linen and clothing received from a laundry service must be stored in a proper manner to prevent contamination; and (3-15-22)( ) hf. 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). (3-15-22) 065. 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, and furnishings. (3-15-22) 07 6. 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. (3-15-22) 261. – 304. (RESERVED) 305. REQUIREMENTS FOR THE LICENSED REGISTERED NURSINGASSESSMENT. For each resident the licensed registered nurse must assess and, document, including date and signature sign, the following: (3-15-22)( )
01. Resident Medications and Therapies. Each resident's use of, and response to all medications,
(including over-the-counter, and prescribed therapies), the monitoring of side effects, interactions, abuse, or other adverse effects, and ensuring the resident's physician or authorized provider is notified of any identified concerns with medications and therapies. (3-15-22)
02. Current Medication Orders and Treatment Orders. Each resident's medication and treatment
orders are current and verified for the following: (3-15-22) a. The medication listed on the medication distribution container, including over-the-counter- medications, is consistent with physician or authorized provider orders; (3-15-22) b. The physician or authorized provider orders related to therapeutic diets, treatments, and medications for each resident are followed; and (3-15-22) c. Acopy of the actual written, signed, and dated orders are present in each resident's care record. (3-15-22)
01. Pre-Admission Assessment. A review of the resident’s health and medical status including
identification of medical and care needs. ( )
02. Quarterly Nursing Assessments. The facility nurse must visit the facility at least once every
ninety (90) days to conduct quarterly assessments. The assessments must include: ( ) a. Review of the residents’ health and medical status, including any changes in medical or physical status; and ( ) b. Recommendations for changes needed to the NSAto meet the residents’needs. ( )
03. Change in Resident Health Status. The health status of each resident by conducting a p Physical
assessment and, identifying symptoms of illness, or any changes in mental or physical health status. (3-15-22)( )
04. Recommendations. Recommendations to Notify the administrator regarding any medication
needs, other health needs requiring follow-up, or medical changes needed requiring amendments to the NSA. The nurse must notify Notify the physician or authorized provider of recommendations for medical care and services that are needed medical changes. (3-15-22)( ) IdahoAdministrative Bulletin Page 152 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
05. Progress of Previous Recommendations. The progress of previous recommendations regarding
any medication needs or other health needs that require follow-up. (3-15-22) 065. Self-Administered Medication. Each resident participating in a self-administered medication program at the following times: Residents must be assessed prior to self-administering medications and every ninety (90) days thereafter. (3-15-22)( ) a. Before the resident can self-administer medication to ensure resident safety; and (3-15-22) b. Every ninety (90) days to evaluate the continued validity of the assessment to ensure the resident is still capable to safely self-administer medication(s). (3-15-22) 07. Resident and Facility Staff Education. Recommendations for any health care-related educational needs, for both the resident and facility staff, as the result of the nursing assessment or at the direction of the resident's health care provider. (3-15-22) 306. -- 309. (RESERVED) 310. REQUIREMENTS FOR MEDICATIONSAND TREATMENTS. Facility policies and procedures must specify how medications will be handled. (3-15-22)
01. Medication Distribution System. Each facility must use medi-sets or blister packs for prescription
medications. The facility may use multi-dose medication distribution systems that are provided for resident’s receiving medications from the Veterans Administration or Railroad benefits. The medication system must be filled by a pharmacist and appropriately labeled in accordance with pharmacy standards and physician or authorized provider instructions. The facility's licensed nurse may fill medi-sets, blister packs, or other Licensing Agency approved systems as described in Section 39-3326, Idaho Code The facility must ensure. (3-15-22)( ) a. All medications must be kept in a locked area such as a locked box or room; (3-15-22) b. Poisons, toxic chemicals, and cleaning agents must not be stored with medications; (3-15-22) c. Biologicals and other medications requiring cold storage must be maintained at thirty-eight degrees Fahrenheit to forty-five degrees Fahrenheit (38°F-45°F), per manufacturer’s guidelines and the temperature monitored and documented daily weekly; (3-15-22)( ) d. Assistance with medication must comply with the Board of Nursing requirements; (3-15-22) ed. Each prescription medication must be given to the resident directly from the medi-set, blister pack, or medication container; (3-15-22) fe. Each resident must be observed taking the medication; and (3-15-22) f. Medications and treatments must be provided per physician or authorized provider orders. ( ) g. Each prescribed PRN must be available in the facility. (3-15-22)
02. Discontinued and Expired Prescriptions. Discontinued or outdated medications and treatments
must be removed from the resident's medication supply and cannot accumulate at the facility for longer than thirty (30) days. The unused medication must be disposed of in a manner that ensures it cannot be retrieved properly. The facility may enter into agreement, a copy of which must be maintained, with a pharmacy or other authorized entity to return unused, unopened medications for proper disposition. A written record of all drug disposals must be maintained in the facility and include must document the following: (3-15-22)( ) a. Adescription of the drug, including the amount; (3-15-22) IdahoAdministrative Bulletin Page 153 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule b. Name of the resident for whom the medication is prescribed; (3-15-22) c. The reason for method and date of disposal; and (3-15-22)( ) d. The method of disposal; (3-15-22) e. The date of disposal; and (3-15-22) fd. Signatures of responsible facility personnel and witness. (3-15-22)
03. Controlled Substances. The facility must track all controlled substances entering the facility,
including the amount received, the date, a daily count, reconciliation of the number given or disposed, and the number remaining. (3-15-22)
04. Psychotropic or Behavior Modifying Medication. (3-15-22)( )
a. Psychotropic or behavior modifying medication intervention must not be the first resort to address behaviors. The facility must attempt non-drug interventions to assist and redirect the resident’s behavior. (3-15-22) b. Psychotropic or behavior modifying medications must be prescribed by a physician or authorized provider. (3-15-22) cb. The facility must monitor the resident to determine continued need for the medication based on the resident’s demonstrated behaviors document residents’response to the medications including demonstrated behaviors and any side effects that impacted the residents’health or safety. (3-15-22)( ) c. The facility must provide behavior updates to the physician or authorized provider when requested. ( ) d. The facility must monitor the resident for any side effects that could impact the resident’s health and safety. (3-15-22) e. The use of psychotropic or behavior modifying medications must be reviewed by the physician or authorized provider at least every six (6) months. The facility must provide behavior updates to the physician or authorized provider to help facilitate an informed decision on the continued use, and possible reduction, of the psychotropic or behavior modifying medication. (3-15-22) 311. -- 3189. (RESERVED) 319. COMPREHENSIVE ASSESSMENT REQUIREMENTS. The facility must complete assessment information as described in Subsections 319.01 through 319.04 of this rule, prior to admitting the resident to the residential assisted living facility. The remainder of the comprehensive assessment must be completed within fourteen (14) days of admission. Comprehensive assessment information must be updated when there is a change, or at least every twelve (12) months. The comprehensive assessment must contain the following: (3-15-22)
01. Resident Demographics. Resident demographic information, including: (3-15-22)
a. Date of birth; (3-15-22) b. Placement history; (3-15-22) c. Identification of any medical diagnoses, including any information about specific health problems, such as allergies, that may be useful in a medical emergency; (3-15-22) d. Prescription and over-the-counter medications and treatments; (3-15-22) IdahoAdministrative Bulletin Page 154 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule e. Information related to cognitive function; (3-15-22) f. Legal status, to include copies of legal documents when applicable (e.g., guardianship or power of attorney); and (3-15-22) g. Names and contact information of representatives and emergency contacts. (3-15-22)
02. Level of PersonalAssistance Required. The facility must assess the level of assistance required to
help the resident with the following: Activities of daily living, including bathing, dressing, toileting, grooming, eating, communicating, medications, and the use of adaptive equipment, such as hearing aids, walkers, or eyeglasses. (3-15-22)
03. NursingAssessment. Information related to the resident's health, medical status, and identification
of any health services needed, including frequency and scope. (3-15-22)
04. Maladaptive Behaviors. Evaluation of maladaptive behaviors, including: (3-15-22)
a. The resident's behavioral history, including any history of traumatic events; (3-15-22) b. The intensity, duration, and frequency of each maladaptive behavior; (3-15-22) c. Potential contributing environmental factors, such as heat, noise, or overcrowding; (3-15-22) d. Any specific events that can trigger maladaptive behaviors; (3-15-22) e. Potential contributing health factors, such as hunger, pain, constipation, infection, fever, or medication side effects; and (3-15-22) f. Recent changes in the resident's life, such as a death in the family or changes in care. (3-15-22)
05. Resident Preferences. Resident preferences and historical information that includes: (3-15-22)
a. Religion and church attendance, including preferred church contact information; (3-15-22) b. Historical information including significant life events, family, work, and education; and (3-15-22) c. Hobbies or preferred activities. (3-15-22)
06. Outside Services. Information related to outside services, including the service type being
provided, when, and by whom. (3-15-22)
07. Assessment Results. The results of the comprehensive assessment must be used to develop the
NSA, identify training needs for staff, and evaluate the ability of an administrator and facility to meet the identified resident’s needs. (3-15-22) 320. NEGOTIATED SERVICE AGREEMENT (NSA) REQUIREMENTS. Under Section 39-3309, Idaho Code, each resident must enter into an NSA completed, signed, and implemented no later than fourteen (14) calendar days from the date of admission. An interim plan must be developed and used while the NSAis being completed as described in Section 330 of these rules. (3-15-22)( )
01. Use of NSA. The NSAprovides for the coordination of services and instruction to the facility staff.
Upon completion, the agreement must clearly identify the resident, describe services to be provided, the frequency of such services, and how such services are to be delivered. (3-15-22)
02. Key Elements of the NSA. A resident's NSA must be based on the comprehensive assessment
information described in Section 319 of these rules. NSAs must incorporate information from the resident's care record, described in Section 330 of these rules. (3-15-22) IdahoAdministrative Bulletin Page 155 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
03. Signature, Date, and Approval of Agreement. The administrator, resident, and any legal
representative must sign and date the NSAupon its completion. (3-15-22)
05. Development of the NSA. The resident, and other relevant persons as identified by the resident,
must be included in the development of the NSA. Licensed and professional staff must be involved in the development of the NSA as applicable. (3-15-22)
06. Copy of Initial Agreement. Signed copies of the agreement must be given to the resident, their
representative, and their legal guardian or conservator, and a copy placed in the resident's record, no later than fourteen (14) calendar days from admission. (3-15-22)
07. Resident Choice. A resident must be given the choice and control of how and what services the
facility or external vendors will provide, to the extent the resident can make choices. The resident's choice must not violate the provisions of Section 39-3307(1), Idaho Code. (3-15-22)
08. Periodic Review. The NSA must be reviewed when there is a change in a diagnosis for a resident
or other change in condition requiring different, additional, or replacement services, or at least every twelve (12) months. (3-15-22) 321. -- 329. (RESERVED) 330. REQUIREMENTS FOR FACILITY RECORDS. The facility must maintain complete, accurate, and authentic records which are preserved in a safe location protected from fire, theft, and water damage develop policies and procedures in accordance with Sections 39-3316, Idaho Code, for a minimum of three (3) years. (3-15-22)( )
02. Electronic Records. Electronic records policies and procedures must be developed and
implemented that specify which records will be maintained electronically. Policy development and implementation must ensure: (3-15-22) a. The facility must print and provide paper copies of electronic records upon the request of the resident, their legal guardian or conservator, advocacy and protection agencies, and the Department. (3-15-22) b. Security measures must be taken to protect the use of an electronic signature by anyone other than the person to which the electronic signature belongs and to protect that person's identity. The policy must specify how passwords are assigned, and the frequency they are changed. (3-15-22) c. Security measures must be taken to ensure the integrity of any electronic documentation. (3-15-22) 032. Record Confidentiality. The facility must safeguard confidential information against loss, destruction, and unauthorized use comply with the Health Insurance Portability andAccountabilityAct (HIPAA). (3-15-22)( ) 043. Resident Care Records.An Each resident must have an individual care record must be maintained for each resident with all entries kept current. Entries must be documented during each shift and completed by the person providing the care, including the date, time, name, and title of the person making the entry (3-15-22)( ) a. Entries must include the date, time, name, and title of the person making the entry. Staff must sign each entry made by them during their shift. (3-15-22) ba. Care records of all current residentsThe plan of care must be available to staff at all times. and include: (3-15-22)( ) IdahoAdministrative Bulletin Page 156 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule c. In addition to an NSA, as described in Section 320 of these rules, each care record must include documentation of the following: (3-15-22) i. Comprehensive assessments, as described in Section 319 of these rules; (3-15-22) ii. Current medications, treatments, and diet prescribed, all signed and dated by the ordering physician or authorized providerAcopy of written, signed, and dated medication and treatment orders; (3-15-22)( ) iii. Treatments, wound care, assistance with medications, and any other delegated nursing tasks. Documentation must include any PRN medication use (if applicable), including the reason for taking the medication and the efficacy; (3-15-22)( ) ivii. Times the NSA is not followed, such as during refusal of care or services. This includes any time a medication is refused by a resident, not taken by a resident, not given to a resident, and the reason for the omissionDocumentation when the resident refuses care or services or the resident missed taking prescribed medication including the reason; (3-15-22)( ) v. Calls to the resident's physician or authorized provider, including the reason for each call and the outcome; (3-15-22) viiv. Notification to the facility nurse of changes in the resident's physical or mental condition; (3-15-22) vii. Nursing assessments, as described in Section 305 of these rules; (3-15-22)( ) viii. The results of any physician or authorized provider visits, including phone calls to providers including the reason and outcome; (3-15-22)( ) ixvii. Copies of all signed and dated care plans prepared by outside service agencies; (3-15-22) xviii. Notes regarding outside services and care provided to the resident, such as home health, hospice, or physical therapy; (3-15-22) xiix. Unusual events such as incidents, accidents, or altercations, and the facility's response; and (3-15-22) xii. When a resident refuses medical treatment or physician's orders, the facility must document the resident and their legal guardian have been informed of the consequences of the refusal and the resident's physician or authorized provider has been notified of the refusalDocumentation the physician, authorized, and legal representative provider has been contacted when a resident consistently refuses medical treatment or physician orders. (3-15-22)( ) 05. Admission Records. As described in Section 39-3315, Idaho Code, resident admission documentation must include: (3-15-22) a. The resident's preferred providers and contact information, including physician or authorized provider, optometrist, dentist, pharmacy, and outside service providers. (3-15-22) b. Results of the resident's last history and physical examination, performed by a physician or authorized provider. The examination must have been conducted no more than six (6) months prior to admission. (3-15-22) c. Physician or authorized provider orders that are current, signed, and dated, including a list of medications, treatments, diet, and any limitations. (3-15-22) d. A written admission agreement that is signed and dated by the administrator and the resident or IdahoAdministrative Bulletin Page 157 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule their legal guardian or conservator, and meets the requirements of Section 216 of these rules. (3-15-22) e. If separate from the admission agreement, a copy of the payment schedule and fee structure signed and dated by the resident or their legal guardian or conservator. (3-15-22) f. If the facility manages the resident's funds, a signed and dated written agreement between the facility and the resident or their legal guardian or conservator that specifies the terms. (3-15-22) g. A signed copy of the resident's rights, as described in Sections 550 and 560 of these rules, or a signed and dated statement that the resident or their legal guardian or conservator has read and understands their rights in a residential assisted living facility. (3-15-22) h. An interim care plan signed by the resident, responsible party, and the facility, completed prior to, or on the day of, admission. (3-15-22) i. Documentation indicating the resident has been informed of the facility's emergency procedures, including resident responsibility. (3-15-22) 064. Behavior Documentation. For residents who exhibit maladaptive behaviors, behavior management records must be maintained in the resident record, including the facility must maintain documentation of the following: (3-15-22)( ) a. An assessment of maladaptive behaviors, as described in Section 319 of these rules. (3-15-22)( ) b. Abehavior plan that includes at least one (1) intervention specific to each maladaptive behavior.s; (3-15-22)( ) i. Interventions must be the least restrictive possible; and must include the date and time of each maladaptive behavior, a description of the behavior, the interventions implemented and the effectiveness of each intervention. (3-15-22)( ) ii. Each intervention must be reviewed as appropriate, based on the severity of the behavior, to evaluate the effectiveness and continued need for the intervention. (3-15-22) c. Ongoing tracking of behaviors, including documentation of the date and time each maladaptive behavior was observed, the specific behavior that was observed, what interventions were used in response to the maladaptive behavior, and the effectiveness of each intervention. (3-15-22) 075. Discharge Records. Resident discharge documentation must include: (3-15-22) a. When the discharge is involuntary, the facility's efforts to resolve the situation and a copy of the discharge notice, signed and dated by the resident and the facility. If the resident refuses, or is unable to sign the notice, the facility must maintain evidence that the notice was delivered to the resident and the responsible partyA copy of the written notice of discharge if applicable; (3-15-22)( ) b. The date and the location where the resident is was discharged; and (3-15-22)( ) c. The disposition of the resident's belongings. (3-15-22) 086. Additional Resident Records. The facility must also maintain the following for each resident: (3-15-22) a. A record of all resident personal property that the resident has entrusted to the facility, including documentation to identify and track the property to ensure that personal items are kept safe and used only by the resident to which the items belong with a value of more than fifty dollars ($50); and (3-15-22)( ) IdahoAdministrative Bulletin Page 158 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule b. Any A record of complaints or grievances voiced by the resident including the date received, the investigation with and the outcome, and the response to the resident. (3-15-22)( ) 097. Resident Admission and Discharge Register. The facility must maintain an admission and discharge register listing the name of each resident, the date admitted, and the date discharged. The admission and discharge register must be produced as a separate document, apart from resident records, and kept current. (3-15-22)( ) 10. Hourly Adult Care Documentation. A log of those who have utilized hourly adult care must be maintained, including the dates the service was provided. Individual records must be maintained for each person utilizing hourly adult care. The individual record documentation must include: (3-15-22) a. Admission identification information, including contact information for the responsible party in an emergency, and the physician or authorized provider; (3-15-22) b. Information, such as medical and social, relevant to the supervision of the person; and (3-15-22) c. Care and services provided during hourly adult care, including assistance with medications. (3-15-22) 1108. Dietary Records. The facility must maintain on-site a minimum of three (3) months of dietary documentation, as follows records including: (3-15-22)( ) a. Copies of planned menus, including therapeutic menus, that are approved, signed, and dated by a dietitian; andPlanned, substitution, and therapeutic menus that have been approved and signed by a dietitian. (3-15-22)( ) b. Served menus, including therapeutic menus, which reflect substitutions made. (3-15-22) 09. Water Supply. Laboratory reports documenting the bacteriological examination of a private water supply. ( ) 12. Records for Water Supply. Copies of laboratory reports documenting the bacteriological examination of a private water supply must be kept on file in the facility. (3-15-22) 130. Personnel Records.Arecord for each employee must be maintained and available, which includes the following: (3-15-22) a. The employee's name, address, phone number, and date of hire; (3-15-22) b. Ajob description that includes the purpose, responsibilities, duties, and authority; (3-15-22) c. Evidence that on, or prior to hire, staff were notified in writing if the facility does or does not carry professional liability insurance. If the facility cancels existing professional liability insurance, all staff must be notified of the change in writing; (3-15-22) dc. A copy of a current valid license for all nursing staff and verification from the Board of Nursing that the license is in good standing with identification of restrictions; (3-15-22)( ) ed. Signed evidence of training as described in Sections 620 through 641 of these rules and dated record of all required staff training; (3-15-22)( ) fe. Copies of CPR and first aid certifications; (3-15-22) gf. Evidence of medication training as described in Section 645 of these rules; (3-15-22)( ) hg. Criminal history and background check results that meet Section 009 of these rules and state-only IdahoAdministrative Bulletin Page 159 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule background check results ; (3-15-22)( ) ih. Documentation by the licensed nurse of delegation to unlicensed staff who assist residents with medications and other nursing tasks; (3-15-22)( ) ji. When acting on behalf of the administrator, a signed document authorizing the responsibilityA signed and dated record identifying any administrator or manager designees; and (3-15-22)( ) kj. CopiesRecords of contracts with outside service providers and contract staff. (3-15-22)( ) 141. As Worked Schedules. Work records must be maintained in written or electronic format which reflect: indicating direct care staff names and shifts worked. (3-15-22)( ) a. Personnel on duty, at any given time; and (3-15-22) b. The first and last names of each employee and their position. (3-15-22) 153. Fire and Life Safety Records. The administrator must ensure the facility's records for fire and life safety are maintained. The facility must maintain on file: (3-15-22) a. FireThe results of fire detection, alarm, and communication system reports inspections, maintenance, and test results including: (3-15-22)( ) i. The results of the annual inspection and tests; and (3-15-22) ii. Smoke detector sensitivity testing results. (3-15-22) b. The results of any weekly, monthly, quarterly, semi-annual, and annual sprinkler system inspections, maintenance, and tests; (3-15-22)( ) c. Records of the mMonthly examination of the portable fire extinguishers, including initials and date and documenting the following: (3-15-22)( ) i. Each extinguisher is in its designated location; (3-15-22) ii. Each extinguisher seal or tamper indicator is not broken; (3-15-22) iii. Each extinguisher has not been physically damaged; (3-15-22) iviii. Each extinguisher gauge shows a charged condition; and (3-15-22) v. The inspection tag or documentation for the extinguisher must show at least the initials of the person making the monthly examination and the date of the examination. (3-15-22) d. Documentation for when a fire watch is instituted and a fire watch log for each round of patrol, identifying who conducted the fire watch, date, time, and situations encountered. (3-15-22) 331. -- 334. (RESERVED) 335. REQUIREMENTS FOR INFECTION CONTROL. The administrator is responsible for ensuring that facility must develop policies and procedures consistent with recognized standards that control and prevent infections for both staff and residents are developed and implemented throughout the facility, to include:. (3-15-22)( )
01. Staff with an Infectious Disease. Staff with an infectious disease must not work until the
infectious stage no longer exists or must be reassigned to a work area where contact with others is not expected and likelihood of transmission of infection is absent. (3-15-22) IdahoAdministrative Bulletin Page 160 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
02. Standard Precautions. Standard precautions for infection prevention must be used in the care of
residents to prevent transmission of infectious disease according to in accordance with the Centers for Disease Control and Prevention (CDC) guidelines. These guidelines may be accessed on the CDC website at http:// www.cdc.gov/hai/. (3-15-22)( )
03. Reporting of Individual with an Infectious Disease. The name of any resident or facility
personnel with a reportable disease listed in Facilities must report any cases of resident or staff illness consistent with the diseases listed in IDAPA 16.02.10, “Idaho Reportable Diseases,.” must be reported immediately to the local health district authority with appropriate infection control procedures immediately implemented as directed by that local health authority The facility must follow guidance from local health districts. (3-15-22)( ) 336. -- 399404. (RESERVED) 400. REQUIREMENTS FOR FIREAND LIFE SAFETY STANDARDS. Afacility's buildings must meet all requirements of the local and state codes that are applicable to residential assisted living facilities for fire and life safety standards. Facilities’ evacuation capability is considered “impractical” as defined by NFPA, Standard 101. (3-15-22) 401. FIRE AND LIFE SAFETY STANDARDS FOR NEW BUILDINGS HOUSING THREE THROUGH SIXTEEN RESIDENTS. A newly constructed facility, change of ownership, or a building converted to a residential assisted living facility on or after January 1, 2021, housing three (3) to sixteen (16) residents on the first story only must comply with NFPA, Standard 101, Chapter 32, Small Facilities. (3-15-22) 402. FIRE AND LIFE SAFETY STANDARDS FOR NEW BUILDINGS HOUSING SEVENTEEN OR MORE RESIDENTS AND MULTI-STORY BUILDINGS. A newly constructed facility, change of ownership, or a building converted to a residential assisted living facility on or after January 1, 2021, housing seventeen (17) residents or more, or any building housing residents on stories other than the first story must comply with requirements of NFPA, Standard 101, Chapter 32, Large Facilities. (3-15-22) 403. FIRE AND LIFE SAFETY STANDARDS FOR EXISTING BUILDINGS LICENSED FOR THREE THROUGH SIXTEEN RESIDENTS. Existing facilities licensed prior to January 1, 2021, housing three (3) to sixteen (16) residents on the first story only, must comply with the requirements of the NFPA, Standard 101, Chapter 33, Small Facilities. Existing buildings that are not sprinklered may continue to operate, except when Section 401 of these rules apply. (3-15-22) 404. FIRE AND LIFE SAFETY STANDARDS FOR EXISTING BUILDINGS LICENSED FOR SEVENTEEN OR MORE RESIDENTSAND MULTI-STORY BUILDINGS. Existing facilities licensed prior to January 1, 2021 housing seventeen (17) or more residents and multi-story buildings or any building housing residents on stories other than the first story must comply with NFPA, Standard 101, Chapter 33, Large Facilities. (3-15-22) 405. ADDITIONAL FIRE AND LIFE SAFETY STANDARDS FOR ALL BUILDINGS AND FACILITIES.
01. Electrical Installations and Equipment. Electrical installations and equipment must comply with
applicable local or state electrical requirements in NFPA, Standard 101, Mandatory References. (3-15-22) a. Extension cords and multi-plug adapters are prohibited; (3-15-22) b. Relocatable Power Taps (RPTs) must be Underwriter Laboratories (U/L) approved with the following requirements: (3-15-22) i. RPTs must be directly connected to a wall outlet; and (3-15-22) ii. Have a built-in surge protector. (3-15-22) IdahoAdministrative Bulletin Page 161 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
02. Prohibited Applications. The following are prohibited uses of an RPT: (3-15-22)
a. Medical equipment; (3-15-22) b. Daisy chain or plugging one (1) plug strip into a second plug strip; (3-15-22) c. Appliances; (3-15-22) d. As a convenience, in lieu of permanent installed receptacles; and (3-15-22) e. Extend through walls, ceilings, floors, under doors or floor coverings, or be subject to environmental or physical damage. (3-15-22) 031. Medical Gases. Handling, use, and storage of medical gas must be according to NFPA, Standard 99, Chapter 11, Performance, Maintenance, and Testing as referenced in Section 004 of these rules local fire code standards. (3-15-22)( ) 04. Fuel-Fired Heating. Fuel-fired heating devices and systems must be inspected, serviced, and cleaned at least annually by a person professionally engaged in the business of servicing these devices or systems. (3-15-22) 052. Natural or Man-Made Hazards. When natural or man-made hazards are present on the facility property or border the facility property, suitable fences, guards, railing, or a combination must be installed to provide protection for the residents. (3-15-22) 063. Telephone. The facility must have a telephone on the premises available for staff use in the event of an emergency. Emergency telephone numbers must be posted near the telephone. (3-15-22) 04. Prohibited Applications. The following are prohibited uses of a Relocatable Power Tap. ( ) a. Medical equipment; ( ) b. Daisy chain or plugging one (1) plug strip into a second plug strip; ( ) c. Appliances; ( ) d. As a convenience, in lieu of permanent installed receptacles; and ( ) e. Extend through walls, ceilings, floors, under doors or floor coverings, or be subject to environmental or physical damage. ( ) 406. -- 409. (RESERVED) 410. REQUIREMENTS FOR EMERGENCYACTIONS AND FIRE DRILLS. Fire drills must be conducted not less than six (6) times a year on a bimonthly basis, with not less than two (2) conducted during the night when residents are sleeping. Records must be maintained on file at the facility and contain a description, date, and time of the drill, response of the personnel and residents, problems encountered, and recommendations for improvement quarterly and at least one per shift per year and include date and time of drill including personnel and residents involved. (3-15-22)( )
01. Report of Fire. A separate report on each fire incident occurring within the facility must be
submitted to the Licensing Agency Any fire or fire incident occurring within the facility must be reported to the Department within thirty fifteen (3015) days of the occurrence. The reporting form, “Facility Fire Incident Report,” issued by the Licensing Agency is used to secure specific data concerning date, origin, extent of damage, method of extinguishment, and injuries, if any. A fire incident is considered any activation of the building's fire alarm system other than a false alarm, during testing of the fire alarm system, or during a fire drill. (3-15-22) ( ) IdahoAdministrative Bulletin Page 162 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule
02. Fire Watch. Where a required fire alarm system or fire sprinkler system is out of service for more
than four (4) hours in a twenty-four (24) hour period, the authority having local jurisdiction must be notified, and the building evacuated, or an approved and documented fire watch provided for all parties left unprotected by the shutdown until the fire alarm system has been returned to service. (3-15-22)( ) 411. -- 429. (RESERVED) 430. REQUIREMENTS FOR FURNISHINGS, EQUIPMENT, AND SUPPLIES, AND BASIC SERVICES. Each facility must provide to the resident (3-15-22)( )
01. Common Shared Furnishings. Appropriately designed and constructed furnishings to meet the
needs of each resident, including reading lamps, tables, comfortable chairs, or sofas.All items must be in good repair, clean, safe, and provided at no additional cost to the resident Common areas must be furnished with appropriate reading lamps, tables, chairs, or sofas that are clean, safe, and in good repair. (3-15-22)( )
02. Resident Sleeping Room Furnishings. Comfortable furnishings and individual storage, such as a
dresser, for personal items for each resident in each sleeping room. All items facility provided furnishings such as a dresser, or bed, must be in good repair, clean, and safe. Resident beds shall be at least thirty-six (36) inches wide. (3-15-22)( )
03. Resident Bed. Each resident must be provided their own bed, which will be at least thirty-six (36)
inches wide, substantially constructed, clean, and in good repair. Roll-away beds, cots, futons, folding beds, or double bunks are prohibited. Bed springs must be in good repair, clean, and comfortable. Bed mattresses must be standard for the bed, clean, and odor-free.Apillow must be provided. (3-15-22) 043. Resident Telephone Privacy. The facility must have at least one (1) telephone that is accessible to all residents, and provide local calls at no additional cost. The telephone must be placed in such a manner as to provide the resident privacy while using the telephone. (3-15-22) 054. Basic Services. The following are basic services to be provided to the resident by the facility within the basic services rate: Basic services and personal supplies must be provided in accordance with the admission agreement. (3-15-22)( ) a. Rent; (3-15-22) b. Utilities; (3-15-22) c. Food; (3-15-22) d. Activities of daily living services; (3-15-22) e. Supervision; (3-15-22) f. First aid; (3-15-22) g. Assistance with and monitoring of medications; (3-15-22) h. Laundering of linens owned by the facility; (3-15-22) i. Emergency interventions and coordination of outside services; (3-15-22) j. Routine housekeeping and maintenance of common areas; and (3-15-22) k. Access to basic television in common areas. (3-15-22) IdahoAdministrative Bulletin Page 163 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 06. Basic Supplies. The following are to be supplied by the facility at no additional cost to the resident: linens, towels, wash cloths, liquid hand soap, non-sterile exam gloves, toilet paper, and first aid supplies, unless the resident chooses to provide their own. (3-15-22) 07. Personal Supplies. Soap, shampoo, hair brush, comb, electric razor or other means of shaving, toothbrush, toothpaste, sanitary napkins, and incontinence supplies must be provided by the facility unless the resident chooses to provide their own. The facility may charge the resident for personal supplies the facility provides and must itemize each item being charged to the resident. (3-15-22) 08. Resident Supplies and Furnishings. If a resident chooses to provide their own supplies or furnishings, the facility must ensure that the resident's supplies or furnishings meet the minimum standards as identified in this rule. (3-15-22) 431. -- 449. (RESERVED) 450. REQUIREMENTS FOR FOODAND NUTRITIONALCARE SERVICES. The facility food services must meet the standards in IDAPA 16.02.19, “Idaho Food Code,.” as incorporated in Section 004 of these rules. The facility must also implement operational policies for providing proper nutritional care for each resident, which includes procedures to follow if the resident refuses food or to follow a prescribed diet. (3-15-22)( ) 451. MENUAND DIET PLANNING. The facility must provide each resident with at least the minimum food and nutritional needs in accordance with the Recommended Dietary Allowances established by the Food and Nutrition Board of the National Academy of Sciences. These recommendations are found in the Idaho Diet Manual incorporated by reference in Section 004 of these rules. The menu must be adjusted for age, sex, and activity as approved by a registered dietitian. (3-15-22)
01. Menu. The facility must have a menu Must be planned or approved, and signed, and dated by a
registered dietitian prior to being served to any resident. The planned menu must meet nutritional standards. (3-15-22)( ) a. Menus will provide a sufficient variety of foods in adequate amounts at each meal; (3-15-22) b. Food selections must include foods that are served in the community and in season. Food selections and textures should account for residents' preferences, food habits, and physical abilities. (3-15-22) cb. The current weekly menu must be posted in a facility common area; and (3-15-22)( ) dc. The facility must serve the planned menu. If substitutions are made, the menu must be modified to reflect the substitutions. (3-15-22)
02. Therapeutic Diets. The facility must have a therapeutic diet menu Therapeutic menus must be
planned or, approved, and signed, and dated by a registered dietitian prior to being served to any resident. (3-15-22)( ) a. The therapeutic diet planned menu, if possible, must meet nutritional standards; (3-15-22) b. The therapeutic diet menu must be planned as close to a regular diet as possible; and (3-15-22) c. The facility must have for each resident on a therapeutic diet, an order from a physician or authorized provider. (3-15-22)
03. Facilities Licensed for Sixteen Beds or Less. In facilities licensed for sixteen (16) beds or less,
menus must be planned in writing at least one (1) week in advance. (3-15-22)
04. Facilities Licensed for Seventeen Beds or More. Facilities licensed for seventeen (17) beds or
more must: (3-15-22) IdahoAdministrative Bulletin Page 164 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule a. Develop and implement a cycle menu which covers a minimum of two (2) seasons and is four (4) to five (5) weeks in length; (3-15-22) b. Follow standardized recipes; and (3-15-22) c. Have available in the kitchen a current copy of the Idaho Food Code and Idaho Diet Manual. (3-15-22) 452. -- 454. (RESERVED) 455. FOOD SUPPLY. The facility must maintain a seven (7) day supply of nonperishable foods and a two (2) day supply of perishable foods. The facility's kitchen must have the types and amounts of food to be served readily available to meet all planned menus during that time. (3-15-22) 456. -- 459. (RESERVED) 460. FOOD PREPARATIONAND SERVICE.
01. Food Preparation. Foods must be prepared by methods that conserve nutritional value, flavor, and
appearance. (3-15-22)
02. Frequency of Meals. Food must be offered throughout the day, as follows: Meals must be served at
least three (3) times per day at regular intervals with snacks and fluids offered between meals. (3-15-22)( ) a. To provide residents at least three (3) meals daily, at regular times comparable to normal mealtimes in the community; (3-15-22) b. To ensure no more than fourteen (14) hours between a substantial evening meal and breakfast; (3-15-22) c. Ensure that residents who are not in the facility for the noon meal are offered a substantial evening meal; and (3-15-22) d. Offer snacks and fluids between meals and at bedtime. (3-15-22)
03. Food PreparationArea.Any areas used for food preparation must be maintained as follows:
(3-15-22) a. No live animals or fowl will be kept or maintained in the food service preparation or service area; and (3-15-22) b. Food preparation and service areas cannot be used as living quarters for staff. (3-15-22) 043. Disposable Items. The facility will not use single-use items except in unusual circumstances for a short period of time or for special events. (3-15-22) 461. -- 509. (RESERVED) 510. REQUIREMENTS TO PROTECT RESIDENTS FROM ABUSE. The administrator must ensure that policies and procedures are developed and implemented to ensure that all residents are free from abuse. These policies and procedures should be posted in a conspicuous place in the facility, shared with new residents, families upon admission, all residents annually thereafter, and made available upon request. (3-15-22) 511. -- 514. (RESERVED) IdahoAdministrative Bulletin Page 165 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 515. REQUIREMENTS TO PROTECT RESIDENTS FROM EXPLOITATION. The administrator must ensure that policies and procedures are developed and implemented to ensure that all residents are free from exploitation. These policies and procedures should be posted in a conspicuous place in the facility, shared with new residents, families upon admission, all residents annually thereafter, and made available upon request. (3-15-22) 516. -- 519. (RESERVED) 520. REQUIREMENTS TO PROTECT RESIDENTS FROM INADEQUATE CARE. The administrator must ensure that policies and procedures are developed and implemented to ensure that all residents are free from inadequate care. These policies and procedures should be posted in a conspicuous place in the facility, shared with new residents, families upon admission, all residents annually thereafter, and made available upon request. (3-15-22) 521. -- 524. (RESERVED) 525. REQUIREMENTS TO PROTECT RESIDENTS FROM NEGLECT. The administrator must ensure that policies and procedures are developed and implemented to ensure that all residents are free from neglect. These policies and procedures should be posted in a conspicuous place in the facility, shared with new residents, families upon admission, all residents annually thereafter, and made available upon request. (3-15-22) 526. – 599. (RESERVED) 600. REQUIREMENTS FOR STAFFING STANDARDS. The administrator facility must develop and implement written staffing policies and procedures based on the number of residents, resident needs, and configuration of the facility, for staffing to ensure adequate care is provided to residents which include: (3-15-22)( )
01. On-Duty Staff Up and Awake During Residents' Sleeping Hours. Qualified and trained sStaff
must be up and awake, and immediately available in the facility during resident sleeping hours. (3-15-22)( )
02. Detached Buildings or Units. Facilities with residents housed in detached buildings or units must
have at least one (1) staff present and available in each building or unit when residents are present in the building or unit. The facility must also ensure that each building or unit complies with the requirements for on-duty staff during resident sleeping hours to be up, awake, and immediately available in accordance with the facility's licensed bed capacity as provided in this rule. The Licensing Agency will consider a variance based on the facility's written submitted plan of operation when residents are present. (3-15-22)( )
03. Personnel Management. The administrator is responsible for the management of all personnel to
include contract personnel. (3-15-22)
04. Sufficient Personnel. As described in Section 39-3322, Idaho Code, the facility will employ and
the administrator will schedule sufficient personnel to: (3-15-22) a. Provide care and supervision, during all hours, as required in each resident's NSA, to ensure residents' health, safety, and comfort, and to ensure the interior and exterior of the facility is maintained in a safe and clean manner; and (3-15-22) b. To provide for at least one (1) direct care staff with certification in first aid and cardio-pulmonary resuscitation (CPR) in the facility at all times. Facilities with multiple buildings or units will have at least one (1) direct care staff with certification in first aid and CPR in each building or each unit at all times. (3-15-22) 03. Cardio-Pulmonary Resuscitation (CPR) and FirstAid Certification. Provide for at least one (1) direct care staff with certification in first aid and CPR in the facility at all times. Facilities with multiple buildings or units will have at least one (1) direct care staff with certification in first aid and CPR in each building or each unit at IdahoAdministrative Bulletin Page 166 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule all times. ( ) 601. -- 619. (RESERVED) 620. REQUIREMENTS FOR TRAINING OF FACILITY PERSONNEL. The facility must follow structured, written training programs designed to meet the training needs of personnel in relation to responsibilities, as specified in the written job description, to provide for quality of care and compliance with these rules. Signed evidence of personnel training, indicating hours and topic, must be retained at the facility. (3-15-22) 621. -- 624. (RESERVED) 625. ORIENTATION TRAINING REQUIREMENTS. The administrator must ensure that each staff member Staff must completes orientation training specific to their job description as described in Section 39-3324, Idaho Code. Staff who have not completed the orientation training requirements must work with a staff who has completed the orientation training, within thirty (30) days of hire. Prior to working alone staff must have completed the orientation training requirements. (3-15-22)( )
01. Number of Hours of Training. A minimum of sixteen (16) hours of job-related orientation
training must be provided to all new personnel before they are allowed to provide completed prior to providing unsupervised personal assistance to residents. The means and methods of training are at the facility’s discretion. (3-15-22)( )
02. Timeline for Completion of Training. All orientation training must be completed within thirty
(30) days of hire. (3-15-22) 032. Content for Training. Orientation training must include the following: (3-15-22) a. The philosophy of residential assisted living and how it guides caregiving; (3-15-22) ba. Resident rights; (3-15-22) c. Cultural awareness; (3-15-22) d. Providing personal assistance; (3-15-22) e. How to respond to emergencies; (3-15-22) fb. Reporting and documentation requirements for resident care records, incidents, accidents, complaints, and allegations of abuse, neglect, and exploitation; (3-15-22)( ) g. Identifying and reporting changes in residents' health or mental condition; (3-15-22) h. Advance directives and do not resuscitate (DNR) orders; (3-15-22) ic. Relevant policies and procedures; and (3-15-22)( ) j. The role of the NSA; and (3-15-22) k. All staff employed by the facility, including housekeeping personnel and contract personnel, must be trained in infection control procedures for universal precautions. (3-15-22) d. Training must be specific and appropriate to the population served. ( ) 626. -- 629. (RESERVED) IdahoAdministrative Bulletin Page 167 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 630. TRAINING REQUIREMENTS FOR FACILITIES ADMITTING RESIDENTS WITH A DIAGNOSIS OF DEMENTIA, MENTAL ILLNESS, DEVELOPMENTAL DISABILITY, OR TRAUMATIC BRAIN INJURY. A facility admitting and retaining residents with a diagnosis of dementia, mental illness, developmental disability, or traumatic brain injury must train all staff to meet the specialized needs of these residents. Staff must receive specialized training within thirty (30) days of hire or of admission of a resident with one (1) of these conditions. The means and methods of training are at the facility’s discretion. The training should address the following areas: (3-15-22)
01. Dementia: (3-15-22)
a. Overview of dementia; (3-15-22) b. Symptoms and behaviors of people with memory impairment; (3-15-22) c. Communication with people with memory impairment; (3-15-22) d. Resident's adjustment to the new living environment; (3-15-22) e. Behavior management, including the consistent implementation of behavior interventions; (3-15-22) f. Activities of daily living; and (3-15-22) g. Stress reduction for facility personnel and the resident. (3-15-22)
02. Mental Illness: (3-15-22)
a. Overview of mental illnesses; (3-15-22) b. Symptoms and behaviors specific to mental illness; (3-15-22) c. Resident's adjustment to the new living environment; (3-15-22) d. Behavior management, including the consistent implementation of behavior interventions; (3-15-22) e. Communication; (3-15-22) f. Activities of daily living; (3-15-22) g. Integration with rehabilitation services; and (3-15-22) h. Stress reduction for facility personnel and the resident. (3-15-22)
03. Developmental Disability: (3-15-22)
a. Overview of developmental disabilities; (3-15-22) b. Interaction and acceptance; (3-15-22) c. Promotion of independence; (3-15-22) d. Communication; (3-15-22) e. Behavior management, including the consistent implementation of behavior interventions; (3-15-22) IdahoAdministrative Bulletin Page 168 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule f. Assistance with adaptive equipment; (3-15-22) g. Integration with rehabilitation services; (3-15-22) h. Activities of daily living; and (3-15-22) i. Community integration. (3-15-22)
04. Traumatic Brain Injury: (3-15-22)
a. Overview of traumatic brain injuries; (3-15-22) b. Symptoms and behaviors specific to traumatic brain injury; (3-15-22) c. Adjustment to the new living environment; (3-15-22) d. Behavior management, including the consistent implementation of behavior interventions; (3-15-22) e. Communication; (3-15-22) f. Integration with rehabilitation services; (3-15-22) g. Activities of daily living; (3-15-22) h. Assistance with adaptive equipment; and (3-15-22) i. Stress reduction for facility personnel and the resident. (3-15-22) 631. -- 639. (RESERVED) 640. CONTINUED TRAINING REQUIREMENTS. Each employee must receive a minimum of eight (8) hours of job-related continued training per year. (3-15-22) 641. ADDITIONALTRAINING RELATED TO CHANGES. When policies or procedures are added, modified, or deleted, the date of the change must be specified on the policy and staff training must receive additional training related to the changes be updated. (3-15-22)( ) 642. -- 644. (RESERVED) 645. ASSISTANCE WITH MEDICATIONS.
01. Training Requirements. To provide assistance with medications, staff must have the following
training requirements, and be delegated as described in this rule. Prior to assisting residents with medications, staff must complete the following: (3-15-22)( ) a. Before staff can begin assisting residents with medications, successful completion of aA medication assistance course offered by one (1) of Idaho’s community colleges. 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 or a curriculum approved by the Department. This training is in addition to the curriculum minimum orientation requirements. (3-15-22)( ) 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. (3-15-22)
02. Delegation. The facility nurse must delegate and document assistance with medications and other
IdahoAdministrative Bulletin Page 169 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 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. (3-15-22) 646. -- 899. (RESERVED) 900. ENFORCEMENTACTIONS. 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. (3-15-22)( ) 901. ENFORCEMENTACTION 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 residentsIf the Department determined non-compliance with these rules immediately jeopardizes the health or safety of residents the Department may take action in accordance with Section 39-3358, Idaho Code. (3-15-22)( ) 902. -- 909. (RESERVED) 910. ENFORCEMENTACTION OFA 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 LicensingAgency. (3-15-22)( ) 911. -- 919. (RESERVED) 920. ENFORCEMENTACTION OF LIMIT ONADMISSIONS.
01. Reasons for Limit on Admissions. The Department may limit admissions for the following
reasons: (3-15-22) a. The facility is inadequately staffed or the staff is inadequately trained to handle more residents; (3-15-22) b. The facility otherwise lacks the resources necessary to support the needs of more residents; (3-15-22) c. The Department identifies repeat core issues during any follow-up survey; and or (3-15-22)( ) d. An acceptable plan of correction is not submitted as described in Section 130 of these rules 39- 3352, Idaho Code. (3-15-22)( )
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 or bans on admissions to the facility will remain in effect until the Department determines the facility has achieved full substantial compliance with requirements or receives written evidence and statements from the outside consultant that the facility is in compliance. (3-15-22)( ) 921. -- 924. (RESERVED) 925. ENFORCEMENTACTION 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 IdahoAdministrative Bulletin Page 170 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule multiple penalties, even though such act, omission, or incident may violate more than one (1) rule. (3-15-22)
01. Civil Monetary Penalties. May be imposed when it is determined a facility is operating without a
license, has repeat non-core deficiencies that place residents at significant risk for potential harm, or the facility fails to comply with conditions of the provisional license. Actual harm to a resident or residents does not need to occur. 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 c Civil monetary penalties are imposed,
such penalties are assessed at ten dollars ($10) for each day the facility is or was out of compliance. The amounts below are per deficiency, multiplied by the total number of occupied licensed beds according to the records of the Department at the time non-compliance is established. (3-15-22)( ) a. Repeat deficiency is ten dollars ($10). Example below: Number of Occupied Repeat Deficiency Times Number of Days Amount of Penalty Beds in Facility Out of Compliance 11 $10.00 30 days $3 300 (3-15-22) ba. In any ninety (90) day period, the penalty amounts may not exceed the limits shown in the following table: Limits on Accruing Civil Monetary Amount Number of Occupied Beds Repeat Deficiency in Facility 3-4 Beds $2,880 5-50 Beds $6,400 51-100 Beds $10,800 101-150 Beds $17,600 151 or More Beds $29,200 (3-15-22)
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. (3-15-22)
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 thed 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 dated 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 penalty. (3-15-22)( )
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. (3-15-22) IdahoAdministrative Bulletin Page 171 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 926. -- 929. (RESERVED) 930. ENFORCEMENTACTION OF TEMPORARY MANAGEMENT.
01. Need for Temporary Management. The Department may impose, and appoint the action of use 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 it is determined there is immediate jeopardy to the health and safety of the residents, such as: (3-15-22)( ) a. During an orderly transfer of residents of the facility to other facilitiesTo ensure the safe relocation of residents due to a facility closure; or (3-15-22)( ) b. A temporary manager is necessary to bring the facility back into substantial compliance Ppending improvements to bring the facility into compliance with program requirements. (3-15-22) ( )
02. Notice of Temporary Management. The Department will give written notice to the facility of the
imposition of temporary management. (3-15-22)
03. Who May Serve as a Temporary Manager. The Department may appoint any person or
organization that meets the following qualifications: (3-15-22) a. The temporary manager must not have any financial interest in the facility to be managed; (3-15-22) 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; (3-15-22) 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 LivingAdministrator's license; and (3-15-22) 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. (3-15-22) 042. 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 may revoke the facility's license will have the authority to direct and oversee the day-to-day operations of the facility including the enforcement of policies and procedures and ensuring the facility is in compliance with these rules. (7-1-24)( ) 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; (3-15-22) 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; (3-15-22) 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; (3-15-22) 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 IdahoAdministrative Bulletin Page 172 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule expenditures are directly related to correcting the identified deficiencies; (3-15-22) e. The temporary manager does not have authority to cause or direct the facility to encumber its assets or receivables; (3-15-22) 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 (3-15-22) 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. (3-15-22) 053. Responsibility for Payment of the Temporary Manager.All compensation and per diem costs of the temporary manager must be paid by the licensee. (3-15-22) 06. Termination of Temporary Management. A temporary manager may be replaced under the following conditions: (3-15-22) 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. (3-15-22) 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. (3-15-22) 931. -- 934. (RESERVED) 935. ENFORCEMENTACTION OFA 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. (3-15-22) 936. -- 939. (RESERVED) 940. ENFORCEMENTACTION 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. (3-15-22)
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: (3-15-22) a. The licensee has willfully misrepresented or omitted information on the application or other documents pertinent to obtaining a license; (3-15-22) b. When persuaded by a preponderance of the evidence that such conditions exist which endanger the health or safety of any resident; (3-15-22) 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; (3-15-22) d. The licensee has demonstrated or exhibited a lack of sound judgment essential to the operation and management of a facility; (3-15-22) e. The licensee has violated any of the conditions of a provisional license; (3-15-22) IdahoAdministrative Bulletin Page 173 June 4, 2025 – Vol. 25-6 DEPARTMENT OF HEALTH AND WELFARE Docket No. 16-0322-2501 Residential Assisted Living Facilities ZBR Proposed Rule 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; (3-15-22) 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; (3-15-22) 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; (3-15-22) i. The licensee is actively affected in their performance by alcohol or the use of drugs classified as controlled substances; (3-15-22) j. The licensee has been convicted of a criminal offense other than a minor traffic violation within the past five (5) years; (3-15-22) k. The licensee is of poor moral and responsible character or has been convicted of a felony or defrauding the government; (3-15-22) 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; (3-15-22) m. The licensee has previously operated any health facility or residential assisted living facility without a license or certified family home without a certificate; (3-15-22) 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; (3-15-22) 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; (3-15-22) 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; (3-15-22) q. The licensee fails to pay civil monetary penalties imposed by the Department as described in Section 925 of these rules; (3-15-22) r. The licensee fails to take sufficient corrective action as described in Section 130 of these rules; or (3-15-22) s. The number of residents currently in the facility exceeds the number of residents the facility is licensed to serve. (3-15-22) 941. -- 999. (RESERVED) IdahoAdministrative Bulletin Page 174 June 4, 2025 – Vol. 25-6
Documents
- Full text (state register) · April 02, 2025
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